Over the last thirty years, the diagnosis of multiple personality
disorder (MPD or MPS) has been made with increasing frequency in the
USA and Canada (Boor, 1992; Freeland et al., 1993), where it has been
estimated to be "roughly as common as schizophrenia" (Ross, 1997).
Although many psychiatrists remain deeply sceptical about the
phenomenon (French & Shechmeister, 1983; Lewis & Bard, 1991; Dinwiddie
et al., 1993; Saks, 1994), its inclusion in DSM III (American
Psychiatric Association, 1980) in 1980 as a distinct clinical entity
both reflected its acceptance by a section of American psychiatric
opinion, and encouraged the identification of further "cases"
(Halleck, 1990). With the publication of autobiographical and other
accounts of MPD sufferers (e.g. Thigpen & Cleckley, 1957; Schreiber,
1973; Hawksworth & Schwartz, 1977; Keyes, 1981; The Troops for Truddi
Chase, 1987; Casey, 1991), MPD has been absorbed into the popular
consciousness. With thousands of cases diagnosed and proponents
publishing large personal series (Bliss, 1980; Bliss & Jeppsen, 1985;
Putnam et al., 1986; Coons et al., 1988; Ross et al., 1989; Ross et
al., 1990), it has inevitably entered the courtroom and into the
practice of forensic psychiatrists and psychologists (Slovenko, 1993).
Courts have recognised so-called "alter" personalities as having
separate existences for the purposes of sworn testimony (Allison,
1982; Slovenko, 1989; Perr, 1991). Alters have asked for separate
legal representation (French & Shechmeister, 1983). MPD has resulted
in acquittals in cases of forgery (Allison, 1982) and rape (Perr,
1991). It has been presented as evidence of incompetency (unfitness to
plead) (Saks, 1994), on occasion with success in murder cases (Coons,
1991). It has formed the basis of successful insanity pleas in cases
of rape (Keyes, 1981) and murder (Allison, 1982; Perr, 1991).
Defendants have malingered MPD (Abrams, 1983; Orne et al., 1984;
Coons, 1991). The disorder has been the subject of at least one civil
malpractice suit for wrongful (positive) diagnosis (Serban, 1992), and
conversely it has been argued that clinicians face legal jeopardy if
they fail to diagnose MPD in patients "with the condition" (Hardy et
al, 1988). This use of MPD in the court-room has aroused concern about
its implications for the attribution of moral, legal and criminal
responsibility, and raised fundamental questions about individuality,
"personhood", and the justification for punishment (Gillett, 1986;
Slovenko, 1989; Halleck, 1990; Saks, 1992; Slovenko, 1993; Beahrs,
1994; Saks, 1997). The US experience and the particular difficulties
that have confronted US courts are examined in detail below.
1) The right to legal representation
French and Shechmeister (1983) report a Californian case, where an
"alter" specifically requested separate representation. The authors
acknowledge that his interests were substantially different to those
of the other personality "present" and, as such, to represent both
might present a conflict of interests. They could find no basis in law
for the exclusion of the second personality as a representable entity.
Their casual survey of local defence attorneys suggested that a second
personality could readily obtain such representation, initially at
least, provided that he presented himself in the proper manner. The
authors concluded that "any personality presenting itself for
representation before diagnosis of MPS may gain at least initial
representation, but once a diagnosis of MPS has been established, the
socially identified primary personality will be represented and all
others will be ignored as symptoms of illness".
2) Allowing different personalities to give evidence at court
It is a small step from individual representation to accepting the
existence of individual entities, and to allowing different alters to
give evidence in court. In the USA, it would appear that it is neither
a particularly rare, nor recent phenomenon for different "alters" to
be allowed to testify. Allison (1982) reports a number of cases from
his own practice. In one case, two pleasant personalities were
"brought out" in court in a man whose "bad personality" had been
arrested for drunken driving. The man then published an autobiography
(Hawksworth & Schwarz, 1977). In another case, that of Anthony J.,
Allison had discovered two alters, "John Grace", a vulgar man who
admitted to the assault and robbery of a doctor's wife, which formed
the substance of the case, and "Alexander", a "rescuer", who supplied
the attorney with all the information that Anthony J. and John Grace
"did not have". John Grace managed to escape from the courthouse, but
was later recaptured, an incident of which Anthony J. had "no memory".
At the trial, Anthony J. took the stand and testified that he did not
remember committing the crimes charged. Then at the attorney's
request, John Grace "came out to testify how he had committed the
crimes, throwing in snide, nasty comments at the judge and the
district attorney along the way". Having waived jury trial, Anthony J.
was found guilty on all counts by the judge. Allison expresses concern
that John Grace might put Anthony J. at risk by antagonising his
gaolers. His conclusion from the case is that, if multiple
personalities are being sent to gaol, then "some adequate treatment
must be found in prison".
The giving of evidence in court by different alters, and the implicit
acceptance that individual personalities can exist as autonomous
entities within an individual person, can result in ever more
complicated tangles of confusion about the attribution of moral and
legal responsibility and can lead to laughable scenes at court
(Halleck, 1988). A defining case of the legal and procedural
difficulties that can arise is that of the State of Wisconsin v. Mark
A. Peterson in 1990, when six of the supposed 47 personalities of a
female witness were sworn in separately. The 26 year-old Sarah
complained that two of her personalities, a child and an adult, had
been raped by Peterson, a 29-year-old grocery worker. It was alleged
that Peterson had made friends with another 26-year-old personality,
called "Franny". He had then been instrumental in calling forth
"Jennifer", a 20-year-old personality, who, according to Franny,
"liked to dance and have fun". Peterson and Jennifer then had sex in
the back of his car. During intercourse, another personality suddenly
intruded, that of a six-year old named Emily. Peterson allegedly told
Jennifer to tell Emily to keep their activities "a secret". Instead,
Franny and Emily "told" Sarah, the "predominant personality", who made
a complaint to the police. Neither Franny, nor Emily, nor Sarah was
said to have consented to sexual intercourse. After a one day pre-
trial hearing (Slovenko, 1989; Los Angeles Times, 1990; Saks, 1994),
the main trial attracted national media attention (Time Inc. Magazine
Company and Compact Almanac, 1990; Washington Post, 1990a; Washington
Post, 1990b).
