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Do You Have Multiple Personality Disorder?

Years after Sybil, the debate continues

By Craig Malisow 

Sadie sits on the therapist's couch, ­whimpering.

She's somewhere between two and three years old, and already the most horrible things have happened to her. That finger twisting through her hair is a tell-tale sign of sexual abuse, according to her therapist, Richard Hodgin.

"Hey kiddo," Hodgin says gently. "Need help?"

Sadie looks like she's about to cry, and she bows her head.

Hodgin understands. He asks Sadie to summon Rachel.

Sadie exhales and retreats into the fractured mind of a woman in her mid-­twenties whom Hodgin is treating for multiple personality disorder. Sadie exists only in Rachel's head, among more than a dozen other personalities, or "alters." Rachel sits beside her husband in Hodgin's Woodlands office. It's after hours; the building is deserted and Hodgin reclines comfortably in his chair, sans shoes.

"She just has that little-bitty baby way of seeking comfort," Rachel [not her real name] says of Sadie. Rachel says her abuse started around the time she was two or three; hence Sadie, the youngest alter.

Rachel says she grew up in a satanic cult, where she was molested and forced to participate in animal sacrifice. When she was about 16, she says, the cult got her pregnant in order to offer the child to the devil. She says her own grandfather and father are important members of this cult, which operates mostly out of the grand­father's house north of ­Houston.

Now Hodgin says, "Pick a teenager, please."

"Tabitha's 12," Rachel says. "Is that teenager enough?"

Enter Tabitha, a detail-oriented alter whose age marks the time Rachel's parents separated. Tabitha says her mother didn't know about the abuse, and Tabitha never told.

"They had my sisters," Tabitha says of the cult. "They had my cousin."

Hodgin says he's seen many cult cases, and that's how it works. They scare the kids into silence. So even as Rachel says she was raped over a 15-year span, her mother never knew. Apparently there was no physical evidence that sounded an alarm to Rachel's mother and doctors.

Multiple personality disorder, clinically labeled "dissociative identity disorder," entered popular culture with The Three Faces of Eve, a 1957 book and movie about a woman who claimed to have two alternate personalities (besides the host, or "real," personality). Enormously popular, the movie netted an Academy Award for Joanne Woodward, in the title role. Woodward turned up about 20 years later in another popular movie based on a book about DID, Sybil. A story about a woman whose mother's abuse allegedly split her into 16 alters, Sybil revived the popular interest of DID sparked by Eve.

Although numbers vary, data indicates that there were only a handful of reported cases of DID worldwide prior to Sybil, and an explosion in the United States alone afterwards.

It was greeted with considerable skepticism in the psychiatric community. But it's been in the DSM, the psychiatric diagnosis manual, for nearly 30 years, and renowned physicians at prestigious institutions have conducted studies and treated thousands of patients diagnosed with DID. Each year, hundreds of mental health professionals come to the Houston-Galveston Trauma Institute for a conference devoted to DID treatment.

In 2007, Switching Time, a Chicago psychologist's account of treating a woman with 17 alters, attracted national attention and was seen as another validation by those who felt shunned by doctors who had dismissed their claims of DID. This year, former Dallas Cowboy Herschel Walker's memoirs hit the shelves, revealing his struggle with the condition. (Walker recently discussed his battle with the condition on Good Morning America, and was scheduled to appear on Nightline.) Unfortunately, professionals treating DID disagree on what level of trauma can cause a person to split into dozens — in some cases, thousands — of alters, including those of different ­species.

Whether you grew up with parents who neglected you or had cow's blood forcibly injected into an orifice as part of a demonic ritual, you can wind up with DID. Hodgin says there are thousands of undiagnosed cases in Houston alone. So the resurgence of interest in DID could be a good thing if it spreads awareness and shows people there is a solution.

Or, it could mean a whole new generation of delusional people will be diagnosed with a disorder that doesn't exist, and they won't get the help they need.
_____________________

Here's one scenario:

A patient walks into a therapist's office for the first time. She says she's been traumatized by years of ritualistic abuse by men in red and black robes who held secret ceremonies where animals were slaughtered and young girls were raped with the mission of producing a sacrificial lamb for Lucifer.

