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.

The Easy Conclusion

In the years since the Skeptics’ beginnings in 1985 we’ve seen paranormal and pseudoscientific fads come and go. The Shroud of Turin was big back then, till carbon dating did it in (except in the minds of the hard-core Shroud Crowd, who now claim that rising from the dead involves an emission of neutrons which increases the atomic weight of the carbon in your winding cloth). Uri Geller is more feeble than ever, UFO sightings are in decline, and Bigfoot has made himself even scarcer than usual. But quackery in the name of “alternative” medicine still flourishes, and cold readers (such as the lamentable James Byrne) periodically meander on stage.

However, there haven’t been any significant new trends in the pseudoscience until the recent arrival of False Memory Syndrome (see reprint, “The New Victims of Sex Abuse”, p. 12). In a sense, this fad was a disaster waiting to happen. In the 1950s, hypnotic regression was used to help people discover their past lives. Harmless, perhaps, and a even comfort for someone to learn of having once been a rich courtesan in Atlantis or, better still, a Chinese Empress (but oh those aching feet!). In the 1980s, this same structure of therapeutic hypnosis was being used to help people remember how they were spirited to the planet Zork in a flying saucer in order to be subjected to medical procedures.

The sorry new development sets out from UFO abduction, but is much more sinister because it attaches itself to a demonstrably real social problem: sexual abuse. By incorporating the concept of hypnotic recovery of repressed memories into the current hysteria over sex abuse, the lives of thousands of families are being destroyed.

Consider a phone call I recently received. An articulate widow in her seventies, who with her husband raised five children, had seen my newspaper article on False Memory Syndrome and wanted to tell me her story. One of the children, a woman in her middle thirties, is a troubled soul who had been visiting a counsellor for the last year. The daughter’s therapy has “disclosed” that her mother and late father sexually abused her in her childhood. The abuse began before she was three (a remarkable memory to have, since the hard-wiring for long-term memory doesn’t even exist till after then). Her father had regularly raped her till she was seventeen. She had “forgotten” all this until just now.

Her brother says it’s rubbish, and the mother is shattered, but the daughter fully believes it, having been manipulated by her therapist to confabulate pseudomemories. The daughter has now denied her mother access to the grandchildren. This distraught old woman, who knew nothing about FMS or that others have had the same thing happen to them, had been contemplating suicide. (Fortunately, I’ve been able to get her some competent help.)

Hers is not a unique case, and if something isn’t done to bring the problem of FMS to public attention we will see many more cases in New Zealand. We’re working on it.

This issue of the Skeptic is coming to you a few weeks late because the last two months have been among the busiest in our history. The spectacularly successful visit of James Randi, along with a very well covered annual conference have helped us to boost Skeptics membership to about 350. Thanks to everyone who helped in organising those events.

One a per capita basis, we are probably the strongest national Skeptics organisation in the world. It would be temptingly easy to conclude from this that New Zealanders are simply more sensible and intelligent than people elsewhere. So why argue? For once, we’ll take the easy, tempting conclusion!

Satanic Panic in Christchurch

There is a worldwide epidemic of satanic child abuse allegations. Are they true? Has satanic child abuse happened here in New Zealand?

The most extensive child sex abuse case to be heard in a New Zealand court was the Christchurch Civic Creche affair. Nor was this an ordinary sexual abuse case, for throughout the lengthy period of investigation and the initial depositions hearings, bizarre claims of ritual sexual abuse were made. There were several similarities between this case and a sexual abuse case which had first surfaced in the US ten years earlier in 1983 — the highly publicised McMartin preschool case in Los Angeles — which also dealt with claims of ritual sexual abuse. In both cases, claims were made of the existence of child pornography networks and satanic conspiracy.

Although New Zealand has frequently been judged a highly secularised society, claims of Satanism were widely accepted during the initial investigation into the Christchurch creche case, and were repeated during the depositions hearings. Indeed, the whole affair led to a moral panic concerning child sexual abuse which later spread throughout the country.

It is important to stress that a moral panic is not an entirely spontaneous public reaction to a perceived problem such as child sexual abuse. It is also a consciously planned course of action which involves one or a number of different interest groups. Panics concerned with sexual abuse cases in general often involve groups such as fundamentalist Christians, mental health professionals, social workers, law enforcement officers, and the media.

The events which led to this particular “satanic panic” in Christchurch can be traced to Christian fundamentalist groups and the direct import from the United States of the satanic ritual abuse scenario.

The Satanism scare in the United States gained momentum during the 1980s, in the aftermath of the religious cult scare of the 1970s. Christian fundamentalist interests — especially groups which subscribed to the belief that the “end time” had arrived and that satanic forces would be particularly strong during this period — were behind the moral panic which spread across the United States.

Additionally, some mental health professionals and law enforcement officers were prepared to disseminate the idea that Satanism was rife. Of these two groups, the former were often associated with adults who alleged that they were “survivors” of ritual sexual abuse.

Indeed, the origin of the modern Satanism scare can be traced to the earliest “survivor” account — the book Michelle Remembers, which was published in 1980 by Michelle Smith, co-authored by her therapist, later husband, Lawrence Pazder.

As the panic spread during the 1980s, the satanic scenario was broadened to incorporate such elements as large-scale child abduction, ritualistic abuse of children, human and animal sacrifice, and cannibalism.

Law enforcement officers, social workers, and mental health professionals provided the key secular network for spreading ideas of Satanism through their involvement in seminars and workshops aimed at combatting the satanic menace.

