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PSYCHOTHERAPY OF MULTIPLE PERSONALITY by Ralph B. Allison, M.D. Presented at the Annual Meeting of the American Psychiatric Association Atlanta, Georgia May 1978 Revised August 1984 (c)1978 Ralph B. Allison,M.D. SUMMARY An outline is given for diagnosis and treatment of multiple personality disorder (MPD) based upon therapy of a series of thirty patients diagnosed as having this disorder. Diagnostic criteria are elucidated in emotional, ideational, physical and behavioral realms. The use of hypnosis in exposing alter-personalities is described. Usually there were found an original personality, persecutor personalities and helper personalities. Above all these was found the Inner Self Helper (ISH), who was the therapist's collaborator. The etiology is hypothesized as due to a combination of factors, including the inborn inability to learn from errors, unwillingness to make moral choices, high sensitivity to others' emotions and exposure to a polarized family structure. The therapy plan presented consists to recognition of alter-personalities, intellectual acceptance of having the disorder, coordination of alter-personalities, emotional acceptance of having the disorder, neutralization of persecutors, psychological fusion and spiritual fusion. INTRODUCTION The psychologically crippling disorder known as multiple personality disorder (MPD) has been of intermittent interest to psychotherapists since 1815 when the case of Mary Reynolds was reported (Mitchell, 1815). The disorder is characterized by the "presence of one of more alter-personalities, each presumably possessing differing sets of values and behaviors from one another and from the "primary" personality, and each claiming varying degrees of amnesia or disinterest for one another" (Ludwig, et al, 1972). Statistically, the disorder is listed on Axis I as 300.14, Multiple Personality (DSMIII, 1980). For simplicity, I call the disease "multiplicity." Many now call it MPD. Those who suffer from it are "multiples." Patients with this syndrome have a severe histrionic personality disorder (Axis II-301.50) with their preferred unconscious defense mechanisms being repression, denial and dissociation. They consistently push out of their awareness any unpleasant feelings and negative attitudes. The resultant collections of psychic negativity in their unconscious minds provide the nuclei for pathological alter-personalities. Because of the paucity of published reports, the MPD has been considered to be quite rare. In my review of the available case reports (Allison, 1974a), I found 96 patients described in the English literature. The most completely described was Prince's Miss Beauchamp (1913). The most famous of the 1950's was Eve (Thigpen & Cleckley, 1957), and Sybil (Schrieber, 1973) was the most noted from the 1970's. Eve's personal version was published (Sizemore & Pittillo, 1977) filling the gaps of the first report. The first male to write of his trials with multiplicity was Hawksworth (1977). In my opinion, this small number of reported cases is due to for by several factors. First, since repression and denial are such readily used defense mechanisms of these patients, they refuse to accept clear signs of multiplicity, even when such are obvious to friends and relatives. Second, to bypass this resistance, hypnosis is the most effective way to uncover an alter-personality. But since only 10% of American psychiatrists are estimated to use hypnosis, the other 90% are not going to probe into the patient's unconscious mind this way, even when the history is suggestive. Third, determining frequency by published reports is an inadequate way to count cases, as most therapists do not have the time and effort required to prepare their cases for professional journals. Fourth, there is a personal reluctance on the part of many therapists to accept the existence of multiple personalities in any patient, so another label may be applied. According to one patient who had seen many institutional psychiatrists, closed mindedness was due to the psychiatrists being too preoccupied with their own problems to try to understand the patients' difficulties. Those who were open minded were too busy with institutional duties to have enough time for therapeutic encounters There are many MPD patients in treatment but unlisted, as I have known of therapists with thirty such patients in treatment in one year. One retired psychiatrist said he treated 20 to 30 such patients in his career. Another psychiatrist diagnosed 40 patients with multiple personality in a three year span. How many others there are is a matter of conjecture. How many undiagnosed multiples exist is, of course, quite unknown. THE DATA BASE Between 1972 and 1976, thirty patients were seen by the author in whom the diagnosis of MPD was made. Twenty-six were female and four were male. Twenty-eight were Caucasian and two were Mexican-American. The average age was 29.4 years, with the range from 18 to 51 years. At the start of treatment, 46.7% were married, 16.7% were single, 13.3% were divorced and living alone, 13.3% were living with a boyfriend, and 10% were separated. The reasons for seeking treatment were as follows: 1) Depression and/or suicide attempt 40.0% (12) 2) Found to be multiple elsewhere 23.3% (7) 3) Hysterical physical symptoms 10.0% (3) 4) Visual hallucinations 6.7% (2) 5) Court evaluation 6.7% (2) 6) Sexual problem 3.3% (1) 7) Alcoholism 3.3% (1) 8) Wanted lithium 3.3% (1) 9) Believed she was possessed 3.3% (1) The average length of time in treatment before this diagnosis was made averaged 5.1 months, with a range of one day to 30 months. The average number of alter-personalities found was 9.7, with a range of one to 50+. The age of creation of the first alter-personality was reported as follows: 0-5 years 43.3% (13) 6-10 years 40.0% (12) 11-15 years 10.0% (3) unknown 6.7% (2) In 55.3% of cases, the original personality sought treatment. In 36.7%, an alter-personality came for treatment. In 10%, it was unknown who came. Transsexual alter-personalities were found in 26.7% of cases. As of June, 1976, 50% had fused their personalities, 30% were not fused, and the status of 20% was unknown. Social status was as follows, following an average length of treatment of 14.7 months: 1) Doing well, not in treatment, fused 20.0% (9) 2) Still in treatment here, not fused 16.7% (5) 3) Still in treatment here, fused 13.4% (4) 4) In treatment elsewhere 6.7% (2) 5) Dropped out of treatment, not fused 3.3% (1) 6) In prison 3.3% (1) 7) In methadone clinic 3.3% (1) 8) In board and care home, not fused 3.3% (1) 9) Died of gun shot wound to head 3.3% (1) 10) Suicided 3.3% (1) 11) Unknown 3.3% (1) Since 85% of my patients have been females, in the following discussion I will use the feminine pronouns when referring to the patient in the singular. Only when I refer to something unique to males will I use the male pronoun. `As a result of the continuously unfolding experience, I was able to try different forms of therapy on successive patients and eventually evolved a plan of treatment which seems generally applicable, at least as far as the basic principles are concerned. Naturally, the disorder runs a spectrum from mild to severe, and not all the procedures described may be needed in the mild or moderate cases. Also, the timing of the necessity for certain procedures will vary and is different for every patient. Still, there is a general flow of events which becomes inevitable for personality fusion to occur and become permanent, and it is that flow a therapist must keep in mind. MAKING THE DIAGNOSIS The first step in proper treatment is making the correct diagnosis. These patients commonly have been through numerous institutions and various therapists with no constructive changes being made in their basic psychopathology. The foundation for the diagnosis is an accurate history. Common complaints are periods of amnesia, auditory hallucinations, fast mood swings, suicide attempts, severe headaches, difficulties in impulse control and stormy marriages. Many are ashamed to tell of periods of amnesia and may forget they forgot. Some will attribute it to drinking bouts, but, when pressed, will admit to lapses of memory during times of sobriety, usually after getting angry. Most will not volunteer a history of auditory hallucinations since they know that would brand them as "crazy," and they fear being locked up. Therefore, a very casual type of questioning about hallucinations is needed. Voices may be hostile or helpful or both, alternately. The hostile one may tell the patient very derogatory things and urge suicide or homicide. A helpful voice will reassure and guide the patient in a constructive direction. A helpful voice must receive the therapist's special notice, and the patient must be encouraged to do what the helper inside advises. A history of mood swings from suicidal depression to happily bar hopping can be misinterpreted as a manic depressive pattern. However, 48 hours is the minimum time for a true manic depressive illness to cycle, and a multiple can switch every few minutes, as each personality emerges. The patient may be quite conscious of the shifts from glad to sad or may black out while getting angry and wake up feeling hung over from a drunk and very depressed. The main feature to note is the patient's feeling of lack of control over the shifts. In contrast to a manic depressive whose shifts occur