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|MULTIPLE PERSONALITY DISORDER|
|THE CONCEPT OF PERSONALITY|
Behavioral expressions of humans and other complex social animals are defined by three psychological components: temperament, culture, and personality. Temperament is inborn and characterizes a specific animal species. A fox constantly runs about looking for food or mischief, but a lion sleeps twenty hours a day. Cows mainly rest or feed slowly, but dolphins are highly active, spending brief moments to feed and long hours to play. Humans devote long hours to work, rest, sex, learning, exploration, and entertainment. These biologically predetermined characteristics are resistant to change within the lifetime of an individual and define us as a species.
Culture is a set of acquired traits and is learned in a social environment. Culture can dampen or enhance personal expression. Hispanics are generally vivacious, but Scandinavians are more reserved. Germans are private people, but Italians seem to expose their private lives in the streets. New Zealanders dress conservatively and the same way, but Americans dress to express their different tastes. Asian cultures suppress individualism, but Americans embrace it.
Personality is a psychological concept that reflects acquired behavioral trends of individuals. We spontaneously evaluate other people within the same culture and categorize them based on the overall impression they make on us. Although personality is difficult to define exactly, we intuitively know what personality is and do not hesitate to form our opinions about the mental, social, and behavioral traits of others.
The above characterization of the psychological makeup of humans is largely correct, but neither an individual's impression nor psychology as a science is able to fully and correctly recognize the relationships between temperament, culture, and personality. Each of these psychological components is produced by a complex system of neural structures, connections, and chemicals. Damage to even one attribute of the biological, neural, or psychological makeup of a person can produce subtle or major changes in behavioral expression. These issues are especially important in the multiple personality disorder, when all three psychological components of the human being interact and project the images of unique personalities (personas or alters) within a personality (persona or alter) system. The labels persona and alter are used intentionally to indicate that the neuropsychological construct of a "personality" in the multiple personality disorder is not the same thing as the purely psychological set of traits known as personality.
A complete personality (both in healthy people and in multiple personality disorder) is a binary system consisting of the dominant affective half and the subordinate semantic half. The semantic half can speak, but has no emotions. The affective half has emotions, but cannot speak. Only a complete personality speaks and has emotions. The brain has several cognitive levels, and each level has its autonomous personalities. Personalities of different brain levels are related by common experiences, but are separate and can reconfigure themselves independently of the other brain levels. Such restructuring typically results in corresponding changes in the cognitively related personalities of the other brain levels. Interestingly, behaviors observed by a therapist may lead to incorrect conclusions about the personality system. The top brain level can be purely semantic, and the lower brain level can be purely emotional. And the therapist incorrectly concludes that he is dealing with an emotional personality that can talk. However, multiple personalities typically exist only in the two highest brain levels, because lower brain levels can bear a lot of suffering without disintegration. They only manifest the classical PTSD symptoms, especially misdirected anger and rage. There is a possibility that physical torture or other somatic suffering might break up even the next lower brain level, but this assumption has not been confirmed clinically.
Multiple personality is a challenge for doctors because traditional medical and psychological disciplines have narrow focus, rigid boundaries, and do not interact. Multiplicity is typically judged by its behavioral and cognitive manifestations, but the diagnosis does not include the underlying neural and biological processes. A psychologist who believes that multiple personality is simply the product of internal beliefs and mental constructs will have a hard time understanding a patient suffering from multiplicity. Likewise, a psychiatrist who treats such a patient for abnormal levels of hormones and neurotransmitters will not make much progress. Only by combining all brain sciences, can the healer succeed in treating the patient. Failure to employ a multidisciplinary approach will lead to misunderstanding of the condition and to a failure to maximize the potential benefits of the treatment.
To understand the personas/personalities of people with multiple personalities, we need to learn about the overall neurocognitive makeup of the human brain. Only with this blueprint in our hands, can we reliably recognize what individual personalities consist of and what properties they have. Knowing and correctly applying the neurocognitive organization of the mind is not merely an academic exercise, but is critically important for our ability to identify personalities, evaluate their neurocognitive completeness or disintegration, recognize the underlying brain disorders, and devise appropriate treatment strategies. These issues are especially significant when personalities exhibit diverse ages, diverse cognitive abilities, or diverse physiology, handedness, blood pressure, sexual orientation, allergies, illnesses, or responses to drugs and medications.
WHAT IS MULTIPLE PERSONALITY DISORDER?
Multiple personality should be viewed as one of several dissociative manifestations arising from severe traumas. Traumas can lead to various dissociative modes, and the dominant one determines which diagnostic label the patient receives. The less prominent dissociative modes can result in disorders that complement multiplicity or exist as independent parallel disorders. For example, a person with multiple personality usually has many personalities with deficient emotional intelligence, or with impulsive behaviors, or with symptoms of post-traumatic stress disorder. Similarly, a person with bipolar disorder can have multiple personality, but its symptoms may be masked by the strong indicators of mania and depression.
Multiple personality disorder itself is a complicated neurocognitive condition. The diagnostic label of MPD was first used in France at the end of the nineteenth century . A case of a split personality containing just two minds was already reported (based on hearsay) by Dr. S. L. Mitchill in 1816 . Various other labels undoubtedly existed for patients in older times. In all likelihood, the doctors were only aware of a subset of the symptoms, and failed to acknowledge the full spectrum of the manifestations. Similar problems exist even today, and multiple personality is often simplified to some specific trait. The subjects are considered mentally deficient or abnormal, and hardly anyone cares to investigate their condition in depth. The first impression typically results in a "diagnosis" of some other disorder the doctor is familiar with. The unfamiliar is ignored, and the familiar is substituted for diagnosis, even though there are no facts to warrant such a false diagnosis.
The problems of poor qualification of medical personnel already begin in medical schools, where professors teach students that MPD is a rare condition. What the professors mean is that they never saw one patient who had MPD. As a result, MPD appears just as exotic to doctors as it appears to the general public.
Multiple personality disorder has only become widely recognized after the publication of Diagnosis and Treatment of Multiple Personality Disorder by Frank W. Putnam . Since that time, many other professionals have confirmed his findings, and yet they are a tiny minority, not exceeding a few thousands worldwide. Despite the general denial of the illness, multiple personality disorder exists and is much more common than anyone would believe. This brain disorder often arouses odd attitudes, and most people want to hear fantastic-sounding stories about the expression of multiplicity, but show little concern with the real impact this severe neuropsychological condition has on the sufferers.
Multiple personality is easiest to explain from the clinical viewpoint. Every person has various sides to her nature. She can become aware of her sides if she pays close attention to her moods. Sometimes she is happy, and at other times she is sad. Sometimes she is reasonable, and at other times she is demanding. Sometimes she is confident, and at other times she does not know what to do. Occasionally, a person can have ambivalent feelings. Depending on the particular environmental stimuli, one of her moods happens to be dominant in a given situation. All the moods are in mutual contact, influence each other, and perceive themselves as one mind. This is totally normal, but when something causes these neuropsychological entities to become mutually isolated, multiple personality is produced.
Multiple personality disorder (MPD), also known as dissociative identity disorder (DID), is a relatively permanent state of mind; the mind is split into partially or completely isolated neuropsychological modules. Each complete personality system has its own memories, emotions, and preferences, and behaves as a unique person. Some modules (usually called personalities or alters) are aware of the existence of other modules, whereas some personalities believe that they are the only mind in the body.
In everyday life, only a few personalities emerge to interact with the environment. A woman with multiple personality disorder may activate only one personality at work, another personality at home, and another personality when she is with her friends despite having several dozen personalities in her arsenal. Her personalities may be awake at the same time and watch the behavior of the currently active personality. They can affect her behavior by letting her know how they feel. This may happen in silent ways, unbeknown to the personality in charge of the body, or by talking and producing "audible" internal voices the activated personality hears .
Multiple Personality Disorder is a good name for the described illness. Unfortunately, most health professionals have been unable to diagnose the disorder. After years of political maneuvering at the highest levels of the mental health system, the name was changed to Dissociative Identity Disorder. The new name might have been chosen to appease both the promoters and adversaries of the diagnosis, but the change has signaled a denial of multiple personality by the mental health system. In effect, the establishment decreed that the earth is the center of the universe and there is no proof otherwise. Anyone opposing this view is a heretic and will be dealt with by the system. Such attitudes are not caused by deliberate ill will of the deniers, but by a mental disorder called psychopathology. But then again, there is no proof that psychopathology exists either.
The author does not use the Dissociative Identity Disorder label, because its creation is unnecessary. The international label is still MPD. The term DID is a defeatist one and has been created for political reasons: to placate emotionally deficient American skeptics who are incapable of recognizing clinical manifestations of multiplicity. Furthermore, DID implies that the illness is about personal perception of one's identity, which is a purely psychological construct. The DID term does not include the neural and biological aspects of the disorder and is thus less descriptive than the original name Multiple Personality Disorder is.
On the personal level, multiple personality manifests a unique dissociative disorder. The mind of a multiple is permanently dissociated, which means that the mind is broken up into compartmentalized functional modules. Selection or suppression of these modules produces the phenomenon of multiple personality. In addition to MPD, there are several other dissociative disorders that can lead to permanent dissociative states of the mind. These states may produce symptoms that are indistinguishable from MPD if encountered over a relatively short time. By contrast, some dissociative modes are only temporary and selective, and a person is momentarily dissociating. The mind returns to normal operation soon after. Also during this mode of dissociation, the mind distances itself from certain functional parts. They are not personalities, but components of the overall united mind. For example, while danger lasts, some segments of the mind become inactive and allow a soldier to fight without experiencing fear. He is temporarily detached from his emotion, but he can reactivate and even succumb to the emotional effects once the danger is over.
As for the possible number of personalities the mind can have, this is a tricky topic. In theory, the number of personalities can be huge. In real life, personalities are only created in response to overwhelming traumas, and the same personality can be responding to all traumas of the same type. This is why repeated child rape does not produce a new personality during every episode of rape. Only when the contextual attributes change is there a need to form a new personality.
Although most personalities are created as a direct result of a trauma, some personalities are created as a byproduct of such splitting. When two disagreeable neuronal areas split from each other, one or more smaller areas may be left behind. Also these areas of the neural substrate may become independent personalities if the neuropsychological conditions are right.
The likely triggers (severe traumas) of permanent dissociation hint that the number of possible personalities could run in the dozens. In extreme cases, when the abuse is lifelong, several hundred personalities might be expected to exist. By contrast, according to MPD skeptics, thousands of personalities have reportedly been identified by some doctors. This claim is difficult to accept. It is unlikely that a psychotherapist would be able to encounter thousands of personalities and keep track of them. Most individuals can only identify a few thousand people in real life. The likelihood that a doctor doing two hours of therapy per week could discern a comparable number of personalities, which only emerge briefly and occasionally, is highly questionable. The author reports that he was able to identify only a few personalities in most non-patient multiples, and only two dozen personalities in the most severe cases, which are more likely to become mental patients. Some of the subjects were studied for decades, but did not have dramatically higher numbers of personalities, relative to the non-patient multiples, who were studied just for several years. The clinical experience suggests that there could be up to several hundred personalities in a person in extreme cases, but identifying them all may not be achievable.
Note: All the author's subjects were evaluated in full consciousness and without the use of hypnosis. Hypnosis might reveal additional personalities of the unconscious mind, which can remain inactive during consciousness. In addition, exploration of specific childhood traumas often exposes additional personalities. The number of all personalities in an average multiple could be about two dozens. However, the author suspects that some of the severe cases may have had at least a dozen more personalities than he managed to encounter.
In the 1980, most studies of multiples reported relatively low numbers of personalities, roughly 15 per patient. A decade later, quite a few patients were diagnosed with between 30 and 45 personalities. The reason for the increase is not clear, but might reflect an improved ability of clinicians to recognize individual personalities. Honestly, identifying personalities that wish to stay unrecognized may be difficult. Many may look very similar to each other and may only differ in habits, vocabulary, gestures, and memories. The problem with identification of personalities is particularly big when a patient only has one or two therapy sessions per week. At this low exposure, a number of personalities may not be encountered for months, and the therapist needs to periodically relearn who is who.
HOW DOES A NORMAL PERSON GET MPD?
Normal people do not get MPD. If a person exhibits multiple personality, his or her life must have been anything but normal despite superficial semblance of normalcy. Multiple personality disorder typically develops at a young age because of some kind of very traumatic experience, usually long-lasting and severe abuse. The earliest age when MPD can develop has not been clearly established, but seems to coincide with early infancy. Allison, who is an expert with extensive clinical experience, believes that MPD predominantly develops before the age of 7 years . Other clinical workers have reported dramatic age regression in their patients with MPD down to the toddler age. Such effects hint at the existence of multiple personality even in preschool age, but complex dissociative disorders could also produce an identical age regression. According to the author's discoveries, the foundations of the neural structure and cognitive organization of a personality already exist during the third month after birth, and repeated mental shocks should be able to break up the personality even at this early age. It seems that the frequent development of MPD in early childhood is more a function of abuse that occurs at this age, rather than of different neurobiological mechanisms in young versus older victims. The fact of life is that vulnerable subjects are children and are abused much more frequently than adults are. Because of this relationship, MPD typically originates in childhood.
Abuse that leads to development of multiple personality can be emotional, physical, or sexual, or combinations thereof. In reality, all abuse is mental. The mind perceives and interprets the harmful acts as abusive. The aftereffects of childhood sexual abuse seem to be responsible for more than 90% of all MPD cases. By contrast, non-abusive traumatic events do not cause multiplicity. Multiple personality disorder only develops when a person is helpless and unable to escape her suffering or the threat of suffering, especially when the abuse is repetitive or lasting weeks, months, and years. A significant factor leading to the development of multiple personality is the dependence of the victim on the abuser and establishment of a personal relationship with him. He becomes an essential and psychologically inseparable part of her existence, but he is also her torturer in the mental sense. The cognitive substrate of the brain is unable to reconcile these dramatically opposing experiences and is forced to split into pieces.
In therapy, contemporary MPD healers like to tell their patients that MPD manifests their strength and intelligence. The naked truth is different. Splitting into personalities is a chaotic response and has little to do with intelligence or mental strength. The very existence of personality splitting bears testimony to the subject's insufficient mental strength. And the inability to process the cognitive input reveals that intelligence is of no help. Every neural area that is exposed to the experience of unbearable abuse tries to isolate itself from the awareness. Some neural regions are more successful than others. Dissociation blocks the information flow at reasonably predictable brain areas occupied by cognitively disadvantaged neural substrates. They are either too close to the source of the information or do not have the ability to handle it. They bear the brunt of the mental attack. After the breakup, the remaining (dysfunctional) mind starts to make arrangements to handle the current cognitive processes. This mode of operation stands for coping with mental challenges. The brain is now damaged. The available cognitive resources are scarce and often inadequate. The poor behavioral responses confirm these facts. It is this post-traumatic functioning that produces the manifested characteristics of personalities (host, protectors, persecutors, firefighters, and others). The emotional intelligence of these entities is low, which shows in disproportionate, hyper-specific, or inadequate responses.
