What Is It Like?
WHAT IS IT LIKE to be a multiple? The formal criteria of the diagnostic manuals are too impersonal. Nineteenth-century patients with “double consciousness” fit the criteria, but their experience, their ways of getting on (or not), the resulting family and social life—all those are quite unlike the life of a modern multiple. To start with, there was usually only one well-defined alter; today, sixteen alters is the norm. In France, a century or so ago, cases of doubling had the symptoms then associated with florid hysteria—partial paralyses, partial anesthesia, intestinal bleeding, restricted field of vision. English cases of double consciousness were more restrained but regularly went into a trance—an intervening period of unconsciousness or confusion—between the two personalities. In addition, the second state was often described as trance, even though the person seemed normal enough to an outsider.
Times change, and so do people. People in trouble are not more constant than anyone else. But there is more to the change in the lifestyle of multiples than the passage of time. We tend to behave in ways that are expected of us, especially by authority figures—doctors, for example. Some physicians had multiples among their patients in the 1840s, but their picture of the disorder was very different from the one that is common in the 1990s. The doctors’ vision was different because the patients were different; but the patients were different because the doctors’ expectations were different. That is an example of a very general phenomenon: the looping effect of human kinds.1 People classified in a certain way tend to conform to or grow into the ways that they are described; but they also evolve in their own ways, so that the classifications and descriptions have to be constantly revised. Multiple personality is an almost too perfect illustration of this feedback effect.
I shall later describe the double consciousness of old, but first we need to see what it is like to be a multiple, today. This presents a problem. People in therapy go through many stages, some of which are very painful. Nowhere is this more striking than in a clinic for dissociative disorders. The most distinctive symptoms become fully evident only in the course of treatment. Hence the published descriptions of multiples best fit patients in therapy. Thanks to very recent publicity, some people do now walk in to a doctor’s office claiming to have a number of personalities, but during the 1980s only a clinician well versed in detecting certain signs was likely to spot a multiple. All too many clinicians actively sought out alters, but there was always a core of more cautious practitioners who wanted multiplicity to lie dormant until the patient was well enough to grapple with it and its causes.
I shall present a picture of multiple personality that was current during the 1980s. Notice that it is internal to the multiple personality movement. Skeptics would describe the phenomena very differently, and even people diagnosed as multiples usually portrayed themselves very differently before diagnosis. Before trying to say what it is like to be a multiple, we should do a little logical spadework. We know how to describe individuals, even though few of us are as deft as novelists, gifted biographers, or insightful journalists. We are not so clear when we move to one level of abstraction, when we try to characterize not an individual but a kind of person. It is often thought that a class, such as a class of people suffering from an illness, is best defined by necessary and sufficient conditions. This means that to be in the class a person must satisfy all the conditions (necessary); anyone who satisfies all the conditions is automatically in the class (sufficient). The DSM tries to define disorders that way, even though it does not always succeed. Schizophrenia was characterized in a confusing way, as befits that cruel but complex disease. The definition read like a menu. You had to pick and choose within sets of criteria, and no one criterion was strictly necessary. We need not worry about that here, because the DSM entries for multiple personality look like necessary and sufficient conditions.
They are not always used in that way. For example, DSM-IV added an explicit amnesia condition. Yet many authors agree that there are multiples for whom amnesia is not apparent, even though in the most florid and complex multiples one will always find some amnesia.2 Amnesia shows up, it is said, in at least 90 percent of known cases. But 90 percent is not 100 percent. The condition is not treated as necessary after all. Should clinicians be more strict in using their diagnostic manuals? Frank Putnam fears that the DSM criteria are too weak. They allow too easy a diagnosis of multiple personality. Even the stricter DSM-IV is not good enough for him. “Recent corrective efforts to increase the specificity of the DSM-IV criteria were only partially successful.”3 Putnam thinks that overdiagnosis is a real danger, especially when the diagnosis itself is under attack. I have mentioned the criteria used by his unit at the National Institute of Mental Health. Before diagnosing multiple personality a clinician must actually witness switches between two alter personality states, must meet specific alters more than twice, and must encounter amnesias. Contrast this demand for more careful diagnosis, checked by tighter necessary conditions, with a breezy statement by Colin Ross, a recent president of the ISSMP&D. “I have never encountered a false positive diagnosis of MPD made by another clinician, so a requirement for more rigorous criteria has never arisen.”4 Has the president of any other professional society of medical specialists ever averred that he has never encountered a mistaken diagnosis?
