CHAPTER 3

The Movement

WE HAVE BEEN FAMILIAR with psychological “movements” ever since madness was medicalized, and certainly since the advent of psychoanalysis. No one hesitates to speak of the movement founded and orchestrated by Sigmund Freud. Multiplicity has no founding and controlling parent, but if ever there was a movement, it is the multiple personality movement. It has a rather fresh, American quality to it. It appeals to down-home folks, who are much more at ease with the bizarre than city slickers are. Although the professional organization, the International Society for the Study of Multiple Personality and Dissociation, was established by psychiatrists (M.D.’s) and a few psychologists (Ph.D.’s), the movement has had an egalitarian look. Patients and doctors share platforms. At the May 1994 Fourth Annual Spring Conference of the ISSMP&D, the full registration fee for ISSMP&D members was $250, but there was a category for patients, “Multiple Attending Members,” with a $25 reduction. From the beginning, when the leading figures were at the podium, it was Connie and Buddy and Rick and Cathy, not Dr. This and Dr. That. As for patients, some afflicted people find it a relief to be able to come out and manifest their multiplicity in public. Thus the movement has been able to draw both on the recent language of liberation—for example, gay liberation—and on older memories of fundamentalist revival meetings. No statistics exist, and perhaps none could exist, but many therapists who work with multiples say that they themselves have suffered from dissociative disorders, and add that they recovered memories of childhood abuse during their own therapy.

In the coarse measure of decades, the multiple movement germinated in the sixties, emerged in the seventies, matured in the eighties, and is adapting itself to new environments in the nineties. If my talk of a movement seems a little sardonic, consider that when I subscribed to Dissociation, “The Official Journal of the International Society for the Study of Multiple Personality and Dissociation,” and became an Affiliate of the Society, I received a document designed to look just like a medical school diploma. An accompanying flyer enjoined me as follows: “Display your professionalism. Be proud of your commitment to the field of multiple personality and dissociative disorders. Display your certificate in a handsome membership plaque ($18.00 including shipping/handling).” Successful movements require accidents, essentials, and institutions. They begin in corridors, in chance encounters of like minds, in late-night conversations, in small but vigorous meetings. Both hard work and some charisma are needed. But a movement will “take” only if there is a larger social setting that will receive it. The essential ingredient for the multiple movement has been the American obsession with child abuse, a mix of fascination, revulsion, anger, and fear. I shall describe some of that in the next chapter, and I conclude this one with a few words about institutions. First I will describe three isolated initiating events each of which has left its stamp on the movement. Before there were any thoughts of institutionalizing multiple personality, the achievements of three people stand out: Cornelia Wilbur (1908–1992), Henri Ellenberger (1905–1992), and, in the next generation, Ralph Allison.

Wilbur was a psychiatrist and psychoanalyst, but her impact came largely through the novel about her patient Sybil. There has always been a popular face to the idea of multiple personality. The romantic fiction and poetry of the nineteenth century positively reeks of duality. Dr. Jekyll and Mr. Hyde is the best known, Dostoyevsky’s Mr. Golyadkin of The Double is the greatest artistic creation, and James Hogg’s The Private Memoirs and Confessions of a Justified Sinner is the one that scares me the most. There is a host of lesser works. Stories, rather than medicine, entrenched the idea of the double in European consciousness. The modern movement has thrived not on fiction but on a new genre, the multobiography. This is the book-length story of a multiple, usually packaged as an “as-told-to,” and often turned into a movie or TV special.

The Three Faces of Eve set the pace.1 Surprisingly many people have heard of this 1957 work, even though they cannot remember ever having read the book or seen the movie. Perhaps it is the brilliant title that we remember. Eve was the work of two psychiatrists who treated Chris Costner Sizemore. In 1954 they wrote her up for an academic journal.² Their popularized book of the case became a best-seller, and the movie did well. But Eve did not begin the modern movement. No one who writes in movement literature has a good word to say for the book, and many critics voice harsh judgment of her psychiatrists. In order for multiple personality to take off, it needed a larger cultural framework within which it could be explained and located. That framework was child abuse. Eve happened before child abuse had become an American obsession. Written in an age of innocence, the book did nothing to make multiplicity intelligible.

