Definition of “Memory Gap”: When a person cannot understand why they do not remember a period of time, certain behavior, or an event

People have a lot of experience with normal forgetting. After all, time passes. Many things are routine, trivial, or uninteresting. Also, a person sees what others forget. So most people know very well what is normal forgetting.

(Of course, I'm not talking here about a general problem with memory, such as is seen in Alzheimer's. People with the kind of memory gaps discussed in this post have generally good memory, often exceptionally good memory, which makes these memory gaps so puzzling.)

When I ask someone if they have memory gaps, I rarely have to explain what I mean. A person who has had memory gaps will usually give me an example. For example, one woman told me that her boyfriend had recently asked her if she was enjoying the coat he had given her. She told him yes, so as not to hurt his feelings or appear stupid, but she really didn’t know what he was talking about. However, when she got home, she found the new coat in her closet. But she still did not remember getting it. (And we determined that she had not been intoxicated, and that the coat had not been put in the closet without her knowing it as a surprise or practical joke. Also, let me add, Feb. 1st, she said that she had been having memory gaps since childhood, so this was no big deal.)

Talking about the coat made her uncomfortable. I could see that she wanted to change the subject. But I kept discussing it. And after about five minutes, her demeanor suddenly changed, and I was talking to another identity, who explained how she had gone shopping with the boyfriend and made him aware of how much she loved that coat, and how she was happy when he gave it to her. I then stopped discussing the coat, and her demeanor suddenly changed back to her regular self, who had no memory—a memory gap—for what had just happened.

Neither the regular identity nor the alternate identity accepted the idea that she had multiple personality. The regular identity did not call me a liar when I told her about my conversation with other identity, but she did not remember it, and thought the idea of multiple personality was far-fetched. When, at a later time, I talked again with the alternate identity, she remembered both my conversation with her and my conversation with the regular “host” identity. But the alternate identity rejected the idea of multiple personality, because she felt that she was a person in her own right.

Do novelists occasionally have memory gaps during times when they write, or in the rest of their life?

Failure to diagnose dissociative identity disorder is inevitable with the interview taught in American psychiatry residency training programs

Psychiatric diagnosis depends on an interview called the Mental Status Examination (MSE). Psychiatrists are not able to diagnose a disorder if the MSE fails to elicit its symptoms, its Diagnostic Criteria.

The Diagnostic Criteria for dissociative identity disorder (multiple personality disorder), found in DSM-5 (the diagnostic manual), may be abbreviated as follows:

Criterion A: alternate identities

Criterion B: memory gaps

Interviewing the “Host” Identity

Since the psychiatrist will be interviewing the patient’s “regular” or “host” identity—who is unaware of any other identities—neither the psychiatrist nor the patient (the host identity) will suspect dissociative identity disorder.

Alternate Identities Hide and Remain Incognito

Alternate identities will usually hide during psychiatric interviews. But even if an alternate identity does come out during the interview, it will not give its name or identify itself. It will answer to the patient’s regular name in order to fool the psychiatrist.

Why? Because they didn’t make this appointment. They are not the patient. And they see the psychiatrist as being an ally of the host identity in the doctor-patient relationship. Moreover, they fear that if the psychiatrist knew about them, he would try to get rid of them, out of loyalty to the host identity, his patient.

Memory Gaps as Footprints

Therefore, since the psychiatrist will not see—or at least not knowingly see—alternate identities, the key to making this diagnosis is to screen for it by getting a history of memory gaps. The host identity is usually aware of having had memory gaps, and will give that history if asked, but only if asked, because the gaps are nothing new, and the host has always tried to ignore them.

If there is a history of memory gaps—and if they have no medical or neurological cause—then the gaps may be periods of time during which alternate identities have been “out.” So getting a history of memory gaps is like finding the footprints of alters, but not the alters themselves.

The MSE and Memory Gaps

Does the traditional MSE interview ask patients if they have a history of memory gaps? Unfortunately, it does not. It evaluates short-term memory and long-term memory. It does not ask about memory gaps.

If alcoholism is at issue, the traditional MSE may inquire about alcoholic blackouts. But it fails to inquire about nonalcoholic “dry” blackouts.

The Formal Diagnosis 

The diagnosis of dissociative identity disorder is not made unless and until the clinician knowingly meets, and has conversations with, the alternate identities (Criterion A), and then finds that the host identity has amnesia (memory gaps) (Criterion B) for those conversations.

However, as explained above, the diagnostic process usually starts with Criterion B (memory gaps), and eventually leads to Criterion A (alternate identities).

“But I never see that.”

When told that a colleague has made the diagnosis of dissociative identity disorder, most American psychiatrists wonder why, if it’s real, they never see it. The reason is that the traditional MSE fails to ask patients if they have a history of memory gaps.

Except for the rare cases in which alternate identities are overt in the initial interview, it is only after getting a history of memory gaps, and then finding out what caused the memory gaps, that a psychiatrist will make this diagnosis.

