“The Double” by José Saramago (post 5): Novel’s narrators, who say they are mere transcribers of characters’ thoughts and actions, may be doubles, too.

A little more than halfway through this novel, the protagonist, a divorced history teacher, has contacted his double, a married movie actor. After comparing physical details, they do not doubt that they are duplicates, which they see as strange, but a fact.

As previously noted, one of the outstanding things about this novel, right from its beginning, is the narrator’s plural self-reference. I have looked at the discussion of this novel in Wikipedia, and have read several book reviews, including one by a famous novelist, but none notes the narrator’s plurality.

At this point in the novel, the married actor is wondering if he can profit from the fact that he and the divorced history teacher cannot be told apart, even by people, like the history teacher’s girlfriend, who know them intimately. The narrator refuses to give a hint as to how this will work out:

“…do not count on us, mere transcribers of other people’s thoughts and faithful copyists of their actions, to anticipate the next steps…” (1, p. 189).

The idea that the writer of a novel is a “mere transcriber” of a story that other personalities have provided is a relatively familiar idea that other writers have expressed, too. For example, Cormac McCarthy, in an interview with Oprah Winfrey, said he has “a sense of taking dictation” from “a committee” (search “cormac oprah”).

Less noted, but surprisingly common, is the fact that the narrative voice of a novel may be plural. For example, I have noted that some novels seem to have different writers for their first and second halves, with a character portrayed as having multiple personality in the first half, but with the issue of multiple personality completely forgotten in the second half (e.g., Graham Greene’s The Third Man and Joyce Carol Oates’ You Must Remember This). Other novels, famous for being difficult to read, skip from one narrator to another.

However, Saramago’s The Double is the first novel I’ve noted to have one consistent narration that makes plural self-reference, implying that the narrator is a consistent combination of personalities. And since these personalities have not spoken up and said they are different from each other, it may be that they are doubles like the two characters.

1. José Saramago. The Double [2002]. Translated from the Portuguese by Margaret Jull Costa. Orlando, Harcourt, 2004.

José Saramago (post 4): Protagonist’s voices not understood by Dialogical Self, Subpersonalities, Hearing Voices Movement, or Postmodernism.

In the last post, the protagonist of José Saramago’s The Double was engaged in a dialogue with a voice in his head. The voice was nameless, and was, therefore, named for its unique characteristic, its common sense. I interpreted this conversational inner voice to be the protagonist’s Common Sense alternate personality; that is, within the psychiatric conceptual framework of multiple personality (aka dissociative identity).

I have read a little further, and the protagonist has now had a dialogue with another, different voice in his head (1, pp. 85, 104-105). This confirms that I had not misinterpreted a literary personification of common sense; but rather, that the protagonist has multiple, distinct, alternate personalities. Moreover, since the title of the novel does not refer to these other personalities, the author seems to have considered having such alternate personalities as being, in his experience, ordinary psychology.

Other possible conceptual frameworks for interpreting the protagonist’s nonpsychotic conversations with voices in his head are Dialogical Self Theory (2), Subpersonalities (3), Hearing Voices Movement (4), and Postmodern Literature (5).

The advantage of these other frameworks is their recognition that hearing voices is surprisingly common in a substantial minority of normal people. But any bona fide, psychological process would have the possibility of breaking down or becoming excessive, leading to its corresponding mental disorder; for example, normal anxiety has its corresponding anxiety disorders. Hearing voices as viewed in these other perspectives does not qualify as a bona fide, normal, psychological process, because it does not have its corresponding mental disorder.

The advantage of the psychiatric framework of multiple personality for interpreting the protagonist’s conversations with voices is that it brings to bear a body of knowledge for understanding the protagonist, the narrator, the novel, and the author. The disadvantage of the psychiatric framework is that psychiatry, per se, is interested in psychopathology, and does not address the corresponding normal version of multiple personality.

This blog is about the normal version of multiple personality.

1. José Saramago. The Double [2002]. Translated from the Portuguese by Margaret Jull Costa. Orlando, Harcourt, 2004.

2. https://en.wikipedia.org/wiki/Dialogical_self

3. https://en.wikipedia.org/wiki/Subpersonality

4. https://en.wikipedia.org/wiki/Hearing_Voices_Movement

5. https://en.wikipedia.org/wiki/Postmodern_literature

“The Double” by Nobel novelist José Saramago (post 3): Protagonist’s dialogue with alternate personality; “double” in mirror; narrator’s plural self-reference.

“Saramago's experimental style often features long sentences, at times more than a page long. He used periods sparingly, choosing instead a loose flow of clauses joined by commas. Many of his paragraphs extend for pages without pausing for dialogue, which Saramago chooses not to delimit by quotation marks; when the speaker changes, Saramago capitalizes the first letter of the new speaker's clause. His works often refer to his other works. In his novel Blindness, Saramago completely abandons the use of proper nouns, instead referring to characters simply by some unique characteristic, an example of his style reflecting the recurring themes of identity and meaning found throughout his work.”—Wikipedia

[Added Oct. 29: I reject the concept of experimental style. Search "experimental."]

