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Acocella's book covers the scandal of the 1980s in which overzealous therapists misdiagnosed people with MPD. Some of these people may have been abused, others not; some may have been multiple; some might even have had MPD. But what was done to them was horrible. Hardly less horrible was the CYA retrenchment of the psychiatric industry, relabeling MPD as "DID" and stating categorically that no one really has many selves.
One Woman's StoryIn late 1989 Elizabeth Carlson, a thirty-five-year-old woman who lived with her husband and two children in a Minneapolis suburb, was in the hospital being treated for severe depression. She was referred to a psychiatrist, Diane Humenansky, who came to see her, and went on seeing her after she left the hospital. As Carlson recalls, Humenansky soon suggested to her that perhaps her problem was not depression but multiple personality disorder. MPD, Humenansky explained, was an elusive illness: many diagnosticians failed to recognize the alternating personalities, or alters, for what they were. As a result, many women -- nine out of ten MPs were women -- ended up getting misdiagnosed. But experts now knew that there were certain telltale signs of MPD. Did Carlson ever "zone out" while driving and arrive at her destination without remembering quite how she got there? Why, yes, Carlson said. Well, that was an alter taking over the driving and then vanishing again, leaving her, the "host" personality, to account for the blackout. Another sign of MPD, Humenansky said, was "voices in the head." Did Carlson ever have internal arguments -- for example, telling herself, "Turn right" and then, "No, turn left"? Yes, Carlson replied, that happened sometimes. Well, that was the alters fighting with each other inside her head.
Carlson was amazed and embarrassed. All these years, she had done these things, never realizing that they were symptoms of a serious mental disorder.
Multiple personality, Humenansky went on to explain, was associated with childhood sexual abuse, though the abuse might be forgotten. Carlson should think hard: had anyone ever taken liberties with her? Carlson didn't have to think hard. She distinctly remembered being molested as a child by two different men in her family. She had never forgotten these episodes. That didn't mean she hadn't forgotten other episodes, Humenansky said. Worse ones, maybe.
To help Carlson remember, Humenansky gave her books to read. One was The Courage to Heal by Ellen Bass and Laura Davis, which had just come out -- the book now known as the Bible of the recovered memory movement. One-third of American women were survivors of childhood sexual abuse, The Courage to Heal declared, though many did not remember the abuse. If a girl was repeatedly molested, she might have not only suppressed the memory but developed separate personalities in which to seal off the terrible knowledge. The book explained this theory of multiple personality disorder, and gave first-person accounts. In a later edition, one woman wrote:
I remember splitting for the first time when I was four and my father was trying to force me to sodomize my pet rabbit with a roofing nail. He got very angry when I refused, and finally, in a rage, he threw me down on the basement floor and raped me. When I came back to myself after the experience, there were three parts of me.... They were Benjamin -- ageless, spiritual and protective; Bunny -- little and worried; and Scarlet, the only female and the one who dealt with the sexual abuse.
Humenansky also gave Carlson books about MPD cases. One was Corbett Thigpen and Hervey Cleckley's 1957 The Three Faces of Eve, the story of a shy, depressed housewife, "Eve White," who, on the odd weekend, would metamorphose into "Eve Black," a vivacious party girl, leaving her host personality with unexplained hangovers and a reputation in local bars. Between this book and the 1957 movie based on it, featuring an Academy Award-winning performance by Joanne Woodward, Eve became, for a while, the prototype of the multiple personality. In later cases, as in Eve's, there was usually the good-bad split -- "librarian by day and streetwalker by night," to quote MPD expert Frank Putnam. Later multiples, like Eve, also tended to show asymmetrical amnesia, with the "good" personality remaining ignorant of the activities of the "bad" one while the latter knew all about her prim counterpart and enjoyed making her life hell.
Eve, however, was merely the John the Baptist of multiple personality; the Christ was "Sybil Dorsett," a Columbia University graduate student who in 1954, at age thirty-one, turned up in the office of a psychoanalyst named Cornelia Wilbur and stayed for eleven years. In 1973 this case became the subject of a mass-market book, Sybil, by the journalist Flora Rheta Schreiber. Three years later the book was turned into a gripping TV movie with Sally Field as Sybil and with Joanne Woodward, passing the torch, as Dr. Wilbur. The book was a best-seller; the movie won four Emmy awards. Sybil became the most famous psychiatric patient in history, and her manifestation of what Wilbur called multiple personality disorder became the pattern of the disorder, in a form substantially different from Eve's. For one thing, MPD now had a clear cause: childhood abuse. Eve had suffered traumas as a child, but she was never sexually assaulted. Sybil was, repeatedly, by her mother. Furthermore, the mother's actions were sadistic, perverse, extravagant. According to the book, she probed the child's vagina with a knife and a buttonhook. She hung her upside-down and, using an enema bag, filled her bladder with ice-cold water. Then she tied her to the family piano and forbade her to urinate while she, the mother, sat down and played Chopin.
