Eleven characters in search of a therapist

This is an account from a successful US academic who was diagnosed with "dissociative identity disorder" after several years in treatment for depression, alcohol abuse, bulimia and blackouts. The American Psychiatric Association now favours the term "DID" over "multiple personality disorder". Advocates of the controversial diagnosis take it to be a valid description of a discrete form of mental disorder. Patients who inhabit two or more quite separate identities are assumed to be victims of extreme and sustained abuse in early childhood.

The diagnosis disrupts the typical belief that we are continuous, unitary, reflective selves. The flexibility of consciousness claimed here entails more than temporary psychogenic amnesia ("hysterical fugue"), the artistic convenience of the actor's role or the writer's nom de plume . The conventional post-Freudian wisdom describes a single horizontal split between the conscious (containing a unitary ego) and the unconscious, with the superego straddling the two. The DID concept inserts vertical splits, with the defence mechanism of dissociation working overtime. Locked rooms replace an open-plan unconscious. Their prisoners occasionally escape and take control of the bodybefore returning to their respective cells.

Critics of the diagnosis question the authenticity of several hermetically sealed identities ("alters") and argue that DID is a sociocultural artefact of North America. They suggest that alters are collusive products benefiting therapists and patients alike. The rules of the US health insurance industry encourage professional approval of the diagnosis.

Hollywood and the tabloid press crave the abject and the bizarre. Some apprehended criminals have been afflicted by DID. Prevalence is a by-product of therapist records. Validating epidemiology from large non-clinical populations is noticeably absent.

Plunging straight into the mire of these criticisms, Robert Oxnam explains that until he was in his forties, he did not know that he had the disorder; it was discovered by his therapist. Throughout his therapeutic narrative, Oxnam is coached about the structure and function of DID by his psychiatrist, Jeffrey Smith - Jwho also offers an epilogue to instruct readers and has helped promote the book with Oxnam. In Britain, personal diffidence and ethical doubts would make such a scenario unlikely.

In A Fractured Mind , no fewer than 11 personalities are reported. If Smith is included, the book has a dozen authors. Beneath Robert, the presenting ego or dominant personality, dark and exotic dramas are played out in the tales of the alters. The names of many are variants of the main man ("Young Bob", "Bob", "Robbey"). Childhood had been a blur until they emerged to tell the story. "Baby" reports the terrible physical, sexual and emotional abuse experienced in early life. Robert does not name the perpetrator of these past crimes. He prefers broadcasting his current inner life to holding others to account for his torment. "Tommy" is an angry boy who is punitive at the behest of the "Witch", the introjected and unnamed abuser.

In succession to "Baby", "Bobby" accepted that he was a bad boy. He is in turn a suicidal, creative and impish soul, once locked in an inner castle, but now skating in Central Park in the body of an ageing scholar.

Scholarship characterises another alter, "the librarian", a prim but flirtatious lady who catalogues all the information flowing into Oxnam's mental life.

Internal conversations begin to occur between alters. Eventually, 11 are clustered down to three. Inner strangers are gradually introduced and blend into one another until - voilá! - therapeutic "integration" occurs.

At this point, a reader wonders if this book is non-fiction, fiction or faction. It unintentionally highlights conceptual confusion in the human sciences about, for example, "personality", "identity", "self", "persona", "personhood", "ego state", "habitus" and "character". As for the clinical field, DID may be a product of psychiatry, but so are all its preferred and revisable functional diagnoses.

Whether you are persuaded by the DID concept or baffled by how daft the North American therapy industry can get, fair attention is drawn to the early origins of personal dysfunction. Although DID may be rare or even a collusive fiction, abuse in childhood is not. It is a major contributor to adult misery in all shapes and sizes. DID and the related "false memory syndrome" are discreditable in the eyes of many. Sadly, this book may give comfort to those who minimise the significance of early trauma.

David Pilgrim is visiting professor, department of primary care, Liverpool University, and honorary professor, Lancashire School of Health and Postgraduate Medicine, University of Central Lancashire.