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Diss 2 2 8 OCR Rev.Pdf OBSERVATlO!'lS O~ THECL.uM OF IATROGENESIS I:-i THE PRmIULCATIO:-i OF ~IPD: ADISCUSSION C{'orgc B. Grl'aH's. Ph.D. Dr. George B. Greaves, Ph.D. isAdjunct Professor ofPsycbol­ In this regard I a.m fortunate, rather than speechless, for ogy at Georgia State University and Founder and Past­ lhe subject of iatrogenesis in MPD was one o f UIC topics President of the International Society for the Study of Da,id Caul and I spoke of at length during the year of his Multiple Personality and Dissociation. election to the presidency of the International Society for the Study of Mu ltiple Personality and Dissociation For reprints wrile George B. Greaves, Ph.D .. P.C., 529 Pharr (lSSMP&D), a position I held at the time. Road, NE, Atlanta, Georgia 30305. Dr. Caul's concerns about iatrogenic issues in MPD lay mainly in two areas. On the one hand, he was concerned that An earlier ve~iOI1 of this paper was presented as part of the multiplicity was being overdiagnosed by therapists who were David Caul Memorial Symposium: Iatrogenesis & MPD, at neophytes to the field eiUlcr to attain narcissistic gratifica­ the Fifth International Conference on l\'lultiplc Personality/ tion a1 "having a multiple of their own~ or through despair­ Dissociative Stales, Chk"go, Illinois, October 8, 1988. ingly giving a diffi cult and confusing patient the label of an illness known to be treatable, Dr. Philip Coons has touched ABSTRAGr nicely on the area of therapist '~dr i ablcs in misdiagnosis. On the other hand, David was quite concerned about The tlrm "iatrogencsis" has bolh intensional and extensior/al (i.e., Ihe whole irrational debate about the so-called iatrogenic romlOlaJivt! amI denotalivt) meanings which lIrt frequently aHl­ originsofMPD. David knew full well thalclinical MPD could fused. While th ~fo llr prroiOlu papers of the David Caul MemO/iat not be created e"e ll if one tried, but he wanted to get ule Symposi um Oil iatrogenic issues ill l7I!dtiple l,"sO/wlity disorder whole issue out in the open, kwithin the rank and file of the explore the extensional sensl' of the lenn, Ihe discussant of this l)'m­ Society," 10 use his phrase, posillm foclISI!s on the "iatro~"ic (lebate" over MPD in it,~ i"ten­ Caul was vel)' concerned that the major critics of MPD sional fonll, augmenting th~ scope of Ih ~ durl/ssiOIl considtrabl)'. were assuming what were merely speculations and conjec­ His (omments are based on extensiv(' cOIIVersatiOlu with David Caul tures as scientific matters of fact, then using these assump­ abo-ut the sllbjul during lIu: )'cor prl'ceding Dr. Caul's untimely tions to "beat up on ~ capable, responsible therapists and death. their patients. David's ultimate concern was not with the scholarly "It ain't over until Lhe fat lady sings," David Caul used to debate itself, not even with the welfare oftherapisLS, but with say. I feci like the fat lady now, the last act in a long show. the adverse impact the iatrogenesis "accusations" were hav­ The presenters in the David Caul Memorial Symposium ing on already-diagnosed ~' I PD patients: that of demoraliz­ on Iatrogenic Issues in MPD - Drs Philip Coons ( 1989), ing them, dcvaluing them as suffering from an unreal illness, Catherine Fine (1989), Richard Kluft (1989), and Moshe frustrating (hem in their efforts at receiving treatment. Torem ( 1989) - ha,'e cO\'ered the truly iatrogenic issues in Caul had spellt Ihe bulk of his career in the st."l.le and multiple personality disorder U... IPD) so thoroughly, from so community mental health syslem of Ohio, and sen·ed the many points of view, and from so much richness of clinical system with the dedication and conviction of a c;:lreer mili­ experience and case presentation, that it is impossible to tal)' officcr. The bureaucracy itself David often disliked, at review them without redundanq'. times immensely, But what the public mental health system There is agreement among all presenters that: I) iatro­ stood for - affOl'dablc, qualit), mental health care for genic artifacts related to MPD can be found in certain everyone - he believed in and was an ardent spokesman. diagnostic and treatment procedures; 2) those attentive to For all thc restrictions he felt , he accomplished some re­ therapist-induced artifacts can learn to avoid them; and 3) markable things during his career. artifacts generated by MPD patients' subtle dcfensh'e strate­ Thus, Caul's concerns with the iatrogenesisdebate were gies cannot be altogether avoided, but they can be recog­ but one concern in his larger body of concerns about MPD nized and ameliorated. patients' welfare, David assumed the presidency of the As a discussant, the critical analyst of a symposium of ISS~'fP&D with a mission, an agenda, and a vision. Had he ideas, the harmony of the foregoing papers would leave me li ved out his prcsidency, and his pasl-presidency responsi­ with nothing to say; except that in this role I have the bilities, we would have seen the full details of his vision. He Concurrent responsibility of amplifying and supplementing held his detailed plans close to his heart, I belie,'e, but I know what has already been stated about the subject at hand. the scaleofhis mission. David's final professional dream was 99 D1SS0{ ~\no~, \o!.ll, ~o 2:JulK' !9..'