Thigpen and Cleckley (1954)

Background

We know that each of us has something which is unique about us and which separates us from others, and we tend to refer to that as our personality. Personality has been defined as ‘the distinctive and characteristic pattern of thought, emotion and behaviour that define an individuals personal style and influence his or her interactions with the environment’ (Atkinson et al. 1993:525).

Personality is a hypothetical construct. We can never physically see it, we can only infer personality from behaviour. Personality tests include projective tests (Rorschach) which are a measurement of attitude that involves asking respondents to give their interpretation of a picture (i.e. ‘project’ their own attitudes onto the picture) and psychometric tests which is a measure attainment of an aspect of an individual like Memory or intelligence (IQ).

Multiple Personality Disorder (MPD) is defined in the DSM as dissociate personality disorder (DID) which involves the existence of one or more personalities in one individual. It is an example of a neurotic disorder. Not only is there more than one personality but they can be completely separate from one another and may be unaware of one another. Normally polar opposites.

Each personality will have different memories, perceptions and intellectual abilities and may even use spectacles of different strengths.When one of the personalities is in control all characteristics are engaged and all other personalities disappear. Another feature is fugue amnesia – significant information can be forgotten, such as leaving home and not remembering why.

MPD is not to be confused with schizophrenia.Schizophrenia is a psychotic disorder marked by some, or all of the following symptoms:Delusions, Hallucinations, Incoherent word associations, and Inappropriate emotions or lack of emotions. People with MPD do not show the disturbances of emotion, perception and reality testing associated with schizophrenia.

MPD usually starts in early childhood and is often associated with some kind of traumatic event. Putnam et al (1983) surveyed therapists working with DID clients and found that 80% of their clients had suffered child physical abuse, 70% victims of incest.

Watch the following video clip which documents cases of Multiple Personality Disorder, Write down any characteristics you can identify of the disorder.

Some have questioned the validity of the diagnosis of MPD. Is it really possible for more than one personality to reside in one body, each with experiences, memories and wills separate and distinct from one another? Although cases had been reported in the past, modern psychiatry in the 1950s has tended to reject MPD because of a lack of objective evidence. The diagnosis relies heavily on the patient subjective reporting of experience, and may therefore be the product of the patient’s deceit or the observers wishful thinking.

Aim

To describe the case study of a 25 year old married woman referred to 2 psychiatrists (Thigpen and Cleckley) for severe headaches and blackouts, but soon discovered to have a multiple personality.

Method/Procedure

Case study method with the patient attending therapeutic sessions for a 14 month period

Treatment involved psychotherapeutic interviews and occasional hypnosis with Thigpen and Cleckley.

Family members were interviewed to corroborate some of the ‘Eve’s’ stories.Eve also undertook a number of psychological tests including psychometric tests to measure IQ and memory ability. Two projective tests were carried out, supposedly to gain some insight into unconscious feelings and wishes: the tests were drawings of human figures and the Rorschach ink blot test. A handwriting expert also compared the handwriting of the personalities.

When a third personality appeared an EEG was used to measure and compare the brain activity of each of the personalities.

Sample

One woman, 25 years old, Married.

Three main personalities:

Eve White: 25 years old, had been married for 6 years and had one daughter. Marriage was shaky. During treatment she left home and lived in the city about 100 miles away. Her personality was neat, demure, honest and very anxious.Headaches after losing baby – started therapy.

Eve Black: Opposite of Eve White. Mischievous and childish. Had little concern for husband or child – they weren’t hers! Uncooperative. Erotic

Jane: Mature, sincere, capable and interesting. Aware of both other personalities. Gradually took over from Eve White but couldn’t get rid of Eve Black.

Results

Eve White has been referred for therapy and attended interviews about headaches, blackouts, marital problems, and personal problems.

The therapists 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.letter

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.

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.

Watch the video clip below to see the interviews with Eve White, Eve Black and Jane:

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 Whites life considerably as Eve Black found herself more able to ‘take over’ than before.

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.

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 Whites daughter except that of an unconcerned bystander.

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:

Tests EW EB Jane
IQ 110 104 Not done
Memory test superior inferior Not done
EEG 11 per second (normal) 12.5 per second (psycho-pathic?) 11 per second
Drawing of human figures Healthier than EB, some anxiety, OCD traits, rigid and hostile Less healthy than EW Hysterical tendencies No test
Personality(Rorschach) Repressive, anxious, unable to deal with hostility Regressive,Hysterical, far healthier than EW No test

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’. During one such episode of hypnosis, 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.

It was decided that 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.

Conclusion

Thigpen and Cleckley remain convinced that they witnessed a case of multiple personality.They did wonder whether they had become so involved that they ‘lost their sense of judgement and over dramatised the case’. However, external data from family and husband and data from the subjective and objective measures supported the idea that there were two personalities.

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.

–Evaluation

Strengths

+ Case study method lots of in-depth rich qualitative data (e.g. the interviews and hypnosis) which superficial methods might miss or ignore. As a result, we gain more of a holistic view of phenomenon being studied. Reveals origins of abnormal behaviour and helps us to understand and help the patient.

+ High ecological validity of data obtained as a real life patient was studied using real life methods for therapy. Therefore findings are likely to generalise to real life situations.

+ Case study method often uses small sample sizes. As a result researchers are likely to form close bond with participant’s and thus participants are more likely to behave naturally, increasing the validity of data gathered.

+ Longitudinal design allows the researchers to study development over time, therefore giving us a more in-depth understanding of behaviour.

+ Both quantitative and qualitative data obtained. The results from the psychometric tests and EEG can be easily analysed and allows for comparison between ‘personalities’, whilst the data obtained from the interviews, hypnosis, and projective tests provides an in-depth picture giving rich insight. 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. The use of independent experts increased the reliability of this study as observer bias reduced.

+ Findings provide support for the nurture side of the debate. Suggests that environmental factors, particularly traumatic events, can profoundly affect our mental health. Whilst there might be a genetic predisposition to certain mental health disorders, there is no doubt that they are triggered by events in people’s lives.

+ Usefulness: first fully documented case of MPD which has no doubt led to the disorder being more easily recognised

Weaknesses

– Lack of generalisability to the population due to single cases being too small and unrepresentative. We have no way of assessing how typical this individual is of other people with MPD and therefore we have to ask whether this study is unique to Eve or whether we can generalise it to other cases.

– The methods used (e.g. interviews, hypnosis) involves retrospective reporting (when an individual is asked to look back over his/her life). As a result, memory may not be accurate and indeed, people may deliberately mislead the researcher. The data may therefore be unreliable.

– Case study method often uses small sample sizes. As a result the researchers are likely to form a close relationship with the participant which may introduce bias (Observer bias and subject reactivity bias). Therefore, one must question the validity of the findings.

– There are many ethical issues to consider in this study. Eve White was treated like more of a subject than a patient – during the treatment Eve White got worse but was used more for the purpose of research than to treat her symptoms.

– Self-report and projective tests are based on subjective interpretation of the therapist. They are also subject to issues such as social desirability bias and demand characteristics, and therefore Eve may have been a skilful actress, which affects the validity of the findings.

– Lacks validity: Eve may have altered her ‘intelligence’ when out as Eve Black, by not answering the questions correctly even if she could. That is, she would be wanting the therapists to believe that she had more than one personality.

– Usefulness: MPD is a highly controversial diagnosis and there is some concern that patients are being incorrectly labelled as suffering from the disorder as a result. 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.

 

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Section A Questions

Section B Questions

Multiple Choice Quiz

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