“If someone with multiple personalities threatens to kill himself, is it considered a hostage situation?”
Background: What is Dissociative Identity Disorder?
Dissociative Identity Disorder, once known as Multiple Personality Disorder, is defined as a disorder in which two or more distinct personalities coexist and oftentimes fight within the same individual. It is not a form of schizophrenia, which we have talked about before on this series. While it is also a neurotic disorder, it does not deal with the connection with understanding reality, which is a major symptom of the psychosis labeled as schizophrenia.
Who Were Thigpen & Cleckley?
Dr. Corbett H. Thigpen (who lived from January 8, 1919 – March 19, 1999) was an American psychiatrist and the co-author of the popular, nonfictional book The Three Faces of Eve, which was first published in 1956. Hervey Milton Cleckley (who was born sometime in 1903 and died on January 28th, 1984) was also an American psychiatrist and one of the leading pioneers in the field of psychopathy. His famous book, The Mask of Sanity, provided one of the most influential clinical descriptions of psychopathy as seen by the expansion and modernization of modern psychology in the twentieth century. He claimed that a psychopath could appear normal and engage in normal society, but deep behind the “mask” was the world of the mental disorder. While he did in fact write his Mask of Sanity in 1941, he is most known for his involvement of the 1954 case study of a female patient labeled as Eve, which would later become the book The Three Faces of Eve in 1956, which he co-wrote with his psychiatric partner Corbett Thigpen, and the movie of the same name in 1957. Thigpen and Cleckley’s reports and case studies re-popularized the controversial and little-understood diagnosis labeled as multiple personality disorder. Although Thigpen and Cleckley didn’t originate the ideas, they popularized them and the idea of individual differences in psychology.
Case Study: The Three Faces of Eve
The Three Faces of Eve
Eve White, a pseudonym used throughout the study to ensure confidentiality, had been recommended to Thigpen and Cleckley after reporting that she was suffering through “severe and blinding headaches.” During her first psychological interview, she complained of periods of amnesia, which she referred to as “blackouts”, after each of her headaches. Her family was apparently not aware of anything that would suggest a loss of consciousness.
Throughout her interviews, several emotional difficulties revolving around her life were revealed. Thigpen and Cleckley, the psychiatrists, believed that she had a large number of complex yet commonplace martial and personal conflicts. They were intrigued that Eve had no recollection of a recent trip she had taken with her husband, which they had been informed of through Eve’s phrasing of amnesia. Interested enough, they used hypnosis in an attempt to call the memories back. The amnesia, while Eve was under hypnosis, suddenly cleared. Several days later, a letter from Eve While arrived at Thigpen’s office. The letter concerned her therapy and started off in her usual calligraphic handwriting, but ended with a childlike scrawl.
Confused, the psychiatrists brought up the letter to Eve during her following visit. She denied sending it, but did admit she had begun one – one she never finished and thought she had thrown away. During that interview, Eve White (who was normally considered a very self-controlled, introverted, and the picture perfect model of the “conservative 1950’s woman”) became increasingly distressed and asked if hearing an occasional voice made her clinically insane. She seemed incredibly stressed and desperate for answers. The therapists took notes.
She began reporting that she heard an imaginary voice addressing her throughout the past few months. During this conversation, Eve White began feeling immense pain. She thrust her hands to her head and cringed. After an incredibly tense moment of silence, her hands dropped to her sides and the therapist observed a “quick and reckless smile” erupt across the now seductive face of Eve White. She grinned as she said in a cheeky, bright voice: “Hi there, Doc!”
Eve White was no longer the quiet girl she had been during her first interview. She had different physical movements – instead of shyly sitting in her chair she swung her legs across each other. Her gestures and eye movements became frisky – much more lively and passionate than those of Eve White’s personality. When asked her name, she immediately replied that she was “Eve Black”.
The therapist noted that this new mindset had a “childish daredevil air, an erotically mischievous glance, a face marvelously free from the habitual signs of care, seriousness and underlying distress.” Her voice and language structure had evolved into the complete opposite of what she had shown in previous meetings, and the therapist began to think of her as an entirely different woman.
