Personality, personality "theory" and dissociative identity disorder: what behavior analysis can contribute and clarify.
Behavior analytic accounts of Dissociative Identity Disorder, formerly known as Multiple Personality Disorder, are rarely presented in depth. This lack of recognition is due to misunderstanding the applicability of the behavior analytic position on personality, abnormality, and related issues. Arguments are made here that a behavioral analysis of Dissociative Identity Disorder demystifies and clarifies these behaviors. Behavior analysts can communicate to a wider audience by addressing more phenomena of a clinical and popular interest.
In Phelps (2000) an argument was made that behavior analysis has more relevance to personality and especially "multiple personality" than is commonly presented. Some of the arguments of Phelps are reiterated here and expanded upon.
When behavior analytic accounts of personality or abnormal behavior are introduced, the discussion is usually brief, with references to faulty learning, inadvertent conditioning experience or aberrant behavior models. The brevity is to be valued; it shows the behavior analyst's hesitation to speculate in the absence of data as to how a particular behavior was acquired (Thompson & Williams, 1985). Further, behavioral theorists are reluctant to attribute explanatory or causal status to mental or intrapsychic or other variables inherent to the individual as a cause of the individual's behavior (Skinner, 1974). Nevertheless, this hesitation to speculate has led many writers to conclude that since behavior analysts have little to say or they say the same things repeatedly about different behaviors, behavior analytic contributions are irrelevant (Phelps, 2000). On the other hand, psychoanalytic, humanistic and cognitive theorists can also be accused of saying the same things about very different behaviors. A proposal is made here to re-evaluate behavioral accounts of personality and their relation to Multiple Personality Disorder (American Psychiatric Association, 1987), now called Dissociative Identity Disorder or DID (American Psychiatric Association, 1994).
WHAT IS PERSONALITY IN BEHAVIORAL TERMS?
In 1937, Gordon Alport catalogued some 50 definitions of personality. Little has changed except there are now more definitions and theories of personality; most refer to internal or intrapsychic variables that in vaguely defined ways cause a person's behavior but do not refer to personality as being behavior (Hayes, Follette, & Follette, 1995; Pronko, 1988). Conversely, few behavioral theorists have written extensively about or defined the behaviors of personality (Phelps, 2000). Since personality is behavior, other writings are pertinent without specifically addressing personality or granting privileged status to personality. Behavioral theory is personality theory. For instance, Skinner (1953) argued that personalities represent "topographical subdivisions of behavior" and that a particular personality was "tied to a particular type of occasion ... a given discriminative stimulus," (p. 285). Some twenty years later, Skinner echoed his prior position: "a self or personality is at best a repertoire of behavior imparted by an organized set of contingencies." (Skinner, 1974, p. 149). In their extensive treatment of personality and learning, Dollard & Miller (1950) stated that "Human behavior is learned ... We also learn fears, guilt, and other socially acquired motivations ... factors which are characteristic of normal personality," (p. 25.) Correspondingly, Eysenck (1959) stated his position on personality as being, "personality as the sum total of actual or potential behaviour patterns of the person, as determined by heredity and environment," (as quoted in Chesser, 1976, p. 291). Bijou & Baer (1966) saw personality as the acquisition and effects of contingencies between "social reinforcement for social behavior, under social SDs," (p. 721). In 1984, Harzem interpreted a personality (characteristic) as being "a cluster of functional relations between (1) a set of variables and (2) the already-established behavior patterns of an individual," (p. 39 1). In his own behavioral system, Staats (1993) gave a definition of personality as, "personality is composed of specifiable, learned behaviors," (p. 10).
Interbehavioral theorists have defined personality as Kantor (1924) wrote, "we cannot consider personality to be anything more than the individual's particular series of reaction systems to specific stimuli," (p. 75). In comparable terms, Pronko (1980) defined personality as "the total series of a given individual's interactions with the relevant stimulus objects," (p. 201). In consonant papers, Keller & Schoenfeld (1950) and Kohlenberg & Tsai (1991) addressed the term "self" much as others above defined personality. Keller & Schoenfeld described the self as "a word that is meant to designate the ability to speak of (be 'aware' of) one's own behavior, or the ability to use one's own behavior as the SD for further behavior, verbal or otherwise," (p. 369) and "the 'Self,' in short is the person, his body and behavior and characteristic interactions with the environment, taken as the discriminative objects of his own verbal behavior," (p. 369). Kohlenberg & Tsai discussed self from the perspective of the individual, as one who reports self-observations of their specific personality, "the experience of the self lies in specification of the stimuli controlling the verbal response 'I'," (p. 128-129). Lastly, Hayes (1984) and Hayes, Kohlenberg, & Melancon (1989) discussed how our verbal environment shapes our behavior into having a sense of self or to experience our environment (seeing, feeling, hearing, etc.) from a distinct perspective of "you" (Phelps, 2000).
