Multiple Personality

Multiple Personality Disorder (MPD) is labeled Dissociative Identity Disorder (DID) when it causes a person distress and is categorized as a psychiatric disorder. DID is discussed in the context of dissociative disorders in Chapter 12 (Abnormal Psychology).

On the other hand, many cases of multiple personality are not psychiatric disorders at all, by modern standards. As we will see when grappling with the perennial question, "What defines abnormal behavior?" in the next chapter, experts now agree that psychiatric disorders (to deserve that label) must cause distress.

A survey of Multiple Personality sites on the internet will show that people who self-identify as multiple personalities are generally not distressed by it. They often celebrate it.

Psychologists and psychiatrists also recognize now that phenomena very similar to multiple personality can appear in religious rituals. For example, ecstatic dancing leading to a trance-like state is found both in Africa and among American pentecostal Christians.

In our culture, multiple personality is approximated by method acting. This is the technique by which an actor tries for "complete emotional identification with a part," in order to bring that character to life on camera or on the stage.

Multiple personality is not a new phenomenon. Taylor and Martin (1944) reported 76 cases of multiple personality in the English language literature, before any of the modern best-sellers about multiple personality was published.

The earliest report was written by a Dr. Mitchill in 1817. The paper was titled, "A Double Consciousness, or a Duality of Person in the Same Individual." That case involved a young woman named Mary Reynolds whose family came to Pennsylvania from England in 1797 when Mary was four.

The original personality was melancholy and shy. The second personality (which emerged when she was 19) was "witty" and "fond of company."

After a period of alterations, the second personality became dominant. When Mary was 36 only the second personality remained, and it continued to be the only one until her death at 61.

Mary Reynolds was typical of reported multiple personality patients. She had a strict upbringing. Her original personality was shy and sad, but her second personality was uninhibited and fun loving. Her case came from a time before hypnosis was known, so it was not due to hypnosis.

How was Mary Reynolds typical of DID patients?

The same basic pattern was found in the famous case of Eve. It was publicized in the 1957 bestseller by Thigpen and Cleckley: The Three Faces of Eve (1957).

The original personality (Eve White) was shy and repressed; the alter (Eve Black) was carefree. Hypnosis was not involved in creating the alternative personality, because Eve Black wrote a letter to the therapist before he used hypnosis.

The Three Faces of Eve was published in 1957 and became a best-seller, then a movie starring Joanne Woodward as Eve. Later Sybil was published in 1973. It, too, became a movie, again starring Joanne Woodward, this time as the psychiatrist Dr. Wilber.

The Sybil case was apparently a case of method acting itself, unless one prefers the term "fraud." Sybil (whose real name was Shirley Mason) acted out various identities under the direction of her therapist, Flora Rheta Schreiber (Dr. Wilber in the book and movie). Schreiber knew Shirley Mason for ten years before deciding she had multiple personalities.

The two had a long, intimate relationship (including 2,354 office sessions, hypnosis, living together at one point, and repeated administrations of sodium pentothal). Shirley Mason also read The Three Faces of Eve and found it fascinating.

Mason's doctor started writing a book about Mason's case long before it was concluded. Mason was offered a portion of royalties if she re-integrated and got well, which she did.

In the early 1990s, revelations about the case came from Dr. Herbert Spiegel, who served as a stand-in therapist with Shirley Mason when Dr. Schreiber was out of town.

During his sessions with Mason, Dr. Spiegal said, Shirley asked if Dr. Spiegel preferred for her to talk about her alters, or act them out as if they were inhabiting her, the way Dr. Schreiber preferred.

In other words, Shirley Mason was well aware that she was acting in order to satisfy the desires of her therapist. That revelation was verified later by detailed information from treatment transcripts.

Other early cases of multiple personality may have been similar responses to social relationships with doctors or therapists. Merskey (1992) re-analyzed the old cases identified by Taylor and Martin (1944). Merskey wrote:

It appeared to me that publicity had become so widespread, that there was no way in which we could say with certainty that any modern case arose without some contribution from suggestion...

Historical analysis offered one way of resolving this difficulty. If cases existed before the development of widespread publicity...they would enable us to learn what true cases were like originally...