Most American psychiatrists think that they never see such cases, because they do not routinely ask their patients if they have a history of memory gaps.

Books That Illustrate the Problem

Note: These books were chosen, because they are excellent in other regards.

1. Mark Zimmerman, M.D. Interview Guide for Evaluating DSM-5 Psychiatric Disorders and the Mental Status Examination. East Greenwich, RI, Psych Products Press, 2013.

Patients are never asked if they have a history of memory gaps, and the book never even mentions dissociative identity disorder.

2. Paula T. Trzepacz, M.D., Robert W. Baker, M.D. The Psychiatric Mental Status Examination. New York, Oxford University Press, 1993.

Patients are never asked if they have a history of memory gaps, and the book never even mentions multiple personality disorder (the name of the disorder at the time this book was published).

3. David J. Robinson, M.D. Brain Calipers 2nd Ed.: Descriptive Psychopathology and the Psychiatric Mental Status Examination. Rapid Psychler Press, 2001.

Patients are never asked if they have a history of memory gaps, and the book never even mentions dissociative identity disorder.

4. Abraham M. Nussbaum, M.D. The Pocket Guide to the DSM-5 Diagnostic Exam. Washington, D.C., American Psychiatric Publishing (A Division of American Psychiatric Association), 2013.

At first, this guide looks enlightened. Its general psychiatric interview includes the following screening question under the heading of Dissociation: “Everyone has trouble remembering things sometimes, but do you ever lose time, forget important details about yourself, or find evidence that you took part in events you cannot recall?” And in its brief chapter on Dissociative Disorders, this guide includes dissociative identity disorder.

However, in contradiction to the above, its outline of the Mental Status Examination includes “recent and remote” memory, but omits memory gaps. And in its chapter, “A Brief Version of DSM-5”—covering, the author implies, the really important disorders—it omits dissociative identity disorder (even though the author, having read DSM-5, should have known that dissociative identity disorder has a greater prevalence than schizophrenia).

Therefore, the mixed-message of this guide is that the conscientious psychiatrist should screen for multiple personality by asking a question about memory gaps, but if the psychiatrist doesn't have time to do everything, and must focus only on what, in the author’s opinion, is really important, then screening for dissociative identity disorder can be omitted.

In short, even when American psychiatrists are taught how to screen for dissociative identity disorder, they are told not to bother.

In conclusion, to make the MSE capable of screening for dissociative identity disorder, its evaluation of memory must include memory gaps. This would require the addition of one word to the outline of the MSE taught to psychiatrists:

Traditional MSE

Memory: short-term, long-term

Revised MSE

Memory: short-term, long-term, gaps

Salman Rushdie’s Interviews: On Autonomous Characters, Theme of the Double, Multiple Personality, and Divided Self in Midnight's Children and Satanic Verses

“Padma is one of my favorite characters in [Midnight’s Children], because she was completely unplanned. In the first version, she appeared as a very minor character in the last fifteen or so pages; then, when the narrator began to ‘tell’ the book, she arrived and sat there, she simply demanded to be told the story and kept interrupting it, telling Saleem to get on with it. She became very important because she literally demanded to be important” (1, p. 14).

“What I meant was that Saleem's whole persona is a childlike one, because children believe themselves to be the centre of the universe, and they stop as they grow up; but he never stops, he believes—at the point where he begins the novel—that he is the prime mover of these great events. It seemed to me that it was quite possible to read the entire book as his distortion of history, written to prove that he was at the middle of it. But the moment at which reality starts to face him it destroys him; he can’t cope with it, and he retreats into a kind of catatonic state or he becomes acquiescent and complacent” (1, p. 41).

“I do find it difficult to start writing until I can hear the people speak” (1, p. 98).

“Many of the characters in [The Satanic Verses] are for a long time not really unitary selves, they’re just collections of selves…And I think that’s also true about people, that we are not unitary selves, we are a kind of bag of selves, which we draw out from; we become this or that self in different circumstances” (1, p. 103).

“I think, like most writers, that I am most completely myself when I write, and not the rest of the time. I have a social self, and my full self can’t be released except in writing” (1, p. 46).

“Then I suppose what I finally understood, which actually let me start writing, was that [The Satanic Verses] is about, unsurprisingly I suppose for me, about divided selves…And I discovered, only now, really, only in the last few weeks when I’ve been obliged to start talking about the book, that I keep doing this, it seems. That it seems to me I’ve done it, if you look at every novel…Doubles, yes…obviously Saleem in Midnight’s Children…And here I am doing it again. I feel ashamed of this…Maybe becoming conscious of it is a way of stopping” (1, p. 90-91).

1. Michael Reder (Editor). Conversations with Salman Rushdie. Jackson, University Press of Mississippi, 2000.

Elena Ferrante (post #2): The First-Person Narrator of Her First Novel Has Multiple Personality

At the beginning of the novel, Delia’s mother, Amalia, has recently committed suicide by drowning. The end of the novel is as follows:

“I dug in my purse and took out my identification card…With a pen…I drew around my own features my mother’s hair…I was Amalia” (1, p. 139).