Second, Sybil had a dissociation history worthy of her abuse history. As described by her therapists, Eve had had only three faces. (Eves White and Black were later joined by a Jane.) Sybil had sixteen personalities, keyed to specific traumas. There was Ruthie, a baby, who split off upon watching her parents have sex. There was Peggy Lou, who came out when Sybil's grandmother died. One personality played the piano; another could install sheet-rock; two had English accents; two were men. Sybil wasn't so much a person as a club.
With this case the disorder not only changed, it spread. Prior to Sybil, MPD had been one of the rarest of mental disorders. In a 1944 article two researchers, W. S. Taylor and Mabel Martin, reported that a search of the medical literature of the nineteenth and twentieth centuries had yielded only seventy-six cases that met their definition. But after Sybil, MPD exploded. One expert estimates that between 1985 and 1995 there were almost 40,000 new cases. And curiously, the latter-day multiples looked a lot like Sybil. The modal MPD patient, experts reported, was a white North American female around age thirty. As with Sybil, her disorder had begun in childhood, flowering into a large constellation of alters. In one study of 236 cases, the mean number of alters was sixteen, Sybil's count exactly. And whereas early sexual trauma had not been reported in a single one of the Taylor and Martin cases, most of the new multiples, like Sybil, said they had suffered child abuse, usually including sexual abuse.
Actually, in both these respects, Sybil's descendants soon out-stripped her. Patients were eventually producing a hundred, four hundred, a thousand alters. (A case with forty-five hundred was recently reported.) And whereas Sybil had confined herself to human alters, later MPs branched out. In a Wisconsin malpractice case that was settled in 1977 for $2.4 million, the patient claimed that among the 126 alters she developed in MPD therapy there were several angels, a duck, and "Lillith," the bride of Satan. The Georgia-based psychiatrist George Ganaway, one of the first authorities to caution against fascination with MPD, reported that he had been presented with "sages, lobsters, chickens, tigers, a gorilla, a unicorn, and 'God.'"
In abuse too, Sybil was rapidly outdone. Reports of child rape and sodomy were common. Truddi Chase, author of the MPD memoir When Rabbit Howls, recounts that her stepfather used to lower her down a well and throw live snakes on top of her. In this efflorescence of abuse reports, an important contributor was "satanic ritual abuse," or SRA, which spread to MPD from the day-care scandals of the early 1980s. Now MPs were claiming that they had been molested not just by individuals working on their own but by multigenerational cults of Satan-worshipers who met by night to rape young girls and thereby breed babies. On other nights, the cult members aborted, stabbed, skinned, and ate the babies, while wearing hooded garments. These Satanic cults created MPD not just in the usual way, by traumatizing the child and thus causing her to split. Through sophisticated brainwashing techniques, they deliberately programmed her with task-specific alters, who, as in The Manchurian Candidate, would carry out assignments -- usually murder, sometimes suicide -- at the bidding of the cult.
Another area in which the new multiples left their forerunners in the dust was self-destructiveness. Eve had considered suicide; Sybil too was suicidal and would occasionally put her fist through a window. But the MPs of the eighties and nineties were more ingenious. In one popular MPD biography, Suffer the Child, the subject pours drain cleaner on her genitals. A former multiple interviewed in Mark Pendergrast's Victims of Memory tells him that she began pulling her toenails off: "I didn't feel anything. I would rip the whole nail right off, blood all over the place." Other multiples have shown journalists their self-inflicted cuts, their third-degree burns. Self-mutilation was accepted by many MPD writers as a regular feature of the disorder, a "coping mechanism." In the words of MPD expert Colin Ross, "Every time you cut, you're working on trying to keep the body safe." Starting in 1990, self-mutilators -- a group that includes many kinds of patients, not just MPs -- had a newsletter, The Cutting Edge, that they could subscribe to. In a 1996 issue "Carla" writes in that she doesn't really want to stop cutting herself and that her new therapist has left the decision up to her. So she's cutting again, "yet it's been a time of tremendous growth and potential."
