>>I’ll give you
a quick introduction, I’ll tell you quickly
what I’m gonna go over, and it’s divided
into three sections, so I’ve got three
sets of slides, and we’ll take
a break between each of those
sections. And we’re
finishing at… 9:00 or 9:15? 9:15– it’s a
little loose?>>We could go later if you–
>>11:15, 12:00? (audience laughing) Uh, so, I’m a psychiatrist,
born in Canada, grew up in Canada,
went to medical school in Canada from
’77 to ’81. Did my psychiatry
training in Canada from ’81 to ’85. Then, I was an
academic psychiatrist in Canada,
’85 to ’91. And then, in ’91,
I moved to Dallas where I’ve been since, running
a hospital-based trauma program. In ’98, we opened
a trauma program here at Forest View,
and then, in 2000, I kind of inherited a
pre-existing trauma program at a hospital
in LA. And in Dallas, I’ve– I’m
now at my third hospital. So the first hospital
I was at is closed– the corporation went
out of business. Second hospital I was
at closed temporarily, so we moved to a
sister hospital in the Dallas area. So basically, I… help with oversight,
overview, educating the staff,
consulting to the staff. I do lots of writing,
lots of talking, and I do, in Dallas,
three groups a week in person. Here in Michigan,
I do two groups a week by video conference. I come up once a month
for two days. And in LA, I do
two groups a week by video conference, and go
kind of intermittently to LA. So I’m actually
hands-on involved in clinical work,
not just a theory guy, sits at his desk
and smokes cigars and plays golf
sort of thing. I decided to be a
psychiatrist way back, and then kind of
did a life detour around and about, got to
medical school in ’77, 100% intending to
be a psychiatrist. But I learned fairly
quickly in medical school that it’s best to keep
that a little bit quiet, because the surgeons
and the internists generally didn’t have
a whole lot of respect for psychiatry, and
were all disappointed if they heard you’re
going to psychiatry. Didn’t really have any
particular thoughts
about trauma, dissociation, multiple
personality disorder, anything kind of
in that ballpark at the beginning
of medical school. Then in… early in… Hey. For some reason,
when you phoned me, I answered, I said, “Hello,”
but you weren’t there.>>I was standing outside too
long– my phone fell asleep. (laughing)
>>Oh, not to mention you. This is Jessica, who’s
the program director at the Forest View
hospital.>>Hello.>>Feel free to sit somewhere.
>>Okay.>>And so, early in the
third year medical school, you start doing
rotations, and… you do surgery,
internal medicine, pediatrics, obstetrics,
gynecology, and psychiatry. And your basic job as
a medical student is to get harassed
by the nurses, try and stay
out of the way, and do some kind of menial
task that nobody else wants to do. And that involves taking
a history, for one thing. So somebody comes in, and you
have to go take a history and write it up
in great detail, because the psychiatrists
don’t want to spend all that time asking
all those questions or writing
that stuff out. And as you’re doing
that, of course, then you learn,
by asking questions, talking to people, finding
out what’s going on. And so… kind of like a third of
the way into the rotation, which was eight weeks, I was assigned to do an
intake history on a woman who had been referred
in by her family doctor. And she was late-ish 20s,
and her story was– so this is in Edmonton,
in Canada– her story was, a week previous to
my talking to her, she had all of a sudden
come to at the airport, and she had a blank
spell of a week, and didn’t know
where she’d been. Not even what city
she was in, for a week. Then, from that point
in time, going back, she had normal memory
for a month, and at that point in time, she
had come to at the airport, but that time she was
missing a whole month. So that was kind
of the puzzle of what’s going
on with this woman, and I’d read a little
bit about hypnosis, so I was kind of practicing
my hypnosis techniques with people who are… not really trauma people,
just general adults, psychiatric in-patients for help for sleep,
help for relaxation, maybe a little
anxiety reduction. Basically just practicing
the rigmarole of hypnotizing
somebody. So since she had amnesia,
I thought, “Well, maybe I’ll
try hypnotizing her, “see if she
can remember.” She’s very easy to
hypnotize, and immediately she remembered that she had
been in eastern Canada– she was separated
from her husband, she was in eastern Canada
visiting her kids, on both occasions, and she had bought them
a whole lot of presents. Well, where did she
get the money from, was the question. Well, where she
got the money from was her pretty wealthy,
high-spending construction guy
boyfriend. And he wisely had
decided to set up a joint account
with her, and she had taken a whole bunch
of money out of his account and put it in four
different accounts, and then, during the period
of time she didn’t remember, she’d emptied out
those accounts, used that to buy
the plane ticket and buy a whole bunch of
presents for her kids. So is that true or did
that really happen? So what we did is
called the banks and went through
a procedure, and a detective actually
came in and interviewed her, because she had bounced
a couple of checks. So all these bank accounts
did in fact exist, the money in fact
was spent. She was married– or
separated– she did have kids. And so, that was
interesting, as a third-year
medical student. And my supervising
psychiatrist was off on vacation
for a couple of weeks, so his replacement
supervisor basically said, “Oh, yeah, whatever
you wanna do.” That was my
supervision. And… after a couple of
these hypnosis sessions, she said,
“You know, sometimes, “I joke around
with my boyfriend, “and I tell him, ‘That
wasn’t me you kissed, “‘that was Suzy,'”
a different name. I said, “Yeah,
okay, whatever.” And then, I can’t
really remember why, but I decided after
I had hypnotized her and she’s all relaxed
and everything, to say, “Well, how are
you feeling today, Suzy?” All of a sudden, 11-year-old
Suzy’s talking to me. She’s the one who
did all the money and the bank accounts
and bought the ticket and went back and
saw the kids, and the grown-up regular
person didn’t remember. So there I was with a case
of multiple personality. Third-year medical student,
know nothing about nothing. So my supervisor, by
this point, had come back from his period of
vacation, so I said, “Well, I’ve got this
multiple personality case.” He’s like,
“Oh, yeah, okay.” “Well, what should
I read about that?” This is in 1979. He says,
“I don’t know. “Why don’t you go
to the library?” Good suggestion. So I go to
the library. Started looking
around in textbooks, and I find a couple
of review papers, one from the ’70s
and one from the ’60s, and I learn that this
is the 200th case of multiple
personality disorder ever diagnosed in the
history of Western medicine. Huh. So that’s a
little bit weird. And what are
the odds of that? And so, I end up
writing that case up and publishing it in the
“International Journal “of Clinical and Experimental
Hypnosis” in 1984. That was my first case–
that’s how I got into it. And I thought, “Well, that
was really interesting, “but obviously I’m
never gonna see “another case again. “It’s just a
statistical fluke.” Then, finished
medical school, I’m in my
residency program, and we have a long-term
psychotherapy program where each resident
follows two people for as long
as required. And every year,
on each of those cases, you change supervisor. So you get a bunch
of different cases and a bunch of
different supervisors. So I’m working
with this woman who’s a pretty seriously
battered spouse, depressed, agoraphobic,
anxious, and lo and behold, she
has a couple parts inside. So now I’ve
got two cases. Then I finish my
residency in 1985, and, um, at the end
of the academic year, which is the
end of June, and in September, a woman comes
to the emergency department, is assigned to me as a general
in-patient psychiatrist, and lo and behold, I
figure out that she has multiple personality
disorder. So now, I’ve
seen three cases. So at this point, I’m
the leading expert in western Canada with
the most publications of any psychiatrist
in western Canada. Equals two. Three cases,
two publications. So this is how I
stumbled into this area. I had no idea, no attitudes,
no thoughts, and so, now, the puzzle
gets even bigger. Well, wait a minute, if
there’s only been 200 cases, how come now I’ve got
three all by myself? And the possible answers
to this question are… “There’s something very
weird about Colin Ross– “he makes people act like they
have multiple personality, “and they just do that
for whatever reason.” Or, it must be
much more common than just a couple
hundred cases. And so, I’m gonna talk
about the epidemiology, how common it is,
how it can be diagnosed, and, in ’94, when
“DSM IV” came out, the name was changed from
“multiple personality disorder,” MPD, to “dissociative
identity disorder,” DID, but it’s the
same basic thing. So multiple personality and
dissociative identity disorder are the same thing. So jumping into
some slides here, I’m gonna show
you some data now and a little bit of the
science of how all this works. If I can. Mmm. Oh, okay,
this one. Okay. So first of all, it’s
always good to define terms. So if you read the general
psychology literature, psychiatry literature, you’ll quickly find that
there’s people out there who don’t believe
in all this stuff. Psychologists,
psychiatrists. And one of the
things they say is that dissociation’s
an extremely vague thing, nobody knows what it is,
nobody can define it, nobody can measure it. Well, that’s true
in their minds. But not in my mind. It’s actually very
clearly defined. But the confusing point
is that there’s actually four different meanings
of the word “dissociation” that are used in
the literature, and people aren’t always clear
which meaning they’re using, and people who
are reading aren’t always clear which
meaning they’re intending, so there is
confusion. But it can be sorted
out quite easily. So dissociation–
meaning number one is it’s a general
systems meaning of the word
“dissociation.” General systems theory
is just a theory of how systems in the
universe operate, in general. Could be a solar system,
could be a cell, could be an atom, could
be an organization. So it’s how
systems operate. And in the general
systems meaning, “dissociation” is the
opposite of “association.” So if two things
are associated, they’re connected,
they’re interacting, they’ve got something
to do with each other. If they’re dissociated,
they’re disconnected, not interacting, out of
relation, split apart. So dissociation
basically means the same as “disconnected.” And I’ll come back
to all these meanings as we go
through it. Second meaning is it’s
a technical term in cognitive
psychology. So this is guys who do
experiments with rats and mice and all kinds of
different animals. And there’s thousands
and thousands of papers published in psychology
about all kinds of learning experiments
and so on. So a typical experiment is,
if you’re looking at memory, there’s conscious memory,
unconscious memory… which is declarative memory,
or procedural memory… or explicit memory,
implicit memory. They all kind of mean
conscious, unconscious. And so, there’s a famous
guy who had brain damage, who… if you met him 50 times
in the last month, every single time,
he has no idea that he’s met you before,
it’s a brand new thing, because he can’t record any
memories and store them. They just disappear
automatically because of the damage
to his brain. And this guy’s very
well-studied and so on. And so, there’s a whole
bunch of different tasks that he was run through,
and lo and behold, the more he
did a task– like there’s a task where
there’s three pegs like this, and you stack blocks on them,
and you have to re-stack them in a certain pattern, and like anything in life,
the more you do it, the better you
get at it. Well, his performance
improved with practice at the same rate as
normal college students, although he had no
memory whatsoever of ever being exposed
to the task. Which shows that his–
part of his memory’s intact and learning
and recording, he just has no
conscious record of it, which is part of
piles of evidence that procedural memory,
declarative memory are separate systems. You can knock one out,
and the other can still be
operating. And then, in
human experiments, there’s basically– you take
all these college students who are guinea pigs
who get course credit and the professors crank
out lots of papers, so it’s good
for everybody. And you run them through
all these different tasks. Well, one task is you
memorize a list of word pairs, which are homophonic
word pairs, meaning they sound the same,
like R-E-E-D and R-E-A-D, but they have
different meanings. So you have maybe 30 of
these pairs of words, and you memorize them,
and then a week later, you’re asked to write
down as many of them as you can remember. So pretty good
chunk of people are not going to remember
reed/read, consciously– they don’t
write it down. So it’s gone from
their memory. And then, what you do
is you give them a cue. So with spontaneous recall,
the information isn’t there. You give them a cue. “What’s the name of a
tall tubular plant “that grows
in marshes?” And they’re supposed to
write down the answer. So the first group, like
you guys on this side– your word list
included reed/read. Your word list
did not. So you guys, when you’re
asked that question, you misspell R-E-E-D
as R-E-A-D much more frequently
than you guys, who are never
exposed to reed/read. Because the word read–
R-E-A-D– is grumbling around in
your brain somewhere. You can’t consciously
access it, you don’t remember
it was on the list, but it’s affecting
your output, your conscious verbal
or written output, showing that you can have
information in your brain that you can’t
access consciously, but it’s affecting
your behavior. And there’s zillions of
experiments like this. So this means that the
memory is dissociated. It’s not in
conscious memory. So the conscious–
I can remember my name and my address and
my parents, etcetera– that system, the
information isn’t there, it’s dissociated and
held in the other system. So that’s a technical
meaning of dissociation, and that kind of dissociation
is experimentally proven over and over and
over and over. It’s a very rigorously
proven thing. That’s just how
the mind operates. Which is just common
human experience. So there’s all
this controversy about whether this
kind of dissociation and this kind of
amnesia actually occurs… but if you think about
it for a second, this is the way your mind
operates all day every day. “So, what was
