The idea that sadistic childhood abuse could lead to multiple personality disorder has seized the public imagination, but could it be a diagnostic fad?
At the height of her illness, Carol had dozens of different personalities. Two were small children: Lucy, aged 9, and “little Carol”, aged 5, who liked to watch children’s television.
Another was an older female called Louise who had recovered disturbing memories: when younger, Carol/Louise had been sexually abused by her parents and forced to make child pornography. Then there was a more aggressive persona, who acted as Carol’s protector and during questioning would fly into a rage.
While Carol’s case sounds like an extreme example of multiple personality disorder (MPD), the reality, as Carol eventually discovered, is even stranger.
None of those details are true. Not the pornography, not the sexual abuse, and not the different personalities; they had all been summoned into existence by Carol’s psychiatrist. “This doctor [was] very charismatic and manipulative,” says Carol.
If Carol’s case were isolated, it might be put down to a vulnerable patient encountering a misguided doctor. Yet Carol is not alone. Sceptics about MPD, including myself, say that many, perhaps the vast majority, of such diagnoses are fantasy – arising from risky techniques that can plant ideas in people’s heads.
The debate has raged for many years but in the US the tide of opinion is turning against the validity of MPD. Yet in the UK there is a campaign for more awareness of the condition, and for treatment to become more widely available. As an investigative journalist who has written on this subject for many years, I am now doing a PhD on MPD and related controversies, and it is emerging that some UK therapists seem unaware of MPD’s fall from grace across the Atlantic. “The higher levels of acceptance of this dubious diagnosis in the UK are very worrying,” says Chris French, a psychologist and false memory researcher at Goldsmiths, University of London. “There is a sizeable minority of therapists here who buy into ideas that are not supported by the evidence.”
If one thing is responsible for doctors’ and the public’s enthusiasm for MPD, then it is Sybil, a book published in 1973. Billed as the true story of a woman with 16 personalities, Sybil was later made into a highly watchable film starring Sally Field. The movie was, by some estimates, seen by a fifth of the US population.
Sybil spread the idea that childhood abuse could trigger the development of multiple personalities. Abused children imagined that these awful events were happening to someone else, so the theory ran, prompting an alter ego to grow in isolation behind a wall of amnesia. Some would create a new “alter” with each incidence of abuse. All the while, the child’s original personality would have no memory of the trauma.
These alters would only emerge during therapy in adulthood: given enough therapy, the personalities might even reintegrate into a single unified personality.
The number of reported cases of MPD began to grow. In 1980, the diagnosis entered the most important textbook for US psychiatrists, the Diagnostic and Statistical Manual of Mental Disorders (DSM). It was classified as an extreme form of a more common (and less controversial) symptom, dissociation. People who dissociate feel detached from reality and may have spells of amnesia. Between 1980 and 1998, there were 40,000 reported cases of MPD in the US alone. That compares with fewer than 200 cases ever reported worldwide before Sybil appeared.
Over time the nature of MPD became more and more bizarre. The number of personalities harboured by each patient grew, from an average of two per person, hovering for a while at 16 – Sybil’s tally – then swelling to 100 or more. These could include personalities of the opposite sex, animals – in one case a lobster.
Right from the beginning there were doubts raised about the validity of MPD. For a start, this condition was entwined with another highly contentious idea – the theory that we can repress memories of traumatic events, which would emerge during therapy.
As sceptics are fond of pointing out, this idea contradicts most people’s everyday experience, that unpleasant events lead to especially vivid memories, not repressed ones. Sceptics say that, far from being recovered, these memories are false, created by ill-advised therapy techniques. These include asking leading questions and encouraging clients to imagine specific events happening, often while hypnotised or taking barbiturate drugs.
One of the strongest planks of evidence against the validity of recovered memories is work led by Elizabeth Loftus, a psychologist at the University of California, Irvine. Her team has shown that those techniques can create false childhood memories.
