of this case study was to provide an account of the treatment of a
25-year-old woman who was referred to Thigpen and Cleckley because of
'severe and blinding headaches'.
The psychiatrists used
a case study method. This consisted of interviews with the patient and her
family, hypnosis, observation, EEG tests and a number of psychometric and
projective tests including, memory tests, ink blot tests and intelligence
The patient (referred
to as Eve White in the study) had been referred for therapy to one of the
authors because of ‘severe and blinding headaches’. At the first interview
she also complained of ‘‘blackouts’’ following her headaches
However they were
puzzled that Eve White had no memory of a recent trip. The therapists used
hypnosis and the amnesia was cleared.
Several days after a
visit to the therapists, a letter from Eve White appeared at the therapists’
office. The letter concerned her therapy and was written in her usual
handwriting, but at the bottom of the page there was a paragraph that looked
like a child had written it.
On her next visit Eve
White denied sending the letter, though she recalled having begun one, which
she never finished and thought she had destroyed. During the interview, Eve
White who was normally very self-controlled became distressed and asked
whether hearing an occasional imaginary voice made her insane.
She reported that she
had on several occasions over the last few months briefly heard a voice
addressing her. During this conversation Eve White, as if in pain suddenly
put both hands to her head. After a tense moment of silence her hands
dropped, and the therapist observed a ‘quick, reckless smile’ and in a
bright voice she said: ‘Hi there, Doc’!
To the therapist it
seemed that the usually conventional and retiring Eve White had changed into
a carefree person. She also seemed to have a very different physical
presence in terms of manner, gestures, and eye movements. When asked her
name she immediately replied that she was Eve Black.
The therapist noted
that this new person ‘had a childish daredevil air, an erotically
mischievous glance, a face marvellously free from the habitual signs of
care, seriousness and underlying distress’. The voice and language structure
were also very different, and to the therapist it appeared to be an entirely
Over the next 14
months, during a series of interviews totalling approximately 100 hours,
extensive material was obtained about the behaviour and experience of Eve
White and Eve Black.
The therapists believed
that Eve Black had enjoyed an independent life since Eve’s early childhood
and when she was ‘out’ Eve White was not aware of what was happening. In
contrast, when Eve Black was not out she was aware of what was happening.
According to the
therapists, Eve Black’s behaviour was ‘characterised by irresponsibility and
a shallowly hedonistic desire for excitement and pleasure’. She succeeded
in concealing her identity not only from Eve White, but also from her
parents and husband. Eve Black denied marriage to the man, who she despised,
and denied any relationship to Eve White’s daughter except that of an
unconcerned bystander. To her husband, daughter and parents her unpleasant
behaviour, harshness and occasional acts of violence were explained in terms
of ‘unaccountable fits of temper in a woman who was habitually gentle and
Both personalities were
given a series of psychometric (i.e. IQ and memory tests) and projective
tests (i.e. Rorschach and drawings of human figures) by an independent
expert with the following results:
IQ test results: Eve White obtained an
IQ of 110 and Eve Black 104.
Memory Test results: Eve White had a
superior memory function than Eve Black
Rorschach test (ink blot test) and
drawings of human figures results: The profile of Eve Black was far
healthier than Eve White. Eve Black though was regressive whilst Eve
White was repressive showing obsessive-compulsive traits, rigidity and
an inability to deal with her hostility.
As Eve White became
aware of Eve Black’s existence through the therapy, she became able to
prevent her ‘getting out’ on occasions, and so negotiation was necessary for
Eve Black to get more time ‘out’. After eight months of treatment Eve
White seemed to be making progress. Her ‘blackouts’ had ceased and she was
working well at her job (as a telephone operator) and ‘was reaching some
acceptable solution to her marital problems’.
However as the
treatment progressed, Eve White’s headaches returned and so did the
‘blackouts’. Eve Black denied all responsibility and said that she also
experienced lack of awareness during these ‘blackouts’. Eve White’s general
state of mind was deteriorating and confinement was considered. It became
easier for the therapist to call up whichever personality he wanted to
examine, and childhood experiences were investigated under hypnosis. During
one such episode, Eve White appeared to relax into a sleepy state. ‘After
two minutes, her eyes opened, blankly staring about the room trying to
orient herself. When her eyes finally met those of the therapist, slowly,
with an unknown husky voice and immeasurable poise, she said, ‘Who are you?’
The therapists believed
that another personality had emerged who called herself Jane. The other
personality, they argued, was more responsible than Eve Black and more
confident and interesting than Eve White.
After Jane appeared the
three personalities were given
electroencephalogram tests (EEG). It was possible to make a clear
distinction between the readings of Eve Black and the other two
personalities. Although it was not possible make a clear distinction
between Eve White and Jane’s EEG.
Having been able to
work with the three personalities for several months the therapists
concluded that if Jane could take possession of the personalities the
patient would regain full health and find her way to a happy life. Jane had
awareness of both Eves’ thoughts and behaviour but did not have complete
access to their memories prior to her appearance. Jane had learnt to take
over many of Eve White’s tasks at home and work to help Eve White and showed
compassion to Eve White’s daughter. However, although the therapists could
work with Jane to determine whether Eve Black had been lying, Jane had not
found a way to displace Eve Black, or to communicate through her.