Here, these theorists argued that the people composing our social milieu refer to us with the term "you" used in different ways; on some occasions, you is used to refer merely to us as a physical body, as a person may say to us, "I saw you bleeding in the emergency room,"; in other circumstances, our verbal environment shapes our behavior and models for us to see ourselves seeing from our own perspective, i.e., from a perspective of you, where seeing refers to experiencing and interacting with the world (feeling, hearing, moving, etc.). Now consider the following question from different perspectives, "If you lost your arms and legs, would you still be you?" (Hayes, 1984. p. 103). From the perspective of one as mere physical body, or "My body is me," the answer would be no. The answer, from the outlook of the individual with a perspective of you is yes; you could still envision yourself seeing yourself as you. That is, our verbal environment teaches us a general tendency to respond to our own observations of our own behavior verbally and give us "a sense of self" or to acquire and have self-knowledge as a result.
The commonalties in these behavioral definitions are obvious. Personality consists of behavior-environment contingencies, being subject to control and modification by the environment. Further, personality or the self cannot be given explanatory or causal status for other behaviors, except as part of a behavioral chain or as discriminative stimuli for further behavior. Instead, the terms personality and self are behaviors in need of explanation and identification of their causal variables, (Skinner, 1974). Finally, each of these definitions points to personality as being highly consistent yet still malleable, within limits imposed by the environment and the individual's heredity. Pronko stated: "everything is in a state of flux; so is personality. An inventory of one's personality would stop only with the death of the individual." (Pronko,1980, p. 201). Our personality repertoires are stable and variable as a function of historical or present environmental events; the concept of any individual having "multiple personalities" is implicit in behavioral definitions of personality, (Kantor, 1924; Skinner, 1953). Skinner (1957, 1989) also discussed different repertoires of personality or self observable either by other individuals or the person so behaving, traceable to environmental contingencies. Although amongst the definitions cited here only Eysenck explicitly acknowledges the role of genetic variables, other behavioral writers do not dismiss hereditary factors as being a distal yet functional variable in determining behavior (Skinner, 1974). Some readers may not agree with including Eysenck as being a behavioral theorist but Eysenck's definition of personality describes personality as behavior.
Other "behavioral" writers that have addressed personality have seemed reluctant to define personality in precise behavioral terms but instead have proposed that personality is a product or output of a complex interaction of internal (but not necessarily genetic) and external variables (Bandera, 1999; Mischel and Shoda, 1999).
In contrast to the behavioral views of personality, the spectrum of conventional "personality theories" approaches the subject matter as though it were something we can only speculate about, as if we were studying exobiology. This loose speculation leads to the multitude of personality theories and a field that hardly seems to have human behavior as its referent. Perhaps someday a new specialty in psychology will emerge as the investigation of "Theories of Personality Theory" to study and perhaps rationalize the proliferation of personality theories.
WHAT IS MULTIPLE PERSONALITY?
The behavior pattern commonly known as Multiple Personality Disorder but now called Dissociative Identity Disorder (American Psychiatric Association, 1994) might be considered only a recent phenomenon. This behavior, however, was described in every DSM system since its inception (American Psychiatric Association, 1952, 1968, 1980, 1987, 1994); in addition, Flournoy (1900) described similar behaviors at the turn of the century. With a liberal interpretation, the self-report of the Biblical demoniac in Mark resembles those of multiple personalities: "my name is legion, for we are many," indicating that these behaviors are possibly ancient.