that movie, okay? “Oh, yeah, yeah– but what
was the actor’s name? “Well, yeah, he was in that
other movie with Kevin Bacon, “and Kevin Bacon
knew this guy “who knew that guy–
oh yeah, that’s his name.” So we’re constantly
doing these little… various mind tricks
with ourselves, or we’re just repeating
the recall effort, and then the
information’s there. It wasn’t there,
and now it is there. So it’s just an everyday
universal human experience, that information can
be in your brain, you can’t find it, but with some
sort of procedure or effort, it pops back. And there’s lots of evidence
showing that hypnosis and other research, that the memory that you
can’t access initially, and then it gets cued
and you do remember it, has the same rate
of memory error as just memory–
regular memory you’ve remembered
all along. So it’s not more accurate,
it’s not less accurate. Then, there’s a
phenomenological meaning of dissociation. So when I went
to medical school, I was taught if you use
a bunch of big words, you sound
really smart. So phenomenological
meaning. That just means the
symptoms that people report that are in all these
different questionnaires and symptom measures that
we’ll get into in a bit. So that’s the actual symptoms
that people experience are dissociative symptoms. Then, there’s anxiety symptoms,
there’s depression symptoms, etcetera. There’s nothing
mysterious about it, it’s just symptoms
that people report that kind of cluster
into this group, just like depression symptoms
cluster into a group. And then, there’s a
postulated intrapsychic defense mechanism. So this is a theory about a
dissociative defense mechanism that’s operating
in your brain. So the funny thing is that
this meaning of dissociation– some sort of theory about
what’s going on in your brain, how your defense
mechanisms work, is actually only
one possible cause of the phenomenological
symptom form of dissociation. So there may or may not
be this defense mechanism called “dissociation”…
but it’s only one of many possible causes
of the phenomenon of dissociation. You can see where we can get
really confused really fast. One person’s talking about
this defense mechanism, another person’s talking
about a symptom. But if you sort
these meanings out and you keep them clear,
here they are. There’s also a lot
of confusion about the difference between
repression and dissociation that I’ll come back to
in the third segment. And “repression” being
a Freudian term. And the best way to,
uh, explain that is a guy named Hilgard
who created something called
“Neodissociation Theory.” He talks about
horizontal splitting and vertical splitting. So this is just a diagram
for the difference between repression
and dissociation. Because people talk
about repressed memories. It’s sort of the same
but not really the same as dissociative amnesia. So if there’s a horizontal
barrier in your mind, the theory of repression,
as stated by Freud, is you have information in
your conscious mind, your ego, and it’s upsetting,
you have conflict about it, you don’t like it,
so you push it down into your unconscious mind,
or your id. And there’s a
horizontal barrier. Your conscious
mind’s up here, your unconscious
mind’s down there. And when stuff is pushed
into the unconscious mind, then it gets all involved
with dreams and fantasy and unconscious
mental processes and get it all
elaborated and distorted, and things can happen
to that memory that don’t happen if
the information’s just stored in your
conscious mind. And there’s actually two
subtypes of repression. One subtype of repression is
called “repression proper,” where it’s in your
conscious mind, like something traumatic
or conflictual happens… you can’t deal with it
and you push it down. Primal repression
is nothing to do with experience
or memory– that’s where you
have some impulse coming from your
unconscious mind or your id, and it’s trying to come up
into your conscious mind– say, some
sexual impulse– your conscious mind is
all hung up about it and uneasy about it so it
just keeps it squashed down. It never actually makes
it up into consciousness. So there’s these two
subtypes of repression. That’s Freudian
Repression Theory. Dissociation is different–
it’s vertical splitting. In dissociation,
nothing is pushed down into the unconscious,
into this mysterious place that you can never
exactly pinpoint or find. It’s in a different compartment
of the conscious mind. So the barrier,
the split, is this way. There’s conscious mind here,
which doesn’t remember, and conscious mind there
that does remember. So it’s kind of a different
model and different theory. A lot of people who don’t
believe in dissociation, who attack
dissociation, and say you can’t have
repressed memories of massive trauma–
it’s not possible, the mind doesn’t
work that way, also say that the
dissociative disorders are based on all this
bogus Freudian theory about repression. Which is just a
scholarly error. Dissociation theory is a
completely different thing from repression theory. It’s a different
set of mechanisms, even at the
theory level. And in early Freud, like
his studies on hysteria published in– just before
the end of the 19th century, he, with his co-author Breuer,
describes classical, classical multiple personality
kind of cases. Whole series of women, tons
of childhood sexual trauma, they come into therapy
30 years later, they’ve got all kinds
of different symptoms, including amnesia and sometimes full or
partial multiple personality. And when he was
writing like that, he assumed that the memories
were real and accurate and the incest
really did happen. So when
repression theory– when early Freudian
theory applies, then it’s really more
dissociation he’s describing, and the assumption is the
incest really happened, the memories
are accurate. Not perfectly accurate,
but basically accurate. Then, in 1897– so that’s
called the “seduction theory”– they were seduced
by adult pedophiles, and that’s why they’ve
got all these symptoms 20 or 30 years later–
that’s seduction theory. In 1897, he repudiated
the seduction theory. He decided that the
memories were false. In order to explain
to himself why the memories are false,
he developed repression theory. So repression theory is
all based on the idea that these are
false memories. Not maybe 100.0%, but
substantially, mostly. So the people who attack
the dissociative disorders make a couple of
conceptual errors. They say that dissociation and
repression are the same thing, which is not true. And then, they say that
these are false memories, because the therapists
are basing their therapy on repression theory,
which is completely bogus, and that’s why they’re cooking
up all these false memories. Which is completely
wrong and backwards. If you follow repression
theory as stated by Freud, you assume the
memories are false. You don’t
believe them. So the people who don’t believe
in dissociative disorders are accusing the therapists
of believing false memories because they’re
making their therapy based on
repression theory. It’s all just
a big huge mix-up. So this is what
goes on in my field. So now, we’re gonna talk
about the phenomenological meaning of dissociation,
and symptoms. So there’s the– so I’m gonna
guess this is the pointer. There we are. So there’s the dissociative
disorders interview schedule that I developed, that’s
a structured interview– a bunch of
standardized questions. And you’ll see the
dissociative experiences scale, which is a 28-item measure
you fill out yourself, you score it, and
the total score can go from
zero to 100. And then, there’s
the SCID-D, which is another
structured interview for dissociative
disorders developed by a woman
named Marlene Steinberg. So in this project, in general
adult psychiatric patients in a hospital in Dallas,
we excluded anybody who already had a
dissociative diagnosis, which is only like
one or two people. So these are all people
who don’t think they have a
dissociative disorder, never been treated for
a dissociative disorder, never been told they have
a dissociative disorder. And what we do
is we give them the dissociative
experiences scale, and an interviewer gives them
the one structured interview. And then, a second interviewer
who doesn’t know the results of the dissociative
experiences scale, or the DDIS, interviews them with the
second structured interview. And then, we look at, “Well,
what’s the agreement rate here?” So this is just general adult
psychiatric inpatients. And lo and behold, in basically
a one-hour research interview, or even 45 minutes, according to the one
structured interview, 40%, according to the
SCID-D, 44%, and then, the third arm
of the study was… after all these people had
done two structured interviews, I was randomly
assigned 52 people by the research
assistant, who are a combination
of people who are negative for a dissociative disorder and positive for a
dissociative disorder, and I had to decide how many
had dissociative disorders, and I actually was
the most conservative. But if we
look at DID… it’s not a
rare thing. So there’s about– there’s
10 to 12 studies now in eight or nine
different countries more or less
set up like this. You get general
adult inpatients, exclude anybody who has
a dissociative diagnosis, give them the dissociative
experiences scale, one or other of these
structured interviews, sometimes a
clinical interview, and the overall average of
all these studies is 4.4% of general adult inpatients
in psychiatric hospitals have previously
undiagnosed DID– dissociative
identity disorder. They don’t think they have it,
they don’t claim they have it, they’ve never been
told they have it, they’ve never had
treatment for it, and it can
be detected in a fairly simple
research interview. So that’s kind of the
epidemiology of it. And then, in the
mental health field, there’s a thing called
“inter-rater reliability.” So it’s– if two psychiatrists,
or 100 psychiatrists, absolutely cannot agree who’s
depressed and who isn’t, like it’s game over,
right? Doesn’t matter what
treatment you believe in or what genetic research
you wanna do. If you can’t degree who is
and who is not depressed, it’s just chaos. So the statistic for
the rate of agreement is called
“Cohen’s kappa.” Which varies from
plus 1 to minus 1. So if Cohen’s kappa
is 1.0, then two different raters
agree 100% of the time who’s depressed,
who is not. If it’s minus 1, they
disagree 100% of the time. So it’s perfect agreement,
perfect disagreement. And then, random is right
in the middle at zero. So here’s the
Cohen’s kappas for DID. If we compare one structured
interview to the other, my structured interview
to the clinician, for some reason this
number’s a little low, using the
dissociation scale, and there’s a sort of sub-scale
within it that you can analyze. So these are kappas
ranging from 0.71 to 0.81. In the “DSM V”
field trials– so “DSM V” came
out in 2013– in the “DSM V” field trials,
which is a lot of money spent, we’re getting a
large number of people to interview lots and
lots and lots of patients, and they look at
the Cohen’s kappa for the different
diagnoses, Cohen’s kappa for
depression was 0.28. Cohen’s kappa for
schizophrenia was 0.40. So psychiatrists
are really lousy at deciding and agreeing on
who is clinically depressed and who isn’t, and the top of the scale
in the DSM field trials was actually PTSD,
which was in the– I forget the exact number,
it was around 0.72. So DID and PTSD actually
have higher Cohen’s kappas than most… of the major, well-known,
regularly talked about psychiatric diagnoses. So that’s
good to know. And in my structured
interview, there’s all these
different sub-sections. So… there’s psychosomatic symptoms,
Schneiderian psychotic symptoms, secondary
features of DID, which is dissociative borderline
personality disorder, ESP paranormal
experiences, and then
total score. So, like on this scale,
there’s 16 items here. There’s 11 here. There’s 33 here. There’s nine here. So all I did was just
take the average score here and divide it by 9,
multiply it by 100. Take this one, divide by 16,
multiply by 100. So I converted them all to
scales that go from 0 to 100. And then, I put
them on this graph. And what we have
here is DID. I don’t know if we can–
oh, here we are. So this is DID. This is dissociative disorder
not otherwise specified, which is basically
partial DID. And this is schizophrenia,
and then we have… psychiatric adolescence,
chemical dependency, GI clinic– gastrointestinal
clinic– population, and the general
population. So… I’ll come back– I’m gonna
talk about this thing here. If I can get the
pointer to show up. Well, I’m gonna
talk about this in the next section. Why do people with DID have
more psychotic symptoms, more symptoms of
schizophrenia, than people with
schizophrenia? But leaving that aside, clearly,
this structured interview, this kind of walking through
all these symptoms, clearly differentiates
people with DID from almost DID, and
then from other groups. Which is part of
showing the validity and the reliability
of any disorder. You wanna be
able to do that. Okay, so one of
the conundrums is… what’s the relationship between
dissociative identity disorder and borderline
personality disorder? There’s all kinds of
controversy about it, all kind of attitudes, all
kinds of academic fighting. Basically, the academic
world is a bunch of– it’s like the Bloods and
the Crips, basically. It’s gang warfare at
the intellectual level. So there’s guys stabbing
each other in the back, attacking each other,
discrediting each other, blocking promotions,
intriguing. Except, again, not
here at GRCC, right? So BPD and DID– borderline
personality disorder– are really embroiled in
a lot of controversy. And one of the skeptical things
is, “Oh, those people with DID– “they’re just a bunch
of borderlines.” Well, so I did some
research comparing a large sample of
people with DID to a large sample
of people with BPD, and what do
we find? “Comorbidity” means all the
other mental health problems that go along with
your main problem, and what gets to be
the main problem’s kind of arbitrary. So comorbidity’s basically
a whole mess of depression, anxiety, substance abuse,
all kinds of different things. And lo and behold,
the comorbidity profile of these two things
are pretty similar. Basically everybody
with DID and BPD, if you’re in a
psychiatric hospital, either is or has
been depressed, has some kind of
mood disorder. Lots of anxiety,
lots of panic, lots of PTSD. So it’s very similar,
but the DID people are just a little
bit more. That’s the
general pattern. In terms of their
dissociative disorders, well, amazingly, 100% of
the people with DID have DID on the structured interview.
