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Kenneth A. Nakdimen, MD, psychiatrist, on the creative process of normal writers.
Search "name index," "subject index," "theory."
Sat urday, February 7, 20 15
Blog Comment
I am still reading the novel. So, at this point, I can only say two things: First,I
am surprised to find that the narrators sanity is the novels central question.
And that it is a seriously posed question, since the text says that the people
who know him bestfrom his own family and culture, his parents and
girlfriendthink his claim of hearing voices and reading minds is
crazy.Second, if Saleem does not have a psychosis like schizophrenia, but,
rather, has the nonpsychotic condition, multiple personality, then the above
scenario is a very good illustration of why multiple personality is so hard to
diagnose: When the symptoms first arise in childhood, the child soon finds
that disclosing the symptoms causes problems, so the child becomes good at
keeping the symptoms secret.
1.SalmanRushdie.Midnight'sChildren.NewYork,RandomHouse,1981/2006.
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wrong date. Butin my India, Gandhi will continue to die at the wrong time.
Does one error invalidate the entire fabric? Am I so far gone, in my desperate
need for meaning, that Im prepared to distort everythingto re-write the
whole history of my timesToday, in my confusion, I cant judge (1, pp.
189-190).
Thus, the mentality behind the introduction is not the same mentality that is
behind the first-person narration. Had the former been in charge of writing
this novel, the date of Gandhis death would have been, at the very least,
corrected in a re-write, because the background should be very realistic, and
there is no literary necessity, in plotting or characterization, to get the date of
Gandhis death wrong.
I have written in past posts that the unreliable narrator is suggestive of
multiple personality. My argument is even stronger when the narrator
isunnecessarily unreliable, and is in clear violation of the authors own
principles.
1.SalmanRushdie.MidnightsChildren[1981].NewYork,RandomHouseTrade
Paperbacks,2006.
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F riday, February 6 , 2 015
I think, therefore I am, because a person is a thinking being; that is, a being
with consciousness. Thus, more than one consciousness means more than one
being. Co-consciousness means at least two beings who are aware of what each
other thinks. If there is only one body, it is called multiple personality.
Novelists Use Normal Multiple Personality to Write Novels
Prof. Galya Diment is saying that Woolf and Joyce had normal multiple
personality, and that they each used two of their alternate identities as
complementary characters in these novels.
She calls it The Autobiographical Novel of Co-Consciousness. I call it Multiple
Identity Literary Theory.
1.GalyaDiment.TheAutobiographicalNovelofCoConsciousness:Goncharov,
Woolf,andJoyce.UniversityPressofFlorida,1994.
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later time, I talked again with the alternate identity, she remembered both my
conversation with her and my conversation with the regular host identity.
But the alternate identity rejected the idea of multiple personality, because she
felt that she was a person in her own right.
Do novelists occasionally have memory gaps during times when they write, or
in the rest of their life?
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F riday, January 30 , 201 5
name or identify itself. It will answer to the patients regular name in order to
fool the psychiatrist.
Why? Because they didnt make this appointment. They are not the patient.
And they see the psychiatrist as being an ally of the host identity in the doctorpatient relationship. Moreover, they fear that if the psychiatrist knew about
them, he would try to get rid of them, out of loyalty to the host identity, his
patient.
Memory Gaps as Footprints
Therefore, since the psychiatrist will not seeor at least not knowingly see
alternate identities, the key to making this diagnosis is to screen for it by
getting a history of memory gaps. The host identity is usually aware of having
had memory gaps, and will give that history if asked, but only if asked, because
the gaps are nothing new, and the host has always tried to ignore them.
If there is a history of memory gapsand if they have no medical or
neurological causethen the gaps may be periods of time during which
alternate identities have been out. So getting a history of memory gaps is like
finding the footprints of alters, but not the alters themselves.
The MSE and Memory Gaps
Does the traditional MSE interview ask patients if they have a history of
memory gaps? Unfortunately, it does not. It evaluates short-term memory and
long-term memory. It does not ask about memory gaps.
If alcoholism is at issue, the traditional MSE may inquire about alcoholic
blackouts. But it fails to inquire about nonalcoholic dry blackouts.
The Formal Diagnosis
The diagnosis of dissociative identity disorder is not made unless and until the
clinician knowingly meets, and has conversations with, the alternate identities
(Criterion A), and then finds that the host identity has amnesia (memory gaps)
(Criterion B) for those conversations.
However, as explained above, the diagnostic process usually starts with
Criterion B (memory gaps), and eventually leads to Criterion A (alternate
identities).
But I never see that.
When told that a colleague has made the diagnosis of dissociative identity
disorder, most American psychiatrists wonder why, if its real, they never see
it. The reason is that the traditional MSE fails to ask patients if they have a
history of memory gaps.
Except for the rare cases in which alternate identities are overt in the initial
interview, it is only after getting a history of memory gaps, and then finding
out what caused the memory gaps, that a psychiatrist will make this diagnosis.
Most American psychiatrists think that they never see such cases, because
they do not routinely ask their patients if they have a history of memory gaps.
Everyone has trouble remembering things sometimes, but do you ever lose
time, forget important details about yourself, or find evidence that you took
part in events you cannot recall? And in its brief chapter on Dissociative
Disorders, this guide includes dissociative identity disorder.
However, in contradiction to the above, its outline of the Mental Status
Examination includes recent and remote memory, but omits memory gaps.
