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About Dr. Allison

Prepared for Presentation at the      
Marin County Psychiatric Society
                 April 1982
           Ralph B. Allison, M.D.
            Retyped August 1988

     During a ten  year  span  of  clinical  psychiatric 
practice,  I had the opportunity to  treat  and  observe  over 
60  patients,  both male and  female,  who  demonstrated  the 
presence  of  both  primary and alter-personalities.     All 
were  considered  to   possess   the basic  characteristics  of
the   histrionic   personality   disorder (formerly  the
hysterical  character disorder).         However,  their
clinical  pictures  did  not  necessarily  follow  that 
portrayed  in DSM  III (1).     They showed the  basic  pattern 
described  by  Tupin (2)  of  an  exaggeration  of  either  male
or  female  stereotypical social behavior.     They also
showed, when  tested  on  the  Minnesota Multiphasic Personality
Inventory  or  the  California  Psychological Inventory,    the
preference  for    the    psychological    defense mechanisms 
of    denial,  repression  and  dissociation.         Their
management of hostile  impulses  was  handled  by  dissociation 
prior to any actual acting out behavior.


1.   The existence within the  individual  of  two  or  more 
distinct personalities, each of which is dominant at a
particular time.

2.   The  personality  that  is  dominant  at  any   particular 
 time determines the individuals behavior.

3.   Each  individual  personality  is  complex  and  integrated
 with its own unique behavior pattern and social relationships.


     The true incidence in  the  population  is  unknown  but 
studies at NIMH currently underway  by  Frank  Putnam,  M.D. 
will  give  more accurate data than is currently  provided  by 
the  currently  popular method of  counting the reported  cases
in  the literature. One experiment  in  Finland  by  Kampman 
(3)  showed  that,  of  mentally healthy  high  school 
students,  only  8%  could  create  an   alter-personality under
 hypnosis  with  specific  instructions  on  how  to do it. 
Therefore, one  could  speculate  that  8%  of  the  population
might have the capacity to  dissociate  to  the  degree 
necessary  to manufacture such entities.  This  figure  may  or 
may  not  apply  to the mentally ill  population.  However, 
case  finding  by  Kluft  (4) in Philadelphia, among chronically
 suicidal  patients  in  long  stay hospitals  and  groups  of  
non-improving   outpatients   has   shown multiplicity to be
frequently present  as  the  reason  for  the  lack of progress
in treatment.  In his  series  of  70  cases  treated,  73% were
female and 27% were male.  In  my  cases,  80%  were  female 
and 20% male.     In the  subsample  of  cases  seen  primarily 
for  legal evaluation, 75% were male and 25% female.


1.   The  unconscious  mental     defense  mechanisms  of     
denial, repression  and  dissociation  are  used  as  the 
primary  means   of dealing    with  unpleasant  stimuli,  
instead   of   more   socially appropriate learned coping

 2.   Instead of physical means, mental methods  are  used  to 
deal with both physical and emotional trauma, at least  in  the 
initial phases of the period of trauma.  Hateful  thoughts 
towards  abusers are preferred  to  physical  actions,  such  as
 striking  back  or running away from home.

3.   Hostile attitudes and feelings  must  be  dissociated, 
cannot be "owned," due to parental injunctions such as,  "Thou 
shalt  not hate me, your parent, while I have the right to beat
you up."

4.   The prime  or  original  personality  creates  a 
"persecutor" alter-personality for the purpose of  first 
handling  anger,  then for  the feelings  related  to sexual 
abuse.    Then  a   "rescuer" alter-personality must   be
created, followed by  an  organizer  of the inner forces, an
entity  I  have  christened  the  "Inner  Self Helper" or ISH

5.   If the first alter-personality is created before  the  age 
of eight years, an additional type of  alter-personality  is 
created, the "false front."   This alter-personality may assume
all  of  the social functions and duties  of  the  original 
personality,  which then remains "inside the mind" frozen in
emotional  development  at the age  of the first  dissociation. 
  There may  be  a  series  of false front personalities during
childhood,  as  each  one  becomes incompetent  to  handle 
progressively  more  complicated   duties. This
alter-personality is very fragile and can  splinter  into  any
number of alter-personalities (third generation  fragments  or 
ego states), often numbering between 10 and 50.  In  contrast, 
if  the first alter-personality is created after  the  age  of 
eight,  the primary  personality remains  in charge.    In 
those  cases  seldom will more than six alter-personalities be
found to have  ever  been created.


