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MAYBE MULTIPLES IN COURTS AND CORRECTIONS
                   by
          Ralph B. Allison,M.D.
         California Mens Colony
       San Luis Obispo, California
Presented at the Meeting of the            
American Academy                   
of         
Psychiatry and the Law                   
in         
Ottawa, Ontario, Canada           
October 15-18, 1987                    

Experience Outside Prison       

I
	For 16 years, I practiced psychotherapy in a private practice
setting and in county mental health clinics in California, while
doing forensic evaluations for courts and attorneys.  In 1972, I
met my first patient with Multiple Personality Disorder (MPD). 
This led to a decade of  teaching, writing and consulting on
that subject.  During that decade,  I conducted forensic
evaluations of 13 men and women in whom there was a possibility
that they were multiple.  Of that group 69% (N=9) went to
prison, 15% (N=2) were found not guilty of the crimes charged,
8% (N=l) were found not guilty by reason of insanity (NGI) and
sent to a state hospital and 8% (N=1) were put on probation.    

	I was able to follow the courses of three of the men who went
to prison The insane one was followed for 2 years, when he
returned to the community, subsequently becoming a subject for
the "60 Minutes" program with Mike Wallace.       

	Naturally, the primary concerns in evaluating these defendants
prior to trial has been to determine the answers to the
following questions:       

	1.  Did they have a mental illness at all, or were they
malingering?       

	2.  Was the mental illness MPD or something else, such as
schizophrenia?

	3.  Was the mental illness related to the criminal offense so
that an insanity plea could be logicallv supported?        

	4.  If I thought the defendant had MPD, how could I demonstrate
the data supporting this opinion to the judge  and jury so they
would understand the reasons behind my opinion?        

	In the majority of these cases, opinions and  feelings about
amenability to treatment were set aside, since  ultimate
disposition would be up to the judge and jury.  In  the  only 
case where the defendant was found NGI and sent to a state 
hospital, two of us psychiatrists went to the hospital, oriented
and educated the treatment staff on what needed to be done and
conducted periodic re-examination of the patient until he  was
released as integrated and no longer dangerous.  We felt  he 
was eminently treatable, but not by the usual means used at the
hospital for their most commonly admitted patients.             

II                    

Experience Inside Prison        

	For the past six years, I have been treating  patients  in a
medium security prison in Central California which  is  assigned
the responsibility for housing most of the State's inmates who
have a documented history of major mental illnesses but who  are
able to function as outpatients.  My case load has been
approximately 400 inmates, whom I saw in 10 sick calls a week.  

	When I came to work behind bars, I had seen a number  of
multiples, 85% of them women and 15% men.  Among  those  seen 
only for court actions, the ratio was reversed.  Therefore, I
expected to be able to find quite a few male multiples in the
prison.  I also hoped to find out what could be done with them
after my forensic colleagues had finished their work and the
juries had found them sane and guilty.  Such has not been the
case.        

	Since I do not have statistical information regarding those
patients I have seen in prison whom may have been dissociators
or multiples, I can only  give you my rough impressions.  Very
few of those with solid histories of dissociation had entered
pleas of NGI, so psychiatric evaluations were non-existent prior
to conviction.  They had amnesia for the crimes but were clearly
responsible for the charged deed.  They were so shocked at what
they had done, they pled guilty and offered no excuses.  It was
only when I saw them at routine intake interview in prison that
the story came out which could support a long standing history
of MPD.  They were not trying to escape punishment, but they
certainly wanted to know why they did the deed charged, so they
would never do it again.  only one inmate admitted that he
totally fabricated a story of MPD on the advice of his attorney.
 Obviously, no one bought it.        

	While I was in private practice, I treated a male multiple who
had spend most of the prior 20 years in one prison or another. 
While there, he kept waking up in the prison hospital after
being in fights for which he had no memory.  He knew he had done
wrong and that he had some sort of serious mental disorder. 
When I asked him why he had never asked for psychiatric
treatment, he said, "Doc, in prison there are two kinds of
psychiatrists.  The good ones are too busy with paperwork to
treat patients.  I wouldn't waste my time  with  the others." 
With this comment in mind, I attempted to keep the paperwork
under control while I spent the majority of my time seeing
patients.        

