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About Dr. Allison

                    FROM ALTER-PERSONALITIES
                     Ralph B. Allison, M.D.
          Prepared for the Annual Fall Meeting of the
      International Society for the Study of Dissociation
                      Seattle, Washington
                        Nov. 14-17, 1998

     In 1972, I met "Janette,"the first patient of mine in whom I diagnosed Multiple Personality
Disorder (MPD) correctly. She also taught me that the human mind has two parts, when her Inner
Self Helper (ISH) called me on the phone to introduce herself to me. I interviewed her alter-
personalities (alters), but did not complete her psychological integration. One reason was that I
did not know how to do appropriate therapy for a dissociator, and the other reason was that she
moved out of state.
     In 1973, I met "Carrie," the second patient in whom I diagnosed MPD, this time
incorrectly. In retrospect, what I took to be an angry alter who wanted to kill her and me was
really an Internalized Imaginary Companion (IIC). I then met at least 10 other IICs whom I
thought were alters. Carrie did make one real alter, however, in my office when I told her that her
diagnosis was MPD. This alter was formed due to her inability to cope with the diagnosis I had
made. She therefore met my present criteria for Dissociative Identity Disorder (DID), but not
     Carrie also left town, and most of her IICs disappeared without treatment. But when she
returned to my town, she impulsively married a chronic alcoholic man. She soon fought with him
and created a new angry IIC which tried to kill me and her husband. I sent her to a hospital, but
she was soon released. The following day, she committed suicide after learning that her husband
had deserted her.
     Such was my introduction to the problem of the difficult and important responsibility of
therapists of dissociating patients to learn to tell the difference between alters and IICs. This
problem of differentiation was emphasized even more when I was asked to evaluate one of the
Los Angeles Hillside Stranglers, Kenneth Bianchi. The debate over whether he had MPD or was
faking his presentation of other "personalities" involved some of the most noted names in our
profession and continues to this date. Since he did not act like my patients with MPD, I took a
middle ground in the debate. Now I believe that all the "personalities" he showed us examiners
were IICs. Instead of either suffering from MPD or faking mental illness, he had a third condition
which superficially looked like MPD, but which was created by "emotional imagination," not

     Dissociation: The word "dissociation" has come to be used as an explanation for many
psychic symptoms which have nothing to do with that process. I prefer a very conservative
definition. The word comes from the Latin "dis" for "not," and "sociare" for "to join." Dissociate
is defined as "to separate from association or union with another."  Therefore it is the breaking in
two of something that was one before external trauma was applied to it. 
     To apply this term to psychopathology, we must first realize that the human mind consists
of two parts which are bonded together at birth in all human children. Unfortunately, the
European languages, including English, do not have root words for these two parts, making
discussion of the concept difficult. In Japanese, they are called the Risei and Kanjou. Plato, in
about 300 B.C.E., called them the Rational Soul and the Irrational Soul. The ISH in Janette, who
had MPD, was what Plato would have called her Rational Soul. In patients with MPD, I call these
"parts" the ISH and the Original Personality. In integrated persons, I call them the Intellectual Self
and the Emotional Self.
     Multiple Personality Disorder (MPD): There are several conditions which must be met
before a child can develop MPD, by my definition. First, she must be Grade V hypnotizable, one
of the top 4% of the population. Only these persons can dissociate adequately to create true
alters, regardless of the stimuli. A child who is not Grade V hypnotizable, if exposed to the other
factors, will create some other type of psychopathology.
     Second, she must be subjected to life threatening physical and/or sexual abuse before the
age of seven. Since children of this age are usually cared for by parents, the abuser will usually be
a parent. Parental punishment which angers the young child is not enough. The child must actually
fear death will result from the threatened and applied punishment. The seventh birthday is the
approximate age when dissociation of the Intellectual Self from the Emotional Self is no longer
possible as the bonding of the maturing integrated mind is solid enough to withstand any
psychological trauma.
     Third, she must view her parents in a polarized fashion. She sees one as the abuser and the
other one as the potential rescuer. However the parents keep switching roles, so she is sure that
neither one will actually rescue her from the other one.
