Multiple personality disorder is a genuine syndrome, says the American Psychiatric Association. But some prominent psychiatrists call it a trash can diagnosis, a mental illness invented by doctors and imposed on patients to explain symptoms they have yet to properly diagnose. Whether it is real or not, there are more and more MPD patients, and more and more doctors who are grappling with its existence.

"They used to be an interesting curiosity," says Paul McHugh, director of psychiatry at Johns Hopkins School of Medicine and an MPD skeptic. "Now the wards are filled with them. It's the disorder of the '90s."

It has popped up in recent criminal cases; the Wisconsin woman who said that one of her nonconsenting personalities was raped; the Maryland man, charged with murder, who claimed in his defense that he suffered from MPD.

Clinicians link MPD to severe, sadistic childhood trauma, often involving sexual abuse. Sometimes it is associated with witnessing a murder at a young age. Children escape trauma through fantasy and daydreaming, or spontaneous dissociation. But if a child confronts repeated and often life- threatening trauma, during the delicate development period before the age of 9, the disconnected states can freeze into alter-personalities, or "alters", doctors say. There is minimal leakage between them.

A multiple's system usually includes a depressed, overwrought host personality, a group of frightened children alters, and several alters who act as either protectors or persecutors, says Frank Putnam chief of the unit on dissociative disorders at the National Institute of Mental Health. He calls MPD a "highly creative survival technique" for children enduring "hopeless" circumstances.

Traumas of a Childhood

It is several weeks before the self-help meeting at Jay's house. She has agreed to meet over lunch in her doctor's office, to allow a guest to observe her in therapy. She hopes it will educate people about the devastating effects of childhood sexual abuse.

Jay won't eat. The tuna salad, the pickles, the potato chips sit on her plate. Jay has been in therapy intermittently since 1970. She was diagnosed in 1969 as a manic-depressive and schizophrenic. She lives on government disability payments. A year ago she joined the growing number of mental patients whose diagnoses have been reclassified as MPD. (While numbers of cases are hard to come by, doctors attribute the trend to increased awareness about child abuse and its aftereffects.) For the past year, she has been seeing Janieth Wise of the Psychiatric Institute of Washington.

Jay is a friendly kind of shy. The skinny kid at the edge of the court who wants to play ball but is afraid to ask. Even indoors, she wears flipdown sunglasses over her gold-rimmed prescription lenses. She wears two shirts, as usual, even on this scalding day, a blue t-shirt and a button-down blouse. Layers, but never enough layers.

From the time she was a toddler, Jay endured searing physical and sexual abuse, Wise says.

"How old are you?" Wise prompts, trying to establish which of the alters is "out."

"Fifteen," Jay says. "The body is 42."

Wise nods. For multiples, "the body" is a house with many inhabitants, Each alter has unique physical attributes, sometimes including different eyeglass prescriptions, different responses to the same medication, different IQ's.

During the past year of treatment with Wise, Jay has been trying to retrieve and deal with the memories of her abuse. This is how multiples "integrate" their personalities, or recover, Wise explains.

The doctor's voice mixes gentle with matter-of-fact. Over the next few hours, she reviews with Jay the traumas of Jay's childhood, apparently triggering in her patient a run of personality changes. She is all over the emotional spectrum. Charming, infantile, ethereal, bold. There is no single Jay to hold on to, to like or dislike. Trying to catch her is like trying to catch one tree as you roar by a roadside forest.

The exchange is perplexing, terrifying. It begs to be proven false. How could family members behave so cruelly? Maybe it's imagined. Maybe it is embellished. Maybe it's true because Jay believes it's true. Or maybe it simply is true.

Wise begins: When Jay was 2 1/2, she was sent to live with a relative.

"Tied my neck," Jay interjects.

"That's right," Wise says. "Is Desiree around? Does she want to come out and talk to the lady?"

Desiree is three years old, Wise says. Desiree does not want to come out. She is the alter Jay invoked when her guardian used to bind her in bed or tie her to a tree, Wise explains. Around that time, three of Jay's male relatives allegedly sodomized and raped the toddler, Wise says, causing a shattering, a "major split" in Jay's personality.

Jay is looking queasy.

"You're safe," the doctor assures the woman clutching the blue paper tablecloth. "Come back to now, connect to now."

Jay is whimpering something about fire. Her posture is crumbling, chin falling. She is heading somewhere down, deep.

Wise takes Jay's hand and introduces Melanie. She offers the alter's history: Melanie is between 3 and 5. At that age, her guardian took Jay down the street to a man who raped her and repeatedly abused her, Wise says. He did it in a basement where there was some sort of a pit. He told Jay that if she told anyone, he would drop her in the pit. He said the hole was full of fire. He told her it was Hell.

