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--- plural_glossary:system_exclusionist [2026/06/07 18:06] – [Obstacles to diagnosis] jaime
+++ plural_glossary:system_exclusionist [2026/06/07 19:20] (current) – [Non-disordered plurality is different from a dissociative disorder, but not incomparably so] jaime
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 The very serious inherent problem with the approach is that DID and OSDD by their nature are poorly understood even in an expert capacity and also cause the afflicted to live in constant self-disavowal and denial. Therefore, systematically gatekeeping the relevant labels to those who actually need them is fundamentally impossible, because there is no reliable way whatsoever to determine who does or does not actually need them, //and// trying to do so anyway is //extremely harmful// because those who //do// need the labels are by their nature highly prone to embracing any possible excuse to believe they don't.
+"Sure it's possible to tell who needs the label, just get diagnosed." There are several major problems that make that solution unworkable.
 ==== Obstacles to diagnosis ====
-"Sure it's possible to tell who needs the label, just get diagnosed." There are two major problems that make that solution unworkable.
+Perhaps the most obvious is that diagnosis is not accessible to everyone, or for that matter even most people. Psychiatrists willing to diagnose a dissociative disorder are few and far in-between, the diagnostic process is grueling and expensive, and it also costs a lot of money just to see a psychiatrist at all, in general, in the first place.
-First, and more obvious, diagnosis is not accessible to everyone, or for that matter even most people. Psychiatrists willing to diagnose a dissociative disorder are few and far in-between, the diagnostic process is grueling and expensive, and it also costs a lot of money just to see a psychiatrist at all, in general, in the first place.
+Compounding upon other problems with seeking a diagnosis is that people who actually have an undiagnosed dissociative disorder are unlikely to seek a diagnosis due to the self-disavowing effect of the disorder, //and// if they //do// seek a diagnosis, the fact that the evaluating clinician //understands// undiagnosed dissociative disorders make people unlikely to seek a diagnosis makes the //clinician// less likely to //diagnose,// because the fact that the patient even came in at all is in and of itself cause for suspicion of imitative or factitious DID.
-Second, less obvious, but more important: Even the professionals who are supposed to diagnose the condition actually don't know jack shit about it. I'm not saying they haven't done their research, I'm saying the //scientific community// hasn't done the research. I'm saying the info //isn't out there.// We understand a lot about dissociative disorders, and I'm not discounting that. But the modern understanding is not nearly sufficient to even reliably diagnose them, let alone treat them.
+==== Professional incompetence ====
-We don't even know what causes them or how they work. The trauma model remains in conflict with the sociocognitive model. Granted, all modern research supports the trauma model, and none supports the sociocognitive model---for DID, anyway. But first of all---I would //love// it if this meant professional opinions would actually //follow// the research and //start actually believing their patients,// but for //some fucking reason,// the sociocognitive model //remains// the widely preferred and practically applied explanation, which makes it not only more challenging but also more //unattractive// to seek diagnosis---and second of all, what about OSDD? Sure, it's looking like the trauma model is the correct explanation for example OSDD-1, but what about other presentations of the condition?
+Less obvious, but more important: Even the professionals who are supposed to diagnose the condition actually don't know jack shit about it. I'm not saying they haven't done their research, I'm saying the //scientific community// hasn't done the research. I'm saying the info //isn't out there.// We understand a lot about dissociative disorders, and I'm not discounting that. But the modern understanding is not nearly sufficient to even reliably diagnose them, let alone treat them.
-Consider: OSDD might also be caused by coercive persuasion including thought reform or recruit by sects or cults, a presentation given as example OSDD-2. Wouldn't certain kinds of [[endogenic]] systems, e.g. [[parogenic]], clearly be identifiable as a form of self-inflicted coercive persuasion, particularly in the sense of thought reform or a sect or cult? "I have [[headmate|headmates]]. I am willfully forcing myself to believe this. If I force it hard enough, then I will actually believe it. Since the belief is metacognitive in nature, actually believing it will make it functionally true." There's no reason an OSDD-2 system couldn't form by that means. Iatrogenesis of OSDD is unquestionably possible, even if DID cannot result from the same.