In the above, I have boldfaced one way in which Saramago’s style is like what happens in the treatment of multiple personality, in which, since many alternate personalities are nameless, the therapist will often refer to an alternate personality by its unique characteristic.

In the following excerpt from a six-and-a-half page paragraph in Saramago’s The Double, the protagonist, Tertuliano Máximo Afonso, carries on a conversation with a voice in his head (an alternate personality), which is referred to by its unique characteristic, its common sense. His commonsense personality is advising him how to deal with a problem.

The protagonist’s problem is that he recently saw a video of a movie recommended by a colleague in which he was shocked to see that one of the minor character actors, playing a clerk at a reception desk, looked exactly like him, the “double” referred to by the novel’s title:

“…Tertuliano Máximo Afonso’s common sense finally turned up to give the advice that had been noticeable by its absence ever since the clerk at the reception desk first appeared on the television screen, and this advice was as follows, If you feel you must ask your colleague for an explanation, then do so at once, that would be infinitely better than walking around with all kinds of questions and queries stuck in your throat, but I would recommend that you don’t open your mouth too much, that you watch what you say, you’re holding a very hot potato, so put it down before you get burned, take the video back to the shop today, that way you can draw a line under the whole business and put an end to the mystery before it begins to bring out things you would rather not know or see or do, besides, if there is another person who is a copy of you, or of whom you are the copy, as apparently there is, you’re under no obligation to go looking for him, he exists and you knew nothing about him, you exist and he knows nothing about you, you’ve never seen each other, you’ve never passed in the street, the best thing you can do is, But what if one day I do meet him, what if I do pass him on the street, Tertuliano Máximo Afonso broke in, You just look the other way, as if to say, I haven’t seen you and I don’t know you, And what if he speaks to me, If he has even a grain of good sense, he’ll do exactly the same, You can’t expect everyone to be sensible, That’s why the world’s in the state it is, You didn’t answer my question, Which one, What do I do if he speaks to me, You say, well, what an extraordinary, fantastic, strange coincidence, whatever seems appropriate, but emphasizing the it is just a coincidence, then you walk away, Just like that, Just like that, That would be rude, ill-mannered, Sometimes that’s all you can do if you want to avoid the worst, if you don’t, you know what will happen, one word will lead to another, after that first meeting there’ll be a second and a third, and in no time at all, you’ll be telling your life story to a complete stranger, and you’ve been around long enough to have learned that you can’t be too careful with strangers when it comes to personal matters, and frankly, I can’t imagine anything more personal, or more intimate, than the mess you seem about to step into, It’s hard to think of someone identical to me as a stranger, Just let him continue to be what he has been up until now, someone you don’t know, Yes, but he’ll never be a stranger, We’re all strangers, even us, Who do you mean, You and me, your common sense and you, we hardly ever meet to talk, only very occasionally, and, to be perfectly honest, it’s hardly ever been worthwhile, That’s my fault I suppose, No, it’s my fault too, we are obliged by our nature and our condition to follow parallel roads, but the distance that separates or divides us is so great that mostly we don’t hear from each other, Yes, but I can hear you now, It was an emergency and emergencies bring people together, What will be, will be, Oh, I know that philosophy, it’s what people call predestination, fatalism, fate, but what it really means is that, as usual, you’ll do whatever you choose to do, It means that I’ll do what I have to do, neither more nor less, For some people what they did is the same as what they thought they would have to do, Contrary to what you, common sense, may think, the things of the will are never simple, indecision, uncertainty, irresolution are simple, Who would have thought it, Don’t be so surprised, there are always new things to learn, Well, my mission is at an end, you’re obviously going to do exactly what you like, Precisely, Good-bye, then see you next time, take care, See you at the next emergency, If I manage to get there in time…” (1, pp. 23-25).

A few pages later, the protagonist, looking in his bathroom mirror, “became the actor” (1, p. 28) (saw his double from the movie in his mirror), and had to cover the mirror with shaving cream to avoid “a nervous breakdown, a sudden fit of madness, a destructive rage” (1, p. 28).

People with multiple personality sometimes see an alternate personality when they look in the mirror. Occasionally, they find this disturbing, like the protagonist above. Search “mirror” and “mirrors” in this blog to see past posts on mirrors and multiple personality.

I have just started to read this novel, but it already appears that there is more multiple personality in it than that implied by the title. In addition to the commonsense alternate personality (see above), the narrator may have multiple personality, as indicated by plural self-reference. Sometimes the narrator’s “we” might be meant to include the reader, but other times it refers only to the narrator; for example, “we believe” (1, p. 3) and “we” and “in our view” (1, p. 4). Either the narrator is using the royal or editorial “we,” or the narrator consists of two or more personalities.

1. José Saramago. The Double [2002]. Translated from the Portuguese by Margaret Jull Costa. Orlando, Harcourt, 2004.

Nobel Prize novelist José Saramago (post 2): His “identity problem provoked by my surname,” pseudohallucinations, and “compulsive” lying.

Identity Problem

In the previous post, I quoted Saramago’s puzzling explanation for how he got, and why he kept, a surname based on a clerical error. Do his multiple surnames mean that he had an identity problem like multiple personality? He, himself, says that his dual surnames were associated with an identity problem, when he refers to “the delicate identity problem provoked by my surname” (1, p. 41).