(audience chuckling) But that’s good to know that
the structured interview is picking all these people
up, not missing them. So the interesting
thing, though, is the people with BPD,
11% also have DID. So the borderline
personality disorder people have said in “DSM IV”
and “DSM V,” that dissociative symptoms
in BPD are kind of minor. But actually, in fact, they’re
complex, chronic, and major. And there’s
lots of ’em. Lots of eating
disorders. A little bit more
in the DID group. And this is what we see
clinically all the time. When you’re treating DID,
you’re always treating a whole bunch of other
stuff at the same time. And then, in terms of the
personality disorders, again, astoundingly,
100% of the borderlines are borderline. But so are over half
of the people with DID. And they have lots of
these other personality
disorders as well. So personality disorders
are very overlapping things. They’re not clear, simple,
discrete categories. And if you have borderline
personality disorder, you’re likely to
meet criteria for two or three
others, at least. But, yet again, the patterns,
they’re very similar, but overall, the DID
people tend to be more. So they’re more similar
than they are different. Well, I wasn’t
satisfied with that, so I did
another study. With inpatients again,
and now we’ve– using the structured
interview, we’ve divided them into people who have
both DID and BPD, only DID,
only BPD, and neither. And the data– like if I
decided I was gonna fake some data so it
would look good, I’d just make it
look like this. It doesn’t get
any better. It’s perfect– it fits with
exactly what I predicted. Which the people who have
both are the most severe. The people who have neither
are the least severe. And these two groups
are in between. So there’s a
total trauma score, and then duration of
sexual abuse in years, number of different abusers,
number of types of sexual abuse, duration of
physical abuse in years, number of
physical abusers. It just goes
down, down– I mean, it’s not perfect, it
bumps up and down a little bit. But basically, it’s
just a line like this. So when you have both,
you’re worse off than if you have only one
of those two diagnoses, and if you have either
one, you’re worse off than somebody
who has neither. In terms of different
diagnoses… same thing. You’re more depressed,
you’re more substance abuse, more psychosomatic
symptoms, more amnesia, fugue– that’s another
dissociative diagnosis– depersonalization
dissociative disorder, now, though I specified. So not surprisingly,
these guys have the most, these guys have
not so much, and these guys
are in between. But the people
with just DID– this is supposed
to be under here– have more dissociation than
the people who have just BPD, which makes sense, which fits,
which is logical. So basically,
the message here is– we’ve got lots of
research on this. We’re not just walking
around with opinions. And then, uh… all these different
symptoms clusters that were on
that graph– so the people with
DID have the most, these guys are intermediate,
these guys are the least. And all these different
symptoms clusters are serious
mental health trouble. Okay, well, that’s
sort of interesting. So we actually have a whole
body of literature showing– using the same rules that
you use for depression, dissociation, psychosis,
substance abuse, anxiety, so same rules,
same sort of methodology, we’ve shown that our
diagnoses perform as well, are as reliable, are as valid,
hang together as well, as any other set
of diagnoses. Which is cool,
but who cares? Because the only thing that
really counts is treatment. So I’m gonna show you a couple
of treatment outcome studies now, where we give a bunch
of questionnaires on admission to
the program– this is in Dallas. Then, we repeat the
questionnaires at discharge. And then, one study
at three months, another study, that’s
just an analysis now, at up to 10 months,
another study two years. So what happens when all
these dissociative people come into the hospital
and we treat them? This is a typical sample,
so most– it’s 90% women, average age is
usually in the 30s. You can’t be an adolescent
in our program. The federal government
won’t let adolescents be mixed in
with adults. Average length
of stay, which is a combination
of inpatient and stepping down
to the day program– average length of stay in the
program overall is 18 days. What happens to
their symptoms? Well, before I
tell you that. So they have lots and
lots of sexual abuse. Lots of depression, lots of
borderline personality disorder, lots of psychosomatic
symptoms, half are DID, half have
substance abuse problems. Very typical of
our population. So it’s a
typical sample. And lo and behold,
in this 18 days, the Beck depression
inventory’s the most used depression inventory. Drops by close
to 50%. The “how suicidal they are”
drops to close to 50%. How hopeless they are,
pushing 50%. And the dissociation score
doesn’t significantly change. So this is the targets
that we address in the inpatient setting. “You’re here basically
because you’re suicidal.” It’s more or less
a suicide program. We could call it
all kinds of things. The best name
would actually be the “Dealing with Your
Feelings” program, but that doesn’t quite have
the marketing ring to it. And I don’t think the
manage care companies would be thrilled
by that name. But the depression, the
hopelessness, and the suicide– those are the targets
of the treatment. And that’s a very
nice drop in scores, and the dissociation takes
much longer to treat. So we take the
dissociation into account, and we work with it, but
we’re not really targeting it– that’s not our main
treatment target. Uh, another study. Same concept. 50 people this time,
admission and discharge. The SCL-90 is a whole hodgepodge
of different symptoms, all across the board. The Beck score goes down,
suicide, hopelessness. Dissociation
doesn’t change. So we got several
replications of this. And, um,
what you see– this is just a list of
the references here, which, if any of you want
copies of the slides, you can provide, right?
>>Say that again?>>You can provide these slides
to anybody who wants them?>>I could, if that’s
all right with you.>>Yeah, yeah, absolutely.
>>I’ll post them on–>>They’re only 50 bucks a set,
so it’s a pretty good deal. (audience laughing) So this is just showing that,
you know, I’ve published a bunch of
outcome studies. And what happens
at three months is it’s not that– okay, it’s
nice to be in the hospital, we give you some TLC,
you improve, and then,
two weeks later, you’re right back
to where you were. Those gains are sustained
at three months, 10 months, two years,
and, in fact, the symptom levels keep
going down, down, down. So here’s a study I did,
published in the ’90s, where we interviewed
a bunch of people in the program
in ’93. They’re there
for a few weeks. Then, we re-interview them
two years later in ’95. And here, we’re asking
about, this point in time, going back
for a year. Here, we’re asking
two years later going back
for a year. Using standardized
diagnostic interviews here. And the number of
active diagnoses– depression, substance abuse,
eating disorders, schizophrenia,
etcetera, DID– is dropped by 50%, and the number of
personality disorders active in the preceding year
has dropped by 50%. And all these people
meet criteria for borderline
personality disorder. But they’re
a sub-group. Everybody in this
study met criteria for multiple
personality disorder. I just pulled out the
25 who met criteria for borderline,
as well. And what we have is really
nice treatment outcome, two years later. Their psychosomatic
symptoms are dropping, their psychotic symptoms,
dissociative symptoms, their borderline has dropped
by a third, basically. Paranormal experiences,
which we can talk about more if anybody’s
interested. How suicidal they are,
how many suicide attempts. Their dissociation score
now, in two years, has dropped
substantially. Their depression score– and this is just another
depression measure. So lots of different
kinds of problems dropping down
substantially. And this is an
interesting thing, in terms of their
abuse histories. So there’s– the people who
hate dissociative disorders and think they’re all bogus
are always accusing us of cooking up all these false
memories out of nowhere. So this is the duration of
physical abuse in years– child physical abuse,
up to age 18. Number of perpetrators, duration
of sexual abuse in years, number of perpetrators, and number of types
of sexual abuse. So that’s a whole list of
different sexual things one person can
do to a kid. And lo and behold,
when we asked them exactly the same
questions two years later, there’s no statistically
significant increase. There’s a little
bit of an increase in a couple of ’em,
not really here, not really here,
not really there. So two years later, after more
of this “false memory therapy,” they’re not reporting
more trauma memories than two years
previously. Which is pretty good
evidence that we’re not just pulling fake memories
out of nowhere. So that’s… the first talk. Thank goodness
for water. And so, the summary
point here is– and so, this whole thing
could be extended to a half day. And I could go into
so much detail you’d all probably be
suicidal yourselves. (scattered chuckling) But basically,
the point is, there’s a whole
bunch of research, it’s a substantial
body of literature, it’s replicated in many
different countries. There’s good psychometrics
to it, so… there’s all these different
statistics that are used to see how solid and
strong a measure is. We’ve used
all of those. One of the studies I did
was actually a series of six or seven papers– one’s called “Trauma and
Dissociation in China,” in the “American
Journal of Psychiatry,” which was the
official journal of the American
Psychiatric Association. So I worked with
people in Shanghai, at Shanghai Mental
Health Center. Basically, I talked to them
and they did all the work. And so, multiple personality
is never diagnosed, it’s not in their
diagnostic manual, it’s not taught, it’s not
in their popular culture, it’s not in movies
or on TV or… they don’t have
soap operas with people with multiple
personality. And it was quite
readily detected in our research
protocol. And that’s important,
because that’s a culture where the multiple
personality can’t be explained by contamination, or “I
picked it up from the radio,” or “I picked it
up from TV,” or “I picked it up
from my therapist.” So just a lot
of research, and the quantity of
research is smaller than for depression
or schizophrenia, but the quality
is about equal. I rest my case. Here is the stereotype
that dominates the field– “Schizophrenia is a
biological brain disease. “It’s genetic.” Of course, the environment can
sort of color the symptoms a little bit, so if
you have schizophrenia and you’re somewhere in
the jungles of New Guinea, you’re not gonna think that the
CIA or the FBI are after you, because you’ve
never heard of them. But the basic form
of the disease, how common it is, it’s a
universal genetic brain disease. Hear that from the American
Psychiatric Association, National Alliance for
the Mentally Ill. If you just search
schizophrenia on the web, you’ll get told over
and over and over it’s a genetic
brain disease. Not all the time, but
a fair bit of the time, they’ll explain–
(clearing throat) excuse me– that schizophrenia is
not split personality. Not multiple
personality. There’s people out there
who are confused. And they think
that schizophrenia and split personality
are the same thing. But we professionals
who are physicians, who treat biological
brain diseases, know that that’s
not the case. It’s very clear. It’s a totally
separate category. And it’s kind of this
fluffy, neurotic light thing that’s highly suspicious,
maybe not even genuine at all. Schizophrenia…
it’s just like cancer. And schizophrenia is not
caused by bad parenting. Just like arthritis or
cancer are not caused by bad parenting. And dissociative
identity disorder is a reaction to
the environment. So everybody’s
agreed on this. People who don’t
believe in it think it’s a reaction
to bad therapy. People who do
believe in it think it’s a reaction
to childhood trauma. But everybody’s agreed– it’s not an internal
biological disease that you’re
genetically born with. It’s a reaction to
the environment. And you don’t treat
it with medication. Although people with DID
are frequently on medication because they’re also depressed
and also anxious and so on. But the DID,
the dissociation itself– there’s no medication
for that. And everybody’s
agreed on that point. So you treat it with an
environmental intervention, not with medication. And if you believe in it, you
treat it with psychotherapy. If you don’t believe in it, you
treat it with “benign neglect,” which, if you
don’t feed into it, you don’t reinforce it,
you don’t talk about it, it just kind
of fizzles out. And this you get stated
in professional journals and books
and so on. So totally separate
compartments. Genetic brain disease,
reaction to the environment. Never the twain
shall meet. They have nothing to
do with each other. So if I was a regular
biological psychiatrist, I would’ve just
cleared that up for you, end of discussion. I actually just got
back from this year’s American College of
Psychiatrists meeting, which also, funnily,
was also in Puerto Rico. Sad to say I was stuck on
the beach for two afternoons.>>(faux concern) Ohh!
