Dissociative Identity Disorder

Shaili Jain's The Unspeakable Mind (2019) is an impressive examination of the stress experienced by a veteran community that too often is handled with a sense of clinical sterility that borders on inhumanity, or a that of pandering condescension. However, what is striking about Jain's text is the lack of analysis of how trauma manifests in what Heidegger would refer to as average everydayness. This, to me, seems like a missed opportunity, especially as it pertains to trauma-based ethics since all (...) too frequently manifestations of trauma do not occur as they are portrayed to in popular culture, but in the day-to-day and moment-to-moment living of those who deal with trauma. In this article I interrogate everyday manifestations and ideal manifestations of trauma using a comparative lens. My hope is that by focusing my analysis on my process of engagement with traumatic experiences I can help develop new discussions about trauma that will both allow for the discovery of new modes of thinking-about trauma as well as illuminate more nuanced methodologies of healing for those effected by post-traumatic stress in future research. (shrink)

I argue here that our rights in our bodies are not well explained by self-ownership – and thus, also, that we cannot infer any further distributive implications of self-ownership from intuitions about body rights via inference to the best explanation. And I sketch an alternative view, on which we do indeed own our bodies, but not because we own ourselves. Self-ownership, I argue, provides a satisfying explanation only if we take it seriously: not as a mere metaphor, but as an (...) expression of a literal, reflexive ownership relation between me and myself, whatever I myself am. I go on to canvas the most prominent theories of what human beings like me literally are, arguing that each of these theories makes it hard to see how our self-ownership can ground our rights in our bodies. In the second half I consider and refine alternative, interest-based, explanations of our rights in our bodies, drawing on suggestions in this direction from Kasper Lippert-Rasmussen and Alan Wertheimer. I show how it is possible in principle to affirm that body ownership rights remain (in a sense) natural rights, even on the sort of interest-based view of ownership that many (including myself) take to preclude all or most fully natural property rights. I argue that many body rights can be grounded prefiguratively, in facts about the possible emergence of sufficiently just authority-assigning practices, rather than (as with most property rights) in their actual existence. Finally, I return to the distributive issues that motivated much interest in self-ownership in the first place – particularly, the question of whether and in what way our rights in our bodies generate rights in other things, by labor or otherwise. Without actually answering this question, I show how the account developed here would proceed in doing so: not by positing body rights as a methodologically prior constraint on rights of other kinds, but rather by considering the implications entire systems of rights and duties have for the interests of those who possess and are bound by them. (shrink)

While there is still a limited understanding of the Selfhood phenomenon, an emerging consensus is that the experiential Selfhood refers to a sense of the undergoing experience in its implicit first-person mode of givenness that is immediately and tacitly given as “mine”. It is also evident that there are phenomenological disruptions within self-consciousness ranging from normal everyday short-lived dissociative episodes to pathological, intense and prolonged forms of dissociative experience classified as depersonalization disorder (DD). In the present study we explored the (...) neurophenomenology of Selfhood (using the recently introduced neurophysiological three-dimensional construct model of experiential Selfhood, Fingelkurts et al., 2020) in a newly diagnosed and untreated 29-year-old female who suffers from DD. According to the triad model of Selfhood, three major components of Selfhood (phenomenal first-person agency – “Self”, embodiment – “Me”, and reflection/narration – “I”) are related to three operational modules (OMs) of the self-referential brain network (reliably estimated by electroencephalogram operational synchrony analysis). We have found that subject with DD exhibited a strong enhancement of functional integrity of the brain Self-module, a moderate decrease in the functional integrity of Me-module, and a pronounced decrease in the functional integrity of I-module, – all of which were associated with severity of specific DD symptoms. (shrink)

The article based on Kuhn’s paradigmatic approach and Lakatos’ methodology of scientific research programmes, analyses certain aspects of selected cognitive functions of religous beliefs. Our approach is based on the search for angalogy between scientific theories on one hand and systems of religious beliefs on the other hand. Contemporary philosophy of science demonstrates that scientific models are the products of creative analogous immagination, data are theory-laden, theories as a whole are resistent to falsification and it is hard (if at all) (...) to find reliable criterions for the selection of a paradigm. These «subjective features» are more evident within religion, since a wider range of models, greater impact of interpretations on data, greater arduousness in regard to the commitment to a paradigm and more ambiguity in the process of the selection of a paradigm, exist in this area. However, with each of these features, I see the difference between science and religion in their degree and not in absolute contrast. (shrink)

