Comment by pnathan | Hacker News Reader

Comment by pnathan | Hacker News Reader

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I'm friends with someone who has clinical DID. It is, as near as I can tell, not induced by media, etc, but by extreme and profound trauma.

> The people who have traditionally been treated for DID have suffered, greatly, and not in the cool arty time-to-dye-my-hair-again type of suffering common to social media performance, but actual, painful, pitiable suffering. Those patients who have been diagnosed in the past with the disorder, by doctors, and who have spent years and years dealing with the consequences, are often truly debilitated people, whether the disorder itself is real or not. They require intense therapy, are often medicated with powerful drugs, and are frequently subject to long-term hospitalization. They tend to live broken and pain-filled lives, like most people with serious mental illness.

This is a relatively accurate description of their life. Clinical DID is not cute or something to parade in front of people you don't know.

I have extraordinarily little interest in open DID fora like Reddit, because these fora don't adequately encompass my friends' reality.

Dude has exactly zero expertise in the field or experience with this population, and yet he makes these kinds of claims. And all based on an article or two he found.

Pathetic. Almost every psychiatric diagnosis is problematic, and articles questioning any's validity can be dug up. Doesn't mean the emotional/cognitive/behavioral cluster does not exist.

The link between trauma and disassociation is incontrovertible, and DID is merely an extreme version of this. Case reports of it across Western, Middle Eastern and Asian societies across the last 2 centuries show a remarkable degree of consistency in their reports of this, so the idea that this is some kind of passing fake fad is absurd.

The only thing the article adds is a critique of a Tik-tok sub-culture. Color me shocked that this is not a particularly enlightened group - but I guess this is the kind of hard-hitting "journalism" popular Substacks were made for.

Tik Tok culture also has a similar fascination with glamourising, well, any mental illness or disability really.

There's a whole subgenre of ADHD Tik Tokers, for example.

And it's also well observed that, monkey see, monkey do, when the monkey is a teenager looking to differentiate themselves. Like the mass German outbreak of "Tourettes". [0]

I feel your outrage might be better aimed at people trying to turn serious disorders into a cute personality quirk for social media.

[0]: https://academic.oup.com/brain/article/145/2/476/6356504

So I should save my outrage for juveniles acting like juveniles on a juvenile platform rather than a grown man playing psychologist and successfully clickbaiting a moderated adult platform?

One could argue I shouldn't be outraged at either, particularly given HN's track record of dealing with anything complex involving human beings rather than technology. But I haven't entirely given up on adults capable of engaging in extended discourse, for better or worse.

No matter what one might think of Freddie deBoer, it is worth being aware of his own experience with psychosis. While this is not the same thing as DID, it did give him relatively deep personal insight into aspects of serious psychiatric disorder:

https://freddiedeboer.substack.com/p/since-you-asked

There re still plenty of people who have a severe distaste for his writing, his political views and his behavior, and I think that's fine. However I think it's unfair to claim that this article is "all based on an article or two he found."

"I have ADHD so I'm an expert on autism."

"I have been treated for ADHD and as a result I understand some of the ways that a lot of psychiatric institutions fail patients with disorders such as ADHD, autism and others."

The article (despite the clickbait-y title) isn't really about the existence of DID.

Then it shouldn't have been couched in those terms for the first few paragraphs, and especially not by blithely staking such a claim.

Imagine being told your problems aren't real as a prelude to making a point. Just for clicks. Screw this guy.

> so the idea that this is some kind of passing fake fad is absurd

Two things can be true simultaneously. DID is real, however, exceptionally rare...and there is also a passing fake fad where (mostly) teenagers struggling with their identities (extremely common at this age) are self diagnosing this and amplifying whatever confusion they might actually feel into this specific pattern of behaviors.

> The only thing the article adds is a critique of a Tik-tok sub-culture. Color me shocked that this is not a particularly enlightened group - but I guess this is the kind of hard-hitting "journalism" popular Substacks were made for.

there's definitely a _thing_ where certain mental illnesses are - imo - social media gamed for clout/followers. DID is apparently a popular one for that. I've seen it a bit.

guy should have looked more at the literature though.....