Delia’s switch to an Amalia alternate personality is not an acute grief reaction. The whole novel is about how this has been going on since Delia was a child.

“But I still had the impression of not being alone. I was being spied upon, not by that Amalia of months before who now was dead but by me coming out on the landing to see myself sitting there” (1, p. 24).

Delia is prone to dissociative trance states (not unusual in people with multiple personality): “I fell into a torpor crowded with images…in my waking sleep…I had dreamed it that way countless times with my eyes open, as I did now yet again…” (1, pp. 30-31).

“By then I knew that in that image of fantasy there was a secret that could not be revealed, not because one part of me didn’t know how to get to it but because, if I did, the other part would have refused to name it and would have driven me out” 1, p. 35).

“When I came to myself, I felt drained, depressed by the sensation of being humiliated in front of the part of myself that watched over every possible yielding to the other” (1, p. 37).

“I decided to put on makeup. It was an unusual reaction. I didn’t wear makeup often or willingly…But just then I seemed to need it…’You’re a ghost,’ I said to the woman in the mirror. She had the face of a person in her forties… ‘I don’t like you,’ I whispered as I put on some blusher. And in order not to be contradicted, I tried not to look at her” (1, p. 42).

As I have previously discussed in this blog in reference to Gabriel Garcia Marquez and others, people with multiple personality sometimes have a problem with mirrors, because they may see another identity in the mirror, and they may not like it.

In childhood, one of Delia’s alternate identities had evidently told her father stories about her mother Amalia’s infidelity. It is not clear what had actually happened. It may have been that, in childhood, Delia’s Amalia identity had been molested. “‘You told your father everything.’ Everything. Me. I didn’t like that suggestion and didn’t want to know what ‘you’ he was talking about’” (1, p. 50).

A typical statement by a person with multiple personality, each of whose identities has its own, separate, memory bank: “I remembered but I couldn’t tell myself” (1, p. 118). That is, one of her identities had memory of something that it wouldn’t share with another of her identities.

Delia says of her childhood, “I was pretending not to be me. I didn’t want to be ‘I,' unless it was the I of Amalia. I did what I imagined Amalia did in secret…I was I and I was her…I felt I was her, with her thoughts…” (1, pp. 130-131).

In childhood, she had told her father that someone “had done and said to Amalia, with her consent, in the basement of the pastry shop, all the things that in reality Antonio’s grandfather had said and perhaps done to me” (1, p. 133).

In short, the novel describes a woman who has had multiple personality since childhood.

Note: I have not read Elda Buonanno’s La Frantumaglia: Elena Ferrante's "Fragmented Self,” which is based on Elena Ferrante’s own nonfiction book, and on how this theme appears in Ferrante’s novels. I don’t know if multiple personality, per se, is discussed.

1. Elena Ferrante. Troubling Love [1992]. Translated from the Italian by Ann Goldstein. New York, Europa Editions, 2006.

Nobel Prize novelist Thomas Mann’s Confessions of Felix Krull, Confidence Man, a novel about multiple identities, possibly multiple personality

Thomas Mann (1875-1955) had worked intermittently on this story for nearly fifty years, and it was still unfinished at the time of his death. Why so long and inconclusive? Was it just an idea he had picked up from the story of a real-life confidence man, or from other things he had read? Was it a metaphor for hidden struggles with sexual orientation? Or is this another example of a novelist’s saving his personal issue with multiple personality for his last novel, like Dickens’s Drood, Twain’s Mysterious Stranger, Hemingway’s Garden of Eden, and Melville’s Confidence Man?

The first-person narrator, Felix Krull, works as a waiter at a Paris hotel, where he sleeps in the employees' dormitory. At the same time, he maintains an apartment elsewhere in Paris where he keeps an upper-class set of clothes, which he wears when he dines out with the rich. This “amounted, as one can see, to a kind of dual existence, whose charm lay in the ambiguity as to which figure was the real I and which was the masquerade…Thus I masqueraded in both capacities, and the undisguised reality behind the two appearances, the real I, could not be identified because it actually did not exist” (1, p. 230).

He had never been satisfied to be who he was, “glorying as I did in the independent and self-sufficient exercise of my imagination,” “holding lively imaginary conversations,” and even bringing “the muscles controlling the pupils…under voluntary control. I would stand in front of my mirror, concentrating all my powers in a command to my pupils to contract or expand…My persistent efforts, let me tell you, were, in fact, crowned with success…I actually succeeded in contracting them to the merest points and then expanding them to great, round, mirror-like pools. The joy I felt at this success was almost terrifying and was accompanied by a shudder at the mystery of man” (1, pp. 10-12).

