Psychological Consultation Report: Mrs. White and Miss Black

Mental Illness Awareness

Book excerpt

By: Corbett H. Thigpen and Hervey C. Cleckley

Date: 1952

Source: Corbett H. Thigpen and Hervy C. Cleckley. The Three Faces of Eve. New York: Bantam, 1998.

About the Author: Hervey C. Cleckley was a professor of psychiatry and neurology at the Medical College of Georgia, as well as Chief of Psychiatry and Neurology at University Hospital. Hervey Cleckley, along with Corbett Thigpen, became famous for his work with multiple personality disorder when the nonfiction best-selling book The Three Faces of Eve was published in 1952, based on the two physicians's work with their patient Christine Costner Sizemore. Cleckley later wrote another text, The Mask of Sanity, concerning psychopathy and sociopathy. Corbett H. Thigpen was a Clinical Professor of Psychiatry at the Medical College of Georgia. Along with Hervey C. Cleckley, he became well known in both scientific and popular press circles with the publication of The Three Faces of Eve. Along with his long and distinguished career in the practice and teaching of psychiatry, Thigpen had an abiding fondness for magic, and was an adroit amateur magician.

INTRODUCTION

Dissociative identity disorder (DID), formerly called multiple personality disorder (MPD) is thought to have existed since very early humans first experienced trauma. Since at least the eighteenth century, there have been detailed clinical and scientific records in which DID/MPD was considered a form of psychopathology. The first modern scholarly description of multiplicity was published in 1791 by Eberhardt Gmelin, who described a young woman living in Stuttgart who suddenly began speaking and acting as though she were a French aristocrat, even speaking her native German with a heavy French accent. It is noteworthy that this behavior occurred during the French Revolution, during which many members of the French aristocracy fled to Stuttgart. Of clinical interest is that when she was the "French Woman," she could remember everything that had occurred as either persona; the "German Woman" denied any knowledge of the existence of the "French Woman."

Early American physician Benjamin Rush (1745–1813) collected a number of case histories of persons exhibiting symptoms consistent with DID/MPD during the late eighteenth and early nineteenth centuries. Rush wrote the first American psychiatry text, entitled Medical Inquiries and Observations Upon Diseases of the Mind, published in 1812. He believed that that dissociation was a doubling of consciousness, and was caused by a cerebral hemisphere disconnection.

In 1816, the case of Mary Reynolds was published by the physician Samuel Latham Mitchell. This was the first time that a clinical report of DID/MPD was in the popular press, and it attracted significant media and public attention, with stories about her appearing in Harper's New Monthly Magazine in 1860. Mary Reynolds published an autobiography in which she detailed her experiences: at nineteen, she said that she took to her bed for nearly three months; during that time she was blind and deaf for a period of five weeks. After recovery from the temporary sensory loss, she had an episode in which she slept for more than a day; when she awakened, she reported having no recollection of her former life. She spent the next several weeks relearning many of her previous skills, with the exception of handwriting: she often used mirror writing (writing in reverse, from right to left). Her "new" personality was considered far more fun-loving and outgoing than her prior self. After more than a month, she had another long period of sleep, and woke as her former self, with amnesia for the intervening time. For the next fifteen years, her personalities alternated frequently until, when she reached her mid-thirties, the second personality remained in control of her consciousness, and she did not shift again. She died at age sixty-one.

French physician, psychiatrist, and philosopher Pierre Janet (1859–1947) studied DID/MPD extensively, and published numerous case studies during the late nineteenth and early twentieth centuries. In 1906, Morton Prince, founder of the Journal of Abnormal Psychology, published his account of the case of Christine Beauchamp, entitled The Dissociation of a Personality; Miss Beauchamp exhibited three different personalities, in addition to her waking self. The Beauchamp case has been cited in psychology and psychiatry texts as recently until the present day, both because of the clinical aspects of the case and because Prince stated his belief that the disorder was caused iatrogenically (caused by therapists, typically through hypnotism). Currently, there continues to be a significant cadre of mental health professionals as well as laypersons, who assume that DID/MPD is akin to false memory syndrome, and can be situationally caused. There has not yet been conclusive evidence presented in the scientific or scholarly literature that has attributed causality for MPD/DID.

