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Ralph B. Allison: WHEN THE PSYCHIC GLUE DISSOLVES Dr. Allison har i flera †r arbetat intinsivt med sidopersonligheten och dess problematik. Han har utvecklat ett diagnosschema och en metod f”r behandling av multipla personligheter, d„r hypos anv„ndes som ett hj„lpmedel. Dr. Allison, som nyligen bes”ke Sverige f”r att undervisa p† tre†rsutbildningarna, anser att denna typ av str”rning „r betydligt vanligare „n vad som ordin„rt beskrives i den psykiatriska litteraturen. I denna artikel, som „r den f”rsta i en serie, tar Dr. Allison upp de faktorer, som kan utl”sa upptr„dandet av en sidopersonlighet, och diskuterar i f”rsta hand risken att en helt vanlig hypnossession, med vilket syfte som helst, kan fungera p† detta s„tt med m„nniskor, som redan har en latent liggande sido-personlighet. The psychological disorder known as multiple personality occurs in persons with an extremely hysterical character disorder. Hysterics are those who predominantly use the defense mechanisms of repression, denial and dissociation. Any psychological trauma is so poorly tolerated that they unconsciously repress both memory and emotions relating to such events. They then wall these off from the rest of their consciousness, creating the nucleus for an alter-personality. If the trauma is extreme, such as a rape, one incident may be adequate to create an alter-personality whose interest is in manipulative sexual behavior. If the insult is minor, such as a disparaging remark about good grades in school, then it may take a long series of such insults to generate enough resentment and hurt feelings to energize an alter-personality. As a result of 5 1/2 years experience treating 39 such patients, I have come to the conclusion that those individuals who have the capacity to spontaneously create alter-personalities from the wear and tear of life alone form a specific group. The rest of us cannot do it, although we may be able to do something similar in an experimental situation. These individuals seem to have a very weak ''psychic glue'' holding their various parts together, and, therefore, they will split into segments under circumstances which would not do more than emotionally upset the rest of us. This characteristic may be called ''poor ego strength'', ''lack of guts'', "put together with poor protoplasm'', or other such phrases, but it seems to be a reality. They just do not have the psychological strength to take life's blows without splitting apart. My experience has shown that there are four important stimuli which may bring about the dissolving of this ''psychic glue'' and make manifest already existing alter-personalities. The first is extreme emotional trauma, such as rejection by lover or parent. The second is extreme physical pain, combined with the unwillingness of medical staff to offer physical and emotional support. The third trigger is alcohol. This is the most dissociating chemical readily available, and one which causes blackouts and personality changes in many non-hysterics. And the last stimulus is an hypnotic induction for any reason, be it smoking control, weight reduction, or sexual problems. It is to this last item that I would like to pay some attention, since it seems to have escaped notice, at least as reflected in the literature and in the statements of those who regularly give courses in hypnosis. That is not surprising, since reports of patients with multiple personality are rare in the literature, so not much has been written about how they might come to light. There also may be a time lag from the moment of the hypnotic session and the overt appearance of an alter-personality, so the hypnotist may be totally unaware he/she had any such effect on a person who came to him/her. One thing must be emphasized. All such patients have been very emotionally disturbed since early childhood. They have shown such symptoms as depression, suicide attempts, narcotic abuse, somatic conversion symptoms, poor impulse control, and alcoholism. The hypnosis session did not, of course, cause any of these symptoms, anymore than it caused the alter-personality to be created. What hypnosis, being induced dissociation, can do, is to so weaken the ''psychic glue'' that the patient no longer can keep up the facade of integration and the alter-personalities become more free to act independently of the primary personality. A few case examples are offered to illustrate the phenomenon. 1. Mrs. A., age 50, came to Dr. J. for hypnosis because of compulsive smoking. She suffered from emphysema and could not reduce her cigarette usage to below 50 cigarettes a day. She was an easy hypnotic subject and Dr. J gave instructions in self hypnosis to help her take better care of her lungs. That evening, Dr. J was called by phone by a female voice saying she was going to stop Dr. J from dealing with Mrs. A since he might find out about ''her''. In a moment, Mrs. A came on the line and , hearing Dr. J's voice, asked why he had called her. He recognized he had been talking to an alter-personality, arranged for her to see me immediately and we hospitalized her. Over the years of subsequent therapy, she showed a number of alter-personalities created during a miserable childhood. 2. Mrs. B. age 26, had separated from her husband after hospitalization for functional abdominal pains. She moved to another town, and lived with a boy friend who was a college psychology major who dabbled in hypnosis. He hypnotized her one evening and she promptly manifested six different alter-personalities. He took her to a psychiatrist the next day. He saw her until she reunited with her husband and transferred her to my care. Therapy showed that the alter-personalities had existed since preadolescence. With great difficulties, she finally integrated all her personalities. 3. Mrs. C, age 25, was seen with her husband, by Dr. J, for help with her frigidity. Under hypnosis, Dr. J attempted to find the cause of her resistance to sexual approaches by her husband. He found an alter-personality who had been developed to cope with Mrs. C's brothers and considered all men enemies. Dr. J referred her to me where outpatient therapy with the couple brought about the discovery of the original personality and the elimination of the alter-personality. The sexual problem disappeared with the disappearance of the alter-personality. 4. There is another patient, Mrs. D, age 30, whom I saw for several years because of multiple personality and a very heavy drinking and barbiturate abuse. I had seen her first, a year before treatment started, in jail for the purpose of preparing a legal report, since she had been caught writing bad checks. She claims that I hypnotized her lightly during that interview, but I do not recall doing so. During therapy, she told me that that hypnotic induction, for history clarification only, had been the point where she had begun to lose the tenuous control she had over her very negative alter-personalities, and her life had really gone to pieces after that. I do know that at the beginning of the therapy, I deeply hypnotized her to try to find the best helper personality in her, since she was not able to cooperate with anyone and was drinking herself into a stupor frequently. I saw a new personality who claimed her favorite hobbies were to have sex and get drunk. And, after leaving my office, she proceeded to do just that. That patient never did improve and is now a chronic alcoholic. I include this one became she was very open with me about the causes of her problems, and even though I am not sure if I induced hypnosis in the jail, if I did, she shows the time lag that can occur, with progressive loss of control over the coordination of the various aspects of her personality. CONCLUSION By stating that I believe a single hypnotic session can make manifest the alter-personality in a person who has already created them, I do