Dissociative identity disorder (multiple personality) is increasingly diagnosed, often follows ch... more Dissociative identity disorder (multiple personality) is increasingly diagnosed, often follows childhood trauma, and is characterized by rigidification of phenomena that resemble hypnosis. To interpret dissociated aspects of selfhood as autonomous entities is a useful heuristic; but when taken too literally, it leads to three kinds of anomaly: (1) legal: dissociators remain culpable for misdeeds carried out beyond apparent awareness or control; (2) clinical: legitimization sometimes leads not to relief, but to escalating cycles of regressive dependency; and (3) scientific: the form of dissociated entities varies with how they are defined, in ways that are intrinsically motivated and clinically manipulable. These anomalies yield to an evolutionary perspective that views dissociative identity disorder as an evolved strategy of adaptive deception of self and others; e.g., a beaten subordinate avoids further retribution by "pleading illness." Such a deceit best avoids detection when fully experienced; through its intensity and persistence, it becomes real at a new level. One's basic competencies remain intact, however, and are the source of the anomalies described. They can be clinically accessed and empowered, providing the key to therapeutic change when dissociative processes are problematic. Overall, despite clear impairment in subjective awareness and volition, dissociative-disordered individuals are best held fully accountable for the consequences of their actions.
Reframing is being tested as a potentially viable way to address intractable conflict where sacre... more Reframing is being tested as a potentially viable way to address intractable conflict where sacred values are at issue. In memory of Johan Verhulst, MD.
The journal of the American Academy of Psychiatry and the Law, 1999
Psychological trauma heightens and rigidifies the penchant of humans for dichotomizing others int... more Psychological trauma heightens and rigidifies the penchant of humans for dichotomizing others into allies and enemies. With today's "adult delayed recall" controversy a case in point, traumatized individuals tend to unite into tightly knit in-groups that resemble cults and to denigrate others as enemies. This process creates new enmities where objective interests otherwise clash only minimally. The trauma response is reinforced by the neurobiology of avoidance and reenactment. Among all protagonists, polarized beliefs are mutually shaped by suggestive interactions that resemble hypnosis. The end result is to reenact and perpetuate the trauma response on a large scale. In the contemporary milieu, this process presents a formidable obstacle to cooperative problem solving. Discussion focuses on strategies by which clinical and forensic psychiatrists can help to master this obstacle. These strategies include balancing interests, extending the role of informed consent, and ...
Dissociative identity disorder (multiple personality) is increasingly diagnosed, often follows ch... more Dissociative identity disorder (multiple personality) is increasingly diagnosed, often follows childhood trauma. and is characterized bv riqidification of phenomena that resemble hypnosis. To inteipret dissociated aspeck of selfhood as autonomous entities is a useful heuristic; but when taken too literally, it leads to three kinds of anomaly: (1) legal: dissociators remain culpable for misdeeds carried out beyond apparent awareness or control; (2) clinical: legitimization sometimes leads not to relief, but to escalating cycles of regressive dependency; and (3) scientific: the form of dissociated entities varies with how they are defined, in ways that are intrinsically motivated and clinically manipulable. These anomalies yield to an evolutionary perspective that views dissociative identity disorder as an evolved strategy of adaptive deception of self and others; e.g., a beaten subordinate avoids further retribution by "pleading illness. " Such a deceit best avoids detectio...
Hypnosis" denotes either specific phenomena (altered volition, perception, cognition, and recall)... more Hypnosis" denotes either specific phenomena (altered volition, perception, cognition, and recall) or interpersonal transactions that often elicit them. Basic research leads to paradox: hypnosis is validated, and shown to be dissociative in essence, at the same time that neither its phenomena nor transactions can be separated from those of everyday living without logical absurdity. This paradox can be resolved by assuming that consciousness and volition are complex, occurring simultaneously at many levels in the same waking individual. Hypnotic-like phenomena and transactions occur spontaneously, in either covert or overt forms. The former are pervasive, whereas the latter are often associated with psychological trauma. Forensic implications are twofold: for criminal responsibility, and the reliability of eyewitness testimony. Hypnotic-like states and transactions are rarely affirmed as an insanity defense because at some level these subjects are aware of what they are doing and why. Diminished capacity and mitigation of sentence are more appropriate defense strategies. Several conflicted traditions of case law have evolved to protect eyewitness testimony from hypnotic-like distortions in cognition, perception, and memory that can occur either during or outside of formal hypnotic procedures. These include the admissibility of posthypnotic testimony, due process safeguards at eyewitness identification procedures, and the admissibility of expert testimony on the findings of eyewitness research. These areas are inseparable from one another and demand a systematic coordinated approach.