Should the therapist accept that as the patient's reality and work toward the goal of making the person well again, or should she explore the possibility that the incidents described might not be entirely accurate?

If you're Jean Goodwin, co-founder of the Houston-Galveston Trauma Institute and professor of clinical psychiatry at the University of Texas Medical Branch in Galveston, you accept the story at face value. Whether or not it happened is an issue for law enforcement, not for a mental health expert.

Goodwin earned a medical degree at Harvard and a master's in public health and epidemiology from UCLA. She has researched DID for decades, publishing articles in peer-reviewed journals; testifying as an expert witness in trials where trauma and dissociation were key elements; treating DID clients in her private practice; and participating in the Trauma Institute's annual DID ­conferences.

She told the Houston Press that her job isn't to determine the accuracy of a client's story, and that treatment should not depend on whether the supposed cause of the trauma actually occurred.

Here's another scenario:

A patient walks into a therapist's office for the first time. She says she's been traumatized by an attack of a gigantic flying purple dinosaur. Should the therapist accept that as the patient's reality and work toward the goal of making the person well again, or should she explore the possibility that the incident described might not be entirely accurate?

If you're Jean Goodwin, you tell the Houston Press that a therapist might want to explore that story's validity, and how the client came to believe it. The Federal Aviation Administration should not be alerted and SWAT should not be summoned, because gigantic flying purple dinosaurs are not a matter for law enforcement.

So when — if ever — is it appropriate for a therapist to suspect that a story is true and when it might be the confabulation of a disturbed brain? If you're Jean Goodwin, you say that that question will be answered the following day, when you have more time to talk.

Ultimately, Goodwin told the Press she was not comfortable talking about DID alone, without being able to discuss its oft-accompanying mood disorders.

Jon Allen, associate editor of a journal published by the International Society for the Study of Trauma and Dissociation, the only medical organization in the country devoted exclusively to DID and related traumas, declined to comment entirely. Allen is a professor of psychiatry and behavioral sciences at Baylor College of Medicine. He's also a staff psychologist at Houston's Menninger Clinic, described on its Web site as being among "the leading psychiatric hospitals in U.S. News & World Report's annual ranking of America's best hospitals." Although Allen was not available to discuss DID, a recent Menninger press release touted a new book he co-authored on "mentalizing," which is described as "the ability to 'tune in' to one's own thoughts and feelings and to put oneself in another's shoes."

(Apparently, Allen is available to discuss a $55 book he co-wrote, but unavailable to discuss matters not covered in that book.)

Although Goodwin couldn't discuss DID in detail, her colleague Norman Decker could. Decker, a psychiatrist, is the president of the Trauma Institute and a professor at the Menninger Department of Psychiatry at Baylor. He earned his undergrad and medical degrees at Columbia and is a past president of the Houston Psychiatric Society.

Decker reiterated that it isn't just physical and sexual abuse that can cause DID, but psychological abuse as well.

"Any one of the three can be severe enough to cause DID, and psychological abuse may be the worst," he says. "Or another way of looking at it is...severe neglect is extremely traumatic and may be the worst kind of abuse."

So why don't all neglected children grow up to have DID?

"What's traumatic for person A may not be traumatic for person B. So, people have different potentialities for it."

Fortunately, Texas isn't home to just the Trauma Institute, but also the Ross Institute, just outside Dallas, founded by Colin Ross, a leader in the field of DID. Ross, a psychiatrist, was able to talk about his approach to new patients who present possible symptoms of DID.

Ross earned his medical degree in Winnipeg, Manitoba, in the 1980s and, in addition to his DID research, he became interested in cults and conspiracies. He recently wrote a book about CIA mind-control experiments, which included building the kind of perfect human killing machine depicted in The Manchurian Candidate. In his research, Ross has claimed that the CIA funded mind-control experiments on unwitting subjects, including children, in the quest to create the perfect soldier. One study Ross claims to have found involves a joint CIA-prostitute project where hookers lured johns into safehouses, dosed them with LSD and then had sex with them in front of a one-way mirror while secret agents took notes.