!9 that all MPD patients everywhere could receive at least the "multiple personality epidemic," though Boor had no informed, and ultimately competent treaunent. The iatro­ idea of the magnitude oflhe problem when he coined the genesis issue was astumbling block he felt he had to remove. phrase. This is my first experiencc in what is partially a posthu­ But the iatrogenic effects in multiple personality in mous collaboration with a revered colleague; I hope I repre­ the 1980s are not ontological in nature as unnamed critics sent our integrated views fairly. would have us believe - we have not been creating multiple personality willy-nilly ontologically - wc ha\'e instead been RETHINKING THE ISSUE creating multiple personality cpistemologically and, I might add, systematically. One of the curses of classical education is that one learns As I pointed out recently at the First Eastern Regional to think logically; the curse is doubled when one obtains an Conference on r... lultiple Personality disorder (1989), in my advanced degree in philosophy, for one learns to think "HistOlJ' of MPD" address, nothing exists in the realm of logically within any system oflogic. By the time I was 24 and knowledge until it is first described. In this important sense, had obtained my master's degree in philosophy and was Eberhardt Gmelin (1791) should be credited with the inven­ appointed a university instructor on thc subjcct, I realized I tion of MPD, by being the first to havc both dcscribed and was completely ill-prepared for the world of people, who named the prototypical disorder (llllgelallshle Persolllichkeil seemed rarely to think logically al all. Having discovered my or "exchanged personality"). Following science and medi­ mistake, I sought doctoral training in clinical and social cinc, wc might just as well today bc calling MPo "Gmelin's psychology where quite irrational matters are researched in syndrome,~ for which we might bc bettero[f; for as both KJuft most systematic ways, even if not always logically. (1985; 1988) and I-licks (1985) have pointed out, the con­ If psychological training didn't harm me; my philo­ temporary term "multiple personality" is disturbingly para­ sophical training positively ruined me. doxical, a confusing oxymoron. I think to myself, Richard Kluft deftly shore the sheep of In 1980 multiple personality was reinvented epistemol­ iatrogenesis in 1982, followed by confirmation by Bennett ogically in a series of five works which essentially described Braun in 1984. Why now are we having again at the twice­ and defined cvel)' aspcct of "Gmelin's syndrome," from the shorn beast, this time in a full symposium? history of the illness to its suqjectivc phenomcnology to its My thoughts turn to my systematic studies of Ludwig etiology to its objective phenomenology, uniquc diagnostic Wittgenstein, an Austrian-British twentieth-century analyti­ symptoms and signs, and its treatment(Allison, 1980; Ameri­ cal philosopher who taught at Cambridge University until can Psychiatric Association, 1980; Bliss, 1980; Greaves, 1980; his early death at the age of 52. Rosenbaum, 1980). I paraphrase him: These works, in turn, laid the groundwork fora plethora ~Problems in [knowledge] start with the formulation of of published articles, scientific meetings, professional train­ the problem ... whcn problems pcrsisttheyarc ill-conceived ing seminars, and hospital treatment programs, culminating problems from the start ... the problems of philosophy are in the founding of the ISSl\IP&D and the launching of problems in the conccption of the problem. ~ (Wittgenstein, DISSOCIATION, the ofTieial journal of the Society. 1950) Such a "grass roots" movement, as Richard Lowenstein The "buzzword" in the Caul symposium is "iatrogene­ (1989) calls it , is unusual in the history of psychiatry. Con­ sis," meaning literally "of physician origin." In Webster's temporalJ' interest in multiple personality (post-1943) has Ninth New Collegiate Dictionary iatrogenesis means "in­ not arisen from the writings of heralded professors or from duced inadvertently by a physician or his treatment." "Inad­ the collaborative esoteric researches of m:Bor uni\'crsities. vertent" means both: 1) inattenti\'c and 2) unintentional. Instead, it has arisen from the amalgamated observations Both issucs are covercd thoroughly in the papers above. and research of many independent, highly-trained medical But the papers abovc, particularly Kluffs (1989) contri­ and psychological scientists, ranging from New Zealand and bution, clcarly state that MPD proper cannot be created Australia to Holland and Canada and throughout the United either by misaltention, inattention, unintention, or e\·cn by States.
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