EFFECTS ON THE THERAPIST WHO TREATS PATIENTS WITH MPD by Ralph B. Allison, M.D. Presented at the Eighth Regional Conference on Trauma, Dissociation & Multiple Personality Cuyahoga Falls, Ohio April 22 - 24, 1993 INTRODUCTION My role today is to discuss the effects on the therapist of treatment, and this implies that there are both good and bad effects. I am put in the position of the person who asks, "I have both good and bad news. Which do you want to hear first?" In my days of private practice, one of my fiercest critics finally confessed to me that he could not stand patients who were manipulative and dependent. Multiples are masters of those two characteristics, but they proceed in ways that are not as obvious as we might hope. They have spent their early years using their abilities coping with what they consider abuse by those in their world, and they have become masters in using mental instead of physical means of defense. These methods are very difficult to detect, much less deflect. Since most of society do not even recognize that they even exist, they are a perfect means of sabotaging the enemy. These patients come to see much of society as the enemy and therefore subject to preemptive strikes in the name of self defense. Usually the therapist is seen as a savior of the multiple, so he/she is exempt from such attacks. But inevitably, the therapist will either fail to satisfy the dependent needs of the patient or will be placed in the role of the villain via transference. Then the therapist becomes an unwitting victim of the "defensive" methods the patient has been using all his/her life. INTERPERSONAL PHENOMENA SAPPING Sapping was first used in this context by Karagulla in 1967 (Karagulla, S., Breakthrough to Creativity, DeVorss, Santa Monica, CA, 1967) to describe the extraction of physical energy from another person by the patient. The sapper is a self centered individual who feels too weak to exist all by himself/herself, so he/she proceeds to suck energy from those around him/her. After I have been sapped, I barely have the strength to write. I will then sleep for about four hours; when I am again full of energy, my family are ready to go to bed. My second multiple, whom I shall call Gail, introduced me to sapping when she told me, "Dr. Allison, you are so big and strong. I wish I could have some of your energy." Feeling gallant, I said, "If I knew how to give you some, I'd be glad to do so." Little did I know that such would later take place. One Saturday night, I was with my wife at a dinner party when Gail phoned in a panic. Since I had had to hospitalize her several times for self destructive acts, and she never called unless she was almost out of control, I left the party and drove to her apartment. She greeted me with outstretched arms, grasping my hands with hers. Then I saw that both her forearms were bloody with multiple slash wounds. I went to her bathroom to get towels and found there the bloody pocket knife Laura, her persecutor alter-personality, had used after Gail had called me. Right after the phone call, Gail had blacked out, and Laura came out to punish her for giving in to her boyfriend who had told her he didn't want her to come to a party with him that evening. After wrapping her arms with the towels, I drove her to the hospital where the ER surgeon agreed to suture the wounds on her arms. Since there were so many lacerations, I used hypnosis to numb both arms and avoid multiple injections of a local anesthetic. To keep her arms in place, I sat by the operating table with my fingers touching hers all during the 90 minute surgery. I felt fine all this time, and the surgeon was grateful that he could suture away without worrying about the need for more anesthetic. The surgery went well, the patient was well behaved, and finally bandages were applied to both arms. Now the crisis was now over, at her insistence, I drove her to the party where her boyfriend was, and she persuaded him to let her come into the house. I drove back to my wife's party where she handed me a plate of food. I sat down to eat but could barely lift the fork to my mouth. Emotionally, I felt normal, but I barely had enough energy to breath. My wife told me I looked tired and suggested we go home immediately. I must have looked terrible to her since this was a very special occasion for her, and she likes to stay to the very end of parties. I accepted her invitation to leave and slept most of the next day, which was Sunday. Monday, I was back at work feeling normal again. I believe that Gail sapped me the moment she grabbed my hands at the door, as she felt powerless to deal with the threat of Laura, who always complained how weak Gail was in dealing with those nasty boyfriends she went out with. I was her source of strength, and she took all she could get, ignoring my need for the same. Since I continued to touch her fingers during the surgery, she continued the process. The imbalance in my own system did not become apparent until I was back in the fold of my own family and friends, when I could become dependent on my wife. Then my emergency system, which allowed me to do my job at the hospital and drive home safely, gave way, and