The concept of “dissociation” describes a variety of phenomena that involve a divided or disunified experience, ranging from everyday experiences such as daydreaming to the fascinating and controversial phenomenon of dissociative identity disorder —formerly called multiple personality disorder. Because of the wide assortment of phenomena, theoretical unity has been difficult to achieve, and there is no received consensus of what dissociation is, with many arguing the concept is imprecise, confusing and/or ambiguous. The aim of the thesis is to use resources (...) from Heidegger’s existential-hermeneutic phenomenology to articulate core structures of dissociative experiences. In pursuing this aim, I identify three problems that any satisfactory theory of dissociation must confront: the motleyness problem, the ontological problem, and the normative problem. Before developing the Heideggerian account, I first track the development of these three problems over a two-part philosophical history of dissociation. After identifying consciousness as one of the ontological commitments that run through the history of consciousness, I then situate dissociation within the philosophy of mind by critically evaluating Tim Bayne’s unity of consciousness thesis with reference to whether it can satisfactorily accommodate dissociative phenomena. After showing that the three problems remain a significant challenge to theorizing dissociative phenomena, I move to articulate dissociative experiences using the Heideggerian ontological structures of Jemeinigkeit and Unheimlichkeit. I conclude by evaluating this Heideggerian account of dissociation against the three problems. (shrink)

Thomas Kuhn dengan konsep revolusi ilmiahnya memiliki karakteristik pemikiran dan model filsafat baru dalam hal sejarah lahirnya ilmu pengetahuan dan filsafat sains serta peranan sejarah ilmu pengetahuan dalam mengkonstruksi ataupun merekonstruksi munculnya ilmu pengetahuan baru. Bagi Thomas Kuhn sejarah ilmu pengetahuan merupakan starting point dalam mengkaji permasalahan fundamental dalam epistemologi keilmuan karena sains pada dasarnya selalu ditandai dengan kuatnya paradigma serta revolusi ilmiah setelahnya. Fase inilah yang diistilahkan Thomas Kuhn sebagai fase sejarah lahirnya ilmu pengetahuan baru, dimulai dengan normal science, (...) kemudian terjadi anomaly dan crisis, setelah itu barulah muncul revolusi ilmiah sebagai bentuk lahirnya ilmu pengetahuan baru. Pemikiran Thomas Kuhn tersebut dapat dikontekstualisasikan dengan pengembangan keilmuan Islam dengan tujuan membangun keterbukaan pemikiran keislaman terhadap anomali dan crisis serta munculnya revolusi dalam ilmu keislaman sehingga memotivasi munculnya paradigma baru di ranah keilmuan Islam. Berbagai pendekatan dalam studi Islam dapat digunakan seperti pendekatan normatif, historis, sosiologis, antropologis dan pendekatan lainnya dalam rangka membumikan Islam menjadi agama yang rahmatan lil alamin. Kata Kunci : Paradigma, Revolusi Ilmiah, Thomas Kuhn. (shrink)

The Quest for Physical Theory (QPT) comprises the eight Lowell lectures that Kuhn gave on Tuesdays and Fridays in March 1951 in the Lecture Hall of the Boston Library. He was 28 years old at the time, a member of the Harvard Society of Fellows, a recent Harvard PhD in Physics (1949), and an instructor in the general-education course on science set up by James Conant, Harvard’s President. Kuhn seized the opportunity of the Lowell Lectures to present his new, and (...) ground-breaking at the time, take on science which was shaped by Kuhn’s forays in psychology, philosophy, history, and logic. It is obvious from reading the lectures that Kuhn was very confident of his views and was aiming to jolt the public with his revisionary account. To a complacent audience, accustomed to the standard, textbook picture of science, he hurled the provocative claims that there are no pure facts, that prejudice plays a decisive role in scientific practice, that the then-current history of science fabricated mythologies about past science, that perception is not passive, and that the overthrow of a theory does not add to previous knowledge. All these claims more than foreshadow the basic elements of Kuhn’s model in The Structure of Scientific Revolutions (SSR). It is not just that the lectures speak to the emergence of Kuhn’s ideas that were later refined, as George Reisch, the editor of QPT, says in his introductory essay. The lectures show that Kuhn had conceived his model, almost in its entirety, very early on, which means that the much-debated influence exercised on him by later works, such as Toulmin’s, Hanson’s, or Polanyi’s in the 1950s, was secondary to the exploratory readings of his youth. These later influences must have solidified his early conception. (shrink)

ICD-10 and DSM-5 do not provide clear diagnosing guidelines for DID, making it difficult to distinguish ‘genuine’ DID from imitated or false-positive cases. This study explores meaning which patients with false-positive or imitated DID attributed to their diagnosis. 85 people who reported elevated levels of dissociative symptoms in SDQ-20 participated in clinical assessment using the Trauma and Dissociation Symptoms Interview, followed by a psychiatric interview. The recordings of six women, whose earlier DID diagnosis was disconfirmed, were transcribed and subjected to (...) interpretative phenomenological analysis. Five main themes were identified: endorsement and identification with the diagnosis. The notion of dissociative parts justifies identity confusion and conflicting ego-states. Gaining knowledge about DID affects the clinical presentation. Fragmented personality becomes an important discussion topic with others. Ruling out DID leads to disappointment or anger. To avoid misdiagnoses, clinicians should receive more systematic training in the assessment of dissociative disorders, enabling them to better understand subtle differences in the quality of symptoms and how dissociative and non-dissociative patients report them. This would lead to a better understanding of how patients with and without a dissociative disorder report core dissociative symptoms. Some guidelines for a differential diagnosis are provided. (shrink)

Deutsche Krankheit: eine Diagnosestellung mit Rückblick und Ausblick auf Krankheitsverlauf.