Impossible Bugs Bunny
Famously, Loftus got people to believe that they had met Bugs Bunny at Disneyland – impossible, since Bugs is a Warner Brothers character, not a Disney one. Loftus estimates that about a third of people would be susceptible to forming such false memories.
Loftus’s studies can be set against a broader backdrop of neuroscience work that explains why our memories can be fallible. Every time we recall a past event, its encoding in our neuronal synapses becomes malleable, and thus potentially subject to change.
In other words, if you vaguely remember an uncomfortable night camping as a child, and someone asks you to imagine that abuse took place that night, some people could form such a memory. Especially if the person asking is a trusted therapist, who convinces you that your troubles have all the hallmarks of childhood abuse – and the only route to recovery is to start remembering it. “That’s one way it could happen,” says Loftus. “The therapist might say ’80 per cent of people with your symptoms have been abused.'”
Similarly, MPD sceptics say that the different personalities are a fiction created during therapy. Not all of us would succumb to such a process, of course, but a minority of people would be vulnerable, particularly those with a propensity to fantasise.
As the patient buys into the idea, they start to blame any mood swings or difficult character traits on their other personalities. “When people exhibit the symptoms of MPD, the question is how do they get that way?” says Loftus, who has given evidence about false memories in dozens of court cases. “I don’t think I have ever seen a case caused by childhood trauma. I have seen plenty of cases caused by the medical provider.”
As well as suggestive questioning, people were also influenced by what they heard about MPD in newspapers and on television, says Steven Jay Lynn, a psychologist at Binghamton University in New York, and co-editor of Science and Pseudoscience in Clinical Psychology. “Public belief was amplified by a global multimedia industry,” says Lynn.
The recovered-memory movement took a stranger turn in the 1980s, when some therapists started reporting that their clients had been victims of organised cults carrying out satanic worship, baby sacrifice and cannibalism. What followed were campaigns – almost literally witch-hunts – against parents or childcare providers accused of satanic child abuse in the US, UK and many other countries.
Some people even claim to have recovered memories of time in the womb, past lives and meeting aliens. “If you believe in the validity of recovered-memory techniques, then you should believe in alien abductions,” says Chris French. “It’s the same techniques used.”
Carol’s psychiatrist was one such believer. Carol began therapy after suffering from stress as a single mother studying at university while holding down two jobs.
Carol mentioned to her college psychologist that, when under pressure she would “switch to autopilot” to keep going. The therapist took this as a symptom of dissociation and urged her to see a colleague who specialised in MPD.
Indeed, this psychiatrist diagnosed Carol with MPD at her first session. And so began years of therapy, which led to Carol accepting some fantastical notions – all endorsed by her doctor – that not only had she been abused by her parents but also that they were part of a satanic cult, and that she had been abducted by aliens.
Unsurprisingly, Carol’s mental health did not improve. She became estranged from her parents and suffered nightmares. “I complained that I was getting worse and I was told that in MPD therapy you always get worse before you get better,” she says.
After several years, Carol rebelled. “I told him I didn’t want to continue MPD therapy because it was making me sick,” she says.
It was thanks to an episode of Sesame Street that Carol realised that what she had previously taken to be manifestations of her different personalities were, in fact, just different moods. “That day the topic presented by Grover and Kermit was feelings,” she recalls. “The puppets would describe a feeling and then explain to viewers how they felt and show how a feeling made them look.”
It was a light-bulb moment. Carol realised that a person could have a different feeling without changing to a different personality. “I remembered that I never had to switch personalities when I felt a different feeling before I started therapy.”
Carol stopped acting like she had different personalities. She eventually realised her “recovered” memories were also made up, aided by a group called the False Memory Syndrome Foundation, based in Philadelphia. Formed to support families wrongly accused of abuse, the foundation had been contacted by 6000 families within two years.
Carol eventually tried to sue her doctor for malpractice, but after various delays, her case was ruled to be out of time. For that reason Carol’s real name and other identifying details have been changed in this article.
