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About Dr. Allison

                     Ralph B. Allison, M.D.
                        Presented at the
                     Annual Meeting of the
                American Psychiatric Association
                        Atlanta, Georgia
                            May 1978
                      Revised August 1984
                  (c)1978 Ralph B. Allison,M.D.                            SUMMARY
     An outline is given for diagnosis and treatment of  multiple personality disorder (MPD)
based upon therapy of a  series of thirty patients diagnosed as having this disorder.    Diagnostic
criteria are elucidated in emotional, ideational,  physical and behavioral realms.  The use of
hypnosis in exposing  alter-personalities is described.  Usually there were found an  original
personality, persecutor personalities and helper  personalities.  Above all these was found the
Inner Self Helper  (ISH), who was the therapist's collaborator.  The etiology is  hypothesized as
due to a combination of factors, including the  inborn inability to learn from errors, unwillingness
to make  moral choices, high sensitivity to others' emotions and exposure  to a polarized family
structure.  The therapy plan presented  consists to recognition of alter-personalities, intellectual 
acceptance of having the disorder, coordination of      alter-personalities, emotional acceptance of
having the disorder,  neutralization of persecutors, psychological fusion and spiritual  fusion.

     The psychologically crippling disorder known as multiple  personality disorder (MPD) has
been of intermittent interest to  psychotherapists since 1815 when the case of Mary Reynolds was 
reported (Mitchell, 1815).  The disorder is characterized by the  "presence of one of more
alter-personalities, each presumably  possessing differing sets of values and behaviors from one 
another and from the "primary" personality, and each claiming  varying degrees of amnesia or
disinterest for one another"  (Ludwig, et al, 1972).  Statistically, the disorder is listed on  
Axis I as 300.14, Multiple Personality (DSMIII, 1980).  For  simplicity, I call the disease 
"multiplicity." Many now call it  MPD.  Those who suffer from it are "multiples." Patients with  
this syndrome have a severe histrionic personality disorder (Axis  II-301.50) with their preferred 
unconscious defense mechanisms  being repression, denial and dissociation.  They consistently  push out of
their awareness any unpleasant feelings and negative  attitudes.  The resultant collections of
psychic negativity in  their unconscious minds provide the nuclei for pathological 

     Because of the paucity of published reports, the MPD has  been considered to be quite
rare.  In my review of the available  case reports (Allison, 1974a), I found 96 patients described in
the English literature.  The most completely described was  Prince's Miss Beauchamp (1913). 
The most famous of the 1950's  was Eve (Thigpen & Cleckley, 1957), and Sybil (Schrieber, 1973) 
was the most noted from the 1970's.  Eve's personal version was  published (Sizemore & Pittillo,
1977) filling the gaps of the  first report.  The first male to write of his trials with  multiplicity was
Hawksworth (1977).

     In my opinion, this small number of reported cases is due  to for by several factors.  First,
since repression and denial  are such readily used defense mechanisms of these patients, they 
refuse to accept clear signs of multiplicity, even when such are  obvious   to friends and relatives. 
Second, to bypass this resistance, hypnosis is the most effective way to uncover an
alter-personality.  But since only 10% of American psychiatrists  are estimated to use hypnosis,
the other 90% are not going to  probe into the patient's unconscious mind this way, even when the
history is suggestive.  Third, determining frequency by published  reports is an inadequate way to
count cases, as most therapists  do not have the time and effort required to prepare their cases  for
professional journals.  Fourth, there is a personal  reluctance on the part of many therapists to
accept the existence  of multiple personalities in any patient, so another label may be  applied. 
According to one patient who had seen many  institutional psychiatrists, closed mindedness was
due to the  psychiatrists being too preoccupied with their own problems to  try to understand the
patients' difficulties.  Those who were open  minded  were  too  busy  with  institutional  duties  to   have enough time for  therapeutic 
     There are many MPD patients in treatment but unlisted, as I have known of therapists
with thirty  such  patients in treatment in one year.  One retired psychiatrist said he treated 20 to
30  such patients   in his career.  Another psychiatrist diagnosed 40 patients with multiple
personality in a three year span.  How  many others there are is a matter of conjecture.  How
many  undiagnosed multiples exist is, of course, quite unknown.
                        THE  DATA  BASE
     Between 1972 and 1976, thirty patients were seen by the  author in whom the diagnosis of
MPD was made.  Twenty-six were  female and four were male.  Twenty-eight were Caucasian
and two  were Mexican-American.  The average age was 29.4 years, with the  range from 18 to
51 years.  At the start of treatment, 46.7% were  married, 16.7% were single, 13.3% were
divorced and living alone,  13.3% were living with a boyfriend, and 10% were separated.  The 
reasons for seeking treatment were as follows:

     1)   Depression and/or suicide attempt  40.0% (12)
     2)   Found to be multiple elsewhere     23.3% (7)
     3)   Hysterical physical symptoms       10.0% (3)
     4)   Visual hallucinations              6.7% (2)
     5)   Court evaluation                   6.7% (2)
     6)   Sexual problem                     3.3% (1)
     7)   Alcoholism                         3.3% (1)
     8)   Wanted lithium                     3.3% (1)
     9)   Believed she was possessed         3.3% (1)

     The average length of time in treatment before this  diagnosis was made averaged 5.1
months, with a range of one day  to 30 months.  The average number of alter-personalities found 
was 9.7, with a range of one to 50+.  The age of creation of the  first alter-personality was
reported as follows:

          0-5 years 	 43.3%     (13)
          6-10 years     40.0%     (12)
          11-15 years    10.0%     (3)
          unknown   	  6.7% 	   (2)

     In 55.3% of cases, the original    personality sought  treatment.  In 36.7%, an
alter-personality   came for treatment.    In 10%, it was unknown who came.  Transsexual  
alter-personalities  were found in 26.7% of cases.  As of June,   1976, 50% had fused  their
personalities, 30% were not fused, and  the status of 20%  was unknown.  Social status was as
follows, following an average  length of treatment of 14.7 months:
     1)   Doing well, not in treatment, fused      20.0%    (9)
     2)   Still in treatment here, not fused 	   16.7%    (5)
     3)   Still in treatment here, fused           13.4%    (4)
     4)   In treatment elsewhere        			6.7% 	(2)
     5)   Dropped out of treatment, not fused       3.3%	(1)
     6)   In prison                					3.3% 	(1)
     7)   In methadone clinic           			3.3% 	(1)
     8)   In board and care home, not fused  		3.3% 	(1)
     9)   Died of gun shot wound to head     		3.3% 	(1)
     10)  Suicided                 					3.3% 	(1)
     11)  Unknown                  					3.3% 	(1)

     Since 85% of my patients have been females, in the  following discussion I will use the
feminine pronouns when  referring to the patient in the singular.  Only when I refer to  something
unique to males will I use the male pronoun.

     `As a result of the continuously unfolding experience, I  was able to try different forms of
therapy on successive patients  and eventually evolved a plan of treatment which seems generally 
applicable, at least as far as the basic principles are  concerned.  Naturally, the disorder runs a
spectrum from mild to  severe, and not all the procedures described may be needed in the  mild or
moderate cases.

     Also, the timing of the necessity for certain procedures  will vary and is different for every
patient.  Still, there is a  general flow of events which becomes inevitable for personality  fusion to
occur and become permanent, and it is that flow a  therapist must keep in mind.

                      MAKING THE DIAGNOSIS

     The first step in proper treatment is making the correct diagnosis.  These patients
commonly have been through numerous  institutions and various therapists with no constructive
changes  being made in their basic psychopathology.  The foundation for  the diagnosis is an
accurate history.  Common complaints are  periods of amnesia, auditory hallucinations, fast mood
swings,  suicide attempts, severe headaches, difficulties in impulse  control and stormy marriages. 
Many are ashamed to tell of  periods of amnesia and may forget they forgot.  Some will  attribute
it to drinking bouts, but, when pressed, will admit to  lapses of memory during times of sobriety,
usually after getting  angry.