1.   Psychological: The prime defect  seems  to  be  a  failure 
of the primary personality to learn  by  experience,  a  defect 
which leads  to  antisocial  behavior  over  a  long  period  
of   time, unchanged by punishment or the direct results of  the

2.   Social: Traumas in the family may include  being  unwanted 
by at least one parent, sexual and physical abuse  by  a  parent
or  a parent substitute, polarized parents, mandatory secrecy 
of  family problems, unresolved sibling rivalry and  youthful 
marriage  to  a sadist (in the case of females).

3.   Physical: These individuals appear  to  have  nervous 
systems which are hypersensitive to the "vibes" of other
persons,  so  that they can easily  perceive  the  emotions  of 
others  around  them, especially the negative ones.  They are
then  very  much  influenced by  the  moods  of  those  around 
them.  Such  persons   are   "emotional albinos."

4.   Moral:    Prior  to  therapy,  they  have  not  decided 
whether   to be  good  or  bad  persons.  The  formation  of  
alter-personalities   is their   method   of   demonstrating  
the   moral   ambivalence    without developing  a  true  sense 
of  guilt,  which  might  inhibit  the  acting out.


1.   Symptoms  which  are  most  prominent  at  the   start   of
therapy are  depression  and  amnesic  spells,  during  which 
suicide   attempts may be made.     Physical  complaints   may 
include   severe   headaches, backaches,   colitis,  
stammering,    convulsions,    alcoholism,    drug addiction and
sexual dysfunction.        There  are  usually   reports   by
family  members  and  friends  of  complicated  social  
behavior   during amnesic  spells,  such  as  the  taking  of 
long  trips,  renting   motel rooms,  making  dates  and 
entering  into  illegal  or            immoral activities  with
other  individuals.         The  hearing   of   accusatory
voices  inside  the  head   may   be   admitted,   if   the  
patient   is questioned in a non-threatening fashion.

2.   Signs   may   include   an   incongruity   between   the   
atrocious history  which  is  obtained  and  the  calm,  
unweathered   facial   and bodily appearance  presented by the
patient.          Longitudinal    scars on  the  forearms  may 
be   present   from   repeated   self-mutilations. Rarely  is 
the  spontaneous  switching  of  personalities  seen   on   an
initial interview.      If  it  does  occur,  that  is,  of  
course,   the basic  clinical requirement for  the diagnosis.   
      The  patient,   in such a situation,  may  suddenly  act 
like  a  young  child,  or  becomes very  seductive   or  
violent.   Patients   with   multiplicity   usually have  a 
sensitive  spot  in  the  middle  of  the  forehead  which, 
when touched  by  the  therapist,  will  facilitate  the  
switching   from   a hostile to a helping alter-personality.


1.   The  MMPI  and  the  CPI  (when  interpreted  by  the  
Behaviordyne, Inc.  computer  program),  usually  will  show  a 
high   hysteria   score (over    55)  and    the  diagnosis    
of  dissociating        hysterical personality disorder as one
of the preferred diagnoses.

2.   Rorschach  test  findings,  per  Wagner's  criteria   (6), 
 may   be the  most  reliable  test   results,   regardless   of
  the   differences between  responses  of   the   different  
alter-personalities.   Wagners' five   guidelines   indicate  
that   a   goodly   number   of    movement responses must  be 
present,  at  least  two  of  the  movement  responses must  be 
qualitatively  diverse,   at   least   one   of   the   movement
responses  must  reflect  a  feeling  of  being  oppressed, 
there  should be  at  least three  color  precepts  and  at 
least  one  color   percept should be "positive" and another

