Made to Disorder

Your therapist is probably giving you multiple personality disorder.

Oh sure, he’s going to deny it. He will say you obviously had some problems to begin with, and that he just uncovered the form they’re taking and their source. And there you will be, disassociated into several different personalities. People you don’t know will greet you with names you don’t recognize. You’ll find notes around your apartment written in unfamiliar handwriting. You’ll walk into hotel rooms without pants (every person who has ever had multiple personality disorder has always had one who was a slut).

And maybe by the end of it you will remember seeing your father drink the blood of a newborn baby. So strange that you had forgotten something like that for the last twenty years, you think it would be a pretty memorable event. Or being raped by your brother. Never mind the fact that you never had a brother, you are sure it happened. And your therapist will say, Aha! That is why you are such a mess, can’t keep a boyfriend or a job for more than six weeks, that is why you dread going home for Christmas. It’s because you remember your parents donning black robes and smearing the blood of a virgin all over your face before they let their friends have their way with you on a Satanic altar. That must be it.

Oh, and that will be $250, sweetie. You can leave the check with the receptionist.

Back in the 1980s, multiple personality disorder was a thing. The thing. You don’t hear so much about it today; it’s like we all woke up one day and thought, right, probably not possible after all, let’s move on. But when MPD was hot, it wasn’t just something to be burdened with, a problem to be overcome: It was something to be proud of. Look at how complex you are, you contain multitudes, literally! Gloria Steinem called MPD “a gift.” As Debbie Nathan tells it in Sybil Exposed: The Extraordinary Story Behind the Famous Multiple Personality Case, after the disorder became an official diagnosis in the The Diagnostic and Statistical Manual of Mental Disorders, hundreds of thousands of MPD diagnoses were made. Psychiatrists were calling it an epidemic; they claimed that potentially millions of Americans (mostly women) had this affliction/gift.

At the base of this disorder was abuse. Abuse so intense and dramatic that it was wiped from victims’ memory but still shattered their psyches. From the mid-1980s to the early ‘90s, on Oprah, on Sally Jessy Raphael, on Maury, on Geraldo, doctors and victims and Satanic specialists told us that our country was in the grips of a devilish epidemic. Underground cults were ritualistically abusing the nation’s children; black magic gatherings were slaughtering untold numbers of newborn babies (the ever-renewable source of newborn babies was never revealed). This had been discovered not through forensic evidence, but through memories recovered, a great many of them from multiple personality disorder patients.

But there was also something else at the base of this disorder. It was the strange and mysterious dynamic between analyst and analyzed, between healer and patient.

If you remove any details that reveal time or place, stories of fragile, impressionable young girls who go into psychiatric treatment for mysterious ailments begin to sound oddly similar. As so often happens when you’re chasing a historic mystery, one story tugs on another, and women through time find themselves in the same situation over and over again — the dress and setting is different, but they are all essentially playing the same role. The symptoms and the diagnoses of the frightened patients may change from idiopathic paralysis to blackouts, and the treatment from ovarian compressions to psychotropic medication, but a pattern emerges nonetheless.

So Blanche in Asti Hustvedt’s Medical Muses: Hysteria in Nineteenth-Century Paris became Alice James in late 19th-century Boston in Jean Strouse’s biography. They both became Sybil in 1970s New York City, and also Erika and Julie Ingram in 1988 Olympia, Washington in Lawrence Wright’s Remembering Satan: A Tragic Case of Recovered Memory. Hustvedt notes the strange contagious properties of these disorders, and how quickly a mental illness — something that is supposed to be innate, a “chemical imbalance” with biological roots — can become a cultural fad. “As was true for hysteria, these contemporary disorders [anorexia, bulimia, self-mutilation, chronic fatigue syndrome, and multiple personality disorder] are thought to be contagious, spread by suggestion, imitation, and therapy.” And like hysteria, which was all the rage in the 19th century, multiple personality disorder and recovered memories swept through the lives of a great number of girls and women before disappearing almost completely. After all, no one comes down with a case of hysteria anymore.

We learn how to be mad, the same way we learn how to be male or female, or how we learn how to participate in society. We look to others we respect and imitate their behaviors. We follow the instructions of teachers and parents, and we are subtly punished or rewarded for various quirks until we learn to mold ourselves in a certain way to avoid responses we don’t like and attain the responses we do. We’re not all superstitious pigeons trapped in Skinner’s boxes, flapping our wings and hoping for food pellets over electrical shocks, but the behaviorists did manage to get a few things right.

