The International Journal of Clinical and Experimental Hypnosis 1984, Vol. XXXII, No. 2, 102-117 DIFFICULTIES DIAGNOSING THE MULTIPLE PERSONALITY SYNDROME IN A DEATH PENALTY CASE RALPH B. ALLISON Morro Bay, California Abstract: The problems involved in diagnosing the multiple personality syndrome in a rape-murder suspect are illustrated by the case of Kenneth Bianchi and the Hillside Stranglings. Hypnotic investigations of his amnesia revealed "Steve," who admitted guilt for the rape-murders. "Billy" later emerged, claiming responsibility for thefts and forgeries. Attempts to evaluate Kenneth Bianchi with methods used in therapy yielded an original opinion that he was a multiple personality and legally insane. Later events showed the diagnosis to be in error. A new diagnosis was made of atypical dissociative disorder due to the effects of the examining methods themselves. Warning is given that it may be impossible to determine the correct diagnosis of a dissociating defendant in a death penalty case. The diagnosis of the multiple personality syndrome is difficult enough in the case of clinical patients, with their extensive use of denial, repression, and dissociation. The difficulty is greatly compounded when the individual under consideration is charged with first degree murder and is facing the death penalty. Because of the rarity of the occurrence of the multiple personality syndrome in the general population, guidelines for diagnosis are based on samples of limited size (Allison, 1978; Coons, 1980). When faced with the question, the forensic psychiatrist has to view these guidelines in the context of the legal situation, with its many differences from the clinical setting (Allison, 1981). All these difficulties existed in the case of 27-year-old Kenneth Bianchi and the Hillside Strangler case (Schwarz, 1981). THE CRIMINAL CASES In the fall and winter of 1977-78, the nude bodies of 10 women were found on various hillsides of Los Angeles County. All bad been raped and then strangled. Extensive police investigation failed to identify the killer or killers. On January 11, 1979, 22-year-old Karen Mandic and 27-year-old Dianne Wilder were raped and then strangled in a vacant house in Bellingham, Washington. Their clothed bodies were found in the Mandic car several hours after their friends notified police, since they had not reported to work on time. Immediate police investigation revealed physical evidence Manuscript submitted August 11, 1982; final revision received November 29, 1982. which led to the arrest, the following day, of Bianchi as the sole suspect. The Los Angeles Hillside Strangler Task Force was notified, and their detectives interviewed Bianchi, who had lived in the Los Angeles area when the 10 killings occurred in 1977-78. After their interrogation of him, the detectives did not consider him a likely suspect. When first questioned by his defense attorney, Dean Brett, Bianchi claimed to have been driving his car some distance from the crime scene when the victims were killed. When confronted with facts which made his alibi impossible to believe, he then claimed be had fabricated the story to fill in the gap in his memory for the time span in question. Brett called in the first forensic psychiatrist, Donald T. Lunde, M.D., from the Stanford School of Law. Lunde reported that Bianchi gave a history of repeated spells of amnesia since childhood and recommended calling in someone experienced in the use of forensic hypnosis. John G. Watkins, Ph.D., Professor of Psychology at the University of Montana, was called in by Brett. During Watkins's hypnotic interview, what appeared to be an alter-personality, "Steve," appeared, claiming responsibility for the 2 local killings and involvement in 9 of the 10 Los Angeles deaths. On March 30, 1979, the defense entered a plea of not guilty by reason of insanity, based on the possibility that Bianchi suffered from the multiple personality syndrome at the time of the offenses. Along with Charles W. Moffett, M.D., a Bellingham psychiatrist, the present author was appointed by the Court to examine the defendant, with specific instructions to determine whether or not he suffered from the multiple personality syndrome. Subsequently, the prosecution appointed Martin I Orne, M.D., Ph.D., Professor of Psychiatry at the University of Pennsylvania and Saul J. Faerstein, M.D., of the University of' Southern California Institute of Psychiatry and the Law, Los Angeles. EVALUATION STRATEGY Since I had identified my first multiple personality syndrome patient in 1972 (Allison, 1974), I had seen 48 other individuals who appeared to have the multiple personality syndrome, 40 females and 8 males. My forensic experience included court appearances in seven cases (involving five males and two females). The crimes involved were bank robbery, forgery (see Ashby, 1979), embezzlement, theft, assault, drunken driving (see Hawksworth & Schwarz, 1977), and arson. The arsonist was later convicted of two murders, but the multiple personality syndrome diagnosis was not offered as a defense in those trials (Allison & Schwarz, 1980, pp. 159-182). Thus, the Bianchi case was to be the first one I was involved with where the charge was murder, the maximum penalty death, and the only possible defense legal insanity based on a diagnosis of the multiple personality syndrome. After serious consideration of my options, I decided that the only way I could determine if the multiple personality syndrome diagnosis was correct was to match Bianchi's performance against that of multiple personality syndrome patients I had