Multiple Personality Disorder: Fact or Fiction?
Alexandria K. Cherry Rochester Institute of Technology
Multiple Personality Disorder, or MPD, is one of the most talked about and publicized disorders known and is the center of much debate and criticism. What is currently known about MPD has become common place over the past 20 years. The past two decades have shown an increase in the number of cases of MPD but there are many professionals that are skeptical about whether it even exists. It was found that the longer a clinician has been out of school, the more skeptical of MPD they become. This paper reviews what MPD is, relates it to Dissociative Identity Disorder (DID), and reviews the criticisms of the disorder. The conclusion that is reached is that DID exists and is related to MPD. There are slight differences between the two but in no way should that imply both are equally accepted. This paper also explores the reasons for the high rates of clinical skepticism.
Interest in Multiple Personality Disorder (MPD) started in Europe during the late 1800's. It has gained attention at times, like the "Eve" and "Sybil" cases, and then fallen into the background again (Pica, 1999). There are many reasons for this and many criticisms of those reasons as well. Still the theories of this disorder have survived through much criticism and tweaking. The first part of this paper explores what MPD is. Then the subject of Dissociative Disorders and Dissociative Identity Disorder, or DID, are each discussed. The next topic that is discussed is how Multiple Personality Disorder and Dissociative Identity Disorder relate and differ. Finally, the idea of Multiple Personality Disorder, being a skewed misconception created by society, and the need for a more accepted term (DID) is emphasized.
This really goes back to reasons for why the popularity and recognition of Multiple Personality Disorder is ever changing. A mixture of MPD being a "popular" disorder and the unclear classification of the disorder are the major reasons for the criticism (Lilienfeld et al., 1999). These reasons are found to be justified and supported. The result is that Dissociative Identity Disorder is an excellent substitute and reclassification for what was known as MPD.
A basic knowledge of how Multiple Personality Disorder is described is needed to continue. MPD is hypothesized to be caused by severe childhood trauma that creates a mental split or "dissociation" as a defense against that trauma (Spanos, 1994). The different personalities that occur are called alters. These different parts develop separately and in adulthood help the sufferer deal with stress by expressing resentment or help calm the main personality. Each patient possesses two or more selves and each identity has it's own mood, memories, behaviors, and experiences.
Multiple Personality Disorder
The disease theory of Multiple Personality Disorder is that unhappiness in adulthood stems from trauma in childhood (Gleaves, Hernandez, & Warner, 1999) and the trauma is so severe that the individual creates multiple identities to cope with it (Spanos, 1994). The severe trauma is thought to be a result of physical or sexual abuse in childhood. Likewise, most modern patients are women who have been diagnosed with other disorders before being diagnosed with MPD. This is because the intense trauma caused by abuse may create other disorders as well. Because it is associated with other disorders, it was not long before MPD appeared in the Diagnostic and Statistical Manual of Mental Disorders. It first appeared in the 3rd edition (DSM-III); however the name was changed to Dissociative Identity Disorder in the DSM-IV (Dunn, 1992).
Unlike Multiple Personality Disorder, which is more like a disease, where a person has it or does not have it, most professionals feel that dissociation ranges from a "normal" state, daydreaming, to more pathological forms (Waller, Putnam, & Carlson, 1996). So it's not hard to conclude that Dissociative Disorders are rather rare but dissociative experiences are very common (Kihlstrom, Glisky, & Angiulo, 1994). The next step is to explore the most common personality traits that are related to dissociation. These are hypnotizability, absorption, fantasy proneness, and some aspects of openness to experience (Spiegel, & Cardeña 1991). These can be risk factors for dissociative problems.
Dissociative Disorders and Dissociative Identity Disorder
A clinician named Janet, in 1889, who worked with hysterics at the Salpertriere, felt that dissociation is a response to stress but some people are predisposed to the disorders (Kihlstrom, Glisky, & Angiulo, 1994). Janet also coined the term dissociation which was used to describe the split in consciousness that resulted when patients were exposed to traumatic events (Pica, 1999). From his theories it was found that there are distinguishable types of Dissociative phenomena. Dissociative Disorders are groups of syndromes that at the core alter the sufferer's consciousness, affecting memory and identity, which also follow Janet's work (Kihlstrom et al., 1994).
