THE CASE OF ALTER-PERSONALITIES V. IMAGINARY PLAYMATES by Ralph B. Allison, M.D. P.O.Box 6546 Los Osos, CA 93412-6546 Phone & Fax 805/528-7599 Running Head: "Alter-Personalities v. Imaginary Playmates" Submitted to The American Journal of Forensic Psychiatry July 1997 ABSTRACT The differentiation of Alter-Personalities from indwelling Imaginary Playmates is essential when evaluating a defendant whose offense may have been committed by a Mental Entity other than his Original Personality. Two examples of defendants who exhibited dangerous Imaginary Playmates are presented. Explanation is given as to how dissociation is a function of the Essence (Intellectual Self), while imagination is a function of the Original Personality (Emotional Self). Creation of Alter-Personalities is considered involuntary for forensic purposes, but creation of Imaginary Playmates is considered voluntary. Treatment is needed for integration of Alter-Personalities, but the defendant can destroy Imaginary Playmates by an act of will. Key Words: Playmate, Imagination, Alter-Personality, Multiple Personality, Dissociation INTRODUCTION In forensic psychiatry, a major issue which often needs to be addressed is whether an illegal act was "voluntary" or "involuntary." The law commonly considers a voluntary act which violates a criminal statute to be worthy of punishment, but the same act done involuntarily might not warrant punishment, and the perpetrator might be referred for treatment of the underlying mental illness. When the misbehaving party appears to be a Mental Entity (ME) which only intermittently controls the defendant's body, then the psychiatric examiner must determine whether or not that ME was created voluntarily or involuntarily. The thesis proposed here is that a ME which is a bona fide dissociated Alter-Personality is created involuntarily, but a ME can also be an Imaginary Playmates residing inside the body, and these are created voluntarily. THE PROBLEM AND SOME ANSWERS As long as man has been on this globe, the shamans, philosophers and other wise individuals have known that each of us humans is composed of body, mind, and spirit. I acknowledge the great importance of the "body" part, the brain, but here I put it aside to focus on the other two aspects, the mind and spirit. While working with dissociators for the past 25 years, I have learned that both the mind and the spirit are composed of the same "substance," intelligent energy or consciousness, but each has a different role to play in human life on earth. In healthy persons, they are psychic partners bonded together for a common goal. The "mind" is the Original Personality and is usually in charge of the physical body, while the "spirit" is perceived by the Original Personality as that "still small voice within." But the bond can be broken under certain circumstances, allowing the "spirit" to control the body. This breaking of the bond between the two is one variety of dissociation. My clinical experience has been with highly hypnotizable patients who were severely traumatized before the age of seven and showed evidence of dissociation known as Multiple Personality Disorder (MPD). In these patients, the first dissociation was between the "mind" and the "spirit," but I used other terms to describe these MEs. In these patients I called the "mind" the Original Personality or the Emotional Self. I called the "spirit" the Inner Self Helper (ISH) (1) prior to personality integration, and the Essence or Intellectual Self after integration (2). During the period of personality disintegration, the Essence takes on the role of ISH so as to maintain enough order to keep the patient alive. In these patients with MPD, the Original Personality hides inside the mind to escape further life-threatening abuse. The ISH uses dissociation to create appropriate Alter-Personalities (Alters) to run the body until a therapist can be found who will return the Original Personality to control of the body. This is all done for the sake of survival of the whole person, but without any participation by the Original Personality, which is still an infant or small child. This is one variety of pathological dissociation, one which often goes on for decades. A shorter lasting type of pathological dissociation would commonly be called a fugue state in a highly hypnotizable person. During a serious emotional upset after age seven the Essence dissociates from the Original Personality so as to be able to run the body itself. It also may cause temporary amnesia to the Original Personality. This condition lasts from minutes to days, during which the Essence runs the body while the Original Personality takes a rest. When the crisis has been handled properly, the Essence allows the Original Personality to regain control of the body and then may provide memories of what happened when the Original Personality is able to handle them. Nonpathological dissociation in highly hypnotizable persons led to the discovery of the Hidden Observer by Hilgard (3) at Stanford University. Grade V hypnotizable students were found to be able to reveal a ME which was aware of what the person had been hypnotized to be unable to perceive. I believe this Hidden Observer is the same as what I called the ISH, Essence or Intellectual Self, but it was found in nontraumatized individuals under hypnosis. Hypnosis is one method of inducing artificial dissociation in susceptible subjects. I now know that dissociation is a method used by the Essence for the purpose of assuring the survival of the individual. It acts without the consent or knowledge of the