(audience laughing)>>So each year, there’s
a Dean award lecture, where some top researcher
in schizophrenia gets an award for
his lifetime work– or her lifetime work
on schizophrenia. And they basically
give a talk describing their lifetime
work on schizophrenia. So this guy Kenneth Kendler
got that award, and he’s pretty well “top dog”
guy in schizophrenia and genetics. And it’s kind of
a catchy talk with a catchy title. “The Genetics of
Schizophrenia– “Toward the
Identification “of Individual
Susceptibility Loci.” That sounds kind
of scientific. Kind of like some
big shot talking. And he is
a big shot. And, oh… whoop… Oh, there it
goes, okay. A little tricky. He doesn’t look like
Dr. Evil, right? He’s a kindly academic
looking kind of guy. And this is a quote
from the talk based on his lifetime
of research on genetics. “Most, if not all
of the reason “why schizophrenia
runs in families “is due to shared genes and
not shared environment.” Most, if not all, of the reason why
schizophrenia runs in families is genetics. It may not be all…
but it could be all. But if it’s not all,
it’s most, if not all. So in other words,
it’s predominantly, “major big league”
a genetic disorder. That’s his conclusion from
his lifetime of research. So…
what are the facts? What’s the research that
supports this conclusion? Well, there’s a
methodology called “twin concordant
studies.” Which are a little bit
old-fashioned now. The reason they’re
old-fashioned now is because of what the data are,
which we’ll get to in a second. So basically,
there’s identical twins, non-identical twins. Identical is MZ–
monozygotic– one egg. Fraternal, non-identical
twins are DZ– dizygotic–
two eggs. And what you wanna
look at is concordance. So if the first
identical twin is female, how often is the second–
this is a quiz question. If the first identical
twin is female, how often is the second
identical twin female? 100% of the
time, right? If the first identical
twin has red hair, always red hair. Etcetera. So some traits clearly are
purely genetically controlled. And if you take one of
these identical twins– let’s say you have a set of
Chinese identical twins, you take one out of
the family at birth and put ‘im in an
English-speaking family, they’re gonna grow up
speaking English. Whereas the one that
stayed in the Chinese Chinese-speaking family
is gonna speak Chinese. So from that, we know that
what language you speak isn’t coming
from your genes, it’s coming from
your environment. But incredibly, when
you’re– a Chinese kid is adopted into
a Caucasian family, they don’t become
Caucasian. So now we know
that being Caucasian, or being female,
or having dark hair, is genetic, and it’s not
modified by the environment. So the first thing you wanna do
is look at the concordance rate. If the concordance rate
is very, very low, then you know that it’s
not really genetic. If it’s purely genetic,
then the concordance rate’s going to be 100%. But what’s the concordance
rate for speaking Chinese versus speaking English
in identical twins? It’s almost 100%,
right? So you, the concordance rate
doesn’t prove it’s genetic, it just means it
very well could be. Then, you’ve gotta
go look at adoption and do some
other strategy. So the concordance rate
is kind of the first pass. So you wanna look at
the concordance rate for cystic fibrosis
in identical twins. It’s 100%. If the first twin
has cystic fibrosis, other twin
always has it. First twin doesn’t have it,
other twin never has it. It’s a purely
genetic disease, totally proven medically,
nobody doubts it. So what’s the story
with schizophrenia? Which is mostly,
if not all, genetic? Well… to find out, we should go to
the expert, Kenneth Kendler. So in this same talk,
he’s presenting his data, which supported
the conclusion that schizophrenia’s mostly,
if not all, genetic. And he looked at this
16,000 pair of twins, and he looked at the concordance
rate for schizophrenia. So what do we think– like if
I was gonna take a poll here, to support the conclusion
it’s mostly genetic, what kind of concordance do
you think we would want? It’s not likely
to be 100%, because the mental health
field’s kind of like fuzzy. But we’d want some kind
of high number, right? So if the concordance
rate was 90%, then I’d go, “Yeah,
it very well could be “mostly, if not all,
genetic.” 80%? Eh, that’s still mostly,
if not all. 70%– well, that’s getting
away from “if not all,” but still mostly. 60%– well, that’s
just barely mostly. So what was the actual
concordance rate that he observed and
published in his research that got him the award
for demonstrating that schizophrenia
is mostly genetic? Anybody wanna
take a guess?>>32.
>>(laughing). That’s a
good guess. In his own sample– and this is actually higher than
the real actual average number, if you add together
all the best studies. In his own data set, when the
first twin has schizophrenia, the other identical twin does
not have it 70% of the time. That simple fact,
by itself, proves conclusively,
scientifically, medically, biologically,
beyond a shadow of a doubt, no other possibility, that schizophrenia could be at
most only a little bit genetic. And this result– which
the numbers bounce around from study to study, but
when you add together the best-designed studies,
and the most recent studies, it actually comes out more
in the low 20s, like 22%. So what’s up
with my field? How, how does this myth
get perpetuated? So you go to these
academic meetings, and the top expert
in the world, comes and gives
his award speech and says it’s mostly
genetics, 31%, and everybody goes…
(scattered laughing) “Good talk.” There’s something
really wrong. I mean, it’s just
absolutely not possible. So I have a letter in press,
letter to the editor, at a journal called
“Psychosis,” which is edited by a friend
of mine who’s very skeptical about all these “genetic
biological schizophrenia” guys. So he liked
my letter. So the letter is… Something like January 29th,
or something like that. There’s, in the journal
“Nature,” which is– “Nature” and “Science” are
the two top science journals in the world. So if you’re– if you figure
out the structure of DNA for the first time
in human history… and your name is
Watson or Crick, where do you publish
your paper? “Nature.” I mean, it is top,
top journal. So in this
journal “Nature,” there’s a paper
published in January, and there’s
a write-up– I just talked about the write-up
in the “New York Times.” There’s numerous other write-ups
in many other media outlets. This is the biggest,
most important, fundamental advance
in the study of the biology of
schizophrenia ever. We’ve really, for
the first time, started to tap into the
underlying genetic causation of schizophrenia. We’re really starting
to figure it out. We’ve really got our hands on
something for the first time. That’s what the author said,
all these different commentators. What was the
research? So there’s like 39–
some huge number– 39,000 people with
schizophrenia, 28,000 controls. And this is a schizophrenia
genetics consortium, which has pulled together
all of these studies where they do
genome-wide analysis, which is they– they
can just basically throw your blood
in a machine, and it’ll scan
your entire genome. Because now, thanks to
the Human Genome Project– and this is getting
cheap enough now that they can do
these gigantic numbers. So that’s millions of dollars
of research money. And what they
zoned in on was a single
nucleotide polymorphism, which means little variations
in one ATGC base pair. And they looked at
a specific gene called the “C4
complement gene.” And they looked at four–
out of all these genes that they scanned, they
finally found one somewhere that had some sort of
statistical significance to it, and it turned out to be
the C4 complement gene. And there’s
four variations of this single nucleotide
polymorphism. For the first three
they looked at, there was no increased risk
of schizophrenia at all. But the fourth one, this is where they found
this fundamentally new insight into the underlying genetic
biology of schizophrenia. Which is now gonna open up
this revolution in psychiatry. So if you have
this gene variant… how much does your risk
of schizophrenia go up? This fundamental
breakthrough finding. The most significant,
profound finding in the history of
schizophrenia and genetics. What would you
think it might be? The answer is your odds of
developing schizophrenia sometime in your life
go up from 1% to 1.27%. That’s it! It’s just– it’s like being at the Mad
Hatter’s tea party or something. I mean, it’s
just ridiculous. It doesn’t
make any sense. It’s massive over-hyping
of this result, which then generates more
grants, more motions, more interests,
more excitement, and diverts
money away from studying maybe
something in environment that’s causing people
to go crazy. Like child abuse,
for instance. So this is dominating
the field all the time, this kind of thinking. Okay, so, just jumping
over to DID now, just to refresh
you a little bit. What is DID? What’s a typical
description of it? Well, here’s–
this is the– so we’re in the category
now of neurotic reaction to the environment, totally different box from
genetic brain disease, which isn’t even, in fact,
a genetic brain disease, which we’ve known
scientifically for decades, but we keep
saying that it is. Little side detour– back
to the American College of Psychiatrists meeting
in Puerto Rico last week, the mood disorders award
was a lecture given by a woman who’s actually
in University in Galveston, not too far
away from me. Top handful of childhood
depression experts in the world, presenting all
her research. And she’s talking
about how effective anti-depressants
are for children. And she’s very
pro-anti-depressants. Because genetic brain
disease, medication, are all part
of a package. That package is
promoted as a package. Okay, so we can diagnose
depression in children. So this is
an hour talk. It turns out that the
FDA has only approved two anti-depressants
for kids under 18. Fluoxetine, which is Prozac,
and escitalopram. For Prozac,
there’s two studies. For escitalopram,
there’s one. Showing positive results. She didn’t mention how
many studies there are where there’s no difference
between drug and placebo. In the FDA, you could have
10 different studies of Prozac. They only require that
two show a difference between the drug
and a placebo. If there’s eight
other studies that show no
difference at all, they don’t care,
doesn’t matter, gets approved, goes to market. That’s how the
whole thing operates. Then, there’s a whole bunch
of other anti-depressants on the list where
all of the studies failed to show any other–
any difference at all between the drug or
the anti-depressant and the placebo
for depressed kids. But we got two drugs, a
total of three studies. So then, she averages
together all the literature on anti-depressants
in kids. Thousands and
thousands and thousands and thousands
of kids. And she says, “How many kids
respond to anti-depressants “compared to placebo?” Where “response” is defined
as your depression score drops by 50%
or greater. So being a responder
doesn’t mean you’re better, it just means you’re
at least half better. So not a very tough
definition of “responder.” Overall, when you add the
whole world’s literature on anti-depressants
in children, you add it together,
60% respond to the anti-depressants
and 50% respond to placebo. That’s it. It’s not too
impressive. And so, there’s this whole
room full of 500 psychiatrists, and they’re all,
“Uh-huh, yeah, good, “great talk,
here’s your award.” There’s something
fundamentally wrong here. Okay. But at least we know that
dissociative identity disorder and schizophrenia
are separate things. So here’s a classical– it’s
a little bit older text. You’ll see the language
is a little bit archaic, but, you know,
typical case description of dissociative
identity disorder. “The delusion of being
possessed is very commonly seen “as a specific type of
‘double personality.’ “Single emotionally
charged ideas or drives “attain a certain
degree of autonomy, “so that the personality
falls to pieces. “These fragments can
exist side by side, “and alternately
dominate the main part “of the personality, the
conscious part of the patient. “However, the patient
may also become “a definitely different person
from a certain moment onwards.” It’s completely consistent
with the entire DID literature. “Naturally, such patients
must speak of themselves “in one of their
two versions, “or they may speak in the
third person of the other two, “usually he designates himself
by one of his several names. “The splitting of the
psyche into several souls “always leads to the
greatest inconsistencies. “In a few cases, the
‘other’ personality “is marked by use of
different speech and voice. “Thus, we have here two
different personalities “operating
side by side.” Extremely clear
definition of DID. “When specific ‘persons’
speak through the patients “in various cases of
automatic speech, “each person has
his own special voice “and distinct
manner of speech. “Thus, the patient
appears to be split “into as many different
persons or personalities “as they have
complexes.” Complexes is not talked
about that much now. It’s a late 19th,
early 20th century term. “The blocking of the
recall of memories “is a common occurrence
during the examination “of these patients.” So they have
lots of amnesia. Okay. So this would be from
some classical textbook on dissociative
identity disorder, right? This is clearly
not schizophrenics. This is people with
split personalities. Different voices,
names, ages, amnesia. What book is
this from? There we go. This is a book
by Eugen Bleuler, published in 1911. He’s the guy who coined
the term “schizophrenia.” It used to be called
“dementia praecox” before that, which means “early
onset dementia.” This is the guy who invented