A good analogy of personality splitting is a platoon of soldiers during an aerial attack. The soldiers form a functional unit. They can hear bombs speeding through the air, and they are scared. They frantically run in all directions, but some are hit, no matter what they do. Neither intelligence nor mental strength has effect on the outcome. The survivors end up scattered all around the neighborhood and are afraid to return to the danger zone and become a functional unit again.
The above analogy realistically describes what happens to a victim of unbearable traumas. Similarly as the exploding bombs, the traumatic experiences kill, injure, and shatter the neural and mental components of the brain. Some parts are permanently destroyed, and no amount of therapy can bring them back to life. Other parts survive, but are seriously wounded. They can heal over time and can function better, but many of the injuries leave permanent scars and disabilities. And some parts just become shattered into pieces that can be picked up and glued back together. After a successful therapy, the surviving parts function as a unit again. But the unit is different, less complete, less intelligent, and less competent than what it would have been without the abuse.
Car accidents or similar single traumatic events that occur suddenly and allow no opportunity to agonize do not produce multiple personalities. However, clinical investigators report that people who have experienced only one traumatic event can have multiple personalities. Such person's include witnesses of parent murder, or victims of rape by strangers, or survivors of sudden natural disasters. Whether or not such events cause multiple personality is questionable. The events certainly can produce post-traumatic stress disorder, time loss, repressed memories, and similar effects, but multiplicity is probably not the typical outcome. It seems that such single traumatic events often mask previous traumas that were frequent and led to the creation of multiplicity even before the occurrence of the recent one-time traumas. The contemporary traumas may result in creation of additional personalities. By contrast, incestuous child rape by a parent, which is presumably a repetitive activity occurring several times a week and lasting years, causes constant fear and tension in the mind of the child, and unavoidably produces severe dissociation and multiple personality disorder. Dissociation takes place not only during the actual abusive episodes, but also during any future reminders of the abuse. Thus, dissociation is an ever-present process. The longer it goes untreated, the bigger damage it does to the mind, the brain, and the body.
A grown-up person who is only abused in adulthood can develop multiple personality disorder, too, but her effects are likely to be less apparent, and her treatment may be easier. Incestuously abused children with multiple personalities may create additional personalities when they are re-abused in adulthood. The author describes an incest victim with multiple personality disorder who started smoking at the age of 20, when she was violently raped. Incidentally, she developed a new personality "Smoker" who regularly smoked, but only in the privacy of her home. Even twenty years after the traumatic incident, some of her other personalities did not know about her existence, and the person was known to all her friends and colleagues as a nonsmoker. The author also encountered a subject from an abusive relationship who developed a new personality at the age of 35 years. The personality exhibited normal adult behaviors, but had no awareness of life events that preceded her creation. These clinical examples suggest that traumas can produce new personalities at any age.
In the academic circles, an interesting theoretical question emerges with regard to creation of personalities. Experts sometimes wonder whether or not multiple personality disorder can be produced by other mechanisms than severe traumas. Indeed, such a possibility seems likely, but is difficult to confirm clinically. If, for example, a mother is a victim of childhood abuse and develops MPD, she may create an unhealthful psychological atmosphere in her family, and her child may respond to the mother's personalities differently. The mother may not abuse the child severely or sexually, but the overall unpredictable atmosphere she creates is likely to induce dissociation in the child's mind. The child unconsciously learns to selectively engage the most appropriate brain areas to match the activated personality of the mother. The mother's unpredictable behavior does not cause sufficiently intense traumas in the child, but the overall cumulative effect over years of interactions causes that the child appears to be psychologically indistinguishable from a real multiple. Such a child does not have the sharply defined separation between her personalities as true multiples have. The isolation is not absolute, but sufficient enough to justify the label of MPD. A child affected in such a way is likely to be easier to treat because the boundaries between her personalities are relatively permeable and are predominantly psychological, rather than biological.
Identifying patients with this type of MPD is difficult because a clinician cannot tell for sure whether the child, in addition to facing a changing and unpredictable parent, was also abused so severely to warrant biological separation of personalities. The fact is that an overwhelming number of parents with MPD do abuse their children, and both the abuse and the overall family environment shape the child's personalities.
Despite of years of research in dissociative disorders, the exact mechanism of traumatic dissociation is still poorly understood. It can be said with a degree of confidence that non-abused personalities in therapy do not want to be exposed to the traumas the abused personalities experienced. The healthy parts try to keep themselves safe and comfortable. Interestingly, the healthy parts originally have no awareness that any sort of a trauma was experienced by the abused subject. This fact hints that the healthy personalities did not dissociate from the one who was subjected to unbearable traumas during the abuse. Their awareness of the traumas was nonexistent prior to therapy. It was the traumatized personality who frantically tried to block her painful awareness during the assault. She produced massive amounts of chemicals to stop the incoming messages of her suffering. The process was chaotic and targeted all cognitive pathways in all possible ways and directions. The violated personality has become detached from all other cognitive parts of the mind. The only link to this personality is now maintained by the unconscious mind. Because of the isolation, the unconscious mind sends all future contextually similar stimuli of abuse to the already abused personality. The link has been established, and the painful messages can take no other paths. The cognitive context serves as an address to the abused personality. Only when an abusive experience becomes sufficiently different in its context, will the unconscious mind channel the messages to different (as yet non-abused) regions of the mind. Naturally, the mind will react the same way as the previously abused segment of the mind did, and a new personality will be created. This is the most plausible scenario of the dissociative mechanism to date. Further research will be needed to determine whether the ideas are correct or not.
The main division of personalities is given by their brain levels. In the classical case of MPD, both the basal system and the cortical system will have one family of personalities. Each family will be governed by a dominant personality. In polyfragmented subjects, several families of personalities may exist at each brain level.
Clinicians working with multiples have identified various types of personalities. The categories describe behavioral manifestations and attitudes, which are driven by different memory banks. The following characterization of personalities applies to middle-aged female multiples. Males, children, and adolescents are likely to have somewhat different psychological makeup. In general, personalities manifest differences in cognitive and executive abilities. Some personalities are strong-willed and in charge of other personalities. Others are submissive and do not challenge the leaders. One personality type, known as the host, has been identified by clinicians and recognized for its dominant control over the body. This personality lives in the cortical system.
The host personality is essentially the same as other personalities are, and is controlled by the same neural mechanisms as they are. However, the host is also involved in unique control mechanisms that imbue the host with prominence in the brain. The host is not the true person, who happens to have additional cognitive parts in the form of the other personalities. Every personality is a cognitive system in its own right. The personalities and their interactions, as a group, are the individual perceived by an observer. Surprisingly, many subjects with MPD commonly state "I have multiple personalities." The subjects incorrectly believe that their minds, as they perceive themselves, are the persons, which happen to have additional smaller cognitive modules labeled personalities. The subjects (and most therapists) do not understand that what they perceive as "I" is just one of several personalities, and each of them perceives itself as "I."
The significant trait of the host is that she is the most powerful personality in the mind. She controls the body frequently and has strategic influence on the multiple's life. Changes in daily routines (illness, vacation, seminar, relocation, business trip, etc.) may cause that other personalities emerge as temporarily dominant. When daily life returns to normal, the host personality resumes its prominent role. Interestingly, the host has the luxury of being absent for days, weeks, and months, and the multiple's other personalities carry on as if everything were under control. Even more stunning fact is that in some multiples several of the leading personalities may be gone for extended periods, and those next in ranks, such as numbers four, five, six and seven are still able to carry out their duties on the job and at home.
In the majority of cases, the host covers the roles of a parent and a spouse, and also goes to work. The host tends to be overwhelmed by life and is one of the most depressed or serious personalities. Another of her traits is profound loss of emotional intelligence and with it associated consequences:
The two leading ladies belong to different brain levels and different families of personalities, and both leaders have strong organizational tendencies and abilities. Consequently, multiples are attracted to managerial jobs. Cortical personalities related to a host are few and come out infrequently. Personalities of a basal family are relatively numerous (5 to 10 typically) and come out often.
The Host sets strategies, approves critical decisions, and controls the most important happenings in the life of the multiple. She can be activated by using her full name, such as Jane Doe, or simply Mrs. Doe. She will also respond to the name Jane, but she clearly prefers the last name, at least in the majority of multiples. Likewise, she preferably uses the last name to address other people. She may even talk about her spouse and friends by using their last names with proper titles. Female multiples are more likely to use the expression Mr. Doe, but male multiples may simply use the last name Doe.
The Leader of the Basal System takes care of everyday matters as determined by the host. She also manages the most important acts and events that require sociable character. The host would be unable to perform them successfully because of her harsh nature and her lack of social responsiveness. The Basal Leader will respond to her full name, such as Jane Doe, but strongly favors her first name Jane. Similarly, she is much more likely to address others by their first names. This egalitarian mentality contrasts the impersonal officialism of the host. The host may become activated when a big problem arises and may address a subordinate worker in trouble as Miss Doe. Minutes later, the multiple switches to her Basal Leader and addresses the worker as Jane. The described use of names applies to the American society. Multiples in other cultures are likely to use different ways of addressing people.
The two leading ladies with no emotional intelligence are only found in multiples who have fully developed MPD. In cases of very severe dissociation, the Cortical Leader may lose her dominant influence. She may come out only at times, and the Basal Leader is promoted to overall leadership in the mind. Subjects who were not abused as profoundly may have multiple personalities only at one brain level. The other family is in one piece and behaves as one personality. Her behavior is similar to that of a Leading Lady, but she has a full range of emotions and also has fair emotional intelligence. She may influence the behavior and emotions of the other family at times.
On occasion, the host may become relaxed, sociable, friendly, and her facial features may appear more lively. This state has always been associated with the activation of another personality of the cortical family. The personality does not come out openly, but retains the key physical features of the host. She speaks and acts through the host. In a private setting, after the hidden personality develops sufficient trust in the person she is with, the personality may come out in the open. The immediate consequence is her facial transformation. It may happen in a big way. She may be unrecognizable as the known individual. She may turn into a stranger, sometimes of different ethnicity. Also her voice, vocabulary, style of speech, posture, body language, physical strength, illnesses, weaknesses, habits and preferences may seem foreign to the naive observer. But a good observer will recognize the vocabulary, linguistic patterns, and attitudes he encountered in the host during her "better mood."
A remarkable trait of the host is her rationalization. Rationalization includes the mildest degree of confabulation, and some factual statements of the host are occasionally fabricated to fill in gaps in her memory. By contrast, biographical memories of traumas are grossly distorted in the host. But the prevailing trait of rationalization is not falsification of reality. The main characteristic of rationalization shows as incorrect logical association of the known facts. The relationship between cause and effect in traumas and personal issues is understood very poorly, but the host is sure that her reasoning is perfect. The same phenomenon occurs in people with anosognosia (unawareness of one's illness, which is a personal matter), but at a higher level. A patient with anosognosia often disowns her left side and produces fantastic explanations about her paralyzed left arm. The explanations are delivered "sensibly and logically," but without the slightest recognition that the claims are irrational. The host personality exhibits identical reasoning patterns when she is confronted with her rape. The host is semantic by nature and, therefore, has very poor memories of her personal history. As a semantic part of the mind, she is unable to successfully retrieve and process personal experiences. She usually denies her trauma at first. As the questioning continues, she may vaguely admit such a possibility. Meanwhile, she ignores facts and reality, makes irrelevant memory associations, changes the focus, and leads the therapist away from the main topic. In doing so, she may unknowingly hint at additional traumatic experiences addressed by the questioning. The issue is disturbing and motivates her to say two or three things in response to a simple question, instead of just saying no. A normal person with affective intelligence would say no, and then would ask why the therapist thinks that she was raped. Instead, the host personality produces numerous implausible explanations to the therapist's questions (Gazzaniga's interpreter; see split brain on the internet.) and lacks awareness that her responses are evasive and have poor logic. Interestingly, the host and other semantic personalities tend to raise their chin or throw their head backwards during such intense mental stimulation. This trait arises from the semantic mind in general and is commonly seen in domineering stuck-up people who habitually raise their chins. A dialogue between a therapist (T) and the host (H) of Jane Doe may look like this:
T: I have learned from court records that you were raped on the job at thirty when you worked as a nurse.
H: I was never raped. You are mistaken. It must have been another of your patients.
T: Also the newspapers wrote about it. They identified the victim as J.D.
H: It wasn't me. Many women have initials J.D. Jane Dean, Jane Drew, Jane Denver. It could have been Julia.
T: My colleague who treated you at the time remembers the case.
H: Ahhh, you must have heard the false rumors people said about me when I was in training at twenty-three.
T: I have been seeing women like you for thirty years. I can clearly recognize the post-traumatic reactions in you.
H: You are totally wrong! You don't know anything! You should go back to school!
T: So, you were never raped on your job?
H: Some women may have been raped on the job. Not me.
Another influential personality type is the representative. She typically belongs to the basal family, but even the cortical personality is likely to have a sociable representative. She goes to work, offices, shops, events, meetings, and reunions to represent the multiple outside the family. This personality may go out with her real-life friends and also tends to emerge during interactions with the real-life members of her extended family. She is usually asexual, but may engage in sex if it is perceived as a form of social interaction.
The two leading families control the body perhaps ninety percent during the day, and nearly hundred percent at work. The remaining time is shared by various other families of personalities, or by personality fragments. These hidden psychological entities of the past do not play a major role in the current life of the multiple, but are the ones who lived through unbearable traumas. They are relatively numerous and usually have extreme attitudes with limited scope. Their effect on current happenings is largely disruptive. They may take drugs, engage in illegal activity, be promiscuous, or attempt to commit suicide.
Some multiples have several families of personalities that have adults who are influential in the personality system. There may be several cortical or basal families of commensurable power and status. When one family of either type gives up its power because of internal family problems (infighting, stress, emotional upheaval, or loss of control to another family), other families spontaneously fill in the power vacuum. Such patients typically have large numbers of personalities, about three or four dozens, or more.
Putnam  suggested that several personalities sometimes closely cooperate and behave as if they were the host personality. This impression may take place when the personalities are similar in age and appearance. However, close examination of the seemingly united entity reveals individual personalities with unique cognitive and physical traits. Once the recognition is made by the observer, the false impression of unity never comes to mind again. Personalities that can best produce the apparent psychological unit are those of the leading basal family, and the key personality in the group is the head of the basal family. Almost every individual in the group is highly sociable, and some personalities are emotional. The overall impression is one of normalcy. The cortical family can also have several major personalities that appear as one to the uninitiated, but a good therapist will recognize bigger differences than among the members of the second family. However, the amazing trait of the basal and cortical families is that both families have personalities with essentially the same functions. The basal and cortical personalities are unrelated, but perform the same functions at their relative brain levels.