When Sarah, the complainant took the witness stand, the District
Attorney summoned in turn a number of her personalities. At one point,
the prosecutor and the judge later recalled, she switched briefly
into the personality of a dog (New York Times, 1994).The judge
required the woman to take an oath each time that she changed
personality, and the lawyers formally introduced themselves to each
different personality. The District Attorney began with Franny, who
talked of meeting Peterson in a coffee shop, and telling him in
conversation of her unusual affliction. "I recall telling him that
there were many of us in the body". Franny remembered him asking to
meet Jennifer, but had "no personal knowledge" of what happened after
that, because she hadn't been present. The district attorney then
called forth Jennifer, who waved at the jury, shouting "Hi!" in a
voice different to that of Sarah or Franny. Several jurors lifted
their hands to wave back. Jennifer described in detail the sexual act
in which she had agreed to engage, with (apparently) no understanding
of what had been going on. Asked by the defending attorney: "Didn't
the two of you have sex?". She replied: "I dunno. What's sex?"
Jennifer did however reveal that she had at some point undergone a
tubal ligation. Jennifer denied being a multiple personality or being
in treatment with a therapist or giving such information to Peterson.
The district attorney suggested to the jury that it was obvious that
none of the individual personalities had a mental illness; they were a
mental illness. The defence attorney made motions in the absence of
the jury, reasoning that his client had sex with Jennifer, that
Jennifer was "in touch with reality", and that, even if Sarah didn't
know what she was doing in the front seat of Peterson's car, Jennifer
did. Peterson then testified that he thought he was having sex with
Franny. He stated that he did not know she was ill, but thought she
was "a possible promiscuous person", (a statement that acquired new
meaning in the light of the number of personalities allegedly involved
in, or at least in "the body" at the time of, the sexual act). The
prosecution introduced psychiatrists who testified that Sarah was
suffering from multiple personality disorder, with the number of alter
personalities varying from eighteen to forty-six, some of which were
"fragments", carrying only certain emotions. Sarah's therapist related
to the court that Emily, the six-year old victim, sometimes ate
crayons which the other personalities then had to spit out.
The judge at the outset cautioned those in court that the case was a
sensitive one and "not a circus". Events suggested otherwise.
Spectators queued from the early hours for a seat in court, and
folding chairs had been brought into the courtroom in order to
increase its capacity. The judge had to warn the audience that those
leaving to go to the "bathroom" were likely to find that they had lost
their places upon their return. The District Attorney screened his
jury pool by asking for a show of hands from those who thought the
case too bizarre to contemplate. "You will get the chance to observe
her transform from one personality to another", he said. "It is
somewhat dramatic and most unusual. Is there anyone who feels they
could not be part of that process?" No hands were raised. Awaiting the
verdict, Sarah held audience with the press. She recounted that she
had a personality called "Ginger", who enjoyed getting drunk and
picking up men in bars. She refused to allow access to Ginger, stating
that, when Ginger last appeared, she had "gone on a bender and nearly
killed the body". Sarah stated that one of her personalities,
"Leona", was an "empath", able to experience the emotions of all the
alters, empath being a term absent from Webster's American Dictionary,
but popularised in the television programme "Star Trek". It also
transpired that a number of her personalities were male, although no-
one appears to have asked her whether these were also raped. In
exchange for a cigarette, she brought out a male personality called
Evan. "Oh God", said Evan. "I'm wearing a dress! I hate it when that
happens". Evan bemoaned the indignity of having to urinate in a
sedentary position. "It's the way the body is built", he/she
explained. "I tried it standing once, but I missed the john" (Time
Inc. Magazine Company and Compact Almanac, 1990; Washington Post,
1990a; Washington Post, 1990b).
The jury found Peterson guilty of second degree sexual assault under a
section of the criminal code making it an offence to have sexual
intercourse knowingly with a person who suffers from a mental illness
which renders that person temporarily or permanently incapable of
appraising his or her conduct. This offence carries a maximum sentence
of ten years. A juror, discussing the jury's deliberations with a
reporter after the trial, explained that it had not been necessary for
the jury to decide whether Sarah had a multiple personality disorder,
but rather whether or not she was ill. After the bizarre proceedings
in court, the jury had been satisfied that she must be mentally ill in
some way and that this must have been evident to Peterson. The
conviction was reversed on appeal (Saks 1994), because the defendant's
expert had not been permitted to examine the victim. Prosecutors
decided not to retry the case, as a retrial was deemed too traumatic
for the victim. The case is not unique in terms of a "multiple"
complaining of rape (Saks, 1994). In a 1992 case, James and Marilyn
Dorsey were found guilty of the rape of a "multiple". According to
prosecutors, "the Dorseys would trigger the 24-year old's vulnerable,
child-like persona and then abuse her. To call the 5-year old, they
would talk about alleged molestations by the woman's grandfather"
(Atlanta Journal and Constitution, 1992). Further examples of alters
testifying may be found at various points in the discussion below.
There are no other examples of canine alters in the witness box, but
mythical beings and animals are not particularly rare in MPD
sufferers. In a civil case in Wisconsin in 1997, Nadean Cool sued her
therapist, who had brought out more than 120 personalities, including
an angel, a devil and a duck. The therapist had then charged group
therapy rates. The matter was settled out of court for $2.4 million
(Loftus, 1997). Alter personalities discovered by other therapists
have allegedly included lobsters, tigers, chickens and Ninja turtles
(Observer, 1998).
