10 Famous Cases Of Dissociative Identity Disorder

suraj kumar,osh state university,group-10 b

Dissociative identity disorder (DID), often called multiple personality disorder (MPD), has fascinated people for over a century. However, though it is a very well-known disorder, mental health professionals are not even sure if it exists. It is possible that it is a form of another illness, like schizophrenia. Another theory is that it doesn’t exist at all, and those who have it, including the following people, are simply acting.

10Louis Vivet

Photo credit: Henri Bourru & Prosper-Ferdinand Burot

One of the first recorded cases of multiple personalities belonged to Frenchman Louis Vivet. Born to a prostitute on February 12, 1863, Vivet was neglected as a child. By the time he was eight, he had turned to crime. He was arrested and lived in a house of treatment into his late teens.

When he was 17 years old, he was working in a vineyard, and a viper wrapped itself around his left arm. While the viper didn’t bite him, it terrified him so much that he had convulsions and psychosomatically became paralyzed from the waist down. While paralyzed, he was housed in an asylum, but after a year, he started walking again. Vivet now seemed like a completely different person. He didn’t recognize any of the people at the asylum, his mood was much darker, and even his appetite was different.

When he was 18, he was released from the asylum but didn’t stay out long. Over the next several years, Vivet was in and out of hospitals. During a stay between 1880 and 1881, he was diagnosed with multiple personalities. Using hypnosis and metallotherapy (placing magnets and other metals on the body), a doctor discovered up to 10 different personalities, all with their own traits and history. However, upon reviewing the case in later years, some experts believe he may have only had three personalities.

9Judy Castelli

Photo credit: Universal Publishers

Growing up in New York State, Judy Castelli suffered physical and sexual abuse, and afterward, she struggled with depression. A month after she enrolled in college in 1967, she was sent home by the school psychiatrist. Over the next several years, Castelli struggled with voices inside her head that told her to burn and cut herself. She nearly ruined her face, almost lost sight in one eye, and almost lost the use of one of her arms. She was also hospitalized several times for suicide attempts. Each time, she was diagnosed with chronic undifferentiated schizophrenia.

In the 1980s, she began singing in clubs and cafes in Greenwich Village. She almost got signed to a record label, but that fell through. However, she was able to find work and headlined a successful off-Broadway show. She also found success in sculpting and making stained glass.

Then, during a therapy session in 1994 with the therapist she’d had for over a decade, multiple personalities started to emerge, seven at first. As she continued her therapy, 44 personalities appeared.

Since finding out that she has DID, Castelli has become a strong advocate for the disorder. She was on the board of the New York Society for the Study of Multiple Personality and Dissociation. She continues to work as an artist and teaches art to people with mental illness.

8Robert Oxnam

Photo credit: Robert Oxnam

Robert Oxnam is a distinguished American scholar who has spent his life studying Chinese culture. He is a former college professor, the former president of the Asian Society, and currently a private consultant for matters regarding China. While he is quite accomplished, Oxnam has struggled with his mental health.

In 1989, a psychiatrist diagnosed him with alcoholism. That changed after a session in March 1990, when Oxnam planned to leave therapy. While speaking with Oxnam, the doctor was addressed by one of his personalities, a young, angry boy named Tommy, who lived in a castle. After that session, Oxnam and his psychiatrist continued their therapy and found that Oxnam actually had 11 separate personalities.

After years of treatment, Oxnam and his psychiatrist whittled down the personalities to just three. There is Robert, or Bob, who is the core personality. Then there is Bobby, who is a younger, quizzical, free-spirited man who loves rollerblading in Central Park. Another is a “Buddhist-like” personality known as Wanda. Wanda used to be part of another personality known as the Witch.

Oxnam wrote a memoir about his life called A Fractured Mind: My Life With Multiple Personality Disorder. It was published in 2005.

7Kim Noble

Born in the United Kingdom in 1960, Kim Noble says her parents were factory workers who were unhappily married. From a young age, she was physically abused, and then she suffered from many mental problems as a teenager. She overdosed a few times and was placed in a mental institution.

In her twenties, her other personalities emerged, and they were incredibly destructive. Kim was a van driver, and one of her personalities named Julie took over her body and plowed the van into a bunch of parked cars. She also somehow got involved in a pedophile ring. She went to the police with information, and when she did, she started receiving anonymous threats. Then someone threw acid in her face and set her house on fire. She couldn’t remember anything about the incidents.

In 1995, Noble was diagnosed with dissociative identity disorder, and she has been getting psychiatric help ever since. She is currently working as an artist, and while she does not know the exact number of personalities she has, she thinks it is somewhere around 100. She goes through about four or five different personalities a day, with Patricia being the most dominant one. Patricia is a calm, confident woman. Another notable personality is Hayley, the one involved with the pedophile ring that led to the acid attack and the fire.

Noble (as Patricia) and her daughter appeared on The Oprah Winfrey Show in 2010. She published a book about her life, All of Me: How I Learned to Live with the Many Personalities Sharing My Body, in 2012.

6Truddi Chase

Truddi Chase claims that since she was two, in 1937, her stepfather physically and sexually assaulted her, while her mother emotionally abused her for 12 years. As an adult, Chase was under tremendous stress while working as a real estate broker. She went to a psychiatrist and discovered that she had 92 different personalities that were vastly different from each other.

The youngest was a girl about five or six years old named Lamb Chop. Another was Ean, an Irish poet and philosopher 1,000 years old. None of the personalities worked against one another and seem to be aware of one another collectively. She didn’t want to integrate the personalities because they all had been through so much together. She referred to her personalities as “The Troops.”

Chase, along with her therapist, wrote the book When Rabbit Howls, and it was published in 1987. It was adapted into a TV miniseries in 1990. Chase also appeared on a very emotional segment of the Oprah Winfrey show in 1990. She died on March 10, 2010.

