THE AMERICAN JOURNAL OF CLINICAL HYPNOSIS Volume 17, Number 1, July 1974 A New Treatment Approach for Multiple Personalities RALPH B. ALLISON, M.D. This paper presents a review of the various treatments tried, and their apparent effectiveness, in the 14 year course of treatment by many therapists of a patient with five personalities. Effectiveness of treatment before and after the correct diagnosis was established are contrasted. Treatment modalities covered insulin shock, electroconvulsive shock, drugs. traditional psychotherapy, state hospital and community hospital milieu therapy, hypno-therapy, conjoint therapy, desensitization, and the Internal Dialogue. as discovered by the patient herself. The evolution of a treatment approach using one of the patient's personalities as a co-therapist is described. Who am I and you and you, Which of us is really true, I need you and you need me, Is that why there is three? I deny and you reject, Fulfillment we all neglect, The face I see is not me, The eyes of you and yet I see. Not alike you and you and I, You curse, you pray, I cry. Dissociated we all three, Why can't you and you and I be me? Such was the plaintive cry of the first patient with multiple personalities who exposed her complex psychological state to me. No such patient had ever been presented in Grand Rounds in training, and my search in the traditional psychiatric texts gave no help for laying out ground rules for effective therapy. Morton Prince's masterpiece about his eight years with Miss Beauchamp (Prince, 1913) seemed to be more of a daily diary of her very energetic activities and her constant rebuffing of his therapeutic endeavors. Only recently, and after my patient came for treatment, did two books appear, detailing the content and progress of years of treatment. Sybil (Schreiber, 1973) was reported to be the first such patient to be treated by psychoanalysis, although the story is replete with the use of hypnosis, sodium amytal interviews, rides in the country with her therapist, and other such very therapeutic, but unusual techniques for any traditional psychoanalyst. Then Stoller reported on his 11 years of treatment of Mrs. G., (Stoller, 1973) a woman who had an alternate personality as well as the greatest array of psychopathology I had ever read about in one person. He, too, is a psychoanalyst, and a most flexible and imaginative one at that. Of course, I had seen the movie The Three Faces of Eve and I re-read the book (Thigpen & Cleckley, 1957). In 18 months of treatment, the appearance of a new personality did occur, after significant childhood memories were recalled. Yet, when I read Eve's own autobiography (Lancaster, 1958), there were marked differences in the two stories and just what therapeutic methods other than recovery of early memories really helped was quite unclear. Also, Prince (1913) very strongly pointed out that fusion of the several personalities was the direction to head, yet Thigpen and Cleckley had, as a permanent cure, the creation of a new and healthier personality. Which direction should I go? The literature on this subject is sparse, and there is not even a heading for this diagnosis in the Cumulative Index Medicus. Prince published a summary of 20 cases in 1906 (Prince, 1906) the design of which was used in a review of all 76 cases known before 1944 (Taylor & Martin, 1944). My own search of the English language literature revealed individual case reports of only nine cases since 1944, two males and seven females (Thigpen & Cleckley, 1957; Alexander, 1956; Bowers & Brecher, 1955; McKee & Wittkower, 1962; Morton & Thoma, 1964; Smith & Sager, 1971; Ludwig, et al., 1972; Schreiber, 1973; and Stoller, 1973). Theoretical papers on this particular form of hysteria are even more rare than clinical reports. On looking through the early works on the psychodynamics of hysterical phenomena (Breuer & Freud, 1956) we find the statement that "after considerable experience with these phenomena, we think it probable that in every hysteria we are dealing with a rudiment of what is called (In French) 'double conscience,' dual consciousness, and that a tendency to such a dissociation, and with it the emergence of abnormal states of consciousness which we propose to call 'hypnoid,' is the basic phenomenon of hysteria." A review of the literature before 1962 and a critical discussion of the various conceptions of multiple personalities as related to hypnotizability was presented by Suttliffe and Jones (Suttliffe & Jones, 1962). CASE REPORT So that a very complex story will be more understandable, it shall be told in the following segments: the course of events during the ten months she was under my care, past history as it was reconstructed during therapy, a survey of the many treatment methods tried before the accurate. diagnosis was made, a review of the treatment methods applied after correct diagnosis was made, psychological testing, and completion of therapy. My Ten Months Elizabeth came for treatment in March, 1972 after she and her husband, Don. had arrived in town from another state. She had recently been released from a state hospital near her home town and had remarried Don to be able to have her two children with her. They came to the West Coast to getaway from all their relatives and to try to start a new life. Don brought her to my office, and she presented a most puzzling picture. She gave a long history of psychopathology, but yet appeared very neatly groomed, overly composed, distant and withdrawn. They had a copy of a discharge summary from the State Hospital with a discharge diagnosis of schizoaffective schizophrenia, yet this seemed quite inconsistent with her appearance and behavior. She also gave a history of severe depressions for many years, but with a hyperactive spell recently after coming to this area. Since manic depressive illness had been confused with schizoaffective schizophrenia in several recent patients of mine, I started her on lithium carbonate. However, a week later, she overdosed on that drug and flurazepam. I hospitalized her at our local general hospital psychiatric ward for further evaluation and treatment, I called in a psychologist to do projective testing. During interviewing, the psychologist mentioned that she seemed to be expressing her feelings with alternate sides of her personality. With that, Elizabeth started talking about the "she" who was so depressed and suicidal, while the one who was talking felt quite differently. The psychologist determined that she had come across a person with two different personalities, with completely different ways of thinking and feeling. She called me that evening to report what she had seen. The next day, I confirmed her impression of two personalities, Elizabeth and Betsy, and also discovered a third one, Julie Ann. Later I was to discover that at that time there was a fourth one, whom I came to call Beth. This one actually talked to me in my interviews at the hospital, but I thought it was Elizabeth. Elizabeth talked to the nurses, but Beth never did. Much later, I also discovered that there had been present, in the past, a fifth personality, who I called the dumb 16 old, who only lasted a few months. After a week's evaluation, I transferred Elizabeth to another general hospital with a larger psychiatric ward. After six weeks, she came home, allegedly integrated into only Elizabeth,. whom I then saw on an outpatient basis, along with her husband, singly and conjointly. During the following eight months, I spent two hours a week with either Elizabeth or Don or both. Elizabeth was seen alone 25 times, Don alone 21 times, and they were seen together nine times. They made the decision as to whether to come alone or together, depending on the current problems. Don had made it very clear, when they first came, that he was not