As the number of MPD patients grew, so, naturally, did the field designated to treat them. Until about 1975, there had been no MPD specialty to speak of. Multiple personality disorder had no separate listing in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or DSM, the guidebook to diagnosis. The condition was simply mentioned in passing as a subtype of "hysterical neurosis." But in 1980, after strenuous lobbying by interested therapists, the new edition of DSM gave multiple personality disorder a primary-level listing among the dissociative disorders, conditions in which some part of mental functioning splits off from consciousness. MPD was now a full-fledged psychiatric syndrome. In 1984 the new MPD enthusiasts founded an organization of their own, the International Society for the Study of Multiple Personality and Dissociation (ISSMP&D), and began holding annual conferences, cosponsored by Rush-Presbyterian-St. Luke's Medical Center in Chicago and chaired by MPD expert Bennett Braun. Rush-Presbyterian subsequently opened the country's first dissociative disorders (DD) unit, under Braun. Other units followed. The field soon had its own journal, Dissociation, which began publication in 1988. By 1990 the average annual output of publications on MPD had multiplied 6,000 percent over the pre-1970 level.
Among those publications were two comprehensive textbooks, Frank Putnam's Diagnosis and Treatment of Multiple Personality Disorder and Colin Ross's Multiple Personality Disorder (both 1989), from which one could learn how to recognize and treat MPD. Both books offered the same theory of the disorder, the theory that Wilbur had offered for Sybil. (It is called the "Wilburian paradigm.") The cause of MPD was trauma, usually abuse, usually including sexual molestation. In order to cope, the child imagined that the abuse was happening to someone else, another "her," who then split off from the main personality, growing in isolation behind a wall of amnesia -- a process called dissociation. As dissociation occurred again and again, the personalities multiplied, each developing its own name, nature, and function and typically remaining the age it was when it first appeared.
Both Putnam and Ross published surveys claiming to demonstrate the correlation between MPD and childhood abuse, and both, in their textbooks, offered treatment plans focusing on the abuse. Clearly, if forgotten trauma was the cause, the cure was to remember and come to terms with the trauma. The therapist had to flush out the alters and get them to divulge their secrets, in protracted reenactments called abreactions. In a typical abreaction, as Colin Ross described it, the patient might "cry out, plead with the father to stop, clutch her pubic area, try to push the father off, attempt to spit out semen, or curl up in a corner." These were violent scenes. (David Calof, an MPD-treater, reports that one of his patients had a stroke during an abreaction.) Ross warned that abreactions should not be allowed to go on too long, but others were less conservative. Bennett Braun said he had having supervised nine-hour abreactions.
Obviously, the rise in the number of MPD cases boosted the growth of the MPD specialty. And vice versa. George Ganaway recalls that when he went to his first ISSMP&D conference in 1985, most of those attending, apart from the speakers, had seen perhaps one or two cases of MPD. But what they learned at that conference caused them, when they went home, to view their patients in a new light. "And when we came back the next year," Ganaway says, "we each had many more MPD patients to talk about." In addition to what they picked up at conferences, they had the swelling MPD literature to inform them.
This, apparently, is how Diane Humenansky, Elizabeth Carlson's therapist, learned about multiple personality disorder. She read the experts -- Putnam, Ross, Braun -- together with Sybil. She spoke to Cornelia Wilbur. She attended an ISSMP&D conference. And eventually she had a number of newly diagnosed multiples under her care. Humenansky declined to be interviewed by me on the subject of Carlson; therefore my account of her treatment of Carlson is based on Carlson's description of it, supplemented by court records. It is hard to know what Humenansky was thinking, or indeed if she was in a position to practice psychotherapy in a responsible manner. Carlson says Humenansky told her she had been through three divorces, had lost custody of her children to her third husband, and was taking antidepressants. Nevertheless, when she began treating Carlson, Humenansky was a fully accredited physician -- a graduate of Wayne State Medical School, though, according to Carlson, she claimed it was Harvard -- with admitting privileges at several Twin Cities hospitals.
Carlson says Humenansky gave her not just books but videotapes too: the movie versions of Sybil and The Three Faces of Eve, talk shows featuring survivors of childhood torture. She told Carlson that if she felt any physical discomfort -- anxiety, chills -- while watching the videos, that was a "body memory": it meant that these things had happened to her too. According to Carlson, Humenansky also had her do visualization exercises, "trying on" scenes of being molested by people in her family. Using this technique, Carlson soon recovered memories of being molested by as many as fifty relatives, including both parents, both sets of grandparents, aunts, uncles, and great-grandparents.
She began having horrifying dreams. The dreams too were memories, Humenansky said. In their therapy sessions she would have Carlson abreact the remembered scene. If Carlson came into the therapy session with no memories, that meant she was "stuck," and Humenansky gave her more videos: pornographic movies, war footage of people being decapitated.