5The Trial Of Mark Peterson

On June 11, 1990, 29-year-old Mark Peterson took an unidentified 26-year-old woman out for coffee in Oshkosh, Wisconsin. They had met two days prior in a park, and while they were out, the woman says she started to show Peterson some of her 21 personalities. After they left the restaurant, Peterson suggested that they should have sex in his car, and she agreed.

However, a few days after the date, Peterson was arrested for sexual assault. Apparently, two of the personalities did not consent. One was 20 years old and emerged during sex, while another personality, a six-year-old, watched on.

Peterson was charged and convicted of second-degree sexual assault because it is illegal to knowingly have sex with someone who is mentally ill and cannot give consent. The verdict was overturned a month later, and prosecutors didn’t want to put the woman through the stress of another trial. Her personalities had increased to 46 between the incident in June and the trial in November. Peterson was never retried for the crime.

4Shirley Mason

Born January 25, 1923, in Dodge Center, Minnesota, Shirley Mason apparently had a difficult childhood. Her mother, according to Mason’s accounts, was nothing less than barbaric. Her many acts of abuse included giving Shirley enemas and then filling her stomach with cold water.

Starting in 1965, Mason sought help for her mental problems, and in 1954, she started seeing Dr. Cornelia Wilbur in Omaha. In 1955, Mason told Wilbur about weird episodes where she would find herself in hotels in different cities with no idea how she got there. She would also go into shops and find herself in front of destroyed products with no clue what she had done. Shortly after the admission, different personalities started to emerge in therapy.

Mason’s story about her horrible childhood and her multiple personalities was turned into a best-selling book, Sybil, and it was turned into an immensely popular TV miniseries of the same name featuring Sally Fields.

While Sybil/Shirley Mason is one of the most well-known cases of DID, it also has come under a lot of scrutiny for its authenticity. Many people believe that Mason was a mentally ill woman who adored her psychiatrist, and Cornelia planted the idea of multiple personalities in her head. Mason apparently even admitted making everything up in a letter she wrote to Dr. Wilbur in May 1958, but Wilbur told her it was just her mind trying to convince her she wasn’t sick. So Mason continued on with therapy. Over the years, 16 personalities emerged.

In the made-for-TV version of her life, Sybil lives happily ever after, but the real Mason became addicted to barbiturates and dependent on her therapist, who paid her bills and gave her money. Mason died on February 26, 1998 from breast cancer.

3Chris Costner Sizemore

Chris Costner Sizemore remembers her first personality split when she was about two years old. She saw a man pulled out of a ditch and thought he was dead. During this shocking event, she saw another little girl watching.

Unlike many other people diagnosed with DID, Sizemore didn’t suffer from child abuse and came from a loving home. However, from seeing that tragic event (and another gory factory accident later), Sizemore claims that she started acting strange, and family members often noticed. She would often get into trouble for things she had no memory of doing.

Sizemore sought help after the birth of her first daughter, Taffy, when she was in her early twenties. One day, one of her personalities, known as “Eve Black,” tried to strangle the baby, but “Eve White” was able to stop her.

In the early 1950s, she started seeing a therapist named Corbett H. Thigpen, who diagnosed her with multiple personality disorder. While working with Thigpen, she developed a third personality named Jane. Over the next 25 years, she worked with eight different psychiatrists, and during that time, she developed a total of 22 personalities. All the personalities were quite different when it came to demeanor, age, sex, and even weight.

In July 1974, after four years of therapy with Dr. Tony Tsitos, all the personalities integrated, leaving her with just one.

Sizemore’s first doctor, Thigpen, and another doctor by the name of Hervey M. Cleckley wrote a book about Sizemore’s case called The Three Faces of Eve. It was adapted into a film in 1957, and Joanne Woodward won the Academy Award for Best Actress for her portrayal of three of Sizemore’s personalities.

2Billy Milligan

From October 14–26, 1977, three women around Ohio State University were kidnapped, taken to a secluded area, robbed, and raped. One woman claimed the man who raped her had a German accent, while another one claimed that (despite kidnapping and raping her) he was actually kind of a nice guy. However, one man committed the rapes: 22-year-old Billy Milligan.

After his arrest, Milligan saw a psychiatrist, and he was diagnosed with DID. Altogether, he had 24 different personalities. So when the kidnapping and rapes happened, Milligan’s defense attorney said it wasn’t Billy Milligan who was committing the crimes. Two different personalities were in control of his body—Ragen, who was a Yugoslavian man, and Adalana, who was a lesbian. The jury agreed, and he was the first American found not guilty due to DID. He was confined to a mental hospital until 1988 and released after experts thought that all the personalities had melded together.

In 1981, Daniel Keyes, the award-winning author of Flowers for Algernon, released a book about Milligan’s story called The Minds of Billy Milligan. An upcoming film based on his story, The Crowded Room, will reportedly star Leonardo DiCaprio.

Milligan died December 12, 2014 at the age of 59 from cancer.

1Juanita Maxwell

In 1979, 23-year-old Juanita Maxwell was working as a hotel maid in Fort Myers, Florida. In March that year, 72-year-old hotel guest Inez Kelley was brutally murdered; she was beaten, bitten, and choked to death. Maxwell was arrested because she had blood on her shoes and a scratch on her face. She claimed she had no idea what happened.

While awaiting trial, Maxwell saw a psychiatrist, and when she went to trial, she pleaded not guilty because she had multiple personalities. She had six personalities besides her own, and one of the dominant personalities, Wanda Weston, committed the murder.

At her trial, the defense team, through the use of a social worker, drew Wanda out on the stand. The judge thought that the transformation was quite remarkable. Juanita was a soft-spoken woman, but Wanda was boisterous and flirtatious and liked violence. She laughed while she admitted to beating the senior citizen with a lamp over a disagreement about a pen. The judge was convinced that she either had multiple personalities or deserved an Academy Award.