3.   Neurophysiological  evaluations  at  NIMH  have   so   far 
 shown definite  differences  between  patients  and  normal  
subjects,   but variations between patients  are  too  great  to
 allow  any  one  test to  be a  reliable indicator  of the
diagnosis      (Putnam,   personal communication,  1982). 
Specifically,  "the  visual  evoked   potential component   
differences  among  the  alternate     personalities    of
individuals  with  Multiple  Personality  Disorder  are  
significantly greater than  among  the  simulated  alternate    
 personalities    of normal controls.      This  was noteworthy 
on the   evoked    potential component,    P-100,    previously 
  associated    with     individual differences    in 
personality.      obsessive-compulsive     alternate
personalties  of  individuals  with  MPD  show   the   same  
amplitude differences that obsessive-compulsive patients do."


     In non-forensic cases,  hypnosis  is  usually  needed  to 
confirm or  deny  the  diagnosis  when  there  is  a  suspicious
 history.  But the hypnotic examiner  must  be  completely  open
 minded  and  looking only  for  the  true  explanations  for 
the   patient's   amnesia   or strange behavior.      The
examiner must not  suggest  that  some  other entity might  be
responsible.       A  recent  amnesic   episode   about which
the patient is  anxious  can  be  an  excellent  place  to 
start the exploration  for the truth.       Recall of  the  time
 just  before that episode, with  recitation  of  events 
leading  into  the  amnesic period and a reliving  of  the 
feelings  occurring  at  the  start  of the episode, can be a 
powerful  trigger  for  activating  the  already existing 
alter-personality     which  was  responsible      for   that
particular episode.  In  California,  as  of  April  1982, 
hypnosis  is forbidden  in  forensic  cases,  since  any 
witness   who   has   been hypnotized  during  the 
investigation  of  the  crime  will         be considered to be 
subsequently giving "tainted"  testimony.          Any approach 
to  a  criminal  defendant  who  is  suspected  of  being   a
multiple will have to be  in  a  manner  which  avoids  the 
appearance of inducing hypnosis.

     If the patient reports  an  internal  voice  talking  to 
him/her, the examiner may ask the patient  to  talk  out  loud 
to  that  voice, while in a  light, self-induced trance.      
The   instructions   might include, "Go back to  just  behind 
your  eyeballs,  so  that  you  two occupy the same space.  Then
talk  to  the  source  of  that  voice  out loud  so  that  I 
will  know  what  you  are  saying."  Sometimes  the; examiner
will  get  exactly  what  is  asked  for,  but  sometimes  the
alter-personality will  come  out  to  object  to  the  examiner
doing anything  at  all,  giving  the  examiner  an   excellent
chance   to interview the alter-personality.


1.   Play Acting  or  Conscious  Simulation:  This  would  be 
unlikely: in  a  non-legal  case  but  exposure  to  a   genuine
multiple   and questions by a patient as to whether or not the
therapist  thought the  patient  was  a  multiple  would  be 
suspicious  signs  in  a questionable  case.  Genuine  multiples
strongly  deny  that  they might have such  a  disorder  and 
would  rather  have  an  organic disease  to  explain  their 
symptoms.     Yet,  some   actors   and actresses may be
dissociating in the course of  playing  historical roles  or 
character  parts, but  they  have  no  amnesia.       The
distinction may be unclear  between  the  disease  of 
multiplicity and the mental state of the over-involved character
actor,  except for the absence of amnesia and the  ego 
syntonic  reason  for  the personality changes.

2.  Unconscious Simulation:    Just as anyone  with  the  need 
and histrionic character traits can unconsciously  mimic  any 
physical symptom, as in a conversion disorder, so can a 
histrionic  patient mimic a multiple, if previously exposed to a
genuine  multiple,  as might occur  in a psychiatric  hospital
setting.    The   difference would  be  in  the  lack  of  a 
history  of  amnesias  or   sudden personality changes and  the 
lack  of  symptoms  meeting  specific psychological needs, such
as the management of  anger.  The  course of the illness  would 
differ  in  that  "fusion"  of  the  "alter-personalties"  would
occur  only  when  the  secondary   gain   is accomplished, not
with effective psychotherapy.