Janet also theorized about when vulnerability was at its highest. The developmental window of vulnerability is 18 months to 8 years old (Pica, 1999). This is important because it helps to predict how many alters may appear. There is a significant negative correlation between the age of appearance of an alter personality and the number of personalities. This can bring up other arguments, which are not covered in this paper, regarding Freudian explanations.
It is easier to understand a disorder if one knows how it is measured. Scales like the Dissociative Experiences Scale (DES) measure how dissociated a patient is (Waller, Putnam, & Carlson, 1996). There are also other measures that will not be covered here (e.g., Watson, 2003). The DES was created in the mid-1980s by Carlson and Putnam to address two deficits in the current body of knowledge: (a) a need for a test to detect dissociative disorders and (b) the need to quantify dissociation for research studies. This scale is the most widely used for this purpose.
The DES measures are related to: amnesia, depersonalization/derealization, and absorption. Amnesia is evidence that an individual has engaged in complex behavior that they have no memory of or the experience of "snapping out of it" in the middle of an activity and having little or no idea how they got there. Depersonalization or derealization is out of body experiences and other extreme forms of amnesia. Absorption is losing contact with current surroundings.
Another measure that is sometimes used is Hypnotic Susceptibility. This may be due to the fact that historically Multiple Personality Disorder has been viewed as an artifact of hypnosis and related to fantasy, suggestibility, and hysteria (Cormier & Thelen, 1998). Fantasy proneness, absorptions and imaginative involvement are other diatheses, for reasons stated already. A person with a high degree level of imagination or someone who has vivid dreams may score high on these types of tests. The real difference between these individuals and a person with Dissociative Identity Disorder is that the dreams of someone without the disorder is the reality of the afflicted.
Multiple Personality Disorder is among the most historic of disorders dating back to ancient forms of shamanism and demonic possession (Pica, 1999). The idea of multiple identities is present in many cultures but there are distinct differences (Spanos, 1994). For example, shamanism and demonic possession are respected and practiced events in some cultures. There are also similarities between cultures. The major similarity is that these individuals are more influenced by hypnosis and more able to enter a dream state because of their ability to dissociate. Even with some similarities, it suggests that MPD is not cross-cultural. This also raises one of the major criticisms of MPD.
The Next Step
The criticism is that Multiple Personality Disorder is a form of manipulation and both the client and clinician can be at fault. Some professionals feel that MPD is a tactic, of the client, to manipulate others into felling sorry for them or for them to get what they want. Therapists can also help to mold the patient into acting like they have MPD if they really have some other disorder (Spanos, 1994). Mental health professionals express concern that MPD is created through hypnosis, demand, suggestion or shaping by the therapist (Cormier & Thelen, 1998). The other general feeling is that MPD is really borderline personality disorder or schizophrenia.
This raises the question as to whether most cases of Multiple Personality Disorder are really another condition altogether. MPD is diagnosed with less accuracy than schizophrenia and the two are confused with each other frequently (Hayes & Mitchell, 1994). Could this be because one is frequently mistaken for the other, or because professionals in the field are skeptical about MPD? A survey administered by Hayes and Mitchell seems to point in the later direction. 24% of most professionals are skeptical of MPD. Skepticism is defined as the inclination to doubt. Even though doubt is sometimes good, in excess, it could be detrimental. They found that skepticism and knowledge of MPD are inversely related. The correlation was mild and there was a low response rate to the questionnaire. So it would probably be beneficial to explore this situation more, before any conclusions on diagnosing MPD are made.
Nevertheless, many professionals still feel that Multiple Personality Disorder should not be a diagnostic entity (Cormier & Thelen, 1998) even though some feel that there have been numerous, nationwide, consistent clinical reports done supporting it (Gleaves, Hernandez, & Warner, 2003). Since the first argument of skepticism has been ruled out, an analysis of the construction of MPD must be made. In Spanos' 1994 exploration on the subject he concluded that MPD is socially constructed where the characteristics of the disorder change over time to meet the changing expectations. The support for this argument is the changes between cultures, from above, and the changes over time. Since the 19th century the number of identities has gone from 2 or 3 to greater than 20, sometimes reaching 100. Also today animal alters are acceptable for an identity. The last big one is that when MPD was first recognized convulsions was one of the major symptoms but now it is not. The conclusion of Spanos' argument is that the expectations of people with the identities and the reaction of the audience are different across time and cultures.