3) Age of criminal responsibility
Slovenko (1989) has asked whether, if the alter in charge at the time
of a crime was a minor whilst the host personality was an adult, the
trial should be held in juvenile or adult court. In Florida, in 1979,
Juanita Maxwell (a maid at a local hotel) was charged with stabbing to
death a 73-year old woman with a pair of scissors in an argument about
a ball-point pen (Saks, 1997). She claimed that Wanda, one of the
seven personalities that allegedly inhabited her body, was
responsible. Wanda was nine years old (Slovenko, 1993). Wanda
testified: "Juanita was with me, but she wasn't aware of what was
going on" (Detroit News, 1995). Slovenko sets out the questions the
case raised: "To what extent is a sub-personality allegedly a minor
really like a minor? Is a nine-year-old sub-personality like an
ordinary nine-year-old. To what extent does the host personality
permeate the sub-personality? Does the sub-personality have 'full
control' or 'control' over the host personality?" The defendant was
found not guilty by reason of insanity, and sent to Florida State
Hospital, where her principal therapy was haloperidol in doses of upto
85 mg. per day (Detroit News, 1995). Released in 1986, she was
arrested in 1988 for robbery of two banks, actions which were
attributed to Wanda. Her lawyer claimed that she was "psychologically
absent at the time of the incidents", whereas the prosecuting attorney
noted that there was "one person, one set of fingerprints, one set of
teeth, one heart, one liver" (Slovenko, 1989). Maxwell eschewed an
insanity defence, as she did not wish to be returned to the state
psychiatric hospital. In 1991, she was allowed to plead no contest to
the bank robberies and given an unusual sentence of three years in
gaol, (which she had already served), and probation for life. She has
featured on the talk show circuit, including the Oprah Winfrey
programme and the CBS programme "60 minutes" (29th September 1991). A
television film is "under development" in Hollywood, where the story
is said to be "hot property" (Detroit News, 1995). In a more recent
case, a 31 year old teacher arrested on child pornography and sexual
assault charges produced three teen alters (New York Times, 1997), so
presumably rendering his sexual focus more age appropriate. It is
perhaps surprising that more cases involving child alter perpetrators
have not been reported, given the frequency (and popularity) of child
alters in MPD cases.
In 1989, there were said to be ten women on death row with a diagnosis
of multiple personality disorder (Slovenko, 1989). It is unclear what
would happen to someone facing execution, if a child alter became
predominant. Interpretation of "competency to be executed" in many
states focuses on an inmate's ability to understand his situation,
whilst others also require an ability to assist a lawyer in the
appeals process. Saks (1997) has suggested that a predominant child
alter might fail these criteria, if he/she was too young to understand
the concept of death or to instruct his/her lawyer.
4) Discontinuance and the public interest
The tendency to be overwhelmed with the bizarreness of the
presentation is evident in early cases from the USA. In a 1979 case in
San Bernardino, California, the MPD phenomenon was taken literally,
and Esther Minor was found not guilty of forgery (without insanity
being an issue), because her alter personality, Raynell Potts,
admitted writing the bad cheques concerned (Ashby, 1979). In a further
case in Hawaii in 1984, six psychiatrists testified with little or no
agreement between them (State v. Rodrigues, 1984; Slovenko, 1989;
Perr, 1991; Steinberg et al., 1993; Saks, 1997). The defendant, a 23-
year old marine, was charged with three counts of sodomy and one of
rape; his victims were all young girls, whom he would lure into
secluded areas. The court summarised the testimony as follows: "The
defendant had anywhere from one to three personalities - personality A
could appreciate the wrongfulness of his acts and conform his
behaviour to the requirements of the law, but could not control B; B
could understand the wrongfulness of his conduct but could not conform
his behaviour to the requirements of the law; and personality C did
not care whether what he did was right or wrong, or about the
consequences of his conduct." One psychiatrist, theorising that there
was one personality, testified that A committed the acts; four
doctors, theorising that there were two personalities, testified that
B committed the acts; and another psychiatrist testified that C
committed the crimes. The judge found that evidence of MPD was such
overwhelming proof of insanity that he granted an acquittal, without
putting the matter to a jury. His decision was later overturned on
appeal, because of his failure to put the matter to a jury (see
below).
Such defences have not always been successful. In another case (State
v. Darnall, 1980; Slovenko, 1993), the defence counsel argued that
undeniable evidence of MPD is such overwhelming proof of mental
disorder that the trial court was bound to find the defendant not
responsible for his actions as a matter of law. Five experts gave
evidence. All agreed that the defendant suffered from MPD. The primary
personality, Ned, was said to be weak, ineffectual and highly
dependant on his father, whose murder was the subject of the case.
When Ned was subjected to more emotional stress than he could handle,
an aggressive second personality, Nathan, would appear and take
charge. One expert also discovered a third, well-balanced personality
named Nate. The three defence experts were all of the opinion that,
while Ned could appreciate the criminality of his actions, he was
unable to conform his conduct to the law because of his disorder. The
state's two experts did not think that an alternating personality
would necessarily preclude responsibility. The court concluded that
this evidence was sufficient to put the matter of responsibility to a
jury, and denied a directed verdict. The jury found Darnall guilty of
murder.
Fitness to plead (competency) and insanity defences
In the USA, MPD has been used as an argument that a defendant was
unfit to plead in competency hearings. In at least two murder cases,
defendants with MPD have been found incompetent to stand trial (Coons,
1991). The very assessment process for competency can be complicated
by the MPD diagnosis. Griffith (in Allison 1982) asks which
personality should be examined for competency, whether they should all
be examined as they appear, and, if so, which one should be used. In
State v. Badger (1988), discussed further below, it was contended that
the defendant was unfit, because he could not control the switching of
his personalities and this might happen in court, with each
personality having no memory of what had just happened to the other.