     Forth, if there are siblings, she is the only one of the children so severely abused. The
other children are treated normally, or at least not punished with the severity and intensity applied
to this one child. This child has a symbolic meaning to the abuser which does not exist for the
     In the case of MPD, by my definition, the first dissociation is between the two parts of the
mind, the "Intellectual Self" and the "Emotional Self." When the child is subjected to a life
threatening trauma, her Intellectual Self breaks away from her Emotional Self for survival
purposes. Her Emotional Self is sent into a safe place away from the body and brain, while her
Intellectual self becomes the ISH and starts manufacturing alters. These alters are made from
"personality parts" that her Emotional Self would have taken unto itself over the future years of
growth and development. The first alter the ISH makes is a False Front alter which is designed to
be sufficiently submissive to the abusive parent to avoid getting murdered.
     An example of a "pure" case of MPD, by my definition, is Christina Peters, coauthor of
"Tell Me Who I Am Before I Die." Her qualifications for this diagnosis are explained in my paper
called, "Multiple Personality Disorder, Dissociative Identity Disorder and Internalized Imaginary
Companions,"submitted to Hypnos in 1998.
     Dissociative Identity Disorder (DID): DID, by my definition, does not start until after the
age of seven, so there is no dissociation of the Intellectual Self from the Emotional Self.
Therefore, there is no ISH. The patient is in the upper 50% of the hypnotizability range, in Grade
III to V. The Intellectual Self creates the first alter as a result of a traumatic situation which is too
complex for the Emotional Self to handle at that age. However, it need not be life threatening. 
     A typical example would be the rape of a nine year old girl by her 13 year old cousin. In
that case, she would make an alter who could handle sex and enjoy it. She would also deal with
men by trying to humiliate them as her cousin had humiliated her. The alter would be a prostitute
who controlled her "Johns"in the process of sexual interaction. Such an alter is designed to
protect the immature girl who had no social training in how to cope with such a trauma. The
therapeutic need is for the Emotional Self to learn how to handle similar difficulties, which
requires social training in coping methods. Once she decided to handle this type of problem
herself, instead of handing responsibility over to her alter, the alter will fade and eventually
atrophy from disuse.
     Carrie was an example of DID by my definition. She did not make any alters until the age
of 22 when I saw her for treatment. Then I mistakenly told her she had MPD. She could not cope
with that diagnosis and created one alter to handle that type of stress. This alter then met Janette,
whom she considered her "mother." She considered me both her "father" and her obstetrician,
since I had created and delivered her. Fortunately she was the suicide preventer, until the last day
of Carrie's life. 
     Imagination: The word "imagination" comes from the Latin word "imago" for "image."
Imagination is "the act or power to form a mental image of something not present to the senses or
never before wholly perceived in reality." Thus, while dissociation is a posttraumatic process of
breaking in two that which was originally one, imagination is the creation of something that did
not exist before.
     Since imagination is a function of the human mind, it is reasonable to look at the type of
imagination each of the two parts of the mind utilizes. The Intellectual Self uses "inspirational
imagination" while the Emotional Self uses "emotional imagination." Inspirational imagination is
what is behind great works of art and literature, and it brings into play much data which is not
ordinarily available to the common man. This process brings out the best in each human who uses
     However, when strong negative emotions are ruling the Emotional Self, it uses "emotional
imagination" to deal with those emotions. Desire for revenge is the usual reason for a person
using emotional imagination to create a dangerous Internalized Imaginary Companion. In killers I
have evaluated for murder trials, they commonly were not in personal lethal physical danger, but
someone they loved was. They wanted revenge on the abuser of their loved ones, and they
imagined into existence killing machines. These murderous IICs took over their bodies sometimes
and eventually killed people other than the original villains, innocent victims. 
     In my review of the psychological literature, it appears to be an assumption of those who
write about Imaginary Companions or Playmates that all such entities only exist outside of the
bodies of the persons who created them. That is just not true. My own patients, who made such
imaginary creatures, have described to me how they could move them to wherever they want
them to reside. They made them, and they could control what they do and where they do it. They
can place one outside themselves, in a doll, or inside their own body, depending on their wishes.