In 2001, Ross posted on his Web site a report of an East Texas cult he said was "likely" kidnapping and sexually abusing young girls and that would probably commit mass suicide in 2011. The report contained no references or footnotes indicating where Ross gathered this material. When asked where this information came from, Ross said he heard it fourth- or fifth-hand and never seriously studied the cult. Since the report was seven years old, he said, he couldn't remember anything other than what he had written. It is unclear whether authorities were ever alerted to this criminal ring, or given the address of the compound where girls were "likely" being detained and raped. (In deference to the age of some of his DID research, the Press asked Ross if questions should be limited to studies he conducted after 2001. Ross stated that was not necessary, since, unlike the East Texas cult that will probably kidnap and rape little girls for the next three years, his DID research has continued uninterrupted since the 1980s).

Ross's studies have also led him to support another researcher's theory that the 1978 mass suicide of the Jonestown cult in South America was actually a CIA mind-control experiment. In 2007, the Church of Scientology bestowed upon Ross its human rights award, given to "mental health industry whistleblowers who have risked their professional careers to expose dangerous psychiatric practices."

In his research, Ross has studied populations he believed were likely to contain a high percentage of people with DID.

Based on data from a survey Ross and his colleagues conducted in Winnipeg in the late 1980s, 50 percent of strippers and five percent of prostitutes have DID. (Curiously, Ross and other leading DID researchers apparently neglected to study the incidence of DID in populations where child abuse is well-documented. There does not appear to be a study of child survivors of Nazi death camps; survivors who suffered abuse at the hands of pedophile priests; Japanese-American children forced to live in internment camps during World War II; or any of the hundreds of children the FBI and other law enforcement agencies rescued from the horrors of international child-porn rings. Psychiatrist Lenore Terr, a prominent researcher in the area of childhood trauma, has conducted numerous studies of groups of children who survived actual events, but those studies related to childhood post-traumatic stress disorder, not DID).

When it comes to a patient presenting such an improbable story as her father raping her as part of a complex, supremely well-organized underground network of satanic cults, Ross says he adheres to the principle of "therapeutic neutrality."

"You don't believe the memories and you don't not believe the memories," Ross says. Whether or not the events happened as described in the aforementioned scenario is beside the point; the result is that the patient likely has unresolved conflicted emotions toward her father, he says. On one hand, the child may feel the biological impulse of love and loyalty to her parent; and on the other, she is angered and saddened by what she believes was her father's cruelty. So the goal then is to reconcile these opposing forces and work toward an emotional stability that will allow the child to reconcile with the father. Ross says he's dealt with patients who, after years of therapy, come to realize that the satanic ritual abuse never occurred, while others can be healed and still maintain it ­happened.

Ultimately, it's a win-win situation. If the old man truly did force his daughter to drink cow's blood and chop her own baby's head off to welcome the winter solstice, reconciliation is possible. And if the daughter only thinks this happened, reconciliation is still possible. (In that event, the best-case scenario would be one in which the family hasn't already been torn apart by the daughter's accusations, because in that case, Ross says, the father never even has to know what his daughter is ­thinking.)

But Ross says that, even in the event where the child has previously screamed satanic abuse from the hilltops, a loving father-daughter relationship is still ­possible.

This might be a good time to clarify that not every person diagnosed with DID has claimed satanic ritual abuse.

There does not appear to be a study that has ever tabulated the different types of claims, and such a study would be a massive undertaking, given that DID exists on a continuum of alleged maltreatment running from neglect (i.e., parents who actually do nothing to the child) to incest and cannibalism (i.e., parents who put a terrific amount of planning and creativity into the torture of their child). Skeptics point that not only does the psychiatric diagnosis manual, DSM-IV, not adequately define the "abuse" necessary to trigger DID, they argue that the manual does not give a clear explanation of just what constitutes an alternate personality. How long must this alter stick around, and what purpose(s) must it serve to be properly labeled a true separate personality?

For example, in a 2004 article in the Canadian Journal of Psychiatry, DID skeptic August Piper cited a study by a leading DID researcher who had a patient with an alter whose sole responsibility was to "gaily [walk] in the fields picking flowers — usually ­dandelions."

This wide net of criteria allows an amazing volume of alters to exist in one host. When DID first appeared in DSM-III in 1980, the condition allowed up to 100 alters. Yet, judging by some researchers' subsequent claims, that number seems downright paltry. Piper points to another leading researcher's study of two patients with more than 4,000 alters between them.