going to be left out of the therapy process, and I was most grateful for his insistence on that principle. They have now moved to Texas, where Don got a new job, and I feel we can now review what has happened and learn something about how to treat patients with this rare and complex problem of multiple personalities. Past History Elizabeth was born 29 years ago in a Southwestern state, the second of three children. Her older brother was the favorite of her mother. and she then became the favorite of her father. When she was three, he went overseas in the Army, and, in her loneliness, she created an imaginary playmate, who continued as Beth. Beth was a very healthy and mentally normal female. At three and one-half she created a second imaginary playmate, Julie Ann, who was more loving, sweet, a good Christian, but weaker than Beth in coping with the problems of life. When her younger brother was born, she was nine years old. At the moment her mother first laid the new baby brother in her arms, after coming home from the hospital, her resentment and hatred were so strong, she created Betsy to store all the negative feelings. Betsy dropped the baby on his head a few weeks later, and was responsible for all the hostile actions Elizabeth could not condone in herself. Betsy evolved into the typical Eve Black stereotype (Thigpen & Cleckley, 1957), sexually promiscuous, drug abusing, manipulative, hateful of all humans, selfish and incapable of love. At 15, Elizabeth took an overdose of aspirin in a suicide attempt and was hospitalized. An appendectomy was done. When she was 16, she was so miserable at home that she was doing very poorly in school, in spite of high native intelligence. She thereupon created a fifth personality, the dumb 16 year old. who flunked her courses, and finally persuaded her mother to let her drop out of high school. Elizabeth then married her first husband, Vick, at age 17, to get away from home, only to find that he was a transvestite. Julie Ann delivered their only child, a daughter, who was born breech with the umbilical cord around her neck, causing cerebral palsy. Vick blamed Elizabeth for the birth injury, and she accepted the pronouncement. After three hospitalizations of 13 days, one day, and 14 days for depression, with insulin shock and six electroconvulsive treatments, she divorced Vick and let him and his second wife raise the child. After a six day courtship, Julie Ann married Don for the first time. They had a good first year, but she delivered a stillborn as her first child by Don. Since she then believed that she was now fated to have only defective children, Julie Ann gave up any effective existence, and Elizabeth became more depressed and hostile towards Don for any little slight. Don and Beth did have two children, who are now with them. After a ethchlorvynol overdose, Elizabeth was hospitalized in the local state hospital for the first time from February to May 1971. Most of the time Betsy was out, taking psychedelic drugs the attendants passed out, was gang-raped by the attendants, and linked up with drug pushers she kept in touch with upon her discharge. She got pregnant and had a therapeutic abortion. She made one suicide attempt in the hospital. Discharge diagnosis was hysteria. While on pass, Don presented her with divorce papers. This was finalized after her discharge and he got custody of the two children. Actually Betsy pushed Elizabeth into making sure Don got the divorce. She was readmitted to the State Hospital, because of depression, from July to November 1971,. and entered into the same destructive pattern as before. But this time Elizabeth wanted to get her two children back, but didn't dare marry Don again. So Betsy married Don instead. and they came West. Treatment Prior to Diagnosis of Multiple Personalities When she overdosed at 15, her parents were not informed. Of course, the appendectomy did not help her mental turmoil. In her first three private hospitalizations, insulin shock, and then EST were used. EST was the main treatment in the next two private hospitalizations. This did not relieve the depression. It caused more memory problems, blackouts, and her headaches became worse. She feels this allowed Betsy to become stronger. The State Hospital report stated the "patient was placed on antidepressants which seemed to be of no help. She was then given mild tranquilizers and later major tranquilizers. . . . She attended group therapy and appeared to participate very well, gaining some insight into her own problems." When phenothiazines were used in amounts large enough to sedate, she did worse, since she couldn't function well in any capacity. She did do well on perphenazine-amitriptyline (dosage unknown) in between state hospitalizations. During the second state hospitalization, "she was placed in individual and group therapy and much of her guilt feelings, she was able to express. She had had a deformed child and had felt very guilty, feeling she was responsible for this child. Gradually, with her therapy, she became less depressed and became happy. However. throughout her hospital stay. she has been capable of dramatic behavior. She also found it difficult to make definite decisions about her future. At one time, she turned in her 48-hour release request, but when confronted with unrealistic plans for the future, she immediately withdrew it and agreed to stay until more concrete plans could be formulated." No antidepressants of the tricyclic variety were effective when used alone, and about every one was tried by one doctor or another. I first used lithium carbonate 300 mg. TID. and she liked its calming effect. She was on trifluperazine 5 mg. BID. but refused to take it when she got home. She was on no drugs at the time she left this area. Individual psychotherapy was tried at the State Hospital by a student psychologist who fell in love with her. After he asked Elizabeth to marry him, Betsy wrote him a nasty letter which cooled his ardor. Encouraging the restricted, inhibited Elizabeth to give up her inhibitions was harmful, since then Betsy took over, and anything could happen. Any type of psychotherapy before the proper diagnosis was known was ineffectual, since only one personality entered into the transaction. Betsy stood by and scoffed or sabotaged, and the others just didn't know how to help the therapist, since they were not asked to participate. Treatments After Diagnosis of Multiple Personalities During the most recent hospitalization, the other psychiatrist chose to ignore the existence of any other personality except Elizabeth and focused on her as having a variety of feelings. While in the hospital, this seemed to work, and she came to believe it. Later, however, she felt this was not the right approach, since it was like sticking her head in the sand and not dealing with the realities of the situation. This type of patient so avoids the realities of life by not facing them, that the therapist is not showing an alternative approach when he, too, is avoiding the fact that there is more than one personality. Betsy did not show up with the total hospital environment suppressing her appearance, but she surfaced upon discharge and was present at my last meeting with Elizabeth, trying to masquerade as Beth, but both Elizabeth and I called her bluff. One of the big problems was that, since Elizabeth had not entered into the latest marriage contract with Don (Betsy had), she had a blockade up about Don even touching her, much less having sexual intercourse with her. Rarely she permitted this, and was very unemotional about it. At those times when she was emotionally involved, it may have been Beth who was in charge. I tried Wolpe's desensitization under hypnosis (Wolpe, 1958), with her visualizing Don coming from a distance closer and closer, as she remained in the