The court held that: "This problem, should it occur during trial, can
be overcome by having the defendant's attorney explain to him what has
occurred just prior to the personality change" (Lewis and Bard, 1991;
Steinberg et al., 1993; Saks, 1997). Further cases concerning MPD and
competency are cited by Saks (1994 & 1997).
Insanity defences on the grounds of multiple personality appear to go
back at least until 1977. The earliest successful such defence was in
the case of William Milligan, a 23-year old man from Ohio, who was
arrested for a series of nine rapes on a university campus (State v.
Milligan, 1978; Keyes, 1981). His lawyers decided upon an evaluation
by a psychologist because of his inconsistent presentation and
demeanour. The psychologist found his IQ to be 68, diagnosed
schizophrenia, and stated that he was not competent to stand trial.
The judge then ordered an assessment for the court by a local forensic
psychiatry unit. The psychiatrists involved diagnosed MPD, and called
in Dr. Cornelia Wilbur, the psychiatrist who had explored the 16
personalities of Sybil, the subject of a best-selling book and a
television film (Schreiber, 1973). She confirmed the diagnosis, and
the court agreed to a three-month period of inpatient evaluation and
treatment. The doctors succeeded in "partial fusion" of the
personalities involved, sufficient that Mr. Milligan could be deemed
competent to stand trial. Evidence was submitted that the rapist was
not Milligan, but Adelena, an alternative personality, who was a
nineteen year old lesbian. Milligan was said to have ten
personalities: two females who craved affection and eight males who
hated sex. The principal Milligan personality was said to be unaware
of Adelena or of her actions. Milligan waived the right to jury trial.
The court-appointed psychiatrists all supported the NGRI plea. The
prosecuting attorney decided not to challenge the psychiatric
evidence. The judge stated that, lacking any evidence to the contrary,
he was obliged to make an NGRI finding. Milligan was admitted to an
open psychiatric unit. The judge described the history of Milligan's
life, including early alleged childhood sexual abuse (hotly contested
by the family), as "mind-boggling", an adjective that some evidently
thought might better be applied to the outcome in court, which Thigpen
& Cleckley (1984) described as "a gross miscarriage of justice and
denigration of psychiatry". Milligan was eventually released from
hospital in 1988, with the total 24 personalities finally identified
having been "fused". Ohio is taking legal steps to recover part of the
$453,000 that his hospital stay is said to have cost, following the
success of 'The Minds of Billy Milligan' (Keyes, 1981). A film of the
case is said to be planned with the working title 'The Crowded Room'.
Subsequent arrest has not been accompanied by an MPD presentation
(Columbus Dispatch, 1996).
Details of two further successful insanity defences are available,
both in murder trials. In another early case from 1980 in Sacramento,
California, Paul Miskimen was found not guilty by reason of insanity
for the murder of his wife (Sacramento Bee, 1980; Allison, 1982). All
the psychiatrists involved in the Miskimen case agreed that the murder
was committed by Miskimen's "alter personality" while in a "co-
conscious state" and that Paul Miskimen himself had no capacity to
stop the killing (Allison, 1982). In the case of Mr. A, who murdered
his girl-friend in August 1985 (Perr, 1991), the exact date of the
offence was not known as various parts of the dismembered body were
found in plastic rubbish bags throughout the county park system over
an eight day period. The body was decapitated and the trunk was
severed, with the limbs sawn off. Mr. A denied that he had committed
the murder, but stated that one of his other personalities, Billy Ray,
might have done it. An interviewing psychiatrist found evidence of the
appearances of Billy Ray ("a vicious sociopath") in Mr. A's past,
dating back to 1968. There had been assaults with a knife and a
hammer, and Mr. A had a long history of psychiatric admissions with
twenty-one different diagnoses over the years. Mental state
examination of Mr. A was unremarkable. The psychiatrist advised the
court that all could be explained in terms of multiple personality
disorder, and that Mr. A. did not meet the standards required for
criminal responsibility. He explained: "Because of the nature of this
condition, the host personality is not able to fully know right from
wrong, or even to know the nature and quality of the act". The court
found Mr. A "not guilty by reason of insanity". Four years later, his
therapist at the admitting hospital reported that seven distinct
personalities had now emerged.
The frequency of insanity defences on the basis of MPD in the USA is
not known. Coons (1991) found nineteen US cases between 1977 and 1991
where MPD was used as the basis of an insanity defence in homicide
cases. At least two were found not guilty by reason of insanity, two
incompetent to stand trial and one guilty, but mentally ill. In at
least one case, the diagnosis had been made before the murder took
place. In those cases where the defence was rejected, it is not known
upon what basis the juries had arrived at their conclusions; whether
they did not believe in MPD, did not believe the defendant, or did not
agree that MPD warranted a finding of NGRI. Coons comments that a
follow-up of the cases to see whether the MPD behaviour continued
after the conviction would be pertinent. Owens (1997) lists forty-two
cases, in which MPD was raised as a defence. Steadman et al. (1993)
conclude from an eight state US survey covering the late 70s to the
mid-eighties that MPD is used infrequently in insanity defences. The
survey found that only 15 of 7,689 insanity defence cases for which
diagnostic information was available involved defendants with a
diagnosis of MPD. However, use of the defence is not equally
distributed, seven of these fifteen MPD cases coming from a single
state (Appelbaum and Greer, 1994), and extrapolation from the survey
to all 52 states would be unreliable. In the decade following the
survey, MPD has continued to be used as the basis of insanity
defences. The overall number of MPD cases diagnosed in North America
has increased into the thousands, and it becomes increasingly likely
that pre-diagnosed MPD sufferers will come into contact with the legal
system, the pre-existence of the diagnosis being likely to strengthen
the case for defences based upon its presence.
