“Postmortem” by Patricia Cornwell (post 2): First-person protagonist and a voice in her head argue with each other, a textbook symptom of multiple personality

The Textbook

Multiple personality patients “will report hearing voices talking, arguing…in their heads. The voices may be pejorative and critical or supportive…Many multiples are fearful of acknowledging the existence of voices early in the course of therapy, lest the therapist think that they are ‘crazy’…Many host [regular] personalities already have some form of communication with the other alters [alternate personalities] when they present for treatment, although they are usually not aware of what is happening. The experience of the host personality is that he or she gets into arguments with himself or herself” (1, pp. 81-82).

The Novel

“My anxious inner voice was nagging at me again. You just can’t accept you made a mistake, I admonished myself. You just can’t handle the truth…But what if? What if the scenario were a more pernicious one? I silently argued…You want someone to blame because you can’t face the fact that you probably screwed up!” (2, pp. 252-253).

1. Frank W. Putnam, MD. Diagnosis and Treatment of Multiple Personality Disorder. New York, The Guilford Press, 1989.

2. Patricia Cornwell. Postmortem [1990]. New York, Pocket Books/Simon & Schuster, 2017. 

“Postmortem” by Patricia Cornwell (post 1): In first novel featuring Dr. Kay Scarpetta, chief medical examiner, a serial killer, Mr. Nobody, terrorizes the city

The Author

In a video interview, Cornwell describes her creative process and relationship with her characters (1). In a newspaper interview, “I grew up with fear,” she gives some insight into her background (2). Wikipedia provides an overview of the author, who has sold more than one hundred million books (3).

The Novel

In the first ninety pages, first-person narrator, Dr. Scarpetta, is medical examiner on the case of an unidentified serial killer who is terrorizing the city, and is “…an obsession of mine. Mr. Nobody” (1, p. 4). Since that way of referring to the killer is only tentative, I’m not sure whether to relate it to past posts on the namelessness of alternate personalities.

Aside from that, the only things so far to suggest that Scarpetta might have multiple personality—which, as far as I know, has never been attributed to this character—are the following two passing remarks by Scarpetta:

“At the same time I think a part of me knew” (1, p. 70). People with undiagnosed multiple personality may feel they have distinguishable “parts” (personalities) that know things.

“…I heard myself say” (1, p. 87), implies two thinking “parts” (personalities), the hearer and the sayer.

1. Video Interview https://www.youtube.com/watch?v=5ZUKsX8oKKM

2. Newspaper interview https://www.theguardian.com/books/2015/nov/01/patricia-cornwell-i-grew-up-with-fear

3. Wikipedia. https://en.wikipedia.org/wiki/Patricia_Cornwell

4. Patricia Cornwell. Postmortem [1990]. New York, Pocket Books/Simon & Schuster, 2017.

“The Push” by Ashley Audrain (post 2): Blythe sees her daughter as homicidal, which her husband thinks is crazy. Whose view will be vindicated?

Cynics would say Blythe will be vindicated, because as a woman and mother, she would appeal to a much larger novel-buying demographic. Feminists would say Blythe should be vindicated, because women and mothers are unfairly called crazy. Readers who recognize Blythe’s symptoms of multiple personality would say that she will be vindicated, because multiple personality is not a psychosis, and she is in touch with reality.

Early in the novel, before Blythe had seen anything homicidal about her young daughter, Violet, she perceived Violet’s abnormal responsiveness: “She should want me. I’m her mother. She should need me” (but she doesn’t). Blythe’s husband replied, “There’s nothing wrong with her,” implying there was something wrong with Blythe.

And Blythe varies in her feelings toward Violet, depending on which of Blythe’s two mothering personalities is in control: “I rarely felt this yearning for her, especially when I should have, but when I did, I couldn’t remember [she had a multiple-personality memory gap] what it was like not to want her. Who was that other mother? The one who brought me such shame?” (1, p. 86).

At a later date, after she had witnessed Violet push her little brother, Sam, to his death in traffic, Blythe says, “I have no memory of what happened next or how we got to the hospital,” another multiple-personality memory gap (1, p. 151).

And at a still later date, Blythe developed an alternate personality based on her deceased son, Sam. She would sometimes interact with this alternate personality like an imaginary companion: “my imaginary friend…My sweet son” (1, p. 243).

