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.