I can tell that rejection would actually be easier for some of the personalities to handle than my sincerely and willingly responding to their needs. When I cuddle or comfort little Missy, she cringes as though expecting punishment for her expression of need. Both Renee and Joan Frances have given me obviously parent-inspired warnings that “you don’t know what you’re getting yourself into” by responding to the personalities’ needs. The Jo personality refuses to acknowledge openly that she has any needs whatsoever.
I find that the pathology, dependency, need, and fear of rejection all make far more sense than talk of malingering or manipulation if one accepts the diagnosis of Multiple Personality Disorder. That is a very large “if” for my colleagues! Their uncertainty is making me take stock of my own psyche and of my professional intuitions as well.
I’m so sure of the diagnosis during the sessions. The transformations are undeniable. I usually see at least Renee and Jo during each appointment, and I can tell when a personality switch is occurring. There’s always a pause, a lowering of eyelids. Then Renee comes in a flash—bright, gay, and immediately oriented. Jo comes slowly, seeming dazed, fuzzy, almost drugged—not sure of where she is or how much time she has lost. Sometimes the transformation period, which lasts no more than half a minute, brings yet someone else. Those same eyes, so pleading and full of pain in Jo, so twinkling and merry in Renee, grow cold and full of contempt. This is Joan Frances, who despises herself for her “playacting” and who hates me for “allowing it to continue.” Renee has at least tacitly given up her description of this all as “a game,” but Joan Frances seems wedded to the idea.
I even see physical differences among them. Renee’s hands seem delicate and long-fingered, and then turn rough and spatulate when Jo has control. The whole body seems to shrink when Missy is out. I can’t deny that I’m both intrigued and overwhelmed by this patient. Treating Jo is a challenge that I haven’t known in twenty years of clinical work. Despite the skepticism around the office, I’m pleased to have the chance to work with a disorder that is apparently so rare.
Treating a multiple raises so many new questions for me. The legal and ethical tenets of confidentiality, for example, usually so straightforward, now have me stumped. I’d never repeat what a patient told me to some other patient, but I am not sure how this applies to information that is offered by one personality.
Should I keep Missy’s secrets as though she were alone in her body? I would certainly keep my promise to a personality if I had verbally assured her that I would not tell something to another personality, but otherwise I think that it is up to me to decide what to share. Missy’s secrets are important for Jo, Joan Frances, and Renee to hear. I am sharing them with Jo because I think that Jo needs to confront the fact that she was most probably a victim of child abuse. So far, Missy seems unaware of or unconcerned about my talks with Jo. If Missy reacts in a negative way to my sharing her secrets, I will re-evaluate the situation.
The lack of support I feel among my colleagues makes me unwilling to talk with them about this case. In what is probably a far greater breach of confidentiality, I have been taking my own uncertainty and excitement home.
Since we’ve been married, Gordon and I have shared many clinical experiences. At his inner-city high school, Gordon has worked with his share of abused and dysfunctional children, and he has been the object of misplaced hostility. He says that Jo (in all of her various personalities) acts and reacts much like his abused students. Gordon has answered the phone when the personalities call and has learned to distinguish the different voices and vocal mannerisms. His willingness to accept the reality of the disorder—even hearing most of it second-hand—and his insight from twenty years of teaching make him a very valuable colleague and confidant. Unlike my discussions at the office, I can talk out my dilemmas with him without his stopping to ask me if I am sure she is multiple.
I honestly care about Ms. Casey and want her to be well. I know that she will take more time, energy, and commitment than my other patients, but I’m willing to do what is needed. It feels very good to know that I’ll have Gordon’s caring for me and his empathy for Jo to support me through the process.
—
WHO IS THIS LYNN WILSON and what is she trying to prove?
Two months into treatment. I thought that by now Lynn would be sick of me, but instead she seemed more and more accommodating. Lynn gave each personality her home phone number and bought an answering machine so she’d know if anyone tried to reach her.