     The first dissociation is separation of the Intellectual Self from the Emotional Self. The
Emotional Self is sent off into hiding, where it is stripped of all personality traits. The Intellectual
Self takes on the role of ISH, who then must make alters. The ISH creates all alters from
personality traits which are compatible with that child, traits she would have eventually developed
over time. Therefore, they are all traits which can eventually be integrated successfully into the
Emotional Self at a later date.
     The ISH creates the alters as if writing a computer program which is designed to do a
certain list of tasks which are needed at the time. It can only do what it was programmed to do,
nothing more. It is not capable of growing and developing indefinitely, as is the Emotional Self.
The first alter needed to run the body is a False Front alter, one passive enough not to get killed
by the abusing parent. Each False Front alter is capable of being "the child" for a short time, and
then it must be replaced by a new False Front alter which is designed to handle the next phase of
     Since the False Front alter cannot be programmed to become angry because of continued
abuse, the anger developed by such abuse must be placed into another alter, which is called the
Persecutor alter. This one strikes back in antisocial ways, and the ISH then has to manufacture a
Rescuer alter to deal with the social consequences of this misbehavior. Other alters might be
Handicapped ones and those made by Identification with other children. Therefore, there will be a
large number of alters of different types, plus the ISH. 
     The original personality, a.k.a. the Emotional Self, is absent during youth and young
adulthood, only appearing when the therapist has succeeded in ridding the Persecutor alters of
their anger. Only then is it safe for the Emotional Self to take onto itself all of the alters, absorbing
their personality traits into itself.

     When the Emotional Self faces a problem she is not mature enough to handle, the
Intellectual Self then makes an alter who can handle that problem. This alter is designed to be
activated when certain ideas and/or emotions are triggered in the Emotional Self. Then the alter
comes forth to deal with the problem. The older the patient gets, the less suitable are the solutions
the alter provides, so the behavior becomes less and less adequate for the real needs of the patient.
The patient needs to learn from peers how to deal with those issues she has been avoiding by
letting her alter come forth and "solve" for her.
     Imaginary Creations are ubiquitous among children and are not a sign of psychopathology.
They are willingly made by the Emotional Self of the child to deal with a wide variety of social
and personal needs. The ones that have caused a major social problem for us clinicians are those
who have ended up in court cases, usually for murder. Management of their creators' anger and
need for revenge has been the major reason for their existence. One confusing factor is that this
anger is often in response to what is retrospectively considered child abuse, so abuse has been
considered all that is needed for making these "personalities." But this has not been life
threatening abuse. But nonlethal abuse can and does lead to intense anger against the abuser.
What does the child do with that anger? He imagines into existence a "hitman" who can maim or
kill his abuser. That is the simple answer for a child who has not yet been socialized into following
the rules of society in such matters. 
     There is no lower age limit for such use of emotional imagination in children, if the need is
there, and the creative ability is high. Henry Hawksworth described how he made his IIC
"Johnnie" between his first and second birthdays, to take the blame for all the misdeeds his father
accused him of doing as an baby boy. When the demand was there, the ability to respond was
there. Henry later developed MPD, at the age of four, so he also was Grade V hypnotizable. Only
when he thought his father was going to kill him did he dissociate and create true alters as well.
Possibly his high hypnotizability aided him in his early use of his imagination. This combination of
Grade V hypnotizability combined with frequent and early use of emotional imagination makes for
a very confusing clinical picture in abused children.
     Many other reasons have existed in children who make IICs, such as loneliness, hurt
feelings, fright, and irritation. There is no limit to the reasons which children around the world
have used for creating IICs. What adults have failed to realize is that IICs are easy to make, and
they are equally easy to destroy by an act of will. To decide to get rid of them, the child needs to
realize that the benefit of keeping them is now less than the cost. When the child realizes that, the
child can tell them to disappear, and the IICs are no longer in existence. There is no need to use
therapy aimed at "integration" since IICs are not made of personality traits which should be
integrated into the Emotional Self. They are made of newly imagined-into-existence traits which
are not "natural" to the child. Whatever they are made of is totally disposable.