In 1954, Cleckley and Thigpen published their case report of work with Christine Costner Sizemore in the Journal of Abnormal Psychology, and interest in DID/MPD was again piqued in the mental health community. In 1957, the case achieved wide popular acclaim through the publication of their nonfiction book, The Three Faces of Eve. In brief, the details of the case are as follows: the patient was referred for treatment by her spouse, as a result of severe and blinding headaches, reported by the patient to be followed by blackouts. Her psychiatrists were puzzled by her amnesia for a recent trip, and utilized hypnosis, which cleared the blocked memory. Shortly thereafter, they received a letter from the patient that included a paragraph apparently written in a different handwriting than the rest of the missive. The patient denied sending the letter, although she reported having started and then thrown it away. During the course of therapy, she admitted hearing voices, and then appeared to experience a sharp headache. Moments later, she shifted into another personality, who had very different mannerisms and body language; she also referred to herself by a different name. The book (and the movie) is based on some fourteen months of therapy and interviews with the patient and her two "alters."

PRIMARY SOURCE

PSYCHOLOGICAL CONSULTATION REPORT

This twenty-five year-old married female patient was referred for psychological examination with a provisional diagnosis of dual personality. Two complete psychological examinations were requested, one of the predominant personality, Mrs. White, the other,… of the secondary personality, Miss. Black.

The patient is the oldest of three siblings, having twin sisters. She quit school two months before graduation form high school. She was employed as a telephone operator. She has been married six years and has a girl four years old. Patient states that she did things recently she cannot remember having done, and expresses serious concern about this condition. The following psychological tests were administered in both examinations:

    Wechsler-Bellevue Intelligence Scale
    Wechsler Memory Scale
    Drawings of Human Figures
    Rorschach

Test Behavior Patient was neat, friendly, and cooperative. However, while Mrs. White was more serious, more conscientious, and displayed more anxiety, Miss Black appeared somewhat less anxious and was satisfied with giving more superficial responses. Still the basic behavior pattern was very similar in both personalities, indicating that inhibitory forces were not markedly abolished even in the role of the desired personality. Speech was coherent, and there were no distortions in ideation or behavior according to the assumed personality. No psychotic deviations could be observed at the present time.

Test Results While Mrs. White is able to achieve an IQ of 110 on the Wechsler-Bellevue Intelligence Scale, Miss Black attains an IQ of 104 only. There is evidence that the native intellectual endowment is well within the bright normal group; however, in Mrs. White's case anxiety and tenseness interfere, in Miss Black's superficiality and slight indifference as to achievement are responsible for the lower score. While Mrs. White shows more obsessional traits, Miss Black shows more hysterical tendencies in the records. It is interesting to note that the memory function in Miss Black is on the same level as her Intelligence Quotient, while Mrs. White's memory function is far above her IQ, although she complained of a disturbance of memory. The only difficulty encountered by both personalities is on recall of digits, a performance in which telephone operators usually excel! On the other hand, the Rorschach record of Miss Black is by far healthier than the one of Mrs. White. In Miss Black's record a hysterical tendency is predominant, while Mrs. White's record shows constriction, anxiety, and obsessive compulsive traits. Thus Miss Black is able to conform with the environment, while Mrs. White is rigid and not capable of dealing with her hostility.

Personality Dynamics A comparison of the projective tests indicates repression in Mrs. White and regression in Miss Black. The dual personality appears to be the result of a strong desire to regress to an early period of life, namely the one before marriage. Miss Black is actually the maiden name of Mrs. White. Therefore, there are not two different personalities with completely dissimilar ideation, but rather one personality at two stages of her life. As is characteristic for this type of case, the predominant personality is amnesic for the existence, activities, or behavior of the secondary or subordinate system, while the secondary personality is aware and critical of the predominant personality's activities and attitudes. The latter reaction is quite similar to the ego-conflict in obsessive compulsive disturbances.

Mrs. White admits difficulty in her relation with her mother, and her performance on the Rorschach and drawings indicate conflict and resulting anxiety in her role as a wife and mother. Only with strong conscious effort can she compel herself to subject herself to these roles. The enforced subjection results in ever increasing hostility. This hostility, however, is not acceptable to her, and activates a defense mechanism of regression to avoid severe guilt feelings, by removing the entire conflictual situation form conscious awareness. At the same time, the new situation (in which she plays the role of Miss Black) permits her to discharge some of her hostility towards Mrs. White. Miss Black on the other hand has regained her previous status of freedom from marital and maternal conflicts, and thus has liberated herself from the insoluble situation in which Mrs. White found herself through her marriage. In addition, she can avert the—in her conviction—inevitable spiritual loss of her child. Thus, it is not surprising that she shows contempt for Mrs. White who permitted herself to become involved in such a situation because of her lack of foresight, as well as her lack of courage to forcefully solve the dilemma.