without an outside stimulus, there is usually a situation which triggers the change in a multiple even though the multiple has repressed memory of this event. As a result of the depressive periods, suicide attempts occur in situations where desire for death is absent. It is very easy for the therapist to brush off these attempts as attention getting devices, which they are, but these patients are, at times, really suicidal if their vital emotional supports have been removed. They may show self mutilative acts, such as slashing their forearms with a knife, which is really not suicidal. This may be a persecutor personality punishing the main personality for being such a weakling. The period of cutting is blocked out by amnesia, a very good clue. Several of my patients were easily diagnosed when they arrived at the emergency room with such slashed arms and amnesia for the event. They were eager to find out why and willingly underwent hypnotic interviews in which they clearly described the alter-personalities who were responsible for the slashing. This problem had to be resolved before they could leave the hospital, and they then began effective therapy for the first time in their lives. A number of patients suffered from severe "migraine" headaches and were hospitalized repeatedly for neurological evaluations and treatment. One patient had an elevated spinal fluid pressure, so was diagnosed as having pseudotumor cerebri. It was later determined that the headaches were caused by the persecutor personality using this way of punishing the weak primary personality, the usual cause of severe headaches in these patients. When parents of these patients are questioned, they report difficulties since birth with impulse control. These patients, as children, have struck out at siblings, become unreasonably jealous, exhibit temper tantrums and destroy property, all for what seem to be minor irritations. At school, they trigger fights, then cry at being rejected by schoolmates. They seem to have an unlimited capacity for hatred, yet relatives outside of the nuclear family may be extremely loving and protective of them. They gain friends easily with their charm, but lose them with escapades that make friends desert for self-protection. The marital histories are usually full of failure and conflict, in the case of women. The men were too unstable to enter into marriage, with two exceptions, and one of those marriages lasted only three months. The women ran away from miserable homes as teenagers and married the first men who asked them. With their low self esteem they preferred men who were equally disreputable, so marriage to ex-convicts, sexual perverts, habitually unfaithful men, sadists, religious fanatics and fatherly types who needed child brides seemed to be the order of the day. Relatives or close friends may tell the therapist about sharp changes of personality, even to the degree of claiming to have another name. Some relatives will refer to the movie "The Three Faces of Eve" as the source of comparison and be quite correct. However, the therapist must be careful that this description is not being applied to social role playing and must insist that the diagnosis only be made officially when the switching has been seen in person. The basic criteria for making the diagnosis of MPD is the clinical presence of two or more personalities alternating control of one physical body. Only when therapists have seen a shift of personality can they make this diagnosis with assurance. If the patient is seen in a highly volatile state in an emergency situation, the switching may be easily observed as the facial expression, voice and posture all change spontaneously, often in the middle of a sentence. If the patient is in a calm state, a hypnotic induction for any reason may allow an alter-personality to come out, even if not requested. This other personality will often claim to have her own name, a very specific purpose to perform for the primary personality, knowledge of activities during amnesic spells, and knowledge of the incident which brought it into existence originally. If the patient has not been exposed to other multiples, such as on a small hospital ward, these alter-personalities can be taken as genuine and not play acting. However, if the patient has seen another active multiple switch personalities, great caution must be taken in assuming that these mental creations are anything more than an attempt to get as much attention as the multiple patient she observed. This situation requires continued observation and consultation with careful comparison to patients known to have genuine MPD. If the patient is currently being charged with a crime, it would be almost impossible to be certain that the phenomena is genuine, since the patient might very well be willing to fake such behavior to be declared not guilty by reason of insanity. Some patients were referred by local physicians or psychologists who used hypnosis for weight control, smoking and sexual problems. Another patient manifested alter-personalities after her boyfriend hypnotized her for fun at home. Other patients, whose alter-personalities were in balance for years, became worse, bringing them to treatment. I consider hypnosis the method by which one can open the Pandora's box in which the personalities already reside. I do not believe that such hypnotic procedures create the personalities any more than the radiologist creates a lung cancer when he takes the first x-rays of the chest. A type of alter-personality can be created by instruction under hypnosis in normal persons as shown by Kampman (1976). But in the type of hypnotic approach used to get information about unconscious processes, or to implant corrective ideas regarding sexuality, there is no stimulus to push a patient to make a new personality. Besides, that is not the way personalities are created. It is much more complex than just responding to a non-specific hypnotic induction. The personalities then shown have existed for years, and hypnosis loosens the controls the patient has on them, except at times of extreme stress. These are the same personalities who have been coming out for years to cause the problems the patient came complaining of in the first place. Also, a newly formed personality takes time to grow and develop. It cannot come out with any intelligence within seconds of its creation by the patient. It must mature and grow inside the mind for days or weeks before it is able to act as an independent entity. Most patients have come to treatment for depression and suicide attempts, and there is no suspicion in their minds that multiplicity is involved. These can take months to diagnose properly because there is no logical reason early in treatment to use hypnosis, and the patient, being a good actress, puts on a pleasant in the office, while living a chaotic life outside. Finally, the patient becomes trusting enough to report amnesic spells in which she does weird things, or she tells the therapist she is sure there is another one inside doing the dirty work. Then she is willing to cooperate in a hypnotic interview in which the personality emerges and exposes the secret to the therapist. When the suspicion of MPD exists, an excellent physical test is to touch a forefinger to the patient's forehead between the eyebrows. In multiples, a change comes about in their mood and emotional control. Either the patient calms down from an excited state, or, if calm, may react violently with shrieks and visual imagery. This was first described in Sweden by Odencrants (1968), and it has proven to be a useful diagnostic tool. The patients are very aware of this sensitive spot on their forehead and avoid wearing bangs which could touch it. If a hostile personality is out, the fastest way to bring the primary personality into control is to touch that spot and call for the other personality to regain control. There have been times when I have pushed on the patient's forehead so hard that I drove the negative alter-personality back into the recesses of the mind so far it was three or four months before it could come out again. Because of the inconsistent clinical picture, the usual psychological test battery has not, in my experience, been useful in making a diagnosis of MPD prior to overt exposure of an alter-personality. When the history is suspicious, my favorite test is the California Psychological Inventory (CPI) as computer interpreted by Behaviordyne, Inc. of Palo Alto, California. Since about half the questions are identical with those on the Minnesota Multiphasic Personality Inventory (MMPI), the computer readout includes a section on "Hysterical Personality Features" and an hysteria score derived from the MMPI. A high degree of hysteria on the readout, an hysteria score over 55, and the diagnosis of hysterical personality disorder (dissociating type), in one of the three top diagnostic choices would make a patient a prime suspect for further investigation of MPD. TABLE I Results of CPI at Onset of Treatment (N=25) Degree of Hysteria Ave. Hyst. Score No. % Extremely hysterical 60.7 1 4 Hysterical 60.0 14 56 Rather hysterical 57.1 2 8 Some signs of hysteria 54.0 28 Few signs of hysteria 53.0 5 20 Not especially hysterical 51.7 1 4 ============================================================= Average Hysteria Score 57.7 Range of Hysteria Scores 51.7 to 64.8 Preferred Diagnoses on CPI Diagnosis No. % Hysteria in some form 9 36 Alcoholic 6 