Liza is an adult survivor of severe childhood abuse. She considers herself to have multiple selves - twelve altogether - ranging from a scared six month-old self, to an anorexic lesbian self, to a dance-student self. Liza believes that she subconsciously created these selves to enable her to distance herself from her traumatic experiences; instead of her, Liza, experiencing the abuse, someone else experienced it instead. Although such a coping strategy may have enabled her to survive her childhood, it has led to difficulties as an adult. Liza's personalities are "Not a bad bunch really", but they are generally amnesiac for each others experiences and all tend to want different things. They like different men, have different friends, wear different clothes, drink different drinks. One wants to study psychology, the others don't; some want to enter therapy, others think they'll be better off left alone; one isn't very impressed that "someone else" chose to marry her husband.
In Hidden Selves six British therapists consider how they would treat a patient such as Liza. Peter Dale and Graz Kowszun doubt the usefulness of the diagnosis of Multiple Personality Disorder (M.P.D.). They would prefer to understand Liza's difficulties as stemming from a combination of more conventional problems - anxiety, epilepsy and alcohol abuse. The other therapists accept that Liza has multiple personalities, but differ in what they regard as an appropriate therapeutic goal. John and Marcia Davis would hope for the eventual integration of the personalities. They would help Liza to come to know her many selves and then attempt to fuse them into one using hypnotism. Jenifer Antony-Black and Phil Mollon doubt that integration is an appropriate end. They would instead aim at enabling Liza's personalities to share memories and to effectively work together in the pursuit of common goals.
The basic format of Hidden Selves - one patient tells her story, and then therapists from different orientations respond - is novel and potentially highly informative. Unfortunately this potential is not fully realised. The six therapists appear to have written their contributions in isolation. As a result the differences between them are less clearly brought out than they would have been in an explicit debate. It is not always clear why the therapists would adopt the approaches they suggest. Do Dale and Kowszun believe that the phenomena of multiple personality does not exist, or do they merely think that such talk tends to reinforce symptoms and be unhelpful to patients? Do Antony-Black and Mollon reject integration because they think it is akin to murdering some of the personalities and so morally wrong? Or is it just because clinical experience leads them to think that integration is unlikely to succeed?
More seriously, the contributors fail to appreciate how foreign talk of M.P.D. and its treatment will be to most of their British audience. Just last year I attended a meeting of Cambridge psychiatrists who universally agreed that M.P.D. was an exclusively American phenomena, most probably created by over-zealous therapists via suggestion. A joke illustrated the differences between (sensible) British psychiatrists and their (nutty) colleagues on the other side of the Atlantic:
Patient and British doctor:
Patient: I don't feel myself today. Patient and U.S. doctor
British Doctor: What seems to be the problem?
Patient: I don't feel myself today
U.S. Doctor: That's interesting. Who are you at the moment?
Yet, despite M.P.D. previously being almost unknown in Britain, in Hidden Selves therapists talk casually of having treated "many patients" and then don't give any details. Obvious questions are left unanswered: How many? When did they start appearing? How were they treated? How did they respond?
The hoped for results of treatment are also left rather vague. As a reader I wanted far more detail: If hypnotism is employed to integrate personalities what exactly is the result? Is the final personality that of the original host, or an amalgamation of the various personalities? If Liza retains all her personalities, but they come to share goals and memories, then what is it that continues to distinguish them from each other? How do patients who have undergone these treatments feel about it afterwards?
All in all Hidden Selves is an interesting project that is insufficiently developed. Multiple personality is not so much explored as briefly skimmed over.
Rachel Cooper is a lecturer in the Department of Philosophy at the University of Bristol, England. She has research interests in the philosophy of science, especially psychiatry, and in 20th century history of psychiatry.
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