And in its chapter, A Brief Version of DSM-5covering, the author implies,
the really important disordersit omits dissociative identity disorder (even
though the author, having read DSM-5, should have known that dissociative
identity disorder has a greater prevalence than schizophrenia).
Therefore, the mixed-message of this guide is that the conscientious
psychiatrist should screen for multiple personality by asking a question about
memory gaps, but if the psychiatrist doesn't have time to do everything, and
must focus only on what, in the authors opinion, is really important, then
screening for dissociative identity disorder can be omitted.
In short, even when American psychiatrists are taught how to screen for
dissociative identity disorder, they are told not to bother.
In conclusion, to make the MSE capable of screening for dissociative
identity disorder, its evaluation of memory must include memory gaps. This
would require the addition of one word to the outline of the MSE taught to
psychiatrists:
Traditional MSE
Memory: short-term, long-term
Revised MSE
Memory: short-term, long-term, gaps
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Wednes day, January 28, 20 15
1.MichaelReder(Editor).ConversationswithSalmanRushdie.Jackson,University
PressofMississippi,2000.
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F riday, January 23 , 201 5
Elena Ferrante (post #2): The FirstPerson Narrator of Her First Novel
Has Multiple Personality
At the beginning of the novel, Delias mother, Amalia, has recently committed
suicide by drowning. The end of the novel is as follows:
I dug in my purse and took out my identification cardWith a penI drew
around my own features my mothers hairI was Amalia (1, p. 139).
Delias switch to an Amalia alternate personality is not an acute grief reaction.
The whole novel is about how this has been going on since Delia was a child.
But I still had the impression of not being alone. I was being spied upon, not
by that Amalia of months before who now was dead but by me coming out on
the landing to see myself sitting there (1, p. 24).
Delia is prone to dissociative trance states (not unusual in people with
multiple personality): I fell into a torpor crowded with imagesin my waking
sleepI had dreamed it that way countless times with my eyes open, as I did
now yet again (1, pp. 30-31).
By then I knew that in that image of fantasy there was a secret that could not
be revealed, not because one part of me didnt know how to get to it but
because, if I did, the other part would have refused to name it and would have
driven me out 1, p. 35).
When I came to myself, I felt drained, depressed by the sensation of being
humiliated in front of the part of myself that watched over every possible
yielding to the other (1, p. 37).
1.ElenaFerrante.TroublingLove[1992].TranslatedfromtheItalianbyAnn
Goldstein.NewYork,EuropaEditions,2006.
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Wednes day, January 21, 20 15
then expanding them to great, round, mirror-like pools. The joy I felt at this
success was almost terrifying and was accompanied by a shudder at the
mystery of man (1, pp. 10-12).
NOTE: The reason I quote this about controlling his pupils is that some people
with multiple personality appear to have alternate personalities who differ
from each other in visual acuity, and this might be caused by alters' differing
from each other in pupillary contraction.
My basic attitude toward the world and society can only be called
inconsistentThere was, for example, an idea that occasionally preoccupied
meIt was the idea of interchangeability (1, p. 224).
The rest of the novel is about his exchange of identities with someone.
In conclusion, I cant say with certainty that Felix Krull is about multiple
personality or that this would mean that Thomas Mann had multiple
personality. But I think that the above is sufficient to raise the possibility.
1.ThomasMann.ConfessionsofFelixKrull,ConfidenceMan.Translatedfromthe
GermanbyDenverLindley.NewYork,AlfredA.Knopf,1955.
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F riday, January 16 , 201 5
are the stuff of the soulI do not think of the soul as unitary, as an essence, as
one single thing, or even as a thing at all. It does not denote an unchanging
core of personal identity. One person, one soul, may have many facets and
speak with many tongues (1, p. 6).
The soul was the last bastion of thought free of scientific scrutiny (1, p. 208).
in the latter part of the nineteenth centuryMemorybecame a scientific
key to the soul, so that by investigating memory (to find out the facts) one
would conquer the spiritual domain of the soul and replace it by a surrogate,
knowledge about memorySubsequently, what would previously have been
debates on the moral and spiritual plane took place at the level of factual
knowledge (1, p. 198).
Regarding multiple personality, Hacking would include himself among the
less arrogant and more reflective doubtersThey accept that the patient has
produced this version of herself: a narrative that includes dramatic events, a
causal story of the formation of alters [alternate personalities], and an account
of the relationships between the alters. That is a self-consciousness; that is a
soul. [Reasonable] doubters accept it as a realityNevertheless, they fear that
multiple personality therapy leads to a false consciousness. Not in the blatant
sense that the apparent memories of early abuse are necessarily wrong or
distortedthey may be true enough. No, there is the sense that the end
product is a thoroughly crafted personThat is a deeply moral judgment (1,
pp. 266-267).
Hacking says that, in most cases, the patient, not the therapist, has produced
the multiple personality narrative. The condition really occurs. But he suspects
that cultural beliefs and therapeutic practices have a major impact on the
patients narrative.
The reason he thinks so is that he has never diagnosed, treated, or even
interviewed people who have multiple personality. As he says, The whole field
of multiple personality is ripe for participant observationBut that is a task
for others. I have scrupulously limited myself to matters of public record (1,
p. 7).
Even though Professor Hacking is honest, and acknowledges that he has never
been a participant observer of multiple personality, I dont think that that fact
registers with most readers. For who could believe that a nonfiction book
about an observable matter would be written by someone who had never
observed it?
1.IanHacking.RewritingtheSoul:MultiplePersonalityandtheSciencesof
Memory.PrincetonUniversityPress,1995.
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Monday, January 12, 20 15
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