Inside Karen’s Crowded Mind

That's a good thing, given the way it's believed to begin. According to psychiatrists, MPD arises primarily in children who are subjected to severe physical, sexual and emotional abuse. Having no other escape, they create different personalities to handle different parts of their troubled lives—then wall the personalities off from one another with mental barriers, so that no single persona has to handle too much. "As a child, if Daddy is about to do bad things to you, you say, 'I'll go to my secret place where it's not happening to me, but to some other little girl'," says Putnam.

To a lesser extent, the same thing happens routinely to trauma victims when they experience numbing, detachment and even out-of-body experiences. "Rape victims often say that during the rape, they saw themselves floating above the person, feeling sorry for her," says Dr. David Spiegel, associate chair of psychiatry at Stanford and co-editor of a new textbook on traumatic dissociation. The difference is that adults who detach themselves in this way usually reintegrate later. Chronically abused children may not, because their sense of identity is still malleable—and because the trauma is so persistent.

The abuse Karen Overhill endured, as described in Baer's book, was almost inhuman. While she was still in grade school, her father and grandfather subjected her to late-night, quasi-religious rituals, in which they strapped her to tables and told her she was evil. Saying that "God wanted her to suffer," they stuck her with pins and violated her prepubescent body with electric cattle prods, screwdrivers, knives and even crucifixes. They shut her into coffins. They dunked her in cold water. Her mother, who seemed incapable of acknowledging the atrocities, maintained deniability by taking a night job. It is impossible to verify these accounts, but in 1993, Karen's father was convicted on 19 counts of sexually molesting his granddaughter, Karen's niece.

The creation of separate alters may seem a bizarre way to cope, but it's not as if patients imagine themselves as Cleopatra or Napoleon. Each persona handles a different aspect of the sufferer's life. As Baer explains in his book, an alter named Claire would emerge when Karen was dragged from bed at night, so that Karen had little memory of the abuse the next day. When the torture began, Miles would take over. As a boy, he couldn't be violated in the same way and therefore couldn't fully absorb it mentally. Elise was created so that Karen could go to school the next day and act normal, having donned long pants and sleeves to cover the bruises. Sidney was the ball-playing child who related to Karen's father as if nothing was amiss, allowing Karen to survive in a household where, as a young girl, she was dependent on her dad. Lacking decent parents of her own, Karen even created Katherine and Holdon to be the responsible adults in her life, modeling them on figures she saw in sitcoms like "Father Knows Best" and "The Dick Van Dyke Show." The alters would come and go as needed, taking over Karen's conscious thoughts. When she regained awareness, all she knew was that she had "lost time."

This system protected Karen as a child, but in her late 20s, she descended into a deep depression that sent her to Dr. Baer. The key to treatment was reintegrating the alters into the single personality Karen has today. It was a painstaking process, convincing each alter to merge, but it worked. With each reintegration, says Baer, Karen acquired that alter's memories and character traits—strength, humor, compassion, anger. With each one, she became a more colorful, complete version of herself. Still, she was fragile. It took an additional eight years of therapy to build up her self- esteem. Today, meeting with a reporter in her midwestern apartment, she projects warmth, openness and a remarkable lack of rancor. Her alters would be proud.

© 2007