24 Depressive 4 16 Schizophrenic 3 13 Antisocial 2 8 Obsessive compulsive 1 4 The results of the CPI testing on 25 patients with clinically evident multiple personalities is shown in Table I. Interestingly, 24% showed few or no signs of hysteria in the readout. This is most likely due to a tendency to fake good on the test and deny pathology. Twelve percent showed schizophrenia as the preferred diagnosis, probably due to the high incidence of bizarre answers. Seventy-six percent were either hysteric, depressed or alcoholic. Considering the high incidence of alcohol abuse and suicide attempts, that is not an unreasonable combination of diagnoses. The hysteria scale is elevated to 57.7 with a range of 51.7 to 64.8. This is a deviation from the norm of 50.0 to the 0.01 level of significance. There is a serious problem in using any test, however, since some time has to pass to take it. During that time, the major influences on thinking may pass back and forth from one alter-personality to another, so the answer is a combination of many different thought patterns and can be thoroughly confusing. Another problem is that the questions presume a life history from birth, with a mother and father, from childhood to adulthood. Alter-personalities who have not experienced large portions of the growth process do not know how to answer questions about how they felt in the past. All they know is how they think and feel about current matters. TYPES OF ALTER PERSONALITIES There will be found basically two types of alter-personalities that are created by dissociation resulting from psychological trauma. A negative, angry, persecutor personality, such as Johnny (Hawksworth & Schwarz, 1977), is the commonest reason for the patient to come for treatment. As a counteraction, a rescuer personality will be created, possibly out of a friendly imaginary playmate from childhood. There may be other neutral personalities, such as a "normal" child, one which represents a fixation of emotional development at a preadolescent stage. A helper alter-personality may come forth in the natural habitat and tell the therapist that she is not the patient, as happened with Eve (Thigpen & Cleckley, 1954) and Sybil (Schreiber, 1973). In my cases, they have preferred to call me on the telephone or put their voices in audiotape (Allison, 1974a). These personalities can trace their existence back to early childhood or to recent traumatic incident. All the alter-personalities will know the age at which they were created and why. They will have a narrow psychological purpose to serve. They have a limited range of emotions to express and a narrow band of activities they are interested in pursuing. They use similar terminology, referring to the primary personality in the third person. They talk of "coming out" to do their work. They are not patients of the therapist, and only talk to the therapist because they are doing "her," the patient, a favor. Their facial appearance, posture, and speech patterns may be markedly different from that of the primary personality but may be very similar to the primary personality if they have had time out in which they pretended to be the primary personality. In some cases, it is only the thought processes which are markedly different, while the face and body appear similar, at least in the office setting, when strong emotions are not being stimulated. It might be thought that the therapist's interest in multiplicity could create these alter-personalities. This could not be if the alter-personality is first identified by someone before the therapist has seen the patient, or when the alter-personality clearly comes about, in its own mind, to serve a rescue function. If the therapist shocks the patient, as I did once by telling one patient the diagnosis before she was ready to cope with it, another personality can be formed from that psychic shock. In my case, that new personality was a rescuer and repeatedly saved the patient from suicide attempts, so she was helpful during the remaining therapy. When hypnosis is used to explore the mind, various minor personality fragments may be found. These are of no importance and can be ignored most of the time. Paying attention to them can encourage them to grow to maturity" and that must be avoided. Also, the patient can create a false alter-personality which has no psychological roots, and no purpose other than to amuse, mystify or confuse the therapist. That presents no problem since it never shows up again, if the therapist realizes it is of no psychological importance and goes on about the task of unifying the personality. THE INNER SELF HELPER Somewhere in therapy, hopefully early, an especially important entity, which I have christened the Inner Self Helper, may make itself known. It is quite different from the persecutor or rescuer personalities, whose characteristics are in Table II. The characteristics of this entity are listed in Table III. I described my first meeting with such an entity in 1973 (Allison, 1974a). Since then, such entities have been manifested in all of the seriously ill patients who have gone on to fusion. This entity will not accept the definition of personality, and has, itself the power to create helper personalities. I abbreviate the full name to ISH, which means "similar to, or alike." This is appropriate, since it is similar to the main personality in many of its basic characteristics. It has knowledge and strength but is incapable of showing hatred or fear. But it is a reflection, in a higher plane, of the primary personality. It is bright if the patient is bright, and not so bright if the patient is dull. It is shy or assertive, depending on the nature of the primary personality. Its value to the therapist is tremendous, as they have awareness of all that is wrong inside the mind and can work with the therapist to make corrections. There are certain things the therapist must do, certain things the patient must do, and certain things the ISH must do. Neither one can abdicate and expect the others to do its work. The ISH must let the doctor handle medicines and physical problems, since the ISH's role is strictly mental. Psychotherapy for the primary personality is done by both the ISH and the therapist. The patient has the duty to resolve to become one and to make appropriate social decisions as well as to battle persecutor personalities. The most concise self-definition given by an ISH is as follows: "I have many functions. I am the conscience. I am the punisher, if need be. I am the teacher, the answerer of questions. I am what she will be, although never completely, for she has her emotional outlets which I do not need. But she will have my reasoning ability to look at things objectively. I will always be here, and I will always be separate, but the kind of separateness which is yours, a oneness with a very fine line of distinction. An emergency backup perhaps. I must be the ability to know. If I am gone, she is just a body. She can send part of me off and leave a small portion. But if all is taken, she is a shell. Now my function is overseer of the dump. I am kept busy sorting out the different messes created and the problems created between the alternate personalities." The relationship between the therapist and the ISH is unique since the ISH is all intellect and a delight to converse with for any intellectual therapist. It is also aware of the therapist's feelings and failings and has no capacity for transference feelings. The ISH and the therapist are usually talking about a third party, the patient. They share ideas back and forth, with no coercion on either side. There is no human to human relationship with which to compare this partnership. It is so unique a relationship, it has to be experienced- to be believed. The therapist quickly comes to realize that the therapist, too, has an ISH, which is in constant communication with the patient's ISH. Why else did the therapist change tactics and do certain acts in the therapy session which worked out so perfectly? The patient of Stoller (1973) didn't listen to her ISH, Charlie, and got into trouble. Dr. Stoller did listen to his and became a successful psychiatrist and professor. Jung described his ISH, Philemon, in great detail in his autobiography (Jung, 1965). In the psychological model of Psychosynthesis, Assagioli (1965) labels this part of the mind the Transpersonal Self. In successful people, it is well integrated into the rest of the personality. In the multiple, it is disconnected, as are many other parts. TABLE II Characteristics of an Alter-Personalities from Unconscious Forces 1. Has identifiable date of creation 2. Was created as a result of specific life trauma of psychological need 3. Was created to serve a specific emotional purpose 4. Has potential range of good and bad emotions 5. Has potential for good and bad motivations 6. May be interested in establishing separate identity from primary personality 7. Is capable of making other similar alter-personalities 8. Has a sense of being male or female TABLE III Characteristics of an Inner Self Helper (ISH) 1. Has no date of origin; has always been present since patient's birth or shortly thereafter 2. Can only love; is incapable of hatred 3. Has awareness of and belief in God 4. Is aware that God put it in charge of teaching this person how to live properly 5. Has power to clean up the mess, with help of therapist 6. Has more powerful helpers above itself 7. Knows all