the term “schizophrenia,” writing one of the classical
20th century’s textbooks on schizophrenia, describing a substantial
chunk of his caseload. It’s exactly the same
thing as “DSM IV,” “DSM V” dissociative
identity disorder. In great
minute detail. And he says that splitting
is the fundamental thing going on in
schizophrenia. And he says that splitting
is exactly the same thing as dissociation, which
is Pierre Janet’s term for the same thing
as he calls splitting, and Pierre Janet is
kind of the father of dissociation theory. So the guy who originally coined
the term “schizophrenia”– every psychiatrist
knows that– most psychiatrists,
of course, don’t read the book– is completely confused
about the difference between DID and
schizophrenia. And many people that he’s
calling “schizophrenic” clearly have DID. So there’s actually,
in fact, mass confusion in the profession… I’m sad to say. I might turn around and
chortle for a second but… I’m very sad
to say that. Okay, so let’s look
at this relationship between dissociation,
psychosis, and some research. Genetic brain disease. Oh, by the way, the
woman who was giving the talk about
anti-depressants in children for an hour didn’t
mention child abuse, childhood trauma, PTSD, or
anything like that, once. In an hour. That’s how relevant
all that stuff is to childhood
depression. Which we’re treating
with anti-depressants that don’t work any
better than placebo because it’s a
biological disease. Okay, so this is general
population in Canada. Team knocked on people’s
doors and interviewed them with the standardized
dissociative disorders interview schedule,
dissociative experiences scale. So this is people in
the general population. Not in treatment. And I divided them
into 397 people who had no psychotic
symptoms at all and 35 who reported
three or more. Simple. I mean, this is not
rocket science, right? And look at the difference
in their abuse histories. Physical or sexual
abuse, or both, 8.1% if you have no
psychotic symptoms. 45% if you have
three or more. From this, you might
consider the possibility that physical and sexual abuse
have got something to do with psychosis. You would think. So… your rate of having psychosis
goes up from 8% to 45%, not 1% to 1.27%. I mean, that’s a
massive finding compared to the
strongest finding in all of schizophrenia
genetics ever after they’ve spent
literally a billion dollars or whatever
they’ve spent. Same people. Much higher dissociative
experiences scale scores, more somatic symptoms,
secondary features of DID, more borderline criteria,
more ESP paranormal. This is starting to look
like the same pattern as when I compared DID to
borderline personality disorder. It’s all the same
kind of comorbidity. Okay, different study. This is 83 people
in Canada. Long, stable, clinical
diagnoses of schizophrenia. Most of them have
been diagnosed as having schizophrenia
for 10 years or more. Same dissociative
experiences scale score, same dissociative disorders
interview schedule, I divide them into people say
they were abused physically or sexually or both
in childhood, and people who say they
were neither physically nor sexually abused. Lo and behold, if you have a
longstanding stable diagnosis of schizophrenia,
and you answer “yes” to a very simple
question– “Yes, I was either physically
or sexually abused or both,” you have much more
dissociation, more somatic symptoms–
this is another set of dissociative
symptoms. You’re more borderline. You have more of
all this stuff. You have more
schizophrenia. You’re twice as many
psychotic symptoms as the person with schizophrenia
without an abuse history. And those Schneiderian
symptoms– named after Kurt Schneider,
a German psychiatrist– are the hardcore symptoms
that are everywhere in the schizophrenia literature
and in the DSM criteria. Whole different measure
of standardized thing that’s used in tons
of research. Whole list of different
types of psychotic symptoms. Lo and behold, the
abused schizophrenics has way more of those than
the non-abused schizophrenic. Ideas of reference is… uh, “That message on
the side of the bus “is deliberately
meant for me. “They put it on the
bus to let me know.” That’s an idea
of reference. Voices,
paranoid ideation, thought insertion is thoughts
being stuck in your mind that aren’t
your own. Hallucinations, reading
someone else’s mind. So in schizophrenia,
the symptoms are divided into positive
symptoms and negative symptoms. The positive symptoms–
and they’re measured by this thing called the
PANSS, “positive and
negative syndrome scale,” and by lots of
other scales. They’re everywhere in the
entire schizophrenia literature. Negative symptoms are the
things you should have that you’re missing. So that’s kind of
burned out, empty, no social connectedness,
no life, no spontaneity, no desire
for anything. The positive symptoms
are things that are there that you shouldn’t have,
like being agitated, mixed up, jumbled up thoughts,
hallucinations, delusions. And lo and behold, the
abused schizophrenics got more positive symptoms
and fewer negative symptoms. And the composite score is just
when you add the two together. So now, we’re starting to
see that “Wait a minute…” we can see– take
a whole bunch of– say everybody in this
room has schizophrenia, I go, “All you guys who have
physical and sexual abuse “in childhood sit
on this side, “all you guys who don’t
sit on this side.” You guys over here
are gonna have way more negative symptoms,
fewer positive. You guys are gonna have more
positive, fewer negative. And these symptoms
have a lot to do with how well you
respond to medication, what your treatment needs are,
what your housing needs are, what your relationship
qualities are like, and what your
prognosis is like. We can make this major
differentiation into a much more treatable
treatment response group, much more difficult, simply by
asking a couple of questions. But that is nowhere in the standard
schizophrenia literature, until the last
few years. Starting to
creep in now. Okay, so now we’ve
got 160 people with multiple
personality, 83 people with
schizophrenia. Let’s compare them. So they’re not matched
demographically so it’s not
perfect research. Ideally, it should be
the same average age, same percentage of
female, and so on. But this is
a first look. Oh, wow…
what do you know? People with multiple
personality have twice as much childhood abuse as people
with schizophrenia. But people with
schizophrenia have way more than the base rate in
the general population. People with MPD have– by all these
different indicators, much more
severe abuse. They don’t just have
more “yes” answers, they have much
more severe abuse. They have more
dissociative disorders. Not surprising. But wait a
minute here, these are people
with schizophrenia, 25% of them are coming up
meeting criteria for MPD, DID, on a standardized
interview. So it’s not like
these are really clear, distinct
separate groups. They’re all overlapping,
confusedly mish-mashed together. Substance abuse
about the same. More depression, more
borderline personality. So by and large, this
is the same pattern, whether you compare
abused schizophrenics to non-abused
schizophrenics, people with DID to
people without DID. And the common theme
is the trauma. Some more dissociative
symptoms. Higher dissociation score,
more somatic symptoms, dissociative symptoms,
borderline. Here we are again. Well, that’s interesting,
but take a look at this line. Yet again, the people
with multiple personality have more symptoms of
schizophrenia, on average, than people with
schizophrenia. So these symptoms
of schizophrenia cannot possibly be
specific to schizophrenia. They may not even
have anything to do with brain disease
at all. They might be trauma
dissociation symptoms that the person wouldn’t have
if they weren’t abused as a kid. Okay. Well, we’ve got all these
clinicians out there who can tell the difference
between schizophrenia and dissociative
identity disorder– they never diagnosed
dissociative identity disorder, they just know
it’s rare and iffy. So if that was
actually true, what would we think we would
see in large series of people who have a diagnosis of
multiple personality or are in
psychotherapy for it? We wouldn’t see
previous clinicians saying they had
schizophrenia. But in these two series,
40%, a quarter, had previous diagnoses
of schizophrenia from other clinicians, half had been treated
with antipsychotics, and a bunch had had
electroconvulsive therapy, shock therapy. Which tells us that
the previous clinicians thought these people were
seriously, seriously, seriously mentally ill, needed the most
heavy-duty treatments for major serious mental
illness that we had, and a half of the time,
or a quarter of the time, got an actual diagnosis
of schizophrenia, proving that most clinicians
cannot tell the difference. And these are people who
are participating in, you know, high-level,
hardworking, cognitively functioning
psychotherapy. This is the PANSS, that positive
and negative syndrome scale. This is the norms for
schizophrenia in the manual. And this is the
DID series. Yet again, DID people are
more positive, less negative. So… This is just
my research. These findings have been
replicated in multiple samples with multiple
different measures. Okay, so we all know
that hearing voices is… a sign of psychosis and very
typical of schizophrenia. So… This is the Schneiderian
symptoms of schizophrenia, which include several different
forms of hearing voices. What’s the percentage of
people with schizophrenia who have at least one
Schneiderian symptom? This guy Kurt Schneider said,
“These are the hardcore symptoms “of schizophrenia.” Well… this is published series
in the literature. Only a third of the people
in this published series of schizophrenia cases had
any of the core symptoms of schizophrenia. That’s a little weird. So if you total these
12 or so series, there’s 2,500 people,
only just over half had any of these
Schneiderian symptoms, which are the core,
defining symptoms of schizophrenia,
in theory. On the other hand, if you
have multiple personality, 87% have one or
more symptoms. So again, there’s
like multiple ways of looking at it,
multiple sources of data, same pattern over
and over and over. What gets called
“psychosis” is actually more typical of
people who are dissociative than of people who
are psychotic. So I took this same series–
1993, ’95– now, I pulled out the people
who had psychotic diagnoses on the structured
interview. Schizophrenia or
schizoaffective, which are the two major,
heavy duty psychotic diagnoses. So these people all, in fact,
had multiple personality, all were getting treated
with psychotherapy. But… 36 of them met
standardized DSM structured interview criteria
for psychotic diagnosis in ’93. In ’95, they’re on fewer
medications and lower doses, and their primary treatment’s
been psychotherapy, and now instead of
100% met criteria in the previous year,
only a quarter did. Their Axis I diagnoses
are dropping. Same pattern as we
saw when we pulled out the borderline people. And the same thing
over and over. Their thought
disorder scores, this other measure, the–
(mic cuts out). Thought disorder, psychosis,
depression’s dropping down, all different things
are dropping down. Another measure of
psychotic symptoms, in my structured interview–
dropping, dropping, dropping, dropping,
dropping. So all kinds
of symptoms, including the psychotic symptoms,
are going down, which is a
good thing. The positive symptoms
are going down. Also the negative symptoms
are going down. The dissociation score
dropped dramatically. Depression,
Hamilton depression, the SCL-90s– the
all across the board different symptoms. Then, there’s a
psychosis sub-scale. So we’ve got four different
measures of dissociation– of psychosis, rather, all
following the same pattern. So we’re successfully
treating– “oh, wait a minute, what
are we treating again? “Oh, yeah, borderline
personality disorder. “No, no, no,
schizophrenia. “No, I mean, actually
we’re treating depression. “No, no, we’re treating
anxiety disorder. “Wait a minute,
we’re treating…” We’re treating this whole
pot of different diagnoses. And the typical clinician
who sees these people, says they have schizophrenia,
schizoaffective, bipolar, some
heavy duty diagnosis, gives them meds, maybe ECT,
and no psychotherapy. This is just the way
the field operates. Which I think
is a sad story. There’s probably, I
actually just read a paper this morning–
or this afternoon, while I was sitting
at the airport, waiting for three hours…
(scattered chuckling) which was handy, because I got
lots of emails done and stuff. Um, it’s a
summary article, and they were talking about
15 different studies published. None of these
existed 10 years ago. Mostly in the
last five years. They’re studies with
like 5,000 people, 7,000 people, 3,000 people
in the general population. Or large collections of
schizophrenia patients, psychotic patients, like,
hundreds and hundreds, and there’s multiple
studies like this. Just asking about
childhood physical abuse, sexual abuse, neglect,
bullying, family violence, a whole bunch of
different forms of trauma, and lo and behold,
it’s way up there in people
with psychosis. So having a history of severe,
chronic childhood trauma increases your risk
for psychosis in many, many, many studies,
in many different samples, by like,
20-fold, 40-fold. There’s a study called
the “Adverse Childhood
Experiences” study, which is done in a
Kaiser Permanente population in San Diego. So they had
17,000 people who were all in the
Kaiser Permanente system, and they gave ’em this adverse
childhood experiences scale, and then they reviewed
all of their medical
psychiatric records, because they
owned them all. And the adverse childhood
experiences scale has 10 different questions, and
