Memory expert Elizabeth Loftus, Ph.D., warns that psychiatrist Marlene Steinberg, M.D., in her new book Stranger in the Mirror, is trying to breathe new life into a form of therapy that once destroyed thousands of lives. Dr. Steinberg responds.
When you look into a mirror, who looks back? If you sometimes have the eerie feeling that you don't really know who that is in the looking glass, then you may be one of the 30 million Americans who suffer from Dissociative Identity Disorder (DID). Such is the extraordinary claim of psychiatrist Marlene Steinberg.
Steinberg, with the help of writer Maxine Schnall, makes her case in Stranger in the Mirror: Dissociation: The Secret Epidemic of Our Time (Cliff Street Books, 2000). In it, she states that DID is due to traumatic experiences, typically childhood sexual abuse. According to the theory, the traumatic experiences are too horrendous to contemplate, so the victim forces them into a dark corner of psychic inner space, where they nevertheless chafe the unknowing ego, eventually splitting it into fragments that later manifest themselves as alternate personalities. This is one reason why when a DID victim looks in the mirror, she may see a stranger staring back.
Steinberg thinks this is what happened to many of her patients. She goes into detail about three in particular, including Nancy, who supposedly experienced abuse by her father, mother and grandfather. When discussing this abuse, she would abruptly switch personalities, from the mother of teenagers that her friends and family knew, to an anguished 8-year-old child. When in "child mode," Nancy would slip into grade-school speech, saying "skeered" and "veery," for example, as in, "I'm veery skeered."
Then there was Jean, the 40-year-old mother of two pursuing a college degree. Jean didn't buy the DID diagnosis at first: "When I tell Jean that I have diagnosed her with DID," Steinberg writes, "she becomes defensive." Jean apparently insisted that she came to therapy because of panic attacks, anxiety and poor school performance; couldn't they just deal with those problems?
Apparently not. Once the diagnosis of DID is made, therapy must focus on dredging up those repressed memories of abuse; there is no time to waste talking about anxiety or how to improve a "D-" in American History. Important, long-buried memories must be brought to light.
Steinberg claims a high success rate for which, unfortunately, she provides no documentation. In evaluating her claim, consider how she defines success. In the manuscript version of her book, she writes, "I consider achieving functional cooperation among a person's alternate personalities a successful outcome of therapy... " In other words, if you and your 37 selves are all getting along with one another, Steinberg will pronounce you cured!
To make a diagnosis of DID, Steinberg uses a test she developed called the Steinberg Clinical Interview for DSM-IV Dissociative Disorders, (SCID-D, for short). She modestly characterizes the test as a "breakthrough diagnostic tool," but offers no scientific evidence for its validity. Nevertheless, her confidence in the instrument knows no bounds: If the test says you have DID, then you have DID.
Steinberg's faith in her "breakthrough" tool may have prompted her to include in her book a series of questionnaires, adapted from the SCID-D, that readers can use to determine whether they, too, are in need of treatment for dissociative disorder. I sat down one day and took these tests. To my dismay, I found that I had amnesia and suffered from "mild identify confusion."
Identity confusion? I thought I was a college professor, a researcher in the field of memory, sister to two wonderful brothers, aunt to adorable nieces and nephews. While I admit I occasionally wonder what I want to do next in life, this hardly seems to qualify as identity confusion.
The test includes items such as, "I have a critical commentary in my head about things I do," and, "Who I am can change from day to day." I had the choice of checking these and similar items "never, .... once or twice," "sometimes," "many times," or "almost all the time." It seems likely that most people would admit to having these experiences now and then, but it turns out that the only way you can avoid a diagnosis of identify confusion is to check "never" to all the items. Steinberg admits that mild or short-lived episodes of dissociative feelings are normal, but her test makes it hard for people to escape a diagnosis.
It doesn't take a crystal ball to foresee thousands of people finding themselves described in the pages of Steinberg's book and having their fears confirmed by its tests. Nor will it be very surprising if many of these people go to therapists who, wittingly or unwittingly, implant memories of childhood cruelty that never happened. No doubt some innocent people (especially parents, grandparents and siblings) will be accused of the "remembered" abuse, and some may be sued or prosecuted. Some may even go to prison.
This is not just exaggerated speculation; indeed, it has already happened. In the 1980s and '90s, thousands of people, most of them women, entered psychotherapy for treatment of depression, anxiety, eating disorders, sexual dysfunction and other problems, and were told that their troubles were due to repressed memories of childhood sexual abuse. These painful memories, they were told, lay festering in their subconscious, causing their symptoms. It would be necessary for the patient to "recover" the memories in order to heal their current ailment.
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