Multiple Personality Delusions

The “News of the Weird” recently reported that a man had turned himself in to the police for a crime he thought he must have committed because he didn’t remember doing it! He claimed to have a split personality. He remembered becoming angry at a waiter in a Chinese restaurant and the next thing he knew, he was playing video games at his cousin’s house. When he read about the restaurant being robbed, he decided his other personality must have committed the robbery during that “lost time” he couldn’t remember.

I don’t buy it. Do you?

The story of “multiple personality disorder” (MPD) goes like this: a child is abused and protects himself by “tuning out.” Awareness and memory of the abuse are compartmentalized in a separate part of the mind. Two distinct personalities then exist in the same mind: they can spontaneously switch from one to another. One personality has no knowledge of the other and can’t remember anything it did while in the other state. The “alter” personality calls itself by a different name, dresses differently, behaves differently, has a different voice and vocabulary, different likes and dislikes, and often claims to have a different age and sex. One personality may travel to another city; the other personality then emerges and has no idea where he is or how he got there.

But wait: it gets weirder, and the story becomes so bizarre that no reasonable person could accept it. Hypnosis reveals more and more personalities (in one case, no fewer than 4500!). Some of the alters are children, others may be gorillas, lobsters, unicorns, angels, or even trees! One personality speaks a foreign language but the others have no knowledge of it. The alters have different brain waves, different blood types, even different eye color! The patient has diabetes when under the control of one alter but not when controlled by another. Increasingly fantastic “memories” surface, of childhood sexual abuse, torture, and Satanic cults. The White Queen in Through the Looking Glass practiced believing six impossible things before breakfast, but even she would get indigestion trying to swallow all these claims.

Popular awareness of MPD can be traced back to the book and movie The Three Faces of Eve, but it really took off with the publication of Sybil in 1973 and the subsequent film adaptations. Today we even have an MPD TV series: United States of Tara.

The book Sybil, by journalist Flora Schreiber, described the case of Shirley Mason (called Sybil in the book) and her treatment by psychiatrist Dr. Cornelia Wilbur. A full 16 alters emerged over 23 years of treatment. Under hypnosis, after much prompting, Sybil eventually “remembered” horrific abuse by her mother: Mom hung her upside down and raped her with kitchen utensils, forced ice water from an enema bag into her rectum and bladder, made her watch while she defecated on neighbor’s lawns and had lesbian orgies with teenage girls in the woods, etc. She told Dr. Wilbur about waking up in other cities with no memory of how she got there, and about finding clothes in her closet she didn’t remember buying. Eventually she was “cured” by getting all her alters to converge into one personality.

In a new book, Sybil Exposed, Debbie Nathan reveals that Sybil was an elaborate fraud. The patient, doctor, and journalist conspired to capitalize on Shirley’s story, even forming a company to share the profits from the book and spin-off products. Now that all the participants are dead, Nathan was able to access documents, tapes, and transcripts of therapy sessions that revealed shocking facts.

A little detective work showed that much of what Shirley “remembered” could not possibly have happened. For instance, there were no woods anywhere near the place where “orgies in the woods” had allegedly occurred, and her claim that her school grades had suddenly dropped (because one alter was in charge during math instruction and another alter had no knowledge of arithmetic) was refuted by confirming that her grades had never dropped. Early diaries were demonstrated to be fakes written long after the fact. The first reports of her “fugues” to other cities show that she knew where she was and did remember things she later denied remembering. The most damning document was a 5-page letter she wrote to Dr. Wilbur early in the course of treatment confessing that she didn’t have alters and had made it all up to please Dr. Wilbur and keep her attention.

Dr. Wilbur rejected her confession as just another symptom of her illness! Wilbur had a vested interest in proving Sybil had MPD. It made her famous. She became acknowledged as “the” expert on MPD, taught other psychiatrists to diagnose it, formed an organization to promote it, and was instrumental in getting it recognized as a new disease in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Shirley was a creative, imaginative, artistic, suggestible, easily hypnotized, vulnerable patient. She had always been a daydreamer who had difficulty separating fact from imagination: long before starting therapy, she claimed to have won a contest that didn’t even exist at the time. Wilbur developed an inappropriate personal relationship with her patient and they became codependent. Wilbur paid her rent, shared meals, and provided 18 hours of therapy a week. She heavily drugged Sybil with narcotics and other psychoactive medications. She hypnotized her daily and gave her intravenous “truth serum” (Pentothal) and even electric shock treatments in her home with a portable device! Transcripts of therapy sessions clearly show that Dr. Wilbur was the first to suggest alters and memories of abuse, and she browbeat her patient into admitting things she initially denied. Most damningly, the alters only displayed themselves in the therapy sessions; no one else in Shirley’s life ever observed them.