The diagnostic literature shows the definition of multiple personality as changing markedly over the editions of the Diagnostic and Statistical Manual of Mental Disorders. In the DSM-I, these behaviors were termed Dissociative reaction, (American Psychiatric Association, 1952), which came to be called Hysterical neurosis, dissociative type in the DSM-II (American Psychiatric Association, 1968). In each of these, multiple personality was not viewed as a discrete disorder but was grouped with somnambulism, amnesia, and fugue states. Only in the DSM-III does Multiple Personality Disorder appear as a separate diagnostic category, with a description of this behavior. This disorder's defining features were proposed being "the existence within the individual of two or more distinct personalities, each of which is dominant at a particular time," (American Psychiatric Association, 1980, p. 257). The DSM-IIIR of 1987 gave nearly identical defining features as "the existence within the individual of two or more distinct personalities or personality states," (American Psychiatric Association, 1987, p. 269). The defining features evolved further in the DSM-IV where this behavior pattern came to be termed Dissociative Identity Disorder. Its features became, "the presence of two or more distinct identities or personality states that recurrently take control of behavior," (American Psychiatric Association, 1994, p. 484). Both the 1980 and the 1994 definition bear close resemblance to defining features of individuals with behavioral repertoires referred to as "mediums," "channelers" and "psychics," (Hines, 1988; Spanos, 1994). In these latter three categories however, the differential personality repertoires, the differential self-report, and the differential remembering are under the control of more obvious public discriminative antecedents.
The subtle change in the 1994 definition is notable; distinct personalities were no longer seen as existing within the person or as a part of the person, but the behaviors displayed different states or conditions. This definition is less organismic or person-centered and more behavioral-environmental in theory than earlier versions. With the reader's indulgence, the personality is behavior with variations or as "topographical subdivisions of behavior, occasioned by discriminative stimuli and controlled by reinforcement contingencies." A person whose behavior is consonant with this diagnostic label displays a personality showing more variability than that of the "average or normal" individual; the individual lacking one coherent personality displays a personality repertoire which is very divergent, with large variation in the contingencies between antecedents and responses. The antecedents, i.e., people, places, events, etc., of the individual in question occasion more responses of an idiosyncratic nature which are maintained by reinforcement contingencies singular to that individual. Along this approach, one writer took the new definition to mean that the individual displaying these behaviors could no longer be described as having more than one personality. Instead, the person should be viewed as having less than one whole, coherent personality (Sapulsky, 1995). Likewise Kohlenberg & Tsai (1991) reported that such individuals might not have acquired all the characteristics of a stable, singular personality.
HOW COMMON ARE THESE BEHAVIORS?
The frequency of multiple personality has been debated over time. While some descriptions of these behaviors occurred early in the 20th century, but from the 1920s to the early 1970s, there was a marked deficit of cases (Spanos, 1994). Kohlenberg (1973) termed these behaviors as being "relatively rare" as did Caddy (1985); other reports saw it as very numerous in number late in the last century. For instance there were more cases reported from the mid1970s to the mid-1980s than in the previous two hundred years (Orne, Dinges, & Orne, 1984). Curiously, the substantial increase in reported cases has occurred almost exclusively in North America. This behavior pattern is rarely diagnosed in the United Kingdom, France, and Russia; no case has ever been reported in Japan (Spanos). In North America, the bulk of reported diagnoses is made by a small minority of professionals. Most professionals go through an entire career and rarely if ever see such behaviors, (Mersky, 1992; Modestin, 1992; Spanos).
The dramatic increase in the reported numbers of cases has been attributed to differing factors. Possibly, cases which were un-diagnosed in previous decades are now being diagnosed due to greater vigilance for these behaviors; it has also been proposed that the label is being applied (and over-diagnosed) to individuals whose behaviors are readily suggestible (American Psychiatric Association, 1994). One can reasonably conclude that the prevalence of Dissociative Identity Disorder was disputed in the late 20th century and still is disputed. Some readers may also dispute the validity of this diagnosis as the DSM-IV, unlike earlier versions of the DSM, does not provide any diagnostic reliability information, (American Psychiatric Association, 1994). Hopefully the up-coming DSM-V will clarify the situation.
WHAT CAUSES THESE BEHAVIORS?
