THE DEVELOPMENT AND DYNAMICS OF L ‘
r MULTIPLE PERSONALITY 9* '

Thesis for the Degree of PILD. I

MICHIGAN STATE UNIVERSITY

EMANUEL BERMAN

, 197's- ;

 

 

 

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9" “~53 ‘

 

 

 

 

ABSTRACT .

THE DEVELOPMENT
AND DYNAMICS OF
MULTIPLE PERSONALITY
BY

Emanuel Bermsn

Following a historical survey on past research and
attempted explanations of multiple personality, a study of
one case is reported. The subject, a 20 year old Black
female, has been observed for 18 months, in and out of the
hospital. Nmerous interviews were conducted with her
and with members of her family, and fourteen self-
descriptive, objective and projective psychodiagnostic
tests were administered to both personalities, some of
them on several occasions. A shorter battery of tests was
administered to the subject's mother and to five siblings.

The major conclusions reached are:

l. The psychological reality of the split between
the two personalities is confirmed, and seeing it as a
simulation or a delusion is not supported by the data.
Blind judges do not see any greater similarity between the

two personalities than between each of them and other
persons, members of the same family.

2. The split consistently spreads over numerous
levels, including physical appearance, expressive move-
ment style, self concept, cognitive functioning, affective
functioning and object relations.

.3. The two personalities cannot be explained as
representing single structural systems in the traditional
sense (e.g. id or super-ego), and drives and defenses are
interwoven in each. Their closest approximation to
structural elements is in their similarity to the "libidinal
ego" and "anti-libidinal ego", which are described by
Fairbairn and Guntrip not as constant mental entities, but
rather as possible constellations of dynamic patterns.

1;. An attempted genetic reconstruction points to
the existence of an initial integrated personality, but
suggests an early onset of the splitting process, related
to the deprivation of infantile oral needs. A cumulative
process of splitting, internalizing and fusing objects
appears to be involved in the gradual formation of the
two personalities in their present form, and neither can
be accounted for by identification with a single figure.
Oedipal dynamics are important in this process, but their
impact is determined by crucial pre-oedipal variables.

5. Marked changes within both personalities are
detected throughout the study period, and the se appear

to be related to the effects of psychotherapy and ex-
ternal events. A close relation exists between changes
in the two, at times bringing about greater convergence,
at other points greater distance. This complementarity
reinforces the the conclusion that the two personalities,
beyond their separate phenomenological existence, are
closely interrelated.

6. Role theory, and a broader sociological per-
spective, also contribute to the understanding of the
split. The two personalities embody conflicting role
eXpectations imposed on women in American society, as well
as conflicting images in the evolving Afro-American
identity.

Discussing the study's theoretical implications,
it is suggested that dynamic personality theory will bene—
fit from abandoning the insistence on the monad-like unity
of personality. The observations of sociologists on the
inner representation of divergent roles, of hypnotists on
the uncovering of childhood patterns in age regression, of
therapists on subpersonalities in their patients, all
suggest a need for a greater recognition of Splitting in
normal life. Freud's structural concepts are insufficient
in explaining individual differences in these complex
formations. A systematic theory of "multiple selves" is

called for.

THE DEVELOPMENT
AND DYNAMICS OF
MULTIPLE PERSONALITY

BF

Emanuel Barman

A THESIS
Submitted to
Michigan State university

in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Department of Psychology

1973

 

Copyright by
Emanuel .Berman
1973

Dedicated
to "Diana"

and to "Julie"

ii

ACMOWLEDGEI’IENTS

This dissertation would not have been possible
without the contributions of dozens of teachers and
colleagues, both in Michigan and in New York. The list
offered here is of necessity partial.

Professor Robert A. Zucker, chairman of the
doctoral committee, followed the project from its first
stage with great interest and devotion, and played a
central role in shaping its methodology and its theo-
retical direction. Professor Albert I. Rabin, as a member
of the committee, made many valuable suggestions.
Professors Arthur Seagull and Bertram Karon also served
on the committee, and I am grateful for their encourage-
ment to pursue my own interests and not to compromise for
an "acceptable" study. I am well aware of the suspicious-
ness within the scientific community toward idiographic
research, and of the pioneering and innovative spirit
expressed by my committee, and thus by the Department of
Psychology at Michigan State University, in accepting
such research as a doctoral dissertation.

Among other members of M.S.U. faculty I would like
to acknowledge the contributions of Professor Milton
Rokeach (now at Washington State University), chairman of

iii

my first guidance committee, through his discussion of

the issues of specificity and generality in psychology,
and of the relation of values to personality structure;

of Professor Joseph Reyher, through his analysis of the
figure drawings; and of Professor Eugene Jacobson, through
his discussion of role theory. The latter theme, and

its relevance to this study, was also illuminated by a
discussion with Dr. Ephraim Yuchtman of Tel Aviv Univer-
sity.

Most of the research has been conducted during my
internship at the Albert Einstein College of Medicine in
New York, and was encouraged by my supervisors, members
of the Division of Psychology in the college's Department
of Psychiatry. Professor Harry Fiss (now at the
University of Connecticut medical School) personally
supervised the analysis of most of the tests administered,
and his availability as a New York-based committee member
was invaluable. He also edited my first report on the
testing results. Professor Aryeh Anavi, in many thorough
discussions of the case, helped me in crystallizing my
understanding of its uniqueness, and in understanding its
implication for a "theory of multiple selves". Important
comments were made in seminar discussions by Professors
Phfima Engelstein, Saul Grossman, Michel Radomisli, Joe
Richman, Moshe Verdy and Fred Wolkenfeld, as well as by
several staff members at Jacobi Hospital and Bronx State
Hospital.

iv

All of my fellow-interns at Einstein (1971/72)
followed the study with interest and encouragement. One,
however, must be singled out. It was Carole Shulman (now
a staff psychologist at Hillside Hospital) who first
suggested the topic as appropriate for a doctoral dis-
sertation. Her continuous help culminated in many hours
devoted to editing and improving the present manuscript.
My gratitude to her cannot be overstated.

I am thankful to Judith Malamnd, Israel Orbach
and Linda Spetner, Einstein interns of the following
year (1972/73) for their labor in scoring the degree of
similarity among tests, and thus assessing blindly the
degree of splitting and validating my conclusions.

Fred Coplon M.D., a resident in psychiatry at
Einstein, played a central role in treating the subject
of this study. Many of the conclusions drawn here re-
sulted from our discussions, and many of the findings are
based on his reports on the history and the course of
treatment, which he kindly allowed me to quote. The
atmosphere of friendly collaboration that existed between
us was essential for a successful research.

other psychiatrists at Einstein who contributed
to my initial understanding of the case were Dr. George
Gero (of the New York Psychoanalytic Institute),

Dr. Paul Nemetz and Dr. Lisa Strober. At a later period
I greatly benefited from Dr. Albert E. Scheflen's careful

observations on the kinesic characteristics of the twa
personalities, which were complemented by Loni Serlin, a
dance therapy trainee at Bronx State Hospital. Members of
the nursing staff at Jacobi Hospital recorded many
observations on the subject during her hospitalization
periods, and these notes helped me in analyzing her
history.

Joanne Lama carefully typed this manuscript, and I
am grateful for her efforts and for her ability to
accept stressful time pressures.

Finally, I have no words to express my gratitude to
Ruth. Without her I could have never survived the tensions,

anxieties and frustrations involved in preparing this study.

vi

1.1
1.2

1.3

1.4

II.

III.
3.1

3.2
3.3
3.1L
3.5

TABLE OF CONTENTS

INTRODUCTION
Past studies of Multiple Personality
Variations of Multiple Personality
1.21 Types of organization
1.22 Nature of differences
1.2 Source of split
1. Outcome
Attempted Explanations
1.31 Supernatural

1.32 Physiological
1.33 As an artifact of simulation or

shaping
1.3h Psychological
1.35 Sociological
Methodological Problems

1.hl Psychological testing
GOALS AND HYPOTHESES

METHODOLOGY
Direct observations
3.11 Videotape recording
verbal communications with subject
verbal communications with family
Testing of subject
Testing of family
3.51 Comparison by judges

vii

51

53
53

55
SS
56
59
S9

IV.
h.1
h.2
m3

IND

Il..5

5.1

5.2
5.3
BA

FINDINGS

 

Subject's family history

Subject's life prior to study

The initial picture:

Diana & Julie

.31 Appearance & general attitude

Kinesios

Cognitive functioning
Affective functioning

h

h.32

n.33 Self Concept
{I'gs

h.36

Object relations

Developments with time

h hi Crises & stability: 9—11, 1971

Mina Attempted integration:
fl.flfi Convergence: 11-12, 1971

Intensified tranference:

2, 1972

h.h5 Follow up:

1972 - 1973

11, 1971

12, 1971 -

Diana, Julie, parents and siblings

h.51 Judgements on similarities

n.52 Members of the family

DISCUSSION

Genetic reconstruction in analytic

perspective

Confirmation of hypotheses

Validation of past explanations

Theoretical implications

REFERENCES

viii

168

183
185
189

193

Table

QO‘U'l-F'WN

LIST OF TABLES

Tests administered to Diana - Julie
Adjective Checklist responses

WAIS results

Rorschach responses

TAT responses

value Survey responses

Perceived degrees of similarity between
tests (average)

Family Rorschach psychogrmms

57
76
83
85
96
121
1h0

lhé

’13

PI
\OCONIO‘VIFU’NH};

(D

H Fl #4 £; I4 H H H
-q o~ U1 \p m H 0

LIST OF FIGURES

Incidence of reported multiple personality cases
The subject's family geneology
Schemes of characteristic postures
Female drawing by Diana (10-71)
Female drawing by Julie (10—71)
Tree drawing by Diana (10-71)

Male drawing by Diana (10-71)
Bender Gestalt by Julie (10-71)
Male drawing by Julie (10-71)
Female drawing by Julie (ll-71)
Male drawing by Julie (ll-71)

Self drawing by Julie (ll-71)

Self drawing by Diana (ll-71)
Julie's semantic space

Diana's semantic space

Female drawing by Diana (2-72)
Male drawing by Diana (6-72)

62
7h
80
81
92
95
101
102
111
113
11h
119
123
125
133
137

List of Figures (cont'd)

Figure

18
19
20
21
22
23

First figure
First figure
First figure
First figure
First figure
First figure

drawing by mother
drawing by Mildred
drawing by Sebastian
drawing by Jane
drawing by Henry
drawing by Gloria

xi ,

1MB
150
155
158
162
166

 

I. INTRODUCTION

1.1 Past studies of multiple personality

"Multiple personality" is defined by webster's
dictionary (1958) as "a pathological state of mind char—
acterized by the person affected exhibiting two or more
distinct personalities or types of individual characters".
This definition fits well the current usage of the concept
in the psychological and psychiatric literature.

Little has changed in this usage since 1823, when
H. Dewar suggested that "a divided consciousness, or double
personality (is) exhibiting in some measure two separate
and independent trains of thought, and two independent men—
tal capabilities, in the same individual; each train of
thought, and each capability, being wholly dissevered from
the other, and the two states in which they respectively
predominate subject to frequent interchanges and alterations".

More recent definitions frequently reflect particular
theoretical biases of the authors. Thus, Fox (in Leavitt -
19h7) suggests it "consists in the alteration of two or more
distinct personalities, the sum of whose distinctive
characteristics, roughly speaking, is equivalent to what
should be the normal personality of the individual". Taylor

and Martin (l9hh) offer an almost opposite view: "A case
of multiple personality we take to consist of two or more
personalities each of which is so well developed and in-
tegrated as to have a relatively coordinated, rich, unified,
and stable life of its own".

The issue of multiple personality first appeared in
the history of abnormal psychology at the beginning of the
19th century. The earliest reference is possibly by the
British scientist, Erasmus Darwin (1801): "I was once con-
conned for a very elegant and ingenuous young lady, who had
a reverie on alternate days which continued nearly the whole
day; and as in her days of disease she took up the same kind
of ideas, which she had conversed about on the alternate day
before, and could recollect nothing of them on her well days;
she appeared to her friends to possess two minds".

The case of Mhry Reynolds, a Pennsylvanian women (1793 -
185h), is believed to be the first to be published in de-
tail. It was first reported briefly in 1817, and later
fully described by Mitchel (1888). This dull and melancholy
young woman, then nineteen, was found one morning "in a
profound sleep from which it was impossible to arouse her".
When she did wake up, she had no memory, no knowledge of
language, no consciousness of ever existing before. She
had to be re-educated in all aspects of life, but learned
rapidly, and could read and write after a few weeks. Her
character changed as well: "Instead of being melancholy
she was now cheerful to extremity. Instead of being

2

 

 

reserved she was buoyant and social".

After five weeks of the new life she awoke as her "old
self" with no memory for the transformation. Thereafter
the two states alternated irregularly, until at the age of
thirty—six the second state became permanent. At this
stage, however, this more lively and joyful self was much
more responsible and practical than at its first appearance.
"Some of her family spoke of it as her third state".

William James (1890), after discussing this case in detail,
suggests that as "the secondary character is superior to
the first, there seems reason to think that the first one
is the morbid one". The same controversial view was later
adopted by Prince (section 1.3h).

Taylor and Martin (19hh), after thoroughly surveying
the literature and eliminating cases which did not fit their
definition, list Mary Reynolds as the first scientifically
established case; the second acceptable publication on their
list is that by von Feuerbach (1828). This is a discussion
of a German epileptic, Sorgel, who possessed a criminal and
a decent personality, the latter amnesic to the former
(Prince, 1906).

Next in the list appear two British cases by Mayo
(1815), and Skae (1815), both of the dual, alternating,
mutually amnesic type (section 1.21). In the 1870's, sev-
eral French cases became prominent in the scientific world.

The last two decades of the 19th century saw the peak as

the interest in this phenomenon; the list of Taylor and
Martin also proves this was the peak of frequency in re-
ported cases (Figure 1).

Number of Cases

30

25

20

 

15

 

10

 

 

 

 

T‘”“‘*n
LL L AL
13 0' 1820 lBhO 1860 1860 19 O 19 O 19h0_

 

 

Figure 1. Incidence of reported multiple personality cases
(1800 - 19h0)

Sutcliffe and Jones (1962) suggest several reasons for
the great interest. Under the impact of Darwinishy they say,
belief in the unity and immortality of the human soul has
been called into question. Identity as a concept was chal-
lenged, and people were concerned about the moral and legal
responsibility of human beings in view of the findings of
the French hypnotists such as Janet and Bernheim who demon-
strated manipulations of memory and will in their subjects.

h

The interest in animal magnetism, mediumship and telepathy,
which was encouraged by the Society for Psychical Research,
established in 1880, added a new perspective to this con-
cern. The connection.between telepathy, hypnosis and
multiple personality is central to the writings of Myers
(1886) and other authors on "psychical" issues.

Within psychology, the cases of multiple personality
were utilized by both sides in the controversy between
physiological reductionism.and autonomous psychological
theories. Azam.(l892) utilized his discussion of Felida X -
-- the most famous French case in the area -- both to exem-
plify and develop a physiological theory based upon Broca's
speculations about cerebral localization. Others suggested
that dual personalities represent alternating dominance of
the left and right hemispheres of the brahn. Janet (1891)
was decidedly opposed to physiological explanations and de-
veloped a theory of his own (section 1.3M).

As a final cause of the abundance of cases, Sutcliffe
and Jones suggest the state of psychiatric diagnosis around
the turn of the century. Descriptive labels were almost
arbitrarily applied to emotional disorders with no attempt
at a logical arrangement of categories. This made diagnostic
fashions hate a powerful force. When."multiple personality"
became popular, cases were frequently attributed to it
through partial similarity, while at a later stage many of
them would have been diagnosed as manic-depressive (mood

alterations), schizophrenic (recurring regressive periods),

5

epileptic (sudden behavior change) or brain damaged (amnesia).

The study of multiple personality in the 20th century
is linked to the name of a person educated in the 19th
century, who in many ways still belonged to its cultural
climate. Morton Prince, who established the Journal of Ab-
normal Psychology in 1906, saw multiple personality as a
central issue in its domain. This perception was clearly
represented in the first volumes of the new Journal. A year
earlier Prince published one of the most detailed case his-
tories of that period's abnormal psychology: "The Dissocia-
tion (fa Personality", a book devoted almost entirely to
the case of Christine Beauchamp. Prince's theory of mul-
tiple personality, developed in the book and in later
publications will be discussed in greater detail (sec-
tion 1.31;).

The interest in multiple personality gradually declined
during the 20th century. By 19%, Taylor and Martin listed
76 cases; not many will be added to the list today. The
notable exception is the case of Eve White, described by
Thigpen and Cleckley (1957). While lacking in theoretical
depth, their book, and the movie based upon it, again
focused the public attention on this intriguing phenomenon.

When the present study was close to its completion, two
new reports of multiple personality cases were published, by
Ludwig et a1 (1972) and by Horton and Miller (1972). The
tower is based mostly on a descriptive research accompanied
by thorough tests in neurology, physiology and learning

6

psychology. The latter reports the findings and outcomes of
an individual analytically oriented psychotherapy. Theo—
retically, Ludwig et a1. go in a role-theory direction,
while Horton and Miller emphasize identification problems.
With their sophistication and divergence, these new studies
may signify a renewed interest in a long neglected area.

1.2 Variations of multiple personality

A first step in the direction of explanation is fre-
quently classification. I will therefore review some of
the suggested classifications in the area, before turning to
theoretical formulation per se.

Taylor and Martin (l9hh) suggest two leVels of classi-
fication: (1) types of organization, (2) nature of dif-

ferences between personalities.

1.21 Types of organization

Three types of organization are described on the level
of the relationship between the different personalities.

An additional differentiation uses the nature of amnesia as
a criterion:

1.211 An alternating personality, when only one at a
time is dominant and conscious. A typical example is the
Norma — Polly — Louise case reported by Goddard (1926).

1.212 A coconscious personality, when one personality
continues to function subconsciously while another is domi-
nant. In most reported cases, this possibility appears in
combination with alternation; but at times it is reported as
the only phenomenon, as in the Anna Hinsor ("Old Stump")
case observed by Barrows (myers, 1903) in which one per-
sonality had control of the right hand, and the other of
rest of the body.

1.213 An intraconscious personality, where a cocon-

scious personality can follow the dominant one's

8

 

thoughts. This was the case in "Miss Damon - Miss Brown"
study by Erickson and Kubie (1939).

Among the 76 cases reported by Taylor and martin, an
alternating personality appears in 72; a co-conscious per-
sonality in 23; and an intraconscious one in 8.

1.21h A special sub-classification suggested by the
same authors is guided by the nature of amnesia. Many alter-
nating personalities are mutually amnesic, remembering no-
thing of each other's experiences. Thus, in the case
published by Hodgson and discussed by James (1890), there
was no commonality of memory to "The Rev. Ansel Bourne" and
to "the merchant, Albert Brown". While Brown appeared spon-
taneously only for 2 months in 1887, he re-appeared when
Bourne was hypnotized by William James in 1890, and then
again had no memory of Bourne's life.

1.215 One-way-amnesia appears in other alternating
personalities. Thus, in Azam's case of Felida X (Prince,
1906), the "secondary" personality had memory for both,
while the "primary" one knew only her own life; this indeed
was one of the reasons that made Prince dispute the attribu-
tion of "primary" and "secondary" titles by Azam.

One-way-amnesia is very characteristic of co-conscious
personalities. In Erickson and Kubie's (1939) patient, the
subconscious Jane Brown knew everything about the dominant
Miss Damon, while the latter could learn things from Jane
Brown only indirectly through automatic writing.

1.216 Taylor and martin, in discussing mutual and

9

one-way-amnesia as sole possibilities, imply that some type,
of amnesia is essential to multiple personalities. Prince
(1906) argued, however, that "meals is not in any way an
essential characteristic of secondary personalities" and
that "retention of memory is more likely to be met with
when the alterations have gradually developed". Ellen-
berger (1970), in his own classification of successive
(alternating) multiple personalities, indeed adds a third
possibility "mtually cognizant of each other". His example
is a case of alternating personalities reported by Cory
(1919), in which "A" and "B" were on good terms with each
other.

A careful examination of the case reveals, however,
that amnesia was not absolutely absent: "When either appears
she is aware of what the other has done (...) But the inner
thought that lies back of an act is known only to the self
that performs it. Of this inner life each knows only as
much as the other sees fit to reveal".

1.217 Another difference between the classifications
suggested by Taylor-Martin and by Ellenberger is in their
approach to cases involving more than two personalities.
Among the 76 cases on the Taylor-Martin list, 14.8 involve twa
personalities, 12 three personalities, 1; four, 5 five, 2 six,
2 seven, and one each involve eight and twelve different per-
sonalities. Taylor and Martin still see all these cases as
varieties of their basic types, and categorize the 12 per~
sonality case as alternating and including mutual and

10

one-way-amesias. Ellenberger sees them as qualitatively
different from simultaneous (co-conscious) or successive
(alternating) cases, and suggests a third category of "per-
sonality clusters".

Counting personalities is one of the least reliable
assessments in this field. Wilson (1901;), in describing the
dozen personalities of his patient Mary Barnes, includes a
"personality" B-IV which is deaf, dumb and totally amnesic,
as well as a "personality" B-I a described as being in coma
and simulating death, thus lacking any consciousness. It is
surprising that Prince (1906) is ready to accept them in his
comt. Confusion appears in less extreme cases as well.

W.F. Prince (1916) speaks of "a case of quintuple persona-
lity", describing five distinct patterns, named "Real Doris",
"Sick Doris", "Margaret", "Sleeping Margaret", "Sleeping
Real Doris". This comt is disputed by Ladd (1919), who
believes there were actually only twm personalities involved.
Taylor and Martin (19%), in an apparent compromise, speak
of four.

1.22 Nature of differences

Structural classifications, while pointing to important
characteristics, seem to contribute little to a causal under-
standing of the phenomenon. More meaningful in this respect
may be the other classification suggested by Taylor and Mar-
tin, involving the nature of the differences between split
personalities. 'Iheir list includes:

1.221 General quality - including temperament,

11

 

sociability, values, etc. , This seems to be an over-inclusive
category, as the lack of any such differentiation will cast
doubt on the diagnosis of multiple personality itself!

1.222 Propriety or good behavior: criminality vs.
innocence. While a central component in the pepular view of
multiple personality, heavily influenced by Stevenson's 'Dr.
Jekyll and Mr. Hyde", this differentiation is far from being
general. Taylor and Martin find it in half their cases, but
in many instances they refer to subtle variations in social
acceptability rather than to a real good - evil dichotomy.
Sorgel (Prince, 1906) seems to be the only historical figure
to conform to the "Jekyll-Hyde" pattern; be murdered a per-
son most cruelly and drank his blood while in his secondary
personality, and in his trial was judged irresponsible and
acquitted.

1.223 Sex: in nine cases one personality was of another
sex or sexual orientation than the other(s). Violet Z.
(Muhl, 1922) wrote automatically with both hands at the same
time 3 the left hand wrote in a feminine style and charac-
terized herself as a girl, while the right hand wrote in a
masculine style and claimed to be a man. It can be noted
here that more than two thirds of the reported cases occur
in women.

1.2214. Youthfulness; significant differences in age
appear in 20 out of 76 listed cases. In the B.C.A. case
described by Prince (1919), A was a woman of 11.0 while B
was like a girl of 20. Sally, in Prince's (1905) Beauchamp
case, was a child of ten or twelve.

12

 

1.225 Sensibility differences —- paresthesias, anes-
thesias, etc. This is a wide-spread phenomenon in this as
in other forms of dissociation. Thus, Sally Beauchamp
(Prince, 1905) felt no fatigue, and was analgesic and tac—
tually anesthetic (unless pain or touch were indicated by
visual or auditory stimuli; e.g. pricking would hurt her
only if she saw the needle).

1.226 Particular responses as paralysis or automatic
acts also commonly differentiate split personalities, as
well as differences of skill, knowledge of languages, etc.
In Cory's (1919) case, B. had a good voice and enjoyed
singing, which A. was unable to do at all.

1.23 §gurce of split

TWO more classifications were never conducted syste-
matically but seem of utmost importance; they concern the
emergence of the split and its final outcome.

As to the source of the split, a clear continuum can
be seen in the degree of intervention by an investigator or
therapist in the process. Three points on this line are:

1.231 Cases in which the split was initiated from the
outside as part of an experimental or clinical treatment.
Thus, Leavitt (19h?) discusses a case in which "the experimen—
tal application of hypnosis resulted in apparent 'isolation'
of components of the psyche with each component being mani-
fested as a distinct and separate personality entity".
Actually, the secondary personality "was produced by sug-

gesting that the (automatic) writing was under control of a

13

 

 

certain.part of his personality unaware to him", and
similarly a tertiary "personality" was suggested at a later
point. Both were introduced to facilitate psychotherapy
‘with the subject, a twenty year old soldier who developed
hysterical paralysis during Wbrld war II.

