LETTERS
the negative address.
social
attitudes
that
Dr. Prenzlaucr
and
colleagues
REFERENCES
1. Hendin H: Black Suicide. New York, Basic Books, 1969 2. Hendin H: Suicide in America. New York, WW Norton, 1982 3. Schneider SG, Farberow NL, Kricks GN: Suicidal behavior in adolescent and adult gay men. Suicide and Life Threatening Behavior 1989; 4:38 1-394 4. Robins E: The Final Months: A Study ofthe Lives of 134 Persons Who Committed Suicide. New York, Oxford University Press, 1 981 5. Rich CL, Fowler RC, Young D, Biankush M: San Diego Suicide Study: comparison of gay to straight males. Suicide and Life Threatening Behavior 1986; 16:448-457 HERBERT
HENDIN, New
Multiple
Personality
Disorder:
A Factual
York,
M.D. N.Y.
Error
J. Modestin,
M.D.
(1), quoted
our
work
on multiple
personality disorder in India (2) and attributed to us the hypothesis that the patients with the same “basic fault” in India are more prone to develop hysterical psychosis in comparison to multiple personality disorder in the United States. We did speculate whether “possession syndrome” and multiple personality disorder represent the cross-cultural variants of the same dissociative disorder in India and the United States respectively, but we did not suggest the same about hysterical psychosis. Dr. Modestin seems to be unaware of the literature emanating from India on face and descriptive validity of possession syndrome (2-5) and naively substitutes it with “hystenical psychosis.” An informed awareness of the literature on both these entities would suggest that they are not the same. Possession syndrome certainly is a dissociative disorder seen in South Asia, but it is not a psychotic illness. We still reiterate our original hypothesis that the unavailability of the diagnostic category of “ possession syndrome” and similar dissociative disorders in the current U.S. diagnostic system may be one of the reasons for overdiagnosis of multiple personality disorder in this country.
EDITOR
2. Adityanjee, Raju GSP, Khandelwal 5K: Current status of multiple personality disorder in India. Am J Psychiatry 1989; 146:16071610 3. Teja JS, Khanna BC, Subramanyam TS: Possession states in Indian patients. Indian J Psychiatry 1970; 12:71-78 4. Varma LP, Srivastava DK, Sahay, RN: Possession syndrome. Indian J Psychiatry 1970: 12:58-69 S. Akhtar 5: Four culture-bound psychiatric syndromes in India. mt J Soc Psychiatry I 988; 34:70-74
ADITYANJEE, Bronx,
Dr.
Modestin
M.D. N.Y.
Replies
SIR: The possession syndrome is known in many (1). Even though it may take on special transcubturab
cultures
forms (2) and in that case, perhaps, represent a special culture-bound entity, it has always been considered an expression of hysteria or schizophrenia in most cases by Western psychiatrists ( 1 , 3,
4). The immediate SIR:
TO THE
basis
of my “naive
substitution”
of posses-
sion syndrome with hysterical psychosis is, however, the paper by Adityanjee et al. In that paper they themselves talk about “spirit possession-perhaps a form of hysterical dissociation state” and about “the documented high prevalence of hysterical possession in India [emphasis added].” So if they consider the possession syndrome to be different from hysteria, which, incidentally, has by no means been generally proven, they should be more careful in their own formulations. The descriptive criteria for a psychotic disorder, as defined, eg., by Research Diagnostic Criteria (5), will most probably be met in the vast majority of “possessed” patients.
REFERENCES
1. Ellenberger Basic
Books,
HF: The
2.
Kiev
3.
Charcot JM, Richer haye et Lecrosnier,
4.
Jaspers Verlag,
K: Aligemeine I 963
Spitzer
RL,
S.
Discovery
of the Unconscious.
New
York,
I 970
A: Transcultural
Endicott
(RDC) for a selected York State Psychiatric
Psychiatry. P: Les 1887
New
Psychopathologic,
J, Robins group
York,
Demoniaques
Institute,
6th
E: Research
of functional
New
Free
dans
Press,
l’art. ed. Berlin,
Diagnostic disorders,
York,
1972
Paris,
3rd
Dela-
Springer-
Criteria ed.
New
1978
REFERENCES
1. Modestin Psychiatry
J: Multiple personality 1992; 149:88-92
disorder
in Switzerland.
Reprints
Am
]
Psychiatry
I 49;1
0, October
1 992
ofletters
J. MODESTIN, M.D. Zurich, Switzerland
Am J
to the Editor
are not available.