Original Personality. Since the Original Personality is considered the social person, such behavior is involuntary from the point of view of the Original Personality of criminal defendants. Fortunately for our criminal justice system, it would be extremely unusual for any Essence to design an Alter which deliberately performs a felonious act, such as killing another person, since such acts are not conducive to personal survival. Therefore, I became suspicious that MPD was not the correct diagnosis in felony cases where the evidence indicated a ME other than the defendant's Original Personality committed the violent crime. The many differences between dissociating individuals I had seen for treatment and those examined after arrest for violent felonies were presented in a paper titled "Maybe Multiples in Courts and Corrections" (4). At the time, I did not know what might be the origin of MEs responsible for these serious felonies. The answer became clear to me when I examined the murder defendant described in Case No. 1. During his preliminary hearing, his sister described how both she and her brother created Imaginary Playmates after their father shot and paralyzed their mother in front of them. I met his murderous Imaginary Playmate during my interview. After he tried to strangle me, I had him moved to a secure interview room. There the defendant talked to me over the phone as the quiet placid boy, while his murderous Imaginary Playmates talked to him from the wall beside him. Now I realized that many examiners were confusing Imaginary Playmates inside a defendant's body with dissociated Alters. To confirm this hypothesis, I interviewed a woman who had integrated 70 Alters 13 years before (2). During the last month of my therapy with her, she manifested a number of MEs who had not required psychotherapy to disappear, as had the Alters I knew well. She admitted to me then that, at the time, she, the Original Personality, was panicked because I planned to move out of the area, and she had deliberately imagined into existence a number of hostile MEs to entice me to stay. They used her body to insult and physically attack me in the office. After I left town, she got rid of all of these Imaginary Playmates during a nine day stay in a state hospital. What she had willed into existence she willed out of existence. She described how she could easily move them from inside her to outside her body by an act of will. LITERATURE REVIEW With this new insight, I reviewed many articles on Imaginary Playmates in the psychiatric and psychoanalytic literature. What I discovered was an almost universal lack of interest by the writers on whether or not these MEs could exist within the bodies of their creators. They usually assumed that Imaginary Playmates existed only outside the body of the child who created them. One exception was Bach (5) who reported on "Robin: An Imaginary Alter Ego". He wrote that, after her grandmother's death when she was 4 , "she invented a double named Robin. Robin was permitted to wander in the woods and fields adjoining the house and to experience all the adventures that were forbidden to Margaret. When engaged in these adventures, the little girl became Robin; that is, she deliberately assumed an alter ego that completely replaced her self. Late in the evening, when the father would return to the gloomy household bringing fascinating stories of the world outside, Margaret would dress up in her best clothes and become Robin. Then she would tell her father of her own imaginary adventures in a ritual which they shared for many years." Another exception was a paper by Fotheringham and Thompson (6) who described four individuals with Down's Syndrome. Three had external Imaginary Playmates and one was thought to have MPD, the only time MPD had ever been reported in someone with Down's Syndrome. But the only difference between the first three and the one with "MPD" is that the latter patient's two MEs resided inside the body of that person. His "alter-personalities" appeared in his early 20's without any history of abuse but apparently handled his anger at his roommates. One ME may have been modeled after the lead actress in the TV show, "The Bionic Woman." All one needs do to call the MEs in the fourth case Imaginary Playmates is to accept the premise that a ME can exist inside the creator's body, as well as outside. Then I re-read the autobiography of my male patients with MPD, Henry Hawksworth (7). He described how he first created two Imaginary Playmates before he dissociated his Essence from his Original Personality at age four. Then his Essence created two Alters to run his body. "Soon, like other lonely children, I began countering the emotional strain of not having real friends by inventing imaginary playmates who lived only in my head. The first of these, unfortunately, was Johnny. I would spend hours alone carrying on conversations with him. Shortly after my second birthday I was given a Charlie McCarthy doll and I pretended that Johnny lived inside it. I would hold the doll on my knee and make the mouth move whenever Johnny was supposed to be talking. . . . "I began blaming Johnny whenever my father became mad at me. . . . Johnny was the one who was bad and should be punished. . . . "When I was three I created a new playmate. This was Peter; he formed in my mind shortly after I received a book about Peter Pan for my third birthday. The story, of course, is about a boy filled with nothing but goodness. He loves nature and can talk with flowers. He is 100 years old, yet he never grows up. He is tender and