known best (i.e., those who had been in long-term therapy with me). This meant asking Bianchi to act like a patient, even though he would not actually be in the patient role with me. I knew of no other way to secure his cooperation in doing the mental maneuvers I needed him to perform so that I could compare him with my patient sample. The areas to be compared were family and psychiatric history, performance on several hypnotic procedures, and certain psychological tests. I knew there was a risk in approaching Bianchi in the forensic setting as a pseudo-patient, when I was not under contract to be his therapist, but I saw no other way to accomplish the task for which I had been appointed. Prior to my first visit to Bellingham, I asked Brett to tell Bianchi to have ready some questions he wanted answered regarding a specific period of his childhood, in order to give me a logical reason to use hypnotic age regression, my main therapeutic modality for multiple personality syndrome. Also, the Minnesota Multiphasic Personality Inventory (MMPI; Dahlstrom & Welsh, 1960) had already been given to Bianchi on April 9, 1979. I asked John Johnson, a psychiatric social worker assisting Brett, to give Bianchi a California Psychological Inventory (CPI; Gough, 1964) before my arrival. Further CPls were completed in June, 1979 by Bianchi and his two "alter-personalities."2 The clinical examination was carried out in two separate visits, one in April and one in June of 1979, each lasting 1.5 days.3 After the April visit, Bianchi was seen again by Watkins for further hypnosis and Rorschach testing. Bianchi was also seen by Orne, Faerstein, and Moffett before my second visit. THE APRIL, 1979 INTERVIEWS Structure The first several hours were devoted to obtaining a detailed history and listening to the reactions Bianchi expressed to the interview with Lunde. Lunde had noted the discrepancy between Bianchi's view of his mother as a saint and the documented history of her maternal psychopathology. While discussing his feelings about her, Bianchi willingly played the patient role, thus cooperating in my plan. He also admitted to a history of senseless lying to his wife, but claimed that he would do his best to give us the true facts as he knew them, with so much at stake. Per my prior 2These tests were computer scored by Behaviordyne, Inc. of Palo Alto, CA. 3A transcript of the videotaped clinical examination which took place in April and May of 1979 has been deposited with the National Auxiliary Publications Service (NAPS). For 255 pages, order Document No. 04181 from NAPS % Microfiche Publications, P. 0. Box 3513, Grand Central Station, New York, NY 10163. Remit in advance in U S. funds only, $78.25 for photocopies or $4.00 for microfiche, and make checks payable to Microfiche Publications -NAPS. Outside the United States and Canada, add postage of $28. 00 for photocopies, $1.50 for microfiche postage. instructions to Brett, he asked to know what important events had happened at age 8 when he had lived on Villa Street in Rochester, New York. I then explained the use of ideomotor signals to help answer his question. The second session of the day began with ideomotor signals under hypnosis, which indicated that the ages of 9 and 13 were significantly related to the current problems. Regression to age 9 was accomplished, then progression to age 13. With progression to age 27, the criminal entity "Steve," emerged. I then called on Ken to replace "Steve." Dehypnotizing Ken did not seem necessary. Next, I used ideomotor signals to determine if there were any other entities besides Ken and "Steve" and received a negative answer. Then I suggested that Bianchi might have a dream that night which would help him learn to cope with "Steve." (I did this because Watkins had already suggested that Ken would have increasing awareness of "Steve" but not what he was to do with that awareness.) I suggested that he use "the highest elements of helping power inside [his] mind," in an attempt to activate an Inner Self Helper, which has been of great help to the victims of the multiple personality syndrome (Peters & Schwarz, 1978). The following morning, he reported a dream of being with a twin brother, "Sticks," at one age, then with him again at an older age, when the twin was called "Steve Walker." Next, I asked Bianchi to conduct a dialogue with "Steve" as if he were talking to him on the telephone. This he did, speaking only as Ken but never as "Steve." Results 1. Regression to age 9. Bianchi remained in a trance-like state, talking in the present tense. He did not behave as a conscious 9-year-old boy, in a state of revivification, as many multiple personality syndrome patients do. He reported his best friend to be Billy Thompson, the boy next door. Only when I asked if he ever hid inside his head did he mention talking there to "Steve Walker, my second best buddy." This reportedly occurred while he was hiding under his bed to escape his mother's wrath when she was very angry with his father for gambling too much. 2. Regression to age 13. This time Bianchi told of arguing by neighbors and between his parents, sneaking out to visit school buddies, and "Stevie" trying to talk him into running away from home. Only after I asked about the biggest problem that year did he mention his father's sudden death at work. No mention was made of any new personality being created thereby, as I had expected. 