This essay explores the topic of Dissociative Identity Disorder (formerly called “Multiple Personality Disorder”) with special attention to such Quadrophenia masterpieces as “Dr. Jimmy” and “The Real Me.” A number of major philosophical questions arise: Can two or more “persons” really inhabit the same body? How can we hold Dr. Jimmy morally responsible for the reprehensible actions of Mr. Jim? Wouldn’t it be wrong to do so if they are really different people? What is it to be the “same” person (...) over time? Does Dr. Jimmy really have free will? The focus is on the much discussed and important notions of personal identity, free will, and moral responsibility. (shrink)

The Who was one of the most influential of the 1960s British Invasion bands—not just because of their loud and occasionally destructive stage presence—but also because of its smart songs and albums such as “My Generation,” Who’s Next, Tommy, and Quadrophenia, in which they explored themes such as frustration, angst, irony, and a youthful inclination to lash out. This collection explores the remarkable depth and breadth of the Who’s music through a philosophical lens.

While many theorists have argued that dissociative identity disorder is a case of multiple selves or persons in a single body, I maintain that DID instead should be understood as involving a single self who suffers from significant disruptions to self-consciousness. Evidence of overlapping abilities and memories, as well as the very logic of dissociation, supports the claim that DID results from internal conflict endured by a single self. Along these lines, I will maintain that alter-formation should be understood as (...) the result of extreme emotional ambivalence. While it is true that subjects with DID exhibit volitional conflict, as Frankfurt [1988. The Importance of What We Care About. New York: Cambridge University Press; 1999. Necessity, Volition, and Love. New York: Cambridge University Press] maintains, I argue that these incompatible volitions have a deeper source: conflicting desires and affective stances concerning basic emotional needs that are not easily abandoned. A single subject turns to... (shrink)

If someone with dissociative identity disorder commits a wrongful act, is she responsible? If one adopts the Multiple Persons Thesis, it may seem that one alter cannot be responsible for the actions of another alter. Conversely, if one regards the subject as a single person, it may seem that she is responsible for any actions she performs. I will argue that this subject is a single person, but one who suffers from delusions of disownership and therefore does not fulfill ordinary (...) requirements for responsible agency. This is because she suffers from extreme ambivalence: her deep-seated needs and desires conflict, and she forms alter-personalities as a way to cope with inner discord without abandoning any of these contradictory impulses. However, although the ability to exercise autonomous agency is eroded in such cases, the capacity for autonomous agency is preserved. The subject with DID is weakly responsible for her wrongful acts. (shrink)

This groundbreaking volume of original essays presents fresh avenues of inquiry at the intersection of philosophy and psychiatry. Contributors draw from a variety of fields, including evolutionary psychiatry, phenomenology, biopsychosocial models, psychoanalysis, neuroscience, neuroethics, behavioral economics, and virtue theory. Philosophy and Psychiatry’s unique structure consists of two parts: in the first, philosophers write five lead essays with replies from psychiatrists. In the second part, this arrangement is reversed. The result is an interdisciplinary exchange that allows for direct discourse, and a (...) volume at the forefront of defining an emerging discipline. Philosophy and Psychiatry will be of interest to professionals in philosophy and psychiatry, as well as mental health researchers and clinicians. (shrink)

Gloria Ayob Begins her commentary with the main metaphysical and ethical motivations for including the personal perspective in psychopathological assessments. The metaphysical motivation: human actions are performed for a reason. Thus, from the personal perspective, explaining human actions amounts to justifying them by appeal to individual’s reasons. However, does it follow from this peculiarity that “explanations of human behavior that appeal to empirical generalizations and those that consist in justifying an action by appeal to reasons are of entirely different logical (...) orders” (Ayob 2013, 127) as she contends? I do not think so for two main reasons. First, in both cases, genuine explanations involve factual .. (shrink)