Personalities tend to be stable over a long time, but major changes, such as death in the family, chronic illness of the multiple, divorce, imprisonment, and above all disclosure of multiplicity to the patient, may lead to reconfiguration of personalities. The host who used to be present for several years may disappear, and a few novel personalities may show in her place. One of them will be the "new host." She will have the key behavioral characteristics of a host, but may be very different in appearance, mentality, and unique traits from the old host. Interestingly, while some personalities of one family may merge together, those of the other family may disintegrate during the same period. The process of reconfiguration of the two leading families may take from hours to a few days from the triggering event. A week later, the patient may look and behave like an unknown entity. Just as common is occurrence of personalities who had been dormant for years.
Many of the powerful and highly sociable personalities have no emotional intelligence supplied by their brain level. They often believe that they do not need their body to survive. They do not take care of their body. They can be equally indifferent when a personality tries to kill another personality or attempts suicide. They fail to raise alarm and inform other personalities who are able to stop the acts. Luckily, the indifferent personalities can be taught to take action when it is desired. Contracts can be forged to make the indifferent personalities responsible for the acts of others.
In sexually abused multiples, strong sex drive is usually expressed by a unique personality that may naturally complement the frigidity of the above personalities. This personality, the sexual one, is an adult who engages in sex responsibly and considers it a normal part of life. By contrast, many multiples also have one or more highly sexually active personalities that live for nothing but sexual adventures. Suggestive sexual talk and face-to-face physical proximity may easily bring out these entities. They are often accompanied by the seductive one. She is flirting, smiling, pleasing, provoking, and is seemingly asking for sex, but is asexual. She typically belongs to a basal family. By contrast, a different personality that shows essentially identical traits may be highly promiscuous and eager to have sex whenever she can. Some child personalities have been sexualized, but not necessarily raped. They may enjoy sitting on a person's lap and have their hips, buttocks, thighs, and vulva fondled. Since fondling was the only time a significant other paid them attention, the personalities associate such interaction with love and comfort. Similarly, some children who were groomed all the way to sexual intercourse will believe that sex is an expression of love. In turn, they will believe that to love someone means to satisfy a person sexually. And they will also believe that their total worth is in their ability to sexually gratify others. Next to these notable personalities, a common multiple has numerous other parts, but their cognitive scope, purpose, and control over the body are limited.
An interesting aspect of many sexually abused multiples is that their personalities tend to seek the company of and sexual contacts with significantly older men. A ten year old child may want to have sex with a 25-year-old partner; a 25-year-old multiple will hook up with a 45-year-old man, and a 60-year-old multiple will be looking for an 80-year-old man. The gap of one generation is preserved as the multiple ages, and that is fascinating. She does not seek a man of the same age as was her original abuser during the years of her violation. It is as if her mentality is controlled by a lasting concept or a value, rather than by specific memories. The influence of the concept indicates that she does not engage her higher affective intelligence, but relies on her habits.
Limited repertoire of personalities is one of the most prominent cognitive aspects that differentiates them from non-multiples. A mentally healthy person has various interests and needs, but a specific personality only lives in its limited world and is unable to go outside its boundaries. When the cognitive limits are reached, the personality often becomes silent and unable to participate in a discussion. Such a cognitively poor personality may have nothing on her mind but her enjoyment of a sport or a game. Another personality may only be interested in being in a bar and drinking her favorite liquor. Another personality only cooks and cleans the house. Another personality only takes care of her children, but has no other functions. By contrast, some powerful personalities are capable of a broad coverage of diverse topics. Recognizing these entities as personalities is difficult. The subjects may give the impression that they do not have MPD. It may take an expert psychologist and several hours of interactions before the cognitive deficits of these personalities become apparent. In most cases, these seemingly normal people will have functional deficits in areas of emotional intelligence. They may not be able to look at things from the viewpoint of another person, may lack empathy, may have rigid attitudes, and may show striking indifference to human emotions, drives, concerns, and fears.
Every multiple seems to have child personalities. They may be needy and longing for love and attention. Other child parts are angry troublemakers. Some of them have narrow interests and try to satisfy their desires whenever possible. Child personalities contain most of the traumatic experiences that produced the subject's MPD. Child personalities often engage in emotional relationships with other people, but the dominant personalities thwart the relationships without the slightest feeling of remorse. The main reason for the indifference is that the two leading personalities are usually unaware of the existence of other personalities.
The great paradox of personalities is that the most powerful and most frequently activated personalities usually have no knowledge of traumas that resulted in multiplicity. Such personalities are able to handle everyday tasks, but have no ability to restore the personality system and form a single mind anew. By contrast, less significant personalities possess enormous destructive power and are able to harm or kill the subject. Some of these infrequently activated personalities hold the traumatic memories of the past. These personalities need to be engaged in therapy to restore the patient's mind with the help of the therapist at first, and under the guidance of the powerful personalities at a later time.
WHO HAS MULTIPLE PERSONALITY DISORDER?
The men and women in the author's studies show equal prevalence and degrees of severity of multiple personality disorder, but there are significant differences in the manifestations. Multiple personality disorder is much easier to diagnose in women because they typically show dramatic emotional changes when they switch from one personality to another. Men are less likely to display emotions and usually switch to another personality in subtle, inconspicuous ways, but sometimes may suddenly change the focus of their interests. The findings in adults also seem to be applicable to girls and boys.
Multiple personality disorder is more common and more severe among these people:
As for ethnic predisposition, multiple personality disorder has been labeled an American illness. The reason is given by the different levels of awareness and the numbers of diagnosed cases in the USA versus the rest of the world. With the exception of a few industrialized countries, mainly in Europe, multiple personality is considered an American psychological invention. By contrast, the author has found no substantial difference between the incidence of MPD in the USA and the incidence of MPD in other countries or cultures. His findings indicate roughly equal prevalence of MPD in subjects born and raised in the USA, Mexico, Europe, Russia, Israel, China, and Southeast Asia. Despite the generally commensurable statistics, the author reports that he found unusually high prevalence of high-degree MPD among Chinese women.
IS MPD HEREDITARY?
Multiple personality is a brain disorder produced by severe life experiences of an individual. So far, absolutely no indications have been found to suggest that MPD can be transferred through the genetic code. Contrary to this lack of impact on inheritance of MPD, victims of severe sexual traumas often develop significant genetic mutations that often lead to serious illnesses and even deaths. Some of the genetic changes only affect an abused child, while others are hereditary and can propagate through multiple generations. Because of the genetic mutations, children of victimized parents are predisposed to having numerous illnesses. Interestingly, clinical experience suggests that genetic mutations alone are often not enough to produce the illnesses. Many children only develop the "hereditary illnesses" when the faulty genes are triggered by severe stress or environmental chemicals. This scenario is likely to happen because future parents who are abused in childhood do unintentionally learn to be abusive. The values in the family of origin and the abusive experiences of the parents are permanently impressed in their memory and control their behaviors. These mental effects cause that abuse of children continues through countless generations. It commonly happens that abused children swear to themselves during their abuse that they will never harm a child when they grow up. Surprisingly, virtually all abused children become abusers. Not emotional abuse, not physical abuse, but sexual abuse is by far the dominant form of severe child abuse parents inflict on their children. This form of abuse also has the highest likelihood of producing MPD.
WHAT IS THE PREVALENCE OF MPD?
In 1989, a top American expert Frank Putnam believed that there were only several thousand people with multiple personality disorder in the entire United States . In 1991, Ross conducted a study and conservatively estimated that 1% of the general population in North America had MPD . These data contrast the findings of the author, who identified the following prevalence of MPD:
The right conditions mean several things: The evaluator is an expert who knows what she is looking for; the evaluator is capable of triggering switches in the patient; and the discussed topic is sufficiently sensitive to provoke dissociative switches. The author reports that he is able to induce switches in many younger women, who sometimes fear him so much that they succumb to panic attacks, but he gets differential responses from older women, who usually like him and are less prone to switch to another personality. Nevertheless, the author met several women in their 60's and 70's who exhibited stunning transformations and plenty of affect during switches between their personalities. The author also met a 70-year-old man who switched to a personality of a seductive little boy when he was exposed to the topic of child sexual abuse. These clinical observations indicate that multiple personality disorder does not diminish with age. On the contrary, dissociation tends to become more pervasive with time, spread to additional parts of the brain, and lead to complex dissociative disorders, such as Bipolar Disorder, Borderline Personality Disorder, and reportedly even schizophrenia [7,8,9].
The discrepancy between the here reported prevalence of multiple personality disorder and the generally accepted numbers may shock many experts, but one has to keep in mind that reports about the prevalence of child sexual abuse met with similar disbelief. For example, Sandra Butler quotes a Dr. Weinberg's study published in 1955 . According to the study, the extent of incest was 1.1 incest offenders per 1 million people in the USA in 1930. Hall and Lloyd quote Finkelhor's data  based on 13 studies in the USA between 1975 and 1985. The incidence of sexual abuse was from 6% to 62% for females; and from 3% to 31% for males. In her book Secret Survivors, E. Sue Blume writes, "More than half of all women were violated as children, most by someone they loved" . Yet the true prevalence of sexual abuse can only be correctly assessed after recognizing the visible signs of incest. The author's studies of the prevalence of child sexual abuse paint a far more sinister picture than is presented above.
Given the history of our awareness of child sexual abuse, it is not surprising that many mental health professionals in the United States believe that the "fad of MPD" will go away. The British psychiatric diagnostic system does not even acknowledge the existence of MPD .
WHAT ARE THE FOOL-PROOF SIGNS OF MPD?
Many professionals still remain skeptical about the existence of multiple personalities. The doctors want confirmation, evidence, and proof. But these are ideological expressions that have no place in medical science. There are no symptoms of multiple personality that serve such a purpose. The indicators are not accompanied by the labels confirmation, evidence, or proof. The symptoms are what they are. Nothing more. Incidentally, diagnosis of multiple personality disorder largely depends on a person's ability to interpret the observed symptoms. It is relatively easy to identify the physical symptoms of incestuous rape and say with near absolute certainty that a child has been raped. But confirming the existence of multiple personality disorder is more difficult. Several accompanying symptoms have been associated with this condition through extensive clinical work; see the page signs. Despite the presence of such symptoms, the diagnosis of multiple personality disorder demands confirmation through clinical work.
The assessment of multiple personality disorder is a subjective process that may take two routes. One way is to collect statistically significant dissociative experiences; in the legal parlance, the preponderance of evidence. The outcome of this test is determined by the willingness of the subject to share his or her experiences with a mental health expert, and by the expert's ability to filter out the patient's subjective opinions and interpret the meaningful answers. This work focuses on past events as they are perceived by the subject. The other method is the old-fashioned monitoring of the subject's psychological reactions (body language) in response to the therapist's suggestions and body language. This interaction happens at the present time and is known as the transference and countertransference phenomenon. But this process need not be easy. It all depends on the chemistry between the therapist and the patient, and on the overall social environment. Although many multiples do manifest their disorder within an hour, some cases are hard to crack. The author spent a year briefly interacting with one of his coworkers. Except for a mild depression and being anhedonic, she showed no clear signs of MPD. Then they were sent together to an off-site facility, and she exhibited three other personalities during the short trip. This behavior of multiples is common. Many personalities will not come out in public, but will eagerly manifest their presence when they are with a trusted person in private. For the same reason, hospital psychologists may spend days or weeks rigorously testing a subject who is suspected of having multiple personality. The diagnosis seems elusive. But take the subject to the cafeteria or for a brief stroll in the park, and she will readily switch to her other personalities while engaged in casual talk with someone who treats her as a person, and not as a mentally ill patient.
Next to clinical work, therapists use written tests to find out what possible mental disorder a patient has. By using the tests, a therapist may be able to identify multiple personality in cases when the subject truthfully answers the test questions. However, many patients are frequently misdiagnosed or not diagnosed at all. This outcome is particularly troubling because a qualified MPD therapist should be able to make the diagnosis within three sessions just by talking to the patient. The troubling aspect of giving somebody a test is that the therapist does not have the needed expertise and emotional intelligence to diagnose the condition clinically, but he erroneously feels qualified to treat it if the diagnosis is made.
DIAGNOSIS OF MULTIPLE PERSONALITY DISORDER
The easiest way to recognize multiple personality disorder is through direct contact with individual personalities. When a personality becomes activated in the body and says "I am Anna. Don't call me Maria. I hate her. She is a wimp," the statement is absolutely clear. But such open declarations rarely occur in everyday life. They are exceptions that are usually seen only in the therapeutic environment.
It needs to be stressed that most subjects with multiple personality behave no differently than other people do. The behaviors are normal on the surface and do not arouse the notion that something might be out of the ordinary. It usually takes some major discrepancy between factual reality and the claims of the multiple to arouse the suspicion that something is not right. For example, the multiple may say that she never uses lipstick, but the therapist can see her painted lips. Or she may say that she cannot stand her husband, and later the therapist sees her to embrace him and passionately kiss him. Or the multiple says that she came to therapy by a bus, but the doctor saw her park a car in front of the office. Only after such obvious discrepancies occur, can the doctor recognize that something is not in order. The natural reaction is to think that the patient is not telling the truth. If she is confronted with her lie, she may say that she misunderstood or was not paying attention. But there will be many more cases of such lying and denial of reality. If the doctor gave the multiple a lie detector test about her true behaviors, her unaware personalities would pass it by denying the multiple's behaviors. They would give factually incorrect answers or they would produce completely confabulated answers. How the doctor handles the discrepancies between his observations and the multiple's statements is critical. If the multiple is blamed, confronted in a hostile manner, or is prematurely shown proof that she lacks awareness of what she does, she is likely to quit therapy. Interestingly, after the doctor finishes his questioning, exhausts all his skills to make the patient admit the truth, and fails in the process, the multiple may inconspicuously switch to her knowledgeable personality and voluntarily confirm all the disputed facts.
A beginning mental health professional cannot expect to recognize multiple personality disorder the first time he sees it. The condition was only discovered some 100 years ago, even though it has probably existed throughout human history. For a long time, there were very few diagnosed cases. They were not the average multiples we daily meet in the supermarket. The prominent subjects manifested extreme behavioral inconsistencies, so that the incompatible behaviors became noticed by doctors. Such extreme cases are few even in today's world, but striking examples of abrupt behavioral changes are all around us. The author presents several striking behavioral and reasoning anomalies that had gone unnoticed by the people who witnessed them. And even when the anomalies were pointed out to the bystanders, they did not find them abnormal, not even peculiar! Incidentally, subtle behavioral shifts and changes in affect will have no chance to be noticed by the common psychologist.
There are two big obstacles that prevent mental health professional from recognizing multiple personality disorder. The first problem is caused by the general belief that multiple personality is a rare condition. This naturally leads to insufficient attention to this issue in medical schools, and a lack of focus on the topic by the already practicing doctors.