Lewis and Bard (1991) have summarised the major defences based on
multiple personality disorder into four, the second relating to
competency and the other three to insanity:
"1) The defendant has no control over the actions of his or her
secondary personalities and can therefore not be held responsible for
them.
2) The defendant does not remember the acts of secondary
personalities and therefore cannot participate in his or her own
defence.
By virtue of suffering from MPD, it is impossible for the defendant to
conform his or her behaviours to the law or to know right from wrong.
Like a sleep-walker, the defendant was unconscious of alternates
behaviours and hence cannot be held accountable for them."
From the judicial decisions in a series of cases in different states,
it is possible to discern signs of a common approach to some of these
issues beginning to take form. The approach, however, is flawed. Seven
such judgements are examined below:-
i) The case of Robin Grimsley in Ohio in 1982 (State v. Grimsley,
1982; Perr, 1991; Lewis & Bard, 1991; Saks, 1997) involved the appeal
of a woman who had pleaded "no contest" to a charge of drunken
driving. She had previously been diagnosed as suffering from MPD, for
which she was receiving therapy. She claimed that, at the time of the
offence, distress over the report of a lump in her breast had lead her
to dissociate into an "alter", Jennifer, who was impulsive, angry and
alcoholic. She denied any memory of, or control over, Jennifer's
actions, and so had "acted unconsciously, or involuntarily without
volition and therefore had committed no crime". The court concluded
that the evidence did not establish that Jennifer was either
unconscious or acting involuntarily:
"There was only one person driving the car and only one person accused
of drunken driving. It is unmaterial whether she was in one state of
consciousness or another, so long as in the personality then
controlling her behaviour, she was conscious and her actions were a
product of her own volition. The evidence failed to demonstrate that
Jennifer was unconscious or otherwise acting involuntarily".
The court thereby made the point that, as long as the "alter" who was
"in control" at the time was aware of what she was doing and able to
exercise volition, then the (whole) person would be held responsible.
A second claim made in the appeal was that Robin could not give
evidence because she was largely amnesic for Jennifer's actions. The
court concluded: "If we were to allow the bare existence of a
defendant's multiple personality to excuse criminal behaviour, we
would also relieve from responsibility for their criminal acts all
defendants whose memories are blocked". The court therefore confirmed
that amnesia for an offence did not in itself constitute a reason for
lack of criminal responsibility, or imply a failure to form an intent.
ii) A Georgia court in 1983 tended in the same direction when faced
with Phyllis Kirkland, a woman charged with two bank robberies, who
asserted that these had been committed by a different personality,
"Bad Sharon" (Kirkland v. State, 1983; Perr, 1991; Lewis & Bard, 1991;
Saks, 1997). Dressed in each case in a wig, a jogging suit and
sunglasses, she had threatened bank employees with a gun and mace
spray and had escaped in a black Cadillac with darkened windows. The
Court reached the following conclusion: "In the facts of this case,
the purported fugal personality, "Bad Sharon", is a well-developed,
rational and conscious personality, so for legal purposes we will not
distinguish them". And: "The law adjudges criminal responsibility
according to a person's state of mind at the time of the act; we will
not begin to parcel criminal accountability out among the various
inhabitants of the mind". A verdict was reached of "guilty, but
mentally ill". What was found to be determining in this case was that
the alter who committed the robberies did so with "rational,
purposeful criminal intent and with knowledge that it was wrong". In
other words, the court considered the state of mind of the alter at
the time of the crime. The lower court's finding was upheld on appeal.
iii) The final judgement in Rodrigues (State v. Rodrigues, 1984)
leaves unclear the question as to whose mental state should be focused
on. The court stated: "Since each personality may or may not be
criminally responsible for its acts, each one must be examined under
the American Law Institute (ALI)-Model Penal Code (MPC) competency
test". Here, it is not clear whether the "multiple" meets the insanity
test if any "alter" is insane, or only when the "alter" who committed
the crime is insane. The latter is suggested later in the judgement: "
Responsibility is a question for the jury where, as here, there are
diverse opinions as to which personality performed the act and whether
that personality was sane or not". Saks (1997) finds the suggestion
that all the personalities should be examined as regards criminal
responsibility wasteful of resources. In her view, it would be better
to establish which alter was in control at the time of the offence and
then go on to examine that alter.
iv) In a case in New Jersey in 1988, already referred to above, (State
v. Badger, 1988; Perr, 1991; Lewis & Bard, 1991), the court considered
"whether a person who suffers a multiple personality disorder is
mentally competent to stand trial for a crime committed by a
personality other than the dominant one". Christopher Badger was said
to have eight different personalities and had been diagnosed as
suffering from MPD at the age of 17. He alleged that the attempted
burglary in question had been committed by an alter, Philip, and that
Christopher had no memory of any of the events of that evening. A
psychiatrist reported that both Christopher and Philip knew right from
wrong, but that only Philip could relate the facts and co-operate in
his defence; and Philip could change back into Christopher at any
time. The court saw this as analogous to a defence of amnesia and
stated: "New Jersey has flatly refused to allow amnesia concerning a
crime to be a bar to prosecution".
v) In a case from Massachusetts in 1993 (Commonwealth v. Roman, 1993;
Appelbaum & Greer, 1994; Saks, 1997), Norma Roman was charged with
possession of heroin with intent to supply. A large quantity of
heroin, some cocaine and a large sum in cash had been found in her
flat. Ms. Roman claimed to have MPD. She gave evidence that, whenever
she found drugs in the flat, she threw them out. Two of Ms. Roman's
seven alters also gave evidence. "Vicky" admitted that she sold drugs,
although she knew it was illegal. "Alice Meijas" gave evidence that
she knew about Vicky's activities, but was unable to control them.