1.232 Cases in which the split was apparently spon-
taneous, but it first appeared in.a hypnotic trance initi-
ated by the investigator or the therapist. This was the
case with Prince's Miss Beauchamp whose alternate personality
first appeared hypnotically, and whose normal personality -
as Prince (1905) defined it - was "recovered" through hyp-
nosis. In.another case of Prince, that of Hrs. J. (Prince,
1906) the only manifestation of a split was the existence
of a hypnotic personality.

1.233 Cases in which the split clearly'existed prior
to the first contact between subject and investigator, and
its emergence could not therefore be influenced by the latter.
This was true of the first documented case in psychiatric
history, that of Mary Reynolds (Mitchel, 1888). Another re-
port that meets this criterian is that by Goddard (1926),
where the alternations between Norma and Polly started and
were observed before any treatment was offered, even.before
the patient came under the author's attention.

I This differentiation.is of crucial importance, in the
attempt to understand the causation of multiple personality.
The cases in the first group, these artificially induced, as

well as some of those in.the second group, where some

lu

suggestion was evident, were often used as model for under-
standing the phenomenon of splitting in its entirety. Only
the cases in the third group, where no part is played by the
investigator in starting the split, can prove this to be an
inadequate paradigm (section 1.332).
1. Outcome

Dividing reported cases in terms of outcome, and ex-
cluding those in which outcome is unknown, three rough
categories can again be outlined:

1.2h1 Cases in which the existence of more than one
personality persists, in spite of all attempts to reduce
them (or unite them) to one. Thus, Felida X, the famous
French patient of Azam (1892), showed throughout h5 years of
observation many changes in the relationship between her 2
personalities, but neither did fully disappear. The secon-
dary condition became more and more the predominant one,
although it never became exclusive. As long as Azam ob-
served her, Felida had short relapses into her primary
normal condition (Ellenberger,l970, p. 138).

1.2h2 Cases in which one of the initially present per-
sonalities stays, while the other(s) disappears. This hap-
pened with Mary Reynolds (Mitchell, 1888), whose second
personality overcame the first one. Goddard (1926, p. 182)
also reports "Gradually the Norma personality became es-
tablished and Polly rarely appeared -- For the past two

years there have been practically no lapses".

15

1.2113 Cases in which a new, presumably integrated per-
sonality emerges and brings the split to an end. This was
the case with Christine Beauchanm (Prince, 1905) when the
normal and healthy B replaced both B I - supposed for many
years to be the normal personality, but melancholic and
neurasthenic - and the child-like B III, as well as the later
developed choleric B IV.

Sidis and Goodhart (190h) also describe a case of suc-
cessful integration. 'Iheir subject, the Rev. Hannah, deve-
loped a secondary personality following an accident, and for
a while two personalities co-existed. In a retrospective
report, he describes the re-unification (p. 226); "Yet how
could one person live and feel both lives? Here was the
critical point. But the doctors persisted they were both
my lives, and indeed I knew each one was, though it is im-
possible to take two men and make them both into one. But
the lives were constantly becoming more and more personal,
until at last, by a deliberate, voluntary act, the two were
seized, and have both remained for half a year to the pre-
sent date".

Thigpen and Cleckley (1957) believe their "Jane" re-
placed both Eve White and Eve Black. Ludwig et a1 (1972)
describe "Jusky" as the integration of Jonah, Usoffa, Samy
and King Young, the four initial segments of their subject.

Closer inspection will lead us to the conclusion that
the last two categories (1.2142 and 1.21.1.3) are not really

different, and that the choice of a new name or retention

l6

of one of the old names is irrelevant to the true nature of
the final personality. Some integration seems to be present
in all cases where the split disappeared. Mitchell (1888)
says of the later stage in Mary Reynold's life: "The

change from a gay, hysterical, mischievous woman, fond of
jests and subject to absurd beliefs or delusive convictions,
to one retaining the joyousness and love of society, but
sobered down to levels of practical usefulness, was gradual.
, The most of the twenty-five years which followed she was as
different from her melancholy,morbid self as from the
hilarious condition of the early years of her second state.
Some of her family spoke of it as her third state". Simi-
larly, Goddard (1926) remarks: "We were surprised to find that
what we now had was a blend of the Polly-Norma personalities

rather than the Home we had known".

17-

1.3 Attempted Explanations

No comprehensive or generally accepted theory of mul-
tiple personality has emerged so far within psychiatric,
psychological or psychoanalytic theories. Many partial ex-
planations have been, nevertheless, suggested throughout the
years, and I will attempt to sunmarize the major points made.

1.31 Supgrnatural eXplanations

Historically, the phenomenon now described as multiple
personality is closely related to the ancient concepts of
possessions and mediumships. James (1890, p. 375) sees po-
ssession and multiple personalities as two of the three types
of alterations in the present self (the third being insane
delusions) and comments that the differences between these
types are not always clear. It is interesting to find an
Indidan investigator, V.K. Alexander (1956) who reports a
case of a girl "possessed with two evil spirits" and re-
defines it as a case of multiple personality. The belief
in the possibility of a real presence of a deceased person's
mind in one's body, which James (1890, p. 396) is cautious not
to dismiss, is rejected by the Indian reporter.

James was not exceptional in this respect among his con-
temporaries. As mentioned (in section 1.1), many studies of
multiple personality were conducted by members of the Society
for Psychical Research and reported in its publications.

Myers (e.g. 1886) wrote extensively on the subject; also,

18

Barrett (e.g. 1885), Hodgson (e.g. 1891) and later WkF.
Prince (1916-8). As recently as 1933 a Swiss psychiatrist,
Bircher, accepted without reservations the reports of a se-
condary personality of his patient, "Ikara", a Zurich house-
wife, about her 1ife in.a prehistoric age, and explained her
as a reincarnation. Ellenberger (1970, p. 133) while discus-
ing the case remarks: "It is regrettable that he did not
make a detailed investigation of his patient's personal
background".

' 0n.the other hand, many investigators rejected clahms
of supernatural nature even when made directly by their pa-
tients. Cory (1919), speaking of "B", one of the two per-
sonalities of his patient, comments: "Yet notwithstanding
her ability to follow a psychological analysis, after a full
statement of the case she retains unmodified her conviction
that she is a reincarnated spirit, and she lived and died
long ago". Cory does study carefully his patient's personal
background and attempts to moms with psychological explana-
tions to some of the peculiarities of the case, as "B"'s
pseudo-Spanish language.

Cory's approach is identical to the one that will be
followed tn the present study. Multiple personality will be
examined as a natural phenomenon which must be explained
wdthin.the limits of scientific understanding.

1m32 Physiological explanations
Azam.(1887) was the major proponent of a physiological

l9

theory to explain multiple personality. Utilizing and ex-
pending Broca's theories of cerebral localization, Azam
made several hypotheses about the brain structure of his
patient Felida X. He attributed the splitting of her per-
sonality to fluctuations in the functioning of cerebral
lobes or areas, caused by interruptions of the blood supply
to them. The evidence for this hypothesis was ancedotal in
nature, as was the evidence for Myer's (1886) explanation to
another famous case, that of Louis Vive. Myers believed
that in the good, civilized character the left lobe was
dominant, while in the primitive and unrefined character the
right lobe was the influential one. Other "ad-hoe" physio-
logical theories of that period are discussed by Sutcliffe
and Jones (1962, pp. 2h0-2u2) who characterize them as "often
very crude and ... readily modified on the basis of slim
evidence".

Few systematic physiological and neurological studies
were conducted on cases of multiple personality, and those
conducted did not lead to new explanations. In a recent
research by Ludwig et a1 (1972) several psychophysiologioal
measures were utilized. Galvanic Skin Response for emo-
tionally laden words differentiated between the four per-
sonalities of the patient, and GSR conditioning was only
partially transferred; this, however, is consistent with
purely psychological explanations and is irrelevant to the
causal” explanation of multiple personality. Using

20

 

neurological measures, they noted significant differences

in EEG patterns (contrary to the report of Thigpenzand
Cleckley, l95h) and VER (Visual Evoked Response) results,
and one of the personalities was hypalgesic. The authors
tend, however, to see the latter finding as "consistent with
a hysterical conversion reaction" (p. 305), and speculate
(p. 306) that "the differences noted on VER and EEG tests
may likewise reflect differences in emotional status among
personalities". Thus, their causal explanation is of a
social-psychological nature.

The most recent attempt to postulate a physiological
explanation to multiple personality is that of Condon,
Ogston and Pacoe (1969). They report a high frequency of
strabismus (dissociation of normal occulomotor parallelis)
in.fiLmed interviews with "Eve Black" and her counterparts.
Nowhere do they explain, however, how this could have con-
tributed to the split.

While not dismissing the physiological line of thought,
this present study -- due both to the rarity of physio-
logical explanations in recent literature, and to the aut-
hor's.lack of training in physiological research -- will be
limited to the psychological aspects of the problem and will
test the validity of psychological theories only.

1.33 Multiple_personality as an.artifact
The theories explaining multiple personality as an.arti-
fact are, strictly speaking, psychological in.nature. They

21

will, nevertheless, be discussed separately from other psy-
chological explanations, from which they diverge due to the
crucial difference be tween explaining a phenomenon and "ex-
plaining it away", i.e. dismissing its existence.

The present theories can be subdivided according to the
person seen as responsible for the artifact, the patient or
the investigator.

1.331 Multiple personality as a simulation.

The issue of credibility runs through the literature
dealing with multiple personality from its earliest days.
Plumer (1860) says: "Mary Reynolds had no motive for prac-
ticing an imposture, and her mental and moral character for-
bids the supposition that she had either the disposition or
ability to carry out such a fraud". Likewise, William James
(1890, p. 393) discussing his observations on the case of
Ansel Bourne, comments in a footnote: "The details of the
case, it will be seen, are all compatible with simulation.

I can only say of that, that no one who has examined Mr. Bourne..
practically doubts his ingrained honesty, nor, so far as I

can discover, do any of his personal acquaintances indulge

in a skeptical view".

Later researchers were less generous. "After 1910,...
Ellemerger (1970, p. 114.1) reports -- there was a wave; 'of re-
action against the concept of multiple personality. It was
alleged that the investigators, from Despine to Prince, had
been duped by mythomaniac patients...". Due to methodo-
logical difficulties, to be discussed later, the existing

22

reports were insufficient to ward off the suspicions, and
recent investigators find that none of them "resolved the
naive but crucial question of whether these alter per-
sonalities are 'authentic', 'fake', or explicable on some
other basis" (Ludwig et a1, 1972, p. 298).

Taylor and Martin (191414, pp. 291-293) list several
arguements for the genuinesness of split personalities: "The
subjects ... number more than a hundred ... (and) are widely
distributed in time and space. Most of them had never heard
of other cases. A number of the subjects are uncommonly
high-minded, honest people ... Likewise, the observers
number more than a hundred: they, too, are widely distri—
buted: many of them knew little or nothing of one another's
work: and most of them have been accustomed to watching for
fraud and to maintaining professional standards. Finally,
many of the cases have been judged independently by dif-
ferent observers: and among all the various cases, there are
essential parallels in the records for each type of mul-
tiple personality".

A more subtle version of the simulation theory appears
in recent publications. Alexander (1956) suggests that "it
is the same ego that acts in disguise in the various per-
sonalitiesfik although he does not imply conscious cheating
but rather an unconscious (or preconscious?) defense mec-
hanism. Most notably, Sutcliffe and Jones (1962, pp. 251-257),
while rejecting the possibility of deliberate pretense (de-
fined by them as "simulation with correct perception")

23

suggest instead a theory of "as if behavior", classified as
”simulation with erroneous perception".

"Multiple personality cases -- they summarize their
argument -- were found to be free from social pressures to
assume a new identity which usually surround instances of
simulation with full awareness: the "agreement with others"
to seems a role (actor), or the need to simulate a new
identity in order to escape the reprimand of others (ab-
sconding criminal). The multiple personality patient' s
assumption of new identity allowed him to escape his own
restrictive standards, rather than to conform to the rules
or requirements of others. Self delusion, rather than de-
liberate pretense, would be appropriate to these conditions".

While the content of this discussion is very valuable,
the subsequent decision cf Sutcliffe and Jones to use the
term "simulation" in defining multiple personality is mysti-
fying and misleading. It ignores Freud's contribution in
differentiating between hysterical symptoms and simulation,
and confuses conscious and unconscious processes. When their
confusing vocabulary is discarded, Sutcliffe and Jones can
in fact be counted as serious opponents of the dismissal of
multiple personality as simulation.

Simulation as an explanation is also discarded by Lud-
wig et al (1972, p. 301) who note in describing the MP1 pro-
files of the four personalities of their patient: "From
our perspective the internal consistency of the individual
profiles is remarkable and argues against the possibility

2h.

of faking, especially by a relatively unsophisticated per-
son from a lower socioeconomic group". The same disparate
and consistent patterns emerge from their other measures
(section 1.14.1) and augment their belief in the reality of
the Split. 8

1.332 Multiple personality as shaped by the investi-
gator.

The accusation that investigators of multiple per-
sonality "involuntarily shaped the manifestations they were
observing" started appearing after 1910 (Ellenberger, 1970,
p. 1’11). Sutcliffe and Jones (1962, p. 248) offer three
major arguments in favor of this assumption:

1. "Cases having the most luxuriant growth and long
life of additional personalities were under protracted
hypno therapy" .

2. "During the course of therapy all the clinicians ac-
cepted the idea of "other" personalities, gave them names,
discussed them with patients, and admitted in their accounts
of the cases that the transformations had impressed them".

3. "Demand characteristics (Orne, 1959) are likely to
be particularly strong in a therapeutic atmosphere". The
therapist's belief, at times fascination, is "likely to
communicate itself to the patient".

The issue of shaping appeared in major controversies
around 19th century psychologists and hypnotists. Charcot
was criticized by Janet of discussing his patients in 3
their presence, thus influencing their subsequent behavior
in line with his models (Ellenberger, 1970, p. 98). Janet, in

25

turn, was also blamed for reinforcing certain behavior pat-
terns in his own patients (Sutcliffe and Jones, 1962, pp. 2&8 —
2&9). "Having found this deeper trance and change of per-
sonality in Lucie, M. Janet naturally became eager to find
it in his other subjects" -- comments James (1890, p. 291).

Prince, Thigpen and Cleckley all claimed they were
skeptical about multiple personalities, but in practice
fully accepted the emergence of new personalities in their
patients and frequently actively encouraged the transforma-
tions (e.g. Thigpen & Cleckley, 1957, p. 60). As mentioned
earlier, the alternate personalities of Miss Beauchamp
(Prince,1905) and Mrs. J. (Prince,1906) appeared in a hyp-
notic trance induced by the author, and thus their pre-
vious "latent" existence is a matter of inference. Mc~
Dougall (1926, p. #97) warned that "in the course of Prince's
long and intimate dealings with the case, involving as it
did the frequent use of hypnosis, both for exploratory and
therapeutic purposes, he may have moulded the course of its
development to a degree that cannot be determined".

An extreme outgrowth of this speculation is Harriman's
(19h2, 19h3) theory. Harriman describes an ingenious hyp-
notic procedure in which student volunteers "develop" mul—
tiple personalities through indirect suggestions. "One
wonders, therefore —- concludes the author (l9h3, p. 643) --
how much the "classic" examples of multiple personality are
due to the interpretations which have been assigned to auto—

matic behavior or to roles indirectly suggested to these

26

subjects, and how much they are mental phenomena which de-
mand a type of scientific insight differing from that found
in the field of psychology or psychiatry".

Sutcliffe and Jones (1962, p. 251) note that "the evidence
of Harriman's studies is incomplete, since only a few of the
behaviors found to be characteristic of multiple personality
are covered". A more crucial criticism is possible:
Harriman's subjects chose for themselves their own new roles,
and he discusses these roles as determined by fantasies and
identification with significant persons. While the actual
external emergence of a second "character" is artificially
induced, Harriman's experiments demonstrate its universal
potential and possibly its universal presence in the un-
conscious. They reinforce the conclusion of Sutcliffe and
Jones (1962, p. 259) "that the contrast between multiple
personality and certain behaviors of normal people was probably
too strongly drawn".

It must be conceded, however, that all cases in which a
dual personality emerged under hypnosis are bound to be con-
troversial. The "hard core" cases of multiple personality,
which make an explanation by shaping or suggestion imposs-
ible, are those numerous instances in which the split oc-
curred prior to any intervention by a therapist or investi-
gator and was independently observed by others. Some of
these cases were listed earlier. The present study will in-
vestigate one in detail.

2'7

1.3h Psychological explanations

We are now approaching the attempts to eXplain mul-

tiple personality while accepting it as a bona fide phe-

 

nomenon of a psychogenic nature. These attempts are
numerous and mostly fragmentary, but following their de-
velopment 4- roughly in a chronological order -- illuminates
the recurrence of certain concepts, themes and theoretical
insights.

The French Pierre Janet appears to be the first to
formulate a theory of multiple personality. In his classi-
cal "L'Automatisme Psychologique" (1889) he discusses
"successive existences" as a complex manifestation of the
activation of psychological "automatisms". Subconscious
fixed ideas can prevent the perception of some sensations,
thus excluding them.from.memory, and creating split parts
of the personality endowed with an autonomous life and de-
velopment. The origin of the splitting is in traumatic
events of the past, and one of its causes is a narrowing of
the "field of consciousness" due to psychological weakness.
The Split, as well as parallel hysterical symptoms, can be
cured through the discovery and subsequent dissolution of
the subconscious system.manifested in it.

These ideas, which in Ellenberger's (1970, p. h06)
View stand "at the threshhold of all modern dynamic psychiatry",

include many elements that influenced the explanation of

28

multiple personality to the present day: the unconscious
source: the influence of a childhood trauma; the split-
ting; the energetic function served.

Janet's contemporary William James, (1890, pp. 3811-5)
accepts Janet's view that the source of the split is inhi-
bitions bearing "on a certain class of sensations (making
the subject anaesthetic thereto) and also on the memory of
such sensations". The anaesthetic and "amnesic" hysteric
-- he proceeds -- is one person; but when you restore her
inhibited sensibilities and memories by plunging her into
the hypnotic trance -- in other words, when you rescue
them from their 'dissociated' and split-off condition, and
make them rejoin the other sensibilities and memories ~-
she is a different person".

This may be the first expression of the idea that the
"secondary" personality is actually the primary, more com-
plate and less inhibited one. This is a central issue for
Prince (1906, p. 181) who complains about some cases discus-—
sed by Jules Janet (Pierre's brother) in which: "The
first abnormal personality ... was regarded as the normal
state or personality, while the completely normal person
who was artificially restored was, in consequence, re-
garded as a secondary (dissociated) personality".

In general, however, Prince's theory still resembled
Janet's, and is based on the assumption that "alteration
of personality is effected through the primary organization
by experience and later coming into dominating activity of

29

particular systems of ideas with their affects, on the one
hand, and the displacement by dissociation or inhibition
of other conflicting systems on the other". (Prince 1919,
p. 225).

"It should be noted -- explains Prince (1919, pp. 226-
227) -- that the formation of a secondary personality is the
result of two processes, dissociation and synthesis ...

As to the mechanism by which pathological dissociation is
effected, it may be well to point out here that there is
no reason to suppose that it is anything more than an ex-
aggeration of the normal mechanisms by which ... mental
processes are temporarily inhibited from entering the
field of consciousness ... By the second process, syn-
thesis, particular systems of ideas with the conative
tendencies of their feeling tones rise to the surface out
of the unconscious and become synthesized with the per-
ceptions, and such memories and other mental systems and
faculties of the individual as are retained". Prince men-
tions three categories of such particular systems: (1)
systems belonging to one "side" of the character: (2) out-
grown systems of childhood; (3) repressed sentiments and
thoughts now rising to the surface.

The issue of the emotional shock or trauma, raised by
Janet, also emerges in the writings of Prince and his
contemporaries. Christine Beauchamp (Prince, 1905) lost her
mother at the age of 13, and Prince suggested this was the

30

point where the split started. Doris (W.F. Prince, 1916)
also lost her mother in traumatic circumstances, and one
of her splinter personalities appeared according to the
author on that occasion: he believed, however, that a
prior splitting was caused by the shock of being dashed
upon the floor by her furious father. Cory (1919, p. 281)
had no doubt that "the cause of the dissociation (in his
patient A-B) was..a shock that A received from the tra-
gic death of her father". Norma's twin sister died at
ten (Goddard, 1926, p. 182) and her father died of tubercu-
losis when she was sixteen, shortly before the appearance
of her alternate personality, Polly.

The major trauma is reported in most cases to be ob-
ject loss. In the Home - Polly case however, there
appears the theme found by Freud and Breuer (1895) in their
hysterical patients. Goddard (1926, p. 185), in his charac-
teristically stilted language, reports: "The vita sexualis
was manifested through the hallucinosis incestus patris".
Both personalities persistently reported intercourse with
the father at the age of 111 (two years prior to his death),
and the ease with which Goddard determines this is but a
hallucination discloses a moralistic bias, and a total dis-
belief in Freud's findings on sexual development. "Why
did a young woman without experience and with an unusually
pure mind in regard to such matters, have such a dream or

imagination?" - asks Goddard (1926, p. 186), and answers she

31

must have acquired the idea when.staying in a "home for
wayward girls". Thirty years were to pass before the
oedipal issue was raised again as relevant to the under-
standing of multiple personality (Alexander, 1956; later
Horton and Miller, 1972).

Goddard's faithfulness to 19th century ideas is also
manifested in his return to Janet's energetic postualtes.
"we have seen from.Norma's history that she has always
been a child of what we may call "low vitality" ... with
no surplus of energy ... (therefore) these cell bodies
which are the supposed storehouses of energy are ...
possessed not of their full quota of energy, but barely
enough to start the next neuron into activity". This makes
it possible for one part of the nervous system to be acti-
vated without arousing other parts, and thus a splitting
of consciousness occurs (Goddard, l926,pp. 188-189).

Goddard's position is regressive in nature, as Janet's
approach was rejected by Prince (191h, p. A99) who wrote:
"Janet, when interpreting such phenomena, attributes them
to "psychological feebleness" in consequence of which the
personality cannot synthesize more than a certain number of
emotions and ideas to form the personal self-consciousness.
It certainly cannot perform the synthesis involved in re-
taining certain formerly possessed sentiments, etc., but it
is not because of feebleness. Many hysterics can synthesize

quite as many psychological elements as a normal person,

32

but not sentiments and emotions of a certain character,
i.e., those which pertain to certain experiences, to cer-
tain systems of remembrances".

Avoiding the neurological terminology, and attempting
to synthesize both Janet and Prince, Taylor and Martin
(l9hh, p. 296) explain energetic notions of multiple person-
ality: "Lowered general energy undoubtedly favors mul-
tiple personality ... Severe conflicts between urges use
up energy ... and they precipitate emotions which like-
wise use energy, unbalanced urges, and are disruptive".

A Freudian version of the energetic concept is
offered by Glover (19h3, p. 12): "The weakness of the ego
depends on the degree to which early nuclei retain energy
and are capable of a degree of autonomoic function -- in
this way preventing mental energies from being distri-
buted amongst more integrated layers. Energy can be with-
drawn or absorbed from more integrated layers in two main
ways: (a) regression to, and re-activation of primitive
interest; (b) absorption of energy by direct conflict in
the more integrated layers themselves. This conflict is
in its turn exacerbated where there exists already an ex-
cessive amount of active primitive interest. (I suggest
the use of the term dissociation to describe this clini-
cally)".

Glover sees his use of the concept of dissociation as

radically different from that of Janet, in whose

33

"atomistic association - theory ... dissociation is a
falling away of groups of atoms from.the aggregate of
consciousness". In his usage, dissociation.is a pos-
sible result of repression, reaction formation etc., not
a defense mechanism in itself. His attempt to introduce
the concept into psychoanalysis was, however, not quite
successful. Thus, Alexander (1956, p. 275) writes: "I
strongly feel that cases of multiple personality are not
cases of dissociation, but rather cases of repression and
identification" -- a dichotomy which disregards Glover's
suggestions. Eidelberg (1968) does not list the concept
of dissociation in his "Encyclopedia of Psychoanalysis".

Another way of describing the different uses of the
dissociation concept is offered by Guntrip (1969, p. 96):
"Janet held that the psyche, through some inherent weak-
ness, could lack the strength to hold itself together and
could 'fall apart' into dissociated fragments operating
independently. Freud£s_gypamic explanation in.terms of
emotional conflict and repression.led the way to the op-
posite view that ego-weakness is the outcome, not the
original cause,_of a splitting of the primary unity of the
pgyphe under severe early traumatic stress. Fairbairn is
one of the first to point out that hysteria runs back in-
to a schizoid condition of the personality".