I felt so weak I could go on no longer. Sapping of personal energy can occur in different ways. Gail did it through the means of touch. Others will stare at the victim and sap through the eyes. Others will talk incessantly and sap through the mouth. Some use no obvious site of attachment and are said to sap via the solar plexus. Those who are psychic enough to see auras around others can identify what is going on. Dr. Karagulla learned about the process when she went to social gatherings with women she met as subjects for research in psychic ability. At the parties, they pointed out the various guests who were using the above methods to sap energy from other guests and warned Dr. Karagulla to avoid them. When far enough along in therapy, my own multiple patients have confirmed what I have described. Naturally, they hid this information from me as long as possible so that they could use the technique on me whenever necessary. ZAPPING Another process commonly used by these patient is called zapping. This word comes from the comic book hero pointing his index finger at the villain while a lightning bolt shoots from his finger. ZAP is written in bold print in the background. These patients have also learned how to zap people, which is the opposite of sapping. Whereas in sapping they remove something (energy), in zapping they inject something into the unwitting subject of their attention. Patients who have admitted to using these techniques claimed to have "powerful minds." If a person with a powerful mind dislikes you, he/she has the potential energy to damage your emotional stability and the soundness of your thinking processes. There are three kinds of zapping. One type is emotional zapping - the injection of negative emotions into another person, making them angry, for example, when they have no personal reason to be so. Another type is ideational zapping - the injection of a foreign belief system or thought pattern into another, also known as brain washing, or, pardon the vulgarity, mindfucking. The third type is physical zapping - the causation of physical injury in another by mental means. I believe that I have been subject to each type at one time or another. All of us therapists come in a human form and are not perfect human beings without emotions of our own. If we were truly enlightened human beings, then possibly there would be no way some one else could make us blow up with unreasonable anger. But we are not perfect people, and we come with a certain suit of emotional clothing which can be used against us. If we are a little bit paranoid, we can be come very paranoid. If we are irritated, we can become very angry, etc. So I suspect that the reason I have reacted to these patients is that, in the process of living, I have had my own emotions fairly out in front, and patients could easily find a way to magnify them when they wanted to punish me for dissatisfying them. My patient Liz was in a halfway house where only one of the staff members accepted her multiplicity. The others told her she was playacting and could stop anytime she wanted to. This stirred up intense anger in her, which energized Barbara, her angry alter-personality. She knew that if she didn't neutralize Barbara, she would get expelled from the halfway house, and she had nowhere else to live. On a Saturday afternoon, she called and asked me to come out. With the one supportive staff member present, I used my technique for expelling anger energy into a bottle I could then toss into the garbage. I thought that I was eliminating the danger Barbara presented by having Liz shed a lot of her anger that way. It seemed to work at the time as Liz calmed down, and I was able to leave her in a state of self-control. The next day, the non-believing staff members came on duty and her anger rose in her again, with Barbara in full blossom. She called me at home that Sunday at 6 p.m., and I came out again to complete the project of neutralizing Barbara with a repeat of the bottle routine. I felt fine after leaving both times. When I got home that Sunday evening, I started folding the family laundry, my usual weekly chore and something I really don't mind doing. My wife asked me very politely if I wanted her to help. I blew up at her in an angry rage, telling her that I could fold clothes perfectly well and that I didn't need her implying that I was incompetent. She quietly took my tirade and asked, "Why are you acting like this? You haven't been this way all week." That struck home, since I knew I was being irrational, but I couldn't help myself. I thought, "What is different? Oh yes, I went to the halfway house yesterday and again today to get rid of an angry personality. She might have dumped some of her anger on me and I brought it home. Well, if that is so, I had better do what I teach multiples to do with their excess anger." That night, when I went to bed, I laid there with my fingers outstretched and thought about anger flowing out of my body through my fingers into the universe. I kept it up until I felt I had discharged all that Barbara might have dumped on me. Later, I asked Liz' ISH what had really happened. She told me that the first time I tried to neutralize