3. Appearance of "Steve." "Steve" was seen in full bloom, out of trance. He was very crude and nasty, using the word "fuck" in every sentence. He lunged at Johnson, who was operating the video camera behind my right shoulder. He talked about Ken in the third person, constantly putting him down. He freely admitted to strangling the two local victims cause I hate fuckin' cunts." He committed the crime, he said, to get Ken out of the way, so that he could control the body full-time. He further admitted to killing four of the Hillside Strangler victims and watching his cousin, Angelo Buono, kill the other five victims. He denied there were any others like him inside Ken. When I called for Ken and put my hand in front of his forehead, "Steve" slumped into his chair and was replaced by a very tired Ken. 4. "Telephone" conversation with "Steve." Ken talked to "Steve" about childhood friends in Rochester, a psychological clinic evaluation done at age 9, and the two local killings. Ken appeared to know "Steve," accept his existence, and know that "Steve," who considered himself above the law, had committed the murders. Ken, in contrast, considered himself a law-abiding citizen who knew it was wrong to kill. THE JUNE, 1979 INTERVIEWS Goals Since April, 1979, Bianchi had been hypnotized by Watkins and was seen by Orne. Information from Los Angeles indicated Bianchi had secured fake diplomas as a psychologist, using the name "Thomas Steven Walker," but giving a mailing address of "% Mrs. K. Bianchi." He had rented a psychologist's office in the evenings and had passed out professional cards at the title company where he worked. Numerous items found in Bianchi's apartment in Bellingham were found to have been stolen from a store where he had worked as a security guard. None of this could have been explained by the existence of "Steve," the killer. The videotape of Orne's "hypnotic" session with Bianchi showed Orne telling "Steve" that he, Orne, could not believe "Steve" had been interested in working in a title company. Orne asked "Steve" if he were aware of another part within him that Ken did not know about. Following "Steve's" denial, "Steve" was replaced by a crying 9-year-old "Ken," who was followed by a 14-year-old "Billy." who admitted responsibility for the false diplomas, the psychologist role-playing, and the various thefts. When Orne asked if there was a higher level source of information present, Bianchi nodded in the, affirmative, but he refused to talk to Orne in that mode. Therefore, my goals in the second trip to Bellingham were to interview "Billy" and to talk to that higher source of knowledge. I had a long list of questions for both of them. Structure The first several hours were spent trying to get Bianchi's cooperation in these tasks, as lie claimed he had amnesia for all the material he had produced during the various hypnotic sessions, and he was tired of seeing those sessions first reported in the newspaper. He appeared quite depressed and claimed to have tried to hang himself after his interview with Faerstein. The second period was spent getting handwriting samples and questioning the Inner Self Helper, the higher source of knowledge. Many answers were quickly and clearly provided by "Ken's friend," as this entity called itself. I then asked Ken to enter into a dialogue with "Billy," which he could not do. I called out "Billy," secured his handwriting samples, and then asked him to initiate a dialogue with Ken. I could hear both voices this time. Ken then carried on a dialogue with "Steve." Finally, "Billy" came out to take the CPI. During the third period, Bianchi made pictures of the faces of "Billy" and "Steve," using the Identi-Kit, under the supervision of Detective Fred Nolte. Then I called out "Steve" and persuaded him to take the CPI. The test booklet was left with Johnson so Ken could take that test again, also. Results To reach "Ken's friend," I had to appeal to that part of Ken's mind that had refused to talk to Orne. He initially talked in the first person and then switched to the third person in referring to Ken. After one question of his own, Ken asked me to give the questions. He told of "Steve's" beginning, of his killing, and pimping in Los Angeles. "Billy" was defined as "a source of secrets, of denial of facing up to the facts," having been created when Ken went daily to his father's casket prior to burial. "Billy" and Ken were co-conscious, while Ken was amnesic for all "Steve" did. "Billy" was the thief and pretended to be a psychologist as a new way to meet people. "Steve's" emotions were "anger, hate, and violence, while 'Billy's' were non-violent, such as deceit." A week after Bianchi had been infected with gonorrhea by his wife, who claimed to have been raped while on vacation, "Steve" had killed the first of the Los Angeles victims, a prostitute. Bianchi's feeling of being betrayed was considered by Brett and Johnson to be a logical motive for this first murder. But "Ken's friend" denied the psychological connection, explaining that the physical weakness resulting from the infection had left Ken defenseless against "Steve's" coming out. "Billy" appeared to be a shy, quiet, 14-year-old boy, who now wanted to cooperate with Ken in dealing with "Steve." He took the CPI quickly calmly and cooperatively When "Steve" and Ken spoke together this time, I could hear both voices while they talked of "Steve's" plan to send the coat and scarf of one of the local victims to cousin Buono. Bianchi reported that talking to "Steve" left him with a chill at the end of his spine, but he was comfortable talking with "Billy." While making the Identi-Kit pictures, Bianchi repeatedly closed his eyes and appeared to visualize each face inside his head, carefully correcting the features to his satisfaction. Neither picture looked at all like Bianchi, and both matched the personality characteristics seen on interview. When "Steve" returned to take the CPI, he was initially quite resistant, but he finally gave in, expending much energy in foot shuffling and pencil jabbing. PSYCHOLOGICAL TEST RESULTS The Behaviordyne computer reports a series of diagnoses in the order of preference. Both the MMPI and CPI scales can be run off using the CPI answer sheets. 