Indeed, before suggesting the word dissociation,
Glover (19h3) refers to the same process as nucleation of

the ego. What he discusses, nevertheless, is but a more

3%

detailed view of Freud's tripartite division. A much more
radical view was offered by Fairbairn as early as 1931.
Strangely enough, no references to Fairbairn's position

are to be found in later writings on multiple personality.
Leavitt's insistence on identifying the split personalities
in his case with representations of the superego and the id
(Leavitt, 19h7, pp. 286-289), in spite of evidence to the
contrary (manifestations of drives in the "superego" person-
ality, and of guilt in the "id" personality) is an example
of the results of this disregard.

Leavitt quotes Alexander (1930) to justify his
approach: "Therefore, when I describe the superego as a
person, and neurotic conflict as a struggle between dif-
ferent persons, I mean it, and regard the description as
not just a figurative presentation". This is exactly the
approach criticized by Fairbairn (1952, p. 218) when he raises
"the question whether Freud's tripartite division of the
mind has not led us to regard the ego, the id and the
super-ego too much in the light of entities". Instead,
Fairbairn suggests a flexible scheme, in which ego, id and
super-ego represent only three out of many possible func-
tioning structural units. He discusses a patient in whose
drowns and fantasies stable personifications appear; this
discussion leads him to the conclusion "that independent forma-
tions may become differentiated in the unconscious, having

boundaries which do not conform to those implied in Freud's

35

tripartite division of the mind, and that such independent
formations may also invade consciousness in cases of mul-
tiple personality". (Fairbairn, 1952, p. 220)

Fairbairn regards his suggestion as an outgrowth of
Freud's view (in "the Ego and The Id") that multiple per—
sonality may have its origin in the various identifications
of the ego. In subsequent papers he continued to develop
these ideas, gradually abandoning libido theory and for-
ming his new object relations theory. In l9hh (1952, p. 90)
he suggested that "repressed 'impulses' are inseparable
from an ego structure with a definite pattern", and
utilized multiple personality as an example of such link-
age. While in l9h3 (1952, p. 62) he formulated the view -—
along Kleinian lines -- that "what are primarily repressed
are neither intolerably guilty impulses nor intolerably
unpleasant memories, but intolerably bad internalized ob-
jects", this view is reformulated (1952, p. 168) in the theory
"that repression is exercised not only against internalized
objects ... but also against ego-structures which seek re-
lationships with these internal objects".

While never fully followed, Fairbairn's ideas are sup-
ported by suggestions made by other contemporary investi-
gators. Erickson and Kubie (1939, p. 505) assume that the
split in their subject started during a traumatic childhood
event, when "the young woman had made a very deep and pain-

ful identification with her grandfather".

36

Geleerd, Hacker and Rapaport (19’45, p. 2114.), speaking
of amesia and allied conditions -- including double per-
sonality -- suggest "that in some cases at least (and
possibly in all) the fugue state is brought about by a
reversal of the process by which the superego was origi-
nally created. The superego or parts of it seem to be
placed again into the outside world" ... In general, how-
ever, their discussion is loyal to Freud's original topo-
graphical and libidinal concepts.

A similar loyalty to Freud's topography is exhibited
in other contemporary discussions. Thus, sutcliffe and
Jones (1962, p. 256) speak of multiple personality as "an
escape from the anxieties of a strong superego repressive
personality by creating a relaxed, easy going alternate."
Freud's original framework is also kept by Luparello
(1970) who attributes fugue states to a regression to an
early phase of the mother - child relationship. Luparello
emphasizes the role of denial in dealing with reality and
external perceptions, in comparison to the more selective
functioning of repression directed toward internally de-
rived ego representations (Jacobson, 1957). Four features
of fugues are listed: resemblance of sleep; intense se-
paration anxiety: suicidal impulses 3 and murderous im-

' pulses against love objects that turned away.

Although "fugues with change of personal identity"

(i.e., multiple personality) are included by Luparello in

37

his domain, there is no splitting in the case he dis-
cusses, which is limited to retrograde amnesia (return to
an earlier period). This may account for the fact that
no explanation is offered for the choice of a second
identity in other instances of "amnesia".

Tb explain this, it is necessary to return to the
phenomena of identification, Thus, Osgood and Luria
(l95h, pp. 588-590), in.their discussion.of the Eve White -
Black case, note that Eve Black fully identifies with her
father and rejects her mother to meaninglessness. This
they interpret to indicate "the Electra complex as the un»
derlying dynamism", and suggest that in Eve Black "selfish
needs for superiority and playing the father role are
achieved". Playing the father role is more than is usually
regarded as the "Electra complex", but the distinction be-
tween cathexis and identification (internalization?) is
not discussed by the authors.

Similarly, Alexander (1956, p. 275), is analyzing the
relationships between his patient Soosan and her male split-
personality Kotchu, concludes that "Kotchu was a personi-
fication of Soosan's sexual impulses which were repressed.
The only cause to which we can.attribute this repression is
an oedipus situation, the father image in this case would
be her uncle. In this culture, however, the paternal
uncle is usually the father image and children address him
as 'little father'". In the reported case, however, "Kot—

chu" reported that he "disguised himself as the uncle" in

38

a hypnotic fantasy. Soosan not only desired her uncle;
she "became" the uncle.

Horton and Miller (1972) who also emphasizes the role
of incestuous oedipal wishes in their patient, offer the
most comprehensive formulation so far of the etiology of
multiple personality from an identification view point.
Summarizing their own case, as well as others (e.g. Lip~
ton, 19h3, Mhsserman, 1961), they reach the following con—
clusions:

"(1) The parent of the same sex is an unsatisfactory
identification model and appears to show multiple per—
sonality facets that are contradictory; (2) the parent of
the opposite sex presents multiple facets of personality
functioning that are quite distinct and contradictory with-
in the family structure; (3) the individual has the
capacity to make meaningful emotional relationships so
that substitute identification figures are sought; the
syndrome follows the loss of these relationships; (A) to
maintain marginal ego integration, knowledge of the dif-
ferent personalities is repressed. A failure of this dy-
namic repressive mechanism leads to acute ego disintegration

in the absence of therapy".

1.45 g§gciological explanations

 

Some of the recent explanations of multiple personality
seem to abandon the intrapsychic domain in favor of more

sociological, or perhaps social-psychological, formulation.

39

One such direction was indicated by Murphy (19147, p. 1.1.31.)
when he concluded that "most cases of multiple personality
appear essentially to represent the organism's effort to
live, at different times, in terms of different systems

of values".

As mentioned (section 1.222), many of the differences
in "propriety" between the two "partners" of a dual per-
sonality are related to social norms of the period rather
than to absolute moral judgements, Several such diffe-
rences, Taylor and Martin (191114, p. 289) report, "were more
serious for the Victorian personalities involved than they
would be for us". It is not hard to speculate about the
possible usefulness of "splitting" as a way to avoid the
conventions and role-expectations of one's society, or per-
haps to simultaneously respond to contrasting role expec-
tations.

A poem published in "Punch", and quoted by Prince
(1919) seems to express such a view in its description of
one of Prince's cases: "Whenever I am A./ The perfect
saint I play; / My virtues are noted, / And I am devoted /
To doing good works all day. // ... A proper and prim young
girl, / A hair-very-trim yomag girl, / A chaste, unemo-
tional, highly devotional, / Terribly grim young girl. //
Whenever I am B / I am the very D / Delighted in joking /
And cigarette smoking / And having a rare old spree. // ...
A very alert young girl, / A cheeky and pert young girl, /
A rackety, rollicking, merrily frolicking, / Bit-of—a-flirt

yams girl 0 o o I!

14.0

 

Taylor and Martin (19141;, p. 295) speak of a situation
in which past and present circumstances have caused the
individual "to develop at least one disparate, protective
role ... (in which) the individual can escape from some of
his stresses, and so can feel more comfortable than he
knows otherwise".

"The individual derives his role -~ they continue —-
from experience, whether passively or actively, and con-
sciously or unconsciously. Passively, a role may come to
him from out of his own history, or from a living example,
or from verbal or other suggestion. Actively, he may se-
lect or synthesize a role from his various observations
and thoughts ... The role that he finds acceptable may
be simple at first ... however, the more the individual is
interested in it and is unable to make it either include
or exclude the rest of his make-up, the more he learns
new reactions that augment the welcome role ... (which)
grows stronger and richer".

In postulating a goal-directed behavior, such ex-
planations come close to seeing multiple personality as
simulated (section 1.331). Sutcliffe and Jones (1962)
thoroughly explain the difference between multiple per-
sonality and consciously assumed roles and reject the idea
of deliberate pretense; although they emphasize the im-
portance of social settings in creating variability of
identities.

14.1

The most comprehensive social-psychological dis-
cussion of multiple personality is offered by Ludwig et al
(1972) in their analysis of their patient Jonah. Each of
his three split personalities is competent in dealing with
a certain type of social challenges 3 one is most suited to
respond to sexual stimuli, another to those requiring
aggressive action, a third one to interpersonal difficulties
requiring a legalistic approach, "and each views himself
and the world through a value system based in these emo-
tional themes". "Actually -- they explain (p. 308) -- this
automatic switch over to another personality is highly ad-
aptive since this alter identity has accumulated and de-
veloped many nonshared experiences and skills over the
years relative to its emotional specialty and is in a bet-
ter position for handling the particular situation".

In emphasizing the contextually determined and role
specific behaviors, the authors approach those sociologists
who find role theory a sufficient tool for explaining in-
dividual actions, and tend to avoid the concept of per-
sonality. In assuming inner consistency of each of the
"role performers", however, they differ from this extreme
view. Their position is most closely related to Brown-
fain's (1952) findings about various systematized "self
pictures" acquired by individuals and selectively expressed
and acted out in different social contexts.

In stating that "all individuals, to some extent, can

be 'different' people under different circumstances , de-
pending upon their emotional needs and the external situa-
tional demands", Ludwig et a1 approach the idea of "sub-
personalities" as inner representations of social roles,
and point to a possible bridge between role theory and
personality theory.

113

1.14. Methodological problems

The methodological development in the study of mul-
tiple personality corresponds to the changes in methods of
psychological and psychiatric research in the 19th and 20th
centuries.

In its first stages this research was purely obser-
vational in nature. Reports by Mitchell (1888), Mayo
(1814.5), Skae (1814.5) or von Feuerbach (1828) are nothing but
thorough descriptions of observable facts. While this
approach in its best examples led to very detailed and ex—
act reports based on extensive journals (Prince, 1906, is
the most perfect specimen) the resulting studies could not
penetrate the external facts and contributed little to the
causal understanding of the cases they investigated.

Hymosis was the first and foremost research method
introduced into the field, most notably by Janet. It was
utilized as both a research technique and treatment tech-
nique, frequently central to the discovery -- or, some say,
creation -- of multiple personalities (section 1.232) as
well as to their re-integration (section 1.2143). The his-
torical role of hypnosis in this area was twofold. 0n the
one hand, by making it possible to communicate with dif-
ferent personalities according to the investiagors': needs
(e.g. Ludwig et a1, 1972, p. 299) and by recovering memories
long repressed and not otherwise accessible (e.g. Erickson
and Kubie, 1938), hypnosis contributed greatly to our under-
standing of multiple personality. 0n the other hand, the

L411,

use of hypnosis considerably increased the suspicions re-
garding the genuineness of the whole phenomenon (section
1.332). The latter consideration contributed to the
avoidance of hypnosis in the present study.

Of related value is the method of automatic writing
(e.g. Erickson and Kubie,1938) which is of particular
usefulness in the study of coconscious and intra-conscious
personalities (sections 1.212, 1.213). This method like-
wise inVOlves a degree of suggestion and invitation on the
researcher's part and is the subject of the same criti-
cisms as hypnosis.

Objective physiological and neurological investigations
were introduced by Azam (1887), in his studies of Felida X,
and by Bourn and Burot (1885) in their experiments on
Louis Vive. Based on the limited scientific knowledge of
their time these studies were simplistic and lacking in
controls. EEG has been studied in more recent cases (Thig—
pen and Cleckley 195k, p. lh5; Ludwig et a1, 1972, p. 30h), but
physiological investigation in general has contributed little
to the psychological understanding of multiple personality
(section 1.32).

More valuable have been subjective reports of persons
having split personalities. One must agree with Prince
(1919, p. 230) who says: "If the writer is endowed with the
capacity for accurate introspection and statement such an

account ought to give an insight into the condition of the

115

mind during these dissociated states that is difficult to
obtain from objective observation, or, if elicited from a
clinical narration of the patient, to accurately trans-
cribs".

Prince (1919) himself quotes extensively from the
written reports of "B", one of the split personalities in
the "B.C.A." case, and from those of "C", in Prince's view
the recovered reintegrated personality. The influence of
Prince's ideas and vocabulary is evident in these reports
but they are still rich in relevant autobiographical and
introspectiVe detail. The report supplied by Sidis and
Goodhart (190k) also describes vividly the experience
of the split: "It seems to me, on reasoning, as if there
were two bodies alike, like twins, perhaps, beings that
had lived entirely different lives, or like twins of the
same body ... Yen would think it impossible to join the two
lives into one; they would seem so discontinuous and dif-
ferent ... I cannot fit the parts of the one into the space
of the other" (PP. 196-199).

1.hl Psychological testing of multiple personalities

The deveIOPMent of psychological testing in this cen-
tury supplied the researcher with a method highly useful
for the study of multiple personality, which can help
overcome problems of reliability (as those posed by obser-
vational studies) and validity (as those created by hyp—
nosis). So far, however, the use of psychological tests

in this area has been limited.

A6

An early example of the use of systematic psycho-
logical measures is Prince's (1929) utilization of
McDougall's classification of emotions as a basis for dif-
ferentiating among the personalities of Miss Beauchamp.

The same scale was recently used by Ludwig et a1 (1972,
p. 301) following Prince's model.

Erickson and Rapaport (19ul) presented the results of
projective and psychometric tests administered to two per—
sons with dual personalities, but their report was not
published. Geleerd et a1 (19h5, p. 219) while discussing five
patients with fugue states and varying degrees of split-
ting treated at the Mbnninger Clinic, note: "The psycho-
logical tests in all our patients showed a predominance of
compulsive features".

The first detailed report on the projective testing
of a multiple personality was published by Leavitt (l9h7).
It concerned, however, not a "natural" case, but one de-
liberately developed in psychotherapy (section 1.231).

The Rorschach and the TAT were administered to "Dick,

Frank and Leo". Leavitt (19h7, pp. 287-8) explains:
"EMployment of these projective techniques seemed to offer
certain advantages. Rorschach cards and the T.A.T. plates
are standard stimuli, and responses lend themselves to an—
alysis. Thus, responses of the disparate personalities
could be compared with well-established clinical personality
patterns. In addition, the Rorschach and, to a lesser ex-
tent, the T.A.T. responses are less influenced by ratio—
nalization mechanism than is verbalization".

Leavitt discusses the different approaches of the three

in the testing situation, reproduces the psychogrmms of

’47

 

the Rorschach test and supplies summaries of the stories
given to TAT cards A, 7 BM, 6 BM, 13 MF, 16 and 1 EM. The
results are of considerable interest and their complexity
far excedes the author's initial assumptions as to the
nature of the experimentally produced personalities as
"superego" and "id" personifications. Distriubtions of
locations, determinants and content vary on the Rorschach;
the TAT stories express different degrees of repression,
anxiety, dependency and maturity.

Thigpen and Cleckley (1957, pp. 128-129) express open
prejudices against projective tests. "From any patientis re-
sponses in such tests one can, if he likes, theorize in-
definitely, and by the manipulation of the currently popu-
lar dynamic concepts, work out explanations of dubious
validity along any line he might choose" (PP. 128-129). It
is not surprising that they conclude that "the Rorschach
and other projective tests ... revealed nothing important"
in their case.

The testing report itself, however (Winter, 195h), gives
a totally different picture. "A comparison of the pro-
jective tests indicates repression in Mrs. White and re-
gression in Mrs. Black", concludes the examiner, and his
analysis of test results (on the W-B, Wechsler Memory Scale,
Figure Drawings and Rorschach) leads to many other differ-
entiating elements. The raw data, unfortunately, is neither
reported nor referred to, and attempts to secure it, by this

author, have so far been unsuccessful.

h8

 

The case of Eve White/Black was also studied through
the analysis of handwriting (Thigpen & Cleckley;195h, p. lh9),
but this was limited to the question of separateness or
unity of the three personalities. Much more impressive
was the use of the semantic differential (Osgood & Luria,
l95h) which led both to a detailed "mapping" of the inner
world of Eve White, Eva Black and Jane, and to important
hypotheses regarding the development and reasons of the
split itself.

Ludwig et a1 (1972) utilize several methods of psycho—
logical testing, divided into three categories. (1) The
self descriptive techniques utilized were systematic in-
terviews based on MoDougall's scale of emotions, Form R
of the MMPI (Hathaway & McKinley 1967), the Adjective
Check List (Gough & Heilbrun, 1965) and self drawings. All
revealed considerable differentiation. (2) Intelligence
was measured by the Kent Emergency Scale (Kent, l9h6), the
Shipley Scale (Boyle, 1967) and by the Similarities and
Block Design subscales of the WAIS. No considerable diffe-
rences were found on this level. (3) Finally, learning
and memory tasks (paired words, associate learning, logical
memory) were used to assess transfer of learning and re-
tention of knowledge. They indicated uneven practice ef-
fects between personalities. This issue was further
studied through psycho-physiological methods of GSR measure-

ments and conditioning.

#9

 

In view of the thoroughness of Ludwig and his asso-
ciates, the lack of any unstructured techniques (beside
the drawings) is disappointing. This avoidance cannot be
justified by the non-psychoanalytic approach of the authors.
The TAT, for examPle, has been utilizedcextensively in ob-
jective non-clinical research (e.g. on achievement moti-
vation) and can be interpreted simply as "thought sampling"
(McClelland et 31,1953, 1). 321), analyzed in behavioral terms
(deCharms,l968, pp. 191-208) or "conceptualized as an imaginal
reflection of the subject's current social position within
the surrounding matrix of social role " (Klinger 8c McNelly,
1969, p. szu).

SO

II. GOALS AND HYPOTHESES

The basic goal of the present study is to reach a
better understanding of multiple personality -- its
genesis, its dynamics, its functions. Contemporary psycho-
analytic theory, in particular object relations theory, is
utilized as a theoretical framework for such understanding,
and the validity of Fairbairn's concept of ego splitting
(section 1-34) is examined. The relevance of sociological
role theory (section 1.35), and of the notion of subper-
sonalities as a general phenomenon of human life, is also
given consideration. As a more far-reaching goal an at-
tempt is being made to draw conclusions from multiple per-
sonalities as to the normal processes of personal develop—
ment and of the crystallization of self identity.

Due to the exploratory nature of the study, its hy-
potheses could be stated only in general terms. The main
hypothese offered at the planning stage were:

A. Multiple personality is not a delusion or a simulation
but a psychological reality. The split personalities
are separate, well crystallized and internally consis-
tent patterns.

B. These patterns can be detected not only in external-

conscious -verbal behavior; the split persists on

51

D.

the levels of intellectual functioning, cognitive
style, expressive movement and fantasy life.

The split personalities cannot be seen as representing
single structural systems (e.g., superego or id);
drives and defenses are interwoven in each, in dif-
ferent combinations.

Beyond their separate phenomenological existence, the
split personalities can also be seen as closely re—
lated, as representing alternative and complementary
solutions to the same initial dilemmas.

Through a genetic reconstruction it is possible to
trace an early pattern of an integrated personality,
which includes elements later existing in all per-
sonalities; none of them could therefore be defined

as the "real" one.

With the influence of psychotherapy or external chan-
ges, the split personalities will change; due to their
inter-dependent nature, changes in one will always be

complemented by changes in the other(s).

p 52

 

III. METHODOLOGY

Due to the rarity of multiple personality cases, the
present study is based on one case only: a black female,
20 years old, who in this report will be called Diana, and
whose secondary personality will be here called Julie.

In order to compensate for the limitations imposed by
studying one subject, a large and varied sample of obser-
vations has been utilized. This study lies methodologi-
cally in the tradition of the idiographic approach (A11-
port, 19h2), and is guided by the belief that "psychology
will become 9233 scientific, i.e. better able to make pre-
dictions, when it has learnt to evaluate single trends in
all their intrinsic complexity". (Allport, l9h0)

The material collected and analyzed in this study can
be roughly divided into five categories:

3.1 Direct observations

Diana was admitted on September 17, 1971 to a psychia-
tric ward of Jacobi Hospital, which is part of the Bronx
MUnicipal Hospital Center affiliated with the Albert Ein-
stein College of medicine. On the ward (10W) she was
assigned to Frederic Coplon, M.D., at the time a first year

resident, for psychotherapy; and to me, at the time a

53

psychology intern, for psychological testing. She stayed
in the hospital, with some interruptions, till February
13, 1972.

During these five months Diana has been observed al-
most daily by myself, by Dr. Coplon, and by many other
members of the ward staff. These observations were made
in scheduled individual sessions, in group therapy, in
therapeutic community meetings, and during informal en-
counters on the ward. Many of these observations were
recorded in the progress notes and in the nurse's notes,
routinely added to Diana's hospital charts, and were aVail-

able to me in preparing the present study.

3.11 Vidgotape recordigg

 

In October 1971 two interviews were conducted by a
medical student, Mark Chenven, who was at the time in
training on the ward: one with Diana, one with Julie.
These interviews, each lasting close to an hour, were both
recorded on videotape, thus creating a permanent record of
the appearance of the two personalities, their patterns of
expressive movement, and of voice and tone of speech, in
addition to a transcript of their verbalizations.

These two recordings were viewed by me in March 1972
together with Dr. Albert E. Scheflen, in order to draw
conclusions as to the non verbal differences between Diana

and Julie.

SLI-

 

3.2 verbal communications with the subject

During the same period about fifty interviews were
conducted with Diana and Julie by“myse1f, by Dr. Coplon,
and by other staff members. The content of most of them
was recorded in the progress notes, and others were re-
ported to me Verbally. They clarified the subjective
view of the subject regarding her condition, and (together
with material from the family) made a reconstruction of
her past possible.

In October - November 1971 Diana and Julie wrote a
report on their life, entitled "They even didn't lmow my
name". Some chapters of the report were written.by Diana,
and others by Julie. Diana allowed me to read the report,
but asked me to return it before I could copy any parts of
it. It is no longer available, and therefore it cannot be

directly quoted.

3.3 Verbal comunications with family members

During the period of Diana's hospitalization, several
contacts were made by Dr. Coplon with Diana's family, and
their content was reported to me. In addition, I made
visits to the family's home on June 11+, 15, 16 and 19, 1972.
During these four visits I interviewed Diana's mother, three
sisters (to be called here Mildred, Jane and Gloria) and
two brothers (to be called Sebastian and Henry), and also
held a short conversation with Diana herself.

The interviews focused around three themes: family

55

history, in particular the deceased father's personality;
perceptions of Diana, her development and her present prob-
lems; the interviewee's own life and concerns. The re-

spondents' earliest childhood memories were also elicited.

3.h Test of the sub'ect

Fifteen psychological tests were administered to Diana
and to Julie, mostly between September and December, 1971.
Circumstances (the unpredictability of the alterations,
Julieis frequent refusal to cooperate) prevented any strict
ordering of the tests. To prevent a constant order effect,
Diana took first about half of the tests, while Julie took
first the other half. Some tests were readministered at
later points, but three tests were never completed by
Julie, who in two cases stubbornly claimed the tests were
too cumbersome. I

Table 1 lists the tests administered. They were all

analyzed according to existing norms.

56

s 0H
.osseao s a

scape coupes»
.. mam 083 0.3

 

 

as-eH-HH as-HH-HH [seam .maosssomom amm maozssomom

museum» cocoon ms-mm-~
sa_sdso H>-H segue Heusroa as-em-o Hmofi .soesomsom .som sosnomnom
HEININH hflOn—GobflH hp.“
permanence wood .hoacaMoz lassomaom cammnm
means a: as-a-ma s assesses Haas -apass «sameness
osogooa
as-m-wa as-oH-HH mmoa .ssSNaHom eHm roam sea assesses

ms-m-o

ooh» one Neummnm

meson moss» as .oaom He-oa-aa as-oa-aa mesa .aasm
.oeqsem .oaes_wsaesaosH Heussoa as-m-oa meme .aosososzm man senses a swan
oasuonom
02.8.8998 hound
consume Heumauoa omoa .meaazem mass usemaom manages
steam to: ms-m-e omoa .ssam mm sensuous esoeam
as-m-oa as-m-oa mmoa .aoesom em essence soesom
asap“ om mesa .snsp pass
so sonata» assesses as-mm-oa He-ma-oa -Haom s sauce use scone oeapoonee
amass sedan as nausea»

mwamaom nexus carom neuron omen cocoaomom :9“an anon. mo osz

 

casse-ecaao o» eonoamasasee memos

 

. H 0.368

57

7 ,- ...__._~..._.._ -..... .

meme .noessom s

 

 

 

 

as-m-oa Heusm-oa Haas .paoaeasm <3 escapsaoomme egos
kuwmsoa oasem oeaomfiaflopfiu
as-s-oa Op sm-o mmofl .smflmsooz mHes passe teammate
H»-H-mfl He-oH-HH woos .sosoaom we seesaw osae>
.om.mH
.eH.sesH.ma.smm.awwH H»-HN-HH
N.H as-oauaa
sassmH.HH.m.awm H»-HH-HH
.gmaquH61mwo noes dogmas
.aes.aeo.s.m.fl sense as-:-oa as-sm-o mesa .asasss ass -soame caresses
soapoagsoo
Heum-oa as-sm-oa emoa .oesom on oosepsem
:moa .eaasn
on ooowmo Scan 3900 hmmfi 405m om Eden. Hmwpnonohufin
.80 so an: course $-73 Elma.” sesame 6830 mm causesom
casseman seaanwsm» coarse»
oxagom some» 3mm new?» comb: ooceaomom canard amen. mo ofiwz

3:943»: .H 0.3mm.