Piper, a psychiatrist practicing in Seattle, believes the research and logic behind DID are often flawed. For example, if alters are born from severe trauma and are charged with protecting the host from the awareness of the abuse, why is it easy to summon them in such non-stressful environments as a therapist's office?

"The fundamental question here is...how does a scientist know things?" Piper says by phone from Seattle. "You shouldn't be asking the little questions about what [DID experts say], because they're always going to give you some kind of bullshit answer. Or I will always give you a bullshit answer. It isn't the question 'What you know,' it's how you got there."

And while many people living with DID allegedly experienced abuse so savage and relentless that it actually caused the brain to think it belonged to a completely different person, and, in some cases, repress memories of the torture for decades, it's pretty easy to find online support groups and individual blogs where those living with DID air it all — every last excruciating detail.
_____________________

In Hodgin's office, Rachel braces herself and tries to explain the horror.

The abuse started when she was about three. Her grandparents lived nearby, and she'd often spend weekends there, with cousins and other children in the extended family. Her mother wouldn't come around, but her father did. He had to. Rachel's grandfather was His Highest, the cult leader. Therefore, her father played an important role.

From day one, Rachel was groomed to give them a child, a sacrifice to be offered to Satan. So the cult had to let her know her body belonged to them; it existed for their purposes. When she was too tiny for penile penetration, they used fingers and small objects. As she grew older, she graduated to intercourse, and they warned that if she ever told, they would kill her or other members of her family. So she was raped vaginally, orally, anally, and she kept the secret to save herself and others. Her mother never knew a thing.

The Press could not find any records of criminal charges involving children for either her grandfather or her father in the state of Texas. Her father, who now resides in a different state, was charged in 2006 for aggravated assault and ultimately received probation. The victim was not a minor. (Both men declined to comment for this story).

Rachel says the ceremonies took place in her grandfather's house, or in the woods behind it, in cemeteries and mysterious buildings. Cult members wore flowing robes of black and red, the children white. They lit fires and chanted in a foreign tongue. Their high holidays fell on the same days as Christian celebrations, only theirs were, of course, for unimaginable evil.

Rachel pauses and lets out a deep breath.

"I'm trying to stay here," she says, and the room is silent for a time.

"Give her a moment," Hodgin says, while plunking around on his laptop. He's been treating Rachel for three years and knows what she can and can't handle. Tonight, he's a kind of lifeguard, making sure Rachel doesn't wade too far into the deep end.

She continues, and answers a question about whether her behavior was affected to the point where a teacher or other kids at school would suspect that something was very, very wrong.

"School was safe," Rachel says. So she did well there. And her alters would handle schoolwork — like Tabitha, who flourished in the structure and schedule of the ­classroom.

All along, Rachel says, she had experienced bouts of severe amnesia. Someone might ask her how she enjoyed a vacation, and she would have no memory of such a thing. But eventually, she felt the presence of others inside her. She would catch a fleeting feeling of one — a force that would sort of jump out and say, "It's not safe!" Some were dominant and became recognizable. They had names. But it wouldn't be until she met Hodgin that she could truly start putting the pieces together. (Skeptics argue that DID is primarily a therapy-created illusion, one in which an overzealous therapist and an easily suggestible patient combine fact and fantasy to the point where there's no telling one from the other. However, there are cases, like Rachel's, where patients have decided prior to therapy that they are multiples.)

When Rachel was 15, she says, a cult member got her pregnant. She's not entirely sure, but she thinks it may have been her father. The sacrifice was not conducted upon the child's birth, but through an abortion, when she was three or four months pregnant. It was carried out in the office of a doctor who was either part of the cult, or at least a compatriot. Strapped into the seat, her feet in stirrups, Rachel felt the doctor inject her with saline, a pain worse than when she was seven and vaginally raped for the first time.

Rachel recounted the event on her blog:

"The doctor looked up and nodded. I felt my daddy's breath on my ear as he whispered, 'Push, bitch'....I bit my lip as another contraction came. I wanted her. I knew she was there. I could feel her. I couldn't let her go. 'Push, whore. Kill her. You deserve to'....My only satisfaction from the whole ordeal was that the doctor wasn't prepared. He was soon splattered with our blood, mine and my daughter's."