Current thinking suggests that dissociation could be a significant comorbid diagnosis in a proportion of schizophrenic patients with a history of trauma. This potentially may explain the term “schizophrenia” in its original definition by Bleuler, as influenced by his clinical experience and personal view. Additionally, recent findings suggest a partial overlap between dissociative symptoms and the positive symptoms of schizophrenia, which could be explained by inhibitory deficits. In this context, the process of dissociation could serve as an important conceptual framework (...) for understanding schizophrenia, which is supported by current neuroimaging studies and research of corollary discharges. These data indicate that the original conception of “split mind” may be relevant in an updated context. Finally, recent data suggest that the phenomenal aspects of dissociation and conscious disintegration could be related to underlying disruptions of connectivity patterns and neural integration. (shrink)

One of the central problems of personal identity is to determine what we are essentially . In response to this problem, Lynne Rudder Baker espouses a psychological criterion, that is, she claims that persons are essentially psychological. Baker’s theory purports to bypass the problems of other psychological theories such as Dissociative Identity Disorder and the problem of individuating persons synchronically. I argue that the theory’s treatment of Dissociative Identity Disorder leads to untenable results, is invalid, and consequently fails to individuate (...) persons. (shrink)

This is a response to an article published inSociety & Animals in 2008 that argued for the existence of a “species identity disorder” in some furries. Species identity disorder is modeled on gender identity disorder, itself a highly controversial diagnosis that has been criticized for pathologizing homosexuality and transgendered people. This response examines the claims of the article and suggests that the typology it constructs is based on unexamined assumptions about what constitutes “human” identity and regulatory fictions of gender identity.

As witnessed by recent films such as _Fight Club_ and _Identity_, our culture is obsessed with multiple personality—a phenomenon raising intriguing questions about personal identity. This study offers both a full-fledged philosophical theory of personal identity and a systematic account of multiple personality. Gunnarsson combines the methods of analytic philosophy with close hermeneutic and phenomenological readings of cases from different fields, focusing on psychiatric and psychological treatises, self-help books, biographies, and fiction. He develops an original account of personal identity and (...) offers a provocative interpretation of multiple personality: in brief, "multiples" are right about the metaphysics but wrong about the facts. (shrink)

As witnessed by recent films such as _Fight Club_ and _Identity_, our culture is obsessed with multiple personality—a phenomenon raising intriguing questions about personal identity. This study offers both a full-fledged philosophical theory of personal identity and a systematic account of multiple personality. Gunnarsson combines the methods of analytic philosophy with close hermeneutic and phenomenological readings of cases from different fields, focusing on psychiatric and psychological treatises, self-help books, biographies, and fiction. He develops an original account of personal identity and (...) offers a provocative interpretation of multiple personality: in brief, "multiples" are right about the metaphysics but wrong about the facts. (shrink)

Body integrity identity disorder (BIID), previously called apotemnophilia, is an extremely rare condition where sufferers desire the amputation of a healthy limb because of distress associated with its presence. This paper reviews the medical and philosophical literature on BIID. It proposes an evidenced based and ethically informed approach to its management. Amputation of a healthy limb is an ethically defensible treatment option in BIID and should be offered in some circumstances, but only after clarification of the diagnosis and consideration of (...) other treatment options. (shrink)

The so-called “problem of personal identity” can be viewed as either a metaphysical or an epistemological issue. Metaphysicians want to know what it is for one individual to be the same person as another. Epistemologists want to know how to decide if an individual is the same person as someone else. These two problems converge around evidence from mediumship and apparent reincarnation cases, suggesting personal survival of bodily death and dissolution. These cases make us wonder how it might be possible (...) for a person to survive death and either temporarily or permanently animate another body. And they make us wonder how we could decide if such postmortem survival has actually occurred. In this essay I argue, first, that metaphysical worries about postmortem survival are less important than many have supposed. Next, I'll consider briefly why cases suggesting postmortem survival can be so intriguing and compelling, and I'll survey our principal explanatory options and challenges. Then, I'll consider why we need to be circumspect in our appraisal of evidence for mind-body correlations. And finally, I'll try to draw a few tentative and provocative conclusions. (shrink)