According to Carlson, Humenansky also used a method called guided imagery, in which the patient is talked through an imaginary scene in order to awaken buried memories. In one scenario Humenansky told Carlson to picture herself going downstairs. Look for an altar, Humenansky said. Carlson saw a stone slab. Look around for candles and daggers, Humenansky said, Carlson saw them. Now look for the baby, Humenansky said. Carlson does not remember at what point her own imagination, primed by the books and videos, took over, but soon she saw a pregnant woman, and then the baby was born, and then the afterbirth was sitting on the altar, and people in hooded robes were eating it, and so was she. (That was the first of many cannibalism scenes Carlson recovered with Dr. Humenansky. Today, she still has nightmares about them.) The therapy sessions often ended with Carlson weeping uncontrollably. Carlson says Humenansky would give her tranquilizers and tell her to chew them, so that they would take effect faster.
At the same time that Carlson, under Humenansky's guidance, was recalling the abuse that caused her personality to split, the two of them were also "mapping the system" -- that is, identifying the different personalities. Ever since Sybil it had been accepted that any moderately elaborated MP system was likely to include child alters. Carlson obligingly dug up hers. One was Little Miss Fluff, a nickname that she had been given as a girl because she liked frilly dresses and crinolines. Another was Suzarina: that had been her imaginary playmate when she was a child, and it was decided that the playmate must have been an early alter. To fill the Eve-Black slot, Carlson came up with Wild Child, a teenage tramp, and Nikita, a more mature temptress. Sybil had had two male alters; so, quite soon, did Carlson. She also located two nuns, Sister Mary Margaret and Sister Mary Theresa (the latter wanted to join the Peace Corps), and a scared, depressed old lady called the Old Lady.
Some of these alters were discovered through "journaling," a technique recommended by MPD experts. Carlson was told to keep a journal; then, going over it, Humenansky picked out recurrent thoughts and identified them as alters, or as traces of abuse memories. When Carlson's mood changed -- indeed, when she changed her hair or clothing style -- Humenansky told her she had "switched," or changed alters. If she showed up for her session in a short skirt, that meant Nikita was "out." If she was depressed, that was the Old Lady taking over. With each new personality they unearthed, Carlson was asked to supply the name, but if she drew a blank, Humenansky did the naming.
In the middle of the treatment, according to Carlson, Humenansky went to the ISSMP&D conference in Chicago and returned with the news that MPs also tended to have lesbian, animal, and devil personalities. Carlson thereupon produced something that growled and that they figured was either an animal or a devil. She also came up with a lesbian alter. Humenansky urged her to get in touch with this side of herself, so Carlson went to a strip club with a lesbian friend, got drunk, and tried, with little success, to have sex with her.
Interestingly, though -- and this seems to be the case with a number of MPs who have not yet written memoirs -- Carlson never quite got the hang of multiplicity. To this day, she doesn't know how many personalities she had. "After twenty-five, I lost count," she says. Humenansky had Carlson write down their names, ages, and key memories on index cards for reference. Still, Carlson says, "I couldn't keep the dam things straight." Once, she lost the card file, and they had to do the whole thing all over again.
There were times when she would walk into Humenansky's office and say that she didn't want to recover memories or explore alters that day. She just needed to talk. She recalls:
Dr. Humenansky said, "Well, who am I talking to?" And I would say, "This is just me." She said, "No, I want to know which alter I'm talking to."Later, Carlson says, Humenansky put her under sodium amytal ("truth serum") and asked her, "OK, who's the 'Just Me' person?"
Meanwhile, Carlson's mental condition was worsening. The main events of her week were her two appointments with Humenansky, one individual session and one meeting with a group that Humenansky led for her MPD patients. For a year, she was so depressed that she rarely left her bedroom. She hung blankets over the windows, so that the room was always dark. She wore a flannel nightgown and huddled under piles of blankets. Heavily drugged, she sometimes slept eighteen to twenty hours a day. She woke up screaming from nightmares and went into fits of projectile vomiting. "I stank, the room stank. Every few days or so, my husband or my daughter would take me and shove me into the shower and hose me down." Then she would go back to bed.
Carlson's daughter Lisha, who was in her teens, took over the household and the care of her younger brother. Eventually, she had to drop out of school. Carlson's marriage, which had already been troubled when she began seeing Humenansky, deteriorated day by day. Carlson says Humenansky suggested that perhaps her husband, David, was trying to kill her. Carlson threw him out of the house repeatedly. Meanwhile, she had cut off all contact with the rest of her family because, as she now understood from her therapy, they were still members of the cult that had abused her as a child, and if they found out what she was revealing in therapy, they would murder her. She couldn't even answer her telephone when it rang, because if the caller was a cult member, he or she could say a key word that would trigger the emergence of a homicidal alter, and then Carlson would kill somebody, perhaps her husband or children.