Over the next 14 months, Eve White/Black was interviewed for around one hundred hours. Thigpen and Cleckley discovered that although Eve Black could appear out of nowhere, she could only be “called out” to the world when Eve White was under hypnosis. It was also confirmed that Eve White couldn’t be “brought back” unless Eve Black was under hypnosis. After several sessions, the hypnosis was no longer needed for obtaining changes, but it began to complicate Eve White’s life as Eve Black began to find it easier to “take over” using amnesia and mind-splitting headaches.
Thigpen and Cleckley believed that Eve Black had enjoyed an independent life since Eve White’s early childhood. They uncovered a number of incidents during Eve White’s childhood where she engaged in acts of disobedience and total mischief in which she was not aware of what was happened and punished for. Some of these incidents were backed up in later interviews which were conducted with her mother, father, and husband.
According to the therapists, Eve Black’s behavior was utter irresponsibility and a desire for pleasure, action, and excitement. She succeeded in not only concealing her identity from Eve White but also from her parents and husband. Eve Black denied marriage to “that man”, who she admitted she despised, and denied every possible relationship to Eve White’s daughter, whom she referred to as an “unconcerned bystander.” Eve White’s loved ones – her family – had always referred to the unpleasant behavior and harshness caused by Eve Black to be “unaccountable fits of temper in a woman who was habitually gentle and considerate.”
Since Eve Black was able to take over much easier than before, she avoided family and close friend. She sought the company of strangers and was able to remain unrecognized by imitating the characteristics of her counterpart. Both of these personalities were then given two psychometric tests.
IQ Categories (click to expand)
The IQ Test:
An intelligence quotient, more commonly known as an IQ, is a score derived from one of several standardized tests designed to assess human intelligence. Eve White obtained an IQ of 110 and Eve Black obtained an IQ of 104. While both of these scores fall into the category of “average/normal intelligence”, Eve Black scored six points lower.
The Rorschach Test:
Next, the two personalities were asked to take the Rorschach Test, which is a a type of psychoanalysis exam in which a standard set of symmetrical ink blots of various shapes and colors are presented one by one to the subject, who is asked to describe what they suggest or resemble. Eve Black was labeled as regressive, while Eve White was repressive. White showed obsessive-compulsive traits and an inability to deal with her hostility. Black showed sexual obsession.
The therapists noted that Eve Black had “often misled the therapist into believing she was cooperating, when in fact her behavior was particularly detrimental to Eve White’s progress.” The therapists began noting that Eve Black showed little compassion and was not easily persuaded to help with the therapy. As Eve White became aware of Eve Black’s existence through the long and drawn out interviews and tests, she began being repressed by her other personality. After eight more months of treatment, Eve White seemed to finally make progress. Her “blackouts” ceased after Thigpen and Cleckley begged Eve Black to help. She began increasing her performance at her job, which was being a telephone operator. It seemed to look like she was reaching acceptable and reasonable solutions to her marital problems.
However, therapy and treatment continued. Eve White’s headaches returned and so did her periods of amnesia. Eve Black denied all responsibility and began reporting the same experiences. Eve White’s state of mind deteriorated rather quickly, and it got to the point where Thigpen and Cleckley considered ending the case study and confining her into a mental asylum for the rest of her life. It became too easy for the therapist to call up whichever personality he wanted to examine, and childhood experiences literally gushed out of her mind as she was investigated under hypnosis.
During one episode, Eve White appeared relaxed until two minutes into the event. She awoke unprepared in the middle of hypnosis, and her eyes wandered around the room until she saw the therapist. She spoke with an unknown and husky voice, “Who are you?”
The therapists believed a third personality appeared. Much too all disappointment, she did not call herself “Eve Gray.” She labeled herself as “Jane” and was labeled as “more responsible than Eve Black yet more confident and interesting than Eve White.”
Example of Results from an Electroencephalogram
After Jane appeared, the three personalities were given electroencephalogram (EEG) tests. It was possible to see a clear distinction between the brain scans and readings of Eve Black and the other two personalities, however it was not possible to see a clear distinction between Eve White and Jane.
Having been able to work with the three personalities (Eve White, Eve Black, and Jane), for several more months, the therapists concluded that Jane could take possession of the entire body and regain full health, leading her way to a happy life. Jane had awareness of both Eves’ thoughts and behaviors but had no access to their memories prior to her “creation.” Jane had learned to take over Eve White’s tasks at work and home and showed dedication and compassion for her daughter. However, although the therapists could work with Jane to determine whether Eve Black had been lying, Jane was unable to find a way to displace Eve Black or to communicate through her.