There are specific reasons why Eve is light-years away from more recent multiplicity. The doctors in charge elicited only three personalities. The patient took over the story and wrote three books giving very different visions of her life—these books, in retrospect, are the three faces of Eve. First, using a pseudonym, and with the support of her doctors, she published her own version of their story, The Final Faces of Eve.3 Those faces were not final, for she later went public, granting a scoop to the Washington Post on 25 May 1975. She reneged on her doctors, upon whom she poured scorn in her next book, I’m Eve.⁴ She found more than twenty personalities and her own hidden history of abuse. She did not so much join the movement as serve as a perfect exemplar of the new vision of multiplicity that emerged in the 1970s—including misdiagnosis or maltreatment by an earlier generation of doctors. She went on the lecture circuit denouncing her former therapists, although movement psychiatrists gave the impression of keeping their distance from her. Does one ever trust a double agent? Sizemore was not yet finished. In 1989 she gave us A Mind of My Own.⁵ It turns out that her first alters had been with her from birth. That’s because they are past-life alters.

Eve’s original psychiatrists were later to condemn the profligacy and propagandizing of the multiple movement. They accused it of finding vastly too many multiples.⁶ ‘Eve,’ they implied, had been correctly treated, even if she later fell into bad company. A clinician might at best see one or two genuine cases of multiple personality in a lifetime. The epidemic that surged in the late 1970s was, they said, largely composed of unhappy people who cultivated symptoms that made them feel important, and was fostered by uncritical medicine.

So the multiple movement was introduced not by The Three Faces of Eve but by a very different multobiography: Sybil, published in 1973.⁷ It too became a movie, a very long one. I recently watched the film in the company of a mixed bag of undergraduates. Even they found it pretty horrifying, these young people who have lived their whole lives in a media world that made them sharply aware of family violence. The book is a fictionalized “as told to” story. Cornelia Wilbur began treating Sybil in Nebraska; it happened that when Wilbur moved to New York to begin psychoanalytic training, Sybil also moved there to enter graduate school, and resumed treatment. Wilbur began to uncover Sybil’s personalities. The process continued even when Wilbur moved on to a medical school position in Lexington, Kentucky.8

Wilbur’s professional accounts of the case were routinely rejected by scholarly and medical journals, apparently on the grounds that no one could take multiple personality seriously. One crushing insult followed upon a paper she read at the annual meeting of the American Academy of Psychoanalysis. Wilbur believed that the academy published all the papers that were read, but she was telephoned and told there were “space problems.” Since Sybil’s story would not be received by the experts, it had to be told for the public. It was written up by a journalist, Flora Rheta Schreiber. Schreiber insisted that Sybil be cured before she began work.⁹ A book without a happy ending would not sell. When Sybil was cured, Schreiber came to live in what had virtually become the Wilbur-Sybil ménage, and wrote the book. Wilbur had at least six other multiples under her care during that period, one of whom was Jonah, whom I mentioned in the previous chapter.¹⁰

Wilbur’s work broke new ground because she actively sought out childhood traumas. She traced Sybil’s multiplicity to perverse, vindictive, and usually sexually oriented assaults by Sybil’s mother. Wilbur was no orthodox Freudian. She worked on Sybil’s memories with both hypnosis (anathema to Freud) and Amytal.¹¹ She did not believe in the ritualized distancing between patient and analyst demanded by American psychoanalysis. The two women became friends, went for long rides in the country, and lived for a while in the same house. Sybil’s treatment involved 2,534 office hours. It took so long, Wilbur was to tell people, only because in the 1960s there was simply no knowledge about multiple personality.¹²

A doctrinaire Freudian would work with Sybil’s memories of abuse in order to help the patient understand what they meant to her in the present. It would be of little moment whether these were true memories or fantasies. But the growing bond, in popular awareness, between child abuse and perverse family sex was a perfect fit for the mistreatment of Sybil by her mother. That involved not just cruelty but a barely concealed sexual fetishism—constant punishment by cold water enemas, with the anus tied so as to prevent expulsion. Her mother stuck sharp objects into her anus and vagina. There was what has since become a dreary litany of sex-associated cruelty. Wilbur went on to confirm, as best she could, that the events Sybil painfully came to remember really had happened. She went to the family home and saw at least the instruments of torture, the enema bag, the tool for lacing boots that had been stuck into Sybil’s orifices. The passive father did not contradict the stories. Of course the existence of the objects of torture—which were also, in those days, common household furnishings—did not prove that they had been perverted for sadistic uses. But Wilbur believed Sybil, and by the time of the book and above all the film, no one could doubt the reality.