Norma pleaded not guilty by reason of insanity on the grounds that, in
Massachusetts, an insanity finding may occur when the defendant lacks
"substantial capacity to appreciate the wrongfulness of his behaviour
or to conform his behaviour to the requirements of the law." In
instructing the jury, the trial judge stated that they "must focus on
the particular mental statein which you find the defendant was
operating at the time of the criminal conduct". This implied that, if
the personality in control at the time of the offence did not qualify
for an insanity verdict, then the defendant must be found guilty.
Norma appealed against her subsequent conviction on the grounds that
the judge should not have focused on the personality in control at the
time (Vicky), but rather on the "core" personality (Norma), and
whether or not Norma lacked the capacity to control Vicky and so
conform her conduct to the requirements of the law. The appeal court
concluded: "Our law requires jurors to determine criminal
responsibility of the person at the time of the commission of the
crime. The judge so instructed the jury. There was no error".
vi) In State v. Wheaton (1993), which is discussed at length by Behnke
(1997a), defendant Dea Wheaton contended that an alter personality
named Cassie was "in executive control of the physical body" at the
time of the offence. The Supreme Court of Washington was asked to
define the standard by which to determine whether someone with MPD met
the legal definition of insanity. A psychiatrist appointed by the
trial court had outlined two approaches; the "global" approach, which
would "result in a finding of insanity whenever the host personality
is not in executive control or co-conscious at the time of the
offense"; and the "specific alter" approach, which depended on whether
the "alter that was in executive control at the time of the offense"
were legally sane. The court did not find the specific alter approach
helpful, as there was no indication as to why the alter in charge at
the time should be found responsible. In considering the global
approach, the court looked to the principle that "one who is
unconscious at the time of the act is not responsible for his or her
criminal acts", but did not find this to resolve the issue:
"It is not enough to say that Dea Wheaton was unconscious at the time
of the offense. That would matter if the focus should be on the
personality Dea Wheaton. If the focus here should be on the alter in
executive control, as the trial court concluded, the question would be
whether Cassie was conscious at the time of the offense.The fact that
Dea Wheaton was not conscious does not help resolve the underlying
question, i.e. is it proper to focus on the alter personality?"
vii) New ground appears to have been broken with the case of Denny-
Shaffer (US v. Denny-Shaffer, 1993; Appelbaum & Greer, 1994; Saks,
1997). Ms. Denny-Shaffer, a mid-wife in New Mexico, was accused of
kidnapping a baby from a hospital nursery. She had gone to a
neighbouring hospital, posing as a medical student on a paediatrics
rotation. She selected an infant, and left with it under her arm.
During the next three weeks, she drove to Texas, where she tried to
convince an old boy-friend that he was the father of the child. She
had also visited her parents in Minnesota and told them the same
story. Later, it was said that the offence had been conducted by two
alters, Rina (an irresponsible adolescent) and Bridget (a "Mother
Superior" personality). Gidget, the host personality, was "not
present" at the time of the abduction. At trial, the issue arose as to
whether the defendant was able, in the words of the statute, to
"appreciate the nature and quality or the wrongfulness of his acts".
One expert in his evidence set out the choice before the court in its
interpretation of the statute, as to whether the test should be
applied to the host personality or the alter in control. There were
two possible ways of assessing the defendant's responsibility:-
"(1) that in the light of the presence of a host personality and
several alter personalities, if the statute means that all alters, or
at least the host personality, must be fully aware of the nature,
quality, and wrongfulness of an act, then Denny-Shaffer was not
responsible at the time of the abduction; and (2) on the other hand,
if an MPD victim is viewed as a single individual with varying
personality components, and not divided as separate people, the issue
changes; in such a case the question would be whether the personality
in control at the time of the offence was unable to understand the
nature, quality and wrongfulness of her acts. If this is the proper
interpretation of the statute, then the defendant did suffer from a
significant mental illness, but it was not such as to render her
unable to understand the nature, quality and wrongfulness of her
acts".
The original trial judge, adopting the second argument, (similar to
the rationale in Commonwealth v. Roman), had refused to allow
consideration of the insanity defence after hearing a prosecution
expert state that the two alters in control at the time of the offence
were aware of the wrongfulness of their acts, and a defence witness
say that she could not be sure whether the controlling alters
understood the wrongfulness of their acts. On appeal, the trial
court's approach was over-ruled. The appeal court concluded that the
host personality should be understood to be the defendant, and that
"it is the host or dominant personality, which must be the focus of
possible criminal responsibility". Denny-Shaffer ought to be permitted
to put her defence to the jury: "We hold that, where the evidence
would permit a jury to find that a defendant suffers from MPD and that
the host personality was unaware of the criminal conduct at issue and
did not participate in or plan that conduct, the jury may also find
that the "defendant" satisfied (the statutory) requirements and thus
return a verdict of not guilty by reason of insanity."
The striking feature of these cases is that both defence and
prosecution experts appear to agree about the presence of multiple
personality and the committing of crimes when an "alter" is in
control. Once this is taken as given, the court is obliged to try and
make sense of the situation in terms of existing competency and
insanity laws. The tendency of the courts in these cases, presumably
in an attempt to preserve the integrity of the accused, appears
paradoxically to be to deny that a single person is on trial and to
treat individuals with MPD as though they are several different
people, each of whom may be held responsible for his or her own
behaviour. The courts appear to have been trapped into a logical
inconsistency. If it is the mental state of the so-called alter
personalities in control at the time of the offence that is considered
in relation to insanity pleas, then the integrity of the "host"
personality is lost. If the "host" personality and its state at the
time of the offence is taken as predominant, then the integrity of the
individual (and common sense) are preserved, but responsibility is
parcelled off to personality fragments with no independent existence.
(The judgement in Kirkland v. State appears self-contradictory in this
respect). No solution to this conundrum is apparent, unless the whole
basis of the "multiple personality" diagnosis is rejected.