58

3.5 Testing of family members

On June 1h, 15, 16 and 19, following the interviews,
the same six family members listed in section 3.3 were
tested. The tests administered were:

Rorschach (full)

TAT (cards 1, 14., 6 GF, 7 (HP, 9 GF, 13 MF, 12 T'M- to
the females; cards 1, 11, 7 EM, 8 BM, 9 BM, 13 ME‘, 12 M -
to the males).

Draw a Person (of both sexes)

3.51 Compgrison_py;judges

Eight judges, all graduate students in clinical psy-
chology, were asked in July 1972 to compare the Rorschach
and TAT protocols of Diana, Julie, the mother, the two
brothers (Rorschach only, so that their sex is not dis-
closed) and the three sisters. Three of the judges re-
turned their completed questionnaires.

The judges knew nothing of the nature of the study,
and they worked under the assumption.they were rating
Rorschach and TAT protocols (each test separately) of
eight or six individuals, respectively.

The task was comparing each pair of protocols on.each
test (a total of 28 Rorschach pairs, and 15 TAT pairs),
and rating than on the following scale: h— very similar,
3- somewhat similar, 2- not too similar, 1- not similar at
all. No specific instructions were given.as to the rele-

vant criteria; the judges were simply asked to use their

59

clinical judgement in an overall comparison.

The goals of this experiment were twofold: (1) to
assess the degree of similarity between Diana and Julie
in the eyes of an unbiased observer, and whether the fact
that they are two personalities of the same person can be
detected from their answers; (2) to find similarities to
the personality patterns of Diana and Julie among other
family members, possibly supplying role models or mani-
festing parallel influences.

6O

IV. FINDINGS

l4..l The subject's family history

Diana's parents both come from the South. Her father
was one of the older children in a large family, and re-
ceived no education. His own father died in 1933, when
he was a teenager, and his mother had a hard time sup-
porting the family and bringing up the children.

Diana'smother was an only child. Her mother died
when she was 7 years old, and she was brought up by her
aunt and uncle. Her father moved to another town, and re-
married ten years later. He came to visit her occasion-
ally. She completed high school.

They met in New York City, and married in 19lll. They
both wanted a big family. Between 1911.2 and 1957. seven
children were born (Figure 2). There were also two still-
born, following the births of the first and of the second
child.

For several years,the family lived in a small, over-
crowded apartment, under difficult economic conditions.

The father, lacking any vocational training, became an
apartment building superintendent in a white neighborhood.

'61

deH!’
(9 g 312%..

mammal H4!

~m965§§5s3‘

 

I171

Mfim
J‘}
635::g‘f
I p g fl w I ;
.353§33
_, Q
¢ 5 m a; h 71 <3
“5’6

The children (with birth dates): Iris, Mildred, Sebas-

tian, Diana, Jane, Henry, Gloria

Figure 2: The subject's family geneology.
He himself drank, at

Later he became part owner of a bar.
The

times heavily, and was known to have female friends.
relationship between father and mother was tense. The
mother earned some money as a day - time foster mother.
Diana's sisters all did very well. Iris (she married
in 1972), Mildred and Jane completed high school, and
younger Gloria and the brother Henry are still students.
Mildred is at-present a medical technologist, Jane a teach-

er, and both live in the house. The "black sheep" of the

family were Diana and her older brother Sebastian; the

latter has been addicted to heroin for several years.

62

The father developed lung cancer in the early 1960's.
This was kept a secret from the children for a while, but
was later disclosed as his condition worsened. He died in
the hospital in May, 1965. Next, the mother's own
father, who meanwhile has moved to New York City with his
second wife, became ill and almost fully disabled. The
mother was frequently called from their Bronx apartment to
her father's place in Nanhattan, and was very exhausted.
Her father died in 1968. Around that time the family moved
to a new, more spacious apartment. For the last few years
mother has been taking care of Diana's daughter, born in
1968 (section h.2), but this became a problem recently due
to the mother's ill health, which made it necessary for her
to stop working and to be hospitalized for several weeks,
in 1971.

A more detailed description of family members, based

on interview and testing data, appears in section h.5.

63

h.2 The subject's life prior to the beginning of the study

Diana was born on October 18, 1952, the fourth child
in her family. (Figure 2). Pregnancy was difficult, and
so was birth. The mother suspects she was diabetic at the
time without being aware of it.

Infancy and early childhood were normal. Mother is
unable to date maturational stages, but believes that
Diana's speed of growing was similar to that of her other
children, and presented no problems. She had all usual
childhood diseases except for measles; at age 11 she had
a tonsillectomy.

Age 11 is also reported by Diana as the approximate
time she started menstruating; this did not particularly
upset her. She had begun to masturbate before the time,
but she found it more pleasurable after the onset of
menses.

Diana was seen by the family as a stubborn and moody
child. Sebastian, three years her senior, describes her
as always doing stupid things. When hurt in play, she
would immediately run to her father. Mother mentions tem-
per tantrums when Diana couldn't have her way, fights in
school, and cases of disloyalty to her siblings (squealing
on Sebastian when he did something wrong) possibly related

to competitiveness.

61;

 

 

It is clear Diana was closer to her father than to
her mother. Diana believes she was his favorite, and this
is confirmed to different degrees by Mildred, Sebastian
and Jane. Father took Diana with him on his job, to visit
friends, the ball games, and so on. He even took her once
to meet one of his girl friends and the child she had had
by him; Diana also mentions at least one prostitute he had
known, who lived in their building and was "beautiful and
sexy". While never beating Diana (as he did her mother
and siblings when drunk), he would frequently kiss her and
caress her, and she remembers many of his caresses as
openly sexual. She always has had sexual feelings about
him, and never felt any conscious guilt over them.

Diana believes her father's favoritism aroused her
mother's and siblings' resentment. She never felt close
to her mother, and experienced her as cold and ungiving,
responsible but strict and bossy. (Contrary to Diana's
experience, Henry describes the father as being stricter
than the mother. Dianais resentment is not openly shared
by any of her siblings). Recently Diana wishes for a
better relationship with her mother, but does not believe
this to be possible, and feels some guilt about creating
such distance between them.

The father's death in 1965 is seen by Diana and the
family as a major trauma in her life. She became very up-

set when he got sick; her usual mood swings became worse,

65

and she would frequently disappear from.the house without

explaining where she went. When the father died, Diana --
13 years old at the time -- absolutely refused to acknow-

ledge his death, even though she attended the funeral.

Two days later she disappeared for three days, and was un-
able to account for her whereabouts on return.

From.that time on she often claimed not to have done
or said something others attributed to her. Family and
friends assumed she was lying, and she herself was puzzled
by these lapses of memory, which lasted for hours, at times
for days. The most extreme lapse occurred at the age of la,
when she became pregnant without having any memory of hetero-
sexual intercourse. (She could recall one homsexual en-
counter into which she was forced by an older girl.)

The fetus, a well formed male, was aborted by a lady
in the neighborhood. Diana was very upset about the whole
experience, and fearing her mother may "flush the baby down
the toilet" wrapped it up in.a blanket and hid it in a
drawer. It was discovered by the mother three days later.

Following this event, Diana continued her pattern of
running away, and was seen several times in family court.
In June, 1967 she was remanded by the court for psychiatric
evaluation in Jacobi hospital. Hospital records described
her as "very restless, can't keep still, oriented x3,
friendly, denies hallucinations and delusions". The diag-
nosis offered was: "Adolescence Adjustment Reaction". Af-

ter two days in the hospital she was returned to the court.

66

"According to Probation Officer, -- the letter from the
hOSpital's psychiatric service says -- patient complained
of some back condition and seemed unable to walk. Our
Nursing Staff's observation does not substantiate this nor
does the attending physician's examination. She partici-
pated in Ward activities. There is some indication of
limited intellectual functioning which makes her dis-
interested in school. Also she mentions an invblvement
with a 19 year-old man".

Sexual activities indeed became central in Diana's
life. Following the "rape" by the older girl, which she
experienced as frightening but enjoyable, and after her
first stay in the Youth House, she had many more homo-
sexual experiences, usually mutually tender and leading to
. orgasm. She also started dating heterosexually, but always
felt some disgust about having sex with men, and was never
able to achieve orgasm heterosexually, not even when she
has fantasies about her father during intercourse.

The first heterosexual intercourse she can remember
occurred at age 16. It resulted in a second pregnancy, and
Diana gave birth to a daughter. Adoption was considered,
but rejected (Sebastian reports he was the one who ob-
jected to the idea most strongly) and the girl remained with
the family. Diana took care of her during the first months
of her life, and also managed to complete 11th grade, but
then disappeared, and for about two years would only visit

67

occasionally with the family and with the baby.

What she was doing during these two years was mys-
terious to the family, and to some extent to Diana her-
self. Her periods of confusion and loss of memory were now
frequent. There were things she could remember doing, but
the memory was vague and dream-like; other things she could
not recall at all, and at times she would find herself in
the company of older men, when she could net remember meet-
ing. She lived in New Jersey with one of these older men,
but the only periods of which she had full awareness and
memory were her visits at home.

This mystery lasted until 1970, when for the first
time Diana started hearing the voice of another girl who
named herself Julie. Following a series of "conversations"
initiated by Julie, Diana came to realize that Julie and
she have shared the same body for several years.

Julie informed Diana that she came into being just
prior to the father's death, in order to protect Diana from
the shock. She was the one who became pregnant, leading
to Diana's abortion. She had no feelings for Diana's family
and baby, which did not belong to her. She was generally
amnesic to Diana's life, and knew it only vaguely,
similarly to Diana's memories of her fugue states, which
actually were periods when Julie "took over".

Contrary to Diana, Julie was mostly heterosexual, and

was able to reach orgasm with men. For a few years she

68

has been a prostitute. For some periods she worked as a
streetwalker in Manhattan. At other times she would stay
with older men, in their late 30's or kO's, her favorites.
Contrary to Diana's inhibitions, Julie enjoyed sex freely,
and for pay would do anything with men or with women. She
was very proud of some encounters with athletes and other
celebrities, and enjoyed trips to Florida, Canada and
Puerto Rico with older lovers.

Diana came to realize that the older man with whom
she stayed in New Jersey was actually attracted to Julie.
He interpreted the alterations as mood swings, and showed
preference to Julie and disappointment with Diana. Hew-
ever, around the middle of 1971, Diana's presence -- in-
frequent during the past two years, when Julie was "out"
most of the time -- became more and more frequent, and she
even brought her daughter to live with her. In late July
her lover threatened to leave her, apparently as a result
of the change. Frustrated and jealous, Diana poured nail
polish remover over him and lit it, thus burning his
shoulders and back to a degree necessitating hospitali-
zation. Surprisingly, no charges were pressed. She re-
turned, accompanied by her daughter, to live with her
family in the Bronx.

In August the alterations -- always heralded by a
severe headache -— became more frequent. Julie informed

Diana that she was planning to take over completely, as

69

Diana was unable to cope with the world. Diana became
very frightened about this prospect. She applied to the
'Metropolitan.Mbntal Health Center, was seen for a few
screening interviews, and was assigned a psychotherapist.
On.Friday, preceding the wednesday of her first appoint-
ment, she became very anxious. She went to the Center and
refused to leave, saying she would wait there until she
saw her doctor. The medical director of the Center took
her to Roosevelt hospital, from.which she was transferred

to Jacobi, and admitted to a psychiatric ward on 9-17-71.

70

ll.3 The initial picture: Diana and Julie

In this section an attempt will be made to describe
Diana and Julie as they were during the first stage of the
study. Strictly speaking, the initial picture is that
presented at hospitalization, on September 17; but as ob-
servations and tests from one day or even one week cannot
be sufficiently rich and thorough, data collected during
the first 8 weeks of hospitalization are incorporated.
While rich in events (to be described in section until),
this period was characterized by stability in the per-
sonalities of Diana and Julie, and no significant gaps or
changes can be found in observations and in testing re-
sults during these 8 weeks.

Diana and Julie are discussed here as if they were
two independent persons. This is not an attempt to con-
vey any theoretical bias, but rather a convenient way to

describe the phenomena observed.

11.31 Appearance and general attitude

The general appearance and style of Diana on ad-
mission are conveyed in a mental status report written by
Dr. Coplon and dated September 18 , 1971.

"Patient presented as well-groomed Negro girl wearing a
wig and asking for her clothes. She spoke in a seduc-
tive, occasionally little-girl voice, and frequently
moved about in her chair and played with the examiner's
chair with her foot. She was quite animated and quite
entertaining in her use of a Southern dialect to describe
various things. She was alert and oriented, demonstrated
no thought disorder, showed no delusional ideation. She

71

denied hallucinations except for the voice of Julie,

which she described as aloud and coming from outside her.
Her mood was neither depressed nor elated, and she showed
a wide range of affect from sadness at her anxiety over
Julie to infectious laughter while describing some of her
confusing exploits as Diana/Julie. Intelligence was above
average, memory intact (except total amnesia for Julie's
periods of existence), calculations done well, proverbs
interpreted apprOpriately".

Julie's first appearance in the hOSpital was on
9-21. Dr. Coplon reports:

"When I spoke to Diana she didn't recognize me, said her
name was Julie. She was much more subdued, hostile and
arrogant. She indicated she had nothing but disdain for
Diana, her baby and her family. She fully intends to take
over completely". In a later description he adds: "She
was arrogant, cool and aloof and seemed very sure of her-
self. She spoke deliberately and more slowly than Diana,
and there was no trace of the friendliness and charm
described earlier. She sat more erect in her chair and was
more guarded about answering questions. She smiled
occasionally but she never laughed".

When allowed to bring her own clothes, each of the
two started using her own wardrobe, without any overlap.
Diana's clothes were neat, modest, in good taste but some»
what childish. Julieis clothes were very expensive and
sexy: tight blouses, short skirts, etc. They also had
separate wigs. Diana were at times a short, curly wig in
an Afro style, not too distinct from her own hair. Julie
always used a long wig with straight black hair, in addi-
tion to a heavy make up.

I first tested Diana on 9-27, administering on that
occasion the Rorschach, TAT, and some subscales of the
WAIS. She was very cooperative and well motivated. Julie,
on the other hand, was very reluctant to be tested when

first asked on 10-h. She said she did not know me, but had

72

 

 

heard about me from Diana. Her refusal to be tested was on the
grounds of her not being a patient in the hospital. I

managed to convince her that the tests may be of interest

to me and to herself whether or not she is a patient, and

she consented to take the Rorschach, TAT, WAIS and DAP.

On other occasions, when I attempted to administer addi-

tional tests, she would either refuse bluntly, or agree
reluctantly, or else start a test but interrupt it in the
middle due to fatigue (this happened twice with the MMPI);

her motivation during this period was never high.

It should be noted that Julie's readiness to stay in
the hospital was solicited at that stage through the
rationale of this being helpful to Diana. Julie herself
never admitted having any problem of her own, or needing
any help. Diana, on the other hand, constantly needed help,
and was very frustrated by Dr. Coplon's refusal to see her
more than three times a week. She would at times sit on

the floor outside his office and cry.

g.32 Kinesios

The difference in movement characteristics between
Diana and Julie was referred to already. A more compre-
hensive view of it was achieved through observing recorded
interviews with both (section 3.11) and evaluating them
under the guidance of an expert in kinesics, Dr. A. Scheflen.

Even when the sound is turned off, significant dif—

ferences can be recognized. Diana uses less space. Her

73

posture is constricted and symmetrical, shoulders are fal-
len, both hands and feet placed closely. It conveys
feeling timid and helpless. Muscle tonus is low, but
there is a greater tendency to touch her own body while
talking, making one wonder if she is in need for feedback
from it. There is also more gesticulation, bilateral in
nature, and rhythmic lateral head sweeps can be observed.
In contrast, Julie's use of space is asymmetrical,
expansive and assertive (see figure 3). Head movements
are vertical, the neck-sways backward. Her left leg is
mostly hanging, while her left arm and right leg tend to
move more. She uses her hands alternately, shifting the
movement from one to the other, but never in symmetry.
Her legs are at times open, and at other times crossed in
a mature and sexually provocative manner. Her index fing—
er is kept out, and the palm exposed in a courting posi-
tion (Scheflen, 1965). All these, as well as a muscle
tonus most clearly observed in the legs, add up to a ty-

pical non-verbal courting behavior.

Julie Diana
Figure 3: Schemes of characteristic postures

7’4

11.33 Self Concept

Diana and Julie see themselves as separate indivi-
duals. "No, I am never Diana, I am me" says Julie in the
recorded interview; and Diana says: "I just can't be and
act like her". A considerable gap between the conscious
self concepts of Diana and Julie is easily discovered in
the testing material.

When asked to describe herself by checking the appro-
priate items on the Adjective Check List (Table 2), Diana
emphasizes traits of emotional irritability avoided by
Julie, such as "touchy and easily hurt", "frequently ang-
ry", "frequently disappointed". Items chosen by Julie and
not by Diana, on the other hand, include "businesslike",
"shrewd and calculating", "thinks only of himself" and
"cold and unfeeling".

The contradiction between the touchy and indiffe-
rent repeats itself in the Sentence Completion test. "I
feel...mixed up", is Diana's response to one of the items;
Julie's is "I feel...good". Diana: "I suffer...with
agony because I'd feel confused"; Julie here disregards the
rule of the test, and instead of completing the sentence

answers: "I don't suffer".

75

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Other qualities emphasized by Julie and denied by
Diana relate to independence and leadership: "dominating",
"forceful", "good leader", "manages others", "self re-
liant and assertive", "able to take care of self", "inr
dependent". Paradoxically, Diana is the one who checks
"likes responsibility".

A related area is having a successful social image.
Julie, but not Diana, sees herself as the one who "makes
a good impression", who is "well thought of", "respected
by others", even "often admired". Seeing herself as
"sarcastic", she may relate this respect to the fact she
"acts important", and is "boastful", "proud and self
satisfied" and even "somewhat snobbish" and’bonceited".
She "expects everyone to admire (her)" and believes this
is achieved, while Diana has the expectation but lacks
belief in.its fulfillment.

Diana's lower self esteem.may be inferred even.from
her choosing only 23 out of 60 adjectives as appropriate
to herself, while Julie chooses #0. This is not a result
of general selectiveness; when asked to describe Julie on
the same list, Diana chooses 37 items. Julie only finds
13 items which describe Diana, in.addition to 3 which she
modifies (Table 2). The consensus about Julie's superio-
rity is reflected in.Sentence Completion as well. Diana
admdts: "I envy...Julie", while Julie is sure: "My

head...is superior over Diana's.

78

 

In the recorded interview (section 3.2) Diana says:

"I am kind of stupid...not stupid stupid, but I don't
know lots of things like her ... I believe people".
Seeing herself as naive, Diana never checks another ad-
jective chosen by Julie: "able to doubt others".

While able to doubt others, Julie cannot acknowledge
any indebtedness or warmth to anybody. "I envy...no one",
"I get pleasure from...myse1f", "my teachers...I am my
own teacher".

Another aspect of the conflicting self—images is
represented in the Draw A Person test. Diana's drawings
of female figures, including one of herself, are all of
little girls (Figure u): helpless, asexual. Julie de—
clines, at this stage, to draw herself, but her female
figures betray a self-image of a more mature and sexy
"woman of the world" (Figure 5). The fact that the woman
in these drawings has no breasts is one of the first in-
dications that this self-content image is far from being
the whole story.

While the self-images of Diana and Julie are opposed
on many levels, there still exists a common ground between
them. Fifteen traits on the Adjective Checklist are chosen
by both as self-descriptive, from "bossy", "resents being
bossed" and "always giving advice", to "can be frank and
honest", "outspoken" and "straightforward and direct".

Two adjectives are chosen on all four questionnaires, i.e.

79

 

 

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Figure 11: Female drawing by Diana (10-71)

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Figure 5: Female drawing by Julie (10-71)

81

   

 

are seen as both self-descriptive and descriptive of the
other by both Diana and Julie; "expects everyone to ad-
mire him", "can be indifferent to others".

In the Sentence Completion test, along with many
contradictions, there are similarities too. Loneliness,
homelessness, sleeplessness, rejection of suicide as a
solution, enjoyment of clothes, fascination with dark-

ness ~- these form an acknowledged common nucleus.

h..31.1. Copitive functioning

Seeing the split as a result of simulation would have
led us to expect commonality in intellectual capacities.
Even with many of the psychodynamic explanations such
commonality could not be ruled out, assuming intelligence
belongs to the "conflict free ego sphere" (Hartmann, 1939).
This, however, does not appear to be the case with the
present subject.

Even on the WAIS, where a similar IQ is achieved by
Julie and Diana -- average 911-95, with slight superiority
of the verbal section over the performance section -- the
patterning of subscales is different (Table 3). Thus,
Diana is more successful than Julie on Comprehension, due

to her better social judgement.

82

Table 3. WAIS Results

Diana Julie
Raw Scaled Raw Scaled
Score Score Score Score
Information 15 10 15 10
Comprehension 111 8 ll 6
Arithmetic 12 ll 9 8
Similarities 111 10 21 11:
Digit Span 7 11 8
Vocabulary 1+1 10 1+3 10
Verbal / 53 / 5%
Digit Symbol 14.6 11.2
Picture Completion 12 9 1h. 10
Block Design 32 10 32 10
Picture Arrangement 20 9 18 8
Object Assembly 26 8 29 9
Performance / 11% / 115
Total / 9 / 99
Verbal IQ 96 97
Performance IQ 9’: 911
Full Scale IQ 9 95

When asked, for example, what will she do with an addressed
stamped envelope found in the street, she gives the ex-
pected answer: put it in a mailbox or give it to a cop.
Julie, on the other hand, responds: "leave it right there -
it's not my name, so I won't bother". Diana also succeeds
in some difficult Arithmetic items failed by Julie, and
manages to assemble the elephant in Object Assembly, with
which Julie is completely confused.

Julie's alleged superiority does materialize when ab-
stract thinking is required, as in Similarities. She
easily connects table and chair as being both furniture,
while Diana responds much more concretely: "they go to-

gether, in order to use a table you ought to have a chair".
83‘

When asked, in what way are air and water alike, Diana
answers "there is water in the air", while Julie says
"necessary to exist".

It should be noted that some subscales were first
administered to Julie, and others first to Diana, but no
systematic influence of the order could be detected.

The highest commonality of responses was achieved in
relatively neutral WAIS subscales: e.g., Information.
The correct answers intthis subscale are close to iden-
tical, as is the final score. The mistakes, however,
differ. The U.S. pOpulation, in a typical example, is
underestimated by Diana to be 80 million, and overesti-
mated by Julie as 800 million.

A defensive constriction and rigidity reduces the
quality of Julie's cognitive functioning. This is well
illustrated on some Rorschach cards in which a similar
percept is seen by both (Table 11.). There is a striking
difference between Diana's vivid elaboration, accompanied
by body movement to describe the image (card III: "2
people in playground, going around like this...this is the
thing in the middle, going around...could be two kids
jumping a top") and Julie's 317%?" and static response
("two boys"). I"

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While on the surface both Diana and Julie have an
acceptable level of reality testing (average WAIS scores,
adequate Bender performance, an extended F+ percent of
80% in both Rorschach protocols), Julie's evasiveness
and constriction in verbal style, in quality (no detail
responses, no movement), and in number of Rorschach re-
sponses (three rejections, only one response per card,
totaling seven responses in comparison to Diana's 18 --
Table 8), makes one feel that she is suppressing her
fantasy life out of fear of disclosing something crazy
and incriminating. It is not surprising that in line
with other flat denials, Julie's responseczwhen asked to
completei"’1~1y imagination..." is "I don't imagine, I am
realistic". Diana may be more honest when she responds:

"m imaginhtion. e e is WOW l u

4.35. Affective functioning
Diana's emotional life is characterized by lability

and imaturity. The infantile part in her seems to live
untouched. Her drawings, already mentioned (e.g., Fi-
gure h) convey this childisbness must directly: roundish
thick lines, naive facial expressions. The tree she
draws is covered with fruit. or her' Rorschach responses
several describe children playing (cards III, VII), and
others refer to images characteristic of children's
stories: dragons, colorful monsters (card X), Batman
(card I).