I figured that one of the reasons she was so willing to schedule extra time was that money was not an issue. Lynn worked for the university-hospital outpatient clinic on salary. She didn’t depend on her patients’ fees, as did therapists in private practice. My student health-insurance plan paid for psychotherapy as long as I used the university clinic.
I liked that Lynn liked me, and she had convinced me that the “voices” had minds and experiences of their own.
“Jo,” for example, told Lynn that she had always felt out of place but had never suspected that she might have a problem that could be fixed. Now that she had the diagnosis to explain her sense of reality, she sorted some of the chaotic jumble of thoughts and memories.
“I’d feel funny having ‘daydreamed’ my way through whole seasons,” Jo said, “but then I’d hear someone say, ‘Time flies,’ or ‘How did it get to be three o’clock already?’ and I’d think that everyone was like me.
“But I guess I never quite convinced myself, because I’m so afraid of people. It’s like I’m carrying around this huge secret that I’m never supposed to tell. But since I don’t remember just what I’m supposed to keep secret, I’m afraid I’ll tell it by mistake.”
“Oh, sweetie, you’ve got a potful of secrets,” Lynn said. “Missy’s just now beginning to tell me some of them.”
“Don’t say that name,” Jo said. “It makes me feel stupid for you to talk about ‘Missy’ as though it were some other person. I don’t want to hear what I say in my sleep.”
During the sessions, Lynn recognized when Missy appeared and told her that it was safe to talk to her there. Missy refused to speak. But when Lynn got out of her chair and sat down on the rug and said, “Come on, sweetie, you can sit with me,” she eagerly scrambled from her chair into Lynn’s arms. She felt lulled by Lynn’s warmth, her rocking, and her gentle voice.
“It’s your hand,” she whispered one night to Lynn on the phone.
“What about your hand, sweetie?” Lynn asked.
“It’s bad. Bad hand.”
“No, Missy, your hands are good hands,” Lynn said, “I like to hold your hands when you sit with me in my office.”
“Bad hand,” Missy insisted. “Sister Mary said so. ‘Right hand right, left hand bad.’ ”
Missy had not been allowed to use her naturally dominant left hand. The nuns who taught her slapped her hand with a ruler or made her sit on it when they found her holding a crayon or pencil with her left hand.
“Mommy says you’re bad. Daddy says you’re bad. Daddy says you’re stupid. Mommy says you’re lazy.”
“You’re a very good girl,” Lynn reassured Missy. “I want you to come see me at my office, and you can color with whatever hand you like.”
At peace after such conversations, Missy slipped back inside, and Jo often “woke up” clutching the telephone, hearing Lynn’s comforting voice through the receiver.
“I’m sorry that I bothered you,” Jo said, “but I didn’t know that I called you tonight. I’m sorry.”
“Don’t worry about it, Jo,” Lynn said. “You didn’t call me. Missy did. Everything’s OK. We’ll talk about it next time we’re together.”
Back in the office, Lynn said, “Missy acts like an abused child.”
“But that’s not true,” Jo said, “I couldn’t have been abused.”
“Just how do you know, Jo, that your parents never abused you?” Lynn asked.
“That’s simple,” Jo said
. “I don’t remember my mother or father ever being mean to me.”
Jo stopped, struck by a new understanding. “You know, I don’t have any preschool memories of being alone with my mother.” Now that she thought about it, that was strange. Although both her parents had worked full-time since she was three, she had very early memories of being with her father, and no memories of being alone with her mother. She remembered babysitters, but not her mother.
Jo dismissed her new insight. Her father wouldn’t let her be hurt. Jo did recall that one time when she was three or four her father had asked how she had gotten a new bruise on her leg. Mother’s explanation seemed reasonable even now: “Joan Frances is a very clumsy child.”
