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The American Journal of Forensic Psychiatry, volume 2, 1981-82,
p. 32-38

Ralph B. Allison

The psychiatric disorder called multiple personality has been
found to exist predominantly in females in a clinical
population, but mainly in males in a criminal offender
subpopulation.  The mental mechanisms of defense of denial,
repression, and dissociation are used by these individuals,
leading to the formulation of hostile-acting
alter-personalities.  Because of a failure of control of the
executive functions by a moral center, these persons violate
society's laws, but have no conscious memory of the act.  They
therefore do not respond to the usual legal sanctions.   Common
findings in this histories and mental status examinations are
presented. It is hoped that quicker identification and correct
diagnosis of these violence-prone individuals can lead to
appropriate legal and psychiatric approaches to the problems
they present to society.

Those psychiatrists, who are regularly involved in the
evaluation and treatment of clients in the criminal justice
system, quickly become aware that there is no firm boundary
between the group called "mentally ill" and those called
"criminal ." Those who violate the major moral codes of our
society include some who have major mental illnesses, such as
paranoid schizophrenia, bipolar affective disorders and other
well-accepted psychiatric illnesses.   Sometimes the criminal
act is directly related to the progress of the illness.  In
either case, psychiatry has well established protocols for
treating such patients, be they in prison or in hospital.

	There is another psychological disorder which, by its very
nature, predisposes its sufferers to criminal behavior but which
causes such controversy among forensic psychiatrists that some
doubt its very existence.  This condition is multiple
personality.  Although this condition has been diagnosed for
over a century, often amid great controversy, only in the 1980
DSM III is there a clear definition.1




	This paper is an attempt to explain, in a very elementary
fashion, why this disorder may be a greater problem to the
criminal justice system than its frequency suggests and how it
might be identified and dealt with when criminal acts are


	Eberhardt Gamelin published the first recorded case of
"exchange personalities" in 1791.2 The first generally accepted
case report from the United States was that of Mary Reynolds.3
At the turn of the century the most outstanding
psychodiagnostician of this problem was Morton Prince, founder
of the Journal of Abnormal Psychology, which carried many of his
articles on the subject.  His extremely interesting description
of Miss Beauchamp4 gives the clearest picture imaginable of what
such a patient thought, said and did in the world of his day.

	The next famous case was Eve, first made known by Thigpen and
Cleckley.5 This case report was followed by her own
autobiography6 and then, 23 years later, by another
autobiography, "I'm Eve," which gave a story quite different
from the first two books.7 Eve was followed by Sybil,8 which was
the next best-seller to bring the subject to professional and
public attention.

	These famous patients, who became the "typical multiple
personality" to many psychiatrists, were, one notes, all women. 
Yet men suffer from this condition, also.  In the mid 1880's,
the first description of this phenomenon in a man is provided by
Robert Lewis Stevenson in "The Strange Case of Dr. Jeckyll and
Mr.Hyde."9 Though this is a fictional account of a chemically
induced dissociation. leading to murder, forensic psychiatrists
would do well to read it again to find out how the twisted mind
of an evil alter-personality responds to society and to his own
act of murder.  In the fever-induced nightmare which provided
the plot for this story, Stevenson saw horrors of the mind which
psychiatrists can seldom reach.

	Two other descriptions of male multiples are worth of note. 
Ludwig et al.10 gave a classic description of Jonah and his
alter-personalities with much psychophysiological information. 
Henry Hawksworth11 published his autobiography, "The Five of
Me," in 1977.  He went to court after fusion and his
psychiatrist used age-regression during testimony to
demonstrated the previous existence of the alter-personality who
committed the crime.  In the legal literature, the only
contribution known is Ashby's description of the trial of Ester
Minor12 in which she was found innocent of a felony bad check
charge because of successful treatment of her dissociation and
the excellent handling of her case by her attorney.  Otherwise
there is little to guide the defense attorney who looks to his
literature for help when such a case appears in his office.