Sybil became a prototype for what was to count as a multiple. She was an intelligent young woman, with a promising career, who experienced substantial periods of lost time. She had fugue episodes; she would recover herself in a strange place with no idea how she got there. But other features are more important. Patients in the past had tended to have two or three or even four alters. Sybil had sixteen. There were child alters. There were two alters of the opposite sex. Some alters knew about others. They argued, fought, tried to help or destroy each other. This idea of dynamic relationships between different personalities had been glimpsed before, but it was the reports of Sybil that made them prominent. Above all, the etiology of her disorder was writ large. She really had been abused as a child. “Sybil,” the main presenting personality, had no memory of those sorry events. But her alters did remember. Indeed they had been created in order to cope with horror. They would be dissociated from the main personality, so that Sybil, herself, did not need to be conscious of those scars. She did not need to hate her mother, who had done those things to her. She could even love her mother, while some of the alters were full of hate. Other alters lived out a life that Sybil would like to have lived, had she not been so assaulted when she was growing up.

In only one way did Sybil differ from the subsequent prototype of the multiple. She had been abused by her mother, not her father or another male. Sexual abuse and incest did not fully reach public consciousness until 1975, two years after Sybil’s publication. In the years after 1975, sexual abuse was primarily abuse by men in the extended family. The story of Sybil did not fit that mold. Her father was passive, at best a facilitator. The evil figure was the sadistic mother.

Sybil set the stage. A very large book of a very different type provided a magnificent backdrop for the revival of multiple personality and dissociation. Henri Ellenberger’s The Discovery of the Unconscious dwarfs most other contributions to the history of psychiatry.13 It will long remain the most richly textured study of thinking about the unconscious before Freud, and of the relationships between that thinking and later dynamic psychiatry. The book is the work of an extraordinary amateur, in the best sense of that word, one who deeply loved his subject and devoted his life to it, while earning his living as a psychiatrist and teacher.14 Ellenberger recovered a good deal of the history of multiple personality in the nineteenth century. He brought to life the greatest theorist of the subject, the man who invented the very word dissociation in its present psychiatric sense—Pierre Janet, who had once been an influential French theorist and investigator. Psychoanalysis has been opposed to multiple personality as an independent diagnosis and may be responsible for the waning of multiplicity during the first half of the twentieth century. But one thing is certain. Freud personally saw Janet as a threat and a rival, and was at pains to emphasize the originality of his own ideas and the triviality of Janet’s. Janet was a victim of Freud’s self-aware management of the psychoanalytic movement. Janet was a scholar; Freud, by comparison, was an entrepreneur who annihilated Janet’s reputation. Unfortunately, Janet’s repeated remarks about Freud’s success read so much like childish spite that the reader’s sympathy for the loser is undermined.¹⁵

When Janet died in 1947 he was almost completely forgotten. But not by Ellenberger, who had known Janet, and who deeply admired his achievements. Ellenberger saw Freud as one in a long line of contributors, and as one who owed much to Janet. Janet himself came to maturity in the heyday of French multiple personalities. He personally studied a number of the most celebrated French multiples. He formulated a theory of multiplicity, and its dynamics, a model suggested by his choice of French words such as dissociation and désagrégation. The word “dissociation” entered English in 1890 thanks to William James, who was fascinated by French psychology, and who was deeply impressed by Janet as a person. Morton Prince, the great American pioneer of multiple personality who came to lead the Boston school of psychology, also used the word in print in 1890, after his visit to France, and it was he who cemented it into English.¹⁶ Janet, in contrast, dropped the word after his philosophy thesis of 1889, Psychological Automatism. I shall point out, in chapter 9 below, that he even ceased to take multiple personality seriously. He decided it was a special case of what is today called bipolar disorder. That is, he came to think that multiples are manic-depressives. But Ellenberger said virtually nothing about Janet’s later work. Hence the legend has accumulated around Janet that he was the great founder of the theory of dissociation.

