Bad Men Do What Good Men Dream: A Forensic Psychiatrist Illuminates the Darker Side of Human Behavior

by Robert I. Simon

  At the trial, the prosecutor requested that Jennifer take Franny’s place on the stand. Once again the eyes closed, and a few moments later Jennifer appeared and waved to the jury. She, too, was sworn in. Jennifer testified in a high-pitched voice that Peterson had driven her to a park and “poked a hole in me with this thing…. I put my arms around him and said it was nice. Mark [then] said, ‘Time to pull out. I don’t want you pregnant.’” The prosecutor asked Jennifer if she knew what “pregnant” meant. She replied, “Yes. A guy puts his finger on your belly button, and a baby comes out.”

  “Emily” was summoned. The 6-year-old personality testified that she was “peeking” and saw Peterson “wiggling his butt” as he lay on top of Jennifer. Leslie, a jokester personality, wanted to tell the court a joke but suppressed the urge when reminded of the seriousness of the proceedings. Leslie—also sworn in separately, as Emily had been— told the court that she had found semen in Jennifer’s shorts later on during the morning after the sexual intercourse.

  Franny, recalled to the stand, described how she had become angry when Emily and Jennifer had told her what had occurred: “I trusted that man, and he did harm to the body,” Franny said. When they told Sarah, she had begun to shake.

  Further testimony came from Sarah’s downstairs neighbors, a couple who had been with her on the day that the Franny personality had met Mark Peterson. The couple had explained to Peterson that Franny’s real name was Sarah and that Sarah suffered from a mental illness. Peterson had nonetheless asked her out to dinner, and when she declined, he had obtained her phone number by other means. Two days later, at an early hour in the morning, Peterson had shown up at Franny’s door and asked her out for coffee. She had accepted. At that point, the husband of the neighbor couple had again reminded Peterson of Sarah’s vulnerability and her mental illness. Mark and Sarah went off for coffee and all that followed.

  The neighbor also testified that he had been present when Sarah was being told by Franny and Emily about the sexual intercourse with Peterson. It was after this that Sarah had become outraged and reported the incident to the police, who had taken her to the hospital, where she was examined for signs of rape. After deliberation, the jury found Mark Peterson guilty of second-degree sexual assault. Jurors disagreed as to whether the woman had M PD. However, in the police report signed by Mr. Peterson, his admission that he knew of other personalities led to his conviction. On appeal, a circuit judge ordered a new trial. The district attorney decided not to put the woman through a second trial that could cause her condition to deteriorate.

  Multiple Personality Disorder: A Primer

  People with classic M PD generally have two or more fully developed personalities, although sometimes they may have only one completely developed personality and other fragments or personality states. These personalities each contain unique memories, patterns of behavior, and ways of relating to other people. Some of the various personalities may not know of the others’ existence. Very few people with M PD have only two personalities. Most have between 6 and 12. In recently reported cases, about half have more than 10 personalities. A few have 50 to 100. Doubtful claims of hundreds, even more than a thousand alternate personalities have been made by some persons.

  The transition from one personality to another is spontaneous. Usually it takes place within a few seconds, as with Sarah, but it can happen gradually, over hours or days. Staring, rapid blinking, and changes in the patient’s usual facial appearance may accompany the transition. Stress or psychologically meaningful cues in the environment often trigger the switching of personalities. Transitions also occur when conflicts break out between personalities or in response to a plan previously agreed to by the various personalities. Hypnosis or drug-assisted interviews can facilitate personality switching.

  When MPD patients seek help, the personality that presents for treatment usually has little or no knowledge of the others. The various personalities may be friends, companions, or enemies. They may be aware of each other, or not. Whatever the style, only one personality at a time interacts with the outside world, though others may be listening in and possibly influencing what is happening. Six-year-old Emily, for example, testified that she had been “peeking” as Sarah was raped. Each personality may report being of a different age, race, gender, or from a different family than the others, and behave according to those differences. Emily, clearly a 6-year-old, had the sexual awareness of a young child, not that of the adult in whose body she was housed.

  Some M PD patients may recognize that they have lost periods of time, develop amnesia about these times, or are subject to confusion for brief or even extended periods. These patients typically report awakening in strange places. Someone whom they met as one personality may hail them as a friend when another personality is in charge. The latter will be baffled by someone who seems to be a complete stranger. Some personalities who are unaware of losing time subconsciously fill in amnesic gaps with fabricated memories (confabulation), or have access to the memories of the other personalities, which they report as if these were their own. If asked about the memory lapses, some M PD patients will admit them, but very few will openly volunteer such information, fearful of being viewed as “crazy” or of being called a liar.

  Individual personalities of MPD patients may be quite different from each other in behavior, beliefs, styles of problem solving, and responses to perceived or real attacks. A quiet, “old maid” personality may alternate with a promiscuous, loud, brassy, bar-hopping, devil-maycare personality. A childlike personality may flee in terror from an attacker, whereas another personality might passively submit to the same attacker, or a third might launch a vicious counterattack. One of my male MPD patients with a dozen personalities found eight different books lying around his house, all being read at one time. The topics varied greatly, from science, weight lifting, cooking, art, comics, cars, and baseball to Zen Buddhism, none of which interested him in the least.

