Laying out the Moods

When I was a graduate studying psychology in the Seventies, I was taught that multiple personality was a rare, almost unheard of disease. One textbook said that there was one multiple per million people; another that there had been fewer than a dozen diagnosed cases in the past fifty years. I went through graduate school, internship, psychoanalytic training, and 15 years of clinical practice in Boston without ever meeting a patient who exhibited symptoms of multiple personality. I was never assigned, and never read, any book or article on the subject. And I never knew or heard of anyone who had such a patient in treatment.

A decade later, there has been an explosion in reported cases of multiple personality. First-year social-work students are routinely assigned several new cases for treatment. There are innumerable seminars, training programmes and weekend workshops that teach clinicians how to recognise and treat multiplicity. New estimates put the number of Americans suffering from multiplicity, not at one in a million, but one in 20.

What exactly has happened, or is happening? Have we just got better at recognising a disorder that has always existed to the extent it does today? And if so, have patients ‘hidden’ their symptoms or presented them in other forms? Or is there actually more MPD than before because the incidence of child sexual abuse, widely considered the root cause of multiple personality, has increased dramatically? Are we ‘creating’ MPD – a point of view advanced by many members of the medical community – because a group of therapists ‘committed’ to the diagnosis are manipulating their vulnerable and suggestible patients? Or is MPD simply a new symptom for an old disease?

Anthropologists teach us that psychiatric illnesses are cultural products. We have fallen ill and talked about our illnesses in different ways at different times and places. Neurasthenia and hysteria were once the ‘popular’ ways of being ill; they gave way to borderline personality and now to multiple personality. From this point of view, the question is not whether multiple personality exists but why it has appeared now and what purposes are served by our fighting about it, as patients sue their families and families sue therapists? In Rewriting the Soul, Ian Hacking suggests an answer: we are struggling with MPD because it is our current way of struggling with the nature of the soul.

In Hacking’s argument, we become sick with MPD because we no longer have cultural permission to be ‘soul sick’. When we can’t any longer talk about exorcising our demons, we turn to the cure of our secular memories. For Hacking, the turning point in the move from soul sickness to memory sickness was the development in late 19th-century France of the sciences of memory, which brought what used to be called the soul within the purview of science. So, on one level, preoccupations with MPD are a way of remaining preoccupied with the soul. On another level, however, fighting about the nature of MPD has become a new way of fighting about psychoanalysis. We may be at the end of the Freudian century, but psychoanalytic concepts such as the dynamic unconscious have a powerful cultural presence. Is fighting over the nature of MPD – whether it is real or ‘constructed’ – one of the ways we are sorting out our commitment to them?

The MPD epidemic has thrown into question the most fundamental tenet of psychoanalysis: the existence of a dynamic unconscious. This is not because sufferers from multiple personality do not suffer from the effects of the unconscious, but because the claim is that they do: they are multiple because their unconscious holds secrets so terrible that simple repression, a massive and motivated forgetting, cannot contain them. Pieces of the self need to be created that can function autonomously, thereby fencing off forbidden memories from the self as a whole.

This claim about the aetiology of multiple personality took shape in 1973, the year of the publication of F.R. Schreiber’s Sybil, a popular book, later made into an even more popular movie, about a case treated by the psychiatrist Cornelia Wilbur. Wilbur believed, and has persuaded many others, that the fundamental cause of multiplicity is repeated trauma at a young age, usually in the form of sexual abuse. When the trauma is severe enough, the child ‘dissociates’ – that is, splits off the personality who is suffering the abuse so that it is no longer experienced as part of the self. A six-year-old girl who sees her parents being murdered is traumatised, but it’s safe to remember the event because the horror may be spoken of and shared. A six-year-old girl whose father demands sexual intercourse at night and cheerily pours out the Shreddies for her and her mother in the morning has a different kind of problem. If she is to meet her needs as a child and a daughter, she must not be her father’s lover. So she defends herself by making this the case: she dissociates so that only one part of the self suffers the abuse. The rest of the self system does not know about it. The family’s videos of a jolly six-year-old playing catch with her father are true representations of the father-daughter relationship untroubled by the forbidden memories. In this picture, dissociation begins where repression is not strong enough to serve. It is massive in its power and ultimately too successful: it leaves an unintegrated piece of the self – an ‘alter’ – within.

