Print

  

    

  
  
  

    

    
Topics




    
Dual Personality, Multiple Personality, 

    Dissociative Identity Disorder - What's in a Name?  
When I diagnosed my first case
    of MPD in 1972 (Janette in "Minds In Many Pieces"),
    I had had no professional training on the subject. I went to the Stanford Medical Library
    to look up articles on the subject since no computerized databases existed then. The book
    called "Index Medicus" was the only place one could start searching for
    published articles. There I found the listing of "Dual Personality." 
    
In the 1970s, when I started meeting with other therapists of "multiples"
    (the term we all came to use for patients with MPD), we informally agreed to call the
    disorder "Multiple Personality Disorder" or MPD for short. I wrote to the
    editors of the Index Medicus to ask them to add Multiple Personality Disorder to the
    subject headings, and they did that. 
    
At that time, a small group of us therapists were struggling with these patients, and
    we created our own networking methods. I published a newsletter, "Memos On
    Multiplicity," for one year as my way of trying to let such therapists know where
    fellow adventurers in this field were. 
    
Eventually, the interest moved from the solo practitioner's office to the academic
    halls of learning. Some practitioners had teaching appointments in graduate schools where
    their opinions about MPD were not always greeted with acceptance. After all, the accepted
    dictums stated that people only were allowed one personality per body. Anyone claiming to
    have patients with two or more personalities had a difficult task convincing those in
    academia that such was possible. 
    
This conflict of views between those therapists dealing daily with dissociated patients
    (some exhibiting dozens of alter-personalities,
    or "alters") and academic teachers who spent more of their days teaching and
    doing research than actually treating severely ill patients, came to a boil with the need
    to revise DSM III. 
    
DSM I (Diagnostic & Statistical Manual of Mental Disorders, Version I) was created
    after WWI to provide a framework for labeling post-war psychiatric causalities. DSM II was
    written after WWII for the same purpose. Remember, these were written in the USA by
    American psychiatrists. However the same terms were accepted by the editors of the
    International Code of Diseases (ICD) through its present 9th edition. 
    
When I met my first multiple, DSM II was in use. MPD was then a minor label under
    "Hysterical Dissociative Disorder." It did not even have its own code number. 
    
DSM III was created while I was in the middle of my practice years. It recognized MPD
    as existing, gave it a code number, and defined its characteristics. We who treated these
    patients finally had found a degree of acceptance in officialdom. "If it is listed in
    here, it must exist." 
    
Then the backlash began. There had always been doubters that such a disease really
    existed, and my struggles with critics are chronicled in "Minds
    In Many Pieces." Personally, I had withdrawn from public debates on the matter to
    deal with private matters, so I only know indirectly about the political battles behind
    the scene during the formulation of DSM IV, the current edition. 
    
The field of "Dissociative Disorders" now had its own section. A committee of
    experts was appointed to decide what disorders should be listed in DSM IV. It was hoped
    that DSM IV would also be the psychiatric section of the new ICD-10, then in progress. 
    
The committee was composed of two groups, psychiatrists whose primary role was as
    therapists and those whose primary roles were teaching and research. The therapists wanted
    to keep MPD much as it was in DSM III. The teachers wanted to eliminate MPD altogether,
    and replace it with "Dissociative Identity Disorder" or DID. I heard one of
    these teachers say in public, "Everybody is born with only one personality.
    Therefore, there can be no such thing as a Multiple Personality Disorder." 
    
With this belief system, the teachers could not agree that MPD could be an accurate
    label for anyone. The treaters on the committee did not know how to explain that, in
    practice if not in theory, their patients acted as if they had other personalities. The
    teachers decided that the patients had the major mental problem of believing that they had
    more than one personality. The goal of therapy should not be integrating the various
    personalities, but getting the patients over their false belief (delusion) that they had
    other personalities at all. (Since I was not present for the deliberation, these ideas are
    only reasonable conclusions from what I heard from others who were there and position
    statements published about the debate.) 
    
So the patients still had a problem, but it was redefined as a different problem than
    the one their therapists were treating them for. Instead of therapists trying to integrate
    "alters" into an original personality, they should now focus their attention on
    the patients "delusion" that they did not have a single identity. Now the
    teachers expected the treaters to treat the patients' "identity disorder," as no
    one could really have multiple personalities. 
    
When the decision was reported out of committee, the teachers had won, and MPD suddenly
    ceased to exist. Now all our multiples had Dissociative
    Identity Disorder or DID. 
    
