Science Delves Into Mystery of Multiple Personalities

“The Minds of Billy Milligan,” “Sybil” and “The Three Faces of Eve” are books about only three people, but they contain details of myriad personalities.

While the works have done much to publicize the existence of multiple personality disorder, the syndrome went virtually unrecognized until the last quarter-century and still is challenged in the medical profession.

There is an increasing acceptance, however, according to Dr. Moshe Torem, head of the University of Akron’s psychiatry and behavioral sciences department.

The cause of the disorder is believed to be child abuse, particularly sexual abuse.

Problem Is Widespread

Recent studies, when averaged, show that at least 25% of all adult women and 10% of the men in this country experienced some form of sexual abuse as children, Torem said.

Perhaps 4% of such victims suffer repeated abuse during crucial developmental stages and fall prey to multiple personality disorder, experts say, although this may be an underestimate.

William Milligan, who has been diagnosed as having 24 personalities, says he was a victim of rape as a child.

Milligan was committed to state custody in 1978 after being found innocent by reason of insanity of raping three women abducted near the Ohio State University campus in Columbus.

During therapy, court hearings and interviews, Milligan told of repeated sexual abuse by his father, who allegedly forced the youth to dig his own grave and buried him alive. Milligan said his father threatened to return him to the ground and leave him to die if the youth ever told anyone of the abuse.

His father has denied the accusations.

Doctors say Milligan coped with the abuse and his disjointed life by relegating pain to part of his mind, in a personality known as David. Other abuse was handled by lesbian “Adalana,” and deaf “Shawn” endured beatings in silence.

Dr. Cornelia Wilbur of Lexington, Ky., one of nine psychiatrists who have confirmed Milligan’s multiple personality disorder, also fused the 16 personalities of a patient known as Sybil, later the subject of a book and television play.

Doctors say Sybil also was the victim of sexual torture as a child.

Chris Sizemore, subject of “The Three Faces of Eve” (1957), was diagnosed as having 22 personalities. She was traumatized as a child by witnessing a series of violent, bloody events.

Sizemore was successfully treated, has written a book, “I Am Eve,” and is working on another. She attended an April conference on multiple personalities hosted by Torem and Akron General Medical Center.

Can Be Cured

“She is living testimony that the disease can be completely cured,” Torem said. “Sybil also is testimony.”

Milligan remains in state custody after nearly 10 years, though he freed himself for about five months by escaping last July 4 from the Central Ohio Psychiatric Hospital in Columbus.

Milligan had been under the supervision of a hospital administrator who has said publicly that he does not believe in multiple personalities.

“It’s not a matter of believing or disbelieving; that’s for religion,” Torem said. “This is science. This is a matter of looking at the facts and forming your conclusions using a scientific method.”

Torem, who attended medical school in the 1960s and performed his residency in the mid-1970s, is not surprised by the lack of recognition accorded to multiple personality disorder. He believes he may have overlooked incidences of the affliction before he diagnosed his first case in 1980.

“In school I was told, ‘This disease is so rare that you will never see a case in the whole lifetime of your career, so it would be a waste of time to study it,’ ” he said.

Misunderstanding may have led some people to confuse multiple personality disorder with schizophrenia--”two totally different diseases,” Torem said.

Schizophrenics sometimes are known as “split personalities.” People with multiple personality disorder can have many personalities, with the average being nine or 10, experts say.

Schizophrenia can be treated with anti-psychotic drugs. While some types of medicine can be helpful in treating multiple disorders, the disease does not respond to anti-psychotic drugs. Treatment generally is psychotherapy in conjunction with hypnosis, Moshe said.

Multiple personality disorder is caused by child abuse; schizophrenia is inherited.

“Schizophrenia can happen in the best of families, even if you had all the loving care in the world,” Torem said. “Schizophrenia is a genetically inherited disease of the brain. It runs in families, like diabetes.”

Voices Inside, Not Outside

Another distinction, Torem said, is that schizophrenics often believe they hear voices coming from outside their heads, while victims of multiple personality disorder usually hear voices within their minds.