NOTE: The reason I quote this about controlling his pupils is that some people with multiple personality appear to have alternate personalities who differ from each other in visual acuity, and this might be caused by alters' differing from each other in pupillary contraction.

“My basic attitude toward the world and society can only be called inconsistent…There was, for example, an idea that occasionally preoccupied me…It was the idea of interchangeability” (1, p. 224).

The rest of the novel is about his exchange of identities with someone.

In conclusion, I can’t say with certainty that Felix Krull is about multiple personality or that this would mean that Thomas Mann had multiple personality. But I think that the above is sufficient to raise the possibility.

1. Thomas Mann. Confessions of Felix Krull, Confidence Man. Translated from the German by Denver Lindley. New York, Alfred A. Knopf, 1955.

Myth of the Cultural Construction of Multiple Personality: The truth is that “Sybil” (1973) was propaganda against multiple personality, and was ignored by most American psychiatrists.

Critics of multiple personality often cite the case of “Sybil”—search “Sybil Exposed” in this blog—as the prime example of how a popular book and movie (about a case of multiple personality) was responsible for a large increase in diagnosed cases.

But Sybil portrayed multiple personality as extremely rare. Otherwise, what would have been the big deal?

The other reason that Sybil was actually propaganda against multiple personality is that most real patients are frightened by books and movies like that.

When people who don’t know they have multiple personality see a movie like Sybil, they see someone afflicted with something that they would never want to have. To them, it looks crazier and more frightening than even a psychosis like schizophrenia.

Real psychiatric patients think: In schizophrenia, you may have hallucinations and delusions, but at least you know who you are and what you are doing. Whereas, in multiple personality, you literally don’t know who you are (are you this personality or that personality?) and you literally don’t know what you are doing (due to amnesia for what other personalities have done). Being like Sybil would be the worst and craziest psychiatric condition that they could imagine.

In the real world, for every patient who didn't have multiple personality but wanted to be like Sybil, there were a thousand patients who did have multiple personality, but who saw Sybil and fled from the diagnosis.

Why, then, were more cases diagnosed in the twenty years following Sybil (1973)? It was not because of Sybil, [whose impact on American culture was trivial]. There were [four] other trends of much greater influence. First, in the 1970s, there was an exponential increase in verified cases of child abuse. Second, there was the “second wave” of feminism. Third, a number of astute clinicians chanced upon the diagnosis and pursued the issue. [added January 17th:] Fourth, Freudian psychology—whose single-consciousness model of the mind had made multiple personality seem logically impossible—was losing its influence. Those were the years that American psychiatry abandoned psychoanalysis in favor of psychopharmacology (treatment with medication).

I, myself, did not diagnose multiple personality until 1987, more than a decade after Sybil. Multiple personality had been barely mentioned in my psychiatric training in the 1970s, when the big thing in American psychiatry had been lithium and bipolar disorder. Sybil (1973) had not caused me or any psychiatrist that I knew to diagnose multiple personality. Indeed, I and most American psychiatrists in the 1970s and 1980s thought of multiple personality as something that they were never likely to see (if we ever thought of it at all, which we rarely did).

As an American psychiatrist who was in American psychiatric training at the time Sybil was published, I can tell you that it had virtually no impact on American psychiatrists. Following the publication of Sybil, and to this day, I would guess that less than one percent of American psychiatrists have ever made the diagnosis. It is in the American psychiatric diagnostic manual because of scientific studies, not because it has ever been widely diagnosed in American psychiatry.

I have previously touched on why so few American psychiatrists make the diagnosis. It has to do with how American psychiatrists are trained, a subject I will come back to.

Credibility: What is the minimum requirement for a nonfiction book, article, or speaker to have credibility regarding multiple personality?

Are opinions about multiple personality credible if the person is

1. a psychiatrist?

2. a psychologist?

3. a psychoanalyst?

4. a psychotherapist?

5. a scholar?

6. well-respected?

Not necessarily! Often not!

The minimum requirement for credibility is that, for months or years, the person has talked with people who have multiple personality, including conversations with their alternate personalities.

Any author or speaker without that experience is not credible in regard to multiple personality.

Ian Hacking’s Rewriting the Soul: Multiple Personality and the Sciences of Memory—Gives Opinions About Observable Matters That the Author Has Not Observed

A professor of literature recently suggested that if I wanted to understand her view of multiple personality, I should read the book by Professor of Philosophy, Ian Hacking. So I have.

In this case, you can tell a book by its cover, since the back flap reveals what motivated the author: Hacking is against “scientizing of the soul.” He is interested in multiple personality only to the extent that it is involved in science’s intrusion into the philosophical, moral, and spiritual soul.

“…[Is] there...such a thing as multiple personality [?]. The straightforward answer is plainly yes…the simple conclusion is that there is such a disorder…Is multiple personality a real disorder as opposed to a kind of behavior worked up by doctor and patient? If we have to answer yes-or-no, the answer is yes, it is real—that is, multiple personality is not usually ‘iatrogenic’” (1, pp. 10-12).

