"YOU'RE NOT A PARANOID SCHIZOPHRENIC--YOU ONLY HAVE
MULTIPLE PERSONALITY DISORDER"
Richard A. Gardner, M.D.
The multiple personality disorder (MPD) diagnosis is very much in vogue. MPD "experts," who are sprouting up everywhere, tell us that MPD is much more widespread than previously realized. One of the reasons, we are told, why MPD has been ignored has been therapists' reluctance to recognize that most (if not all) of these patients were sexually abused as children. Their "dissociated" thoughts and feelings about their sexual abuses have become foci for the development of alternative personalities ("alters"), which have served to help these abused people cope with their abuses.
Child sex abuse is certainly widespread. Sexually abused children most often grow up and some might even forget and repress memories of their abuses. This does not preclude, however, the parallel phenomenon of adults who believe they were abused when they were not and whose recollections of abuse came about in the course of treatment designed specifically to help them recover such memories. One subcategory of those who belatedly recall abuses that never took place are paranoid schizophrenic women who, in association with their therapists, find attractive the sexual abuse explanation for their problems. It is this subgroup of false accusers that I will focus on here.
The MPD diagnosis provides such patients with a more acceptable label, both personally and socially. If one is schizophrenic, then one has to deal with a chronic psychiatric illness that may be lifelong. Because schizophrenia is generally considered to have a high genetic loading, the likelihood of "cure" by any known psychiatric method is minimal and one may have to live under the spectre of transmitting the disease to one's children and grandchildren. MPD, in contrast, can allegedly be "cured" by those who profess skill in its treatment. To be called "paranoid" or "schizophrenic" is to be called "crazy." In contrast, lots of people are "discovering" that they were really suffering with MPD, a diagnosis that is not listed among the psychoses in DSM-III-R. MPD patients also enjoy the benefit of being considered victims. In a world in which victims are held in high regard--where they are constantly clamoring for our understanding and sympathy--joining the ranks of victims may become a source of esteem-enhancement and group identity.
Then there is the money factor. Victim compensation funds (both for the patient and the therapist) are widely available. Social security benefits can be obtained for rape victims, regardless of age. Clinics devoted to the treatment of the sexually abused are likely to get significant money from local, state, and even federal sources. Therapists who diagnose paranoid schizophrenia may not have a paying customer; those who see the same phenomenon as MPD can guarantee themselves an annuity. A lawsuit against one's parents for having transmitted their schizophrenia genes down to the plaintiff patient is doomed from the outset. The same person is far more likely to be successful in a lawsuit against one's father for having sexually abused her in childhood.
At this point I elaborate on the ways in which the two most prominent symptoms of paranoid schizophrenia, paranoid delusions and hallucinations, become reworked into an MPD diagnosis.
The Content of Paranoid Delusions The content of paranoid delusions is not created de novo. Rather, the material is derived from ambient social phenomena that may serve as foci for the paranoid's preoccupations. In 1692, in Salem, some of the people who believed that they (or others) were possessed by witches were, I am certain, paranoid. In the World War II era, Nazi spies were frequently tormenters of paranoids. In Germany at the same time, Jews were commonly incorporated into the delusions of paranoids, Adolph Hitler being the most famous example. During the cold war many paranoids considered themselves to be persecuted by Russian spies. Not surprisingly, since the end of the cold war, fewer paranoids are being tormented by Russian spies. In the 1980s and 1990s they have been replaced by sexual harassers and sexual abusers. Once again, paranoids are incorporating into their delusional systems the "bad guys" of the era.
Projection Central to the paranoid mechanism is projection. The projection mechanism can involve unacceptable sexual feelings. The sexually inhibited person may say: ``It is not I who have sexual feelings toward him; it is he who has sexual feelings toward me.'' And this is one of the elements that may be operative in the false sex-abuse accusation.
Oversimplication The paranoid solution generally involves an oversimplification of a problem that promises a quick and easy solution. This is central to paranoid prejudice: ``If we only get rid of those people, all our problems will be solved.'' A woman who has suffered with a wide variety of psychiatric difficulties throughout the course of her life is likely to embrace a simple solution that promises to explain and cure all her problems. If she believes that her father's sexual abuses of her in childhood caused all the difficulties she has ever had, she has a simple explanation and, presumably, a simple solution. Such women commonly say, "Now everything is understandable. Now I understand why I suffered all these years. Thank God I finally met Ms. X, my brilliant counselor, who has shown me the path to cure. All the doctors I've been to missed the obvious. What a terrible waste of money. All that unnecessary grief for nothing. Now I'm finally on the path to `healing.'"