1. MMPI taken by Ken on April 9, 1979. Preferred diagnosis; psychoneurosis, hysteria, dissociation reaction, consisting of sudden episodes of unaccustomed behavior, related to hysterical acting out, possibly with true amnesia. 2. CPI taken by Ken in April, 1979. Preferred diagnosis: personality with risk of a drinking problem. Second diagnosis: personality trait disorder, dissociating (hysterical) personality with sociopathic and passive aggressive features, emotional instability, and unpredictable (hysterical) acting out of unconscious impulses. 3. CPI taken by Ken in June, 1979. Preferred diagnosis: personality pattern disorder, paranoid personality, with passive hostile behavior. 4. CPI taken by "Billy" in June, 1979. Preferred diagnosis: personality trait disorder, dissociating [hysterical] personality. 5. CPI taken by "Steve" in June, 1979. Preferred diagnosis: psychosis, schizophrenia, paranoid type, with aggressive hostile behavior. FORENSIC CONCLUSIONS Following my April evaluation of Bianchi, I had reported to the Court that Bianchi suffered from the multiple personality syndrome, was legally insane at the time of the offenses, and because of the amnesia for the time period of the offenses, was unable to stand trial. After my June evaluation, I concluded that he was now able to stand trial, but my other opinions remained the same. I submitted 124 pages of reports detailing the data which supported the diagnosis of multiple personality syndrome. Space limitations prevent me from repeating any more of that material here. He was also believed to be insane by Lunde, Moffett, and Watkins. Both Faerstein and Orne considered him sane. With this split opinion, Bianchi agreed to a plea bargain in which lie would plead guilty to 2 counts of first degree murder in Washington and to 5 counts of first degree murder in California in exchange for his testimony against Buono. On October 18, 1979, Bianchi was sentenced to 2 consecutive life terms in Washington. On October 22, 1979, he was sentenced to 6 concurrent life terms in California. Buono had been arrested on October 19, 1979 and is currently on trial for 10 counts of first degree murder. Bianchi has been the primary prosecution witness against him, but his stories keep changing, and no one can tell what version he is going to relate the next time he testifies. THE AFTERMATH Letters from Jail Seven letters were sent to me by Bianchi, from the Los Angeles County Jail, between October 14, 1979 and December 4, 1979. These letters were all from Ken, but in them he referred to "Steve" and "Billy" as himself in different states of mind. I had hoped, in responding to his first letter, that he would clear up some of the still unanswered questions about the Washington crimes. In a letter dated November 10, 1979, he laid the blame on a man he named only as Greg, whom he knew had died in all accident after Bianchi's arrest. He claimed that he and Greg had invited the two victims to the house for a blind date. He claimed that, as "Billy," he had gone to the store, and, when he returned, Greg was in the process of hanging the two women. There was indeed a man named Greg who lived in the area at the time of the crime, but police investigation proved he could not have been at the crime scene with Bianchi the day of the killings. The Compton Case On September 6, 1980, an envelope was delivered to my home, postmarked "Seattle, Washington," but with a return address of "LAPD, Homicide." Inside I found a brassiere and an unlabeled cassette tape. On the tape was the voice of a young man claiming to have framed Bianchi for the murders in Washington, in return for money. Nothing on the tape told me who he was or where I could contact him. The package was turned over to the local police, who contacted the Bellingham Police Department. Two similar tapes were delivered in Bellingham, one to a clergyman and one to the Whatcom County Sheriff's Department. The latter tape had been hand delivered, and the messenger was able to provide a description of the woman who had given it to him at the Seattle airport. On September 29, 1980, the same woman lured a Bellingham woman into a motel room and tried to strangle her. The victim escaped and 24-year-old Veronica Lynn Compton was arrested for attempted murder. She was identified as a scriptwriter from Los Angeles County, a frequent visitor to Bianchi, and the owner of several other tapes on which were recorded threats against my daughters. In March, 1981, she was convicted of attempted murder in the first degree and sentenced to 5 years to life in prison. Other New Information With the list of boyhood friends supplied by Bianchi, detectives searched Rochester to find anyone who could remember his having complaints of lapses of memory or who had observed sudden personality changes in him. No one could be found to corroborate that history which he had given. When his wife was interviewed on television, she denied having noticed any personality changes she could now attribute to the existence of "Steve." None of the psychiatric staff at the Los Angeles County Jail reported meeting