To recap, the major arguments against Multiple Personality Disorder are that it is a form of manipulation, from either the client for clinician, it should really be diagnosed as something else, and that it has been socially constructed. Reclassification as Dissociative Identity Disorder would help to relieve these criticisms. In the pervious section it is clear that the disorder has a strong classification bases, and is clearly defined. This will make it harder for people to feign the disorder, easier to diagnose correctly, and remove any doubt of its being socially constructed.
This paper has shown what Multiple Personality Disorder and Dissociative Identity Disorder are, how they are different and explored the major criticisms of MPD. Multiple Personality Disorder occurs when a child is abused at a young age and their personality splits into several alters to help them deal with the stress. It is very unclear what the necessary traits that a person needs in order to classify as MPD. Dissociative Identity Disorder is more representative of how professionals feel the disorder is. It is a response to stress, not necessarily child abuse, in which the patient reverts into a dreamlike state where more than one identity may appear. The patient is generally unaware of these other personalities and may not remember at all what has occurred during their laps in time.
It is very apparent in the end why the name and classification needed to be changed. There are subtle differences between Multiple Personality Disorder and Dissociative Identity Disorder that help to correct the misconceptions surrounding MPD. Since this disorder is so widely publicized and criticized it is hard to keep a distinct definition to it. The major criticisms are that since Multiple Personality Disorder has been a popular one as early as the 1800's, there has been ample time for the classification of the disorder to be distorted. The other criticism is that since the disorder is under the public eye there are several clinicians and clients who try to feign the disorder. Because of this, there are many professionals who are skeptical about diagnosing MPD. The last criticism is that MPD is really something else. There have been instances where MPD should have been diagnosed as schizophrenia or borderline personality disorder and vise versa. The reclassification to Dissociative Identity Disorder seems to help reduce all of the problems that have arisen. Hopefully this classification will not alter with time and therefore keep criticism of it to a minimum.
Multiple Personality Disorder and Dissociative Identity Disorder Are One and the SameMarissa D. Clopper
Rochester Institute of Technology
In "Multiple Personality Disorder: Fact or Fiction?" by Alexandria K. Cherry, valid criticisms are made against Multiple Personality Disorder, currently known as Dissociative Identity Disorder. I agree with Cherry that there is a long history of confusion and controversy about this so-called existing disorder. Iatrogenesis, where the therapist unintentionally shapes or causes the disorder, continues to be considered problematic in diagnosing MPD/DID. In addition, demand characteristics, hypnotizability, suggestibility, and being easily dissociable are disputes that further complicate the distinction of MPD/DID as a sole disorder (Raulin, Lilienfeld, & Katkin, 2003).
Cherry implied that MPD is in a way different from DID and that by replacing the label of MPD with DID, criticisms are resolved and this disorder is clearly reclassified. However, I have to disagree with this perspective in that the change of labels resolves criticisms and clearly reclassifies the disorder. First of all, MPD and DID are just different labels that define the one and same disorder. It is not necessarily true that MPD is explicitly for those who have experienced abuse in childhood and that DID is for other forms of trauma--aside from child abuse. Both labels include all factors that potentially contribute to the development of MPD/DID along with predisposing characteristics aforementioned. Also, the main symptoms--dissociation, amnesia, multiple identities, derealization, and depersonalization--are present for both labels. Again, MPD and DID are two labels that describe the same syndrome.
Nevertheless, it is possible that the renaming of MPD as DID owes to dissociation as the main symptom that leads to the formation of multiple identities. That might make the overall syndrome more comprehensible than the label of MPD in itself, which doesn't primarily affirm dissociation as the main symptom. Nevertheless, controversies remain regardless of which label is used. Experts are having difficulties in describing the exact symptoms of the disorder and diagnosing an individual with DID. A part of the problem that makes this whole issue confusing is comorbidity. True enough, there are disorders that may overlap that further complicate the distinction of DID as a separate entity.
Despite comorbidity, DID has distinct symptoms that separate this disorder from borderline personality disorder and schizophrenia. Borderline personality disorder includes instability of relationships, emotions, and self-image; fears of abandonment; aggressiveness; proneness to self-harm; and strong emotions (Larsen & Buss, 2005). Nowhere does it state dissociation as one of the symptoms. Therefore, borderline is a separate disorder from DID, but may overlap. As for schizophrenia, the differential diagnosis is where "voices" are perceived to be heard. In schizophrenia, voices are perceived to come from the outside of the mind, while in DID, voices are perceived to be heard internally in the mind. By keeping to this very distinction, DID is capable of being identified exclusively.
