The Bookshelf: The Return of Sybil

Right before our eyes, the myth of transgenderism is crumbling. The ideas that people can really know that they are a “gender” other than what the sex of their body reveals them to be, and that it is sound medical practice to change the body to conform to this state of mind, have never been rationally supportable, for patients of any age or condition. Like many crazes, it seemed necessary that this one should get worse before it gets better, with a sharp rise over the last decade in the number of children irresponsibly subjected to puberty blockers, cross-sex hormones, and even “gender affirming” surgeries that entailed the removal of healthy organs and tissue.  

In the last few years, the regrets of “detransitioners” and the outrage of parents, as well as the increasing invasion of women’s sports and the loss of privacy in spaces hitherto reserved for their sex, have prompted both a political backlash and professional resistance from conscientious practitioners of evidence-based medicine. As journalist Jesse Singal writes, “Cracks have appeared in the supposed wall of consensus” of the professional organizations that once made a solid bulwark of the transgender ideology. For the issue has moved, as it was always bound to do, into the courts of law, and the recent victory of Fox Varian’s malpractice case has apparently prompted a climb-down by both the American Society of Plastic Surgeons and the American Medical Association.  

For my money, the underappreciated hero of this story is Dr. Paul McHugh, former chief of psychiatry at Johns Hopkins University Medical School and Hospital, whom I interviewed for Public Discourse five years ago, when he was ninety years old. In the 1970s, after studies showed that mental health in transgender patients was not improved after surgery, he prompted the cessation of such operations at Hopkins. (The hospital more recently resumed them, at the behest of its plastic surgeons, not its psychiatrists.) Dr. McHugh has been outspoken on this subject ever since, and in 2016 and 2017 he co-authored reviews of the medical literature for The New Atlantis that should have given practitioners reasons for caution at just the time when the transgender craze was reaching its destructive crescendo. Now that the tide at last seems to be turning, McHugh—soon turning ninety-five and still a voice worth heeding—recently gave an interview to Madeleine Kearns of The Free Press, which called him in its headline “Dr. I Told You So.” 

“Dissociation” Reappears 

But now, another psychiatric craze has made a reappearance, one that McHugh did much to discredit three decades ago. In late January (and on February 15 in its print edition), the New York Times Magazine published a lengthy feature titled “What It’s Like to Live with One of Psychiatry’s Most Misunderstood Diagnoses.” That “misunderstood” diagnosis is “dissociative identity disorder,” (DID) once known as “multiple personality disorder” (MPD). In the current edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR, 2022), DID’s “defining feature” is said to be “the presence of two or more distinct personality states or an experience of possession.” Readers and filmgoers who recall The Three Faces of Eve or Sybil will be familiar with MPD/DID as a mental condition in which the patient—most often a girl or woman—manifests several, perhaps a great many, different personalities that may or may not be aware of each other, and that control the body each in turn, acting and speaking as fully formed individuals inhabiting the same human being. 

The Times article features Dr. Milissa Kaufman, a psychiatrist who once suffered from DID herself and who directs a Massachusetts hospital program treating and studying the disorder. We also meet various other patients with the condition, and several other “experts”—none of them, it’s worth noting, being skeptics on the subject. But for Paul McHugh, with whom I discussed the Times feature, it was déjà vu all over again, because the last time “multiple personality disorder” spiked in our culture, in the late 1980s and early 1990s, it was part of a larger wave of “recovered memory” cases concerning alleged childhood sexual abuse; the movement wrecked families, devastated reputations, and landed an appalling number of innocent persons in prison. And, as McHugh and others argued in books and articles during and after this period, “recovered memory” and MPD/DID were mental phenomena almost entirely induced by psychotherapy itself, albeit for the most part unintentionally. 