trance state. This worked to some degree, temporarily, as did exploration under hypnosis of early rape scenes in childhood, which set the stage for these feelings. However, just when I felt I was going to have a breakthrough, out would come Betsy to take over and block any further progress. When Elizabeth started complaining of headaches again, I knew Betsy was taking over on occasion, though Don made sure she couldn't get into any serious trouble. I then taught her self-hypnosis, with induction of anesthesia of the hands and transfer of the anesthesia to the head. She liked that and did it frequently at home. At about the same time, Betsy came out in my office on one visit, and I failed to insist she let Elizabeth take over before leaving, as was my usual rule. When Elizabeth came to, she found herself in the car halfway home sitting beside two dirty hitchhikers. Only then did she fully accept the fact that she really had several personalities. All before had been lip service. But once she had let out the hitchhikers, she knew it was true, and she then took hold of her own treatment. The next weekend, I had a call from the Answering Service that Elizabeth had called while I was out. I called her, and she said that she had made no call to me. A few minutes later, Don called and said Elizabeth was very upset about the supposed phone call and wanted him to leave the house for fifteen minutes to allow her to get to the bottom of it. I told him to go ahead, and he set up his tape recorder by his wife's chair. The following day he brought in the tape for me to hear and I was dumbfounded. After Elizabeth had put herself under hypnosis, the following conversation took place: Elizabeth: I'm in control, I'm in total control. I want to talk to Betsy. Betsy. I want to talk to you. I'm in control, I'm in total control. Can you understand that? I want to talk to you, but I'm in control. I want to talk to you, Betsy. You have my permission to come out. That's the only time you can come out, when I give permission. That is the only time that you can come out, when I give permission. I'm in control, I'm in total control, but you have my permission to come out. You have my permission to come out, Betsy. Betsy: Yea, what do you want? E: Did you make that telephone call? B: No, I told you I didn't make it. E: I want to know if you made that phone call. Now someone made it. I didn't make it. Now who made it? B: I didn't make a call. I told you I didn't. E: Look, I know you made the call. I didn't make the call. If I had made the call, I would know about it. Did you make the phone call? B: I didn't make the call! E: Betsy, you're lying. You know you made the call. Why did you make the call? B: I don't have to talk to you anymore, and I don't want to. E: Betsy, please, come on now. I want to know why you made the phone call. I know you made it. There's no sense lying about it, but I want to know why you made it. B: I didn't make any phone call! And I don't have to talk to you. I can come and go as I want to. This business about you being in total control! You're not in control and you know it. E: I am in control. B: Why didn't you know about a phone call. then? E: Did you make the phone call? Did you make it? B: I told you I didn't make any phone call, and dammit, I didn't. What are you trying to pull on me. anyway? My God. if I'd made a phone call, why wouldn't I tell you? Or why wouldn't you know, better yet? E: Betsy, if you made that phone call, tell me. Betsy . . . Betsy . . . Betsy, . . .Betsy. . I'm in control and I want you to come out. I want to talk to you. Betsy. B: Why don't you leave me alone? Just leave me alone. I ain't bugging you anymore. Just leave me alone. E: All night then, why won't you tell me? Why won't you tell me you made the phone call? It's just that simple. Just tell me and I'll leave you alone. B: If I'd made a lousy phone call, I'd tell you just to get you off my back. But I didn't make . Now let me tell you, dammit, I didn't make it. E: All right, but you've lied about everything, Betsy, you've lied about everything. I don't believe you didn't make that phone call and I'm going to find out one way or another why you made the phone call. I'm going to find out what's going on. Now that I'm in control. I can turn you on and off anytime I want to. You don t have to come out unless I want you to come out. The only time you can come is when I wish for you to. B: You know that's a pack of lies. I can come out any damn time I please. Shit, why should I want to come out anyway around this lousy place. Man, there ain't nothing going on that I want to have anything to do with. Let me tell you something. Let me tell you one goddamned lousy thing, and you'd better listen to it. The next time I do come out. it's gonna be 'cause I want to come out and you're not going to know a thing about it. All of this crap about being in control. You're in no more control now than you ever was, and you know it! E: Betsy, I'm in control, 'cause I know of a lot of things that have happened that you're not even aware of. B: You don't know a goddamned thing and you know it! E: Go on, go on. but I could tell you things that Dr. Allison told me that has happened, and you're not even aware of. How did that happen? B: Ah, Dr. Allison lies like everybody else. He's just trying to make me sick, make me have doubts about it, that's what he's trying to do. But I know where I stand, and you know where I stand. E: Yea, Betsy, I know where you stand. You stand right where I want to put you and I'm putting you away. I am putting you away. You are going to be so far away that you can't come out, ever! B: Ha, ha, ha, You really have yourself believing that., don't you? You've really got yourself believing that you've got this thing licked. You haven't, you haven't got anything licked. One lousy phone call got you so upset that you called me out. Me, mind you, you called me out to talk to. One phone call and if that gets you so upset, then you're not in full control, and you know it. E: OK Betsy, one phone call, sure it upset me. OK. you know about it, it upset me. but I'm not letting it take control. One little thing that happened that I don't know about but I'm not going to let it bother me. OK, I was able to call you out at will, and I can put you back when I want to. Do you understand that? I can put you back anytime I want to. B: You can't put me back anywhere! If I wanted to come out, I'd come out. But I'm just sick and tired of the whole thing. It's just a drag anymore. The whole mess, the whole goddamned mess is a drag. I want to tell you something, lady. If I wanted in, I'd come in. But I'm just biding my time. I'm going to come in when I want to, when I have the opportunity that suits me the best, and then, lady, you ain't gonna have nothing to say about it, one way or the other, you am t gonna have nothing to say about it. Because, you know and I know, you know that I'm in control. That crap about you being in control, who'd believe it? Dr. Allison doesn't believe that shit. You're really a pathetic sight. I'm sick and tired of even having anything to do with you. I'm sick of the whole lousy goddamned mess. I'm sick of it! I hate the sight of you. You make me sick. You and your goddamned Puritanical ideas. It makes me sick! I don't want to talk to you anymore. I can come and go when I want to. E: Betsy . . . Betsy . . . Betsy . . .Betsy. . . . I want to talk to you. I am in control and I say I want to talk to you. Betsy. B: Dammit, leave me alone. I'm so sick of you whining and bawling and crying and going on that I could just die. You know, as a matter of fact, that's not such a bad idea after all. All these years you've tried to do us away. All these years and I've stopped you. Yea, you can thank me for that. I'm the one that saved us, not you. Shit! You'd