     Most will not volunteer a history of auditory  hallucinations since they know that would
brand them as "crazy,"  and they fear being locked up.  Therefore, a very casual type of 
questioning about hallucinations is needed.  Voices may be hostile or helpful or both, alternately. 
The hostile one may  tell the patient very derogatory things and urge suicide or
homicide.  A helpful voice will reassure and guide the patient in  a constructive direction.  A
helpful voice must receive the  therapist's special notice, and the patient must be encouraged to 
do what the helper inside advises.

     A history of mood swings from suicidal depression to  happily bar hopping can be
misinterpreted as a manic depressive  pattern.  However, 48 hours is the minimum time for a true
manic  depressive illness to cycle, and a multiple can switch every few  minutes, as each
personality emerges.  The patient may be quite  conscious of the shifts from glad to sad or may
black out while  getting angry and wake up feeling hung over from a drunk and very  depressed. 
The main feature to note is the patient's feeling of  lack of control over the shifts.  In contrast to a
manic  depressive whose shifts occur without an outside stimulus, there  is usually a situation
which triggers the change in a multiple  even though the multiple has repressed memory of this

     As a result of the depressive periods, suicide attempts  occur in situations where    desire
for death is absent.  It is very  easy for the therapist to brush off these attempts as attention 
getting devices, which they are, but these patients are, at  times, really suicidal if their vital
emotional supports have  been removed.  They     may show self mutilative acts, such as  slashing
their forearms with a knife, which is really not  suicidal.  This may be a persecutor personality
punishing the  main personality for being such a weakling.  The period of  cutting is blocked out
by amnesia, a very good clue.  Several of  my patients were easily diagnosed when they arrived at
the  emergency room with such slashed arms and amnesia for the event.    They were eager to find
out why and willingly underwent hypnotic  interviews in which they clearly described the
alter-personalities who were responsible for the slashing.  This  problem had to be resolved before
they could leave the hospital,  and they then began effective therapy for the first time in their 

     A number of patients suffered from severe "migraine"  headaches and were hospitalized
repeatedly for neurological  evaluations and treatment.  One patient had an elevated spinal  fluid
pressure, so was diagnosed as having pseudotumor cerebri.    It was later determined that the
headaches were caused by the  persecutor personality using this way of punishing the weak 
primary personality, the usual cause of severe headaches in these  patients.

     When parents of these patients are questioned, they  report difficulties since birth with
impulse control.  These  patients, as children, have struck out at siblings, become  unreasonably
jealous, exhibit temper tantrums and destroy  property, all for what seem to be minor irritations. 
At school,  they trigger fights, then cry at being rejected by schoolmates.
They seem to have an unlimited capacity for hatred, yet relatives  outside of the nuclear family
may be extremely loving and  protective of them.  They gain friends easily with their charm,  but
lose them with escapades that make friends desert for self-protection.

     The marital histories are usually full of failure and  conflict, in the case of women.  The
men were too unstable to  enter into marriage, with two exceptions, and one of those  marriages
lasted only three months.  The women ran away from  miserable homes as teenagers and married
the first men who asked  them.  With their low self esteem they preferred men who were  equally
disreputable, so marriage to ex-convicts, sexual  perverts, habitually unfaithful men, sadists,
religious fanatics  and fatherly types who needed child brides seemed to be the order  of the day.

     Relatives or close friends may tell the therapist about  sharp changes of personality, even
to the degree of claiming to  have another name.  Some relatives will refer to the movie "The 
Three Faces of Eve" as the source of comparison and be quite  correct.  However, the therapist    
must be careful that this  description is not being applied to social role playing and must  insist
that the diagnosis only be made officially when the  switching has been seen in person.

     The basic criteria for making the diagnosis of MPD is the  clinical presence of two or more
personalities alternating  control of one physical body.  Only when therapists have seen a  shift of
personality can they make this diagnosis with assurance.    If the patient is seen in a highly volatile
state in an emergency  situation, the switching may be easily observed as the facial  expression,
voice and posture all change spontaneously, often in  the middle of a sentence.  If the patient is in
a calm state, a  hypnotic induction for any reason may allow an alter-personality  to come out,
even if not requested.  This other personality will  often claim to have her own name, a very
specific purpose to  perform for the primary personality, knowledge of activities  during amnesic
spells, and knowledge of the incident which  brought it into existence originally.  If the patient has
not  been exposed to other multiples, such as on a small hospital  ward, these alter-personalities
can be taken as genuine and not  play acting.  However, if the patient has seen another active 
multiple switch personalities, great caution must be taken in  assuming that these mental creations
are anything more than an  attempt to get as much attention as the multiple patient she  observed. 
This situation requires continued observation and  consultation with careful comparison to
patients known to have  genuine MPD.  If the patient is currently being charged with a  crime, it
would be almost impossible to be certain that the  phenomena is genuine, since the patient might
very well be  willing to fake such behavior to be declared not guilty by reason  of insanity.
     Some patients were referred by local physicians or  psychologists who used hypnosis for
weight control, smoking and  sexual problems.  Another patient manifested alter-personalities 
after her boyfriend hypnotized her for fun at home.  Other  patients, whose alter-personalities
were in balance for years,  became worse, bringing them to treatment.  I consider hypnosis  the
method by which one can open the Pandora's box in which the  personalities   already reside.  I do
not believe that such  hypnotic procedures create the personalities any more than the  radiologist
creates a lung cancer when he takes the first x-rays  of the chest.  A type of alter-personality can
be created by  instruction under hypnosis in normal persons as shown by Kampman  (1976).  But
in the type of hypnotic approach used to get  information about unconscious processes, or to
implant corrective  ideas regarding sexuality, there is no stimulus to push a patient  to make a new
personality.  Besides, that is not the way  personalities are created.  It is much more complex than
just  responding to a non-specific hypnotic induction.  The  personalities then shown have existed
for years, and hypnosis  loosens the controls the patient has on them, except at times of  extreme
stress.  These are the same personalities who have been  coming out for years to cause the
problems the patient came  complaining of in the first place.  Also, a newly       formed 
personality takes time to grow and develop.  It cannot come out  with any intelligence within
seconds of its creation by the  patient.  It must mature and grow inside the mind for days or 
weeks before it is able to act as an independent entity.

     Most patients have come to treatment for depression and  suicide attempts, and there is no
suspicion in their minds that  multiplicity is involved.  These can take months to diagnose 
properly because there is no logical reason early in treatment to  use hypnosis, and the patient,
being a good actress, puts on a  pleasant in the office, while living a chaotic life outside.    Finally,
the patient becomes trusting enough to report amnesic  spells in which she does weird things, or
she tells the therapist  she is sure there is another one inside doing the dirty work.    Then she is
willing to cooperate in a hypnotic interview in which  the personality emerges and exposes the
secret to the therapist.

     When the suspicion of MPD exists, an excellent physical   test is to touch a forefinger to
the patient's forehead between  the eyebrows.  In multiples, a  change comes about in their mood 
and emotional control.  Either  the patient calms down from an excited state, or, if calm, may
react violently with shrieks and  visual imagery.  This was first described in Sweden by
Odencrants  (1968), and it has proven to be a useful diagnostic tool.  The  patients are very aware
of this sensitive spot on their forehead  and avoid wearing bangs which could touch it.  If a hostile 
personality is out, the fastest way to bring the primary  personality into control is to touch that
spot and call for the  other personality to regain control.  There have been times when I have pushed 
on the patient's forehead so hard that I drove the  negative alter-personality back into the recesses 
of the mind so  far it was three or four months before it could come out again.