However, the editors of the ICD did not accept DSM IV as their section on Mental
    Disorders. In the newest printing of ICD-9, they did add "Dissociative Identity
    Disorder" below MPD as a synonym. So, in the world outside the USA, MPD still exists.
    Only in the USA have all multiples been told they have a false belief that they have
    alters running their bodies. 
    
But I know that, in the case of MPD, the patient's Original Personality (yes, teachers,
    the only one they have) goes "into hiding" at the time of a life threatening
    assault before the age of seven. Therefore, there is "no one home" to have the
    Disorder of Identity. The Original Personality is the only one capable of having such a
    "false belief," but she is not in executive control of the body or participating
    in social life at all. But the Allisonian ISH I met in these patients had created all
    sorts of alters to run the body in the absence of the Original Personality. Therefore, I
    could not honestly give up the accurate label of MPD and substitute an inaccurate label of
    DID. 
    
But, I had met other dissociating patients who were of the "dual personality"
    type. They had never shown an ISH, and they manifested far fewer alters. Could I apply
    this new label to them? Yes, I decided I could. 
    
So, personally, I came to realize that both MPD and DID can be considered accurate
    labels, but for two different groups of dissociators. Here is how I now use these acronyms
    in my writings. 
    
The key differentiating criteria is the age of the first dissociation, with the seventh
    birthday being the approximate cut-off point for MPD, and the earliest date for DID to
    appear. This is the age the child's mind must mature to so that it can "hold it all together" when severely traumatized.
    After age seven, it may dissociate and form alters, but it will not dissociate into its
    two component parts, the Intellectual Self
    (ISH/Essence) and the Emotional Self
    (Original Personality). 
    
The concept that the human mind originally consists of two parts is not a clear part of
    American/European psychological theory. Root words to express this concept do not exist in
    European languages. Again, "if we don't have a word for it, maybe it doesn't
    exist." 
    
But I learned from my foreign friends that root words for these two parts of the mind
    do exist in Middle Eastern and Oriental languages. My favorite is Japanese, which calls
    the Intellectual Self the "Risei"
    and the Emotional Self the "Kanjou."
    The Japanese recognize that we are constantly switching from being controlled by our Kanjou and being controlled by our emotions, to
    letting our Risei take over to solve our
    problems rationally. 
    
In TV "literature," the same story is repeatedly played out by "Mr.
    Spock" on the original Star Trek series. Leonard Nemoy played the role to the
    Intellectual Self very well. He sounds close to the way the ISHs talked to me when I was doing therapy
    with multiples. In "Star Trek, The Next Generation," Lt. Cmd. Data, an
    "android," plays the same role. In one show, he shows what happens when emotions
    are added to his brain with the insertion of a new chip, which makes him able to emote for
    the first time. 
    
Now, after learning how dissociation occurs in a human before age seven, I realized
    that all humans have a bipartite mind (not to be confused with a two-hemisphered brain).
    When the mind is integrated, as is the usual case, it might be analogized as a coin with
    two faces, Heads and Tails. The Emotional Self
    (Kanjou) is the Tail side and the Intellectual
    Self (Risei) is the Head side. Normally, we are operating somewhere between 99%
    intellectually and 99% emotionally. Both are there, ready to be used. Neither one is good
    or bad. How much we use of which one depends on the situation and the goal we have at the
    time. 
    
To avoid unwarranted assumptions, I wish to note that, for trauma to split (dissociate)
    the Risei from the Kanjou, it requires certain preconditions to be
    present. Just being traumatized before age seven will not always cause the child to
    develop MPD. In other types of people, in different settings, the same trauma may cause
    other types of psychopathology. The situation is not that simple. 
    
Yes, there must be life threatening trauma before the age of seven for anyone to
    develop MPD. But another condition is that the Emotional Self (aka Birth Personality, Original Personality, Kanjou) must be Grade V hypnotizable on the
    Stanford Scale. The ability to age regress by revivification is a trait needed to qualify
    one for being in Grade V. This ability is invaluable in participating in effective
    therapy. 
    
Grade V hypnotizability is a characteristic of the Emotional Self and is a trait given to it at
    birth. This trait is accompanied by other characteristics, such as psychic abilities,
    exquisite sensitivity to the emotions of others, fantasy proneness, flamboyance, and
    "hysterical" traits of all kinds. 
    
In women, this may be seen as typical hysterical female behavior (pardon the sexist
    connotations). In men, the same traits may be seen as antisocial behavior. In American
    society, girls learn to internalize their problems, and boys learn to externalize them. So
    women with MPD tend to develop emotional and physical problems, while the men tend to act
    out antisocially. 
    