It was in this manner that the anti-satanic movement spread to Britain later in the 1980s, and eventually to New Zealand. American fundamentalist Christians, presenting themselves as “experts” in the field of ritual child abuse, were invited to speak at social worker and police seminars. One such “expert” visited Christchurch in August 1991 and was reported as saying that “satanic ritual abuse posed as great a threat to children as sexual abuse” (Christchurch Press, 27 August 1991).

Although the Satanism scare appears to cover a unique, if somewhat bizarre, series of events, it is in fact a development of earlier trends in the child protection movement.

Beginning in the 1960s with the “discovery” of the battered baby syndrome, by the late 1970s child protection became increasingly focused on sexual abuse. This was expanded during the 1980s when false claims were made (in the United States) that as many as 50,000 — or even 90,000 — children were abducted by strangers each year.

It was in the early 1980s that the first adult “survivor” accounts of satanic abuse began to emerge. Following such accounts, the child protection movement made claims that satanic cults were responsible for the majority of the child abductions. The most prominent claims came from an extensive network of social workers, police, and psychotherapists — groups which were already involved in the task of aiding child victims of adult exploitation. They assumed responsibility for this “new” form of child victimisation — satanic abuse — and thus were able to expand their organisational base.

It should also be noted that claims of satanic abuse incorporated psychological categories to explain victims’ behaviour. The psychological material is too complex to permit more than a brief summary here, but two important aspects should be mentioned.

First is post-traumatic stress disorder (PTSD) — a term used in the diagnosis of patients whose maladaptive behaviour could be explained by supposedly traumatic past experiences. PTSD, it has been suggested, is often coupled with multiple personality disorder (MPD) and “occult survivors” were typically attributed with this condition. Indeed, the “expert” mentioned earlier was reported as saying that MPD was the usual damage caused to children by satanic ritual abuse. He also argued that “about half the children suffering [MPD] had been victims of satanic ritual abuse” (Press, 27 August 1991).

A major factor in the diagnosis of “survivors” with PTSD and/or MPD was that patients’ denial was proof; any denial of involvement with satanic ritual was dismissed as a typical symptom of the underlying disorder.

The media’s role in spreading the Satanism scenario cannot be overlooked, since in the United States, Britain, and New Zealand, popular newspapers and television talk shows were very much involved. The New Zealand media, in September 1991 (shortly after reports of the visiting American sexual abuse therapist), reported a workshop presentation which was given at the Family Violence Prevention Conference in Christchurch. The main theme of this particular workshop was ritual abuse and was a prominent feature of the conference.

As co-ordinators of this workshop, the Ritual Action Group (RAG) were concerned with presenting ritual abuse as a serious threat to children in this country. Their presentation drew on both anti-cult and anti-Satanist literature, detailing a definition of ritual abuse, the situations in which it was likely to occur, and the signs parents should be looking for to determine whether their child had been abused.

There was a period of intensified media interest in claims of Satanism following the September conference and the RAG workshop. This included reports that police were stepping up investigations into ritualistic cults, following bizarre claims coming from Australia which told of satanic cults there. These cults were said to have links with child pornography rings, but they were also reported as killing and eating babies.

It was also reported at this time that a “prominent New Zealand policeman” had spent time in the United States studying techniques for investigating links between child pornography and Satanism: the same policeman had earlier been linked with the RAG group. It was during this period of intense media coverage that allegations of ritual abuse in the Christchurch Civic Creche began to surface.

Following similar patterns in the United States and Britain, the links between child pornography, organised sex rings, and ritual abuse have been a prominent feature of the Satanism scare in this country.

Although the first reports of Satanism appeared in 1991, it was not until a year later that a moral panic which focused on the sexual abuse of children broke. From early in 1992, a former male worker from the Christchurch Civic Creche had been under investigation for indecent assault and sexual violation of children. Subsequent events further amplified the panic — the abrupt closure of the civic creche; the police investigation into a “major paedophile ring” operating in New Zealand and reputed to have links with an international network of child pornography dealers; the leader of the Centerpoint commune facing charges of child sexual abuse; and sporadic claims of abuse emerging from other childcare centers around the country.

All these events occurred within the space of two months during the latter half of 1992. Although the Department of Social Welfare began to express concern about their rapidly increasing caseloads of child abuse, it was not until the news broke that four female co-workers were also alleged to have committed indecent assault and sexual violation of children at the creche that the panic gained full momentum. The creche case now took on elements of “organised” abuse rather than being one involving a lone “predatory” male abuser.

It was at this stage that the media concentrated on the bizarre nature of the case, with its alleged elements of ritual abuse. In particular, one alleged incident known as the “circle incident” provided a vivid image which enabled the media to locate this case within an established stereotype of ritual abuse. However, it was not only the media who made links between this case and the ritual abuse scenario. During the depositions hearings the mother of an alleged victim had called for an overseas “expert” on ritual abuse to be brought into the inquiry.

As the events leading to the Christchurch case have shown, religious concepts still feature in the public perception of problem conditions such as child sexual abuse and the amplification of deviance thus generated. This is despite the increasingly secularised nature of New Zealand society.

Christian fundamentalists in particular have been relatively successful in having their ideas on issues such as child pornography and alleged satanic abuse incorporated into the rhetoric of secular agencies such as social work, counselling, and law enforcement. It is no coincidence that this moral panic has focused on children given that, in periods of rapid social change and uncertainty such as New Zealand has experienced in recent years, children represent the hope for the future. This is likely to prove a recurrent theme of perceived social problems.