On Humenansky's recommendation, Carlson now and then checked into the hospital—a situation that, according to the guidelines of Social Security Disability, which was paying for her therapy (Humenansky had arranged this), justified more frequent therapy sessions. Humenansky told her not to mention her cult history to the hospital staff; if she did, the cult would find out that Humenansky was trying to unmask them and would come after her. Once Carlson slipped. A Catholic priest visited her room, and she told him about her cult memories, adding that she felt she was possessed and needed an exorcism. The priest said that she didn't need an exorcism; she needed a new therapist. Leaving out the last part, Carlson happily reported to Humenansky that the priest thought her cult memories were imaginary. Humenansky answered that of course he would say that: the Catholic church was in alliance with the cults. Wasn't Carlson's own cult-ridden family Catholic?
"I just got crazier and crazier," Carlson says. She banged her head on walls and tore out her hair in chunks. "I was ready to kill myself. I thought it was better for me, and better for my children." When, in rare moments of protest, she asked Humenansky why the therapy wasn't helping, the doctor repeated to her a basic principle of MPD treatment: the patient has to get worse in order to get better.
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How could these things have happened? How could Carlson have believed what Humenansky was telling her? According to Carlson and others now repudiating MPD and recovered-memory treatment—they are called "retractors"—it is not hard, given certain circumstances. One is drugs. MPD patients are often given strong medications, particularly benzodiazepines such as Valium, Halcion, and Xanax for anxiety and insomnia. "I have found that MPD patients can tolerate enormous doses of benzodiazepines," writes Colin Ross enthusiastically in his textbook on the disorder. (In a 1995 court case Ross acknowledged that he had put one patient on fifty-one milligrams of Halcion a day, which is one hundred times the prescribed maximum for that drug.) Sequentially or simultaneously, Carlson, during her time with Humenansky, took Xanax, Valium, and Ativan for anxiety; Pamelor, Desyrel, and Prozac for depression; and Restoril for insomnia, often in heavy doses. In the words of one retractor, "If you take enough drugs, you can remember about anything."
A second factor is hypnosis, which has often been used to obtain the information—the alters, the abuse history—that leads to the MPD diagnosis. Already in the nineteenth century it was recognized that the memories that people retrieved under hypnosis, however detailed or convincing, were not necessarily accurate. Later research has confirmed this again and again. To quote a 1985 American Medical Association report, "recollections obtained during hypnosis ... actually appear to be less reliable than nonhypnotic recall." Furthermore, those recollections are exquisitely sensitive to cuing by the hypnotist. This too has been known for a long time. In the words of the nineteenth-century hypnosis authority Hippolyte Bernheim, "When a physician employs hypnosis with a patient, it is wise always to be aware of who may be hypnotizing whom." Experiments have shown that hypnotized subjects, given the appropriate suggestion, can recall former lives as chimpanzees.
Nor does the suggestion have to be stated as fact; a question will suffice. In one experiment, reported in 1983, twenty-seven people were hypnotized, taken back to a night during the preceding week, and asked whether, on that night, they had been awakened by a loud noise. Seventeen of them, almost two-thirds of the group, said yes. And when they were brought out of the trance, thirteen of them continued to believe that they had had this experience—which illustrates another principle of hypnosis: that regardless of the accuracy of the memory, hypnosis increases the subject's confidence in it. For these reasons, courts in about half the states no longer admit hypnotically refreshed testimony. But the message has been slow in getting through to the profession that most often employs hypnosis. In 1992, in a survey of over a thousand psychotherapists with advanced degrees, hypnosis expert Michael Yapko found that almost half believed that memories produced under hypnosis were more accurate than nonhypnotic recall. Indeed, one-fourth believed that hypnosis could recover accurate memories of past lives.
According to a number of experts in the dissociative disorders, that faith in hypnotic recall on the part of the therapist was one of the central pillars supporting the MPD movement. Another crucial factor was high hypnotizability on the part of the patient. The ability to go into a trance varies from person to person, but as MPD experts themselves point out, it doesn't vary that much in MPs. As a group, they are exceedingly hypnotizable. They enter trances easily; they accept suggestions readily. The MPD people point this up as an interesting fact about MPs. What they do not seem to understand is that high hypnotizability is likely to be the interesting fact that got these patients diagnosed as MPs. Imagine that a highly hypnotizable woman goes to a therapist who believes in MPD and in the accuracy of hypnotic recall. Imagine, then, that the therapist asks her, while she is under hypnosis, whether she has other "parts" to her personality—something that most of us feel we have, if only metaphorically (our rational self, our irrational self; our adult self, our child self). Imagine, finally, that the therapist asks her whether she wasn't abused as a child—something that many of us feel we were, if only psychologically, and which some of us were literally. The patient is likely to produce.
