[thelettere]

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

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

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

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

[EdwardDiego]

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

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

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

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

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

[thelettere]

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

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

[PaulDavisThe1st]

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

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

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

[thelettere]

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

[PaulDavisThe1st]

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

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

[pksebben]

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

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

[ralusek]

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

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

[pnathan]

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

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

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

[majkinetor]

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

The same goes for vampires.

[thelettere]

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

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

[Someone]

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

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

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

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

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

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

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

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

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

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

[thelettere]

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

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

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

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

Edit: grammar.