Yet, since he also gives the views of skeptics, he says, “You may be beginning to think I’m of two minds, just a little bit split myself, when it comes to multiple personality…What do I think? Is it real or not? I am not going to answer that question” (1, p. 16).

His real concern is how multiple personality and the sciences of memory (neurology, psychology, etc.) are tampering with the soul:

“Talk of the soul sounds old-fashioned, but I take it seriously. The soul that was scientized was something transcendental, perhaps immortal. Philosophers of my stripe speak of the soul not to suggest something eternal, but to invoke character, reflective choice, self-understanding, values…freedom and responsibility. Love, passion, envy, tedium, regret, and quiet contentment are the stuff of the soul…I do not think of the soul as unitary, as an essence, as one single thing, or even as a thing at all. It does not denote an unchanging core of personal identity. One person, one soul, may have many facets and speak with many tongues…” (1, p. 6).

“The soul was the last bastion of thought free of scientific scrutiny” (1, p. 208).

“…in the latter part of the nineteenth century…Memory…became a scientific key to the soul, so that by investigating memory (to find out the facts) one would conquer the spiritual domain of the soul and replace it by a surrogate, knowledge about memory…Subsequently, what would previously have been debates on the moral and spiritual plane took place at the level of factual knowledge…” (1, p. 198).

Regarding multiple personality, Hacking would include himself among “the less arrogant and more reflective doubters…They accept that the patient has produced this version of herself: a narrative that includes dramatic events, a causal story of the formation of alters [alternate personalities], and an account of the relationships between the alters. That is a self-consciousness; that is a soul. [Reasonable] doubters accept it as a reality…Nevertheless, they fear that multiple personality therapy leads to a false consciousness. Not in the blatant sense that the apparent memories of early abuse are necessarily wrong or distorted—they may be true enough. No, there is the sense that the end product is a thoroughly crafted person…That is a deeply moral judgment” (1, pp. 266-267).

Hacking says that, in most cases, the patient, not the therapist, has produced the multiple personality narrative. The condition really occurs. But he suspects that cultural beliefs and therapeutic practices have a major impact on the patient’s narrative.

The reason he thinks so is that he has never diagnosed, treated, or even interviewed people who have multiple personality. As he says, “The whole field of multiple personality is ripe for participant observation…But that is a task for others. I have scrupulously limited myself to matters of public record” (1, p. 7).

Even though Professor Hacking is honest, and acknowledges that he has never been a participant observer of multiple personality, I don’t think that that fact registers with most readers. For who could believe that a nonfiction book about an observable matter would be written by someone who had never observed it?

1. Ian Hacking. Rewriting the Soul: Multiple Personality and the Sciences of Memory. Princeton University Press, 1995.

Either What I Say Can’t Be True—about Novelists, Creative Writing, Psychiatry, and Multiple Personality—Or It Has Been Known Since Plato and Euripides

The foremost experts in multiple personality—those psychiatrists and psychologists who have specialized in the study and treatment of multiple personality, and have published books about it—do not recognize what I call “normal multiple personality” in novelists or anyone else. And if what I say is true, how could they have missed it?

Many of the novelists and novels discussed in this blog have been studied by groups and networks of eminent scholars. Indeed, much of this blog consists of quotations from their essays and books. So how can I come along and say that multiple personality is involved, if they don’t agree and are not convinced?

But suppose my ideas were to catch on and become popular. I would get credit for only a few minutes. Then everyone would remember all the psychologists, psychiatrists, philosophers, and fiction writers who have been saying the same things—or at least things consistent with what I've been saying—since antiquity (search “Plato and Euripides,” for my post of June 28, 2014).

Skepticism by Some Psychiatrists about the Prevalence of Multiple Personality is Based on Their Not Asking Relevant Questions in Interviews

You, dear reader, may have an agnostic opinion about multiple personality, because you have seen books by psychiatrists and others on both sides. And you have never been told the cause of the skepticism. The cause is that the relevant kind of interview question discussed below is not taught in most psychiatric training programs. And some psychiatrists, including some eminent ones, have never learned it and never used it to screen their patients for multiple personality.

The minimum essential question that a psychiatrist or psychologist must ask in order to know whether or not the people they interview have multiple personality is: Have you ever had memory gaps?

Other versions of the same question: When you are not intoxicated, do you ever lose time? Do things ever happen that nobody else could have done, but you don’t remember doing it? Do people ever refer to things that they assume you remember—things that you or they allegedly said or did—but you don’t remember it. Have you ever found anything among your belongings that you couldn’t account for? Have you ever found yourself somewhere, but didn’t know how you got there? Are there things or events that you know about, and should remember, but you really don’t?

A person who does not have multiple personality will not understand such questions. A person who has had such experiences deserves further evaluation. A formal diagnosis of multiple personality is not made unless and until the psychiatrist actually speaks to an alternate personality, which is beyond the scope of this post.