Over time, there can be many of these splits, creating a cast of inner characters, each of which originally served a protective function, each of which has only partial knowledge of the world. The cure suggested by members of the MPD movement is paradigmatically Freudian: a taking cure in which the ghosts of the past, the repressed memories of abuse, are brought to light. The multiple selves who carry these memories are encouraged to ‘come out’ so that they can be actively engaged in the treatment.

Hacking points out that the majority of MPD professionals – ‘MPD proponents’, as he calls them – are not psychiatrists: they are psychologists and social workers, people left out of the drug revolution of the Eighties and Nineties. In the world of MPD, there is no Prozac, no silver bullet, no talk of an MPD gene; no prestigious dispenser of medication or scientific authority to contend with. To the grass-roots clinicians, the MPD model is reassuringly pre-psychopharmacological and non-biological. One can finally be alone with the patient’s memories.

Yet despite the emphasis on psychodynamics, both in the explanation of MPD and in its cure, the struggle during the past twenty years to have multiple personality recognised as a disease that could be treated by a talking cure was not supported by the psychoanalytic community. On the contrary, psychoanalysts have been violently opposed to the MPD diagnosis, claiming that the memories of abuse were fantasies, even wishes, while the proponents of MPD came to consider psychoanalysts as the enemy. The young psychiatrists who campaigned to have MPD recognised tell similar stories about their clinical training in the Seventies:

as they began to see exemplars of multiple personality, and to report these patients’ descriptions of early sexual abuse to their psychoanalytically-trained psychiatrist supervisors, they were told that their patients were reporting fantasies – which should be interpreted as such. In otherwords, they were advised that their patients, intentionally or unintentionally, were not telling the truth.

The analysts who discounted the truth of patient claims about sexual abuse in the Seventies and Eighties were acting out a new chapter in the long, tormented story that weaves together psychoanalysis and the sexual abuse of children. Freud had at first believed that his patients who complained of being seduced as children were reporting events as they had actually occurred, and indeed that their psychological illnesses had been caused by their being seduced by the adults around them. This has come to be known as the ‘seduction theory’, which Freud held from 1893 to 1897. In 1897, he reversed himself, claiming that the memories of childhood sexual encounters, which he had once believed to be true, were in fact his patients’ fantasies: young children were projecting their own desire for sexual relationships with parents and parental figures. According to Freud’s new theory of the Oedipus complex, children are sexual beings who desire their parents. At about the age of five, they come to repress this desire. It is made unconscious through the internalisation of a parental interdiction. The result of all this psychic activity is a child who has no recollection of incestuous desires and who has a new inner psychic structure: the superego, ready in future conflicts to play the role of conscience.

The development of the Oedipal theory marks the birth of psychoanalysis as we have come to know it. So, in one way, the insistence on the truth of widespread sexual trauma as the cause of multiple personality was an assault on the Freudian edifice. Hence the resistance of psychoanalysts to the first proponents of MPD. By the early Eighties, however, the psychoanalysts themselves were under attack, taken to task, notably by Jeffrey Masson, for disbelieving their patients. From Masson’s perspective, childhood sexual abuse was the real truth and psychoanalysis the lie. The abandonment of the seduction theory was, for Masson, the turning point from which psychoanalysis had never recovered.

Some would have it that Freud ignored child sexual abuse because of his gender, his class, his allegiance to a social status quo. Hacking’s view of Freud’s shifting position on this crucial issue is that he cared less about the truth (or not) of child abuse than he cared about Truth – and, for Freud, the Truth that merited a capital letter was his Oedipal theory. He was willing to overlook the small truth of the sexual abuse he recognised around him in the service of that larger and more important theoretical Truth.

