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Both MPD and DID Should Be Listed In the Next DSM As Labels for Two Quite Different
Groups of Patients with Alter-Personalities
By
Ralph B. Allison, M.D.
PO Box 957
Paso Robles, CA 93447-0957
805/237-2665
ralfalison@charter.net
Presented at the meeting of the
International Society for the Study of Dissociation
at
Toronto, Ontario, Canada
November 7, 2005
Abstract: Extensive clinical practice with dissociators has shown that there are two distinctly
different groups of patients who have bona fide alter-personalities. The group for which MPD is
an appropriate label created their first alter-personality before the age of six, have no resident
Original Personality, and manifest dozens of alter-personalties. The group for which DID is
appropriate created their usually single alter-personality after the age of six, have a resident
Original Personality, and are usually quite socially able. Criteria for both MPD and DID will be
presented, along with some theoretical underpinnings of this point of view.
In 1972, while in private psychiatric practice in Santa Cruz, California, I identified my
first patient with Multiple Personality Disorder (MPD). She was a clone of Eve, so I was able to do
this, since I had no formal education on the subject of the dissociative disorders. All I knew at
the time came from seeing the movie, "The Three Faces of Eve." At that time, DSM II called it
"Personality trait disorder, dissociated (hysterical), multiple personality."
In 1974, I wrote my first paper describing this patient, "A New Treatment Approach To
Multiple Personality." Her most significant difference from Eve was her dissociated "Inner Self
Helper" or ISH, something I spent the next several decades trying to understand.
In 1987, I presented a paper in Ottawa called "Maybe Multiples in Courts and
Corrections." This was my first attempt to tease out the differences between those outpatients of
mine who dissociated and the dangerous felons I was evaluating for murder trials. The felons
presented "other selves" which committed heinous crimes, and I just could not accept that they
had the same problem as did my office patients with MPD.
In 1996, in "The Allison Manifesto on MPD and DID," presented in Budapest, Hungary,
I laid out how I thought the felons and my patients differed in what they showed as "other
selves" and distinguished two groups of patients with bona fide alters, but which were created at
different ages under different situations.
Now I am trying again to present what I consider a valid point of view which differs from
the present tendency to consider all persons showing "other selves" to be dissociators, and
therefore all fitting into a one group we call Dissociative Identity Disorder (DID).
During my earlier years in practice, DSM III was published, and MPD was recognized as
a "real disorder" by being given its own code number. We clinicians were all delighted.
However, a backlash occurred, and, in the mid 1990's, DSM IV was produced, and MPD
was banished, to be replaced by DID. This was a political compromise, since many academic
psychiatrists and psychologists thought MPD to be impossible to have. As one told me, "We all
are born with one personality. Therefore, it is impossible for anyone to have multiple
personalities." He just didn't understand how these patients came to be the way they were.
Plato and Aristotle believed each human has a "rational soul" and an "irrational soul."
Western philosophers have long spoken of each of us being made of "body, mind, and spirit." I
agree. The problem is semantic, as we have not yet agreed on single terms for the "mind"
(Plato's irrational soul) or the "spirit" (Plato's rational soul). For purposes of this talk, I will use
the term "Personality" for the mind and "Essence" for the spirit.
When DSM IV was published, I decided not to use DID for all former MPD patients of
mine, as it was semantically incorrect. But I decided to appropriate DID to apply to a select
number of my patients who clearly fell into a different group from those whom I still felt
deserved the diagnostic label of MPD.
Now I will describe and compare each clinical group. First, one must recognize that
dissociators who make bona fide alter-personalities (alters) do so as a protective, survival
mechanism. One also must understand that each alter is like a computer program, created and
designed by the Essence to work on behalf of the Personality. Therefore, it is involuntarily made,
from the point of view of the Personality.
For a person to have MPD, the following factors are needed:
1. Predisposing factor: Grade V hypnotizable child (top 4% of the population) younger than
age six.
2. Precipitating factor: Experiences life threatening trauma, usually in parental home, before
the age of six.