Putnam’s supplementary criteria are part of a research protocol. When his group evaluates or tests a procedure, it demands strict controls on the individuals assessed as multiples for research purposes. Although my sympathies are entirely with Putnam, rigor may not be so essential to day-to-day clinical practice. For example, a patient might be helpfully treated as multiple even though she had no amnesia. This point is a logical one. Disorders are constituted by a clustering of symptoms, and not, in general, by necessary and sufficient conditions. This is true of most ordinary kinds of things as well. As the great English philosopher of science William Whewell wrote in 1840, “Anyone can make true assertions about dogs, but who can define a dog?”5 Labels often work well without strict necessary and sufficient conditions. Linguists and cognitive psychologists have recently proposed one way in which to explain this fact. They take a hint from Wittgenstein, who suggested that many words connect things by “family resemblances.”6 There is no one feature that runs through all members of a family. Father and daughter and niece have snub noses; niece, son, and two cousins have sandy hair; mother and just one cousin have small feet; and so forth. Only the niece has both a snub nose and sandy hair; no one has all the family features. Wittgenstein also compared names of classes to an old-fashioned hemp rope: it is very strong, but no one fiber runs through one hundred meters of rope. There need be no one bunch of things in common—necessary and sufficient conditions—for the same general word (“dog” or “multiple personality”) to apply to a class of individuals.
Theoretical linguists find more structure in classes than mere family resemblance. Each class has best examples (of dogs, or of multiples), and then other examples that radiate away from the best examples. Thus many people, asked to give an example of a bird, apparently say, “Robin.” People seldom offer “ostrich” or “pelican” straight off. The robin is a best example. The robin is what the psycholinguist Eleanor Rosch calls a prototype.7 Ostriches differ from robins in some ways; pelicans differ from robins in others. We cannot arrange all birds in a single linear order of birdiness, saying that pelicans are more birdy than ostriches but less birdy than robins. If we must draw a diagram, it should be a circle or sphere, with ostriches and pelicans farther from robins than hawks and sparrows, but not in one straight line. The class of birds may be thought of as radial, with different birds related by different chains of family resemblances, the chains leading in to a central prototype.8 Likewise for mental illness, individual patients cannot be simply arranged as more “close to” or “distant from” standard cases. This is because the ways in which a patient differs from the standard may themselves be structured. A patient with no amnesia will also not be remarkable for gaps in personal history, or for having several distinct wardrobes that she does not understand. A patient with malicious persecutor alters will be expected also to be self-destructive and to have injured herself. The nonamnesic patient is not closer to or more distant from the prototype for multiple personality than is the self-destructive patient. There is a set of family resemblances among the patients, with some patients, prototypes, being best examples.
This idea of a prototype is implicit in psychiatry. For example, one of the companion publications to the DSM is the Casebook.9 Under each coded disorder it gives, in plain prose, an example of a patient suffering from that disorder. These vignettes flesh out the formal criteria given in the DSM. Neither the DSM nor the Casebook is a substitute for clinical experience, but a reader might gain a better understanding of a disorder from the Casebook than from the Manual. Prototypes, and radial classes, whether for birds or for mental disorders, are not mere supplements to definitions. They are essential to comprehension. One can make a very strong argument, in the philosophy of language, that what people understand by a word is not a definition, but a prototype and the class of examples structurally arranged around the prototype. In chapter 7, I examine the idea that dissociation is distributed among people along a linear continuum. That is, there is one thing, dissociation, and everyone is slightly dissociative, some are more so, and multiples are the most dissociative of all. This hypothesis might prove less attractive if we thought of both multiple personality and dissociation as radial concepts. Just as it makes little sense to say that a pelican is birdier than an ostrich, so it may make little sense to say, of any two people, that one is more dissociative than the other.
We can easily distill, from the research and clinical literature, the prototype of a multiple during the 1980s. The point is not to give colorful examples, but to show what multiple personality meant to insiders during that decade. To begin with, many multiples came for help because they suffered from severe depression. Perhaps this is the most common symptom, but unfortunately it goes with a great many illnesses. When we start looking for something more specific, one early warning sign is missing time—the patient has no idea what she was doing for a couple of hours yesterday afternoon. Janice recalls leaving the café where she had a pleasant midday snack with her friend, and strolling back to her job as receptionist for a dentist. But she got a dressing-down when she arrived, because she did not walk in until just after 3:30. She has no idea what happened in between. Thus there may be gaps in the recent past (it turns out) because the main, public, personality has been replaced by an alter, of whose activities the host has no memory.