Barbara, it was unsuccessful. Barbara was furious with me and zapped me with anger as I walked out of the halfway house. Thus I had taken a large dose of anger home with me that first day. The next day, I resented being called out again, but could not express that resentment to a needy patient, so, when my wife set me off with a benign question, it all came out at her. Ideational zapping is the implantation of ideas in someone's mind without him/her knowing about it, and then he/she is thinking in a way foreign to his/her prior belief system. In the case of women with hysterical personality traits, this is most often used for sexual seduction, with the message being that the sender is a greatly attractive sexy female who is more than willing to fall into the male target's arms. Of course, this method can also be used with religious or political beliefs. (David Koresh and the Branch Dividians in Waco, TX may be a recent tragic example.) One multiple patient of mine had created an evil monster of a personality which sent such seductive messages for the purpose of controlling men. Once I introduced this young lady, who was really rather dumpy looking, to two male associates of mine. In both cases, they were supposed to be involved in projects in their respective professions. According to her, in both cases, after a brief introduction, she found them making passes at her, even though consciously she didn't want them to do so. In both cases, she found herself having sex with each of them, and, afterwards, neither man knew why he had done so. Since I needed to preserve the business relationship I had with both men, I didn't dare ask them if they had slept with my patient, so I cannot vouch for the accuracy of her reports. But I have no doubt that the process exists, since so many other patients have described how they used this method on other people where I knew of the results. The boyfriend of one of my multiples decided to do an exorcism on her, without advice or consent from anyone else. At the time, she was advertising herself as a witch. After he attempted to exorcise what I considered to be a helper alter-personality, he became a religious fanatic who called me on the phone to invite me to become a member of the new church he had just established. When I refused, he approached a priest friend of mine with the same invitation. Next, he barged into various church meetings to invite the members to desert their church and join his. Eventually, he returned home to Florida where he continued his streetside prostelyzing. His last attempt at converting strangers was with a man on the street who objected loudly to being bothered by this odd young man. The young man beat the stranger to death and was subsequently sentenced to prison for murder. The ultimate in physical zapping is most likely voodoo death. In some way, these patients can cause physical injury to the bodies of people they hate. The seductress I mentioned before told me of an episode in grade school when she had been pestered by a boy on the school playground. She complained to the adults in charge but none were able to make him stop. (In today's world, her mother would have sued the school district for sexual harassment!) One night, in desperation, she visualized him in his bed asleep. Then she visualized his leg broken in several places as her punishment of him. The next day he did not show up for school. His friends told her he woke up that morning with his leg broken, and everyone assumed he must have fallen out of bed in the middle of the night. She felt very guilty about it and had no doubts that she was responsible. Most therapists would say that she was only guilty of wishful thinking, and they might assure her that she really had nothing to do with his injury. But how can they know for sure she didn't? I have seen too many other similar "coincidences" of harm coming to an enemy of a multiple after the multiple spent considerable time brooding over how to get even with the enemy for all the harm done to her. One evening when, with a nurse, I tried to help Helen eject the hostility of her latest nasty alter-personality. We spent two hours with her before she seemed to have expelled it into a bottle. The nurse had a severe headache, and I was sapped of energy. When I tried to do another admission workup that evening, my handwriting was small and cramped. I barely had the strength to drive home. After going to bed, I became nauseated and got up to go to the toilet. Then I suddenly started expelling fresh blood from both ends of my GI tract. I fell to the floor, unable to move. My wife called for a doctor and helped me into the car. When we arrived at the Emergency Room, my doctor admitted me to the ICU for the first of my 11 days in the hospital. The upper GI series showed an acute bleeding duodenal ulcer. I had been having periodic epigastric cramping for a number of months and was on too many committees, traveling to too many meetings while coping poorly with the peer objections to my work on the psychiatric ward. So I was a prime candidate for trouble. When I questioned the patient after my recovery, she claimed that what I had thought was an unpleasant