His acceptance of two surnames—de Sousa and Saramago—suggests, in literary terms, doubles, and in psychological terms, multiple personality.

Incidentally, José de Sousa Saramago is not the only novelist discussed in this blog who has had two surnames, and who chose to be known by the less authentic of the two. See the past post on Danielle Steel (Danielle Fernandes Dominique Schuelein-Steel).

Pseudohallucinations

Many novelists, in their writing process, can see and hear their characters. These are not true hallucinations, because the novelist knows that other people can’t see and hear the characters; in psychological terms, they are pseudohallucinations.

But since novelists often say they experience their characters as “more real than real,” their seeing and hearing them are very vivid, like virtual reality. And the relevance of such experiences to this blog is that people with multiple personality may sometimes hallucinate their alternate personalities, either in mirrors or in ordinary space. These, too, are pseudohallucinations, since the person with multiple personality knows that other people can’t see the alternate personalities.

In Saramago’s memoir of his childhood, there is one brief mention of his ability to have visual (pseudo)hallucinations, when he refers to “the nightmares that afflicted me while asleep and awake” (1, p. 47). Nightmares when you are awake are pseudohallucinations.

“Compulsive” Lying

Saramago’s “classes on Moral and Civic Instruction…did not prevent me…from becoming the biggest liar I’ve had the misfortune to meet. I would lie for no reason, I lied right, left and center, I lied about anything and nothing. Compulsive behavior they would call it today…[For example] my tendency to invent the plots of films I had never seen…[from] the posters that could be found outside all cinemas…From those eight or ten images I would concoct a complete story, with beginning, middle and end…my companions would listen attentively…and I would heap lie upon lie, almost believing that I really had seen what I was merely inventing” (1, pp. 100-102).

Why does Saramago experience all his lying as “compulsive” and not just imaginative fun? Because he would often lie for no reason that he was aware of, as if someone else were pulling his strings. What could explain this in a person with multiple surnames and identity problems? Perhaps this memoir is a “double” story, and Saramago had an alternate personality who enjoyed creating fiction and/or embarrassing his regular self.

Search “lying” in this blog to see the many past posts that discuss lying and liars in relation to other novelists and multiple personality.

1. José Saramago. Small Memories. A Memoir [2006]. Translated from the Portuguese by Margaret Jull Costa. New York, Mariner/Houghton Mifflin Harcourt, 2012.

Nobel Prize novelist José Saramago: When he was seven, his family learned “Saramago” had been put on his birth registration due to clerical error.

Wikipedia

José de Sousa Saramago, (16 November 1922 – 18 June 2010), was a Portuguese writer and recipient of the 1998 Nobel Prize in Literature…In 2003, Harold Bloom described Saramago as "the most gifted novelist alive in the world today" and in 2010 said he considers Saramago to be "a permanent part of the Western canon,” while James Wood praises "the distinctive tone to his fiction because he narrates his novels as if he were someone both wise and ignorant.”

Autobiography

“Saramago was not a family name from my father’s side, but the nickname—meaning ‘wild radish’—by which the family was known in the village…When my father went to the registry office…to declare the birth of his second son, the clerk…was drunk (although my father always claimed Silvano acted out of spite) and he…decided to add Saramago to the plain José de Sousa that my father intended me to be. And, as it turned out…I later had no need to invent a pseudonym with which to sign my books…My family was unaware that I had entered life marked by the name of Saramago until I was seven, for it was only when they had to present my birth certificate in order to enroll me in primary school that the raw truth surfaced from the bureaucratic depths, to the great indignation of my father, who had grown to dislike the nickname. The worst of it was that, since…he was called plain José de Sousa, the Law…wanted to know why it was that his son was called José de Sousa Saramago. Feeling intimidated and wanting to make sure that everything was right and proper, my father had no alternative but to reregister himself under the name of José de Sousa Saramago. This must, I imagine, be the only case in the whole of history of humanity of a son giving his name to his father…[but]…my father…always insisted on being called plain Sousa” (1, pp. 37-39).

José Saramago’s use of the name “Saramago,” not only as a pen name, but as his real name, does not make sense to me. Does it make sense to you?

1. José Saramago. Small Memories. A Memoir [2006]. Translated from the Portuguese by Margaret Jull Costa. New York, Mariner/Houghton Mifflin Harcourt, 2012.

Jean-Paul Sartre (post 3): Since Søren Kierkegaard and Fyodor Dostoevsky were existentialists, too, is Existentialism rooted in multiple personality?

It is possible that Sartre’s major philosophical work, Being and Nothingness (1943), was inspired, at least in part, by the kind of existential crisis experienced by the protagonist of his novel, Nausea (1938). So the nature of that crisis is relevant.

In previous posts, I pointed out that the protagonist’s symptoms of personality changes (“sudden transformations”) and travel with amnesia (dissociative fugue) support a diagnosis of multiple personality (aka dissociative identity).

So it may be no accident that Kierkegaard is considered to be a founding philosopher of Existentialism, and Dostoevsky (The Double, etc.) is considered to be one of the first existentialist novelists. (Search Dostoevsky and Kierkegaard in this blog for posts related to their multiple personality.)

