MULTIPLE PERSONALITY and CRIMINAL BEHAVIOR Ralph B. Allison The psychiatric disorder called multiple personality has been found to exist predominantly in females in a clinical population, but mainly in males in a criminal offender subpopulation. The mental mechanisms of defense of denial, repression, and dissociation are used by these individuals, leading to the formulation of hostile-acting alter-personalities. Because of a failure of control of the executive functions by a moral center, these persons violate society's laws, but have no conscious memory of the act. They therefore do not respond to the usual legal sanctions. Common findings in this histories and mental status examinations are presented. It is hoped that quicker identification and correct diagnosis of these violence-prone individuals can lead to appropriate legal and psychiatric approaches to the problems they present to society.

Those psychiatrists, who are regularly involved in the evaluation and treatment of clients in the criminal justice system, quickly become aware that there is no firm boundary between the group called "mentally ill" and those called "criminal ." Those who violate the major moral codes of our society include some who have major mental illnesses, such as paranoid schizophrenia, bipolar affective disorders and other well-accepted psychiatric illnesses. Sometimes the criminal act is directly related to the progress of the illness. In either case, psychiatry has well established protocols for treating such patients, be they in prison or in hospital.

There is another psychological disorder which, by its very nature, predisposes its sufferers to criminal behavior but which causes such controversy among forensic psychiatrists that some doubt its very existence. This condition is multiple personality.

Although this condition has been diagnosed for over a century, often amid great controversy, only in the 1980 DSM III is there a clear definition.1 A. THE EXISTENCE WITHIN THE INDIVIDUAL OF TWO OR MORE DISTINCT PERSONALITIES, EACH OF WHICH IS DOMINANT AT A PARTICULAR TIME.

B. THE PERSONALTY THAT IS DOMINANT AT ANY PARTICULAR TIME DETERMINES THE INDIVIDUAL'S BEHAVIOR.

C. EACH INDIVIDUAL PERSONALTY IS COMPLEX AND INTEGRATED WITH ITS UNIQUE BEHAVIOR PATTERNS AND SOCIAL RELATIONSHIPS.

This paper is an attempt to explain, in a very elementary fashion, why this disorder may be a greater problem to the criminal justice system than its frequency suggests and how it might be identified and dealt with when criminal acts are involved.

BACKGROUND OF THE PROBLEM Eberhardt Gamelin published the first recorded case of "exchange personalities" in 1791.2 The first generally accepted case report from the United States was that of Mary Reynolds.3 At the turn of the century the most outstanding psychodiagnostician of this problem was Morton Prince, founder of the Journal of Abnormal Psychology, which carried many of his articles on the subject.

His extremely interesting description of Miss Beauchamp4 gives the clearest picture imaginable of what such a patient thought, said and did in the world of his day.

The next famous case was Eve, first made known by Thigpen and Cleckley.5 This case report was followed by her own autobiography6 and then, 23 years later, by another autobiography, "I'm Eve,"

which gave a story quite different from the first two books.7 Eve was followed by Sybil,8 which was the next best-seller to bring the subject to professional and public attention.

These famous patients, who became the "typical multiple personality"

to many psychiatrists, were, one notes, all women. Yet men suffer from this condition, also. In the mid 1880's, the first description of this phenomenon in a man is provided by Robert Lewis Stevenson in "The Strange Case of Dr. Jeckyll and Mr.Hyde."9 Though this is a fictional account of a chemically induced dissociation.

leading to murder, forensic psychiatrists would do well to read it again to find out how the twisted mind of an evil alter-personality responds to society and to his own act of murder. In the fever-induced nightmare which provided the plot for this story, Stevenson saw horrors of the mind which psychiatrists can seldom reach.

Two other descriptions of male multiples are worth of note.

Ludwig et al.10 gave a classic description of Jonah and his alter-personalities with much psychophysiological information.

Henry Hawksworth11 published his autobiography, "The Five of Me," in 1977. He went to court after fusion and his psychiatrist used age-regression during testimony to demonstrated the previous existence of the alter-personality who committed the crime.