"Open your eyes, don't be afraid," Wise says, like a kindergarten teacher. "There's no fire now."

Jay is shaking and gasping. "Father made her go back to the fire," she says, talking about herself in the third person, as multiples often do.

Who is out now? Kelly?

Kelly, as Wise tells it, is an alter who idolizes Jay's father. The father who allegedly raped Jay when she was 11 years old. That realization, which surfaced four months after his death last year, caused Jay's most recent hospitalization, Wise says.

The doctor glances at Jay, whose chin is grazing the top of her tuna salad sandwich. "I know you don't believe that," Wise says. Part of Jay's system of personalities don't accept that her father raped her, she explains.

Other alters emerge. Frank, an aggressive 40-year-old who likes motorcycles and sky diving. Jay unbuttons her blouse. Yanks off her shades. Angry, strong eyes appear. She brags about throwing chairs, smashing picture frames in the hospital.

"[Expletive] it!" says Jay. "I don't give a [expletive]!"

She sees her nearly empty glass of iced tea and demands, "Who drank it?"

"Probably Martin," Wise says, adding the 5-year-old boy to the confusing list of characters. And snap. Jay is sucking her pinkie.

"Does that taste good, Christian?" Wise recognizes this kid immediately.

"Better than these pickles," Jay says, giggling. Her eyes are wide. Her cheeks happy. Christian.

The smile falls when Wise brings up a later rape, in 1989. Jay is currently working on this memory in therapy. Suddenly she is moaning, flinching like someone is kicking her. The tempo of her cries grows faster and faster. Jay is frantic.

Wise is calm. The doctor sees this all the time, with Jay and other MPDs, she says. Wise slips her an Ativan.

Jay shuts her eyes, grabs Wise's hand, falls over. She is stiff. It is Charmaine. A catatonic alter, Wise says, who brings the system to the safety of unconsciousness when it is overwhelmed. Wise moves Jay's arms through the air, poses them like a mannequin. She's out.

No, wait, she's back. With an Irish brogue. It's Jamie, "a spirit", Jay says, a woman farmer who died in 1843."

"What's this?" Jay says. She examines a potato chip. "'Tis mighty strange."

Jay says Jamie committed suicide.

"Aye, my sonny died and I could not bear it," this pleasant woman says. "I shot myself and was buried with my boy."

But the spirit is in limbo, she says. She has to help Jay get well to put her spirit to rest. "You take a life, you must save a life. So I popped in one day on Jay."

The tape recorder on the table startles her.

"It's called a tape recorder, it doesn't hurt," Wise says, helpfully. "It will play everything we're saying." Jamie wants a demonstration. She gets it. She calls it "the Devil's instrument."

Jamie is Jay's only alter who has "co-consciousness" with all of her personalities. When Jamie is out, Jay is aware of the host of personalities, Wise says. Jay reviews the cast.

There's Stacey, the alter Jay says tried to slit her wrists in 10th grade when she realized her father had raped her years earlier.

"Her father was the only one really there for her--and when she had to face what he did..." Jay says with an Irish lilt.

And there's Spencer, the alter who thinks he's a surgeon. "Spencer loves to cut up the body with razors," Jay says. He cuts on legs, stomach, arms.

Jay takes a deep breath. She is still holding the potato chip, trying to smooth its ridges with her fingers.

"'Tis hard living with so many people. Sometimes we wake up in despair. We don't know how many people have been sleeping in our bed," she says, like a weary old soul. "The nightmares of so many people turn our bed upside down."

The spirit woman falls asleep. A few moments later, when Jay wakes up, she is Jay again, energetically talking about the MPD self-help group she is organizing.

Meeting Jay & Co.

The session with Wise lasts a couple of hours, and the succession of alters who emerge, disappear and re-emerge is dizzying. You cannot help wondering if this is theater, or more probably, theatrics, an act devised by a disturbed person, consciously or not, to seize attention, evoke sympathy.

Wise never harbored doubts.

With Jay, she says, "you only have to live through one flashback to believe it. You see her being sodomized. You see her face blister up from the fire."

Her face blisters?

"Almost second-degree burns."

And even more perplexing, Wise says:

Martin has bronchitis. Jay does not.

Martin and A.J. have tested positive for multiple sclerosis. Jay has not.

Martin is left-handed. Jay is not.

Desiree's eyes are always bloodshot, as if she's being choked.

Melanie, the alter who was raped in a basement, is allergic to mold or any kind of mildew. Jay is not.

Jay has irritable bowels, and can't tolerate Motrin. Her alters can.

"With MPD," says Wise, "you kind of have to put logic in a handbag and leave it at the door."