Between 1972 and 1980, the author had diagnosed multiple
personality in 59 individuals.   Of these, 78 percent (N=46)
were females and 27 percent (N=13) were males.  Eighteen percent
(N=l 1) patients either required the author to make a court
appearance or were seen primarily for forensic evaluation.  This
criminally involved subpopulation was composed of 73 percent
males (N=8) and 27 percent (N=3) females.  Immediately one notes
there is a 4:1 preponderance of females in the general clinical
group but a reverse preponderance of males in the forensic
subpopulation.  Only a rare male multiple was seen primarily for
treatment.  The majority of males were discovered as the result
of the psychiatrist being invited in by the court or the defense
attorney in a criminal case.

As all cases are complex in nature, their descriptions here are
not appropriate.  However, it is planned that these cases will
be described in a subsequent article.

	There is one basic defect in the psychological make-up of a
patient with multiple personality which is unique to him and
makes him more predisposed to criminal behavior than the
psychotic individual.  This defect is in the internal
relationship between the executive functions of the mind which
involve everyday social functioning and the moral judgment
mechanism we all possess.  By the latter is not meant the super
ego as Freud defined it, which is an incorporation of social and
familial codes of conduct.  What is meant is ability to decide,
on one's own, whether or not a proposed act is morally right or
wrong, before doing it.  Everyone is given the opportunity to do
something despicable, harmful and evil at sometime in his life,
but when most choose not to, the individual's moral judgment
center sufficiently influences the executive center and the
individual, therefore, does not commit the criminal act.  It is
this very important influence which is missing in the multiple
and therefore leads him to repeatedly do acts which are harmful
to himself and to others.  This disconnection or dissociation
also causes him to be unchanged by punishment, admonitions, or a
clear warning of self-destruction.

The favorite psychological defense mechanisms of the child with
histrionic personality disorder, the precursor of multiplicity,
are denial, repression and dissociation.  In denial, he, the
basic core personality, fails to accept the reality that the
rest of us accept, preferring to create a new reality of fantasy
which is not in accordance with the laws of cause and effect, or
of the written laws of society.  He says, "The problem I am
upset about does not occur, therefore I don't have to solve it."
This attitude compounds the problem since the other parties to
the problem, such as mother and father, are never confronted by
the child or anyone else, and they perpetuate their misbehavior.

Since denial does not handle the build-up of hostile, angry and
potentially murderous urges within the child, these are
repressed into the unconscious mind where they continue an
existence out of awareness of the child.  He knows his mother
loves him dearly, since all mothers do, so her beatings are not
consciously seen as causes of hatred.  The hatred is buried and,
when intense enough, dissociates from the rest of the
unconscious mind.

The third mechanism of dissociation is what leads to the
creation of the alter-personality.   The usual purpose is to
create a reservoir for this continuous build-up of murderous
hatred for the abusive parent.  The personality which is in
charge of executive functions of dealing with the angry mother
may decide to do things her way for the sake of peace and
survival, since he feels helpless in contrast to her power and
ability to control his life.  All the negative feeling she
develops are invested into a dissociated energy system which
gains strength over time until it has a structure, identity and
purpose of its own.  Then, when it is needed for protection and
survival of the child, it makes itself known as a hostile
protector, striking back at the child's identified enemy. 
Sometimes this creation is an imaginary playmate on whom all
naughty deeds are blamed.  Sometimes this activity is
accompanied by amnesia of the misbehavior.  In this case, the
child is then accused of doing a horrible deed, such as stabbing
a younger sibling.  The child does not remember doing any such
thing, but he knows he was in the room at the time.  The
resentment of being unjustly accused is added to the previous
unexpressed anger, and a vicious circle is created,

Alternately, the child may have been aware of his anger and of
having done the misdeed.  But when the parent asks, "Did you do
it?" he lies and denies it.  The denial then leads to repression
again, and the next time mother asks "Did you do it?" he really
does have amnesia and believes he did not do it.  He may make up
a story to explain where he was or who else did it.   This is
patently false to the parent, and now he is called a liar, an
even worse sin in children, according to many parents

So what happens? This fledgling alter-personality gets stronger
as child and parent continue to fight with each other.  When the
angry one is about to go one step too far, a rescuer personality
needs to be formed to counterbalance it.  So a helper
alter-personality is created to calmly deal with situations such
as school.  Now we have three personalities sharing the body.