	As a result of the marked limitations inherent within  the
system, I have only been able to treat one male multiple in  the
standard fashion.  He was convicted of bank robbery committed by
his alter-personality, which he had created in the image of  his
father, a Mafia Don in Chicago.  He had vowed never to be like
his father, so he became a Casper Milquetoast with hoodlum 
alterpersonalities.  Therapy consisted of teaching him to be
more assertive in everyday life, so his alter-personalities
didn't have reason to come out and avenge him after someone
walked  all over him and his rights.  This approach worked well,
and he paroled in an assertive but not aggressive state of mind
without any longer suffering blackouts during which he
intimidated others.        

	Another inmate I saw was one whom I had examined 10  years
before for an arson charge.  He then spent two years in
California Youth Authority, and subsequently committed two
murders while intoxicated on alcohol and drugs.  I had seen 
what appeared to be an evil alter-personality during his days on
parole, but he would not let me testify at his trial because  of

the fear I would reveal that he was also a voyeur.  That would
have embarrassed him too much! He went to Death Row where  he 
had a psychotic break.  His term was commuted to life, and I saw
him when he came to my prison on a routine transfer.  I went 
over  his history with him trying to understand what I had seen
10  years before.  He saw himself Primarily as an alcoholic.  He
 had  not dissociated in prison, although he may have done so
while in  CYA. He left our prison after trying to escape and
then putting out a contract on the life of the inmate who had
snitched on  him.  At that point, the best diagnosis was
Borderline Personality Disorder.        		Another inmate was
seen two years after conviction  of murder so I could write "the
rest of the story." At the  trial  he showed a very evil
alter-personality who had killed his  stepdaughter.  I wanted to
find out if I had been led astray  or  if the same entities were
still present in the prison  environment. We spent the visit in
a wire cage in the visiting room at  San Quentin.  With the
exception of one entity, a  highly  religious one, all of those
I had met in the county jail during the  trial were still there.
 The "Nice Guy" who would't hurt a  flea  was clearly the
favorite of the guards, who greeted him warmly  when he came to
the visiting area.  The "Killer" was still  involved  in all the
prison games such as drug smugglinq and gambling, as  he had
been on the outside.  The "Tattletale" who had informed  me  of
the gory details of the murder was working with his public
defender on his appeal of the death sentence.  Each entity had a
necessary role to play in his prison life.  Any  psychotherapy
would have seemed to be contrary to his own best interest in 
that environment.                                 

III           

Institutional Interferences with Treatment        

	When I started working in prison, I was encouraged  to  see
some inmates for traditional psychotherapy in individual  hourly
sessions one to four times a month.  The next year, the
Department of Corrections instituted a Work Incentive Program
which paid inmates in work or school assignments with 
day-for-day credit on their terms.  Work supervisors were
literally threatened with prison themselves it they let inmates
leave  the work site to get medical attention.  This forced
doctors into working evening so inmates could be seen after
leaving the  shoe factory and before the evening lock up time. 
For  some  workers, that meant 40 minutes was available for all
sick call.  This effectively wiped out a large part of our
organized  psychotherapy program and it has not yet recovered. 
It did totally block my ability to schedule patients when I was
mentally fresh enough to deal with them.         

	At that time, I was transferred to a quad where the population
is made of up mostly chronic patients with major mental
illnesses.  Some inmates came through with histories highly
suggestive of MPD, but I was too busy with triage of  acute and
chronic psychotics to follow up on their  cases.  Fortunately. I
usually had one or two second year psycholoqy interns  working
with me, and I could refer these "teaching cases" to them for
evaluation and treatment.  But that is not the some as  working 
up .a problem patient by myself.

	Another problem is that violent behavior by an  inmate beyond a
certain point administratively leads to his transfer to an
institution with a higher security level and out of
psychotherapy of any kind.  Also, for a doctor to talk  to  any
inmate in a total lockup situation awaiting such a transfer
requires the presence of two correctional officers wearing body
armor.  They have many things to do besides stand there and
listen to the doctor talk to the inmate, so the doctor does not
feel free to spend an hour at the door of the patient's  cell.
Likewise, the custody staff are not allowed to leave the
inmate/patient in the doctor's office without the same two
officers present in the room.  This can be inhibiting  for  both
the patient and doctor.        

