Gurney shares, therefore, with Janet and [Alfred] Binet, the credit of demonstrating the simultaneous existence of two different strata of consciousness, ignorant of each other, in the same person. The ‘extra-consciousness’, as one may call it, can be kept on tap, as it were, by the method of automatic writing. This discovery marks a new era in experimental psychology, and it is impossible to overrate its importance.
Another important forerunner (and colleague) of Freud, in the context of a history of hypnotism, was Josef Breuer. He elaborated Janet's view that hysteria was due to earlier traumatic experiences. In his work with one of his patients, known as Anna O. (real name Bertha von Pappenheim), he regressed her back to the start of her problems to achieve a cure. His assumption, clearly, was that early traumas, long repressed into the unconscious mind, could still have an effect on us today. The case of Anna O. was written up in Studies on Hysteria (1895), which was co-authored by Freud.
Multiple Personality Disorder
Let's go back to fugue for a moment. If this odd thing happens only once in a lifetime, it is called ‘fugue’. But what if it recurs? What if Bourne had not become Brown just once, but time and again, for longer and shorter periods, with exactly the same combination of amnesia and state-dependent memory? From late in the eighteenth century, psychologists began to note that the phenomenon of double consciousness could occur spontaneously and in what we would now call a more pathological form in which an individual could oscillate between a number of personalities, all of which have plausible and coherent lives, and none of which is seen as an intrusion in the sense that they all equally belong in the same body. Add to this state-dependent memory and amnesia, and you have the condition we now call MPD.
Oddly, there are no reported cases of MPD until after de Puységur's discovery of double consciousness. This might lead some to doubt the reality of the syndrome. But Adam Crabtree, a therapist and one of the better writers on human psychology, has some important remarks on this:
I believe that the discovery of magnetic sleep and the appearance of multiple personality disorder are directly related. It seems to me that in non-organic mental disturbance there are two elements: the disturbance itself and the phenomenological expression of that disturbance, the symptom language of the illness. The symptoms are a message to others telling them what is going on inside the individual. That is, the symptoms are the language of the inner disturbance. How clearly that inner disturbance will be expressed depends on the adequacy of the language available, and that in turn depends on what categories for understanding humans and the world are current in society.
Until the emergence of the alternate-consciousness paradigm the only category available to express the inner experience of an alien consciousness was possession, intrusion from the outside. With the rise of awareness of a second consciousness intrinsic to the human mind, a new symptom language became possible. Now the disordered person could express (and society could understand) the experience in a new way: it was the second consciousness acting at odds with the normal self.
This means that when Puységur discovered magnetic sleep, he contributed significantly to the form in which mental disturbance could manifest itself from then on. For he helped make possible a symptom language through which the experience of an interior alienation of consciousness could be expressed without resorting to the notion of intrusion from the outside – in other words, without experiencing that condition as possession.
In short, there were cases of MPD prior to the late eighteenth century, but they were not recognized as MPD: they were seen as possession by spirits.
MPD cases tend to be oddly similar, so I shall recount just one or two famous early ones. The first ever occurred in 1789, when Eberhard Gmelin in Stuttgart had a patient calling herself Caroline Brune who alternated between two personalities, one of whom spoke French and was more vivacious, while the other was German and more modest. The most famous early case is undoubtedly that of Mary Reynolds, a quiet, shy woman who in 1811, aged thirty-six, had a fit. When she came to herself, she found she was blind and deaf, and she remained that way for some weeks before recovering her senses. Later she fell into a comatose sleep, and when she woke up, after twenty hours, she had a quite different personality – vivacious, attractive, outgoing. But she was like a young child: she could not even speak, let alone remember people, things and skills. She had to learn everything all over again. Five weeks later she woke up one morning back in her original personality. She was very upset to discover what had been going on for the previous weeks, none of which she remembered. A few weeks later she again fell into a prolonged sleep and returned, on waking up, to Mary-2, the outgoing version, which she picked up where she had left it before in terms of language skills and so on. This switching to and fro between the two states went on until 1829, when she changed permanently to Mary-2 until her death in 1854.