Ellenberger had nothing to do with the multiple personality movement. But the publication of his book made plain that multiple personality had once been an important part of psychiatric thinking. It showed that there was a nonpsychoanalytic but dynamic model of the mind that had been buried by the analysts. The book helped to legitimate multiple personality. Ellenberger unwittingly made it possible for Janet to become the patriarch of dissociation. Fledgling movements tend to have a Manichaean view of the world; they are the Forces of Good fighting real Evil. It helps to have mythic figures to represent the conflict. Once Ellenberger had brought Janet back to life, one could see Janet as Hero, a sort of Anti-Freud.

Ellenberger had another effect that was pure accident. He inspired Richard Kluft, a founding member of the ISSMP&D and the editor of its journal Dissociation. Kluft may have treated more multiples than anyone else; he has the most impressive success rates in therapy leading to integration; he probably has had more patients referred to him for assessment than any other therapist.17 Kluft became fascinated by multiples as a young psychiatrist “who first encountered MPD phenomena in 1970.” He could get no advice. When Sybil appeared, a professor told him it was a fake and he did not read it. Ralph Allison, whom I next describe, was out west and had not published yet. Where did Kluft get his multiple lore? “I hold in high esteem a man whom I consider my teacher, Antoine Despine, M.D., a French general practitioner of high repute, and a student of magnetism (hypnosis), [who] appears to be the first to have effected a non-exorcistic cure of MPD, in his treatment of ‘Estelle.’”¹⁸ Despine was a fashionable spa doctor; Estelle was an eleven-year-old girl. Despine treated her in 1836 and wrote her up in 1838. I shall say more about Estelle in chapter 10. “Despine was indeed my teacher,” Kluft repeats, yet he did not read Despine. “I read about Despine, over and over, in Ellenberger.” Ellenberger wrote a two-page summary of the case of Estelle, just the right length to read over and over again.¹⁹ Ellenberger knew about Despine because for a short time in midcareer Janet referred often to the case and even discovered that his early star patient, Léonie, had probably been trained by a previous handler to pattern her behavior after Estelle’s.²⁰ Here then is a typical accident in the history of science. Ellenberger’s uncritical account of a book published 130 years earlier served by chance as a model for an ambitious young man trying to carve out a new way in psychiatry.

Ralph Allison created his own model. In 1980 George Greaves stated that “there are conservatively some fifty cases of multiple personality that have been identified during the past decade,” i.e., between 1970 and 1979.21 His tally of 50 was remarkable, for he had located only 14 cases between 1944 and 1969, seven of which were patients of Cornelia Wilbur. Twenty of the 50 new cases had been described, with some overlap, by a total of 28 clinicians, excluding Ralph Allison. Allison was cited in connection with 36 of the 50 cases.²² He also knew “a psychiatrist in Honolulu who has seen 50 cases, and one in Phoenix who has seen 30.” The latter was Milton Erickson, the greatest of hypnotherapists, who told Allison that the thirty patients were incurable.²³

Allison’s writing reveals a man of vast enthusiasms, deeply caring for his patients, and charmingly romantic. In his 1980 autobiography Minds in Many Pieces he described not only his rediscovery of multiple personality but also a good deal of pain. He was honest almost to the point of masochism in confessing two failures, one patient who killed herself, and a client who participated in the gang rape of a woman and then murdered her.²⁴ He was sensitive to the harms done to children, but he was able to see that sexual cruelty and exploitation were only one feature of a configuration. In 1974, writing for the new Californian periodical Family Therapy, he published “A Guide to Parents: How to Raise Your Daughter to Have Multiple Personality.”²⁵ Using three of his patients as examples, he offered seven rules for a parent who would like to have a multiple daughter. In the first place, don’t want your child. Let mother and father be at loggerheads, with at most one of them serving as a model for your child, the other despised. The preferred parent should leave home before your child is six years old. Encourage rivalry with her brothers and sisters. Be ashamed of her older relatives and family tree. Ensure that her first sex experience is disgusting, rape at thirteen, say. Make home life so miserable that she will want to leave and marry as soon as possible—setting up house with a mate who perpetuates this tradition of repulsive family life.