It was in this way that Freud committed the psychoanalytic movement to a position about the prevalence of adult sexual abuse of children: it couldn’t be so prevalent as to have really happened to his patients. For over a half century, the growing prestige of psychoanalysis reinforced the dogma. But by the Seventies and Eighties, the psychoanalysts were in a different political position. In the US, their movement was not merely under siege: it was in retreat. The prestige of behavioural and psychopharmacological therapies was growing; one after another, medical school psychiatry departments, once chaired by an élite group of analysts, were falling into the hands of ‘scientific’ psychiatrists. Psychiatric residencies, once places where medical school graduates learned dynamic psychotherapy through case supervision by analysts, were teaching drug and behavioural approaches. Most analysts were finding it hard to fill their practices with analytic patients. All the cultural forces, including the militant MPD movement, with its challenge to Freud’s abandonment of the seduction theory, seemed pitted against the Freudian movement. But of course, if you could divorce psychoanalysis from Freud’s position on this particular issue, the possibility of an alliance between psychoanalysis and MPD looked quite different.

Psychoanalysts had been frozen out of psychopharmacology by their psychodynamic principles and their lack of knowledge about medication. The majority of mental health workers attempting to treat MPD were social workers and psychologists who had also been frozen out of psychopharmacology as a result of their non-medical status. Here in the world of multiples as theorised by Wilbur and Co. they all had a disease they could treat without deference to a prescription pad. ‘Those multiples,’ one analyst said, ‘were our patients.’ They were people suffering not from biochemistry but from their pasts. The problem for analysts was how to hold onto what seemed robust about the Freudian vision while admitting that the Oedipal theory did not need the denial of widespread sexual abuse or even that psychoanalysis did not need Oedipal theory.

In some ways, the growth of the MPD phenomenon was a return of the repressed for the whole idea of repression, so devalued by behaviourist and biological psychiatry. Unlike depression, schizophrenia and manic depression, mental troubles that are now considered amenable to treatment by drug therapy, multiple personality has been seen since the late 19th century as an illness of memory only treatable by a talking cure. Indeed, Hacking’s MPD proponents use a model of cure that bears an uncanny resemblance to the pre-psychoanalytic Freud. They often put their patients into trance by classical hypnosis or other means in order to talk directly to otherwise inaccessible aspects of the patient’s self. New methods were used to facilitate these conversations: patients drew and painted, used puppets, played with anatomically correct dolls, and made patterns with objects in sand trays. But in the memory wars, each side has got trapped in the demands of ideology. Once Freud decided that his Theory (with a capital T) needed the denial of child sexual abuse, he had to deny it consistently. Once the MPD proponents decided that their disease required their patients’ accounts to be true, well, then, their patients’ accounts had to be true. But by the mid-Eighties, this was getting to be a problem.

People who were discovering their abuse and multiplicity in the course of therapy were not only reporting incest: they were reporting abuse during satanic cult rituals, rape not only by parents and family friends, but by scores of cult members who sacrificed foetuses and newborns and drank their blood. They were reporting abductions, rape and mutilations by visitors from other planets. The number of charges was increasing, and their extravagance escalating. More and more families were being destroyed. The world of the TV talk show had discovered MPD; multiples told their stories on national broadcast media. And the more they talked, the more cases of abuse, multiplicity and satanic goings on were reported.

The fact that when a diagnosis becomes more prevalent, more patients appear who fit under it does not mean that the disorder is not ‘real’. For one thing, patients express their distress in culturally sanctioned ways. If television tells them that multiplicity is an acceptable medical diagnosis, they give themselves permission to experience their multiplicity. We learn how to be sick. A multiple with many dissociated part-selves might have learned in the Sixties that the voices she was hearing were signs of a thought disorder: in the Eighties, she would have learned that she should not only listen to them, but listen to hear if there was one voice talking to her or several. The multiplicity would have been constant: what we do with it would have changed. A member of an incest survival group told me that she had once read that incest is rare, that maybe one in a million people has experienced it. The effect of this was to make her doubt that she would be believed if she told anyone what had happened to her. Indeed, she came not to believe herself. With greater cultural permission to speak of their past, people do so. And with greater sensitivity to the way that multiple personality is experienced (and hidden), clinicians are more likely to find it where they once would have labelled a patient ‘borderline’.