Actually, the problem started at a much earlier period of life, with a strong feeling of rejection by her parents, especially after the birth of her twin sisters. Mrs. White loves them dearly, Miss Black despises them. After quitting school to help support the family, she (that is to say Mrs. White) sent home money to be used for overcoats for her twin sisters, denying herself a badly wanted wristwatch. When the money was used to buy them two wristwatches instead of overcoats, she reacted with strong, but repressed, hostility. Significantly, she removed her wristwatch while examined as Mrs. White, stating that she doesn't like jewelry. There are several illustrations of her strong sense of rejection as well as sibling rivalry in her records.

    Leopold Winter, Ph.D.
    Clinical Psychologist
    U. S. Veteran's Administration Hospital
    Augusta, Georgia
    July 2, 1952

SIGNIFICANCE

Dissociative Identity Disorder (formerly Multiple Personality Disorder), as defined (in part) by the Diagnostic and Statistical Manual of Mental Disorders, is characterized by the presence of two or more distinct identities or personality states that recurrently take control of the individual's behavior accompanied by an inability to recall important personal information that is too extensive to be explained by ordinary forgetting.

The disorder is diagnosed far more frequently in the United States than elsewhere in the world, and three to nine times more frequently in females than in males. Females are also typically found to have more "alters," or distinctive personalities than males.

Although the overall population estimates vary, it is reported that up to 1 percent of American adults have some form of this chronic disorder. There is some suggestion in recent evidence for genetic linkage; and for development of the disorder as a result of recurrent and severe abuse or major trauma in early childhood. The disorder remains controversial, with clinician opinion ranging from those who liken DID to false memory syndrome and accept as true iatrogenic causality (occurring as the result of treatment by a health professional), to those who believe that the disorder occurs in 8 to 10 percent of the general population. Most clinicians report viewing dissociation on a very broad continuum, with nearly everyone having some experiences of being lost in a daydream, reverie, book, or movie, and relatively few having the experience of complex and chronic dissociative experiences resulting in functional impairment.

Mental illness, in sharp contrast to disorders with purely physical causation, has long been fraught with stigma. Until just a few generations ago, it was common to hide people with chronic or severe mental illness in institutions, or to lock them away in attics or basements. People with minor psychopathology (disorders in which they are not psychotic, and retain some ability to function in society while actively experiencing symptoms) often denied their illnesses, again for fear of social reprisals. By presenting mental illness in a way that was both acceptable and understandable to the general public, The Three Faces of Eve was instrumental in raising public awareness of psychopathology, as well as giving it an appealing face by having a young and attractive actress portray Eve (who was described positively in the book as well). Over the next few decades, mental illness was made more and more a subject for popular viewing and discussion. Several books, fiction and nonfiction, became bestsellers and were made into films (either for commercial release or for television broadcast, notably Sybil and One Flew Over the Cuckoo's Nest, leading to a spate of films and books describing various disorders from the patient perspective. The popularization of the neurotic as hero (or, at least, as sympathetic or lovably bumbling persona) spawned a film and directorial career for the writer/actor Woody Allen, whose ability to portray the nobility of the fragile psyche made it acceptable (and even trendy) to visit a therapist.

FURTHER RESOURCES

Books

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Washington, D.C: American Psychiatric Association, 2000.

Sizemore, Chris Costner, and Elen Sain Pittillo. I'm Eve. Garden City, N.Y.: Doubleday, 1977.

Periodicals

Becker-Blease, K. A., K. Deater-Deckard, et al. "A Genetic Analysis of Individual Differences in Dissociative Behaviors in Childhood and Adolescence." Journal of Child Psychology and Psychiatry. 45 (3) (2004): 522-532.

Web sites

Allegheny College. "Mary Reynolds (1793–1854): The First Known Case of Multiple Personality Disorder." 〈http://merlin.alleg.edu/employee/a/adale/maryr/Home%20Page.htm〉 (accessed November 21, 2005).

ISSD World. "The International Society for the Study of Dissociation: Diagnostic Tools." 〈http://www.issd.org/world/isworld_5.html〉 (accessed November 21, 2005).

ISSD World. "The International Society for the Study of Dissociation: Guidelines for Treating Dissociative Identity Disorder in Adults." 〈http://www.issd.org/indexpage/treatguide1.htm〉 (accessed November 21, 2005).

Paul R. McHugh. "Multiple Personality Disorder (Dissociative Identity Disorder)." 〈http://www.psycom.net/mchugh.html〉 (accessed November 21, 2005).

Prepublication version of the Journal of Traumatic Stress. "Dissociation: An Insufficiently Recognized Major Feature of Complex PTSD." 〈http://www.onnovdhart.nl/articles/jts_complex_%20ptsd.pdf〉 (accessed November 21, 2005).