Theories attempting to characterize and explain these behaviors are as diverse as the paradigms that propose them. Psychoanalytical theory argued these behaviors as being motivational, motivated and driven by a defective or inadequate identification with the same-sex parent and the abrupt loss of a substitute model (Horton & Miller, 1972; Sackheim & Devanand, 1991). Bowers et al. (1971) argued that a sense of self-loathing and self-alienation leads to the development of multiple personality. Dissociation has also tentatively been attributed to extreme self-hypnosis (Bliss, 1980, 1984; Hilgard, 1977) and neurological aberrations or epileptic postictal activity (Gur, 1982; Schenk & Bear, 1981).
HOW DOES BEHAVIORAL THEORY ACCOUNT FOR THESE BEHAVIORS?
While Skinner (1953) had suggested we all might display multiple personalities, Kohlenberg (1973) first proposed a learning theory account for multiple personality (Phelps, 2000). It can be argued and observed that each of us has differing amounts of variance in our personality repertoires to the point that a common question may arise: "How many personalities do we actually have?" The question isn't how many personalities do we have, but how many behavioral repertoires are each of us capable of performing or exhibiting?
Viewing personality this way, it is obvious that we all execute multiple personalities, with differing grades of behavioral excesses and deficits, beyond what is "normal." These behavioral variations are due to our unique histories of differential stimulus control, reinforcement and punishment contingencies and observational learning experiences (Phelps, 2000). That is to say, we may behave very differently in a lecture hall than when in a church, synagogue or mosque. Any individual no doubt behaves very differently when with one's mother than when with friends at a convention. Despite the variability, an observer would still see "It's still Joe" or that there was enough stability or generalization in Joe's personalities across all contexts for Joe to be recognized as the same person.
THE CONTROL OF SELF-REPORT
Conversely, with the behaviors labeled Dissociative Identity Disorder (DID), the variability between behavioral repertoires is very high, possibly so extreme that the repertoires don't compose one consistent personality repertoire (Sapulsky, 1995). The person him- or herself may even report being a different person, complete with a different name or "identity." While the behavioral variability is more extreme here, it is still on a continuum with the average person. We all exhibit several personality repertoires and there are obvious circumstances of threats of extreme punishment or the potential for deprived reinforcements under which any person might claim to be a different person (Sackheim & Devanand, 1991). Among the behaviors correlated with a diagnosis of DID, self-report is less controlled by public, environmental events and more controlled by events which are private to the person giving the self-report (Kohlenberg & Tsai, 1991; Phelps, 2000). The most apparent question is, what type of experiences could account for this extreme behavioral variability, in the self-report of being a different person, with differences in sex, age, race, physical appearance, etc,?
Commonly, these individuals frequently report having suffered drastic neglect or abuse during their childhood (American Psychiatric Association 1994; Murray, 1994). Reports of a history of childhood abuse are no doubt seen as the defining feature of DID in the minds of many clinicians, as individuals with DID-like behaviors may also display post-traumatic symptoms (American Psychiatric Association, 1994). These reports don't enlighten much since child abuse and neglect sadly isn't rare but the prevalence of these behaviors, while in dispute (American Psychiatric Association, 1994) isn't nearly as common as abuse. Some of these remembered reports of abuse have been considered suspect since the individuals exhibiting these behaviors give highly variable self-reports of their histories. It has also been argued that some of these reports of abuse may have been suggested and prompted by overzealous therapists (Spanos, 1994).
In relating variations in self-observations and self-reports to the consequences delivered by others, the behavior analyst sees a straightforward connection and interaction. Much self-observation and resultant self-report comes from experiences with, observations of, and inquiries from others (Skinner, 1974). Conceptually, a person with behavior so labeled has had learning experiences that resulted in extreme behavioral variance as well as self-reports of their behaviors. The behavioral variances aren't as clearly related to obvious public events, however, as they are in the person who does not exhibit the behaviors labeled as being DID (Kohlenberg & Tsai, 1991).
Kohlenberg & Tsai argued that any individual has the experience of "being someone else," typically as part of a child's imaginary play and these behaviors can be occasioned and reinforced and or punished by the social environment. Having different aspects of one's self or "being someone else," accompanied by different subjective states of remembering and emotion, because of so behaving, can become a very adaptive behavior under some specific circumstances. When experiencing repeated physical or emotional punishment, being somebody else could provide means of escape or avoidance when no other means of escape or avoidance is attainable (Kohlenberg & Tsai, 1991). The child cannot be unaware of the horrible happenings, but the child can come to be unaware that the aversive events are happening to them. By "being someone else" who needn't remember the trauma, the child can distance him or herself from the abuse and still maintain some coarse approximation of a normal emotional relationship with the abuser. From the perspective of the abused person, "My daddy does nasty things to that other little girl, but only because she is so naughty, but my dad loves me and has never done anything bad to me."