90

Diana doesn't want to grow up. Her intense oral
needs were. never satisfied. Her tempting fruit tree
(Figure 6) is behind a closed gate. "My stomach..."
she completes with "...is empty". (Sentence Completion).

' Much of this frustration is close to consciousness:
but complete awareness of it may result in a hysterical
panic. Being abandoned is still the utmost danger: "I
get scared when I get lost, I cry". (WAIS, Comprehension).
0n the Rorschach, one can observe how intense emotional
stimulation leads to disorganization: anatomy responses,
poor fem, arbitrary color use (card IX). In such mo-
ments the usual Judgement is lost (e.g., she would howl
"fire" in a crowded theater -- WAIS, Comprehension), and
an impulsive, destructive action becomes a serious dan-
ger.

‘ This impulsivity is lacking in M16, but so is
spontaneity and warmth. Emotions are strictly under con-
trol, to the point of being out of touch with them. While
Diana is mostly introverted (the M to sum C ratio is 6:1;
in the Rorschach --- Table 8) Julie is dzrictly extre-
verted (0:3 ratio -- no human movement responses). She
saves herself from the acute anxiety and inner turmoil of
Diana by strict isolation of affect and rigid intellectua-
lization. Defenses are stronger, but also more primitive:
sublimation is absent, denial prevails. Even dreaming is
taboo (SC: "Many of my dreams...I don't dream").

91

 

 

 

 

 

 

 

 

 

 

 

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ng by Diana (10

Tree drawi

O
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(Photographed 25% smaller than original)

Figure 6

92

 

These primitive defenses do not always work. Julie's
lines in her drawings (e.g., Figure 5), while angular and
straight, are also thin, shaky and frequently broken, dis-
closing severe anxiety. Inner tension is expressed through
percepts of inanimate movement on the Rorschach, which are
frequent (as secondary characteristics) in Diana's re—
sponses, but appear in Julie's as well (card X -- colors
splashed around).

Mbreover, even the oral dependent needs so forcefully
denied by Julie ("Eating...I eat very little"; "I get
pleasure from...myself" -- 8.0.) do appear in her responses,
in tests less subject to conscious control. In the werd
Associations testy she associates "mother", and then in
recall "nipple", to "breast", not offering sexual associa-
tions which could fit more in her conscious self image.

As noted before, her "sexy" female drawings have no breasts.
other relevant responses are drawing a bird's nest on her
tree (DAP), or offering images as puppies with their

mother (card VII) or an ice-cream cone (card IX) in the
Rorschach. The desire to break through the rigid defenses
is pathetically expressed when she says (S.C.): "I want

to know...how to cry".

h136 Object relations
Diana's central object is her dead father. "God" she

in;
,) "is my father". There is no comfort for his
sf

  

Eno man can substitute for him. "Love in my

‘1“ 93

 

 

life...was miserable, except for my father's love. (SC)
"He didn't even tell me he was dying" she complains in
the recorded interview. The basic desire unfulfilled,
gratification is beyond grasp: man always belong to
other women (TAT 6, 9, 13 -- Table 5) and the attempt to
win one over is doomed to failure. "Most men...are in-
different" (SC). The despair is combined with fear.

The male figure acquires a disproportionate, distorted,
awkward appearance (DAP -— Figure 7), which makes one
wonder if her actual feelings toward her father were
that unambivalent; but now she clearly cannot allow her-
self any negative conscious reference.

This unresolved Oedipal fixation is supplemented by
an unresolved aversion and competitiveness with the mother.
Mother appears as a source of coercion, not of gratifi-
cation, and leads the child to feel "all frustrated and
depressed for nothing" (TAT l). Diana's feelings of being
castrated and mutilated (expressed in images as a tiger
whose tail is cut off -- Rorschach VI) may well be attri-
buted by her to the mother's revenge, as the mother is
jealous of her, "can't stand her because she is young

and pretty". (TAT 12)

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Figure 7: Male drawi by Diana (10-71)
(Photographed 25 smaller than original)

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98

With the main cathexis still on.the father, re-
lationships with peers are limited in intensity, and
'mature genitality is avoided. Nevertheless, there are
still possibilities of less profound interpersonal ties.
Diana is capable of empathy (several good human movement
responses on the Rorschach), has adequate understanding
of social circumstances (WAIS -- Comprehension, Picture
Arrangement), and does relate to people (her TAT stories
usually include interaction).

Frequently, however, she would act masochistically
'within interpersonal relationships, take the blame for
any problem.and offer the other cheek in response to
aggression. This pattern is expressed in many of her
stories on the Rosenzweig Picture Frustration test. 0n
the first picture, for example, the stimulus is: "I'm
very sorry we splashed your clothing Just now, though we
tried hard to avoid the puddle". Diana's answer: "That's
okay, accidents happen”.

Later in the same test the responses become more
assertive, even angry. It seems the hostility, initially
suppressed, may sooner or later reach a point of explosion.
The hope for such an opening-up may be the source of a slip
of pen in one of the RPF test responses, to a story about a
missing hat: "0h goodness sake, I need my hate".

A consistant attitude of tenderness is expressed by

Diana toward her own child. "Children..." she says, "are

99

beautiful", "I like best...my daughter", "I get pleasure
from...taking care of my baby" (SC). "Something was
telling me to give the baby away, but when I saw the baby
I said no" -- she reports in the recorded interview. The
desire to nurture others may also be seen in her vocational
choice: "My greatest ambition...is to be a nurse" (SC).

These needs and capacities stand inssharp contrast
to Julie's arrogant isolation. All her libido is nar-
cissistically cathected onto herself. "Love in my life...
is me" (SC). The pattern of her Bender Gestalt test, in
which the inflated first figure- is surrounded by all the
rest as satelites (Figure 8), is but one indication of
her ego-centrism.

A tendency towards eXpansion is also suggested by
her frequent exaggerations: 500,000 miles from New York
to Paris, 800 million American citizens (WAIS, Information).
This grandiose quality is complemented by paranoid sus-
spiciousness: "Most people...are liars, cheaters and
untrustwarthy" (SC).

Not surprisingly, hostile object relations are more
common for Julie, and she is right when she says: "There
are times...when I hate" (SC). Her sexuality is invaded
by aggression, and its separateness from any emotional
attachment discloses its pro-genital, phallic-sadistic
nature. The man she draws is a horrifying, robot-like mon-
ster (DAP, Figure 9), and when in a TAT story (10) a man

100

 

 

Figure 8: Bender Gestalt by Julie (10-71)
(Photographed 25% smaller than original)

101

 

 

Figure 9: Male drawing by Julie (10-71)

102

is described as kissing a woman "she let(s) him do that...
she gone through the motion, she don't like him". Indeed,
she is well equipped to be a prostitute.

This detachment has a defensive function. Julie ad-
'mits this when.she says, in the recorded interview, "I am
in love with me, so I never get hurt". The fear of re-
Jection.implied here is expressed in her preoccupation
‘with the theme of unattractive girls rejected by men (TAT
12, 13). "I am very...sexy" (SC) she declares, but in
the less direct context of the prbjective test this is
not so clear: "she Just ain‘t sexy, she thinks she looks
sexy but she ain't". (TAT l3)

The lack of capacity for empathy, indicated by the
lack of hmman.movement responses in the Rorschach, is also
indicated in.Julie's TAT stories, which lack real inter-
action. She can.never understand more than one character
in a card. At times she understands none of them, end
hurries to disengage herself: "that's one thing I can't
understand, how they work -- there are easier things to
do". (TAT 2) She is certainly right when, in.the recorded
interview, she says: "I have loads and loads of associates,

I Just have no friends".

103

 

 

 

 

h.h Developments with time

4:41, Crises & stgbility: September 17 - November 12, 1971

As mentioned (section 4.2), Diana was admitted to
Jacobi Hospital on Friday, September 17, 1971. During the
first 8 weeks of her stay on ward 10-w, she alternated be-
tween being Diana and Julie. The pattern of these altera-
tions, and of her adjustment to the hospital life, is of
considerable interest, although no dramatic changes
occurred within these 8 weeks.

A nurse's note of 9-19 describes Diana as quiet,
sucking her thumb, and asking all day if she could go home
and have her clothes. (She was placed in pajamas as a
suicidal precaution). On 9-20 she was relaxed during the
day, but in the evening threw a temper tantrum, attempted
to get into an elevator and refused to leave it, and was
put in seclusion by the ward staff.

Julie appeared on Tuesday, September 21. Her first
encounters with Dr. Coplon and me were reported already
(section k.3l). She was unhappy to stay in the hOSpital,
but consented to do so temporarily so that Diana can be
helped. She acknowledged, realistically, the two of them
share the same body and so her physical presence is needed
for Diana to be treated.

From that point on the alterations became regular.
Diana was around about three quarters of the time, and her

turning into Julie was always heralded by a severe

10h

headache. With one exception, the shift always occurred
during sleep, but not always at night. Within a week or
two everybody on the ward could tell Diana from Julie,
recognizing their different posture, movement style, voice
and way of talking, and later style of clothing, wigs and
make up as well (section 11.31).

0n the first weekend in October Diana received a
weekend pass. Friday night she appeared in the hospita1!s
Emergency Room with her daughter, saying she couldn't
stay at home because her family made her feel she was sick
by constantly inquiring how she was feeling. She wanted
to stay in the hospital with the child, and when told this
wasn't possible agreed to call her brother to that the
child could be taken home. By the time her brother came,
however, she felt better and decided to go with him.

On return Monday she reported spending part of the
time as Diana at home, and another part outside as Julie.
During the following week Diana's frustration over her
therapist's inavailability increased. On Tuesday she did
not share Julie's desire (expressed in the morning) to be
discharged, but still left the hospital without permission
and returned late. Wednesday she took an overdose of
Exedrin, but immediately told Dr. Coplon about it and was
treated.

The following weekend was again divided between Diana
and Julie, and spent well by both, though with mutual

105

 

 

 

 

amnesia. The second week of October was quiet, besides
some conflicts with staff about improper use of canteen
passes. Testing was continued, mostly with Diana, and
she also participated in Occupational Therapy and in
group meetings.

The weekend of October 16 was stormy: Diana attemp-
ted to remember some of her experiences as Julie, helped
by a friend who took her to places familiar to both per—
sonalities. A nurse's notes of October 17 says:
"Returned from pass early, accompanied by male friend,
Very upset, agitated, screaming hysterically, uncontroll-
able. medicated IM and placed in seclusion, crying un-
controllably, yelling 'please help me, you don't under-
stand, I can't remember anything'. Responded to the
name Diana. Holding on to writer and would not let go".

The same day, the evening nurse reports:

"Pt. depressed all evening. Stayed by herself mostly in
her room. Talked with writer and stated that if Julie
leaves her she would never be able to do anything for
herself".

The next morning, "Pt. seemed uncomfortable, complained
of headaches ... today is pts. birthday, was giVen best
wishes by staff, received it casually, seems to be de-
pressed".

On 10-20 Diana was taken for an EEG examination, and
while hyperventilating suddenly changed into Julie. She
was very scared and agitated, screaming and hitting the
staff. The EEG report indicates no difference between
Diana and Julie, and is normal and well organized. The
same evening Diana again left the hospital without per-
mission. The following morning she avoided talking about

that, but told a student nurse she was looking forward

106

"to a birthday present and a visit from my older sister".

On 10-22 a nurse notes: "Seems to be vacilating
between Diana and Julie this AM". No additional infome-
tion is offered on the nature of the vacilation. She goes
for another weekend, and on return is described as being
"in a good mood, socializing well, seem(s) to be in the
Diana facet of her personality".

Julie appears to be "out" most of the weekends now,
and Diana, feeling deprived, asks for mid-week passes '
and receives them. Another nursing student reports:

"Pt. willing to talk about her 'problem', and is con-
tinuing to write her life story. Appears to be in a
good mood".

Julie returned very drowsy from the last weekend in
October, and Diana was drowsy too the next day. She had
a vague memory of Julie taking some pills.

On Wednesday, 11-3, Diana was scheduled to lead the
Therapeutic Commity meeting, as a patients' representa-
tive. She was very anxious from Tuesday night, and the
evening nurse describes the following incident:

"Refused to show her pass to elevator operator, and he
refused to bring her up to 10th floor. Kicked and hit
operator and ripped his shirt".

Wednesday morning Julie was the one to wake up. Dr.
Coplon, suspecting this is another result 61! Diana' s fear
about leading the meeting, commicated to Julie his
belief in Diana's capacity to handle the task. Julie went

107

 

 

to sleep, Diana woke up and led the TC successfully. In
his weekly note, Dr. Coplon observes:

"Pt. working very hard in therapy, seems well able to use
insights and apply them towards tentative behavior change".

The following Monday another incident is reported:
"Became upset this A.M. Screaming and crying, 'I want
my Daddy', uncontrollable... Patient allegedly upset over
her mother's admission to hospital".
This indeed, was the case. The mother's hospitalization
(for medical reasons) created a problem as to who will take
care of Diana's daughter.

Diana went on a pass home, and on return mentioned to
a student nurse that "over the weekend she had gotten a
ring and can't remember who gave it to her". She has
been depressed for a few days, which Dr. Coplon interpreted
to result from "difficulty in dealing with conflicts as
Diana rather than splitting them off". After a therapy
session on Thursday, 11-11, "in which she complained of
feeling very confused about who she is", Diana took Darvon
and Valium tablets, but denied the suicidal gesture implied
and said she just wanted to sleep. The next morning she
woke up as Julie, and sloped from the hospital.

It may be of interest that her first sentence in a
TAT administered on 11-11 (card 30F) is: "She's feeling
very hurt and very down, her boyfriend just left".
h.h2 Attempted integgation: November 12-19, 1971

Julie left the hospital on Friday, November 12, three

hours before her weekend pass was supposed to start. She

108

 

wanted to talk to Dr. Coplon, but he was not available.

Mbnday, November 15, Julie called Dr. Coplon. She
said she was not returning to the hospital, because Diana
had died, and Julie was now a new, whole person. For the
first time she had found a man she could love. "It's ok,
he is a nice Jewish guy and everything is kosher", she
said in a voice that sounded to Dr. Coplon very much like
Diana's.

She agreed to come back to see Dr. Coplon after the
time beyond which the hospital would have to discharge her
(because of her having "gone AWOL"), fearing if she comes
earlier she could be forced to stay. Nevertheless, she
returned to the hospital two hours before the deadline.
Dr. Coplon still agreed to discharge her and to follow her
as an outpatient. In the discharge summary he defines the
goal of future therapy as "to help 'new personality' cope
with conflicts that were formerly dealt with by splitting".

Was there really a new personality? Interviews and
testing conducted on the day of discharge (November 16)
left one with a reserved answer.

Julie was dressed in her usual clothes, but her style -
- an observation shared by Dr. Coplon and myself -- was
closer to that of Diana, and clearly warmer and more
friendly than the habitual "Julie attitude". She was in a
good mood, unusual for both personalities alike. The man

she fell in love with (something that had never happened

109

to Julie before) was the son of wealthy Jewish parents,
was reported to be ready to marry her in the near future,
and to be able to support her without her having to walk
the streets. As to the daughter, she expressed fears
about taking care of her, but appeared to see this as a
necessary step to take, and did reveal some maternal
feeling.

Dr. Coplon later summarized their session of that day:
"It was pointed out to her that Julie's appearance and
sloping from the hospital was probably in part a reaction
on Diana's part to strong feelings she was developing for
her therapist, and a sense of rejection that he couldn't
be everything to her that she wanted. It was also pointed
out that Julie's 'nice Jewish boy" might be a substitute
for her (Jewish) therapist and that if that relationship
didn't work out she might have to be rehospitalized. She
seemed to understand this and agreed to return in one
week".

Julie was in a hurry to leave, and only limited time
was available for testing. Draw a Person, 2 TAT cards and
Rosenzweig's Picture Frustration test were administered.
When asked to sign her first drawing, she signed "Julie",
even though she said earlier that to symbolize the inte-
gration she will have a new name, Karen.

The drawings themselves are of a new quality. Instead
of the overdone female figure of Julie in October (Figure 5),
and the childish girl drawn by Diana (Figure k), the woman
drawn now appears to be a normal teenager (Figure 10).
Anxiety is still evident in the broken lines, and the
separation between bottom and upper parts signifies con-

tinued dissociation, but the body image is much more

110

 

 

‘

03

Figure 10: Female drawing by Julie (ll-71)

111

 

realistic than in the past.

Likewise, the male drawing (Figure 11) is less
menacing than its earlier counterparts (Figures 7, 9),
and more realistic in its proportions; it is "cut down
to size". It lacks hands, however; and when asked to
draw herself (Figure 12) Julie omits even the arms, a
progression which can be understood to signify a struggle
to suppress aggressive impulses. On the other hand, this
new self drawing is the first in which breasts do appear,
reflecting a greater acceptance of female sexual identity.

As to the Rosenzweig test, Julie's responses are
diverse. Mbst are on the polite side, but nine (out of 24)
are openly hostile; to the stimulus "Ybur girl friend in—
vited me to the dance tonight, she said you weren't
going", Julie offers the response: "Well, good for her.

I hope you have a terrible evening". Diana's answer, five
days earlier, was: "Well, since I can't go I don't mind
you taking her, and I hope you two have a good time". The
style is diametrically opposed; among Diana's 2h responses
only one showed a parallel degree of hostility.

Julie never took the RPF test before, so no direct
comparison with her present responses is possible; one can
just note that the nine hostile responses are very much in
"old Julie's" style, but speculate they could be more nu-
merous in the past, and not be outnumbered by the polite

"Diana style" answers.

112

Figure 11:

 

Male drawing by Julie (ll-71)

113

 

 
 
 

,\‘(

,

.4

Figure 12: Self drawing by Julie (ll-71)

11h

 

 

Only 2 TAT cards were administered before Julie asked
to be excused. Her responses are: (1). "He is very very
unhappy and disgusted with his violin, I guess it is (why?)
I don't know why he feels unhappy, I just feel sorry, maybe
he doesn't want to play it. (outcome?) I donlt know, I
just hope he won't be so sad. (2). Picture of puritans'
first farm on the land, breaking grounds. Pregnant woman,
daughter studying to be a scholar, husband breaking the
ground (outcome?) They are hoping they have a good harvest
come Thanksgiving, and I hope so too".

There are many interesting aspects to these stories,
as compared to the ones given by Julie and Diana a few
weeks earlier (Table 5). In content, they resemble more
Diana's stories. What is ommitted are the interpersonal
conflicts: the boy confronts an anonymous authority, no
more his instructor and his mother; there is no more men-
tion of the mother's jealousy of her daughter. Instead,
we have an overall empathy with people, lacking in
differentiation. Hope is directed towards everybody, but
it is hope lacking in conviction, expressed only as hope
("I hope he won't be so sad" rather than "he won't be sad").

To summarize the test findings, the drawings point to
a real change in Julie, the RPF suggests there is still a
considerable difference from Diana, and the TAT arouses
the feeling that what we encounter is not a genuine full
integration but rather a strained attempt by Julie to

115

achieve an integration; an attempt sustained by great ef-
forts to suppress conflict and to "accentuate the posi-
tive" and thus prevent Diana from reappearing.

The strain soon proved to be too great. Three days
later, on November 19, Julie called the ward to say she
had a terrible headache, and agreed to come and see Dr.
Coplon. When she arrived at the hospital she went di-
rectly to her former bed, and was amazed to hear she had
been discharged. When questioned, she identified herself
as Diana. She was confused and sleepy, and vaguely re—
membered Julie taking some pills. The switch must have
occurred when Julie fell asleep in the bus, on her way to
the hospital. Later interviews revealed this followed
Julie's feeling she may be rejected by her new boy friend.

Diana was readmitted to the ward. One week of

attempted integration was over.

my; Convergence: November 19 - December 10, 1971
The nurses' notes for the next week follow a familiar
pattern:

"Pt. admitted quietly to ward. --- quiet, somewhat with-
drawn. Will assist when necessary. --- Involved in
argument with (another patient), quieted down after
allowed to ventilate and Spoken to. --- Socializing, de-
manding, quieter tham'usual. --- Returned from pass, said
she had a pleasant day. Looks slightly depressed".

Dr. Coplon writes on ll-25:
"Pt. has remained Diana since readmission, but she senses
Julie is trying to come back, and she is not sure why. Pt.
less depressed, has been able to talk about some of the
things that led to her feeling low, these seem to have to
do with transference issues of which pt is partially aware".
On 11-27, the nurse reports: "Became hysterical at

116

 

 

luncheon. Screaming, crying, stating 'I want my Daddy'.
Uncontrolled behavior, unmanageable. Placed in seclusion
and medicated... Became calmer. Out of seclusion 20
minutes later as 'Julie'. --— Became 'Diana' again at
five. was fine rest of evening".

There are headaches reported the next few days. On
December 1, a nursing student notes:

" 'Julie' today. Stated, 'I'm Julie, not Diana. I have
nothing to say to you'. When approached later, in room,
stated: 'Ybu must be one of the student nurses who Diana
spoke to. Did she tell you about me? Did you recognize
me?‘ writer replied in affirmative. Said she didn't want
to talk; thensaid 'It's warm in here. I'm going outside
today'. Then looked sideways at writer and said: 'But
not off the grounds'."

On 12-2, Dr. Coplon reports:

"In past week pt dealing more with transference issues, has

been getting frightened about this. After writing allove

poem to me she hasn't been around since, and Julie delivered —
note to me. Julie is beginning to deal with a lot of feelings

about being rejected and loving her boyfriend. She is very

similar to Diana now. She feels she is becoming more like

Diana and Diana is becoming stronger. Julie now has asked

for help with these feelings". Indeed she came for some of

Diana's scheduled therapy sessions.

On 12-6 Diana signed for a voluntary status in the
heapital. That night she disappeared from the hospital,
returning next morning as Julie, after having again taken
an overdose of pills. She went into a stupor, from which
she came out after treatment; awaking as Diana, she could
remember nothing that happened. On 12-9 she was upset,
"crying hysterically for her father". She was concerned
about her baby -— cared for all this time by her family -~
and asked to go home daily to care for the daughter.

Another source of concern was Dr. Coplon's forth-

coming vacation, scheduled to start December 11. Diana

117

 

started having thoughts about harming her therapist so
that he will not be able to go away. She shared these
thoughts with Dr. Coplon himself, and he felt that dis-
cussing them helped her gainxcontrol over them and view
the separation in realistic terms. On the evening Dr.
Coplon left, however, she left the hospital as Julie, and
was discharged after 2 days as being "AWOL".

The mutual amnesia -- reported by staff and the pa-
tient herself during this period -- is sufficient to show
that the attempted integration of mid-November belonged
now to the past. Nevertheless, did it have any lasting
impact? Was the convergence between Diana and Julie real?
Tests administered during this period suggest a cautious
positive answer to this question, and supply us with
other important insights.

The DAP was administered to Diana on the day of her
readmission. The drawings are different from her earlier
ones, much more adult-like, and indeed similar to those
of "integrated" Julie three days earlier. The permanence
of the split, however, is perceived now as established.
When asked to draw herself, Diana draws a face divided into
two halves (Figure 13).

This makes Diana feel as if she was a "freak". It is
not surprising that on the MMPI, administered at the same
period, her highest score is not on any of the clinical

scales, but on the F scale, consisting of the items least

118

 

 

 

Figure 13: Self drawing by Diana (ll-71)

119

 

frequently chosen by the general population. In con-
trast, she achieves her lowest score on the K scale,
measuring personal defesiveness. This combination in-
dicates that Diana becomes critical and harsh in viewing
herself, guided by an urge to display her troubles and
confess her weaknesses. (The total score: *h6"g§'973-1/5:
F*9§:?).

The feeling of peculiarity is also expressed in a
TAT story from ll-2l. Responding to the blank card (16)
in the set, she says:
"Well, it's a story about the unknown, and it's just em ti-
ness... it's confusing. Scientists working in a lab. is
working on a chemical that's unknown, has trouble finding
what it is because chemical is invisible. Working very hard
but ain't getting nowhere. Feels kind of anxious, wants to
find out what this invisible thing is. Will be a great
achievement if he finds out".

But Diana is afraid the search is futile. Responding
to card 20 she tells about a lonely, troubled man trying
to sort out his problems. Asked if he will succeed she
answers: "it's hard to say, I don't think so, I didn't
find anSWers myself, I get more confused".

Does she feel she gets adequate help in this search?
She seems to doubt it. The young doctor who appears in
another story (card 8 BM) is now waiting for the results
of an autopsy performed on his patient, who died.

Returning to the question of convergence, we have to
turn to three tests administered to both Julie and Diana
in late November and early December. The picture emerging

is: the gap between the two is still wide when relatively

120

objective, self-descriptive techniques are employed, but
it narrows when studied projectively.