you either say “yes” or “no,” and the total score
ranges from zero to 10. So, “Yes, I was
sexually abused, “Yes, I was physically
abused, family violence, “parent with substance
abuse, parent went to jail,” different forms
of childhood trauma. And one of the guys who’s
the core guy in the study, is an epidemiologist
from the CDC, so he’s spent his whole life
looking at the statistics of disease at the Center
for Disease Control. And this guy says in talks,
and says in papers, “Most epidemiologists never
get a finding like this “in their
entire careers.” What was the
specific finding? The specific finding
is, if your ACE score– “adverse childhood
experience” score– is 4 or higher,
compared to zero, your risk of IV drug use
goes up 1,400 times. That’s kind of
a big finding. That’s a little bigger
than 1% to 1.27%. And so, ACE scores
go up dramatically… in conjunction with all kinds
of different physical and mental health
problems. The higher
your ACE score, the more psychotic
symptoms you have. More suicide
attempts. More depression. Hearing voices. Being admitted to
psych hospitals. Okay, that’s all kind
of understandable. But other things that go up
dramatically with ACE score include cardiovascular
disease, funnily enough,
having Cesarean sections, cancer, lung disease. There’s a whole bunch
of health outcomes that go up dramatically
with childhood trauma. Childhood trauma
is driving a lot of billions of dollars
of healthcare costs in the United States
per year. What is one of the things–
so when you see the graph, it’s like, “ACE score,
1 through 10,” what’s your likelihood of
having a body mass index above 30, which is the
low end of being obese? People who are obese
in our program, they have BMIs
like 45 and 50. A score of
1, 2, 5. It goes just like this–
(whooshing noise). So what’s the
healthcare costs of cardiovascular disease,
high blood pressure, high glucose, on
and on and on and on, heart attacks,
in our culture? Billions of dollars
per year. That’s just the financial cost,
let alone the human cost. And a significant, major
driving contributing factor is childhood trauma. So we did a
study which… we’re just doing
the analysis on now, but we got kind of, like,
the preliminary analysis– 67 people admitted to
the hospital in Dallas for, basically,
for being suicidal. So they’re admitted
to a psych hospital. But they’ve all had
bariatric surgery, weight loss surgery. And most of them are kind
of like a couple years out… and so we looked at–
number one, they’re all
inpatients, they all have serious
mental health problems, they’re obviously not
doing well psychiatrically. Most of them have
lost a ton of weight. What are their
depression scores, their dissociation scores? And we did several different
eating disorder measures. Nothing really
stood out that much except their
ACE scores. These people had
amazing ACE scores, these 67 people. There’s many, many people
with 6, 7, 8, 9. Whereas the general
population is like zero, 1. And so, that’s
one sample. But what we’re
looking at is people who’ve had
bariatric surgery, they’ve lost a ton of
weight, but they’re still doing horribly
psychiatrically. And what is the one thing
that stands out about them? Their massive amount
of childhood trauma. Clinically, we have people
in the program all the time. So, it’s not like
in psychoanalysis where you’ve gotta spend like
30,000 hours digging down into the unconscious
and interpreting stuff. People just
tell you. And I don’t know how
many dozens and dozens and dozens and
dozens of– like, 250- to 350-pound women
I’ve talked to who consciously,
deliberately, are keeping themselves
overweight so that perpetrators won’t
be interested in them. And then, when they have
either big weight loss or they have
bariatric surgery, and their weight goes down, they
get overwhelmingly terrified, because guys start
hitting on them, and perpetrators are
going to come after them. It’s– you don’t have to
dig around, you just ask. “What’s going on? “Why do you keep your
weight up there?” In combination with, it’s
basically comfort food. They’re self-soothing–
that’s their drug of choice. They eat, they eat,
they feel full. They’re distracted,
they’re focused on that. All the bad
feelings are gone. So this is… obviously not the
total cause of obesity, but it’s a significant,
major contributing factor, with costs of
billions of dollars. And it’s the
same thing– you read the obesity literature
or general medical literature, child abuse just
doesn’t get mentioned. Like it doesn’t exist. So the analogy I
came up with is… this is like being an
expert on lung cancer and giving a one-hour talk
on lung cancer and never mentioning
cigarette smoking once. It’s just–
“wait a minute.” Cigarette smoking’s kind
of an important topic in the causation
of lung cancer. It doesn’t cause
every case, but if we could stop
the cigarette smoking, we would drop off so
many cases of lung cancer. That’s the one thing we
know can make a difference. Same thing with
childhood trauma in the mental
health field. So try actually
accomplishing it. But if you could
wave a magic wand and there was no
more physical abuse, sexual abuse,
family violence, the amount of mental
health would drop down– (whooshing noise). So I was kind of hemming
and hawing about whether I should go into this in
exhaustive detail or not, or… do a short version of this
and just wander through other mental health issues, so
I’m still kind of undecided. So I’ll probably
compress it down some. So basically… this is like the drive-by
shooting bullets that get sent my way in
the gang war in academia. This is the stuff that
skeptical people say about DID, and the main point is–
it’s just a really, really, really low-level of
logic and scholarship. I mean, just basic errors of
logic, discourse, analysis. In a philosophy
department, you’d just get laughed
out of the department if you did this
kind of stuff. So… very commonly,
arguments are applied to DID that could just as well
be used against all other
psychiatric disorders. So DID is not
real because… and fill in
the blank. But the same thing
applies to all the other
psychiatric disorders, but that’s never
said about them. So it’s this kind
of double standard, goes on all
the time. Which I’ll give you
some examples of. Skeptics also over-generalize
from biased samples. So in cognitive therapy,
which is a very well-studied, tons of outcome
studies, method of therapy,
originally for depression, and then expanded to
a lot of other stuff. In cognitive therapy, you
look for cognitive errors. So people who have
been abused as kids, kids always blame
themselves, so they think, “I’m bad, I’m unworthy, I’m
causing it, I deserve it, “it’s my fault,” and
then that gets reinforced and ingrained,
reinforced and ingrained. 30 years later, they
come to our program. “I’m bad, I deserved it,
I caused it, it’s my fault. “I deserved to be
abused by my husband. “I deserved to be
abused by myself. “I’m not even a member
of the human race. “I’m a disgrace,”
etcetera. All the time, all the time,
all the time, all the time. So one of the methods of
therapy we applied to this is cognitive therapy,
so we look at this as a cognitive error,
an incorrect belief, because no child deserves to
be abused or causes abuse. So it’s an error
in thinking. And then, we have a
whole bunch of strategies and techniques we do to try
and get them to see that, “No, that’s not true. “It’s never true
of any human being. “You deserve to
be treated well. “The only reason you
weren’t was just bad luck. “It’s all about your
parents, not about you.” So… in the cognitive
therapy literature– I’ll take your question
just in a second– there’s some basic sort of
categories of cognitive error. There’s “all or nothing,”
“black and white” thinking. So… that dominates
presidential debates. You see this “all or nothing,”
“black and white” thinking. “This guy’s gonna
destroy America!” “This guy’s the only
hope for America!” So it’s extreme, polarized
“black and white,” without looking at all
the subtleties in between. And it dominates discussion
in the culture of all kinds of different
issues all the time. But “all or nothing,”
“black and white” thinking is supposed to be typical of
borderline personality disorder. So it’s a form of
mental illness that we treat with
psychotherapy. Another cognitive error
is catastrophization. So the example I use when
I’m teaching it to a patient or client is…
woman’s upstairs, she’s in her bedroom,
she’s about to go to sleep. All of a sudden, she
hears a sound downstairs. She thinks to herself, “If that
dog knocks over his water bowl “one more time, I’m really
gonna be mad at him.” Then, she goes
to sleep. Down the street,
there’s another woman who’s upstairs
in her house. She hears exactly
the same sound. She goes, “I think
a serial killer “just broke
into the house.” Okay, so, the thinking that
you have is going to generate some very different
emotional reactions, right? The woman– the woman’s
who’s kind of, “Eh, hmm,”
go to sleep. The other woman’s
in full panic. So your thinking kicks up
all this “fight/flight,” catastrophe,
adrenaline, and then the counter to
that is to de-escalate, talk yourself down. So this is
catastrophization. Another cognitive error
that mental patients do all the time is
over-generalization. So, “My uncle
abused me, “therefore all men
are pedophiles.” Well, unfortunately, our
colleagues do that all the time. They over-generalize
from biased samples. So they might
see one case of DID diagnosed
by somebody else where there was
lousy treatment and the person
got worse, and then they conclude that all
the treatment is 100% harmful. This happens
all the time. “DID is not valid
because its treatment “has not been
proven effective.” Okay, well, so, we just got
rid of cancer of the pancreas. There’s no effective treatment
for cancer of the pancreas, so therefore, it’s not
a valid disorder, right? You can’t say this
in general medicine. Everybody’d just look
at you like, “What?” But you can say
it about DID. So if it was true that
the treatment of DID has never–
has no evidence basis, never been proven
to be helpful, that would tell us
zero about whether it’s a legitimate
disorder or not. Go back 200 years, we didn’t–
there’s no effective treatments for hardly anything
in all of medicine. That doesn’t mean all the
diseases were not real. So the absence of an
effective treatment tells you nothing about the
validity of the disorder. But on top of it,
there in fact is a bunch of treatment
outcome evidence. So that’s an example of you
can say that about DID, but you couldn’t
possibly say it about cancer of
the pancreas, because everybody
would just think you should have
your license removed. Sorry, you were
gonna ask something?>>Yeah, um,
I was… when we were talking
about childhood abuse, now, things like–
I don’t know, like, uh, parents divorced, or
other experiences that, you know, you could qualify
as psychological trauma, but it was
not intended. Is that something you
guys keep in account when you guys do
your research, like, “Oh, we asked this question–
have you ever– “were you abused
as a child?” The person might not
think about it as, “I was not abused,”
but, you know, there was certain
experience that would, uh, be considered
as trauma. You know, think like, “Oh,
my parents got divorced,” but, you know,
it’s not–>>So this was an
excellent question. And, of course, it’s
really complicated. Nobody’s got all
the answers. Because… there aren’t really
any measures that ask about every single kind
of upsetting or traumatic thing that can happen. And so, the focus is
often on physical abuse, sexual abuse– you know,
big, obvious clear stuff. But actually in the patients
who come to the program, half the trauma comes
from good things that should have
happened that didn’t. Namely, bonding,
connecting, loving, unconditional love,
nurturing, protection. And so, they felt very scared,
small, sad, lost, lonely. But nothing happened. Nobody fired a gun. Nobody hit you. So a lot of trauma
is actually things that never
even happened. And then, there’s kind
of like mild trauma, and then medium trauma,
and obvious, huge trauma, and then there’s… some people can
run faster, some people are
better at math, some people are a little
tougher at surviving trauma. Maybe two people have the
same amount of trauma, but one’s got a
fairly okay parent and one’s got two
not-okay parents. So the one with the
one okay parent got the same amount
of sexual abuse, or they had a good aunt,
or they had something to counterbalance the
effect of the trauma. So there’s all these
different things that kind of
come into play. And measuring it all is
like pretty complicated and hard to do. But there’s– like a recent
literature started to grow showing very clearly
that childhood bullying has lots of serious
mental health consequences. 10 years ago, there was
nothing about bullying in the mental health
literature. And then, divorce,
it all depends, because sometimes, the
amount of family pathology and the amount of trauma goes
down because of divorce, because you got rid of
the not-so-good parent. Other times,
it goes up. So there’s not
just one pattern. I don’t know if that
answers your question.>>No, yeah–
yeah, definitely. Makes sense– so you would
think that in your field, that’s probably one good
area where more research could build up on,
like, trying to measure some of these variables, like–
>>Yeah, absolutely. We always need
more research. So of course, my opinion is, we
should take a billion dollars from all this genetic research
that’s going nowhere and put it into this
kind of research. Because there isn’t an
infinite pot of money. And so, being able to
study all this stuff, we’re getting robbed
by all the money being diverted over
in that direction. You look like you still
have another thought there.>>No, no, no, I’m fine.