Suffice it to say that 99% of the time the interviewer will not need hypnosis or drugs; there will be no context—legal or otherwise—in which malingering would make sense; and the interviewee will prefer to have almost any other diagnosis.

Either a psychiatrist screens all his patients for multiple personality by asking one simple type of question—“Have you ever had memory gaps?—or a psychiatrist’s skepticism about multiple personality is based on don’t ask, don’t tell.

Is Multiple Personality a fad and a debatable interpretation, or has it been documented for over 400 years, and is it clearly observable?

Cases of the clinical disorder, multiple personality disorder, have been documented for over 400 years (see post earlier today).

And that is just the clinical disorder. One would expect the normal version of multiple personality—the subject of this blog— to be much more common than the clinical disorder (just as one would expect more people to have normal anxiety than to have an anxiety disorder).

And since imaginary companions are known to be relatively common in childhood, it is reasonable to expect that something so similar, multiple personality, would be just as natural to human psychology, and also relatively common.

But isn’t that kind of thing just for children, in childhood? Don’t adults outgrow that? Many don’t. It is just that they are more discreet about mentioning it, and may think about it in other terms. Who would be so indiscreet as to say so? Novelist Stephen King, for one. I have quoted Stephen King in this blog as saying that novelists don’t outgrow it.

But the main point I would emphasize is that the diagnosis of multiple personality involves the observation of certain unmistakable behavior (the diagnostic criteria in the diagnostic manual). That is why the vociferous critics of multiple personality have not been able to get it kicked out of the diagnostic manual. Too many people have seen it.

Multiple personality is neither a fad nor an interpretation. Just the opposite. It has been documented for over 400 years and it is observable.

Multiple Personality Stands the Test of Time: A More Complete History of Multiple Personality (aka Dissociative Identity) Goes Back to 1584

http://www.dissociative-identity-disorder.net/wiki/History_of_DID

Which is Longest Standing, Most Established, Psychiatric Diagnosis? Multiple Personality since 1791; Obsessive-Compulsive since 1860s; Schizophrenia since 1890s; or Panic Disorder since 1980

As indicated above, multiple personality has been a distinct psychiatric diagnosis for 70 years longer than OCD, 100 years longer than schizophrenia, and 189 years longer than panic disorder.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4959824/

http://www.ncbi.nlm.nih.gov/pubmed/2667880

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181977/

http://www.ncbi.nlm.nih.gov/pubmed/19698673

Some literary fiction—by Marcel Proust, Henry James, etc.—is hard to read, because of the author’s multiple personality and failure to heed Toni Morrison.

Many people are “bored” with literature like that of Proust and James:

http://www.nytimes.com/1997/03/16/magazine/literature-bores-me.html

But these critics don’t have a good theory as to why such authors write that way and why other people think those authors are extraordinarily good.

My recent posts on Proust may explain what is going on. His writing involves the perspectives of multiple selves, who often come and go without each identity’s being identified. That’s difficult to follow.

Another difficulty is that the author’s alternate personalities are so autonomous that they ramble on in pursuit of their own interests. As quoted in a past post, Toni Morrison, who had been an editor, said that she could tell when a character had gotten away from a writer. She cautioned writers to control their characters and let them know whose novel it is. But since some of her own novels are as hard to read as James or Proust, it may be that she has not always taken her own advice.

Why do some readers love that kind of writing? It can be rewarding to find that something, which seems crazy at first, makes more and more sense the more you look into it.

Great Commercial, Genre, Plot-Driven Fiction vs. Great Literary, Thematic, Character-Driven Fiction: It is considered literary if it looks harder to do.

If I could write a great commercial novel or a great literary novel, I would be doing that now instead of writing this blog. But I can’t do either. I’m writing this blog to find out how it’s done. And finding out, for me, is fun.

What I’ve found so far is that most novelists have multiple personality. Do literary novelists have more complex multiple personality systems than genre novelists? Did Henry James have a more complex system than J. R. R. Tolkien? I don’t think so.

Do literary novelists treat more important issues, and have greater insight, than commercial novelists? That seems unlikely, since most literary novels are not initially conceived as a way to deal with important issues, and most literary novelists are not philosophers.

Novels are considered literary if they look harder to do. Marcel Proust is considered more literary than Agatha Christie, because it looks easier to write what Christie wrote. But, for Proust, writing what Christie wrote would have been impossibly difficult.

Neither great commercial novelists nor great literary novelists mechanically construct their characters. Nor do they control their characters like puppets. Their characters come to them, not from them (subjectively speaking). Their characters, and various narrative voices, are co-authors (subjectively speaking). If their characters and narrators—alternate personalities—prefer genre formats or literary formats, that’s not the novelist’s (regular self’s) choice alone.

I admire great novelists, both commercial and literary, because very few people with multiple personality (and hardly anyone without multiple personality) can write great novels of any kind.