     Because of the inconsistent clinical picture, the usual  psychological test battery has not, in
my experience, been useful  in making a diagnosis of MPD prior to overt exposure of an
alter-personality.  When the history is suspicious, my favorite test is  the California Psychological
Inventory   (CPI)    as computer  interpreted by Behaviordyne, Inc. of Palo Alto, California.   
Since about half the questions are identical with those on the  Minnesota Multiphasic Personality
Inventory (MMPI), the computer  readout includes a section on "Hysterical Personality Features" 
and an hysteria score derived from the MMPI.  A high degree of  hysteria on the readout, an
hysteria score over 55, and the  diagnosis of hysterical personality disorder (dissociating type),  in
one of the three top diagnostic choices would make a patient a  prime suspect for further
investigation of MPD.
                            TABLE  I
              Results of CPI at Onset of Treatment
Degree of Hysteria            Ave. Hyst. Score         No.       %

Extremely hysterical               60.7           		1         4    
Hysterical                         60.0           		14        56   
Rather hysterical             	   57.1           		2         8
Some signs of hysteria   		   54.0   		        28         
Few signs of hysteria              53.0      			5         20        
Not especially hysterical          51.7 				1         4    
Average Hysteria Score             57.7 
Range of Hysteria Scores           51.7 to 64.8

                   Preferred Diagnoses on CPI
         Diagnosis                      No.       %
Hysteria in some form                   9         36   
Alcoholic                         		6         24
Depressive                              4         16
Schizophrenic                           3         13   
Antisocial                              2          8
Obsessive compulsive                    1          4

     The results of the CPI  testing on 25 patients with  clinically evident multiple
personalities is shown in Table I.  Interestingly, 24% showed few or no signs of hysteria in the 
readout.  This is most likely due to a tendency to fake good on  the test and deny pathology. 
Twelve percent showed schizophrenia as the preferred diagnosis, probably due to the  high incidence 
of bizarre answers. 

Seventy-six percent were  either hysteric, depressed or alcoholic.  Considering the high incidence
of alcohol abuse and suicide attempts, that is not an  unreasonable combination of diagnoses.  The
hysteria scale is  elevated to 57.7 with a range of 51.7 to 64.8. This is a  deviation from the norm
of 50.0 to the 0.01 level of  significance.

     There is a serious problem in using any test, however,  since some time has to pass to take
it.  During that time, the  major influences on thinking may pass back and forth from one 
alter-personality to another, so the answer is a combination of  many different thought patterns
and can be thoroughly confusing.    Another problem is that the questions presume a life history
from  birth, with a mother and father, from childhood to adulthood.    Alter-personalities who
have not experienced large portions of  the growth process do not know how to answer questions
about how  they felt in the past.  All they know is how they think and feel  about current matters.

     There will be found basically two types of alter-personalities that are created by
dissociation resulting from  psychological trauma.  A negative, angry, persecutor personality, 
such as Johnny (Hawksworth & Schwarz, 1977), is the commonest  reason for the patient to
come for treatment.  As a counteraction, a rescuer personality will be created, possibly out of  a
friendly imaginary playmate from childhood.  There may be other  neutral personalities, such as a
"normal" child, one which  represents a fixation of emotional      development at a preadolescent

     A helper alter-personality may come forth in the natural  habitat and tell the therapist that
she is not the patient, as  happened with Eve (Thigpen & Cleckley, 1954) and Sybil  (Schreiber,
1973).  In my cases, they have preferred to call me  on the telephone or put their voices in
audiotape (Allison,  1974a).  These personalities can trace their existence back to  early childhood
or to recent traumatic incident.  All the alter-personalities will know the age at which they were
created and  why.  They will have a narrow psychological purpose to serve.    They have a limited
range of emotions to express and a narrow  band of activities they are interested in pursuing. 
They use  similar terminology, referring to the primary personality in the  third person.  They talk
of "coming out" to do their work.  They  are not patients of the therapist, and only talk to the
therapist  because they are doing "her," the patient, a favor.  Their facial  appearance,    posture,  
and speech patterns may be markedly  different from that of the primary personality but may be
very  similar to the primary personality if they have had time out in  which they pretended to be
the primary personality.  In some  cases, it is only the thought processes which are markedly 
different, while the face and body appear similar, at least in  the office setting, when strong
emotions are not being  stimulated.

     It might be thought that the therapist's interest in  multiplicity could create these
alter-personalities.  This could  not be if the alter-personality is first identified by someone  before
the therapist has seen the patient, or when the alter-personality clearly comes about, in its own
mind, to serve a  rescue function.  If the therapist shocks the patient, as I did  once by telling one
patient the diagnosis before she was ready to  cope with it, another personality can be formed
from that psychic  shock.  In my case, that new personality was a rescuer and  repeatedly saved
the patient from suicide attempts, so she was  helpful during the remaining therapy.

     When hypnosis is used to explore the mind, various minor  personality fragments may be
found.  These are of no importance  and can be ignored most of the time.  Paying attention to
them can encourage them to grow to  maturity" and that must be  avoided.  Also, the patient can create
a false alter-personality  which has no psychological roots, and no purpose other than to  amuse,
mystify or confuse the therapist.  That presents no  problem since it never shows up again, if the
therapist realizes  it is of no psychological importance and goes on about the task  of unifying the

                     THE INNER SELF HELPER

     Somewhere in therapy, hopefully early, an especially  important entity, which I have
christened the Inner Self Helper,  may make itself known.  It is quite different from the persecutor 
or rescuer personalities, whose characteristics are in Table II.    The characteristics of this entity
are listed in Table III.  I  described my first meeting with such an entity in 1973 (Allison,  1974a). 
Since then, such entities have been manifested in all of  the seriously ill patients who have gone on
to fusion.  This  entity will not accept the definition of personality, and has,  itself the power to
create helper personalities.  I abbreviate  the full name to ISH, which means "similar to, or alike."
This  is appropriate, since it is similar to the main personality in  many of its basic characteristics. 
It has knowledge and strength  but is incapable of showing hatred or fear.  But it is a  reflection,
in a higher plane, of the primary personality.  It is  bright if the patient is bright, and not so bright
if the patient  is dull.  It is shy or assertive, depending on the nature of the  primary personality. 
Its value to the therapist is tremendous, as  they have awareness of all that is wrong inside the
mind and can  work with the therapist to make corrections.  There are certain  things the therapist
must do, certain things the patient must do,  and certain things the ISH must do.  Neither one can
abdicate and  expect the others to do its work.  The ISH must let the doctor  handle medicines
and physical problems, since the ISH's role is  strictly mental.  Psychotherapy for the primary
personality is  done by both the ISH and the therapist.  The patient has the duty  to resolve to
become one and to make appropriate social decisions  as well as to battle persecutor personalities.

     The most concise self-definition given by an ISH is as  follows: "I have many functions.  I
am the conscience.  I am the  punisher, if need be.  I am the teacher, the answerer of  questions.  I
am what she will be, although never completely, for  she has her emotional outlets which I do not
need.  But she will  have my reasoning ability to look at things objectively.  I will  always be here,
and I will always be separate, but the kind of  separateness which is yours, a oneness with a very
fine line of  distinction.  An emergency backup perhaps.  I must be the ability  to know.  If I am
gone, she is just a body.  She can send part of  me off and leave a small portion.  But if all is
taken, she is a  shell.  Now my function is overseer of the dump.  I am kept busy  sorting out the
different messes created and the problems created between the alternate personalities."

     The relationship between the therapist and the ISH is  unique since the ISH is all intellect
and a delight to converse  with for any intellectual therapist.  It is also aware of the  therapist's
feelings and failings and has no capacity for  transference feelings.  The ISH and the therapist are
usually  talking about a third party, the patient.  They share ideas back  and forth, with no
coercion on either side.  There is no human to  human relationship with which to compare this
partnership.  It is  so unique a relationship, it has to be experienced- to be  believed.