For this reason I undertook a review of the major historical cases, looking at the original documents so far as they were accessible. To my surprise, there was not a single case which allowed a valid diagnosis of MPD, free either from a misunderstanding or from the effects of suggestion...

I began as somebody who believed that multiple personality might occur, but only rarely. I finished as a skeptic who had discovered that there was not a single true case from the past on which one could rely and who could only conclude that the present cases were being generated by social and professional forces. (Merskey, 1992).

What was Merskey's original intent, in reviewing early cases? What did he conclude?

Merskey's skepticism echoed doubts by the same psychiatrists who treated Eve and wrote The Three Faces of Eve: Thigpen and Cleckley. They were alarmed by the sudden increase in diagnosis of multiple personality after their book appeared. They wrote:

Over the past 3 decades we have together seen tens of thousands of psychiatric patients. Other than Eve, we have seen only 1 case (presented by a psychiatrist in Georgia) that appeared to be undeniably a genuine multiple personality. (Thigpen & Cleckley, 1984)

Hundreds of cases were referred to Thigpen and Cleckley as possible multiple personalities after they published The Three Faces of Eve, because they were considered authorities on the subject. All but one turned out to be "people seeking attention, trying to evade responsibility for crimes, or looking for a dramatic change in an unsatisfactory life."

What did Thigpen and Cleckley think about the hundreds of cases referred to them?

Note that Merskey, Thigpen, and Cleckley all adopted the assumption that a "true" disorder, to be a clinical entity, must force itself upon a person unbidden, like an infection or illness. If multiple personality emerged from a therapy or doctor-patient relationship, it did not count as genuine by definition.

If one is looking for a marker of true or genuine DID, the other obvious criterion might be amnesia. The original personality must have amnesia for the time when alters are out, and this is known to all who deal with multiple personality.

If accompanied by later amnesia for the activity of alternate personalities, multiple personality sounds much like the dissociative fugue state, which can occur as a result of seizure activity. We will discuss dissociative disorders in the next chapter.

However, the occurrence of amnesia in multiple personality cases may be optional, making it more like hypnosis. If that is the case, then perhaps amnesia can occur with multiple personality, maybe even usually occurs, but need not occur.

That is the state of affairs with hypnosis. Recall from our discussion of hypnosis in chapter 3 (States of Consciousness): hypnosis was once defined by amnesia.

In the mid to late 1800s, a person was not considered to have been truly hypnotized unless they could not remember the period of hypnosis. Then it was discovered that people could remember the events of hypnosis.

To recall the events of hypnosis, later, subjects had to be urged to do so. Suggestion caused hypnosis, and suggestion was the key to remembering the events of hypnosis later.

Something similar happened with Eve (Chris Sizemore), one of the few multiple personality cases Thigpen and Cleckley deemed authentic. During an early hypnotic session, Eve 2 (the mischievous alter) was asked to speak to Eve 1 (the sad, conventional personality) using their shared inner voice, when a signal was given by the psychiatrist.

This was an example of post-hypnotic suggestion. It was executed, as planned, while Eve 1 was talking to the therapist.

Her eyes grew wide with wonder, and she told the psychiatrist that now she realized she must indeed have a separate personality within her. The usual barriers of memory were broken down, and they were broken down simply by suggesting to the patient that they would be.

In the 1990s, two opposing theories emerged regarding the origins of Dissociative Identity Disorder (DID). They seem like opposites, but several scholars have pointed out they could both be true. They are not mutually exclusive.

The post-traumatic model (PTM) is the original assumption that multiple personality can act as a defense against traumatic memories (Gleaves, 1996). This idea goes back to the 1880s and Pierre Janet's concept of dissociation as a way of splitting painful material from consciousness.

For those subscribing to the post-traumatic model, DID can be defined as a "post-traumatic stress syndrome of childhood origin" (Chance, 1986). In almost all cases thought to be authentic, the origins of the syndrome are in the pre-school years.

The original Eve case fit that pattern. Chris Sizemore (the woman from Augusta, Georgia, called Eve in the famous books) traced her problem back to a pair of childhood incidents.

One memory involved a body removed from a pond near her home. The other involved her beloved grandmother scolding her for rolling a ball under the porch, then dying soon after, leading preschooler Chris to conclude she might be responsible for her grandmother's death.