  Several of the personalities may function reasonably well in the patient’s workplace or in interactions with other people. These “functional” personalities may alternate with others that function poorly or that even appear to have a specific mental disorder. Among the more common disorders represented in these patients are mood disorder, anxiety disorder, and the maladaptive personality traits that indicate personality disorder. When such disordered personalities are present, it is often difficult for the therapist to determine whether each of these is a separate psychiatric disorder or if they are just different facets of one patient’s M PD. Sarah, for instance, was receiving medications for severe anxiety and depression, even though some of her personalities were neither anxious nor depressed.

  The personalities may be so different that the eyeglass prescription for one may not fit another of the patient’s personalities, probably reflecting different stress levels. Similarly, the different personalities in one body may have different responses to the same medication, different brain wave patterns, IQ scores, and handwriting. Distinct differences also exist in preferences for foods, friends, types of entertainment, and other interests.

  The personalities are sometimes aware of one another and may talk with one another. Sarah had heard voices “babbling” in her head since she had been 4 years old. Other M PD patients wake up at night and hear multiple-party conversations going on inside their heads. Usually, if someone reports conversations with dissociated parts of themselves, these may be taken as indicators of a psychotic state. Not so for M PD patients. They are not considered to be psychotic. Their dissociated experiences are different from the delusional and hallucinatory experiences reported by people with other mental disorders, such as schizophrenia. Particularly in forensic settings, reports of dissociated conversations often contribute to the misdiagnosis of M PD patients as malingering psychopaths or schizophrenics. The confusion is made more likely because many of the behaviors observed or reported seem psychotic or seem to be evidence of severe lying: amnesia, the use of differ
ent names, reports of finding surprising things in one’s possession, self-mutilation, and suicide attempts. These behaviors make more sense when seen as part of an M PD patient’s illness but are often mistaken as symptoms of other disorders.

  Most of the personalities are given distinct proper names, usually different from the person’s first name and often from the last name as well. The name is usually announced to the person the first time the personality “comes out” and may reflect the kind of abuse that the personality has experienced, or the sort of function it performs. “Floozie” may be the name given to a disavowed immoral, sexual personality, whereas “Abigail” may denote a morally strict, priggish personality. Some personalities do not have a proper name and are called strictly by their function: “protector,” “organizer,” or “executioner.” Personalities are organized by the function they serve for the person. There are usually two camps: protective personalities and destructive personalities. When the destructive personalities take control, they may engage in self-mutilation, attempt to complete (or actually succeed in completing) suicide, abuse children, or commit assault, rape, or even murder. Destructive personalities harbor anger, guilt, and hatred that they direct at the host personality. “Ginger,” one of Sarah’s personalities, was an alcoholic who drank and drove, an activity surely intent on “harming the body.” Sarah’s male personality, known as “Shadow,” took on the pain of her childhood and was rageful and violent. At times, he lacerated Sarah’s arms by crashing them through windows. “Patty” and “Justin,” also destructive personalities of Sarah’s, would put out cigarettes in her hands. For most of us, our minds are occupied by one person. As much empathy as we can muster for another person, we cannot experience his or her feelings. But M PD patients feel like they are experiencing someone else’s feelings when in contact with an alternate personality. It would be very disconcerting to have a number of persons inhabiting our minds as do MPD patients—particularly persons who hate us.

  It is when destructive personalities erupt into the real world that persons with MPD may commit violent crimes. More women than men have MPD, but incarcerated males have a higher incidence of MPD than is generally reported in the psychiatric literature. Males with M PD appear to be at a greater risk for external violence than do females with M PD.

  The murderous rage and hatred that is often manifested by the destructive personalities is directly traceable to the extraordinary physical and sexual abuse that most people with MPD have experienced in their childhoods. Some of the destructive alternate personalities repeat the hatred, assault, and rape that the MPD patient experienced in childhood. Often, the heinous crimes they commit are directly reflective of the abuse they themselves once received. The protector personalities are also formed in reaction to this child abuse. They protect the host by encapsulating painful memories and thereby permit the host personality to function in society.

  In fact, many MPD patients are quite functional, hold down responsible jobs, maintain stable relationships, and find some enjoyment in life. But, all too often, the more disturbed among MPD patients live in chaos, the result of various alternative personalities, many of them destructive, taking over the host personality and plunging it into disaster characterized by frequent hospitalizations, attempted suicides, and, rarely, terrifying crimes.

  Sowing the Winds of Child Abuse

  In 97% of cases of M PD, psychiatrists have found that the patients experienced severe child abuse before they had reached age 6 or 7. Usually after the age of 7, children develop psychological means of managing traumatic experiences other than by dissociation.

  Before going into the specifics of the M PD sufferer’s abuse, I want to stress the magnitude and seriousness of the problem of child abuse in general. In the United States and elsewhere in the world, the staggering statistics of child abuse are exposing the darkest side of humankind. In 2005, 3.3 million referrals alleging 6 million cases of child maltreatment were reported to child protective services agencies. Neglect was the most common form of child maltreatment. Of the 6 million cases, 63% were classified as neglect; 17% physical abuse; 9% sexual abuse; and 7% emotional maltreatment. Because of the underreporting of child abuse, the actual number of child maltreatment cases is much higher.