The famous case of Kenneth Bianchi indicates that the continuous redefining and specific steps in making a proper diagnosis of DID have improved. Bianchi was seen to be feigning DID because his alters did not continue consistently over time, did not act under hypnosis the way normal individuals would, and did not have behavioral changes that were witnessed by people who knew him well (Putman, Zahn, & Post, 1990). Malingering and factitious disorders and physical conditions are considered and if they exist, a diagnosis of DID is ruled out.
Apparently, with more research, DID is capable of emerging as a clear and sole disorder as maintained by considering potential factors that contribute to the disorder, steps in making a proper diagnosis, and cases, such as Bianchi, that have appeared in history. DID may be continually redefined as we explore new evidence in the future. This scenario is similar to encountering a new disease that we don't formally recognize until at a point that it becomes obvious. For instance, AIDS was not known to be caused by a virus as there were various symptoms such as Kaposi's sarcoma that were thought to exist on its own, but a pattern began to emerge in the homosexual population as well as those who were exposed through using drugs (sharing dirty needles), received blood transfusions, and the like. Through research, this disease was finally recognized to be caused by a virus (HIV); thus, labeled AIDS. Overall, controversies and redefinition will continue until the disorder becomes distinctly clear; but until then, MPD and DID represent the same disorder, regardless of the labels.
Dissociative Identity Disorder: With Whom Am I Speaking?Travis W. Silverman
Rochester Institute of Technology
In the study of Multiple Personality Disorder, a most intriguing aspect of the disorder is the number of personalities a patient experiences, as well as how those unique personalities interact within the single body. This aspect of the disorder was mentioned in the paper by Alexandria K. Cherry, "Multiple Personality Disorder: Fact or Fiction?" Due to its interesting and changing nature from patient to patient, the area of interaction and expression personalities within the patient warrants further discussion.
The topic brings many questions to mind. Is there a dominant personality, and if so which is it? How many personalities reside in the patient? How does each of the personalities interact? Are they aware of each other? To better understand these questions, knowledge of what is at the base of the disorder is most helpful. Most people (those without DID) have one group containing their cognitive faculties, including recognition of the self, memory, intent, sensation, and consciousness. This grouping within the person allows for one singular sense of continuous identity, and thus a single personality. This singular identity is not present in patients with DID; instead of having one singular identity, they experience many strands of the self where there is a breakdown of the cognitive faculties.
In multiple personality or dissociative identity patients, several distinct states of mind or personalities reside in one body. There is a varying range of how many personalities may be present, ranging from 2 personalities to over 20 personalities within one shared body. Each of these personalities has its own sense of self and has its own habits of thought, emotions, and memory. These identities may or may not be aware of each other. In some cases the identities are aware of each other; this is referred to as "co-consciousness"--while one personality is in control, the others are in the background, in the back of the mind, aware of what the current personality is doing and seeing what the current personality sees (Brown, 2001). A good way to think of this is as though looking at a picture or movie and being both the observer and observed. This leads to the way in which memory is experience by each of the personalities individually. When a memory is stored, it is claimed by the personality that was in control of the body at the time of the event; the other personalities would not refer to that event/memory as happening to themselves but instead to another personality. The awareness of other personalities and the system of memory claiming allows the multiple personalities to be unaware of the gaps in time allowing co-existence without question (Carter, 2003).
In some cases the other personalities may not be aware of each other or may work against each other in both body and mind. In other words, one personality may seek to undo what another has done. The lack of memory may create gaps in the memory, causing the personalities to feel as though they did not exist for the period of time when they were not in control.
A final aspect of the interaction of personalities is the factor of responsibility for actions. If one of the personalities is in control and commits a crime, how is the body to be held responsible? How are punishment and responsibility to be placed? The answers to these questions are more case-based than across-the-board answers. The awareness of the other personalities of the act as well as capabilities or dominance must be considered because due to the shift in personality there may also be a shift in beliefs including right from wrong (Kennett & Matthews, 2002). One personality may be more malevolent than the others. One way to tell if the personalities are aware of each other in deciding responsibility is to see how they refer to each other. Do they refer to each other as him or her, or are they unaware of the person they are being asked about (Brown, 2001).