3.  Dissociation After Arrest:    In legal cases,  some  degree 
of dissociation  may  be  suspected  during  a  crime  spree  
by   an otherwise non-criminally oriented defendant because  the
 defendant seemed to be playing two roles for  a  period  of 
time.  One  role might be the good worker and family man during 
the  day,  and  the other role would be the fiendish, sadistic
rapist  at  night.  Upon arrest,  the  defendant  would  claim 
at  least  some  degree   of amnesia, such as the lack of
recognition of some  of  the  victims. Yet  there  was  no 
witnessed   history  of  amnesic   spells   or personality
changes in childhood or early  adulthood.  Upon  arrest and  the
sudden  confrontation  with    such   revolting   illegal
activity, the defendant may, with any suggestion at all,  create
a psychic entity which accepts responsibility for  the  crimes,
uses another name, ridicules the defendant and is  the  very 
embodiment of evil itself.  Yet there is no solid  evidence 
that  this  entity existed prior to the arrest, and it never
appears  in  jail  after sentencing,  if  at  all.    The 
psychiatric  examiner  may   quite naturally assume that this
evil entity  did  indeed  exist  at  the time of the crime
spree, yet it may have only been a  part  of  the defendant's
mental apparatus when  the  crimes  occurred,  only  to split
off under hypnosis when the psychiatrists were called  in  by
the defense attorney.  At that point, the defendant, who  may 
have had retrograde amnesia for his ego dystonic  crimes, 
unconsciously allows this evil portion of his mind to
crystallize into  an  entity which confesses for him.  When he
is  confronted  with  this  entity on  videotape,  he  is  able 
to  let  'him'  take  the   emotional responsibility for the
crimes and provide him with  the  basis  for an insanity plea,
which is  rarely  successful.  After  conviction, this entity
disappears, never  to  be  seen  in  prison,  without  the
benefit of formal psychotherapy.

4.   Spirit or Demonic  Possession:  In  most  of  the  world 
outside of the USA, spirit possession is  considered  a  reality
 and  a  more likely  explanation  for  the  presence  of 
alter-personalities  than is any psychological diagnosis.  In 
the  USA,  public  opinion  polls indicate that 40% of  the 
population  believe  in  spirit  possession and 5% believe that
they, themselves,  have  been  possessed  at  some time in the
past.  Sixty  percent  do  not  believe  in  possession  as a
reality.     Therefore,  if  the  examiner,  who  most  likely 
sides with the majority, finds entities  who  claim  to  be 
demonic,  under the  control  of  archdemons,  and  with  no 
point  of  psychological origin,  he/she  has  a  real  problem 
 in   making   a   psychiatric diagnosis.      One  option  is 
to  call  this   state   an   Atypical Dissociative Disorder 
called The Possession Syndrome.        This  can be  defined  as
 a  state  of  mind  in  which  the  patient  has   no conscious
 belief  in  possession  (which  would   be   considered   a
delusion  by  the  skeptical  majority),  but  shows  evidence 
of  an unconscious  belief  in  being  possessed  by  entities 
from a supernatural source.  The  patient's  behavior  is 
determined  by  the form these beliefs  take in  his/her mind.  
    Since  it  is   highly unlikely that any two persons  will 
agree  as  to  just  what  it  is like to be possessed, there is
no typical clinical picture.         The only  common  thread 
is  the  belief  in  being  possessed  by   evil entities  which
come  from outside.       It  would  be  expected  that cultural
stereotypes will be used  in  creating  the  details  of  the
experience of being possessed.