The next trauma is usually involved with sex in the sense of
rape or incest.  This is less likely with boys, but still
possible.  With girls, incest and rape are seen as sexual
control, manipulation and humiliation of the girl victim.  The
alter-personality created from such experiences then seduces men
to be able to control and humiliate them in return.  However,
the preferred victims of the humiliation soon also includes the
original executive personality, so that the one who was
protected is now the target herself

In the case of the male rape victim, according to Groth and
Burges, the impact on the male victim is often a feeling of life
being threatened, a wide range of mixed emotions and disbelief,
a marked disruption in the victim's lifestyle, considerable
anger, fantasy or planned retaliation and marked confusion if
the victim had been forced to ejaculate. 13 In the case of two
male multiples who both committed several rape-murders, sexual
assault did occur to them as children.


Case Number 1.

This 18 year old white male was first seen for a court-ordered
examination after his arrest on several charges of arson.  While
the physical evidence was overwhelming against him, he had
amnesia for most of the night during which the houses were
torched.  He was sentenced to the state youth authority prison
and was again seen on release because of a suit he and his
brothers had filed against the state.  This was regarding an
automobile accident several years earlier in which he and his
brothers were severely injured while his mother was decapitated
in front of them.  Their attorney was trying to prove that the
accident was so mentally upsetting they were incompetent to have
filed the suite prior to the expiration of the allowed filing

During the interview after release from prison, a very hostile
alter-personality appeared, claimed credit for numerous crimes,
and called the primarily personality derogatory names for
wanting to work, pay bills, go to church and do other such
activities.  During subsequent investigations it appeared that
this entity had been created at the age of 7 when the youngster
was raped by a gang of neighborhood boys.  In spite of
presentation of the psychological data in court,

the boys were all found competent to have filed the suit on time
and the suit was dismissed.

About a year later, this man with an accomplice, broke into a
woman's home, raped and killed her.  	A month later, he took a
homosexual man home from a bar and, after intercourse, he
strangled him to death, having no clear idea why he was doing
so, In the first trial, for killing the woman, he was found sane
and guilty of first degree murder and sentenced to death.  For
the murder of the man, he was found guilty of second degree

Case Number 2

This 26 year old white male had been arrested on charges of
raping and strangling two young women.  He had no memory for the
period of time during which the killings occurred.  A defense
psychologist hypnotized him and found an alter-personality which
admitted to the two killings and to five similar killings in
another state This personality had apparently developed at age 9
to handle his anger toward his mother.  She was displacing onto
him her anger of her husband, who was losing much of the weekly
paycheck at the local racetrack.

	The documented medical history indicated that, from the age of
5-7, the boy suffered from daytime urinary dribbling, which was
thought, by most doctors, to be an emotional response to his
overprotective mother.  She demanded a physical explanation and
so he was subjected to several cystoscopies and a meatotomy, all
to no avail.  When mother went to work, his urinary symptoms
disappeared.  Considering the intense nature of the ambivalent
feelings towards his mother and her insistence on doctors
repeatedly traumatizing his genito-urinary tract, I believe he
felt raped and was symbolically reacting in a dissociated state,
when he raped and killed his victims.  He was given two life
sentences in the one state and six life sentences in the other.

When a sexually active negative alter-personality develops to
the point of severe danger, the mind, in its wisdom, may create
another rescuer personality which can stop the persecutor
personality before it goes too far.  If not, it acts as a
rescuer-defender and seeker of help after the crisis is past and
so we have five personalities formed.