Resistance to Alteration by Logic Those who try to alter paranoid delusions by logic and confrontations with reality suffer nothing but frustration. When the father, mother, and other family members try to convince the accusing woman that her beliefs are false and that many of the elements in her scenario are absurd and even impossible, their arguments fall on deaf ears. If the accusing woman does respond, she provides some kind of a rationalization that may be as implausible as the original scenario. They and their therapists commonly claim, "There was no point to even confronting him; he would deny it anyway, so why waste time." When the mothers of these women try to convince them that the accusation has no basis in reality, they will claim that the mother is only trying to protect the father in order to preserve her marriage.
Enhancement of Self-Esteem Paranoids suffer with deep-seated feelings of insecurity, a factor contributing to the need for projection. People with stronger egos are willing to tolerate socially unacceptable impulses within themselves and have enough compensatory assets to counterbalance personality weaknesses and socially unacceptable thoughts and feelings that they may harbor. Admitting that one makes mistakes requires a certain degree of ego-strength. This is one of the reasons paranoids are so resistant to logic and confrontations that might demonstrate that their thinking is awry.
A paranoid's feelings of low self-worth may be compensated for by developing the belief that he (she) is more astute than others regarding the ability to appreciate the significance of subtle information. Paranoids often consider themselves quite skillful in detecting innuendo, slights, and trifling disparagements that pass others by. They pride themselves on their ability to detect hostility in everyday inadvertencies. For women who promulgate false sex-abuse accusations against their fathers, they may, in retrospect, pride themselves on their new-found sensitivity to the most subtle manifestations of sexual abuse, manifestations that others were too blind and/or stupid to detect. In the extreme, this compensatory mechanism for ego- enhancement may result in grandiosity and an all-pervasive feeling of superiority. These feelings strengthen the individual against those who inevitably react with hostility to the paranoid's accusations. A vicious cycle then ensues in which those who disagree and argue with the paranoid unwittingly contribute to the strengthening of the paranoia and its derivative symptoms.
Release of Anger Generally, these are very angry women. When the problems that generate anger are not resolved, anger builds up and presses for release. Society always provides targets that facilitate such release, and these change with the times. Various rules and regulations are set up that strictly define which areas of release are acceptable and which are not. Some of the more common vehicles for release in our society are competition, gossip, worthy and noble causes, sports (both as a spectator and as a participant), family squabbles, and violent themes in books, television, and cinema. Family members are safe targets for such pent-up anger because they are often captive and are less likely to retaliate as strongly as strangers.
Throughout history women have been, and still are, terribly subjugated by men. There is no question also that the women's liberation movement is, overall, a constructive force in human progress. However, every movement has its fanatics and zealots, and the women's movement is no exception. Most women have some justification for feeling angry at men in general. However, those who believe that the best way to deal with this anger is to destroy every man in sight are certainly not making constructive use of their anger. Such women give the women's movement a bad name and work against its progress. A sex-abuse accusation can be a powerful and effective method of anger release. One can almost instantaneously gain social sanction as well as the support of police, prosecutors, district attorneys, and potentially, judges and juries. A more powerful and predictably effective method for angry release has rarely been available to a single person.
Sexual Factors in Paranoia For many (if not most) women, their father was once the most important person in their lives and, at the time of the accusation, may still occupy the number one (or possibly the number two) level in the hierarchy of men who have influenced them. If one considers what has been going on in recent years in the realm of false sex-abuse accusations, it might have been predicted that such accusations against husbands (which started in the 1980s in the context of child-custody disputes) would spread to fathers.
One way for little girls to deal with their sexual feelings toward their fathers is via the mechanism of projection: ``It is not I who harbor intense sexual desires toward my father; it is he who has strong sexual cravings for me.'' Normal girls entertain such fantasies occasionally, and much is repressed and suppressed. In psychotics, who often experience an outpouring of primitive repressed impulses, such material is frequently brought into conscious awareness. Paranoids, because they have significant compromises in their ability to differentiate between fact and fantasy are likely to convert this fantasy into a delusion. One could argue that these patients provide convincing evidence for the existence of the Oedipus complex, evidence far more compelling than Freud ever enjoyed in his lifetime. It is beyond the purposes of this article to discuss my own opinions on the Oedipus complex, derived from over 35 years of working intensely with children. These opinions have been discussed elsewhere (Gardner, 1992).