Effective treatment decisions sometimes require substantial risk of short-term harm, which can be... more Effective treatment decisions sometimes require substantial risk of short-term harm, which can be shown after-the-fact to have been preventable, thereby carrying some liability risk. To err on the side of short-term comfort or safety, however, may greatly increase the overall and long-term risks. For instance, to intrusively restrain a borderline patient from threatened acting out, may (1) fuel a regressive cycle that heightens future risk, (2) deprive the clinician of therapeutic leverage, and/or (3) so disrupt the treatment system that other patients unnecessarily suffer. Long-term thinking is not always convincing to judge or juror, because of less direct causal connections; hence, there is pressing need to develop rational criteria for when it should hold sway. Two competing trends of legal doctrine are relevant: risk-benefit analysis (utilitarian) and absolute values (absolutist). Presumptions of appropriate short-term risk separately weigh five relevant factors, in interaction...
Criminal justice is inextricably associated with the attributive concept of volition. Although th... more Criminal justice is inextricably associated with the attributive concept of volition. Although the voluntary-involuntary distinction is subjectively vivid, causal research shows its poles to be inseparable, i.e., the dichotomy is deceptive. Why a bulwark of civilization should be founded on paradox, may be clarified by examining the role of self-deception in man's evolutionary heritage. Natural selection for an optimal degree of self-deception probably occurred, both to facilitate deception of others and to foster human cooperation. This contributed to the evolution of psychiatric disorders, the voluntary-involuntary continuum, and large scale social systems. Society and its members reach an equilibrium within the truth-deception continuum, manifest in individuals by conscious versus unconscious and voluntary versus involuntary, and in society by tension between what actually occurs (realism) and its organizing ideals (idealism). Three legal models of criminal justice are under...
... formulations absurd. This is not to debunk the validity or value of a rigorous scientific app... more ... formulations absurd. This is not to debunk the validity or value of a rigorous scientific approach, nor to promote or rationalize undisciplined cultism by removing the grounding that a scientific orthodoxy can provide. By carefully ...
Psychiatric practice involves an implied contract in which each party fulfills a specialized role... more Psychiatric practice involves an implied contract in which each party fulfills a specialized role and incurs corresponding duties and obligations to be discharged as best able. Patients incur duties at three levels. First are specific duties that arise from patients ' specialized role in their own health care: (1) to provide accurate and complete information, and (2) to cooperate with treatment within the bounds of informed consent. Second are general duties that apply to all citizens, but are especially relevant within the mental health context: (1) to respect the physical integrity of self, others, and property, and (2) to obey the law. The controversial "duty to protect " is at a third level, a transcendent duty that is specific to the context at hand, but in principle can apply to more than one party. Advantages of enforcing patients ' duties include better care by treating professionals, optimum level of functioning of patients, and improved systems-wide mor...
Dissociative identity disorder (multiple personality) is increasingly diagnosed, often follows ch... more Dissociative identity disorder (multiple personality) is increasingly diagnosed, often follows childhood trauma, and is characterized by rigidification of phenomena that resemble hypnosis. To interpret dissociated aspects of selfhood as autonomous entities is a useful heuristic; but when taken too literally, it leads to three kinds of anomaly: (1) legal: dissociators remain culpable for misdeeds carried out beyond apparent awareness or control; (2) clinical: legitimization sometimes leads not to relief, but to escalating cycles of regressive dependency; and (3) scientific: the form of dissociated entities varies with how they are defined, in ways that are intrinsically motivated and clinically manipulable. These anomalies yield to an evolutionary perspective that views dissociative identity disorder as an evolved strategy of adaptive deception of self and others; e.g., a beaten subordinate avoids further retribution by "pleading illness." Such a deceit best avoids detection when fully experienced; through its intensity and persistence, it becomes real at a new level. One's basic competencies remain intact, however, and are the source of the anomalies described. They can be clinically accessed and empowered, providing the key to therapeutic change when dissociative processes are problematic. Overall, despite clear impairment in subjective awareness and volition, dissociative-disordered individuals are best held fully accountable for the consequences of their actions.
Reframing is being tested as a potentially viable way to address intractable conflict where sacre... more Reframing is being tested as a potentially viable way to address intractable conflict where sacred values are at issue. In memory of Johan Verhulst, MD.
The journal of the American Academy of Psychiatry and the Law, 1999
Psychological trauma heightens and rigidifies the penchant of humans for dichotomizing others int... more Psychological trauma heightens and rigidifies the penchant of humans for dichotomizing others into allies and enemies. With today's "adult delayed recall" controversy a case in point, traumatized individuals tend to unite into tightly knit in-groups that resemble cults and to denigrate others as enemies. This process creates new enmities where objective interests otherwise clash only minimally. The trauma response is reinforced by the neurobiology of avoidance and reenactment. Among all protagonists, polarized beliefs are mutually shaped by suggestive interactions that resemble hypnosis. The end result is to reenact and perpetuate the trauma response on a large scale. In the contemporary milieu, this process presents a formidable obstacle to cooperative problem solving. Discussion focuses on strategies by which clinical and forensic psychiatrists can help to master this obstacle. These strategies include balancing interests, extending the role of informed consent, and ...
