When I diagnosed my first case of MPD in 1972 (Janette in "Minds
In Many Pieces"), I had had no professional training on
the subject. I went to the Stanford Medical Library to look up
articles on the subject since no computerized databases existed
then. The book called "Index Medicus" was the only place one could
start searching for published articles. There I found the listing of
In the 1970s, when I started meeting with other therapists of
"multiples" (the term we all came to use for patients with MPD), we
informally agreed to call the disorder "Multiple Personality
Disorder" or MPD for short. I wrote to the editors of the Index
Medicus to ask them to add Multiple Personality Disorder to the
subject headings, and they did that.
At that time, a small group of us therapists were struggling with
these patients, and we created our own networking methods. I
published a newsletter, "Memos On Multiplicity," for one year as my
way of trying to let such therapists know where fellow adventurers
in this field were.
Eventually, the interest moved from the solo practitioner's
office to the academic halls of learning. Some practitioners had
teaching appointments in graduate schools where their opinions about
MPD were not always greeted with acceptance. After all, the accepted
dictums stated that people only were allowed one personality per
body. Anyone claiming to have patients with two or more
personalities had a difficult task convincing those in academia that
such was possible.
This conflict of views between those therapists dealing daily
with dissociated patients (some exhibiting dozens of
alter-personalities, or "alters") and academic teachers who
spent more of their days teaching and doing research than actually
treating severely ill patients, came to a boil with the need to
revise DSM III.
DSM I (Diagnostic & Statistical Manual of Mental Disorders,
Version I) was created after WWI to provide a framework for labeling
post-war psychiatric causalities. DSM II was written after WWII for
the same purpose. Remember, these were written in the USA by
American psychiatrists. However the same terms were accepted by the
editors of the International Code of Diseases (ICD) through its
present 9th edition.
When I met my first multiple, DSM II was in use. MPD was then a
minor label under "Hysterical Dissociative Disorder." It did not
even have its own code number.
DSM III was created while I was in the middle of my practice
years. It recognized MPD as existing, gave it a code number, and
defined its characteristics. We who treated these patients finally
had found a degree of acceptance in officialdom. "If it is listed in
here, it must exist."
Then the backlash began. There had always been doubters that such
a disease really existed, and my struggles with critics are
chronicled in "Minds
In Many Pieces." Personally, I had withdrawn from public debates
on the matter to deal with private matters, so I only know
indirectly about the political battles behind the scene during the
formulation of DSM IV, the current edition.
The field of "Dissociative Disorders" now had its own section. A
committee of experts was appointed to decide what disorders should
be listed in DSM IV. It was hoped that DSM IV would also be the
psychiatric section of the new ICD-10, then in progress.
The committee was composed of two groups, psychiatrists whose
primary role was as therapists and those whose primary roles were
teaching and research. The therapists wanted to keep MPD much as it
was in DSM III. The teachers wanted to eliminate MPD altogether, and
replace it with "Dissociative Identity Disorder" or DID. I heard one
of these teachers say in public, "Everybody is born with only one
personality. Therefore, there can be no such thing as a Multiple
With this belief system, the teachers could not agree that MPD
could be an accurate label for anyone. The treaters on the committee
did not know how to explain that, in practice if not in theory,
their patients acted as if they had other personalities. The
teachers decided that the patients had the major mental problem of
believing that they had more than one personality. The goal of
therapy should not be integrating the various personalities, but
getting the patients over their false belief (delusion) that they
had other personalities at all. (Since I was not present for the
deliberation, these ideas are only reasonable conclusions from what
I heard from others who were there and position statements published
about the debate.)
So the patients still had a problem, but it was redefined as a
different problem than the one their therapists were treating them
for. Instead of therapists trying to integrate "alters" into an
original personality, they should now focus their attention on the
patients "delusion" that they did not have a single identity. Now
the teachers expected the treaters to treat the patients' "identity
disorder," as no one could really have multiple personalities.
When the decision was reported out of committee, the teachers had
won, and MPD suddenly ceased to exist. Now all our multiples had
Dissociative Identity Disorder or DID.