Many recent publications about multiples are tricked out with the apparatus of statistics—and with fashionable scientific metaphors, parallel distributed processing, state dependent learning, or whatever. Allison’s writings are from another world and another time. He practiced in Santa Cruz, California, in the late 1960s. In trying to understand the self, he suggested that Theosophy provides the best model. “There is one life in all beings.” The task of every human being is to come to be aware of one’s Inner Self, tranquil and understanding, a self that shares in that one world-life. “To be truly in touch with one’s Inner Self,” he wrote, “is the key to mental and spiritual health. Patients with multiple personality provide a striking example of persons who have lost touch with that inner part of them which is creative, non neurotic, problem-solving and everything else that is needed to survive and grow in the world as it is.” The doctor needs this sensibility, for “the therapist must be in touch with his own Inner Self, since his Inner Self is in constant communication with the patient’s Inner Self.”

The last thing that an emergent science wants is intimations of Madame Blavatsky, so Allison has been slightly marginalized. In retrospect he is honored as the pioneer of the first protocol for treating multiple personality disorder, a suitably scientific-sounding achievement.26 But it was his proselytizing that fired up the movement. During the late 1970s it was he, above all others, who was organizing workshops on multiplicity at the annual meetings of the American Psychiatric Association, and even presenting papers in the main program.²⁷ He circulated copies of two manuals about the psychotherapy of multiple personality.²⁸ His idea of the Inner Self Helper was cautiously accepted, at least in the early days, by some mainstream psychiatrists. In his conception, the Helper is not at all like alters as envisaged by modern multiple theory. It is not created in childhood to cope with trauma. It “has no date of origin as an alter personality. The ISH is not ‘born’ to handle a patient’s unexpressed anger or violent trauma.” It “is present from birth and is present in a normal person as well as in a multiple, although in a multiple personality, the ISH appears as a separate individual.” Helpers are incapable of hate; they feel only love and express both awareness of and belief in God. “They serve as a conduit for God’s healing power and love.” They are ungendered, unemotional. They communicate “in the manner of a computer repeating programmed information.”²⁹ That sounds all too like the benevolent computer Hal, in Stanley Kubrick’s 1968 movie, 2001: A Space Odyssey. Allison’s Helpers seem to have voices like Hal’s: calm, measured, knowing, slightly awe-inspiring. Clinicians have written about the effect on some patients of reading Sybil, but multiples, as I have suggested, reflect or distort a far wider spectrum of current culture than that, and Kubrick’s film loomed large in the popular imagination of the day.

Allison wrote that the Inner Self Helper “is really the conscience.”³⁰ He would work with the Helper to find out more about the patient. “There is no human to human relationship with which to compare this partnership. It is so unique a relationship that it has to be experienced to be believed.”³¹ “Inner Self Helper” is naturally parsed as Inner Self-Helper, i.e., something internal that helps the self. Allison meant the Helper from the Inner-Self, the Self that has always been there. When Allison published his autobiography in 1980, he pictured Helpers as transcending individuals. “There may be more than one ISH, each ranked in a hierarchy, and the highest ISH often speaks of being next to God. I have found it difficult to summon this type of ISH; it seems almost as though the therapist is not worthy of such contact.” Allison asks, “Do I believe this?” He answers, “I have no other explanation.”

Putnam discussed uses of the Internal Self Helper in his textbook, but he omitted the theosophical background. The idea was secularized; perhaps even the switch from “Inner” to “Internal” Self Helper signals this (and moves us from Inner-Self Helper to Internal Self-Helper).32 Other workers took a less than benign view. The personality structure of multiples is full of plots and subplots, threats and counterthreats, and Helpers are not immune. David Caul said that

the therapist must not be afraid to “horse trade” with the ISH, who will always be protective of the personalities and will see to it that therapy is provided and that the personalities will get the best deal possible…. The ISH will almost never play all of his cards at once.³³

Multiple personality has long had close links with spiritism and reincarnation. Some alters, it has been thought, may be spirits who find a home in a multiple; mediums may be multiples who are hosts to spirits. The scientific version of this idea goes back to the 1870s; much of the best turn-of-the-century English-language research on multiple personality was published in the journals of the London- or Boston-based societies for psychical research. Allison has been sympathetic to this vein of ideas. He once found it necessary to exorcise an intruding evil spirit. One of his most important patients, Henry Hawksworth, had psychic powers and could perceive the auras of people he met. When he was cured, he used this ability in his job as a personnel officer, assessing actual and potential employees in part by their auras. Allison encouraged Hawksworth to write an auto-multobiography, The Five of Me.³⁴