Dissociative identity disorder (multiple personality) is increasingly diagnosed, often follows ch... more Dissociative identity disorder (multiple personality) is increasingly diagnosed, often follows childhood trauma. and is characterized bv riqidification of phenomena that resemble hypnosis. To inteipret dissociated aspeck of selfhood as autonomous entities is a useful heuristic; but when taken too literally, it leads to three kinds of anomaly: (1) legal: dissociators remain culpable for misdeeds carried out beyond apparent awareness or control; (2) clinical: legitimization sometimes leads not to relief, but to escalating cycles of regressive dependency; and (3) scientific: the form of dissociated entities varies with how they are defined, in ways that are intrinsically motivated and clinically manipulable. These anomalies yield to an evolutionary perspective that views dissociative identity disorder as an evolved strategy of adaptive deception of self and others; e.g., a beaten subordinate avoids further retribution by "pleading illness. " Such a deceit best avoids detectio...
Hypnosis" denotes either specific phenomena (altered volition, perception, cognition, and recall)... more Hypnosis" denotes either specific phenomena (altered volition, perception, cognition, and recall) or interpersonal transactions that often elicit them. Basic research leads to paradox: hypnosis is validated, and shown to be dissociative in essence, at the same time that neither its phenomena nor transactions can be separated from those of everyday living without logical absurdity. This paradox can be resolved by assuming that consciousness and volition are complex, occurring simultaneously at many levels in the same waking individual. Hypnotic-like phenomena and transactions occur spontaneously, in either covert or overt forms. The former are pervasive, whereas the latter are often associated with psychological trauma. Forensic implications are twofold: for criminal responsibility, and the reliability of eyewitness testimony. Hypnotic-like states and transactions are rarely affirmed as an insanity defense because at some level these subjects are aware of what they are doing and why. Diminished capacity and mitigation of sentence are more appropriate defense strategies. Several conflicted traditions of case law have evolved to protect eyewitness testimony from hypnotic-like distortions in cognition, perception, and memory that can occur either during or outside of formal hypnotic procedures. These include the admissibility of posthypnotic testimony, due process safeguards at eyewitness identification procedures, and the admissibility of expert testimony on the findings of eyewitness research. These areas are inseparable from one another and demand a systematic coordinated approach.
Effective treatment decisions sometimes require substantial risk of short-term harm, which can be... more Effective treatment decisions sometimes require substantial risk of short-term harm, which can be shown after-the-fact to have been preventable, thereby carrying some liability risk. To err on the side of short-term comfort or safety, however, may greatly increase the overall and long-term risks. For instance, to intrusively restrain a borderline patient from threatened acting out, may (1) fuel a regressive cycle that heightens future risk, (2) deprive the clinician of therapeutic leverage, and/or (3) so disrupt the treatment system that other patients unnecessarily suffer. Long-term thinking is not always convincing to judge or juror, because of less direct causal connections; hence, there is pressing need to develop rational criteria for when it should hold sway. Two competing trends of legal doctrine are relevant: risk-benefit analysis (utilitarian) and absolute values (absolutist). Presumptions of appropriate short-term risk separately weigh five relevant factors, in interaction...
Criminal justice is inextricably associated with the attributive concept of volition. Although th... more Criminal justice is inextricably associated with the attributive concept of volition. Although the voluntary-involuntary distinction is subjectively vivid, causal research shows its poles to be inseparable, i.e., the dichotomy is deceptive. Why a bulwark of civilization should be founded on paradox, may be clarified by examining the role of self-deception in man's evolutionary heritage. Natural selection for an optimal degree of self-deception probably occurred, both to facilitate deception of others and to foster human cooperation. This contributed to the evolution of psychiatric disorders, the voluntary-involuntary continuum, and large scale social systems. Society and its members reach an equilibrium within the truth-deception continuum, manifest in individuals by conscious versus unconscious and voluntary versus involuntary, and in society by tension between what actually occurs (realism) and its organizing ideals (idealism). Three legal models of criminal justice are under...
... formulations absurd. This is not to debunk the validity or value of a rigorous scientific app... more ... formulations absurd. This is not to debunk the validity or value of a rigorous scientific approach, nor to promote or rationalize undisciplined cultism by removing the grounding that a scientific orthodoxy can provide. By carefully ...
Psychiatric practice involves an implied contract in which each party fulfills a specialized role... more Psychiatric practice involves an implied contract in which each party fulfills a specialized role and incurs corresponding duties and obligations to be discharged as best able. Patients incur duties at three levels. First are specific duties that arise from patients ' specialized role in their own health care: (1) to provide accurate and complete information, and (2) to cooperate with treatment within the bounds of informed consent. Second are general duties that apply to all citizens, but are especially relevant within the mental health context: (1) to respect the physical integrity of self, others, and property, and (2) to obey the law. The controversial "duty to protect " is at a third level, a transcendent duty that is specific to the context at hand, but in principle can apply to more than one party. Advantages of enforcing patients ' duties include better care by treating professionals, optimum level of functioning of patients, and improved systems-wide mor...
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