One past post quotes Kierkegaard as follows:

“…in the pseudonymous works there is not a single word which is mine, I have no opinion about them except as a third person, no knowledge of their meaning except as a reader, not the remotest private relation to them…My wish, my prayer, is that if it occur to anyone to cite a particular saying from the books, he do me the favor to cite the name of the respective pseudonym…

“Each time I wish to say something, there is another who says it at the very same moment. It is as if I were always thinking double, as if my other self were always somehow ahead of me…” (1, pp. 135-151).

1. Josiah Thompson. Kierkegaard. New York, Alfred A. Knopf, 1973.

Jean-Paul Sartre’s “indeterminacy of the self”: Times Literary Supplement on Nobel Prize novelist-philosopher misses multiple personality in his novel “Nausea”

October 24, 2017

The Times Literary Supplement

Jean-Paul Sartre and the demands of freedom

by Gary Cox

“…He continued studying and writing, however, and by 1938 finally made his name with the publication of his cult existentialist novel, Nausea…

“We do not exist simply in our own right as chairs do, but always in relation to – and as the negation of – our situation. A chair is, but we must constantly create ourselves over time through our actions. We have to choose who we are each moment by what we choose to do, without ever being able to become a fixed entity. This is what existentialists call the indeterminacy of the self. The self is not a thing, it is a being unavoidably caught up in a constant temporal process of becoming.”

https://www.the-tls.co.uk/articles/public/jean-paul-sartre-cox-demands-freedom/

However, the indeterminacy of the self portrayed in Sartre’s novel Nausea involves the dissociative fugues and sudden transformations of a person with multiple personality, as previously discussed in the following post:

July 14, 2015

Nobel Prize novelist Jean-Paul Sartre’s Nausea:  The novel’s opening—saying the protagonist's “sudden transformations” must be explained—is totally forgotten

“Sudden Transformations”

The novel begins with the protagonist’s worry about his “sudden transformations.” For example, due to some kind of change that suddenly came over him, he left France and went to Indo-China, and then, after six years, he suddenly reverted to his regular self and returned to France.

He is trying to understand what is wrong with him, and is worried that he will have another “sudden transformation”:

“I have to admit that I am subject to these sudden transformations…That is what has given my life this halting, incoherent aspect. When I left France, for example, there were a lot of people who said I had gone off on a sudden impulse…

“And then, all of a sudden, I awoke from a sleep which had lasted six years…I couldn’t understand why I was in Indo-China. What was I doing there?…[And so he returned to France]…

“If I am not mistaken, and if all the signs which are piling up are indications of a fresh upheaval in my life, well then, I am frightened…I’m afraid of what is going to be born and take hold of me and carry me off—I wonder where? Shall I have to go away again…Shall I awake in a few months, a few years, exhausted, disappointed…I should like to understand myself properly before it is too late” (1, pp. 14-15).

Author Forgets Sudden Transformations

Amazingly, the rest of the novel makes no mention of sudden transformations. Instead, the protagonist’s problem becomes “nausea,” which eventually leads to his epiphany about existence (1, p. 182), “absurdity” (1, p. 185), and “contingency” (1, p. 188), and his discovery that he might prevent Nausea by becoming a novelist (1, pp. 245-246).

Multiple Personality

The protagonist is described at the beginning of the novel as having the two cardinal symptoms of multiple personality: personality switches and amnesia. And he did not have just the one six-year fugue. He says that he is prone to these sudden transformations, which are what has given his life its “halting, incoherent aspect.”

1. Jean-Paul Sartre. Nausea [1938]. London, Penguin Books, 2000.

Comment

The Times Literary Supplement essay refers to Sartre’s Nausea as “a cult existentialist novel,” implying that it is not an obscure work, but is well known. However, apparently, little attention has been paid to the fact that the protagonist has dissociative fugues, a characteristic symptom of multiple personality (also known as “dissociative identity”). Search “dissociative fugue” in this blog for past posts on the subject. In short, the protagonist’s “sudden transformations” are switches from one personality to another.

Does this mean that Sartre had multiple personality and that existentialism is a reflection of it? I do not know enough about Sartre or existentialism to offer an opinion. All I know is that the protagonist of Sartre’s Nausea has multiple personality: his “sudden transformations” portrayed at the beginning of the novel and then forgotten.

Seven reasons that skeptics, psychiatrists, psychologists, philosophers, literary professors, writers, and others are against multiple personality.

One reason people give for being against multiple personality is that they have never seen it. But there are many conditions that they have never seen, yet they are not antagonistic toward them.

A second reason some people are against multiple personality is that it is absurd to think that a person could have other people inside them. But multiple personality does not mean, and has never meant, multiple people.

Indeed, to get away from that misunderstanding, the American Psychiatric Association changed the name from “multiple personality disorder” to “dissociative identity disorder” to emphasize that the person is psychologically divided, not physically multiplied. When the person switches from one personality to another, it may look like they are more than one person (hence the persistent popularity of the older term), but the diagnosis has never claimed that anyone is more than one person.