Jo knew she had to be utterly truthful, even when her version of the truth conflicted with what Lynn wanted to hear. Truth was vital to Jo, because she had a hard enough time keeping track of the spotty reality she experienced. Jo realized that she wasn’t clear enough about what really happened ever to be a convincing liar.
Jo tried to think about her suspicion that Lynn liked her. She figured that Lynn was nice to her because she was a patient. Jo’s mother had shown her what it meant to have a professional mask. The times Jo saw her mother at work in the lab, busy and efficient as she drew blood and marked vials, Nancy smiled warmly at the patients, ready with a sympathetic comment. If a patient or a doctor called Nancy at home, she immediately became the caring professional, no matter what had been happening before the phone rang. When Lynn hung up after an evening phone call from Missy, Jo suspected that Lynn resumed screaming at her husband or kids.
Lynn told Jo that she honestly cared about her, but Jo couldn’t trust that. Her parents had said that they cared, but they didn’t seem to like her much. She figured that they had to care for her. They didn’t have a choice.
Other people seemed to care about her for short periods—some teachers in high school, Keith—but they had all gone away, no matter how much Jo had come to depend on them.
Jo supposed she was lonely, but her aloneness was an integral part of her life. She sometimes wondered what it would be like to have a friend, to feel intimate connection with another person.
Jo understood that Lynn’s concern, genuine or not, was a precious but temporary gift. She continually apologized for all the phone calls she didn’t remember making. Lynn said that she wouldn’t let Jo interfere in a way that would lead to rejection. “It would be bad for both of us, Jo, if I let you take more than I have to give. Don’t worry. I can take care of myself.”
Jo reacted to Lynn’s assurances with humiliation. “Of course you take care of yourself,” Jo said. “You protect yourself so that I don’t intrude. I know that you need to protect yourself from me. But I feel so bad, so guilty, when you remind me of that—as though I could presume to be important enough to intrude.”
While Jo worried that her dependency on the therapist would lead to Lynn’s rejection, the Joan Frances personality worried that that same dependency would lead to her mother’s abandonment.
Joan Frances knew that her mother would not approve of her seeing Lynn, but, no matter how strongly she made the resolution to stop therapy, she found herself sitting in Lynn’s office or leaving the building after a vaguely remembered appointment session. Joan Frances pleaded with Lynn to help her. “Please make me better before my mother tells me that I must stop seeing you. Please make me a better person so that she will love me.”
DIARY May 8, 1981
It is clear that the various personalities I am seeing are quite different from one another.
The physical changes are startling. I have come to know Missy, Jo, Renee, and Joan Frances well and am no longer surprised by the move from one personality to another. In fact, I experience each of them as different from the others in the same way as my other patients are different from one another. Although they share the same body, they are not the same and do not wear the body in the same way. It may be more accurate to say that the various personalities share the same physical space in a serial manner.
Their descriptions of their parents have virtually nothing in common. Renee even denies that they are her parents. She doesn’t claim different parents. She doesn’t claim any at all, saying that she is “a creation of this entity alone.”
Jo worshipped her father and describes him as wise, gentle, and loving. His only flaw she claims as her own biological problem—she was resigned to never completely pleasing him because she turned out to be his daughter instead of his son.
Jo pities her mother for not being as “rational” as she describes herself and her father but denies that Nancy could have abused her.
Joan Frances says her mother is perfect, someone she models herself after. She is tortured because she is disobeying her mother by seeing me. Nancy reportedly told her daughter the other day, “For Mother’s Day, I want a happy girl who realizes how lucky she is.” Since Mother’s Day is a couple days away, it would take a miracle to deliver that present. And so the pressure and guilt continue to grow. But Joan Frances’s regular calls home make me sure that Nancy offers limited support and acceptance, as well as her dose of unrealistic expectations.
Her father, Joan Frances said, was “a cold, insensitive bastard who made life hell for my mother.”
