Thigpen+and+Cleckley+-+Period+2

** Background ** 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 schizophrenia. Schizophrenia is a type of psychosis where contact with reality and insight are impaired. Other symptoms can include hallucinations and delusions.
 * Thigpen and Cleckley( A Case of multiple Personality)**

** Aim ** The **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'.

** Procedure/Method ** 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 tests.

**Findings/Results** 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 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 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 considerate’. 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: 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. 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 progress’. 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. 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.

**Explanation** 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.

** Evaluation of Procedure ** **Strengths** 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 client. Such 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 tests. ** Weaknesses ** 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 personalities.

** Evaluation of Explanation ** 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.