3. Continuing factor #1: Polarized parents, with one seen as bad and the other as good and
potentially protective, but the parents keep changing roles. Therefore, rescue is
impossible.
4. Continuing factor #2: Polarized siblings. Only this child is so badly abused by her
parents. Other children are treated much better.
For a person to have DID, the following factors are needed:
1. Predisposing factors: Hypnotizability in the upper half of the population, age six or older.
2. Precipitating factors: Trauma which need not be life threatening, but is of such a nature
that the child has had no training to know how to handle it. Typical traumas are rape for
girls and physical assault for boys.
3. Continuing factors: No adult is available to teach the child how to cope with this specific
stress.
To develop the MPD syndrome, the first dissociation is the separation of the Essence
from the Personality at the time of the life threatening trauma. This causes the Essence to take on
the job of ISH, which is equivalent to Disaster Control Officer. The ISH immediately sends the
Original Personality off to somewhere safe. She, the Original Personality, will not return until it
is safe to do so. The ISH then makes and programs the first alter, a False Front Alter, so as not to
anger the abusing parent. Otherwise, the parent might kill the infant. Since the False Front Alter
is not programmed to handle anger, when further abuse does cause anger, the ISH then creates
another alter who can handle anger, which I called the Persecutor Alter. When the Persecutor
Alter makes a mess, the ISH makes a Helper Alter to clean it up. The process goes on and on, so
dozens of alters are formed over time, each for a specific survival function.
The resulting person comes for therapy in her twenties, brought in by her eldest False
Front Alter, pushed by her ISH, and accompanied by numerous alters. No Original Personality is
at home in her body.
The development of the DID syndrome begins when the first dissociation is at age six or
later, due to a rape or physical assault. One alter is created by the Essence, which does not
dissociate from the Personality. This single alter is designed to deal with this one type of trauma.
Assault to a boy will lead to a violently protective alter. Rape to a girl will lead to a sexually
aggressive alter who wants to use sex in order to control men. The Original Personality is home
in the body and may proceed with social and educational development. The Original Personality
comes in for therapy, accompanied only by one alter.
The therapy approaches for the two groups are different. With patients with MPD,
hospitalization for suicide attempts is often needed. Outpatient hypnotherapy with age
revivification is the most efficient method of treatment. Only the angry Persecutor Alters need
"treatment" so that they become willing to give up their "anger-energy." The other alters need
social work and encouragement to cooperate with each other. When all the anger-energy is gone,
the Original Personality is allowed back into the body by the ISH, who then supervises the
Psychological Integration of the alters into the Original Personality. When this psychologically
integrated patient has enough experience solving problems using non-dissociative methods, the
ISH/Essence integrates into the Original Personality, a process called Spiritual Integration.
During treatment of DID, the Original Personality is in charge. He has to learn to cope in
an adult manner with the type of trauma he could not handle in his youth. Education in coping
skills is needed so the Original Personality can grow and assume all the duties of adult life. The
alter atrophies with disuse and integrates into the Original Personality when no longer needed.
There are many variations on this theme. One important fact to remember is that
"IMAGINATION IS NOT DISSOCIATION." Dissociation has become a favorite buzz word in
psychology to cover many mental processes which can be otherwise explained. Dissociation is a
survival mechanism, as when used to create alters. The process involves the ISH getting the
native personality traits out of what might be called the patient's "Personality Parts Warehouse"
so that another alter can be created from them. Therefore, the alter will be able to integrate into
the Original Personality at a later date. All the pieces of the jig saw puzzle came from the same
box, so to speak.
There are at least two types of imagination, Inspirational and Emotional. Inspirational
Imagination is used by the Essence and the Personality to create great works of art and valuable
inventions. It is the most powerful ability of the human mind.
But the Personality can also use Emotional Imagination. One-third of college students
report having had a childhood imaginary playmate. When lonely, they used their Emotional
Imagination to create a wonderful playmate. When they went to school and had human friends,
they mentally destroyed it.