Practical Problems

Five women file down the stairs into Jay's basement. They light up cigarettes and settle on the rust-covered couches. They eat chips, homemade cookies. The mood is festive. The lights are low.

"It's 7:33 p.m., do you know where your alters are?" Christy says. They laugh self-consciously. Most of them have been diagnosed with MPD in just the past year. The lingo is new for them. Christy pulls an afghan over her face and announces, "I am the afghan alter." The women laugh some more.

They come from Manassas, Lakeridge, Fairfax, Annandale. Some are married, have kids.

Many of them work, successfully suppressing their affliction. The hemorrhage of alters Jay exhibited with her doctor was uncommon--but because Jay's illness is particularly pronounced and because in the "safe" environment of a doctor's office, MPD sufferers will often switch personalities more rapidly, and with less control, than in a public setting. Therapy itself encourages switching.

And so it is that this group includes an office manager, a lab technician and two former nurses who now do volunteer work. All have been to college. All seem creative, intelligent, good-spirited. They look like women gathered for a bridal shower or a weight-loss group. It is only when they begin to talk, to describe their daily lives, that the fluidity of their identities sinks in, that their tentative grasp on reality comes through.

Mary Beth, 23, says she has 17 alters. She recently lost her job, she says, because of the disorder. She has the button nose, pudgy legs, green glass eyes of a doll. A doll whose owner cut off her hair, leaving a ruin of short gold spikes. Mary Beth went to sleep one night with shoulder-length hair. When she woke up, she explains, she found "someone" had cut it all off. She isn't sure which alter did it.

Memory loss is one of the most disturbing aspects of being a multiple, the women say.

Mary Beth usually determines which alter was out by checking her CD player, she says.

"If it's Barbra Streisand, then Terri was out. If it's Led Zeppelin -- Danny," she says, good-naturedly. But sometimes I wake up in the living room with carpet fuzz on my nose and the cat sleeping on my back and I have no idea what happened."

Christy was a nurse for four years and doesn't remember a thing about her work, she says in a disturbing monotone. She says she is 29, but gravity pulls hard on her face. Her eyes are gray-green-blue, or maybe brown. They seem to elude classification.

She is wearing a T-shirt that says, "I Suffer from CRS. Can't Remember [expletive]." Next to her on the couch, Brenda wears a black T-shirt with white print: "Out of Body. Back in Five Minutes." Christy doesn't remember giving birth to her daughter, she says. She can't remember her 6-year-old as a baby at all.

"I don't even remember how I drove here tonight," Mary Beth says.

The women try to meet every week. During two of these self-help sessions, a reporter sits in the corner, listening to the women and their worries. They agree to this on the condition that their last names be withheld. Many fear reprisals from the people who abused them.

They talk about raising normal children, while they still sleep with teddy bears and rag dolls. About the daily MPD aggravations; managing a checking account, when your signature changes six times a day. Keeping up with the laundry from six daily shifts in alters and, hence, six outfits. Going shopping, switching personalities and then forgetting what you came out to buy.

Mary Beth says she bought a waterproof alarm watch because she kept switching in the shower, and would rewash herself for hours as different people. Now, no matter who she is, after half an hour in the shower her alarm signals the body to get out.

The women discuss the bewildering experience of discovering clothes in their closets that they don't recognize.

"When a polyester dress showed up in my closet, I knew I was in trouble," Mary Beth says, wearing her usual jeans and T-shirt. Christy says one alter went out and bought $400 worth of clothes, in sizes 2T and 6X, to fit her children alters. She had to go back and return them, mall after mall.

They compare the physical changes they say they experience as they switch personalities. Christy: Tomatoes give her hives when she is one alter. Can't walk as another. Experiences vision changes. Has difficulty with medication because her alters respond so differently to the same medication. Just like Jay.

Mary Beth: Has an alter who can't talk. An alter who can't read. Two different alters who took IQ tests in the hospital. One scored 92. The other, in the 150s.

The women complain about therapists who can't keep their alters' names straight.

"My doctor says, 'How about that Leo?' Mary Beth says. "I'm, like, that's not my alter."

"Yeah," Jay chimes in. "Dr. Wise always calls Stacey 'Tracey.'"

They discuss their plans. For some it is just making it to dinner. Mary Beth wants to be a psychiatric nurse. Christina wants to specialize in dissociative disorders.

The problems of having opposite-sex alters come up; Danny, Mary Beth's 18-year-old male alter, tried to register for the Selective Service. He agreed only recently not to take off his shirt in public. And he learned the hard way that he can't use the men's room in restaurants.

Laughter. Yes, yes! That happened to me too!