The link between dissociative identity disorder and “recovered memory” of sexual abuse is present again in this reappearance of DID in the Times. DID is said to be “a response to repeated abuse,” in which children cope by “creating” other identities to whom the terrible things happened, which enables them to forget about the experiences themselves. What’s different about this new round of cases is that, in the age of social media and the aftermath of COVID isolation and its attendant online obsessions, DID shows all the signs of becoming a social contagion akin to transgenderism. There are “act out your multiple personalities” TikTok videos, and even a national meet-up in (where else?) Orlando, Florida of “people living with D.I.D. and other dissociative disorders.” 

In short, we may be in for another round of what is, probably in most if not nearly all cases, an iatrogenic (therapist-induced) mental disorder (a description that would probably fit a great many transgender cases as well). This new wave might also result in some wrecked lives and false accusations. (Even some of the same doctors involved decades ago in propagating the disaster are named as still at it in the Times piece.) So it’s a good time to take stock of some of the best books that were written on the recovered-memory and multiple-personality crazes the last time around. 

Recovering Our Memory of “Recovered Memory” 

Dorothy Rabinowitz of the Wall Street Journal did some of the most dogged reporting on parents and childcare workers falsely accused of abuse on the basis of “recovered memories,” and collected these accounts in her 2003 book No Crueler Tyrannies. The most preposterous tales of child abuse—“children seduced in mass orgies, violated by caretakers dressed as clowns, in magic rooms”—were amazingly treated as credible by police, prosecutors, and courts of law. Sometimes the purported victims were children at the time charges were made; other times they were adults who had spent years in therapy until they “remembered” the awful things that had supposedly happened to them long ago. But in every case the abuse had been a “repressed memory” until therapists elicited it. 

Yet there is plenty of clinical evidence that this is not how memory of trauma works. As psychologist Richard McNally explained in his 2003 book Remembering Trauma, “Studies have revealed that children exposed to repeated trauma, such as physical abuse, chronic community violence, or the Cambodian holocaust, remember these experiences all too well.” He adds that “other evidence indicates that incest survivors do not forget the traumas of their childhood.” We do not, however, carry around perfect recordings of past experiences in our heads; as the memory-research psychologist Elizabeth Loftus explains in her 1994 book (with Katherine Ketcham) The Myth of Repressed Memory, “My work has helped to create a new paradigm of memory, shifting our view from the video-recorder model, in which memories are interpreted as the literal truth, to a reconstructionist model, in which memories are understood as creative blendings of fact and fiction.” Hence the frequently “perfect” memories “recovered” by patients in therapy after years of “repression” are extremely dubious. 

As for the closely related phenomenon of multiple personalities, this seems even more plainly to be something that few people, if any, experience before therapy brings it to the surface. As sociologist Richard Ofshe and his co-author Ethan Watters write in Making Monsters (1994): 

While the disorder is not real at the beginning of the therapy, there is little doubt that the patients are truly suffering as they come to accept the therapist’s diagnosis. Examining the fad diagnosis of MPD, the cruelty of recovered memory therapy becomes particularly clear. Thousands of clients have learned to display the often-debilitating symptoms of a disorder that they never had. They become less capable of living normal lives, more dependent on therapy, and inevitably more troubled. 

Dissociative identity disorder is not, in other words, nonexistent. It is all too existent in the persons suffering from it, having emerged in therapy after they first presented some other problem to a mental health professional. 

Another valuable perspective on this subject was offered by the gifted amateur Frederick Crews, an English professor at Berkeley who traced the recovered memory and dissociative identity trends back to the thought of Sigmund Freud, the founder of psychoanalysis, in The Memory Wars (1995), which originated in the pages of the New York Review of Books. Freud, Crews argued, “has been the most overrated figure in the entire history of science and medicine—one who wrought immense harm through the propagation of false etiologies, mistaken diagnoses, and fruitless lines of inquiry.” (Crews went on to write a superb critical biography of Freud.) When I read in the Times magazine article that Dr. Kaufman was strongly influenced by Freud, my alarm bells went off. 