However, the editors of the ICD did not accept DSM IV as their
section on Mental Disorders. In the newest printing of ICD-9, they
did add "Dissociative Identity Disorder" below MPD as a synonym. So,
in the world outside the USA, MPD still exists. Only in the USA have
all multiples been told they have a false belief that they have
alters running their bodies.
But I know that, in the case of MPD, the patient's Original
Personality (yes, teachers, the only one they have) goes "into
hiding" at the time of a life threatening assault before the age of
seven. Therefore, there is "no one home" to have the Disorder of
Identity. The Original Personality is the only one capable of having
such a "false belief," but she is not in executive control of the
body or participating in social life at all. But the Allisonian ISH
I met in these patients had created all sorts of alters to run the
body in the absence of the Original Personality. Therefore, I could
not honestly give up the accurate label of MPD and substitute an
inaccurate label of DID.
But, I had met other dissociating patients who were of the "dual
personality" type. They had never shown an ISH, and they manifested
far fewer alters. Could I apply this new label to them? Yes, I
decided I could.
So, personally, I came to realize that both MPD and DID can be
considered accurate labels, but for two different groups of
dissociators. Here is how I now use these acronyms in my writings.
The key differentiating criteria is the age of the first
dissociation, with the seventh birthday being the approximate
cut-off point for MPD, and the earliest date for DID to appear. This
is the age the child's mind must mature to so that it can "hold it
all together" when severely traumatized. After age seven, it may
dissociate and form alters, but it will not dissociate into its two
component parts, the
Intellectual Self (ISH/Essence) and the
Emotional Self (Original Personality).
The concept that the human mind originally consists of two parts
is not a clear part of American/European psychological theory. Root
words to express this concept do not exist in European languages.
Again, "if we don't have a word for it, maybe it doesn't exist."
But I learned from my foreign friends that root words for these
two parts of the mind do exist in Middle Eastern and Oriental
languages. My favorite is Japanese, which calls the
Intellectual Self the "Risei" and the
Emotional Self the "Kanjou." The Japanese recognize that we are
constantly switching from being controlled by our
Kanjou and being controlled by our emotions, to letting our
Risei take over to solve our problems rationally.
In TV "literature," the same story is repeatedly played out by
"Mr. Spock" on the original Star Trek series. Leonard Nemoy played
the role to the Intellectual Self very well. He sounds close to the
ISHs talked to me when I was doing therapy with multiples. In
"Star Trek, The Next Generation," Lt. Cmd. Data, an "android," plays
the same role. In one show, he shows what happens when emotions are
added to his brain with the insertion of a new chip, which makes him
able to emote for the first time.
Now, after learning how dissociation occurs in a human before age
seven, I realized that all humans have a bipartite mind (not to be
confused with a two-hemisphered brain). When the mind is integrated,
as is the usual case, it might be analogized as a coin with two
faces, Heads and Tails. The
Emotional Self (Kanjou) is the Tail side and the
Intellectual Self (Risei) is the Head side. Normally, we are
operating somewhere between 99% intellectually and 99% emotionally.
Both are there, ready to be used. Neither one is good or bad. How
much we use of which one depends on the situation and the goal we
have at the time.
To avoid unwarranted assumptions, I wish to note that, for trauma
to split (dissociate) the
Risei from the
Kanjou, it requires certain preconditions to be present. Just
being traumatized before age seven will not always cause the child
to develop MPD. In other types of people, in different settings, the
same trauma may cause other types of psychopathology. The situation
is not that simple.
Yes, there must be life threatening trauma before the age of
seven for anyone to develop MPD. But another condition is that the
Emotional Self (aka
Kanjou) must be Grade V hypnotizable on the Stanford Scale. The
ability to age regress by revivification is a trait needed to
qualify one for being in Grade V. This ability is invaluable in
participating in effective therapy.
Grade V hypnotizability is a characteristic of the
Emotional Self and is a trait given to it at birth. This trait
is accompanied by other characteristics, such as psychic abilities,
exquisite sensitivity to the emotions of others, fantasy proneness,
flamboyance, and "hysterical" traits of all kinds.