1.   The Goal:    The long  term  goal  of  treatment  is 
personality integration  so  that  only  one personality  
inhabits   the   body thereafter.     This goal is  supported 
by  the  view  that  what  has actually happened is  personality
splitting  or  disintegration,  not the creation of truly
separate entities  who  need  to  be  taught  to share time in
the body.  If  the  therapist's  goal  is  that  teaching time 
sharing  is  best,  this     indicates  an   ill   trained   and
unimaginative therapist.  A  comparison  to  surgery  is 
appropriate. The  therapist  should  do  all  he/she  can,  
with   the   patient's assistance, to  put  the  pieces  all 
back  together  again.  If  the therapist  cannot,  only  then 
should  he/she  help  the  patient  to learn to live  with  the 
condition.  But  the  therapist  should  try all he/she can to
cure the basic  defect  first,  and  the  defect  is in the lack
of unity within the  mind.  The  basic  method  for  doing that
is to have  the  patient  recall  to  consciousness  all  of 
the traumatic situations  which have led  to the dissociations. 
       The presently  active  primary  personality  must  become
aware  of   the feelings  generated  by  those  traumatic 
events  and   must   accept those feelings  as  naturally 
occurring  and  his/her  own.  With  the help  of  the 
therapist  and  the  inner  Self  Helper,   the primary
personality  must  replace  hostile  feelings      with  
neutral   or positive ones,  thus  eliminating  the  need  for 
an  alter-personality to  act  out  in  a  destructive  fashion.
Each   patient    will demonstrate a unique style for
accomplishing this goal.

2.   The     Plan;  Personality  integration  appears   to  
follow   the following steps.     They   are   not   necessarily
 sequential,    but usually overlapping.  Details can be found
in my article (7).

a.   Recognition  of  the  existence   of   the   alter  
personalities:     The  patient  must  be  fed  back  all  of 
the  data   which   the     therapist   receives   which   
indicates  who   the    alter-     personalities are, what they
do and why they exist.

b.   Intellectual   acceptance   of   having   multiple  
personalities:     The  patient  comes  to  accept,  on  a 
superficial   basis,   the     truth of  what  the  therapist 
is  showing  and  telling  him/her,     even  though  he/she 
does  not  really  believe  the   information     deep  down. 
This  allows  the  psychotherapy  to  begin,   usually    
utilizing  age   regression   under   hypnosis,   with  
sequential     review of the  causes  of  the  creation  of  the
negative  alter-personalities.

c.   Coordination  of alter-personalities:     The   therapist  
must     assign  duties, if necessary,  to helper    
alter-personalities     in  such  areas  as  suicide 
prevention,  child  care,  work   and     marriage,   so  that 
all    life   sustaining   functions    are     maintained while
therapy proceeds.

d.   Emotional  acceptance  of  being  multiple:  This  comes 
about  as     the result of some  incident  which  no  one 
could  have  possibly     staged  for  the  patient's  benefit, 
an  event  which   convinces     the patient  of  the  accuracy 
of  what  the  therapist  has  been     trying to get across for
some time.     This  marks  the  turning     point  from  the 
patient  grudgingly  cooperating   in   treatment     to a whole
hearted  commitment  to  becoming  one,  no  matter  the    

e.   Elimination of  persecutor alter-personalities:    The 
alter-     personalities  which   are   activated  by   
hostility    and     aggressive  sexuality  are  the  most 
dangerous   ones   and,     therefore,  should  be  first  on 
the  therapist's  list   for     neutralization.  After 
psychotherapy  reveals  their  origins,     various imagery
methods can be  used  to  either  reform  such     entities into
helpers or to eliminate them entirely  from  the     patient's 
psychic  structure.     For each  persecutor  alter-    
personality,  there  may  be  one  rescuer  alter-personality,  
which will then have  nothing  to  do  and  will  disintegrate
from disuse atrophy.

f.   Psychological  fusion:   When all  of  the  persecutor 
alter-personalities have been  neutralized,  all  of  the 
resultant     fragments will come together automatically.     In
the case  of a   patient  with    over  10   personalities,  clusters      of
personalities may fuse prior  to  the  grand  integration, 
thus     removing the casualties from the scene  of  battle.  As
two  or     more alter-personalties  become  more  alike  In 
function  and     attitudes,  they  may  fuse  spontaneously.   
These    partial     fusions  will  leave  those 
un-neutralized  alter-personalities  to the attention of the
therapist,  so  that  he/she  need  only     focus on those
still active.

g.   Spiritual fusion:  When  all  of  the  alter-personalities 
have     blended together, in whatever  way  the  patient  may 
do  this,     the primary personality, or a  new  version 
thereof,  will  co-exist with  the  Inner  Self  Helper,  who 
will  then  function     primarily as a mental  teacher.  In 
the  months  following  the     psychological fusion, the ISH
will  be  teaching  principles  of     healthy  living  to the 
primary personality.      When  all   of     these lessons have
been  learned,  and  there  is  no  essential     difference
between the two  in  thought  patterns,  they  become     one,
in a quiet spontaneous process.