And in an embarrassing situation with her estranged husband, Blythe has a dissociative experience (multiple personality is a dissociative condition): “My head floated away…I left myself. I watched from above” (1, p. 248).

None of the above experiences is labelled as dissociative or as having anything to with multiple personality, because they are probably in the novel only as a reflection of the author’s psychology.

Concluding Evidence of Multiple Personality: The whole novel is narrated by Blythe in the first person, except for the last two pages, where an unnamed, unlabelled, alternate narrator personality describes what is happening with Blythe in the third person (1, pp. 302-303).

I don’t know the author’s explanation for switching narrators in the last two pages, but I would be surprised if her explanation had anything to do with multiple personality, since the issue, though present (see above), has been unacknowledged throughout the novel, as in most novels.

1. Ashley Audrain. The Push. Pamela Dorman/Viking/Penguin Random House, 2021.

Added next day: A possible rationale for the sudden, last-minute change in narrator has just occurred to me. The final line of the novel is supposed to be a twisty clincher as to whether or not Blythe had been credible, and it might have undermined the credibility of the twisty clincher if Blythe had been the narrator. Okay, I see that. However, the sudden change in narrator personality is a multiple-personality-style personality switch, which is another example of the multiple-personality way that the author thinks (which is like most other great fiction writers).

“The Push” by Ashley Audrain (post 1): Narrator-Protagonist Blythe Connor says, “A part of me knew…,” which suggests an alternate personality

In the first quarter of this novel, there are no good guys among the main characters. The narrator, Blythe Connor (a name which might connote a woman who happily cons people) (the back flap says the author’s background is in publicity) addresses her former husband, Fox Connor (a clever con man?).

Most reviews discuss the novel as being about motherhood and problem children (Violet, here). And Blythe adds emphasis by repeatedly giving flashbacks to her horrible mother and grandmother, and her own abused childhood. But no woman is single, so men are partly responsible for everything horrible that happens.

Blythe is an aspiring fiction writer, but how she got into writing and what she writes about in her fiction have not been mentioned. The story is focused on her horrible motherhood, which has run in her family.

So far, inside the novel, I have come across only one inadvertent suggestion of multiple personality. Blythe says, “A part of me knew…” (1, p. 33). Persons with undiagnosed multiple personality may think of themselves as having “parts” that know things.

The cover (2) of the novel features an inkblot (as in The Rorschach test) of a woman split in two, back to back (at least, that’s what it looks like to me). I don’t know who was responsible for this cover or what they had in mind. It could be either a generic reference to psychological problems or a specific reference to multiple personality. In addition, the letters of the title have splits. And so do the letters of the author’s name. In short, intentionally or inadvertently, the cover suggests a split personality.

1. Ashley Audrain. The Push. Pamela Dorman/Viking/Penguin Random House, 2021.

2. https://www.penguinrandomhouse.com/books/625327/the-push-by-ashley-audrain/

“Faust” (post 3) by Goethe (post 5): Why is Part Two a non sequitur? Goethe didn’t know. Then who did know?

Part 1 ends when Faust’s beloved has been imprisoned for killing their out-of-wedlock child. Faust goes to free her. She refuses to flee with him. And as a “voice from above” (God) says, “She is saved!” (1, p. 167), Faust leaves with Mephistopheles.

Part 2, according to this edition’s Notes, is a non sequitur. “The change of scene in passing from Part One to Two is shocking: from a night-shrouded death cell to an Alpine field of flowers bathed in a soft twilight…The common reader, turning to it from Part One, is dismayed, the uncommon reader as well. Whatever is going on? It defies all rules, with royal indifference…Goethe is reported by J. F. Eckermann, his Boswell, as saying, ‘It would have been a fine thing indeed if I had strung so rich, so varied and diversified a life as I have exhibited in Faust upon the slender string of one pervading idea.’ ‘What does it mean,’ people came and asked him. ‘As if I knew myself,’ was his reply” (1, pp. 453-454).

The alternate personality, who did know, but was not asked, did not explain.

1. Johann Wolfgang von Goethe. Faust: A Tragedy, Parts One [1806/1829] & Two [1831], Fully Revised. Translated from the German by Martin Greenberg. New Haven, Yale University Press, 2014.

Added same day: The above is an example of what I have previously called a "split inconsistent narrative." Search it for discussions related to other works.