>>Okay. (chuckling) So, uh, “DID is
not a disease “because it is
influenced by culture.” So this gets published
in psychiatry journals. Okay, so… hold on a second here,
so you’re telling me that there’s actually
psychiatric disorders that are not influenced
by culture? It’s an absurd
proposition. Every anthropologist in
every anthropology department in the whole planet would
laugh his head off at you, or her head. It’s ridiculous. There’s no culture-free
psychiatric disorder at all. So the fact that something
is influenced by culture… tells you nothing
about nothing, in terms of the validity
of the disorder. But sort of lurking
in behind there is this idea that, “Oh, it’s
not influenced by culture, “because it’s a
biological brain disease.” “The absence of cases
outside North America “proves DID is a
North American artifact.” So we’ve accumulated
lots of cases from outside
North America, so that one’s kind of
starting to drop off now. But let’s just say it–
well, it was a fact, if we go back 30 years,
25 years. There’s a lot more
cases being diagnosed in North America than
outside North America. So what does
that prove? Well, there’s two competing
hypotheses to explain it. So I’m talking
about DID here, but I’m actually illustrating
kind of the logic of how the mental health
system works, and what arguments are,
and how you prove things and disprove
things, and… which could be
applied to all kinds of different
disorders. So the two competing
hypotheses are– well, it’s just being diagnosed
more often in North America because the clinicians
have become aware of it in North America, and everybody
else hasn’t got up to speed yet. That’s one hypothesis– and it’s
a real, legitimate disorder, and if we do research
in other countries, we’ll find lots of DID
all over the place. The second
hypothesis is… it’s just a hysterical
fad kicked up by these crazy
therapists… one of whom is me. And that’s why it doesn’t
occur outside of North America, because they aren’t
as hysterical in the rest
of the world. So the fact that in the ’80s,
DID was being diagnosed a lot more inside North
America, was a fact. But it’s equally consistent
with both hypotheses. But the skeptical
people use the fact to prove
their theory. But that’s not
how science works. What you do is you have
an observation, a fact, then you construct a
theory to explain the fact, and then you have to
test your theory to see if it’s
right or not. You don’t just go,
“Well, here’s the fact, “here’s my theory, the
fact proves my theory.” No scientist
operates like that. So what you have to do
is do some research and do some studies
and find out, “Okay, “are there no cases
outside North America? “Yes or no?” So it’s this completely
unscientific kind of intellectual
function. “Increase of diagnoses
of DID in the ’90s “is evidence of its artifactual
nature”– same idea. Also, going back in time,
DID was rarely diagnosed– (mic cuts out) and that proves it’s just
a fad in the 20th century, which is unfortunately
persisting into the
21st century. But it’s the same
two theories. It’s always been around, going
back for thousands of years, we just haven’t gotten
up to speed on it until… into the
20th century, versus, “no, we’ve created
a fad in the 20th century.” So the fact that
there’s more cases diagnosed 1980 to ’90 than all
of the 18th and 19th centuries doesn’t prove which
theory is correct. But the skeptics use the fact
to prove their own theory. “Skeptics make appeals
to authority.” So appeal to
authority is… “Oh, by the way, I know this is
true, because Freud said so.” So you just– “Freud, you
can’t argue with Freud.” That’s an appeal
to authority. Or if you’re a philosopher,
“Wittgenstein said so.” Or if you’re an English
literature person, you might say
something about Dickens. So the skeptics prove
that they’re correct by referencing their friends
and their co-authors. Over and over and
over and over and over. So there’s a little
group of guys who belong to the club, and
everybody in the club agrees, therefore the
club is correct. It’s just
not science. Validity can be
inferred from anecdotal short-term treatment
outcome, which I measured– talked about before. So if you find
a couple of cases that did poorly… you can then conclude that
all treatment of all cases of DID is bad
and wrong. You just, you couldn’t say
this about schizophrenia. You know, a couple of
people with schizophrenia came to the hospital and they
got some sort of crazy treatment and they did badly, therefore
schizophrenia is not real? You just cannot
say that anywhere in the mental
health field. But you can say
it about DID. Bad therapeutic practices
call the validity of DID into
question. Okay, so you go to Mexico
to get Laetrile for cancer and you die at exactly the
same date as you would’ve if you didn’t go to Mexico,
proving that cancer’s not real. It just doesn’t
make any sense. “Diagnostic criteria
for DID are vague, “therefore DID
is not valid.” Okay. That could be true. If it was true, that the
diagnostic criteria are vague. But how are we gonna find
out if the diagnostic criteria are vague? Well, we’ve got to do
inter-rater reliability studies and look at the
Cohen’s kappa. So we actually
have evidence that the criteria for
DID are less vague– like they’re–
the DID– depending on if you wanna
go up or down on the scale, either the criteria
for depression are twice as vague as
the criteria for DID, or the criteria for DID
are half as vague as the depression criteria,
based on the Cohen’s kappas. So why are we saying
that DID is vague when it’s actually
demonstrably much less vague than depression? And what is the– how do you diagnose
substance abuse, according to
the “DSM V”? Well, obviously you’ve
got to take a bunch of some kind
of substances. But you have– all the
wording is things like “clinically significant.” So what’s “clinically
significant”? There’s no number
for that. It’s kind of
a vague term. To be depressed, you have to
be depressed, down, sad, blue, most of the time for
at least two weeks. Yeah, but how much
most of the time? It’s completely
undefined. It’s literally just
“most of the time.” So this is one of
the reasons why the agreement level
is so low. So we’re applying this
argument of vagueness to DID, which applies more
to other diagnoses. “Lack of proven
physiological differences “between alters
invalidates DID.” There’s no proven
physiological difference between any mental disorder
and any other mental disorder. So this applies to
all mental disorders. We don’t have– and this
is according to “DSM V”– we don’t have a blood test,
we don’t have a brain scan, for diagnosing
any “DSM” disorder. “If repression is not
proven, DID is not real.” Did that earlier. “Diagnosis of DID encourages
irresponsible behavior.” It could. It doesn’t in my
treatment programs. I hold people with
DID responsible for all their behavior, and they
get the natural consequences of their behavior just
like anybody without DID. So just because–
you can use DID to go, “Oh, I can’t help it–
little Joey inside did it,” but you don’t
have to. So if we had a rule in the
mental health system that if you’re
depressed, you get half as long
a prison sentence as somebody who’s
not depressed, how many people would be
depressed all the time? Everybody. If we had a rule that
said depressed people get double the sentence,
everybody would be, “I’m not depressed.” So you can totally manipulate
it by the rules of the system. It’s not inherent in the
disorder or the diagnosis. Uh… “They’re really just
borderlines”– went over that. “It’s an artifact
of suggestibility “and highly hypnotizable
individuals.” So this is one of
the common things. You just hypnotize these
people and suggest to them that they have a canary
living in their left ear. All of a sudden,
they have a canary living in their
left ear. It’s a very
chauvinistic, demeaning, belittling view of women,
because most of the people in treatment are women, that
they’re “so impressionable,” you just tell them, “Oh,
you have somebody inside.” “Oh, yes, I have
somebody inside!” I mean, it’s like women don’t
even know their own minds. It’s a very
belittling model. And we actually have
all kinds of research. People with DID who’ve
never been hypnotized don’t really differ in
their symptom profiles from people who
have been hypnotized. “It’s impossible to have
more than one personality “in the same body, therefore
it’s not a real disorder.” Well, of course it’s
impossible to have more than one personality
in the same body. Nobody’s saying there’s
literally different people living in there. And I explain this to
patients all the time. I call it the
“central paradox of DID.” So it took a while
to figure this out. Because if you say
this the wrong way, the person goes, “Oh, you’re
telling me it’s not real? “I’m just making it up,
it’s all in my head? “I might as well go
kill myself right now.” So you’ve gotta be careful
how you deliver it. So it took me a
while to figure out how to state the
central paradox of DID, which is it’s both real and
not real at the same time. And I’ve given this
explanation to hundreds and hundreds of
people with DID. What do I
mean by that? Well, on the one hand, it’s
not literally concretely real. So if we took an
X-ray of your head, we wouldn’t see all these
little skeletons in there. And if there really
were little skeletons running around
inside your brain, your brain would be just all
mashed up and you’d be dead. And nobody goes, “Oh, yeah,
there’s skeletons in there.” Everybody goes, “Oh, that’s
cute– little skeletons.” So nobody debates
the point. So it’s not literally,
concretely true (indistinct) people, personalities
in there. But on the other hand,
it’s completely psychologically true. And very subjectively
compelling. And people really do
open up their closets, and there’s like
three outfits– so this was a… very conservative 39-year-old
married housewife, and there’s like 16-year-old
party girl stuff. She doesn’t
remember buying it. There’s the receipt,
her credit card, sort of like
her signature, and she can’t remember from
2 PM to 4 PM yesterday, because her teenage
alter went shopping. These experiences
actually happen. They’re very
psychologically real. They’re just not
literally real. So this whole thing
about it’s not possible to have more than
one personality is, like, completely
irrelevant. “A few clinicians are
making all the diagnoses.” Uh, that was true… in 1980. It’s not true today. But so what? At one point in time, a
small number of clinicians were making all
the AIDS diagnoses. What does
that prove? There’s people who
see– have clinics every week where
numerous people with cystic fibrosis
come to see them, and there’s other
pediatricians who don’t see any
cases at all. Well, that’s because these guys
specialize in cystic fibrosis. It’s completely
ordinary. It’s unsurprising. Nobody says, “Oh, a few
clinicians are seeing “most of the cases
of this disorder, “therefore
it’s not real.” They just go, “Oh, those
guys specialize in that.” “Incorrect references are
indicative of careless research “in the skeptical
literature.” So the skeptical guys
do a really lousy job on their references. They even get like
the wrong references. Or they quote
a reference supporting a point that doesn’t
even support that point. So just lousy
scholarship. “DID has been created
experimentally, “which proves
it’s not valid.” Hmm… okay. So there’s nothing
worse in medicine than having an animal
model of a disorder. Right? So biological cancer
researchers never want to study
mice that have cancer. Well, of course
they do. These are called
“animal models.” All of medicine is based
on things in test tubes and things in animals
that are a model of the disease in humans, so
we can study how it works, whether it’s the immune system
or arthritis or cancer. So animal models, or experimental models
of something, don’t disprove it. They help us to
study how it works. So nowhere else
in medicine is an experimental
version of the disorder used to invalidate
the disorder. What are the experiments
where people created DID that proves
it’s not valid? It’s so
preposterous. You wouldn’t believe
that this stuff could get in
the literature if it wasn’t in almost all of
the major psychology textbooks as evidence that
DID is not valid. So the experiment is,
you get a whole bunch of undergraduates,
such as you guys. I bring you in. I give you a… little bit of training
for an hour or two about what DID is,
what it looks like. I teach you about child
alter personalities. And then, I ask you to
come back next week and act as if you have
multiple personality, and a little girl comes out
and talks and she’s so cute, and she doesn’t remember what
happened a long time ago. So you do that. The reason you do that is,
you get course credit for it. And this is the proof
that multiple personality can be created
experimentally– literally. They get college
students to act as if they have
multiple personality, after they give them
a little training on how to do
the acting. That’s it. Do any of these people
have multiple personality for another year? Or go to the
counseling center and say, “I can’t remember what
happened yesterday?” None. So what if we got
you guys together and we said, “Okay, I’m gonna
teach you about back pain. “You’re all gonna act like
you’ve got lumbar disc pain, “and you’re gonna
be going, ‘Oh, oh,’ “and you’re gonna ask the
doctor for some painkillers, “and maybe you need to
take a week off of school. “And you can’t hand in
your paper this week.” And so, you all start
going, “Oh, oh, oh.” This proves that disc pain
isn’t a real thing? So teaching people to
fake something temporarily in order to get course
credit tells us nothing about whether the
thing they’re faking actually happens in
the world or not. But it’s– I’m not
kidding, like the majority of undergraduate
psychology textbooks cite these experiments as
compelling, conclusive evidence that DID is a
fake disorder. Which, again, if you did
that with depression, everybody’d just go, “Well,
they’re just faking depression. “They don’t
actually have it. “It stops as soon as
the experiment’s over.”>>What about “BLUEBIRD”? (indistinct).>>This guy’s read too
many of my books here for his own good. So another line of argument,
which I was not gonna get into, but it’s a whole
‘nother half-day talk, is one of my books originally
was called “BLUEBIRD,” but I reissued it
as “The CIA Doctors.” It’s about 15,000 pages
of documents that were declassified in the
’70s, plus a ton of papers from medical journals
from the ’50s and ’60s about CIA mind control
experimentation, all totally documented,
done at major institutions, Ivy league schools. Closest place where MKUltra top
secret experimentation was done to here would be Ionia
State Hospital in Michigan. The experiment there
was five or six military psychiatrists who had severed
in the Vietnam war who were now back working at
the state mental hospital in Michigan, cleared at
top secret by the CIA, knowing it was CIA funding,
were interviewing incarcerated
sex offenders, and giving them barbiturates,
marijuana, and hallucinogens, to see if they could get them
to confess to crimes they’d never been
charged with. That seems a
little dicey. That doesn’t, no, I don’t
think that would exactly pass the proper ethical
review board. You’ve got incarcerated
sex offenders, you’re giving them
street drugs to see if you can get
them to confess to things, and then you’re not going
to bother reporting that to the police
at all. And it’s cleared
at top secret. So these are the documented
types of experiments that were done, including
creating Manchurian candidates, which is artificial
multiple personality, which is the movie “The
Manchurian Candidate.” This is fact,
not fiction, described extensively
in documents, that if you
take somebody, you don’t just
go, “Hey”– it’s the same as creating
a suicide bomber. You don’t just walk up
to somebody on the street and go, “Hey, would you like
to blow yourself up next week?” You’ve gotta recruit them,
you’ve gotta work on them, you’ve gotten soften
them up a little, you’ve gotta give
them some rewards. 72 virgins in heaven–
pretty good reward. Not sure if it’s
a real reward. So to get somebody
to kill themselves, I mean,
it’s a project. You’ve got to have
a susceptible person, and you can’t choose like the
head of the government’s son, and they’ve gotta
be kind of desperate, and they’ve gotta be
kind of adrift in life, and then you’ve
gotta work on them, work on them,
work on them. If you take somebody
such as a marine and you work on them
for a period of months with all kinds of
interrogation techniques and brainwashing
techniques, you can create artificial
multiple personality, and use the person
in the background to go on missions, and
the person out front doesn’t remember,
and this is described in great detail
in documents going back to the
second World War. So what I do with
that is, I say, “That proves the
reality of civilian “clinical multiple
personality.” If you control somebody,
traumatize them, threaten them,
manipulate them enough, this is how the
human mind reacts. Not in all people. But a sub-group
of people. So if you react
to brainwashing by creating a new
alter personality, why wouldn’t you react
to childhood abuse by creating a new
alter personality? Oh, “DID must be completely
unconscious to be genuine.” I don’t know where these
guys even came up with this. They say that
people like me believe that DID is
totally unconscious. Nobody in the DID field
has ever said that. They just kind of invent
that out of nowhere, and then they
argue that, “Well, “since it’s not completely
unconscious, it’s not genuine.” Which doesn’t make
any sense– I mean, who ever comes in and
says, “I’m here, doctor, “because I’m completely
unconscious “of being depressed.”