Thus, the Value Survey (Table 6) suggests a picture
congruent with the initial contradictions in self image.
"Family security", ranking first on Diana's list of ter-
minal values, is ranked no. 17 out of 18 in Julie's list,
which is headed by "An exciting life". A similar gap ex-
ists in reference to "True friendship" (no. 3 & no. 16).
The conflict over instrumental values is not as Specta-
cular, but is still considerable. "Capable" is the first
on Diana's list, and only no. 6 on Julie's, while "In-
dependent", Julie's choice for no. 1, is only no. 8 for

Diana.

Table 6. Value Survey Responses (ll/12-l97l)

Terminal Values

DIANA JULIE
1. Family security 1. An exciting life
2. Inner harmony 2. Pleasure
3. True friendship 3. Wisdom
h. A comfortable life A. Freedom
. An exciting life 5. Happiness
6. Happiness 6. Inner harmony
7. Social recognition 3. A sense of accomplishment
8. Wisdom . A comfortable life
9. Pleasure 9. Self respect
10. Self respect 10. Mature love
11. Freedom 11. Social recognition
12. A world at peace 12. A world of beauty
13. A world of beauty 13. Equality
. Equality 1h. A world at peace
15. Mature love 15. National Security
16. National security 16. True friendship
17. A sense of accomplish- 17. Family security
ment

121

 

Table 6. (cont'd)

DIANA JULIE
18. SalVation 18. Salvation

Instrumental Values

1. Capable 1. Independent
2. Courageous 2. Courageous
3. Loving 3. Responsible
h. Ambitious k. Self—controlled
5. Responsible 5. Logical

6. Forgiving 6. Capable

g. Honest 7. Ambitious

. Independent 8. Intellectual

9. Intellectual 9. Polite
10. Clean 10. Clean

ll. Cheerful ll. Broadminded
12. Polite 12. Honest

13. Helpful l3. Cheerful
1h. Logical 1k. Loving

15. Imaginative 15. Helpful

16. Broadminded 16. Obedient

17. Obedient 17. Imaginative
18. Self—controlled 18. Forgiving

Similarly, the gap is still great on the Semantic
Differential. Julie tends to cluster concepts together,
and many of them fall into three extreme groups. "Sex"
and "money" are seen as totally good, strong and active
(in Figure 14 they appear therefore in the top, distant,
left corner of the page), "Hate”, "marriage" and "mental
illness" fall into the opposite extreme, seen as absolutely
bad, weak and passive (and thus appear in the bottom, close,
right corner in the figure). "Mother", "father", "family"
and "nurse" are described as absolutely neutral (exact
center of the semantic space) and thus reduced to meaning-

lessness. This is a rigidly defensive pattern of

122

 

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Figure 114.: Julie's Semantic Space

123

 

 

simplifying reality.

Diana's responses are much more complex, exhibiting
higher tolerance of ambiguity and ambivalence (Figure 15).
"Father" is the only exception —— it gets only positive,
strong and active adjectives. All other concepts aroused
more mixed feelings. Thus, eVen though "mother" and "boy-
friend" are both perceived as neutral in terms of the
evaluation and activity factors, the former is seen as
weaker than the center—point, the latter as stronger.

When asked to define the concept "me", Julie gives
it adjectives highly loaded on the evaluation factor
("clean", "tasty", "valuable") and on the activity factor
("hot", "fast", "active"), but appears ambivalent as far
as potency is concerned (the concept is seen as "strong",
"deep" but rather "small"). She clusters "me" with "sex"
and "money", with "drugs", with "prostitute" and "self
control" and with "boyfriend".

For Diana, the concept "me" arouses much more ambi—
valence. It is seen as "clean" but not quite "tasty" and
rather "worthless", thus being close to neutral on the
evaluation dimension. On the activity factor, "me" is "hot"
but not too "active" and neutral as to "fast". On the
potency dimension, it is "deep" but rather "weak", and
neutral in reference to "large". "Mb" is not closely
clustered with any other concept, and it is surrounded by

"family", "baby", "prostitute", "mother" and‘boyfriend".

12k

     
   

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Figure 15: Diana's Semantic Space

125

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pf

"mental illness" is not far, and surprisingly neutral. "Me"
is clearly excluded from.the good-active-strong cluster, where
"father" is approximated by "nurse" (the wished-for vocation
is seen as unavailable, even.more distant than "prostitute")
and "marriage".

There are many more differences, but some noteworthy
similarities between Diana and Julie. "Doctor" is seen by
both as good, rather passive ("cold" and "slow", they agree)
and close to the middle in potency. "Confusion", on the
other hand, is seen by both as bad, close to neutral in
activity, and extremely potent.

Diana's Holtzman is not too different from her Ror-
schach, two months earlier. Again the form level is gene-
rally adequate, human movement is perceived frequently, color
and shading responses also appear, and the content includes
childhood themes (monster, animals), anatomy responses,
twins, tail-less creatures (monkeys, in this case). waever,
morbid images appear now more openly: "a man stab(s) a
lady or has sex with her" (Card 2 -- sex equated with murder),
"brain divided and all messed up" (Card 6 -- the feeling of
peculiarity also expressed in the TAT, MMPI and self drawing),
and a direct reference to one of her great traumata (Card 16):
"babies ... going to be twins ... kind of shaped funny, blue
around the eyes, not born yet - my baby wasnit ready to be
born yet, was kind of funny".

unlike Julie's guarded Rorschach in October, her
Hbltzmen.in.December is highly bizarre. No more able to sup-

press her fantasies (only one rejection out of k5 cards), they

126

all come out now, like "clouds bursting with rain" (card 7).
The responses are frequently personalized and symbolic, and
their correspondence to the cards is minimal. The feeling of
change is prevalent, and not always received positively: "I
start to walk like Diana, with a limp, and I used to walk
good!" (card 21). Nevertheless, Diana's superiority in
some respects is acknowledged: "one person reached
reality, society; one just starting... I am just starting
to feel, Diana climbing the ladder to reality... (but)
reality itself has a gap at the top!" (card 18).

The feeling that the wished for reality is flawed
leads to a grim conclusion: "If Diana and I could get to-
gether, our mind would be a?” little distorted". (card 9).
Later, this fear is expressed with even greater emotional
impact (card 26): "If I ever/cry it will be red, like
blood, not tears like everybody else... if I ever cry,

I'll lose my mind".

There are a few jollier responses (e.g. dancers): but
the more common theme is (card k3) "a confused brain in
misery". Again and again reappears the percept of split-
ting and reuniting, the obsessive issue of (card 314.) "two
peeple trying to get together, some thing behind them

pulling them apart".

by; Intensified transference: December lfll-February 1972
Julie left the hospital on December 10; Diana was re-
admitted on January 12, 1972. For what has happened in

127

the interim period we have one source only, namely Dr.
Coplon's account. In a summary prepared on 1-23-72, he
writes:

"She remained Julie for about four days, and during that time
she was high on.amphetamines and barbituates. When she
switched back to Diana she contacted a member of the ward
staff who had planned to see her in.my absence and made
arrangements to see her once during the first week and once
during the second week. She remained fairly stable during
that time and on the day of my return called to ask for out-
patient appointment. I agreed to see her as an out-patient
twice weekly.

For the first three sessions she remained stable. She was
caring for her daughter at home and making plans to go to
night school to complete her high school degree preparatory
to going to nursing school (a long-time ambition of hers).
She was somewhat upset about her mother's recent hospitaliza—
tion for pancreatitis and was also upset about Julie's plans
to get set up in a house of prostitution, because this con-
flicted with her own plans to go to school. However, she
seemed to be able to cope with these situations. There was
no talk during these sessions about transference issues.

Julie appeared for the fourth session, and she was the Julie
of old -- arrogant, aloof, poised. She said she had had
enough of feeling things for peOple (referring to the two
week episode during which she had been in love with the "nice
Jewish boy") and that she wouldn't do that again. Her pur-
pose in coming was to tell me that Diana wasn't coming back
to see me again because she (Diana) was in love with me and
I wasn't reciprocating her feelings. She also said that
Diana could be quite dangerous when she doesn't get what she
wants and reminded me that she (Julie) had perhaps saved me
from getting hurt by not giving Diana her gun when I was
leaving on vacation.

I pointed out that Diana needed help in controlling her
feelings and said I hoped to see her (either as Diana or as
Julie) at our next appointment. Julie said she could take
care of Diana and that she didn't think either would be
seeing me again.

At the next session.Diana appeared and was very depressed and
tearful. She asked to be transferred to another therapist
because I wasnlt helping her with her feelings (i.e., I
wasnit returning her feelings of love). She said that she
wanted to move in with me and have me be her daddy, and she
really couldn't see any reason why I wouldn't do this.

128

She made it clear that she didn't want me as a lover but,
only wanted me to hold her and take care of her. She also
seemed quite convinced that some day I would let her move
in, and she implied that might be facilitated by her re-
moving other objects of my affection. When I interpreted
this as a threat to my wife, she denied it but did so in
a very coy manner.

The next day the patient called the ward and left a message
that she was planning to kill my wife. That night she
called my wife at home and gave her three days to move out,
or "I'll have to get rid of you." I spoke to the patient
by phone shortly after this, and she was quite convinced
that, although, I might be mad initially if ‘she killed my
wife, I would soon get over it and allow her to move in

as my little girl. She wouldn't come to the hospital that
night but agreed to come and see me the next day. She

came at the scheduled time and was re-hospitalized. Al—
though she said she never would have returned to the
hospital if she knew I would hospitalize her, it seems clear
that on some level she knew she would be kept".

A nurse reports on January 12:

"Admitted to ward screaming and yelling, being restrained by
four guards. Placed in quiet room and medicated". The
following day the note reads: "Seems well oriented and alert.
Is not socializing well. Appears angry".

In a mental status exam of 1-13, Dr. Coplon writes:

"Pt is depressed and angry at being hospitalized but talks
quite freely. She is alert and oriented, speech is logical
and coherent. Intelligence is above average but judgement
and insight are impaired in the specific area of the
appropriateness of her behavior prior to coming into the
hospital. There is a definite delusion that I will at some
point agree to let her move in with me and be her daddy, and
she is also convinced that if she killed my wife I would
eventually foggive her and still let her move in. She seems
to have no conception of the fact that murder is a serious
crime and usually results in someone being confined to a
prison or mental institution for long periods of time. In
other areas pt's reality testing seems intact".

To the previously stated diagnosis of "Alternating personality"
Dr. Coplon adds "Transference psychosis".

On Friday, 1-111, Diana is described as "quiet and
cooperative, offers no complaints", and nurses' notes of

the following days are similar. On 1-17 Dr. Coplon reports:

129

"Pt's reality testing has gradually improved to the point
where she seems in control of her feelings. She has accepted
hospitalization and seems willing to cooperate, probably
will be able to have visits home soon".

Indeed, Diana went on several passes the next few days,
and reported doing well on them. In a treatment summary
prepared on 1-23, Dr. Coplon mentions:

"She began to feel very. sorry that she frightened me and
my wife, and she accepted as reasonable the statement that
future threats or other similar forms of acting on her

positive feelings for me would result in immediate termina-
tion of treatment".

As to Julie, she briefly appeared on 1-17. "She
seemed relieved that Diana had not carried out her plans
(although she felt sure that she would have prevented Diana
from.trying to hurt my wife) and agreed to accept hospi-
talization.and treatment because she realized that Diana
had certain impulses that she (Julie) might not be able to
control". Her next appearance is reported by a nurse on
1-28. "Turned into Julie today AML& PM; Acting similarly
to Diana. Soft spoken, infantile, quiet. Dressed in wig
and hot pants".

Also in his 1-23 summery, Dr. Coplon reports new de-
lusional ideas revealed by Diana.

"For instance, she's been convinced for many years that be-
cause her mother was unpleasant to her father she would
suffer one year for every month her father had suffered with
cancer and would die at the end of that time. This means
that the patient's mother, who has suffered from.pancreatitis
for a year and a half, is expected by Diana to die after
another year and a half of suffering (patient's father died
after three months in the hospital). Diana says she doesn't
'want this to happen, but she is sure it will happen. She
also has the idea that her father was killed by the doctors
caring for him.because they injected cancer into him.so that
they could experiment on him. Another unusual idea she has is
that she will die in an.auto accident at the age of thirty,
something about which she is absolutely sure. She asserts

130

 

 

that she once accurately predicted the circumstances of an
accident in which she was later involved, and she is con—
vinced her other predictions will come true".

During this period Diana also participated in a psycho~
drama group held in the hospital. In one of the group
meetings she was instructed to role—play Julie. She did
it quite successfully, but remained fully aware of being
"Diana playing Julie" rather than "real Julie".

Following her delayed return from a weekend pass on
1—31, a change is noted. On Tuesday, 2-1,

"pt walking barefoot wearing long wig. Can be seen with
another male patient...not verbalizing with anyone else.
went to adolescents' meeting and stood in front of mirror
and started shouting "Dr. Coplon I want something for
nausea, I feel nauseous". Dr. Coplon took pt out of the
meeting. Went to psychodrama in PM and apparently fainted".

On 2-2, the same nurse reports:

"Began screaming and yelling and threatening to 'tear the

place up'". In the afternoon: "Fainted in hallway". "Stated ~-
felt weak, wasn't able to see anything, wasn't able to stand".
More fainting spells are reported next morning. In the after-
noon: "Pt requested canteen pass which Was given to her.

Pt left hospital... called Dr. Coplon and stated she had gone
AWOL and took an overdose".

Diana was treated for the overdose of pills at Ford-
ham hospital, and returned to the ward the following day.

On 2—7 she is described as "confused, agitated ... with-
drawn", and in the evening as "angry and demanding". She
went on a pass to attend school and again disappeared. On
Thursday, 2—10: "Returned to ward as Diana. When asked
why she didn't come back said 'I don't know', indbating it
was Julie who left". Dr. Coplon explained to her "that she

must accept responsibility of passes as Diana or Julie".

131

This appeared to be futile. She went AWOL again the next
day, was discharged on 2-13, and became an outpatient
again, seeing Dr. Coplon twice weekly.

I never met Julie again, and was not able to administer
any more tests to her. I met Diana on Tuesday, February 22,
after making an appointment over the phone. She was
friendly, cooperative and mildly optimistic. She was at-
tending school regularly, and while feeling tired and over—
worked hoped to pursue her studies and become a nurse. I
administered the DAP again, and started a retesting on the
Rorschach; after the 6th card, however, Diana became very
impatient and asked permission to go.

The Rorschach responses given are similar to those of
the first test (Table A): A bat and a "lady shape" on I,
"two people sitting down with hands together—~greeting each
other" on II (a new response), twin dancers on III, a men-
ster on IV, a bat on V and a lien or tiger rag on VI.

The drawings, on the other hand, are different from
past performance. Although lacking the childish quality
of the September drawings (e.g. Figure 6), they also lack
the articulate nature of the November series (e.g. Figure
13). The woman she draws now (Figure 16) is empty and
expressionless, drawn in crude lines and imbalanced pro-
portions. The male drawing is of a similar, primitive na-
ture, and the tree is a collection of unconnected stick-

like branches with vague fruit at their ends, all placed

132

 

Figure 16: Female drawing by Diana (2-72)

133

on top of a trunk lacking closure.

The regression and sadness expressed in these draw-
ings made it impossible to share Diana's optimism. It
was clear she is paying a heavy price for her relatively
smooth functioning, and it seemed doubtful how lasting
this adjustment could be.

mus Follow-up: 1912-1973

After her discharge in February 1972, Diana continued
seeing Dr. "Coplon as an outpatient. In a report prepared
in January 1973, he describes the course of treatment.

"Tre‘atment focused on Diana's sexual difficulties with
different men in her life, and she actually seemed to be
making progress in this area. However, after about four
weeks as an outpatient, Diana became convinced that people
ware following her and were poisoning her food, and she in-
sisted on being hospitalized for protection. This was
interpreted to her as an attempt to get closer to me and to
have me take care of her, and she was told she would be
hospitalized at a nearby state hospital but not on my ward.
She decided to try to wvrk through her fears outside the
hospital, and after a week on phenothiazines she seemed to
have recovered from her brief psychotic episode.

Diana was not as stable after this, and Julie began to be
more intrusive in her activities. Diana began to talk again
of how much she loved me and how she wanted me to be her
daddy. Julie appeared occasionally for sessions to tell

me how Diana felt about me and how hepeless it was to try

to help her. There were a couple of other brief psychotic
episodes in which Diana became convinced that a man she

was dating had the same face as her father. In general the
patient's life became more chaotic, both in therapy and
outside of it.

About one month before my next vacation Diana spent an en-
tire session discussing impulses she had to kill her
daughter. These were very frightening to her and made her
wonder "Whole next?". That night she again called my wife
and told her she was on her way u to kill her. When I
was able to contact her by phone {she agreeably left her
number with my wife), I explained that I wouldn't be able

13b.

to treat her any longer and that I wanted her to be
hospitalized at the state hospital where she'd begin treat-
ment with someone else. She finally agreed to meet me in
our emergency room and was transferred to the state hos-
pital".

Diana was committed to Bronx State Hospital, and a
closed ward was recommended. The psychiatrist in charge
on the unit to which Diana was admitted did not share the
belief in multiple personality as a genuine phenomenon.

He saw Diana as simulating, and refused to acknowledge
Julie's existence. Diana stayed in the hospital for about
a month and was mostly treated with phenothiazines. Upon
discharge she was referred to the hospital's outpatient
clinic, as Dr. Coplon decided to discontinue the treatment,
feeling the transference was too intense to deal with.
Diana did not keep her outpatient appointments, and con-
tinued appearing occasionally in Dr. Coplon's office.

Diana has been referred to a therapeutic nursery for
ex-patients and their children. She attended this nursery
-- with her daughter -- for several months, but was finally
terminated because the staff felt her frequent temper tan-
trums and hysterical reactions were too upsetting for other
children and mothers.

On June 5, 1972 I met Diana again. She rented an ap-
artment for herself and her daughter, but was still spending
most of the time at her mother's house. She reported
feeling over-medicated, and being unable to do much at home

or outside. Family interviews in the next weeks (section
1|..5) revealed the family felt she was still quite disturbed.

135

Julie, she told me, did not appear for more than.a.month,
but she was constantly fearful of what "Julie mmy'be pre-
paring " .

The Blacky test, administered on 6-5-72, makes it
clear that the experience of maternal deprivation was never
resolved, in spite of the actual dependence on the mother.
In the first card Blacky is seen as unwanted: "mother
tired, doesnit want Blacky to bother her; the baby is
feeding anyway on his mother". In the second card Blacky
is about to tear up his mother's collar, because "he
‘wanted to feed when she didn't want hhm to, and he sensed
that". Themes of helplessness, Jealousy and guilt are ex-
pressed in other stories while pleasant experiences are
totally lacking.

DAP was also administered. The drawings show little
change since February. The male is particularly childish,
helpless -- and lacking hands (Figure 17). The splitting
appears both on the first drawing (a line dividing the fe-
male figure in the middle) and in the self drawing (a we-
man with two heads).

Following my contacts with Diana and the family, I re-
ferred Diana to a private psychiatrist who specializes in
hypnotherapy and accepts Medicaid patients. Diana attended
one session and never returned. The psychiatrist, an
elderly woman, told me Diana got very upset in.the session
when her belief that Dr. Coplon is her father was described

to her as a fantasy.

136

 

 

Figure 17: Male drawing by Diana (6-72)

137

g;- u-

The day following her first (and only) session with
the female psychiatrist Diana again appeared in Dr.
Coplon's office and told his secretary to tell him his
daughter is there to see him. He refused to see her, and
she started a small fire under his door, and was then es-
corted by policemen to Jacobi hospital's emergency room.

I met her there, by chance. At first she was acutely
delusional, insisting her age is seven years. After a long
conversation with Dr. Coplon and me, Diana became more
rational, and agreed to go back to the psychiatrist to whom
I referred her -- a promise not kept. This was the last
time I saw Diana to the time of this writing.

There were a few more threats to Dr. Coplon's wife,
but they subsided toward the end of 1972, after two of
her letters were sent to the police for investigation. In
January 1973 a nurse in Jacobi hospital reported meeting
Diana and finding out she has just married. The husband
is her brother-in-law; his brother married Diana's oldest
sister, Iris, in 1972. Both brothers came from Africa.

This research would have benefited from further
follow-up, but from the point of view of Diana's interest
any: further assessment at this stage appears to be poten-
tially harmful. A certain equilibrium appears to have been
achieved, and as shaky as it may be -- it should not be
disrupted.

138

h.5 Diana, Julie, parents and siblings

h.§l Judgements on similarities

As mentioned earlier (section.3.51), Rorschach and TAT
protocols of Diana, Julie, siblings and mother were blindly
compared by three judges. The results are summarized in
Table 7. The higher the score, the higher is the degree of
similarity found.

On the Rorschach Diana and Julie are found to be not
similar at all; all three judges give them.a score of 1,
thus classifying their pair of protocols as one of the
seven least similar pairs out of 28 comparisons.

On the TAT, two judges saw'Diana and Julie as not
similar at all (score 1), while one judge saw them as some-
what similar (score 3). This places their pair of pro-
tocols in the middle group in average perceived similarity,
with four pairs perceived as more similar, four as less
similar, and six as equally simdlar (total of 15 compari-

sons--the brothers were here excluded).

139

 

Table 7. Perceived Degrees of Similarity between Tests

 

 

 

(Average)
Rorschach
M s} D Ju J H G
.13 J. J 3'-
mother ‘25 ’3 '1 '25 :3 1'3. :3:—
J— a 3
Mildred (M) ‘3 ‘3 ‘2 I I i 3;,
Sebastian (S)
I ' '2 ’2
Diana (D) J I
3 I 5
Julie (Ju)
Jane (J) ’2 ‘ 1
Henry (H) 25
Gloria (G)
as
M D Ju L G
mother 2'15 1% ’33" I: ‘2
a. J»- 3’
Mildred (M) I a l 3 I i :23
}, /
Diana (D) I 3 I 3
Julie (Ju) I 3
J,
Jane (J) I 3

Gloria ( G)

very similar
somewhat similar
not too similar
not similar at all

Scale:

HNUJ-F’
Illl

Who in the family is perceived as similar to them?
On the Rorschach, Diana is seen on the average as "not
similar at all" to her sister Jane, and as "not too simi-
lar" to her mother and other siblings. On the TAT, all
the comparisons with her come on the average closest to
"not too similar".

As to Julie, her Rorschach protocol is perceived on
the average as "somewhat similar" to that of Jane (the
one least similar to Diana's!). Julie - mother compari-
sons come close to "not too similar", while all the other
comparisons with siblings come close to (or reach) the
level of "not similar at all". Julie's TAT responses, on
the other hand, are perceived as "somewhat similar" to
those of Gloria; the other comparisons range between "not
too similar" and "not similar at all".

To smmnarize, the judges perceive Diana and Julie as
two separate persons, whose closeness to each other is
smaller than their closeness to other family members (Ror-
schach) or comparable to it (TAT). Diana does not closely
resemble anybody among the tested family members. Julie
resembles her sisters Jane (in the Rorschach) and Gloria

(in the TAT).

1552 Members of the family
(4521 Father
Diana's father died of lung cancer in May 1965

111.1

(section 1|..l). All we know about him comes from descrip-
tions of other family members.

As mentioned earlier, he was born in the South, as
one of the older children in a large family, and lost his
own father while a teenager. He moved to N.Y.C.,:met his
wife and married her, and became an apartment building
superintendent, later also a part owner of a bar. His in-
come was never sufficient for the big family (seven child-
ren).

When asked to describe her late husband, the first
trait Diana's mother bringsrup is his inconsistency. He
went off and on, she says. At times he was alright: a
good husband and a good father. At other times he became
indifferent, moody, depressed. At these times he would
drink heavily, withdraw from everybody, and become vio-
lently abusive. In one of his "moody" periods (which
would last for a day to three days at a time) he hit Mil-
dred with a lamp. She needed 19 stitches.

When asked how he was with different children, the
mother says he favored the twa boys (Sebastian and Henry)
as well as Diana, who was very pretty as a baby.

Mildred also believes Diana. and Sebastian were
father's favorites and remembers he spent more time with
them. The most salient themes in her description of her
father are: he drank a lot and had trouble in keeping a
job, having no skills or education. He also didn't like

to work hard physically, and thus had trouble in providing
for the family.

Mildred vividly remembers the times he would come home
drunk, start fights and break things in the house. She re-
calls the incident in which she got hit, but declines to
describe it in detail.

Sebastian did not experience himself as father's
favorite, and he tends to deny any favoritism, although he
remembers father frequently pacified Diana when she got
upset. His first response when questioned is: "He was
my father... I wouldn't say good father. He didn't look
after us".

Sebastian believes his father loved his mother, but
his voice while saying this is hesitant, and he uses the
words "I guess". He can't recall other women in father's
life, but noted he always came home late. He and father
got along well, and when he was 10 - ll he would help daddy
in his job as a super, in the white neighborhood.