h.   Post-fusion  experiences:  After  fusion,  the  patient 
usually     feels  that  he/she will  never  again have 
problems.        The     reality  is  that  the  problems  the 
patient  now  faces   are     modern versions of those the
patient,  as  a  child,  mishandled     by creating 
alter-personalities.      Now  the  patient  has   a     second
chance to use  newly  learned  coping  skill  in  dealing    
with  those  old problems.      Another  major   experience  
the     patient  may  have  is  the  experiencing  of  normal 
emotional     reactions to making good  decisions  regarding 
major  problems.     Patients usually believe that they  will 
always  feel  good  if     they have make  the  right  choice 
in  a  difficult  situation.     But now the  patient  feels 
miserable  after  having  made  the     correct decision,  since
the  previous  ambivalence  could  not     be maintained.  The 
patient  may  be  surprised  to  learn  that     to gain
something, one may have to lose something else.        In    
the process of this loss, pain is felt.


     Multiplicity is not  a  self-limited  disease.  once 
initiated, an alter-personality can well continue to exist  into
 old  age,  and several patients over 50 years  of  age  have 
been  treated  by  the writer.  In the process,  they  can  well
 exhaust  parents,  spouses, children, employers, friends,
physicians  and  anyone  else  who  has ever cared for them. 
Suicidal acting out  may  be  viewed  by  others as only an
attention getting device, but,  for  the  patient,  he/she often
wants to die.  Survival is  possible  because  of  the  inherent
ambivalence  manifested    by  the  rescuer     
alter-personalities. Children  can  be  abused,  mentally  and 
physically  by  an  alter-personality who does not consider
herself to be  the  mother  of  the children.    Individuals 
who  really  do  physical  harm   to   these patients  may,  if 
not  natural  parents,  be  victims  of   serious 
physical  assault  or  even  murder  by   an   alter-personality
who believes it is  protecting the patient from death.      
About  80%  of the marriages  of  multiples  in  treatment 
ended  In  divorce  after the patient improved,  since  the 
spouse  was  now  sicker  than  the patient,  and  no  recovered
patient  wants  to  stay  married  to  a disturbed mate.

     In my series,  there were many suicide attempts but only   
one successful  suicide,  that one  being  due  to desertion of
the patient's  husband    after  she  had  left    
therapy,  which   was incomplete.     One  other patient  was
declared  a suicide  by    the coroner,  after  fusion,     but 
all  evidence    pointed  to    the possibility  that  the 
patient  was  accidentally  killed  trying  to settle a fight
between two men in  the  house.  one  patient  died  of unknown
caused, with no clarification at autopsy.

     A number  of  patients  were  involved  in  homicidal 
acts.  One patient reported killing her stepfather  and  his 
two  friends  after they had  tried to kill her.      One male 
multiple  killed  his  wife with no more reason than that she 
nagged  him  one  time  too  often. One male killed a lone woman
after  raping  her  and  then  killed  a man after they had had
homosexual activity together.

     After  treatment,  which  varied  in  length  from  one 
week  to three years, averaging 18 months, most  of  the 
patients  moved  from the location of treatment, where they 
were  too  well  known  to  the helping  agencies,  to  other 
towns  where  they  were   not   known. There  they  have  faded
Into  anonymity,  leading  quiet  and   very average lives.


1.    American  Psychiatric  Association,   Diagnostic   and  
Statistical      Manual  of  Mental  Disorder,   Third  
Edition,   Washington,   DC,      APA, 1980
2.    Tupin,  J.  Psychiatric   Grand   Rounds,   UC   Davis  
School   of      Medicine, Sacramento, CA, Jan. 1981
3.    Kampman,    R.  Hypnotically   induced   multiple  
personality:    An      experimental  study.   International  
Journal   of   Clinical   and      Experimental  Hypnosis, 1976,
24, 215-227
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