Dissociative Identity Disorder and Miss Dorsett
An accurate diagnosis of any disorder entails a plethora of factors. There are however three elements which almost unarguably must always be employed for a dependable diagnosis; a well-defined construct, a reliable and valid psychological test to measure said construct and most importantly the practicing clinician must conduct themselves in an ethical and professional manner at all times. Unfortunately for Sybil Dorsett, none of the above were implemented in her diagnosis or treatment.
Sybil Dorsett sought psychotherapy from Dr. Connie Wilbur in the 1950s. Unfortuitously, it was not until 1960 that Multiple Personality Disorder (MPD) first appeared in the Diagnostic and Statistical Manual of Mental Disorders (DSM) II nomenclature and only as a minor label under Hysterical Dissociative Disorder. The publication of the DSM-III in 1980 redefined MPD and included it as a separate diagnosis. Regrettably, Sybil’s diagnosis and treatment therefore did not coincide with a time where a well-defined construct nor widely accepted diagnostic criteria existed and as such posed a major difficulty for Sybil to receive a proper diagnosis.
An additional hurdle to Sybil’s case was the lack of a specific test for DID. There still exists no specific test for DID to this day. However, additional symptoms of DID including depression, posttraumatic symptoms, suggestibility and amnesia do have corresponding reliable and valid psychological tests which can aid in modern diagnosis. There have also been studies conducted testing interpersonality amnesia/implicit transfer of memories; yet another feature of DID, using a multitude of word-based tasks. Another testing method that is showing promise is EEG technology. Patients with DID have been found to have greater differences in brain wave activity between alter identities than those without DID who were simply simulating different personalities. EEG technologies could prove to be useful for future diagnoses. Further consideration should also be given to developing a test that could distinguish between real and false recovered memories. Unfortunately, Sybil’s diagnosis occurred when the aforementioned technologies and tests did not exist, again proving it difficult to make an appropriate diagnosis.
Most problematically in the case of Sybil was the lack of professionalism on the part of her clinician Dr. Wilbur. Dr. Wilbur suggested that Sybil read up on DID after only having complained of psychological distress. Miraculously Sybil returned a few years later with new personalities. Additionally, Dr. Wilbur treated her for free and provided psychotropic drugs and barbituates. Dr. Wilbur also unscrupulously used hypnosis and sodium pentothal while extensively probing for repressed sexual trauma. Within a few weeks Dr. Wilbur had already begun planning to write a book about Sybil. Dr. Wilbur even persisted despite doubts expressed in an open letter to her by Sybil “I do not have any multiple personalities…”. Due to the above-mentioned incidences of malpractice Dr. Wilbur’s publications have largely been dismissed.
The case of Sybil Dorsett is an exemplary illustration of the perils that can result from the lack of a well-defined construct, an absence of psychological tests that allow for reliable and valid diagnosis and engaging in malpractice.