One of the forefathers of MPD research was Pierre Janet. Two of his female hysterical patients – Lucie and Léonie – proved to have multiple personalities. In both cases, through hypnosis, Janet found that the original cause was a childhood shock. It was precisely this kind of work that enabled him to develop the concept of ‘subconscious fixed ideas’ and to show that they continue to exert an influence on conscious life too. Janet was the first to achieve cures by integrating the repressed memories into the consciousness of his patients. Just the mere voicing of these lost memories by patients can lead straight away to the cure of a symptom. Breuer's Anna O. (who was also, incidentally, a ‘multiple’, as MPD sufferers are colloquially called) could not drink water, until she remembered and described an occasion when she was shocked that a friend let her dog drink out of her glass; after that, she could drink again.
Janet, as we have seen, classified MPD as a form of hysteria, and it is true that MPD is often accompanied by some of the appalling ‘conversion symptoms’, such as bleeding, headaches, spasms, paralysis and local anaesthesias, which are one of the characteristics of hysteria. Louis Vivé (born in 1863) suffered from paralysis and lack of feeling on his right side, and found it difficult to speak; Félida X., the famous patient of Azam, suffered from hyperaesthesia of the skin, haemorrhages and poor circulation.
In a long and famous book, The Dissociation of a Personality (1905), Boston psychiatrist Morton Prince (1854–1929) described his work with a patient known by the pseudonym ‘Miss Beauchamp’. Prince, Boris Sidis (1867–1923) and William James were the main researchers keeping hypnosis alive in the States in the early years of the twentieth century. Christine Beauchamp (real name Clara Fowler) was a modest girl who was occasionally taken over by a mischievous personality whom she called ‘Sally’. Actually, Christine had four personalities in all: what Prince called B1, the person who came to his office with headaches and insomnia; B2 was simply B1 hypnotized; B3 was Sally, and B4 was a short-tempered personality. Although at first Prince decided to try to make B4 the dominant personality, effectively eliminating B1, he eventually chose to amalgamate B1 and B4, squeezing out B3-Sally. This process of amalgamation or integration has been the therapy of choice in all MPD cases since the time of Janet and Prince.
I should stress, before going any further, that MPD is rare. Only a few hundred cases have been documented, though there is anecdotal evidence of many more. It is only psychologists such as Eugene Bliss who are heavily committed to the existence of MPD who speculate that about 10 per cent of the population may be multiples. Most people, including professional psychologists involved in the field, would regard this as a huge exaggeration – and that is assuming that they believe in the reality of MPD in the first place.
Three Famous Recent Cases of MPD
The book that really brought MPD to people's awareness in modern times was The Three Faces of Eve, published in 1957. It tells the story of the psychiatric treatment, by two American doctors, of a woman known as ‘Eve White’. Her real name, Christine Sizemore, was revealed in the autobiographical sequel I'm Eve (1977), which also shows ho
w incomplete her earlier treatment had been, in the sense that nineteen more personalities had appeared since the end of her treatment. A further autobiographical sequel, A Mind of My Own, published in 1989, tells of her eventual triumph over MPD. Anyway, in The Three Faces of Eve she was a mousy, timid, conventional person who spontaneously manifested another personality, ‘Eve Black’, who was flirtatious, coarse and mischievous – exactly the same character differences as were exhibited by Caroline Brune, Mary Reynolds and Christine Beauchamp (and by a number of other MPD victims too). Prince had used hypnosis to bring Miss Beauchamp's other personalities into existence, but Eve Black did not appear through hypnosis, although hypnosis had already been used on Eve White in the course of the therapy, and it was subsequently used as an easy way to summon Eve Black. Later, Eve Black's appearances became so normal that hypnosis was no longer necessary to summon her. At a late stage of the therapy, a third personality appeared, called ‘Jane’, a mature, calm and intelligent person, who seemed to the therapists to offer hope for the future, if Jane could become the dominant personality. This in fact happened, and the new, more integrated person is called Evelyn White in the book.