In the legal literature, the only contribution known is Ashby's description of the trial of Ester Minor12 in which she was found innocent of a felony bad check charge because of successful treatment of her dissociation and the excellent handling of her case by her attorney. Otherwise there is little to guide the defense attorney who looks to his literature for help when such a case appears in his office.

THE DATA BASE Between 1972 and 1980, the author had diagnosed multiple personality in 59 individuals. Of these, 78 percent (N=46) were females and 27 percent (N=13) were males. Eighteen percent (N=l 1) patients either required the author to make a court appearance or were seen primarily for forensic evaluation. This criminally involved subpopulation was composed of 73 percent males (N=8) and 27 percent (N=3) females. Immediately one notes there is a 4:1 preponderance of females in the general clinical group but a reverse preponderance of males in the forensic subpopulation.

Only a rare male multiple was seen primarily for treatment.

The majority of males were discovered as the result of the psychiatrist being invited in by the court or the defense attorney in a criminal case.

As all cases are complex in nature, their descriptions here are not appropriate. However, it is planned that these cases will be described in a subsequent article.

There is one basic defect in the psychological make-up of a patient with multiple personality which is unique to him and makes him more predisposed to criminal behavior than the psychotic individual. This defect is in the internal relationship between the executive functions of the mind which involve everyday social functioning and the moral judgment mechanism we all possess.

By the latter is not meant the super ego as Freud defined it, which is an incorporation of social and familial codes of conduct.

What is meant is ability to decide, on one's own, whether or not a proposed act is morally right or wrong, before doing it.

Everyone is given the opportunity to do something despicable, harmful and evil at sometime in his life, but when most choose not to, the individual's moral judgment center sufficiently influences the executive center and the individual, therefore, does not commit the criminal act. It is this very important influence which is missing in the multiple and therefore leads him to repeatedly do acts which are harmful to himself and to others. This disconnection or dissociation also causes him to be unchanged by punishment, admonitions, or a clear warning of self-destruction.

The favorite psychological defense mechanisms of the child with histrionic personality disorder, the precursor of multiplicity, are denial, repression and dissociation. In denial, he, the basic core personality, fails to accept the reality that the rest of us accept, preferring to create a new reality of fantasy which is not in accordance with the laws of cause and effect, or of the written laws of society. He says, "The problem I am upset about does not occur, therefore I don't have to solve it." This attitude compounds the problem since the other parties to the problem, such as mother and father, are never confronted by the child or anyone else, and they perpetuate their misbehavior.

Since denial does not handle the build-up of hostile, angry and potentially murderous urges within the child, these are repressed into the unconscious mind where they continue an existence out of awareness of the child. He knows his mother loves him dearly, since all mothers do, so her beatings are not consciously seen as causes of hatred. The hatred is buried and, when intense enough, dissociates from the rest of the unconscious mind.

The third mechanism of dissociation is what leads to the creation of the alter-personality. The usual purpose is to create a reservoir for this continuous build-up of murderous hatred for the abusive parent. The personality which is in charge of executive functions of dealing with the angry mother may decide to do things her way for the sake of peace and survival, since he feels helpless in contrast to her power and ability to control his life. All the negative feeling she develops are invested into a dissociated energy system which gains strength over time until it has a structure, identity and purpose of its own. Then, when it is needed for protection and survival of the child, it makes itself known as a hostile protector, striking back at the child's identified enemy. Sometimes this creation is an imaginary playmate on whom all naughty deeds are blamed. Sometimes this activity is accompanied by amnesia of the misbehavior. In this case, the child is then accused of doing a horrible deed, such as stabbing a younger sibling. The child does not remember doing any such thing, but he knows he was in the room at the time. The resentment of being unjustly accused is added to the previous unexpressed anger, and a vicious circle is created, Alternately, the child may have been aware of his anger and of having done the misdeed. But when the parent asks, "Did you do it?" he lies and denies it. The denial then leads to repression again, and the next time mother asks "Did you do it?" he really does have amnesia and believes he did not do it. He may make up a story to explain where he was or who else did it. This is patently false to the parent, and now he is called a liar, an even worse sin in children, according to many parents So what happens? This fledgling alter-personality gets stronger as child and parent continue to fight with each other. When the angry one is about to go one step too far, a rescuer personality needs to be formed to counterbalance it. So a helper alter-personality is created to calmly deal with situations such as school. Now we have three personalities sharing the body.

