Nancy Ross was alone in her kitchen smoking a cigarette. Go ahead and finish it, she heard Alice say. It'll be the last one you'll have.
Ross withdrew as if behind a curtain, she recalled. When she returned, she was standing on a bench with a telephone cord wrapped around her neck.
Shocked, she suddenly realized that what her therapist had been telling her must be true: She was sharing her body with someone else.
An 'Inner Family'
In fact, Ross, a 40-year-old Redondo Beach resident, said she eventually learned she was living with an "inner family" of 13 personalities, each with a name and a purpose. They included the Actress, a promiscuous flirt; the Nun, a righteous moralist; the Kid, a mischievous 5-year-old; Marsha, who faints under stress, and Richard, the gatekeeper who directs their comings and goings.
There was also Alice, a suicidal personality who didn't care that if she killed herself Nancy would die too.
Sometimes dramatic and frequently bizarre, stories of selves-within-a-self are not as rare as commonly thought and are increasing, say those who study multiple personalities such as Ross. Of the many professionals who remain skeptical that the phenomenon is real, most have never personally encountered a case, said psychiatrist Frank Putnam, multiple personality researcher with the National Institute of Mental Health in Washington.
However, the diagnosis gained respectability four years ago when multiple personality was added to the American Psychiatric Assn.'s list of official diagnoses. Last year, nearly 500 professionals attended the first international conference on multiple personality in Chicago, and four professional journals devoted solely to the subject were published.
Among believers, there is much debate over the nature of multiple personality disorder, its causes and treatment.
To share knowledge and opinions, a multidisciplinary group of mental health professionals called the Multiple Personality Study Group has been meeting once a month for the last seven years at the UC Irvine Medical Center. They have reviewed between 100 and 150 diagnosed cases of multiple personality in Orange County. Based on that figure, group leader Donald Schafer estimates the incidence of multiple personality in the general population to be one per 20,000.
While stories like "The Three Faces of Eve" and "Sybil" have fascinated the general public, therapists nationwide are now treating thousands of other multiple personalities from doctors to drifters. The vast majority were physically or sexually abused as children.
Most are women. Some speculate the reason is that girls are more often abused.
Some say multiples have above-average intelligence; some believe there is a genetic predisposition to develop split personalities. Others disagree.
Walling Off Conflict
It is agreed that creating separate personalities is a type of "dissociative reaction." Ross' therapist, Ted Barnes of Santa Ana, believes it is a sophisticated defense mechanism that intelligent children adopt to handle continuous terror or pain. "No one could take it all and remain sane."
Their system of walling off conflict reduces stress that otherwise might lead to a mental disorder such as schizophrenia, which Barnes believes is more difficult to treat than multiple personality. Though multiples are commonly confused with schizophrenics, they differ in that the different personalities deal with the real world while schizophrenics create their own separate reality, he said.
In general, multiple personalities hold themselves together "with spit and baling wire," unknowingly leading multiple lives for two or three decades until amnesiac blackouts force their separate lives to collide, or flashbacks bring back the past, said Barnes, a licensed counselor, certified hypnotherapist and member of the UCI study group. Barnes, who holds an MS degree in counseling from Cal State Fullerton, is president-elect of the Orange County chapter of the California Assn. of Marriage and Family Therapists and president-elect of the California Society for the Use of Hypnosis in Family Therapy.
Like other multiples, Nancy Ross has lost chunks of her own history. She knows there was physical, sexual and emotional abuse. She remembers times in her childhood when she would hear familiar footsteps nearing her bedroom and would lie on the floor hoping to be mistaken for a lump of clothes. She remembers hemorrhaging after a tonsillectomy and hearing her stepfather scream at her to stop bleeding. And she remembers she was repeatedly struck at school by nuns who told her horror stories of what happened to children who didn't believe in God.
Pursued by the Actress
At 20, she married to leave home. She has little memory of that five-year marriage. Less than a year after her divorce, she was married again, this time to an abusive alcoholic. Along the way she migrated from New York to California, becoming, for a time, a waitress, a secretary, a cab driver, a house cleaner, a live-in companion and a licensed massage therapist. She lived with another man for 10 years. He lived, she said, with the Kid and Cynthia, an angry, destructive personality who changes age at will.
There were other men, pursued by the Actress, she said. But after each conquest, the Actress would retreat, leaving a surprised lover to confront an angry personality in the morning. It was usually Alice, a lesbian.
(Usually, said Barnes, the central, overt personality deals with the world normally, and the others come out under stress. Students, for example, have complained of other personalities showing up to take a test for which they studied.)
