Response to The New Yorker

by PEM

#3: Critique of the Article

I’m going to start from the approach that this is a one-sided article. I’m not going to present the other side (I have tried to do that above), but rather discuss the ways in which the author is misleading and unfair in presenting her own side. I want to answer a few specific points, and then I want to talk about three particular issues: the author’s use of misleading implication, the harmfulness of child sexual abuse, and feminist issues.

A few specific points: The author takes the closing of dissociative disorder units in hospitals as proof that psychologists and psychiatrists have turned away from the multiple personality diagnosis. Some indeed have turned away because of fear of lawsuits, but the closing of hospital units has to do with decreased insurance coverage for inpatient care. I don’t doubt a study would find similar decreases in hospitalization for other disorders and the closing of specialized units as the total number of hospital patients decreases. Also, Acocella takes as a key piece of evidence that Herbert Spiegel, a therapist who worked briefly with Sybil, claims that Sybil admitted to developing personalities to please her main therapist, Cornelia Wilbur. It seems to me that even if this report is true (Acocella gives no source), it is more likely that Sybil claimed to have faked the others to please Dr. Spiegel out of her own struggle with denial, or that Dr. Spiegel interpreted what he heard according to his own preconceptions. His statement is proof of nothing more than his own point of view.

The thing that bothers me most about the article is that the author implies much more than she can prove. She spends a great deal of time on one example of apparent malpractice by a therapist, which only proves that multiple personality and memories of abuse can be created by improper therapy practice. She presents no evidence that such practices are common. In fact, she names only two therapists who have been successfully sued for such malpractice. The closest she comes to making any kind of case that therapists frequently create multiple personalities is to suggest that the use of hypnosis very easily leads to implanting the therapist’s ideas in the patient. Since many therapists do not use hypnosis, she is forced to argue that this can happen when clients spontaneously go into trance states.

I do not believe that most people are so easily manipulated (if hypnosis worked that well it would be much more popular with people who wanted to loose weight or stop smoking). In any case, her argument has degenerated into something that applies equally to any diagnosis by a therapist—there is no greater reason to throw out multiple personality on those grounds than manic depression or any other diagnosis. (For a scientific critique of the idea that multiple personality is frequently induced by therapists see the journal Dissociation vol. 2, no. 2, 1989.)

The author also argues, by implication, about the effects of childhood sexual abuse. She starts out by saying that therapists cannot prove “that childhood sexual abuse causes any kind of adult psychopathology, let alone M.P.D.” She mentions a recent report (I didn’t know there was one more recent than 1974) that argues that “a majority of victims suffer no extensive harm.” Then she backs off from that, and claims to view this finding with “repugnance.” But despite her supposed repugnance, she clearly implies that sexual abuse is not necessarily harmful, and then she claims that it is paranoid to accuse people who say such things of trying to protect sexual criminals.

At this point in her argument, I very much wish to know what her own experience is that leads her to such strong feelings on these issues. She tells nothing of her own interests and the Notes on Contributors identifies her only as a staff writer for The New Yorker and dance critic for the Wall Street Journal. From my perspective, I’m not surprised that studies can find that sexual abuse is not always harmful. I always remembered some of the sexual abuse I experienced as a child, but for many years I was in denial and believed that it had not done me any harm. I believe that childhood sexual abuse is always seriously harmful (though the harm may be hidden inside or may not show for many years), and I think most people would expect that.

Acocella argues that the popularity of multiple personality was possibly a result of the feminist movement. She suggests that feminism made new opportunities for some women, but others were left behind in difficult lives deprived of traditional sources of protection and self-respect. Those women could gain self-respect and attention by seeing themselves as abuse survivors. This seems to me to be contradicted by the basic pattern of the disorder: persons with multiple personality are actually more likely to lead relatively-successful lives than people with other mental disorders of similar severity.

She also argues that feminists changed the emphasis of the child protection movement from physical abuse to sexual abuse. That may be true; in Rocking the Cradle of Sexual Politics: What Happened When Women Said Incest (Reading, MA: Addison-Wesley Publishing Company, 1994) Louise Armstrong argues that when she helped raise the topic of incest for public discussion she saw incest as a key example of patriarchy: men believed that they had ownership and the right to sexual use of the bodies of their wives and children. However, Armstrong argues that the child protection movement and therapists turned away from feminist analysis and instead chose to focus on women and girls as victims. Armstrong would certainly disagree with Acocella’s argument that feminist and child-protection came together in a belief in recovered-memories (which in any case are almost irrelevant to child protection, which deals in large part with abuse for which there is physical evidence). The understanding of child sexual abuse and its long-term effects is contested between feminists and therapists—the two groups are certainly not in conspiracy with each other.

Acocella argues that multiple personality and recovered memories came into dispute when prominent people began to be accused of child sexual abuse. In that I think she is entirely right. Louise Armstrong points out very effectively that women and children are still not believed; respectable men often win custody of their children even when there is physical evidence of sexual abuse. Society is unwilling to believe that respectable people sexually abuse children, and with managed mental health care making it more and more difficult for survivors to get effective help, the people who want to sweep the whole issue back under the rug seem to be winning. Acocella gives an effective description of the backlash and of how it has scared therapists.

The article ends with a call to pay attention instead to poor children who are physically abused. I assume that Acocella is from a middle class background, so this sounds suspiciously like saying that the focus should be taken off middle class parents and put instead on the poor. Middle class people would very much like to believe that child abuse in any form is a problem that affects “them”, not something that decent people do. But it is not only a problem of the poor, and we must be willing to face the pain in our own midst before we can effectively help others.

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