At this time, the moral judgment center of the mind becomes
quite separated from the executive personality.  The
alter-personalities at first have a protective functioning
toward the executive personality but after awhile they may
develop interests and activities of their own that the executive
one knows nothing about.  Time is lost and no accounting can be
made of it.  Again, denial is used to ignore this reality. 
Activities get done but the executive personality cannot yet
remember how or when they occurred.  Minor acts of delinquency
may occur but the executive personality cannot figure out how he
got himself in a jam.  After all, why would anyone think a
sterling character like him, honest, loving to all, could ever
do something like that? They must be mistaken.  But he is also
noble and self-sacrificing, so he takes his punishment like a
man, never being sure why he is being punished.  The appearances
of the alter-personalities will occur when certain specific
emotions are aroused, as these are their specific triggers. 
Brief outbursts of erratic behavior are ignored by the executive
personality.  Longer periods of planned activity by the 

alter-personalities are simply dismissed.  After all, no one's
memory is perfect.  The alter-personality is very careful to
keep its real existence in the world a secret from the executive
personality, since its interests conflict markedly with the
professed moral code of the executive one.

But eventually, when the multiple leaves home where all of the
switching may be very adaptive and necessary and arrives in the
world of adults and laws, a law may be broken.  And what will
the defense lawyer, judge or examining psychiatrist hear of.?

	The defendant is probably in his late twenties, if this is his
first arrest.  He is bright, verbal, engaging, polite, eager to
please and cooperate with the examiner.  He is just as puzzled
by how he got into this jam as is everyone else, and he assures
everyone that he will cooperate in trying to answer all
questions.  But except for his pathological family history, he
does not have much to tell.  He has no recollection of
committing the criminal act and is not sure he has even been to
the scene of the crime.  He might have, but he has no direct
recollection of being there at that time.   He is not paranoid
in thinking someone has unjustly accused him; he is just
puzzled.  But this is not the first time he has been so
mystified.  He found himself once jailed in another city.  The
jailors were calling him by a completely different name.  They
were also angry with him for having given them a hard time at
the booking window.  He couldn't understand that, since he has
always admired and liked policemen, and he never had a fight
with anyone in his life, at least not one that he remembers.

He is holding down a steady job now, but he has repeatedly
changed employers in the past.  He has a girlfriend today, but
she is the third heavy romance he has had this year.  He pays
his bills on time, but he also finds money either present or
missing from his pocket, something he cannot explain.  Once he
woke up in his apartment to find a new sports coat in his
closet, one so flashy he would never have bought it.  He has
been very depressed, he says, and he has seriously considered
killing himself a number of times, even though the problems were
not objectively too bad.  But he goes into these bad moods where
he feels death is the only way out.  Once while alone in his
room, he even fashioned a noose, but he suddenly snapped out of
the blue mood and ripped it up so he couldn't use it again.  He
may have been very heavily into psychedelics and sedative drug
abuse, but he's not interested in narcotics.  This interest may
have been only sporadic so he never really became addicted to
any drugs.  Alcohol abuse may be mentioned and quickly invoked
as the sole reason for the blackout spells, but, on careful
questioning, he reports that he gets very depressed or angry
first, then he has one drink, then he blacks out.  Also he had
blackouts in his school years before he ever started drinking. 
He never mentioned them to anyone because he thought everyone
experienced blackouts during which they traveled to distant
parts of the city, waking up to find themselves leaving a place
that was strange to them,

He may also be puzzled by school reports of fighting with
teachers, since he would never do that.  Also he may have gotten
an award in a certain class he can't remember attending.


	Now this pleasant young man with history of probably having
done horrible crimes does not look and act like a chronic
schizophrenic, so the examiner may not go through the usual
routine of asking about auditory and visual hallucinations.  But
if the examiner is compulsive in taking a mental status
examination, this nice young man may report that he has heard
voices talking to him inside his head, not from the outside. 
These voices may call him vulgar names, tell him he is no good,
or maybe even cheer him up when all is black.  He may have had a
visual hallucination once, like the ghost of his grandmother
sitting on his bed, or a vision of a building that wasn't there
a few seconds later.  He hesitates to tell anyone these things,
since he knows he isn't crazy and only crazy people see and hear
things like that.  He knows he might be locked up in a mental
hospital forever if he told anyone such things.