The second problem causing poor diagnosability of the multiple personality disorder is attributable to mental disabilities of the health professionals. Because of childhood sexual abuse, their minds are dissociated and often incapable of recognizing changes in the patient's body language and affect. The therapists' attention only focuses on spoken words. This usually happens to male psychiatrists with precisely sculptured edgy goatees. The men have lost their emotional intelligence, have suffered permanent neuropsychological damage, and no amount of training or schooling can fix their mental deficits. Teaching them to recognize multiple personalities is just as futile as teaching a cat to tell the difference between red and green colors. The cat does not have the necessary neural circuitry, and neither do the dissociated psychiatrists. So, the doctors are like the leading personalities of a multiple. They lack emotional intelligence and fail to recognize the existence of other personalities.
Naturally, doctors like these, who see no evidence of multiplicity, find no proof and disagree with the notion that the mind could have several entities that function independently of each other. Even when the psychiatrists encounter a person with multiple personality disorder and an expert explains to them what they see before their very eyes, they fail to recognize it or understand it. Incidentally, the purported phenomenon of MPD has been labeled by various psychiatrists as hysterical psychosis, psychotic neurosis, witchcraft, fiction, folie à deux, psychoheresy, attachment disorder, and even crock of dung. Also philosophers are having a hard time accepting that the brain could have several independent minds. That is not how they perceive the mind. But it also needs to be mentioned that they have been unable to explain how the healthy mind works. Expecting them to grasp the physiology of multiplicity is really too much.
Another common objection to the existence of MPD is purely mathematical. There was almost no mention of the illness prior to 1970, but publications about the disorder flourished during the following decades. In the minds of skeptics, the sudden occurrence of books about the condition clearly shows that MPD is not real, but is a fad. About as big a fad as the theory of relativity is. Prior to 1916, there was nothing published about the topic. But hundreds of articles were published during the following decades. The theory of relativity is obviously another fad that will fade away once all the delusional theoretical physicists undergo psychotherapy with one of the skeptical psychiatrists. Interestingly, some mental health professionals do accept the existence of multiple personality, but attribute it to the wrong causes. Some people believe that MPD is a product of social construction that is caused by pure psychology, rather than by damage to the brain. Others contribute MPD to divine intervention during extreme traumas.
Rejection of the existence of an illness is not restricted to multiple personality. During WWI, a phenomenon called the "shell shock" emerged. The severe physical stress of the explosion resulted in nerve damage. The problem was known to the troops in the trenches, who had first-hand clinical experience, but was officially dismissed by medical theoreticians and bureaucrats who ran the health establishment. Only much later, the term post-traumatic stress disorder (PTSD) was accepted to account for the effects of traumatic experiences in war.
A common problem among nonbelievers in MPD is that they approach the condition with minimal theoretical knowledge and with exaggerated expectations. Anyone who fits this description may end up disappointed because the sensational expectations may not materialize. Ideally, an evaluator should have rich experience with the suspected person. This takes weeks if not months of close and frequent interactions, preferably in various social and physical environments. Only comparison of the multiple's long-term trends with his or her current state can reveal whether or not a behavioral anomaly exists. Lack of understanding of this mechanisms causes skeptics to complain that proponents of MPD do not describe what a specific personality looks like and how one should recognize her. The clinical fact is that not every examiner has the ability and the time to activate alternative personalities. Manifestation of multiplicity depends on unconscious nonverbal interactions between a multiple and the observer, and not every person makes a multiple switch. Furthermore, clinical experience has established that diverse personalities are likely to come out in numbers only when they trust the person with whom they interact. In such a case, angry, fearful, seductive, and vulnerable personalities can be expected to come forth.
The Author Considers the Existence of MPD Detected when Certain Signs Occur:
1) The subject switches to another personality and shows an abrupt change in cognitive and/or emotional expression that can be explained by no other means but multiple personality disorder. The subject may change her adult seriousness to childish giddiness or anxiety, or she may show startling changes in semantic knowledge and the use of the knowledge. She may become unable to reason or evaluate a simple fact although she should be able to do so. She may not know that she has a college degree or won the Miss America pageant, Nobel Prize, Pulitzer Prize, or a $10 million lottery prize. Or, she may not know her job title, her marital status, or her address. Another common indicator in this group is that a young personality talks about the distant past lively and passionately as if the events were very recent. The observer gets the impression that the personality cares too much about the impact of the distant events on her present life. In reality, the personality stopped aging and is locked in the past. The past is the present for this personality.
2) The subject shows unbelievable gaps in episodic memory. A man with multiple personality disorder may not know that he had a car accident two days ago, that he got drunk at a party last week, or that he was pulled over by a state trooper and got a speeding ticket this morning.
Many clinical workers treating incest victims often describe vast gaps in memory, when several years or entire childhood are inaccessible. These statements are too generic and do not strictly agree with thorough clinical investigations. Multiples can frequently remember stunning details from time periods that are believed by therapists to be repressed. The patients can remember events that happened just seconds before or after traumatic events, but the actual traumas are inaccessible. Multiples can also remember their immediate reactions to traumas, but incorrectly associate the responses with some innocent detail that occurred within the context of the peritraumatic experience. The usual outcome of this false association is misdirected anger at the detail or persons involved with the detail at the time of the traumas. Just as often, multiples misdirect their anger when the detail is brought up in therapy, but it is now the therapist who becomes the target of the patient's anger.
3) The subject is "consistently inconsistent." He sets a course of action and demands adherence to his plan, but then completely reverses himself and eagerly pursues the new strategy. And then he may reject either approach and invent something entirely new. Frequently, his strategy may survive without any changes, but the reasons for the strategy may undergo a lengthy process of rationalization and contradictory justifications.
Naturally, once multiple personality disorder is detected, it is much easier to notice such behavioral patterns in the future. This does not mean, however, that the recognition of the subject's disorder automatically leads to the identification of his or her personalities. Getting to know individual personalities takes many hours of focused therapy or other long-term interactions.
A clinical evaluator of multiple personality disorder has to be careful not to confuse multiple personality disorder with complex dissociative disorders or with straight dissociation from the prefrontal cortex. All three conditions can exhibit dissociative switches and loss of emotional intelligence. And whenever multiple personality disorder occurs, complex dissociative disorders and straight dissociation from the prefrontal cortex may also emerge, but not all the time and not with all personalities.
Straight dissociation from the prefrontal cortex typically leads to reduced intelligence and sometimes rash judgment. Inability to comprehend the connection between cause and effect is very common, particularly in the area of emotional intelligence. By contrast, multiple personality disorder leads to behavioral inconsistencies, emotional outbreaks, contradictory values, beliefs, and strategies, or just plain ignorance. A multiple may be told, "The London Bridge is falling down," throughout the day. Every time, she replies, "Do not try to scare people," and goes about her daily business. One minute before midnight, she suddenly switches between her personalities and exclaims: "The London Bridge is falling down!" and expects nothing less than miracles.
After the detection of MPD, a process of confirmation is needed to make sure that the impression is real. Confirmation is usually simpler because the observer knows what to expect and is highly motivated to pay attention to the usual signs of switching.
Manifestations of Multiple Personality Disorder
From the viewpoint of observers, prominent symptoms of multiple personality are those that directly relate to the multiple.
One very frequent symptom of multiple personality is inconsistency during a dialogue. The multiple may say that she has enough money to buy a new car. A minute later, she may declare that she is poor and cannot afford to buy a tricycle. And shortly after, she may say, "If I had enough money, I would buy a new car." Similar discrepancies often show in a court of law when a multiple is under oath. She may say that she received no money from the defendant. A moment later, she may disclose that she has received the money in question. She may also make a mistake regarding the amount of the money. First, she may say that she was supposed to get $200, but did not get any money. Later, she may claim that she received the $200, but was supposed to get $500. And a little later, the defendant produces a receipt stating that the multiple received the full owed amount of $200. With no written documentation, the whole matter is mysterious, particularly when both parties are multiples. There are two people before the judge; claim two different things, and keep changing their stories. And when even the judge is a multiple, you get a classical courtroom drama.
Relatives and close associates of multiples are uniquely positioned to witness dissociative switches and manifestations of different personalities. The multiples are typically described as being moody or unpredictable. For example, a professor with MPD may abandon her usual calm and proper manners, and may curse and exhibit fits of anger when she teaches a specific subject. She may use unique vocabulary that is not normally part of her speech, may manifest careless behaviors, and may badmouth other professors.
Perhaps the cutest sign of MPD is secondary activity that accompanies the main purposeful effort. Women with this trait are irresistibly charming; they seem to relish every moment of their existence. The secondary activity may involve rapid acts that are barely noticeable by the naked eye. They typically include gestures, facial movements, and changes in the tone of voice. Other secondary activities last up to several seconds. These acts involve spontaneous reactions of some of the personalities while a powerful personality does a main task. For example, a cook may stop preparing the food and succumb to the smell of some spice. She briefly holds it under her nose before she adds the spice to the food. Or she suddenly becomes attracted to some object in the room and spends a moment paying full attention to the object before returning to the main activity. Or she stops talking to the person with whom she is having a dialogue, looks at another person in the room, smiles, and turns back to the important person. The distinguishing feature of these "distractions" is that they have no purpose in the main activity. From the viewpoint of logic, they are unnecessary, but are perceived by observers as traits of sociable and likable personality. Since the changes are rapid and plentiful, they give the multiple a very lively appearance.
Another prominent trait of multiplicity is unfocused behavior and unexpected changes in priorities. A multiple may be waiting for a bus when one of her personalities decides to walk into a nearby store to do shopping. Or the multiple works in her office, stops for no reason, and starts reading a book. Or she decides that she will take her mother to a doctor first thing in the morning, but seemingly forgets about the plan and her mother's health condition. Or she promises to her visiting childhood girlfriend that they will go to the new shopping mall in town, but they end up at the usual mall where the multiple normally shops.
A common trait of people with multiple personality is avoidance of answers to direct questions. The multiples may reply in uncertain ways or may refuse to confirm harmless facts. These types of responses occur because most multiples know that something strange is going on in their minds. The subjects know that they sometimes hear internal voices and are afraid that the untamed entities might reveal personal secrets or do some inappropriate acts. For these reasons, it may be very difficult to talk multiples into doing hypnosis or similar therapeutic work that might access the unconscious mind. Most multiples are secretive and do not want to be known by others. An even bigger problem is that multiples do not want to know themselves and their internal neuropsychological world. The fear of the poorly known unconscious mind keeps many a multiple out of therapy.
Multiples have remarkable ability to adjust their behaviors to environmental conditions. By switching to the appropriate personality, the subjects are able to deal with diverse people, from beggars to kings. Furthermore, they leave almost everyone with a very positive impression of the multiple. This characteristic of a chameleon is most prominent in the most severely abused and brain damaged multiples. Regrettably, they are also the most difficult to treat, and the success rate is low.
Self-diagnosis of Multiple Personality Disorder
It is strange, but many people seem eager to self-diagnose themselves in the comfort of their homes and treat themselves over the weekend. These amateurs have no idea what they are facing. Self-treatment is not recommended. The subjects are not facing just multiple personality, but possibly other dissociative disorders. Most importantly, they may face their incestuous rape or other forms of childhood sexual abuse. The subjects are likely to fail in their "pursuit of happiness" and may cause themselves irreparable harm. Anyhow, they will not be able to find anything abnormal with their minds.
People with multiple personality usually do not diagnose themselves; they never consider the possibility that they may have a mental disorder. Their perception of reality seems normal to them. This is how the world has always been. When they attempt to diagnose their conditions, they are likely to fail. Sigmund Freud, who discovered the connection between childhood sexual abuse and hysteria, denounced his theory when he realized that he also had the symptoms of hysteria; that is the symptoms of incest. A person trying to detect her multiple personality disorder will probably, like Freud, dissociate and dismiss her findings. But for the adventurous souls, here are a few hints:
Most of the time, only one personality is fully conscious and controls the body. Her existence, actions, and experiences are continuous while she is in charge, but the whole organism of the subject perceives the world in discontinuous ways. The nature of the experiences of a multiple is similar to dreams. In dreams, the scene may jump from a busy downtown area to the desert. There is no explanation for the change, no logic, and no time continuity. Likewise, the scenes in the real life of a multiple vary suddenly. For example, the multiple gets up in the morning and makes breakfast, and the next perception of this personality is coming home from work. The entire time between these two events is unknown, as if it had never existed. This is similar to movies, where scenes jump from one place to another. The difference is that a movie always produces some indication of an upcoming change, and a hint what the next scene will be. The actor may say in his New York office, "I am going to Rio on vacation." The next scene shows him on the beach in Brazil. The experience of a multiple is different. Her "Employee personality" says in her New York office, "Bye, see you." And the next thing she knows is being back in her office the "next" day. She has no idea that she went on a three-week vacation to Rio de Janeiro and came back last night.
The period of no registration is often called "lost time." The time is not truly lost; it is only unaccounted for by a specific personality. Some other personality that was active during the period knows what happened, but other personalities do not. As far as they know, they are at one place one minute, and miles away an instant later. Oftentimes, the periods of dominance over the body are very brief, under one second. During these moments, a person may do or say something that is totally unacceptable to her nature. This can be done under the influence of other personalities, and the active personality does not understand why she behaves in a particular way. Or, a personality momentarily seizes control over the body and does an act that is unknown to the usually activated personality. For example, a multiple talks to her boss and is very polite. She suddenly blurts out, "You bastard, I have worked overtimes with no pay!" And then she returns back to her usual politeness as if nothing has happened. Her normally activated employee personality is unaware of the outburst.
Most personalities try to live in the moment and seldom refer to the past. They do so for two reasons. On the one hand, personalities have discontinuous life experiences and believe that everyone perceives the world in the same way. The personalities see no need to deal with their pasts to experience the present. And on the other hand, some personalities are aware of their memory gaps and have developed ways to keep their unawareness of biographical experiences and their lack of temporal continuity hidden. This tendency to hide biographical facts is most noticeable when a multiple is absent because of illness, vacation, or family problems. When she returns to her environment, she encounters countless changes, but she does not comment on them. Her girlfriend has a new handbag made of alligator skin, but the multiple does not acknowledge the fact. She is not sure if she saw the handbag before or not. She might be wrong, and her memory problem would become obvious. Similarly, multiples will not say much about what they did during their absence, or how long they were away. Some personalities will give one reason for being gone, and other personalities will give a different reason. And though the multiple sees her friends after a relatively long period, she greets them as if she never missed a day. In some instances, she will approach her friends casually and will start talking to them without greeting them at all, as if she interacted with them moments earlier. Interestingly, the well-known patient E.P., who had anterograde amnesia, responded very differently every time he saw his wife after a few minutes of her absence in the room. He would be overjoyed that he sees her again, as if they were apart for months or years.
