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Re: Multiple personalitiesFrom: Anna Meenan, MD (annam@uic.edu)Wed Feb 9 10:02:38 2000
At Tue, 8 Feb 2000, Betsy Hyde wrote: > >This is *not* a joke question. > >We have a pregnant patient with depression. Oddly, though, some of us >thought she was *seriously* depressed and suicidal (has a plan...insulin >overdose as soon as the baby is born), while others thought she was just >fine....and that the rest of us were just plain old over-reacting, or poor >judges of psychiatric conditions. > >Two of us did the good cop-bad cop routine with her husband present, and >were able to get her admitted once due to suicide threats, and it turns out >(after contact with her out-of-state therapist) that she has multiple >personality disorder (not called that these days, but I forget the real DSM >term). She signed out AMA as soon as the mandatory hold had expired. >Unfortunately, the only psych bed was on a detox unit, and she found it >exceedingly scary and unpleasant. Psych was *not* at all helpful. > >Has anyone cared for a woman with multiple personalities? If one of the >personalities is suicidal, but another personality is fine, and there seems >to be no rhyme or reason as to which personality appears on a given day, >what do we do? > >What is the legal/moral/ethical responsibility for caring for someone who >sometimes is suicidal yet refuses admission, and sometimes is fine? (She >tends to call and say that she feels really depressed, and is afraid she'll >kill herself before the baby is born, yet refuses hospitalization. Her >partner won't bring her in.) > >And how do we handle the differing personae? > >-- >Betsy Hyde CNM > Very tricky question and very few answers. I thought I had heard somewhere that the psych folks are beginning to question the existence of MPD again. I could be wrong. I had a patient who was alleged to have MPD once (fortunately she was not pregnant) One of the eeriest experiences I have ever had in medicine was getting a letter from one of her personalities demanding to know why authorization had not been given to send one of the other personalities to a special clinic in Chicago. Took us awhile to figure out who the letter was from and when we did it was very strange. I think all you can do is commit her everytime she threatens suicide and hope the non-suicidal personality can keep tabs on the rest of her. I did read somewhere a long time ago that in a patient with MPD, none of the personalities will ever do anything that is radically opposed to the morals and beliefs of another, but that was a long time ago. By the way, I believe they call it Dissociative Disorder now. Good luck, Anna
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