In women, this may be seen as typical hysterical female behavior
(pardon the sexist connotations). In men, the same traits may be
seen as antisocial behavior. In American society, girls learn to
internalize their problems, and boys learn to externalize them. So
women with MPD tend to develop emotional and physical problems,
while the men tend to act out antisocially.
Another factor needed to bring about MPD is polarization of the
parents, the usual caretakers of infants. One parent is seen by the
child as good and the other as bad. What often happens is that the
parents flip from role to role. But if the parents are together in
matters of discipline, MPD will not be likely to occur. Usually one
parent is the primary abuser, while the other one screams or
deserts. The non-abusive one does not rescue the child or the damage
could have been reversed.
The other factor needed for MPD is polarization of the siblings.
This child must be the only one in the family to be abused. This
child was seen as "different" from the other children, and therefore
somehow "deserving" of abuse the other children did not get. "Equal
Opportunity Abuse" is bad enough in its own right, but it creates in
the children a different clinical picture.
So, in our view, MPD is still a valid diagnosis for a clinical
picture, but it requires these preconditions:
1. Life threatening trauma before the age of seven.
(Minor trauma is not enough. The child must fear for his or her
2. Grade V hypnotizable Emotional Self.
3. Polarized parents - one good and one bad.
4. Polarization of siblings. Only this one is abused.
The others are treated decently.
What does this produce clinically?
The first effect is dissociation of the
Intellectual Self from the
Emotional Self. The Intellectual Self (aka Essence, Risei) then
sends the Emotional Self (aka Original Personality, Kanjou) into
hiding somewhere in
Thoughtspace, so the
Original Personality abdicates executive control over the
The Essence takes on the role of
Inner Self Helper (Damage Control Officer) and has to go to work
making the first
False-Front Alter-Personality to run the body. The ISH designs
and programs all alters to do whatever is necessary to keep the
alter is designed to do a job and only that job. It is endowed
with characteristic traits which the Original Personality would have
taken on, if it were in charge. The situation can be viewed as
operating a doll factory, with only the outfits of clothes being
produced. The doll, itself, is not present. The alters are the sets
of clothes, but there is no doll inside any of them. Therefore, they
cannot grow and change. They can only do what the
ISH has programmed them to do.
There is no way that this condition can be called "Dissociative
Identity Disorder." There is no
Original Personality to have any disorder. The
ISH is busy making alters to run the body. The
Original Personality has been removed from executive control.
There are multiple personalities alternating control of this body,
awaiting the end to the abuse and the arrival of a therapist who can
work with the
ISH to bring the Original Personality back in charge. This is
So, when is DID an appropriate diagnosis? When the trauma occurs
after the age of seven to a highly hypnotizable person. Then there
is no dissociation of the
Intellectual Self from the
Emotional Self. The Emotional Self (aka Original Personality) is
still in charge and available to have an Identity Disorder.
The social situation is different, as the child is now often out
of the parental home and in school. The abuser is often someone
outside the birth family. The trauma situation need not be long
lasting or life threatening, more likely some situation the child
was too immature to cope with. One of my cases of "dual personality"
was created by the rape at age 9, by a cousin. The girl created an
angry female alter who became a prostitute. She used sex to
humiliate and control men, like her
Original Personality had been humiliated by her cousin. This
woman could well be said to have a Dissociative Identity Disorder.
Treatment would be effective if she, the
Original Personality, learned better ways of handling sexually
abusive men and other humiliating situations. She would need to
learn better ways of coming to grips with the sexual conflicts she
had. If she succeeded, her prostitute alter would become obsolete
and might "die" of disuse atrophy. This clinical course is much
different from that seen with someone who had MPD, as we have
defined it here.
To provide you with the official definition of DID, here is what
it says in DSM IV:
The essential feature of Dissociative Identity Disorder is the
presence of two or more distinct identities or personality states
(Criterion A) that recurrently take control of behavior (Criterion
B). There is an inability to recall important personal information,
the extent of which is too great to be explained by ordinary
forgetfulness (Criterion C). The disturbance is not due to the
direct physiological effects of a substance or a general medical
condition (Criterion D). In children, the symptoms cannot be
attributed to imaginary playmates or other fantasy play.
