Tolstoy, Goethe, Lessing, Poe, Wharton, Hemingway, Woolfe: Depression, suicide, memory gaps, magical thinking in characters and people with multiple personality.

Among the writers discussed in this blog who raise these issues, the following readily come to mind: Tolstoy’s Anna Karenina, Goethe’s The Sufferings of Young Werther, Doris Lessing’s “To Room Nineteen,” Poe’s “William Wilson,” and Edith Wharton’s The House of Mirth; Ernest Hemingway and Virginia Woolfe in real life.

In some real-life cases, a person has both suicidal depression (or manic-depression) and multiple personality, independent of each other; that is, cure one of the two and the other one remains. In other cases, depression and suicidal behavior are secondary to the multiple personality: work with the multiple personality and the depression remits. I have never seen or heard of multiple personality caused by depression, in which curing the depression cured the multiple personality; although, if you get the depression under control, thus abating the crisis, the multiple personality may go back behind the scenes (where it often is when there is no crisis).

There is no medicine that cures multiple personality, but a medicine, or any substance (including alcohol and other drugs) may affect the balance of power among the personalities. That is, a particular drug may make it easier for one personality, and harder for another personality, to take control. I learned this when a patient’s alternate personality told me that she sometimes hid the host personality’s medicine, because it would make it harder for that alternate personality to come out. (The patient’s regular, host personality knew only that sometimes her medicine would get misplaced.)

Whenever people survive a suicide attempt, the evaluation should include asking them if they remember the attempt. You have to distinguish what they know or have inferred about the attempt (from circumstantial evidence: bandages, what people have said or asked them, etc.) from what they, themselves, personally, directly, actually remember.

You need to make this kind of inquiry, because people who have multiple personality will rarely volunteer the information that they don’t really remember. Usually, the host personality doesn’t remember, and doesn’t want to know about, the alternate personality. And the alternate personality doesn’t want to disclose its existence and be interfered with. But the host personality will often admit to having had memory gaps or lost time, if you directly ask.

It was an alternate personality, not God, who killed Anna Karenina. And the alternate personality may have thought that only the host personality would die, because multiple personality starts in childhood, and some alternate personalities have childlike magical thinking.