Marcel Proust’s In Search of Lost Time (Remembrance of Things Past) (Post #6): Proust’s character switches “selves” and memory banks, which is multiple personality

For a Proust scholar’s comments on Proust’s character’s multiple selves, see the previous Proust post on January 2nd. Obviously, I’m not a Proust scholar. But what I am qualified to do is discuss the following brief quotation, from the last pages of the novel, in regard to multiple personality:

“One of my selves, the one which in the past had been in the habit of going to those barbarian festivals that we call dinner-parties…this one of my selves had retained its scruples and lost its memory. The other self, the one which had had a glimpse of the task that lay before it, on the contrary still remembered…for the memory of my real work did not slumber but proposed to employ the hour of reprieve which was granted me in laying my first foundations. Unfortunately, as I took up a note-book to write, Mme Molé’s invitation card slipped out in front of my eyes. Immediately the forgetful self, which nevertheless was able to dominate the other…pushed away the note-book and wrote to Mme Molé…I had allowed my reply to her invitation to take precedence over my labours as an architect” (1, pp. 1097-1098).

There are two things that distinguish a person’s having different roles from having different personalities: sense of selfhood and memory.

When a person switches from the role of partygoer to the role of architect, there may be a change in mood and interest, but there is no essential change in the person’s sense of selfhood and in what they can remember. In contrast, when a person switches from one personality state to another personality state, there definitely is a change in sense of selfhood and in what the person remembers.

Also, note that one of the character’s selves “was able to dominate the other.” In the case of different roles, you might say that a person was more in the mood for one role or another. But it is only a person-like psychological entity that you would speak of as “dominating” another person-like psychological entity (an alternate personality).

So it is clear that Proust is describing multiple personality.

1. Marcel Proust. Remembrance of Things Past (Volume Three): The Captive, The Fugitive, Time Regained [1927]. Translated by C. K. Scott Moncrieff, Terence Kilmartin, and Andreas Mayor. New York, Random House, 1981.

“Me, Me, Me and My Therapist: This is what it feels like to suffer from dissociative identity disorder” by Vivian Conan in today’s New York Times

“…Outside-Me was a competent grown-up in my 50s, involved with family and friends and holding two jobs…Inside-Me was a conglomerate of 10 or so people-parts whom I referred to variously as I, we, she, they or even ourself. I’d been that way ever since I could remember, but never thought to mention it to any of the five [previous] therapists I’d seen since I was 16.

“It wasn’t until my late 40s that I learned I had Dissociative Identity Disorder [Multiple Personality Disorder]…

“One of those Inside was Wendy, a precocious 6-year-old who, like her namesake in ‘Peter Pan,' was a caretaker. Wendy often dominated our [therapy] sessions, appointing herself speaker whenever she felt any of us was vulnerable. The moment we heard about [her therapist’s upcoming] sailing trip, she’d popped out to direct the interrogation…”

The above is from today's essay by Vivian Conan, who is working on a memoir.

Denial and Dissimulation: Patients Usually Reject the Diagnosis of Multiple Personality and Disclaim the Evidence and Behavior on Which It is Based

With most psychological conditions, the person knows that they have it. They may or may not know what it’s called, but they know, and acknowledge, that they have the symptoms.

For example, a person with panic disorder may or may not know that they have “panic disorder,” but they know that they have panic attacks. For a psychiatrist to say, “Well, you may not know that you experience panic attacks, but I know that you do, unconsciously,” would be ridiculous.

Indeed, there is no diagnosis in the psychiatric diagnostic manual (DSM-5) that involves a psychoanalytic interpretation. And this has been true since 1980 (DSM-3), when psychoanalytic terms and concepts were deleted from the manual.

Unlike other diagnoses in the manual, the person with multiple personality usually doesn’t know that they have it. The reason is that the “patient”—the host personality—usually has amnesia for any period of time during which an alternate personality (alter) has come “out.”

But, even if the host doesn’t know that the person has multiple personality, don’t the alters know? Yes, they do have self-awareness. But, no, they don’t see it as multiple personality. To them, they are other people. (They are alters, not other people, but I’m telling you how they see it.)

Moreover, the alters don’t want either the host or any meddling outsider (like a psychiatrist) to know about them, so they usually come out incognito (answering to the regular name, even though, secretly, they may have their own name).

So how is the diagnosis made? Clues such as puzzling behavioral inconsistencies and memory gaps—the host may know that he or she has a history of memory gaps—will alert the clinician to recognize when an alter does come out. And when the alter is “caught” being out, the alter will often acknowledge who they are and provide information that can be corroborated.

How can you recognize that you are speaking to an alter? To give one clinical example, a patient once came to see me for her usual appointment, and immediately expressed outrage about the antidepressant medication that I had been prescribing for some months. She angrily insisted that I discontinue it. This surprised me, because at past appointments she had always praised the medicine and wanted to continue it.

