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Questions About Herschel Walker's Self-Reported Mental Illness

Is it "dissociative identity disorder" or something else?

Key points

  • If a public figure claims to have a psychiatric condition, then clinicians can discuss the topic.
  • The accuracy and validity of psychiatric diagnoses reported by public figures should be examined, not assumed.
  • Dissociative identity disorder is a highly controversial diagnosis, whose scientific validity is hotly debated, without a consensus on validity.

There long has been debate about psychiatric clinicians diagnosing public figures, in the context of the “Goldwater Rule” of the American Psychiatric Association (APA), which claims such diagnosis is unethical. The idea is that psychiatric diagnosis should not be used to stigmatize or criticize a public figure whose political or social views might be unacceptable to psychiatric clinicians, such as conservative 1960s American politician Barry Goldwater. But what if a public figure himself says he has a mental illness? One would think then the topic is open for discussion.

Georgia Senate candidate Herschel Walker, in an autobiography, has stated that he had been diagnosed with “dissociative identity disorder” (DID), also known as multiple personality disorder (MPD). In recent public debates, he has referred repeatedly to being open about his problems with “mental health” and how he has now overcome those problems.

The public figure here has discussed openly his psychiatric condition and even provided a diagnosis, made by a mental health clinician who personally examined and treated him, so all the conditions of the Goldwater Rule concerns appear to have been met.

The problem is, based on what Walker describes, an experienced psychiatric clinician could raise some doubts about the accuracy and validity of that diagnosis, or at least about the claims that the public figure makes about it. If someone has DID or MPD, the clinical and scientific literature does not support the perspective that it routinely or usually goes away. Though some researchers claim notable improvement with long-term treatment, such improvement is not sudden and usually not absolute.

Another possibility is that we can take this person at his word that his mental health is now fine, but if we do, then the diagnosis of DID or MPD would be thrown into doubt. Journalists who have investigated this matter point out that the clinician who diagnosed Walker is not an individual with advanced psychiatric training. Instead, his clinician, who also was a personal friend, was originally an evangelical pastor. His BA and MA degrees are in Bible studies, and his Ph.D. is reportedly in “counselor education with a minor in psychology.” He expresses an expertise in trauma. Some evidence also exists of his unusual, unscientific views, such as demonic possession.

Just because someone personally examines a patient doesn't mean that clinician is going to make a correct diagnosis. As far as we know, Walker has not had a second opinion or a further evaluation by another psychiatric expert to confirm the supposed diagnosis of DID/MPD.

In short, the accuracy of Walker’s diagnosis is not well-established by adequate evaluation of other conditions that could explain his symptoms, as provided by a qualified expert mental health professional. It also should be noted that there is notable scientific literature arguing against the validity of the diagnostic concept of DID or MPD at all, which casts further doubt on this diagnosis. Even though there are strong advocates for the diagnosis, the scientific evidence to support its validity is weak. Even defenders of the validity of DID, as in the cited article, have to admit that standard diagnostic validation criteria, accepted for research on psychiatric diagnosis, mostly are not met. Opinion abounds, but evidence is rare. It was highly diagnosed in the 1980s and 1990s but has been much less diagnosed since then. There is no scientific reason for its frequency to rise and fall sharply; the likelihood of a cultural fad, rather than a scientifically legitimate disease, has been proposed and supported by some experts.

This analysis does not imply that Walker does not have a psychiatric condition; but other valid proven psychiatric diagnoses are more likely than the scientifically weak and likely invalid concept of DID and MPD. Even if that diagnosis is accepted as valid, his symptoms and lifetime course of illness are not consistent with the claimed course of that condition (i.e., typically severe childhood sexual abuse, reported to be present in about 90% of cases, and long-term continued symptoms that do not suddenly go away).

The most salient feature of Walker’s biography is that he is a famous football player. As is well known, American football is associated with repeated concussions and very high rates of chronic traumatic encephalopathy (CTE). Typical symptoms of CTE are depression, marked impulsivity, violence, suicidality, and, eventually, cognitive decline. Walker, as he has noted, has described some of his psychiatric symptoms, and they mostly represent impulsivity, violence, and suicidality.

One article notes: “In his book, Walker acknowledges violent urges. He writes that he played Russian roulette and recounts sitting at his kitchen table in 1991 pointing a gun, loaded with a single bullet, at his head. 'I wasn’t suicidal,' Walker explained, but 'just looked at mortality as the ultimate challenge.'” Then, in February 2001, when he drove around suburban Dallas, hunting for a man who he said was avoiding his calls after being days late delivering a car Walker had purchased, he said, "I intended to kill the man." Four years later, his wife filed for a protective order due to physical violence. Previously, he “pointed a pistol at her head and said, “I’m going to blow your f’ing brains out.”

CTE does not go away. It gets worse over time. So if it is present, it would be concerning.

It’s one thing to destigmatize psychiatric illness. It’s another to make vague claims about past “mental health” problems – never using the word “mental illness” or “psychiatric illness," which is itself a stigmatizing avoidance of those terms – and then to claim that those problems have gone forever.

An outsider perhaps shouldn't make a definitive diagnosis of a public figure, but if a public figure claims to have had a past psychiatric diagnosis, but now no longer has it, psychiatric experts could legitimately raise the question of whether the known symptoms, treatment, and course of such diagnoses are consistent with the claims of the public figure. And they further can raise other possibilities that the public figure and his personal mental health clinicians could investigate.

More from Nassir Ghaemi M.D., M.P.H.
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