Classifying Madness (Springer, 2005) concerns philosophical problems with the Diagnostic and Statistical Manual of Mental Disorders, more commonly known as the D.S.M. The D.S.M. is published by the American Psychiatric Association and aims to list and describe all mental disorders. The first half of Classifying Madness asks whether the project of constructing a classification of mental disorders that reflects natural distinctions makes sense. Chapters examine the nature of mental illness, and also consider whether mental disorders fall into natural kinds. The (...) second half of the book addresses epistemic worries. Even supposing a natural classification system to be possible in principle, there may be reasons to be suspicious of the categories included in the D.S.M. I examine the extent to which the D.S.M. depends on psychiatric theory, and look at how it has been shaped by social and financial factors. I aim to be critical of the D.S.M. without being antagonistic towards it. Ultimately, however, I am forced to conclude that although the D.S.M. is of immense practical importance, it is unlikely to come to reflect the natural structure of mental disorders. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 12.1 (2005) 25-26 [Access article in PDF] Past Personal Identity Markus L. A. Heinimaa Keywords consciousness, Freud, Locke, personal identity, self-understanding Schechtman's paper presents us with two lines of reasoning, which deserve separate discussion. First, she proposes a novel reading of John Locke's well-known discussion of personal identity and, second, she suggests a way of surmounting difficulties she sees both Lockean view and psychological continuity (...) theories have in dealing with the notion of nonconscious experiences.The criticism that she makes on contemporary theorists basing their view on Locke's work on personal identity (in terms of psychological continuity) seems by and large valid. Schechtman aptly points out that by concentrating on memory as the main constituent of personal identity, they are compelled to appeal to intuitions that are the very target of Locke's criticism (Schechtman 2005, 9) and she proposes that we should focus on Locke's original contention that consciousness is the unifying feature of personal identity. In her reading, this is spelled out as self-referential intelligibility, as capacity to understand oneself as a coherent "process." As far as I can see this description certainly gives a truer reading of Locke than a memory-based account.The second line of reasoning concerns the seeming dilemma she faces when accounting for "unconscious experiences" impact on personhood, as they clearly are "part of our psychological lives" (Schechtman 2005, 16). Here she suggests that developing "Locke's insight in a more satisfying way" is possible in terms of "self-understanding view." She points out how this experiential intelligibility is threatened by in everyday life prevalent bafflement on some of the feelings we have and acts we do. Following Descartes and Freud's examples, this (apparent) unintelligibility is dealt by hypothesizing unconscious "memories or desires or motivations," which then impact our "psychological lives."A question arises here: Is Schechtman's account of personal identity really threatened by the notion of "unconscious experience"? As I see it, a certain streak of psychologism in her writing makes her otherwise coherent account vulnerable in this respect. When assuming that "experiences of which we are not conscious can be a part of our psychological lives" (Schectman 2005, 16), she effectively equates being a person with "psychological being" or being a "psychological subject" (Schechtman 2005, 17). But what work is the notion "psychological" doing here? As far as I can see it, Schechtman could account for Lockean conception of "personal identity" in terms of "consciousness" solely in terms of "process of self-understanding." Of course psychological accounts of personal identity or consciousness are readily available, but the suggested description of the logic of these concepts does [End Page 25] not necessitate them—any such an account is in a sense extraneous to the logic of these concepts.What is suggested here does not basically contradict Schechtman's account of the relation of unconscious to personal identity but only suggests that this account is superfluous. Further, her (mainstream) reading of Freud misses some interesting features of Freud's problematic. In his paper "Psychoanalysis and the personal," Morris Eagle (1988) proposes interpreting Freud's distinction between conscious and unconscious psychological phenomena as the distinction between what is experienced as belonging to one's person and what is experienced as alien in this respect—in terms of "ownership and disownership of mental contents" (Eagle 1988, 92) and concludes that Freudian psychoanalytic theory can be read as being primarily concerned with the problems a person encounters in trying to keep his experience of himself as a person coherent.This reading of Freud has implications for Schechtman's reinterpretation of Locke's conception of personal identity as self-understanding, as the question on the impact of nonconscious phenomena on personal identity would seem to lose its significance here. A more deep going probing into the logic of the Freudian concept of unconscious would be warranted in this context.All in all, Schechtman's account of "personal identity" clearly moves into a sound direction. Yet, one could focus even more closely on Locke's original work and ask about the... (shrink)

Thomas Kuhn's celebrated work, The Structure of Scientific Revolutions revolutionized thinking in the philosophy of science. This book goes beyond Kuhn by explicating the non-deductive notion of paradigm shift in terms of the new concept of representati.

In the second edition of the Essay Concerning Human Understanding, John Locke argues that personal identity over time consists in sameness of consciousness rather than the persistence of any substance, material or immaterial. Something about this view is very compelling, but as it stands it is too vague and problematic to provide a viable account of personal identity. Contemporary "psychological continuity theorists" have tried to amend Locke's view to capture his insights and avoid his difficulties. This paper argues that the (...) standard approach fails because it takes Locke to be a memory theorist, and does not focus enough on his claim that we need continuity of consciousness for personal persistence. An alternative reading of Locke is offered, emphasizing the role of self-understanding in producing continuity of consciousness. This alternative overcomes the difficulties with the standard approach, and shows how it is possible to attribute unconscious psychological elements to a person, even when personal persistence is defined in terms of consciousness. (shrink)