alter-personality was really the spirit of a witch who had died in England in 1890. The patient claimed to be possessed by this witch. When I had angered the witch by trying to interfere in her activities, she became quite angry at me and struck back, aiming her attack at my already ulcerating duodenum. INTERPERSONAL PHENOMENA POLARITY IN THE HOSPITAL In my days of private practice, my hospital setting was a 14 bed ward in a general hospital, where I was a contracted by the patients to treat them. My primary loyalty was to the patient, not to the hospital or it's nursing staff. We did have an experienced psychiatrist hired by the hospital for that role. Naturally, there was a range of attitudes on the part of the nursing staff regarding my MPD patients. Some were skeptics who saw them as manipulating me unmercifully. Then there were those nurses who had themselves experienced psychic phenomena and could identify with some of the experiences these patients reported. They were similar to the patients in their mental mechanisms, but they had had healthy, loving parents and had been raised in stable homes. You might call them "healthy hysterics." They became the "good" nurses, while the skeptics became the "bad" nurses. The inner polarity of the multiples led them to polarize the nursing staff into these groups, with no tolerance for individualism. The problem was solved by the closing of the psychiatric ward due to financial difficulties. By that time, I was ready to leave town, and I took a job with a county mental health clinic. I hoped to avoid all such entanglements with troublesome multiples, but one of my first clinic patients became my Ph.D. thesis on the subject. She had to be hospitalized repeatedly on a private psychiatric ward that contracted with the Mental Health Service. Here again, the polarization occurred, since the two psychiatrists on the ward played into the "good-bad" dichotomy. One of the psychiatrists was very courteous with my multiple and accepted my diagnosis without argument. When he admitted her, we were able to cooperate and resolve problems amiably. But when his partner was on duty, that man called her insulting names, such as "just a manipulating hysteric," at which she rebelled, creating an alter-personality who actually thought I was him at the next office visit and tried to beat my brains in with a flower pot. For that reason, I never saw her without a bodyguard. I never could get him to act more professionally, as she just seemed to rub him the wrong way. The only solution was to hospitalize her in the medical ward of the old county hospital and treat her there myself. The trouble with that arrangement was that I already had a very busy clinic schedule and very little time was left over in my day for hospital rounds, too. PEER REVIEW When I was in private practice, the hospital peer review process required that the case of any psychiatric patient hospitalized for two weeks had to be reviewed by a committee of two psychiatrists and a psychologist. The purpose was to determine if plans for treatment were reasonable and were being carried out. The accuracy of diagnosis was not the basic reason for the review. Yet, when I presented the case of a multiple, the first issue usually debated was the accuracy of my diagnosis. The intensity of the discussion left little time for debate on the nature of the hospital treatment. The chairman of the Peer Review Committee had been an office associate of mine for two years, and he had made my life difficult. He did not like my multiple patients, and they did not like him. Now he was the Chairman of the Department of Psychiatry. After hearing reports of a few cases of MPD at peer review meetings, he appointed a special committee to review my work and report back to the department with recommendations. During the next ten months, I was subjected to various meetings in which I tried to explain what I was doing and what results I was getting. The committee reviewed no charts, interviewed no patients and talked to no ward nurses. The Chairman gave them his opinions, unsupported by any factual observations of either my diagnostic or therapeutic techniques. His opinion was that I was unorthodox and unethical, but I could never find out just what he considered to be orthodox or ethical in the diagnosis or treatment of MPD, since he never diagnosed or treated any patient with MPD. The committee finally recommended restriction of my hospital privileges, but the hospital medical director told them that would create a liability risk for the hospital. He knew I could sue the hospital for restraint of trade since they had no facts to support any actions against me. Fortunately for me, the department voted against any sanctions. In return, I agreed to admit MPD patients only on an emergency basis, which was the reason for most the admissions all along. FAMILY OF THE THERAPIST What happens to the therapist's family while the therapist is treating multiples? I know of one psychiatrist whose multiple patient called him every evening at home. Finally, he asked his teen age son to talk to her instead. After a year of these calls, the son went into a mental hospital acting like a multiple, and