either "Steve" or "Billy." Only in 1980 did the use of the Rorschach for specifically diagnosing multiple personality syndrome come to my attention (Wagner & Heise, 1974). When Wagner independently reviewed the Rorschach protocols of Ken and "Steve," he concluded, My considered opinion is that this is not a multiple personality.... Ken is what I would call ... a paranoid with a psychopathic overlay... Such cases are quite dangerous and, as might he expected, tend to he diagnosed as psychopathic or paranoid . . . Ken is exclusively self centered and preoccupied with his own ideas. He is a compulsive ruminator with a marked incapacity to derive pleasure from interpersonal relationships. He is intimidated by women because of a love-hate relationship with his mother and, under conditions of lowered consciousness (e.g., fatigue, alcohol), is capable of a revenge type of rape-murder. Normally, because, he can't share his thoughts with anyone, he seems quite dull to the casual observer. Qualitatively, it is interesting to note that he makes frequent references to his childhood. This often occurs with people who find themselves in threatening circumstances from which they feel they cannot escape. I believe that "Steve" represents Ken's escape hatch (a last desperate measure). Steve's Rorschach does reveal hostility and sexual preoccupation but there is a perverse, deliberate aspect about it which smacks of psychopathic intent. The refusal to respond and desire not to "play' is psychopathic, not schizophrenic . . . . What is frightening about Ken is that his murders were probably committed without much affect and with a certain detachment. Structurally, the basic inconsistency is that . . . the two Rorschachs are cognitively similar. From my experience, alter-personalities are contained within (and break off from) the major or first personality. This is not the case with Bianchi. Ken and Steve appear to be mirror images - one "good" and the other "bad," like Dr. Jekyll and Mr. Hyde. This type of patterning is viable from a literary but not a psychological point of view. Later, in 1981, 1 started working full-time in a state prison after spending 3 years working in a county jail part-time. In the prison, I began hearing the tales of convicted felons who claimed to have fabricated stories prior to trial so as to create insanity defenses. Having failed at that goal, they were now finding those histories of "mental illness" haunting them when they sought paroles from the Board of Prison Terms. I also met rapists who explained to me some of the mental aberrations they had undergone during their crime sprees, when they acted as law-abiding citizens by day and rapists at night, being, to a great degree, unaware of the two lives they were leading until they were apprehended and confronted with the evidence. These seemed to be honest reports of some type of a dissociative process which only occurred during a limited span of time. THE BUONO TRIAL In October, 1981, 1 was called to testify in Los Angeles in the preliminary hearing for Angelo Buono. The main issue of debate was whether or not Bianchi had ever been "really hypnotized," since a positive judicial decision on that question would cast doubt on the reliability of his testimony. That issue was easily settled in my mind with the concept that there is no way to prove any person is in a state of hypnosis, since there is no universally accepted standard of behavior or objectively measurable physiological process which is accepted as being indicative of a hypnotic state of mind. But the night before I was due in court, I reviewed all the transcripts of my sessions with Bianchi, as well as the events mentioned above. I Wagner, E., personal communication, February, 1980. discovered that, in making the original diagnosis of multiple personality syndrome, I had inadvertently ignored certain items which, at the time, did not fit into a neat pattern. This was not an unusual situation for me in working clinically with multiple personality syndrome patients, as many times bits of data emerged which could not, at that time, be understood in the total context. Further digging into the repressed material usually clarified the problem and allowed me to fit that piece of data into the total picture. This was why I maintained contact with Bianchi by mail in the first place. The facts which I now looked at with more attention, however, fitted a dissociative disorder, but not what I knew to be the multiple personality syndrome. In court, I testified that I had come to a new conclusion regarding Bianchi's psychiatric diagnosis. I now believe that, although he had to have been extremely disturbed to have committed the lust-murders at all, he did not have multiple personality syndrome at the time he committed the crimes. My new view was that all of the pathological elements we had seen as "Steve" and "Billy" had existed in Bianchi's mind for years, but had not "crystallized" into the forms we saw until he was first hypnotized by Watkins (for "Steve") and Orne (for "Billy") (I knew that Watkins had testified that be believed Bianchi was in hypnosis when he first found "Steve" and that Orne had testified that Bianchi had never been really hypnotized by any of the examiners, including himself. While viewing the videotapes of Bianchi with Orne, I believed that Orne did have Bianchi in a hypnotic trance, which gave Bianchi a chance to show his psychopathology in a most dramatic fashion via "Steve' and "Billy.") I was quite willing to take responsibility for bringing out "Ken's friend." The Assistant Attorney