Missy sees Daddy as a refuge from her terrifying mother. She remembers long hours sitting in a place she calls “The Dark” until it was time for Daddy to come home. I’m not yet sure if Missy purposely hid there or if she was placed there.
My guess right now is that both parents offered a mixture of good parenting and abuse. I think that Nancy and Ray Casey were both very troubled themselves.
7.
DIARY May 25, 1981
I don’t expect to have a fully verified story of how Jo’s disorder developed, but I don’t think that historical accuracy is as important as what I call “emotional truth.” People attach different levels of significance to the same events. No two participants in any event remember it in exactly the same way. A single broken promise, for example, among thousands of promises kept, might not be remembered by a parent, but may never be forgotten by the child who was disappointed.
So, when the Jo or Joan Frances personality says that an event remembered by another personality could not possibly have happened, I temper that need to deny by saying that what is recalled has significant “emotional truth” for the one who remembers. What’s important is not the verifiability of the memory, but the significance of the memory to the teller.
But even with the amnesia and denial that accompany Multiple Personality Disorder, I’m amazed by the completeness of some memories of early childhood. I think now that the multiple mind must be a receptacle lacking the normal filters that allow for true repression. What one personality represses, another personality stores completely. The memories have sight, sound, texture. They are vivid in the retelling.
So, verifiable or not, I’ve been able to piece together a family history. Bits of family lore were duly recorded by Renee and by the Reagan and Robin personalities (two personalities who seem to exist solely to provide a storehouse for relevant information that was overheard in early childhood).
Reagan introduced herself one day with a calm “Perhaps I can be of assistance” when I was pushing Jo for some childhood memory. She said that she and Robin have always been around to “listen but not get in anyone’s way.”
Through these personalities, and through Missy’s sharing of “secrets,” I’ve come to make sense of the family background. There has been no reactive behavior, no abreaction of trauma, accompanying the retelling of this information. I suppose that’s because Renee, Reagan, and Robin do not consider themselves members of the biological family. They have resisted all my attempts to make them see that they might have had some involvement in the early-childhood experiences.
Missy doesn’t seem particularly troubled by the memories she shares with me either. I think she has been waiting for a long time to tell s
omeone her secrets. And the other personalities are now allowing her to talk with me freely in the office. Missy has shared some memories from infancy and has even reported remembering the first split in personality—when, as she says, “the other girls came.” She reports that this split occurred before she was a year old.
Missy apparently sensed (or someone else in the group told her) that I was incredulous that she could remember back so far. She explained these prelanguage memories to me by making an analogy with voice recordings on tape or phonograph records. “Things that happen and what people say make scratches on your mind,” Missy said. “You don’t know yet what the marks mean, but they’re there anyway. And then, one day, you know what sounds and things mean. You can talk and know what words are. Then you can play back what happened before, and now you know what happened.” Her aplomb makes it clear that she’s satisfied with her explanation.
I’m not really concerned about whether or not Missy’s explanation fits with theories of child language development or of memory. I suspect that few if any accepted theories of human potential adequately describe multiple personalities. I’m sure that her memories hold a great deal of “emotional truth.” I am convinced that the seeds of this disorder were there long before my patient’s birth.
If I write the narrative as it has been presented to me, it might help me understand what I think I know about Jo’s beginnings. It’s important that I keep in mind, both for me and for Jo, that what’s important is that this is the scenario believed by my patient. Exact truth—who felt what, who did what to whom—matters less than how the personalities react to these beliefs.
Raymond Casey was born at home in a small manufacturing town outside of Syracuse, New York, in January 1925. A sickly baby, the last of twelve children, he spent the first months of his life coddled by his older sisters.
The family was not poor by the town’s standards. As Ray later told his children, there was always “food on the table and love in the house.” The strict Irish-Catholic traditions were ingrained by Ray’s immigrant parents and by the shadow of the church, towering next door to the Casey home. Ray’s father worked in the town’s garment factory, as did Ray’s older brothers.
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