Maxwell was sent to a psychiatric hospital, where she says she didn’t get proper treatment and simply received tranquilizers. She was released, but in 1988, she was again arrested, this time for robbing two banks. She again claimed Wanda did it; the pressure of the outside was too much, and Wanda had taken over again. She pleaded “no contest” and was released from prison for time served.

four cases of supposed multiple personality disorder-evidence of unjustified dignoses

Four Cases of Supposed Multiple Personality Disorder: Evidence of Unjustified Diagnoses

by suraj kumar,osh state university,group-10 b

(based on Canadian Journal of Psychiatry, Vol. 38,(4), May 1993, 245-247.)

Four cases are presented in which an unjustified diagnosis of multiple personality disorder was made. These cases are used to illustrate the concern that some cases of multiple personality disorder may be the result of misdiagnosis by both patients and clinicians.

Traditionally, multiple personality disorder (MPD)  has been considered rare; only 72 cases were reported between 1816 and 1944 . It has been diagnosed with increasing frequency in North America . The change began after Thigpen and Cleckley  wrote The Three Faces of Eve[ and a film was made from the book. The number of cases increased significantly again after the description of Sybil by Schreiber]. This has sparked criticism  and concern that media interest and subsequent publicity about MPD may result in its artificial production .

Case 1
A 42 year old single female presented to the emergency ward complaining of restlessness, depression and inability to concentrate. She was disheveled and agitated, with blunted incongruous affect, thought disorder and auditory hallucinations. She claimed to be unable to remember details of her childhood and that both her parents were alcoholics. She had done well in school until age 16, when she began abusing drugs and alcohol. She worked steadily for several years, until she was limited by her substance abuse and frequent hospitalizations and was then supported by a disability pension. She had several short-lived unstable relationships with men and reported having been raped four times. At age 17 she accidentally cut herself, noticed no pain and began cutting herself repeatedly. She was hospitalized in her early 20s and was treated with phenothiazines for about four years; she was subsequently hospitalized because of suicide attempts and "behaving strangely." She met the DSM-III-R criteria for schizophrenia. A differential diagnosis of a personality disorder with schizophreniform episodes was also considered. A second psychiatric opinion supported this assessment.

The patient was convinced that she had MPD; this was first suggested to her by a friend because of her intermittently childish manner, mood swings and poor recall of childhood events. She read several books on MPD and demanded hypnosis and intensive psychotherapy. After several consultations, she was diagnosed as having MPD by one therapist (with a special interest MPD), and "probable dissociative disorder" by a second therapist. The diagnosis of MPD appeared to be based on the patient’s psychopathology and history and not on the observation of a second, distinct personality. Her psychotic symptoms improved with neuroleptics. The patient, however, refused to even consider the diagnosis of schizophrenia, stating she preferred a diagnosis of MPD since it was "treatable."

Case 2
This 32 year old single female was wheelchair-bound. She reported having suffered a fall in her teens, which led to a discectomy at L3/4, followed by arachnoiditis, a paraparesis and chronic pain. Subsequently, abscesses complicated injections of medication in the left hamstring region with loss of muscle tissue, requiring a myocutaneous hamstring flap and contributing to a contracture.

She had been placed in 47 different foster homes between the ages of 12 and 19 and had been sexually abused throughout her childhood and adolescence by male acquaintances and male foster parents. She admitted to abusing alcohol and street drugs and deliberately harming herself. Nevertheless, she succeeded in earning an income as a wheelchair model and completed several years of university.

A psychiatrist who had hypnotized her decided that she had four additional personalities: Diana, four years old, sought security and attention and had temper tantrums; Gail, age 12, had a personality similar to the patient’s as a teenager; John, age 26, appeared as an auditory hallucination disturbing her sleep, which reactivated her memories of sexual abuse; the Deathman, age 27, intervened when John, Gail and Diana argued. The patient would become suicidal after receiving orders to die from the Deathman or from John. However, Gail and Diana would then provide sufficient support to allow her to get help either from the police or from psychiatric services.

At this admission to hospital, she presented to the emergency with chronic pain, feelings of sadness, hopelessness and suicidal ideation and stated that her symptoms were the result of MPD. When seen, she commented: "I was also treated by a psychiatrist who discovered under hypnosis that I had four different personalities." The doctor’s reply to this was, "I don’t altogether buy the idea of MPD," to which she replied "nor do I." The patient’s subsequent treatment focused on management of her suicidal ideation and chronic pain and not on multiple personalities.

Accordingly, she was transferred to the care of a specialist in physical medicine. It was thought that much, if not all, of her limitation of movement and contractures were not the result of organic disease. Physiotherapy improved the flexion of her knee and hip on the left, and she began to use a walker. She then became depressed and suicidal and was returned to the psychiatric hospital. Morphine sulphate was gradually reduced from 60 mg bid to 30 mg bid. Once again she became free of suicidal thoughts, was able to sit again in her wheelchair and was discharged.

Case 3
This 29 year old female who was separated from her husband presented to the emergency with diaphoresis, confusion and slurred speech. Laboratory work revealed hypoglycemia and she was admitted to hospital for assessment and treatment. Over the next two days, she had two further episodes of unexplained hypoglycemia. She appeared depressed, and self-administration of insulin was suspected.

She described being amnesic for several hours before the onset of her episodes and complained of depression, inability to concentrate, social isolation and hopelessness. She remembered little about her childhood, but recalled that both parents had been chronically ill and that she had had to take care of them. She reported that her mother had multiple sclerosis and agoraphobia and that her father had a bipolar affective disorder. She completed high school and married when she was 19 years old.