General carrying out the cross-examination later told me that Bianchi said to her, "It was the best way I could think of at the time to explain to the doctors how my mind was working then." Once the trial was over, Bianchi no longer needed to explain his motives to the psychiatrists, so neither "Steve" nor "Billy" were necessary for him to bring forth. Ken apparently felt he had the capacity to deal with the problems in Los Angeles County completely on his own. Before I list the factors in this particular case which caused me to change my original diagnosis, I must emphasize that there is no typical patient with multiple personality syndrome against which to match any future patient. To assume that the presence of the exact opposite of these listed characteristics would guarantee the diagnosis of multiple personality syndrome is faulty logic. Diagnosis from any list of necessary findings, as is implied by DSM-III (American Psychiatric Association, 1980) leads one into the pigeonhole myth (Dirckx, 1977, pl. 111-1 12). Human beings are much too complicated to view in that fashion, and more complex methods, such as factor analysis, may be more realistic. But the average clinician has to use the "list of criteria" method to start with, and these points are only guidelines to help those who may come across such individuals in their own local courtrooms. 1. Personality characteristics of Ken. Ken, as himself, seemed to be able to express a full range of emotional feelings. He was not unable to experience anger, resentment, fear, sexual pleasure, and other such feelings that multiple personality syndrome patients learn, from their families, are forbidden and thus require expression through their alter-personalities. That is one reason for creating an alter-personality, to express the forbidden thought and emotion. 2. Regression to age 9. Bianchi did not mention "Steve" as an imaginary playmate until I brought up the idea of hiding inside his own head. In retrospect, it would have been better not to have brought up that concept and to have left Bianchi to his own devices. Unfortunately, any question and tone of voice used gives some message as to the acceptable answer. Bianchi had a very strong need to please authority figures, of which we psychiatrists were the latest version. Multiple personality syndrome patients in therapy can and do ignore what I want to bear and do want to tell their story in age regression. They hint at subjects they are ashamed to mention and just need encouragement to continue, with assurance that they will not be punished for telling the truth. 3. Origin of the villainous "Steve. "Bianchi reported no new or different physical or mental trauma the day he claimed he first heard "Steve" talking to him, while hiding under his bed. A dissociative process in multiple personality syndrome usually occurs when trauma of a life-threatening nature occurs, is too stressful for the child to handle in any physical fashion, and mental mechanisms must be used instead. Had his mother set his clothes on fire or chased him with a hatchet in her hand, the story would have been more convincing. 4. The boy next door. Bianchi's first choice as a best friend was a living boy, a fact which ruled out the need for an imaginary playmate. Multiple personality syndrome sufferers were very lonely children and usually felt there was no one --child or adult-- to whom they could turn in times of crisis. 5. School. Both Ken and "Steve" disliked going to school. If "Steve" really existed in those days, he should have had a different attitude than that of Ken, not necessarily the opposite. Ken could have liked going to school and "Steve" could have just ignored the whole scene, since it held no interest for him. If there had been a hostile teacher who whipped the boys, "Steve" would have been the one who threw ink on her when her back was turned, and then allowed Ken to take the punishment. 6. Buddies. Bianchi reported many neighborhood friends in his later school years. With so many friends, be would not have needed to keep "Steve" around. In addition, "Steve's" obnoxious behavior would have driven away those children who tried to befriend Ken, keeping him in a lonely state of mind. 7. Regression to age 13. The error here was that Bianchi first mentioned fights of neighbors and between his parents, but nothing new. If that was when "Billy" was created, at his father's death, he should have mentioned the death first. Only when I asked about the main difficulty that year did he bring up the subject of his father dying. 8. Creation of "Billy." "Ken's friend" reported that "Billy" wits created during repeated visits to his father's casket at the funeral home. An alter-personality would have been more likely to have been created when news of his father's death was first brought by the messenger from work. It was reported by the family that Ken did go into hysterics when told the tragic news. 9. The murder victims. None of the victims had any emotional tie to Bianchi. They were not threats to him in any way. They were only the objects of the transference of his hatred for his mother, a common reason for lust-murder (Macdonald, 1971, pp. 132-139). Defendants with multiple personality syndrome, whom I have met since the Bianchi case, each killed a spouse or a parent-figure when their anger towards that individual overwhelmed their repressive abilities. 10. Fatigue after hypnosis. Fatigue after only switching personalities is not common with multiple personality syndrome patients, since each alter-personality has its own source of energy and it does not need to draw energy from the primary personality or each other. After age regression, fatigue is common, since much energy is expended in the lifting of repression in psychotherapy. 