Schizophrenia vs. Multiple Personality: If they both have hallucinations and delusions, why are multiples more likely to have relationships and get married?

Many people think of multiple personality as the worst kind insanity, since they don’t even know who they are (this personality or that personality) and they may do things they don’t even remember (one personality has a memory gap for the time that another personality was out). Moreover, they occasionally hallucinate their alternate personalities; e.g., in mirrors, or when they hear the voices of their “characters.” And alternate personalities (and characters) have the delusion that they are people in their own right.

So, if people with schizophrenia also have hallucinations and delusions, what’s the difference?

One of the key factors that leads a psychiatrist to diagnose, or not diagnose, schizophrenia is the person’s interpersonal engagement. For example, in a recent post about Lucy, the patient that Christopher Bollas diagnosed (possibly misdiagnosed) with schizophrenia, Lucy was described as having initiated contact with Bollas and as having asked him to psychoanalyze her. And then she engaged in psychoanalysis with him for more than five years (by telephone, long-distance!). However, the kind of person that most psychiatrists would diagnose as having schizophrenia would never do all that. Schizophrenics (not on medication or only in the early stages of the illness) tend not to initiate and maintain complex interpersonal relationships.

To illustrate how allegedly crazy Lucy was, Bollas described how one telephone session was interrupted while Lucy, according to Lucy, was chased around her house by a dragon. (Lucy had been described by Bollas as a 55-year-old writer, and I wonder if she wrote children’s books, and one of the characters was a dragon.) But Bollas did not panic. He did not try to alert Lucy’s family or neighbors. He waited, and when Lucy got back on the phone, he interpreted Lucy’s hallucinated dragon as having been prompted by the wording of one of his previous comments. In short, neither the nature of Lucy’s relationship with Bollas nor his reaction to her hallucination suggests the condition that most psychiatrists would call schizophrenia, but rather something that features a vivid imagination and is interpersonally engaging.

Psychiatrists may be very dedicated and emotionally involved in helping people with schizophrenia, but there is relatively little risk of their emotional entanglement with particular patients, because one of the features of schizophrenia is its interpersonal deficits. Moreover, the hallucinations and delusions tend to be nonsensical or bizarre, not metaphorical or mythological like dragons. (And, of course, needless to say, schizophrenics never have alternate personalities or memory gaps.)

In contrast, people with multiple personality tend to be emotionally engaging. Although they can be loners, or an angry personality may tell you to get lost, multiples are often emotionally engaging, which is why they are often married, some more than once. Indeed, professional training in how to treat multiple personality routinely includes cautionary advice on how the therapist can avoid getting emotionally entangled and enmeshed. And the hallucinations and delusions of multiples are of the kind that, the more you know what is going on, the more they make sense (the way fiction makes sense).