Ross was unaware she had separate groups of friends, unknown to each other. Some would tell her she was strange, or that she sometimes seemed like another person. The inner voices she had heard since childhood were simply a part of her, she said. "I thought everybody was that way," Ross said.
Traumatized by a Pregnancy
At 27, she enrolled in junior college, surprising herself with superior grades. Now, she is majoring in theater arts at Cal State Dominguez Hills, where she also works as public relations manager of the theater arts department.
Ross dropped her original major, psychology, when she realized she needed therapy herself.
Four years ago, she said she was traumatized by a pregnancy that ended prematurely. "I remember being driven to the hospital by a friend. Marsha came out to handle it. They said I was catatonic, totally disassociated," she recalled.
The therapist she saw then, who asked not to be identified, said he did not believe in multiple personalities at the time, but has since changed his mind. He told Ross she was a borderline personality, a mental disorder characterized by radically shifting moods and self-image.
Two years later, she made an appointment with Barnes, whom she knew as a teacher, for help with exam phobia and later to help her quit smoking. Barnes said he diagnosed her condition early because she showed so many of the symptoms: history of abuse and failed relationships, selective amnesia, flashbacks and blackouts.
After three sessions, other personalities emerged under hypnosis, he said. Her voice and body language would change with each. Ross described the changes as "familiar yet foreign."
She resisted the suggestion she might be a multiple, which is also typical of multiples, Barnes said. "Anyone who walks in and says, 'I'm a multiple,' usually isn't," he said. Other symptoms include a history of conflicting diagnoses and attempted suicides or maimings, he said.
Inner Voices Get Stronger
Meanwhile, Ross said, her inner voices were becoming stronger, telling her she was worthless and ought to kill herself. She began awaking in strange places. She found her house in total disarray after a semi-blackout. Dishes were smashed, and the telephone cord had been slashed. The culprit, she learned under hypnosis later, was previously unknown to the other personalities. In a deep, growling voice he told Barnes his name was Wolf.
She said she started to believe the diagnosis.
Because most psychiatrists and psychologists are taught that multiple personalities are extremely rare, they frequently misdiagnose the problem as schizophrenia, manic depressive or borderline personality, Barnes said. Since more therapists now know what to look for, more multiple personalities are being diagnosed, he said.
The profession has been generally skeptical of multiple personalities. Some have suggested therapists may create the phenomenon through hypnosis. Others believe people may try to fake the condition to gain attention or avoid punishment. Psychiatrists were divided in 1979 when Kenneth Bianchi, the so-called Hillside Strangler, displayed four personalities under hypnosis.
"Most psychiatrists know more (about multiple personalities) through the media than their own personal experience. I find they repeatedly express skepticism until they find their first case. Then they are fascinated," Putnam said. The professional journals published last year have provided a rich resource for professionals who believe they have encountered a multiple personality but have no idea how to proceed, he added.
Much interest has focused on recent studies by Putnam and others showing that multiples' brain wave patterns change according to the personality that is in control. Through funding from the Intramural Program, a research arm of the National Institute of Mental Health, Putnam is currently studying changes in brain blood flow, immunology, voice and autonomic nervous system in multiples' personalities.
Some believe the studies bolster therapists' anecdotal accounts of multiples who, for instance, may have vision problems, cardiac arrhythmia, epilepsy or allergies in one or more personalities but not others.
One subject, studied by the UCI Multiple Personality Group, was given anesthesia in preparation for surgery, Schafer said. "The anesthesia worked on a few, but not on the majority of personalities," he said. Not only did the other personalities report feeling pain, but later described the surgery to the amazed surgeon, Schafer said. For a second surgery, the problem was solved by asking the personalities to confer and select one of them to accept the anesthesia for all, he said.
Putnam believes future research may well provide a window into understanding how personality affects the body. But he fears that sensationalizing early research may jeopardize funding for further research. "If it's treated as a freak show or a spacy process, it will never get the legitimacy it needs for real support."
More enthusiastic is Bennett Braun, director of Chicago's Associated Mental Health Services and organizer of last year's international conference. Topographical maps of varied brain waves in multiples are the first objective studies to show major physiological differences within the same human being, he believes. "Now we see it is something that is real . . . . The study of multiples will teach us an incredible amount about both psychiatry and regular medicine."
And Barnes thinks the study of multiples offers valuable insight into the healing arts. He is among those who believe that practicing mental techniques such as positive visualization can arrest disease over time; but multiples can produce physical change instantaneously, he noted. "If we had a clue how it works, the implications are mind boggling," said Barnes, who is planning a paper on what the study of multiples can contribute to the healing arts for next October's international conference in Chicago.