(audience chuckling) It just doesn’t
make any sense. Uh, “Satanic ritual abuse
and alien abductions “are not real, so
neither is DID.” Okay, so… wait a minute, what’s that
got to do with anything? Only two or three
people with DID who describe alien
abduction experiences… out of thousands. So… so a few people
with schizophrenia think they were
abducted by aliens, therefore schizophrenia’s
not real? It’s just not– again,
absolutely makes no
sense whatsoever. Satanic ritual abuse–
well, let’s assume that all the Satanic
ritual abuse memories, which is a sub-group
of people with DID, are not real. Well, okay, so, hello, these
people are psychiatric patients in a mental hospital–
they’re a little mixed up. Who’s surprised
by that? Nobody says, “Oh, these
schizophrenics have delusions, “therefore their
schizophrenia isn’t real.” It just… over and over and over,
this logic just doesn’t
make any sense. And then, the “extreme
case escalation tactic” is just a term
I invented. So they’ll take the most
extreme, out-there case, and use that to be typical of
the entire population of DID. And so they–
they’ll always do that– escalate up to the
extreme situation. So if you go to… I don’t know the
exact percentage, but over three-quarters of
undergrad– (mic cuts out)– or even graduate abnormal
psychology textbooks, you get the
anti-DID approach, and you’ll hear
them talking about the Hillside strangler
case in Los Angeles in the 1970s. Which is a serial killer
who was convicted, who… not 100% for sure, but
probably was faking DID. And that is overwhelming,
powerful evidence that DID is not a
legitimate disorder. One case of one guy
who’s a serial killer– we’re gonna
rely on them? Who tried to get out of
responsibility by faking DID proves what about
everybody else? It’s just so far in outer space,
it’s hard to believe, but it’s in the majority of
abnormal psychology textbooks as powerful evidence
that DID is not real. Textbooks written by,
like, the top professors. This is what
I deal with. Okay, so this is now my favorite
part of the whole thing. So… and so, this book was not
published that long ago. Well, let me skip
that one– sorry. I’ll just– because we’re
a little short on time. Here we are at
my favorite one. So this book was not
published all that long ago. “Sibyl Exposed.” By this woman Debbie Nathan,
who sees herself as a feminist, she’s a journalist. And Shirley Mason was–
is the real person who was in the novel
and the movie, “Sibyl.” So the two big
books and novels before “DSM III”
came out in 1980 where multiple personality
got an official slot, the two big books and movies
were “The Three Faces of Eve” and “Sibyl.” And… Chris Seizmore,
who’s the real Eve from “The Three
Faces of Eve,” I know personally–
amazing woman– has been integrated
since 1975, highly gifted artist,
wonderful person. Has been well
for decades. Shirley Mason, who’s Sibyl,
I never met, and she died. But in this book, this
Debbie Nathan uses the Sibyl case to
establish conclusively that Sibyl really
didn’t have DID– it was just a crazy therapist,
Cornelia Wilbur, which then makes us know
pretty well for sure that all the cases are
ridiculous and not real. But let’s look at
her analysis here. This is all
from her book. So… she’s born in 1923,
died in 1998. She had five sessions
with Dr. Cornelia Wilbur– who I knew, who
is now deceased– in 1945. So five sessions. She functioned well
with no signs of DID from 1945 until she started
seeing her again in 1954. So these are the facts
according to Debbie Nathan. The symptoms of DID began
after the therapy re-started, and were caused by the bad
therapy by Cornelia Wilbur. Okay, but in the book,
Debbie Nathan describes symptoms prior to
first contact with Dr. Wilbur, described to her by many people
in Shirley Mason’s hometown, who she interviewed
directly. Many different
people. Family members and
non-family members. The symptoms from
before first contact included fugue states,
which means going somewhere and not remembering who you
are for a period of time. Blank spells– so clearly
defined chunks of missing time. Spending hours playing with
imaginary companions with names far beyond the age
that this occurs in non-traumatized
children. Pretending to
be Vickie, one of her imaginary
companions at times. Her mother calling
her by the names of alter personalities later
identified in adult therapy. Talking in a high,
childish voice when she was no
longer a child. Numerous symptoms consistent
with somatoform dissociation, which means
psychosomatic symptoms. Going to bars to
drink with men, and not remembering
afterwards, although she hadn’t
consumed that much alcohol. Suddenly going
comatose in public. Suddenly acting dramatically
out of character. All of these
behaviors, described by many
observers in her hometown, going back into her
childhood for years before first contact
with Cornelia Wilbur. Yet, the analysis is
all the DID symptoms were caused by
the therapy. This is a huge…
amount of symptomatology consistent with
pre-existing DID. But then, she goes on to
say that all these symptoms that existed before contact
with Cornelia Wilbur, were caused by
pernicious anemia, a form of anemia. Well, a little
minor problem… pernicious– she never had a
pernicious anemia diagnosis. No doctor ever diagnosed
her with that. It’s just made up
out of nowhere. If the symptoms were caused
by pernicious anemia– which she
didn’t have– why did those symptoms go into
remission from 1945 to 1954? So Debbie Nathan says she
had all these symptoms here before seeing
Cornelia Wilbur, caused by
pernicious anemia, which doesn’t cause
those symptoms anyway and which she
didn’t have. And then, all those symptoms
stop for nine years, although she wasn’t
diagnosed or treated, and pernicious anemia
never goes away, and then they suddenly
started up again and were caused
by Cornelia Wilbur. Like, who’s gonna
believe this? This book gets
published, gets reviewed favorably
all over the places, it’s cited by all
the skeptics. It’ll be in the
psychology textbooks soon. “Debbie Nathan wrote this
compelling analysis.” And the… final nail in the
coffin of DID is that Debbie Nathan
points out that Shirley Mason denied
having MPD herself. Once, in
one letter. Okay, so you treat somebody with
chronic, severe alcoholism, for a long period of time, and
once they write you a letter saying that they don’t
have a drinking problem, that’s it, they clearly don’t
have a drinking problem? (audience laughing) It’s just– again, it’s
just this outer space, Mad Hatter’s
tea party… doesn’t make
any sense. It’s impossible. It’s so far below
any kind of… high school debating clubs
could do way better than this in their level
of scholarship, argument, weighing
the evidence. So then, that raises
the question, “Well, why?” Why is this all going
on in the field? What’s the deal here? Why do all these, like,
high-ranking professors have all this
bad attitude and all these crazy arguments
that make no sense? And my answer is
I don’t know for sure. But I think there’s
multiple sort of factors contributing to this. One is, uh, “My professors
never taught me about that. “I was taught
that it’s rare. “My professors
can’t be wrong. “I can’t be wrong. “It’d be too shameful to admit
that we’ve all been wrong “for all these
decades.” So there’s this sort of egotism,
professional reputation. Another thing is if
it’s actually true, then in the ballpark
of 1 out of 25 inpatients in all the psych hospitals in
the country has undiagnosed DID, and we’re missing
all those cases? That doesn’t make us look like
very sharp diagnosticians. So therefore, we have
to say it’s not real. Another thing is, if there’s
all these people with DID– full DID– plus a whole bunch of
people with kind of half, three-quarters,
a quarter DID, maybe a lot of us are
a little more DID-ish than we would
like to admit to. So maybe, “I don’t
wanna look at them “because I don’t wanna
have to look at myself. “Maybe my behavior’s sometimes
a little inconsistent “and doesn’t exactly mesh
together in a healthy fashion.” Which doesn’t mean
that I have DID. I’m talking
“I” the skeptic. “Maybe I,
the skeptic, “have an unresolved
childhood trauma history “and I don’t want anybody
talking about that stuff.” So therefore… when Colin Ross goes
to the American College of Psychiatrists meeting,
hears a whole hour talk by a top expert on
childhood depression– not a mention of childhood
abuse of any kind once. Then, listens to another
talk about another expert, not a mention of
childhood trauma once. Another talk by
another expert, still no mention
of childhood trauma. Maybe they just don’t
wanna talk about it. Maybe they’re
uncomfortable. Maybe it’s something to do
with personal histories. Next hypothesis. Remember when sexual
abuse was just kind of coming out of
the closet? In 1980, the 3rd edition
of the comprehensive textbook of psychiatry
was published, that I used in my
residency from ’81 to ’85. There’s three volumes, it’s
3,300-and-something pages, two columns each page. Everything you need to know
in psychiatry was in there. Way at the back, after
the important stuff, like depression
and schizophrenia, and drugs, genetics, was a section called
“Topics of Special Interest.” Which really means
irrelevant stuff that we just stuck
in at the end because, you know, gotta be
comprehensive. In there was a short
chapter called “Incest.” In the chapter on incest
was one paragraph talking about how
common incest is, with a reference
to a 1955 study saying it’s one family
out of a million in the United States. Those are the scientific,
academic, medical facts during my training. That’s the level
of denial. Institutional denial. It’s been in place in
psychiatry for a century. It’s actually more than
one family out of 100, not one out
of a million. In this same era,
the mid-’80s, there’s several
surveys where, surprisingly, female
psychiatrists got interested in
childhood sexual abuse, which is mostly, but
not exclusively, girls. It’s about two to three times
as much with girls as with boys. And they did mail-out surveys to
different types of physicians, psychiatrists, psychologists,
and I think in one survey, social workers–
can’t remember for sure. But all different
types of physicians. Have you ever had
sex with somebody who’s currently in
treatment with you? And a bunch of
other questions. They got back– they
described in their article, published in a
leading journal– angry, scrawling, you know,
F bombs and the whole works, from physicians,
swearing at them, accusing of being this,
that, and the other, and not filling out
the questionnaire. And 10% of respondents
said yes– anonymous respondents,
said, “Yes, “I have had sex with somebody
who’s currently in treatment “with me in
my practice.” So 10% admitted. So what do we think
the real rate is? So do we think
there’s pedophiles in the Catholic church? Do we think there’s
any in the Boy Scouts? Do we think there’s any
in the medical profession? Do we think there’s
any in psychiatry? There has to be. There’s pedophiles
everywhere. So part of the whole
deal is pedophiles don’t want anybody
talking about that stuff. Then, the other
part of it is… biological brain
disease model. If the genetics and the
biology of the brain are the big drivers
of mental illness, we can’t allow it to be
true that childhood trauma that’s the
major driver. It’s just
not allowed. So you have to
discredit it. And any diagnoses
that are linked to it, discredit. So to me, that’s what’s
going on in the profession. You look like you
had a question.>>Yeah. Approximately,
what’s the ratio of skeptics to, you know,
clinicians who believe in DID?>>There’s actually
surveys by skeptics, funnily enough, who then
conclude that DID is not valid, should be taken
out of the “DSM,” and in those surveys,
about, uh… it’s a little tricky how
they word the question. So sometimes the
question is, “Should the criteria
be modified?” And the answer is “yes,”
and then they say, “Well, see, it’s
a bogus diagnosis.” Well, hello, the criteria
for schizophrenia just got modified between
“DSM IV” and “DSM V.” So of course we have
to fine-tune stuff, and that
proves nothing. But it comes
out about… bouncing around from
survey to survey, hardcore skeptics are
somewhere between 5% and 15%. Half to two-thirds think
it’s a legitimate disorder, needs more research,
maybe needs some fine-tuning, sometimes questionable. That’s kind of
the ballpark. So, but the very small group
of really vociferous– I mean, they’re like
the jihadists, right? They’re the
anti-DID jihadists. They’re very vocal, very
energized, very active. And have control of undergrad
psychology textbooks, by and large.>>What about the actual lit–
(clearing throat) sorry, the actual
literature? Is there like a lot of
literature– you know, you presented us a
little of the literature you’ve done on
this topic, but is there, like,
a lot of literature that says the opposite
of what you’re saying?>>Well, the literature
that says the opposite just says it, but doesn’t
have any evidence. So these guys, like the guys
who do the experiments to create multiple personality
in college students, they never once describe
interviewing a single person with a clinical
diagnosis of DID. So they do
no treatment, and they don’t even talk
to people to say, “Hey, “tell me about your
experience here.” So it’s totally
armchair quarterbacks, and they don’t have any solid
designed research studies proving any of
their points.>>So there’s not,
I mean, like, actual, empirical
research from their side? It’s mostly just reviews of–
>>Reviews and opinions. And false
reasoning.>>And sometimes, stereotyped
by inaccurate descriptions of what they’re
even rejecting.>>Yeah, right. We were talking
about this before, so the stereotype of
what somebody with DID is supposed
to look like. “So they’re like flamboyantly,
extremely obvious. “They’re right in
your face with it. “They’re claiming no
responsibility for anything. “They’re trying to get all
kinds of special treatment “and privileges. “And there’s no evidence for
any DID before from anywhere.” That’s the stereotype. Which simply is
just not reality. Of course, we know that
everybody from Grand Rapids is actually a Martian
wearing a human costume. Well, we don’t really
have evidence for that, but we know
it’s true. It’s kind of
like that. Anyone else with a
thought, comment, question? About anything in the
mental health field? Or anything to do
with college hockey, that I know a
lot about? (all chuckling) Okay, well, thanks
for listening. Thanks for spending
some time. (applause)

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