Saks (1992, 1994, 1997) argues at great length for a simpler position,
which goes considerably beyond what any court has yet been prepared to
accept. This is that the presence of multiple personality disorder per
se should be sufficient for a finding of not guilty by reason of
insanity. The only exception would be where it can be shown that all
the alters participated actively in the offence. This accounts for the
title of her 1997 book ("Jekyll on Trial", written "with Stephen H.
Behnke"), in which she contends that Jekyll would have been guilty of
the offences committed by Hyde, because he was aware of what had taken
place and nevertheless again took the transforming potion. Radden
(1996) indicates that, since multiples do not fit into the current
insanity and involuntariness defences as currently formulated, they
must be found responsible in criminal law. Saks (1997) disagrees,
arguing that the law is "not lifeless and unchanging" and that the law
should be reformulated to allow MPD cases to be found non-responsible.
In the interim, in her view, multiples should be fitted into current
formulations of the insanity defence wherever possible. Most recently,
Behnke (1997a & 1997b) has set out his differences with Saks. He
argues that the defendant is only one person and that the courts
should treat the different personalities as exotic elements of the
mental state, consideration of which at the time of the offence may be
relevant to the insanity issue. This advice appears sensible, as far
as it goes. However, Behnke appears to accept the idea of "severe
dissociation" into different personalities. If this is adhered to, the
courts must still struggle with the issues of involuntariness and
amnesia, complicated by difficulty in determining the presence of an
alter personality, the total or partial absence of the host
personality, and the difficulty in excluding malingering.
6) Treatability and dangerousness
MPD is said to be "eminently treatable" (Saks, 1997) and, according to
Ross (1997), "there is no psychiatric disorder of comparable severity
that carries such a good prognosis". The treatment is based on
psychotherapy and can be lengthy (Ross, 1997). Ross claims that most
"committed, motivated" (and, presumably, non-forensic) patients can be
treated to stable integration within an insurance policy providing for
100 days of inpatient treatment and 500 hours of individual outpatient
psychotherapy, this meaning about $100,000. This is predicated upon
the existence of suitable treatment facilities and personnel. The
problem, in terms of the compulsory inpatient treatment of offenders,
is how it can be judged when a person is "cured" of his or her
affliction and therefore safe for release. It is said to be
characteristic of alters that they can lie dormant for years, before
suddenly reappearing (Piper, 1994). Even if an offending alter has not
appeared for a number of years, how can there be any indication as to
whether he will or won't reappear in the future? The standard
"treatment" for MPD is "fusion", but, as French & Shechmeister (1983)
state: "Adequately objective criteria for fusion have yet to be agreed
upon.Retrospective proof of adequate fusion may be difficult to
establish." And, if the person is a collection of personalities, then
the person would remain potentially dangerous, because their capacity
to control undesirable conduct would be limited (Halleck, 1990). A
collective would be unlikely to be responsive to the sanctions that
control behaviour in most of the population and, as such, society
would be obliged to take control over its actions. Although the
usefulness of MPD as mitigation has been described (Abrams, 1983), the
dangerousness issue might limit its role in this respect, as in the
U.S., dangerousness can be adjudged to be an aggravating factor in
death penalty decisions (Saks, 1997).
Punishment, personality and "personhood"
For courts to accept the existence of alters literally, or to consider
evidence as to the mental state of different alters, may facilitate
their dealing with competency and insanity issues in the "multiple"
presentation; but such an approach is fundamentally flawed when it
comes to dealing with issues of sentencing. There is, in the end, only
one "body". Saks (1992, 1994, 1997), currently Professor of Law,
Psychiatry and Behavioural Sciences at the University of Southern
California, has argued at length that it is unjust to imprison
innocent alters for the misdeeds of a different alter. Would we wish
to imprison both Siamese twins for the crimes of one of them?, she
asks. If the body is imprisoned, how do we know that the guilty alter
will not simply choose to be absent for the length of the sentence,
leaving innocent alters to suffer the punishment? She contends that
the imprisonment of multiples is unjust, whether alters are considered
as individual people, "personlike centres of consciousness" or
"nonpersonlike parts of one deeply divided person". Her views appear
to have achieved some degree of acceptance in the judgement in the
Denny-Shaffer appeal, where the court alluded to the perceived
unfairness of convicting a host personality for behaviour beyond his
or her control. However, her positions remain on the extreme of the
spectrum of approaches to MPD (Appelbaum & Greer, 1994). Towards the
other end lies the view reported by Halleck (1990) that it can be an
important part of the treatment of the disorder to hold the person
with multiple personality disorder responsible for the behaviour of
their alters in that it will encourage the exercise of control by the
host personality.
There is some superficial validity to the idea that it would be unjust
to hold the whole individual blameworthy, if seen as a collection of
relatively autonomous personalities. A closer examination of the issue
suggests that an individual with a set of autonomous alters is no
longer a morally or legally accountable person recognisable by
society, but rather a collection of partial persons with no collective
capacity for responsibility. Halleck (1990) questions whether such a
"fragmented" person would be able to exercise the fundamental ability
to choose. If there are different autonomous personalities within the
individual, then how can that individual legally choose to enter
contracts, make a will, undergo voluntary treatment in a psychiatric
hospital or have voluntary sexual relationships? Can informed consent
truly be obtained from multiples for surgical procedures (Greenberg &
Attia, 1993)? Indeed, is it possible to obtain informed consent for
psychotherapeutic treatment of an MPD patient (Halleck, 1990)?
