from Psychotherapy Review, 1994

     People suffering from multiple personality disorder (MPD) are of great interest to mental health professionals, to the public, to writers and to the media. That a person could have more than one personality is at once mystical and frightening. It calls up the notion of demonic possession, of a dybbuk requiring exorcism.

     Current day psychiatric thinking holds that MPD is one of the dissociative disorders. During an experience of intolerable stress, a person dissociates, or “spaces out,” in order to remove her/himself from a situation of unbearable helplessness and pain. Call it self-hypnosis or endorphin release, the process serves as a psychological defense mechanism. Later, as painful memories begin to emerge into consciousness, the unconscious mind tries to cope by dissociating again. In time, the process becomes habitual and automatic.

     At the far end of the spectrum of dissociative disorders lies MPD. This disorder usually occurs in people who, as children, suffered the most sadistic and repeated abuse, terrorized and tortured physically and sexually. The victim develops “alters” or other personae, each of whom has a different voice, inflection, posture, and handwriting. Sometimes the alter can be of a different sex or age. Each of these alters represents a different aspect of the person’s feelings, wishes, or impulses. One alter may be angry, gruff, and foul-mouthed. Another may be quiet, sucking her thumb, speaking in the hungry voice of a little girl. Another may be bent on suicide.

     Often people with MPD do not seek treatment for the MPD itself, but rather for depression, or difficulty in interpersonal relationships. During the course of treatment, different alters make themselves known.

     The goals of treatment vary from person to person. In most cases, the basic goals of treatment are no different than in any other illness. The first step is to establish trust, to find out what the patient is looking for, and to address those issues together. Basic problems such as present day anxiety, depression, and poor self-esteem must be addressed first. The defense of multiple personalities is a primitive one, and speaks to the severe nature of the abuse suffered, and the limited capacity of the ego to endure painful memories and the affect that goes with them. When a patient has lost control and is not able to take responsibility for him/herself, the therapist must work towards helping the patient to re-establish control. Often, this means helping to suppress painful memories and feelings, rather than eliciting them, as we have been trained to do in other circumstances.

     The ultimate goal, with regard to the MPD, is to help the patient to integrate the various alters into one, to recognize that each alter represents one aspect of him/herself, and to be able to tolerate a mixture of powerful conflicted feelings and thoughts. This takes patience, time and perseverance. Treatment may require several years, and both patient and therapist should be prepared for the long haul.

     Some have advocated the use of hypnosis or hypnotherapy as an adjunct to the treatment of MPD. Sometimes this treatment can be regressive, helping to bring out more and more personalities, bringing about an intensification of symptoms. Since hypnosis involves a state of heightened suggestibility, it is important to be aware of the danger of suggesting and implanting memories of events that we presume must have happened. How many people with MPD have developed a history of involvement with cults and animal or human sacrifice, either from reading books about MPD, or from the questions and suggestions of their therapists?

     Therapists must be aware of the fascination that MPD holds for us all. It is thrilling to “uncover” another personality, to unveil another memory that had been repressed for years. We must be certain that we are operating for the good of our patients, monitoring our own wishes to watch them perform.

     There is one intervention in MPD that I think is destructive and regressive in nature. When we address the various alters by name, when we call them forth, when we ask the patient to call them forth, we reinforce the notion that each one is a different and real person, a demon that has infested the body of our patient. Patients need help in tolerating the various aspects of their personalities that have been split off into these alters. We should not deter our patients from expressing themselves through the mechanism of multiple personalities, but neither should we should encourage this regressive mechanism by addressing our patients by multiple names. We should help our patients to realize that there is only one “you.”