Blind Spot: Psychiatrist after psychiatrist had missed the diagnosis of multiple personality, while the family of the patient had known about it for years.

I had been a psychiatrist for twelve years before I diagnosed multiple personality for the first time. My American psychiatric training had not taught me how to make this diagnosis. It was twelve years before I finally learned to ask my patients relevant questions.

One patient had been in psychiatric treatment for many years, under the care of a number of previous psychiatrists, who had all diagnosed him as having schizophrenia. In addition to the traditional psychiatric evaluation and mental status exam, I asked him my newly acquired, basic screening question for multiple personality—Have you ever had memory gaps?—and his positive answer was the first step in a diagnostic process which led to my meeting his alternate personalities.

However, when I subsequently spoke with his family to explain why I was changing his diagnosis, his family replied that they had known about the multiple personality for many years. I asked them why they had never told me or any of the previous psychiatrists. They said they assumed the doctors knew about it, since it was so obvious. They had also assumed that the diagnosis of schizophrenia included multiple personality (it does not).

You may wonder how the family knew about the multiple personality, while psychiatrist after psychiatrist had not? Why had the family seen the switches from one personality to another, each having a different name, with some personalities having memory gaps for what other personalities had done?

We psychiatrists had always been seeing the patient’s “host” or “patient” personality, and if any of the alternate personalities ever had come out during appointments, they had done so incognito. Why were the alternate personalities so guarded with psychiatrists? They felt that the host personality, not they, was the patient. And they feared that the psychiatrist, to favor his patient, would try to get rid of everyone else, kill them off, either with medication or a psychiatric form of exorcism. At the very least, he would meddle in their lives.

This is not to say that families always know about the multiple personality. In most cases, they do not. They may have only a vague sense that their family member has variable moods, interests, attitudes, and, at times, may be absent-minded. Mark Twain was known for his excellent memory, but his family said that he was sometimes very absent-minded.

This is also not to say that most patients diagnosed as having schizophrenia have multiple personality. Most patients diagnosed as having schizophrenia have schizophrenia. But families should understand that multiple personality is not a symptom of schizophrenia, and if they see signs of multiple personality in their family member, they should not assume that the psychiatrists know about it.

P.S.: I should add that most patients who have multiple personality, but are misdiagnosed as having something else, are not misdiagnosed as having schizophrenia. Multiple personality can be misdiagnosed as many things, such as depression. Actually, in many such cases, the depression may not be a misdiagnosis. The patient may have both depression and multiple personality, and you need to treat both to get the best results.
P.P.S.: I should also add that I don't think everyone has multiple personality. I have diagnosed multiple personality in only about four percent of my patients, which is much more than most psychiatrists, who never make the diagnosis. But I have not diagnosed multiple personality in 96% of my patients.