     The therapist quickly comes to realize that the  therapist, too, has an ISH, which is in
constant communication  with the patient's ISH.  Why else did the therapist change  tactics and do
certain acts in the therapy session which worked  out so perfectly? The patient of Stoller (1973)
didn't listen to  her ISH, Charlie, and got into trouble.  Dr. Stoller did listen  to his and became a
successful psychiatrist and professor.  Jung  described his ISH, Philemon, in great detail in his
autobiography  (Jung, 1965).  In the psychological model of Psychosynthesis,  Assagioli (1965)
labels this part of the mind the Transpersonal  Self.  In successful people, it is well integrated into
the rest  of the personality.  In the multiple, it is disconnected, as are  many other parts.
                            TABLE II
Characteristics of an Alter-Personalities from Unconscious Forces
1.   Has identifiable date of creation
2.   Was created as a result of specific life trauma of psychological need
3.   Was created to serve a specific emotional purpose
4.   Has potential range of good and bad emotions
5.   Has potential for good and bad motivations
6.   May be interested in establishing separate identity from  primary personality
7.   Is capable of making other similar alter-personalities
8.   Has a sense of being male or female

                           TABLE III
Characteristics of an Inner Self Helper (ISH)
1.    Has no date of origin; has always been present since patient's birth or shortly thereafter
2.   Can only love; is incapable of hatred
3.   Has awareness of and belief in God
4.   Is aware that God put it in charge of teaching this person  how to live properly
5.   Has power to clean up the mess, with help of therapist
6.   Has more powerful helpers above itself
7.   Knows all past history of patient, and can predict short  term future (three days maximum)
8.   Has no sense of personal sexual identity but uses gender designation for therapists
9.    Talks in short, concise sentences; prefers to answer questions and give enigmatic
10.  Is aware of patient's prior lifetimes
11.  May be one of several, arranged hierarchically, with the  lowest most easily accessible, the
highest nearest to God
     Before we deal with ideas about treatment, we must  concern first ourselves with why this
ailment exists in the  patient at all.  As far as I can determine, there is no generally  accepted
etiologic reason propounded by psychological  theorists.  My  constant probing for answers has
led me to  hypothesize    that   these patients were born this way, not  necessarily split of mind,
but with a readiness to split with the  slightest emotional trauma.  The psychological foundation is
an  innate defective unconscious mechanism for integrating daily  experience    into knowledge. 
They cannot be conditioned        by  experiences.  They keep making the same mistakes over and
over  again.  Therefore, they do not act socially responsible since  they do not correct their errors. 
This leads to recrimination on  the part of others and further emotional trauma, leading to the 
eventual creation of alter-personalities.  This same feature of  inability to lean from experience has
been shown to exist in  professional criminals (Yochelson & Samenow, 1976) and may be why 
the disorder is so seldom diagnosed in men.  They probably become  criminals earlier and easier in
our society that do women and are  then absorbed into the penal system.  The women are
tolerated  longer at home and considered mentally ill while the men are  called antisocial.

     The other etiologic factor which has been strongly  indicated by ISH's is that the primary
personality has never  taken a stand for being good or evil and is still sitting on the  moral fence,
playing both sides.  Staying in this state of moral  limbo perpetuates the existence of
alter-personalities, who  represent one side or the other of this moral dilemma.

     Those doing therapy may find it hard to identify with a  person in a moral limbo, since we
made our choice for good before  entering our professional education.  But these patients have 
not, and need to be guided to where they can make a conscious  choice for good or evil, hopefully
for the former.  The choice must always be theirs, and they can  choose to be fused evil,  I 
believe.  If that should happen,  no one is safe around that  person, and there is no longer any
hope for a cure in the positive direction.

     There is, of course, the    total personality structure  present in the person at birth, which
is another important factor  to understand.  The most important facts leading to pathology are  the
emotional hypersensitivity, hypersuggestability, and psychic  talents.  The hypersensitivity may be
so extreme they perceive  auras, or energy fields, around people.  In a room of strangers,  they
may feel literally burned by anger or other negatives  feelings of these persons.  They soak up
these feelings up like  sponges and may become suicidal at the end of the exposure to depressed people.  
This factor must be appreciated and is  countered by "Building the Eggshell," which is described later.

     All multiples are hypersuggestible and therefore  excellent hypnotic subjects.  But that is
where the therapist is  walking on a narrow ledge.  The therapist may inadvertently  suggest a
symptom the patient doesn't need.  Hopefully, the  suggestions are positive ones regarding
improved coping methods.    With this suggestibility used effectively, the therapist should 
comment that the patient can do many positive acts she didn't  think she could do.  When the
patient acts on these suggestions,  she is surprised at the results, and this builds self confidence, 
which is sorely needed.

     Most of the multiples have been involved in some type of  psychic or parapsychological
activity, and it is important for  the therapist to be aware of the theories behind these phenomena.  
 Readings in standard texts in parapsychology will help the  therapist understand such activities as
extrasensory perception,  poltergeist,   out-of-body    experiences, precognition, psychic  attack,
psychometry and energy sapping.  Again, it is essential  that the therapist understand the ethical
and unethical ways in  which these various talents may be used.  Involvement in such  religions as
Satanism and black witchcraft is to be soundly  denounced, but the motives must be completely
explored, so  alternate ways of meeting the expressed needs can be found.

     The characteristics which are useful for healthy  improvement are creativity, good
imagination, excellent memory  and diversified interests and activities.  Many are excellent  artists,
using various mediums.  Poetry is a very common way of  expressing their thought.  Their
imagination can be used  creatively in the hypnotic process.  But the therapist has to  keep in mind
the problems these patients have separating their  fantasies from reality and the tendency to make
reality out of  imagination.

     In spite of many amnesic spells, multiples have excellent  memory for isolated details. 
Never can therapists get away by  claiming they didn't say something last week.  The patient can 
remember interactions in complete detail.  Patients who have been  accused of lying in childhood,
a common fact, will start  memorizing everything that they are aware of, so they can defend 
themselves from further accusations.  They never forget an insult  and clutch onto the memory of
the hurt until the therapist hears  about it and persuades them to stop the one-sided feud.

     The family structure on which the early pathology is  played out is described in my paper
on How to Raise Your Daughter  to be a Multiple Personality (Allison, 1974).     These factors   
are  listed in Table IV.  I do not blame parents  for raising their  children to be multiples, because
of the defects in the child I have already listed.  But the patients are raised in polarized  families 
where multiplicity is encouraged and irresponsible behavior is supported by example.  Seldom is there 
an alternative parental figure who can help the child understand and cope with  what she is going through. 
Therefore, the child may seek inside for a playmate made of imagination, and start creating
alter-personalities that way.  Later they usually marry an emotionally  unstable spouse, and the
home problems are perpetuated.  As so  often happens with chronically disabling conditions, the
spouse  becomes the caretaker, but when the patient is well, the spouse  starts showing
psychopathology, and a divorce suit is soon filed  by the ex-patient.

     Therefore, the pattern seems to be this.  The personality  of the patient arrives in this
lifetime incapable of learning by  experience and undecided about being good or bad.  The
nervous  system has an exquisite sensitivity to emotional energies of  others.  The family is
pathological, with polarity being  encouraged.  The acting out forces the patient into therapy, into 
a corner where she can no longer get by being irresponsible and  undecided by letting
alter-personalities live out her life for  her.