When confronted with this scenario, MPD believers protest that many patients reveal their alters and receive their diagnosis without having been formally hypnotized. But high-hypnotizables do not require formal hypnotic induction in order to go into a trance. Guided imagery will do the job, as will relaxation techniques and other forms of suggestion. Furthermore, many women diagnosed as MPs need no suggestion whatsoever. Whether or not they have multiple personality disorder, a large number of them do seem to have dissociative symptoms—amnesias, "spells," transient feelings that they are not real or that the world is not real. "In some sense," Colin Ross writes, "my patients probably go into trance walking across the hospital parking lot to get to our building."
It is this trance-proneness that makes them unusually vulnerable to suggestion. In a case reported in the New Yorker in 1993 by Lawrence Wright, Paul Ingram, a trance-prone man who had been accused of molesting his daughters, was told by Richard Ofshe, a social psychologist specializing in mind control, that one of the girls was now claiming that Ingram had forced her to have sex with her brother. The story was not true—Ofshe was performing an experiment—but Ingram came to believe it was true. The next day he presented Ofshe with a three-page account, in vivid detail, of how he had made the children have intercourse and had watched. Likewise Elizabeth Carlson remembered in detail the meetings of her family's satanic cult: how the men had beards and wore brown capes, how they aborted the woman's baby and then laid the afterbirth on the altar and started eating it. To obtain this memory, Humenansky did not hypnotize Carlson and didn't have to. Guided imagery sufficed, for Carlson is highly trance-prone.
Another important circumstance in Carlson's case, as in other MPD histories, was the media. During the period of Carlson's therapy, magazines and newspapers were retailing utterly unskeptical stories about MPD. So was the evening news. MPD experts went on TV with their patients in tow. Bennett Braun, of the nine-hour abreactions, appeared on the Chicago evening news with his star patient. At his bidding she "switched" on camera—now she was "Sarah," now "Pete"—thus providing early training for prospective MPs in the television audience.
More important than the news were the talk shows. Phil Donahue was apparently the first talk-show host to present a program on MPD; he was followed by Sally Jessy Raphael, Larry King, Leeza Gibbons, and Oprah Winfrey. Meanwhile, celebrities were coming forward with their tales of childhood sexual abuse: Roseanne Barr, La Toya Jackson, Oprah herself. Some of them claimed to be multiples as well. Roseanne, who had unearthed twenty-one personalities within herself—Piggy, Bambi, and Fucker, among others—made the rounds. Again and again on the talk shows it was stressed that MPD was not rare; it was common, and becoming more so. "This could be someone you know," said Sally Jessy Raphael. Oprah's program was called "MPD: The Syndrome of the '90s." Today, as people are sifting through the wreckage created by the MPD movement, many therapists are blaming the media for spreading the epidemic. They are passing the buck, but still they have a point.
Apart from publicity, another factor that drew women into MPD therapy was of course unhappiness. If Carlson did not undergo satanic ritual abuse as a child, she suffered plenty of ordinary abuse. She came from a family with eight children and a distraught mother. "I believed that that was how all families were," she says. "That if your mother was having a bad day, she beat the crap out of you, bit you, took the belt to you, because you didn't do something as fast as you were supposed to." As for being molested, Carlson thought that was normal too, and when she found out it wasn't, she figured it was her fault: "Because I was such a girly girl, always flouncing around, with the little anklets and the little ringlets, and making the little tea party. I had called attention to myself, and that's how those incidents happened to me." At fourteen, she became rebellious and started running away from home. Then she lapsed into a depression, for which she was hospitalized and given electroshock treatment. Her parents, feeling unable to cope with her, made her a ward of the state, and she was placed in a "youth center." There followed many episodes of depression, together with suicide attempts.
By 1989, when Carlson began seeing Dr. Humenansky, she was on her second marriage, and it was failing. She had two children and no money. (She had sometimes worked as a fitness instructor, but at this point she had been unemployed for four years.) She had tried to go back to college, but in the middle of class she would be seized by a panic attack and would have to leave the room. She was in the hospital again—this was her fifth psychiatric hospitalization, as she recalls—when she was referred to Diane Humenansky. And when Humenansky told her that the cause of all her unhappiness was multiple personality disorder, her life made sense to her for the first time in many years. She felt she had failed in many ways, but now, it seemed, this wasn't her fault: "They tell you that somebody else did these horrible things to you, and that's why you are the person you are." Even in the present, her shortcomings were not hers. It wasn't she who bolted out of classrooms in the grip of a panic attack; it was the Old Lady, who frightened so easily.
