Multiple Personality Disorder

What can events 100 years ago tell us about a modern disorder?

Students often ask me whether multiple personality disorder (MPD) really exists. I usually reply that the symptoms attributed to it are as genuine as hysterical paralysis and seizures, and teach us lessons already learned by psychiatrists more than a hundred years ago.

Consider the dramatic events that occurred at the Salpêtriére Hospital in Paris in the 1880s. For a time, the chief physician, Jean-Martin Charcot, thought he had discovered a new disease he called “hystero-epilepsy”, a disorder of mind and brain combining features of hysteria and epilepsy. The patients displayed a variety of symptoms, including convulsions, contortions, fainting and transient impairment of consciousness.

A skeptical student, Joseph Babinski, decided that Charcot had invented rather than discovered hystero-epilepsy. The patients had come to the hospital with vague complaints of distress and demoralisation. Charcot had persuaded them that they were victims of hystero-epilepsy and should join the others under his care. Charcot’s interest in their problems, the encouragement of attendants, and the example of others on the same ward prompted patients to accept Charcot’s view of them and eventually to display the expected symptoms. These symptoms resembled epilepsy, Babinski believed, because of a municipal decision to house epileptic and hysterical patients together (both having “episodic” conditions). The hysterical patients, already vulnerable to suggestion and persuasion, were continually subjected to life in the ward and to Charcot’s neuropsychiatric examinations. They began to imitate the epileptic attacks they repeatedly witnessed.

Babinski Vindicated

Babinski eventually won the argument. In fact, he persuaded Charcot that doctors can induce a variety of physical and mental disorders, especially in young, inexperienced, emotionally troubled women. There was no “hystero-epilepsy”. These patients were afflicted not by a disease but by an idea. With this understanding, Charcot and Babinski devised a two-stage treatment consisting of isolation and counter-suggestion.

First, “hystero-epileptic” patients were transferred to the general wards of the hospital and kept apart from one another. Thus they were separated from everyone else who was behaving in the same way and also from staff members who had been induced by sympathy or investigatory zeal to show great interest in the symptoms. The success of this first step was remarkable. Babinski and Charcot were reminded of the rare but impressive epidemic of fainting, convulsions, and wild screaming in convents and boarding schools that ended when the group of afflicted persons was broken up and scattered.

The second step, counter-suggestion, was designed to give the patients a view of themselves that would persuade them to abandon their symptoms. Dramatic counter-suggestions, such as electrical stimulation of “paralyzed” muscles, proved to be unreliable. The most effective technique was simply ignoring the hysterical behaviour and concentrating on the present circumstances of these patients.

They were suffering from many forms of stress, including sexual feelings and traumas, economic fears, religious conflicts, and a conviction (perhaps correct) that they were being exploited or neglected by their families. In some cases their distress had been provoked by a mental or physical illness. The hysterical symptoms obscured the underlying emotional conflicts and traumas. How trivial a sexual fear seemed to a patient in whom convulsive attacks produced paralysis and temporary blindness every day!

Staff members expressed their withdrawal of interest in hysterical behaviour subtly, in such words as, “You’re in recovery now and we will give you some physiotherapy, but let us concentrate on the home situation that may have brought this on”.

These face-saving counter-suggestions reduced a patient’s need to go on producing hystero-epileptic symptoms in order to certify that her problems were real. The symptoms then gradually withered from lack of nourishing attention. Patients began to take a more coherent and disciplined approach to their problems and found a resolution more appropriate than hysterical displays.

The rules discovered by Babinski and Charcot, now embedded in psychiatric textbooks and confirmed by decades of research in social psychology, are being overlooked in the midst of a nationwide epidemic of alleged MPD that is wreaking havoc on both patients and therapists. MPD is an iatrogenic behavioural syndrome, promoted by suggestion, social consequences, and group loyalties. It rests on ideas about the self that obscure reality, and it responds to standard treatments.

To begin with the first point, MPD, like hystero-epilepsy, is created by therapists. This formerly rare and disputed diagnosis became popular after the appearance of several best-selling books and movies. It is often based on the crudest form of suggestion. Here, for example, is some advice on how to elicit alternative personalities (alters, as they have come to be called), from an introduction to MPD by Stephen E. Buie, MD, who is director of the Dissociative Disorders Treatment Program at a North Carolina hospital:

It may happen that an alter personality will reveal itself to you during this [assessment] process, but more likely it will not. So you may have to elicit an alter… You can begin by indirect [sic] questioning such as, “Have you ever felt like another part of you does things that you can’t control?” If she gives positive or ambiguous responses, ask for specific examples. You are trying to develop a picture of what the alter personality is like… At this point you may ask the host personality, `”Does this set of feelings have a name?”… Often the host personality will not know. You can then focus upon a particular event or set of behaviours. “Can I talk to the part of you that is taking those long drives in the country?”