Later same day: I could not get interested in Part Two. 

“Faust” (post 2) by Goethe (post 4): Faust sees an alternate personality when he looks in a mirror, reflecting multiple personality trait in the author

Mirrors are a recurring subject in this blog, because it is known that persons with multiple personality may occasionally see one of their alternate personalities when they look in a mirror.

In fiction, this may be explained away by saying it is a “magic mirror.” But it would have made more sense for fiction to have had magical windows.

“FAUST. Who meanwhile has been standing in front of a mirror, going forward to peer into it from up close and then stepping back.

What do I see? What a marvelous vision

Shows itself in this magic glass!

Love, lend me your wings, your swiftest to pass

Through the air to the heaven she must dwell in!

Unless I stay firmly fixed to this spot,

If I dare to move nearer the least bit,

Mist blurs the vision and obscures her quite.

Woman unrivaled, beauty absolute!

Can such things be, a creature made perfectly?

The body so indolently stretched out there

Surely epitomizes all that is heavenly.

Can such a marvel inhabit down here?” (1, lines 2477-2490).

A magical mirror in fiction may reflect multiple personality trait in the writer. In the above example, it is not a problem that the alternate personality would be of a different sex and age than the character or writer, since alternate personalities are often of a different sex and age than the host personality.

1. Johann Wolfgang von Goethe. Faust: A Tragedy, Parts One [1806/1829] & Two [1831], Fully Revised. Translated from the German by Martin Greenberg. New Haven, Yale University Press, 2014.

“Faust” (post 1) by Goethe (post 3): Play dedicated to spirits and ghosts, author’s “reality”; God gives Mephistopheles “carte blanche”; Faust’s “two souls” 

“Dedication”

This play, written in verse, begins with an author’s “Dedication” to the spectral spirits he has enjoyed since childhood:

“Come back, have you, you figures shifting, spectral,

Who first appeared to me when I was young?…

“What lively scenes you bring back, days how happy,

Beloved shadows come again to life;…

“And a yearning, unfelt, unroused for so long,

For that solemn spirit world, seizes me,…

“And vanished ghosts are my reality” (1, lines 1-32).

“Prologue in Heaven”

“The Lord,” in a meeting with “Mephistopheles,” gives his “full consent” for Mephistopheles to work with Faust in the “cat’s way with a mouse,” since, God says, “A good man always knows the way that’s right.” To which Mephistopheles replies, “Yet I’ll seduce him from it soon enough.” The Lord replies “…you have carte blanche. I’ve never hated your likes much, I find of all the spirits of denial, You jeerers not my severest trial…So I’m glad to give him a devil—for his own good, To prod and poke and incite him as a devil should” (lines 330-354).

Faust’s “two souls”

Faust, a scholar, says:

“Two souls live in me, alas,

Irreconcilable with one another.

One, lusting for the world with all its might,

Grapples it close, greedy for all its pleasures,

The other rises up, up from the dirt,

Up to the blest fields where dwell our great forbears” (lines 1138-1143).

Comment

The author’s spirits and ghosts—to the extent that they are imaginary, personified beings, experienced as having minds of their own—are alternate personalities, as are Faust’s two souls. Goethe’s relationship between God and Mephistopheles is intriguing enough to mention, but beyond my scope, unless you want to argue that they are alternate personalities, which I don’t.

1. Johann Wolfgang von Goethe. Faust: A Tragedy, Parts One [1806/1829] & Two [1831], Fully Revised. Translated from the German by Martin Greenberg. New Haven, Yale University Press, 2014. 

“Villette” (post 6) by Charlotte Brontë (post 18): Narrator-protagonist, Lucy Snowe, on the multiplicity of her creative process and sense of identity

“I, to whom nature had denied the impromptu faculty; who, in public, was by nature a cypher; whose time of mental activity, even when alone…needed the fresh silence of morning, or the recluse peace of evening, to win from the Creative Impulse one evidence of his presence, one proof of his force; I, with whom that Impulse was the most intractable, the most capricious, the most maddening of masters…—a deity, which sometimes…would not speak when questioned, would not hear when appealed to, would not, when sought, be found; but would stand, all cold…all granite…like the stone face of a tomb; and again, suddenly, at some turn, some sound, some long-trembling sob of the wind…the irrational demon would wake unsolicited, would stir strangely alive…perhaps filling its temple with a strange hum of oracles, but sure to give half the significance to fateful winds, and grudging to the desperate listener even a miserable remnant…” (1, p. 356).