have had us in the grave a long time ago, but I'm the one that always pulled us out of it, not you. And then you say that you're the strongest. Dammit! Well, I've got just one good mind to let you do it. I've got just one good mind to let you do it. I'm sick of it. too. You know I am just as sick as you are of the whole mess. I want out of it, too. But I'll be damned if I'll let you take over. If I can't have it, you're not going to have it. Anyway, I could have it if I wanted to, mind you, but I just don't want to anymore. I'm just tired. you know. One gets pretty tired after a while and I get tired of battling. It ain't worth it. It ain't worth it. E: Betsy. I want to ask you one more time. Did you make that phone call? B: Jesus Christ! I told you ten times already I didn't make a phone call! E: Betsy, don't lie to me. I know your thoughts and I know your mind. B: You don't know a goddamned thing. E: You might as well quit your cursing and your anger, 'cause you're not upsetting me. I'm not letting you upset me. I'm in control and I'm not letting you upset me. Do you understand that? B: Do you understand that? [teasing] You know, you really, you don't think I get around anymore. Shit, that's the only reason I keep you around. You're laughs, you are laughs, that's the only reason. Ha. ha, ha! Honey, look at yourself. Your hand shakes, what happened? I talked to somebody, sure I did, but I didn't make any phone calls, and you didn't make any phone call. You know what's wrong with you? Your mind is going, lady, it's really going. You're so wound up that your mind is slipping right out of it. And you might say that you're my only real help. Because you are helping me to gain everything I wanted, that is, if I want it anymore, which I'm not so sure I do. But it sure is going to be accomplished, because you're the one that did it. You don't know the tricks that are being played on you. That phone call. That Dr. Allison, he's a pretty smart person, he's pretty smart, all right. But he makes a phone call to you -- us -- that you've made a phone call. Well, you know you didn't, and I know I didn't, but you buy it, and I'm not. that's the whole difference. You're so damned gullible you're buying it. That's really hilarious! E: Betsy . Betsy Then a new voice appeared, calm and reasonable. NEW VOICE: I hear you. I'm trying to help you, but I'm warning you, listen clear, listen clear. E: Betsy? N.V.: No. E: Who am I talking to" N.V.: Listen to me. I'm trying to help you. I've been trying to help you, but you won't listen to me. E: Who are you? N.V.: I told you about the babies. I told you what Betsy was trying to do, what she had done in the past. The only way for you to gain complete control and get rid of her is to hate her so bad, to hate her so bad, that you can completely control her, and you can. I'm trying to help you,. don't you understand. I'm trying to help you. Betsy is out to completely destroy you, and I'm warning you, she can do it if you don't try harder. You can, you know you can. E: Who am I talking to? Who? Julie Ann? N.V.: No. No. Just please listen to me. I've got information, I've got so much information if you'll just listen to it. E: Who are you? N.V.: Do you want to talk to me or not? E: Yes, but I want to know who you are. Did you make the phone call to Dr. Allison? N. V.: Yes, I made the phone call. E: Why? Why did you call him? I thought it was Betsy. N.V.: No. No. I made the phone call. E: But why? N.V.: I'm trying to help you. Betsy's not aware, she doesn't know me. But you know, I know, I know you, I know Betsy, I know Julie Ann. I know everything that's happened. I know everything that you don't know. I know how to get rid of Betsy. I know why Julie Ann went away, and I'm your only hope. If you'll just listen to me. I'm just trying to help you. Because I'm strong. I'm strong but I have to have your confidence and I have to have your belief in me that we can, you and I, get rid of Betsy for good. I mean from now on, so she can never return again, 'cause she doesn't know me. She's not aware of me. She doesn't know about the phone call. E: What were going to tell Dr. Allison? Why did you call him? I don't understand. I'm confused, I'm so confused. I want to know why. N. V.: Because, if Dr. Allison knows, if he knows there's two of us against Betsy, then he'll be able to help you better. He'll be able to help you overcome, to overcome Betsy, because she is just one piece of you, and it's a completely bad piece, and we're going to get rid of it. E: But I don't want any more people. I just want me. I just want one personality. N.V.: But don't you understand'? If you and I work to help you. we will be one. not two but just one. But see. I'm the side. I'm the part that can help, if you'll just let me. I'm the part that you fight. You fight me. You put all your energies to fight me when you should be fighting Betsy. You can get rid of her. You know that, by talking to her, that you're stronger than she is. But you don't believe you are. You don't believe it. And I know, I know you're stronger. E: I'm scared. I'm so scared. [sobbing] How do I know if I can believe you? I don't know anything anymore. I'm so confused and mixed up. N. V.: Elizabeth, please trust me. Believe that I am trying to help you and by helping you, I help myself. Then we can become one and have all the things we want, the good things, the things you know are right, the things that I know are right. We can get rid of her, just knowing that I'm here. E: God help me!' [crying] N.V.: Elizabeth, I'm going to be with you and if you can just try to think strong thoughts and hate the kind of a person that Betsy is and the things that Betsy has made us do, hate all that she stands for, which is the Devil itself. Hate it all and then you and I can become one and be one solid person, solid in every way. Don't be frightened of her. Do whatever I say, to show your feelings, to care, to let yourself go, to let yourself be. Let me please come out. I'm strong. Elizabeth. I'm very, very strong, but you have to want that strongness, you have to want it but let me through, please. E: OK [crying] OK, but will you come out when Dr. Allison talks to me? How can I get you to come out when I want you? N.V.: Elizabeth, I won't come out like Betsy does. I'm not going to press myself, push myself, because this is something you've got to want to do. You've got to want it yourself. But I will be there to help you. I've got the strength, all the strength that you need, if you'll just allow it. Just let yourself accept it, that you are all the things that Betsy isn't, and that we are two against her one, and that we can become one solid person, that loves, that cares, that knows God. E: I can't think about God anymore! It's too hard to think about It anymore. Why did He let this happen, all this confusion, heartache? I'm scared. N.V.: Elizabeth, you let this happen, you let this happen through all your fears and all the things you did that you see as bad. You never let yourself see good. But God's there, Elizabeth. He stands by. He's there. You could accept Him. I have. E: Why, why did Julie Ann go away? Why? She was the good one. Why did she go away'? She's the one I wanted to be. Why did she go away? [crying] N.V.: Because she's not strong enough, Elizabeth. She's not strong enough. She let people hurt; they hurt her so bad, she couldn't fight the world. She didn't know how. She knew God. She knew His love and His mercy, but she was too weak. She hurt too bad. She couldn't withstand the pressures and the pain. But you and I can. E: Please come out whenever Dr. Allison needs you to help. N. V.: I am there. Elizabeth, if you will just let me be. I'm there, I've always been there. But I need your strength as much as you need mine. I'm just a part of it, and you're just a part. But