There are less blatant clues about time. After taking a life history, the clinician may notice that the narrative does not hang together very well. The patient is hazy about the past, and cannot recall what happened when, or is confused about the sequence of life events. Perhaps that is because unknown alters have taken control from time to time, and the host personality has no idea what they did or when they did it. We may suspect that an alter was in control for a whole year of a patient’s life, a year that is at odds with the rest of the case history. For example, Steve’s scholastic record may show that he was wildly erratic at school, doing wonderfully until seventh grade. At that point he got Ds in everything except a course that the transcript of his progressive school calls “Food” (i.e., home economics, or good old uneuphemistic cooking). He got an A in Food. In eighth grade he once again became the A student. Is this because Steve’s female alter had come out in seventh grade? It turns out that Steve, now employed by the World Bank, had said, “I hate math” in seventh grade, just like a talking Barbie doll. So a clinician may start attending carefully to these two very different sides of Steve’s life and in the end find two alternating personalities that persist today.
Obviously missing time is closely connected with the amnesia familiar to clinicians and now encoded in the criteria for multiplicity. Amnesia can be embarrassing for all sorts of reasons. You meet someone at a party who claims to know you; you have no idea who this is. Some patients say they are accused of being liars, for they deny doing something that other people saw them do. Perhaps an alter is the culprit.
Many of the presenting symptoms of multiples are common to many other disorders: bad headaches, sleepwalking, nightmares, and some-times foggy memories of what seem to be troubling events long ago. Or a patient may complain of sharp and uncontrollable flashbacks, vivid and terrifying images of the past, of childhood. There may be severe mood swings every day. There can be horrible hallucinations, neither dream nor fantasy, during long twilight times that precede falling asleep, or in the drowsy periods before the patient awakens (in psychiatric jargon, hypnogenic and hypnopompic phenomena are common).
Many multiples have a history of alcoholism and drug addiction, although sometimes it is only an alter who drinks to excess. There have been stories of an alter who gets drunk on a drop, while another makes it through a whole bottle with decorum. One should be wary of such folklore, just as one should be wary of the claims made of some alters that they speak languages of which the host is ignorant—a phenomenon quite distinct from the case of a person who is genuinely bilingual and who uses one language for one persona, the second language for another. There has been the suggestion that obsessions and addictions are reactions to or results of early child abuse. For example, the resistance of many anorexics to therapy is elucidated by the fact that one alter personality is telling the host personality not to eat, while another is telling it to binge-eat; the obsession with oral intake is explained by forced oral sex in childhood.10
Stormy marriages or love affairs are the rule rather than the exception. What the clinician may see, on a first visit, is someone coming for help with these familiar matters of depression, addiction, or marital breakdown. In some florid cases, a multiple comes in because she is terrified—she wakes up, or comes to, in a strange place, a hotel room, or on a subway train, with no idea of how she got there or what she was doing. She may report hearing voices, not from outside, not from God, but inside her head. More commonly, however, there is a rambling report of assorted symptoms, a few of which, like auditory hallucinations, resemble the symptoms of schizophrenia. It is standard multiple gossip now to say: “Never tell the hospital you hear voices; otherwise they’ll say you are schizophrenic. If you must talk about voices, make clear they are inside your head!”
The DSM symptom profile for multiple personality has one highly unusual entry: “The patient has long been diagnosed with many other psychiatric disorders.” During the 1980s, investigators found that the average number of years a multiple spent in the mental health system prior to diagnosis was almost seven. Even today, only a committed clinician may be confident enough to diagnose multiple personality. To do so one must recognize and establish contact with alter personalities: you must see them come out and take control.
What are these alters like? In 1980 the DSM-III put it this way: “The individual personalities are nearly always quite discrepant and frequently seem to be opposites.” When the presenting individual, the host, is conservative, cautious, and shy, one of the more prominent alters may be lively, flirtatious, and coarse. The DSM mentions “a quiet and retiring spinster” and “a flamboyant promiscuous bar habituée.” The trait most clearly shared by the prototype of the modern multiple and the old double consciousness of over a century ago is that the host personality is reserved and inhibited, while an alter is lively and vivacious. But that is only the beginning. Unlike the old days of double consciousness, nowadays a multiple who never goes beyond two personalities is almost never encountered. A dozen alters is a common configuration; in some samples twenty-five per individual is the mean. People with more than a hundred alters are reported, although in these cases fewer than twenty will regularly assume executive control. Inevitably the more alters that are elicited, the more they seem to be mere personality fragments.
There is a language of multiplicity. DSM-III says that “transition from one personality to another is sudden,” but in the multiple community this is called switching. Talk of an alter’s taking executive control reeks of the business school; in real life, multiples say that an alter is out, or is coming out. Sometimes an alter may leave for another place to be alone. As multiple personality becomes more socially acceptable, some multiples prefer to refer to themselves as we, at least when speaking with a therapist, a family member, another multiple, or themselves.
