Multiple Personality Disorder (MPD) is
defined in DSM-III as a dissociative disorder in which two or more
distinct personalities coexist within one and the same individual.
It is an example of a neurotic disorder.
Multiple Personality is not a form of
is a type of psychosis where contact with reality and insight are
impaired. Other symptoms can include hallucinations and delusions.
aim of this article was to provide an account of the
psychotherapeutic 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, although her family were not aware of anything that would
suggest a real loss of consciousness or serious mental confusion.
During interviews several emotional
difficulties were revealed. The
psychiatrists believed that she had a number of complex, but
relatively commonplace marital conflicts and personal frustrations.
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
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
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
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 different woman.
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 found that although Eve
Black could sometimes ‘pop out’ unexpectedly, she could only be
‘called out’ by the therapists when Eve White was under
hypnosis. Similarly, after a few hypnotic sessions the
therapists could request Eve Black to let them speak to Eve White.
After more sessions they found that
hypnosis was no longer needed for obtaining the changes.
However, the therapists stated that this did complicate Eve
White’s life considerably as Eve Black found herself more able to
‘take over’ than before.
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.
Eve Black told the therapists about a
number of incidents in childhood where she engaged in acts of
mischief or disobedience, which Eve White was unaware of and was
punished for. Some of
these incidents were later backed up in interviews with her parents
and her husband.
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
During Eve Black’s longer periods
‘out’ she avoided her family and close friends, and sought the
company of strangers and she was also able to remain unrecognised
when it suited her by imitating Eve White.
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:
test results: Eve
White obtained an IQ of 110 and Eve Black 104.
Test results: Eve White had a superior memory function than Eve
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.
During the therapy sessions it became
clear that Eve Black had little compassion for Eve White, and could
not be persuaded to help with the therapy.
For example, the therapists noted that Eve Black had ‘often
misled the therapist into believing she was cooperating, when in
fact her behaviour was particularly detrimental to Eve White’s
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
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.
It was decided the Jane was the person
most likely to bring a solution to the troubled mind, and that her growing dominance
over the other personalities to be an appropriate resolution. A
postscript to this remarkable story came in the revelation in 1975
by Eve that she had experienced many other personalities before the
original therapy and after it. She recalled a total of 22 and
suggested that the fragmentation of her personality had been to
protect herself from things she could not bear.
Thigpen and Cleckley were convinced
that they had witnessed an example of multiple personality.
Although Thigpen and Cleckley do not
point to the cause of MPD, the received wisdom is that MPD is
usually a response to child abuse - a way for the individual to
protect him or herself.
Case studies are particularly useful in
revealing the origins of abnormal behaviour.
Through building up a long and detailed case history, case
studies can be used as an aid to understanding and helping the
research can also be called action research as the researchers
involvement is consciously trying to change the persons behaviour.
A major strength of this case study was
that it provides lots of data.
It contained an in-depth picture producing rich qualitative
data (e.g. the interviews and hypnosis) and also lots of
quantitative data such as the results from the psychometric tests.
Thigpen and Cleckley also involved Eve's relatives to help
verify certain recollections, and to add information, and in this
way throw light on the case.
They also asked independent experts to give a variety of
tests including an EEG test, psychometric tests and projective
Case studies only relate to one
individual and we have to be careful generalising from the findings.
We have no way of assessing how typical this individual is of
other people with multiple personality and therefore we have to ask
whether this study is unique to Eve or whether we can generalise it
to other cases.
If the study is retrospective (if the
individual is asked to look back over his/her life) then memory may
not be accurate and indeed, people may deliberately mislead the
researcher. The data may therefore be unreliable.
The close relationship between
researcher and participant may introduce bias.
For example, in this case study, the moment that Eve Black
appears can be seen in a different way to that described by the
therapist. For example
as Eve crossed her legs ‘the therapist noted from the corner of
his awareness something distinctly attractive about them, and also
this was the first time he had received such an impression’.
For the therapist this as a change in her personality, but
more objectively it could be explained as a change in his
perceptions of her.
There are many ethical issues to
consider in this study. Firstly
it could be considered whether Eve White was treated more of a
subject than a patient. The
therapists also recognised the dilemma of deciding what their
involvement should be in helping their patient when they noted that
‘we have not judged ourselves as wise enough to make active
decisions’ about how the drama should develop’, when they note
the moral problems with ‘killing’ one or more of the
It is possible that the therapists
could have been conned by a successful actress. Thigpen and Cleckley
did recognise this but asserted that the performance could not have
continued for so long and so consistently.
However, the diagnosis of MPD is
very unreliable. For
example, there are many more cases reported in the US than say the
UK. This perhaps demonstrates that some psychiatrists are more
likely to diagnose MPD than others.
Interestingly, women are more likely to be diagnosed than
men. An argument
that is gaining popularity is that psychiatrists such as Thigpen and
Cleckley are actually creating multiple personality by unwittingly
leading their patients into believing that they have the condition.
The case study of Eve was made into a movie,
‘The Three Faces of Eve’. The public did not hear anything else
about the case until 1975 when Eve revealed that she had
approximately 22 personalities some of which she experienced before
and some after the therapy.
She believed that fragmentation of her personality had been
to protect herself from things she could not bear.
In 1977 Chris Sizemore (Eve’s real name)
with her cousin, wrote ‘I’m Eve’ and revealed herself as the
famous Eve in TV interviews.
Thigpen, C.H. & Cleckley, H. (1954) A case of multiple personality.
Journal of Abnormal and Social Psychology, 49, 135-51