  This rate reflects only the reported cases; many more instances of child abuse go unreported. Some experts believe that the actual rate of abuse is at least twice as high and that 3 million cases annually represents only the tip of the iceberg. For example, 10% to 15% of all “childhood accident” cases treated in emergency rooms are actually the direct result of physical abuse. Although estimates vary, in 1993 the National Committee for Prevention of Child Abuse reported 1,299 confirmed child deaths from mistreatment that ran the gamut from neglect to physical injury and sexual abuse. Some experts put the actual death toll at 5,000 a year. These fatalities result from the following causes: abuse, 55%; neglect, 40%; and both, 5%. Much violence is curtailed by societal restraints. However, when the front door closes at home, violence may break out within the family. For many abused children, home is the most dangerous place to be. Children may unwittingly precipitate violence by just being children, or they may stir up latent problems and violence in the parents. Often the messenger is harmed.

  The country has been slow to awaken to the horrors of child abuse. However, the death of 6-year-old Lisa Steinberg at the hands of her adoptive parents became indelibly etched in the minds of Americans. As millions of spectators watched on television, Hedda Nussbaum accused her common-law husband, disbarred lawyer and cocaine addict Joel Steinberg, of striking Lisa with fatal blows. Pounded into unconsciousness, Lisa was left lying on the floor of the couple’s middle-class, Greenwich Village apartment for 12 hours. While Steinberg went out to dinner, she remained unconscious, with water and undigested food from a recent meal oozing out of the side of her mouth. Nussbaum was unable to find the psychological strength to do anything about the situation. When Steinberg returned, Nussbaum informed him that Lisa could not be revived. Steinberg insisted that he and Hedda freebase cocaine before calling for help. Steinberg reportedly tortured Lisa and Hedda Nussbaum for years. In court, Steinberg received a sentence of 8 to 25 years for manslaughter. The charges against Nussbaum were dropped as the result of a successful battered-woman syndrome defense. Steinberg was released in June 2004 after serving 17 years of his sentence.

  Then there was Susan Smith, who drowned her children by strapping them into safety seats in her car and driving it into a lake. She first received national attention by reporting that a passing carjacker had abducted the children. Smith went on television, tearfully begged for the return of the children. She showed home videos of them and herself, looking for all the world like a devoted mother gamboling on the floor with her two happy toddlers. Friends described her as a loving mother. Later, she confessed to killing the children. She let it be known that because she was severely depressed she had intended to kill herself along with them, but at the last minute had changed her mind and let the children go alone to their watery deaths. She received a life sentence for the murder of her two sons. During the trial, the dark underside of a small southern town was exposed—the lies, the adultery, the incest, and the human failures.

  There is little in the psychiatric literature or in the experience of most forensic psychiatrists to indicate that mothers kill their children in a cold-hearted, calculating manner. Most often, the killings are formed in a state of fear, panic, dissociation, depression, or psychosis. Susan Smith was sexually abused as an adolescent, but it is unlikely that she would have developed MPD at that age. Instead, she had a history of deep depression and had attempted suicide twice as a teenager. No psychiatric diagnosis can explain everything about this unfathomable human tragedy. Perhaps F. Scott Fitzgerald came closest to the truth about such situations in The Crack-Up: “In a real dark night of the soul, it is always three o’clock in the morning.” Every parent, except for the few saints among us, has now and then caught a terrifyin
g glimpse of that darkness.

  Incestuous abuse accounts for a large proportion of all child abuse. Its true dimensions are unknown, but by extrapolating from a 1986 landmark study—itself skewed toward underreporting—an estimated 60,000 per million, or 6%, of women in the United States may have been abused by close blood relatives (including stepparents) before they reached the age of 18. In 75% of cases, the incest abuse victim is a daughter and the perpetrator is her father. Therefore, as many as 45,000 per million women may have been incestuously exploited by their own fathers.

  Male incest survivors have been underestimated, and, until recently, their plight has been denied and ignored. One such survivor was Dr. Richard Berendzen, who made national headlines when he resigned as president of American University in Washington, D.C., after having been caught making bizarre, obscene phone calls to women about having sex with children. His own sexual abuse at the hands of his mother was later described in his book, Come Here: A Man Overcomes the Tragic Aftermath of Childhood Sexual Abuse. At least 20% of sexual abuse against boys is directly perpetrated by women. It has been estimated that approximately 5% of women are pedophiles; that is, they have sexual desires directed toward children. Other perpetrators include babysitters, mentally disturbed mothers, mothers who enable men to abuse their sons, teachers, mentors, neighbors, and family friends.

  Almost all parents at one time or another experience angry or violent feelings toward their children, but most do not act them out in an abusive manner. Similarly, some parents experience sexual feelings toward their children. Many do not act them out. Others do. Child abuse, more than any other destructive act, reflects the theme and title of this book: that bad men (and women) do what good men (and women) only (occasionally) dream.