It is clear that more than one aspect of Dissociative Identity Disorder needs to be considered when concluding how the personalities interact. They may very well be aware of each other and have a system that allows for relatively viable sharing of the body. Other cases, however, may pose more trouble wherein the personalities are unaware of each other and may show even malicious behaviors while not in control. An in-depth look at each case would provide the most accurate results as to how the personalities interact.
The Therapist's Role in Multiple Personality DisorderCharles M. Spuckler
Rochester Institute of Technology
In "Multiple Personality Disorder: Fact or Fiction?" Cherry stated that the patient can appear to have Multiple Personality Disorder in order to gain attention. The therapist could also induce Multiple Personality Disorder in the patient while neglecting other disorders. There have been many reports of therapists who made the Multiple Personality Disorder appear in a patient or made it worse. Such cases help to question the existence of Multiple Personality Disorder, given that it appears to be a reaction to the way a therapists treats it. The therapist can, however, use treatments for Multiple Personality Disorder that will help the patient recover when other techniques will not work. Multiple Personality Disorder may exist, but it is affected greatly by the actions of the therapist.
One case study helps to emphasize the role of the therapist inducing Multiple Personality Disorder. The patient in this study had some symptoms that would suggest Multiple Personality Disorder. These symptoms included amnesia. The therapist who treated the patient heard this symptom and attempted to call out a multiple personality in the patient. This was done through hypnosis and calling the name of the other personality, which was given by the therapist. The patient developed the additional personality because of the therapist's actions. The therapist's eagerness to observe Multiple Personality Disorder caused it to surface, and the therapist ignored completely the problems that the patient actually had. Treating the patient's actual problems could have prevented any dissociative disorder (Chitalkar & Pande, 1996).
Hypnotism is a common way of creating Multiple Personality Disorders. According to therapists who use it, hypnotism provides a method for allowing different personalities to appear. It has been shown, however, that patients treated by hypnotism are more likely to have certain symptoms and personalities. Hypnotized patients are also more likely to report abuse, which fits most therapists' vision of the cause of Multiple Personality Disorder (Rowell & Gee, 1999).
Both of the above reports show that it is possible for therapists to greatly affect the patient. The patients in the studies may have had some symptoms similar to Multiple Personality Disorder, but their behavior appeared to have been affected by the therapists. The therapists had an idea of how Multiple Personality Order functions and got the patient to act in a manner that agreed with their beliefs. This may weaken the case for Multiple Personality Disorder existing, because the therapist controls to a large extent the patient's actions.
It should also be noted that the most common cause of Multiple Personality Disorder is childhood abuse. An abused child will dissociate the painful memories and repress feeling of trauma. Often these memories of childhood abuse are only revealed through a recovery process with a therapist. Such recovered memories are often false and come from the therapists urging that abuse had taken place. Patients may feel that they need to conform to the therapist's opinions. Again, this shows that the therapist is changing the way the patient thinks in order to fit the most likely path of Multiple Personality Disorder.
The therapist can worsen Multiple Personality Disorder but also must recognize that it exists how it can be treated. It has been reported that therapists who do not believe in Multiple Personality Disorder will seek to get the patient to repress all signs of it. This treatment may reduce outward signs of the disorder, but the disorder remains and could actually become worse due to the treatment. The major goal of many treatments for Multiple Personality Disorder is to work through the underlying issue thought to have caused the disorder (Kluft, 1999).
The therapist is in a difficult position when dealing with patients with Multiple Personality Disorder. Therapists must not encourage the preexisting disorder to agrees with their own ideas about the disorder, but therapists also must not ignore the disorder completely. Therapists could be better educated about Multiple Personality Disorder and how likely it is for a patient to change his or her behavior to meet the expectations of the therapist.
Heads I Win, Tails You Lose: Are Multiple Personality and Dissociative Identity Disorder Really Different?Erin M. Wells
Rochester Institute of Technology
Multiple Personality Disorder (MPD) seems to be a very popular and heated topic of debate. It is interesting to think about what it would be like to have different people emerge from one's self and not even recollect what happened while the alter was present. Another possible source of intrigue that may have aided in the popularity of MPD may be its relatedness to demonic episodes and the seeming ability to "just get away from it all," as I'm sure many have wanted to do. The existence of Multiple Personality Disorder as an actual diagnosable and treatable disorder was the topic of Alex Cherry's paper, and I am wondering if it is actually "fiction" or if the criticizers are claiming its nonexistence just because they can't support or explain the symptoms either way.