Finally, with the MPD diagnosis came the promise of a cure. As Humenansky explained, the reason no treatment had ever worked for Carlson before was that she had been treated for the wrong disorder. Now that her MPD had been identified, she could receive appropriate therapy, and her alters, giving up their secrets, would fuse into one personality. This therapy worked, Humenansky said, and many authorities had said so before her. Furthermore, it promised to be interesting. Just as with psychoanalysis, which is a direct ancestor of MPD therapy, the idea of going to the bottom of oneself, of finding out what really happened, sounds very brave. It also sounds efficient, like solving a crime—"a whodunit of the unconscious," as Flora Rheta Schreiber called the case of Sybil. You find the criminal, and then everything can go back to normal. In The Three Faces of Eve, that is exactly how it works. Eve has a culminating traumatic memory, screams like a banshee, and fuses on the spot.
MPD therapy offers a further inducement, political solidarity. Child molesting is primarily a crime against females, and that, according to MPD insiders, is why MPD has been so ignored in the past, because women had no political power. To own up to one's abuse, to reveal the damage done—in short, to have MPD—is to stand up for women. Humenansky said that she was going to write a book on MPD, and that Carlson's story would be part of it. Carlson was joining a vanguard. They also talked about Carlson's going into the business: "I would have my therapeutic family, Dr. Humenansky and the group, and then I would become a therapist, with her. She would oversee things, and I would do therapy, to help other multiples." Indeed, Carlson had a therapeutic family already, Humenansky's MPD group. At their meetings, the women would get down on the floor, switch into their child personalities, and play board games, while Humenansky sat in a chair smiling down on them—like Mother Goose, Carlson says. "There we'd be, playing Candyland, and our insurance companies would be getting charged for it!"
To this machinery of causes, add one last element, fear. Carlson says that when she was not responding to Humenansky's therapy as she was supposed to---when she failed to come up with new alters, new abuse memories—the doctor reminded her that patients who undermined their own treatment and thereby failed to get better could have their children removed to foster care. (Carlson's children were not David Carlson's. They were from earlier unions.) According to Carlson, another woman in Humenansky's MPD group had had her son removed temporarily, on the doctor's recommendation. Humenansky also mentioned the possibility of Carlson's going to the state mental hospital. Such threats are not uncommon in MPD therapy, and they have added force in that MPD patients often feel they are doing poorly as mothers—which, as they sink into the grip of this therapy, is often the case. Some have been persuaded to bring their children in for therapy too. Carlson's daughter Lisha was in treatment with Humenansky for over a year, but the girl never embraced the therapy the way Elizabeth did. She was too frightened by what it was doing to her mother. According to Lisha, Humenansky told her she had reason to fear: the illness was genetic.
Eventually, Carlson came to her senses, almost by accident, or two accidents. After she had been in treatment for a year and a half, a friend in her MPD group recommended to her a new medication. She got a prescription from Humenansky, started taking the drug, and felt better, so she flushed all the other pills down the toilet. Around the same time, a problem arose in the MPD group. Humenansky brought in a new patient, and nobody liked her. "She monopolized the hour," Carlson says. "No one else could talk. Also, she kept lifting up her blouse and showing us where she had sprayed oven cleaner on herself. It was horrible, all pus and scabs." When the others protested, Humenansky told them that if they didn't like the group the way it was, they could start their own group. They did. Once a week, they got together, and as they talked in Humenansky's absence, they began to notice certain odd things: all of them had similar abuse memories, memories that furthermore closely resembled events in the books Humenansky had given them to read. Carlson recalls: "One woman said, 'I have a confession to make. I made up an alter named Nikki because everybody else in the group had a Nikki and I felt left out.' Slowly it began to dawn on us, what had happened. And then things changed. We started keeping secrets from Dr. Humenansky. But I didn't feel I could quit therapy. I was afraid of her. Also, a lot of the time, I still felt I needed her."
Then one day Carlson called Humenansky's office to confirm an appointment. As she recalls, Humenansky told her "that the MPD group was conspiring against her and that she was dropping all of us as patients, on the advice of her attorneys. This was in November. I begged her to keep me until the holidays were over. Christmas was always hard for me. She said no and hung up. I cried. That was the end. Two years." ....
I Contain MultitudesWhy were so many women thought to have multiple personalities?
(uh... maybe because they did? - Astraea)
By Peter D. Kramer
The recovered memory movement is a case of a host of good intentions paving a precipitous road to hell. In the early 1960's, pediatricians breached decades of silence by naming the battered child syndrome. The same years witnessed a revival of feminism and a new willingness to speak frankly about sexual molestation. Meanwhile, psychotherapy was moving from old ideals of neutrality to treatments based on empathy and even advocacy for patients.
Each of these changes was important and necessary. But America has trouble with proportion, and by the 1980's the melding of child protection, politics and clinical zeal had produced outsize claims -- that a third of all girls are sexually abused, for example, and that women's personalities are largely, even universally, shaped by early sexual trauma. One corner of this hell was a 10-year epidemic of multiple personality disorder.
