Probably the most controversial of all psychiatric diagnoses, multiple personality disorder (MPD) has as its primary symptom the presence of two or more conscious identities in the same person, although only one is conscious at a time. Each identity is capable of controlling behavior. These other personalities are commonly referred to in the MPD literature as “alters,” and they are said to function independently of and usually without awareness of each other. The disorder also involves signiﬁcant amnesia without apparent brain damage, as the primary personality is usually unaware of the existence and activities of the alters. The number of alters varies in reported cases from as few as one to as many as several thousand.
Such an extreme dissociation requires fairly unusual circumstances to occur, and the consensus of the MPD treatment community is that severe, horriﬁc child abuse is usually involved, frequently involving cult ritual activities or sexual victimization. As a defense against such trauma, the child goes into hiding in his or her own mind, creating new personalities who are stronger and better able to cope with the stress and pain. All of this occurs unconsciously, of course, and the person is unaware of the existence of both the alters and the abuse until a therapist helps him or her to recover memories of both. This is the explanation of the disorder endorsed by the MPD community, but another, very different, explanation has entered the mainstream psychological research community: that MPD is an iatrogenic condition.
An iatrogenic (from Greek, literally meaning physician-induced) condition is one that exists as a result of treatment, unlike conditions that exist independently and require treatment. This is a strong claim, made in its most potent form by Nicholas Spanos in his book Multiple Identities & False Memories: A Sociocognitive Perspective. Spanos argues that MPD is “created by therapists with the cooperation of their patients and the rest of society.” There are several compelling reasons to accept this argument, among them the strong similarities between MPD cases and other cases of false memory syndrome: the clients typically have no memories of abuse when ﬁrst consulting the therapist, and only “recover” them following extensive therapy, which involves such controversial techniques as hypnosis and guided imagery. Once recovered, the memories usually prove impossible to corroborate and often contradict known information regarding the dates and alleged perpetrators. The typical patient also has no record of either reporting or manifesting alters prior to entering therapy. Most psychiatrists and clinical psychologists never see a single case of MPD, but a small handful see hundreds each in a single year. If a disorder is never seen in anyone who hasn’t sought therapy, and whether it appears depends on the therapist’s pre-existing ideas about the disorder, the iatrogenic explanation seems quite reasonable.
In addition to the therapist, Spanos also blames the cultural context. Indeed, the birth of MPD as currently understood can be traced back to a single successful book and television movie: Sybil. The book, by Flora Rheta Schreiber, appeared in 1973, followed by a very successful TV movie starring Sally Field in 1975. Prior to the book, a total of ﬁfty to seventy-ﬁve cases suggestive of multiple personalities had been reported by psychiatrists worldwide. Since the movie, there have been about 40,000 cases, almost all in North America. The woman known as Sybil (not her real name) died in 1998 at age 75, and since then a number of people involved with the case have come forward to reveal further details. When she ﬁrst approached her therapist Cornelia Wilbur, Sybil showed no symptoms of MPD and had reported no memories of abuse. In sessions that involved use of both hypnosis and sodium pentothal (ﬁlm buffs may recall its frequent appearance in old spy movies as “truth serum”—just the thing for enhancing suggestibility), Wilbur suggested giving names to her various emotional states to deal with her problems more directly. Some of this information comes from Herbert Spiegel, a therapist who met with Sybil as a substitute when Wilbur went out of town. He further reports a conversation with Schreiber as she prepared the book, in which he told her all of this and Schreiber responded that if she didn’t say that Sybil had multiple personalities, the book wouldn’t sell. All of this information is important in light of the fact that Sybil’s case was the one that established the currently accepted pattern of both symptoms and etiology, including the notion that severe abuse was involved, and it is still frequently cited as the classic case of the disorder.
Sybil was not the ﬁrst successful book or movie about MPD. That honor goes to The Three Faces of Eve, written by Corbett Thigpen and ﬁlmed with Joanne Woodward as Eve. That book/ﬁlm combination was much less inﬂuential on the therapy community and the public, perhaps because of its failure to provide a clear-cut and dramatic explanation for Eve’s disorder. Sexual abuse was not part of the story, and so it doesn’t ﬁt what has now become the classic proﬁle. The problems with the evidence for MPD, and with the therapeutic techniques involved in uncovering it, are severe enough that the DSM-IV changed the name of the disorder from MPD to Dissociative Identity Disorder (DID). This partly reﬂects the absence of a clear deﬁnition of what an alter is, and it partly reﬂects the skepticism in the psychological/psychiatric community regarding the existence of multiple personalities. Note that this is not meant in any way to ignore or dismiss the suffering of the clients with DID—the disorder is real and quite traumatic. The controversy is over how the disorder develops in the ﬁrst place, not over whether they now have a condition in need of attention.
- Borch-Jakkobsen, M. “Sybil: The Making of a Disease? An Interview with Dr. Herbert Spiegel.” The New York Review of Books, April 24, 1997;
- Spanos, N. P. Multiple Identities and False Memories: A Sociocognitive Perspective. Washington, DC: American Psychological Association, 1996.