Multiple-Personality Disorder

Even for a psychiatric patient, Karen Overhill seemed unusually devoid of hope on the day in 1989 she walked into the Chicago office of Dr. Richard Baer. As weeks of therapy grew into months, antidepressants didn't help her, at least not consistently. She was suicidal—and the flat, emotionless way she stated her wish to die made Baer fear that she might actually follow through. Eventually, Karen began to volunteer stories of childhood abuse. And she mentioned odd memory lapses. She would find herself in strange places with no awareness of how she'd gotten there. She couldn't even remember having had sex with her husband, although she must have, since they had two children.

Baer suspected a much deeper problem than the depression and suicidal thoughts Karen admitted to. Still, he kept his speculation to himself during the first four years of therapy, for fear of planting ideas in Karen's mind. He waited for her to volunteer the information, and in a way, she finally did. In November 1993, an envelope with Karen's return address arrived in the mail. Inside was a single sheet of lined paper and a letter written in a child's penciled scrawl. "My name is Claire," it began. "I am 7 years old. I live inside Karen."

The remarkable medical journey that ensued is the subject of Baer's new book, "Switching Time." It recounts the 17-year course of Karen's therapy in all its painful detail and sheds new light on multiple personality disorder (MPD), the controversial illness that afflicted her. (Karen Overhill is a pseudonym Baer created to protect his patient and her family.) The book describes the challenges Baer faced as more and more of Karen's alter egos emerged—men, women and children—a total of 17, each with his or her own character traits, mental problems and agenda. Baer had to get to know them all, then persuade them to wipe out their individual identities by merging into one. It was the defining case of his career—and one that may have saved Karen's life.

But was Karen's disorder real? There have been allegations that some purported MPD sufferers were just publicity seekers. Yet Baer doesn't have the slightest doubt. As he points out, there are easier ways to gain notoriety than 17 years of therapy. And how could a poseur have maintained each alter's distinct memories, personality, voice and mannerisms for years, never mixing them up? "Meryl Streep couldn't have done it," he says. The alters even wrote him letters in different handwriting.

Still, it's easy to see why MPD remains controversial. Although the condition has been observed for 200 years—and is officially recognized by the American Psychiatric Association under the formal name "dissociative identity disorder"—it is rare enough that most therapists never treat a case. Some psychiatrists doubt that it exists at all, claiming it is the product of suggestion. In some cases, they're probably right. The 1973 best seller "Sybil" led to a wave of diagnoses by therapists who didn't really understand the condition. One psychiatric hospital in Maryland "had a whole ward with patients—some male, some female, some mooing like cows or barking like dogs," says Dr. Paul McHugh, former chair of psychiatry at Johns Hopkins and a leading skeptic. It didn't help that both the made-for-TV movie version of "Sybil," which starred Sally Field, and the 1957 film "The Three Faces of Eve" gave exaggerated portrayals of radical personality shifts, which made MPD seem more bizarre than believable—or that the disorder was later enmeshed in the controversy over false "recovered memories" of childhood abuse. MPD became an embarrassing diagnosis in the psychiatric community.

But it didn't go away. Dr. Frank Putnam—who has studied the condition extensively, first at the National Institute of Mental Health and now at Cincinnati Children's Hospital—continues to receive calls from psychiatrists around the country who are stunned when a patient of theirs turns out to have the disorder. "There's nothing like seeing a patient who has it to make you believe," he says. Today there are clearer diagnostic criteria and a better understanding of the causes. The condition, says Dr. Herbert Speigel, who occasionally treated Sybil during her therapist's absence, is "real, but rare."

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.