A person with multiple personality disorder may experience that people approach her and behave as if they knew her, but she has no idea who the people are. She may mask her lack of knowledge by being overly polite and by providing no or very generic answers to specific questions. She may also exhibit rapid changes in her attention. Instead of talking to the people who claim to be her close friends, coworkers, or neighbors, she just briefly greets them, steps aside, and often remains totally oblivious to their presence. These phenomena typically result from conflicts between environments. The multiple may switch to a personality of a vacationer while she travels, and she may have a difficulty dealing with known people she meets at an unknown place. Similarly, the multiple may bring her coworkers to her home when her family is present. She may exhibit numerous switches as her employee personality deals with her coworkers, as her mother personality deals with her children, and as her wife personality deals with her husband. The same degree of switching may arise when she is concurrently in the company of her abusive parent and her psychotherapist who treats her for incest.
A multiple may find photographs of herself, but she has no clue what events they depict. A mentally healthy adult should always be able to recognize a photograph of herself and associate it with an episode in her life, assuming that the photo shows sufficient contextual information. Likewise, the host may find photographs of other personalities, but is unable to recognize them as known people. As far as she knows, they are strangers.
A multiple is told by her children that she promised something, but now she (her other personality) is against it. The activated personality is unaware of making any such promises.
She may discover new facts in her life. She wakes up one day and finds that she has holes in her ear lobes although she has never worn earrings. Or, she buys a pair of gloves because her hands are freezing. As she leaves the store, she discovers her old gloves in the pockets of the coat she is wearing. Or, she asks her children, "What happened to our cat? Where is it?" Unbeknown to her, the cat has been dead for three months.
In general, the host personality is the one who suffers from health problems and unpleasant cognitive experiences. Among the most troubling ones are: chronic depression, severe headaches that are caused by personalities fighting over the body, fading of consciousness, blackouts or lost time, memory lapses, constant anxiety that something bad will happen, fear of losing one's mind and going crazy, hallucinations, fear of losing control over self, fear of seeing a stranger in the mirror instead of her face, fear of inexplicable changes in one's daily life, fear of various voices in one's head, desperation, and frequent suicidal thoughts. Self-injuries and overdose on medication are common problems in multiples. The host often develops psychosomatic illnesses, such as digestive disorders, irritable bowel syndrome, malabsorption of vitamins and nutrients, leaky capillaries and gut, urinary tract problems, kidney stones, neuropathy, poor locomotion and limb coordination, osteoporosis, spinal hump, diabetes, Alzheimer's disease, and discoloration of the irises of the eyes. The center bands of the irises typically become yellowish green. In extreme cases, blood may erupt within the eyes and flood the irises. The host is also likely to have nightmares, scary daytime flashbacks, panic attacks, and out-of-body experiences. She is commonly afraid of touch, of being alone with a man, of being raped, and of ending up in bed with a stranger. If the host finds diaries, notes, pictures, drawings, or personal objects of the other personalities, she destroys the materials to deny the existence of the unknown others. Naturally, the others are angered by the destruction of their private possessions, give the host headaches, persecute her with spoken words, attack her physically or may try to kill her.
HOW TO DEAL WITH MULTIPLES?
People occasionally discover that someone known to them has the symptoms of MPD. How should the discoverer handle the situation? The reaction depends on what is intended to be achieved. When you discover that your spouse has the signs of multiplicity, you may genuinely want to help him or her get better. By doing so, you are entering a dangerous territory. Most multiples are unaware of their illnesses and refuse to believe that they are sick. Giving them a book to read about the disorder is unlikely to help. The multiples may become resentful and may react in ways that are uncooperative or outright hostile. Breakup of marriage is a real possibility.
Many laymen and also health professionals assume that people with MPD are dangerous and psychotic when they switch to other personalities. This is a wrong assumption. A multiple should be viewed as different neuropsychological entities in the same body. The trouble is that a naive observer does not know who will emerge and when. This uncertainty raises fears and doubts whether it is safe to be in the multiple's presence. However, the same doubts could be activated when we meet an unknown person. Is he good or bad? Will he hurt me? Since he is a stranger, we should be prepared for anything.
Sure, some personalities are unreasonable and belligerent. This is an expectable consequence of abuse. But, for the most part, multiples are average people and are able to bring the most extreme personalities under internal control. The seemingly unfriendly personalities only come out for a cause, usually to defend the multiple against harassment, abuse, or maltreatment, and not to deliberately harm others. But harm of others is also common. Males with MPD often become sadists, murderers, and rapists. Likewise, some women with MPD are abusive, quarrelsome, and belligerent for no obvious reason.
The discovery of multiplicity by a healthy spouse and the revelation of the fact to the multiple are likely to activate personalities that have been dormant or largely inactive until now. The multiple may engage in harmful addictions, may commit illegal acts, may become reckless, or may disappear for days at a time. Whatever the future brings, the healthy spouse can expect stormy seas ahead. Failure of the relationship is more likely than a success is. Treatment of the multiple, if it ever starts, is more likely to fail than to bring positive results. The same dynamics exist between children and parents. Love or devotion are usually unable to positively influence the outcome. Families may fall apart, and the multiple may end up much worse off than he or she was before the revelation of the illness.
A different situation exists at work. What should you do when you discover that your boss has MPD? The usual revealing sign is this scenario: The boss says, "Move these boxes to the other room." You start working as told. The boss looks at you and asks, "What are you doing?"
"I am moving the boxes to the other room, as you have told me."
"No, that is not what I have told you. I have told you to leave these boxes here and sweep the floor in the other room."
Exchanges like these will likely occur several times within a month. The boss says one thing, denies it a minute later, and substitutes a different instruction for the original one. Also common is the boss's forgetfulness. He sends you to do something, and he momentarily does not know where you are and what you are doing.
What can you do with such a boss? Your reaction should be in agreement with your goal. Do you want to get fired by your boss? Go ahead. Tell him or her about multiplicity. Do you want to bring it to the attention of your boss's boss? Go ahead. Get fired that way. Middle and upper managers tend to hire people like themselves: that is multiples. The higher manager may feel that you are indirectly accusing him or her of being mentally ill. If being fired is not enough for you, tell others and get ready for an expensive lawsuit. Your revelation, whether true or false, is libel per se. You will lose. If the multiple is in a position where other lives are at risk because of the boss's multiplicity, you still will not win. Even if the boss is sent for mental evaluation, chances are high that the examining doctor will have MPD, too, and will find nothing wrong with your boss. Now you will look like a paranoid or mentally deranged, and you will ruin your career. The best approach to dealing with a boss with MPD is to accept the fact and live with it, or find yourself a new job. Hopefully, your new boss will not have MPD. But do not bet on it, because multiples love working in managerial positions.
NEUROCHEMICAL ASPECTS OF MPD
Multiple personality disorder breaks up the mind into isolated but functional parts (personalities). Personalities behave almost normally just like a whole person, with the difference that instead of a unified mind, there are several neuropsychological entities. Break up of the mind into personalities is triggered by severe mental traumas and is achieved by producing neural chemicals that cause disintegration of the brain and mind. Which chemicals cause such a disintegration is not easy to determine because personality consists of multiple neural structures. Each structure uses unique combinations of chemicals to carry out its normal functions. Incidentally, disintegration of the original personality and formation of isolated subpersonalities require different chemicals in different neural structures. Despite these differences, the total number of all the chemicals that are needed to break up a personality is not overwhelming. Disintegration of just one neural structure can be enough to produce clinical manifestations of multiplicity. In fact, this is the usual trigger that sets in motion the process of personality disintegration.
It is important to correctly understand what neurochemicals do. Most brain researchers believe that chemicals cause this or that, but fail to consider the effects of cognition. The brain uses two important types of chemicals. One type of chemicals sustains contact and long-term communication between brain structures, and another type mediates transmission of the cognitive content. In MPD, the mind modulates both chemicals by means of a third type of chemicals that is produced in response to the outcome of cognitive processes. Interactions among the three variables can result in dissociation.
DIFFERENCES BETWEEN MPD AND SCHIZOPHRENIA
Clinical experience shows that doctors frequently confuse MPD with schizophrenia. Unlike MPD, schizophrenia is an illness characterized by intermittent or permanent loss of rational thought and emotional intelligence. In schizophrenia, the brain and mind are damaged, fragmented, and the neocortex shows striking hypoactivity in the frontal lobe. The reason behind the usually permanent demise of parts of the brain is purely biological and is not affected by personal experiences. There is strong circumstantial evidence that schizophrenia is associated with DNA corruption and tends to be hereditary to some degree. In schizophrenia, the ability to recognize the relationship between cause and effect or to respond in socially appropriate ways is poor, almost nonexistent. For example, schizophrenics lack the most basic skills in communication and turn taking. They may exhibit the perseveration phenomenon. They may talk about a topic in hair-splitting detail and with great interest long after the issue is considered of no concern to others. Schizophrenics may also manifest indifference or inappropriate behaviors when dealing with very significant issues. Death in the family may be of no concern to a schizophrenic. He may joke about it or may start laughing as others describe how the person died.
Although schizophrenia is often associated with a lack of emotions and understanding of emotional valence, subjects with multiple personality disorder are usually lively, emotionally sensitive, extremely sociable, and are able to effortlessly blend into any situation. According to the author, very few cases of insanity might start as multiple personality disorder that later leads to schizophrenia, but multiplicity is much more likely to be a precursor to Alzheimer's disease. Interestingly, Read and Hammersley have reported that they found very strong association between physical/sexual child abuse and schizophrenia. The manifestations mainly show as auditory hallucinations and flashbacks [7,9]. Similar association was identified by Lysaker et al. . Do these studies mean that severe childhood abuse typically leads to both multiple personality disorder and schizophrenia? Probably not. Putnam specifically points out the frequent misdiagnosis of multiple personality as schizophrenia .
Schizophrenia and multiplicity differ in their onset, brain areas they affect, illness progression, behavioral and cognitive manifestations, and the underlying neural mechanisms. Although some clinical traits of schizophrenia may be confused with multiple personality disorder and vice versa, the neurophysiological mechanisms of these two illnesses are usually totally different. However, schizophrenia may produce the same manifestations as those found in complex dissociative disorders and other conditions. The different illnesses affect different neural substrates that just happen to support the same mental function. In such cases, it is possible to recognize that schizophrenia and complex dissociative disorders have not only a lot in common, but also show subtle differences. In other cases, the affected neural substrates are different from those of schizophrenia in the beginning of an illness, and the functional impairment is different from the symptoms of schizophrenia. As the illness progresses, it can damage neural substrates that are also involved in schizophrenia. The illness is diagnosed as schizophrenia despite different mechanisms leading to the same neural damage.
Some personalities may occasionally become biologically corrupt and may acquire a neuropsychological organization that is identical to that of a schizophrenic. When this happens, both the fragmented personality of a multiple and the whole mind of a schizophrenic exhibit schizophrenic-like behaviors, and the illnesses are indistinguishable because the behaviors are produced by the same neural structures. The difference is that a multiple may switch to a different personality and become normal again.
Schizophrenic-like behaviors of either a multiple or a true schizophrenic are strange. The subjects show peculiar reasoning qualities and unshakable beliefs, and yet these behaviors correspond to periods when the subjects behave "normally." From time to time, either subject can have a psychotic episode, which shows as an inability to logically and socially respond to the environment, and typically involves a busy irrational activity. Most schizophrenics may enter this mode for tens of minutes, while multiples usually do not stay in this mode more than a few seconds or minutes. But multiples may enter this mode repeatedly during the same day. Because of the reversible temporal changes and identical operating modes in both illnesses, schizophrenia could be considered a dissociative illness. In fact, schizophrenia represents a special case of biologically triggered complex dissociative disorders. Contrary to common complex dissociation, which only lasts briefly and the mind then returns to its normal function, schizophrenia is usually a non-recoverable or long-lasting condition. The inability to restore normal brain function is attributable to biological decay and malfunction of cortical and other structures.
At least 5 years before schizophrenia results in any identifiable symptoms, the subject may engage in nonconforming behaviors or may do things his way. He fully knows what he is doing, and he understands that the acts are improper, but he does them in spite of social norms and expectations. He may appear to be nonconforming, defiant, or disobedient. Occasionally, he may engage in seemingly psychopathic behaviors when relating to animals or people. He may sleep with his boss's young wife, or do strange and harmful things to animals. He may tie cans to a dog's tail and let it run about, or close a cat in the oven and turn on the heat. Or, while eating in a restaurant, he may provocatively get up and start running after he notices that the police have entered the room and are looking for a suspect. The misguided behaviors often lack focus and emotional desire. They are more like quest for fun and excitement, or they are reenactments of events seen on television or in the environment. The externally motivated behaviors can be good or bad. However, the external influence on the schizophrenic's behavior and the lack of internal censorship of bad behavior are recurrent problems with schizophrenics. A typical example would be grabbing a person's genitals as the budding schizophrenic saw it done by Paul Hogan in the movie Crocodile Dundee. These abnormal acts are rare at first. They may only occur once a year and do not raise any notion that the subject has a mental illness.
Schizophrenia seems to affect more males than females and usually shows the first cognitive manifestations between 18 and 22 years of age. In the earliest stage of schizophrenia, the illness mainly affects emotional intelligence, and the subject engages in silly behaviors regularly. He shows clear deficits in the understanding of the relationship between cause and effect in the area of social relations and personal well-being. Within a year, reasoning and executive functions begin to exhibit deficits in the understanding of the relationship between cause and effect in all areas of logic. As the illness progresses, the subject loses emotion but is not depressed. He starts hearing voices, may become philosophical or narcissistic, and may experience the alien hand syndrome, believing that his hand is moving without his will, as if it were controlled by some external (alien) force. Many schizophrenics also have difficulty with sensory integration and assembly of a mosaic from small pieces. They may fail to recognize an item or living thing if they see only a fragment of the image. In this advanced stage, patients also have psychotic episodes. They become more frequent as time goes on and manifest no understanding of the relationship between cause and effect, which is the core symptom of schizophrenia in advanced stages. The subjects have no memories of the psychotic episodes after they pass. Although the patients are usually not psychotic between episodes, they still manifest grossly distorted belief-based reasoning and profound loss of touch with reality. Surprisingly, they may be positive that their beliefs are reality. For example, a schizophrenic may say that he grew up in France and traveled the world as an ambassador, even though he was born in Iowa and never left the state. If his claim is questioned, he may say, very seriously, that he knows who he is. And he may produce another confabulated "fact" to support his false claim. This creation of false positives distinguishes schizophrenia from multiple personalities, which tend to show the opposite effect. They fail to recognize known objects, places, or people.
Unlike schizophrenia, multiple personality disorder is predominantly noticeable in women. The onset of multiple personality disorder takes place shortly after an abusive episode. The person appears normal at first. She only has a gap in her knowledge about the violation. But who would be looking for the record of her rape by Dad? No one even suspects such a possibility. And even if someone did, that someone would not want to find out. Further child abuse creates additional gaps in memory and the associated neural substrates. Biological chemicals and various neurotransmitters are produced in unregulated fashion. There is too much or too little of them. Under the influence of the chemical effects, the neuropsychological unity of the brain (and even the body) gradually disintegrates, and personalities occur. The biological component of MPD causes that each personality has different facial features and biological makeup. Maintenance of the dissociative boundaries requires constant production of the necessary chemicals, which leads to further neural damage and more complex dissociative disorders.