In this paper we argue that dissociative identity disorder (DID) is best interpreted as a causal model of a (possible) post-traumatic psychological process, as a mechanical model of an abnormal psychological condition. From this perspective we examine and criticize the evidential status of DID, and we demonstrate that there is really no good reason to believe that anyone has ever suffered from DID so understood. This is so because the proponents of DID violate basic methodological principles of good causal modeling. (...) When every ounce of your concentration is fixed upon blasting a winged pig out of the sky, you do not question its species' ontological status. James Morrow, City of Truth (1990). (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Misprision of IdentityHarold Merskey (bio)Misprision the deliberate concealment of one's knowledge of a crime...A misreading, misunderstanding, etc.A failure to appreciate the value of a thing...(Concise Oxford Dictionary)There are options in the forms of identity that Charland's subjects assume. There are options as well in the meaning of this title, which may apply severally or individually to the choices under consideration. Are those who change their identity with labels—or reject (...) labels—correctly assuming accurate descriptions, or incorrectly misleading themselves and some others? In which of these cases are observation and intervention ethical, and do they pose demands on medical ethicists, or should they simply be ignored?Types of AutonomyParticipants in chat rooms on the Internet may justifiably be considered to be individuals who are seeking a current method of communication to promote a view of themselves, or ideas that they possess, or projects that they endorse. In this they may resemble others who have used more traditional methods of presenting their ideas, their claims, their wares, hard merchandise, literary material, or political or philosophical propositions to the public at large. These others may be sales persons, advertisers, poets, singers, clowns, buskers, politicians, preachers, missionaries, learned public speakers, television presenters, news commentators (but not necessarily reporters), and anyone indeed who talks to other people in public about matters that she or he wishes to bring forward. They have a point they want to make. They may be grouping themselves as 'survivors' or pro-anorexia, or Multiple Personality Disorder victims, but they are not necessarily operating as patients who are looking for a fiduciary relationship with physicians or other health care practitioners. It is thus a long step to turn them into individuals who may have a claim on the doctor–patient relationship.Do we wish to undertake research on them? Research or study in the first instance for these circumstances must be in the field of social science. The rules of what it is ethical for a sociologist to do apply first. The rules of situations where one person has more power and the other depends on that individual for assistance without exploitation may differ considerably from case to case. In so far as there may be some special rules as to what is fair, reasonable, just, kind, merciful, or prudent to study individuals who expose themselves and their interests publicly, this is perhaps best done first by reference to standards for journalists.That criterion may be too lenient a standard for most health professionals because journalists seem to be quite willing to expose the subjects of their observations to public obloquy and to [End Page 351] present information about many individuals—information that the persons themselves do not consent to see in the public domain, but that the journalist, having acquired, feels entitled to make known. Still there are believed to be some standards that journalists observe and these tend to protect the weak and the more vulnerable, although that does not mean that they are regularly followed. They tend to emphasize not printing material that is salacious or very lewd and would have personal reference, but they do not withhold comparable information if they consider that it is accurate and describes the behavior of individuals who are of interest to the public which, in certain circumstances, may mean almost anybody.So up to this point it seems that our normal respect for the autonomy of the individual in chat rooms can be balanced against our interest in freedom of speech, which leads to open and very broadly based publication of information and observations.The Burden of the LabelOnce the medical label is affixed, a different level of stringency begins to apply to what may be studied or published. Because we feel that individuals' self-esteem is at risk and perhaps their lives, we hesitate to make cutting or pejorative comments about distressed people. Such diagnoses as cancer or depression may be held back from the patient (and, certainly, in the case of depression, even more may be kept from others around the patient). Likewise unspoken thoughts may be automatically acknowledged and, like radical material, may be carefully segregated and... (shrink)

Now that consciousness is thoroughly out of the way, we can focus more precisely on the kinds of things that can happen underneath. A contrast can be made between dissociation and repression. Dissociation is where a memory record or set of autobiographical memory records cannot be retrieved; repression is where there is retrieval of a record but, because of the current task specification, the contents of the record, though entering into current processing, are not allowed into consciousness. I look at (...) hypnotic amnesia and dissociative identity disorder in relation to this contrast. (shrink)