Expansion and Spread Paranoia tends to expand regarding the complexity of the delusional system and often spreads to include an ever-increasing number of people. For many of the women who accuse their fathers of sexual abuse, family members and friends are divided into two categories: those who agree that the sex abuse has taken place and those who do not. The woman may consider all individuals who support the father's position to be capable of aiding and abetting his abuse--even at present. Although, as an adult, she considers herself strong enough to resist any present advances, her children would certainly not be able to protect themselves. Grandchildren, who previously may have had a loving and warm relationship with their grandfather, are now removed entirely from any contact with him--even by mail and telephone. Gifts are returned because they are considered to be sexual ``bribes.'' And the accusing woman's mother, as one who supports her husband's denials, is considered to be similarly untrustworthy. Because she ``looked the other way'' or was ``too stupid to see what was going on,'' the woman now suspects that her mother would be similarly incapable of preventing her husband from perpetrating similar abuses on her grandchildren. The accusing woman's siblings, who refuse to align themselves with her, are similarly distrusted as potential facilitators of her father's sexual abuse of his grandchildren. Many of these women go into hiding, take refuge in selected shelters (where they are likely to find other paranoids, the justification for such centers notwithstanding), move to distant states, and cut off entirely all communication with the accused father and his extended family.
Paranoia and the Legal System Angry people want to wreak vengeance on those whom they believe have abused them. Our legal system (both civil and criminal tracks) provides a ready and willing vehicle for gratifying this morbid desire. On the civil track, such women commonly demand punitive as well as compensatory damages (which includes payment for their ``therapy''). Because the trauma has been ``enormous,'' the amount of money that can provide compensation is generally an amount equal to the total value of the assets of the father. And because the therapy must be intense and prolonged ("no one can predict how long--it may be lifelong), then payment for such treatment is also justified. In some cases the blackmail element here is easily seen. I have seen letters written by such women in which their fathers were told that if they did not come forth with the indicated amount of money, the daughter would press criminal charges, with the threat of years of incarceration.
On the criminal track there is a sea of prosecutors and district attorneys who are quite happy to enjoy the notoriety that comes from bringing ``perverts'' to justice. And the public media, as well, are happy to provide these "guardians of justice" with the notoriety (and future promotions and salary increments) that they crave.
Auditory Hallucinations and "Alters" Often, an hallucination is a concrete symbolization of a delusion. Also, like the delusion, the projection element is often operative. In order to qualify as a bona fide hallucination, there must be an associated impairment in reality testing, to the point where the experience becomes egosyntonic. Voices perceived as coming from within (to be clearly differentiated from the patient's own inner thoughts, which do not have an auditory component) warrant the label hallucination just as much as voices that are considered to come from without (Kolb and Brodie, 1982). This is an important point with regard to the relationship between inner hallucinatory experiences and the so-called alters. The alters of many hallucinating, paranoid schizophrenic women are basically internal type auditory hallucinations. Calling them alters, rather than auditory hallucinations (which is what they really are), is one of the great psychiatric and psychological rationalizations of the late 20th century. One would think that well-trained psychiatrists and psychologists should know better and recognize a schizophrenic when they see one.
The Wish-Fulfillment Element Hallucinations can be wish fulfilling. Probably one of the more common examples is the hallucination of a recently deceased loved one. These are generally considered to be less pathological than those that do not have such an obvious purpose. Another example would be the woman who hears the voices of an old lover who abandoned her many years previously. He repeatedly professes his affection and amorous inclinations. For the MPD patients being described here the repressed wishes being gratified are sexual. The alters of these paranoid women describe in exquisite and ever-expanding detail the wide variety of sexual encounters they had with the accused father. These voices, we are told by MPD experts, have nothing to do with schizophrenic hallucinations; rather, they are the wailing voices of abused women, victims of abominable sexual acts perpetrated against an innocent child.