                            TABLE IV

Common Factors in Childhood of the Multiple Personality Patient
1.   The child is unwanted at birth.
2.   There is intense polarity between mother and father.
3.   One parent, especially the favored one, disappears before the  child is six years old.
4.   Sibling rivalry is encouraged, and the child is not helped to  deal with it.
5.   The child is taught to be ashamed of her family tree.
6.   The first sexual experience for girls is extremely traumatic.
7.   Home life as an adolescent is so miserable the girls run away  to get married, and the boys
join the military.
8.   The girls marry sexual deviates who carry on the pathological  traditions of their parents.
                        THE THERAPY PLAN

     Since most papers on the subject of MPD are single case  reports, little is available to
guide a therapist who is meeting  the first such patient.  Excellent theoretical discussions of the 
problems involved are presented by Taylor & Martin (1944) and  Suttcliffe & Jones (1962).  The
one paper which presents pointers  for effective treatment by Bowers, et al (1971) should be
studied  by any therapist presented with such a patient.

     In my experience, the therapy has fallen into nine  intertwining stages of activity.  The
order in which these  processes occur varies in each patient, but, with the help of the  ISH, the
therapist will be able to take each step as needed.

1.       Recognition of Alter-Personalities

     As in any disease, until the patient is aware of what  disease she has, she cannot effectively
work with the therapist.    There is massive resistance in most patients against accepting  the label
of MPD, since denial and repression are their favorite  defense mechanisms.  But when the
therapist has adequate proof of  amnesic spells in which alter-personalities make themselves 
known, this must be presented to the patient.  Various physical  methods of proof may be needed. 
A Polaroid picture may be taken  when an alter-personality is out.  A tape recording of 
conversation between therapist and alter-personality may be made.    Asking the patient to talk
out loud, in trance, with an alter-personality, creating an inner dialogue, as I have described 
elsewhere (Allison, 1974) may be very useful.  When the patient  is able to do automatic writing,
this proof may be convincing,  since the therapist did nothing to put those words on paper. if 
family    members    or neighbors will confirm the therapist's  suspicion and tell the patient, that
may begin to dissolve the  denial.  But, in the early stages of therapy, there is only going
to be     a tentative agreement that it may be so, but not whole-
hearted   acceptance.  That only comes later.

2.        Initial Special Techniques

There are two imagery techniques which I have found
useful    for most multiples.  The first I call "Building the
Eggshell." Since these are hypersensitive people, I show them  how to develop protection against
psychic harm by building an  imaginary eggshell around themselves.  The patient rests quietly  in
an easy chair while I go through the following spiel:

     "Rest quietly, relax and close your eyes.  Now think of a  beam of pure light coming down
from the sun into the top of your  head.  Have it radiate from the very center of your being
outward  into your air space.  As it does, have it push out all that is  unworthy in you, all that is
evil, harmful or unwanted.  Let this energy fill your entire air space so that in no way can you be  
outside it.  Let it expand and become stronger and more brilliant  so that it goes as far above your 
head as you can reach, as far to your side as you can reach, as far behind you as you can  reach, and 
as far below you as you can reach.  Then, as a tomato  with a soft pulp needs a skin to hold it together, 
start  thickening the outer surface of this energy field.  Because of  the shape of the human body, it 
will be shaped like an eggshell  Thicken this eggshell as thick as you think you need for  protection.  
If things are calm and peaceful, you may need it to  be only one or two inches thick.  If you anticipate 
being around difficult people, you may need it two or three feet thick.  Now  if you remember your
biology class in school, you know that every  cell in your body has around it a semi-permeable
membrane. (Vary  this part depending on the education of the patient.) This  membrane is
designed in such a way that food will pass through it  into the cell but poisonous substances are
kept out.  Also, all  the elements manufactured inside the cell that are needed for the  function of
the cell are kept in, but all waste products are  passed out. in this way, a perfect relationship is
maintained  between this cell and all other cells.  Exactly the same type of  membrane is needed
around your body to allow it to be in balance  with the bodies of others. 

     "The first thing you need to do is to cover the outside  of the eggshell with many tiny
mirrors.  These mirrors are  designed to reflect back to their makers all the negative  thoughts that
may be sent your way by anyone, all thoughts of  malice, hatred, jealousy, etc.  The mirrors are
100% reflective,  so you need add no energy to the system; just let the negative  thoughts rebound
like ping pong balls off a paddle.  In this way  the negative thoughts will not enter your body of
thoughts and  interfere with the quality of your thinking.  However, all  positive thoughts, such as
admiration, love or affection will  come right through to improve you, help you, teach you and 
otherwise benefit you.  That is the first step.

     "The next step is   to coat the outside of your eggshell  with a non-stick surface,  like the
Teflon used in frying pans.    This non-stick coating is to be designed to deflect all negative 
emotions others may dump   on you.  These negative emotions of  hatred, guilt, self pity,  etc., are
just their mental garbage  which you don't need.  With  the Teflon coating, you can have it  just
slither down into the garbage disposal system the Good Lord  provides for such trash.  However,
all the positive emotions such  as love, affection, praise and appreciation will come right  through
to warm you and strengthen you.  These feelings will also  stimulate you to express the same
emotions towards others.  Now,  that is what is needed for the outside.

     "On the inside, you need to do the same as that which  works for each cell in your body. 
The first thing is to get rid of the junk in your mental household.  You will notice down by  your 
feet a one-way-out trap door.  Pick up that silver shovel  and start shoveling out that door all the 
mental trash you have preconceived notions, outdated ideas, fears, anxieties  resentments, etc.  These 
may have been useful at one time but they are now junk; so get it out of there.

     "At the same time, you keep all the valuable things in  your mental house - the lessons you
have learned, the experiences  you value, the talents you have, your favorite memories.  Polish 
them, keep them clean and beautiful.

     "Every morning before you get out of bed, repeat this  process so you keep your eggshell
in good repair.  It can't last  long without repairing.  Let the light in through the top of your  head,
repair the cracks in the shell, replace any broken mirrors,  fix any scratches in the Teflon and
shovel out the trash that has  accumulated since yesterday.  Then you will be ready for the rest  of
the day.  When you feel you have finished, you can open your  eyes."

     This is usually very much appreciated, enables the  patient to cope better and use less
     The other special procedure is called "The Bottle  Routine." It was invented to cope
with the over-accumulation of  negative energy one patient had after a partial fusion.  She was  so
full of unmanageable hatred and fear, no tranquilizer could  calm her down.  This method, which
presupposes that one can  transfer human feelings into a physical object, worked in her  case and
is useful in emergencies until the underlying problem  can be resolved.  The spiel goes as follows:

     "Close your eyes and think of your body as a giant  battery with positive and negative
emotions flowing around in it.    Like any battery, it has two terminals, an 'out' terminal, which  is
your left hand, and an in, terminal, which is the top of your  head. (Place your right hand on top of
the patient's head and  push down slightly.) We all easily pass outward to others the  positive
emotions such as love and affection since this is  permissible in our society.  However, we are
often not allowed to  pass out the negative emotions, so they store up in our body and  cause us
harm.  But they can be moved out, and I will show you  how.  It doesn't matter how long they
have been there; they don't  change with time.  Even those from early childhood can be  removed. 
Now just concentrate on moving the anger energy out of  your left foot. (At this point I touch the
left shoe with my  left hand and move my hand to the areas I am taking about,  avoiding touching
the erotogenic areas.) Move the anger energy  out of your toes, sole, heel and ankle, moving it up
through your  calf into your buttocks.  Move it out of your pelvis and  buttocks.  Move the anger
through your abdomen and out of your  back, up through your heart, lungs and chest into your
shoulder.    Then move it down your left arm to your elbow, through your  forearm, wrist and
store it temporarily in your left hand."

