Dissociative Identity Disorder: The People Inside - Inside MPD

Written by Edward Dolnick

"Why is he here?" she whispered, gesturing toward me.

Riley recognized a personality named Sandi, a bright but terrified four-year-old. She explained who I was, and I mumbled a few words I hoped would be calming. A minute or two passed, and Sandi seemed more at ease. "Want me to write my name?" she asked timidly.

Still on the floor, on her hands and knees, Sandi painstakingly printed her name on a piece of paper. The letters were about half an inch tall, the stem of the a on the wrong side. "You know what?" she asked. "There's two ways to make a letter in my name." Underneath the lowercase n, Sandi carefully wrote N. "But you can't write both kinds of 'Sandi' at the same time."

After a few minutes more, Sandi ventured back to the couch to show me her writing. Riley told her that it was time to speak with Julia again.

I was taking notes, not watching, and I missed the switch. But there, sharing the couch with me again, was Julia. She seemed a bit befuddled, the way someone does when you wake her, but she knew me and Riley and where she was. "You've been gone a couple of hours," the therapist said. "Do you remember? No? Let me tell you what happened."

Frank Putnam, a psychiatrist at the National Institute of Mental Health and perhaps the leading authority on multiple personalities, lists three rules of thumb: The more abuse the patient endured, the more personalities: the younger the patient when another personality first appeared, the more personalities; and the more personalities, the longer the time needed in therapy.

Personalities, he explains, often see themselves as different in age, appearance, and gender, somewhat the way a woman with anorexia sees her skinny body as grotesquely fat. They seem unable to grasp that they share one body. Julia finds notes in her home, written in different handwriting and signed by various of her personalities: "I hate Julia so much. I want her to suffer. I'll cut her when I can. you can count on it."

A multiple may have as few as two and as many as hundreds of personalities. The average number is 13. Sybil, the woman portrayed in the movie by same name, had 16; Eve according to her autobiography, had not "three faces" but 22. Anne Riley says Julia has close to a hundred personalities. Multiples can sometimes control switches between personalities, particularly once they have become aware of their alter egos through therapy. Some switches are akin to flashbacks, panic reactions triggered by a particular memory or sight or sound, such as the siren that rattled Julia. Other switches are protective, as if one personality had handed off to someone better able to cope.

Surprisingly, many people with multiple personalities do fairly well in the workaday world. "There's a lot going on beneath the surface, but if it's so far beneath that it's not perceived, then for all practical purposes things are going along smoothly," says psychiatrist Richard Kluft of the Institute of Pennsylvania Hospital. A stranger would be unlikely to notice anything amiss. Spouses or children often think something is very strange, but have no explanation for what they see. "Once you've described the diagnosis to the family," says Putnam, "they call up for a week rattling off incident after incident that suddenly makes sense."

One multiple in six has earned a graduate degree. Some work as nurses, social workers, judges, even psychiatrists. Julia, who is not working now, was a drug abuse and alcoholism counselor for a time. In many cases, the personalities "agree" to cooperate, striking such deals as that the "children" will stay home and the "grown-ups" go to work.

In fact, personalities typically have specific roles and responsibilities. Some deal with sex, some with anger, some with child-rearing. Others are "internal administrators," deciding which personalities are allowed "out," which have access to various bits of information, and which are responsible for memories of trauma. Often, it is the administrator who holds down the person's job. The administrators, Putnam says, come across as cold, distant, and authoritarian, intentionally aloof to keep anyone from coming close enough to find out about the other selves.

All multiples have a "host," the personality they most often present to the world outside the workplace. The host usually does not know about the other selves, though there is often one personality who does. Julia is the host, and her memory is packed with holes, while Elizabeth, the first of Julia's personalities I met, knows everyone. Elizabeth once put together a list for Anne Riley headed "Inside People." It filled a sheet of notebook paper and read like the cast of a large play: Susan, 4, very timid; Joanne, 12, outgoing, deals with school: and so on. A few have last names, too, and some have only labels, such as "Noise."

Nearly all multiples have child personalities, like Julia's Sandi, frozen in time at the age that some trauma occurred. Most have a protector personality, often a male if the patient is female, as in the case of Julia's George, who emerges in response to threats of danger. The threat could be real - a mugger - or it could be mistaken - a stranger innocently approaching to ask for directions.

Harder to understand, many multiples have a persecutor personality who is at war with them. Julia's threatening notes are written by persecutors. The danger is real. Most people with multiple personalities attempt suicide or mutilate themselves. Julia has "come to" to find herself bleeding from rows of self-inflicted razor wounds. "Multiples seem to teeter continuously on the brink of disaster." Putman says.

Strangely enough, some personalities seem to differ physically. For example, in a survey of 92 therapists who had treated a total of 100 multiple personality cases, nearly half the therapists had patients whose personalities responded differently to the same medication. A fourth had patients whose personalities had different allergic symptoms.