Citation

Lewis DO, Bard JS. Psychiatr. Clin. North Am. 1991; 14(3): 741-756.

Affiliation

New York University School of Medicine, New York.

Copyright

(Copyright © 1991, Elsevier Publishing)

DOI

unavailable

PMID

1946033

Abstract

As clinicians become more sophisticated regarding MPD, we can expect many more cases to come to the court's attention, especially among violent offenders. This is because violence and MPD have very similar origins in early extraordinary physical and sexual abuse. As offenders become more knowledgeable, we can also expect to encounter more and better malingering. At this time, however, we are far more likely to overlook the problem than we are to overdiagnose it. Why is it that MPD is recognized so infrequently in the offender population? Probably because so many of its characteristics are similar to the symptoms associated with antisocial personality. For example, amnesia for behaviors is dismissed as lying, fugue states appear to be attempts to evade justice; finding things in one's possession looks like stealing; self-mutilation and suicide attempts seem manipulative; and the use of different names at different times and in different circumstances is interpreted as the conscious use of aliases in order to evade the law. Even the dramatic, at times heart-wrenching emotional catharses relating to abuse revealed during hypnosis are so painful that the average person has difficulty accepting that they happened and, therefore, dismisses them as exaggeration or total fabrication. Most often, the diagnosis is missed because the clinician does not even consider it a possibility. In this article we have reviewed some of the ways in which courts have approached the issue of MPD and some of the problems specific to its diagnosis in forensic settings. The clinician must keep in mind that in cases in which issues of mental illness are raised, the law reflects that which it is taught by alleged experts. The case law on multiple personality is still sparse, leaving much room for new data and new interpretations of these data. The current tendency to treat each alternate as though it were a whole and responsible individual as opposed to an imaginary construct, a symptom of a mental illness, reflects the confusion among clinicians as well as attorneys regarding the phenomenon of MPD. As we continue to learn more about the disorder and its forensic implications, we must be careful to avoid presenting to the court clinical impression as fact or mythology as truth.

Language: en