“I Never Promised You a Rose Garden” by Joanne Greenberg (post 5): Positives (Cure), Negatives (Misdiagnosis), and the Author’s Afterword.

Positives

Age: The patient’s multiple personality appears to have begun as a way to cope with surgery (to remove a urinary tract “tumor”) at age five. So by the time she was psychiatrically hospitalized at age fifteen, she had had multiple personality for ten years. However, since most people with multiple personality don’t get helpful treatment until they are over thirty, if ever, this patient got help at a relatively young age, when the condition was less entrenched and easier to cure.

Doctor: Her psychiatrist, Dr. Frieda Fromm-Reichmann, was known for treating psychotic patients with psychotherapy (in preference to the crude biological treatments available around 1950). She is superb at establishing a doctor-patient therapeutic alliance. Her patient must have felt very safe to have revealed her inner world, its characters, and secret language.

Successful Outcome: After several years of psychiatric hospitalization and several more years of outpatient treatment, Joanne Greenberg has felt and functioned very well for all these many years.

They say you can’t argue with success, but I will anyway:

Negatives

Misdiagnosis: The psychiatrist—having never asked the patient if she had a history of memory gaps, losing time, and things happening that nobody else could have done, but she didn’t remember doing them—did not know that her patient had this symptom, which is seen in multiple personality, but not in schizophrenia. It is caused by one personality's having amnesia for the times that other personalities have been in control. And as seen in quotes from the text in a previous post, the patient had had many such experiences for many years. But patients usually don’t volunteer this information unless specifically asked.

Misunderstanding Patient: The psychiatrist, not knowing about the multiple personality, did not know which personality she was talking to at any given time. Since the typical host or regular personality does not know the secrets of the other personalities and their inner world, then the secrets being told about the inner world, etc., were probably being told by one or more of the alternate personalities (who usually do not identify themselves, and prefer to remain incognito, unless they know that the person they are speaking to knows what is going on).

Residual Symptoms?: At various times throughout the story, the patient is said to still feel the presence of the “tumor,” which had been surgically removed at age five. I don’t know if this was discussed in therapy sessions, but if it was, what would the psychiatrist have made of it? Without knowing about the multiple personality, would the psychiatrist have thought that there might be a five-year-old alternate personality, who was frozen in time, to when the tumor was still actually there, and that this problem might be resolved by working with that personality (for example, helping her age-progress to when the tumor was gone).

In short, there might be certain issues that never get entirely resolved if they are not addressed in the way they are found in the patient’s multiple personality. Perhaps the “tumor” was resolved in some other way (the child-aged alternate personality might have spontaneously age-progressed), but there might have been other issues that were not resolved. Multiple personality can still be present without its causing problems, which is what I mean by its “normal version” in the title of this blog.

In any case, here, the practical positives appear to far outweigh any theoretical negatives, so let the last words come from:

Joanne Greenberg’s Afterword

“There are some comic elements in all of this. Now and then, I’ve had to defend my right to have been schizophrenic and to have recovered…I’ve heard the causes of my illness hijacked by people for use in their own agendas…and some are worth a laugh. The hard truth is that we don’t know enough about the brain’s capacities to do any more than speculate on cause or cure. I don’t know what caused my illness—not really, or how, exactly, it was cured. I do know what helped, and who was there to help” (1, pp. 290-291).

1. Joanne Greenberg. I Never Promised You a Rose Garden [1964]. With a new Afterword by the author. New York, Holt Paperbacks, 2009.