Hawksworth had been in trouble with the law, and the painful practice of forensic psychiatry became Allison’s vocation. One client was condemned to death for a brutal rape-murder. He had first been directed to Allison as an arsonist. Mark (it turned out) set fires in an alter state. There had been a grisly incident in his youth; he was gang-raped by teenagers. Later his mother was decapitated in a car crash for which the man wrongly blamed himself. After much work Allison elicited “an enraged monster,” Carl, and then a rescuer alter. Mark, qua Carl, married another of Allison’s patients, Lila; she, in her personality of Esther, was another violent being. Switching took place even during the wedding, and the marriage was doomed. Carl subsequently murdered a homosexual lover. Later on, Mark, or whoever, in the company of a pal, raped a woman chosen at random for her good looks; then Carl murdered her. Allison does not exonerate Mark. He makes plain that all of Mark’s alters knew about these murders, even the rescuer personality whom Allison regarded as an Inner Self Helper. Allison learned a powerful lesson from this horrible sequence of events. Contrary to his view that an Inner Helper would never allow a person to do profound wrong, the rescuer knew about the murders. Mark, wrote Allison, had no conscience.

Allison has continued working with criminals. But even he reached a point of partial burnout, arguing in 1994 that it is impossible to treat multiple personality successfully within the prison system.35 The cruelties of other prisoners, the needs of the patients, but above all the behavior of the authorities themselves invalidate any psychiatric process.

As a pioneer in the field, Allison was an expert witness in the trial of the famous Hillside Strangler, a man who had terrified Los Angeles in the late 1970s. A rapist in Columbus, Ohio, was diagnosed in 1977 as suffering from multiple personality, and the man was found not guilty by reason of insanity.³⁶ Kenneth Bianchi entered the same plea for the murders in Los Angeles and Washington State. He plea-bargained but the proceedings seemed to turn into a trial not of disgusting serial killings but of hypnosis and psychiatric diagnosis.³⁷ Allison himself concluded at the end of it all that the defendant was not a multiple but did dissociate during psychiatric interviews.

We should not think of these trials as something new. As soon as the new wave of double personality appeared in France in 1876, the doctor of the first and most famous patient raised the forensic question. “To what extent,” he asked, “would such a person be responsible for committing a crime or misdemeanor?” He consulted a number of Bordeaux magistrates and legal experts. They argued that the multiple would be responsible for the actions of an alter, but “eminent psychiatrists think otherwise.” Little has changed in the intervening hundred years; the division of professional opinion still exists. “The courts,” the doctor concluded, “have not hitherto had to deal with such a situation, but it could happen tomorrow.”³⁸ How right he was. The Hillside Strangler case, with its battery of competing expert witnesses, recapitulated a French trial that took place in Nice in 1892. The events were less gruesome but included two attempted murders, the victims were women, and the accused pleaded (using the terminology of the day) that an alter had committed the crime. The expert witnesses for the defense were the best, starting with Charcot. The three prosecution witnesses were almost equally distinguished.39 The experts for the prosecution complained that the accused was schooled in his disorder and knew the medical facts all too well. They placed him under conditions of strict observation for three months, undoubtedly violating what we would now think of as his civil rights. The plea failed: the court declared the defendant guilty, but with diminished responsibility.

Allison has never sensationalized his patients. When it comes to multiple personality, students of jurisprudence and forensic psychology quite properly focus on questions of responsibility.⁴⁰ But we should not ignore the other side of that, the voyeurism captured in generations of gothic horror stories. My favorite plot is from Paul Lindau’s The Other; it played on the Vienna stage in 1893. An investigative magistrate gradually finds that the crime he has been assigned to solve was committed by his second self.⁴¹