past history of patient, and can predict short term future (three days maximum) 8. Has no sense of personal sexual identity but uses gender designation for therapists convenience 9. Talks in short, concise sentences; prefers to answer questions and give enigmatic instructions 10. Is aware of patient's prior lifetimes 11. May be one of several, arranged hierarchically, with the lowest most easily accessible, the highest nearest to God PSYCHOPATHOLOGY Before we deal with ideas about treatment, we must concern first ourselves with why this ailment exists in the patient at all. As far as I can determine, there is no generally accepted etiologic reason propounded by psychological theorists. My constant probing for answers has led me to hypothesize that these patients were born this way, not necessarily split of mind, but with a readiness to split with the slightest emotional trauma. The psychological foundation is an innate defective unconscious mechanism for integrating daily experience into knowledge. They cannot be conditioned by experiences. They keep making the same mistakes over and over again. Therefore, they do not act socially responsible since they do not correct their errors. This leads to recrimination on the part of others and further emotional trauma, leading to the eventual creation of alter-personalities. This same feature of inability to lean from experience has been shown to exist in professional criminals (Yochelson & Samenow, 1976) and may be why the disorder is so seldom diagnosed in men. They probably become criminals earlier and easier in our society that do women and are then absorbed into the penal system. The women are tolerated longer at home and considered mentally ill while the men are called antisocial. The other etiologic factor which has been strongly indicated by ISH's is that the primary personality has never taken a stand for being good or evil and is still sitting on the moral fence, playing both sides. Staying in this state of moral limbo perpetuates the existence of alter-personalities, who represent one side or the other of this moral dilemma. Those doing therapy may find it hard to identify with a person in a moral limbo, since we made our choice for good before entering our professional education. But these patients have not, and need to be guided to where they can make a conscious choice for good or evil, hopefully for the former. The choice must always be theirs, and they can choose to be fused evil, I believe. If that should happen, no one is safe around that person, and there is no longer any hope for a cure in the positive direction. There is, of course, the total personality structure present in the person at birth, which is another important factor to understand. The most important facts leading to pathology are the emotional hypersensitivity, hypersuggestability, and psychic talents. The hypersensitivity may be so extreme they perceive auras, or energy fields, around people. In a room of strangers, they may feel literally burned by anger or other negatives feelings of these persons. They soak up these feelings up like sponges and may become suicidal at the end of the exposure to depressed people. This factor must be appreciated and is countered by "Building the Eggshell," which is described later. All multiples are hypersuggestible and therefore excellent hypnotic subjects. But that is where the therapist is walking on a narrow ledge. The therapist may inadvertently suggest a symptom the patient doesn't need. Hopefully, the suggestions are positive ones regarding improved coping methods. With this suggestibility used effectively, the therapist should comment that the patient can do many positive acts she didn't think she could do. When the patient acts on these suggestions, she is surprised at the results, and this builds self confidence, which is sorely needed. Most of the multiples have been involved in some type of psychic or parapsychological activity, and it is important for the therapist to be aware of the theories behind these phenomena. Readings in standard texts in parapsychology will help the therapist understand such activities as extrasensory perception, poltergeist, out-of-body experiences, precognition, psychic attack, psychometry and energy sapping. Again, it is essential that the therapist understand the ethical and unethical ways in which these various talents may be used. Involvement in such religions as Satanism and black witchcraft is to be soundly denounced, but the motives must be completely explored, so alternate ways of meeting the expressed needs can be found. The characteristics which are useful for healthy improvement are creativity, good imagination, excellent memory and diversified interests and activities. Many are excellent artists, using various mediums. Poetry is a very common way of expressing their thought. Their imagination can be used creatively in the hypnotic process. But the therapist has to keep in mind the problems these patients have separating their fantasies from reality and the tendency to make reality out of imagination. In spite of many amnesic spells, multiples have excellent memory for isolated details. Never can therapists get away by claiming they didn't say something last week. The patient can remember interactions in complete detail. Patients who have been accused of lying in childhood, a common fact, will start memorizing everything that they are aware of, so they can defend themselves from further accusations. They never forget an insult and clutch onto the memory of the hurt until the therapist hears about it and persuades them to stop the one-sided feud. The family structure on which the early pathology is played out is described in my paper on How to Raise Your Daughter to be a Multiple Personality (Allison, 1974). These factors are listed in Table IV. I do not blame parents for raising their children to be multiples, because of the defects in the child I have already listed. But the patients are raised in polarized families where multiplicity is encouraged and irresponsible behavior is supported by example. Seldom is there an alternative parental figure who can help the child understand and cope with what she is going through. Therefore, the child may seek inside for a playmate made of imagination, and start creating alter-personalities that way. Later they usually marry an emotionally unstable spouse, and the home problems are perpetuated. As so often happens with chronically disabling conditions, the spouse becomes the caretaker, but when the patient is well, the spouse starts showing psychopathology, and a divorce suit is soon filed by the ex-patient. Therefore, the pattern seems to be this. The personality of the patient arrives in this lifetime incapable of learning by experience and undecided about being good or bad. The nervous system has an exquisite sensitivity to emotional energies of others. The family is pathological, with polarity being encouraged. The acting out forces the patient into therapy, into a corner where she can no longer get by being irresponsible and undecided by letting alter-personalities live out her life for her. TABLE IV Common Factors in Childhood of the Multiple Personality Patient 1. The child is unwanted at birth. 2. There is intense polarity between mother and father. 3. One parent, especially the favored one, disappears before the child is six years old. 4. Sibling rivalry is encouraged, and the child is not helped to deal with it. 5. The child is taught to be ashamed of her family tree. 6. The first sexual experience for girls is extremely traumatic. 7. Home life as an adolescent is so miserable the girls run away to get married, and the boys join the military. 8. The girls marry sexual deviates who carry on the pathological traditions of their parents. THE THERAPY PLAN Since most papers on the subject of MPD are single case reports, little is available to guide a therapist who is meeting the first such patient. Excellent theoretical discussions of the problems involved are presented by Taylor & Martin (1944) and Suttcliffe & Jones (1962). The one paper which presents pointers for effective treatment by Bowers, et al (1971) should be studied by any therapist presented with such a patient. In my experience, the therapy has fallen into nine intertwining stages of activity. The order in which these processes occur varies in each patient, but, with the help of the ISH, the therapist will be able to take each step as needed. 1. Recognition of Alter-Personalities As in any disease, until the patient is aware of what disease she has, she cannot effectively work with the therapist. There is massive resistance in most patients against accepting the label of MPD, since denial and repression are their favorite defense mechanisms. But when the therapist has adequate proof of amnesic spells in which alter-personalities make themselves known, this must be presented to the patient. Various physical methods of proof may be needed. A Polaroid picture may be taken when an alter-personality is out. A tape recording of conversation between therapist and alter-personality may be made. Asking the patient to talk out loud, in trance, with an alter-personality, creating an inner dialogue, as I have described elsewhere (Allison, 1974) may be very useful. When the patient is able to do automatic writing, this proof may be convincing, since the therapist did nothing to put those words on paper. if family members or neighbors will confirm the therapist's suspicion and tell the patient, that may begin to dissolve the denial. But, in the early stages of therapy, there is only going to be a tentative agreement that it may be so, but not whole- hearted acceptance. That only comes later. 