together we can be the whole. E: I'm tired. I'm so tired. This soft, calm 'reasonable voice belonged to the personality I chose to call Beth, and was her first appearance on the scene when I was aware of her as distinguished from Elizabeth. This was also the first instance of what I now call Internal Dialogue Therapy, which Elizabeth used repeatedly at home. Elizabeth and Beth would calmly discuss how to handle such problems as her mother's forthcoming visit. Beth never took over unless requested and politely left when her task was done. She always knew what Betsy and Elizabeth were thinking and doing. She was the one who clarified the history for me as to who did what and when. If she did not consciously know the answer, I would put a pen in her hand and ask her to write the question, then to let the hand write the answer automatically. She would develop a blank stare, the hand would start moving and the answer would be then written on the paper. Elizabeth felt that as she came first of all the personalities, she was going to continue in existence as the only one. By establishing a ready means of communication with Beth, she was able to fulfill her vow to herself. In the office, my main co-therapist was Beth. I would call her out to advise both Don and me as to how Elizabeth was feeling about the subject under discussion and how we might best help her. A sample of such a therapy session is recorded below. Both Don and Elizabeth were being seen together. Don brought up the question of why Elizabeth seemed depressed today. E: I'm really not that depressed right now. I have been all day. I wasn't going to come up here today, but I had a talk with myself. I decided that instead of sitting here thinking about it, I would get out and get over it. Dr. A: Do you mind if I try to find out what it is that you're depressed about, since you were in a good mood yesterday? . . . So why don't you go into a trance while I count to 5? 1, 2, 3, 4, 5. Now I'd like to talk to Beth and see what's behind this. [Her eyes open.] What might the depression be due to? Beth: Well, she's been pretty depressed because of me. She doesn't like me to do things. She just wants me to butt out. She thinks she can handle it by herself and I'm not so sure she can. Dr. A: Well, how do you think we can work at this? Beth: I'm at the point now where I don't know what to do. Dr. A: You've been throwing in some good concepts here and there and trying to present some good ideas for her to have? Beth: Yea. I just put the thoughts there. Dr. A: You just introduce the idea and let her think about it? Beth: Yea, but sometimes she gets carried away with this. I put the thought there and she builds on it and she thinks it's her original thought, and she thinks then she doesn't have any need for me. It backfired, in a way I don't really know if that's good or bad. Dr. A: Are you worried about your existence? Beth: I don't want to exist. just as me. [Yet], I don't want to go out of existence. Dr. A: You were created as a partner, and I would suspect you have been very helpful at those times when she let you contribute some constructive ideas. But if she has the constructive ideas of her own free will. then you're not needed for these kinds of events. You are a part of her, you become a part of her operation, of her personality, which I hope would not appear to be a loss on your part at all, since you continue to live in her that way. Beth: Sometimes I think about that, that she can pretty well dismiss me if she wants to, as far as my being able to actually do anything. She does and she can. I can think. I know what's going on. I don't seem to be able to do a lot about it except to think my thoughts. I can't act on them. Dr. .A: But she has handled things well this last week, so there was no reason for her to ask help from you or anybody else. Beth: That's true. Dr. A: You were there,. available, if needed. Beth: That's true. I've been confused this last week as to what to do, to know where to go. Dr. A: That's what we're here to discuss. We're trying to see if there is any need at the present time that she hasn't been able to handle quite adequately by herself. This depression - is it due to some specific guilt or fear? Beth: I'm not really aware of anything concrete. I don't really know why she's depressed. Don: Do you feel like it might be because of her attitude towards me? Beth: Maybe. Dr. A: Has there been some particular attitude you know was present that Don isn't aware of? Beth: Most of the time she feels better towards Don than she did before, but there's still times she has the resentment and she doesn't want to have it, and it depresses her. Dr. A: We had an obvious situation yesterday, the attempted suicide of your younger brother. Could you clarify just how she's reacting to that'. Beth: Oh. it's bothered me, too. Dr. A: Previously you said the only historical material she allowed herself to remember about her brother was when he was a couple of months old and she dropped him on his head. and felt horrible about it. She told me she didn't want to remember anything more from that period of time. And she felt bad about her brother's suicide attempt, but there is not much she can do to help him. Now you know everything that she has done with her brother and how her parents treated her. I'm just wondering about your reaction to your brother's attempted suicide, knowing all that had gone on with the brother. Has knowing all this made your reaction any different than hers? Beth: I don't feel guilty because it was something I wasn't in control of. Had that been what caused part of this problem, it's not something that I could do anything about now.. . . Dr. A: Now Elizabeth wasn't responsible for the harm that came to him, either. Beth: No, but she still feels that she was. Dr. A: She still takes responsibility for what Betsy, was doing? Beth: She still takes the responsibility for everything that Betsy ever did. Dr. A: I know that when you were at [the other hospital] she had come to the point of not taking on all the guilt of the things Betsy did, and I felt that was a constructive direction. Beth: I don't think she ever got to that point actually. She was trying to. She wanted to leave the hospital. She wanted to go home to the kids, and she knew this was what was expected of her, and she more or less went along with it, and she thought eventually that it would come. She still feels very guilty about everything Betsy has done and she's got to the point now where she doesn't believe any of this. Dr. A: Any of what? Beth: Of the personalities - me and Betsy - she figures she just thought it all up so she can put it all back. It's not very reasonable. but that's the way she. . . . Dr. A: It's not very simple. Beth: But she's not able to do that, she can't. Dr. A: How can you - I'm going, to lay it on you - start dissolving this guilt that Elizabeth is carrying around. That's what seems to be the main bad feeling that makes her do other things that cause trouble. Beth: Well, I've tried at times to put the thought in that she wasn't guilty of these things and that, even if she was, she could be forgiven for them. Forgiveness would take away a lot of it. But she even screams back at me. "I'm guilty. I did it, it's my fault!" Dr. A: Isn't it about time she considered that she has paid her debt? Beth: She's come to the point that she knows that she hasn't really got the right to blame herself. but she has the need. Dr. A: . . . There comes a point where bygones are bygones. You know her better than anybody else. If there is a new concept, a new way of looking at it, the way you would look at it, that would be more acceptable than anything I could say. Beth: Well, personally, I think that if she could allow herself to pray like she used to, because she believes strongly in God, and