The typical symptoms of multiple personality include isolated knowledge about events, different quality and level of emotional expression, and slightly reduced intelligence. Multiples may appear to lack education, knowledge, or the reasoning power to comprehend certain things. As a whole, emotional intelligence of multiples is slightly reduced, and most adult personalities will show no reasoning deficits during common everyday interactions. Younger personalities and personality fragments often exhibit psychopathology as a result of very poor emotional intelligence. Unlike in schizophrenia, understanding of the relationship between cause and effect is usually preserved in non-emotional areas. The most noticeable deficit is lack of knowledge. The missing knowledge can involve isolated facts, procedures, skills, periods of life, and biographical memories of specific people or places. The gaps pertain to both recognition (identification of a known person or item) and remembering (recall of a biographical experience or public event learned about from the news media). Unlike schizophrenics, who confabulate and "make up" fantastic stories all the time, multiples usually say things that are true, or they confabulate relatively infrequently. In addition, multiples appear rational. When they say something that is not true, their false beliefs are often attributed to normal forgetting or mistakes, rather than to a mental illness.
As for the alleged symptoms of schizophrenia in the above mentioned studies [7,9], the symptoms appear to be closer to those of multiple personality disorder. Some of the hallucinations seem to be produced by multiple personality disorder, and some are probably caused by complex dissociative disorders. Hallucinations in complex dissociative disorders are very similar to those occurring in schizophrenia, but are not the same. There are differences in cognitive quality and in the neural substrates that generate the hallucinations. It appears that the scientists incorrectly attributed the observed hallucinations to schizophrenia. But then again, a lot depends on the definition of schizophrenia. The author has defined schizophrenia based on the cognitive architecture of the brain, while others associate schizophrenia with the existence of psychotic behaviors. Because of the different approaches, schizophrenia in the author's model is associated with specific neural structures, rather than with apparent psychosis. The author's definition is narrow and specific, while purely clinical manifestations of irrational behaviors lead to diagnoses of diverse types of schizophrenia. The flaw of such classification becomes apparent when psychotic behaviors of mental patients are conceptually handled as fever in patients with biological illnesses. No matter what the cause is, the presence of increased body temperature warrants the label "fever," and the patient is given the standard medication to lower his body temperature.
Hallucinations of schizophrenics typically produce ideas and voices that arrive from an unspecified direction or from some distant place outside the subject's mind, and only rarely involve a particular person. For example, the subject experiences various voices coming from a group of people in a neighboring building. The building, and not the individual people, is the source of the voices. The subject may also hear or mentally register an instruction seemingly arriving from a satellite or from a distant town. The voices of schizophrenics are marked by no or very poor interactions with the subject and by no or very poor interactions among themselves. The voices usually do not stay for long, but are different every time. If an isolated voice repeats the same brief statement in the same manner, this activity can reflect schizophrenia or complex dissociative disorders. A repeated message coming from the same source may exhibit minor changes, but the core of the message remains unchanged. Most importantly, the voices and mental intrusions in schizophrenics lack the emotional traits experienced by normal people. Voices and ideas of a schizophrenic do not get upset or joyful. They just comment or issue instructions, but give no feedback in case of no response by the subject. For example, a single voice or several voices say, "You will obey us" and repeat the same message without ever changing the phrase or tone of voice. The voices tend to occur out of context and typically reflect no continuity with the past or the future. The voices almost never state: "I told you yesterday that you have to do this" or "Ask Jack what he thinks about it" or "What do you plan to do this weekend?"
There is a potential problem with the manifestations of internal voices, and a health professional dealing with a subject who hears voices has to make sure what is happening. A child may repeat the same sentence or word and give the impression to have schizophrenia. The deciding factor is not what the child says, but what the voices inside the child's mind say and how they behave. Even a healthy child may repeat an expression she hears in the environment. The repetition may occur many times a day and may persist for a week. This is absolutely normal. The young child is learning, and unusual behaviors of adults may not be easily understood by the child. The repetition reflects this fact and stops when the child incorporates the unique experience into the preexisting cognitive schemes. This behavioral mode is particularly pronounced in traumatized children. They repetitively react to traumas through language and behaviors. Also autistic children tend to do repetitive activities. They manifest a struggle of the mind with the cognitive material. The information is difficult for the autistic children to explain and incorporate into cognitive schemes because the most advanced brain structures fail to participate in the cognitive process.
By contrast to schizophrenics, hallucinatory experiences of multiples can be easily recognized based on the number of the voices involved and based on their interactions. If two or more voices talk among themselves or include the subject in their conversation, the voices manifest MPD. If an individual voice instructs the subject to do something, and the voice comments about the personal qualities or faults of the subject, and if the voice emerges repetitively and has something new to say every time, this also reflects MPD. Almost universally, the voices of multiples get emotional when their requests, ideas, orders, or suggestions are ignored. In some cases, the voices can be accompanied by visual hallucinations. The other personalities are "seen" (in the mind) as real persons who talk to the subject. If the visualized persons interact among themselves or with the subject, the case typically manifests MPD. Interaction does not mean pursuit of a common goal. Interaction involves exchange of ideas, looks, gestures, feelings, and consideration of the viewpoint of the other personality.
In addition to the above scenarios, it is possible that a person has both multiple personality and schizophrenia. He may develop MPD in response to childhood traumas, and may become a schizophrenic later in life. Such a subject is schizophrenic in brain function, mentation, and behavior, and all observations of the subject are consistent with the qualities of schizophrenia. On top of that, individual personalities may show unique preferences, knowledge, reactions, and abilities. The coexistence of MPD and schizophrenia is possible because the illnesses affect different areas of the brain or affect the same areas in different ways. Unfortunately, this theoretical conclusion is only based on the physiology and cognitive architecture of the brain, and is next to impossible to confirm clinically. Furthermore, a schizophrenic with MPD may also exhibit the manifestations of complex dissociative disorders.
To determine whether or not sexual abuse causes schizophrenia, the author evaluated six preteen schizophrenics (diagnosed by others) for the symptoms of childhood sexual abuse. Five subjects had the primary visible signs of childhood abuse, and one subject had no obvious symptoms. The prevalence of the primary symptoms was 60% higher than in the general public, but the quality or quantity of the symptoms was less than average. Likewise, the subjects had very few secondary symptoms of abuse. Only one subject had exceptionally prominent secondary symptoms of abuse. As a whole, the symptomatology is a mixed bag, and the findings sharply contrast other dissociative illnesses, which produce very striking quality and quantity of child abuse symptoms. The discrepancy is doubly surprising because schizophrenia should produce the strongest symptomatology of any illness or disorder that is caused by abuse. The reasoning goes like this:
There are three basic dissociative modes. The mildest forms of abuse only lead to reduction in emotional intelligence. More severe abuse causes multiplicity. The most severe abuse gives rise to complex dissociative disorders. Complex dissociation typically includes diverse dissociative modes and the accompanying illnesses. At least two of the illnesses are conceptually similar to schizophrenia. If the illnesses were more profound, schizophrenia would result.
The interesting thing about the three dissociative modes is that they are very common, and so is childhood abuse. By contrast, schizophrenia only affects about 1% of the total population. The numbers suggest that dissociation that produces schizophrenia should be something special, way beyond the relatively mild dissociative disorders seen in multiples. In turn, the accompanying symptoms of any traumatic experiences that produce schizophrenia should be very strong. This is not the case. Because of the inconclusive results, schizophrenia cannot be associated with childhood sexual abuse at this time. Nevertheless, the increased prevalence of primary symptoms of child abuse in "diagnosed schizophrenics" calls for a large study to resolve the inconsistency. It is clear from the author's studies that the manifestation of visible symptoms of sexual abuse does not always correspond to the level of abuse or to the level of the psychological reaction. Many victims who were abused in the most severe ways show only mild or no obvious symptoms. By contrast, the mind is usually affected in proportion to the level and duration of abuse. Unfortunately, this assessment takes time and direct interaction with the evaluated subject. Schizophrenia enormously complicates the process because of defective reasoning. The illness leads to false positives and an impression of excessive abuse in comparison with the general population. The reason is that schizophrenics have minimal moral or mental blocks, and easily volunteer information about their sexual abuse. Non-schizophrenic incest victims hide their abuse to the utmost and do not admit it even to themselves. The investigator may conclude that they were not abused, and that schizophrenia is caused by sexual abuse in childhood.
Interestingly, the six evaluated "schizophrenics" did not show the classical symptoms of schizophrenia as defined by the author. The subjects did not show lack of emotion and did not consistently show autistic-like disorders. On the contrary, the children were highly emotional, were disturbed by their hallucinatory experiences, and often struggled to suppress them. A true schizophrenic rarely becomes disturbed by his unreal perception. He comments about his experiences factually or with amazement, but without undue stress. He tends to defend his corrupt thought as being logical and does not see it as abnormal or in conflict with his conceptual memories of the world. Furthermore, a real schizophrenic has deficits in prepulse inhibition and easily becomes overwhelmed by loud repetitive sounds of a police siren, fire alarm, gun fire, or pneumatic hammer. Patients with MPD rarely exhibit these problems.
On the surface, it may not seem important whether or not the seemingly irrational behaviors of some children are caused by schizophrenia or multiple personality disorder. However, the etiology of these illnesses has major effect on treatment and recovery prognosis. It is not possible to treat true schizophrenia. The most advanced brain structures have been damaged and cannot be recreated. The problem is further enhanced by destructive treatment methods, such as ECT. Not even stem cell therapy can help because of the way the brain is structured and functionally interconnected. Even the best treatment outcome only prevents further neurocognitive degeneration, but fails to undo the harm already done. By contrast, fusion of multiple personalities into one mind can completely mend the mind, or at least neutralize the "schizophrenic personality" to such a degree that she has insignificant impact on behavior or internal life of the mind. The prognosis for recovery is much better in children under 10 years of age because of their high neural plasticity. Unfortunately, misdiagnosis of MPD is all too common. The affected children are prescribed drugs to suppress behavioral improprieties, and the treatment is considered successful. Naturally, the children are returned to their homes, where their sexual abuse continues, and their mental condition is getting worse. Even if the misdiagnosis is recognized at some point, it may be too late because the medications may have irreversibly damaged the children's brains.
DIFFERENCE BETWEEN MPD AND HYSTERIA
Multiple personality disorder and hysteria occur together. Hysteria could be considered a special trait of multiple personality. Hysteria only occurs in severe cases of MPD and reflects the disruption of the main control mechanisms in the brain. The uniqueness of hysteria is that it last for a sufficiently long time to be reliably noticed, and that it frequently affects somatic abilities. [Thus, hysteria could be attributable to dissociation within the habit system, as was speculated earlier.] Or, looking at the condition from another perspective, hysteria manifests disrupted switching between personalities. An unfriendly personality asserts its will and blocks normal switching between personalities or blocks a normal function of the personality in charge. The subject may become paralyzed on one side despite no obvious damage to the body or the brain. The problem may last hours or days before everything returns to normal. At other times, the willful personality may produce hysterical laughter, or may urinate on the spot, or may do some other outrageous act, and no other part of the brain is able to stop her.
CAN A PERSONALITY BE EXORCISED OR CREATED IN THERAPY?
Not in the supernatural sense. Personalities are complex neuropsychological entities. Some parts of these entities can be banned from reaching consciousness. The usual way to do this is through hypnosis. The mechanism does not work in a healthy conscious mind. Dissociation of some sort, either temporary (hypnosis) or permanent (MPD), is required to enable the suppression of an inconvenient segment of a personality structure. The approach only works with certain types of personalities, particularly those that are incomplete and fragmented. Suppression of the undesirable personality can be achieved through direct appeal to the personality to stop interacting with the world, with others, or with the mind, and stay forever dormant. This approach works (only temporarily) even when the hypnotist makes the request in religious terms. The fragment does not care whether God, Satan, President, or the patient's dog wants him to disappear and never come back. The factual meaning of the request, and not the supernatural overtone, is what suppresses the personality. Similarly, the suppressed personality fragment can be reactivated in the future by an appeal to become active again. But the personality cannot be erased from the records of the memory forever. This would require destruction of the neural substrates that hold the personality. So, in a sense, the personality fragment is like software that is permanently programmed into the neural substrate. The information cannot be overwritten because it is encoded by means of stable, nonerasable biological synapses. The corresponding neuropsychological entity can only be banned from participation in mental processes (temporarily) or it can be combined with other cognitive parts of the brain.
Some personality fragments are difficult to ban after a simple order or request. In such a case, other parts of the brain can be recruited to block the unwanted personality fragment. The blocking can be done by other personalities or by the Internal Self Helper .
By means of a similar mechanism that leads to the suppression of a personality fragment, a psychological entity can be programmed into the mind of a hypnotized subject. This propensity of the brain to accept certain psychological content or entities into the dissociated mind is manifested as posthypnotic suggestion, when the subject acts on a suggestion made during hypnosis after he regains consciousness. The creation of a multifaceted psychological entity that is comparable to a personality can occur in a similar way, but requires special techniques. They are not mentioned for reasons of possible misuse.
Psychotherapists working with MPD patients routinely meet adult patients who have several adult personalities, child personalities, and some doctors even report personalities of the opposite gender. Exceptionally, the reports about the types of personalities also include animals, inanimate objects , God, Satan, stuffed animals, and people thousands of years old or from another dimension . These claims immediately arouse laughter and disbelief in laymen with zero clinical experience in MPD and zero understanding of how the brain works. The laymen do not accept the possibility that the claims might be true and that a personality might sincerely believe to be an animal, alien, 1000-year-old man, God, Satan, or person of the opposite sex. But if such beliefs are genuine — and clinical experience indicates that — then it is important to explain how the entities are generated and what they represent in the neuropsychological sense. The answers to these questions are provided in the author's work and will not be revealed here.
However, it is useful to consider a similarly striking condition of anosognosia. The patients may deny that their left arms belong to them and confabulate some irrational explanation why they have dysfunctional left limbs attached to their bodies . These are also cases of false claims and unbelievable behaviors, but the conditions can be readily tested by seeing the patients' limbs and hearing the irrational confabulated answers. It turns out that both multiple personality and anosognosia share some neural substrates that are responsible for such "internal realities."
The clinical possibility of creating a psychological entity in the mind should not lead to the idea that therapists can and do create multiple personalities in their patients. Creating some artificial entity that behaves like a personality is not that simple. In addition, a therapist is unable to program complex neuropsychological characteristics at will. By contrast, stage hypnosis reveals that people can be "programmed" to play certain roles. A hypnotized person can be told to become a weather reporter. At the hypnotist's command, she gets up, appears awake and conscious, and starts reciting a seemingly realistic weather forecast. She does not make an actual weather forecast. It may be freezing outside, and she forecasts a warm and sunny day. The discrepancy does not bother her. There may be an earthquake happening at the moment, but she ignores it and proceeds with her report. She is just fulfilling a demand in a state of mind when she is unable to critically censor her behavior and evaluate reality. The unnatural acts show disagreement between explicit behavior and body language. A true and complete personality exhibits cognitive drives and emotional reactions that are proportional to environmental stimuli. She judges reality, acts voluntarily, and her body language manifests the state of her body and her mind. A hypnotized subject or a personality fragment lacks these properties.