Moreover, the diagnosis of multiple personality has nothing to do with schizophrenia and is not a psychosis. It is unfortunate that use of the nonspecific term “madness” has often confused multiple personality with schizophrenia.

A third reason is that many people come from religious traditions that believed in demon possession. They may see the diagnosis of multiple personality as infringing on religion, or may feel that multiple personality actually is demon possession, which is frightening. But the diagnosis of multiple personality assumes that it is a psychological condition.

A fourth reason goes back to the first reason, and is that even eminent and vastly experienced psychiatrists may never have seen a case of multiple personality. I discuss this at length in past posts on the standard mental status examination: it fails to inquire about memory gaps or to investigate puzzling inconsistencies. Most psychiatrists in the USA and probably elsewhere have never been taught how this diagnosis is made or how undiagnosed cases present.

A fifth reason is the false connection between multiple personality and “repressed memory” and “satanic ritual abuse,” which were fads.

A sixth reason is the lingering effect of Freud and the concepts of “repression” and “the unconscious.” In contrast, multiple personality is based on the concepts of dissociation and multiple dissociated consciousness. In multiple personality, things that are “unconscious” to one personality are perfectly conscious to another personality.

A seventh reason is the claim that multiple personality is a meaningless idea, because, in a sense, everyone has multiple personality. But everyone does not have the subjective sense of being more than one person, and does not have memory gaps for the periods of time that an alternate personality was in control.

The kernel of truth in the idea that everyone has multiple personality is that many more people do have it than most people think, because, as I discuss in this blog, there is a normal version, which is much more common than the clinical version.

The normal version is normal in that it does not cause the person clinically significant distress or dysfunction. Indeed, the normal version may be an asset; for example, in writing novels.

Misunderstanding of Multiple Personality by British Medical Journal and World Health Organization results in misdiagnosis of J. R. R. Tolkien’s Gollum.

In 2004, the British Medical Journal published an article by medical students about the diagnosis of J. R. R. Tolkien’s character Gollum. They considered and rejected the diagnosis of multiple personality due to the following misunderstanding:

“The presence of two personalities, Gollum and Sméagol, raises the possibility of multiple personality disorder. In this diagnosis one personality is suppressed by the other and the two personalities are always unaware of each other's existence. In this case, Gollum and Sméagol occur together, have conversations simultaneously, and are aware of each other's existence” (1).

The article’s misunderstanding of the nature of multiple personality was based on the World Health Organization’s ICD-10’s (1992) clinical description and diagnostic guidelines for multiple personality:

“F44.81 Multiple personality disorder This disorder is rare, and controversy exists about the extent to which it is iatrogenic or culture-specific. The essential feature is the apparent existence of two or more distinct personalities within an individual, with only one of them being evident at a time. Each personality is complete, with its own memories, behaviour, and preferences; these may be in marked contrast to the single premorbid personality. In the common form with two personalities, one personality is usually dominant but neither has access to the memories of the other and the two are almost always unaware of each other's existence. Change from one personality to another in the first instance is usually sudden and closely associated with traumatic events. Subsequent changes are often limited to dramatic or stressful events, or occur during sessions with a therapist that involve relaxation, hypnosis, or abreaction” (ICD-10).

Thus, the British Medical Journal and the World Health Organization make two major errors about multiple personality: They say that only one personality may be evident at a time, and that alternate personalities are almost always unaware of each other’s existence. But the opposite is common and routine, as indicated by 1. the fact that it is common for one personality to be a protector or persecutor of another personality (and they have to monitor and interact with the other personality to protect or persecute it), 2. the fact that one personality may hear the voices of other personalities, and 3. the fact that one technique commonly used in therapy is for a group of personalities to have a discussion among them to work out their conflicts, like group therapy (which is possible because the presence of more than two personalities is common).

The World Health Organization and the British Medical Journal could have known better if they had read any of many journal articles or textbooks on multiple personality, such as Putnam’s (2). And I hope that the World Health Organization’s next edition, ICD-11, scheduled for 2018, is more up to date.

1. BMJ. 2004 Dec 18; 329(7480): 1435–1436. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC535969/

2. Frank W. Putnam, M.D. Diagnosis and Treatment of Multiple Personality Disorder.  New York/London, The Guilford Press, 1989.

Added May 9, 2021: BMJ and WHO are basing their misunderstanding on cases in which there are only two personalities. But there are almost always more than two personalities. If you think there are only two, then your diagnosis is probably incomplete. And with more than two personalities, some personalities are unaware of each other, which is why there are memory gaps. But other personalities are co-conscious, either one-way or two-way. Novelists, BMJ, and WHO oversimplify.

Novelists like “a room of one’s own” to alter their state of consciousness, but also so people won’t see their physical appearance change from Jekyll to Hyde.

To get ready to write, most novelists have a routine that helps them to alter their state of consciousness. Some novelists have compared writing to self-hypnosis. And to do self-hypnosis, it helps to have a quiet place, with everything the way they want it; in other words, a room of one’s own.

But once novelists become adept at their self-hypnosis, they could do it almost anywhere, such as coffee shops. So there must be an additional reason that many novelists prefer to write in seclusion.