Another factor needed to bring about MPD is polarization of the parents, the usual
    caretakers of infants. One parent is seen by the child as good and the other as bad. What
    often happens is that the parents flip from role to role. But if the parents are together
    in matters of discipline, MPD will not be likely to occur. Usually one parent is the
    primary abuser, while the other one screams or deserts. The non-abusive one does not
    rescue the child or the damage could have been reversed. 
    
The other factor needed for MPD is polarization of the siblings. This child must be the
    only one in the family to be abused. This child was seen as "different" from the
    other children, and therefore somehow "deserving" of abuse the other children
    did not get. "Equal Opportunity Abuse" is bad enough in its own right, but it
    creates in the children a different clinical picture. 
    
So, in our view, MPD is still a valid diagnosis for a clinical picture, but it requires
    these preconditions: 

      
1. Life threatening trauma before the age of seven. (Minor trauma is not enough.
      The child must fear for his or her life.) 
      
2. Grade V hypnotizable Emotional Self. 
      
3. Polarized parents - one good and one bad. 
      
4. Polarization of siblings. Only this one is abused. The others are treated
      decently.
    
    
What does this produce clinically? 
    
The first effect is dissociation of the Intellectual
    Self from the Emotional Self. The
    Intellectual Self (aka Essence, Risei) then sends the Emotional Self (aka Original
    Personality, Kanjou) into hiding somewhere in Thoughtspace,
    so the Original Personality abdicates
    executive control over the physical body. 
    
The Essence takes on the role of Inner Self
    Helper (Damage Control Officer) and has to go to work making the first False-Front Alter-Personality to run the body.
    The ISH designs and programs all alters to do whatever is necessary to keep the child
    alive. 
    
Each alter is designed to do a job and
    only that job. It is endowed with characteristic traits which the Original Personality
    would have taken on, if it were in charge. The situation can be viewed as operating a doll
    factory, with only the outfits of clothes being produced. The doll, itself, is not
    present. The alters are the sets of clothes, but there is no doll inside any of them.
    Therefore, they cannot grow and change. They can only do what the ISH has programmed them to do. 
    
There is no way that this condition can be called "Dissociative Identity
    Disorder." There is no Original Personality
    to have any disorder. The ISH is busy
    making alters to run the body. The Original
    Personality has been removed from executive control. There are multiple personalities
    alternating control of this body, awaiting the end to the abuse and the arrival of a
    therapist who can work with the ISH to
    bring the Original Personality back in charge. This is truly MPD. 
    
So, when is DID an appropriate diagnosis? When the trauma occurs after the age of seven
    to a highly hypnotizable person. Then there is no dissociation of the Intellectual Self from the Emotional Self. The Emotional Self (aka Original
    Personality) is still in charge and available to have an Identity Disorder. 
    
The social situation is different, as the child is now often out of the parental home
    and in school. The abuser is often someone outside the birth family. The trauma situation
    need not be long lasting or life threatening, more likely some situation the child was too
    immature to cope with. One of my cases of "dual personality" was created by the
    rape at age 9, by a cousin. The girl created an angry female alter who became a
    prostitute. She used sex to humiliate and control men, like her Original Personality had been humiliated by her
    cousin. This woman could well be said to have a Dissociative Identity Disorder. 
    
Treatment would be effective if she, the Original
    Personality, learned better ways of handling sexually abusive men and other
    humiliating situations. She would need to learn better ways of coming to grips with the
    sexual conflicts she had. If she succeeded, her prostitute alter would become obsolete and
    might "die" of disuse atrophy. This clinical course is much different from that
    seen with someone who had MPD, as we have defined it  here. 
    
To provide you with the official definition of DID, here is what it says in DSM IV: 

      
300.14 Dissociative Identity Disorder (formerly Multiple Personality Disorder) 
    
    
Diagnostic Features 
    
The essential feature of Dissociative Identity Disorder is the presence of two or more
    distinct identities or personality states (Criterion A) that recurrently take control of
    behavior (Criterion B). There is an inability to recall important personal information,
    the extent of which is too great to be explained by ordinary forgetfulness (Criterion C).
    The disturbance is not due to the direct physiological effects of a substance or a general
    medical condition (Criterion D). In children, the symptoms cannot be attributed to
    imaginary playmates or other fantasy play. 
    