gentle yet remains all boy. He is able to express emotions I, too, had always felt, but which I had had to hide because they hadn't fit my father's concept of masculinity." (pg. 23-24) The next year, when he feared death at his father's hands, his Essence, Jerry, dissociated from his Original Personality, Henry, who went into hiding in his mind for the next 40 years. Dana, an Alter, was made by his Essence to run his body, along with Johnny and Peter. Later, Phil, another Alter, was created by his Essence. When he was 43 years old, Henry came back in charge of the body, after he destroyed both Imaginary Playmates, and both Alters integrated into the original Henry. So here we had a man who showed both Alters and Imaginary Playmates, indicating the difficulties in making the proper diagnosis. CASE NO. 1: FRED, THE CABBIE KILLER Fred, a 24 year old black man and member of a local CRIPS street gang, was seen in jail while on charges of murdering a cab driver. He and his brother had robbed the cab driver, and then his brother took the victim's bank card to an ATM to get more money. While alone with the driver, Fred shot him to death with several bullets. Prior to leaving, his brother had tried to persuade him not to kill the man. Fred had been in continuous trouble since entering school and had been incarcerated numerous times. He was on parole from the youth authority. Prior to trial, a psychologist who had never handled a forensic case before diagnosed him as having MPD. Other forensic examiners disagreed with that diagnosis, but he was been found incompetent to stand trial and was sent to the state forensic hospital. There, Fred was diagnosed as malingering MPD and found to be competent to stand trial. In the hospital, he repeatedly assaulted staff members and was in seclusion most of the time. On return to county jail, he repeated assaulted correctional officers and was kept in chains whenever out of his cell. I was called in by his attorney just prior to his trial because she wanted me to advise on a placement in state prison for treatment of his MPD after his anticipated conviction. During his preliminary hearing, his older sister had testified that they were both present when their divorced father came to their house and shot several bullets into their mother in front of all the children. The father was sentenced to prison for attempted murder. The mother was thereafter confined to a wheelchair. In her bitterness, she repeatedly told Fred he would grow up to be just like his father. Fred was seven years old when his mother was shot. The sister testified to personality changes in Fred after his father's shooting his mother. He started talking to himself, and "he wouldn't be Fred." She reported talking to "Mr. Mann" or "Chuck" instead. "Mr. Mann" was perfect, always dressed just right and very concerned about how to act properly around girls on the bus to school. "Chuck" was a bully who kept getting Fred into trouble. The sister reported that she also made her own Imaginary Playmate, named "Akasha Richardson," at this time. With "Akasha" inside her, she could be bolder and more assertive at school. "Akasha" also sat next to her at home so she could talk to her. "Akasha" stayed with her until she got pregnant at age 17. She reported that another sister also had "other people." My interview began in an office with Fred in wrist and ankle chains. He was hostile, yelling and swearing abruptly, and I quizzed him about the duties of the officers of the court. (At the hospital, he had shown full ability to understand court procedures.) He claimed ignorance of the duties of anyone in a courtroom. When I calmly challenged his claim of ignorance, he rose from his chair and came towards me, aiming his wrist chains at my neck. I immediately verbally terminated the interview and headed for the door to get a correctional officer. I resumed the interview in a bail bondsman's room, by phone through Plexiglas. This time I interviewed a much calmer, more juvenile, cooperative young man who also had several delusions, including the belief that he was going to leave the jail for another state after his trial. He calmly give me all the history I asked for during the next 90 minutes. After reviewing all the reports, I had a list of 19 names that were reported to be his "Alters," including "Mr. Mann" and "Chuck." Fred reported that "Chuck" considered himself white, but "Amrak" hated white people and wanted to hurt them. "Madam" and "Chuck" protected him. There was no clear pattern of beneficial purposes as I had come to expect in noncriminal patients with MPD. He was able to tell me some characteristic of each name but "Mr. Mann." During this part of the interview, he claimed several of his "friends" were in the room with him in different locations, talking to him as voices, but none of them seemed particularly helpful. None took over his body to introduce themselves to me. Fred repeatedly closed his eyes and lost concentration with me, but never talked as another person during that time. I agreed to a diagnosis of schizoaffective disorder, but not MPD. It was clear to me that, at the age of seven, he had felt guilty because he was not able to protect his mother from his angry father, so he created a series of Imaginary Playmates to contain and manage his conflicting feelings. "Mr. Mann" had to be perfect, to help keep him alive in that family. "Chuck" and the other antisocial MEs were made by identification with his father and fueled by his intense anger at the man. This "identification with the aggressor" led him to kill the cab driver in the