     By then I will have moved my left hand to the back of the  patient's left hand.  Then I
repeat the same statements for the  right side, starting with the     toes on to the shoulders, 
continuing from the right shoulder to  the left shoulder and down  the left arm to the hand.  Then I
place a bottle or other object  in the left hand and say, "Now start pushing all the stored up  anger
into the bottle." The patient, if cooperative, starts  squeezing very hard, so I know the imagery is
going well.  Then I  touch the right hand and say, "Now start moving the anger energy  out of
your right hand, through the wrist, to the forearm, past  the elbow, into the upper arm, into the
shoulder.  Then move it  over to the other shoulder, down the arm to the wrist, to the  hand and
pour it all out.  Now the greatest amount is stored in  your head.  I want you to take through the
top of your head all  the energy which is the opposite of hatred, which is love.    Imagine a beam
of pure white love energy coming down from above  to act as a counter force to drive the anger
out." (Here I keep  my right hand on top of the patient's head and cup my left hand  above the left
ear as if I am pushing something downwards.)  "Push the anger energy out of your skull, hair,
brain, ears, eyes, nose, cheeks, chin, into your neck, down into your  shoulder, down your arm, past your
elbow and wrist, into your  hand.  Now continue to push all the anger out.  Once you have the 
flow channels started, they will continue to work."

     I watch to see the degree of tension in the squeezing  left hand and encourage the patient
to keep pushing out all the  anger possible until the hand relaxes and the grip loosens.  I  don't put
a time limit on this but tell the patient to take as  long as is needed to do the job, and then I will
take the hate  energy away for good.

     Whether or not something really goes into the bottle, who  can tell? But when I have
handed such a bottle to another  multiple who was not present and had no idea what happened,
she  always showed terror of the object and insisted I throw it away.    There are times when the
patient should not cast out negative  feelings, but must accept and integrate them.  If so, the
patient  will refuse to do this procedure and must be allowed to do it her  own way.

3.    Intellectual Acceptance of Having Multiple Personalities

After the evidence accumulates, and the patient has reason  to believe her therapist and friends,
she will stop denying    that other personalities exist inside her head.  She will start talking about
the other personalities as real people who  co-exist inside her head and will have an intellectual
curiosity  about why they came about and what they are all about.  However,  the therapist must
not be lulled into a feeling of complacency  that the patient really believes all this stuff about other 
personalities.  She is still playing a game with the therapist  and going along with the theory, but
does not believe it "in her  gut." Doubts that are expressed by relatives, teachers, friends  or
others will be readily accepted by the patient to deny what  the therapist is telling her.  The
therapist can expect to be  accused by unhappy relatives of having brainwashed the patient  into
believing a fairy story.  The therapist may be accused by  the pathogenic relatives of making the
patient sicker, since "she  was fine until he put all this nonsense into her head about these  other
personalities." This, of course, ignores the fact that the  patient had been acting weirdly since
infancy and was practically  forced into the therapist's office by these same people because  of her
odd behavior.

     But that is still the time to get started on substantial  psychological problem solving.  The
most effective way I have  found to do this therapy is with hypnotic age regression.  Since  all
multiple patients are highly hypnotizable, they can me age  regressed if they are willing to try. 
The first step is to have  the patient enter a light trance and ask the all knowing part of  her mind
lift one finger when an age is mentioned when a major event occurred which feeds energy to the negative personality  that needs to be dealt with first. 
The patient always has a  "biggest baddie," and that is the one to tackle first.  I count  from zero
to the patient's current age and make a note of when  the finger lifts.  If there is time, I will follow
with the first  age regression session.  If the finger first raised at number  five, I will then tell the
patient that, as I count downwards, I  want her to become the age I count to.  When I reach five, I
will  ask to talk to the patient as she was at the age of five.  I keep  repeating this, suggesting that
when her eyes open, the patient  will be age five, feeling just like she did at that age, and that  she
will be willing to talk over the important problems she faced  at that age.  If the process is not
interfered with by an alter-personality, I am talking with a five year old child when the  patient

     Then I have to enter into a therapeutic discussion in the  same way a child therapist would. 
The child brings up the  problems of a new baby sibling, or a move to a new home, whatever  was
the issue at that age.  There is seldom any difficulty with  the child understanding my presence or
questioning why she  suddenly dropped into my office.  If need be, I will explain that  her parents
were aware she had problems and had asked me to talk  them over with her, just as one would in
regular child therapy.    The goal of the session is to help the child come to a resolution  of her
emotional conflict.  It might be getting over hatred of  the sibling, or receiving reassurance that
she will make friends  in the new town.  Whatever it is, when the resolution is reached,  the child
often closes her eyes and returns to a trance state  spontaneously.  If she doesn't, she may ask to
leave, and I tell  her she can leave the same way she came, by closing her eyes and  going back
inside her head.  When the trance state is again  apparent, I tell her to start counting up to the
present age.

     After a session or two, I learn how fast the patient  works out problems.  Some are very
resistant to changing their  attitudes and require an hour per problem.  Others are more  flexible
and can work through three or four problems per hour.    By starting at the early ages and
working chronologically, the  child-patient and I develop a rapport, and the themes are  repeated. 
I can refer to an earlier session for material to help  in a later problem, if need be.

     Since I have previously listed the ages to be covered, I  cross off each age as we cover it
and it's associated problems.    When I get to the end of the list, I presume that I have resolved  all
the problems that have fed negative energy, such as anger or  fear, into that particular
alter-personality.  Theoretically,  that personality should be ripe for neutralization.  I view it as  a
tree with several roots.  Each problem is a root, and if we can  pull up each root which ties this
personality into the patient's  unconscious mind, then, when all roots are pulled up, the tree
can be toppled with a breeze.  On rare occasions, the personality  is such a weak fragment it just
evaporates an we resolve the  final problem.  But the long standing "baddies" have to be 
approached through a ritual.  Each patient has her own effective  ritual.

     It often requires the therapist's presence to "catalyze"  the interaction between the ISH,    
which has the power to  neutralize the negative personality, the primary personality, who  must
make the decision to give up the negative personality, and  the negative personality itself, which
may or may not fight to  stay the way it is.  While a benign helper alter-personality can  be
brought into the primary personality, a hostile destructive  one will usually have to be neutralized
in some fashion,  depending on the ISH's instructions.  If the ISH does not have  advice about
specific mechanism, I use the standardized approach  based on "The Bottle Routine".  After
checking with the ISH to be  sure the patient has met all the conditions to neutralize the 
alter-personality, I put a bottle in the patient's hand, ask her  to close her eyes and go up to the
level of the ISH.  Then I ask  the patient to join with the ISH, to become one with its power  and
to bring the ISH down to cast out the negative energy of the  bad personality.  Then I put my
hand on top of her head and move  my cupped hand down her head, neck, shoulder and arm out
to the  bottle, all the time telling the patient that I am helping by  pushing out the negative energy
from each part of the body I  touch into the bottle.  The patient, when cooperative, goes  through
quite a contortion as if really pushing something down  her arm and out her fingers.  Some
patients need no object and  just extend their fingers.  One "spoke in tongues" to do it.    Some
silently sat and prayed, showing no outward movement, but  said they consigned the personality
to God to do with as He  wills.  The patient may have a vivid visual experience of  powerful
helpers dealing a deadly blow to an enemy inside her  head.  Whatever works should be used.  No
one can say what really happens.  The  goal is to drain the negative personality of energy.  The
personality can be recharged if the patient backslides and repeats the kind of poor problem
solving which brought it about in the first place.  Then the therapist has to  tackle the
psychotherapy problem again until permanent changes  are effected.