Many alters are unaware that others exist within the same individual. This is especially true of the host, who at the beginning of treatment commonly denies being a multiple. On the other hand, some alters may know about other alters and actually be acquainted with them, talk with them, or jointly engage in some activity. This is called co-consciousness. The alters argue with each other, snarl, or console. One alter may be out and yet have another alter yammering away beside the left ear, telling her what a ninny she is. Many therapists try to introduce different alters to each other, believing that thoroughgoing co-consciousness is a necessary step toward integration. I should not give the impression that alters just come out as soon as a diagnosis is made. One clinician remarked that the experience is more like watching a few cats fighting underneath a blanket—a lot of noise, movement, and pain, but you can’t make out the individual cats. Alters are encouraged and cultivated as therapist and patient come into a trusting relationship with one another.
A first step in therapy may be getting alters to respect each other. This is especially necessary because there are vicious, cruel alters, evil even to the point that they will threaten suicide in order to murder other alters whom they loathe. A psychiatrist may have to make contracts with such persecutors, getting them to agree that they will not go beyond certain limits. Alters are said to be literal but litigious. They abide by their promises, but the contract must be ironclad; if there is a loophole, an alter will find it and take advantage of it.11
Just to balance the sheet, there are also helpful alters, which some clinicians look for and encourage as assistants in the therapy. The most valuable of all may be an Inner Self-Helper, who knows all the alters, and who can encourage them to cooperate with the therapist and each other. And there are protector alters of various kinds. Cornelia Wilbur—a founding figure of the modern multiple movement and the doctor whose treatment was described in a famous multobiography of 1973, Sybil—had such a patient.12 Jonah, an African American in Lexington, Kentucky, had three alters: Sammy, King Young, and Usoffa Abdulla. Sammy had formed when Jonah was six, after an incident when Jonah’s mother had stabbed his father. King Young arose when his mother had dressed him in girl’s clothes. The fourth character was a protector. When Jonah was nine or ten a gang of white boys was beating him up; suddenly Usoffa Abdulla sprang into action and demolished the gang. He was available for emergencies from that time on. And unlike Sammy and King Young, who had fairly rich characters, Usoffa Abdulla was very much a fragment, with little emotion or involvement with anyone else. Like the original Superman, he had no interest in sex. He was there to serve and protect. He is one of the most dignified and sympathetic figures in the literature.13
Jonah was a man of the late sixties, an era of black pride and the Black Panthers. Even though he had only four personalities, he foreshadowed later prototypes in that the alters were traced back to childhood events. The alters coped with insult and violence. The theory of the alter as a coping device was coming into being, in part thanks to the work of Wilbur herself. But there was also a global change in sensibility, produced by the hard work of activists in the women’s movement. During the 1970s the public conception of child abuse and neglect was shifted to sexual abuse and incest. The theory of multiple personality followed in train. By 1986 a questionnaire survey of clinicians treating multiple personality produced a sample of one hundred patients, ninety-seven of whom reported experiencing significant trauma in childhood, most often sexual in nature.14 This result has been repeatedly corroborated. By 1990 there was no firmer item of knowledge about multiple personality than the fact that it was caused by childhood trauma, usually repeated acts of sexual abuse. There are two mutually reinforcing aspects of this knowledge. On the one hand, virtually all multiples in therapy now have child alters. On the other hand, these child alters become, in treatment, witnesses to the abuse that brought them into being.
Very roughly there are two trajectories for an alter formed in childhood. Some remain child alters, forever locked in time. Others grow up and cope with incidents in later life that are reminiscent of the initial trauma. The alters of a single individual differ not only in age, but also in race, sexual inclination, and even sex. That is, a person whose body is of one sex may, when an alter is in control, resolutely claim the opposite physiology, rejecting all ordinary evidence to the contrary. I am not here speaking of a wish to be of the opposite sex, which some analysts might see as the root of the problem. The alter simply is of the opposite sex. “But what do you do when you go to the bathroom?” asks the doctor, who is a man, attempting to cast some light of reality on this delusion. “Same thing as you do, jerk.” There is, then, an immense amount of gender confusion, and often, in therapy, it turns out to be connected with early incidents of incest, rape, sodomy. This or that alter may display mild versions of symptoms of old-fashioned hysteria. These are now called conversion symptoms: the patient is insensitive to pain in some region of the body, but without any neurological cause. There may even be temporary paralysis of a limb. Often these effects can be traced back to some assault, on that part of the body, during childhood.
In many respects multiples are conformists—they are so far from being “mad” that some of the alters are different types of normal people. You can learn a lot about contemporary culture from the life of a multiple. I mentioned Jonah and the Black Panthers; in another old case, the promiscuous alter of a very proper host was the first to wear miniskirts in her small town in Iowa. More recently, “shop till you drop” is not a bad joke but sound sociology. A prudent penny-pinching host has an alter who shops endlessly and extravagantly. Or there is the cool, brisk administrative assistant of a rising executive. She dresses impeccably in tailored suits. She has a small closet where sensible clothes hang neatly on padded hangers. But there is another wardrobe that she stays away from, packed messily with glitzy sequined garments she has seen only in late-night reruns of old B movies. When she last looked into the wardrobe she shut it in a hurry; the stuff in there was repugnant, frivolous, lewd. She has endless credit cards. Even when she destroys unwanted cards new ones appear. Bills from strange shops in another part of town keep coming in. She pays them.
