Dissociative Identity Disorder: The People Inside - Splitting Personalities

Written by Edward Dolnick

Originally, the "splitting" into different personalities helps the child survive. But as it becomes the routine response to crisis, even in adult life, what was formerly life-saving becomes life-threatening.

Some Therapists believe that the incidence of the disorder has been wildly exaggerated. They propose a simple explanation - faddism - and a more complex one: They say the multiple personality diagnosis represents self-deception on the part of both patient and therapist. "We're all different

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people in different situations," says Eugene E. Levitt, a clinical psychologist at the Indiana university School of Medicine. "You're one person with your wife, an entirely different person with your mother, still another person with your boss.

"A person may be unaware that he turns different facets of his personality to different people," Levitt says. "The man who comes home and domineers over his wife doesn't realize or doesn't want to realize, that he cringes before his boss."

The goal of therapy, Lefitt says, is to help patients discover and face up to the sides of their characters that they would rather deny. But some patients' personalities as if each were a separate person. And this can unwittingly encourage patients to believe there are independent "personalities" that are beyond their control. Levitt also points out that the overwhelming majority of therapists have never encountered a multiple personality, while a few diagnose such cases regularly.

One skeptic says, "It's the cop-out of the eighties. It used to be, 'The devil made me do it,' and 'Demon rum made me do it.' Psychiatry had gotten away from demons, and now we've got'em back."

The defenders of the multiple personality diagnosis concede that everyone has many sides and many moods. That's why "you're not yourself today" is a cliché. The difference between healthy people and multiples, they say, is that healthy people have little problem accepting that they're sometimes angry, sometimes sad, and so on. We have a continuous stream of memories that provides a feeling that all those selves are "me".

People with multiple personalities, in contrast, have disowned parts of themselves. "If you've been raped daily by your daddy," says Robert Benjamin, the Philadelphia psychiatrist, "you can't feel just normally ambivalent about your father. you either say. 'My father is a monster,' which is unacceptable, because it shatters your image of your family, or you say, "I can't think anything but good about my father, and the parts of me that think my father is a monster, I don't want to hear from.'"

It may be impossible to know whether therapists are over diagnosing multiple personality, but it is known that people have fooled therapists by faking the illness. In the most notorious case, Kenneth Bianchi, the Hillside Strangler, tried unsuccessfully to beat a murder rap on the grounds that he shouldn't be held responsible because he had an alternate personality who had done the killing. Four therapists examined him: three decided he wasn't a multiple, but one still believes he is. Police evidence eventually showed that he is not.

Under any circumstances, the diagnosis can be hard to make because people with multiple personalities work so hard to cover up. Patients wander through the mental health system for an average of seven years before being accurately diagnosed. On the way, they pick up one label after another - schizophrenic, depressive, manic depressive.

During her teens Julia saw a psychiatrist for depression. "He just told me that all teenagers have their issues and that I came from a very upstanding family," she says. She tried to commit suicide at 15, by swallowing sleeping pills. She steered clear of the mental health system after that, but was finally diagnosed about five years ago, after she checked herself into a hospital, hallucinating that she was being chased by neon orange spiders. A resident made the diagnosis when, in the middle of an interview, Julia suddenly said, "I can tell you some things about what's going on, I'm Patty."

Most cases, like Julia's, are diagnosed at around age 30. It's not clear why things go wrong then. It may be that the person becomes more conscious of episodes of lost time; it may be that the multiple's defense system erodes when he or she is finally safe, away from abusive parents. In many cases, some new trauma precipitates a breakdown. A rape, for example, may trigger a flashback to childhood abuse. Often, the death of an abusive parent unleashes a welter of conflicting emotions and leaves the multiple in chaos.

For both patients and therapists, treatment is a long and harrowing ordeal. The first hurdle is that patients with multiple personalities all had their trust violated when they were young, and are therefore wary of confiding in any authority figure. They have had a lifetime's practice in keeping secrets from themselves and others, and that practice is hard to change. And the treatment itself is painful: the key, says Putnam, is exhuming, reliving, and accepting the original trauma, and that obliges the patient to confront terrifying, repulsive, and deeply hidden memories.

Patients have two or three sessions a week of therapy, usually for three years or more. Hypnosis is useful, especially in dredging up painful memories. The goal is to transfer the traumatic memories across the boundaries separating the personalities, to make the pain more bearable by sharing it.

If that happens, the separate personalities can fuse together, with the more similar ones being the first to merge. But nothing is simple. Often when the therapist thinks he or she has met all the personalities, new ones seem to emerge, as if from hiding. And once they are fused, more therapy is needed to develop some way other than "splitting" to cope with problems.

The prognosis for multiple personality is fairly encouraging, though few good follow-up studies of treatment have been carried out. Kluft, one of the most esteemed therapists in the field, has reported a success rate of 90 percent in a group of 52 patients. He calls treatment successful if a patient shows no signs of multiple personality in the two years following the end of therapy.

After bad experiences with another therapists, Julia has been seeing Riley for two and a half years. She talks about the prospect of integrating her various personalities wistfully, but without much hope. "In my better moments I say, 'You should be damned proud you've survived, don't let the bastards win now,'" she says, "But my idea of myself is very disjointed and that's really frightening.

"I don't have a history," she goes on. "Not just for the bad things, but for the accomplishments, too. I was in the National Honor Society in high school, I had a very good college record, but I don't have any sense of pride, any feeling that I did it."

She talks as if she is at the mercy of someone with a remote control channel-changer who keeps zapping her out of one scene and into another. "If I could just lose less time," she says plaintively. "If I could just have - I hate the word - 'normal' reactions to things.

"Do you know my idea of heaven? A little room with no doors and no windows, and an endless supply of cigarettes and Diet Pepsi and ice.

No more surprises, ever.

Edward Dolnick is a contributing editor.
Hippocrates July/August 1989

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