The woman in her office, Dr. Marlene Hunter concluded, exhibited a number of unusual symptoms. For one thing, people she did not know seemed to know her, while others frequently called her a liar. She also suffered from depression and severe headaches. Hunter, a hypnotherapist as well as a general practitioner in Vancouver, said that hypnosis seemed to offer the woman some relief from her headaches. Still, little about the case made sense until the doctor attended a workshop in 1978 on a mental illness that the professionals were just starting to understand—multiple personality disorder. It is an illness in which different parts of a person’s personality begin to function as though they belonged to separate people.
It almost always develops as a result of severe, prolonged childhood trauma, usually involving sexual or other physical abuse. The next time she hypnotized her patient, Hunter asked whether there was someone else who wished to speak. A voice that Hunter said sounded completely unlike the voice that she had heard before replied, “Of course, what took you so long?”
Interest: Since Hunter first encountered the disorder, she has diagnosed or treated a further 22 people with the illness. Her experience is typical of many who work in the field. Only a decade ago, most mental-health experts believed that multiple personality disorder was extremely rare. Now, they are diagnosing and treating thousands of people with the illness. As awareness of the illness has grown, so has scientific interest in it, with researchers publishing a growing body of studies about who develops it and why.
Patients who develop multiple personality disorder usually seem to have two important features in common. Studies have shown that more than 90 per cent have suffered extreme childhood abuse, usually before the age of 12.
The other common feature is a strong ability to dissociate—to split off or block out feeling, memories and events from the mainstream of their consciousness. According to Dr. George Fraser, head of the Anxiety and Phobic Disorders Clinic at the Royal Ottawa Hospital, some children use their ability to dissociate, or go into a self-induced hypnotic trance, as a way of blocking out the pain caused by the abuse they
suffered. Said Fraser: “The problem is that if the abuse goes on long enough, a part of the brain develops its own memory bank.”
When that happens, the separate memory bank can begin to function like a separate personality. And because it is a defensive technique that seems to work to protect the person involved from painful memories, the mind con-
tinues to create other whole or partial personalities that, in some circumstances, dominate the individual’s behavior. Dr. Colin Ross, director of the dissociative disorders clinic at Winnipeg’s St. Boniface General Hospital, said that multiple personality disorder is the most extreme form of dissociative disorders, which also include psychogenic amnesia and depersonalization neurosis. According to Ross, all people are capable of dissociating to some extent, whether by daydreaming or becoming totally absorbed in a book. But some children carry the process much further. Said Hunter: “Developing multiple personality disorder is a very creative, sophisticated way of coping with an intolerable situation.”
Fragments: Studies show that most people who have the disorder develop about 15 different personalities. Some may even develop hundreds. In some cases, the different personalities are aware of each other. Some of the personalities may consider themselves to be male or female, regardless of the person’s actual sex. As well, each personality has specific functions. One personality may be full of rage, while another may be a child. Fraser said that, in one rare example, one of his patients, who had more than 1,000 whole and partial personalities, had developed a separate personality fragment for each of her highschool courses.
Usually, other people would interpret the behavior of the different personalities as mood shifts on the part of the subject. Still, there can be marked differences in the way different personalities speak, dress, and act—and even in their handwriting. Dr. John Curtis, who is currently treating more than 40 multiple personality disorder cases at Halifax’s Nova Scotia Hospital and in his private practice, said that the changes are often quite subtle. A doctor who is working closely with a patient, he said, may learn to identify “who is out” in most instances.
“A co-worker might just think that the person was moody,” Curtis added.
Eventually, the victim of multiple personality disorder experiences severe stress. According to Fraser, many patients seek help during their 20s and 30s when they experience amnesia or memories of childhood abuse. Others become concerned when they hear their alternate personalities speaking and experience them as voices in their head. According to Ross, more than 70 per cent of multiple personality disorder patients attempt suicide.