2. Initial Special Techniques There are two imagery techniques which I have found useful for most multiples. The first I call "Building the Eggshell." Since these are hypersensitive people, I show them how to develop protection against psychic harm by building an imaginary eggshell around themselves. The patient rests quietly in an easy chair while I go through the following spiel: "Rest quietly, relax and close your eyes. Now think of a beam of pure light coming down from the sun into the top of your head. Have it radiate from the very center of your being outward into your air space. As it does, have it push out all that is unworthy in you, all that is evil, harmful or unwanted. Let this energy fill your entire air space so that in no way can you be outside it. Let it expand and become stronger and more brilliant so that it goes as far above your head as you can reach, as far to your side as you can reach, as far behind you as you can reach, and as far below you as you can reach. Then, as a tomato with a soft pulp needs a skin to hold it together, start thickening the outer surface of this energy field. Because of the shape of the human body, it will be shaped like an eggshell Thicken this eggshell as thick as you think you need for protection. If things are calm and peaceful, you may need it to be only one or two inches thick. If you anticipate being around difficult people, you may need it two or three feet thick. Now if you remember your biology class in school, you know that every cell in your body has around it a semi-permeable membrane. (Vary this part depending on the education of the patient.) This membrane is designed in such a way that food will pass through it into the cell but poisonous substances are kept out. Also, all the elements manufactured inside the cell that are needed for the function of the cell are kept in, but all waste products are passed out. in this way, a perfect relationship is maintained between this cell and all other cells. Exactly the same type of membrane is needed around your body to allow it to be in balance with the bodies of others. "The first thing you need to do is to cover the outside of the eggshell with many tiny mirrors. These mirrors are designed to reflect back to their makers all the negative thoughts that may be sent your way by anyone, all thoughts of malice, hatred, jealousy, etc. The mirrors are 100% reflective, so you need add no energy to the system; just let the negative thoughts rebound like ping pong balls off a paddle. In this way the negative thoughts will not enter your body of thoughts and interfere with the quality of your thinking. However, all positive thoughts, such as admiration, love or affection will come right through to improve you, help you, teach you and otherwise benefit you. That is the first step. "The next step is to coat the outside of your eggshell with a non-stick surface, like the Teflon used in frying pans. This non-stick coating is to be designed to deflect all negative emotions others may dump on you. These negative emotions of hatred, guilt, self pity, etc., are just their mental garbage which you don't need. With the Teflon coating, you can have it just slither down into the garbage disposal system the Good Lord provides for such trash. However, all the positive emotions such as love, affection, praise and appreciation will come right through to warm you and strengthen you. These feelings will also stimulate you to express the same emotions towards others. Now, that is what is needed for the outside. "On the inside, you need to do the same as that which works for each cell in your body. The first thing is to get rid of the junk in your mental household. You will notice down by your feet a one-way-out trap door. Pick up that silver shovel and start shoveling out that door all the mental trash you have preconceived notions, outdated ideas, fears, anxieties resentments, etc. These may have been useful at one time but they are now junk; so get it out of there. "At the same time, you keep all the valuable things in your mental house - the lessons you have learned, the experiences you value, the talents you have, your favorite memories. Polish them, keep them clean and beautiful. "Every morning before you get out of bed, repeat this process so you keep your eggshell in good repair. It can't last long without repairing. Let the light in through the top of your head, repair the cracks in the shell, replace any broken mirrors, fix any scratches in the Teflon and shovel out the trash that has accumulated since yesterday. Then you will be ready for the rest of the day. When you feel you have finished, you can open your eyes." This is usually very much appreciated, enables the patient to cope better and use less tranquilizers. The other special procedure is called "The Bottle Routine." It was invented to cope with the over-accumulation of negative energy one patient had after a partial fusion. She was so full of unmanageable hatred and fear, no tranquilizer could calm her down. This method, which presupposes that one can transfer human feelings into a physical object, worked in her case and is useful in emergencies until the underlying problem can be resolved. The spiel goes as follows: "Close your eyes and think of your body as a giant battery with positive and negative emotions flowing around in it. Like any battery, it has two terminals, an 'out' terminal, which is your left hand, and an in, terminal, which is the top of your head. (Place your right hand on top of the patient's head and push down slightly.) We all easily pass outward to others the positive emotions such as love and affection since this is permissible in our society. However, we are often not allowed to pass out the negative emotions, so they store up in our body and cause us harm. But they can be moved out, and I will show you how. It doesn't matter how long they have been there; they don't change with time. Even those from early childhood can be removed. Now just concentrate on moving the anger energy out of your left foot. (At this point I touch the left shoe with my left hand and move my hand to the areas I am taking about, avoiding touching the erotogenic areas.) Move the anger energy out of your toes, sole, heel and ankle, moving it up through your calf into your buttocks. Move it out of your pelvis and buttocks. Move the anger through your abdomen and out of your back, up through your heart, lungs and chest into your shoulder. Then move it down your left arm to your elbow, through your forearm, wrist and store it temporarily in your left hand." By then I will have moved my left hand to the back of the patient's left hand. Then I repeat the same statements for the right side, starting with the toes on to the shoulders, continuing from the right shoulder to the left shoulder and down the left arm to the hand. Then I place a bottle or other object in the left hand and say, "Now start pushing all the stored up anger into the bottle." The patient, if cooperative, starts squeezing very hard, so I know the imagery is going well. Then I touch the right hand and say, "Now start moving the anger energy out of your right hand, through the wrist, to the forearm, past the elbow, into the upper arm, into the shoulder. Then move it over to the other shoulder, down the arm to the wrist, to the hand and pour it all out. Now the greatest amount is stored in your head. I want you to take through the top of your head all the energy which is the opposite of hatred, which is love. Imagine a beam of pure white love energy coming down from above to act as a counter force to drive the anger out." (Here I keep my right hand on top of the patient's head and cup my left hand above the left ear as if I am pushing something downwards.) "Push the anger energy out of your skull, hair, brain, ears, eyes, nose, cheeks, chin, into your neck, down into your shoulder, down your arm, past your elbow and wrist, into your hand. Now continue to push all the anger out. Once you have the flow channels started, they will continue to work." I watch to see the degree of tension in the squeezing left hand and encourage the patient to keep pushing out all the anger possible until the hand relaxes and the grip loosens. I don't put a time limit on this but tell the patient to take as long as is needed to do the job, and then I will take the hate energy away for good. Whether or not something really goes into the bottle, who can tell? But when I have handed such a bottle to another multiple who was not present and had no idea what happened, she always showed terror of the object and insisted I throw it away. There are times when the patient should not cast out negative feelings, but must accept and integrate them. If so, the patient will refuse to do this procedure and must be allowed to do it her own way. 3. Intellectual Acceptance of Having Multiple Personalities After the evidence accumulates, and the patient has reason to believe her therapist and friends, she will stop denying that other personalities exist inside her head. She will start talking about the other personalities as real people who co-exist inside her head and will have an intellectual curiosity about why they came about and