“Is there another Lucy Snowe?” (1, p. 486).

1. Charlotte Brontë. Villette [1853]. Edited by Margaret Smith and Herbert Rosengarten. Introduction and Notes by Tim Dolan. Oxford, Oxford University Press, 2000/2008. 

Harold Bloom’s Rage to Read, “The Daemon Knows,” and Multiple Personality in Literary Creativity

Since this Sunday’s front page of The New York Times Book Review will feature the following essay on Harold Bloom by Robert Gottlieb…

Robert Gottlieb. “The Rage to Read.” January 31, 2021. https://www.nytimes.com/2021/01/23/books/review/bright-book-of-life-harold-bloom.html

…I will take this opportunity to reprint my post on a book by Bloom that Gottlieb does not mention:

December 11, 2015

"The Daemon Knows" by Harold Bloom: He refers to daemons as supernatural, alternate personalities, who produce and/or appreciate creative works.

“What lies beyond the human for nearly all of these writers is the daemon, who is described and defined throughout this book. The common element in these twelve writers…is their receptivity to daemonic influx. Henry James, the master of his art, nevertheless congratulates his own daemon for the greatest of his novels and tales” (1, p. 4).

“Whitman had no poetic method except his self, though I should say ‘selves,’ as there were three of them: ‘myself, Walt Whitman, an American, one of the roughs,’ and also ‘the real Me’ or ‘Me myself,’ and the nearly unknowable ‘my Soul’ “ (1, p. 54). “The ‘real Me’ or ‘Me myself’ is an androgyne, whereas the persona Walt is male and the soul is female” (1, p. 57).

But Whitman said that he had more than three personalities:

“Do I contradict myself?

Very well then…I contradict myself;

I am large…I contain multitudes” (1, p. 68).

“Shakespeare entertained a bevy of daemons: Hamlet, Falstaff, Iago, Cleopatra, Macbeth among them. They did not possess him, though Hamlet and Falstaff edged closest. It is a nice question whether daemonic Ahab possessed Melville. The twelve great writers centering this book were all possessed…” (1, p. 122).

“Where is Melville the man in Moby-Dick? Split at least three ways (Ishmael, Ahab, narrator), he is somewhat parallel to Whitman, who in 1855 also is tripartite…” (1, p. 125).

“Daemonic agency is the hidden tradition of American…narrative (Poe, Melville, Hawthorne, Twain, James, Faulkner)…In narrative, the protagonists are possessed by daemons, conquistadores somehow ordering a chaos of unruly other selves” (1, p. 135).

“The obscure being I could call Bloom’s daemon has known how it is done, and I have not. His true name (has he one?) I cannot discover, but I am grateful to him for teaching the classes, writing the books, enduring the mishaps and illnesses, and nurturing the fictions of continuity that sustain my eighty-fifth year” (1, p. 156).

Hart Crane…Like John Keats, he had a truer sense of other selves than most of us can attain” (1, p. 158).

“Emerson, a scholar in the broadest sense, formulated what he chose to call ‘the double consciousness’ “ (1, p. 165). Search “double consciousness” in this blog.

“I conclude by expressing a lifelong sense of personal gratitude to Hart Crane, who addicted me to High Poetry. He taught me that my own daemon desired that I read deeply, appreciate, study, and clarify my response to his work. In doing so, my long education began and is ongoing” (1, p. 496).

1. Harold Bloom. The Daemon Knows: Literary Greatness and the American Sublime. New York, Spiegel & Grau, 2015. 

“Villette” (post 5) by Charlotte Brontë (post 17): Polly/Paulina is probably another character with unacknowledged multiple personality

In the last post, the protagonist, Lucy Snowe, was discovered to have multiple personality by virtue of a discrepancy in memory from one time to another (implying that different personalities had different memory banks). Her multiple personality would not have been suspected from obvious overt behavior, which is most commonly the case, and the reason that finding memory gaps is usually the first step in making the diagnosis.