Dissociative Identity Disorder reflects a failure to integrate various aspects of
    identity, memory, and consciousness. Each personality state may be experienced as if it
    has a distinct personal history, self-image, and identity, including a separate name.
    Usually there is a primary identity that carries the individual's given name and is
    passive, dependent, guilty, and depressed. The alternate identities frequently have
    different names and characteristics that contrast with the primary identity (e.g., are
    hostile, controlling, and self-destructive). Particular identities may emerge in specific
    circumstances and may differ in reported age and gender, vocabulary, general knowledge, or
    predominant affect. Alternate identities are experienced as taking control in sequence,
    one at the expense of the other, and may deny knowledge of one another, be critical of one
    another, or appear to be in open conflict. Occasionally, one or more powerful identities
    allocate time to the others. Aggressive or hostile identities may at times interrupt
    activities or place the others in uncomfortable situations. 
    
Individuals with this disorder experience frequent gaps in memory for personal history,
    both remote and recent. The amnesia is frequently asymmetrical. The more passive
    identities tend to have more constricted memories, whereas the more hostile, controlling,
    or "protector" identities have more complete memories. An identity that is not
    in control may nonetheless gain access to consciousness by producing auditory or visual
    hallucinations (e.g., a voice giving instructions). Evidence of amnesia may be uncovered
    by reports from others who have witnessed behavior that is disavowed by the individual or
    by the individual's own discoveries (e.g., finding items of clothing at home that the
    individual cannot remember having bought). There may be loss of memory not only for
    recurrent periods of time, but also an overall loss of biographical memory for some
    extended period of childhood. Transitions among identities are often triggered by
    psychosocial stress. The time required to switch from one identity to another is usually a
    matter of seconds, but, less frequently, may be gradual. The number of identities reported
    ranges from 2 to more than 100. Half of  reported cases include
    individuals with 10 or fewer identities. 
    
The Inner Self Helper (ISH) 
    
In my first case of MPD, I was introduced to a psychic entity who was normal, all
    knowing of personal history, and helpful to me in doing therapy. After I had met similar
    entities in other severely dissociated patients, I came to call it the Inner Self Helper
    or ISH. By following psychologically integrated patients for several decades, I learned
    what the ISH does after the disorder is corrected. It then prefers to be called the Essence of "my charge," another name
    for the Intellectual Self, Kanjou, or Hidden Observer of Hilgard at
    Stanford University. It has many useful functions. As a matter of fact, without it
    present, the person is in need of life support systems. 
    
But, during therapy of a patient with MPD, by my definition, the ISH is a highly
    necessary co-therapist to any ethical therapist, no matter how talented in psychotherapy.
    The ISH observes and intervenes on the inside while the therapist attends to matters on
    the outside. Between the two of them, effective therapy can be done in a much shorter
    time. In my most complicated case of MPD, it only took me three years of twice a week
    therapy to achieve integration of 70 alters into the Original Personality. With the time limitations
    of the public clinic in which I worked, only because of the guidance of the ISH did I get
    the integration done the day before I departed that employment. Therefore, I highly
    recommend therapists of true MPD patients should be happy to meet the ISHs in their
    patients and listen to what they have to say. Not to do so is like the surgeon ignoring
    the advise of his hospital's radiologist and laboratory pathologist. 
    
Characteristics of the Inner Self Helper (ISH) 

      
A. Prime Directive of the ISH is to keep patient alive until her Life Plan is
      completed and fulfilled. The ISH will prevent suicide in any way possible. 
      
B. Has no date of origin; has always been present. 
      
C. Can only agape love; is
      incapable of hatred. 
      
D. Has awareness of and belief in "The
      Creator." 
      
E. Is aware that the Celestial
      Intelligent Energy (CIE) put her in charge of teaching this person how to live and
      move forward properly. 
      
F. Is able to work on the inside of the patient's mind, as co-therapist, while
      the human therapist works on the outside. 
      
G. Knows all about history of patient and can predict short term future. 
      
H. Possesses no personal sense of gender identity, but will assume either gender
      the therapist is comfortable with. 
      
I. Talks intellectually instead of emotionally, carefully chooses precise words,
      speaks in short concise sentences; prefers to answer questions; gives enigmatic
      instructions. ("Teach her humility today.") 
      
J. Avoids using slang; does not have the capacity for put-downs or guilt-trips. 
      
K. Is aware of patient's past lifetimes. 
    
    


    

    

    

    Back to Homepage 
    

    


    Copyright © 1996 Ernest & Allen