When disbelieving doctors encounter personalities in a hospital, the discovery does not indicate that the personalities were created by some monstrous psychotherapist or that the patient is playing roles that are unwittingly rewarded by the hospital staff. The patient behaves as she does even when she is not rewarded, and even when she suffers. It is the physical and social environment of the hospital that preferentially activates certain personalities. Loss of interest in the patient or punishment of the patient for "playing roles" changes the patient's behavior and may reduce personality switching. But this state never lasts long. Other personalities emerge and exploit the opportunity to come out when more powerful personalities withdraw in response to the acts of the ignorant hospital staff.
HOW DOES MPD AFFECT A MULTIPLE'S LIFE?
Multiple personality disorder creates discontinuous life experiences that start and end abruptly. The victim's life is unstable and seemingly out of control. She has extremely limited ability to learn from her past experiences, and she uses unproductive ways of coping with problems. She is often unable to recognize or avoid danger. Even worse, she is unconsciously drawn to dangerous situations. She may like the action, the thrill, the excitement, or simply her familiarity with the situations. When making decisions, she is likely to focus on one positive attribute and ignore all negatives, disadvantages, and dangers. Because of her poor emotional reasoning, she is prone to get in trouble. But instead of dealing with problems, she tends to switch to other personalities, and her problems stop to exist in her activated consciousness. For example, instead of paying a speeding fine, she may ignore the ticket until she is in very big trouble. Then she fails to show up for a court hearing and does not respond to court letters or phone calls. She is digging herself deeper and deeper into problems and appears nonchalant about the possible consequences. Her inability to change her life leads to depression, and sometimes even suicide. The success rate for completed suicides is not that high. By contrast, thinking about suicide is very common, and suicidal attempts can become repetitive in seriously mentally damaged patients.
In addition to splitting into personalities, the mind of an incest victim also dissociates from the prefrontal cortex, which is involved in higher mental functions . The inaccessible knowledge of the dormant personalities and the reduced reasoning ability because of dissociation from the prefrontal cortex make the activated personality stupid. Although stupidity is as yet unrecognized consequence of dissociation, the affected person suffers dearly. Dissociative stupidity mainly shows in lifestyle, values, religion, politics, and social interactions (which are modulated by emotional intelligence), but also in semantic knowledge. Dissociative stupidity and psychopathology are caused by the malfunction of the same neural networks. The distinction between these two disorders is rather scholastic than practical.
Dissociative stupidity is an inability to comprehend things because of poor emotional intelligence. Psychopathology occurs when a person acts under the control of his or her dissociative stupidity. This can produce harmful behaviors that are directed toward self or others. For example, a person who believes that he is a descendant of aliens who live at a far away star has poor emotional intelligence. He is unable to differentiate between reality and fiction. By contrast, a person who devotes his life to establishing a contact with such a believed civilization exhibits psychopathology.
Despite diminished emotional intelligence, the affected subjects may be geniuses in science, manual skills, games, and similar unemotional endeavors. The author suggests that dissociative stupidity and/or psychopathology is the most widespread mental illness, affecting more than 90% of the general population. But such a claim, similarly as the claim about the existence of multiple personality disorder, sounds truly outlandish. Not many people will believe it. But what else can do people who have no theoretical knowledge, no clinical experience, and also have insufficient emotional intelligence? They can only believe or disbelieve what others report.
There are several dissociative modes that have nothing to do with multiple personality, but often accompany this condition. The modes are produced by activation of specific mechanisms of the brain. One of the mechanisms leads to depersonalization, fugue, dreamlike experiences, dreams, hypnotic trance, false associations, and fantasy. Any healthy person can enter this operating mode at times, but a person who has suffered severe childhood traumas enters this mode often, and sometimes it becomes the dominant operating mode of the brain. More information about this dissociative mode is on the page Repressed Memories in the EMDR section.
A frequent problem of a person with MPD is her failure to mention important facts to significant others. The multiple appears to have selective knowledge, particularly when she deals with a sensitive topic. She may be accused of being unfair, selfish, or dishonest. But she also exhibits such selective knowledge even when she is not affected in any way. For example, a multiple may fail to mention to her husband that her lifelong friend has died, that her mother has been taken to the hospital after suffering a heart attack, that their bank account has been frozen, that their child is being investigated by the police for buying illegal drugs, or that their neighbor has been murdered inside his house. It may take weeks or months before the multiple mentions such facts in passing, and she is surprised when she learns that her husband does not know. The same forgetful behavior can also show in patients with other brain disorders, such as frontal lobe syndrome or frontotemporal degeneration. For example, a person with these conditions may say that she does not know where her close childhood friend is, and one day she may suddenly remember that her friend died 10 years ago.
A universal characteristic of multiples is their differential attitude towards different people. The appropriate personality only comes out to interact with specific people or in specific environments. For example, multiples activate different personalities when they deal with the coworkers versus the bosses. The different people can be in the same room, and the multiple switches between her personalities to achieve maximum match with the environmental stimuli. And no one usually notices the changes in her demeanor and cognition.
Multiples often face psychosomatic illnesses because living as a multiple is stressful for the organism. There can be undue physical stress and inability to stay in touch with the body. The person also makes bad choices in life and needlessly exposes herself to stressful situations and lifestyle. Such problems are easily avoided in normal people. Their brains are used fully and all the time. The people get tired and thus protect their bodies against exhaustion. A multiple's mind only employs some parts of her brain at a time while most of her neural circuits rest. But her body never gets a rest and has to meet the mental and physical demands of several personalities. It is not uncommon for multiples to run in the marathon when they are seriously ill or have a physical injury.
A common problem of multiples is that they make their lives too complicated and refuse to give up their numerous hobbies and engagements. Multiples may have several jobs or be members of several organizations. Or they surround themselves with a lot of children or pets or other living things that need constant attention and care. Male multiples tend to do the same, but usually get machinery and equipment that require frequent maintenance. Also common are unnecessary perks, including a swimming pool, jacuzzi, sauna, riding horse, or a small airplane. Acquisition of these items is driven by both multiplicity and low emotional intelligence of specific personalities.
Personal relationships can be lifesavers for many multiples. Sadly, a common consequence of MPD shows as an inability to experience and express emotions. A woman with MPD may have no emotion in either of her leading personalities. All her emotional functions are confined to subordinate personalities. Because of dominance of the powerful personalities, the subordinate part who likes or loves someone is unable to produce behavioral signals of emotional attachment; she manifests no connection between her internal feelings and the external stimuli the multiple sends to her admirer. Despite the blocking, the multiple (the basal leader) is sociable, content, talkative, or always smiling. She is perceived as attractive, mysterious, challenging, and unfathomable. Her smile may look like one of indifference, superiority, mockery, disdain, challenge or self-enjoyment. The usual amorous eye or hand contact is entirely missing. Also absent are emotional modulation of her voice and factual expression of fondness through words. The multiple even fails to say that she would like to be with the other person or that she appreciates his presence.
Meanwhile, the subordinate personalities in love occasionally manage to express their affection to the admirer. These brief moments indicate to him that she (the multiple) loves him. He just needs to figure out how to please her and how to meet her unspoken expectations. Putnam believes that a multiple gives her admirer unrealistic tests of loyalty he can not pass . In reality, she is not testing him. The impression she leaves in the mind of the admirer is often one of indifference or one of amusement by his unsuccessful advances. After some time, the admirer becomes frustrated, exhausted, and resigned. He may stop caring about her; he may even dislike her. But she is the same as before. She never asks her admirer personal questions. She never seeks his company. She has no interest in what he does, where he lives, or what he likes. However, under the influence of a subordinate part in love, the leading personality may occasionally (out of the blue) give her admirer a utilitarian present. This act is usually perceived as odd behavior, rather than an expression of fondness, and does nothing to improve the relationship. To promote the wavering relationship, one sociable personality may recruit the help of her real-life girlfriends. The inexperienced team typically devises various awkward schemes that produce more harm than benefit.
If separation of the couple is imminent (often because of the multiple's voluntary departure or objective reasons), the personality in love may, after months or years of behavioral passivity, momentarily break through the dominance of her powerful colleagues to express her feelings. She may burst in tears, she may desperately embrace her admirer, or may blurt out painfully colored words of abandonment. The perplexed admirer may still try to find out what is behind the unexpected emotional outburst, but a powerful personality takes over and walks away, seemingly hurt. Developing such one-sided attraction into a personal relationship is unrealistic, and many highly sociable multiples remain single despite having dozens of suitors. Similarly, many multiples live as single mothers from the start, or they get divorced after years of marriage. The relationships fail because the leading personalities lack emotional intelligence and have no interest in people on the personal level. The same failure can be expected when a man tries to develop a personal relationship with a lesbian woman. She has no feelings for men, neither emotional nor sexual.
By contrast to nonexistent emotional bonding, the powerful personalities like symbolic and formal manifestations of "love." They crave presents, flowers, restaurant dinners, publicly delivered songs, a wow or kiss in public, the ring, shared trips, shared thrill and excitement, and reassurance that she is the most beautiful woman, that he has been waiting his whole life for her, and that he will love her forever. With this mentality, the multiple attracts the wrong men, but her powerful unemotional personalities believe that this superficial format is love.
SHOULD PERSONALITY SWITCHING BE INFLUENCED?
The simple fact is that a multiple does switch in response to naturally occurring environmental triggers. She switches between her personalities regardless of external encouragement. She can resist the temptation to switch, but when the environmental stimulus becomes strong, the switch occurs, and she is unable to prevent it. In addition, there are many times when a personality may become activated in the body voluntarily. But is it a good idea to encourage her to switch more or less often?
That depends on what the people in the multiple's life wish to achieve. Encouragement of switching through exposure to further traumas, stressful lifestyle, or intentional abuse will result in more switching and possible creation of additional personalities. The mental health of the multiple can become damaged more than it already is. Similarly, a therapist who encourages a multiple to "come out" and switch in a safe manner so that her personalities can be identified and worked with makes it easier for the multiple to switch. She will manifest the existence of more personalities and may give the impression to outsiders that the personalities were created by the psychotherapist. But this situation is different from traumatically induced switches. The personalities come out from hiding because they feel safe and are recognized. This process needs to be encouraged if a psychotherapist ever hopes to combine the personalities into a functional mind.
As for discouragement of multiples to switch, this is not a good idea. This strategy, whether wished for by another person or by one of the powerful personalities of the multiple, can backfire. External pressure not to switch can result in the opposite effect. The multiple may fight against restrictions of her internal life and may manifest her freedom through increased switching and acting out. Harmful, criminal, antisocial, and inappropriate acts that would not have occurred earlier thanks to censorship by more prudent personalities are now possible. The mature personalities may not only ignore what the other parts of the mind do, but may even encourage such behaviors to show the external oppressive authority that they will do as they please.
A different situation exists when one or more mature personalities try to rule over the rest of the mind and prevent the younger or less powerful personalities to be in charge of the body. The censorship will never be absolute, and the less prominent personalities will find ways to let their presence be known. This can happen through brief seizures of the body and acting out one's will. Or it can happen as internal struggle between personalities. The dominant personalities, which control the body for large parts of the day, will hear complaining or angry voices, threats, and disrespectful comments. Also visual flashbacks of childhood traumas can emerge and haunt the strong nonabused personalities. Constant medication may become the only way out of the turmoil. Who wins the struggle is not certain, but the fighting and the medication will surely cause more severe mental and neural damage to the patient's brain. The person may develop bipolar disorder, borderline personality disorder, neurodegenerative disorders, psychosomatic illnesses, or psychotic personalities that mimic true schizophrenia. Similarly, some personalities may mimic bipolar disorder or borderline personality disorder. Telling the difference between these disorders may not be possible during a brief encounter with a patient. Only a comprehensive evaluation over the course of weeks or months can determine which illness or illnesses are involved. This is so because the illnesses have not only overlapping symptoms, but also may involve the same neural structures. The fight between personalities may produce no victor in the end. The subject may die or may spend the rest of her life locked up in a mental institution.
IS MPD TREATABLE?
Depends who you ask. Some doctors incorrectly associate multiple personality disorder with moodiness or role playing and report almost absolute success rate of MPD treatment. This is not surprising. The patients either had no MPD or their MPD was not recognized and treated by the doctors. Apart from such doctors who cannot tell the difference between MPD and normal behaviors, many qualified professionals treat MPD with mixed results.
In theory, multiple personality disorder is "treatable." Unfortunately, this disorder is seldom recognized by mental health professionals, who often exhibit multiplicity themselves. The doctor and the patient are blind to the indicators or take them for normal human traits. If multiple personality disorder is diagnosed by a true expert, the victim may be unwilling to explore her childhood. She often leaves therapy before any progress is made. Even in a successful treatment, the outcome may be far from what the therapist may desire. The author proposes that only few incest victims are diagnosed with multiple personality disorder, fewer start treatment, and even fewer finish. After all, therapy for multiple personality disorder involves dealing with the trauma of childhood sexual abuse. Not many people can face the pain. Nonetheless, some healers occasionally report merging of personalities into a unified mind. Kluft, who is one of the top experts in the world, reports an incredibly high success rate . But merging of personalities into a single mind sounds better than it really is. The unity of the mind is more apparent than real. Although the doctor believes that the personalities merged, the manifestation is only superficial. According to the author's discoveries in the physiology and cognitive architecture of the brain, restoration of the mind to the pre-dissociative form and function is not possible. Significant aspects of emotional intelligence have been excluded from merging or have been lost forever through deafferentation and neuronal deaths. As a result of demise of emotional intelligence, multiples typically need one or two years of additional therapy after final fusion of personalities into one cognitive unit. They have to be taught skills and behaviors that occur naturally in a person with good emotional intelligence. The simulation of proper choices in life is never perfect. The healed patient keeps making many mistakes in all areas of her existence. See the page Intelligence for more information.
A serious problem of MPD patients is their brain damage. Similarly as schizophrenics, leading personalities of multiples do not believe that there is anything wrong with their brains and minds. The subjects refuse to see a doctor. Other multiples, those who hear voices, are afraid to face this reality. They hide the existence of such voices from themselves. The subjects tend to deny the voices, suppress them with loud music, or make themselves believe that the voices are not as bad and frequent as they are. Other multiples are afraid to mention that they hear voices because this would be interpreted by most doctors as schizophrenia. Chances are that the multiple would be exposed to frequent injections of mind-altering drugs, electroconvulsive shocks, destructive brain surgeries, and other criminal activities that are routinely perpetrated by the medical establishment. Whatever brain damage the multiple has already suffered would be made much worse by doctors. Hiding the experiences of one's multiplicity often becomes a matter of survival. The chances that a multiple would find an expert doctor who knows what he is doing are slim, practically nonexistent. Most multiples spend years being treated with misunderstanding and harmful medications by leading psychiatrists who do not have the foggiest what is going on in the patients' minds. But even when a multiple does find a qualified doctor, there is no guarantee that she will be able to tolerate the necessary psychotherapy.