Six weeks later, she was dragged to a church used by the cult and forced to "re-create" the sacrifice for the pleasure of the other cult members. This is also described on her blog.

Dressed in white, Rachel was led by a man in a red robe and trailed by "a barrage" of black-robed men who moved "as one, like liquid, like something ­gelatinous."

They passed an organ "looming like a monster in the darkness," down a staircase and past the bathrooms, where she remembered "having to wash my mouth in the urinal" and "what my breasts sound[ed] like slapping against the cold wall."

Once again, she was strapped down, this time to an altar, where the robed men surrounding her began to groan and masturbate. Rachel's uterus "clamps down and spasms, looking for her [the aborted baby], trying to hold her in." A "privileged" man in a black robe approaches her with a syringe.

"'No!' I cannot help it. I know it is only cow's blood to squirt into my vagina and make it look like the abortion had happened here in front of all of them, but the last time a needle was plunged into me, I delivered my firstborn. Dead. And in pieces."

Rachel includes her photograph and her first and middle names on her blog. Under "About Me," she writes: "From birth to age 19, I lived under the rule of one sect of the occult of which my father and grand­father were members." On one of her two MySpace pages (one for the "real" Rachel, the other for her alters) she declared that she did not want to hear from anyone who questioned the existence of satanic ritual abuse or DID.

The Press left numerous messages for Rachel's father, who never responded, as well as a message with Rachel's grandmother, asking the grandfather to call. He didn't. However, this greatly upset Rachel, for it apparently broke a cardinal rule among those who claim to have DID: You do not question. It is strictly a one-way process. When patients present to therapists and physicians who treat DID, their stories are almost universally accepted as true, often for less than compelling reasons. In his 2007 book Switching Time, psychologist Richard Baer wrote that he believed his 37-year-old patient's history because of the "desperation" in her voice.

The Press got similar results in the case of Jennifer, a DID sufferer who wrote her thesis on the condition for consideration of her master of science degree for the University of Texas Southwestern Medical Center in Dallas.

Jennifer and her husband both claim to have DID, and they maintain a Web site with personal histories and educational material of the condition. In her thesis, she included a bio containing her parents' names (including her mother's maiden name) and the name of her brother.

While her thesis does not name her abuser, her Web site does. It is her father, who allegedly began molesting Jennifer when she was about four. This resulted in the advent of at least 54 alters, whose names include Entropy, B-Quiet, Wallpaper, Purple Rain, BluVelvyt and The Lost One. Collectively, they are known as the Tiger Wolf Crew. They often work together in age-based groups; Jennifer's site includes, for example, a poem written "by the Littles of TWCrew."

Jennifer also writes of how her father's brand of abuse changed over the years:

• There were also different images of my father. His abuse preferences changed as I aged:

• The man who seemed to be exploring my body as if it was something he had never seen before...a scientist experimenting with a new discovery.

• The gentle man who slid into bed at night as if he was visiting a mistress, pressing me into his body as if trying to consume me...the lover who wanted closeness and refused to stop until I faked an orgasm.

• The man filled with intense rage who would be so forceful that my body would bleed, who seemed to need to see my hot tears...the bull on a ­rampage.

• The man filled with fear that he would be exposed, who threw me against the wall and strangled me until I blacked out...the one capable of murder.

Jennifer writes on the site of her 1996 confrontation with her father, who had divorced Jennifer's mother years earlier and moved out of Texas.

"What makes you say/think this, where did these so-called memories (his wording) come from," she writes. Then, he turned to Jennifer's mother: "He told her that he wanted to do something to prove that he was innocent, that he would even take a polygraph. (When he asked me if I wanted him to take one, I laughed and told him that he was such a smooth liar that he could mess up a polygraph to say/do whatever he wanted it to do)."

The confrontation made her stronger, and today Jennifer is a mental health professional who treats others. She includes on her site helpful material like "Reclaiming Sex: Tips for Multiples, Survivors and Significant Others." Multiples, for example, should not keep stuffed animals in any areas where sexual activity occurs. "It may also be helpful to have different pajamas: comfy ones that indicate that lils [child alters] are safe to come out at any time, and then sexier lingerie that signals that lils should not be out."