> Case reports of it across Western, Middle Eastern and Asian societies across the last 2 centuries show a remarkable degree of consistency in their reports of this

The same goes for vampires.

It should go without saying that a rumor is not a case report. Name one physician who published a report based on extensive first person experience with a vampire (and not, say, Renfield's syndrome).

Plus the case reports are only supplemental to the larger and more empirical lines of evidence for it.

> Almost every psychiatric diagnosis is problematic, and articles questioning any's validity can be dug up

That’s true, but this seems one of the more problematic ones. See for example https://en.wikipedia.org/wiki/Dissociative_identity_disorder....

Because of that, I don’t think it is problematic for anybody to say its controversial whether this disorder really exists.

This goes a bit further, though, claiming it probably doesn’t exist.

IMO, that isn’t saying the patients are faking having problems. It’s saying we don’t know much of mental illnesses, and that creating this label doesn’t help the world.

I think most in the field will acknowledge the first part of that statement. That’s why this is called a disorder (“a functional abnormality or disturbance”) and not a disease, a term we reserve for cases where we know what causes it.

As to the second part: I think a new label only makes sense if its definition groups people together not only because they have similar abnormalities, but also because they are helped by similar treatment. That’s very hard to judge for disorders, because “doesn’t respond to the standard treatment” can easily lead to a conclusion “diagnosis was incorrect”. That also is what those writing the DSM struggle with.

A problem, though, is that patients prefer hearing “you have foo” to “we don’t know”, even if there is no difference in treatment between the two.

I think that’s why those claiming “most people claiming to have foo don’t” (which I would say currently is true for such things as autism and ADHD), the stronger “foo is rarer than diagnosed” or the even stronger “foo doesn’t exist” are met with much resistance.

But again: I think the last two are statements about the state of psychiatry as a science, not about patients.

Just because it's more often contested doesn't exempt the author from the responsibility to grapple with (or at the very least make himself aware of) the reasons why it's included in the DSM and the ISD and why it's been acknowledged (if grudgingly) since the very beginnings of the discipline and before - including a long section in James "Principles of Psychology" - if he's going to make such a claim. He seems patently unaware of the long list of psychological principles that no one contests that align with the diagnosis - from the existence of discrete states in sleep and infancy, to brain microstates, to state-dependent learning, to extreme state switching in bipolar, periodic catonia and the other disassociative disorders, to the commonality of hypocrisy of which the individuals themselves are blithely unaware, and the trickiness of personality science.

And that's not even addressing the highly detailed and often highly public case studies of DID across time and cultures, the research showing dramatically different brain readings across the spectrum based on the current identity of the DID patient, ect, ect.

But he doesn't even attempt to address any of that because he has no idea what the hell he's taking about. It's a deflationary article with the populist message that psychologists and Tiktokers are the dumb. So I get why it's popular, but it adds all of nothing to the conversation. He's just another panderer milking the public for attention and money.

And as for the label, again one can acknowledge the existence of a biopsychosocial cluster without coming down on either side of the question of whether or not they are symptoms of an underlying disease. There's a long history of scholars doing this, particularly in the sociology of mental health. Additionally the author does not appear to be making any such argument here against the psychiatric nosology as a whole - just this one diagnosis.

Edit: grammar.

I dated someone who had it- was beaten heavily during their childhood formative years, and told me that the separation of identities was a means of coping.

It seemed like an extreme emotional compartmentalization which left them with a fractured sense of self.

Some people might say that they could have just been pulling an elaborate hoax on me from a year and a half. But the amount of acting it would have required just to convince me of this without any real reward would have been a sign of even greater emotional problems than even the different personalities.

Yeah. Think about years-of-sexual-abuse-and-physical-torture-by-a-relative trauma. Think about locked-in-a-basement-forced-to-eat-excrement trauma. Think about forced-for-years-to-rape-your-brother trauma.

This is the kind of thing that create severe DID cases.

Those things unfortunately exists and occur. Those people are not faking it.