     While some negative alter-personalities will totally  disappear with this approach, others
will remain, but without  their negative attitudes.  These are the ones who are still  needed by the
patient for some useful purpose, such as providing  information for further therapy sessions.  So
that these "shells"  of alter-personalities will not reabsorb the anger and hate that  still resides in
the patient, I find it essential to have them  fill up their "emotional vacuum" with positive energy. 
To do  this, I put my hand on the patient's head and ask her to pull in  from the universe all of the
healing, loving energy available for the asking, to have it fill all the space that was just vacated  
by the anger.  When that alter-personality then returns to normal  awareness, she is glowing with happiness 
and love for all mankind.  She then becomes a helper for the rest of her tour and  can aid in therapy 
as long as she is needed.  When she is no  longer needed, she comes out to say farewell and goes away to 
"someplace yellow."

     During this part of therapy, the patient must be advised  of the wisdom and judgment of
the ISH and urged to submit in  every   way   to the ISH's directions.  This is a difficult 
instruction for most patients to accept, being rebellious as they  are and seeing the ISH as a harsh
parent.  But experience usually  teaches them the reasonableness of this advice.  But it must be 
repeated over and over again.  The patient must develop a sense  of being a student to the ISH,
who is the guru, as well as a  feeling that the ISH is a higher part of her mind.  Frequently,  the
patient will become jealous of the attention the ISH receives  from the therapist.  Then resentment
develops, followed by  refusal to follow the orders of the ISH.  Remember, the ISH is  with
the patient 24 hours a day, 7 days a week.  It gives orders  all that time in a calm, deliberate
fashion.  The patient has the  option of ignoring the orders at her peril, but she can do so.    Only
on the request of the therapist, or in a life and death  emergency, will the ISH take over the
control of the body, but  never to do something the main personality should but won't do.   
Mistakes are allowed to happen, but rarely to the point to  serious physical or mental harm.

4.      Coordination of Alter-Personalities

     During the entire course of therapy, the patient and  therapist both must work to
coordinate the efforts of the  positive personalities.  They often have been working parallel,  not
really knowing what the others are up to, or that others  exist.  Often, a personality will be out to
do its duty and have  no awareness that it is only one of many.  When I first meet such  a
personality and inform it that there is a whole family of  personalities in the head the personality
must know and work  with, it frequently tells me this is nonsense, since such things  as multiple
personality just don't exist.  To correct such doubt,  I just ask the ISH to speak to that
personality, and the booming  voice in the head is usually quite persuasive that I know what I  am
talking about.

     When a negative personality is encountered, a positive  side must be sought.  If there is
any way to move an angry  personality into a protective role, it should be done.    Conversion to
the cause is much more to be sought than  excommunication from the order.  Each started for a
purpose, and  if that purpose still must be served, the personality must be  kept.  Only when the
primary personality has learned how to handle that issue by herself, can the alter-personality cease 
to function. Helpers will fade when they are no longer needed. No ritual is needed for them, as they 
just lose energy and no longer function, blending their talents, attributes and memories with the 
primary personality.

     An ambivalent personality may want to help but is made up  of both negative and positive
aspects.  If it wants to shed the  negative aspects of itself and become a full fledged helper, then 
"The Bottle Routine" is used with that alter-personality out at  the time.

     Since suicidal and murderous impulses are contained in  the negative alter-personalities, a
clear understanding of the  proper rescue methods must be developed by all entities involved.   
The ISH must know how to contact the therapist during off hours,  and    the spouse must be
taught how to bring the primary  personality into control if a persecutor gets out.  The hospital 
emergency room and inpatient psychiatric ward staff must know how  to cope with suicide
attempts and reach the therapist quickly.

     There must be one alter-personality whose role includes  suicide prevention.  The therapist
must keep contact with that  one to assess suicidal risk and determine how much external  control
is needed.  Since the primary personality is quite an  actress, the therapist can seldom get a true
idea of the suicidal  potential from her.  The rescuer will be the informant needed to  evaluate and
report such risk.

     In case of violent behavior, a simple and essential  technique to teach nurses, spouses and
close friends is the touch  on the forehead, described in "Making the Diagnosis." Firm  touching of
that spot will usually bring out whatever helper  personality is called.  The one exception is when
the patient has  gone into what I call a "transitional trance," a coma in which no  personality is in
charge.  Then no response is noted to any  outside stimuli, and calling loudly and waiting is about
all one  can do.  Eventually someone will take charge of the body.

5.   Emotional Acceptance of Being Multiple

     During most of the treatment, the patient may still doubt  the  existence of the other
personalities, the accuracy of the  diagnosis and the sanity of the therapist for reporting such 
ridiculous observations.  But at some point in time, an event  occurs which cannot be ignored,
forgotten or denied.  It may be  the first time the voice of the persecutor is heard, since not  all
patients hear voices.  This may be when filthy hitchhikers  are found in the car, and the patient
knows that she would never  have picked up those awful people.  Whatever it is, the patient 
becomes aware of the evil within herself and cannot avoid facing  it any longer.  Then and there,
emotional acceptance of being multiple occurs and the patient enters the next phase in the therapy 
program.  Now the patient becomes the director of the  treatment activities, since the ISH is now 
able to feed information on how to improve, and the data is acted on without  delay or question.  
This is when the therapist must back off on  pursuing any preconceived notions of what therapy should 
be, for the patient know what needs to be done.  The drive to get well is  now strong and over-shadows 
all the neurotic drives that have  previously pushed the patient into such chaotic life patterns. Major
changes are demanded by the patient if the old patterns  interfere with getting well.  This may
include separating from  the spouse, or at least being willing to, if the spouse's  psychopathology
and need to keep the patient sick becomes  apparent, as they often do.

     Now may arise the crucial question - Who is really the  patient? Who is the original
personality? Prince (1913) was  quite right in his advice to look for the underlying basic 
personality, since only that one can get well.  In over one-third  of my cases, the original
personality did not enter therapy and  was discovered during therapy.  The ISH knows it is under
there  somewhere and will advise the therapist in due time when it is  safe for that one to come
out.  A careful history of the starting  ages of the personalities is most helpful in preparing the 
therapist for this aspect.  When the first negative alter-personality has been created before the age
of eight, when,  according to psychoanalytic theory, the personality is fairly  well formed, the
primary personality had gone underground and an  alter-personality was formed to take over. 
Unfortunately, the  new alter-personality is usually weak, neurotic, depressed and  limited in
emotional scope and     eventually    ends up in a  therapist's office.  I have heard of this retreat of
the original  personality as early as birth, right on the delivery table.    Others have been out of
consciousness since 21 to 50 months of  age.

     There are many different ways in which this original  personality may first manifest itself. 
It may be the only one  present, if all alter-personalities have just disappeared.  In  that case, the
therapist may suddenly have a three year old  patient, with a family to raise and a job to do.       
Fortunately,  it is only emotional growth that is missing, not intellectual or  physical.  It is of
utmost importance to control with whom the  patient is in contact at that point.  If this
transformation  occurs at home, the spouse must take time off to be there, acting  as a good
friend, since the patient knows no three or four year  old can be married and have little offspring
running around.  The  hospital may be the place for her, and the nurses become family  figures
who help the patient become oriented.  Here I explain to  the patient that she has had a "sleeping
sickness" and is a  modern version of Rip Van Winkle.  They marvel at their big  bodies, but I
explain that the body continued to grow while they were asleep and their emotional growth will soon 
catch up.