what they are all about. However, the therapist must not be lulled into a feeling of complacency that the patient really believes all this stuff about other personalities. She is still playing a game with the therapist and going along with the theory, but does not believe it "in her gut." Doubts that are expressed by relatives, teachers, friends or others will be readily accepted by the patient to deny what the therapist is telling her. The therapist can expect to be accused by unhappy relatives of having brainwashed the patient into believing a fairy story. The therapist may be accused by the pathogenic relatives of making the patient sicker, since "she was fine until he put all this nonsense into her head about these other personalities." This, of course, ignores the fact that the patient had been acting weirdly since infancy and was practically forced into the therapist's office by these same people because of her odd behavior. But that is still the time to get started on substantial psychological problem solving. The most effective way I have found to do this therapy is with hypnotic age regression. Since all multiple patients are highly hypnotizable, they can me age regressed if they are willing to try. The first step is to have the patient enter a light trance and ask the all knowing part of her mind lift one finger when an age is mentioned when a major event occurred which feeds energy to the negative personality that needs to be dealt with first. The patient always has a "biggest baddie," and that is the one to tackle first. I count from zero to the patient's current age and make a note of when the finger lifts. If there is time, I will follow with the first age regression session. If the finger first raised at number five, I will then tell the patient that, as I count downwards, I want her to become the age I count to. When I reach five, I will ask to talk to the patient as she was at the age of five. I keep repeating this, suggesting that when her eyes open, the patient will be age five, feeling just like she did at that age, and that she will be willing to talk over the important problems she faced at that age. If the process is not interfered with by an alter-personality, I am talking with a five year old child when the patient awakens. Then I have to enter into a therapeutic discussion in the same way a child therapist would. The child brings up the problems of a new baby sibling, or a move to a new home, whatever was the issue at that age. There is seldom any difficulty with the child understanding my presence or questioning why she suddenly dropped into my office. If need be, I will explain that her parents were aware she had problems and had asked me to talk them over with her, just as one would in regular child therapy. The goal of the session is to help the child come to a resolution of her emotional conflict. It might be getting over hatred of the sibling, or receiving reassurance that she will make friends in the new town. Whatever it is, when the resolution is reached, the child often closes her eyes and returns to a trance state spontaneously. If she doesn't, she may ask to leave, and I tell her she can leave the same way she came, by closing her eyes and going back inside her head. When the trance state is again apparent, I tell her to start counting up to the present age. After a session or two, I learn how fast the patient works out problems. Some are very resistant to changing their attitudes and require an hour per problem. Others are more flexible and can work through three or four problems per hour. By starting at the early ages and working chronologically, the child-patient and I develop a rapport, and the themes are repeated. I can refer to an earlier session for material to help in a later problem, if need be. Since I have previously listed the ages to be covered, I cross off each age as we cover it and it's associated problems. When I get to the end of the list, I presume that I have resolved all the problems that have fed negative energy, such as anger or fear, into that particular alter-personality. Theoretically, that personality should be ripe for neutralization. I view it as a tree with several roots. Each problem is a root, and if we can pull up each root which ties this personality into the patient's unconscious mind, then, when all roots are pulled up, the tree can be toppled with a breeze. On rare occasions, the personality is such a weak fragment it just evaporates an we resolve the final problem. But the long standing "baddies" have to be approached through a ritual. Each patient has her own effective ritual. It often requires the therapist's presence to "catalyze" the interaction between the ISH, which has the power to neutralize the negative personality, the primary personality, who must make the decision to give up the negative personality, and the negative personality itself, which may or may not fight to stay the way it is. While a benign helper alter-personality can be brought into the primary personality, a hostile destructive one will usually have to be neutralized in some fashion, depending on the ISH's instructions. If the ISH does not have advice about specific mechanism, I use the standardized approach based on "The Bottle Routine". After checking with the ISH to be sure the patient has met all the conditions to neutralize the alter-personality, I put a bottle in the patient's hand, ask her to close her eyes and go up to the level of the ISH. Then I ask the patient to join with the ISH, to become one with its power and to bring the ISH down to cast out the negative energy of the bad personality. Then I put my hand on top of her head and move my cupped hand down her head, neck, shoulder and arm out to the bottle, all the time telling the patient that I am helping by pushing out the negative energy from each part of the body I touch into the bottle. The patient, when cooperative, goes through quite a contortion as if really pushing something down her arm and out her fingers. Some patients need no object and just extend their fingers. One "spoke in tongues" to do it. Some silently sat and prayed, showing no outward movement, but said they consigned the personality to God to do with as He wills. The patient may have a vivid visual experience of powerful helpers dealing a deadly blow to an enemy inside her head. Whatever works should be used. No one can say what really happens. The goal is to drain the negative personality of energy. The personality can be recharged if the patient backslides and repeats the kind of poor problem solving which brought it about in the first place. Then the therapist has to tackle the psychotherapy problem again until permanent changes are effected. While some negative alter-personalities will totally disappear with this approach, others will remain, but without their negative attitudes. These are the ones who are still needed by the patient for some useful purpose, such as providing information for further therapy sessions. So that these "shells" of alter-personalities will not reabsorb the anger and hate that still resides in the patient, I find it essential to have them fill up their "emotional vacuum" with positive energy. To do this, I put my hand on the patient's head and ask her to pull in from the universe all of the healing, loving energy available for the asking, to have it fill all the space that was just vacated by the anger. When that alter-personality then returns to normal awareness, she is glowing with happiness and love for all mankind. She then becomes a helper for the rest of her tour and can aid in therapy as long as she is needed. When she is no longer needed, she comes out to say farewell and goes away to "someplace yellow." During this part of therapy, the patient must be advised of the wisdom and judgment of the ISH and urged to submit in every way to the ISH's directions. This is a difficult instruction for most patients to accept, being rebellious as they are and seeing the ISH as a harsh parent. But experience usually teaches them the reasonableness of this advice. But it must be repeated over and over again. The patient must develop a sense of being a student to the ISH, who is the guru, as well as a feeling that the ISH is a higher part of her mind. Frequently, the patient will become jealous of the attention the ISH receives from the therapist. Then resentment develops, followed by refusal to follow the orders of the ISH. Remember, the ISH is with the patient 24 hours a day, 7 days a week. It gives orders all that time in a calm, deliberate fashion. The patient has the option of ignoring the orders at her peril, but she can do so. Only on the request of the therapist, or in a life and death emergency, will the ISH take over the control of the body, but never to do something the main personality should but won't do. Mistakes are allowed to happen, but rarely to the point to serious physical or mental harm. 4. Coordination of Alter-Personalities During the entire course of therapy, the patient and therapist both must work to coordinate the efforts of the positive personalities. They often have been working parallel, not really knowing what the others are up to, or that others exist. Often, a personality will be out to do its duty and have no awareness that it is only one of many. When I first meet such a personality and inform it that there is a whole family of personalities in the head the personality must know and work with, it frequently