As mentioned earlier (section h.2), Diana adored her
father. She saw herself as his favorite, and enjoyed his
kisses and caresses, while never being beaten by him as
her mother and siblings were. She knew about other women
he had, met one of them (and ae‘child be had by her), and
also met a prostitute who lived in their house, with whom
the father had a relationship.

Jane had little contact with her father: she felt he

was usually out of the home or asleep; She sees him now

1&3

 

as "a hurt man", a man who did not reach his goal. "He
let it out on other people".

Henry offers a physical description of daddy: a short
man, limping, who drank a lot and made cigarettes with
tobacco and bamboo paper. He was strict--stricter than
mother. He and Henry got along well, although at times
daddy would force his son to do things. Henry recalls one
incident in which father got robbed, and then ran into the
house and started calling several people for help. The
anxiety and confusion expressed were clearly perceived by
the child.

Gloria, the youngest, says her father "did things just
to be evil". She recalls his round face, his short-cut
hair, and his habit of rolling up cigarettes. When he got
mad; he took his problems on mother, at times hitting her.
Nevertheless, Gloria feels she was liked by him as a baby
and as a girl; she recalls his giving her pocket money,
and even offering her some wine to drink.

The inconsistency of the picture is again apparent.

14.522 Mother.

As mentioned earlier (section Ll..l) Diana's mother is
an only child, who was brought up by an Aunt after her
mother's death at the age of seven. Her father moved away,
remarried, and only in his last years (prior to his death
in 1968) resumed close contact with her. She graduated
high school before moving to N.Y.C. and getting married.

m__

 

 

In the interview she comes across as an honest, re-
sponsible, realistic but somewhat limited woman. She con-
veys a feeling of exhaustion and depression, possibly re-
lated to her illness (pancreatitis and diabetes), and to
troubles with Diana and Sebastian. There isn't much
warmth in her interactions, but she does not seem to be
the utterly cold and depriving mother Diana (but not her
siblings) describes.

Test results reveal an average - low intelligence,
(e.g. low differention of drawings), a conventional out-
look (e.g. 5 Popular responses out of 13 on the Rorschach
-- see Table 8); low creativity and very low self con-
fidence. Mother frequently downgrades herself ("I guess
my imagination isn't good"..."I am not familiar with in-
struments"), and is frequently hesitant to decide between
alternatives (hat or eagle on Rorschach I; identical or
different figures on Ror. III; baby or doll on TAT 7 GF;
etc.)

Her emotional life is quite constricted (70% F on the
Rorschach), there is little ability to empathize (only
one M, the popular on III) and no ability to integrate
affect (the only color appears in a pure color response
to IX; the figures she draws appear frozen and unexpressive).

Generally, reality testing is adequate (F+ percent,
based on F and F- responses, is 90). There are, however,
several reservations to be made. The confusion, inde-

cisiveness and constant doubt interfere with a firm

th

experience of reality. More radical breaks appear at
times, as evidenced by the transparencies in the drawings
and by confabulations on Bar. II (pigs holding torches) and
Her. VIII (hman hands reaching to pigs, the hands dis-
proportionately big).

Table 8. Family Rorschach Psychograms

t + r * : y 1 '*
normed{mafia..Stémm‘IDmrfiLiu-j-Li4"“‘7 “("394 I 553,99

 

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rescues; e" 7 7 7 J 7 f 7

M6

While puzzled by such percepts, she is not over-
whelmed by them. Uhreal experiences are dealt with through
rationalization. Thus, on TAT 1 she suddenly notes:

"You know, there is something unusual, there is an extra
hand". When questioned about it, she finds a way out:
"maybe another person behind him".

Sexuality is repressed, and relating to men highly
conflictual. On the Rorschach, the phallic looking card VI
is rejected, while on card VII she "can't get nothing out
of bottom" (where female genitalia are frequently per-
ceived). The female and male figures look alike, the for-
mer lacking any feminine curves (Figure 18), the latter
having the legs coming out separately from the trunk,
with no place for genitals.

Sexual intimacy is characterized by violence (rape
appears in TAT 13 ME' and 12 M, and she makes one story for
both cards) and mutual rejection. If the sequence of the
TAT stories is to guide us, then the feeling of being re-
jected by the man comes first ("she is trying to make
love to him and he more or less is rejecting her"--k),
and then she reciprocates the rejection ("I don't think
she would accept him"--6 GF, the next card administered).

As to the motherachild relationship, it is marked by
an authoritarian - hostile attitude ("mother giving her
instructions, or either scolding her" -- TAT 7 (F) and both
parent and child are seen as unhappy. This may apply to

M7

 

 

Figure 18: First Figure drawing by mother

1’48

her relation to her mother, to her own daughters, or (most
probably) to both. A specific relevance of this description
to Diana is indicated by her saying that the girl in the
story "has a baby out of wedlock...so young".

h.523 Iris

Iris, the oldest daughter, was not available for inter-
viewing or testing, and little is known about her. Born
in l9h2, she married an African man in February 1972 and
moved out of the house. She graduated high—school, and
works regularly.

It is of interest that the peak of Diana's psychotic
transference to her therapist came close to her sister's
marriage date. On card IV of the Blacky test Diana says:
"Tippy is in love with another dog, Blacky is angry --
she will get married or move away and he will have no sis-
ter to play with". As mentioned (section h.h5) Diana
married the brother of Iris's husband in January 1973.

h.52h Mildred

Mildred was born in 19h6, is unmarried and lives with
the family. She is a high school graduate, and works in a
medical setting. Asked about her first memory she recalls
being afraid in the darkness, at the age of 3 or u.

The most striking part in her test performance are her
figure drawings: tiny stick-figures in the middle of the
page, in a style characteristic of h year old children
(Figure 19). The other tests reveal at least average in—
telligence, which leads to the conclusion that these

1m;

 

Figure 19: First figure by Mildred

150

drawings reflect an experience of being a fragile "no-
body", lost in the world and overwhelmed by its demands
and expectations.

Related to this experience is a highly inadequate
reality testing. Similarly to the mother, this starts
with an extreme indecisiveness and confusion (TAT 7 GF:
"little girl holding either a baby or a doll, sitting in
living room or a parlor; I can't tell whether her mother,
or a maid, or a baby nurse, trying to explain to her...").
It goes further into an F+ percent of 11.5 on the Rorschach:
most percepts do not match the inkblots.

An extreme example is her first response to card II:
"looks like a bat; wounded bat, bleeding, like it has been
hurt; or maybe is angry, sometimes you get angry and get
red". The color shock is combined with perseveration
(the popular bat was seen on I), the emotions aroused
lead away from reality, subjective experience is pro-
jected unto the bat in a confabulatory manner, primary
process is surfacing.

The experience balance is one-sided and extrover-
sive: l C, 6 FC, no M. While several color responses
are bound to forms, the form level is inadequate in most
(as in the example given above), and in combination with
the pure color response to card IX (almost identical to
mother's) and with the tendency for W (over 70%), point
in a hysterical direction. The lack of human movement

or human figures in general is absolute ; although there

151

are 7 popular responses (out of 21), the Popular human
figures on II and III are not perceived, and the
hesitation between "large man" and "bear" on IV is re-
solved in favor of the animal.

Another salient feature is the high degree of anxiety,
expressed in 6 Fc responses and in one pure texture re-
spones, morbidly depressive in its content ("guts, in-
side of an animal...something dead, spread out"--VI). It
is noteworthy that in the previous response to card VI,
the good percept of a tiger-skin rug is spoiled by seeing
two heads."

Mildred's TAT stories are similarly grim, expressing
depression related to coercion ("forced to play, sulking"
--l), ineffectiveness ("she is trying to restrain him...
looks like he is going out"--h.), pessimism ("he is telling
bad news, she is shocked"--6 GF), alienation ("baby doesn't
belong to either one of them"--7 GF). Sibling rivalry is
prominent ("could be sisters...this one angry, this one
suspicious"--9 GF), sex arouses guilt ("not married...
feeling guilty...he is hiding his face"-g-13 IF), and the
ambivalence regarding men is resolved in the negative di-
rection (between an evil man and a helpful doctor, she
finally decides the man in card 12 M looks "more like doing
harm" to the lying woman perceived).

1|..525 Sebastian

Born in 1915.9, Sebastian recently returned home after
three years in the service. He returned addicted to heroin,

152

and at the time of our interview he started attending a
methadone program. Although a high school graduate,
Sebastian has difficulty in finding a :job, and earns
money only occasionally. Besides Diana, he is seen as
the other black sheep of the family.

The interview with Sebastian was of great interest;
suspicious at first, he soon proved to be a young man of
high intelligence and great sensitivity. He gave inte-
resting details about Diana's life, saying the two of
them were very close prior to his going to the service.
He shared with me his anxieties about relating to women,
and asked for advice about receiving psychotherapy.

His first memory is of crawling around the house
"on one foot and one knee". He stood up on a chair in
the living room, and upon noticing him his mother ex-
claimed: "Look, he is walking!" He then fell, and some-
one came to pick him up.

The Rorschach protocol confirms the impression of
the interview: it is rich, perceptive, creative, and on
the whole well balanced. Out of 53 responses, only 7 are
Popular, and the F+ percent -is 83. Location is well dis-
tributed (7 W, 1 WS, 2 S, 3h. D, 9d) and so are determinants.
The experience balance is close to equal (M:ZC = 7: 6),
with numerous human movement and color (mostly F0) re-
sponses.

At the same time, there are indications of anxiety
(.7 Fe, 2 pure shading responses), of explosive inner

153

tension (3 m), of negativism (3 S and WS responses) and of
fragmentation (Hd) H). In some instances, there is a
tendency to loose distance from the percepts, emphasizing
emotional) quality ("woman's lips...1ook passionate" -- I,
"face of lion...homely look, sad expression" -- V). This
tendency reaches a morbid peak in the only pure color re-
sponses, which is fabulized ("flesh of something, living
tissue...as if side is ripped up"-- the orange part of
VIII). This, however, is an exception; other color responses
are well integrated with form, and one can conclude that
emotional outbursts may punctuate an-tl‘otherwise“ controlled
affective functioning in Sebastian's life.

What are, though, the sources of the anxiety, inner
tension and potential outbursts? One answer is indicated
by Sebastian's first response in DAP, which is an anxious
drawing of a person of unclear sexual identity (Figure 20).
When asked to draw a person of the opposite sex, the
result is a more clearly delineated man, and he confirms
the first figure was meant to be a female. On the Ror-
schach, while seeing female sex organs on three occasions
(III, IV, VI), he never notices the phallic forms as such,
and the ambiguous figures on III are seen as female
cannibals. An even more direct indication of sexual con-
fusion appears in TAT 13 MF‘, where the standing man is
perceived as a lesbian woman.

The difficulty of achieving manhood is a central
theme in the TAT. Mother tries to deny her son's

151+

 

I
I I
I"

._ l

, -’,___ .4 M

I 1
,I k
I ,

\a’flw...,.-- - "‘

Figure 20: First figure drawing by Sebastian

155

manhood, saying "you are just a child, a baby, what do you
know about the world" (9 EM). The son is "trying to claim
his manhood", and the ending is vaguely optimistic, "in
time she will find out he is a man now". But when re-
lating to a woman his age, the protagonist (14.) needs to be
encouraged by her: "be a man". It takes great effort

to undo mother's infantilizing approach, and the lack of
confidence in one's manhood leads to sexual difficulties:
even when turned to a lesbian -- avoiding the need for
genital potency -- the protagonist of story 13 MF is ar-
shamed for not being sexually satisfying.

As to father figures, they let one down, either
through corruption (the lawyer in 7 BM, is a con-man, and
the young man is convicted) or through ineffectiveness
(the doctor in 12 M is well meaning, but "the young fellow
probably dies and never wakes up").

11.526 Jane

Jane was born in 1953, about a year after Diana, and
thus is the closest in age to her in the family. She
successfully graduated high school, and at the time of the
interview completed one year of studies in a community col-
legs. She contemplates a career in teaching. As her
earliest memory she does not bring any particular incident,
but rather general memories of going to school, playing,
liking some things and disliking others, and being smaller
than other kids in school.

156

The same trend toward generalizing is evident in
Jane's Rorschach, in which 8 out of 9 responses are W,
the 9th being the Popular and salient animals on VIII.
Card IX, for which W responses are rare, is rejected al-
together.

The low productivity and the generally conventional
protocol (7-8 Populars, with perseveration of insects from
I to V and VI) cannot be explained by low intelligence; ’
this is counterindicated by a rich vocabulary ("id" and
"ego" in TAT card 1), by original drawings and by a well
integrated vista-M response to card III ("two people
looking over a valley'), and additional "Ms" on VII ("girls
sitting on a rock looking at each other") and II ("two
people hit each others hands"). The right explanation
seems to be depression, and this conclusion is reinforced
by the emphasis on black color, directly expressed in V
(and possibly present in the responses to I and VI).
Chromatic c'olor appears only once -- a gold fish in X --
as a secondary determinant, leading to an introversive ex-
perience balance of 3:;2.

Another aspect of the inconsistent performance on the
Rorschach may be an attempt to cover up a rich and dis-
turbed fantasy life. The drawings, for one, are very
bizarre (Figure 21): disporportionately large heads, arms
growing from the neck and bent in a flower - like posture,
half of the face (including one eye) covered in the woman,

157

/’ ”x V',"‘v ‘ \
I/F'
|
I
“7) (
.. )
.7-
'3

Figure 21: First figure drawing by Jane

158

three teeth sticking in the man's mouth. The aggression
expressed in the latter feature may also account for re-
sponses as "two people hit each other's hands" (Ror. II),
"she dies...gets hit by a car" (TAT 7 Q4"), "his wife has
been raped, or took an overdose...he leaves and will com-
mit suicide" (TAT 13 MF), and "he will suffer and die
eventually" (TAT 12 M). The depression, therefore, may
be seen as a result of suppressed but potent aggressive
drive.

The turn from other-directed towards self-directed
aggression can be openly seen in TAT 13 MF. In the first
version of the story, the wife has been raped; in the
final version, she took her own life. Indirectly, how-
ever, even this act is other-directed, as it leads to the
husband killing himself as well.

The deaths of Jane's protagonists are always blamed
on others: mother's thinly disguised moralistic attitude
towards the daughter who has a baby out-of-wedlock (7 GF),
the poor husband's inability to give his wife a bigger
apartment and luxurious life (13 MF), the father's not
having any money for a doctor for his ill son (12 M). All
of these themes appear to be derived from Jane's actual
family history.

What will the outcome be for Jane? Conscious of her
inner conflicts (coating them in psychological jargon, she
describes in card 1 a little boy whose "ego and id are both

159

working at the same time"), of her constant "daydreaming"
and "worrying" (6 GF), she poses an alternative. She may
be rescued by an understanding man -- "they start dis-
cussing this book they are reading; she forgets all about
her problem" (6 GP), or she may be driven to death by a
negligent man, who disregards her daydreams (13 ME). The
responsibility for her fate is placed outside of her (1;):
"She is leaving an alternative, he has to choose".

11.527 Henry

Henry, Diana's younger brother, was born in 1956, and
is now a high school student. ‘He is doing well, but his
mother expresses fears he may follow his brother's path.
The earliest memory he reports is of the age of (about)
four, when one of his sisters did not go to school, stayed
home and played with him. His mother was also present.

The one theme most salient in Henry's test data is
violence. Similarly to his sister Jane, violence appears
in many TAT stories; "from the look in his eyes, he is
going to kill the person" (11.), war experiences are "like a
slaughterhouse" (8 BM), the man who had sex with a pros-
titute "might have killed her...or raped her" (13 MF). Uh-
like Jane's guarded Rorschach, however, Henry's preoccu-
pation is equally expressed in response to the less
structured stimuli. The two elephants (II), at first seen
just with their trunks together, turn out to have "cut their
legs -- blood -- and cut their head, maybe were fighting".

160

Closeness implies violence in card V as well, where "two
horses just jumped in each other's head". The two girls
in VII "may fall down.if they shake -- thousands feet";
in VIII two lions are fighting a person, maybe a zombie;
and while the first response to IX is "two pigs ready to
kiss", there soon follow two men who are "mean...don't
like each other".

As may be seen from these responses, Henry tends to
fabulize many of his percepts, although he always uses
elements of an adequate form level. This combination of
rich, turmoiled imagination with an.axact perception of
reality gives his responses their surrealistic flavor.

While there is no denial of the aggressive impulses,
they are experienced as fearful, and require control.

"Boy is young, looks scared" (83M), but his first response
to his being drafted is counterphobic: "might try it for
a while, then run away". The girls on top of the cliff
(Ror. VII) "lean back -- if someone pushes them.forward
they will fall in the middle". This may also explain why
he would never turn the cards upside down, and why the
figures Henry draws -- in anxious lines, but with a human
expression, adequate sexual characteristic and age-appro-
priate-maturity--have no hands (Figure 22).

Anxiety and distancing are also expressed in 3 shading
responses (Fc) on the Rorschach, two of them.involving

elaborate vista percepts. Color appears only twice, in

161

Figure 22:

 

First figure drawing by Henry

162

card II: secondary to animal movement in one case (ele-
phants' blood), to inanimate movement in the other (red
coming out of a rocket). Following this initial color
shock, color is avoided in all other chromatic cards, again
suggesting fear of the outcome of emotional involvement.
Human movement, on the other hand, is frequently perceived
(6 out of 21 responses -- at times in anthropomorphized
animals--) and the experience balance is therefore
introversive.

Henry does not perceive his parents as helpful in
controlling his impulses. Mothers are portrayed as coercive
(TAT 1) but not empathetic; their investment in their sons
is narcisistic only. When the protagonist in 6 EM tells
his mother he was sentenced for jail, "mother isdisappoin-
ted or hurt", not responding to his feelings. Fathers
appear to be good for nothing, being "too old to under-
stand...boring" (7 BM). In the last card administered, 12 M,
Henry sees the son as being already dead, and all the
father can do‘for him is pray, then go home.

11.528 Gloria

Gloria was born in 1957, and is the youngest child in
the family. She studies in high school now, and hopes to
attend college and to become an accountant or a secretary.
She cannot recall her earliest memory when asked about it.

In reviewing Gloria's Rorschach performance, we en-

counter phenomena which by now can be recognized as family

163

...}.

fifyr

characteristics: frequent fabulized responses, loss of
distance from the inkblots, preoccupation with violence.
In addition, a tendency to project symbolic significance
reaches it peak in some responses, as in card VIII where
the tail—less panthers are seen as escaping from city life
(the red D), where they don't belong, to the jungle (grey
D). Gloria's involvement in the answer is manifested
when she ends her response with a direct advice to the
panthers: "go to grey"!

While the general form level is low (F+ is 65% of F,
Fc and ch responses), there are at least two gross con-
taminations. In II, the S is seen bothuas the space be-
tween the persons and as a card table at which they sit;
in III the Popular menare powdering the face of "a lady
cat", but their heads are identical with her eyes.

Castration themes are abundant: "tail-less panthers"
are climbing a broken cliff (VIII), an elephant's horn is
"broken", "coming off" (VII). A woman has no head (I), a
bleeding heart has been torn out (II), a giant is cut-up
at his waste line (IV). The latter percept also belongs
to a group of images where splitting is the theme; a re-
bot with two hearts (III), a rabbit split in the middle
into two halves (V), a spine and a birth canal first
perceived together and then attributed to two persons, male
and female (VIII).

The experience of living a lonely fantasy life, 130--
lating oneself from other people, in constant fear of being

161;.

exposed to them, is not only evident from the Rorschach,
but also directly described in it. "Looks like a king-
dom...lone1y kingdom, nobody discovered it, or its people
left. No scenery of life" (VII). "This looks like a
made-up country, where a tiny person is a king. People
have no insides, you can see through them" (IX).

Fantasy is much more under control in the drawings
(Figure 23), which are rigid, symmetrical, doll-like, but
without extreme pathology. 0n the TAT, story 12 M is of
a nightmarish quality: "Man is asleeping, his father
going to smother him, smash him in the face, hurt him or
kill him". When asked about the father's motivation, she
uses the same words she used in discussing her own father:
"just for evil". The ending is optimistic: the son
wakes up and fights back.

Of great interest is also Gloria's story to card 1,
dealing with a boy who has no idea how to play the violin
he has. This is different from stories of all other sib—
lings, dealing with parental coercion, but almost
identical to Julie's story to the same card. The diffe-
rence lies in the outcome: Julie's protagonist "breaks
it up", Gloria's "will find his way of playing his music".

While other men in Gloria's TAT lack the father's
malice, they are still unpleasant ("trying to fool her",
to get her frightened —- 6 GF) and cannot satisfy the
woman's needs (in 13 MF the man is too shy to fulfill the

165

 

Figure 23: First figure drawing by Gloria

166

woman's frank sexual expectations). Mother is described
again as boring and coercive, but not irresistible (9 CE"):
"she finally do go outside; mother gets upset, but she
puts her doll down, and goes outside; she grows up".

The desire to give up infantile fixations, and reach
maturity and independence, to leave her "made-up country"
and "see what's out there for herself"--this wish arouses
in one a genuine empathy, coupled with some fears about

the extent to which Gloria's fragile ego will enable her

to reach the hoped-for autonomy.

167

V. DISCUSSION

5.1 A _genetic reconstruction in a psychoanalytic
perspgctive

So far, we have dealt with facts and with low-level
inferences. In attempting now to reconstruct the life of
our subject, from infancy to the period of the study, and
to explain how she became the Diana and the Julie of the
present, we stand on a less firm ground. Partially, this
is a general problem of the science of personality: the
assessment of the past is more speculative than the
assessment of the present, which is available to the re-
searcher much more directly. An additional difficulty in
this case arises from the fact that we are facing a per-
son whose development has been different from the usual,
and whose present personality casts doubt on some of our
basic assemption on human nature.

Some theories appear better equipped than others as
a framework for such a reconstruction. The following
discussion is grounded in Freudian theory, and is most
directly related to the conceptualizations of Melanie
Klein, Fairbairn, Kornberg and Guntrip.

168

The choice of one group of theories against others
is yet another reason to see this reconstruction as
merely one possible way of organizing the data collected.
There is no doubt that the objective findings reported so
far could lead to different conclusions if they were
viewed from the point of view of different theories (e.g.
Jungian or Sullivanian).

Diana's psychological history is marked by a series
of unresolved conflicts; at the root of these conflicts
stands an early oral deprivation.

There is abundant evidence for such deprivation in
the testing material. The drawing of a fruit tree behind
a gate (Figure 6), the response "My stomach...is empty" in
Sentence Completion, and the story given to the first
card of the Blacky test ("mother tired, doesn't want Blacky
to bother her; the baby is feeding anyway on his mother")
are merely the most striking examples. The mother's test
responses indeed indicate a great difficulty in giving,
and nurturant mother figures are consistently absent from
the inner world of Diana's siblings. (section.h.5)

Kernberg (1966, p. 665) discusses some potential re-
sults of such conditions: "excessive frustration of early
instinctual needs (especially oral) is probably the main
cause of the lack of differentiation between self and ob-
jects, because excessive frustration reinforces the normal

‘gieposition to regressive refusion of self and object

169

 

images, representing early merging fantasies between self
and object in an attempt to retain or regain absolute
gratification". This process is discussed at length by
Laing (1960), who describes ontological insecurity as the
root of "the divided self".

Full re-fusion, as defined by Kornberg, is characte—
ristic cf psychosis. A milder version is also possible:

"in the case of borderline personality organization, what
predominates is not re-fusion between self and object images,
but an intensification and pathological fixatigg;of split-
tigg processes" (Kernberg, 1966, p. 666).

-The elementary splitting process refers to the mother
herself. Fairbairn (1952, pp. 110-111) explains: "It is the
experience of libidinal frustration that calls forth the
infant's aggression in relation to his libidinal object and
thus gives rise to a state of ambivalence. --- Since it
proves intolerable to him to hava a good object which is also
had, he seeks to alleviate the situation by splitting the
figure of his mother, into two objects. --— There can be no
doubt, however, that a bad (viz. unsatisfying) object may be
desired. Indeed it is just because the infant's bad object is
denied as well as felt to be bad that it is internalized".
Further, Fairbairn hypothesizes that the bad internalized ob-
ject is split again into (a) "the needed or exciting object
and (b) the frustrating or rejecting object".

This process of splitting is not limited, however, to
object representations. Melanie Klein (19h6, p. 298) states:

170

 

"I believe that the ego is incapable of splitting the ob-
Ject -— internal and external -- without a corresponding
splitting taking place within the ego". Kornberg, while
objecting to many aspects of Kleinian theory, shares this
belief when he describes how "each of these dissociated
ego segments contains a certain.prflmitive object image,
connected with a complementary self image and a certain
affect disposition which was active at the time when

that particular internalization took place" (1966, p. 672).