But the very best book to read on this subject is Paul McHugh’s Try to Remember: Psychiatry’s Clash Over Meaning, Memory, and Mind (2008). Starting in the late 1980s, McHugh was drawn into quite a few cases, as both clinician and expert witness, where recovered memories and multiple personalities were claimed after extensive therapy. His assessment was that “MPD is not a natural condition produced in a natural way by the mind faced with a life event.” Nor does it arise from “some disruption of the brain mechanisms responsible for memory.” It is instead “a behavior taken up by the patient in order to meet the expectations of, win the support of, or otherwise satisfy other people who carry power to affect the future.” MPD/DID is, in short, “a behavioral artifact rather than a natural mental disorder.” 

In direct clinical experience, McHugh came to the conclusion that the best treatment for patients with dissociative identity disorder is for doctors and hospital staff resolutely to ignore the “alters” (other identities), speaking only to and about the actual patient herself, and in a relatively brief period the disorder abates entirely. McHugh is so confident of this course of treatment that he and his co-author Phillip Slavney counseled such “turning aside of attention” in MPD/DID cases in their book The Perspectives of Psychiatry (2nd ed. 1998), used in the medical-school training of psychiatrists. 

Psychiatry’s Misdirection 

What distinguishes Try to Remember, however, as much more than a review of the recovered memory–multiple personality craze of thirty years ago, is McHugh’s exploration of how and why his own profession, psychiatry, remains vulnerable to capture by such “overvalued ideas” as repression, dissociation, and even post-traumatic stress. In contrast to other branches of medicine, psychiatry takes as its subject more than merely the body of the patient, but his or her mind. The brain-mind “discontinuity”—how that organ in our skulls can be the seat of our consciousness but not fully yield an etiology for our thoughts, feelings, and behaviors—remains fundamentally unresolved, and there is no reason for confidence that we will ever unravel the mystery entirely. Hence much of psychiatry is a business of observing and classifying behaviors and affects as wholesome and unwholesome for human flourishing. 

Perhaps too much of psychiatry is such classification. In the last half century the DSM has become a Sears catalogue of putative mental disorders, in which practitioners go shopping when patients present themselves. But it is important, McHugh says, to “understand why an entry in DSM does not certify a diagnostic entity as ‘real.’” The manual is full, he remarks, of “overinclusive diagnoses,” a field guide that “promotes the diagnostic misdirections and therapeutic rigidities that abound today.” What psychiatry needs, McHugh argues, is more deep consideration, patient by patient, of the causes of their problems, not merely their “symptom patterns.” The fact that DID is in the DSM tells us practically nothing of value. And the claim, retailed in the recent Times article, that modern scanning technology can confirm that DID is a phenomenon of the brain commits a category error by forgetting the brain-mind discontinuity problem. What one sees on the scan of the brain is incapable of “confirming” the subjective experience of the mind as “real.” 

A more etiological and holistic approach to psychiatry is the project McHugh and Slavney undertook in The Perspectives of Psychiatry and their follow-up volume Psychiatric Polarities, and it’s the approach taken by their fellow Johns Hopkins professors Margaret Chisolm and Constantine Lyketsos in their med-school textbook Systematic Psychiatric Evaluation (2012). The insight of the “Hopkins School” is that psychological disturbances can arise in four ways: from a disease a patient has, from the sort of person the patient is, from the patient’s behaviors or what he does, or from what he has encountered or experienced in his life. (These are the “perspectives” of McHugh and Slavney’s title.) Diagnosis and treatment, in this model, do not begin by slotting the patient into a DSM symptom pattern. 

Leaving such works as these mostly to the practitioners and students of psychiatry, what lay readers such as ourselves can most profit from are McHugh’s reflections on his profession’s failings—and its promise—in Try to Remember, as well as in his collected essays in The Mind Has Mountains (2006). If the witch crazes of recovered memory and multiple personalities are making a comeback, perhaps now aided by social contagion online, we would do well to gird ourselves with a sound understanding of psychiatry’s vulnerability to misdirection—and of the harm it can do to the souls under its care. We have lately seen too much of this misdirection with transgenderism, and “dissociative identity disorder” should not be rehearsed all over again. 

Image licensed via Adobe Stock.