tells me this is nonsense, since such things as multiple personality just don't exist. To correct such doubt, I just ask the ISH to speak to that personality, and the booming voice in the head is usually quite persuasive that I know what I am talking about. When a negative personality is encountered, a positive side must be sought. If there is any way to move an angry personality into a protective role, it should be done. Conversion to the cause is much more to be sought than excommunication from the order. Each started for a purpose, and if that purpose still must be served, the personality must be kept. Only when the primary personality has learned how to handle that issue by herself, can the alter-personality cease to function. Helpers will fade when they are no longer needed. No ritual is needed for them, as they just lose energy and no longer function, blending their talents, attributes and memories with the primary personality. An ambivalent personality may want to help but is made up of both negative and positive aspects. If it wants to shed the negative aspects of itself and become a full fledged helper, then "The Bottle Routine" is used with that alter-personality out at the time. Since suicidal and murderous impulses are contained in the negative alter-personalities, a clear understanding of the proper rescue methods must be developed by all entities involved. The ISH must know how to contact the therapist during off hours, and the spouse must be taught how to bring the primary personality into control if a persecutor gets out. The hospital emergency room and inpatient psychiatric ward staff must know how to cope with suicide attempts and reach the therapist quickly. There must be one alter-personality whose role includes suicide prevention. The therapist must keep contact with that one to assess suicidal risk and determine how much external control is needed. Since the primary personality is quite an actress, the therapist can seldom get a true idea of the suicidal potential from her. The rescuer will be the informant needed to evaluate and report such risk. In case of violent behavior, a simple and essential technique to teach nurses, spouses and close friends is the touch on the forehead, described in "Making the Diagnosis." Firm touching of that spot will usually bring out whatever helper personality is called. The one exception is when the patient has gone into what I call a "transitional trance," a coma in which no personality is in charge. Then no response is noted to any outside stimuli, and calling loudly and waiting is about all one can do. Eventually someone will take charge of the body. 5. Emotional Acceptance of Being Multiple During most of the treatment, the patient may still doubt the existence of the other personalities, the accuracy of the diagnosis and the sanity of the therapist for reporting such ridiculous observations. But at some point in time, an event occurs which cannot be ignored, forgotten or denied. It may be the first time the voice of the persecutor is heard, since not all patients hear voices. This may be when filthy hitchhikers are found in the car, and the patient knows that she would never have picked up those awful people. Whatever it is, the patient becomes aware of the evil within herself and cannot avoid facing it any longer. Then and there, emotional acceptance of being multiple occurs and the patient enters the next phase in the therapy program. Now the patient becomes the director of the treatment activities, since the ISH is now able to feed information on how to improve, and the data is acted on without delay or question. This is when the therapist must back off on pursuing any preconceived notions of what therapy should be, for the patient know what needs to be done. The drive to get well is now strong and over-shadows all the neurotic drives that have previously pushed the patient into such chaotic life patterns. Major changes are demanded by the patient if the old patterns interfere with getting well. This may include separating from the spouse, or at least being willing to, if the spouse's psychopathology and need to keep the patient sick becomes apparent, as they often do. Now may arise the crucial question - Who is really the patient? Who is the original personality? Prince (1913) was quite right in his advice to look for the underlying basic personality, since only that one can get well. In over one-third of my cases, the original personality did not enter therapy and was discovered during therapy. The ISH knows it is under there somewhere and will advise the therapist in due time when it is safe for that one to come out. A careful history of the starting ages of the personalities is most helpful in preparing the therapist for this aspect. When the first negative alter-personality has been created before the age of eight, when, according to psychoanalytic theory, the personality is fairly well formed, the primary personality had gone underground and an alter-personality was formed to take over. Unfortunately, the new alter-personality is usually weak, neurotic, depressed and limited in emotional scope and eventually ends up in a therapist's office. I have heard of this retreat of the original personality as early as birth, right on the delivery table. Others have been out of consciousness since 21 to 50 months of age. There are many different ways in which this original personality may first manifest itself. It may be the only one present, if all alter-personalities have just disappeared. In that case, the therapist may suddenly have a three year old patient, with a family to raise and a job to do. Fortunately, it is only emotional growth that is missing, not intellectual or physical. It is of utmost importance to control with whom the patient is in contact at that point. If this transformation occurs at home, the spouse must take time off to be there, acting as a good friend, since the patient knows no three or four year old can be married and have little offspring running around. The hospital may be the place for her, and the nurses become family figures who help the patient become oriented. Here I explain to the patient that she has had a "sleeping sickness" and is a modern version of Rip Van Winkle. They marvel at their big bodies, but I explain that the body continued to grow while they were asleep and their emotional growth will soon catch up. In other situations, the child personality will only come out when the therapist is present, to work out problems that occurred in past times. Then the therapist must go through "age progression" therapy. As the child personality grows, she becomes upset about those events that were traumatic, such as rape, parental desertion, physical attack, or death of a close friend. These episodes must be faced, accepted, and dealt with. The therapist must perform the role of crisis counselor, providing guidance and understanding just as the rape has been completed, for example. Forgiveness towards self and enemies must be taught, to eliminate the intense anger which developed in her at that time. Substitute parents may have to be provided, if the real parents were so brutal the patient will not accept them as parents now. The selection of proper persons for the new parental roles is a very delicate procedure. Never should the therapist volunteer. The therapist is needed as a therapist, and therapist and parent roles cannot be easily mixed. Usually there is a good friend available who has already assumed that role for the patient and is willing to be the new parent for the growing child personality. The most important fact that this person has to know is that the assignment is for life. A new father figure doesn't have to be around the patient at all, after cure, but he must never deny his fatherhood role. This new parent must be willing, during the growing period, to deal with the grown adult patient as if she were a little child, bringing dolls, toys and cuddly blankets to the hospital if indicated. Again, the ISH gives explicit directions as to what to bring at what time to support the growth process. Primarily, the parent is there to provide the love and attention that every child needs, and that is what gives the patient the strength to face the problems she had avoided for years. 6. Neutralization of Persecutors The way to deal with the roots of negative alter-personalities with age regression therapy has been described earlier. The same procedures must be done with each negative personality unless the ISH informs the therapist of an easier or shorter way. To neutralize them requires the patient to overcome those two basic defects mentioned before, one psychological and one moral. The patient must now accept responsibility for everything she thinks, feels or does, no longer delegating responsibility to another personality. Obviously, this can only be done by the original personality, who copped out in the first place. It cannot be done by a helper alter-personality. This may seem like a simple pattern for therapists who have always been accountable for their behavior, but it is a new type of commitment for the patient. The other aspect that needs solution is the failure of the patient to pick which camp to join, the "White Hats" or the "Black Hats." This process may be described in any terminology, but it is important that the patient get off the moral fence and choose sides. Here, religion is important to the patient. The failures in this stage are either those who give lip service to some abstract religious idea, or who could accept none of those offered. Church attendance is not related to religious belief, and may be detrimental if the clergyman and congregation try to coerce the patient into a belief system and pattern of behavior contrary to what the ISH is advocating. But the patient must be supported in her quest for a compatible religious orientation. The patient's clergyman may be well involved already, and now is the time for him to work closely with the therapist. The clergyman can take a great deal of the burden off the therapist's shoulders, if the therapist will explain what is going on and accept the clergyman as a co-professional. 