Christ, and the Bible, and all the teachings, and she knows there is forgiveness. If she could ever just pray once, really pray about what she feels, I feel that she'd feel better about herself. . . . Don: I'm in complete agreement. I've wanted to go [to church] but every time she doesn't want to. Beth: She has to make up her mind. I can give her thoughts but she rejects a lot of that, too. Dr. .A: . . . There might be a way to let that religious capability we have come out in some more natural way [other than in traditional church attendance.] Beth: I do know one thing. Every church service that I ever attended, there was one particular thing in the preacher's sermon that she felt he was preaching at her, and she got really paranoid about it. Dr. A: There has to be an attitude change, if it [a sermon] doesn't make sense, I've got as good a mind as any to evaluate it. This is the kind of attitude change you have to go through as you grow up. because if you're going to buy everything any body says. you'll be conned. Beth: This is one of Elizabeth's needs. She takes what everybody else says as Gospel. She doesn't think enough of herself to think "Well. my opinion is as valuable as theirs." I know one incident when she was 16. Dad's best friend was the preacher in the church, well thought of, everybody liked him and he made a pass at her. He came to school, he called her out of class. asked her if she'd do some typing for him, at the same time, asked if she'd go out with him. Well, she didn't want to say anything to her folks. She did try to get them to see it was an odd thing for a preacher to come to school and call you out of class. Of course, everybody, when she got back to class they asked her about it. Of course they all made something out of it, and she wouldn't go into details about it, and she never told her folks. Dr. A: Did she do anything to be ashamed of? Beth: O, no, but after that she couldn't hardly go to church. Dr. A: You can see that could pretty well foul up her trust in preachers. Beth: Whenever she brought it up to her parents, and she tried to get them to think about it was wrong for him to do, they just said, "Well. he just used poor judgment." They just dismissed it at that. But it was pretty bad. Dr. A: These are the kinds of experiences that can happen in the organizational church and we all have to learn to separate out individuals that we're dealing with and the ministers and the beliefs they are trying to get over. As a child, the two will be fused together, he who believes it is that which he believes. As adults, we know better. Beth: That's what I believe. Dr. A: If you can throw these kinds of corrections in when you see this kind of thinking going on . . . Beth: One thing I would like to do is buy a Bible. We don't have a Bible in the house. Don: This last week, do you feel that what I have done and said has been of any help? Beth: I don't think there has been anything wrong with what you have done. Don: Is there any way, maybe when she's asleep, that you can come out and give me an idea of how to help you handle the situation? Beth: I won't go against what she feels. Don: What I mean is, if she's in a receptive mood towards me. Beth: But she's going to have to let me in enough to convince her. I'm not going to tell her what she doesn't want to know. Don: I don't want to say the wrong thing. Dr. A: I appreciate your feelings, but you may be underestimating your own judgment and intuition. It's available to you, if you relax and do what comes naturally. I'll give you all the help I can here, but it is going to come to you as a feeling it's the right thing to do, and if you trust that feeling I don't think you'll have too much trouble. You never got feedback, to know whether or not it was the right thing to do. Don: That's what I need. Dr. A: We can get feedback now, but as far as a decision you have to make on the scene. . . .I think that you base it upon what you think is right, and that's different in every situation. At times of crisis you've had to make a decision and every time you've made it. something has worked out to everybody's improvement. I think you've got the capacity there though you may not trust it. I think it's in her, too. I'm counting on it being in me. Beth: This is the only way I'm able to do it. This is all I can do. Don: I can never get her to believe I'm not fed up. I never loved anybody like I've loved you, not just a personal love but love as the mother of our children. Dr. A: Don. you don't need to ask her questions if she isn't immediately available. You've got answers up here. [Pointing to my head.] They may be very vague hunches but operate on what you've got. Elizabeth has got her own self-interest at heart. She knows you are looking after her, too. Whatever message she gives you on how to look after her, take what you get. You also have to evaluate what's best in looking after her from what you know and how you size it up. But don't avoid paying attention to that voice that tells you the right thing to do. Don: You remember when we were getting back together, the kids said their prayers. Do you think she resented that or would that be helpful? Beth: Oh, no, she didn't mind. It's just that mothers forget. Don: When we first went back, we first said prayers. It seemed she continually tells me I'm real wrong, I bulldoze. Beth: I'll have to tell you this much. Sometimes you do just that. To end the discussion with Beth, all I did was to tell her that it was time for Elizabeth to come back. She closed her eyes, relaxed and in a few seconds, when the eyes opened, I found Elizabeth talking to me again, with full, partial, or no memory of what had been said by Beth. Another very important step Elizabeth took shortly before leaving the area was to be re-baptized in her church. She had felt dirty and sinful when baptized as a child. Only when she started talking with Beth did she finally come to accept herself as worthy to be a child of God and a member of His church. Psychological Testing Test results at the state hospital were summarized as follows: "On the WAIS the patient achieved a full scale IQ of 110,. indicating functioning at the 'bright normal level.' There is no apparent organic brain involvement. Extreme impulsivity is noted, indicative of a low tolerance for frustration and suggesting that acting-out behavior is probable. Also revealed are severe depression, strong guilt feelings, anxiety, marked sexual conflicts and strong feelings of inadequacy and inferiority. There are also egocentric and psychopathic traits as well as some paranoid ideation, schizophrenic signs and a loose control of intellectual functioning. The total testing suggests schizophrenia, schizoaffective type, depressed." The psychologist, Catherine Field, Ph.D., reported as follows: "The Bender-Gestalt, Figure Drawing and Rorschach tests were administered. Present test results were very poor quality, indicating profound disturbance and contained schizophrenic signs. The Rorschach record is much too scant to reveal dynamics; the patient rejected three out of ten cards, produced only three acceptable popular responses, with the remaining seven concepts showing inappropriate affect, disintegration and dissociation. The patient's drawings were poorly executed, infantile productions with inconsistency, ambivalence and occasional break with reality evident. "The clinical picture is clearly that of multiple personality. without evidence of organic etiology. Dissociation appears frequent and severe enough to account for schizophrenic test productions." Each personality completed a Minnesota Multiphasic Personality Inventory and each answer sheet was interpreted by a computer. Elizabeth, Betsy and Julie Ann did theirs during my hospitalization. Beth took hers shortly after I learned of her