"With doctors you're afraid you might go too far," Christy says. "If you tell them everything, they'll say, 'Did you bring your toothbrush?' and commit you."

Mary Beth tells the group that a 7-year-old came out at a friend's house. Her hosts were so alarmed, they called an ambulance, she says.

"Don't they know you're multiple?" Christina asks. She is new to this, the most recently diagnosed patient in the group. She listens, mostly, pulling on the light blond curls that snake down her back.

"They think MPD means I can fix a car, wash my hair and watch TV at the same time," Mary Beth says.

Christina: "My friends say I'm just moody and forgetful."

Mary Beth: "You feel like a freak of nature." Her watch alarm beeps. "Oop!" she says, "Time to take a pill."

The hands on their watches jump, they say.

"You mean the whole world's clock doesn't go from 4 p.m. to 10 p.m.?" Christy teases. "Twenty-four hours is a hell of a long time for one day; I've never experienced a full day."

Would "Normal" Be Better?

The fifth group meeting is somber. The women discuss their ambivalence about becoming "single-minded." This is the goal of therapy, to put all together in one, to become "normal." But there is terror in this, as if integrating meant killing several close friends.

"Some of my alters aren't married. They hate my husband. If I integrate.." Christy muses.

"I hate the idea of integration," Mary Beth says.

"I don't know what I'd do without Patricia to go to parties for me," Christy says.

"Or Donnie to go to work," Mary Beth says.

"When I was first diagnosed I wanted to integrate," Christy says. "Now I'm not so sure."

Jay is huddled at the end of a couch. Her pretzel-thin body is folded over on itself. She seems to be sheltering herself from the voices, stories, pain.

The others take turns talking about their parents. They love them. They hate them. Why did their parents hurt them? Most of the women had been molested by their fathers, they say. The mothers sometimes joined in. One woman talks shakily about how her mother used to lock her in the basement with her rapist father. Other times, her mother held her down while her father raped her, she says. "And people thought my family was the model happy family."

"I worry about my 6-year-old," Christy says. "One alter is hyper- vigilant and sits in her doorway at night to make sure my husband won't abuse her."

"I need a Xanax, I'm leaving," says Mary Beth, but she stays put.

The conversation drifts to suicide. All think about it. Most have tried.

Jay, now sitting on the carpet, speaks:

"I tried to cut my arm off." Jay rolls up a sleeve. A butterfly Band-Aid straddles the purple gash. Her friends shift on the couches. To look. To look away.

Lately, the voices of three alters--Stacey, Sam and Samantha, Jay says--have been urging her: Find the razors you hid. Cut yourself. Cut it.

Jay tells the story; Mary Beth shakes her head. Saturday night, four nights ago, Mary Beth left Jay alone for a few hours. When she returned, she found Jay spilling blood on the yellow Formica kitchen counter.

"It's scary having friends like us," Christina says, hugging her knees. "We could go at any time." The pure white cat weaves through the couches.

"The people told me if I cut my arm, the blood would come out black and all the evil would come out of me," Jay says. "They told me to let it bleed until it turned red."

Lost in Song

The fifth meeting ends close to midnight. The women hug Jay. She looks beaten. She has been beaten by the voices inside. No one knows when they will be meeting at Jay's house again. She is checking herself into the psychiatric hospital tomorrow morning. Her friends wish her luck, kiss her and climb the stairs out of her basement.

Mary Beth stays behind to help Jay pack. Stuffed animals and religious relics clutter Jay's room. Snowball, a white teddy bear, sits on her bed. A bust of Jesus, crowned with thorns, rests on her dresser.

Mary Beth gets out Jay's aqua cosmetic bag. It bulges with medication. There are 11 different containers. "This is supposed to keep you in some kind of condition," Mary Beth says.

It's too much to take. Jay slips away. She is Kelly, she says. She is 8 years old. (Kelly is the one her doctor said idealizes her father.) Jay points to her nightstand, to a miniature house with pink windows and glossy white walls.

"I can move in there," she says. "I can play there 'cause no one else is allowed."

Jay is calmer now. Sweeter. She curls up on her bed and sucks her thumb. Her voice is soft. "I don't want to go to sleep. I have to tell my mother something."

She wanders into the next room to see her clown collection. There is a bookshelf filled with musical ceramic clowns. Two clowns playing drums. A tall orange clown. A fat brown clown. A clown drying the eyes of a child.

She sits cross-legged on the floor and winds them up, one by one. They play "You Light Up My Life," they play "Send In the Clowns," they play three shelvesful of music.

Jay is saying something. "I love them ... are free." What? Her eyes are glittering. She is chattering happily. It is impossible to hear her. Her words disappear among the multitude of songs.

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