So, in short, Jane was aware of Eve Black and Eve White. Eve Black was aware of Eve White. Eve White was, for the majority of the time, unaware of both Eve Black and Jane.
It was decided that Jane was the most stable of the three personalities and was the most likely solution to the battlefield inside Eve’s troubled mind. Her growing dominance over the other two personalities seemed to be an appropriate resolution to the problem given to Thigpen and Cleckley to begin with.
The Three Faces of Eve Movie Poster
The book was written, the movie was produced, and the patient received no benefits or reward for either. In 1975, almost two decades afterwards, “Eve” claimed that she had experienced many other personalities before the original therapy and after it. She has recalled a total of twenty-two personalities and suggested that the fragmentation of her personality was a defense mechanism, possibly to protect herself from daily chores she could not bear.
Thigpen and Cleckley were convinced that this would become the prime example of multiple personality disorder, and it did. Although they did not point to an exact cause of the disorder, they brought up the idea that it could be a response to child abuse as a way for the individual to protect him or herself. This case study was useful in revealing the origins of abnormal behavior. It gave a long and detailed history that is used as an aid to understanding and helping clients with the same problems today.
The Study of Eve gave an in-depth picture providing rich qualitative data through the interviews and process of hypnosis and also quantitative data through the psychometric tests. Thigpen and Cleckley involved outside sources, such as Eve’s relatives and family, to verify most information and asked independent third party experts to give a variety of tests, including the EGG – which has been considered the strongest piece of evidence pointing towards the argued fact that this disorder exists. Although it is incredibly possible that Thigpen and Cleckley could have been lied to this entire time, it is argued that a falsified performance could not have been continued for so long and consistently.
Even today, Multiple Personality Disorder diagnosis are considered very unreliable. For example, there are more cases reported in the United States of America compared to every other country on the planet. This could be because of the fact that American psychiatrists are more likely to pinpoint the disorder on individuals. Interestingly, women are more likely to be diagnosed then men. Perhaps Thigpen and Cleckley actually unwittingly led patients into believing they actually have the condition. Perhaps the monster they discovered was merely a figment of their own imaginations, and the work of a natural actress attempting to get out of her marriage.
Tags: AP, case study, Cleckley, Eve, individual differences, IQ, multiple personality disorder. special edition, pyschology, Thigpen, Three Faces of Eve
Multiple Personality Disorder (MPD) is defined in DSM-III as a dissociative disorder in which two or more distinct personalities coexist within one and the same individual. It is an example of a neurotic disorder.
Multiple Personality is not a form of schizophrenia. Schizophrenia is a type of psychosis where contact with reality and insight are impaired. Other symptoms can include hallucinations and delusions.
The aim of this article was to provide an account of the psychotherapeutic treatment of a 25-year-old woman who was referred to Thigpen and Cleckley because of 'severe and blinding headaches'.
The psychiatrists used a case study method. This consisted of interviews with the patient and her family, hypnosis, observation, EEG tests and a number of psychometric and projective tests including, memory tests, ink blot tests and intelligence tests.
The patient (referred to as Eve White in the study) had been referred for therapy to one of the authors because of ‘severe and blinding headaches’. At the first interview she also complained of ‘‘blackouts’’ following her headaches, although her family were not aware of anything that would suggest a real loss of consciousness or serious mental confusion.
During interviews several emotional difficulties were revealed. The psychiatrists believed that she had a number of complex, but relatively commonplace marital conflicts and personal frustrations.
However they were puzzled that Eve White had no memory of a recent trip. The therapists used hypnosis and the amnesia was cleared.
Several days after a visit to the therapists, a letter from Eve White appeared at the therapists’ office. The letter concerned her therapy and was written in her usual handwriting, but at the bottom of the page there was a paragraph that looked like a child had written it.
On her next visit Eve White denied sending the letter, though she recalled having begun one, which she never finished and thought she had destroyed. During the interview, Eve White who was normally very self-controlled became distressed and asked whether hearing an occasional imaginary voice made her insane.