the psychiatrist and his wife were in continuous couple therapy to deal with the difficulties between them. My wife put up with many evenings when I would come home tired, depressed and sure I was being pushed around by everyone. Because of the constant demands these patients put on me and my attempts to do the "right thing" by making house calls and emergency room visits more frequently than other psychiatrists might have, she felt threatened and cheated, with good reason. Since most of these patients were women, she warned me that I was being manipulated more as a man then needed as a physician. In retrospect, she was right more often than I care to admit. SOCIAL PHENOMENA The mother of my second multiple was a nurse at the local medical center. Even though I had only good words to say about this lady, her guilt about possibly causing her daughter's illness was transformed into blaming me for making her daughter so sick. She conveniently forgot that it was she who referred her daughter to me after the young lady stuck a knitting needle all the way through her wrist in a suicide attempt. She told the doctors with whom she worked her complaints about my terrible treatment of her daughter, but one of the doctors was kind enough to tell me what she was saying about me to all who would listen. When her daughter eventually committed suicide, the mother urged the surviving husband, a severe alcoholic, to file a malpractice suit against me for wrongful death. His attorney told my attorney that he intended to try me on my reputation, not the merits of the case. My attorney reminded him that the case still had to have merits, regardless of the mother's view of my reputation. MALPRACTICE SUITS Psychiatrists generally have a low malpractice risk, and most of the time the reason for a suit is for the same sort of mishaps that occur to any patient in a hospital. I have been sued three times in my life, and all suits occurred during the same year. Two of the three suits were because of patients with MPD. Yet, in none of the three cases did the patient complain of the quality of my services. In the case just mentioned, the patient committed suicide because her alcoholic husband had left her after she had been hospitalized twice when new hostile alter-personalities took over her body. Another suit came about because an unlicensed psychologist brought a female multiple to me for hospitalization. She insisted that he continue to see her in the hospital, since she was in love with him. To get her into the hospital at all, I agreed to let him visit when I made rounds each day. I discovered that her core personality was a hidden three year old girl who, according to the ISH, could come out only if we could find her new mother and father figures to whom she could relate in today's world. The head nurse agreed to be the new mother figure. After much discussion, the "psychologist" was accepted by the ISH as a suitable father figure. He did alright only as long as I was present when he visited her, and she matured to the age of 19 before I considered her ready to go home to her husband and two children. Then the psychologist started shifting roles from father figure to therapist, and he was a terrible therapist. When he came to visit her in the evenings when I was not present, he told her she had to resume sexual relations with her husband as soon as she arrived home. But she did not feel she knew the husband well enough even to date him, since she had only met him there in the hospital. To obey her "father," she created a new personality who could have sex with her husband after discharge. The "psychologist" continued with such bad advice while treating her at home that she attempted suicide twice. She finally returned to my care in the hospital and made a complete fusion, without his help. After discharge, she filed a malpractice suit against the "psychologist" and won $30,000. He countersued me, claiming that I was an unfit supervisor of his therapy, when I was not his supervisor at all. He also filed suit for libel, claiming that I instigated the malpractice suit, which was not true. He kept the suits on file, with no hearings ever, for four years, before his attorney could convince him to drop it. Since I have been out of private practice, I have been consulted on three malpractice suits against psychiatrists by ex-patients who had MPD. All involved the violation of reasonable boundaries between therapist and patient, with alleged harm to the patients. There is much to be said on this subject, but I do not yet understand why it seems so easy for therapists of all persuasions to justify the novel relationships they get into with patients with MPD that they would avoid with any other patients. My best guess it that these patients, who can shift roles at the blink of an eye, expect us therapists to change roles just as fast. We try to accommodate, thinking that it is good for therapy to be flexible and adaptable. Since the patient has little sense of what is "proper behavior," they accept the therapist's bending the rules and feed into the therapist's need to be all things to all patients, at least in a solo private practice. In addition, the