Although most novelists don’t think of themselves as having multiple personality, per se, many do think of themselves as having a regular self and a writing self—which is multiple personality, even if they don’t call it that—and in multiple personality, it is common for alternate personalities to see themselves as looking different from the regular personality. Thus, seclusion may be preferred to prevent other people from seeing the change in appearance when the person switches from the regular, host personality to any of the alternate personalities.

Of course, if you were to ask novelists if they change appearance when they write, they would probably deny it, because you would be speaking to the regular personality, not an alternate personality. The regular personality has only a vague idea, if any idea at all, about the alternate personalities.

It is the alternate personalities who think that they look different, and who would prefer seclusion, in a room of their own, so that you don’t see them.

Why, then, are some novelists comfortable writing in the presence of other people? Either their alternate personalities remain inside during the writing or they have decided that most people are unobservant and don’t notice that they look different.

An Issue for Married Novelists: Your spouse, knowingly or unknowingly, may have relationships with your characters, narrators, or other alternate personalities.

Novelists are often impressed by the fact that their characters, narrators, etc., know things that their regular self or writer self had not known. And it is not just that they seem to have minds of their own, but that they seem to have lives of their own.

The novelist may assume that these others’ lives exist only inside, in the dream world, so to speak. And for the most part, that’s true. But mightn’t they sometimes come out into the regular world, too?

You don’t think so? How would you know? You admit that they sometimes know things you don’t. And does your spouse sometimes act like things have been going on that you don’t recall?

Married to a Novelist: Spouses of fiction writers might corroborate the thesis that most novelists have a normal version of multiple personality.

I don’t know if any spouse of a novelist has paid attention to whether the novelist has multiple personality—defined as more than one personality plus memory gaps—and if they did find that the novelist has multiple personality, has written about it.

The only thing I have in a past post that inadvertently addresses this is quotations from the memoir of actress Claire Bloom about her former spouse, novelist Philip Roth, in which she describes occasional changes in his behavior, and his claim of having had amnesia (a memory gap). Of course, you might discount what people say about each other when they are divorced, but the things she says do not sound like typical vindictiveness.

Do you know of any other relevant memoirs of spouses of novelists? Or, if you, yourself, are a spouse of a novelist, any comments?

Can you tell a book by its cover? When the cover of a novel has a fragmented portrayal of a person, does the publisher imply multiple personality?

In yesterday’s post, I speculated about a novel that I have not read, based on the the front cover, the title, and the book review in the New York Times. I thought it would be bizarre to have a front cover like that if it were not meant to convey that the protagonist has multiple personality. But it is possible that all the publisher meant to convey is that the protagonist has conflicts.

Indeed, what is the difference between the view that the character is conflicted between her wishes to be a mother and her wishes to be a writer vs. the view that she has multiple personality, with a family personality and a writer personality, who are in conflict? There are subjective and objective differences between these two scenarios.

Subjective

If the character had multiple personality, she would feel that her family self and her writer self were like two different people. For example, the writer self would feel that she is a person in her own right, that she is the real person, that writing is what she values, and that she can’t identify with the wish to have children and devote herself to family life. She feels her mind is made to create stories and fictional worlds. This is how she is, how she feels, and she is not ambivalent about the type of person she is and what she wants.

In contrast, a character who did not have multiple personality would feel ambivalent. On the one hand, she has enjoyed writing and found it fulfilling, but she also gets joy and fulfillment from family life. Each way of life has pluses and minuses. She can identify with both. So she is conflicted.

Objective

Multiple personality usually has memory gaps to one extent or another, because one personality may have amnesia for the periods of time that another personality was in control. For any particular pair of personalities, they may both be unaware of each other, or one may be aware of the other, but not vice versa.

For example, the family personality may know that she has published things in the past (books with her name on it are in her home on a bookshelf), but may have amnesia for the fiction-writing experience itself, so she does not really identify with it. Meanwhile, the writing personality may be conscious of the family life and the family personality’s activities, but can’t see why a person would want to do that and can’t identify with it.

If the above were the scenario, then other characters, such as the woman’s literary agent or editor, might find that the woman (family personality) does not seem to remember things related to the writing, that she should remember.

Aside from these memory issues in multiple personality, the narrator or other characters might note thinking and behavioral differences. The woman may be noted to have different kinds of thoughts, and to dress and behave differently, depending on which personality was in control.

New York Times Book Review by Edan Lepucki of “The Resurrection of Joan Ashby” by Cherise Wolas: Is this about another writer with multiple personality?

The cover of the book has the kind of fragmented face by which publishers convey that the story is about a person with multiple personality.

In the title of the novel, the word “resurrection” seems to imply that the protagonist, writer Joan Ashby, will eventually “resurrect” her writing personality after its death-like hibernation during the time that her family personality had taken over.

The print version in tomorrow’s New York Times Book Review is titled: “Lost and Found: A writer, her career derailed by domesticity and motherhood, tries to recover her self.”

See what you think: https://www.nytimes.com/2017/10/20/books/review/resurrection-of-joan-ashby-cherise-wolas.html?_r=0

When Writing Book Reviews (post 3): You don’t need to know everything in the following posts on psychiatry, but you should read them to get up to date.