1417
the negative address.
social
attitudes
that
Dr. Prenzlaucr
and
colleagues
REFERENCES
1. Hendin H: Black Suicide. New York, Basic Books, 1969 2. Hendin H: Suicide in America. New York, WW Norton, 1982 3. Schneider SG, Farberow NL, Kricks GN: Suicidal behavior in adolescent and adult gay men. Suicide and Life Threatening Behavior 1989; 4:38 1-394 4. Robins E: The Final Months: A Study ofthe Lives of 134 Persons Who Committed Suicide. New York, Oxford University Press, 1 981 5. Rich CL, Fowler RC, Young D, Biankush M: San Diego Suicide Study: comparison of gay to straight males. Suicide and Life Threatening Behavior 1986; 16:448-457 HERBERT
HENDIN, New
Multiple
Personality
Disorder:
A Factual
York,
M.D. N.Y.
Error
J. Modestin,
M.D.
(1), quoted
our
work
on multiple
personality disorder in India (2) and attributed to us the hypothesis that the patients with the same “basic fault” in India are more prone to develop hysterical psychosis in comparison to multiple personality disorder in the United States. We did speculate whether “possession syndrome” and multiple personality disorder represent the cross-cultural variants of the same dissociative disorder in India and the United States respectively, but we did not suggest the same about hysterical psychosis. Dr. Modestin seems to be unaware of the literature emanating from India on face and descriptive validity of possession syndrome (2-5) and naively substitutes it with “hystenical psychosis.” An informed awareness of the literature on both these entities would suggest that they are not the same. Possession syndrome certainly is a dissociative disorder seen in South Asia, but it is not a psychotic illness. We still reiterate our original hypothesis that the unavailability of the diagnostic category of “ possession syndrome” and similar dissociative disorders in the current U.S. diagnostic system may be one of the reasons for overdiagnosis of multiple personality disorder in this country.
EDITOR
2. Adityanjee, Raju GSP, Khandelwal 5K: Current status of multiple personality disorder in India. Am J Psychiatry 1989; 146:16071610 3. Teja JS, Khanna BC, Subramanyam TS: Possession states in Indian patients. Indian J Psychiatry 1970; 12:71-78 4. Varma LP, Srivastava DK, Sahay, RN: Possession syndrome. Indian J Psychiatry 1970: 12:58-69 S. Akhtar 5: Four culture-bound psychiatric syndromes in India. mt J Soc Psychiatry I 988; 34:70-74
ADITYANJEE, Bronx,
Dr.
Modestin
M.D. N.Y.
Replies
SIR: The possession syndrome is known in many (1). Even though it may take on special transcubturab
cultures
forms (2) and in that case, perhaps, represent a special culture-bound entity, it has always been considered an expression of hysteria or schizophrenia in most cases by Western psychiatrists ( 1 , 3,
4). The immediate SIR:
TO THE
basis
of my “naive
substitution”
of posses-
sion syndrome with hysterical psychosis is, however, the paper by Adityanjee et al. In that paper they themselves talk about “spirit possession-perhaps a form of hysterical dissociation state” and about “the documented high prevalence of hysterical possession in India [emphasis added].” So if they consider the possession syndrome to be different from hysteria, which, incidentally, has by no means been generally proven, they should be more careful in their own formulations. The descriptive criteria for a psychotic disorder, as defined, eg., by Research Diagnostic Criteria (5), will most probably be met in the vast majority of “possessed” patients.
REFERENCES
1. Ellenberger Basic
Books,
HF: The
2.
Kiev
3.
Charcot JM, Richer haye et Lecrosnier,
4.
Jaspers Verlag,
K: Aligemeine I 963
Spitzer
RL,
S.
Discovery
of the Unconscious.
New
York,
I 970
A: Transcultural
Endicott
(RDC) for a selected York State Psychiatric
Psychiatry. P: Les 1887
New
Psychopathologic,
J, Robins group
York,
Demoniaques
Institute,
6th
E: Research
of functional
New
Free
dans
Press,
l’art. ed. Berlin,
Diagnostic disorders,
York,
1972
Paris,
3rd
Dela-
Springer-
Criteria ed.
New
1978
REFERENCES
1. Modestin Psychiatry
J: Multiple personality 1992; 149:88-92
disorder
in Switzerland.
Reprints
Am
]
Psychiatry
I 49;1
0, October
1 992
ofletters
J. MODESTIN, M.D. Zurich, Switzerland
Am J
to the Editor
are not available.
1417
