There’s been documentation of it for decades, even strictly in professional contexts. Why is it so common for doctors to not believe in dissociation, nonetheless dissociative disorders?
Huh, not that it comes up often but there are doctors who don’t. One of my kids has this issue and they’ve always seemed receptive
I’venever run into a doctor that doesn’t. I’m not saying they don’t exist, I just can’t say it’s rare that they do
You may have run into either a locality based thing, or are misinterpreting exactly what it is they don’t believe.
See, the tiktokization of such things has made a massive problem. You have people faking shit, exaggerating shit, self diagnosing, spreading inaccurate information as fact, and outright trying to scam people with any of the above.
I use tiktok as the example because it got so much worse when it spread there. It turned into a nigh epidemic of people just saying they have a dissociative disorder, even without any ill intent, but not having even consulted a professional, much less gone through diagnosis. And, strangely, they’re all magically unresponsive to treatment. Which is bullshit, they aren’t even under care.
They then form their personas around it, performatively, start feedback loops with other people doing the same thing, and then try to complain about doctors not believing them, despite never having never been to one, or just not liking being told that they don’t fit the diagnostic criteria.
And there is a criteria. It’s not perfect, as psychology and psychiatry aren’t easy to research. It’s an ongoing, young science. But a lot of the people thinking they have a dissociative disorder just don’t. They have some other issue for sure, but reject that possibility because they’ve wrapped themselves up in the idea of it. Then there’s the fakers that for whatever reason have latched onto the idea.
So you get doctors saying that it’s bullshit, because it is. But that doesn’t mean they don’t believe the disorders exist, just that it’s rare and the people you see online practically bragging about it are full of shit. It looks like they’re rejecting the idea, when it’s rejecting the fad of it.
I know this is a problem, but this isn’t so much what I’m referring to. Specifically, I have one friend who very obviously suffers from dissociation, and I’ve had to help advocate for her because she is so often dismissed despite being a pretty much textbook case trying get treatment through all the correct routes, as well as two different psych profs I’ve had, one who said a lot of people didn’t believe in dissociative disorders, and another who directly said that dissociative disorders don’t have any evidence.
Well, I think the issue is one of scale and semantics.
Your post asked about the subject matter in a broad sense, using the keyword “rare”.
My comment was based on that, and I gotta say that your response here actually makes my comment more relevant, not less. What you’re describing isn’t a rarity, it’s a small sample group. You can’t call something rare in a colloquial context and only point to a local experience, with limited numbers of examples. Well, you can, but you gotta expect responses to include broader perspectives.
The sample group you used is tiny. It doesn’t reflect standards of care, or the general professions of psychology and psychiatry.
I would also say that, without seeing the records of the patient in question, your opinion (and mine) of the validity of the diagnoses given is pointless. We don’t know if those practitioners do or don’t believe in dissociative disorders, only that they didn’t diagnose it in this case.
Secondary to that, neither you or I are qualified to make a diagnosis at all, much less based solely on what you’ve observed of the patient. You say you’ve observed memory loss, blackouts, and that the patient is still mobile and speaking during the events. That isn’t definitive of dissociative disorders. It is a symptom of multiple possible issues, and most of those have to be ruled out as much as anything being ruled in.
In a different comment, you listed a handful of diagnoses, which can present with the same kind of blackouts. Won’t always, but neither do the various dissociative disorders.
Now, I will also say that patients in general, and women in specific get dismissed way more commonly than is acceptable. It could well be that that’s leading to a misdiagnosis, if that’s what this is. I’ve dealt with that for myself, for loved ones, and as an advocate for my own patients back in the day.
Dissociative disorders absolutely exist, btw. Whether or not they should be called that based on what happens internally is worth some debate. It’s also worth debating what the criteria for diagnosis of them should be, if the underlying causation is not what could be called dissociation. The dissociation could well be a symptom of something else rather than a disorder of its own, and thus need to be called something else. It could be closer to panic disorder rather than something like schizophrenia, in other words.
For that purpose, schizophrenia is the diagnosis or the underlying function of the brain. Panic disorder is a maladaptation caused by other things, rather than the actual cause of the panic attacks a person has.
What is your particular understanding of “dissociation”, as in the specific signs and symptoms you see in your friend?
No one serious disagrees about the literal existence of dissociative behaviors (i.e. “checking out” for reasons both physiological and psychological), but plenty of people disagree about the phenomenology + clinical nature of DID and related DSM constructs.
Basically, periods where they just black out for a while and then have little recollection of what happened. Its obvious enough that even others unfamiliar with mental health have commented on it. It also seems to come with a change in personality, not as in pop-culture multiple personalities, but more like she forgets key experiences, or certain feelings. For example, being out and having a good day, then out of nowhere, being despondent and while she might be able to robotically list off the events of the day, she can’t conjure any of the related emotions. Before she learned that it wasn’t just a normal chronic depression thing, she described it as feeling like “the sunken place” from Get Out, watching herself doing stuff. Watching it happen as a friend, its like she’s possessed. An overly-religious person in her life literally tried to perform an exorcism on her (which would be really funny, if it weren’t so sad). Even in terms of background, she has more than enough trauma to raise a ton of red flags for things like BPD, DID, PTSD, CPTSD, etc. but all of that has largely been ignored. Like I said, pretty obvious and textbook case for something like that, but its mostly just been dismissed, usually as ADHD or bipolar.
Edit: and to be clear, all of these symptoms have been present for decades, well before either of us was much aware of mental health as a topic, nonetheless dissociative disorders and their modern romanticization.
Yeah, that’s pretty textbook.
Outside of the usual semantic arguments about what constitutes a primary diagnosis, I can’t see a good reason why that would get so much pushback (sexism aside).
What was the argument for prof #2?
Also, a lot of doctors don’t follow up on any symptoms they don’t directly witness or have tests for.
It was brought up briefly in a discussion on diagnosis criteria, but there wasn’t much beyond that and there wasn’t really much follow up, since no one wants to be the one to start an argument with the person marking their papers.
Just bad doctors. I’ve met many whose careers are based on treating these disorders (or symptom of a disorder)
When it comes to doctors, they generally only know their own specialty, and even then within specialties you will have disagreement or poorly trained professionals. And also, this is just a personal bias, I wouldn’t expect any doctor to hold any modern opinion about psychological conditions. You need to see a psychologist for that.
I think “believe” is maybe the wrong word. I’ve dealt with a few medical professionals and I’ve come to the conclusion that they are mostly just like you and me, unsure of what’s going on, but armed with more helpful niche knowledge and the pretense they know everything. They have come up through a process of learning that leans heavily on the scientific method. Shit needs to be verifiable. That is not to say that none of them act on hunches. But these are mostly hunches they have a body of experience for. Many psychological conditions are hard to diagnose. They can’t check the liver stats or x-ray the ankle as an indicator. They also know mental care is underfunded and understaffed in most places. So I don’t think it’s a question of believing these conditions exist, it’s more about weighing a lot of these factors in their heads and the result of that may be that fewer cases get recognised.
Ask them what kind of anaesthetic Ketamine is
Delicious and a key part of this healthy breakfast.