March 24, 2017

American Psychiatric Revolution of 1980: USA embraces Bipolar Disorder (British) and Multiple Personality (French), but abandons Psychoanalysis (Freud)

The third edition of the psychiatric diagnostic manual, DSM-III, was published in 1980. Whereas previous editions had used psychoanalytic terms (e.g., “neurosis”) and assumed the validity psychoanalytic concepts (e.g., “repression” and “the unconscious”), the 1980 edition prided itself on its scientific objectivity. Psychoanalytic terms were no longer used; psychoanalytic theory was no longer assumed; and all diagnoses now had diagnostic criteria (a list of specific signs and symptoms).

Prior to DSM-III in 1980 (and the 1970s leading up to it), USA psychiatry had had an overly broad concept of schizophrenia. Some patients who actually had bipolar disorder (aka manic-depression) or multiple personality had been misdiagnosed as having schizophrenia.

Two events, the introduction of lithium in 1970 (to treat bipolar disorder) and a study that compared British and USA psychiatric diagnosis, convinced USA psychiatrists that they had been misdiagnosing some patients as having schizophrenia, who actually had bipolar disorder.

Another medical awakening in the 1970s was the prevalence of child abuse. Until 1970, psychiatric textbooks had stated that, literally, only one child in a million was the victim of child abuse. But now it was found to be much more common than that.

USA doctors had had blind spots for bipolar disorder and childhood trauma.

Also in the 1970s, some psychiatrists, who may have wondered what else psychiatry had missed, began to recognize cases of multiple personality and its connection to childhood trauma. I was not one of those psychiatrists. My focus in the 1970s was on bipolar disorder. I did not realize that any of my patients had multiple personality until 1986.

The reason I give credit to French psychiatry for multiple personality is that the origin of its basic concept, dissociation, is most associated with French psychiatrists like Pierre Janet (1859-1947). Unfortunately, for most of the 20th century, Janet’s concept of dissociation was eclipsed by Freud’s concept of repression. Since Freud’s concept could not explain the occurrence of even one case of multiple personality, so long as Freud was popular, the diagnosis of multiple personality would likely be missed.

However, DSM-III (1980)—and subsequent editions of the American Psychiatric Association’s official diagnostic manual (the latest edition is DSM-5, published in 2013)—do have a chapter devoted to dissociative disorders, including multiple personality (aka dissociative identity disorder), but do not have a chapter for “repression disorders,” because Janet was right and Freud was wrong.

February 5, 2016

Must literary critics know any psychiatry? Are critics incompetent if they fail to note the unacknowledged multiple personality that is present in many novels?

Acknowledged Multiple Personality

When Alfred Hitchcock directed “Psycho” and Charles Dickens wrote “The Mystery of Edwin Drood,” they assumed that everyone watching the film or reading the book would know some psychiatry: When the character’s multiple personality was finally revealed, everyone would recognize it. And any critic who didn’t recognize it would be incompetent.

Unacknowledged Multiple Personality

Novels discussed in this blog illustrate that unacknowledged multiple personality is relatively common, much more common than acknowledged multiple personality. In these works, the author hadn't intended to raise the issue of multiple personality, and it is there only because it reflects the author’s own mind and own concept of ordinary psychology.

The Critic’s Responsibility

One of the traditional responsibilities of literary criticism is to explain why a novel has the impact that it does. Unacknowledged multiple personality gives characters and plots an aura of hidden meanings and psychological depth. It is one of the things that makes a novel “serious” and “literary.” Critics should know about this.

December 8, 2014

Schizophrenia, Bipolar Disorder, Multiple Personality: Objectively, Not Emotionally, Multiple Personality is the Least Controversial

Schizophrenia and Bipolar Disorder

For more than a hundred years—and now as much as ever—there has been a scientific controversy as to whether schizophrenia and bipolar disorder are, or are not, different diseases. The four main reasons for the controversy are:

1. genetics: studies show a large overlap for bipolar and schizophrenia.

2. medication: many of the same medicines are used to treat both.

3. heterogeneous symptoms: two persons diagnosed with schizophrenia may be quite different from each other; this may also be true of two persons diagnosed as bipolar.

4. overlap of symptoms: persons diagnosed with schizophrenia or bipolar disorder may have many of the same symptoms. This is sometimes such a problem that an intermediate diagnosis, schizoaffective disorder, is used.

Why, then, don’t news stories about schizophrenia begin: “In the latest study of schizophrenia, one of the most controversial diagnoses in psychiatry…”? The reason is that it is a controversy, about which, very few people get emotional.

Multiple Personality

In contrast to schizophrenia and bipolar disorder, the symptoms used to diagnose multiple personality are not found in any other psychiatric disorder.

And whereas schizophrenia and bipolar disorder have been recognized clinical entities, reported in the medical literature, for about a hundred years, multiple personality has been a recognized clinical entity, reported in the medical literature, for at least two hundred years.

This is not to say that what is now called schizophrenia and bipolar disorder did not always exist. They probably did—although some historians dispute that they did—but they had not been considered distinct diagnoses.

And this is not say that multiple personality has only existed for two hundred years. Previously called demon or spirit possession, it had been known since antiquity.