She reported that she had on several occasions over the last few months briefly heard a voice addressing her. During this conversation Eve White, as if in pain suddenly put both hands to her head. After a tense moment of silence her hands dropped, and the therapist observed a ‘quick, reckless smile’ and in a bright voice she said: ‘Hi there, Doc’!
To the therapist it seemed that the usually conventional and retiring Eve White had changed into a carefree person. She also seemed to have a very different physical presence in terms of manner, gestures, and eye movements. When asked her name she immediately replied that she was Eve Black.
The therapist noted that this new person ‘had a childish daredevil air, an erotically mischievous glance, a face marvellously free from the habitual signs of care, seriousness and underlying distress’. The voice and language structure were also very different, and to the therapist it appeared to be an entirely different woman.
Over the next 14 months, during a series of interviews totalling approximately 100 hours, extensive material was obtained about the behaviour and experience of Eve White and Eve Black.
The therapists found that although Eve Black could sometimes ‘pop out’ unexpectedly, she could only be ‘called out’ by the therapists when Eve White was under hypnosis. Similarly, after a few hypnotic sessions the therapists could request Eve Black to let them speak to Eve White.
After more sessions they found that hypnosis was no longer needed for obtaining the changes. However, the therapists stated that this did complicate Eve White’s life considerably as Eve Black found herself more able to ‘take over’ than before.
The therapists believed that Eve Black had enjoyed an independent life since Eve’s early childhood and when she was ‘out’ Eve White was not aware of what was happening. In contrast, when Eve Black was not out she was aware of what was happening.
Eve Black told the therapists about a number of incidents in childhood where she engaged in acts of mischief or disobedience, which Eve White was unaware of and was punished for. Some of these incidents were later backed up in interviews with her parents and her husband.
According to the therapists, Eve Black’s behaviour was ‘characterised by irresponsibility and a shallowly hedonistic desire for excitement and pleasure’. She succeeded in concealing her identity not only from Eve White, but also from her parents and husband. Eve Black denied marriage to the man, who she despised, and denied any relationship to Eve White’s daughter except that of an unconcerned bystander. To her husband, daughter and parents her unpleasant behaviour, harshness and occasional acts of violence were explained in terms of ‘unaccountable fits of temper in a woman who was habitually gentle and considerate’.
During Eve Black’s longer periods ‘out’ she avoided her family and close friends, and sought the company of strangers and she was also able to remain unrecognised when it suited her by imitating Eve White.
Both personalities were given a series of psychometric (i.e. IQ and memory tests) and projective tests (i.e. Rorschach and drawings of human figures) by an independent expert with the following results:
IQ test results: Eve White obtained an IQ of 110 and Eve Black 104.
Memory Test results: Eve White had a superior memory function than Eve Black
Rorschach test (ink blot test) and drawings of human figures results: The profile of Eve Black was far healthier than Eve White. Eve Black though was regressive whilst Eve White was repressive showing obsessive-compulsive traits, rigidity and an inability to deal with her hostility.
During the therapy sessions it became clear that Eve Black had little compassion for Eve White, and could not be persuaded to help with the therapy. For example, the therapists noted that Eve Black had ‘often misled the therapist into believing she was cooperating, when in fact her behaviour was particularly detrimental to Eve White’s progress’.
As Eve White became aware of Eve Black’s existence through the therapy, she became able to prevent her ‘getting out’ on occasions, and so negotiation was necessary for Eve Black to get more time ‘out’. After eight months of treatment Eve White seemed to be making progress. Her ‘blackouts’ had ceased and she was working well at her job (as a telephone operator) and ‘was reaching some acceptable solution to her marital problems’.
However as the treatment progressed, Eve White’s headaches returned and so did the ‘blackouts’. Eve Black denied all responsibility and said that she also experienced lack of awareness during these ‘blackouts’. Eve White’s general state of mind was deteriorating and confinement was considered. It became easier for the therapist to call up whichever personality he wanted to examine, and childhood experiences were investigated under hypnosis. During one such episode, Eve White appeared to relax into a sleepy state. ‘After two minutes, her eyes opened, blankly staring about the room trying to orient herself. When her eyes finally met those of the therapist, slowly, with an unknown husky voice and immeasurable poise, she said, ‘Who are you?’
The therapists believed that another personality had emerged who called herself Jane. The other personality, they argued, was more responsible than Eve Black and more confident and interesting than Eve White.