The article questions the assumption that conjoined twins are necessarily two people or persons by employing arguments based on different points of view: non-personal vitalism, the person as a sentient being, the person as an agent, the person as a locus of narrative and valuation, and the person as an embodied mind. Analogies employed from the cases of amputation, multiple personality disorder, abortion, split-brain patients and cloning. The article further questions the assumption that a conjoined twin's natural interest and wish (...) is separation. I first contend that separation is such a radical procedure as to render the post-separation person different from the pre-separation one. Therefore, it is not possible to benefit the pre-separation twin by the act of separation. The article concludes with a critical evaluation of the tendency in bioethics to regard ethical challenges as rivalry between individuals competing for scarce resources. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.2 (2003) 189-192 [Access article in PDF] The Responsibility of the Psychopathic Offender:Commentary on Ciocchetti Piers Benn Christopher Ciocchetti has valuable things to say in his article. He takes as his starting point some common ground between his views and my own, especially about the importance of Strawsonian participant reactive attitudes to our understanding of psychopathy. But he proceeds to claim that the distinguishing feature (...) of psychopaths is not their lack of such attitudes but their inability to understand how relationships are affected by their behavior—and indeed their inability, in some sense, to understand interpersonal relationships at all. He also takes me to task for claiming that the participant reactive attitudes (PRAs)—presumably he includes things like resentment, indignation, gratitude, and so on—are essentially communicative. For him, this is too strong a claim, because we can imagine cases when such attitudes are expressed, but without any communicative purpose.On the latter point, I concede that people often do express PRAs even though they know such expression will have no effect on those whose behavior or attitudes gave rise to them. Different things can explain this lack of effect. For example, imagine a normally responsive person who obstinately fails to see that a certain judgment applies to him or her in a particular case. Take a woman who repeatedly expresses frustration and anger toward her husband for failing to do any domestic chores, but without having the slightest effect on him. Eventually her expressions of anger serve more as an emotional release than as an attempt to get him to change. As in Ciocchetti's example of Mary's reaction to her calls not being returned, she gives up in the end, expressing anger but without any hope of getting through to the other person.But there is another possible explanation for her anger: suppose the husband's failure to contribute to the housework does not arise from his inability to respond to moral claims upon him, but because he thinks he is already doing his duty by being the sole wage earner, and is quite intransigent about this. In that case, the woman might still see him, in general, as a proper object of her PRAs. She sees his fault as local rather than general; a failure, or perhaps even an inability, to think properly about this particular issue rather than about moral demands in general. She might regard her angry outbursts as justified, not because they will have any effect on him now, [End Page 189] but because they are a proper participant response to some earlier failure, which he was then able to do something about—maybe he neglected to think properly about fairness when forming his moral outlook.Compare this case, though, with someone who just does not understand the nature of relationships and the obligations they impose. This is the sort of case Ciocchetti has in mind. Anger is, on his account, understandable, not because it is meant to communicate anything, but because it is "an expression with no further aim at all" (2003, p. 178). On this point, I agree that people sometimes do express anger (or other emotions) without trying to induce a response in someone. At the same time, there is a significant difference between times when we do hope to elicit an appropriate participant response like shame, and times when we do not. When we express such attitudes without any hope of a participant response, we miss something that is, if not essential to, at least typical of such expressions. Getting angry with the neighbor's aggressive dog or scrounging cat is understandable, but it is simply not the same kind of thing as getting angry with a normal, rational adult. The typical case, maybe the necessarily typical case, is when we experience or express such emotions toward, or at least concerning, beings capable of PRAs—and, again typically if not always, such beings are capable of understanding when and why the PRAs of others are directed toward them.But the thrust of Ciocchetti's paper lies not... (shrink)

KEYWORDS: dissociation; multiple personality, person, responsibility.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.2 (2003) 161-167 [Access article in PDF] Social, Cognitive, and Neural Constraints on Subjectivity and Agency:Implications for Dissociative Identity Disorder Peter Q. Deeley In this commentary, I consider Matthew's argument after making some general observations about dissociative identity disorder (DID). In contrast to Matthew's statement that "cases of DID, although not science fiction, are extraordinary" (p. 148), I believe that there are natural analogs of (...) the disorder that, when considered, make it seem less puzzling and exotic. After discussing these examples, I examine the relations between social, cognitive, and neural processes supporting subjectivity and agency, to identify sources of personal identity in cases of DID that can be used as a basis for assessing Matthew's points against Behnke and Sinnott-Armstrong. I am not proposing a comprehensive theory, but rather identifying what I believe are components of such a theory. I then outline an approach to determining criminal responsibility in DID, drawing on analogies with other psychiatric disorders. Dissociative Identity Disorder DID is a disorder described in DSM-IV, which "is characterised by the presence of two or more distinct identities or personality states that recurrently take control of the individual's behaviour accompanied by an inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness" (American Psychiatric Association, p. 519). Recognizing Personal Identity How is personal identity recognized in normal cognition? If we take personhood to involve recognition of continuity of social, psychological, and physical identity for a given individual, then such judgments are routinely made rapidly and automatically as an aspect of what has come to be termed social cognition (Adolphs 2003). There is likely to be considerable redundancy in [End Page 161] the types of information used to make judgments about whether a person is the same as one who was previously encountered, or perhaps heard about—for example, facial features, movement patterns, speech prosody, dress, speech content, gender, ethnicity, social role, among other features, all provide information about individual identity, and hence personhood. When uncertainty exists, it is likely to reflect a loss or alteration of cues that would ordinarily be used in a rapid, automatic, unexamined way (Adolphs 2003). In such extreme cases (for example, severe mental illness or disfigurement), the problem of identification becomes the subject of explicit reasoning (and hence of potential disagreement, because we then engage in post hoc rationalizations to establish criteria for determining personhood, whereas normally we rely on essentially automatic, implicit abilities that work in most circumstances, some of which make little use of linguistic representations and formal reasoning—for example, individual facial identity recognition, which may occur as quickly as 170 ms after stimulus onset [Adolphs 2003]). Nevertheless, examining our judgments and intuitions in cases that force us to explicitly consider whether personal identity is preserved may provide analogies and clues for how we should proceed with DID. Let us consider, then, some natural analogs of DID. Natural Analogs of DID Method Acting I suggest that method acting is an analog of DID (Manderino 1985). Method acting refers to an approach to acting training and performance in which emphasis is placed on intensely imagining and identifying with the mental life of the character being portrayed. Training courses and manuals list many techniques and practices that can be used to facilitate absorption in a role, drawing on different kinds of memory—for example, experiential memories, memories of others, general knowledge (semantic memory), and memories of sensations and feelings, to creative a vivid sense of the subjective experience and actions of the character. Manderino, a method acting teacher, comments: "it is important to investigate the way in which your own mental makeup can improperly influence a character. Insecurities, self-consciousness, shyness or self-doubts can maintain a strong hold, and permitting any of these feelings to enter a performance is to remain the actor and not enter into the mental life of the character. For some, acting allows personal problems to be left behind, and they are thankful for the complete escape that... (shrink)