same way his father had tried to kill his mother. He had no insanity defense, since he had voluntarily chosen to make all these MEs, and I believed he could destroy them whenever he chose to do so. I did not recommend any treatment program in prison, since he had to learn not to assault therapists first. When he found the existence of the MEs to be more trouble than benefit, he could get rid of them all by himself. CASE NO. 2: TED, THE TRANSVESTITE BOMBMAKER Ted was a 34 year old white male electrician who was evaluated for his defense attorney to determine if he had MPD. He had been arrested by the Sheriff's Bomb Squad after his therapist, a Marriage, Family, and Child Counselor (MFCC), called police at Ted's girlfriend's request. Two days earlier, the MFCC had hypnotized him for two hours, dredging up memories of Ted being sexually abused in childhood by his mother and older sister. Ted could not get these memories out of his mind. He purchased material with which to make a bomb so he could blow up the memories in his head. He drew a picture of a pipe bomb, and then read his Bible. He decided he would not go to heaven, so he gave up the idea. He remained in a very agitated state for the next two days, causing his girlfriend to call the MFCC. Ted told police he would never use the items to hurt anyone else and claimed he had worked with bombs as a US Navy Seal. He talked irrationally in the police car. He was charged with intention to make a destructive device. The MFCC told his attorney that Ted had MPD. At the time, he was on probation for burglarizing his mother's earthquake damaged home and was awaiting trial on a DUI charge after he angrily left an Alcoholics Anonymous meeting and crashed his motorcyle. Besides interviewing him in jail, I interviewed his two most recent girlfriends, secured local psychiatric and medical records, secured past VA hospital records, and administered two tests. I first gave him the DES (Dissociative Experiences Scale)(8) then the DDIS (Dissociative Disorders Interview Schedule) (9). Ted claimed his mother liked to dress him in female clothing as a boy and fondled him sexually. He claims he had sexual intercourse with his older sister into his teens. He had his first "nervous breakdown" at age 10 when his dog was killed by a car. In his depression, he carried the dog around in a box until his family persuaded him to bury it. After high school, he had honorable service in the US Navy as a firefighter on board ship. He led a crew in fighting a shipboard fire which killed some of his crewmates, but he suffered no permanent emotional harm. He was a heavy alcohol drinker since age 10, and became addicted to cocaine at age 22. He then spent three months in a VA hospital drug abuse program. He had his second "nervous breakdown" at 29 when he found his fiancee in bed with a black man. He wanted to kill both of them. He returned to a VA hospital for three months. Psychological testing (Minnesota Multiphasic Personality Inventory & Mellon Clinical Multiaxial Inventory) led to diagnoses of Polysubstance Abuse, Organic Affective Disorder, and Mixed Personality Disorder with antisocial and borderline features. He was also considered a transvestite due to a history of crossdressing. He showed no personality switches during these hospitalizations. During the two years he had been in this county, he had made three suicide attempts, each leading to hospitalization. He was thought to have Bipolar Disorder and was on various medications by various doctors. Both girlfriends saw three MEs, two female and one male. They alternated in taking over his body after long drinking followed by depression. The male ME threatened to cut the first girlfriend's throat with a knife when she tried to throw him out of her home. Ted thought they split up on good terms, having no memory of this misbehavior. Between Ted and his two girlfriends, I developed a composite description of four ME's, two male and two female. He showed me none during interviews, as he was sober and on medication in jail. "Tammy" was a seven, 10, or 12 year old "little homemaker" whom he made up at age six to help out in the kitchen. She was made when no one was doing any cooking at home. If he wanted eggs, she would know how to cook them. While "Tammy" was in control, he wore female clothing. "Tamara" was a 17 or 42 year old "crazy older woman" which he made up at age seven as "my alter-ego, another part of me." She is what he thought his mother wanted him to be when he grew up. She was described by one girlfriend as sophisticated, angry, mean, and like his mother. She had no beneficial purpose and wanted to kill people. She was all emotion. When "Tamara" was out, he would dress up with a wig, female clothing and high heels. "Rick" was a male ME which the girlfriends knew as the "macho" one. "He is the one I want to be. He grows up alongside of me, likes hunting, fishing, dancing, mountain climbing, motorcyle racing." "Rick" thought he had been in the US Navy Seals. He also thought he was on a mission to Russia on orders from President Reagan to kill certain officers. He acted out this fantasy in front of the second girlfriend, acting as if he commanded a squad of assassins which included "Tony" and "Cornfed." "Rick" was the one who put the knife to the first girlfriend's throat. "Eric," described only by Ted, was a 25 year old male who told Ted to die and go to heaven. Eric made him think of killing himself. "Eric has only one face, which I see inside. He is my frustration, anger, makes me cut myself, hurt myself, burn myself on the legs so others