The culmination is an individual who never acquires a complete personality, self, or an experience of being one coherent "I" controlled by both public and private events. Instead, the individual who experienced the history of abuse has more than one personality repertoire, primarily controlled by private events (Kohlenberg & Tsai, 1991). On the other hand, during more normal acquisition of personality repertoires, an individual will increasingly engage in being the same person, with these behaviors occasioned and maintained by public and private events; being someone else does not have significant adaptive value.
Besides engaging in different personalities, another aspect of the extreme behavioral variance in this disorder is that of amnesia, or an inability to remember beyond what is considered average (American Psychiatric Association, 1994). In other words, besides extreme variability in behavior and self-report of identity, the self-reports of experiences the person has had also varies widely (Coons, 1994). When exhibiting some personalities, the person reports a history of abuse but not necessarily all the present circumstances. When another behavioral repertoire is exhibited, past abuse may not be reported but the present is reported clearly. It is this behavior that intrigues many. Clinicians and the lay public alike seem to want to know "Is it all in there?" That is, are all the memories and experiences stored somewhere in the mind or brain of this person?
From the behavior analytic point of view, remembering (or failing to remember) is a behavior, more or less likely to occur as a function of its antecedents and consequences (Grant, 1982; Grant & Barnet, 1991; Phelps & Cheney, 1996; Skinner, 1974); storage and accessibility are replaced with probability of remembering. With that clarified, one could say that some or most real experiences can be remembered (potentially) and reported; to remember we must arrange the environment to increase the probability that we will behave in the future as we are now behaving (Phelps & Cheney; Skinner, 1989). But in the cases of individuals with the behaviors of DID, the person is reluctant or unable to remember or report some experiences until that person is in a different situation or the reinforcement contingencies change. Then, the person may change personality repertoires and can remember and report different experiences.
The vivid and lucid imagery of the past that is reported by these persons when displaying differential personalities corresponds with Skinner's "conditioned seeing" (Skinner, 1953). A person may come to see stimulus Z, not just when Z is in fact present, but also when other stimuli that have frequently accompanied Z are present. That is, if I can remember and reinstate the emotional behaviors of my past, I can come to see and hear aspects of my past. If I do not remember how I felt in the past, I am less likely to see, hear or otherwise re-experience the past again (Phelps, 2000). Hallucinations in our remembering like other hallucinations are highly context dependent (Hobson, 1994).
This differential remembering/reporting is also on a continuum in degree, not in kind, from the average person's behavior. We all remember, or fail to remember, as a function of discriminative stimuli. These discriminative stimuli, some of which are self-generated in our verbal behavior, and the reinforcement and punishment contingencies in effect at a given time, enable our remembering behavior. Environmental stimuli guide or prompt remembering just as stimuli guide or facilitate other behaviors (Donahoe & Palmer, 1994; Grant, 1982; Grant & Barnet, 1991; Phelps & Cheney, 1996; Skinner, 1974). But these individuals show behavioral variance in remembering and personality in response to highly specific and subtle stimuli, probably more in response to covert behaviors called moods, thoughts, etc., than the average person. This difference in controlling factors of these persons' verbal behavior is the key to conceptualizing these behaviors (Kohlenberg & Tsai, 1991; Phelps, 2000).
SELF-OBSERVATION AND CONTROLLING EVENTS
To this point, some of the typical behaviors labeled as DID have been described in behavior analytic terms. While a complete account of the behaviors conceptualized under the DID label is not likely, a reasonable accounting of most of these behaviors can be framed, using established behavioral processes.
To pursue this further, the variance in self-report of identity and experience by individuals whose behaviors have been labeled as DID may be based disproportionately on inaccurate self-observations made without seeking verification from the social environment. Simply put, such individuals may attend more to their own observations expressed and reiterated in their own verbal behavior and less upon the observations and reports of others. That is to say, when in Rome and unsure of what to do, persons with DID-like behaviors may not attend to or imitate the behavior of other Romans as models. Instead, these persons may arrive at an inflexible self-produced verbal governance (Fine, 1992) by which to behave or they may attempt to engage in what they judge to be appropriate behavior by observing their own behavior without using social comparisons. Keller & Schoenfeld (1950) described the person as having "the ability to use one's own behavior as the SD for further behavior, verbal or otherwise" (p. 369); here, the person uses their own behavior as a discriminative event to a greater extent than the normal individual.
