The PsychMinder

Her name was not Sybil; nor was it Ting. But little did I know that Ting (a pseudonym) was to become the first of three patients whom I treated for Multiple Personality Disorder (MPD) now called Dissociative Identity Disorder (DID). Ting first visited me 15 years ago when she applied for a job as office manager. Although I did not hire her, she returned six months later as my patient. She presented with complaints of intense anxiety in response to work stress, panic attacks, migraine headaches and obsessive thoughts. The treatment plan was to include typical cognitive-behavioral therapy including relaxation training.  It wasn’t until the sixth visit that I had not so much of a hint that she was suffering from DID. She began the session telling me that when she practiced the Relaxation Response (a breathing exercise), she didn’t like the empty feeling she felt. Then suddenly her face and voice changed dramatically and in front of me was a young child in absolute terror, crouched in the chair as if she were watching a horror movie on the wall (autoscopic hallucination). For not finishing her food, her mother was locking her in the bathroom in total darkness and telling her that cockroaches would come out of the toilet and crawl all over her. In front of me she was  screaming and thrashing in her seat. My heart started pounding.  “Was I dealing with my first case of MPD?” I wondered. Most psychologists go an entire career without ever seeing one case, no less three.

By Ting’s next visit I purchased and read Australian psychologist Frank W. Putnam’s 1989 classic,  Diagnosis and Treatment of Multiple Personality Disorder. Putnam said he had encountered patients with MPD and unable to find a suitable text on the subject, he realized he would be the one to write it. And Ting turned out to be literally “a textbook case.” Jeannie, the protector, would subtly appear during sessions exuding confidence and assertiveness that Ting lacked. Ting was of Chinese origin and was born, adopted and raised in a southeast Asian country. Over the course of a year I met not only Ting and Jeannie, but also the sad girl (the one in terror during the sixth session), the happy girl, a Moslem woman who spoke no English, “boring Ting,” a boy named Paul and “the teaser.” Some were full alters (personalities) and others were what Putnam described as personality fragments. All alters or fragments played important and useful roles. Some alters would set Ting up. For example, they would seduce a guy or a girl and just as sex was ready to begin they would exit, leaving Ting without any memory of how she got into bed with these people. Sometimes Ting could lose time from a few minutes to a year or more. In the therapy, I needed to remind the alters the important role they played as both valuable and necessary support for the personality system as a whole and, therefore, they must not be destructive to the system.

“A Girl Not Named Sybil” was the 10/16/2011 headline  for a New York Times Magazine article condensed from a new book by Debbie Nathan called Sybil Exposed: The Extraordinary Story Behind the Famous Multiple Personality Case.  Sybil, of course, was the 1973 best seller by Flora Rheta Schreiber, about a woman treated by psychoanalyst Cornelia Wilbur, immortalized by the 1976 TV film with Sally Fields, who won an Emmy for her portrayal of a young woman diagnosed with MPD. Ironically, Joanne Woodward, who played Dr. Wilbur, won the Academy Award for Best Actress for her portrayal of an another woman with MPD in the 1957 film The Three Faces of Eve. Both actresses gave very convincing performances in their respective multiple rolls. Based on her research of Dr. Wilbur’s original recordings and transcripts of the sessions with Shirley Mason (Sybil is a pseudonym), Debbie Nathan strongly suggests that Mason was faking the alters during her visits with Dr. Wilbur. Even if Nathan’s assertions were true, does that mean that DID is a myth and a pseudo-disorder resulting from false recovered memories unintentionally induced by the treating provider?

I think not and here is why. It is very true that there are numerous documented cases of recovered memories that turned out to be total unintentional fabrications. Social psychologist Elizabeth Loftus has demonstrated just how easy it is for memories to be created through the process of suggestion. In one study, for example, college students were asked if they saw children get off a school bus based on a film they saw a week earlier. Many participants answered yes when, in reality, there was no school bus in the film. Memories are not fixed in stone and, in fact, may morph with each retelling of the story and in reaction to leading questions. However, does this research on changing memory mean that DID does not exist? While some memories may iatrogenically develop in psychotherapy, does that mean that all recovered memories are false? Besides, the whole premise behind DID is not that the memories were forgotten and later recovered, but rather that specific alters come into existence for the sole purpose of storing, holding and experiencing the traumatic memories, thus protecting the core “personality” from experiencing the trauma.

There has also been the argument that because DID can be faked, it must not be real. Pardon me, but a good actor can fake any role. Martin Sheen made a very convincing President of the United States in West Wing. Does that mean that a president doesn’t exist?

Sybil’s “lost memories” were supposedly recovered during the course of what was known as Pentothol interviews. Sodium Pentothol was originally developed as anesthesia in surgery, but later at lower doses became known as “truth serum.” It could be also used as a substitute for age regressive hypnotherapy, both of which have been associated with false memory syndrome. However, I never hypnotized Ting nor did I administer Pentothol.

Whatever transitions from one alter to the next that unfolded in front of me were either spontaneous or reactive to internal stimuli. Whether all the actual atrocities described to me actually took place, I do not know. What possible motives could Ting have to fake these alters in my presence?  Jeannie may have begun as an imaginary friend when Ting was four as a way of getting some comfort and dealing with her mother. The sad girl developed to absorb the psychic and physical pain of the abuse.  But I do know this: that unless Ting was as talented an actor as Joann Woodward or Sally Fields, to me DID is no myth.