     In other situations, the child personality will only come  out when the therapist is present,
to work out problems that  occurred in past times.  Then the therapist must go through "age 
progression"   therapy.  As the child personality grows, she  becomes upset about those events
that were traumatic, such as  rape, parental desertion, physical attack, or death of a close  friend. 
These episodes must be faced, accepted, and dealt with.    The therapist must perform the role of
crisis counselor,  providing guidance and understanding just as the rape has been  completed, for
example. Forgiveness towards self and enemies  must be taught, to eliminate the intense anger
which developed  in her at that time.   Substitute parents may have to be provided,  if the real
parents were so brutal the patient will not accept them as parents now. The selection of proper
persons for the new parental roles is a very delicate procedure.  Never should the therapist
volunteer. The therapist is needed as a therapist, and therapist and parent roles cannot be easily
mixed.  Usually there is a good friend available who has already assumed that role for  the patient
and is willing to be the new parent for the growing  child personality.  The most important fact
that this person has  to know is that the assignment is for life.  A new father figure  doesn't have
to be around the patient at all, after cure, but he  must never deny his fatherhood role.  This new
parent must be  willing, during the growing period, to deal with the grown adult  patient as if she
were a little child, bringing dolls, toys and  cuddly blankets to the hospital if indicated.  Again, the
ISH  gives explicit directions as to what to bring at what time to  support the growth process. 
Primarily, the parent is there to  provide the love and attention that every child needs, and that  is
what gives the patient the strength to face the problems she  had avoided for years.
6.      Neutralization of Persecutors

     The way to deal with the roots of negative alter-personalities with age regression therapy
has been described  earlier.  The same procedures must be done with each negative  personality
unless the ISH informs the therapist of an easier or  shorter way.  To neutralize them requires the
patient to overcome  those two basic defects mentioned before, one psychological and  one moral. 
The patient must now accept responsibility for  everything she thinks, feels or does, no longer
delegating  responsibility to another personality.  Obviously, this can only  be done by the original
personality, who copped out in the first  place.  It cannot be done by a helper alter-personality. 
This  may seem like a simple pattern for therapists who have always  been accountable for their
behavior, but it is a new type of  commitment for the patient.

     The other aspect that needs solution is the failure of  the patient to pick which camp to
join, the "White Hats" or the  "Black Hats." This process may be described in any terminology, 
but it is important that the patient get off the moral fence and  choose sides.  Here, religion is
important to the patient.  The  failures in this stage are either those who give lip service to  some
abstract religious idea, or who could accept none of those  offered.  Church attendance is not
related to religious belief,  and may be detrimental if the clergyman and congregation try to 
coerce the patient into a belief system and  pattern of behavior  contrary to what the ISH is
advocating.  But the patient must be  supported in her quest for a compatible religious orientation. 
  The patient's clergyman may be well involved already, and now is  the time for him to work
closely with the therapist.  The  clergyman can take a great deal of the burden off the therapist's 
shoulders, if the therapist will explain what is going on and  accept the clergyman as a

7.      Psychological Fusion

     When the original personality has been uncovered, when  the ISH is always listening to by
that personality, and when all  the negative personalities have been neutralized, then it is time  for
fusion of all the positive alter-personalities.  This process  happens spontaneously and may take no
work on the part of the  therapist.  It may happen in an hour, after the last persecutor  is
neutralized, or it may take several weeks.  There may be a  partial fusion first, of integration of
several similar alter-personalities before the final fusion, but this is not the same.    The fusion
process may be quite discomforting for the patient.    There may be poor memory, mental
confusion, alterations in mood  and temper control.  It may be necessary for someone else to 
manage the cooking, shopping and housekeeping chores for a few  days.  There are many styles in
which this occurs, but the end  result is always the same--one original personality, all alone,
except for the ISH.  This is another very important point in the  life of the patient, when she is
exquisitely vulnerable to bad  advice or a poor emotional environment.  Now is when the patient 
is most likely to leave the spouse or ask the spouse to leave.    If combat then ensues between the
two, a murderous or suicidal  fragment may be formed.  Immediate therapy must be instituted, 
often in a hospital.  Within 24 hours, the ISH can shed the bad  energies developed and healed the
split between the fragment and  the original personality.  Other than such short lived fragments, 
no solid alter-personality should be formed after psychological  fusion.  If they are, the patient has
not yet finished her task  of neutralizing persecutors, and that process must now be  repeated to

     The patient now has one personality, which is always  listening to her guru, the ISH.  As
soon as she has caught her  breath, new problems face the patient, only these are not really  new
problems.  They are exact duplicates of the old problems  which the patient has failed to deal with
adequately in the past.    The patient must be advised that these apparent catastrophes are 
happening because of the patient's need to face exactly these  problems now that she has better
coping methods available. if  these problems are faced and dealt with, then she will pass the  test
for promotion to the next grade in the "School of Hard  Knocks."

     It is amazing how the problems hit.  The patient may be  fired from her job, have her
house burn down, face a death in the  family, find she is again illegitimately pregnant, and so on.   
They are tempted with every old vice the negative personalities  indulged in, such as alcohol,
marijuana, cocaine, LSD, heroin and  all the rest.  The therapist must remember that the patient
now  knows perfectly well what to do and can assume responsibility for  taking appropriate
action.  The therapist assists and discusses  options but must not take responsibility out of the
patient's  hands. only if the patient becomes suicidal must the therapist  actively intervene.  This
need to suddenly step back from a  previous posture of active intervention may be a problem for
some  therapists, but those I have worked with have been glad to take a  breather by this time.

     I can talk very glibly about psychological fusion coming  about, but I really do not know
what that phrase means.  The  closest comparison is the that which persons describe when they 
are "born again" in a peak religious experience.  The process is  a reality but, since I have never
experienced it, I cannot  describe it.  The patients know what it is, they know they are  "one" and
they intend to stay that way.  All sorts of subtle and  not so subtle changes occur, all for the
better.  The patients  are a delight to have around, they are considerate of others,  they start
taking care of their physical health for a change.    They are more productive at work.  Their
personal cleanliness improves.  They no longer get into sadomasochistic games with  people.  They 
become independent and no longer ask for  hospitalization.  It is really a lovely state of affairs, 
at least for a while.

8.      Spiritual Fusion

     If, after several months, the patient has faced and coped  with all the old problems which
have been now presented in new  dress, the "School of Hard Knocks" has a graduation ceremony 
called Spiritual Fusion.  This occurs imperceptibly, as it is the  blending of the ISH with the
original personality.  As a result  of the patient always listening to the ISH and following its 
advice, the two become as one, and thus occurs the same sort of  integration the therapist has had
in his head all the time.

     There may have been created in the patient more than one  ISH.  If so, the integration will
occur at the lowest level  first.  The second level ISH will still be available to the  patient and
therapist.  There     may be a different type of  emotional and mental growth needed before this
second level ISH  can be integrated.  During this time, however, the patients are  not likely to be
in regular psychotherapy, but will be learning  from the usual support and educational groups in
the community.    They go to work, attend school, join Alcoholics Anonymous, go to  church, and
otherwise learn how to cope from successfully coping  people.

9.        Post Fusion Experiences

During this time, the patient continues to face problems, as do all of us, but is coping in a more
effective way.  Old legal  problems may still have to be faced.  Marriages may be broken and child
custody battles fought.  The therapist will have  to shift into a new role.  The patient may leave
town to start a  new life, keeping the therapist informed by mail.  Some patients  will be personal
friends of the therapist thereafter.  Others  will drop out of sight, to lead the life appropriate to
their  basic character.

     Whatever    the   result, neither the patient nor the  therapist will ever  be the same again. 
The patient has found  what had never been expected--mental health, a phrase which had  no
meaning before it was a reality.  And what did the therapist  get out of it all, besides the fee? If my
experience is any  guideline, we therapists had our eyes opened to the. unconscious  mind in a
way few people have.  We saw both the heights of glory  and the depths of degradation to which a
human can reach.  We saw  the healing power which resides in our universe and in each 
individual in that universe.  We, ourselves, became a small part  of that healing force.  In doing so,
we found out a lot more  about ourselves than we ever thought was there.  Some of it  scared us,
and some of it worried us.  Some we found we had to  change.  But most of it we found we could
be proud of, just as  we were proud of our patient, the fused multiple personality.

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