Since abnormality is defined by its context, and since we are frequently less adept at self-observation than we are at observing the behavior of others (Skinner, 1974), this in and of itself could lead to aberrant behavior. But individuals with DID-like behaviors persist in their self-observations and reports, even in the face of contradicting evidence from others. They claim to be different persons when in fact there is only one and the same person (or body) present. These individuals have dissociated their self-observations and resulting reports from the reports of others. As a result, they have observations that are not as controlled by the public environment but are instead a function of their own distorted verbal governances (Fine, 1992).
Such inaccurate self-observations may be under the control of reinforcement contingencies other than those exerted by other individuals. In the past, the person with the now present DID-like behaviors learned to attend to and rely more heavily upon his own observations of how he felt, what he needed, whether he was "good" or "bad," etc. (Fine, 1992; Keller & Schoenfeld, 1950). This behavior may have either been due to neglect and abuse, both of which were possibly delivered without regard to what the child did. The behavior might also have been present before the abuse but only emerged as adaptive responses while experiencing the abuse (Kohlenberg & Tsai, 1991).
EMOTIONAL BEHAVIORS AND CONTROLLING CONTINGENCIES
During abuse, emotional outbursts such as crying and responses to pain, which were originally respondent behaviors (Fordyce, 1976; Rachlin, 1985; Turk & Rudy, 1990), caused still more abuse and therefore came under control of avoidance and escape contingencies (Kohlenberg & Tsai, 1991). Pain-inflicted crying led to more pain being inflicted. Crying, smiling, and other emotional displays, which were originally respondents, could come to be under the control of operant contingencies, in an attempt to avoid further punishment. In addition, the care giver's abuse may have been erratic and difficult to predict but was still the focus of attempts by the abused person to predict and avoid further abuse. As a result, the abuse victim may have come to exhibit behaviors and emotions capriciously and histrionically; at other times, virtually no affect would be exhibited. These attempts at self-control from the erratic stimulus events and contingencies were probably not often successful in avoiding or escaping abuse. The person being abused could never learn to predict what events produced or avoided abuse or reinforcement (love) and increasingly would come to attend to him- or herself since other individuals provided unreliable antecedent events as occasions for how to behave.
In the present, however, the former victim has potentially "heightened" operant control of emotions and personality behaviors when confronted with uncertainty or stimulus conditions reminiscent of the past. These individuals are often very skilled at altering their personality repertoires to control others (Spanos, 1994). Kohlenberg & Tsai (1991) reported that these individuals are vigilant and actively attentive to the therapist's discriminative stimuli as to what behaviors will be reinforced or punished. At the same time, different personalities may be displayed with no obvious change in any public, environmental stimuli.
Some writers report that this disorder may only become apparent to a professional or others when "different people" attend meetings, interviews, or therapy; that is, the same individual attends but with a different self-report of identity, memories, and personality behaviors (Sackheim & Devanand, 1991). In so doing, individuals displaying these behaviors can receive a great deal of reinforcing attention from professionals for engaging in these behaviors. Individuals demonstrating behaviors correlated with a diagnosis of DID may be reassured of no further abuse and may be encouraged to try to "be themselves" in as many ways as they "need" to be. The different self-reports and personality repertoires become a source of reinforcement for the formerly abused victims and the professional alike (Spanos, 1994). The risk here is that the verbal repertoires of a person with degrees of behavioral variability could be shaped iatrogenically to reporting to be a divergent person by professionals zealously looking for this disorder (Fahy, 1988; Merskey, 1992). To quote one skeptical critic, "the procedures used to diagnose MPD often create rather than discover multiplicity," (Spanos, p. 153).