The next day, the patient revealed to the psychiatrist that "Mindy," a voice in her head, wanted to hurt her and told her that she was bad. The psychiatrist made no comments on Mindy and asked no further questions about her. The following day the patient admitted that she had been injecting insulin, but insisted that Mindy made her do this. Later that day, she described hearing voices that belonged to Miranda, Kim, Catherine and Sam. She elaborated on their personalities and reported knowledge of them through letters she found signed by them and hearing their voices in her head. She was then transferred to a psychiatric ward.

She had yet another episode of hypoglycemia. On confrontation, she admitted that she administered the insulin deliberately. She described Mindy and the other personalities as "creations." Her comment was, "I can’t resist the impulse to change to a different role. I created a role and really got into it. I took a part of myself and embellished it." She was very familiar with medical illnesses because she read textbooks and the DSM-III and had gotten herself admitted to several hospitals in the past. She had also been admitted with symptoms resembling multiple sclerosis, Guillain-Barre syndrome, abdominal pain (for which she underwent a laparoscopy), psychoses, fugue states and depression. She frequently signed herself out when suspicion about her symptoms arose. These hospitalizations resulted in a separation from her husband.

She first began thinking about MPD four years earlier when a psychiatric nurse informed her that the attending doctor had considered this diagnosis. She familiarized herself with the symptoms and developed Mindy and the other personalities. She was later admitted, diagnosed and treated as having MPD on several occasions, using her personalities as aliases for some admissions to hospital. However, there were never any lapses in her memory and at no time had an alternate personality ever emerged. Over the previous ten months, she had been receiving weekly supportive psychotherapy. This had gone well and she had not feigned MPD until two months earlier, when the therapist suggested she had some signs of MPD. The patient then felt compelled to assume the roles of the different personalities and was quite upset that a useful coping mechanism was found out.

Case 4
A 30 year old divorced woman had been diagnosed with several disorders. A psychiatrist who saw her for a year told her she had four different personalities equalling the same number of mood states observed in his office. She was relieved to learn that she suffered from this disorder, which fit with what she had read in the book Sybil. Treatment consisted of psychotherapy and occasional psychotropic drugs. She stopped seeing the psychiatrist because her condition did not improve.

She sadly recounted various vegetative depressive symptoms, including weight gain, and mentioned similar past episodes interspersed with brief periods of increased irritability, poor impulse control resulting in numerous fights, and an increase in libido. She changed jobs frequently and her interpersonal relationships were unstable. At times, she would indulge in such uncharacteristic behavior as exotic dancing.

She reported that her husband (to whom she was married for one month) had physically and sexually abused her. She also reported that she had been sexually abused by her grandfather (fondling genitalia) when she was eight. After completing school, she left home to fulfill her ambition of singing with a rock band and began abusing street drugs and alcohol.

Both the patient and her mother reported that everyone in the immediate family had been treated for depression. Two uncles had committed suicide, and one aunt had been treated with lithium. Her history revealed numerous visits to her family physician and emergency rooms for frequent migraine headaches.

BipolarII illness was diagnosed on the basis of her present state, the course of the illness and family history. After treatment with lithium for one month, she reported, "this is the best I have felt over the last ten years." Her colleagues and family commented on how well she was doing. She no longer believes she has multiple personality disorder, but has mentioned that she knew the existence of a personality named "Shelley" who liked to "swear, deceive and lie."

Discussion
Putnam et al.  found that MPD could have varied features including amnesia, affective disturbance, suicidal thoughts, insomnia, substance abuse, auditory hallucinations, thought disorder and significant childhood abuse. Out patients fit many of the above features. Three had attempted suicide, all showed affective disturbance, two abused street drugs or alcohol, and one probably abused prescribed narcotics.

These cases show in different ways that MPD can be diagnosed inappropriately. Sometimes it can be abandoned easily (cases 2 and 4), but sometimes the patient may hold it intractably (case 1), perpetuating a misdiagnosis. Treatment may be extensive but inappropriate (cases 3 and 4). The chance of patients hearing of MPD prior to presentation is now so great that it cannot be assumed that anyone with the "condition" will have developed it without prior preparation or suggestion, whether from the media or from health care professionals. If all modern cases are uncertain, it is important to determine the way in which the classic cases emerged. These cases were reviewed, and several appeared to be cases of bipolar affective illness and many more were induced overtly under hypnosis with the therapist directly naming separate personalities . All of the patients suffered from misdiagnosis, iatrogenesis or encouragement by enthusiastic hypnotists.

Fahy  reviewed the recent literature and concluded that there is little evidence to support MPD as a distinct diagnosis. He notes the wide variation with cultural conditions of the number of cases diagnosed (one in Britain in the previous 15 years and thousands in North America), the lack of significant physiological evidence, the weakness of some suggested explanations (such as self-hypnosis), the practice of giving priority to the diagnosis of MPD in patients who have a number of other symptoms which would justify alternative psychiatric diagnoses, the potential for molding by therapists, the failure to elicit a clear pattern of psychiatric diagnosis among the first-degree relative of the patients and the poor scientific quality of the literature on MPD.

Aldridge-Morris  regards multiple personality as a cultural phenomenon and a social role. Kenny  likewise sees it as a play on social roles. Many psychiatrists with extensive experience have never seen a valid case. Ljungberg mentions no case in 381 patients with overt physical symptoms. Takahashi  found that no cases of MPD had been diagnosed in Japan.

Chodoff  noted the rarity of cases in his own practice and observed that in two cases which had been video taped, he was struck by the bolstering of defences--with a stultifying effect on the psychotherapeutic progress--exerted by concentration on the characteristics of the individual personalities rather than the patient’s underlying conflicts. In fact, we agreed that our four patients were misdiagnosed with MPD and were better treated once they were diagnosed correctly.