Both those memories "came back" late in therapy as Sizemore's various personalities re-integrated. That would fit the post-traumatic model, in which memory integration is expected to accompany personality re-integration.

Flora Rheta Schreiber, Shirley Mason's therapist, followed the same script, locating traumatic memories in early childhood. However, transcripts of therapy sessions showed that Schreiber directly suggested memories to Shirley Mason (Sybil) while Mason was under the effects of sodium pentothal, a powerful drug.

Dr. Schreiber suggested details about sexual torture by her mother. Shirley obligingly included them in her memories. Scenes in the Sybil movie, proving the memories were authentic, were written for the movie and do not appear in the book.

The existence of a fraudulent case does not prove other multiple personality claims are a fraud. But it does show a blurry boundary between clinical cases and acting, and it supports Merskey's contention that displays of multiple personality occur under the influence of social relationships.

The social influence model of multiple personality was most clearly stated in the sociocognitive model of Nicholas Spanos (1996). Spanos suggested multiple personalities emerge as the result of interacting with a therapist who elicits them.

What was the Spanos sociocognitive model?

Lilienfeld et al. (1999) pointed out this does not imply conscious deception either by clients or therapists. The role-enactment could be the result of a client trying to do what a therapist (who believes in DID) expects to happen.

This explanation receives support from the existence of two other survivor group narratives. In the 1990s, large groups of individuals reported memories of UFO kidnapping and Satanic Ritual Abuse. Just as with DID, these memories were typically elicited under hypnosis or during therapy by counselors who knew beforehand what they would find.

In both cases (UFO kidnapping and Satanic Ritual Abuse) attempts to investigate the reality behind the memories turned up no evidence matching the large number of claims. In both cases therapists insisted they knew better, encouraging clients to regard their recovered memories as genuine.

The sociocognitive explanation of DID is supported by the existence of many culture-specific dissociative states, commonly called trance states, that appear under approved conditions. "Kinetically associated dissociation" (dancing into a trance state) is found in many African indigenous communities and also in a variety of religions. Henning (2013) notes:

Additionally, trances are often explained as possession by a spiritual being or deity. ...This possession can range from socially sanctioned, positive deity possession to unsanctioned, negative demonic possession...

What point does Henning make about dissociative symptoms and cultural context?

In short, Henning argues:

Dissociative symptoms are enacted through a cultural context of what is considered appropriate. In North America, where DID is highly prevalent in comparison to other cultures, the sociocognitive model suggests that therapists play a major role in the cultural formation of dissociative symptoms in DID.

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References:

Borch-Jacobsen, M. & Spiegel, H. (1997, April 24) Sybil–The Making of a Disease: An Interview with Dr. Herbert Spiegel. The New York Review of Books./p>

Chance, P. (1986, September). The divided self. Psychology Today, p.72.

Gleaves, D. H. (1966) The sociocognitive model of dissociative identity disorder: A reexamination of the evidence. Psychological Bulletin, 120, 42-59.

Henning, A. M. (2013). The Legitimacy and Etiology of Dissociative Identity Disorder. Concept, 36. Retrieved from: https://concept.journals.villanova.edu/article/view/1530 .

Lilienfeld, S. O., Lynn, S. J., Kirsch, I., Chaves, J. F., Sarbin, T. R., Ganaway, G. K., & Powell, R. A. (1999) Dissociative identity disorder and the sociocognitive model: Recalling the lessons of the past. Psychological Bulletin, 125, 507-523.

Merskey, H. (1992) The manufacture of personalities: The production of multiple personality disorder. British Journal of Psychiatry, 160, 327-340.

Schreiber, F. R. (1973) Sybil. Chicago: Henry Regnery.

Spanos, N. P. (1994) Multiple identity enactments and multiple personality disorder: A sociocognitive perspective. Psychological Bulletin, 116, 143-165.

Spanos, N. P. (1996) Multiple Identities and False Memories: A Sociocognitive Perspective. Washington, D.C.: American Psychological Association.

Taylor W. F. & Martin M. F. (1944) Multiple personality. Journal of Abnormal and Social Psychology, 39, 281-330.

Thigpen, C. H. & Cleckley, H. M. (1957). The Three Faces of Eve. New York: McGraw-Hill.

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