However, when a person does have remarkable changes in behavior, beyond what one would expect from having one drink or being with different people, even those who know the person well may be puzzled. But they usually don’t think of multiple personality, as is seen with the character Polly/Paulina:

She changed “into another tone and manner as soon as she had fairly assayed the beverage, just as if it had acted upon her like some disenchanting draught, undoing the work of a wizard…the child of seven was in the girl of seventeen. Graham looked after her a little baffled, a little puzzled…I saw he hardly knew how to blend together in his ideas the dancing fairy and delicate dame…

“But she had other moods besides the arch and naïve…all the child left her…she rose at once to the little lady: her face seemed to alter, that play of feature, and candour of look, which, when she spoke to her father, made it quite dimpled and round, yielded to an aspect more thoughtful, and lines distincter and less mobile.

“No doubt, Graham noted the change as well as I" (1, pp. 282-287).

In short, Lucy Snowe and Graham, who have known Paulina since she was a young child, are puzzled by these behavioral changes (suggestive of multiple personality), but don’t know what to make of it or what questions might lead to an explanation (e.g., age self-image, fund of knowledge, what year it is, and memories that vary with the behavior).

1. Charlotte Brontë. Villette [1853]. Edited by Margaret Smith and Herbert Rosengarten. Introduction and Notes by Tim Dolan. Oxford, Oxford University Press, 2000/2008. 

“Villette” (post 4) by Charlotte Brontë (post 16): Plot twist—Dr. John is Graham from Lucy Snowe’s past—means protagonist has multiple personality

The protagonist-narrator, Lucy Snowe, 24, is working as an English teacher in Belgium. Dr. John is the visiting physician for the school. Lucy gets depressed when she remains at the school while almost everyone else is on holiday. Then, out at night, she faints or blacks out. When she wakes up, she doesn’t know where she is, but the place has furnishings that she clearly recalls from visits to her godmother ten years earlier. She can’t account for it:

“Where was I? Not only in what spot of the world, but in what year of our Lord? For all these objects were of past days, and of a distant country. Ten years ago I bade them good-bye; since my fourteenth year they and I had never met. I gasped audibly, ‘Where am I?’ ” (1, pp. 166-167).

It turns out that Dr. John is Dr. John Graham Bretton, the son of Lucy’s godmother, Mrs. Bretton, both of whom Lucy had known very well from visits to her godmother ten years ago. Recently, when Dr. John and Lucy have met at the school, he has not recognized her as being Lucy Snowe from his past. In contrast, she now says that she has recognized who he was for months, but has not felt like saying so until now.

However, if for months, Lucy had recognized Dr. John as the Graham she had known very well from visits to her godmother’s house years ago, then why, when she now wakes up and sees all those old familiar furnishings, doesn’t she immediately come to the obvious conclusion, that she must be in Dr. John Graham Bretton’s house?

The explanation (not given in the novel or Wikipedia) is that Lucy had more than one personality. The personality that had, for months, recognized Dr. John as her godmother’s son, was not the same personality who woke up in his house.

And though Dr. John now recognizes Lucy as his old acquaintance, why hadn’t he recognized her the various times they had met at the school? Apparently, her teacher personality was not the personality he had previously known, and different personalities may have such different attitudes, facial expressions, and body language that they can seem like different people.

In short, this “plot twist” and “unreliable narrator” is actually a revelation that the protagonist has multiple personality, even if the author did not think of it in those terms.

1. Charlotte Brontë. Villette [1853]. Edited by Margaret Smith and Herbert Rosengarten. Introduction and Notes by Tim Dolan. Oxford, Oxford University Press, 2000/2008. 

“Villette” (post 3) by Charlotte Brontë (post 15): Protagonist Lucy Snowe has “two lives,” trance states, and switches back to being Lucy Snowe

“I seemed to hold two lives—the life of thought, and that of reality; and, provided the former was nourished with a sufficiency of the strange necromantic joys of fancy, the privileges of the latter might remain limited to daily bread, hourly work, and a roof of shelter” (1, p. 77).

Most people feel like they are one person who has both private fantasies and practical thoughts. Persons with multiple personality may feel they have two (or more) ways of thinking and feeling that are so different it’s like different people.

“Oh, my childhood! I had feelings: passive as I lived, little as I spoke, cold as I looked, when I thought of past days, I could feel. About the present, it was better to be stoical; about the future—such a future as mine—to be dead. And in catalepsy and a dead trance, I studiously held the quick of my nature” (1, p. 109).

Her references to a problematic childhood, being suicidal, and trance states are not adequately explained, but such things are more common in persons with multiple personality.