DIFFERENTIAL "INTELLIGENCE" AND PHYSICAL SYMPTOMS
This behavior pattern has been conceptualized as being largely a difference in verbal behavior, but other differences are reported to exist and are marshaled as evidence for this disorder. That is, the individuals who exhibit these behaviors are reported to be different in intelligence and pharmaceutical needs, and have different corrective prescriptions for vision, allergies, and so on (American Psychiatric Association, 1994). Some of these reported differences are explainable in the analysis presented here. For instance, a person's intelligence quotient score consists of his ability to answer specific types of questions and his attempts to perform some nonverbal tasks. Some of these are a person's verbal behaviors (Staats, 1963), in that the person, when displaying some personalities, does not "know as much" as when executing other personalities. The person simply answers fewer questions correctly when performing Bob's repertoire than when performing the personality repertoire of Jose. In terms of nonverbal tasks, "I can't figure this one out" or "I don't know what to do here" can end the trial, just as performing slower or faster can alter the score. The score is taken as a measure of intelligence when all that are being measured are test-taking skills (Staats, 1993) which are largely self-reports. The reported differences in corrective lenses are explainable by differential self-report but the differences in medical conditions may be more difficult to explain.
Pain complaints, paralysis, blindness, etc., also consist of a self-report of a private event. Each of these may be accompanied by publicly observable behaviors such as wincing, reluctantly moving, reporting or appearing to be unable to move or see (Fordyce, 1976; Skinner, 1974). Both the self-reports and the public display of these differences are under stimulus control of the different personality repertoires. When such an individual displays a specific personality, the self-report of pain or other symptom comes or goes with the other behaviors. Originally, the public signs of pain were authentic afflictions in the past as the result of abuse; months or years later, such indications could be self-produced, rule-governed behavior as part of the personality repertoire. These pains and related behaviors could be reinforced and shaped into a "real" affliction by well meaning others as the verbal behavior acquired differential stimulus control of operant pain behavior. The reports of pain and the display of pain-related behaviors can persist as operant behavior maintained by its consequences in the absence of the original painful stimuli (Bonica & Chapman, 1986; Fordyce, 1976; Rachlin, 1985).
As for the reports in the literature of allergic and other responses being present in some personalities and not in others, these too can potentially be accounted for via verbal behavior mechanisms. There are reports that individuals can develop rashes, a wound or a burn or other physiological symptoms in response to another's verbal suggestions, i.e., under hypnosis (Barker, 2001), although it has been argued that many of these symptoms are likely self-inflicted when observers are not present (Johnson, 1989). Verified reports of hypnotically-induced dermatological changes are difficult to substantiate; such effects are difficult to produce and are not as common an occurrence as often reported (Johnson). These reports are not all due to the acts of the person showing the symptoms; instead, these symptoms may be due to an interaction of verbal behavior and conditioning mechanisms, (Barker). Verbal behavior can also facilitate the development of stimulus control via respondent or operant conditioning (Skinner, 1957). If an experimenter were to flash a light in your eyes and then shock you, then you would be expected to recoil to the light after some number of such pairings. If the experimenter were to explain the contingency between the light and the shock, it would be expected for you to recoil to the light after fewer trials (Wilson, 1968). Such instructions are " ... not intended to change the subject's beliefs about what events are to occur, but about the contingency between them" (Boakes, 1989, p. 385).
Relating this to the differential report and display of symptoms is not a big leap. Here, the individuals who display the divergent personalities have self-instructed and subsequently conditioned themselves to display symptoms when performing different behavioral repertories. Over time, the symptoms may come under the stimulus control of the emotions displayed, in addition to the person's verbal behavior, and appear spontaneous to the person him- or herself. To support the argument for conditioning mechanisms producing somatic symptoms, biofeedback has successfully been applied to treat autonomic dysfunctions as diverse as dysmenorrhea and seizure activity (Adler & Adler, 1989), hypertension (Dubbert, 1995), and psoriasis (Goodman, 1994), among others.
HOW SHOULD THERAPY ADDRESS THESE BEHAVIORS?
From the foregoing arguments, therapeutic interventions for persons displaying the behaviors labeled as DID must consist of extinguishing a reasonable share of the behavioral variability in the personality repertoire and reinforcing behavioral stability and generalization; literally, to shape one personality. In an ABA research design, Kohlenberg (1973) reported increasing the frequency of specific behaviors composing one personality of an individual who exhibited DID-like behaviors by differential reinforcement of that personality repertoire. Upon returning to baseline and extinction, these behaviors returned to baseline levels.
