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described by the authors, and the overwhelming number of therapists do not act as
described. Furthermore, the model for competent trauma treatment does not include the
practices described by the authors (Brown et al., 1997).
Another aspect of the Karlin and Orne description of “recovered memory” therapy deserves
mention. It has become commonplace for false memory advocates in their writings and
courtroom testimony to assume that patients who read books like The Courage to Heal
(Bass &Davis, 1988) become contaminated by suggestions contained in the book and begin
manufacturing false memories accordingly. Indeed, some lawsuits were filed against the
authors of The Courage to Heal on a variety of theories, all of which were unsuccessful
(David v. Jackson, 1994 Mark v. Davis, 1994). What Karlin and Orne do not say, however,
is that books on the other side of the repressed memory controversy that are equally as
opinionated and polemical, such as those by Loftus and Ketcham (1994) and Ofshe and
Watters (1994), which Karlin and Orne cite with favor, must then be considered equally as
suggestive in the opposite direction. Indeed, false memory supporters and lawyers have
been using these books as training manuals for recanters in precisely the same way as the
therapists they criticized for using The Courage to Heal as a training manual for accusers.
The suggestion dynamic, however, works both ways. In each case, the vulnerable patients
are exposed to intensive peer group pressure, they are encouraged to read a distinctly one-
sided propaganda-like literature, there is extensive networking with other patients who are
further along in the indoctrination process, and the patients are bombarded with positive
suggestions from benevolent figures of authority and influence who offer them “abuse
excuses” for their past behavior. Whether practiced by therapist or lawyer, whether in favor
of accusing or recanting, the process of undue influence runs in both directions.
The Iatrogenesis Accusation: Multiple Personality Disorder
The iatrogenic thesis is expanded by Karlin and Orne to include the entire diagnosis of
Multiple Personality Disorder (MPD), now called Dissociative Identity Disorder (DID) in the
DSM-IV. Their thesis is simple: patients are trained by therapists to act the role of a person
with MPD. The MPD condition itself does not exist apart from its creation and shaping by the
suggestions of therapists who believe in it.
It must be stated at the outset that the Karlin and Orne position is not accepted by the
prevailing community of experts. Multiple Personality Disorder has been recognized in
psychiatry for over a century, and has been officially endorsed since 1980 in the DSM-III,
and also in the following two revisions. The DSM is the officially recognized standard binding
on psychologists, psychiatrists, and other mental health healers. While Karlin and Orne have
every right to disagree with the DSM-IV position and lobby for change, it must still be
acknowledged that they do not speak the prevailing accepted viewpoint. If they fail to abide
by the DSM-IV position while it is in force, however, they would be committing malpractice.
Their defense --”We do not believe in that condition” --would be as ludicrous as the
psychiatrist who fails to diagnose schizophrenia because he thinks it does not exist, or the
automobile driver who does not believe in speeding laws and so does not obey them. In
essence, the DSM-IV position is “the law” until reversed or overthrown.
In response to this position, some experts have argued in and out of court that the DSM-IV
is not “the law” and should not be so considered. They argue that the DSM-IV is merely a
consensus political document drafted by self-interested parties as a social convention
carrying no more authority than any other expression of opinion.
Proponents of this “social consensus” view fail to recognize that “the law” itself is a “social
consensus.” While everyone is free vocally to disagree with “the law” and urge changes in it,
this disagreement cannot take the form of disobedience without civil or criminal
consequences. So too for disagreements with the DSM-IV. Minority view proponents may

Cultic Studies Journal, Vol. 14, No. 2, 1997, page 51
strenuously urge revision or repeal of certain sections, but downright disobedience
constitutes a violation of the prevailing standard of care set by that profession.
Perhaps the most foolish argument in the scientific literature that MPD is iatrogenic was
published by Seltzer (1994). He tells a story about a therapist of his acquaintance who had
eight MPD cases and was unable to cure any of them. When Seltzer took over the treatment
by denying the existence of MPD and handling the patients as suffering from other
disorders, all of the patients were cured. Therefore, according to Seltzer, MPD is iatrogenic.
It does not take a rocket scientist to understand that all Seltzer has demonstrated, at best,
is that his friend is a poor therapist. He has proven nothing. The laws of logic make it clear
that it is improper to generalize from eight patients of one therapist to all MPD patients of
all therapists. This glaring error, coupled with the absence of detail and the
misunderstanding of the relevant science, should, at minimum, have been spotted in peer
review.
Karlin and Orne are not this foolish. Quite the contrary. Their article raises exceptionally
important points about the genesis, evolving history, and current understanding of the
MPD/DID diagnosis. As they currently observe, MPD has moved from an exceedingly rare
and relatively simple condition to a current epidemic in terms of the number of people
diagnosed MPD, the number of alters these people possess, the alleged behavior of these
alters, and the etiology of the condition beginning with childhood sexual abuse.
The questions and points raised by Karlin and Orne deserve answers. Unfortunately, the
problem is not that there have been no answers, but rather that there have been too many.
MPD has been a popular subject in the recent literature, and each author has provided an
interesting but differing answer to the questions. Thus, Spanos (1996), consistent with his
views on hypnosis, has argued that MPD is not a mental disorder, it is a social construction
of a role played by a patient in response to cues offered by the therapist and the prevailing
culture. This view is essentially the Karlin and Orne position. Along these same lines,
Aldridge-Morris (1989) adds to the social role theory his additional belief that MPD “is a
culture-bound variant of hysterical psychosis occurring in individuals with high
„hypnotisability‟” (back cover). Hacking (1995) places his solutions in the evolving and
competing paradigms in the memory sciences and in the political struggles to understand
victimization. North, Ryall, Ricci, and Wetzel (1993) began by attempting to sort out the
rampant misinformation surrounding MPD, thereby allowing a presentation of objective
facts. When they did so, they found themselves believing that MPD is a real condition,
though one not properly understood by psychiatry. Saks (1997), in what is the definitive
forensic work on the subject, finds MPD to be real, shows how the courts have dealt with
the cumbersome questions of responsibility, and provides a careful analysis of how the law
should treat MPD cases. Dozens of other authors have provided additional advice on the
psychiatric, social, and legal issues involved (Bliss, 1986 Cohen, Berzoff, &Elin, 1995
Kluft, 1985 Kluft &Fine, 1993 Loewenstein, 1991 Putnam, 1989 Ross, 1989).
While it is easy to simply assert the belief that MPD is iatrogenic, it is far more difficult to
prove or disprove the point. Karlin and Orne, in the few pages devoted to MPD, do not prove
their case. I do not have the available space in this response to disprove it. In fact, certain
points they make seem to me to be quite sound. Their ultimate conclusion, however, that all
cases of MPD are iatrogenic, is not persuasive, and has recently been dismantled by Gleaves
(1996a) in a masterful article articulating, and then refuting, the premises of the iatrogenic
position. In essence, Karlin and Orne make a fundamental mistake in believing that because
someone can be trained to act as if he or she has MPD, then it must be true that all cases of
MPD are the product of therapist suggestion and training. Rather, as Fahy (1988) has
clearly stated, while you can get someone to mimic the symptoms of MPD, you cannot
iatrogenically create the actual disorder itself. Those who truly suffer from MPD, and those
who simulate it by suggestion, score differently on a variety of objective tests. Furthermore,