Some leading doctors believe that patients who stay in therapy are generally treatable. People who leave therapy or never start one are usually excluded from the reviews of treatment outcome. Interestingly, the unaccounted for subjects represent the majority of the MPD population. Most of these people have been so profoundly affected by multiplicity and its accompanying disorders that they are incapable of recognizing their mental states as abnormal. They see no need for mental treatment, and reject help when it is offered. These attitudes are an inseparable part of the devastating neuropsychological consequences of severe traumas.
A multiple who stays in MPD therapy may greatly benefit from her treatment. The treatment takes years, and complete healing should be considered a scientific curiosity, and not the expected outcome. Most people affected by this disorder will have to live as multiples for the rest of their lives. This is not so because of a failure of the therapists. The trouble is that the best therapeutic measures have no major impact on the damaged neural substrates or on the restoration of emotional intelligence. Values and bad habits can be changed in therapy, but damaged neural circuits respond poorly. This is particularly true in complex dissociative disorders. Between these two extremes is a gray zone. Some neural damage can be corrected through therapy if the process starts early. But a multiple who has lived with her condition for 30 or more years will always have some permanent neural and functional damage. Luckily for her, she is not conspicuous. She is just an average member of the human race.
MPD patients with comorbid disorders or those who are highly enmeshed in abusive relationships are generally not treatable . Treatment for MPD is very difficult, even in the one-third of sufferers who are considered treatable. Multiples who have no emotions are not treatable at the present. Their lower brain levels must be satisfied and calmed down before higher brain levels are able to function and affectively interact with the environment. It may take years.
Even before MPD is dealt with, the therapist needs to heal the alert and basal systems from PTSD. Acting as the affective mind of the top brain level of the patient, the therapist validates and explains the past events, feelings, and suffering. Cognitive interpretation of what happened is essential because the lower brain levels are confused and have distorted understanding of their traumatic experiences. Also the relationship between cause and effect needs to be spelled out (the trauma and the consequences) and repeated until the lower brain levels understand what happened to them and how it has affected them. Physical safety, somatic stimulation, somatic comfort, and explanation that the trauma happened in the past are the ways to create a healthy base for the functioning of the higher brain levels. Then the healer can focus on the basal system.
The basal system responds to overwhelming traumas in various ways. The affective mind may feel overwhelmed by its suffering so much that it is unable to interact with its semantic half or with the cortical system. Or the basal system is ashamed and unwilling to share its known experiences with the cortical system. Or the basal system calls for help, but the cortical system becomes distressed and shuts down during the trauma and at any future attempt to get help. The affective mind of the basal system can shut down, too. The usual reason for being totally unemotional is a major recent trauma, or a trauma so severe that it has shut down a victim's higher levels of affective mind for years and decades. The emergence of emotions anywhere in the brain (initially in the unimportant personalities of the basal system) is a sign of therapeutic progress. Both the semantic and the affective parts of a basal personality are now active and interact, and the affective part resumes its leading role. This progress quickly impacts other personalities in the same family of personalities. Within days or weeks, spontaneous merging of the complete basal personality with several other basal personalities (which need not be complete at the time) may occur. The change creates a good foundation for successful work with past traumas. However, the ultimate goal needs to be the re-establishment of affective control in the cortical system. The basal system has insufficient reasoning power and cannot comprehend traumas or complex personal issues on its own. This lack of affective intelligence together with dissociative fragmentation of the mind is responsible for the troubling post-traumatic functioning of the victim's mind. Help "from above" is absolutely necessary to overcome traumas. Once the cortical system is functional, its affective part validates and interprets the traumatic events, and all lower brain levels rapidly resolve their traumas. In some instances, the resolution happens without additional re-experiencing of the horrors. Attempts to achieve the same goal by means of the semantic host of the cortical system (the Apparently Normal Part of van der Hart et al.)  retraumatize a complete basal personality (the Emotional Part) , but often fail to achieve a resolution. Such therapeutic failure is common in the classical abreaction under hypnosis, when the basal system relives traumas, but the semantic host is unfit to deal with them . Since hypnosis deactivates major components of the affective mind (which is already hypoactive after severe traumas), hypnosis only makes things worse and further disconnects the affective mind from cognitive processes. Likewise, the popular technique of EMDR relies on the cognitive abilities of the semantic host, and affective reasoning of the cortical system is largely or completely unavailable. The therapist must step in and act as the affective cortical system to bring about a positive change in the basal system. Interestingly, the "almighty" method of EMDR has no direct effect on resuscitation of the cortical affective mind.
The therapist (regardless of the therapeutic method used) has to substitute for the functions of the currently unavailable affective cortical system. The traumatized personality of the basal system needs to have its feelings validated, and the meaning of the traumatic events must be interpreted by the therapist. But the therapist first has to find a way to give the affective basal system support, and enhance the strength and resilience of the affective basal system by means of, for example, resonant coexperience during hypnosis  or dyadic affect regulation in full consciousness during AEDP therapy . And while the discourse between the basal and cortical parts goes on, personalities at both brain levels need to become co-conscious and fused before the hierarchical control of the brain can be restored. Clinicians do not recognize that personalities belong to different brain levels and have unique functions, abilities, roles, and responsibilities. The assumption of most healers is that personalities are made of the same concocted psychological nonsense, and their biological aspects are commonly ignored, rationalized, and dismissed.
Once all the basal personalities are co-conscious and functional, an attempt is made to bring the same change to the cortical system. The affective cortical system is much more sensitive than the affective basal system is and needs to be gently persuaded to face past traumas and resume its leading role in the cortical system and the whole brain. This feat can be accomplished by means of two steps. First, the therapist commiserates, validates the suffering of the basal system, and explains the traumatic happenings and the affective meaning of the trauma. This approach makes the basal system stronger and also reduces its level of distress. Second, the therapist interprets the trauma as something that belongs to the past, and then reaches a positive conclusion about the present. This process is, in essence, the Transformative Emotional Sequence (TES) of Hans Welling . The positive interpretation is accepted by the affective basal system and is delivered along with the traumatic feelings and messages to the cortical affective system. The reduced distress of the basal system results in less distressing messages that go to the cortical system, and facilitates better interaction between the brain levels. Unlike in the past, when only traumas and bad things flooded the cortex and were uncompromisingly blocked from reaching consciousness, the positive message acts as a nonthreatening novelty (odd ball) that unlocks the access to the affective cortical mind. If this technique is not enough, the therapist may try to reason with and persuade the affective cortical ISH (while the subject is fully conscious) to allow the trauma to enter consciousness, because dealing with the material is in vital interest of the subject. The standard ISH is semantic and can speak, while the affective ISH only understands language, but cannot produce it. That the message got through will be obvious from the patient's behavior and from the therapeutic progress.
Finding a good source of information about multiple personality is just as difficult as finding a qualified healer. Although dozens of books have been written about multiplicity, very few are good. Here are some of our impressions about books that are currently considered among the best. The books were usually written in the 1980' and 1990's. Not many books about MPD/DID have been produced since then. MPD has been largely denied by the American mental health system.
#1 Diagnosis and Treatment of Multiple Personality Disorder (1989) by Frank Putnam.
This old publication is still the best work available today. The book is affordable, comprehensive, clearly explains the reasons behind MPD, what it is, how to diagnose it, how to treat patients, and what various problems the healer faces in therapy. Unfortunately, Putnam presents the old treatment method of abreaction, which strives to achieve healing through emotional release. The method revives traumas, but often fails to resolve them. The consequence may be decompensation of the patient. It has been proposed by various clinicians that the healing of traumas comes from integration of the fragmented traumatic memories into a cohesive unit , and not from emotional recall. The book seems to be out of print, but Amazon has several used copies for a fraction of the standard price.
#2 Multiple Personality Disorder from the Inside Out. Barry M. Cohen, Esther Giller, and Lynn W. (editors). This work is highly praised by reviewers. The book portrays the anguish in the lives of sufferers with MPD: the-out-of-control life, the failed relationships, the difficulty with getting help, and other issues before recognizing that something is wrong and during treatment. The work graphically deals with strong emotions, hopelessness, and desperation in the daily lives of multiples, but only briefly mentions what MPD is. The work is a window into the souls of multiples and should be studied by every healer. The information the patients provide is more valuable than many techniques and methods of therapy.
#3 Treating Dissociative Identity Disorder (1996) by James L. Spira, editor. This book is highly praised by reviewers, but our impression is different. The work contains several isolated topics that do not sufficiently explain what MPD is and what it does to the mind, nor does the book explain in detail how to treat patients. Although the work includes articles by leading experts who have practical knowledge, their theoretical concepts about the brain and the underlying pathology of MPD are poor at best. Some authors still rely on Freud's ideas about the mind, believe that MPD is merely a psychological construct, and discourage patients from educating themselves about the disorder. Overall, the coverage is spotty; the theoretical foundations are often unsound; the therapeutic stance is sometimes unhelpful, but there are also some very good ideas. We especially liked Part III Inpatient Interventions, which realistically deals with limited resources available to contemporary mental patients. If the reader is able to distinguish the bad and the good sections, the book may be useful.
For MPD Sufferers
#1 We recommend Diagnosis and Treatment of Multiple Personality Disorder (1989) by Frank Putnam. This work is written for professionals, but it is the best affordable source explaining what MPD is and what to expect in therapy. Most of the material should be understandable to laymen.
#2 Multiple Personality Disorder from the Inside Out. Barry M. Cohen, Esther Giller, and Lynn W. (editors). This work is highly praised by reviewers. The book portrays the anguish in the lives of sufferers with MPD: the-out-of-control life, the failed relationships, the difficulty with getting help, and other issues before recognizing that something is wrong and during treatment. The work graphically deals with strong emotions, hopelessness, and desperation in the daily lives of multiples, but only briefly mentions what MPD is.
#3 Dissociative Identity Disorder Sourcebook (2001) by Deborah Bray Haddock. This work is highly praised by reviewers, but could have been much better, considering the author's strong clinical experience. Chapters 1 and 2 are unfocused, spotty, and disorganized. Definitely not a page-turner. The author seems to assume that the reader already knows the topic and the presented facts. The strong points are detailed examples of realistic cases and the author's ability to ask important questions. She puts a serious effort into the explanation of the theory of MPD, but lacks the necessary knowledge about the human brain. As a result, the author confuses the self, consciousness, subconscious mind, ego states, and emotion with other functions and entities. This is not surprising, because even leading neuroscientists have no idea how the brain works. The following chapters are much better organized, are sound, and most of them are worth reading. Particularly important is information about seeking help.
Lucid Pages has no association with the authors, publishers or distributors. The books are only mentioned because of their perceived merit.
 Diagnosis and Treatment of Multiple Personality Disorder by Frank W. Putnam, pages 47, 55, and 155. 1989 Guilford Press, A division of Guilford Publications, Inc. Printing No 8, ISBN 0-89862-177-1
 Dissociative Experiences Scale (DES). Web page http://www.rossinst.com/des.htm
1996-99 by the Colin A. Ross Institute
 Conspiracy of Silence the Trauma of Incest by Sandra Butler, page 14.
1996 Volcano Press ISBN 1-884244-12-2
 Surviving Child Sexual Abuse by Liz Hall and Siobhan Lloyd, pages 24 and 76.
1993, The Falmer Press, Taylor and Francis Inc. Second edition, ISBN 075070 153 6 paper
 Secret Survivors by E. Sue Blume, page 292. 1990 by John Wiley & Sons, Inc. First Ballantine Books edition: March 1991. Tenth Printing: April 1993, ISBN 0-345-36979-3
 The Central Nervous System Structure and Function by Per Brodal, page 608
1992, 1998 Oxford University Press, Inc. Second edition, ISBN 0-19-511741-7
 J. Read & P. Hammersley, Child sexual abuse and schizophrenia [Electronic version]. The British Journal of Psychiatry (2005) 186: 76
 Paul H. Lysaker, Ph.D., Piper S. Meyer, M.S., Jovier D. Evans, Ph.D., Catherine A. Clements, M.S. and Kriscinda A. Marks, M.S. Childhood Sexual Trauma and Psychosocial Functioning in Adults With Schizophrenia. Psychiatr Serv 52:1485-1488, November 2001.
 Child Abuse Can Cause Schizophrenia, Conference Told, ScienceDaily (Jun. 14, 2006). Retrieved April 7, 2008 from http://www.sciencedaily.com/releases/2006/0606141206.htm
 Kluft, R. P. (1994). Treatment Trajectories in Multiple Personality Disorder. Retrieved May 2, 2008 from http://www.empty-memories.nl/dis_94/Kluft_94.pdf
 Skeptical Inquirer May/June 1998. Retrieved May 23, 2008 from http://www.csicop.org/si/9805/witch.html
 Stanley G. Smith https://scholarsbank.uoregon.edu/dspace/bitstream/ 1794/1415/1/Diss_2_1_8_OCR.pdf
 Sandra Blakeslee, SCIENTIST AT WORK: Vilayanur Ramachandran; Figuring Out the Brain From Its Acts of Denial. January 23, 1996. The New York Times (May 24, 2008.)
 Faure, Henri; Kersten, John; Koopman, Dinet; Hart, Onno van der, 1941. Dissociation : Volume 10, No. 2, p. 104-113 (June 1997): The 19th century DID case of Louis Vivet: new findings and re-evaluation.
 T. Fahy, Multiple personality disorder: where is the split? J. R. Soc. Med. 1990, September, 83(9):544-546
 Onno van der Hart & Paul Brouwn. Abreaction Re-evaluated. Trauma Information Pages, Articles: Van der Hart et. al. (1992) Electronic version.
 Hans Welling. Transformative Emotional Sequence: Towards a Common Principle of Change. Journal of Psychotherapy Integration, 2012, Vol 22, No. 2, 109-136 [Electronic version].
 John G. Watkins, The International Society for the Study of Dissociation, ISSD News, Volume 13, Number 6, December 1995, Pages 1 and 6 [Electronic version]. Retrieved June 8, 2016 from Pat McCkendon's Clinical Social Work.
 Onno van der Hart, Ellert R. S. Nijenhuis and Roger Solomon. Dissociation of the Personality in Complex Trauma-Related Disorders and EMDR: Theoretical Considerations. Journal of EMDR Practice and Research, Volume 4, Number 2, 2010.
 Onno van der Hart & Suzette Boon. Treatment Strategies for Complex Dissociative Disorders: Two Dutch Case Examples. Retrieved July, 14, 2016 from onnovdhart.nl/articles/treatment_strategies.pdf
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