The next trauma is usually involved with sex in the sense of rape or incest. This is less likely with boys, but still possible.

With girls, incest and rape are seen as sexual control, manipulation and humiliation of the girl victim. The alter-personality created from such experiences then seduces men to be able to control and humiliate them in return. However, the preferred victims of the humiliation soon also includes the original executive personality, so that the one who was protected is now the target herself In the case of the male rape victim, according to Groth and Burges, the impact on the male victim is often a feeling of life being threatened, a wide range of mixed emotions and disbelief, a marked disruption in the victim's lifestyle, considerable anger, fantasy or planned retaliation and marked confusion if the victim had been forced to ejaculate. 13 In the case of two male multiples who both committed several rape-murders, sexual assault did occur to them as children.

CASE HISTORIES Case Number 1.

This 18 year old white male was first seen for a court-ordered examination after his arrest on several charges of arson. While the physical evidence was overwhelming against him, he had amnesia for most of the night during which the houses were torched.

He was sentenced to the state youth authority prison and was again seen on release because of a suit he and his brothers had filed against the state. This was regarding an automobile accident several years earlier in which he and his brothers were severely injured while his mother was decapitated in front of them. Their attorney was trying to prove that the accident was so mentally upsetting they were incompetent to have filed the suite prior to the expiration of the allowed filing period.

During the interview after release from prison, a very hostile alter-personality appeared, claimed credit for numerous crimes, and called the primarily personality derogatory names for wanting to work, pay bills, go to church and do other such activities.

During subsequent investigations it appeared that this entity had been created at the age of 7 when the youngster was raped by a gang of neighborhood boys. In spite of presentation of the psychological data in court, the boys were all found competent to have filed the suit on time and the suit was dismissed.

About a year later, this man with an accomplice, broke into a woman's home, raped and killed her. A month later, he took a homosexual man home from a bar and, after intercourse, he strangled him to death, having no clear idea why he was doing so, In the first trial, for killing the woman, he was found sane and guilty of first degree murder and sentenced to death.

For the murder of the man, he was found guilty of second degree murder."

Case Number 2 This 26 year old white male had been arrested on charges of raping and strangling two young women. He had no memory for the period of time during which the killings occurred. A defense psychologist hypnotized him and found an alter-personality which admitted to the two killings and to five similar killings in another state This personality had apparently developed at age 9 to handle his anger toward his mother. She was displacing onto him her anger of her husband, who was losing much of the weekly paycheck at the local racetrack.

The documented medical history indicated that, from the age of 5-7, the boy suffered from daytime urinary dribbling, which was thought, by most doctors, to be an emotional response to his overprotective mother. She demanded a physical explanation and so he was subjected to several cystoscopies and a meatotomy, all to no avail. When mother went to work, his urinary symptoms disappeared. Considering the intense nature of the ambivalent feelings towards his mother and her insistence on doctors repeatedly traumatizing his genito-urinary tract, I believe he felt raped and was symbolically reacting in a dissociated state, when he raped and killed his victims. He was given two life sentences in the one state and six life sentences in the other.

When a sexually active negative alter-personality develops to the point of severe danger, the mind, in its wisdom, may create another rescuer personality which can stop the persecutor personality before it goes too far. If not, it acts as a rescuer-defender and seeker of help after the crisis is past and so we have five personalities formed.