We think it is very unlikely that a sustained diagnosis of an alternate personality ever occurs without social or medical encouragement. Where occasional cases of dissociation do arise in which another identity is assumed, these do not appear to last long if they lack subsequent fostering. Adityanjee et al.  described cases of naive young people who had hysterical dissociation and adopted new roles which quickly remitted.

In developed countries there is always the risk that the patients will have encountered the diagnosis in the popular media. This, in addition to the influence of doctors interested in the field, makes the validity of any modern diagnosis of MPD debatable.

Multiple Personality Disorder: Witchcraft Survives in the Twentieth Century

Since 1980, some psychotherapists have claimed that thousands of Americans are afflicted with multiple personality disorder. Believing such claims requires ignoring their many serious deficiencies.

Any people, given over to the power of contagious passion, may be swept by desolation, and plunged into ruin.

— Charles W. Upham, 1867

An epidemic of psychiatric illness is sweeping through North America. Before 1980, a total of no more than about two hundred cases had ever been found in the entire world, throughout the entire recorded history of psychiatry. Yet today, some proponents of the condition claim that it afflicts at least a tenth of all Americans, and perhaps 30 percent of poor people — more than twenty-six million individuals. An industry involving significant sums of money, many specialty hospitals, and numerous self-described experts, has rapidly grown up around the disorder.

The illness is multiple personality disorder (MPD), a condition that has always attracted a few wisps of controversy. Lately, these wisps have coalesced into clouds that, in drenching rainbursts, pour criticism on the disorder. An examination of the flawed reasoning, unsound claims, and logical inconsistencies of the MPD literature shows that well-founded concerns drive this storm of criticism.

What Is MPD?

MPD is classified as a dissociative disorder. The term dissociation refers to disruption in one or more mental operations that constitute the central idea of “consciousness": forming and holding memories, assimilating sensory impressions and making sense of them, and maintaining a sense of one’s own identity (American Psychiatric Association 1994, 477). The essence of dissociation is that material not in awareness influences behavior, mood, and thought (Spiegel and Schleflin 1994). Thus, the behavioral disturbances prominently manifested in dissociative disorders are considered to be unconscious: that is, resulting from forces beyond the patient’s awareness, beyond voluntary control.

The king of dissociative disorders is MPD,¹ also called dissociative identity disorder. Afflicted people episodically fail to recall vital data about themselves, but what distinguishes MPD from all other psychiatric conditions is the putative cause for these memory failures. The condition’s proponents claim the memory failures occur because patients are periodically taken over by one or more “alter personalities” (variously referred to as “identities,” “ego states,” “alters,” or “personality states”). These guest personalities, submerged since being formed during childhood — more on this later — rise to the surface and impose their own memories, thoughts, and behaviors on patients.

The essential feature of MPD, it is said, is that an individual’s behavior is controlled by two or more alters (Putnam et al. 1990); the separate identities are assumed involuntarily (Sarbin 1995; Watkins and Watkins 1984). One personality may feel “carried along in a panicked helpless state” as another endangers it or engages in behavior repugnant to it (Kluft 1983, 75). Patients are said to experience a sense of being made to misbehave or hurt themselves (Putnam 1991). Some theorists even claim the existence of “omnipotent alters,” which can simply compel patients to do their bidding (Lewis and Bard 1991). As an example, C. A. Ross writes of alters that “force [the patient] to jump in front of a truck. [The alters] then go back inside just before impact, leaving the [patient] to experience the pain” (Ross 1989, 115).

The image of all this is of an invading army usurping a government, an operator taking control of a machine, or a parasite attacking another organism. For example, contributors to the MPD literature frequently make statements such as, “If [the patient] drops her guard, the alters take over” (Bliss 1980, 1393). Proponents describe the original personality as the “host” — again recalling notions of a parasite — and describe the change from host to alter, or from one alter to another, as “switching.” Thus, a librarian may one minute be her forty-two-year-old true shy self, but behave in the next like a nine-year-old child, a deep-voiced, foul-mouthed logger, or a promiscuous woman who picks up men in bars (Putnam 1989, 111, 119-120).

These guest personalities, or “alters,” are believed to have many truly remarkable capabilities and qualities. Some have the task of reproducing — of creating new alters. Others, it is claimed, determine which alter will take control of the body at any particular time (Kluft 1995, 364). There are alters of people of the opposite sex, of the treating therapist, of infants, television characters, and demons. Alters of Satan and God, of dogs, cats, lobsters, and stuffed animals — even of people thousands of years old or from another dimension — have been reported by MPD proponents (Fifth Estate 1993; Ganaway 1989; Hendrickson et al. 1990; Kluft 1991b, 166; Kluft 1995, 366; Ross 1989, 112; Ross et al. 1989).

MPD proponents assert that all manner of activities — creating a work of art, driving a car, fighting, doing schoolwork, engaging in prostitution, cleaning a bathtub, or even baking chocolate-chip cookies — are performed by alters (Braun 1988; Putnam 1989, 104; Ross 1989, 112).

Alters are often wily, secretive, and elusive. For instance, R. P. Kluft (1991a) says he has identified guest personalities whose role is to deny that the patient has MPD, thus obscuring the diagnosis. Personalities are also said to try to trick therapists by hiding and impersonating each other (Putnam 1989, 113). They are said to be plastic: “Alter A may be somewhat different when it has been preceded by alter B than when it follows alter C” (Kluft 1988, 49). They are said to multiply: each alter can undergo a cascade of splits, resulting in what is called “polyfragmented” MPD (Frontline 1995; Ross 1994, 60). Or the opposite may occur: during therapy, several alters may coalesce into a kind of “superalter” (Kluft 1988). It is even claimed that they can permanently stop growing at some time, or temporarily stop aging by going into “inner hibernation” and then emerging to resume growing older (Ross 1989, 112). Cases reported in the last few years have shown a median number of two alters at the time of diagnosis; however, during treatment, a further six or twelve usually appear (Putnam et al. 1986; Ross et al. 1989). Sometimes many more are found: as many as one quarter of cases have twenty-six or more alters (Kluft 1988). And the longer patients remain in treatment, the more guest personalities are discovered (Kluft 1988; Kluft 1989): “It is the rule rather than the exception for previously unknown personalities to enter the treatment” (Kluft 1988, 54). Patients with 300 and 4,500 personalities have now been reported (Kluft 1988; Ross 1989, 121; Ross et al. 1989). Kluft has been consulted “several times” on cases where therapists claim — wrongly, Kluft says — to have counted “upward of 10,000 alters” (Kluft 1995, 363).

