He had five personalities and they were all boring!

A sceptical take on multiple personality disorder.

This week I’m going to be looking at multiple personality disorder. Actually it’s no longer called that, but I’ll go into that later. The title of my piece comes from a quip I heard from a university professor talking about someone suffering from the condition. The idea that a rare mental illness in which multiple personalities can coexist within one person is one that has captured the public’s imagination. In 1957 Joanne Woodward won the Academy Award for Best Actress for her performance in the film The Three Faces of Eve, making her the first actress to win an Oscar for portraying three different personalities. Woodward, who was at the time a relative unknown in Hollywood, would later go on to play Dr. Cornelia Wilbur in Sybil, another movie about multiple personality disorder. Sybil, played by Sally Field, had no less than 13 personalities, including two male ones – Mike and Sid. The film was based on a book from 1973 by Flora Rheta Schreiber, which became a publishing phenomenon, selling some 6 million copies around the world.

Shirley Ardell Mason, who was the inspiration for Schreiber’s book, was born and grew up in Dodge Center,Minnesota. She came from a strict Seventh-day Adventist family. Her psychotic mother had allegedly sadistically abused her when she was growing up. This mistreatment had caused her consciousness to split into many different personalities to hold the trauma, so that she wouldn’t be aware of it. She decided to seek psychiatric help and she became a patient of Dr. Connie Wilbur, a Freudian psychiatrist who had a special interest in multiple personality disorder.

Once Mason had been diagnosed with MPD, she started generating more and more personalities including babies, little boys, and teenage girls. Mason probably wasn’t faking it – she was highly suggestible, and was giving Wilbur what she wanted. Wilbur began injecting Mason regularly with sodium pentothal, which at that time was used to help people remember traumatic events that they had repressed. Under the influence of drugs and hypnosis, the very suggestible Mason uncovered more and personalities.

IN 1958 Mason tried to retract what she had said. But it was too late. Wilbur had too much at stake. The doctor used the rationale that her patient was in denial about her problems. Wilbur had too much invested in her theories and Mason’s mental illness.

When people began to recognize her as the patient portrayed in the book, Mason left West Virginia and moved to Lexington,Kentucky, to be near Wilbur. There she taught art classes at a community college and set up a gallery at her house. Mason cared for Dr. Wilbur during her cancer until her death in 1992. Mason herself died at home of breast cancer in 1998, at the age of 75.

So what is multiple personality disorder?  As I said before, we no longer use the term. In 1994, the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) it was rebranded as Dissociative Identity Disorder – DID. The rationale behind the name change was to emphasize the importance of changes to consciousness and identity rather than personality.

DID is a personality disorder in which a person has more than one discrete, separate identity. Each identity is unique, and has its own sets of memories, ideas, thoughts, ways of thinking, and purposes. The alter identities are completely unaware of the other identities, and switches between identities usually occur within seconds. The alters vary hugely both across and within individuals. The number of alters has been reported to range from one to hundreds or even thousands; one clinician reported a case of a patient with 4,500 alters. Only 200 cases of dissociative identity disorder could be found prior to 1979, whereas in 1999, more than 30,000 cases had been reported. One misconception which I would like to lay to rest is MPD is in any way connected to schizophrenia. People with schizophrenia do not have multiple personalities. They suffer from “a breakdown in the relation between thought, emotion, and behaviour, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.” Its most frequent manifestations are auditory hallucinations, paranoid delusions, and disordered speech and thinking.

While at the beginning dissociative identity disorder had many converts, in recent years growing scepticism has emerged. There are a number of reasons that have provoked this scepticism:

The dramatic epidemic in DID cases is I fear not the result of improved techniques in diagnosis and assessment, but from the actions of the therapists and the increased media attention. I am not arguing that DID patients have nothing wrong with them. There is strong evidence that many patents diagnosed with DID entered psychotherapy with psychological difficulties,. But it is the psychotherapists who have generated and maintained DID. Many of the patients had no memory of sexual abuse upon entering therapy. Only after the therapist encourages the patient, did memories of sexual abuses emerge. The late Nicholas J Spanos, a prestigious psychologist, was a DID sceptic. He argued that “patients learn to construe themselves as possessing multiple selves, learn to present themselves in terms of this construal, and learn to reorganize and elaborate on their personal biography so as to make it congruent with their understanding of what it means to be a multiple.”

Nowadays few of us would invoke demonic possession in order to explain such phenomena as epilepsy, brain damage, genetic disorders, neurochemical imbalances, or hallucinations. Yet, not too long ago, this would have been the explanation. What’s more there were experts who were able to identify these cases and exorcise the victims.  We know now that the possessed and those who “cured” them were enacting social roles. Of course to them it was all very real. What we seem to be seeing now is the latest incarnation of demonic possession.

Basic research into human memory has not uncovered any mechanism for repression and recovery of traumatic memories during childhood. The idea that memories can be recovered has been shown to have no scientific basis. Indeed it is extremely dangerous. It is incredibly easy to implant false memories. If you have a vulnerable patient, the inappropriate use of hypnosis can foster convincing pseudomemories for events that never occurred. Psychologists have implanted memories of past lives, UFO abductions satanic rites and sexual abuse. Parents have been arrested and sent to prison for abusing their children on the basis of these supposedly recovered memories. Of course childhood sexual abuse is very real, but these cases of recovered memories are based on completely unscientific methods.

But even if we assume that all the claims of abuse are true, there is a fundamental flaw in the claim that childhood trauma causes DID. If this were the case, the abuse of millions of children over the years would have caused many cases of DID. One obvious example would be the children who were brutalised by the Nazis in ghettoes, trains, and concentration camps all over Europe. However, no evidence exists that any developed it.

A cynic would argue that that this is another example of the psychology industry and its afan for manufacturing victims. Remember psychology critic Tana Dineen’s maxim: PERSON = VICTIM = USER/PATIENT = PROFIT. I have no doubt that economic incentives play a significant role but I think there is more to it than that. A crucial lesson is that beliefs can help to shape reality. Psychotherapists must therefore be aware of the possibility that their therapeutic practices may unwittingly worsen and perhaps even create psychological disorders in their patients.

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