Although no direct evidence can be supplied on this
point, it seems thus plausible to assume that a certain
splitting within.Diana's ego started at a very early age,
much before Julie's open.appearance. At that stage the
splitting was internal and unconscious, unlike the ex-
ternal-conscious splitting developed later. This process
'was described already by Prince (1919, p. 335) when.he spoke
of the "B complex" in the personality of his patient pre-
ceding the appearance of the "B personality" with the
open.split.

Guntrip (1969, pp. 71-72) describes his version of the
ego split "into an ego attached to the exciting object and an
ego attached to the rejecting object". He defines the two
parts as the libidinal ego and the anti-libidinal ego,
respectively, and reaches the conclusion: "Inevitably the
libidinal ego is hated and persecuted by the antilibidinal
ego:..so that the infant has now become divided against

171

himself. This is easy to recognize in the contempt and
scorn shown by many patients of their own needs to de-
pend for help on other people or on the analyst".

Julie's scorn for Diana's dependency (indeed empha-
sizing her dependency on her therapist), Diana's feeling
of being persecuted by Julie -- both sides are precisely
described by Guntrip. One central aspect is, however,
missing: Julie '3 initial role as Diana's protector. This
omission is later corrected by Gtmtrip himself (1969, p. 193):
"In fact, st c at

because it is the child's stggggle to keep himself ggipg
when he feels afraid and has no real help",

The discussion so far focused on the nature of Diana
and Julie as related to the two aspects of the split mother
representation. This, however, is only the first layer in
a complex structure. Split aspects of other object re-
presentations invariably become attached to the split ego
segments. In Diana's case it appears evident how central
a role plays the father in this process.

What is the source of Diana's great attachment to
her father? Kornberg (1966, p. 680) writes: "Severe oral
pathology of the kind mentioned tends to develop the posi-
tive oedipal strivings prematurely in the girl. Genital
strivings for father are used as a substitute gratification
of oral-dependent needs that have been frustrated by the

dangerous mo ther" .

172

Fairbairn (1952, p. 121;) emphasizes the degree to which
the choice of one parent over the other is determined by
distortion, related itself to the earlier split in the
mother. The child now confronts ambivalence about both
parents, and he "seeks to simplify a complex situation...
by concentrating upon the exciting aspect of one parent
and the rejecting aspect of the other...by so doing 3:39
child constitutes the Oedipus situation for himsgli. Ambi~
valence to both parents persists, however, in the back-
ground: and at rock bottom both the exciting and the re-
jecting object remain what they originally were, viz.
figures of his mother”.

This is how Diana came to view her father as all good,
and her mother as mostly bad (e.g. Semantic Differential).
0n the level of this perception, the split Julie-Diana has
some aspects of the split mother-father, and Julie's in-
tention to get rid of Diana represents the fantasy of mother
getting rid of father, killing him "by her unpleasantness"
(section midi). "An inner psychic world has been set up
duplicatinLan original frustratgg situation, an unhappy
world in which one is tied to bad omects and feeling there-
fore alng frustrated, hungrmy, and guiltl, and pro-
foundly anxious, with constant temptation to seek transient
inner relief by projecting it back into the external world"
(Guntrip, 1969, p. 22).

We will have to consider whether this temptation was

173

acted upon in an case, but another issue should be clari-
fied first: the nature of Diana's extreme idealization of
her father. It is described accurately by Kornberg (1966, pp.
668-671) as "a primitive, protective fantasy structure in
which there is no real regard for the ideal object, but a
simple need for it as a protection against a surrounding
world of dangerousobjects. --- On a deeper level the
idealized person is treated ruthlessly, possessively". This
indeed appears to be the case with Diana: we have little
information about her actual behavior toward her father,

but we do know how ruthlessly she treated her (older) lover
and her therapist.

While alive, the father clearly reinforced the sexual
attachment of Diana, as well as the exaggerated dichotomi-
zation between his and his wife's images. In the lack of
positive attachment to the mother, whose past depriving is
now re-experienced as Jealousy ("can't stand her because
she is young and pretty"--TAT 12), there is no way of re-
solving the oedipal conflict. Feminine identification is
thus never firmly established, and Diana continues to see
herself as castrated (e.g. tail-less animals appear on the
Rorschach and Holtzman tests; the bizarre attempt to keep
the dead male fetus can be seen as expressing a desperate
need for a phallic substitute) and to wish she were a boy
(directly expressed on the MMPI).

Father’s death adds a new dimension to the splitting

17h

 

and adds to its functionality. Diana (as she admits now
in interviews) cannot acknowledge this loss; Julie does.
This is exactly the process described by Freud (1927, pp.
155-6) in one of his first discussions of splitting: "In
the analysis of two young men I learned that each -- one
when he was two years old and the other when he was ten --
had failed to take cognizance of the death of his beloved
father -- had 'scotomized' it -— and yet neither of them
had developed a psychosis. Thus a piece of reality which
was undoubtedly important has been disavowed by the ego...
(but this) was only one current in their mental life that
had not recognized their father's death; there was another
current that took full account of that fact".

The function of such a division was even earlier ex—
plained by Freud (1923, p. 152): "it will be possible for the
ego to avoid a rupture in any direction by deforming it-
self, by submitting to encroachments on its own unity and
even perhaps by effecting a cleavage or division of it-
self". In other words, "The two contrary reactions to the
conflict persist as the centre-point of a splitting of the
ego" (Freud, 1938, p. 276).

The same principle is still used by contemporary
psychoanalysts, such as Wolfenstein (1965, p. 6h): "While
the child acknowledges verbally that the parent is dead, he
continues to daydream that the parent will return. We ob-
serve here a splitting of the ego -- what is accepted by

one level is denied on another".

175

The severity of the split in our case cannot be
understood, however, unless we realize that father's
death also intensified the ambivalence about him. His ab-
sence made it easier to idealize and adore him; but his
departure also aroused anger and bitterness: "he didn't
even tell me he was dying".

Guntrip (1969, pp. 21-23) sees such anevent as supplying
the necessary condition for the extreme form of interna-
lization which goes beyond memory: "Objects are only
internalized in a more radical way when the relationship
turns into a bad-object situation through, say, the ob-
ject changing or dying. When someone we need and love...
disappears, dies, i.e. deserts us, that person becomes, in
an emotional, libidinal sense, a bad object. --- In the
language of Bion, bad experiences cannot be digested and
absorbed; they are retained as foreign objects which the
psyche seeks to project. --- Objects are only interna-
lized later in life in this radical way by fusion with
already existing internal-object structures."

Additional objects may have been fused into these
structures, crystallizing as "Diana" and "Julie". Thus,
Diana recalls a sexy girl-friend of her father whose de-
scription is congruent with Julie's appearance and style.
The last name adopted by Julie is the last name of a
cousin of Diana, who was quite close to her around the time
her father died. Test results of Jane and Gloria, Diana's

176

 

sisters (section h.5) illuminate some traits they have in
common with Julie, and these were detected by the blind
judges who compared their Rorschach and TAT protocols.

All these persons may have influenced the formation
of Julie, adding to the rejecting and controlling aspects
of both parents expressed through her. Other, less known
objects may have contributed to the separate structuring
of present-day Diana, by being "partly superimposed upon,
and partly fused with" (Fairbairn, l9hh, p. 121) the needed —
exciting (but unavailable in reality) aspects of both
parents. It is clear that neither represents one con-
sistent identification.

This complexity may account for the diversified di—
rectidns of violence in the case history. Julie's inten-
tion to do away with Diana may represent mother's (re-
jecting side emphasized) perceived responsibility for
father's (exciting side emphasized) death. Diana's
burning her older boy friend because he preferred Julie
may be related to a repressed rage at her father because
he betrayed her with sexy girl friends (and ultimately with
mother). Diana's threats to kill Dr. Coplon's wife appear
as a continuation of her rage at her mother for being her
father's wife.

From all existing structural schemes in psychoanalysis,
Fairbairn's discussion of "the libidinal ego" and its
struggle with the "internal saboteur" (later called by Gun—
rip "the anti-libidinal ego") appears to describe most

177

adequately the Diana—Julie split. What are the charac—
teristics of these two ego segments?

The libidinal ego is attached to the cumulatively in-
ternalized exciting object. It is similar to Freud's id
in being infantile and not well—adapted to reality, but it
is not conceived as a reservoir of instructive impulses,
and it is seen as an object-seeking derivative of the ego.

In describing its development in the child, Fairbairn

(1952, p. 113) says:

"the experience is one of shame over the display of needs which
are disregarded or belittled...he feels reduced to a state of
wothlessness, destitution or beggardom...he feels bad in the
sense of 'inferior'...intensity of need itself increases his
sense of badness by contributing to it the quality of 'demand-
ing too much'." The attack to which the libidinal ego is
subjected represents "a persistence of the hatred which the
child comes to feel towards himself for the dependence dic-
tated by his needs" (p. 115).

Guntrip (1969, p. 163) before attempting to postulate
further splitting, which will not be discussed here, do—
fines: "The libidinal ego aspgct of psychic functionipg
represents...the infant's original nature, the possessor
of his basic and unmet libidinal needs..." The mental
pain caused by this frustration can be easily recognized
in Diana.

"The internal saboteur" has some commonalities with
Freud's super-ego, but no identity with it. It is not an
internalized object, although it is associated with one.

In addition its attack "bears all the marks of being vin—
dictive, rather than moral, and gives rise to an affect,

not of guilt, but of plain anxiety" (Fairbairn, 1952, p. 101).

178

Its source is also different: "The child seeks to circum-
vent the dangers of expressing both libidinal and aggressive
affect towards his object by using a maximum of his a -
gression to subdue a maximum of his libidinal needs" p. 111.1.-
115). There is a certain complementarity between the two
conflicting structures: "The attack of the internal sabo-
teur upon the object of the libidinal ego (the exciting ob-
ject) serves, of course, to perpetuate the attachment of
the libidinal ego to the exciting object by virtue of the
fact that this object is being constantly threatened. Here
we catch a glimpse of the original wolf under its sheep's
clothing, i.e..we catch a glimpse of the original embi-
valent situation!’ (p. 117).

Guntrip renamed "the internal saboteur" as, "the anti-
libidinal ego", and as noted added to it the essential
aspect of "the child's struggle to keep himself going when
he feels afraid and has no real help" (1969, p. 193). Sub-
sequently, he attempts to explain the constructive impli-
cations of this system (pp. 202-206):

(a) It represents an object-relationship with the parents,
and in spite of its negative content (centered around fear
and guilt) this may be better than no relationship at all.
"The infant comes to possess his disturbing parents in
himself, in developing an antilibidinal ego, and its dis-
solution will therefore feel to him to be the equivalent
of loss of parents".

(b) It represents "the struggle to achieve an ego strong
enough to live by (in which) the child turns against his
own actual ego as infantile, weak, and all too prone to
betray him into the power of disturbing adults through his
dependent needs".

(0) It confers a sense of power, through identifying with
powerful persecutory adults in order to repress the in-
fantile self.

All these considerations are valid in the case of Julie,
and can help us to understand her persistence. However, it

must be noted at this point that by emphasizing the striking

179

 

correspondence betwoen Diana and 'the libidinal ego", and
between Julie and "the anti-libidinal ego", we have avoided
so far a major issue: how can an unconscious ego-segment
turn into an active and outwardly-recognizable "per-
sonality?"

Fairbairn never elaborates on this leap, although he
acknowledges its existence and feels competent to deal with
it: "a theory of the personality based upon the conception
of splitting of the ego...(is) obviously adapted to explain
such extreme manifestations as are fetmd in cases of mul-
tiple personality; but, as Janet has pointed out, these
extreme manifestations are only exaggerated examples of
the dissociation phenomena characteristic of hysteria"
(Fairbairn, 1952, p. 159).

How, then, does the exaggeration appear? One hint in
this direction is the discussion of "release of repressed
bad objects", which is different from "the externalization
of internalized bad objects" (and their projection as
persecutors) in paranoia. While not explaining the exact
nature of the differe'ce, Fairbairn (1952, pp. 75-76) warns:
"When such an escape of bad objects occurs, the patient
finds himself confronted with terrifying situations which
have hitherto been unconscious. External situations then
acquire for him the significance of repressed situations
involving relationships with bad objects".

This is:.: somewhat vague, but it does bring to mind

180

Diana's terror when confronted with Julie's decision to

get rid of her. The terror, Fairbairn suggests (1952, p. 67)
may start even prior to the release of the bad objects, as
the child "cannot resist them because they have power over
him. He is accordingly compelled to internalize them in

an effort to control them...(but they) retain their power
over him in the inner world. In a word, he is 'possessed'
by them, as if'by evil spirits".

With a slightly differ-mt emphasis, Klein (1914.6, p. 30h.)
also suggests: "This weakened ego, however, becomes also
incapable of assimilating its internal objects, and this
leads to the feeling that it is ruled by them". One wonders
if such an inability to assimilate is what leads to an
alternative kind of splitting, more in time than in space,
referred to by W.C.M. Scott (in Klein, l9h6) and clearly
present in the relationship between Diana and Julie. Such
splitting in time also serves a schizoid style described
by Guntrip (1969, p. 36): "This 'in and out' programme,
always breaking away from what one is at the same time
holding on to, is perhaps the most characteristic be-
haviorual expression of the schizoid conflict".

A possibility which should be kept in mind is the
function of overt splitting in preventing a total dis-
organization of the personality. An analogy that may il-
luminate this is the shift, within a Rorschach protocol,
from a W - response which describes the full blot but con-
veys poor integration and reality testing, to two D4»

181

responses, each describing successfully a limited part of
the blot. Freud (1923) indeed suggested that division may
be needed to avoid a "rupture".

The question that still remains open is what is the
exact‘mechanism by which the two suppressed ego-segments,
the libidinal-infantile and the anti-libidinal, "over-
throw" the controlling "central ego" and share the "govern-
ment" on the basis of temporal splitting accompanied by a
constant conscious struggle. If, nevertheless, this is
what happened in creating Diana and Julie as we know them
at present, one conclusion is evident. Neither the
infantile-libidinal ego nor the anti-libidinal ego can
successfully be in absolute charge, and the only hope for
greater happiness for our subject is not in suppressing
either of her personalities, but in achieving a new inte-
gration which will again bring both these facets under
the control of a new "central ego". If at all possible,
this may only be achieved through a long and patient pro-
cess of intensive psychotherapy.

182

5.2 Confirmation of hypotheses

Returning now to the initial hypotheses of this study
(section 2), the following conclusions can be reached:
A. The psychological reality of the split between the
personalities was confirmed, and seeing Diana and Julie as
a delusion or a simulation received no support in the
findings (section #3). Blind judges did not see any
greater similarity between Diana and Julie than between
each of them and other persons, members of the same family
(section LL31).
B. The consistency of the split indeed spread over
numerous levels, including general style (section 14.31),
expressive movement (11.32), self concept (L33). cognitive
functioning (11.31;). affective functioning (14.35) and ob-
ject relations (LL36).
C. It became clear that Diana and Julie cannot be ex-
plained as representing single structural systems in the
traditional sense, and that drives and defenses are potent
in both. Their closest approximation to structural ele-
ments is in their similarity to the "libidinal ego" and
"anti-libidinal ego" (section 5.1), which are described by
Fairbairn and Guntrip not as constant mental entities, but
rather as possible constellations of functioning units. It
may be added here that no one identification can account
for the formation of Diana or Julie, but a cumulative pro-
cess of splitting, internalizing and fusing objects appears

183

 

to be involved (sections h.52, 5.1). ‘
D. A close relation and complementarity between the per-
sonalities is strongly suggested by their history (sec-
tion h.2) and initial picture (sections h.33, h.3h, n.35),
but the findings fall short of definite confirmation.

 

E. While no hard evidence can be offered on this point,
the attempted genetic reconstruction (section 5.1) does
lead to the conclusion that the present personalities split
from an early, integrated constellation. The beginning of

the splitting process appears now to be much earlier than

 

was assumed before.
F. Marked changes within both personalities, were de-
tected throughout the study period (section h.h) and they v”
do seem to relate to the effects of psychotherapy (e.g.
transference) and external events (e.g. sister's marriage,
mother's illness). Moreover, changes in one always were
complemented by changes in the other: greater libidinal
capacity in Julie (section h.h2) led to greater maturity
in Diana (h.h3), while the return of Julie to more hos-
tile patterns brought about regression in Diana (h.hh).
In summary, hypotheses A, B, 0 and F were clearly
confirmed, while hypotheses D and B were strongly sup-
ported by the data collected. In future research more
specific hypotheses could be developed on this basis.

18h

S .3 Validation of past explanations

Which, if any, of the explanations of multiple per-
sonality offered during the last twa centuries (section
1.3) are supported by the findings of the present study?

No supernatural influence was ever suggested or ob-
served in the case investigated. As to physiological
theories, there was no systematic attempt to test any of
them, but a routine physical examination, hospital-
prescribed laboratory tests and an EEG examination con-
ducted with both personalities revealed no significant
differences.

Could Diana be simulating? After five months of al-
most continuous observation, and taking into account all
the interview and testing data, this possibility seems out
of the question. An enormous genius and an iron will would
be required to simulate such a consistent picture of a
split without being ever caught off guard, and the persis-
tence of the differences even in test aspects not easy to
understand or manipulate without considerable psychological
sophistication (e.g. the experience balance on the Ror-
schach) strengthens this conclusion. Not one person who
knew Diana and Julie in Jacobi Hospital doubted the sin—
cerity of their story.

A few people on the Jacobi staff did raise questions
as to the iatrogenic aspects of the case. Could the
attention given to the split (therapy, testing, video-taped

185

 

interviews, psychodrama, case conferences) reinforce its
existence? No clear-cut answer exists to this question. It
is clear, however, that the split was experienced by

the subject months (directly) and years (indirectly) prior
to her hospitalization. The treatment and the research may
have prolonger the splitting, but in no way can they account
for its appearance. No hypnosis, or any other form of
suggestion, was used with the patient and (possibly with
one exception: the TC meeting on 11-3-71) the shift was
always spontaneous and unsolicited.

Some of the sociological explanations appear to con-
tribute valid insights to the understanding of the present
case. Murphy's (1914.7) emphasis on the attempt to live in
terms of different sets of values is supported by the con-
flicting results of the Value Survey (Table 6) and other
tests. It also became clear that the splitting made it
possible for Julie to avoid the social conventions of her
family by becoming a prostitute. The prostitute who lived
in their house (and befriended her father) may have supplied
her with the needed role model.

The conflicting role expectations imposed on a young
woman in American society-~to be sexually attractive and
virtuous, to be assertive and submissive, to be autonomous
and nurturant -- are indeed resolved by splitting between
Diana and Julie. The frequency of such role conflicts may be
one of reasons why most known multiple personalities are women.

011 an additional level, the two personalities also em—
body some of the current conflicts in Afro-American identity.

186

Arrogant rebellion, toughness, a 'cool' attitude, refusal to
collaborate with authorities -- all these qualities frequently
attributed to young Black militants are also embodied in
Julie. Diana, on the other hand, may be seen as an example
of "Uhcle Tomism" in her obedience, spontaneity, general
trustfulness and self-derogatory attitude. It is plausible
to assume that cultural images join personal experiences in
shaping the two personalities.

Similarly to the patient of Ludwig et a1 (1972), Diana
and Julie shared among them.different areas of competence
in.responding to social challenges. Characteristically,
Diana was around most of the time in the hospital (where
she was liked, made friends and generally adjusted well to
the institutional life style) while Julie had control over
most of the weekends, earning money street-walking and
mixing with a totally different social group. Their con-
flicting "self pictures" indeed fit well into their res-
pective social contexts. many of Julie's attitudes fit
well with the demands of her occupation (e.g. separation be-
tween.sex and emotions) while Diana's kindness and sub-
missiveness (except for moments of explosion) fit into her
aspirations to become a nurse.

The findings of this study support the belief that ego
weakness is the result of dissociation rather than its cause,

and thus add conviction to Prince's (and later Glover's)

187

arguments against Janet. At the same time, many of Janet's
other ideas still seem to fit our data: this refers parti-
cularly to his firm belief in the reality of the split and
in the role of past traumata, here most importantly the
father's death.

The place of oedipal dynamics is also confirmed, al-
though it now appears that pre-oedipal variables play a
crucial role in determining the impact of the oedipal con-
flict on splitting. Similarly, the emphasis on libidinal
cathexis must be extended to a fuller understanding of

 

internalization processes, so far neglected in this domain.
Only such understanding may give the right theoretical
context to the developmental scheme of Berton.and Miller ’”
(1972), which generally fits the present findings.

Finally, Fairbairn's comments about multiple personality,
while in need of extension and clarification (particularly
on the issue of shift from.unconscious to conscious split-
ting) supply the most successful basis so far for the

understanding of this phenomenon.

188

 

5.h Theoretical implications

The present study, beyond its particular relevance
in the exploration of an unusual clinical phenomenon, could
be viewed in the broader context of the "specificity --
generality" controversy in the social sciences.

I Psychoanalysis and other dynamic personality theories
traditionally stand on one side of this controversy, tene
ding to emphasize the unity and consistency in each per-
son's behavior beyond situational differences. They are
supported in this tendency by the personality assessment
and testing experts, and by quantitative researchers in-
terested in factor analytic and corelational methods.

Behaviorism, Gestalt psychology, field theories (e.g.
Lewin), role theories and other sociological doctrines --
in spite of the immense differences among them -- all
tend to place a lower‘emphasis on this consistency and
continuity, and higher emphasis on the specificity of
behavior in certain contexts, be they defined by social
role expectations, stimulus and reinforcement variables or
field vectors at any given moment. In certain respects,
existential approaches also stand on this side, emphasizing
the free choice of each individual in each situation, and
casting doubt on deterministic notions of character.

In recent years some movement of convergence can.be
detected. Thus, S-R theories take greater interest in the

role of past reinforcement contingencies (i.e. character)

189

 

in comparison to purely situational variables (Berger

and Lambert, 1969, P. 14.21). Social psychologists express the
belief that personality characteristics not only influence
role performance ("role enactment is more convincing,

proper and appropriate under conditions of self-role
congruence" -- Sarbin and Allen, 1969, pp. 522-527) but may
even determine the choice of social role (Arnnoff, 1967). A
theory initially geared towards purely situational vari-
ables -- the theory of cognitive dissonance -- is amended
to account for individual differences (Abelson et a1, 1968,
pp. 22-26, 615-623, 62u-6u7).

It seems to me that a parallel move towards considering
the limitations of extreme "generality" positions will bene-
fit dynamic personality theories. This, I believe, does
not have to reduce the understanding of individual differ-
ences but may improve it, as this understanding may suffer
at present from dogmatic adherence to the belief in the
tmity of personality.

The insistence of contemporary psychology on the
monad-like unity of personality appears to be a direct con-
tinuation of theology's emphasis on the unity of the soul.
Sutcliffe and James (1962, p. 238) are right when they suggest
that "people showed they were reluctant to give up unity,
and part of their reluctance arose from the contemplation
of the moral and religious, ethical and legal problems
raised by disunity".

190-

 

This must be the reason why the phenomenon of mul-
tiple personality still arouses so frequent skepticism and
suspiciousness (section 1.33), and why no systematic the-
cry of splitting in "normal" individuals, of "multiple
selves" or of "subpersonalities", was so far developed.

The existence of such subpersonalities, was often
observed by sociologists, who came to see them as inner
representations of divergent roles (e.g., trait conste-
lations attached to the roles of son, husband, father,
teacher, club member, political activist, which can all be
played by the same individual). It was also observed by
many clinicians in patients who have no alterations or
anmesia, but who nevertheless appear to have more than one
character (e.g. Ries, 1958). Hypnotists are at times am-
azed to discover intact childhood-personality patterns un-
covered during induced age regression (e.g. Bergmann et
al 191”).

It appears that the recognition of such multiplicity
influenced Freud in his structural concepts, in dividing
the psyche into ego, superego, and id. The tendency to
regard these as universal and exclusive entities made them
inadequate in explaining more complex formations and fully
accounting for individual differences. Colby (1955) Per-
ceives this limitation when he writes: "There are...theo-
retical disadvantages to the id-ego-superego model. To-

day its simplicity makes it insufficient to conceptualize

191

 

 

 

 

specifically enough the manifold functions of psychic
activity... In psycho-analysis our knowledge has increased
in such a way that to subsume the complexities of psychic
activity under three undivided categories is to stretch
generalizations too far".

Fairbairn (1931; 1952, pp. 218-222) appears to go in the
right direction when he suggests the possibility of an un-
limited number of different dynamic constellations becoming
differentiated in the conscious, which may also "invade
the consciousness" as in multiple personality. It is
somewhat disconcerning to realize that in later works he
developed his own structural divisions, different from
Freud's but again assumed to be universal and stable, rather
than pursuing his more flexible early conceptions.

If this study can have a general conclusion -- vague
as it may be -- it should be an intuitive endorsement of
the impression expressed by Sidis and Goodhart (19014., 36h):
"Multiple consciousness is not the exception, but the

13W" 0

192

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