Other techniques would involve the client role-playing and rehearsing social interactions and experiencing some situations expected to elicit and occasion "normal" emotional behaviors. Price and Hess (1979) reported success at "reintegrating" the personalities in a dual personality individual by teaching assertiveness skills via role-playing. Caddy (1985) also used assertiveness training and shaping in "reintegration" of a varied personality repertoire. The therapist might videotape the client as they behave, to use for feedback and in shaping and instructing more "cohesive" behavior. Therapy could also dictate a means of teaching the client to engage in more "social-referencing," or seeking public feedback in more instances of what is acceptable behavior. Whereas you or I might ask, "Did you see (or hear) something?" when we are unsure of seeing or hearing, individuals whose behaviors are consistent with the label of DID may have to learn to ask, "Am I still behaving as me?" The therapist could not completely answer this question but family members and significant others could. This process would have to continue until the person reports being the same individual with the same experiences, and has less observable variability in their personal repertoire.
Even if a therapist were to try to pursue such an intervention (most would probably not), this process could be drawn-out and arduous, due to the multiple sources of control that would require intervention. This could possibly sabotage the efforts by those who, with the best of intentions, attend to and reinforce the personality variability. Based on this account, control of the behaviors in this pattern would be difficult for anyone to establish. Even the therapist who occasions and reinforces the variance is not exerting control unless unpredictable behavior is the target behavior. As a result, these individuals likely have been in therapy for years and will continue to seek and need therapy for years to come (American Psychiatric Association, 1994).
This paper has attempted to apply a behavioral analysis to Dissociative Identity Disorder. Why should anyone conclude that a behavioral analysis of this disorder offers any more than other theoretical positions? Behavioral theory treats personality as behavior and identifies the known environmental variables that determine these behaviors. Behavioral theory is personality theory, without granting unnecessary, special status to the behaviors of personality. Other paradigms either reject personality as behavior or attribute causation to inaccessible, internal, and often poorly defined variables (Bliss, 1980, 1984; Bowers et al., 197 1; Gur, 1982; Hilgard, 1977; Horton & Miller, 1972; Schenk & Bear, 1981). The same operant variables that occasion and control personality no doubt have a role in Dissociative Identity Disorder. As an alternative to the "ill-defined" variables criticized above, behavioral theory would argue that the person's verbal behavior (overt and covert) and the bases for the person's relevant verbal behavior, as well as their self-observations are variables to be functionally analyzed and manipulated in understanding the behaviors labeled DID. No claim is being made here that the person's verbal behavior is the functional variable behind dissociative behaviors. As Beck stated, "To conclude that cognitions cause depression is analogous to asserting that delusions cause schizophrenia," (Beck, 199 1, p. 37 1). A person's verbal behavior can play multiple roles in interacting with other behaviors, as antecedent stimuli, as concurrent behavior, or as stimuli that have acquired reinforcing or aversive properties, (Skinner, 1957), or as functional variables that either "complement" or override control by other operant contingencies (Catania, Matthews, & Shimoff, 1982, 1990).
Unless a reader is willing to look at the evidence for the effectiveness of behavior analysis, the arguments made here are moot. Some readers, behavioral or otherwise, may consider any discussion of these behaviors to be a waste of time or even an indulgence in "pop psychology" since they don't really "exist". However, the behaviors labeled as DID receive a great deal of attention from the lay public and in clinical training programs. Therefore, behavior analysts should take the time to explain their analysis of these behaviors; after all, Skinner (1945) spent considerable time analyzing psychological terms, as did Dollard and Miller (1950). It is not however, productive to discuss this behavior pattern as a unique instance of behavior as it is merely an instance of behavioral variability.
While behavior analysts are hesitant to address this and similar behavior problems, other explanations are being widely read. Behavior analysts have important but unrecognized arguments to contribute to the discussion.
Author's Note: I would like to thank Carl Cheney and Charles Lyons for their helpful comments on an earlier draft of this paper. Request
for reprints should be sent to the author at the Dept of Psychology, South Dakota State University, Brookings, SD 57007 or at Bradyjhelps@sdstate.edu.
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Brady J. Phelps
South Dakota State University
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|Author:||Phelps, Brady J.|
|Publication:||The Behavior Analyst Today|
|Date:||Sep 22, 2001|
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