When I remarked on her inexplicable inconsistency, the alter knew that she had been “outed.” And she explained that when the host personality took this medicine, it became very hard for the alter to come out. So the alter would sometimes hide the medicine.

Which reminded me that the patient—the host—had occasionally complained that her medicine would, mysteriously, get misplaced.

Thus, the diagnosis of multiple personality is based on overt behavior, and not on psychoanalytic interpretation. But the “patient” (host personality) will usually deny the diagnosis, and disclaim the behavior upon which the diagnosis was based, since, after all, the host doesn't remember it; and, moreover, the host doesn’t like the whole idea.

Indeed, if, prematurely, you try to prove to the host that they have multiple personality—e.g., by telling the host about a specific item that is hidden in a specific drawer at home, which the alter had told me about—then when they go home and are shocked to find that very item in that very drawer, they may drop out of treatment.

Ian Hacking Reviews DSM-5: Why Would The London Review of Books Have the Psychiatric Diagnostic Manual Reviewed by a Philosopher?

DSM-5 (1) is the latest edition of the psychiatric diagnostic manual. Why would The London Review of Books have it reviewed by a philosopher (2)?

Mr. Hacking has written about psychiatric issues previously, but does he know what he’s talking about?

He doesn’t. For example, he says that before lithium was approved for the treatment of manic-depression (bipolar disorder) in the 1970s, “there was really no effective chemical treatment for any mental illness.” However, the fact is, modern psychiatric drugs date from the 1950s. The significance of lithium was that the previously available medications for psychosis could be used to treat either schizophrenia or bipolar disorder, whereas lithium was effective in treating bipolar disorder, but relatively ineffective in treating schizophrenia. And since the medication for both disorders was no longer identical, the diagnostic distinction between the two disorders became more important.

The above is well-known and easy to look up, but Mr. Hacking didn’t know it and didn’t bother to check his facts. The latter is more significant than the former.

So why would anyone go to him for opinions about psychiatry? And why would The London Review of Books have DSM-5 reviewed by a philosopher?

Added Jan. 3rd: The last philosopher who could write with authority about psychiatry was William James (1842-1910).

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.

2. Ian Hacking. “Lost in the Forest.” London Review of Books, Vol. 35, No. 15, 8 August 2013.

10 Most Popular Posts, Since This Blog Started to Explore: How Great Novelists Think, and Do What They Do

1. Doris Lessing’s “To Room Nineteen”

2. Dickens, Multiple Personality, and Writers

3. Plot-Driven vs. Character-Driven

4. Bakhtin says Dostoevsky created the “polyphonic” novel

5. Henry James’s The Ambassadors

6. Gillian Flynn’s Gone Girl

7. Multiple Personality Pervades Toni Morrison’s Novels

8. The Sound and the Fury: William Faulkner’s Rashomon

9. Debbie Nathan’s Sybil Exposed

10. Oscar Wilde: The Picture of Dorian Gray and who wrote all those Quotations

Marcel Proust’s In Search of Lost Time (Post #5): Literary Criticism Finds That It is Written As Though The Author Had Multiple Personality 

In my December 21, 2014 post on Proust, I quoted from a textbook about the difficulty sometimes encountered in trying to get the life story from a person with multiple personality. The story you get may be “inconsistent or even contradictory” because “memories of their life history are divided up among a number of different alter personalities.”

Proust’s novel presents these very same issues:

“It is not always easy, when indeed possible, to reconstruct the sequence of events…And even when the events we see are presented in order, huge gaps regularly remain between them…To compound our bewilderment, what seemed like a single event often turns out to be the description of a repeated state of affairs…

“To understand the various vicissitudes to which linear time is subject in the novel, we need to turn to the portrait of human interiority it espouses, one in which the overall self is made up of myriad smaller selves…Now these are not just passive memory-traces but also active participants in the psychic apparatus; they are, to borrow a traditional metaphor, citizens…with full voting rights…

“Proust’s idiosyncratic use of maxims points toward a simultaneous division of the self. For it suggests that several different agencies, entirely indistinguishable on the surface, are jointly responsible for their production…We may detect at least five narrative instances all sharing, whether implicitly or explicitly, the first-person pronoun…Nor will the various speakers co-operate, any more than will the different faculties within the Narrator-Protagonist’s consciousness…Viewpoint, in short, dramatises a consciousness which is thoroughly fractured within itself…

“Chronology may be complicated and viewpoint variable, but if there is one single factor preventing us from reading more than six pages in a sitting then it is…the notorious structure of the Proustian sentence…We often feel the presence of multiple sequential selves coursing through the complex prose. Occasionally a group of narrators gathers in a single paragraph, all using different tenses to discuss the Protagonist and each other” (1, pp. 117-134).

1. Joshua Landy. “The texture of Proust’s novel.” In The Cambridge Companion to Proust, Edited by Richard Bales. Cambridge University Press, 2001.