And so here we have a collection of strange girls who had been through some shit. Blanche (real name Marie Wittmann, Blanche being the name of the case study that made her famous) came from a poor, abusive home in Paris. She went to work at the age of 12 and ended up in the home of a man who regularly raped her. By the time she entered the Salpêtrière Hospital at 18, she was plagued by a host of mysterious symptoms.

Alice James was the only girl in a family ruled by a patriarchal father. He uprooted the lot of them time and time again, moving between Newport and Switzerland and Paris and London and Boston. Her only possible escape was marriage, but she had the misfortune to come of age in the post-Civil War era, when single women outnumbered single men by a very wide margin.

Sybil, whose real name was Shirley Mason, was raised in a restrictive religious household. She was punished harshly as a child for reading and writing fiction, and for drawing unrealistic landscapes.

Erika Ingram was raised by a cold father in a large, financially unstable and fundamentalist family. She may have encountered real abuse by either her brothers or her father, but her stories of rape and molestation became so fantastical that it’s kind of hard to tell.

Each woman had serious problems and a background of deprivation and tumult. Each had a certain physical, mental, and emotional fragility. And each woman found herself in an environment where she could practice her illness. Hustvedt writes that the hysterics of Salpêtrière learned how to act from each other. When they were placed in a ward with epileptics, convulsive fits became a central part of the hysterical attack. And when one woman had an attack, the effect would role down the ward until all the women were frothing and writhing.

Blanche’s symptoms also began to match the predictions of her doctor, Jean-Martin Charcot. He was working on a theory about the stages of hysteria and was delighted to find that his most public patient (these were the days, after all, when tourists could come to the hospital and watch demonstrations of hysterical behavior) acted out these stages with perfect timing. Hustvedt writes, “Marie entered with a myriad of vague and difficult-to-diagnose afflictions, and emerged as Blanche, an exemplary hysteric whose symptoms perfectly fit Charcot’s schema.” Having had very little experience with the good kind of masculine attention — what with a father who tried to throw her out the window and a boss who beat her if she didn’t sexually submit to him — it’s no wonder this woman would unconsciously fulfill Charcot’s desires. In return for her fits, her hypnotized performances, and her unexplained paralysis, she received a safe place to live, the loving attention of doctors, and the company of women.

Sybil closely followed Blanche’s example. Where Dr. Charcot wanted hysteria, Sybil’s doctor Connie Wilbur wanted multiple personality disorder. Sybil came to Dr. Wilbur already a bit of a wreck with gaping, grasping emotional needs. When Sybil presented dissociation problems, hinting that sometimes she felt not in control of her body and couldn’t account for periods of time, she found Dr. Wilbur willing to be at her beck-and-call, willing to take her phone calls at all hours of the night, to help her get a job, to assist her financially and give her treatment without payment. She rewarded Dr. Wilbur by splintering even further, shooting off one personality after another, exaggerating recovered memories of abuse by her mother. She was willing to sacrifice her own flawed, deceased mother in exchange for a mother-daughter relationship with her therapist.

At one point, before the publication of Sybil — the book that would make them all famous and spread multiple personality disorder like the flu — Sybil backed down, admitting to Dr. Wilbur that it had all been an act. “I am not going to tell you that there isn’t anything wrong,” she wrote in a letter. “But it is not what I have led you to believe… I do not have any multiple personalities… I do not even have a ‘double’… I am all of them. I have essentially been lying.” But Dr. Wilbur was also getting something out of this arrangement: fame and professional respect; she refused to believe the letter was honest. Sybil so miraculously fit into Wilbur’s preconceived ideas of how MPD would manifest itself. The doctor brushed the letter off as the act of other personalities’ attempts to integrate themselves into Sybil’s consciousness.

Both Blanche and Sybil might have done better had they gone back to being Marie and Shirley. They may have recovered more thoroughly outside the care of their doctors. Many of Blanche’s contemporaries on the hysteric ward fared better outside the hospital walls. Whenever Sybil managed to put some distance between herself and Dr. Wilbur, she almost became a normal girl again. Nathan wrote, “Almost four years had passed since [she] first walked into Connie’s office as an upbeat graduate student with nagging but bearable emotional problems. Now, after hundreds of hours of therapy and countless pills, shots, and machine-induced convulsions, she was a 35-year-old junkie who spent most of her time in bed.” Both Blanche and Sybil chose the confines of their sickbeds over the burden of free will in real life. They both had emotional compensations for their physical torments. Their doctors, being thoroughly rewarded for keeping their patients sick, were happy to accommodate.