SIGNS AND SYMPTOMS At this time, the moral judgment center of the mind becomes quite separated from the executive personality. The alter-personalities at first have a protective functioning toward the executive personality but after awhile they may develop interests and activities of their own that the executive one knows nothing about. Time is lost and no accounting can be made of it. Again, denial is used to ignore this reality. Activities get done but the executive personality cannot yet remember how or when they occurred. Minor acts of delinquency may occur but the executive personality cannot figure out how he got himself in a jam. After all, why would anyone think a sterling character like him, honest, loving to all, could ever do something like that? They must be mistaken. But he is also noble and self-sacrificing, so he takes his punishment like a man, never being sure why he is being punished. The appearances of the alter-personalities will occur when certain specific emotions are aroused, as these are their specific triggers. Brief outbursts of erratic behavior are ignored by the executive personality. Longer periods of planned activity by the alter-personalities are simply dismissed. After all, no one's memory is perfect. The alter-personality is very careful to keep its real existence in the world a secret from the executive personality, since its interests conflict markedly with the professed moral code of the executive one.

But eventually, when the multiple leaves home where all of the switching may be very adaptive and necessary and arrives in the world of adults and laws, a law may be broken. And what will the defense lawyer, judge or examining psychiatrist hear of.?

The defendant is probably in his late twenties, if this is his first arrest. He is bright, verbal, engaging, polite, eager to please and cooperate with the examiner. He is just as puzzled by how he got into this jam as is everyone else, and he assures everyone that he will cooperate in trying to answer all questions.

But except for his pathological family history, he does not have much to tell. He has no recollection of committing the criminal act and is not sure he has even been to the scene of the crime. He might have, but he has no direct recollection of being there at that time. He is not paranoid in thinking someone has unjustly accused him; he is just puzzled. But this is not the first time he has been so mystified. He found himself once jailed in another city. The jailors were calling him by a completely different name. They were also angry with him for having given them a hard time at the booking window. He couldn't understand that, since he has always admired and liked policemen, and he never had a fight with anyone in his life, at least not one that he remembers.

He is holding down a steady job now, but he has repeatedly changed employers in the past. He has a girlfriend today, but she is the third heavy romance he has had this year. He pays his bills on time, but he also finds money either present or missing from his pocket, something he cannot explain. Once he woke up in his apartment to find a new sports coat in his closet, one so flashy he would never have bought it. He has been very depressed, he says, and he has seriously considered killing himself a number of times, even though the problems were not objectively too bad. But he goes into these bad moods where he feels death is the only way out. Once while alone in his room, he even fashioned a noose, but he suddenly snapped out of the blue mood and ripped it up so he couldn't use it again. He may have been very heavily into psychedelics and sedative drug abuse, but he's not interested in narcotics. This interest may have been only sporadic so he never really became addicted to any drugs. Alcohol abuse may be mentioned and quickly invoked as the sole reason for the blackout spells, but, on careful questioning, he reports that he gets very depressed or angry first, then he has one drink, then he blacks out. Also he had blackouts in his school years before he ever started drinking. He never mentioned them to anyone because he thought everyone experienced blackouts during which they traveled to distant parts of the city, waking up to find themselves leaving a place that was strange to them, He may also be puzzled by school reports of fighting with teachers, since he would never do that. Also he may have gotten an award in a certain class he can't remember attending.

THE EXAMINATION Now this pleasant young man with history of probably having done horrible crimes does not look and act like a chronic schizophrenic, so the examiner may not go through the usual routine of asking about auditory and visual hallucinations. But if the examiner is compulsive in taking a mental status examination, this nice young man may report that he has heard voices talking to him inside his head, not from the outside. These voices may call him vulgar names, tell him he is no good, or maybe even cheer him up when all is black. He may have had a visual hallucination once, like the ghost of his grandmother sitting on his bed, or a vision of a building that wasn't there a few seconds later.

He hesitates to tell anyone these things, since he knows he isn't crazy and only crazy people see and hear things like that.

He knows he might be locked up in a mental hospital forever if he told anyone such things.