Many diagnosed multiples work in service industries—including teaching, nursing, and the law, as well as waiting tables, processing driver’s licenses, and retailing in the mall. Alters are a nuisance at work because an antagonistic alter will burst in and take over when you’re talking to your boss or a customer. Multiples develop strategies to cover up the gross gaffes committed by misbehaving alters. In this respect they are a bit like maintenance alcoholics. Marie, a heavyset woman, is serving from a street-side stall in Ottawa where she sells hot dogs and poutine, a Québec dish of fried potatoes and cottage cheese smothered in gravy. Two men drive up and ask for hot dogs. These men and their wieners remind her of her uncle and his drunken crony who would take her for rides and abuse her. She gives a little cry and shrinks to the size of a four-year-old, or so it seems to her. She is crouched under the countertop, whimpering to herself; Esther has come out but as quickly retreats. Then Marie is standing up again, smiling—“Merde, I spilled some poutine, had to clean it up.”
But this is only one side of the story. Some multiples use their alters to take care of different jobs. One takes dictation, meekly producing letter after letter, while the host has withdrawn to another place. A woman who wants to have nothing to do with sex has an alter who does it with her husband. A mother would never do anything to harm her children. But she does slap them around, they say, and there are bruises to show for it. Only the mother’s alter could express that anger. A long-running court case in Columbia, South Carolina, has to do with alimony. In that state, if a wife can be proven to have committed adultery, she will not be awarded alimony in divorce proceedings. One woman’s psychologist clinician, Larry Nelson, testifies in court that his client was faithful; it was an alter who slept with other men.15
Different alters may use different handwriting.16 Older multiples who wear glasses say that they need different prescription glasses for different personalities, and they may carry several pairs around with them. Some clinicians believe that physiological or biochemical differences are associated with switches from one alter to another. That is a good research project, but at present there is no reproducible evidence that these differences are even as great as occur during changes of moods in healthy people.17 Autonomic nervous system responses to noxious stimuli are known to carry over from alter to alter, unhindered by switching.18 It is nevertheless to be expected that there will be all sorts of what are called objective differences between alters. Anger often shows up in high blood pressure; fear makes you sweat. It would be astounding to learn that there is no detectable physiological change when a persecutor alter is out, or when a brusque waitress has turned into a terrified child.
Multiples are incredibly suggestible and are easily hypnotized. Often in a therapeutic session an alter will be in a trancelike state, in which memories come in and out and switches occur rapidly. Eugene Bliss, another founding figure of the multiple personality movement, wrote in 1980 that “to enter the domain of the personalities is childishly simple, for the key to the door is hypnosis and these patients are excellent hypnotic subjects. This is the world of hypnosis. Personalities hidden for decades may be accosted and interviewed, or forgotten memories can be encountered and relived by the subject with all the emotional intensity of a contemporary event.”19 What with all the current talk of suggestion and false memories, few today would be as incautious as Bliss. Yet his innocent enthusiasm is not to be dismissed. Trance states are one of the very few common denominators in a majority of individuals who, in the course of the past two hundred years or so, have satisfied the DSM criteria for multiple personality.
Observers have always reported a different “look” to different alters, and have sometimes included drawings or photographs in their reports in order to suggest the change. This practice is over a century old. We have a set of photographs of the very first multiple personality in history—the first clinical case of an individual said to have more than two stable and distinct alters. That was Louis Vivet, first presented as a multiple in 1885, whom I describe in chapter 12. Likewise the very first individual whose dissociative fugues were studied at length—Albert Dad., in 1887—was recorded photographically in three states, namely, normal, hypnotized, and during a fugue.20 Thus multiplicity was made visual from the very beginning, and faithfully followed new technologies. After movies had been invented, they were used to record switches.21 And now there are innumerable videos. However, even videos do not seem to the casual observer as striking as they do to experienced therapists. To counteract this, some exponents offer us scenes of very radical changes in demeanor. On several occasions I have watched videos after which the presenter said, “Not even the most gifted actress could change roles so well, so abruptly.” My impression was that any ham could have done better. I’m not saying that the patient was faking, only that the roles were poorly done. And why not? Why should we expect an anorexic woman from Chicago, who is severely upset and in a florid state, to act at one moment just like a two-hundred-pound male truck driver from Alabama, and at the next just like a scared three-year-old in a blizzard? No, we are offered sharply distinguished caricatures. In order for it to be clear that the alters are distinct personalities, it does help to have them of different ages, races, sizes, voices.