Why this nearly endless flowering of personalities? According to MPD proponents, it occurs because each trauma or major life change experienced by an MPD patient causes some or all of the alters to be created anew (Kluft 1988).

What Causes MPD?

According to proponents, extraordinary childhood traumas — usually sexual or other abuse by adults — lead to MPD.

The theory is as follows. Because the child cannot physically escape the pain, its only option is to escape mentally: by dissociating. Dissociation is said to defend against pain by allowing the maltreatment to be experienced as if it were happening to someone else (Atchison and McFarlane 1994; Braun 1989; Kluft 1985a; Kluft 1987; Ross 1995). The distress of this childhood maltreatment is also endured by employing repression, a mental mechanism that supposedly allows the child to forget that the abuse happened at all (Lynn and Nash 1994): “Now, not only is the abuse not happening to me, [but] I don't even remember it” (Ross 1995, 67).

Eventually, MPD proponents claim, these defenses begin to be overused — that is, enlisted more and more to cope with commonplace, everyday stressors (Braun 1986, 66; Putnam 1991). The abuse victim’s “dissociated internal structures are slowly crystallized” until they become personalities (Atchison and McFarlane 1994; Putnam 1989, 53-54; Ross 1995a, 67). As mentioned earlier, this alter-building process is supposed to occur almost exclusively in early childhood (Greaves 1980; Vincent and Pickering 1988).

What’s Wrong Here?

So stands the tottering house of MPD theory. Its foundation crumbles and termites gnaw; the storm beats upon it.

The house suffers from at least four serious ailments.

The first: What, exactly, is an “alter personality"?

One might believe that the disorder’s proponents would long ago have taken the elementary step of answering this fundamental question. Such a belief would be mistaken. The MPD literature contains not one single plain, understandable definition that would allow an alter to be recognized if it were encountered on the street, in a person one has known intimately for years, or even in oneself.

The vagueness and imprecision of the alter concept are shown by the frequency with which even MPD experts contradict each other on the fundamental attributes of these entities. As an example, Ross (1990) says patients’ minds are no more host to many distinct personalities than their bodies are to different people; another theorist believes that alter personalities are imaginary constructs (Bliss 1984). But in contradiction, DSM-IV and the writings of several MPD theorists repeatedly stress that alters are well-developed, distinct from one another, complex, and well-integrated (Kluft 1984b, Kluft 1987; Taylor and Martin 1944). Also, MPD-focused practitioners routinely report patients who have dozens or hundreds of personalities — yet Spiegel (1995) has recently claimed that because MPD patients cannot integrate various emotions and memories, such patients actually have less than one personality, not more than one.

Contradictions abound elsewhere, too. On the one hand, Bliss (1984) believes personalities have specific and limited functions, and possess only a narrow range of moods. But on the other, Braun (1984) and other proponents (Putnam 1989, 104; Ross 1989, 81) say that fragments do not have a wide range of mood or affect. One proponent states that fragments “carry out a limited task in the person’s life” (Ross 1989, 81), but then later in the same publication (111-118) argues that personalities may perform only one specific function, represent only a single mood or memory, or exhibit only a narrow range of skills.

This failure to rigorously define the concept of a guest personality leads to all manner of excesses. For example, MPD proponents discover MPD in people whose close relatives, and others who have known those people for years, have never once seen any evidence of alters (Ganaway 1995). Kluft (1985b), for instance, diagnosed the disorder in a series of people — even though he himself acknowledged that almost half of them showed “no overt signs” of MPD. These proponents also find MPD even in people who lack any knowledge whatever of having the condition (Bliss 1980; Bliss 1984; Kluft 1985b), and at least one enthusiast recommends that people be treated for MPD even if they claim not to have the disorder (Putnam 1989, 139, 215).

The imprecision of the alter concept allows MPD adherents to claim that scores of patient behaviors should signal the possible presence of guest personalities. Thus, adherents claim that the following behaviors — and many others — are important diagnostic clues for MPD: glancing around the therapist’s office; frequently blinking one’s eyes; changing posture, or the voice’s pitch or volume; rolling the eyes upward; laughing or showing anger suddenly; covering the mouth; allowing the hair to fall over one’s face; developing a headache; scratching an itch; touching the face, or the chair in which one sits; changing hairstyles between sessions; or wearing a particular color of clothing or item of jewelry (Franklin 1990; Loewenstein 1991; Putnam 1989, 118-123; Ross 1989, 232). In one case known to the author, a leading MPD proponent claimed that the diagnosis was supported by behavior no more remarkable than the fact that the patient changed clothes several times daily and liked to wear sunglasses.

These beliefs about personalities raise some difficult questions that MPD enthusiasts fail to answer. First, how does alter-induced behavior differ from behavior people show every day — say, when they are angry or happy (Piper 1994a)? Do indwelling alters or fragments cause all feelings? If not, how does one determine which emotions result from the activities of alters, which from those of fragments, and which from neither? One proponent acknowledges the difficulty posed by these questions: he says alters may be indistinguishable from the original personality (Kluft 1991b).