How much of this history the examiner gets will depend in great part on the examiner's approach to the defendant. If the examiner has already decided that the defendant is a mean and nasty fellow who should be put away forever, the defendant will pick up that feeling immediately and will give out nothing but what is needed to support such an opinion. But if the examiner comes in with an open mind to gather all the facts and history the defendant has to offer, and to enlist his curiosity in what this all means, the defendant will pour out the stories he has been holding in for many years and treat the examiner like the therapist he has been looking for all the time.

That will present new problems since, if one is a court-appointed examiner, one is not in a position to treat him, but the defendant may not be willing to accept that fact. He now knows that he needs someone to help him understand himself and he wants to enter into a client-therapist contract. Being in jail is not seen as a barrier to this course of action. After all, can't the examiner change roles as fast as the defendant does? If not, there must be something wrong with the examiner, and so the fantasy goes.

DISCUSSION Once the examiner is aware of this type of history and has added multiple personality to the list of diagnostic possibilities, what is to be done next? This is hard to say, since each case is different and one is operating in a legal arena where the rules of conduct are different than in the medical arena. Certainly a fuller workup needs to be recommended before anyone has a clear path to follow. But just where should this be done, and by whom? Should hypnosis or sodium amytal be used now, later, or ever to penetrate the amnesia and possibly expose the suspected alter-personality? This is a very serious question when one is dealing with a mass murderer and five appointed psychiatrists, some of whom have not yet seen the defendant. What psychological tests should be given, by whom, and to whom?

All this also depends upon the belief systems of the defense attorney, the prosecuting attorney and the judge. Is an insanity plea likely to be acceptable under any circumstances? Are we working with the ALI insanity rule or the McNaughten rule in this court? Is the court or the client willing and able to finance the extensive use of videotaping, audio taping and transcriptions from these tapes? What facilities does the state have for treatment, even if he is found to be mentally ill? Can he competently stand trial in the first place? These questions and others will have to be discussed in a subsequent paper.

CONCLUSIONS The condition known as multiple personality is a very real psychological phenomenon which can pose a serious problem to the forensic psychiatrist who suspects the condition exists in a defendant.

While females are more often found to suffer from this disorder in a clinical practice, in the offender population, males greatly predominate. The males are guilty of very violent crimes which are repeated and are not controllable by the usual methods of legal punishment. Therefore, the awareness that this condition exists and that it may be an important factor in the cause of a serious crime is the first step in enabling the forensic psychiatrist to make plans to appropriately deal with this complex situation.

Ralph Allison, M.D.

3240 Main Street Morro Bay, CA 93442 805-772-1272 1 Diagnostic and Statistical Manual of Mental Disorders (Third Edition) Washington, DC, American Psychiatric Association, 1980 2 Larmore K., Ludwig A., Cain R.: Multiple personality - an objective case study. British Journal of Psychiatry 131:35-40, 1977 3 Mitchell SW: Mary Reynolds: a case of double consciousness.

Transactions of the College of Physicians of Philadelphia, 3'rd series, 10, 1888 4 Prince M: The Dissociation of a Personality. London, Longmans Green, 1913 5 Thigpen CH, Cleckley HM: The Three Faces of Eve. New York, McGraw-Hill, 1957 6 Lancaster E: The Final Face of Eve. New York, McGraw-Hill, 19 5 8 7 Pittillo ES, Sizemore CC: I'm Eve. Garden City, NY, Doubleday, 1977 8 Schreiber F: Sybil. New York, Henry Regnery, 1973 9 Stevenson RL: Strange Case of Dr. Jekyll and Mr. Hyde. Norwalk, CT, Heritage, 1952 10 Ludwig AK, et al: The objective study of a multiple. personality.

Archives of General Psychiatry 26:298-3 10, 1972 11 Hawksworth H: The Five of Me. New York, Henry Regnery, 1977 12 Ashby A: Esther Minor: multiple personalities In court. Forum 6: 3-30, 1979 13 Groth AN, Burges AW: Male rape: Offenders and victims. American Journal of Psychiatry 13 7:7, 806-810, 1980 14 Allison R. Schwarz T: Minds in Many Pieces. New York, Rawson, Wade, 1980

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