These stories continue to the present day, endlessly reinforcing a certain image of the multiple. In November 1992, a hundred years after The Other opened in Vienna, the soap As the World Turns hired Terry Lester to play a successful architect who had been abused as a child and acquired a number of alters, one of whom killed his sister. Viewers got courtroom scenes, acquittal, and therapy, but unfortunately the screen-writer died and the killer had to be cured in two posttrial therapy sessions. When the scenes were first aired, many multiples and some clinicians wrote in to say how faithful the story was to real life. When the plot collapsed, Lester “felt particularly bad for the ‘multiples’ I’d been hearing from because we appeared to trivialize the whole thing. I wrote them letters of apology on behalf of the show.”⁴²

There will be a steady diet of thrillers and potboilers telling the latest version of the theory of multiple personality.⁴³ In no other field of mental illness do fact, fiction, and fear play so relentlessly to each other. Serious clinicians deplore the sensationalism, but they cannot escape it. If real child abuse is the major key for the popular acceptance of the theme of multiple personality, then fantasy crime is its minor.

Successful movements, I said, require accidents, essentials, and institutions. Allison, Ellenberger, and Wilbur were fortuitous, accidental meteors in the night sky. During the late 1960s, the essential ingredient, child abuse, was maturing as a major item on the American political and social agenda, and would soon become an integral part of radical feminist campaigns. And institutions were soon to take over multiple personality from a handful of isolated workers. Two years after the publication of Sybil there was a symposium on multiple personality at the mental health center in Athens, Ohio. By 1979, Allison was circulating a newsletter, Memos in Multiplicity. He and others were giving workshops at the annual meetings of the American Psychiatric Association. The real politicking came in the late seventies, when elaborate preparations were made for the third edition of the Diagnostic and Statistical Manual of the American Psychiatric Association, with results that we have seen in chapter 1. With DSM-III the movement had legitimated itself. Regional study groups were established; the first and most enduring may have been in that bastion of conservative politics, Orange County, near Los Angeles. These have proved to be stable organizations: in April 1995 the Orange County Chapter of the ISSMP&D hosted the Eighth Annual Western Clinical Conference of Trauma and Dissociation.

The year 1982 was something of a watershed for these developments, for it was then that the late David Caul organized a steering committee for forming a national organization. That was a matter of quiet and careful planning, but, as is so often the case with watersheds, Time magazine marked this one in its own way. In the fall it ran “The Twenty-Seven Faces of ‘Charles,’” about a twenty-nine-year-old Texan picked up at Daytona Beach, Florida. He would speak in two voices, “the infantile rhythms of ‘young Eric,’ a dim and frightened child, and the measured tones of ‘older Eric,’ who told a tale of terror and child abuse.” In therapy there appeared the religious mystic Cye, forty-eight-year-old housewife Maria, Michael the jock, Mark the enforcer, the German-speaking librarian Max, Spanish-speaking Pete, litigious Philip, lesbian Rachel, prostitute Tina, and more, for a total of twenty-seven alters. Multiples were on the move and Time had it exactly right. By the end of the decade the large number of alters, and the age and gender switches, would be commonplace. Incidents of child abuse would be regarded as a standard part of the causation of multiple personality. Maybe Time was too prescient, for it reported that Eric’s memories of abuse were fantasies.⁴⁴ Hypnosis was used extensively in treatment. Just before Time published, it was reported elsewhere that “most of the personalities have been purged, although there are three or four being treated, officials say. It was the real personality that signed the consent form that allowed [his psychologist] to comment on the case.”⁴⁵

Meanwhile, all during 1982, institutions were quietly coalescing. According to movement folklore, the die was cast on Saturday, 30 April 1983, during a historic supper at Mama Leone’s restaurant in New York.46 Boor, Braun, Caul, Jane Dubrow, Kluft, Putnam, and Sachs resolved to found the International Society for the Study of Multiple Personality and Dissociation. The first of many annual conferences met in Chicago in December. Until 1995 the conferences were under the aegis of Braun and Sachs and Rush-Presbyterian-St. Luke’s hospital in that city, but are cosponsored by the American Society for Experimental and Clinical Hypnosis. In 1983, 325 people came. In 1983–1984 four major professional journals devoted entire issues to the topic.⁴⁷ In October 1985, one active multiple established a newsletter, “Speaking for Ourselves.” Specialized clinics began. In Atlanta, the Ridgeview Institute inaugurated a full program on 2 June 1987. On 31 July of that year Sachs and Braun created the first hospital unit dedicated solely to inpatient treatment—the Dissociative Disorders Unit at Rush-Presbyterian-St. Luke’s. The publication of DSM-III-R in that year confirmed the place of multiple personality among the official diagnoses. “I love victory,” wrote Greaves, president of the ISSMP&D, in the July 1987 newsletter.⁴⁸ The only item missing was a professional journal. Dissociation: Progress in the Dissociative Disorders commenced publication in March 1988, edited, and legally owned, by Richard Kluft.⁴⁹