Some really dysfunctional multiples going through a bad patch switch personalities very rapidly, each time assuming a new stock character. The effect is similar to that of switching TV channels by channel surfing. This impression is enhanced because patients with a great many alters often choose, for some of their personalities, the names of characters in sitcoms, soaps, and crime series. It happens that TV remote controls became widely available in America just about the time that today’s florid multiples became abundant. I am not saying that multiples self-consciously act out television fantasies—or, at any rate, that they do so any more than the rest of us. We constantly mimic others. Art, from great to tawdry, presents us with a selection of stylized characters from whom we acquire bits of our own ever-evolving personal style—and on whom, selectively, we mold our own character. It is very important not to think that there is a special kind of truth about multiples, that each alter is revealing a secret soul, hidden since childhood as an escape from cruelty, but profoundly real. No. The alters are, in this respect, just like the rest of us, if a little more circumscribed in their range of emotions. They too respond to their environment, the people they meet, the stories they watch.
I must repeat that I am describing a prototype. Many patients and their symptoms radiate away from the prototype, but that does not show they are not true multiples any more than the oddities of an ostrich make it any the less a bird. Here is one newly published account: “To me, having multiple personalities does not feel like I have lots of people living inside my body. Rather I find myself thinking and talking to myself in different tones and accents. Some of the voices that talk in my mind sound like children. When I allow them to talk to other people they don’t talk like children to impress anyone or be dramatic. I have to talk like that sometimes in order to express what I need to say. I can’t say it from my adult voice…. Then there are the deep-raspy intent voices that say the meanest things you could imagine. When they talk, I feel hard inside, I feel cold and calculating.”22 The writer describes herself as a victim of extremely severe ritual abuse. Most of the time she is, as you can see, very much in control; she permits the child voices to speak. But when the topic of cults comes up, other voices flow uncontrollably out of her mouth. Clearly this author is at some distance from the prototype I have been describing, especially in that the illness is expressed almost entirely in terms of talking, and not of discordant actions or lost time. This does not show that I have misdescribed the prototype. On the contrary, a radial class has a central prototype and a large number of examples some distance from the prototype, which vary from the prototype, all with their own characteristic idiosyncrasies.
There is now no difficulty in summarizing the 1980s prototype for multiple personality: a middle-class white woman with the values and expectations of her social group. She is in her thirties, and she has quite a large number of distinct alters—sixteen, say. She spent a large part of her life denying the very existence of these alters. The alters include children, persecutors, and helpers, and at least one male alter. She was sexually abused on many occasions by a trusted man in her family when she was very young. She has suffered many other indignities from people from whom she needs love. The needs are, among other things, part of her class values, which may be abetted or taken advantage of by her abuser. She has previously been through parts of the mental health system and has been diagnosed with many complaints, but her treatments have not helped her in the long run until she came to a clinician sensitive to multiple personality. She has amnesia for parts of her past. She has the experience of “coming to” in a strange situation with no idea of how she got there. She is severely depressed and has quite often thought about suicide.
That is the prototype, the typical multiple as presented in expositions by mental health professionals all over North America, an increasingly regular part of the education of anyone training to be a therapist. It is not something stated in official manuals but rather part of the culture, part of the specialized language of multiplicity. Every special branch of knowledge has just such prototypes. It is not a defect in the multiple personality movement that the prototype is not spelled out exactly in any textbook, for prototypes are the carriers of meaning before textbooks are written or understood. Full mastery comes only in clinical experience. This is not because psychiatry is somehow a “soft” or nebulous science; the case is much the same in physics. T. S. Kuhn insisted in his famous book The Structure of Scientific Revolutions that you can’t learn physics from the texts—you have to do the problems at the back of the book.
How then do we know what the prototype is? By looking and listening. All the features that I have mentioned recur in the literature, but a prototype is more general than that. It is part of what people understand by a concept, what they point to when they want to explain it. When I casually meet someone who is in training for some sort of eclectic lay therapy, I will hear, “Oh, we had a class on multiples last week.” And on inquiry I get something like the prototype I have just described.
There is no doubt that prototypes can be misused. They can be presented in such a way as to have dramatic effects on susceptible listeners. As we shall see in chapter 8, a radical wing of the multiple movement believes that many patients have been programmed by ritualistic cults. Yet we can find something very much like cult initiation, with many of the trappings of dubious religion, within the multiple movement itself. It relies heavily on presenting the prototype in a compelling narrative, and inviting each listener to feel that prototype awakening within herself. A striking example is furnished by a July 1994 newsletter from North Carolina. It is written by Gary Peterson, an influential psychiatrist at the forefront of research on child multiple personalities. He urges fellow students of dissociation in his region to spread the word—that is, inculcate the prototype. He says that far too many people still rely on Eve or Sybil or Oprah Winfrey for their information.