Second, how do persons claiming they are overpowered by “irresistible alters” differ from those who attempt to avoid legal sanctions by claiming that, when they committed crimes, they couldn't control their behavior (Piper 1994c)?

Finally, one wonders how seriously to take MPD enthusiasts’ claims that they can accurately keep track of fifteen or thirty invisible alters — or 4,500 — when those alters are deceiving the therapist, growing, splitting, ceasing to age, reproducing, coalescing, going into “inner hibernation,” and changing their characteristics depending on which personality preceded or followed their appearance.

In summary, knowing how to test or prove an assertion that an individual has more than one personality, or how to clinically distinguish between personalities, ego states, identities, fragments, personality states, or the like, is impossible in the absence of agreement about what any of these terms mean (Dinwiddie et al. 1993; Aldridge-Morris 1993, ch. 1). It follows, then, that few limits exist to the number of “personalities” one may unearth. The number is restrained only by the interviewer’s energy and zeal in searching, and by his or her subjective — and perhaps idiosyncratic — sense of what constitutes an alter (Dinwiddie et al. 1993).

Enthusiasts thus expand the concept of personality beyond all bounds. If such a grandly expansive definition is employed, finding thousands of MPD “patients” becomes simple. Without clear behavioral criteria allowing the observer to know when a personality has been encountered, the term personality comes to mean anything and everything patient and clinician want it to. It thus comes to mean nothing.

The second affliction of the house of MPD is laid bare by one startling fact: the disorder’s most dramatic signs appear after, not before, patients begin therapy with MPD proponents.

Those eventually given this diagnosis seek professional help because of many different kinds of psychiatric difficulties. When first presenting for treatment, these patients can exhibit signs or symptoms of each and every psychiatric condition (Coons et al. 1988; Putnam et al. 1986; Bliss 1984). One complaint, however, is conspicuously absent: evidence of separate alter personalities (Brick and Chu 1991; Franklin 1990; Kluft 1984a; Kluft 1985a; Ross 1989, 93).

But when the patients enter MPD-focused therapy, signs of alters’ behaviors skyrocket. For instance, one patient’s guest personalities created apparent grand mal seizures (Kluft 1995); another sold drugs when the host was supposed to be at work (the host would supposedly “come to” miles away) (Putnam 1989, 198). According to proponents, much of the behavior of MPD patients results from alters’ “personified intrapsychic conflicts” (Putnam et al. 1986, 291); the personalities create crises in the patient’s life by attempting to dominate, sabotage, and destroy one another (Kluft 1983; Kluft 1984c). As one example, an alter may lead the patient into compromising circumstances — say, a sexual encounter, an episode of firesetting, or an illegal drug purchase. This personality then vanishes, leaving the patient, who “wakes up” not knowing how he or she got into the situation, to handle the problem (Confer and Ables 1983; Kluft 1991b).

MPD patients often significantly deteriorate during treatment (Kluft 1984c; Ofshe and Watters 1994, ch. 10; Pendergrast 1995, ch. 6). One of the disorder’s leading adherents acknowledges that MPD psychotherapy “causes significant disruption in a patient’s life outside the treatment setting” and that suicide attempts may occur in the weeks following the diagnosis (Putnam 1989, 98, 299). As MPD psychotherapy progresses, patients may become more dissociative, more anxious, or more depressed (Braun 1989); the longer they remain in treatment, the more florid, elaborate, and unlikely their stories about their alleged childhood maltreatment tend to become (Ganaway 1995; Spanos 1996, ch. 20). This worsening contributes to the lengthy hospitalizations — some costing millions of dollars (Frontline 1995; Piper 1994b) — that often occur when MPD patients who are well-insured are treated by the disorder’s enthusiasts. Hospitalizations occur more frequently after the MPD diagnosis is made (Piper 1994b; Ross and Dua 1993).

MPD-focused therapists have struggled mightily to explain these rather embarrassing results of their interventions. Examining these explanations is beyond the scope of this article: see Piper 1995; Piper 1997; Simpson 1995. However, several recent malpractice juries have found the explanations unimpressive. The juries have preferred a simple and logical explanation for the worsening status of these patients: patients worsen after beginning MPD-focused therapy because therapists cause them to do so — by, among other things, encouraging ever-more-dramatic displays of “alters.”

One important way in which therapists encourage such displays is to behave as if alter personalities were real. For example, leading authorities in this field routinely call alters out, hypnotize them, engage in “lengthy monologues” with them, name them, establish treatment alliances with them, talk to their stuffed animals, take them for walks to McDonald’s ("The outside world often seems very big and frightening to child personalities”), engage in playful parody and sarcasm with them, allow them to work on age-appropriate childrens’ projects in occupational therapy ("to show respect for the alter”), and recruit one alter to keep another from hurting still a third (Ross 1989, 227, 252-254; Ross and Gahan 1988). Other MPD adherents encourage alters to solve problems among themselves, to learn the Golden Rule, to participate in “internal group therapy,” and even to decide whether or not the host should enter treatment (Caul 1984; Kluft 1993; Ross 1989, 209).

In 1988, Vincent and Pickering noted that in the published reviews of the literature, exactly one case presenting in childhood was reported in the 135 years prior to 1979. After reviewing the literature published since 1979, they were able to gather a mere twelve cases. (It seems, however, that Vincent and Pickering had to stretch a bit to find even those — four of the twelve were examples not of MPD, but rather of something the authors called “incipient MPD.”) Nine additional cases were found by Peterson (1990).

These minuscule numbers, standing in stark contrast to the thousands of adult cases discovered in recent years, reveal the third weakness: if MPD results from child abuse, then why have so few cases been discovered in children?

The fourth and final weakness of the house is that it is built in a bog, namely, the belief that childhood maltreatment causes MPD. The literature strongly implies that childhood trauma has been unequivocally established as the primary cause of the disorder, and that severe sexual abuse more or less directly leads to MPD (Braun 1989, 311; Ellason and Ross 1997; Putnam 1989, 47; Ross 1989, 101; Ross 1995, 505; Schafer 1986).