Once patients have permitted a psychiatrist to “talk to the part…that is taking these long drives”, they are committed to the idea that they have MPD and must act in ways consistent with this self-image. The patient may be placed on a hospital service (often called the dissociative service) with others who have given the same compliant responses. The emergence of the first alter breaches the barrier of reality, and fantasy is allowed free rein. The patient and staff now begin a search for further alters surrounding the so-called host personality. The original two or three personalities proliferate into 90 or 100. A lore evolves. At least one alter must be of the opposite sex (Patricia may have Penny but also must have Patrick). Sometimes it is even suggested that one alter is an animal. A dog, cat, or cow must be found and made to speak! Individual alters are followed in special notes for the hospital record. Every time an alter emerges, the hospital staff shows great interest.

The search for fresh symptoms sustains the original commitment while cultivating and embellishing the suggestion. It becomes harder and harder for a patient to say to the psychiatrist or to anyone else, “Oh, let’s stop this. It’s just me taking those long drives in the country.”

The cause of MPD is supposed to be childhood sexual trauma so horrible that it has to be split off (dissociated) from the host consciousness and lodged in the alters. Patient and therapist begin a search for alters who remember the trauma and can identify the abusers. Thus commitment to the diagnosis of MPD is enhanced by the sense that a crime is being exposed and justice is being done. The patient now has such a powerful vested interest in sustaining the MPD enterprise that it almost becomes an end in itself.

Certainly these patients, like Charcot’s, have many emotional conflicts and have often suffered traumatic experiences. But everyone is distracted from the patient’s main problems by a preoccupation with dramatic symptoms, and perhaps by a commitment to a single kind of psychological trauma. Furthermore, given that treatment may become interminable when therapists concentrate on fascinating symptoms, it is no wonder that MPD is regarded as a chronic disorder that often requires long stretches of time on dissociative units.

Charcot removed his patients from the special wards when he realised what he had been inventing. We can do the same. Close the dissociation services and disperse the patients to general psychiatric units. Ignore the alters. Stop talking to them, taking notes on them, and discussing them in staff conferences. Pay attention to real present problems and conflicts rather than fantasy. If these simple, familiar rules are followed, multiple personalities will soon wither away and psychotherapy can begin.

Hokum Locum

Skin Lighteners

The pop star Michael Jackson has denied that he uses chemicals to lighten his skin and claimed to be suffering from a disorder called “vitiligo,” which is a spontaneous loss of skin pigment. Jackson said “There is no such thing as skin bleaching. I’ve never seen it. I don’t know what it is.” (GP Weekly 24 Feb, 1993)

In fact, skin lighteners are used extensively by Afro-Caribbean women in response to social pressures. These preparations contain hydroxyquinone which inhibits the production of melanin (normal skin pigment) but cause skin damage with prolonged usage.

“Because the creams are cosmetics rather than drugs they are not subject to stringent tests or regulations and of 33 skin lighteners for sale in Southwark, half were wrongly labelled; six had illegally high hydroxyquinone contents; three contained mercury, which is banned by European law; and two contained cortisone, which should be available only on prescription.” (BMJ Vol 305 p333)

This is a classic illustration of the abuses that occur when potent drugs are allowed to be dispensed as “cosmetics”. I do not know whether Michael Jackson truly does suffer from vitiligo, but with his history of repeated cosmetic surgery and hyperbaric oxygen treatment I would not be surprised if he is using skin lighteners.

Addicted to Sugar

Woman’s Weekly 14/12/92 carries the story of a woman who was chronically depressed until she saw an iridologist who proclaimed the patient “a sugar addict. Her exceptionally high sugar-loaded diet had filled her body with toxins. The whites of her eyes were yellow, and her colon contained faeces which had been present for years.”