Barnes had worked as a co-therapist with five multiples through the UCI study group before he started treating Ross alone. Last month, they spoke together at a workshop of the Orange County Mental Health Assn. By going public, Ross said she hopes to prove multiple personality is a real and devastating illness. When more professionals accept that, more multiples will receive help, she said. One such person is a friend Ross has made through letters. The friend is incarcerated on the East Coast for a murder committed by one of her other personalities, she said.
Therapists say working with multiples has its hazards. Trying to integrate split personalities has been compared to an attempt to form a unified Arab-Israeli nation. Multiples are more violent than the general population, Braun said. But they tend to be less violent when compared with other adults who were abused children, he said.
In addition to potential violence, multiples also have an ability to evoke others' interest and sympathy and therapists tend to become overly involved, Braun said. Moreover, since multiples have trouble holding down jobs, few can afford the bills.
A Point of Disagreement
Therapists disagree whether they should try to fuse multiple personalities into a single personality or, as one therapist put it, aim for a "functional person, no matter whether it's a corporation, a partnership or a one-owner business."
After diagnosis, treatment generally follows the same pattern: discovering the personalities (usually through hypnosis), determining which ones are dangerous, setting up awareness of one another, communication and finally cooperation to achieve mutually agreed upon goals.
Long-term treatment involves recovering traumatic memories from the past, much like treating wartime trauma, Putnam said. Though others disagree, he said the process almost always produces new personalities who may have been formed to deal with a particular trauma and then put to rest. Putnam also believes that as old memories surface, differences between personalities begin to dissolve naturally.
Integration does not mean that different personalities are "killed off," most therapists said. One theory is that the inactive personalities continue to exist much like red and white paint continue to exist after they are mixed into pink.
"They start coming together on their own, usually by stages," Putnam explained. "If you start with 15, they may get themselves down to a a collection of five, then the five will become three, then two and the two will merge."
An average multiple patient has 13 personalities and may learn to function well after three to five years of treatment, Putnam said.
Barnes does not aim to "eliminate" any of Ross' other personalities. Not only is it difficult, but many "integrated" multiples--including the real-life Sybil--complain of extreme loneliness and depression without their "inner families," he said.
Under hypnosis, Barnes said he has practiced "family therapy" with Ross and her other personalities. He said he does not reveal to her anything she cannot recall herself from the hypnosis.
Barnes calls Ross a "recovering multiple," much like a "recovering" alcoholic in that she may never be "cured." However, Barnes does not believe there are regressions once therapeutic progress begins. After two years in therapy, she can call on the others' particular strengths in stressful situations without losing control. She has not experienced "total splitting" (losing consciousness) for six months, he said.
At Barnes' suggestion, Ross sent the Nun on permanent retreat. Wolf has received permission to rip up old magazines and newspapers but nothing else. After Alice was told to stay in a closet for a while, she no longer speaks to Barnes, he said. "But Richard said she (Alice) would soon." When Alice seems violent, the others "gang up on her" and do not let her out, Barnes said.
Ross believes there is no constructive purpose in confronting any of her childhood tormentors. But last Christmas, she returned home for a family visit. "I had to go back to make sure I could," she said. "I needed to see my mother again." Her mother and stepfather are separated now. Both are "born-again" Christians.
However, when she saw the face that belonged to the familiar footsteps, street-wise Richard and a motherly personality, Catherine, came out to help, she said. When the family played Bible Trivia, it was Richard who joined in. "I can't handle religion," she said.
Therapy Has Been Painful
The difference now, she explained, is that she does not lose consciousness when the others "take the spotlight. It's as though I step aside and look over someone's shoulder," she explained.
Therapy has been painful, said Ross. Not only did detailed memories of childhood incest return, she remembered she was raped in her second marriage. "In the beginning I was always unsettled. My head was fuller for a few days. So full, I thought it would explode. There were times I never thought I'd make it one week to the next. Then this summer, all of a sudden, it clicked and I thought, hey, this is working."
While she believes wholeheartedly she is a multiple personality, she said she is unsure she has accepted it emotionally. She worries some personality will come out at work and jeopardize her job as when the Kid once misspelled words she was arranging on a marquee.
In one way, Ross is grateful for her inner family. "They lived my life for me when I wasn't able to do it," she said. "It was my defense mechanism and it helped me stay alive."
But her new life is a drastic improvement, she said.
"I never thought I could be happy," she said. "But I am."
To mark her passage from chaos to control, she gave herself a new name that mirrored what she wants to do: Prosper.
She describes Prosper as outgoing and a good friend. Ross smiled. "I'm getting to like her more."