How much of this history the examiner gets will depend in great
part on the examiner's approach to the defendant.  If the
examiner has already decided that the defendant is a mean and
nasty fellow who should be put away forever, the defendant will
pick up that feeling immediately and will give out nothing but
what is needed to support such an opinion.  But if the examiner
comes in with an open mind to gather all the facts and history
the defendant has to offer, and to enlist his curiosity in what
this all means, the defendant will pour out the stories he has
been holding in for many years and treat the examiner like the
therapist he has been looking for all the time.

That will present new problems since, if one is a
court-appointed examiner, one is not in a position to treat him,
but the defendant may not be willing to accept that fact.  He
now knows that he needs someone to help him understand himself
and he wants to enter into a client-therapist contract.  Being
in jail is not seen as a barrier to this course of action. 
After all, can't the examiner change roles as fast as the
defendant does? If not, there must be something wrong with the
examiner, and so the fantasy goes.


Once the examiner is aware of this type of history and has added
multiple personality to the list of diagnostic possibilities,
what is to be done next? This is hard to say, since each case is
different and one is operating in a legal arena where the rules
of conduct are different than in the medical arena.  Certainly a
fuller workup needs to be recommended before anyone has a clear
path to follow.  But just where should this be done, and by
whom? Should hypnosis or sodium amytal be used now, later, or
ever to penetrate the amnesia and possibly expose the suspected
alter-personality? This is a very serious question when one is
dealing with a mass murderer and five appointed psychiatrists,
some of whom have not yet seen the defendant.  What
psychological tests should be given, by whom, and to whom?

All this also depends upon the belief systems of the defense
attorney, the prosecuting attorney and the judge.  Is an
insanity plea likely to be acceptable under any circumstances?
Are we working with the ALI insanity rule or the McNaughten rule
in this court? Is the court or the client willing and able to
finance the extensive use of videotaping, audio taping and
transcriptions from these tapes? What facilities does the state
have for treatment, even if he is found to be mentally ill? Can
he competently stand trial in the first place? These questions
and others will have to be discussed in a subsequent paper.


The condition known as multiple personality is a very real
psychological phenomenon which can pose a serious problem to the
forensic psychiatrist who suspects the condition exists in a
defendant.  While females are more often found to suffer from
this disorder in a clinical practice, in the offender
population, males greatly predominate.  The males are guilty of
very violent crimes which are repeated and are not controllable
by the usual methods of legal punishment.  Therefore, the
awareness that this condition exists and that it may be an
important factor in the cause of a serious crime is the first
step in enabling the forensic psychiatrist to make plans to
appropriately deal with this complex situation.

Ralph Allison, M.D.

1	Diagnostic and Statistical Manual of Mental Disorders (Third
Edition) Washington, DC, American Psychiatric Association, 1980
2	Larmore K., Ludwig A., Cain R.: Multiple personality - an
objective case study.  British Journal of Psychiatry 131:35-40,
3	Mitchell SW: Mary Reynolds: a case of double consciousness. 
Transactions of the College of Physicians of Philadelphia, 3'rd
series, 10, 1888
4	Prince M: The Dissociation of a Personality.  London, Longmans
Green, 1913
5	: Thigpen CH, Cleckley HM: The Three Faces of Eve.  New York,
McGraw-Hill, 1957
6	Lancaster E: The Final Face of Eve.  New York, McGraw-Hill,
7	Pittillo ES, Sizemore CC: I'm Eve.  Garden City, NY,
Doubleday, 1977
8	Schreiber F: Sybil.  New York, Henry Regnery, 1973
9   Stevenson RL: Strange Case of Dr. Jekyll and Mr. Hyde. 
Norwalk, CT, Heritage, 1952
10  Ludwig AK, et al: The objective study of a multiple.
personality.  Archives of General Psychiatry 26:298-3 10, 1972
11  Hawksworth H: The Five of Me.  New York, Henry Regnery,
12	Ashby A: Esther Minor: multiple personalities In court. 
Forum 6: 3-30, 1979
13	Groth AN, Burges AW: Male rape: Offenders and victims. 
American Journal of Psychiatry 13 7:7, 806-810, 1980
14	Allison R. Schwarz T: Minds in Many Pieces.  New York,
Rawson, Wade, 1980

  Copyright© 2022 - Ralph B. Allison