existence. Behaviordyne, Inc. of Stanford, California interpreted that done by Elizabeth. The readout indicated that the preferred diagnostic label was 301.5 Personality Trait Disorder, Dissociating (Hysterical) Personality. The summary indicated that the statements that can be made most clearly about Elizabeth are as follows: "She uses the defense of repression, and is a hysterical personality. She is naively unaware of her own motives. She denies any hostile or aggressive urges. She dramatizes her feelings of passivity and helplessness. Her moods may fluctuate unpredictably. "She is highly trustworthy. She follows the rules scrupulously. She does not manipulate or exploit people. "She is rather changeable and unpredictable person. She is Puritanical in some ways and not at all so in other ways. She makes decisions quickly, and she changes her mind quickly, too. She trusts people, and then sometimes finds that they disappoint her. She is somewhat naive or immature person who seems sensitive to people giving or not giving things to her. At times she can be jealous, and at times, greedy. She feels that she is disabled by things that happened to her. She denies the conventional religious beliefs, and yet she seems to regard the events of her life as acts of God, that is, produced by some higher power and hence not something that she herself need feel responsible for." The other three MMPI's were interpreted by the Institute of Clinical Analysis, Glendale. California. The diagnostic impression for Betsy was Personality Disorder, Behavior Problem. Description was as follows: "She may be accident-prone due to [her] propensity for thrills and impulsiveness. [She is] charming, manipulative, morally lax and expedient. [She is] unreliable in carrying out a treatment program and very often is financially undependable. "There is a background of confused parental identification with a pronounced disrespect for authority figures who symbolize parental control. [She is] strongly non-conforming and reacts aggressively when frustrated. Unresolved hostilities are acted-out with a persistent tendency to have trouble with the law. Behavior is strongly rationalized resulting in little real acceptance of personal responsibility. "Schizoid dynamics are likely. Anxiety is partially externalized through somatization. Some hysteroid repression is noted. "Patient's positive traits are described as adventurous, frank, individualistic, socially forward, enthusiastic, generous, fair-minded, and verbally fluent. "Defense mechanisms . . . acting-out, intellectualization, projection, reaction formation." There was no diagnostic impression given for Julie Ann. Her personality description is: "Over-sensitivity to criticism or belittlement with hostile reaction to rejection . . . Touchy, resentful, and suspicious. Attempt is made to hide underlying dependency, submissiveness, and lack of confidence. There is more than average concern about the propriety or worthiness of aggressive impulses. ''Patient's positive traits are described as compliant, socially perceptive, persevering, cooperative, trusting, introspective, and grateful. "Defense Mechanisms . . . Intellectualization, projection." The MMPI report on Beth was as follows: "Summary . . . This pattern is essentially within normal limits and would serve to verify or clarify other evidence of normalcy. Self-appraisal seems too faultless and suggests more coping problems than is admitted by the subject. This signifies a strong will that does not easily tolerate interference or strict control. "A facade of 'goodness' tends to confound realistic appraisal and value judgments. "Patient's positive traits are described as adventurous, frank, individualistic, socially forward, enthusiastic, generous, fair-minded. and verbally fluent." So it appeared that Beth was a normal female psychologically. One has to wonder how she could exist then, if she is but a part of such a disturbed total personality. She certainly did appear normal to me, unaffected by the years of family turmoil, emerging first as a normal imaginary playmate, and capable of being all those characteristics needed to make Elizabeth complete. Completion of Therapy Only when Elizabeth took her daughter to enroll in kindergarten did she really decide to get well. She then realized that her daughter needed both a mother and a father, and she had to get well to stay married to Don. Before that, her ambivalence on the subject of the marriage, as expressed by Betsy's constant attempts to find ways to leave Don and return to the drug pushers she had met in the State Hospital, kept her from really trying to improve their marital relationship. Once she made up her mind to get well, she started using the various opportunities she had previously ignored. The other necessary ingredient for cure was her complete acceptance of the fact that she had several personalities. Once she found herself sitting beside those two unwashed hitchhikers, whom she would never have picked up, she really knew, deep down, that Betsy was real and that she would have to get control over her. Since Betsy took care of all the management of anger. and also had all the fun, I had to point out repeatedly her need to express appropriate anger and to go out to have mature female fun, so that Betsy would have nothing to do. Indeed, with any efforts of hers in these directions, Betsy lost her energy. After a while, all Betsy had energy for was to sit on the beach and drink a can of beer, a far cry from her previous wild behavior. This management by alter-personalities of certain drives is well described by Ludwig and his co-workers (Ludwig. et al., 1972). Once she started the Internal Dialogue with Beth, she started remembering all the past history she had so carefully walled off, especially those guilt-producing things that Betsy had done. Beth carefully timed the revelations so that they came as Elizabeth could handle them. I helped once, when she noted that when she wore two of three sets of earrings, she became very irritable with Don. Wearing the third set of earrings, she was quite civil with him. I asked her to bring the first two sets of earrings to the office. I had her hold one set in her left palm and close her fingers over it. I asked, "What feeling comes to you now?" She answered, "Disgust." I said, "Now take yourself back to a time when you felt this same type of disgust." She then visualized herself, as Betsy, back at the State Hospital, being gang-raped by the attendants. The earrings had been given to her as a gift by one of the attendants in payment of her sexual favors. Once the walls started tumbling down around such memories, she recalled more and more, filling in the many gaps in her recollection of the past, and accepting the behavior of Betsy as hers, but not having to feel guilty about it. Elizabeth, Don, and their two children moved to their home state nine months after I first met them, when Don got an excellent job. She has kept in touch with me by phone and letter in the ten months since they left. Back among her old friends she had no more dissociations, saw no doctors for any reason, and weathered a number of crises involving her family members. Her parents filed for divorce, her husband was hospitalized for medical problems, and her younger brother was arrested on drug charges. Elizabeth and Beth are indeed only two parts of the same personality, as planned, and Betsy is apparently no more. My final evidence of the effectiveness of the therapy in this patient is this poem which she sent me five months after leaving this area. I was lost inside myself. Crying out, yet no one heard. I couldn't see but I knew somehow, I was there - somewhere. My eyes were open - I knew. Nothing was there to see. No shapes - No light - was I in Hell? Dear God - Am I? We met - you didn't know. You let me