Even with increased knowledge of the disorder, it is not always easy to diagnose. An article by Ross, Ron Norton, chairman of the department of psychology at the University of Winnipeg, and research associate Kay Wozney, which appeared in the June issue of the Canadian Journal of Psychiatry, reported that 236 patients whom they studied had been in the mental-health system for an average of 6.7 years before they were accurately diagnosed. Many of the patients had been diagnosed for other psychiatric ailments, including manicdepressive illness, anxiety disorder and schizophrenia.
Buried: After the proper diagnosis is made, treatment usually focuses on efforts to integrate the patient’s multiple personalities into one. According to Curtis, this can be a difficult time for both patient and therapist, because the buried memories of childhood abuse seem vividly and painfully real once they are recalled. Still, doctors say that treatment, which can take up to six years, is often successful. “Multiple personality disorder is unusual in that it looks to be the worst of the psychological conditions, but it’s the one you seem to be able
to do the most for,” said Curtis. He said that once the personalities are integrated, the patient retains most of the skills and talents that the multiple personalities possessed.
Attitudes towards multiple personality disorder have changed dramatically over the years. Medical specialists now believe that many of the people accused during the Middle Ages of being possessed by demons were probably suffering from multiple personality disorder. About a century ago, the French psychologist Dr. Pierre Janet and Morton
Prince, a Boston neuropsychiatrist, among others, proposed that a psychiatric illness involving multiple personalities existed. But the pioneering Austrian psychoanalyst, Sigmund Freud, discounted the work, and the idea of a multiple personality condition fell into disrepute. By the time The Three Faces of Eve was published in 1957, most mental-health experts believed that Christine Sizemore, the real-life person now living in Ramsur, N.C., on whom the book and subsequent movie were based, was a unique case of mental illness involving multiple personalities.
Experts now say that skepticism about multiple personality disorder was partly linked to the attitude, prevalent until about 10 years ago, that sexual abuse of children was rare. As late as 1975, the Comprehensive Textbook of Psychiatry, the standard text for many North American psychiatry students, declared that there was only one case of incest in a million in the general population. But changing social attitudes, pressure from the women’s movement during the 1970s, and more sophisticated research methods have helped to establish the facts. In her 1986 study, Oakland, Calif.-based
researcher Diana Russell reported that 38 per cent of San Francisco women had been sexually abused before they were 18 years old, and 16 per cent were victims of incestuous abuse, figures she said would be true throughout North America. According to Winnipeg’s Ross, new psychiatric studies of those suffering from the aftereffects of the Vietnam War indirectly also helped to change attitudes towards the multiple personality disorder. Said Ross: “The Vietnam War stimulated a lot of study into the psychological effects of trauma. Multiple personality disorder was seen as a special form of post-traumatic stress syndrome.” Phenomenon: Still, by 1980, only 200 cases had been identified. That year, for the first time, the American Psychiatric Association officially recognized multiple personality disorder in its Diagnostic and Statistical Manual of Mental Disorders III Partly as a result, by 1986 more than 6,000 cases of the illness had been diagnosed in North America alone, and many researchers believe the real number of cases is much higher. Ross, for one, said that the illness may occur as frequently as one in every 100 persons. He said he based his calculation on estimates that one in 10 children is severely abused. Said Ross: “The incidence is certainly f no less than one in 1,000. £ That would mean that there % are between 25,000 and “ 250,000 suffering from multiple personality disorder in Canada alone.”
In the meantime, scientists are continuing to study the phenomenon. Dr. Frank Putnam, chief of the dissociative disorders unit at the U.S. National Institute of Mental Health in Bethesda, Md., said that scientists at the institute are now trying to find out how to diagnose the disorder in children. As well, they want to find out how victims of the disorder establish their different personalities, how they switch from one personality to another and how memories are transferred from one to another. Other experts said that it is time to start looking at the disorder in a broader context. Margo Rivera, for one, a Toronto psychotherapist who is head of a community education project, Education/Dissociation, at the Toronto-based Ontario Institute for Studies in Education, said that, while the disorder is a grave psychological problem, it is also part of a social problem. “It is not a genetic disorder, it is not a mental disease,” said Rivera. “And it is preventable.” But until child abuse is eradicated, multiple personality disorder will remain a painful, though ultimately treatable, affliction.
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