It is really interesting that Dissociative Identity Disorder (DID) seems much more professionally accepted, enough to be published as a mental disorder. DID even has scales of measure that make it diagnosable, and my question is what really is the difference between a person with MPD and one diagnosed with DID? It seems like a very gray area, where somehow professionals have accepted one and hotly contest the other. Both disorders are thought to be caused by severe trauma and both have symptoms of alterations in consciousness, memory, and identity. Many sources even refer to them as the same disorder simply with a different name. Perhaps it is my severe lack of knowledge in the subject matter, but does it all not seem like semantics? Is DID not getting as much criticism as MPD because with the term "multiple personality" in the title, the disorder seems more outlandish and far-fetched? It just seems disconnected that MPD is contested as being an actual disorder whereas DID appears to be the same thing with a little more political correctness and qualitative support.
I do not contest the skepticism that clinicians can be very suggestive about the manifestation of a client's mental disorder or state. It seems very likely that a highly suggestive person can be manipulated to believe that something happened to them and that the need to deal with it, especially if the client is under some form of hypnosis. Also, the social popularity and media images of the disorder do seem to play a role in the numbers of occurrences and the manner in which the alters diverge. Does the social element of the disorder mean that it's simply made up and should not even be diagnosed? Could it be that individuals that tend to get dissociative disorders like DID are already susceptible to suggestion and the world around them? Perhaps the changing nature of MPD or DID is due to social changes and how they affect the individual with the disorder. Might it be that the reason the number of alters has risen dramatically since the 19th century be due to a more open nature of society itself and the greater acceptance of psychological disorders in general? I do not doubt that there are individuals out there who are truly feigning the disorder or have incorrectly been diagnosed, but maybe some of the criticism can be relieved from MPD or DID if the manifestations of the disorder are allowed to ebb and flow with the attitudes of society. It would be interesting to study the prevalence and ways in which dissociative disorder exhibits cross-culturally. This paper stated that MPD was suggested as not being cross-cultural, and it would be relevant to note if those not being treated professionally for dissociative disorders had different intensities of the MPD versus those receiving therapy.
I guess the real question is whether Multiple Personality Disorder and Dissociative Identity Disorder are really just different names for the same thing? This is a really hard area to study, because the disorders are relatively uncharacterized and are mostly objective in the diagnosis. Moreover, because society and its effects on any individual are not going away, its influence on suggestive disorders like these must be taken into account. Normal personality is somewhat influenced by environment, so naturally multiple identities within one person (whether internal or external) are also going to be impressed upon by the world around them.
Fictions of Dissociative Identity DisorderAlexandria K. Cherry
Rochester Institute of Technology
There have always been many misconceptions regarding the differences between Multiple Personality Disorder (MPD) and Dissociative Identity Disorder (DID). This does not discount the critics of my paper, "Multiple Personality Disorder: Fact or Fiction?" Several arguments criticized the arguments in my paper. These are all without strong foundations and therefore cannot hold up.
The first commentary, "Multiple Personality Disorder and Dissociative Identity Disorder Are One and the Same," by Clopper mades its mistake in the second paragraph. Clopper stated that she did not agree with the conclusion that reclassifying MPD as DID is good and then contradicts this statement in the next sentence by saying she felt that it solves many problems to reclassify the disorder. This argument does not hold up if it makes sense at all.
"Dissociative Identity Disorder: With Whom Am I Speaking?" by Silverman, presented a very interesting twist on the topic discussed in my paper. "The Therapist's Role in Multiple Personality Disorder," by Spuckler, also provided an interesting spin on the topic; he explored the many roles the therapist plays in the disorder. The last commentary, "Heads I Win, Tails You Lose: Are Multiple Personality and Dissociative Identity Disorder Really Different?" provided a very interesting, for lack of a better word, complaint. Though Wells admited to having little knowledge in the topic, she emphasized what many people, professionals and non-professionals alike, have been wondering. There are subtle changes, and the reclassification is important if for only the reason that MPD became distorted over time.
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