Each personality had different handwriting, different brainwave patterns, different profiles arising from various psychological tests, but above all such different personalities, body languages, facial gestures and so on that it was easy for the therapists to tell which personality was in the room with them at any time. Eve White exhibited fugue states and state-dependent memory. She could remember nothing that Eve Black or Jane did, but Eve Black could remember what Eve White did, and Jane could remember all three states.
Speaking as a layman, I have some worries about this – and my worries coincide with those of a number of professional psychologists. My basic worry is that it's all too neat. Eve White had originally entered therapy with marital problems and inexplicable headaches. Once Eve Black has emerged, every misdemeanour, right back to childhood, is blamed by Eve White and her husband on Eve Black, leaving Eve White lily-white. But no one is so one-dimensional; everyone does wrong sometimes, or makes mistakes. It looks as though Ms White was simply objectifying a different side of her nature into a separate personality. The fugue condition is odd: it is this that really characterizes MPD. If it were not for the amnesia and the state-dependent memory, we would clearly be faced with no more than different sides of a person's character. But perhaps it is possible for someone to be so neurotic or hysterical, or so prone to fantasies, or under such stress, that she can reify separate sides of herself successfully enough to bring about such amnesia. It has been known at least since the time of Breuer that hysterical people perform a kind of self-hypnosis on themselves, in which they can (among other things) induce amnesia for certain events. And it isn't really surprising to find amnesia in connection with the kind of radical dissociation that characterizes MPD; after all, we have known about state-dependent memory for ages.
So perhaps MPD sufferers are no more than hysterics who have chosen to blank out some parts of their lives, which then seem to be the work of a different personality, resident in the same body. This is the kind of explanation I would prefer to full-fledged MPD. I remember a difficult interview I had with my father in my early teens, after he had found a confessional notebook I had written and had confronted me with some of the material from it. I just kept saying, as an implausible defence: ‘It wasn't me. Daddy, it wasn't me’, as if that would make it go away. Perhaps if I was a more neurotic type, and had kept this up, the ‘I’ that had misbehaved would have begun to seem a different personality.
Another worry about MPD is that too often the alternate personalities start to appear only after psychotherapy begins. If there were clear evidence in a number of well-documented cases that alternate personalities had been active in someone's life before therapy, that would be different; but such evidence is conspicuously lacking. I'm not suggesting that patients deceive their therapists, or that they are merely role-playing. With dry wit British psychologist Alan Gauld says, about Morton Prince's Miss Beauchamp: ‘The hypothesis of deceit … has therefore little to recommend it except the fact that it would make psychological science simpler if it were true.’ But I am suggesting that it is possible in the therapeutic situation for a hysterical or over-imaginative patient to objectify what are no more than sides of his character, and for therapists to encourage such objectification and to ignore the possibility of spontaneous self-hypnosis.
Perhaps better known than The Three Faces of Eve, and certainly better written, is Flora Rheta Schreiber's Sybil, which was also made into a successful film. But here things seem to get really out of hand. The protagonist, named ‘Sybil Dorsett’ in the book, is said to have no fewer than sixteen personalities before finally, as in the case of Eve's fourth, a seventeenth emerges to combine and reconcile the rest. The book contains dramatic descriptions of the fugue states between personalities, and the distress and isolation Sybil feels when this happens.
