There is a divide in opinion about multiple personality disorder or dissociative identity disorder – when one person has different personalities that assert themselves at different times. That divide is whether MPD or DID really exists. Prominent real world cases such as described in Flora Rheta Schreiber’s 1973 book Sybil have been alleged to be hoaxes.
Among those who do believe in MPD/DID, integration of the personalities is the recommended treatment. A similar solution seems needed for mental health and substance use disorder treatment models.
President Donald J. Trump has created a cabinet position of assistant secretary of mental health and substance use, and nominated a “czar” (or, since the nominee is female, I guess it’s a czarina). The nomination has been controversial, and not for the usual reasons.
Usually when Trump nominates someone, they either appear to be unqualified – their area of expertise has been in another field, such as surgeon Dr. Ben Carson named secretary of Housing and Urban Development – or they have an arguable animus for their department – Rick Perry campaigned on eliminating the Department of Energy he now heads.
Elinore McCance-Katz is a psychiatrist – not a Scientologist or a member of some other group that doesn’t believe in psychotherapy – and she has the support of the American Psychiatric Association (APA) and the National Alliance on Mental Illness (NAMI). So, what’s the problem?
McCance-Katz is thought – by her critics at least – to favor “meds and beds,” that is medicating and hospitalizing people with mental illnesses, more than giving them “psychosocial supports” and leaving them out in the community with care by family and friends.
McCance-Katz is experienced in treating opioid abuse and other drug addictions, in which finding beds is a major problem. If even half of the addicts sought substance use disorder treatment at the same time, we’d find there weren’t enough beds for half of those seeking treatment. For other types of mental illness, that may not be the primary concern.
It’s not an either-or situation however. Substance use disorder and other mental illnesses usually have two causes: biological and psychological. Treating one isn’t enough. In fact. most addicts have both substance use disorder and mental health problems, called dual diagnosis or co-occurring disorders.
Anyone who’s been assaulted, verbally or physically, by a released patient with mental illness who is “off his meds” is less sympathetic to said patient’s right to roam the street and live in a cardboard box. Anyone who has a parent with dementia wishes it were easier to get her help, even if against her will.
With an aging and opioid-addicted population, rather than squabbling, mental health and substance use disorder treatment professionals need to work together.