While schizophrenics can be managed with medication, they cannot be cured, Torem said. Multiple personality victims, on the other hand, “have an excellent prognosis, with many cases where full integration (of personalities) and cures are achieved.”

Skepticism continues, however, partly because of the public’s interpretation of the disease’s name.

To many people, Torem said, the term evokes an unbelievable, fairy-tale image of several people existing in one body, rather than the very real situation of several personalities struggling within one mind.

Result of Trauma

Public acceptance of the disorder might be increased, he said, if people realized it is a form of post-traumatic stress disorder, which is best known as an affliction suffered by some Vietnam War veterans.

The stigma attached to both child abuse and the Vietnam War compels victims to hide their problem, complicating it further.

“A child suffered repetitive abuse. He couldn’t run away, couldn’t fight it or flee from it, so he floated with it; he used internal escape. Part of his personality shut off to deal with the depression, pain, hurt, and another part of the child went on as if nothing had happened,” Torem said.

“If (trauma) happens early in life and continues through crucial developmental stages, you have split ego states that develop in a parallel track and they don’t communicate with each other. You have a barrier of amnesia between these states.”

Bright and Creative

Dr. Bill Smith, chief clinical psychologist at the Menninger Foundation in Topeka, Kan., said the mechanism behind multiple personalities is the same as the one that gives creative writers a basis for developing unusual characters.

“Most who develop this disorder are bright and highly creative. The figures they come up with are often creative and highly embellished,” he said.

“Multiple personality is sort of a caricature of the normal process where individuals have a repertoire of selves. We all have sort of an angry self that we keep under control, and maybe a rebellious self, a more flamboyant, exhibitionistic self.

“Sometimes these ‘selves’ will come out more under the influence of drugs or alcohol, perhaps at a party. They are different sides of us that get activated under certain circumstances, but we still know it’s us.

“The multiple personality is so extreme that the selves have no knowledge of each other; they are unaware of the existence of the others.”

Self-Perpetuating Process

Smith said most multiple personality victims develop more than four personalities. The process becomes self-perpetuating, he said, as a victim learns to hide “undesirable” traits, such as anger, greed or promiscuity, outside his or her central personality.

“It continues with anger, greed, and so on, as more unacceptable parts of the person--or parts of the person the parents cannot tolerate--all get channeled off into fantasy-created, submerged selves.

“In a family where literacy and academic achievement are actually discouraged, the person may develop a highly intelligent, highly literate personality” that is kept hidden from critical parents, he said.

Smith said psychologists find a much higher incidence of multiple personality disorder among females than among males.

Abuse More Common

“Little girls are more likely to be abused and be victims of incest than are little boys,” he said. “Also, since MPD almost always involves an antisocial side, male multiples end up in prison, while female multiples end up in hospitals, because society still is much less likely to prosecute females.

“Unfortunately, if we can’t always adequately diagnosis MPD in mental hospitals, it certainly isn’t going to be diagnosed in prisons.”

If victims are good enough at hiding abusive family lives and the ensuing problems, their reward may be accusations that their disorder is really a hoax. Even “believers” often doubt whether the condition can be cured. In Milligan’s case, doctors’ efforts to gain his freedom caused public outrage and fears that his violent behavior would recur.

Will Seek Help

Torem said problems are possible, but such fears are irrational. Even if they do have a relapse, people with the disorder “at least know that they need to get help to cope.”

The Ohio Legislature is debating a bill that would abolish the plea used by Milligan, innocent by reason of insanity, and replace it with “guilty but mentally ill.”

Some people advocate that offenders who use the new plea should be forced to serve time in prison after they are treated for their mental illness.

“Who’s going to want to get better to go to prison?” Torem asked. “Mental illness interferes with judgment, and ability to see right or wrong. Such people cannot be held accountable for actions they take while they are sick.

“After they are treated for their illness, they are entitled to their freedom.”

Milligan once noted that if he had pleaded guilty to the rapes, he could have been granted his freedom after seven years.

“Do you know how many rapists and assassins are released every year, with no form of treatment, to go out and do it again?” Torem asked. “Psychopaths are much more dangerous to the public than people with MPD.”