That choice to remain sick is perhaps best illustrated by the life of Alice James. She followed the French hysterics, when female vulnerability was the hot new thing in daily life. Jean Strouse, Alice James’s biographer, writes, “With its range of meanings, from refined, sensitive, subtle, and gentle to sickly and frail, the word delicate described the mid-Victorian ideal of beauty: a graceful languor, pallor, and vulnerability — even to the point of illness — were seen as enhancing the female form… Illness, then, made a woman ethereal and interesting.” Like the MPD that would follow, hysteria and neurasthenia (as it was known in the United States), became a gift to the afflicted. It gave them an allure. The demonstrations at Salpêtrière had a huge influence on female society and cases of hysteria spread. In Europe and the United States, women took to their bed with a variety of mysterious ailments, with “fits” and “attacks” breaking up the monotony.

Alice learned quickly that the easiest way to get her family’s attention was with illness. Her brothers William, the philosopher, and Henry James, the novelist, also learned this and cultivated their own mysterious illnesses, but only Alice turned it into her career. Illness was rewarded with long continental cures paid for by her parents, devoted loving attention, and respite from the father’s tyrannical rule. She had no devoted doctor to help give form to her diffuse illnesses, but she managed to shape them through the family’s positive reinforcement. Soon Alice’s timing was rivaling Blanche’s. When her devoted brother William got married, she had a fit. When a woman she did not like joined a vacation, she had a fit. When her closest companion left to tend to an ill sister, she had a fit. Strouse writes, “Nothing could have regained the center of the stage for Alice more effectively than a nervous attack,” and Alice wielded her attacks like weapons.

The interplay between performance and illness is a strange one. All the women suffered, and all the women had real illness. Alice died young of a very real breast cancer. When we come to the case of the Ingram sisters Ericka and Julie, you do want to believe they survived something atrocious, that a teenage girl wouldn’t accuse her father of rape unless something happened, even if the memories recovered by a psychic healer were not the right ones. Sybil’s very famous case, coupled with television sensationalism over supposed Satanic cults, led to thousands of women calling shelters and counselors, saying that they think maybe someone did something inappropriate. A counselor for abused women interviewed in Remembering Satan tells Wright that these recovered memories were difficult even for her to believe. And yet, she tells him, “Here’s my dilemma. We are already struggling against a tidal wave of disbelief. It’s a tidal wave! Nobody wants to believe how bad it really is for women and children.” The performance of illness and its contagious qualities can make you question whether the illness is there at all.

The Sybil case, just like the hysteria case, hit a nerve as a metaphor for women’s lives. Multiple personality disorder had been diagnosed before, most famously in Dr. Morton Prince’s study of Miss Beauchamp in the early 20th century and in some of the French hysterics. But something about Sybil’s case and its timing set off a society of women who felt divided against their own selves. Nathan writes, “The millions and millions of Sybil fans who came to think of themselves as capable of anything also felt so damaged by the cruelties of traditional family life that they could not trust their own mothers, much less their memories… Women and their social struggles were reduced to a bizarre illness. The cure was not critical inquiry or protest marches or efforts at the polls. Instead the cure was drugs and hypnosis.” All of those women got something out of their new diagnoses, too: a sense of community, a sense of inner complexity, and the “gift” of MPD. And all of those doctors got to be on the cutting edge of mental illness research, excavating depths Freud could never have imagined.

The aftermath of these faddish illnesses is a strange one. Are we to believe that these women were faking? Did hysteria ever really exist? And now that the genesis of so many multiple personality disorders has been revealed as a fake, what of all those women whose dissociative disorders were their daily reality? Hustvedt argues that simply because madness is malleable does not mean that it does not exist, or that it is not a real problem: “The symptoms suffered by Blanche and other hysterics are no longer an acceptable way to express illness. Paralysis, for example, was a widespread symptom in the 19th century… Paralysis today is, for the most part, reserved for those who have suffered an accident or a disease of the spinal cord. We have our own ‘symptom pool’ to draw from: fatigue, headaches, irritable bowel, depression, anxiety… Blanche really ‘had’ hysteria. She lived during a period that allowed her to express her suffering in a particular way, through a particular set of symptoms, symptoms that are no longer an admissible way to express illness.”

So maybe your therapist isn’t giving you multiple personality disorder after all. What could he possibly be getting out of it? • 28 October 2011