don't see it. The only bad one is Eric." On the DES, a screening test for dissociative tendencies, Ted had a score of 37.8 and endorsed 20 of the 28 questions. This was not high enough to qualify him as a dissociator, being well below the level found with PTSD. The DDIS, a structured interview, gave the most reliable diagnoses as Substance Abuse, Major Depression (recurrent), Borderline Personality Disorder, and Psychogenic Amnesia. (One characteristic of Borderline Personality Disorder is "identity disturbance: markedly and persistently unstable self-image or sense of self.") My conclusion was that Ted did not have MPD or any other dissociative disorder. He had a Borderline Personality Disorder and the Mental Entities he had shown when intoxicated were made by his emotional imagination. He plea bargained for a four year sentence to state prison. DISCUSSION Confusion is understandable in this area of forensic psychiatry. To ferret out the truth takes a great deal of time and information from multiple sources. I have not even touched on the issue of those who dissociate after the age of seven, as they demonstrate a completely different clinical picture. Malingering has not been mentioned, but is extremely important in any forensic evaluation. Here I have chosen to focus only on the differences between imagination and dissociation, two quite different mental processes. Dissociation is a process used by the Essence for the purpose of creating useful Alters which can substitute to operate the body for an absent Original Personality. Alters are designed for survival of the total organism. If the first dissociation of the Essence from the Original Personality is before age seven, the Original Personality may not be available to run the body for decades. Alters are created for specific purposes, using characteristics that the Original Personality would have taken on if it had stayed in charge. When an Alter becomes obsolete, it must be replaced by a newly created one. Since very few people are highly hypnotizable enough to be able to create Alters, MPD is a real but rare condition. As far as the Original Personality is concerned, the creation of the Alters is involuntary. With proper psychotherapy, Alters can eventually be "layered onto" the Original Personality during psychological integration. The Original Personality cannot do this by itself. Imagination is a process used by the Original Personality for the purpose of creating MEs for a wide variety of purposes. There are no limits to human imagination, so MEs can be created in any size, shape, age, sex, or physical form. They may live inside or outside their creator's body. They are fueled by raw human emotions and are not designed for survival purposes. They may have limited and changing characteristics, as they can be constantly redesigned by the imagination of the Original Personality, as needs and desires change. Since all but the demented can imagine, Imaginary Playmates are ubiquitous throughout mankind. Since they are chosen to be made by the Original Personality, the creation of Imaginary Playmates is voluntary. The Original Personality can destroy any and all Imaginary Playmates, once the person makes up their mind to do so. All that is needed is the will to get rid of them and take responsibility for what they have been doing in the person's behalf. CONCLUSIONS A forensic psychiatrist who evaluates a defendant whose body apparently committed the criminal act while under the influence of a ME instead of the Original Personality needs to determine if imagination or dissociation was used to create that ME. Dissociation requires high hypnotizability and a life threatening trauma, and produces an Alter which is designed by the Essence to prolong that person's life. Persons with bona fide Alters are rare, and Alters are unlikely to have any interest in felonious misbehavior against strangers. From the point of view of the Original Personality, they are created involuntarily. However, MEs created by the imagination of the Original Personality are fueled by raw emotion and are not created with any inner control mechanisms in place. They can exist wherever their creator wants them to be and can do whatever their creator wants them to do. As they can be manufactured by almost any human, they are much more likely to be present in individuals who commit violent crimes. From the point of the Original Personality, they are created voluntarily. REFERENCES 1. Allison RB & Schwarz T: Minds in Many Pieces: New York, Rawson/Wade, 1980 2. Allison RB: Memories of an essence, 1996 (unpublished manuscript) 3. Hilgard ER: Divided Consciousness: Multiple Controls in Human Thought and Action. New York, John Wiley & Sons, 1977 4. Allison RB: Maybe multiples in courts and corrections. Paper presented at the American Academy of Psychiatry and the Law, Ottawa, Ontario, Canada, October 15, 1987. 5. Bach S: Notes on some imaginary companions. Psychoanalytic Study of the Child 1971; 26: 159-171 6. Fotheringham JB & Thompson F: Case Report of a Person with Down's Syndrome and Multiple Personality Disorder. Canadian Journal of Psychiatry 1994; 39:2:116-119 7. Hawksworth H & Schwarz T: The Five of Me: The Autobiography of a Multiple Personality: Chicago, Henry Regnery Company, 1977 8. Bernstein EM & Putnam FW: Development, Reliability, and Validity of a Dissociative Scale. Journal of Nervous and Mental Disease 1986; 174: 727-735 9. Ross CA: Multiple Personality Disorder: Diagnosis, Clinical Features and Treatment. New York, John Wiley & Sons, 1989 

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