Diminution of Guilt Hallucinations, via the projection mechanism, serve to diminish guilt. An alter can assume responsibility for taking legal action. On the civil track, it is the alter who is suing for megabucks to pay for the therapy and provide compensatory damages. It is the same alter (or another one) who reports the accused parent to the police in order to put the person in jail as a "therapeutic" maneuver. The patient herself may not feel guilty about these "healing" maneuvers because it is not she--but the abused alter--who is wreaking vengeance on the accused.
Enhancement of Self-Esteem Hallucinations often involve esteem enhancement. Being singled out from 5.6 billion people on earth for a visit by God is certainly an esteem-enhancing experience. This is especially the case if God takes out a significant amount of time from His, (Her, Its) very busy schedule to spend significant time speaking to the patient. For MPD patients who have allegedly been sexually abused, the belief that one's father has singled her out for special attentions, in preference to all other members of the family, even the mother and siblings, is ego enhancing. Hallucinations (equals alters) can provide compliments, encouragement, and praise for the legal actions taken against the accused parent. They therefore aid and abet the pathological acting out of the delusional/hallucinatory system. Also ego-enhancing is the belief that the father's sexual cravings toward this woman were so enormous that he could not control his impulses and raped her repeatedly throughout the course of her childhood, starting at the age of six months.
Capacity to Spread As is true of delusions, hallucinations have a tendency to spread, expand, and become elaborated upon as the patient becomes progressively sicker. For these "MPD" patients actually suffering with paranoid schizophrenia, this phenomenon takes the form of an endless quest for the discovery of more and more alters, sometimes numbering in the hundreds. Generally, it is the therapist who embarks upon this voyage of discovery which, for most patients, never ends. There are always new alters to be uncovered, alters allegedly buried ever more deeply in the patient's unconscious. Of course, such searches enrichen the therapist because until all the alters are discovered, the healing path cannot be embarked upon. Joining sex-abuse survivor groups, engaging in weekend marathons with other sex-abuse survivors, and proselytizing for the rights of victims not only entrenches these delusions but enhances the likelihood that other people's alters will be brought into one's own collection. I refer to this as the cross-fertilization process.
It may very well be that there has never been a time when paranoid schizophrenics have enjoyed so much secondary gain from their symptoms. In collusion with an army of mental health professionals, representing all levels (especially psychiatrists, psychologists, and social workers), they not only gain social approbation from a significant segment of society but have opportunities for financial remuneration never before enjoyed by psychotics. And a whole network of other professionals are joining in because of the obvious benefits (especially financial) to be derived from such participation. Lawyers well know how much money there is to be made from these sex-abuse victims, especially in association with their lawsuits against their fathers. Prosecutors, district attorneys, and judges enjoy notoriety as they gain the reputation of cleansing society of these old perverts. The media is having a heyday with these women as they consider it part of the "healing process" to expose their perverted fathers to the public and describe in detail the sexual abominations they were subjected to.
It may very well be that there is such a disorder as MPD. Since 1957, when I first began treating psychiatric patients, I have not seen one such patient, although a colleague did present one at grand rounds during my residency training. And it may even be the case that some people who have MPD have gotten that way because they were sexually abused in childhood. Whatever the true prevalence of MPD (from nonexistent and iatrogenic [McHugh, 1993] to common) there is no question that a parallel phenomenon is taking place, namely, the utilization of the MPD diagnosis by paranoid schizophrenics and their therapists for the purposes described in this article. Such patients are not the victims of sexual abuse by their accused fathers. Rather, they are the victims of their therapists and the supporting network of people who profit from convincing these very sick people that they have MPD. Whatever the true prevalence of sex abuse (from common to widespread), there is no question that the parallel phenomenon of false sex-abuse accusations exists. It has been the purpose of this article to describe one subcategory of the false sex-abuse accusation phenomenon and the purposes it serves for this group of false accusers.
Gardner, R.A. (1992), The Psychotherapeutic Techniques of Richard A. Gardner, M.D. (second edition), Cresskill, New Jersey: Creative Therapeutics, Inc.
Kolb, L.B. and Brodie, H.K.H (1982), Modern Clinical Psychiatry. Philadelphia: W.B. Saunders Co.
McHugh, P.B. (1993), Multiple Personality Disorder. Harvard Mental Health Letter . 10(3):4-6.