One man on trial for murder had created an Internalized Imaginary Companion (IIC) at
the age of four when his mother's boyfriend locked him in a closet while the boyfriend sexually
abused the boy's sisters. Consumed with hatred of this man, the boy created an IIC whose goal
was to kill the man. But, at the age of four, he couldn't do much about it. But 20 years later, he
killed an innocent victim, an act for which he was subsequently sent to Death Row.
So great confusion can develop when one of these persons commits an antisocial act and
then shows "another self" to explain what happened. "It's not my fault; Joe did it." Such people
are too often thought to have DID, since the current DSM IV does not provide any way to
discriminate between a product of dissociation (an alter) and a product of emotional imagination
(an IIC). In reality, they are very different.
Alters are designed for survival of the person. Attacking others is not a good survival
mechanism, as police sometimes shoot them, and Death Row is still operating in most states.
Alters are always under the ultimate control of the ISH who created them, but IIC are under no
control by anyone and have no social judgement or conscience.
Both IIC and alters can be designed to hold hostile emotions. IIC are created by the
Personality to manage otherwise unmanageable emotions. Alters are created by the ISH to
handle anger the False Front Alter was not designed to manage. However, alters are angry at
someone who maliciously attacked them personally. IIC are often made because of the child's
anger at some adult who displeased or angered them in some way, but who did not really
endanger them.
Alters who behave badly can be recalled from duty by the ISH and reprogrammed. IIC
who behave badly have no conscience or social judgement. They can be extremely dangerous as
they are under no one's control. They are like military "smart bombs" as they have a hefty
payload of explosives but only a simple targeting mechanism with no recall method.
Alters can be reformed by the removal of their anger-energy, and they then become
Helper Alters. They have a structure which stays intact. IIC who give up their anger-energy
disappear. They were "only anger" in the first place. They have no structure.
Alters will stick around in the background and can be called out under hypnosis. They
cannot be destroyed by an act of will of the patient. IIC can be destroyed by an act of will of the
patient. This often happens voluntarily when the cost/benefit ratio tips too far in the direction of
cost. Once the insanity phase of the murder trial is over with, the IIC is nowhere to be found in
the convicted felon, even when sought for under hypnosis.
Unfortunately, combination cases occur all to frequently. Hypnotizability is a life-long
trait we all have to varying degrees. We all range from zero to Grade V. I am about a Grade II. A
Grade V hypnotizable person has a certain set of personality characteristics, one of which is
being an "emotional albino." They are highly sensitive to the moods and emotions of all those
around them. So they are easily hurt emotionally, even when no intent to do harm exists in the
other persons.
The ability to use emotional imagination readily and often is called Fantasy Proneness.
Research has shown that hypnotizability and fantasy proneness are not coupled together. One
may be high on one trait and low on the other, low on both, or high on both. When we therapists
face a patient who is high on both traits, we are seeing a patient who is the challenge of our
career. They have certainly livened up my professional life, by creating chaos and confusion in
my mind.
It is highly possible for a person with MPD, who has made dozens of alters, to also create
any number of IIC. This is because she is both Grade V hypnotizable and highly Fantasy Prone.
One of these patients of mine decided to punish her husband by making a couple of new
"other selves" every night, just to bedevil him. When she showed them in my office the next
day, I wasted our therapy time trying to deal with them, thinking they were new alters. Finally, I
wised up and realized that they were IIC she deliberately created via emotional imagination, to
pay back her now-reformed husband for all the beatings he had given her in the early days of
their marriage. I told her to "Turn off the Barbie Doll factory," and she did, solving that problem.
This combination of having both alters and IIC acting up is a common situation with
patients with MPD. Knowing which is which is essential so the therapist can intelligently decide
what to do next. Each one requires a different approach. If in doubt, the therapist can always ask
the patient's ISH, who knows the identity of each and every psychic entity in that patient's mind.
Summary
MPD and DID can both be used as labels for two quite separate groups of patients who
manifest bona fide alters. But we should apply neither label to those who use emotional
imagination to create other entities who can inhabit their bodies.
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