+We don't even know what causes dissociative disorders or how they work. The trauma model remains in conflict with the sociocognitive model. Granted, all modern research supports the trauma model, and none supports the sociocognitive model. I would //love// it if this meant professional opinions would actually //follow// the research and //start actually believing their patients,// but for //some fucking reason,// the sociocognitive model //remains// the widely preferred and practically applied explanation, which makes it not only more challenging but also more //unattractive// to seek diagnosis.
-But good luck ever being diagnosed with OSDD-2. If you can find the once-in-a-blue-moon psychiatrist who's willing to diagnose dissociative disorders at all, they will almost certainly actually be trauma-informed. Which is //great. Except:// that their understanding of the (likely) fact that trauma is the real cause of DID and OSDD-1 will almost certainly act as a "curse of knowledge" that blinds them to the possibility of iatrogenesis of OSDD-2 or otherwise.
-Compounding upon the many problems with seeking a diagnosis is that people who actually have an undiagnosed dissociative disorder are unlikely to seek a diagnosis due to the self-disavowing effect of the disorder, //and// if they //do// seek a diagnosis, the fact that the evaluating clinician //understands// undiagnosed dissociative disorders make people unlikely to seek a diagnosis makes the //clinician// less likely to //diagnose,// because the fact that the patient even came in at all is in and of itself cause for suspicion of imitative or factitious DID.
-Finally perhaps the most serious issue with expecting all systems to seek diagnosis is that not all systems want treatment. The plural community largely disagrees with the implicit assumption that plurality is inherently pathological. System exclusionists often feel this attitude minimizes their own struggles with more pathological presentations of dissociative disorders, but fail to take into consideration that their own insistence on understanding //all// plurality as pathological needlessly //stigmatizes less// pathological presentations of plurality. Both sides need to understand plurality //can// be but is not //necessarily// pathological---but especially system exclusionists in particular need to understand this, because they are the ones who reject it.
 ==== Prevalence of undiagnosed dissociative disorders in the general population ====
-I am personally of the opinion that it's //very// likely that //literally every single person// who //ever// claims to be a system has either DID, OSDD-1, //or OSDD-2,// mostly the latter. (Mostly because //claiming to be a system can literally give you OSDD-2,// as covered in the previous section.)
+Fakeclaimers need to understand that dissociative disorders are //more// common than people think, and online presentations of them are //less// common than people think. The internet amplifies the loudest voices, and DID really does sit at 1-2% but that's more common than schizophrenia which is something people get disparagingly accused of having //all the time,// and OSDD is actually estimated at somewhere around an //eight percent// prevalence. In the //non-//clinical population. That's //one in twelve people. Ever. Most people// probably know someone with undiagnosed OSDD. Add that 8% to DID's 1-2%, and it's //certainly// not unexpected for a community spanning a //tenth of the fucking planet// to have a significant online presence. That's bigger than most //countries.// <del>//Possibly all// of them? I'm pretty sure there literally isn't a single country in the world with a higher population than the worldwide prevalence of undiagnosed dissociative disorders and it's not even close.</del>
-It's not so outlandish a claim when you consider that actual dissociative disorders are //more// common than people think, and online presentations of them are //less// common than people think. The internet amplifies the loudest voices, and DID really does sit at 1-2% but that's more common than schizophrenia which is something people get disparagingly accused of having //all the time,// and OSDD is actually estimated at somewhere around an //eight percent// prevalence. In the //non-//clinical population. That's //one in twelve people. Ever. Most people// probably know someone with undiagnosed OSDD. Add that 8% to DID's 1-2%, and it's //certainly// not unexpected for a community spanning a //tenth of the fucking planet// to have a significant online presence. That's bigger than most //countries.// <del>//Possibly all// of them? I'm pretty sure there literally isn't a single country in the world with a higher population than the worldwide prevalence of undiagnosed dissociative disorders and it's not even close.</del>
 Okay so actually there are significantly more people in India than people with undiagnosed dissociative disorders in the whole world but not //very// significantly more. Like it's not even a factor-of-2 difference. It's insane to me that more than a tenth of the world lives in India by the way. Same story with China actually, there are more people in China than there are people with undiagnosed dissociative disorders in the world, but those are the only two countries you can say that about. If all the people with undiagnosed dissociative disorders got together and formed Undiagnosed-Dissociative-Disorderland it would be the third most populated country on earth.