The condition known as Multiple Personality Disorder (MPD) or Dissociative Identity Disorder (DID) is metaphysically strange. Can there really be several distinct persons operating in a single body? Our view is that DID sufferers are single persons with a severe mental disorder. In this paper we compare the phenomenology of dissociation between personality states in DID with certain delusional disorders. We argue both that the burden of proof must lie with those who defend the metaphysically extravagant Multiple Persons view and (...) that there is little theoretical motivation to yield to that view in light of the fact that the core symptoms of DID bear remarkable similarity to the symptoms of these other disorders where no such extravagance is ever seriously entertained. (shrink)

In some recent criminal cases in the United States a defense has been mounted based on an affliction known as Dissociative Identity Disorder (DID) (formerly Multiple Personality Disorder). The crux of the defense rests on the proposition that a dominant personality was incapable of appreciating the nature and quality of wrongfulness of conduct caused by an alter personality. This defense has been successful in some cases, but not others, and so philosophers, lawyers, and psychiatrists are now in debate in an (...) attempt to clarify the issues. One of the salient issues involves the question of personal identity between the individual who allegedly committed the offense and the individual who stands accused. Stephen Behnke and Walter Sinnott-Armstrong have recently put forward a test for establishing personal identity in these cases. In this discussion, I present reasons for rejecting their proposal. (shrink)

In some recent criminal cases in the United States a defense has been mounted based on an affliction known as Dissociative Identity Disorder (DID) (formerly Multiple Personality Disorder). The crux of the defense rests on the proposition that a dominant personality was incapable of appreciating the nature and quality of wrongfulness of conduct caused by an alter personality. This defense has been successful in some cases, but not others, and so philosophers, lawyers, and psychiatrists are now in debate in an (...) attempt to clarify the issues. One of the salient issues involves the question of personal identity between the individual who allegedly committed the offense and the individual who stands accused. Stephen Behnke and Walter Sinnott-Armstrong have recently put forward a test for establishing personal identity in these cases. In this discussion, I present reasons for rejecting their proposal. (shrink)

Many philosophers say that two or more people or thinking beings could share a single human being in a split‐personality case, if only the personalities were sufficiently independent and individually well integrated. I argue that this view is incompatible with our being material things, and conclude that there could never be two or more people in a split‐personality case. This refutes the view, almost universally held, that facts about mental unity and disunity determine how many people there are. I suggest (...) that the number of human people is simply the number of appropriately endowed human animals. (shrink)

Several clinical cases are presented to illustrate the phenomenon of discontinuity of personal narrative. These discontinuities are markedly and overtly present in the cases described, which include cases of bipolar disorder, incipient schizophrenia, dissociative disorder, and others. One of the patients suggests that they are also ubiquitous in people without psychiatric diagnoses.

Many contemporary bioethicists claim that the possession of certain psychological properties is sufficient for having full moral status. I will call this thepsychological approach to full moral status. In this paper, I argue that there is a significant tension between the psychological approach and a widely held model of Dissociative Identity Disorder (DID, formerly Multiple Personality Disorder). According to this model, the individual personalities or alters that belong to someone with DID possess those properties that proponents of the psychological approach (...) claim suffice for full moral status. If this account of DID is true, then the psychological approach to full moral status seems to entail that the two standard therapies for treating DID might, on occasion, be seriously immoral, for they may well involve the (involuntary) elimination of an entity with full moral status. This result should give proponents of the psychological approach pause, for most people find the claim that current treatments of DID are ethically suspect highly counter-intuitive. (shrink)