The themes of MPD struck a chord. It was a time in history when Women’s Lib had created conflicts about women’s roles and when child abuse was just being recognized. There were reports of repressed memories of childhood sexual abuse suddenly coming back under hypnosis, of fathers subjecting their daughters to Satanic rituals, of nursery school teachers torturing their pupils. Prior to 1980 there had been a total of 200 reports of MPD; by 1990, over 20,000 cases had been reported. Strangely, some psychiatrists never saw a case, while others diagnosed it in hundreds of patients. An initial period of enthusiasm segued into a disastrous witch hunt, lives were ruined, and finally there was a backlash. The DSM deleted MPD and substituted DID (dissociative identity disorder). Patients sued their therapists. False Memory organizations were formed. The rate of diagnosis fell drastically.

The idea of repressed memories originated with Freud, and the evidence for it is shaky. In fact, post-traumatic stress disorder (PTSD) occurs precisely because its victims can’t stop remembering. Our scientific understanding of memory is evolving. We know false memories can be created and can seem more real than true ones. We know memories are widely distributed in the brain, not conveniently compartmentalized. We know how experiences are processed for storage as long-term memories. Lack of attention can prevent initial processing. When you drive home “on automatic” and have no specific memory of turning off the freeway, there are no stored memories to access later.

Psychiatry recognizes fugue states or dissociative fugues with reversible amnesia. One problem with investigating such episodes is that we have only the patient’s report of what he can actually remember. New neuroimaging techniques may shed new light. Changes in brain waves don’t require the existence of multiple personalities, but occur when the patient experiences different emotional states. When one alter claims to be unaware of material learned by another alter, we can demonstrate that the learned material influences their answers to questions. I once read the transcript of a psychiatry session with an imaginative woman poet. She started talking like a child and said she felt she was a little boy. Her psychiatrist was wiser than Dr. Wilbur. Instead of encouraging her to develop her fantasies into an alternate personality, he brusquely told her to cut the crap. I suspect she had a narrow escape from MPD.

Dr. Wilbur was guilty of multiple ethical violations and gross malpractice. She should have lost her license; instead, she became world-famous, made big bucks, and spread false ideas that led to untold harm. The MPD/repressed memory story is a good example of what happens when people fail to subject their ideas to scientific testing. A little detective work could have revealed that there was no evidence of those Satanic plots. One patient’s claim to have remembered an affair with JFK was easily disproven with a calendar: she was only seven when he died.

I’m not ready to say that repressed memories and multiple personalities are completely impossible, but I’m confident that the great majority of patients diagnosed with MPD have not had any such thing. We all adapt our language and behavior to meet expectations in different social contexts: that doesn’t mean we have more than one personality. These patients were acting out roles in collusion with their therapists, just as Charcot’s hysterical patients once acted out their bizarre fits at the Saltpêtrière in Paris. Speech and behavior can be faked; under hypnotic suggestion people can be persuaded to act like a chicken and to confabulate false memories. Psychologist Nicholas Spanos has argued that repressed memories of childhood abuse and multiple personality disorder are “rule-governed social constructions established, legitimated, and maintained through social interaction.” The MPD story as explained in Nathan’s book is a cautionary tale well worth reading.

This article was originally published as a SkepDoc column in Skeptic magazine.

 

Dr. Hall is a contributing editor to both Skeptic magazine and the Skeptical Inquirer. She is a weekly contributor to the Science-Based Medicine blog and is one of its editors. She has also contributed to Quackwatch and to a number of other respected journals and publications. She is the author of Women Aren’t Supposed to Fly: The Memoirs of a Female Flight Surgeon and co-author of the textbook, Consumer Health: A Guide to Intelligent Decisions.