For example, when I was in clinical training, I was taught to ask a patient if he or she ‘heard voices’. A positive response would place this patient in the category of borderline personality, under suspicion of schizophrenia. Today’s trainee would be told to continue the investigation with a follow-up question: do the voices come from without or within? If the voices came from within, the patient would be well on his or her way to a diagnosis of Multiple Personality Disorder. Psychiatric diagnosis is a culture-bound art. Diagnostic categories change with the times and with what clinicians are interested in looking for. Hacking makes the point that before the sciences of memory, illness that we now think of as MPD could have been classified as possession. Before MPD was linked with child sexual abuse, it was an exotic splitting, of the kind reported in The Three Faces of Eve. It was the combination of memory and child sexual abuse that allowed MPD to come into its own as a diagnosis. In Hacking’s terms, ‘child abuse made sense of multiplicity’: ‘Psychiatry did not discover that early and repeated child abuse causes multiple personality. It forged that connection, in the way that a blacksmith turns formless molten metal into tempered steel.’

Such sociological arguments enabled the MPD movement to defend itself against the charge that multiplicity was not real because it seemed contagious. But the stories of satanic ritual abuse were of a different order. Sexual abuse could be verified, and often was. There is some evidence of cult phenomena and satanic worship but not on the scale that patients were reporting. If the Eighties had seen the return of the Freudian repressed in the form of a movement to stand Freud on his head one more time and affirm the sexual seduction of children by adults as prevalent and pathogenic, the Nineties saw yet another reversal in the memory wars. In 1992, parents and family members who had been accused of sexual abuse formed a group known as the False Memory Syndrome Foundation. They assembled an advisory board of experts to defend a hypothesis not so unlike what Freud had advanced when he abandoned the seduction theory: that the charges of abuse were fantasies. This time, the False Memory advocates said, the fantasies did not grow out of Oedipal dreams, but out of suggestions made by therapists. And the media which only a few years before had ‘discovered’ child abuse and multiple personality were now discovering false memory. This time the enemy was not the psychoanalysts who had denied a shocking reality but the MPD therapists who had implanted shocking fantasies.

More generally, the false memory and satanic ritual abuse controversies led to suspicion of an even greater villain than the MPD therapists. This was the whole idea of repression. Within the space of a few years, psychoanalytic thinking, which had stood to profit from an MPD windfall, was given a new role in the evolving memory wars: it was father to the idea of repressed experience, now seen as one of the sources of the problem. Real trauma is not repressed, this argument went, buttressed by its own team of experts. Real trauma is remembered. To which MPD therapists and feminists could reply that criticism of the ideas of repression, dissociation and recovered memory was a form of backlash against the long-overdue recognition of widespread sexual abuse of children – society’s repression of its own filthy secret. This argument, put from the ‘grass-roots’, distances itself from both the psychiatric and the psychoanalytic mainstream. Why should their orthodoxies be trusted? After all, they were the ones who had argued that incest was a one in a million phenomenon. The ironies and complexities of the memory wars run deep, and the psychoanalytic community has found itself caught in the middle. Within a very few years, it has found itself challenged from both sides of the controversy. First, it was the enemy of those who believed in massive repression for following Freud in his abandonment of the seduction theory: now, it is the enemy of their enemies for believing in the very notion of repression.

In the course of discussing the social construction of multiplicity, Hacking talks about support for notions of multiplicity in material culture – for example, in the everyday experience of a remote control. The high-tech world offers even more compelling examples. With some online services, it is common practice to create a variety, indeed a multiplicity of virtual selves or personae. People who use computers for this purpose report that they experience these activities as ‘cycling through’ many aspects of themselves. Just as you can click the remote control to move to different imaginative settings, a click of a computer’s mouse enables you to interact as a different aspect of yourself.

This kind of interaction with virtual environments is made possible by the existence of what have come to be called ‘windows’ in modern computing environments. Windows make it possible for the machine to place you in several contexts at the same time; and in this way they have become a potent metaphor for thinking about the self as a multiple, distributed, ‘time-sharing’ system. In this context the self no longer simply plays different roles in different settings – as one does, for example, in waking up as a lover, making breakfast as a mother, and driving to work as a lawyer. Windows give access to a distributed self that exists in many worlds and plays many roles at the same time.