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 ==== Being visible does not invalidate us ====
-"But what about the fact that they're so public about their plurality? Doesn't that make it probably not disordered, because they aren't disavowing it?" First of all, people who publicly identify as plural disavow their plurality //all the goddamn time.// Most of them compulsively tell themselves they're faking //every single day,// no thanks to //you// lot. Also, most plural people don't dare claim to have a dissociative disorder, even if //I'm// claiming they probably do. Plurality is understood as a related but distinct phenomenon. So they're disavowing having a dissociative disorder even when they embrace being plural. I don't think you understand how many layers of irony they're on, it's like 5 or 6 right now my dude. //Also,// I sure don't hear //system exclusionists// disavowing //their// diagnosed DID, does that mean //they// don't have it? Of course it doesn't.
+"But what about the fact that they're so public about their plurality? Doesn't that make it probably not disordered, because they aren't disavowing it?" First of all, people who publicly identify as plural disavow their plurality //all the goddamn time.// Most of them compulsively tell themselves they're faking //every single day,// no thanks to //you// lot. Also, most plural people don't even //claim// to have a dissociative disorder. They would //agree// that they aren't disordered. And many of them aren't. But //if// they //are,// then that means they're disavowing having a dissociative disorder even when they embrace being plural. I don't think you understand how many layers of irony they're on, it's like 5 or 6 right now my dude. //Also,// I sure don't hear //system exclusionists// disavowing //their// DID, does that mean //they// don't have it? Of course it doesn't.
+==== Non-disordered plurality is different from a dissociative disorder, but not incomparably so ====
+Dissociative //disorders// are presentations of //pathological// dissociation. They do //not// encompass //all// dissociation. Modern understanding under the trauma model of mental disorders is that //pathological// dissociation is inherently traumagenic.
+Dissociation encompasses a wide range of experiences, both pathological and otherwise. Alteration of identity is one such possible experience, and //pathological// alteration of identity is exclusive to dissociative disorders, //not// because it's //alteration of identity,// but because it's //pathological.// The trauma model of mental disorders as currently understood claims //nothing// about the existence, nonexistence, or possible causes, of //non-//pathological alteration of identity.
+"But there's no such thing as non-pathological alteration of identity---" You won't find any literature anywhere that explicitly says so. Psychopathology is an //evolving science// of //how// and //when// psychological mechanisms become pathological and how to //treat// them, //not// a //prescriptive taxonomy// of //what// psychological mechanisms //absolutely can or cannot// be regarded as pathological.
+You aren't going to logic away or gatekeep away the simple reality that some people have other people in their head who exist for non-traumagenic reasons, are very real to them, and possess some degree of independence but don't meaningfully make their life harder. No psychiatric literature or research whatsoever tries to make the claim that dissociative //non//-disorders can only happen through childhood trauma, and you have no business making that claim either. The existence of someone who works roughly the same way on the inside as you do is not a personal and directed insult to you just because you work that way because of severe psychological wounds and they don't. And if, despite having different reasons, they work in a comparable way, they should be allowed to use comparable language for how they work.
 ==== In summary ====
-Regardless, and in conclusion: Although modern psychiatric practices have a good success rate in //treating// dissociative disorders, their //egregious// unreliability in //triaging// them makes a compelling case that the medical terminology //should// be appropriated into a less rigorously structured community. That case being: There are fucktons of undiagnosed dissociative patients slipping through cracks in the institution wider than its mom's asscrack and they need somewhere to go, quit turning away your own kind you oblivious fucknuggets.
+Regardless, and in conclusion: Although modern psychiatric practices have a good success rate in //treating// dissociative disorders, their //egregious// unreliability in //triaging// them makes a compelling case that the medical terminology //should// be appropriated into a less rigorously structured community. That case being: There are fucktons of undiagnosed dissociative patients and non-pathological dissociators slipping through cracks in the institution wider than its mom's asscrack and they need somewhere to go, quit turning away your own kind you oblivious fucknuggets.
 ===== System exclusionists aren't evil =====