11. Internal dialogue. The first time he had internal dialogue, Bianchi followed my suggestion too literally and talked to "Steve" as if on a telephone. No multiple personality syndrome patient has ever done that in front of me, even when given the same instructions. Also, Ken claimed to have amnesia for all he said in the internal dialogue, while multiple personality syndrome patients usually have full recollection of both sides of the dialogue. The purpose of the exercise is to bring that repressed material to consciousness. This is one procedure I would now avoid in a forensic case, since there is a clear standard of the "proper" response and few defendants are ready to become aware of unconscious material during the trial phase of their incarceration. After conviction, they are much more likely to be willing to look at their faults and try to correct them. 12. Ideomotor signals. Bianchi's fingers answered "No" to the questions about the presence of entities other than "Steve" being present. This was a lie, if "Billy" had been present in the first interview. But it was a truthful answer, if "Billy" did not crystallize until Orne challenged "Steve" as being an inadequate explanation for the role-playing as a psychologist. It is quite logical to believe that Bianchi then had to produce "Billy" to satisfy Orne's objections. Then there is the question of the basic reliability of ideomotor signals for telling the "unconscious truth." These signals may be very useful in therapy where the social consequences are minimal, but that procedure certainly does not have the sanction of research and judicial decision as a lie detection process. Until the procedure has passed such tests of reliability and validity, it is not acceptable in a court of law and must be reserved for therapeutic and research purposes only. 13. Dehypnotizing. Bianchi did not seem to need dehypnotizing after the age regression and first appearance to me of "Steve." He was so alert that I did not think any procedure was necessary. Was he really hypnotized or not? In another case, when I forgot to dehypnotize a multiple personality syndrome patient who resisted and broke out of her age regression session, she reported being very uncomfortable the next day until she realized she was still in trance and dehypnotized herself 14. Blaming Greg for the murders. Multiple personality syndrome patients who have been arrested for crimes know, at some level, that they are guilty of some wrongdoing, but they are not sure what it is they did. They usually take their punishment, since they feel that they deserve it; they do not blame another individual. 15. The Compton case. Again we see an attempt to lay blame elsewhere. At first, I was perplexed as to why Bianchi should have chosen to send that package to me, instead of to anyone else involved in the case. Gerald Chaleff, Buono's attorney, because of his knowledge of Bianchi's current state of mind, identified this as a hostile act towards me. I tend to agree, since Bianchi had expected that I would be involved in his psychotherapy in the California prison system and may have seen me as a rescuing father-figure. When he found himself locked in the Los Angeles County jail for an indefinite period of time, he may have felt betrayed by me and used Compton to strike back. Ex-patients with multiple personality syndrome have generally been appreciative of my recognition of the reasons for their distress and have remained friendly towards me, even if they did not agree with me at the time of first contact. 16. Bianchi's lying. Bianchi admitted to being a chronic liar, as Ken, even regarding facts which were unimportant. Multiple personality syndrome patients, because of their many amnesic spells, learn to pay careful attention to what happens when they are in charge. They pride themselves on their excellent memory of those events of which they are aware. The charges of lying come about because of their refusal to admit to misdeeds which have been done by an angry alter-personality. 17. No witnesses to personality changes. None of his family members or friends admitted witnessing personality changes, and jail staff witnessed none, even when they had reason to look for them. Multiple personality syndrome patients in hospitals or prisons do show different personalities to different staff members, depending on their feelings about each staff member. Thus, the patients tend to polarize the staff into camps of believers and nonbelievers in multiplicity. None of this happened with Bianchi in either jail. Now, I would say that if the institutional staff is not split on the question of the diagnosis of multiple personality syndrome, and very strongly so, the patient most likely has some other mental disorder. CONCLUSIONS The first principle to remember is that the human mind can do anything. The only limits are those we put on it, with our own narrow view of what is possible. A man under the threat of death, who has never before been a defendant in any criminal action, is not bound by any rules of conduct involving honesty decency or fair play. The only rule is to save his own skin; if he has to use mental gymnastics, so be it. Consciously, he may believe he is telling only the truth; unconsciously, he must act in whatever manner he believes will prolong his life. That is why the unconscious mental mechanisms of defense exist in the first place. The second