7. Psychological Fusion When the original personality has been uncovered, when the ISH is always listening to by that personality, and when all the negative personalities have been neutralized, then it is time for fusion of all the positive alter-personalities. This process happens spontaneously and may take no work on the part of the therapist. It may happen in an hour, after the last persecutor is neutralized, or it may take several weeks. There may be a partial fusion first, of integration of several similar alter-personalities before the final fusion, but this is not the same. The fusion process may be quite discomforting for the patient. There may be poor memory, mental confusion, alterations in mood and temper control. It may be necessary for someone else to manage the cooking, shopping and housekeeping chores for a few days. There are many styles in which this occurs, but the end result is always the same--one original personality, all alone, except for the ISH. This is another very important point in the life of the patient, when she is exquisitely vulnerable to bad advice or a poor emotional environment. Now is when the patient is most likely to leave the spouse or ask the spouse to leave. If combat then ensues between the two, a murderous or suicidal fragment may be formed. Immediate therapy must be instituted, often in a hospital. Within 24 hours, the ISH can shed the bad energies developed and healed the split between the fragment and the original personality. Other than such short lived fragments, no solid alter-personality should be formed after psychological fusion. If they are, the patient has not yet finished her task of neutralizing persecutors, and that process must now be repeated to completion. The patient now has one personality, which is always listening to her guru, the ISH. As soon as she has caught her breath, new problems face the patient, only these are not really new problems. They are exact duplicates of the old problems which the patient has failed to deal with adequately in the past. The patient must be advised that these apparent catastrophes are happening because of the patient's need to face exactly these problems now that she has better coping methods available. if these problems are faced and dealt with, then she will pass the test for promotion to the next grade in the "School of Hard Knocks." It is amazing how the problems hit. The patient may be fired from her job, have her house burn down, face a death in the family, find she is again illegitimately pregnant, and so on. They are tempted with every old vice the negative personalities indulged in, such as alcohol, marijuana, cocaine, LSD, heroin and all the rest. The therapist must remember that the patient now knows perfectly well what to do and can assume responsibility for taking appropriate action. The therapist assists and discusses options but must not take responsibility out of the patient's hands. only if the patient becomes suicidal must the therapist actively intervene. This need to suddenly step back from a previous posture of active intervention may be a problem for some therapists, but those I have worked with have been glad to take a breather by this time. I can talk very glibly about psychological fusion coming about, but I really do not know what that phrase means. The closest comparison is the that which persons describe when they are "born again" in a peak religious experience. The process is a reality but, since I have never experienced it, I cannot describe it. The patients know what it is, they know they are "one" and they intend to stay that way. All sorts of subtle and not so subtle changes occur, all for the better. The patients are a delight to have around, they are considerate of others, they start taking care of their physical health for a change. They are more productive at work. Their personal cleanliness improves. They no longer get into sadomasochistic games with people. They become independent and no longer ask for hospitalization. It is really a lovely state of affairs, at least for a while. 8. Spiritual Fusion If, after several months, the patient has faced and coped with all the old problems which have been now presented in new dress, the "School of Hard Knocks" has a graduation ceremony called Spiritual Fusion. This occurs imperceptibly, as it is the blending of the ISH with the original personality. As a result of the patient always listening to the ISH and following its advice, the two become as one, and thus occurs the same sort of integration the therapist has had in his head all the time. There may have been created in the patient more than one ISH. If so, the integration will occur at the lowest level first. The second level ISH will still be available to the patient and therapist. There may be a different type of emotional and mental growth needed before this second level ISH can be integrated. During this time, however, the patients are not likely to be in regular psychotherapy, but will be learning from the usual support and educational groups in the community. They go to work, attend school, join Alcoholics Anonymous, go to church, and otherwise learn how to cope from successfully coping people. 9. Post Fusion Experiences During this time, the patient continues to face problems, as do all of us, but is coping in a more effective way. Old legal problems may still have to be faced. Marriages may be broken and child custody battles fought. The therapist will have to shift into a new role. The patient may leave town to start a new life, keeping the therapist informed by mail. Some patients will be personal friends of the therapist thereafter. Others will drop out of sight, to lead the life appropriate to their basic character. CONCLUSION Whatever the result, neither the patient nor the therapist will ever be the same again. The patient has found what had never been expected--mental health, a phrase which had no meaning before it was a reality. And what did the therapist get out of it all, besides the fee? If my experience is any guideline, we therapists had our eyes opened to the. unconscious mind in a way few people have. We saw both the heights of glory and the depths of degradation to which a human can reach. We saw the healing power which resides in our universe and in each individual in that universe. We, ourselves, became a small part of that healing force. In doing so, we found out a lot more about ourselves than we ever thought was there. Some of it scared us, and some of it worried us. Some we found we had to change. But most of it we found we could be proud of, just as we were proud of our patient, the fused multiple personality. REFERENCES ALLISON, R.B. A guide to parents; How to raise your daughter to have multiple personalities. Family. Therapy, 1974, 1, 83-88 ALLISON, R.B. A new treatment approach for multiple personalities. American Journal of Clinical Hypnosis, 1974, 17, 15-32. (a) ASSAGIOLI, R. Psychosynthesis. New York: Viking Press, 1965. Pp. 18-19. BOWERS, M.K. & BRECHER, S. The emergence of multiple personalities in the course of hypnotic investigation. Journal of Clinical & Experimental Hypnosis, 1955, 3, 188-199. DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (Third Edition), Washington, DC: American Psychiatric Assn., 1980. HAWKSWORTH, H. & SCHWARZ, T. The five of me. Chicago, Regnery, 1977. JUNG, C.G. Memories, dreams, reflections. New York: Random House, 1965. Pp. 44-46, 183-184, 225. KAMPMAN, R. Hypnotically induced multiple personality: An experimental study. International Journal of Clinical & Experimental Hypnosis, 1976, 24, 215-227. LUDWIG, A.M., et al. The objective study of a multiple personality. Archives of General Psychiatry, 1972, 26, 298-310. MITCHELL, J.K. Medical repository. 1815. ODENCRANTS, G. Hypnosis and dissociative states. In LE CRON, L. (ed.), Experimental hypnosis. New York: Citadel Press, 1968. P. 419 Page 32 PRINCE, M. The dissociation of a personality. London: Longsman Green, 1913. SCHREIBER, R.F. Sybil. Chicago: Regnery, 1973. SIZEMORE, C.C. & PITTILLO, E.S. I'm Eve. Garden City, New York: Doubleday, 1977. STOLLER, R. Splitting: A case of female masculinity. New York: Pentangle, 1973. SUTCLIFFE, J.P. & JONES, J. Personal identity, multiple personality, and hypnosis. International Journal of Clinical & Experimental Hypnosis. 1962, 10, 231-269. TAYLOR, W.S. & MARTIN, M.F. Multiple personality. Journal of Abnormal Social Psychology, 1944, 39, 281-300. THIGPEN, C.H. & CLECKLEY, H. A case of multiple personality. Journal of Abnormal Social Psychology, 1954, 49, 135-151. YOCHELSON, S. & SAMENOW, S.E. The criminal personality, volume I: A profile for change. New York: Jason Aronson, 1976, pp. 376-381.



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