Multiple personality disorder is the Sybil or Three Faces of Eve condition, in which distinct personalities, or alters, recurrently take control of a person's behavior. Its roots extend back to the Victorian romantic interest in divided consciousness -- Jekyll and Hyde -- but the condition has always been controversial, doctors disagreeing as to whether it even existed. In the 1980's, however, it came to be understood as a consequence of child abuse. Enough cases were diagnosed to support a new profit center in mental hospitals, the dissociative disorders ward. Credulous news reports spread the craze.
This bubble, the rise and fall of multiple personality disorder, has caught the attention of Joan Acocella, who is best known as a dance critic but has also long worked as a textbook writer in psychology. It is as a reporter that she confronts M.P.D. in Creating Hysteria. She is not neutral -- angry and scornful, rather -- but then she is describing outrageous events.
Acocella begins by describing the case of Elizabeth Carlson, a 35-year-old depressed mother of two. In 1989, Carlson came under the care of a psychiatrist, Diane Humenansky, who believed that M.P.D. was underdiagnosed. According to Carlson's later testimony, quite minor indicators of dissociation -- for example, "zoning out" while driving -- led Humenansky to walk Carlson through "guided imagery," suggesting she imagine candles and daggers. Carlson kept a journal, and Humenansky picked out themes and then supplied names for aspects of her personality. Carlson soon had many alters; after 25, she lost count. She came to believe that family members participated in a murderous satanic cult.
Almost by chance, Carlson was put on medication that made her feel better. She walked out of her therapy group and compared notes with members who, Acocella says, felt bullied by Humenansky. In 1993 and 1994, Carlson and another patient sued Humenansky and were awarded over $2 million apiece. The verdicts marked the beginning of a rapid decline in diagnoses of M.P.D.
Effective journalism also helped end the fad. In 1993, The New Yorker published Remembering Satan, Lawrence Wright's expose of satanic ritual abuse, a recovered memory variant in which patients recall unspeakable (not to say incredible) torture at the hands of cult members. The two disorders overlapped: many multiples, like Carlson, had dredged up memories of abuse by cults. As Acocella puts it, "For M.P.D. believers, S.R.A. created a crisis similar to the one faced by American Communists when news of the Moscow trials reached the West in the late 30's." If they defended their colleagues, dissociation specialists were extremists; if they pulled back, they were conceding the role of the news media and their own profession in fomenting hysteria. Experts beat a hasty retreat; Acocella's comparison of pre- and post-1993 versions of psychology textbooks is devastating.
By now, both recovered memory and satanic abuse have been debunked repeatedly. Is there room for a book about this special variant, multiple personality? Acocella covers familiar ground, but she finds fresh details.
Multiples tend to be highly hypnotizable women -- 90 percent are women -- who have suffered difficult childhoods. Many are poor. They have been in the mental health system for, on average, seven years, and they almost always meet criteria for other, better-established mental disorders. M.P.D. provides a particular form for suffering, one that is more compelling, for both patient and doctor, than run-of-the-mill depression or anxiety.
Acocella traces that form to the 1974 best seller Sybil, an account of the dramatic exposure by a psychiatrist, Cornelia Wilbur, of early sexual abuse in the case of a housewife with 16 alters. But Herbert Spiegel, a hypnosis expert who cared for "Sybil" when Wilbur vacationed, denied that the patient had multiple personality disorder -- he believed Wilbur created the alters -- and said as much to the journalist who wrote the best seller. Reportedly, the writer replied that the publisher demanded Sybil be a multiple. Acocella makes a convincing case that Sybil used Eve as the jumping-off point for her own imaginative flights. (During the epidemic, Eve re-emerged and claimed 21 alters, in competition with Sybil.) Modern M.P.D. turns out to be an instance of desperate life imitating shoddy art.
Acocella identifies psychiatrists who played a lead role in this fiasco. But her story's hero is also a psychiatrist, Paul McHugh, the common-sensical director of psychiatry at Johns Hopkins, who wrote: "Close the dissociation services and disperse the patients to general psychiatric units. Ignore the alters. . . . Pay attention to real present problems."
If Acocella has a flaw as a critic, it is her own tendency to hyperbole. She has a weakness for superlatives (most famous patient, most credulous doctor). And in estimating the size of the epidemic, she relies on the claims of the enthusiasts whose credibility she successfully attacks. At its height, most psychiatrists had probably still never met a patient with the diagnosis.
Acocella sees the furor as having lessened the pressure for substantive solutions to the problems of disadvantaged women and children. For her, the crucial target is not sexual abuse but poverty. Creating Hysteria should move psychiatrists, political activists and journalists to examine how they contributed to this debacle, and the story it tells poses a particular challenge for psychotherapy: what if the empathetic stance is as risky in its own way as the clinical distance it replaced?