The first meeting of the ISSMP&D challenged orthodoxy. The ninth meeting, in 1992, had health insurance as its theme. A keynote address was given by the vice president of Aetna, a large insurance provider that has found its health insurance products extremely lucrative. On the same platform, from Canada, which has long had completely comprehensive provincial health insurance, George Fraser lectured on the cost-effectiveness of multiple therapy, as evidenced by his clinic at the Royal Ottawa Hospital. When a maverick brand of psychotherapy starts addressing issues such as cost containment for the benefit of insurance carriers, we know that it has established itself. But danger lurks. Has the movement come to mirror Orwell’s Animal Farm? Has the once-radical leadership become complacent about its original concerns—worried about accounting, not patients? I have been speaking of a multiple movement. No one ever challenged that phrase until the fall of 1994, when an old-timer asked me whether there still was, or is going to be, one movement.

I have quoted Spiegel and Kluft: Spiegel working hard to change the name of the disorder, and Kluft inveighing about a multiple subculture. These men are as central to the movement as could be. They are doing what has to be done, when institutions evolve: reestablishing the structure of their discipline, and declaring it a science to be governed by a body of selectmen. The grass roots know what is happening; class differences declare themselves. Putnam has expressed grave worries about the populist base of the multiple movement, observing that “the North American MPD literature, which is very uneven in quality, reflects the heterogeneity of clinical and therapeutic perspectives brought to bear on this syndrome.” He worries about the training of therapists. Much of it is cavalierly dispensed as a cash-and-carry service. In Putnam’s careful phrasing:

At present, MPD therapist education is largely conducted through a recently instituted educational system, designed to provide therapists with the updated information necessary for them to retain their professional licensure. This system, known as Continuing Medical Education (CME), is largely unregulated and caters to popular interests in order to attract paying participants. CME courses and workshops are short, usually only one or two days in length, and typically offer no clinical supervision or direct patient contact.50

Who will finally own the illness: highly qualified clinicians with years of training, or a populist alliance of patients and therapists who welcome a culture of multiples and who cultivate personalities? The movement is perfectly capable of splitting. Stakes are high. Whatever health plan the American people settle for, coverage will be more universal. Who will pay for what? Psychiatric disorders divide into two types—those that respond reasonably well to medication available at a given time, and those that do not. Drugs, no matter how expensive, are much cheaper than long-term psychotherapy. Insurers prefer drug treatment. There is no belief, on the part of anyone in the field, that dissociative identity disorder will respond in a specific way to drugs in the foreseeable future, although of course nonspecific drugs will be used to change behavior, mood, and attitude. Dissociation doctors must capture as much non-drug coverage for dissociative disorders as they can. That will be a top item on the agenda for the medical wing of multiple personality. It will also make dissociation an important player for the wide range of therapies that do not use drugs, and that hope for a share of public health funding. There will certainly be no public funding for the motley assembly of therapies that Putnam alludes to. So the economic interests of the grassroots therapists fundamentally diverge, for the first time, from those of the leading psychiatrists and psychologists in the field.

The name change, from multiple personality disorder to dissociative identity disorder, does matter. A few years ago professionals were advising that one should never, in therapy, eliminate a single alter personality, for that would be akin to murder. Now the message is, get rid of the personalities altogether. Dissociation has become the name of the game, of the disorder, of the journal, and of the organization. If the upper echelon of the movement has its way, multiple personality (literally understood) will disappear. Yet at a deeper level the dissociation game is the same old game as multiple personality, namely, the memory game. For the fundamental shared conviction that may stop schism is that lost memories are the keys to whatever illness this is. The best possible thing to happen to the multiple personality movement has been the appearance of an antimemory movement, the False Memory Foundation. There is nothing like a common enemy to heal splits.