Slovenko (1989) details a number of therapists, who obtain written
consent from all known personalities, including the "caretakers" of
any child alters, before commencing therapy. Griffith (in Allison
1982) asks what happens in the case of a "multiple" choosing to waiver
constitutional rights: would each of the "personalities" have to waive
their rights, or would one be sufficient? Some judges are requiring
that each personality testifying at a trial be sworn in and given the
oath (Slovenko, 1989). Should therefore a search or arrest warrant be
issued for each personality? Should each personality be read their
rights? Is there a Tarasoff duty if one alter, in therapy, threatens
to kill another, who is not co-conscious?
Such arguments come down to what is understood by "personhood" (the
term used in such discussions for "being a person"), personality,
individuality and their relationship to the "host body" (Gillett,
1986). If MPD is seen as the fracture of the personality into
different persons in early childhood secondary to trauma, with each
personality developing in parallel and to more or less the same
degree, with partial or total ignorance of the others, then the
argument that alters should be seen as equal in terms of the court is
perhaps understandable. Not all proponents of the MPD cause would
follow this line. Ross (1997) is firm that alters are "dissociated
components of a single personality". He finds (1997) the defence of
not guilty by reason of insanity inappropriate in MPD. He contends
that mental state should be irrelevant to a determination of guilt or
to sentencing, arguing that psychiatric evidence should only be
considered in deciding where the sentence should be spent, in hospital
or in prison. Saks (1997) does not find the idea of "healing" a
multiple for the purpose of punishing him unusual, given that the
Supreme Court of the United States has upheld the constitutionality of
"curing" a death row inmate solely for the purpose of killing him
(Ford v. Wainwright, 1986). Her objection is in equating the
integrated person with the guilty one: "The integrated person would be
as much a different person from the guilty alter as the guilty alter
is from the innocent alters. Thus, the culpable person would no longer
exist, and the new person would not be culpable". Many authorities
would see these forms of argument as sophistry or casuistry. However
created, the multiple personality situation is one of evasion and
self-deception (Beahrs, 1994). For clinicians and others to sanction
MPD as an illness is simply to sanction the individual's avoidance of
their own personal responsibilities and to allow them to seek refuge
in a socially-sanctioned sick role (Halleck, 1988; Fahy, 1988; McHugh,
1995). This appears to be the crux of the matter. Although the
arguments about MPD in the US courts are far from resolved, many may
sympathise with Bloom, (quoted by Slovenko, 1989), who writes: "Having
worked with patients for 40 years now, I see splitting and
dissociation, not only as defences, but as means to escape moral
responsibility for ourselves and our actions.The murderers and the
rapists can hide behind their numerous personalities to get away with
the crime. And society is reinforcing this sociopathy more and
moreEach person should be held responsible for his own personality. If
it is split, it is his fault. If he errs when he is split, he should
be held accountable".
Relevance to UK practice
It might be argued that the MPD phenomenon is not one to exercise
forensic psychiatrists on this side of the Atlantic, where there are
no "experts" willing to promote the MPD cause in court, no specialised
dissociation clinics and no specialist journal devoted to the cause.
What Piper (1997) refers to as the "fringe triad of recovered memory
therapy, MPD and Satanic ritual abuse therapy" is foreign to U.K.
psychiatry, and the phenomenon of MPD remains largely restricted to
North America (Fahy, 1988; Merskey, 1992; Piper, 1994; Spanos, 1996).
Although some argue that the disorder is not found elsewhere because
it is not looked for (e.g. Bliss, 1984b; Kluft, 1991; Ross 1997),
Spanos (1996) explains its culture-bound nature in socio-cultural
terms. He considers that it has spread so far in the U.S.A., because
it fulfils a social, political and cultural function, suiting desires
to evade personal responsibility and to medicalise personal
dissatisfaction and distress, whilst fitting the agendas of groups as
diverse as the therapy professions, the political right, conservative
Christian evangelists, the child abuse lobby and believers in alien
abduction. No such context exists in the U.K. But whether it be a
cult, an industry or a legitimate field of medical science, the MPD
movement is now large and established in North America, and MPD
remains defined as a mental disorder in both ICD-10 (World Health
Organisation, 1992) and in DSM-IV (American Psychiatric Association,
1994), where it has been dignified with the less controversial
appellation "Dissociative Identity Disorder". The weight of material
written about MPD (see Ross (1997) for a list of recent books) tends
to lend the idea a certain legitimacy in the "therapy" world. Ideas
have a tendency eventually to permeate cultural boundaries, with or
without the proslatysing activities of proponents, such as Ross, who
lectured and led workshops with 150 therapists on a 1997 UK tour,
which achieved considerable media and television coverage (Independent
on Sunday, 1997). We contend that a firm view should be adopted by
British forensic psychiatrists. In brief, there should be no place in
the practice of forensic psychiatry for 'psychological alchemy' or
'siances in the court-room'. The aim should be to validate Aldridge-
Morris' rather optimistic claim (1989) that: "In the U.K., we react to
any suggestion that there are two or more personalities by immediately
saying that there are two or more aspects to one personality, and
asserting that the individual must take responsibility for both of
these aspects. It works."
(Word count = 8479)
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U.S. LAW REPORTS
Commonwealth v. Roman, 606 N.E. 2d 1333 (Mass. 1993)
Ford v. Wainwright, 477 U.S. 399 (1986)
Kirkland v. State, 304 S.E.2d 561 (Ga. App. Ct. 1983)
State v. Badger, 551 A.2d 207 (N.J. Super. Ct. Law Div.1988)
State v. Darnall, 161, 614 P. 2d 120 (Or. Ct. App. 1980)
State v. Grimsley, 444 N.E.2d 1071 (Ohio Ct. App 1982)
State v. Milligan, 77 CR 11 2908 (Franklin County, Ohio 1978)
State v. Rodrigues, 679 P. 2d 615 (Hawai 1984); and 469 US 1078 (1984)
State v. Wheaton, 850 P. 2d 507 (Wash. 1993)
US v. Denny-Shaffer, 2 F.3d 999 (10th Cir 1993)
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