	I saw one young inmate, who clearly manifested 
alterpersonalities, while he was in the Disciplinary Detention 
Unit (DDU) because he had stomped on the head of another inmate.
 No matter what I might do therapeutically to calm down the
personality who did the stomping, that behavior was all the
Warden needed to send him to a higher security prison.  He  did
go, and there the psychiatrist deemed him perfectly normal,  in
spite of my exhaustive workup.  He was sent to a general
population prison, where he did well because his most antisocial
personality was in charge most of the time.  On parole, he
played football for his junior college.  But his football player
personality became irate when the coach would not let him play
in games where big league scouts were known to be in 
attendance.  The coach had good reason, since, in practice,
another personality who didn't know the Plays often took over. 
He stormed out of the coach's office in anger, blacked out,
leaving an antisocial personality in charge.  This personality
robbed five banks before being caught.  The capture occurred
because  a new personality came out while leaving the last bank
and didn't know why he was carrying money bags down the street
being chased by shooting officers.  He hid under a car instead
of running  to the getaway vehicle.       

	At his arraignment in Federal Court, an attention  getting
personality came out, dropped his pants, urinated on the floor
of the courtroom, barked like a dog and meowed like a cat.  The
judge wisely suggested to the defense attorney that his client
might have a mental problem.  The attorney asked him if he had
ever been treated by a psychiatrist and he give my name.  I  was
appointed to examine him for the court in Federal prison, which
I did, finding much the same clinical picture as I had found in
State Prison.  He was found sane and guilty and sentenced to
Federal Prison for 12 years.  A psychology intern there called 
me to report that he created chaos there and was sent to the
Federal Prison Hospital but was sent him back as a malingerer. 
By  this time the inmate was giving the story that he had
studied drama in college and thus had learned how to play all
these Parts.  You can see how such an inmate can tie up many
parts of the criminal justice system.  We have much more to hear
from this young man,  I am sure, when he paroles the next time. 

IV                  

A New Breed of Dissociators?        

	After dealing with a number of neurotic patients with  MPD who
did not go to prison, some who went to prison  for  non-lethal
felonies and those seen because of murder charges, I am coming 
to the conviction that the  neurotic  ones  may  commit  various
 and sundry crimes while acting out their internal conflicts,
but  they are highly unlikely to murder anyone.  The  only 
exception  might be when the victim has previously  tried  to 
kill  the  multiple. But the murderers I have seen who had a 
documented  and  reliable history of manifesting  some  type  of
 alter-personality  have  a number of unique factors not  seen 
in  the  neurotic,  non-killer multiples.        

	These  differences  are  not  included  in  the  DSM-III-R
definition  of  MPD,  which  does,  superficially,  describe  
the murderer accurately as well  as  the  neurotic  multiples  I
 have treated.  The definition is as follows: 

"1. The existence within  the  person  of  two  or  more 
distinct personalities or personality states (each with its own 
relatively enduring pattern of perceiving, relating to,  and 
thinking  about the environment and self). 

2. At least two  of  these  personalities  or  personality 
states recurrently take full control of the person's behavior." 

	These are the unique characteristics which  I  have  found in
murdering men who also met the above definition of MPD:

	1.  Origin  of  criminal  entity:  Whereas  angry  
alterpersonalities  most  frequently  develop  during  the 
course   of overwhelming  physical  and/or  emotional  abuse  by
 a   parental figure, a more frequent  story  in  the  murderers
 is  this:  The little boy is locked in the closet by a  hated 
boyfriend  of  his mother  while  the  boyfriend  is  sexually 
molesting  the  boy's sisters.  He can't do anything  to 
protect  his  sisters,  and  he asks in his head how he can kill
the boyfriend.  A  voice  answers, "I will help you." That voice
 is  the  first  appearance  of  the criminal entity.        