see. Dear Doctor, I'll not forget, You gave me life - you gave me Me! Discussion Just who or what really was Beth, and why did the Internal Dialogue between Elizabeth and Beth seem to be so critical in her healing of the splits in her personality? Was she just another dissociated personality, or something quite different? She had no neurotic conflicts, she was always polite and gracious, she always knew what to do in every situation, and she knew God. Experience with five subsequent patients with multiple personalities, all of whom had an equivalent to Beth, and all of whom found that they could get well only by listening to their Beth, has convinced me that this is the manifestation of a higher part of the personality which is a derivative of the Soul, a part called the Inner Self, the Real Self. or simply the Self. Now putting aside temporarily the question of just what is the Self, why should it be so important for a person with multiple personalities to communicate freely with such an entity. The best explanation I have found is in a science fiction novel, The Mind Parasites, by Colin Wilson, (Wilson, 1967). "But what causes a physical cancer?. . . It springs from the same root as the 'split personality.' Man is a continent, but his conscious mind is no larger than a back-garden. This means that man consists almost entirely of unrealized potentialities.. . . The 'average man . . . prefers the security of the back-garden. "Now a 'split personality' occurs when some of these unrealized potentialities take their revenge. . . . "Cancer is also caused by the 'unrealized potentialities' taking their revenge. The earliest cancer research workers noticed that it is a disease of frustration and old age. . . . "Both cancer and split personality become impossible as soon as man learns to descend into his inner being, for it becomes impossible for these pockets of frustration to build up." Since I am no expert on the subject of cancer, I do not know if there is data on the psychological state of cancer patients to support this quotation. But, if you can stretch the comparison aways, the disease of multiple personalities could be considered cancer of the personality, since the unconscious seems to be multiplying in the same uncontrollable fashion as do the cancer cells, with the creation of coexisting memory systems, belief systems, etc., all poorly connected with one another. Only when all personalities decide to subordinate themselves to the direction and authority of the Beth-personality, can order come out of chaos, and healing proceed. I have shown this quotation to several subsequent patients with multiple personalities, and they all agree that it is quite accurate in describing one force which must be reversed if they are ever to get well. Now back to the question of just who is that "Inner Being," who, in this case is the origin of Beth. Realizing that every psychological theorist, theologian, philosopher and mystic will have his own definition, I shall present the view of the theosophical school as one definition. As presented by Winner (Winner, 1970), "There is One Life in all beings . . . even in the farthest galaxy of fiery suns that we can imagine. And yet this is not a mere pantheism, or concept of a divine life in Nature, because beyond all the manifestations of the universe, which are pervaded by one fragment,' THAT still remains. Yet. when we investigate the writings of the mystics. . . . we find them speaking of some experience by which the individual feels himself 'one with the One.' This Divine Self, . . . is felt to have a fundamental identity with man's own inner being. The self of man is part of the great Self, and is felt to be essentially identical with it and, potentially at least, equally infinite. . . . "There is a general belief, held by the mystics of all ages, that there is a supreme Self with which the individual aspires to realize his unity, which is immanent in all the manifested universe of matter and yet which transcends it. " So far, I have focused on the patient and what caused her to bring forth her Inner Self. But what is required in the psychotherapist for the Beth-personality to emerge? Here again, I call upon the accumulated experience of dealing with the equivalent of this personality in a group of six patients. Most had seen a long list of therapists who were quite unaware of what was going on. First, they had to have complete trust in their therapist. These patient share an exquisitely sensitive receptive mechanism to the feelings and qualities of other people, therapists included. If they feel the therapist is incompetent, is not truly interested in their welfare or is not completely trustworthy, they will not let the Beth personality come out. She is very selective to whom she talks, and will not waste her time if she isn't going to be taken seriously. Secondly, the therapist must call for Beth to come out. She will not come unbidden, except in emergencies, and at these times, the Beth-personality makes the patient place a phone call to the therapist. Then the therapist must realize that he has to call out another part of the personality while on the line, and listen carefully, as she will start pouring out all the hidden facts he needs to know about this patient. She wants to work in conjunction with him and she is a most knowledgeable co-therapist. Thirdly, the therapist must be in good contact with his own Inner Self, since his Inner Self is in constant communication with the patient's Inner Self. Stoller describes his discussions with his patient about her "Charlie," who is the same as Beth, in my opinion, and his description of how he and his inner voice are one is very clearly an excellent description of the mature qualities needed for a psychotherapist of such a patient (Stoller, 1973). To be truly in touch with one's Inner Self is the key to mental and spiritual health. Patients with multiple personalities provide a striking example of persons who have lost touch with that part of them which is creative, non-neurotic, problem solving, and everything else which is needed to survive and grow in the world as it is. Whenever a therapist can bring this communication about, the patient can put his or her own healing forces to work, and that is the most any therapist can ask of himself. REFERENCES ALEXANDER. V. K. A case study of multiple personality. Journal of Abnormal and Social Psychology. 1956. 52, 272-76. BOWERS, M. D. & BRECHER, S. The emergence of multiple personalities in the course of hypnotic investigation. Journal of Clinical and Experimental Hypnosis. 1955, 3, 188-199. BREUER. J. & FREUD. S. On the Psychical mechanism of hysterical phenomena (1893). International Journal of Psycho-Analysis, 1956, 37, 13. LANCASTER. E. The final face of Eve. New York: McGraw-Hill, 1958. LUDWIG. A. M., et al. The objective study of a multiple personality. Archives of General Psychiatry, 1972, 26, 298-310. McKEE, J. B. & WITTKOWER, E. D. A case of double personality with death of the imaginary partner. Canadian Psychiatric Association Journal, 1962, 7, 134-139. MORTON, J. H. & THOMA, E. A case of multiple personality. American Journal of Clinical Hypnosis, 1964, 6, 216-225. PRINCE. M. The dissociation of a personality. London: Longmans Green. 1913. PRINCE, M. Journal of Abnormal and Social Psychology, 1906, 1, 170-187. As quoted in Taylor, W. S. & Martin, M. F. Multiple personality. Journal of Abnormal and Social Psychology, 1944, 39, 281-300. SCHREIBER, F. R. Sybil. Chicago: Henry Regnery, 1973. SMITH. J. J. & SAGER, E. B. Multiple personality. Journal of Medical Society of New Jersey, 1971, 68, 717-719. STOLLER. R. Splitting: A case of female masculinity. New York: Pentangle. 1973. SUTTLIFFE, J. P. & JONES, J. Personality identity, multiple person

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