Where can one find these uninitiated? Many places.
We can find them in our churches and other places of worship, at Women’s and Men’s Centers, at Rape Crises, at mental health centers, at schools, at local self help and business organizations, and many other local institutions.
Peterson urges his followers to work with any such group. He suggests one approach. Begin a presentation “with a life course story.” First of all, warm up audience members by asking them to go through a time regression back to the moment of their birth. Then ask “them to consider what it would be like to have a life such as the one about to be described.” He next provides a script. He tells his acolytes to “read the story deliberately and emotionally, stopping at appropriate places to let the audience absorb the impact of what has just been said.” The age-regression just conducted is reversed: it begins at birth and goes up year by year. It gradually brings out every aspect in the prototype of the multiple, including all the features I have mentioned, plus a rich life history of abuse and confusion. The script concludes at the age of twenty-eight, when the wretched woman whose life course is enacted—and which is to be felt and experienced by the audience—has gone through two divorces, much missing time, many therapies.23 Members of the audience are urged to feel like that … to become like that. This is a powerful way to create mental illness in susceptible auditors. In this book I refrain from personal criticism, as opposed to analysis of texts, but it would be wrong not to state that this procedure seems thoroughly pernicious.
But there is nothing wrong with characterizing an illness by a prototype. A prototype, to repeat, is not an average. Many multiples are as ostriches to birds; I have offered the examples of Jonah, an African-American man, and Marie, an underpaid Québecoise who daily crosses the river from the French-speaking slums of Hull (Québec) to the polished streets of Ottawa (Ontario) to sell poutine. Jonah, Marie, and the victim of cult abuse whom I quoted earlier are all on the edges of that classification, multiple personality; each differs from the prototype in his or her own way. There is nothing linear about radial classifications.
Far from being fuzzy, the use of prototypical examples is sound science and is often essential to conveying meaning. For that very reason, it distances us from real people. Even when the prototypes of which we are told are colorful—nay, florid—they are used only to fix ideas. They don’t tell us what it feels like to be a multiple. How does it feel? That is a natural question, but be cautious. Multiples asked to say how they feel give perfectly good answers, and they don’t say anything very special. They tend to pick up the current lingo and talk about themselves much as anyone else does. That is how language works. When the multiples are not emphasizing the alters, their most notable feature besides depression may be a sort of confusion, daze, haziness, unclarity about bits of the past, an inability to fit together memories and current unhappiness. But how does it feel! Miserable, scary, that’s how it feels. What is it like to be in a daze? Or drunk? Or lost in thought? Can you say very much by way of describing how it feels to be in those states, except by using those very words? Most of us cannot, but the words suffice. The teetotaler may not know exactly how I feel when drunk, any more than the man of whole limbs knows exactly how it felt when I broke my arm, but there is no special problem about mental states. Many therapists believe it helps their clients to get them to talk about their feelings; when they do talk, there is no difficulty understanding what they say.
Now we are in philosophical country, the problem of other minds.24 It is good to call a commonsense witness, an expert on multiple personality, but not on the higher reaches of Wittgenstein. I mean Cornelia Wilbur. There have been many multobiographies since the 1973 story of her work with “Sybil.” A recent one is The Flock: The Autobiography of a Multiple Personality.25 It is not an autobiography but, like Sybil, a novelized true story told by a professional writer. Shortly before her death in 1992, Dr. Wilbur allowed the publishers to quote her for advertising purposes. The Flock, she told them, “states the disorder with understanding and gives a clear indication of what being a multiple is like.”26 Exactly so. There is no other way to know, and there is no special problem about knowing what it is like to be a multiple.