patient's telepathic abilities may make them more adept at knowing the therapist's emotional weaknesses and capitalizing on that knowledge. POSITIVE ASPECTS OF THE EXPERIENCE One of the positive aspects of treating multiples is the opportunity to come to interesting places away from home and meet therapists who have had equivalent experiences to mine and realize that everything I experienced could not have been iatrogenic. How could these other therapists, whom I never heard of, have such similar experiences with patients coming from their own localities? It has been reassuring to feel that we were sharing something that might really be true, whatever the word TRUE might mean. When I have been dealing in hypnotherapy with a multiple, I feel that I have to search in my mind, in whatever corner is necessary, to find just how to speak and act, so that my next move can be a positive one for the patient. It is seldom that I have read about or heard in a lecture just that particular action that is needed for this patient in this situation. When I venture to try something that I think I have just invented, and then find that these other therapists in other states have found the same action to be useful with their patients, it does give me added confidence. This then leads to the fun I have had learning about other scientific disciplines, especially the anthropology of healing processes. No one in medical school ever taught us about shamans and the history of shamanistic healing. But when I learned about them at the Anthropology of Consciousness meetings, I realized that I had been acting very much like a shaman of old, even to having my special tools which I took along on house calls. The most important difference was that I had not gone through the initiation rites required of a shaman nor the training by the senior shaman of the tribe. So where had I learned anything at all? It was certainly not from my peer psychiatrists who definitely thought I had several screws loose. What I did learn in hearing about shamans and spiritualistic healers of today was that they lived in constant contact with entities of the spirit dimension of life. I saw films of doctors in Brazil who did psychic surgery which they believed was really done by the spirit of Dr. Fritz, a dead surgeon from World War I. These surgeries were done without scalpels, anesthesia or antiseptics, yet wounds allegedly healed without infection. Even one of the American born investigators was initiated into being a shamanistic healer and was able to take into him a great healing spirit which worked healing ceremonies through his body for several years after he returned to the United States. Since he had not been born into the culture and therefore had not been conditioned to be a believer, how could it work, if only cultural belief is required? This awareness of help from above is mirrored in the creed of Alcoholics Anonymous, with the concept of giving up control over one's life to a higher power. In medicine, we are taught that the higher power is medical/scientific knowledge, and, that, if we know enough, we are powerful enough to do anything as a doctor. But that source of power wasn't there when I started dealing with multiples. Yet, when I really needed to know how to help a patient, the correct idea came to me. Where did the idea come from? In my case, one of my multiples identified my spirit teacher as an entity named Michael who stayed behind my left shoulder. The concept sounded farfetched, but I liked the idea of such a personal guru, so I began to mention Michael to other patients. The surprising thing was that they could see him, too, and respected his authority. The Inner Self Helpers of my patients referred to him as the entity to contact when they wanted me do something my ego objected to my doing. I have no idea yet why Michael might have such an interest in my being involved with people with MPD, but that seemed to be the right thing to do, so I did it. Since my childhood hobby was building model airplanes, my work with multiples gave me the chance to build people out of the dissociated parts into which they have broken. The creative urge I have to put together something new from raw materials, or at least partially finished parts, is satisfied in dealing with multiples in therapy. Since I take pride in my craftsmanship, I am happy to report that none of my successes has turned out badly in terms of social behavior. The most important benefit which I think being the therapist of a patient with MPD is that it provides each of us with the opportunity to follow the pathway for which we are destined. For some reason, this field has attracted many spiritually minded people. Really good people are the best therapists of multiples. I enjoy knowing them. Those therapists who are arrogant, egotistical, pig headed and obstinate are not long in charge of these patients. For this reason above all, I am both pleased and challenged to be here with you today, to rejoin those old friends of mine who have maintained the course and to meet the newcomers who have joined them in the last decade. Thank you for the opportunity to know all of you. 

  Copyright© 2021 - Ralph B. Allison