“I never had felt so strange and contradictory an inward tumult as I felt for an hour that evening: soreness and laughter, and fire, and grief, shared my heart between them…However, that turmoil subsided: next day I was again Lucy Snowe” (1, p. 119).

She probably feels “strange and contradictory,” because of switching among conflicting alternate personalities, but by the next day, she has switched back to her regular personality, Lucy Snowe.

1. Charlotte Brontë. Villette [1853]. Edited by Margaret Smith and Herbert Rosengarten. Introduction and Notes by Tim Dolan. Oxford, Oxford University Press, 2000/2008. 

“Villette” (post 2) by Charlotte Brontë (post 14): Metaphor, Word Choice, and Multiple Personality; “Faculties” may mean her Alternate Personalities

During Lucy Snowe’s brief first visit to London, she has interesting ways of thinking when she is by herself; interesting, that is, if you assume, as I do, that Brontë’s metaphor and choice of words were meaningful to her.

Common-sense as a Personality

“Into the hands of Common-sense I confided the matter. Common-sense, however, was as chilled and bewildered as all my other faculties, and it was only under the spur of an inexorable necessity that she spasmodically executed her trust. Thus urged, she paid the porter: considering the crisis, I did not blame her too much that she was hugely cheated…” (1, p. 46).

She says, “I said” while alone (to whom?)

“I did well to come,” I said, proceeding to dress with speed and care. “I like the spirit of this great London which I feel around me. Who but a coward would pass his whole life in hamlets, and for ever abandon his faculties to the eating rust of obscurity” (1, p. 48).

But four pages later, she says “I reflected” and “this thought was crossing my mind” (1, p. 52). That is, when she experiences herself as having her own thought, she says so. Which raises the question as to whom she experiences herself as talking, when, by herself, she says “I said.”

Comment

Is “Common-sense” the name Brontë has given to one of her alternate personalities? And when she is alone, but says rather than thinks something, is she speaking to an alternate personality? And is “faculties” her euphemism for alternate personalities? If, as most great fiction writers, Brontë had multiple personality trait, the answers are probably yes.

1. Charlotte Brontë. Villette [1853]. Edited by Margaret Smith and Herbert Rosengarten. Introduction and Notes by Tim Dolan. Oxford, Oxford University Press, 2000/2008. 

“Villette” (post 1) by Charlotte Brontë (post 13): Lucy Snowe, first-person narrator-protagonist, gets thought from, converses with, “solemn stranger”

I have already discussed Charlotte Brontë and Jane Eyre in a dozen past posts, but Villette is said to be her “most autobiographical novel” (1, p. xxxv). I have just started it.

Near the beginning of this 496-page novel, Lucy Snowe, 22, walking alone on a clear, frosty night, and having just seen the Aurora Borealis, converses with a thought or voice that had been inserted into her mind by an unseen “solemn stranger”:

“But this solemn stranger influenced me otherwise than through my fears. Some new power it seemed to bring. I drew energy with the keen, low breeze that blew on its path. A bold thought was sent to my mind; my mind was made strong to receive it.

“ ‘Leave this wilderness,’ it was said to me, ‘and go out hence.’

“ ‘Where?’ was the query.

“I had not very far to look: gazing from this country parish in the flat, rich middle of England—I mentally saw within reach what I had never yet beheld with my bodily eyes; I saw London” (1, pp. 43-44).

Comment

Some readers might interpret the above as a literary metaphor. Some psychiatrists might see it as thought-insertion, a “first-rank symptom” of schizophrenia. In the case of a great fiction writer like Charlotte Brontë, I am inclined to agree with the finding that first-rank symptoms are often diagnostic clues to multiple personality (2).

If her thought or voice comes from an alternate personality, what is its name? It may have no name. Many alternate personalities don’t. So they are referred to descriptively. Brontë calls this one the “solemn stranger.”

1. Charlotte Brontë. Villette [1853]. Edited by Margaret Smith and Herbert Rosengarten. Introduction and Notes by Tim Dolan. Oxford, Oxford University Press, 2000/2008.

2. Kluft, R. P. (1987). First-rank symptoms as a diagnostic clue to multiple personality disorder. The American Journal of Psychiatry, 144(3), 293–298 https://psycnet.apa.org/record/1987-22128-001