This story has all the elements of quackery. Iridology is arrant nonsense adequately dealt with in one of our truth kits, and just what are the “toxins” so favoured by quacks? Can the colon really hold faeces that “have been present for years”? The world’s record for constipation is held by a man who resisted the temptations of the toilet for 368 days. He is said to have become weak after delivering 36 litres of faeces on June 21, 1901, but “there was much rejoicing in the family.” (CMA Journal May 22, 1976/Vol. 114)

This woman clearly suffered from a depression and wasted years in looking for outside “causes”. The iridology diagnosis and treatment is a form of placebo validation of her symptoms, which has allowed her to get better without facing up to more important psychosocial issues. The standard of such stories in the Woman’s Weekly is so pathetic that the staff surely deserve a permanent bent spoon award.

Sports Enhancement

It appears that athletes will do anything to enhance their performance in their chosen sport. Ben Johnson could not give up the use of anabolic steroids and has earned himself a permanent disqualification. Other athletes, such as Katrina Krabbe, have received feeble punishments for the same abuses. Some athletes go to extraordinary lengths to either justify or rationalise their use of performance enhancing drugs. A swimmer (Marlborough Express 16/3/93) complained that a heavy beer-drinking session led to her urine test showing twice the permitted testosterone levels.

A survey of private gymnasiums (British Journal of Sports Medicine 1992;26:259-61) found that 62 out of 160 customers had taken anabolic steroids, along with other drugs to counter the side effects of the steroids. Steroids have been used by some occupational groups, such as debt collectors and bouncers, to enhance physical size and improve employment prospects.

Users have also been observed to participate in needle exchange services through their requirement to administer the drugs intramuscularly. (BMJ Vol 306 13/1/93 p459)

Cooking with Radon

Disused uranium mines are finding a new use as chronically ill people rush to sit in the “health mines” in order to inhale radon gas which is touted to cure everything from migraine to blindness. For as little as $2.50 you receive exposure to radiation while “having a good time playing cards, doing jigsaw puzzles, and reading magazines.” (People Magazine)

(Un) Natural Remedies

Readers will remember the tragic deaths of twin infants from congenital infection of the mother with Listeria, a type of bacteria widely found in seawater and in particular, mussels. It is alleged that the infection was acquired through mussels eaten by the woman as a “natural” source of iron. If only she had taken the completely safe iron tablets available from her local chemist but then, they are not “natural.”

In Belgium, many women have suffered renal failure and died through taking slimming powders containing Chinese herbs, in some cases prescribed by doctors! (GP Weekly 3/3/93) Women are cynically targeted by the diet industry, and it is not surprising that obese people continue to be attracted to slimming remedies which can be eaten.

Oddities of the East

In China, ants are being used in the treatment of Hepatitis B and various rheumatoid diseases. 28000 patients have been treated using medicine made from ants which are rich in zinc and (unspecified) trace elements. 20 percent of a survey of 339 patients were described as “cured,” 77 percent were helped and only 2 percent remained unchanged. No one was made worse. The application of percentages and vague reports of “improvement” does not improve a fundamentally implausible study. (GP Weekly 20/1/93) Applying Skrabanek’s demarcation of the absurd theory, a clinical trial is not indicated.

Chinese herbal preparations often have inscrutable ingredients. A post-menopausal woman attending gynaecology outpatients had a biopsy taken from her uterus, which showed tissue changes consistent with the use of hormones. She was on no medication apart from a herbal remedy prescribed by a homeopath. The doctors found that the list of ingredients included 10 [micro]g of ethinyl-oestradiol (a potent female sex-hormone) with no warnings about long term use. (BMJ Vol 306 16 Jan 93 p212)

The irony of a homeopath prescribing a potent remedy will not be lost on readers. Homeopaths should confine their prescribing to their harmless placebos.

Continuing the theme of arcane Eastern practices, even forms of therapeutic massage are not without side effects. Following a vigorous bout of Shiatsu (Japanese style massage) a patient developed an attack of shingles caused by a reactivation of latent Herpes zoster infection of the affected skin area. (NZ Doctor 18 March 1993)

A man from Belize (Central America) was admitted to hospital with an abscess on his arm which was leaking a shiny pus. He admitted to injecting “white magic” into his forearm a month earlier and an X-Ray showed high density globules in the muscle of his arm.

The material in the injection was mercury, used according to Mayan superstition to ward off evil spirits and increase sexual potency. Tubes of mercury are cheap and freely available in Belize. Historical figures such as Henry VIII were treated for syphilis with mercury, which led to the expression “a night with Venus and a lifetime with mercury.”