Several commentators have recently noted this formulation’s deficiencies. Esman (1994) warns of the dangers of attempting to discover unitary causes of psychiatric disorders; he urges “measured skepticism” about assigning a role for sexual abuse, independently of other aspects of disturbed family function, in the genesis of later adult psychopathology. Numerous investigators, raising similar cautions, state that general family pathology in childhood better predicts adult dysfunction than does childhood sexual abuse alone (Bifulco et al. 1991; Fromuth 1986; Harter et al. 1988; Levitt and Pinnell 1995; Nash et al. 1993). Further, studies repeatedly note the difficulty of separating effects of abuse from the “matrix of disadvantage” giving rise to that abuse (Nash et al. 1993; Bushnell et al. 1992; Hussey and Singer 1993; Mullen et al. 1993). And finally, recent studies warn of the “very real uncertainties that surround evidence” concerning the relationship between childhood sexual abuse and psychiatric disorders (Fergusson et al. 1997), and conclude that available evidence to date does not support sweeping generalizations about childhood sexual abuse as an isolated cause of adult psychopathology (Beichtman et al. 1992; Finkelhor 1990; Levitt and Pinnell 1995).

The evidence for and against a relationship between trauma and dissociative pathology has also been examined. The data should “inspire skepticism, or at least serve to mute the grand conclusions about univariate cause and effect between trauma and dissociation that abound in the professional and lay literatures” (Tillman et al. 1994, 409).

Yet another weakness of this literature is inadequate verification of its child-abuse claims (Frankel 1993; Piper 1994a; Piper 1997). MPD patients very often report bizarre and extremely improbable experiences. For example, in a recent case familiar to the author, one patient claimed to have witnessed a baby being barbecued alive at a family picnic in a city park; another patient alleged repeated sexual assaults by a lion, a baboon, and other zoo animals in her parents’ back yard — in broad daylight. (It should be mentioned that both therapists in these cases are prominent MPD adherents, and neither appeared to have any difficulty believing these allegations). Despite the frequency of claims of this type, “repressed memory patients are seldom referred to medical doctors for examination and possible corroboration of past abuse [though one would assume that] the horrific physical abuse allegedly experienced . . . would require medical care at some point” (Parr 1996). (Space limitations limit discussion of this weakness; see Jones and McGraw 1987; Lindsay and Read 1994; Ofshe and Watters 1994; Pendergrast 1994, chs. 3-5; Spanos 1996, ch. 20; Wakefield and Underwager 1995, ch. 10).

The logic of the claim that childhood trauma causes MPD demonstrates a final serious flaw. If the claim were true, the abuse of millions of children over the years should have caused many cases of MPD. A case in point: children who endured unspeakable maltreatment in the ghettoes, boxcars, and concentration camps of Nazi Germany. However, no evidence exists that any developed MPD (Bower 1994; Des Pres 1976; Eitinger 1980; Krystal 1991; Sofsky 1997) or that any dissociated or repressed their traumatic memories (Eisen 1988; Wagenaar and Groeneweg 1990). Similarly, the same results hold in studies of children who saw a parent murdered (Eth and Pynoos 1994; Malmquist 1986); studies of kidnapped children (Terr 1979; Terr 1983); studies of children known to have been abused (Gold et al. 1994); and in several other investigations (Chodoff 1963; Pynoos and Nader 1989; Strom et al. 1962). Victims neither repressed the traumatic events, forgot about them, nor developed MPD.

Concluding Comments

In the epigraph that begins this article, Upham speaks of the excesses of the seventeenth-century New England witchcraft craze. The story of Sarah Good exemplifies those excesses (Rosenthal 1993). In March of 1692, when thirty-eight years old and pregnant, she heard her husband denounce her to the witchcraft tribunal. He said that either she already was a witch, “or would be one very quickly” (Rosenthal 1993, 89). No one had produced evidence that she had engaged in witchcraft, no one had seen her do anything unusual, no one had come forward to say they had participated in satanic activities with her. But no matter.

On July 19, 1692, Sarah Good died on the gallows.

Three hundred years later, a woman in Chicago consulted a psychiatrist for depression (Frontline 1995). He concluded that she suffered from MPD, that she had abused her own children, and that she had gleefully participated in Satan-worshiping cult orgies where pregnant women were eviscerated and their babies eaten. Her failure to recall these events was attributed to alters that blocked her awareness. No one had produced any evidence for the truth of any of this, no one had seen her do anything unusual, no one had come forward to say they had participated in satanic activities with her. But no matter.

The doctor notified the state that the woman was a child molester. Then, after convincing her that she had killed several adults because she had been told to do so by satanists, he threatened to notify the police about these “criminal activities.”

The woman’s husband believed the doctor’s claims. He divorced her. And, of course, because she was a “child molester,” she lost custody of her children.

Charles Upham recognized the importance of erecting barricades against addlepated ideas blown by gales of illogic. The twentieth-century fad of multiple personality disorder indicates that even after a third of a millennium, such bulwarks have yet to be built.

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Note

1. In the fourth and latest edition of the American Psychiatric Association’s Diagnostic and Statistical Manual, the disorder has been renamed. Although the third edition called the condition MPD, the fourth calls it dissociative identity disorder. The differences between the two disorders’ diagnostic criteria are slight and mainly cosmetic: in the newer criteria, terms such as identities or personality states are employed, rather than the older personalities. Also, the newer definition emphasizes the patient’s inability to recall important personal information.
   Whether the newer term will become popular has yet to be seen; because MPD has the distinct advantage of familiarity, it will be used in this paper.

by suraj kumar,osh state university,group-10 b

the end