When people adopt an online persona they cross a boundary into highly-charged territory. Some feel an uncomfortable sense of fragmentation, others a sense of relief. Some detect the possibilities for self-discovery, even self-transformation. A 26-year-old graduate student in history says: ‘When I join a new virtual community and I create a character and know I have to start typing my description, I always feel a sense of panic. Like I could find out something I don’t want to know.’ A woman in her late thirties who just got an account with America Online used the fact that she could create five account ‘names’ as a chance to ‘lay out all the moods I’m in – all the ways I want to be in different places on the system.’ Another named one of the accounts after her yet-to-be-born child. ‘I got the account right after the amnio, right after I knew it would be a girl. And all of a sudden, I wanted that little girl to have a presence on the Net, I wrote her a letter and I realised I was writing a letter to a part of me.’ A 20-year-old undergraduate says: ‘I am always very self-conscious when I create a new character. Usually, I end up creating someone I wouldn’t want my parents to know about. It takes me, like, three hours.’ In these ways and others, many more of us are experimenting with multiplicity than ever before. Hacking talks about male alter personality as a way for oppressed women to become powerful. Online cross-gender play can have much the same effect. MPD exists in a cultural force field which is increasingly open to considerations of multiplicity.

In Hacking’s view, to get multiple personality in its current form you need the sciences of memory and the social environment of contemporary therapeutic practice. And you need the construction of dissociation as a continuum, something also provided by contemporary sciences of mind: ‘Creating systems of measurement, such as the Dissociative Experiences Scale, can bring a fact – the fact of the dissociative continuum – into being. The test of dissociation establishes a continuum. That doesn’t mean there is one. Giving these tests establishes the objectivity of knowledge about dissociative disorders. But that doesn’t make the knowledge objective.’ Hacking is not concerned with who is right and who is wrong in the MPD wars. MPD, he points out, is diagnosed more often today because we have diagnostic materials that let us ‘see’ this disease and some cases of multiplicity are iatrogenic, produced by therapists who suggest the symptom to their patients. There are instances of satanic abuse: many patients who report this activity did have experiences with cults but such cults are nowhere near as numerous as they would need to be if all patients were reporting ‘real’ occurrences.

There are places where Hacking tortures his prose trying to give everyone and every position their due. He characterises child abuse as both a social construct and an ultimate evil. He declares himself ‘cynical’ about ‘a few actresses who enjoy public wallowing in the trough of their early abuse and subsequent multiplicity’, but then says that ‘for ordinary patients, appropriate emotions are empathy and respect, which is not to say that one should be permissive or indulgent’ Of course, the issue for therapists is precisely how to be empathetic while telling a patient that their recollections did not occur as reported. Empathy or no empathy, an ‘ordinary’ patient will take this to mean that he is being called a liar. Hacking can allow himself such multiple visions by continually returning the focus to memory. The issue is always how it happened that the memory wars became so ideological: why and how this terrain came to be one on which people search for a Truth, for one right answer, and only one. In Hacking’s hypothesis, the charge on these issues derives from the fact that when we think about MPD we are thinking about the soul. As a scientific debate (which is how its proponents and critics view it), the movement can seem bizarre to outsiders. If you think about it in the old context of religious debates on the soul, it seems almost familiar.

In the early, more guarded passages of his book Hacking distances himself from those he characterises as MPD ‘cynics’:

Cynics about the multiple movement argue that both the behaviour and the memories are cultivated by therapists. That is not my argument. I am pursuing a far more profound concern: namely, the way the very idea of the cause was forged. Once we have that idea, we have a very powerful tool for making up people, or, indeed, for making up ourselves. The soul that we are constantly constructing we construct to an explanatory model of how we came to be the way we are.

But when Hacking finally sets aside the role of philosopher and Foucauldian detective, he asserts a certain sympathy with MPD sceptics. His reason: to the degree that therapists are contributing to the production of symptoms of multiplicity, they are creating a new type of false consciousness. ‘That,’ he says, ‘is a deeply moral judgment. It is based on the sense that false consciousness is contrary to the growth and maturing of a person who knows herself. It is contrary to what the philosophers call freedom. It is contrary to our best vision of what it is to be a human being.’ Culture creates our diagnostic categories but that does not mean they are all equal: from the point of view of a secularised soul, you are greatly diminished if you allow yourself to be shaped by this one.