The herb chaparral (aka. creosote bush) has been in the news lately, implicated as a cause of toxic liver hepatitis. It is under scrutiny in the US (NCAHF Vol 16 No 1), but as usual our own Health Department is dithering instead of banning it and putting the onus on the distributor to prove that it is safe. I have sent them a copy of the NCAHF article.

Natural Remedies Neglected

Neglect of proven health and hygiene measures can lead to disease as well. 46 people were infected with Salmonella from an imported Irish cheese made with unpasteurised milk. The infection was traced to four cows excreting the same strain of Salmonella in their faeces. There is no excuse for these human infections because pasteurisation kills all disease-producing bacteria commonly transmitted in milk. (BMJ Vol 306 13/2/93 p464)

Soviet Russia had fewer than 60 cases of Diptheria during the mid-1970s. The present social and economic chaos has led to a resurgence of this disease and almost 4000 cases occurred in 1992. Immunisation used to be compulsory but there are now fears that the vaccine is dangerous and AIDS may be caught from the needles. Diptheria has become endemic in rural areas where the standard of health care is very low. (BMJ Vol 306 13/2/93)

Even New Zealand has groups of ignorant people actively campaigning against immunisation. Those who forget the past are condemned to repeat it!


Thoracic outlet syndrome (TOS) is characterised by subjective complaints of pain and sensory changes in the upper limbs. Skepticism in the literature prompted researchers to examine data, which showed that the diagnosis of TOS is heavily influenced by a patient’s insurance coverage. Those without such cover are rarely diagnosed as having TOS. (NCAHF Vol 16 No1)

There are many operations performed by surgeons which are of questionable indication. Surgery has a potent placebo effect and most surgeons would be reluctant to put operations to the test of a placebo controlled trial as outlined by Dr Bill Morris in the last issue of this journal.

Black Spot Mystery

Many mysteries turn out to have mundane explanations which are seldom accorded the same publicity as, for example, alien abduction stories (actually due to a dream state in susceptible individuals). Local health authorities in Green River, Wyoming sent out questionnaires, mapped homes and exhaustively tested scabby spots from the scalps of school children before concluding that the spots were flakes of tar which had blown off the school roof! (NZ Doctor 1/4/93)

The Devil and Mrs Smith

It’s a mindbending situation, but I guess you’d have to call me a skeptical believer. Like parapsychologist Susan Blackmore, personal experience inclined me towards the idea that supernatural events really happen.

Blackmore’s approach to the problem was carefully designed ESP experiments. My approach was to go boldly forth among the space-cadets themselves, expanding my consciousness, grooving, absorbing the mind-enhancing rays of the Melchizdek Messengers and basking in the all-embracing super-soul of the Maha Vishnu.

My consciousness expanded all right. It expanded so much my brains nearly fell out.

It’s a jungle out there. If the fundamentaist super-cults don’t get you, the communist descendants of the Abominable Snowman will.

You don’t know what the third kind is until you discuss doomsday with the under-cover Pleiadean alien over a sanctified lunch in a Rama/Krishna boutique.

Ten or fifteen years later (time loses meaning in the Etheric world) I was back where I started. I still think there are grains of truth among claims of the paranormal, and from these tiny grains huge empires of hogwash are built.

If every religion on earth miraculously vanished today, they’d be springing up like toadstools again tomorrow. It is bound to happen, because underneath it all, people keep having experiences.

The hypothetical perceiver, Mrs Smith, knows she saw a ghostly entity float through her room last night, so when her scientifically trained doctor says it was just her imagination she goes away thinking, “What do these clowns know anyway?” The next time it happens she goes to a Mayan channeller and seeks advice from the lost ancestors of Mu.

To some extent “psi events” are undoubtably in the mind. Maybe it’s completely “in the mind”. Maybe. But while the wand-like utterance “hallucination” may mean something to someone, it gives me the screaming-jeebies.

Hallucinations are devilishly tricky things. It could be said that the brain mechanism behind the hallucination allows some aspect of the subconscious mind to come into play. Or, it could be said that the “mechannism” allows the mind of the perceiver access to actual external things not otherwise perceivable.

The whole problem with these damnable, luciferic happenings is that they look like real, external events. They are not inside our heads. Until I get a better idea of how this mental process works, I have to remain a little skeptical of the “all in the mind” theory.

Still, whether it’s all in the mind or not, the only way to get at it is through mind research. The paranormal itself has never given us any genuine information on the subject.

One only has to look at the conflicting literature to realise something’s rotten in Denmark.

Of course, the super-cults have an every-ready explanation for all this confusion — demon activity.