“Controversial”

So the next time you hear multiple personality referred to as “the most controversial diagnosis in psychiatry,” you should think, “The most controversial? Compared to what?”

And you should be aware of how the word “controversy” is being used. It is being used to refer to the fact that the issue makes some people emotional.

December 4, 2016

Hearing Voices: According to clinical psychiatry, the field that knows most about it, hearing voices is typical of only two conditions — psychosis and multiple personality.

When Charles Dickens mentioned to someone that he heard the voices of his characters, he was accused of being crazy. But more than a half century later, after author interviews had become common, it was found that most authors hear the voices of their characters.

And surveys have found that a substantial minority of the general public hears voices, too.

So public opinion on hearing voices has gone from one extreme to the other. Whereas it used to be thought that hearing voices always meant that you were psychotic, now many people think that hearing voices means nothing in particular.

Whose opinion on this should you trust? Not academics (psychologists or philosophers). The discipline with most expertise on hearing voices is clinical psychiatry (and clinical psychology, etc.). Clinicians have been asking people “Do you hear voices?” for generations, and the results are in DSM-5, the latest edition of the psychiatric diagnostic manual.

In short, hearing voices (auditory hallucinations) is typically found in two conditions: 1. schizophrenia (and other psychotic disorders), and 2. multiple personality (“dissociative identity disorder”), a nonpsychotic “dissociative disorder.”

Therefore, when nonpsychotic persons hear voices, the condition that they are most likely to have is multiple personality, in which the host personality hears the voices of alternate personalities.

January 30, 2015

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.

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

December 6, 2013

Two Key Clues to Hidden Presence of Multiple Personality (Dissociative Identity): The Person’s Puzzling Inconsistencies and Unreported Memory Gaps

Puzzling Inconsistencies

Real people are not perfectly consistent and predictable. So fiction writers make sure to add a little inconsistency and unpredictability to help turn a “flat” two-dimensional character into a “round” three-dimensional character.

Nevertheless, real people do not act randomly. They are fairly consistent and have reasonable predictability, which is the basis for our concept that a person has a personality.

So what should we make of it if a person has puzzling inconsistencies? One possibility is that we really don't know the person very well, and they have things going on in their life that we don't know about, and these things, once known, will easily explain the inconsistencies. But what if we do know the person very well and we still find their inconsistencies puzzling?

Unreported Memory Gaps

Most people assume that if a person had memory gaps they would complain about it. And that is a safe assumption if the memory gaps are something new. But what if the person has had memory gaps since childhood? It is part of the fabric of their life. It is nothing new. For all they know, everyone else has the same thing. And so it just seems to them like something that is best to ignore. If you don’t ask them about it, they will never tell you.

Psychiatric News

American Psychiatric Association

May 04, 2007

Mental Status Exam

Kenneth A. Nakdimen, M.D.

The standard mental status exam's assessment of memory has a blind spot. It doesn't ask patients if they've had recurrent sober memory gaps (dissociative amnesia), which is often the only clue that a patient might have dissociative identity disorder (DID). It leaves it to patients to raise the issue.

Why don't undiagnosed DID patients bring up the subject of their memory gaps? First, they don't know its clinical significance (that these might be times that other identities were "out"). Second, they are generally unaware that they've lost time, except when something embarrassing, confusing, or disturbing confronts them with the fact, and they don't like to think about it. Third, they're afraid that telling people they have memory gaps—periods of time they don't remember and when they're not in control of their own behavior—might make people think they're "crazy."

Why do clinicians need a "clue" (memory gaps) to the presence of DID? What's the mystery? When DID is present, isn't it obvious? If you've ever seen an interview of a known DID patient, weren't the switches from one identity to another something you couldn't miss?

Actually, what you see in such an interview is the postdiagnosis picture, not how DID presents. Prediagnosis, alternate identities usually answer to the patient's regular name, because they prefer to remain incognito. They lose that reticence once diagnosis has blown their cover, but all that you would have found prediagnosis (if you had inquired) were memory gaps.

Once you discover that your patient does have a history of memory gaps, you can ask about these episodes. For example, after some gaps, a patient finds poems. She agrees that nobody else could have written these poems (which she found among her personal papers), but she doesn't remember writing them; they don't express her views, and they're not even in her handwriting.

Keeping the interview focused on these poems will eventually cause a switch to the identity who wrote them. You might ask this identity why she writes poems, her age, and her name. If you then turn the focus away from the poems, or simply address the patient by her regular name, you will prompt a switch back to the regular identity, who has amnesia (a memory gap) for your conversation with the poetry-writing identity.

The standard mental status exam does not now, but should, screen for memory gaps (dissociative amnesia). Otherwise, when it comes to diagnosing DID, the clinician will be clueless.

May 6, 2017

Harvard Review of Dissociative Identity Disorder (Multiple Personality): Not Fad, Not Cultural, Not Rare, Not Iatrogenic, Not Borderline, Not Temporary.

Harvard Review of Psychiatry. 2016 July; 24(4): 257-270.

“Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity Disorder”

Bethany L. Brand, PhD, Vedat Sar, MD, et al.

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

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4959824/pdf/hvp-24-257.pdf