Dissociative Identity Disorder reflects a failure to integrate
various.phpects of identity, memory, and consciousness. Each
personality state may be experienced as if it has a distinct
personal history, self-image, and identity, including a separate
name. Usually there is a primary identity that carries the
individual's given name and is passive, dependent, guilty, and
depressed. The alternate identities frequently have different names
and characteristics that contrast with the primary identity (e.g.,
are hostile, controlling, and self-destructive). Particular
identities may emerge in specific circumstances and may differ in
reported age and gender, vocabulary, general knowledge, or
predominant affect. Alternate identities are experienced as taking
control in sequence, one at the expense of the other, and may deny
knowledge of one another, be critical of one another, or appear to
be in open conflict. Occasionally, one or more powerful identities
allocate time to the others. Aggressive or hostile identities may at
times interrupt activities or place the others in uncomfortable
Individuals with this disorder experience frequent gaps in memory
for personal history, both remote and recent. The amnesia is
frequently asymmetrical. The more passive identities tend to have
more constricted memories, whereas the more hostile, controlling, or
"protector" identities have more complete memories. An identity that
is not in control may nonetheless gain access to consciousness by
producing auditory or visual hallucinations (e.g., a voice giving
instructions). Evidence of amnesia may be uncovered by reports from
others who have witnessed behavior that is disavowed by the
individual or by the individual's own discoveries (e.g., finding
items of clothing at home that the individual cannot remember having
bought). There may be loss of memory not only for recurrent periods
of time, but also an overall loss of biographical memory for some
extended period of childhood. Transitions among identities are often
triggered by psychosocial stress. The time required to switch from
one identity to another is usually a matter of seconds, but, less
frequently, may be gradual. The number of identities reported ranges
from 2 to more than 100. Half of reported cases include individuals
with 10 or fewer identities.
The Inner Self Helper (ISH)
In my first case of MPD, I was introduced to a psychic entity who
was normal, all knowing of personal history, and helpful to me in
doing therapy. After I had met similar entities in other severely
dissociated patients, I came to call it the Inner Self Helper or
ISH. By following psychologically integrated patients for several
decades, I learned what the ISH does after the disorder is
corrected. It then prefers to be called the
Essence of "my charge," another name for the
Kanjou, or Hidden Observer of Hilgard at Stanford University. It
has many useful functions. As a matter of fact, without it present,
the person is in need of life support systems.
But, during therapy of a patient with MPD, by my definition, the
ISH is a highly necessary co-therapist to any ethical therapist, no
matter how talented in psychotherapy. The ISH observes and
intervenes on the inside while the therapist attends to matters on
the outside. Between the two of them, effective therapy can be done
in a much shorter time. In my most complicated case of MPD, it only
took me three years of twice a week therapy to achieve integration
of 70 alters into the
Original Personality. With the time limitations of the public
clinic in which I worked, only because of the guidance of the ISH
did I get the integration done the day before I departed that
employment. Therefore, I highly recommend therapists of true MPD
patients should be happy to meet the ISHs in their patients and
listen to what they have to say. Not to do so is like the surgeon
ignoring the advise of his hospital's radiologist and laboratory
Characteristics of the Inner Self Helper (ISH)
A. Prime Directive of the ISH is to keep patient alive
until her Life Plan is completed and fulfilled. The ISH will
prevent suicide in any way possible.
B. Has no date of origin; has always been present.
C. Can only
agape love; is incapable of hatred.
D. Has awareness of and belief in "The
E. Is aware that the
Celestial Intelligent Energy (CIE) put her in charge of
teaching this person how to live and move forward properly.
F. Is able to work on the inside of the patient's
mind, as co-therapist, while the human therapist works on the
G. Knows all about history of patient and can predict
short term future.
H. Possesses no personal sense of gender identity, but
will assume either gender the therapist is comfortable with.
I. Talks intellectually instead of emotionally,
carefully chooses precise words, speaks in short concise
sentences; prefers to answer questions; gives enigmatic
instructions. ("Teach her humility today.")
J. Avoids using slang; does not have the capacity for
put-downs or guilt-trips.
K. Is aware of patient's past lifetimes.