Or are things out of hand? If my complaint before about one-dimensionality has any force, then sixteen personalities add up to a more rounded human being. And remember that nineteen more personalities later appeared in Eve. Sybil just expresses more of herself than Eve originally did, on this sceptical hypothesis. Psychologists who believe in MPD talk of the secondary selves ‘depleting’ the primary personality – depriving it of emotions and motivations; but this is just another way of describing what common sense calls the one-dimensionality of each personality. Talk of ‘depletion’ is a redescription, not an explanation, as often happens when scientists try to explain away something bizarre. Consider this paragraph from Sybil in which the personality called ‘Mary’, a practical homebody, is explaining why she has to come out:
Well, Dr Wilbur, right now, it's a practical matter. You probably know that Sybil and Teddy Reeves – a friend from Whittier Hall – have just taken an apartment together on Morningside Drive. You know what a new apartment involves. At 8:45 yesterday morning I had to come out to receive the workmen who are putting in new windows. I had to come out again at 7:15 p.m. because I didn't want Sybil to put up the new drapes. I feel it's up to me to keep the home going.
Surely it makes sense to think of ‘Mary’ simply as a projection of Sybil's practical self. Those who are committed to the reality of MPD talk of the ‘autonomy’ of the separate personalities, by which they mean that ‘Mary’, for instance, can function in the world just as well as Sybil could. But when I am exhibiting the generous side of my nature, I am functioning in the world just as well as when I am exhibiting the mean side. If my scepticism is right, Sybil and her kind are merely suffering from a severe case of dissociation.
Dissociation may be defined as a division of consciousness into two or more simultaneous streams of mental activity, especially when one of these streams influences experiences, thought and action outside phenomenal awareness and voluntary control. It's quite easy to explain the concept of dissociation, because most readers will have experienced it. When you're a little bit drunk, in the state we call ‘being less inhibited’, what you've done, in effect, is given another side of your character permission to come out and play. This is a mild form of dissociation. When you're stoned on marijuana, it's even easier to see that this is a dissociated state, because one of the effects of the drug is a certain clarity of observation of oneself. When you're extremely drunk, you can enter the quasi-amnesic condition in which (perhaps thankfully) you don't remember the next morning what you did. In this case, the dissociation is far more extreme, but no one thinks that a drunk is an MPD sufferer. Or again, many children have an imaginary playmate: this is a case of quite extreme dissociation. Such a playmate may even speak in a different voice and be heard, as if externally, by the child. I suggest that Sybil and her kind choose at some point to fragment themselves so thoroughly that they experience a combination of amnesia and objectification of sides of their character.
Although it's not clear from The Three Faces of Eve
what originally made Eve retreat into MPD, in the subsequent I'm Eve Christine explains how it was early shocks relating to violent death that caused her first dissociations. In Sybil's case it was the awful, cruel and sexually perverse tortures inflicted on her by a schizophrenic mother, and the terrors of the rigid fundamentalism with which she was brought up. Recent studies of MPD have been closely connected with the scare, especially in the States, over childhood sexual abuse, since many apparent multiples reported such abuse as the source of the amnesia and the consequent separation of personalities. I take it that this scare has now been more or less laid to rest. It was a form of mass hysteria, compounded by confabulation between therapists and patients. Of course, incest and sexual abuse of children occur, and may even be more common than we like to think; but at the height of the scare it seemed as though some 50 per cent of people had been abused, and that is too much.
Sybil gradually learnt to recover the other personalities’ memories for herself, and to integrate a more complete human being, a new Sybil. Hypnosis was not used at first, but the breakthrough came using a drug, sodium pentothal, which was administered for many months. When Sybil showed signs of becoming dependent on the drug, it was withdrawn, and hypnosis was used instead. In the first place, because some of the personalities were stuck in childhood, it was used to progress them all to the same age, Sybil's age, to aid integration. Then it was used to visualize integration and make it real. But none of this was instantaneous; it took several more years (Sybil had 2,354 sessions with her analyst in all, spread over eleven years). As integration began to happen, hypnosis was used only for the purposes of analysis – to bring about temporary dissociation of the separate selves to enable the therapist to communicate with them. Finally, hypnosis was used to check that Sybil could recall everything the other selves recalled. There were no gaps: Sybil was integrated.
Hidden Depths: The Story of Hypnosis Page 36