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Mental Disorders

by Nicholas P. Spanos
American Psychological Association, 1996
Review by Lisa Bortolotti, M.A. on Jun 12th 2002

Multiple Identities & False Memories

Spanos's book is an exploration of the recent perplexities that the phenomenon of multiple personalities has generated in the psychological literature (see Hacking 1995, Rewriting the Soul). Similarly to Hacking, Spanos claims that multiple personality disorder (MPD) is a socially constructed condition. This book is nevertheless thoroughly original, thanks to the rigorous method with which MPD is disclosed as an illusion, or better as a collective delusion that involves the therapist/hypnotist, the patient and the social context in which they operate. The strategy used by Spanos relies on an innovative account of hypnosis, a scrupulous analysis of the reconstructive nature of memory and an interesting comparison between dissociative phenomena occurring in different cultures.

The book is very clearly written and engaging in all its parts, with no exception. It is instructive reading not just for those who are fascinated by the case of multiple personality, but for anybody interested in the history of mental illness, in the legitimacy of the procedures of psychotherapy and in the phenomenon of hypnosis. It should appeal to psychologists and philosophers alike, as it sheds light on the complex causal interactions between individuals embedded in a hierarchical social exchange and on the role that shared expectations play in our attempts to preserve our self concept.

The phenomenon Spanos focuses on is the explosion of MPD cases in North America since the 1970s. Many patients, mainly women exhibiting depression and antisocial behaviour, start engaging in psychotherapy to improve their condition. Most women are not aware of the cause for their general feelings of dissatisfaction and inadequacy. Typically the psychotherapist asks them questions about possible traumas in their past and, even when prompted, they cannot recollect anything of importance. At this stage, the therapist uses hypnosis to bring about an age regression and asks them more specific questions about possible traumas, in particular sexual abuse in childhood. Gradually, the patient starts 'remembering' episodes of abuse, vaguely at first and then in full details. Under the pressure of the therapist, and influenced by other reports of MPD, the patient also engages in the enactment of different personalities. This behaviour is rewarded by the therapists, whose expectations are fulfilled, and provides an explanation for the dissatisfaction and inadequacy felt previously by the patient. As a result of this procedure, the patient starts feeling better, even though the 'discovery' of abuse causes dramatic changes in her life (e.g. the patient starts blaming her own family for what she thinks happened in her childhood).

This process raises some challenging questions. Does the patient's body really host 'alters'? Is the remembered abuse a trauma that really happened in the patient's past? Is psychotherapy successful in virtue of its revealing repressed memories via hypnosis? Spanos is very sceptical about the causal relation between early abuse and MPD and about the role that hypnosis plays in the recollection of 'lost memories'. His criticism is very powerful, because it is supported by a very convincing series of experiments that tend to show how hypnosis is not an altered state of consciousness and does not cause in the patient any loss of control on movements or perceptions. There is no clear evidence that hypnosis is useful in the discovery of repressed traumas. Spanos's claim is that the patient does what the hypnotist says, and that hypnotic behaviours are nothing but goal-directed enactments, directed to the satisfaction of the requests of the hypnotist as authority figure. Given this deflationary account of hypnosis, it is not difficult to view so-called lost memories as memory distortions: "clients may reconstruct their memories to make them consistent with what they perceive to be the wishes of the therapist or what they believe will win the therapist's approval or sympathy" (page 67).

The other two main moves in Spanos's argument consist in (1) drawing a parallel between MPD cases and cases of alien abduction or past-life regression, where the role of the therapist/hypnotist is similarly dubious, and (2) comparing recent MPD cases with other dissociative phenomena in other cultures, as for instance spirit possession in Christian societies before the 19th century. Both therapy and exorcism are for Spanos institutionalised procedures by which the patient is taught how to think of herself.. This does not mean that the patients 'fake' the shifts of personalities or the possession, but that they "come to adopt a view of themselves that is congruent with the view conveyed to them by their therapist" or the exorcist (page 246).

Although Spanos convincingly exposes the limitations of psychotherapy, as the science of 'creating' the conditions it claims to cure, there are many questions still awaiting an answer. Not all the phenomena related to the manifestation of MPD are shown to be theatrical enactments, and the cause of the dissatisfaction and inadequacy that patients suffer from still needs to be disclosed. This book is not aimed at offering an alternative explanation for the phenomena commonly referred to as MPD, but just to remind us that in science it is evidence that has the last word. If there is no independent evidence that hypnosis can reveal a forgotten past, then psychotherapists need to be very cautious in drawing serious conclusions from its application.

 

© 2002 Lisa Bortolotti

 

Lisa Bortolotti studied philosophy in Bologna (Italy), London and Oxford (UK) before starting her PhD at the Australian National University in Canberra. Her main interests are in philosophy of mind, philosophy of psychology, rationality, mental illness and animal cognition.