     Age: Alters are at least the age which the child was when they were first made. They may
have grown a few years, but they are usually younger than the chronological age of the adult
     IICs may be any age, older or younger than the patient, and they may change age they
think they are during different presentations.  One time an IIC will claim to be three, another time
seven, another time 14. There is no real age identity for an IIC.
     Appearance inside the mind to the ISH and alters: An ISH or a helper alter will report
that, inside the mind, an alter will appear definite, with strong colors, appearing like a person, or a
swirl of colors, with firm ideas and strong opinions. They will know it is like themselves, and they
will generally know it's name.
     When an ISH or an alter reports seeing an IIC, they describe it as wispy, ill defined,
colorless, with no substance. It may be described as being all emotion, such as "nothing but
anger." They know it is not one of them, and they imply that it can be removed without harm to
the entire organism.
     Inside or outside the patient: The patient with MPD or DID will hear an alter only inside
her head. It is either a friend or foe of the patient. It is stable over time and acts as originally
programmed each time it appears.
     An IIC can be heard by the patient either inside or outside her head. It may be placed in a
doll or other object. It can change from friend to foe and back again, as it is modifiable at the will
of the patient. Its status and activities may change over time, as the patient modifies it to do
different duties as changes in lifestyle occur. It has no definite predictable way to act all the time.
     Appearance to the therapist: Alters are protectors of the child/patient. Some are angry,
others are more appeasers, but all are striving to keep the child alive and operating in a stressful
environment. They are usually human, but I have seen one rabbit alter, created to run faster than a
human, to escape being shot by her father. The rabbit alter transformed into a little girl alter prior
to integration, however.  Alters' complaints focus on the original abusers and those who mimic
them in today's world. On initial interviews, the False Front alter generally does not know of the
existence of the other alters, so she will not offer to introduce them to interviewers on demand.
An alter may pop out unexpectedly and uninvited during an early interview, when the ISH decides
to send it out to let the therapist know what is going on inside the patient's mind.
     An IIC is not necessarily a protector of the entire organism and may have a destructive
agenda. It may be angry at people present in the room who have done nothing deserving of such
hostility. Imaginary Companions outside the body can be of pets, as well as in human form. Those
in the body might claim to be demonic evil spirits, if made by a person indoctrinated in a religion
supportive of such views. In one-shot interviews, such as forensic examinations in jail, one IIC
may readily produce all the other IICs on demand for each examiner. Instead of denial of their
existence, there is a proud presentation of all IIC who are there. There may be reports of odd
relationships between IICs, such as one IIC being a teacher of the Kabbalah to another IIC.
     Control: In the case of MPD, each alter is ultimately under the control of the ISH. The
ISH can recall an alter from duty if it refuses to do what it should do, or if it becomes a harmful
one instead of a helper. The ISH will not stop acting out of a Persecutor alter, but it will prevent
it from doing any self destructive act.
     A dangerous IIC may be out of control of either the Intellectual Self or the Emotional
Self. It is similar to the military "smart bomb," which is packed with a lot of explosives but is
guided only by a TV camera and simple on-board computer towards a preselected target. An IIC
designed for revenge will be filled with a lot of anger and very little thinking as to where that
anger should be targeted. The target is anyone who remotely resembles someone who has hurt
them or their family. Not even that similarity is needed if the social setting resembles one in which
the person became furious as a child. The IIC's aim is fixed on the selected present target, and no
social judgment or calm deliberation is possible once the person allows the IIC control of his
physical body. It will strike out where the creating person has emotionally decided it is to strike
out, regardless of the social or legal consequences. 

     Alters in MPD: Careful hypnotherapy with angry alters is needed for integration of all
alters into the Original Personality. The alters do not get destroyed, since they were made up of
character traits which would fit the Original Personality. Also, their memories must become hers
over time, for full integration to occur. When integration is pending, alters frequently complain
that they are going to be "killed," and they resist that end result. They can be reasonably reassured
that they will continue to exist in another form, as a part of the final personality.
