Nick,
Many thanks. Your reply clears away whatever doubts I had about MPD being a psychosis. I’m not surprised to learn that it is encountered more often in literature than in life. I’ve known very well at least two clinical examples of psychosis (by clinical I mean only that they received extensive medical treatment), but have never known anyone with MPD, and in fact have never met anyone who has known any cases of MPD.
Andrew B.
On 10/11/06 3:14 AM, "Nicholas Grundy" <grundyn@GMAIL.COM> wrote:
Andrew Brown wrote:
>As for multiple personalities, I’ve decide to proceed on the belief that this is a psychotic disorder.
Medically, 'psychosis' is used to describe states broadly featuring:
* Delusions and hallucinations
* Disturbances of thought and behaviour
* Lack of insight, i.e. awareness that these delusions / disturbances are abnormal
Both main diagnostic systems (the ICD-10 and DSM-IV) define psychosis along these lines, and both have stopped using 'neurosis' at all. The only instance of it I can find in my copy of Kumar & Clark's "Clinical Medicine" is a passing reference which is illuminating as to what the term used to mean and, unusually for a medical textbook, slightly literary...
"Doctors have historically tended to diagnose 'stress' or 'psychosomatic disorders' in patients with symptoms that they cannot explain. History is full of such disorders being reclassified as a research clarifies the pathology. A recent example is writer's cramp which most neurologists now agree is a dystonia rather than a neurosis." (chapter 22-4, 6th edition).
As the above suggests, 'neurosis' was originally used to refer to conditions which were thought to be due to "nerves", but it was adopted most influentially by Sigmund Freud to refer to the results of unconscious psychological conflict. As such, it can refer to states which are within the normal spectrum of human experience, so that something as simple as anxiety can be said to be a neurosis.
Multiple personality disorder is rather more common in literature than in reality, and most textbooks would classify it as a dissociative disorder rather than primarily a psychotic one. If pushed, though, I suspect it would qualify as a psychosis simply because sufferers classically are not aware of their other personalities, and so could be said to lack insight.
Jansy wrote:
>What relationship is there between Freud's original theories ( the ones VN might have read) and multiple personality disorder? Isn't hysteria or psychosis enough >to describe delusions or "splits" ?
In Freudian terms, the "splits" would be a coping mechanism for dissociating one's self from the outside world and distancing oneself from the physical and emotional pain of a traumatic or stressful experience. Generally this would be to enable to person to maintain a relatively normal level of functioning.
Hope this helps,
Nick.
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