There is, however, a problem about treating human beings as specimens. If you look from the point of view of the doctor, the classroom, or the medical anthropologist, multiples seem distressingly similar to each other, all clustered around the prototype. Every one is different, though: each is filled with a unique history of shame and pain and confusion, but also aware of some good times, many hopes, and often lots of happy achievement. So I have to apologize for the impersonal, distanced way in which I refer to real people. An account of multiplicity can quickly turn into a freak show. Indeed P. T. Barnum probably did invite one seeming multiple to join the circus.27 Multiples have done service for Geraldo Rivera and Oprah Winfrey. Those shows have an important role in modern American life, but they sensationalize, they stereotype, they are the circuses of our days. I have encountered many dismissive references to those shows in the writings, presentations, and lectures of multiple personality clinicians—and nary a good word for the talk shows, which revel in controversies that highlight the bizarre. I see things differently. Many of those shows are brilliant. They are a forum for a great spectrum of ordinary—and amazingly articulate—Americans to whom nobody else pays much attention. Multiples are among them: very ordinary persons who are suffering a great deal, and who probably have suffered even more. We are talking about how they cope and survive in a world that has too often been hostile. We are talking about failed love, about background cruelty, about family violence, about how to confront and overcome terror, evil, indifference. I apologize to all those individuals, anywhere, who see or feel their personality fragmented but who resent being treated as specimens. I am sorry about the extent to which I distance myself from their suffering. I shall occasionally be critical of, or even hold in contempt, this or that expert on multiple personality, whether skeptic or advocate. I am of course as cynical as anyone else about a few actresses who enjoy public wallowing in the trough of their early abuse and subsequent multiplicity. But for ordinary patients, appropriate emotions are empathy and respect, which is not to say that one should be permissive or indulgent.
Multiples have formed themselves into self-help groups. Early attempts tended to be unstable, for if one person switched into an aggressive alter during a meeting, everyone else felt threatened. Unless there is a nonmultiple facilitator present, more switching may occur, and pandemonium can break out. One group that has tried to get itself together is in Ashville, North Carolina, where the Highland Hospital has a Dissociative Disorders Unit. In January 1993, some of its clients formed a Multiple Personality Consortium, now legally incorporated as a nonprofit organization. It began with about 30 members; by the end of the year there were about 130. Debbie Davis, a businesswoman and a multiple, is a leader of the consortium. She is also chair of the Patient Liaison Committee of the International Society for the Study of Multiple Personality and Dissociation.28 She hopes to change the name to the Client Liaison Committee. “We feel that is more empowering.” She says that the consortium has a transition house in which clients of the hospital can prepare to move back into the world. It maintains a support group regularly attended by between 11 and 20 multiples. The consortium arranges trips—for example, to Six Flags over Georgia—and has regular peer-led meetings. Social get-togethers are particularly welcome, because they provide an opportunity for child alters to come out. One evening it is finger painting for four-year-olds; another it is the Just So Stories. It is clear that Davis and her group are unhappy with the very word “disorder” no matter how it is modified, whether as multiple personality disorder or as dissociative identity disorder.
Now whether or not Davis was telling the whole story about her consortium—such enterprises are of their nature bound to have disruptions—we have evidence here of another stage in the evolution of multiplicity. Could this cease to be a disorder and become a way of life? Some multiples feel threatened at the thought of being cured, of developing one and only one personality, for they lose companions who help them cope with difficult situations. Others feel they have found a community of like-minded people, each of whom dissociates into alters. Multiple self-help groups, which are found all over the continent, have until now developed and progressed in their own ways. Davis intends to bring them all into a communicating network. An electronic bulletin board for multiples was founded several years ago. These people hope to become more and more empowered. And so there may evolve subcultures of multiples, or even a larger, networked, continental subculture. Not everyone favors this development. Richard Kluft concluded an address to the November 1993 meeting of fellow professionals in Chicago by challenging what he called “the MPD subculture.”
Part of the socially prescribed role of being ill is working to recover and leave your illness behind. We are in a position where many of our MPD patients and some of us ourselves are not necessarily bearing this in mind. Instead we are giving license to a lot of MPD patients sitting around learning how to deal with an MPD environment, making MPD friends, talking MPD all day…. I think we’re giving the implicit message to many MPD patients that MPD is forever…. The wish to be validated and not to be alone with one’s illness is understandable…. We all understand the wonderful forces that group cohesion and group membership can bring. However, it is important to realize that one’s commonality should not only be to have MPD, but to get rid of it as soon as possible and to go on with one’s life.
I began this chapter talking about a feedback effect, the way in which classifications affect the people classified, and vice versa. In medicine, the authorities who know, the doctors, tend to dominate the known about, the patients. The known about come to behave in the ways that the knowers expect them to. But not always. Sometimes the known take matters into their own hands. The famous example is gay liberation. The word “homosexual,” along with the medical and legal classification, emerged during the last half of the nineteenth century. For a time the classification was owned by medicine, by physicians and psychiatrists. The knowers determined, at least on the surface, what it was to be a homosexual. But then the known took charge. I do not suppose, even now, that multiples will do that. But I am well aware of how things change. In the fall of 1983 I said, “At the risk of giving offense, I suggest that the quickest way to see the contrast between making up multiple personalities and making up homosexuals is to try to imagine multiple-personality bars. Multiples, insofar as they are declared, are under care, and the syndrome, the form of behavior, is orchestrated by a team of experts. Whatever the medico-forensic experts tried to do with their categories, the homosexual person became autonomous of the labeling, but the multiple is not.”29 I may yet come to eat those words.