In an e-mail to the Press, Jennifer explained that she and her husband have their alters under control to the point that their alters only pop out at age-­appropriate times. There is never the fear that five-year-old Wallpaper will spontaneously take over while Jennifer is driving, filling out a bank deposit slip or engaging in any other adult activity.

Although Jennifer provided enough online information to identify her father by name as a man responsible for perhaps the worst crime a person can commit, she was upset when the Press tried to contact him, to give him the opportunity to respond to the accusation.

Again, protocol was breached — accusations of child rape and a diagnosis of DID were not automatically accepted. (In a subsequent e-mail, Jennifer explained her concern: "I have known people who have lost careers and the custody of their children because of the DID diagnosis — not because of their actions but because of fear and misunderstanding from employers and the court system. It may be hard to find supporters willing to go public with their belief or even with their own personal history of DID, but that isn't the same as there being no supporters. There is still a strong curtain of silence, shame and fear.").

Actually, it's not just some journalists who have difficulty accepting a multiple personality diagnosis without question. People who believe they have DID will bounce from therapist to therapist. Rachel says she saw a therapist for a year prior to seeing Hodgin. She says that therapist thought she was angry that her parents had divorced, and her father may have done "inappropriate" things. As far as Rachel was concerned, that therapist didn't have a clue.

A friend referred her to Hodgin, who specializes in DID, and Rachel could tell right away that Hodgin knew what was going on in her head — and why.

Hodgin received his master's degree in clinical psychology from Houston Baptist University in 1987 and became a licensed professional counselor in 2004. Hodgin says that many therapists are ill-equipped to handle such a complex problem.

"DID patients are like Rubik's Cubes," he says, before trying another simile. He says they see the world like a fly, with hundreds of little windows. "The 200 windows are one picture, but it's all scrambled."

He says later, "I don't go into this looking to say there's got to be a satanic cult here. I don't care. I just want to get the person back to a mental sanity that allows them to be okay. If I can do that, I've done wonders for somebody. All I know is all these people have similar patterns, similar things occurring...and there's a language to it that is quite different."

One of the problems in understanding and treating DID, Hodgin says, is that it can't be explained solely through a scientific model.

"Emotions cannot be researched," he says. "Who's going to quantify them? The development of emotions, the value of emotions — there's no research here holding up on all this. And so we have a dilemma. Yet these people are showing up. What are we going to do with them?...We've got to do something — why? Because they're showing up in psych-houses. So something exists. Whether we call it PTSD, whether we call it DID — what does it matter?"
_____________________

"Okay, [Rachel], why did you come tonight?" Hodgin asks at the end of the interview. Rachel is visibly exhausted from the action of alters popping in and out during the last few hours.

"Because I thought it might help someone else," she says.

Hodgin gets up for the next step, the little ritual they end each session with. He says it's time to "put the tribe back."

He stands in front of Rachel, who's still on the couch, and presses his thumb on a spot on her forehead between her eyes. She exhales and her body goes limp with relaxation. Hodgin says he's eased the tension from her dendrites, which are pain receptors in the brain. (Neurologically speaking, this means that Hodgin's thumb has exerted enough force to permeate Rachel's skull and interfere with the synapses carrying messages between neurons in her brain.)

Rachel rises, and Hodgin hugs her.

As Rachel and her husband make their way to the elevator, Hodgin stays behind to pack up a few things from his office. When asked about the skeptics, about those who believe DID is a phenomenon created by therapists during "treatment," Hodgin brushes it aside. Rachel already had undiagnosed DID when she came to him, he says. It's not a condition he hunts for; it's a condition he recognizes and can treat.

As he says a few days later, "They keep coming and showing up at my office, and they're saying, 'Nobody can help me. Nobody understands.'"

But, thanks to the work carried out at places like the Trauma Institute and the Ross Institute, there are more and more mental health professionals out there who do understand. They understand that DID can be caused by neglect, by severe beatings, by growing up in a "weird" family. They understand that the patient sets her own reality. They don't have to believe what the patient is saying; the important thing is to deal with the unresolved emotions. They know the alters can be integrated and the patient can be healed.

They know that a diagnosis of DID can be true, even if the patient's story is not.

craig.malisow@houstonpress.com