     Alters in DID: Since alters produced after age seven have been created to deal with
specific difficult situations, the patient needs to learn how to deal with those particular situations
on her own. When that is accomplished, the alter will fade as it integrates, as it no longer has a
useful function. There is not likely to be any drastic change, just a maturing of the patient's
personality and a sense that the alter is no longer necessary or desirable. Again, there is no need to
get into a debate about the alter dying or being sent away. The alter knows what is going to
happen and accepts its final fate of gradual disappearance. It has waited all this time for the "other
one" to grow up so it doesn't have to protect her anymore.
     IICs: Since each IIC was created by an act of will of the patient's Emotional Self, it can be
destroyed by an act of will of the Emotional Self. How the therapist leads the patient to that
decision and action depends on the individual situation. In cases where the IIC was needed as a
legal defense, once the trial is over and the patient incarcerated for life, the IIC usually disappears.
It is no longer needed for presentation at trial, and it can be a marked handicapped in getting
along with other prison inmates. 
     One man I saw first in court and then on death row still had two of his three IICs
operating in prison, while one had disappeared. One still operating was the "killer" IIC who now
dealt drugs on Death Row. The other was the "snitch" IIC who now conferred with his defense
attorney on his appeal. Both were needed for survival in that prison environment. The "rescuer"
IIC had disappeared, since he now had nothing to do. The primary person (Emotional Self) was
friendly to all the guards, a useful behavior he enjoyed playing.
     IICs which claim to be spirits of dead people have appeared in mediums since time
immemorial. They have often been sent "to where you belong" by directing them to "look to the
light and go to the light." This is logical for them, as they appear to be "lost" and need to be sent
"home." However, this can only be done if they no longer serve a need for the host person. If they
are asked to leave before the host person, the medium, wants them to go, then they will object
and cannot be persuaded to leave.
     Exorcisms have been used for centuries in all religions for dealing with invading spirits,
which is one version of IICs. This is not foolproof, and is not to be done by the unenlightened or
foolhardy. In psychiatry, it is a sure way to be roundly criticized as "unscientific," even if it works.
However, there may be circumstances where such is appropriate. If the patient has MPD and the
ISH tells the therapist that the psychic entity is "nothing but anger,"this is acknowledgment that it
is an IIC, and there is no good reason to keep it around. If the therapist feels comfortable saying a
brief statement which orders the IIC to go away in the name of the appropriate religious leader,
depending on the religion of the patient, then it will most likely disappear. Its energy will be
recycled by the ISH. It is always necessary to make sure that all intellectual and emotional issues
which caused the patient to make the IIC in the first place have been settled before taking any
such action to get rid of it.
     Since it is better to prevent the creation of an IIC than to have to get rid of it later, the
therapist can simply tell the patient to stop making them. One lady with MPD made up several
IICs each night just to annoy her husband. When I got tired of dealing with them in the office
every week, I told her to "shut off the Barbie Doll factory." She got the message and stopped
making them on a nightly basis. We then could go back to therapy of her MPD.
     Alters are made by the Intellectual Self, either dissociated and acting as an ISH, as in
MPD, or still bonded with an immature Emotional Self, as in DID. Alters are programmed to
operate in a protective fashion for the benefit of the entire person, and they can only grow to the
degree their "program" permits. They are made up of personality traits which will eventually fit
properly into the Original Personality or Emotional Self. Therefore, when rid of anger against
abusing individuals, they are suitable for integration into the Emotional Self of the dissociated
     IICs are newly created imaginary entities, made by an act of will of the Emotional Self by
the use of Emotional Imagination. When they are made of a large amount of hostile emotions
from the Emotional Self, with a small amount of thought, they may be aimed at certain human
targets who have little in common with any earlier abusers. They operate without the social
judgment of either the Emotional Self or the Intellectual Self and can be highly dangerous to
others. All IICs are created by an act of will of the Emotional Self and can be destroyed by an act
of will of the Emotional Self. What motives the Emotional Self is a completely individual matter.

  Copyright© 2023 - Ralph B. Allison