After Jane appeared the three personalities were given electroencephalogram tests (EEG). It was possible to make a clear distinction between the readings of Eve Black and the other two personalities. Although it was not possible make a clear distinction between Eve White and Jane’s EEG.
Having been able to work with the three personalities for several months the therapists concluded that if Jane could take possession of the personalities the patient would regain full health and find her way to a happy life. Jane had awareness of both Eves’ thoughts and behaviour but did not have complete access to their memories prior to her appearance. Jane had learnt to take over many of Eve White’s tasks at home and work to help Eve White and showed compassion to Eve White’s daughter. However, although the therapists could work with Jane to determine whether Eve Black had been lying, Jane had not found a way to displace Eve Black, or to communicate through her.
It was decided the Jane was the person most likely to bring a solution to the troubled mind, and that her growing dominance over the other personalities to be an appropriate resolution. A postscript to this remarkable story came in the revelation in 1975 by Eve that she had experienced many other personalities before the original therapy and after it. She recalled a total of 22 and suggested that the fragmentation of her personality had been to protect herself from things she could not bear.
Thigpen and Cleckley were convinced that they had witnessed an example of multiple personality.
Although Thigpen and Cleckley do not point to the cause of MPD, the received wisdom is that MPD is usually a response to child abuse - a way for the individual to protect him or herself.
Evaluation of Procedure
Case studies are particularly useful in revealing the origins of abnormal behaviour. Through building up a long and detailed case history, case studies can be used as an aid to understanding and helping the client. Such research can also be called action research as the researchers involvement is consciously trying to change the persons behaviour.
A major strength of this case study was that it provides lots of data. It contained an in-depth picture producing rich qualitative data (e.g. the interviews and hypnosis) and also lots of quantitative data such as the results from the psychometric tests. Thigpen and Cleckley also involved Eve's relatives to help verify certain recollections, and to add information, and in this way throw light on the case. They also asked independent experts to give a variety of tests including an EEG test, psychometric tests and projective tests.
Case studies only relate to one individual and we have to be careful generalising from the findings. We have no way of assessing how typical this individual is of other people with multiple personality and therefore we have to ask whether this study is unique to Eve or whether we can generalise it to other cases.
If the study is retrospective (if the individual is asked to look back over his/her life) then memory may not be accurate and indeed, people may deliberately mislead the researcher. The data may therefore be unreliable.
The close relationship between researcher and participant may introduce bias. For example, in this case study, the moment that Eve Black appears can be seen in a different way to that described by the therapist. For example as Eve crossed her legs ‘the therapist noted from the corner of his awareness something distinctly attractive about them, and also this was the first time he had received such an impression’. For the therapist this as a change in her personality, but more objectively it could be explained as a change in his perceptions of her.
There are many ethical issues to consider in this study. Firstly it could be considered whether Eve White was treated more of a subject than a patient. The therapists also recognised the dilemma of deciding what their involvement should be in helping their patient when they noted that ‘we have not judged ourselves as wise enough to make active decisions’ about how the drama should develop’, when they note the moral problems with ‘killing’ one or more of the personalities.
Evaluation of Explanation
It is possible that the therapists could have been conned by a successful actress. Thigpen and Cleckley did recognise this but asserted that the performance could not have continued for so long and so consistently.
However, the diagnosis of MPD is very unreliable. For example, there are many more cases reported in the US than say the UK. This perhaps demonstrates that some psychiatrists are more likely to diagnose MPD than others. Interestingly, women are more likely to be diagnosed than men. An argument that is gaining popularity is that psychiatrists such as Thigpen and Cleckley are actually creating multiple personality by unwittingly leading their patients into believing that they have the condition.
The case study of Eve was made into a movie, ‘The Three Faces of Eve’. The public did not hear anything else about the case until 1975 when Eve revealed that she had approximately 22 personalities some of which she experienced before and some after the therapy. She believed that fragmentation of her personality had been to protect herself from things she could not bear.
In 1977 Chris Sizemore (Eve’s real name) with her cousin, wrote ‘I’m Eve’ and revealed herself as the famous Eve in TV interviews.
Thigpen, C.H. & Cleckley, H. (1954) A case of multiple personality. Journal of Abnormal and Social Psychology, 49, 135-51