principle is that it is extremely difficult--if not impossible--to be sure that a defendant who has not been in psychotherapy for the disorder really has the multiple personality syndrome, since we have no firm criteria against which to measure him. Clinical patients have such different situations and motives and show such variations in behavior, mood, and thinking patterns that there is no typical multiple personality syndrome patient. That is why there can be only general guidelines for determining who is and who is not disturbed in this particular fashion. A clear understanding of the psychodynamics underlying the disorder seems to be the best protection against error. A third principle is that it may be impossible to determine the state of mind of a defendant claiming amnesia at the time of the crime, with his unverified statements being the only available historical evidence of mental status. Bianchi's story supported an insanity plea, but no other evidence could be uncovered to support the idea that he had at diagnosable dissociative disorder while in Rochester, Los Angeles, or Bellingham. He clearly had a longstanding personality disorder, but, without documented psychiatric observation or witnesses to provide evidence of any mental disease, defect, or disorder, I have no other data supporting any dissociative disorder diagnosis during those years of his criminal activity. My support of his insanity plea was based on the assumption that the dissociative disorder shown to the forensic examiners had existed prior to his arrest and was causally related to the commission of the crimes. Since that assumption no longer seems warranted, my forensic opinion now is that there is insufficient evidence to support an opinion that he was legally insane at the time of the crimes. His urges to rape and kill most likely arose from repressed unconscious conflicts, as is true in many crimes of violence, but that concept does not justify an excuse from legal sanctions in our courts today. Because the determination of his mental state during the crimes was hampered by his habitual tendency to lie, the truth may remain a mystery for many years. My prison experience indicates that such an individual defends against insight until faced with parole board hearings when his clear understanding of those unconscious motivations is required before release from prison can be considered. My diagnoses of Kenneth Bianchi, as of the time of the forensic examinations, are as follows: Axis I 300.15 Atypical Dissociative Disorder (see DSM-III, p. 260), occurring under stress of intensive and extensive psychiatric evaluations, while under threat of the death penalty, and limited in duration to the period of time between arrest for murder and sentencing. Axis II 301.89 Mixed Personality Disorder (see DSM-III, pp. 329330), with antisocial, paranoid, and histrionic features. I do not believe Bianchi was deliberately and consciously faking the multiple personality syndrome clinical picture. He possessed the drives to lie, steal, rape, and kill in his unconscious mind since childhood. Certain triggering situations caused the resultant criminal behavior to occur. He may well have chosen to forget a large portion of his criminal behavior over the years to be able to live his version of a normal life at work and at home. But his amnesias were not due to the sudden control of his body by alter-personalities which had been created by psychosexual traumas occurring at the ages of 9 and 13. He found his targets for his negative transference feelings in those women he identified as the streetwalking prostitutes of Los Angeles, even while he was employing other young women as prostitutes himself. Then, for some still unknown reason, he raped and killed two completely innocent women in Bellingham. I believe that he also unconsciously set himself up to be caught in Bellingham so that he could be stopped forever. Fortunately, the Bellingham Police Department, in their thoroughly professional manner, cooperated in his plan. REFERENCES ALLISON, R. B. A new treatment approach for multiple personalities Amer. J. clin. Hypnosis, 1974, 17, l5-32. ALLISON, R. B. On discovering multiplicity. Svensk Tidiskrift fur Hypnos, 1978, 2, 4-8. ALLISON, R. B. Multiple personality and criminal behavior. Amer. J. forens. Psychiat., 1981, 2, 32-38. ALLISON, R. B., & SCHWARZ, T. Minds in many pieces. New York: Rawson, Wade, 1980. AMERICAN PSYCHIATRIC ASSOCIATION Diagnostic and statistical manual of mental disorders (DSM-III). (3rd ed.) Washington, D.C.: APA, 1980. ASHBY, A. Esther Minor: Multiple personalities in court. Forum, 1979, 6. 3-30. COONS, P. M. Multiple personality: Diagnostic considerations. J. clin Psychiat., 1980, 41, 330-336. DAHLSTROM, W G., & WELSH, S. An MMPI handbook: A guide to use in clinical practice and research. Minneapolis: Univer. of Minnesota Press, 1960. DIRCKX, J. H. Dx + Rx: A physician's guide to medical writing. Boston: Hall, 1977. GOUGH, H. G. Manual for the California Psychological Inventory. Palo Alto, CA: Consulting Psychologists Press, 1964. HAWKSWORTH, H., & SCHWARZ, T. The five of me. New York: Regnery, 1977. MACDONALD, J. M. Rape: Offenders and their victims. Springfield, Il,: Charles C. Thomas, 1971. PETERS, C., & SCHWARZ, T Tell me who I ant before I die. New York: Rawson, 1978. SCHWARZ, T. The Hillside Strangler: A murderer's mind. Garden City, NY: Doubleday 1981. WAGNER, E. E., & HEISE, M. A. Comparison of Rorschach records of three multiple personalities. J. pers. Assess., 1974, 38, 308-331.

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