There are many former MPD patients who have been successful in the courts, however. In fact it was the growing tide of litigation against “pro-MPD” therapists that prompted the decline of this diagnosis in the late 1990s.
The first groundbreaking case involved Minnesota psychiatrist Diane Humenansky, who had diagnosed a patient with MPD caused by childhood sexual abuse. The patient received over $2 million after the jury concluded that the memories were false.
Other successful lawsuits followed. A case against Chicago psychiatrist Bennett Braun, involving a patient with 300 personalities, was settled for a record-breaking $10.6 million. “The risk of legal liability effectively shut down most hospital MPD clinics,” says Chris Barden, a psychologist and lawyer who organised many of the malpractice suits.
Some of the main advocates of recovered-memory therapy and MPD had their licences to practise medicine revoked or restricted. The backlash is also evident in the sharp drop in medical research into MPD. “Most of the MPD nonsense came to a crashing halt,” says Barden.
While MPD remains in the psychiatrists’ textbooks – now given the name dissociative identity disorder (DID) – its star is on the wane. Eminent psychiatrist Allen Frances, for instance, who oversaw the fourth edition of theDSM, now says the surge in MPD diagnoses in the 1980s was an “illusory fad”. In a book he co-wrote with a colleague, he said: “We do not deny altogether the existence of DID… together we have seen three genuine cases in 45 collective years of practice.”
In 2006, 83 psychologists and memory researchers put their name to an “amicus brief” – a summary of impartial expert opinion submitted during a court case, testifying against the idea of MPD. “We all agreed that the entire notions of repressed memories and MPD are pernicious myths,” says Barden, who was the author and one of the signatories.
There were also questions raised over Sybil. According to the 2011 book Sybil Exposed, the patient concerned was a disturbed individual, exploited by a therapist and journalist who were both in pursuit of publicity.
Yet in less-litigious Europe, MPD remains more of a respectable diagnosis. It is as if news of the backlash has not yet crossed the Atlantic. “We were behind when these cases were on the increase in the US and now we are behind in the decline,” says Chris French.
Last year, for instance, UK and Dutch researchers published a brain-scanning study of 11 people supposed to have MPD. While lying in a PET scanner, the patients were asked to discuss a traumatic experience that only one of their personalities was aware of, while in that identity. Next, while they were in a different personality, they were “reminded” of the upsetting events. There was more brain activity in the first personality than in the second one who was supposed to be unaware of the events. This did not happen to the same extent with a control group of people who were asked to simply imagine that they had different personalities. The authors said their experiment showed that MPD was real.
Sceptics are far from convinced. “Individuals [with MPD] have shaped their identities and memories over years,” says Scott Lilienfeld, a psychologist at Emory University in Atlanta. “These memories are deeply entrenched and sincerely held.”
A recent survey of over 300 UK therapists found more than a third said they had had a client with MPD. A similar number thought claims of satanic abuse were usually accurate. This is despite the fact that numerous police inquiries found no evidence for satanic abuse, and it is now widely accepted as a myth.
Despite the many successful court cases, there remain overlapping networks of believers in MPD, recovered memories and satanic abuse – a mixture of therapists, “victims” and conspiracy theorists, who publish books, run websites and meet up at conferences. In March, for instance, the “Campaign for the Inclusion and Recognition of Dissociation and Multiplicity” held its second national meeting in London, attended by about 200 people. Their aims include having MPD more widely recognised, and for long-term treatment to be funded by the UK’s National Health Service.
Could this happen? “Let’s hope that, just as the UK followed the US in accepting the MPD diagnosis in the first place, it will now follow the US in rejecting it,” says French.
(Article written by Rosie Waterhouse, who is a journalist in London and is doing a PhD on myths about MPD and satanic ritual abuse, under the supervision of Chris French, at Goldsmiths, University of London. This article first appeared in New Scientist, issue 2936).