	2. Relationship between the primary  personality  and  the
criminal entity: Instead of  the  usual  massive  one-way 
amnesia between the two entities,  with  the  primary 
personality  having little or no direct awareness of the angry 
alter-personality,  as is usual in the neurotic multiples, in
the murderers there  is  an ongoing communicative relationship
between the  two  entities.  it might be a  teacher-student 
relationship  as  in  the  man  whose criminal entity spent many
hours teaching the primary  personality the principles of the
Cabalistic  religion  (whatever  that  might be), to the point
that the primary personality  listed  that  name in the
"Religion" box on his arrest and booking sheets.       

	3. First Psychiatric  Examination  for  Court:  When  first
examined for possibility of MPD, most  neurotic  patients  do 
not know how to  make  contact  with  the  negative 
alter-personality which may force its way  out  against  the 
will  of  the  primary personality sometime during the 
interview.  They  have  no  first hand knowledge of the
alter-personality and do not believe  anyone who tells them that
such a thing exists.  The  killers  have  been able to go inside
their  heads  and  easily  locate  the  criminal entity with no
trouble at all.  If I tell one, "I'd  like  to  meet the Joe you
told me about," he says, "Sure, I'll go get  him."  In a few
seconds, the face and body posture changes, and  Joe  is  in
charge, telling you whatever he  is  willing  to  divulge  of 
his criminal  career.  Such  facility  in   the  ability   to  
change personalities comes about in neurotic multiples only
after  months of hypnotherapy during which they get  practice 
at  locating  the alter-personalities  and  learning  how  to 
open  the   door   to consciousness.        		4. The Killer's
Victim:  I  have  had  only  one  neurotic multiple who may have
killed someone and that  was  unproven.  She remembered killing
her stepfather and his two friends  after  they had attempted to
kill her.  Bodies were never  found,  so  I  don't know if her
memory was truth or fantasy.  The killers I  have  seen for
trial killed persons who were  not  objects  of  revenge.  One
mentioned before killed his seven year old stepdaughter,  and 
one killed the driver of a car in which he had hitched  a  ride.
 Such senseless and irrational choices of victims make these 
defendants very unsympathetic to juries.        

	5.  Psychological  Testing  by  Rorschach:  There    is  a
pattern of responses to the  Rorschach  test  which  seems  to 
be typical of neurotic multiples, which has been described by 
Wagner & Heise(1974).  These killers do not  show  that  same 
pattern  of  response,  but  show  a  pattern  which  Wagner  
considers   more consistent with schizophrenia.        

	6.  Criminal  History   of  the   Antisocial  Entity:   In
neurotic multiples, there are  often  alter-personalities  who 
do isolated illegal acts, when the  primary  Personality  gets 
angry and loses control of the body.  But they don't  seem  to 
have  the ability to maintain a complex criminal lifestyle over
a long  span of  time.  But  in  the  killers,  there  has  been
 a  documented criminal history of the type that required 
recurrent  association with  the  criminal  subculture,  with 
gun  smuggling,   narcotic trafficking, arrests, court 
appearances,  jail  time,  etc.,  all managed  by  the  criminal
 entity.  These  acts  may  have   been completely hidden from
the Primary personality  who  is  convinced he has a clean
record.  These acts were not done to  embarrass  the primary
personality, when he wakes up in jail, as  is  the  common case
in neurotic  multiples.  The  criminal  entity  is  perfectly
willing to undergo the punishment of the criminal  justice 
system and not inflict it upon the passive primary personality. 

V                           

Conclusions

	With this paper I  have  tried  to  mention  some  of  the
important factors that seem to exist when a "maybe  multiple" 
man comes to prison.  I have covered the problems  of 
identifying  and working up such  patients  in  a  busy  prison 
practice  and  the institutional problems of giving minimal
treatment.  The  problems of  security  and  placement  in 
other  institutions   has   been mentioned.  Lastly, I have
tried  to  provide  a  thought  provoker for  those  of  you 
who  do  frequent  forensic  evaluations   of murderers.  There
may be a group of maybe  multiple  murderers  who have bona fide
histories of long standing  dissociation,  and  who may need to
be given a new cubbyhole in DSM IV due to  significant
differences in  the  clinical  and  dynamic  characteristics 
they demonstrate.
                                                         
REFERENCE

Wagner, E.E., & Heise, M.  A comparison  of Rorschach  records
of three multiple personalities.  Journal of  Personality
Assessment, 1974, 38, 308-331.







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