Someone who never had a severe and long term trauma claiming to have DID? Completely different situation.

Do they lose memory when switching personalities? I’d imagine it’d be awkward if one personality didn’t know they were dating someone.

Yeah it's horrible. I have had contact with half a dozen people with severe DID because of extreme trauma experienced before the age of four. DeBoer is a great writer and he's dead right about the effects of social media on all this but he is completely wrong about the literature. The so-called Greenbaum Speech, alternatively called "Hypnosis in MPD", is just one example of the consistent body of work out there showing that it is very real.

Unless you work in a field that exposes you to extremely rare psychological conditions, there is absolutely no way for any person to have had contact with a half a dozen people with severe DID. If you're talking about the new wave of people who are self diagnosing with nonsense, then sure, but that's not what we're talking about.

Run along sonny. There are plenty of ways that someone can have contact with survivors of ritual abuse who also experience DID. In my case I just proved knowledgeable and willing to listen and they reached out to me. One was sexually assaulted by Roman Polanski when she was a child, two or three were beta sex kittens, one was a courier and at least one had an assassin as an alter. So yeah, fuck you.

Rather than saying that one would need to work in a specific field, what I actually meant was "unless you have a highly concentrated exposure to this subset of the population, there is no way to know a half dozen people with this exceptionally rare psychological condition."

> In my case I just proved knowledgeable and willing to listen and they reached out to me

If you put yourself out as a resource for people of a specific characteristic to reach out to you, then your exposure is far from a random sampling.

My broader point is that a random sampling of the population would never produce the quantity of actual cases of DID that is manifesting in young people on social media. In other words, the degree to which DID actually exists and the degree to which people claim to have DID have diverged dramatically in favor of the latter. That statement is not meant to be taken personally as I'm acknowledging that you've established yourself as a beacon for those struggling with this sort of thing to reach out to you.

Someone very close to me had a serious mental illness. Nobody has any idea what the illness is. Different doctors give it different names. The same doctors give it different names.

I eat the impression doctors are less worried about the “anatomy” of the illness, and more worried about finding a cure.

If “take these anti-psychotics daily, get 8 hours of sleep a night, and meet weekly with a therapist” prevents symptoms … they really don’t care if it’s a psychotic disorder (as opposed to, say, a mood disorder).

Psychology seems to going from a “deep mind” approach to a “shallow mind” approach.

Psychology diagnoses (i.e. DSM diagnoses) are mostly about being able to reliably diagnose and communicate between providers, billing, etc. They are very much not about concrete underlying causes but about the ability to decide what label to put on a person.

The usefulness of these diagnoses are rather low and treatment tends towards "throw shit at the wall until something sticks". There are lots of things to try for each cluster of symptoms in common and useful heuristics, but the plain truth is that psychology's top-down approach to identification and treatment of conditions has had limited success and will be (and has been) slowly replaced by bottom-up neuroscience approaches which are starting to reach the levels useful to psychological conditions.

> bottom-up neuroscience approaches are starting to reach the levels useful to psychological conditions

Interesting, do you know of anywhere I can go to read more about this?

It’s all over the place. A perspective from a psychology professor:

https://www.psychologytoday.com/us/blog/talking-apes/201702/...

You seem to be implying that this is a bad thing.

Diagnoses and categorisations are all fake, and constructed. The only reason why it's interesting to diagnose is that we may notice similar treatments are helpful for people with similar diagnoses. Diagnosis isn't inherently useful; it's a means to an end.

It leaves out a very important part of processing illness: knowing what happened.

When people are sick they want to know “what’s wrong with me.” When given medication they want to known how the medication works.

Unexplained healings are better than being sick, but not as good actually knowing what was wrong with you.

For example, someone has 6 hour episode where they detach from reality and have intense hallucinations. What are these hallucinations? Repressed fears? Forgotten desires?

These hallucinations are possible the most intense phenomena this person will ever experience. What do they mean?!?

The real upside is that psychiatrists have the humility to say “we have no idea how this works.”

The downside is it leaves room for pseudo-experts to peddle whatever trash they want.

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