I. URIOSTE Evento: Regional

The instructor in Paula’s human sexuality course suggested that she talk to a psychologist. Several factors contributed to his concern: Although Paula was a good student, her behavior in class had been rather odd on occasion. Every now and then, it seemed as though she came to class “high.” She participated actively in the discussions, but she did not seem to be familiar with the readings or previous lecture material. Her scores on the fi rst two exams had been A’s, but she failed to appear for the third. When he asked her where she had been, Paula maintained with apparent sincerity that she couldn’t remember. Finally, she had handed in an essay assignment that described in rather vague, but suffi ciently believable, terms the abusive, incestuous relationship that her father had forced upon her from the age of 5 until well after she was married and had had her fi rst child. All of this led her professor to believe that Paula needed help. Fortunately, she was inclined to agree with him because several things were bothering her. She made an appointment to talk to Dr. Harpin, a clinical psychologist at the student health center.

Paula Stewart was 38 years old, divorced, and the mother of a son who was 18 and a daughter who was 15. She was about 90 pounds overweight, but in other ways, her appearance was unremarkable. For the past 5 years, Paula had been taking courses at the university and working part time at a variety of secre- tarial positions on campus. She and her daughter lived together in a small, rural community located about 20 miles from the university—the same town in which Paula had been born. Her son had moved away from home after dropping out of high school. Paula’s mother and father still lived in their home just down the street from Paula’s.

Over a series of sessions, Dr. Harpin noticed that Paula’s behavior was often erratic. Her moods vacillated frequently and quickly from anger and irritability to severe depression. When she was depressed, her movements became agitated, and she mentioned that she experienced sleep diffi culties. She threatened suicide

frequently and had, on several occasions, made some attempts to harm herself. In addition to these emotional diffi culties, Paula frequently complained of severe headaches, dizziness, and breathing problems.

It also seemed that Paula abused alcohol, although the circumstances were not clear. This situation was a source of distress and considerable confusion for Paula. She had found empty beer cans and whiskey bottles in the back seat of her car, but she denied drinking alcoholic beverages of any kind. Once every 2 or 3 weeks, she would wake up in the morning with terrible headaches as though she were hungover. Dr. Harpin believed that her confusion and other memory problems could be explained by her alcohol consumption.

Paula’s relationships with other people were unpredictable. She would explode with little provocation and often argued that no one understood how serious her problems were. On occasion, she threatened to kill other people, par- ticularly an older man, Cal, who lived nearby. Paula’s relationship with Cal was puzzling to both of them. They had known each other since she was an adoles- cent. Although he was 15 years older than she and had been married to another woman for more than 20 years, Cal had persistently shown a romantic interest in Paula. He would frequently come to her house saying that she had called. More often than not, this made Paula furious. She maintained that she was not at all interested in him and would never encourage such behavior. At other times, how- ever, she insisted that he was the only person who understood and cared for her.

Paula’s father was still alive, but she did not spend any time with him. In fact, he behaved as though she didn’t exist. She was able to recall and dis- cuss some aspects of the incestuous relationship her father had forced upon her in previous years, but her memory was sketchy, and she preferred not to discuss him.

Throughout the fi rst year of treatment, Paula’s memory problems became increasingly severe. The notes she wrote during classes were often incomplete, as though she had suddenly stopped listening in the middle of a number of lec- tures. She sometimes complained that she lost parts of days. On one occasion, for example, she told Dr. Harpin that she had gone home with a severe head- ache in the middle of the afternoon and then couldn’t remember anything until she awakened the following morning. Another time she was eating lunch, only to fi nd herself hours later driving her car. Her daughter asked her about a loud argument Paula had had with her mother on the phone, and she couldn’t remem- ber even talking to her mother that day. These unexplained experiences were extremely frustrating to Paula, but the therapist continued to believe that they were induced by alcohol.

One day, Dr. Harpin received a message from his secretary saying that a woman named Sherry had called. She had identifi ed herself as a friend of Paula’s and had said that she would like to discuss the case. Before respond- ing directly to this request, Dr. Harpin decided to check with Paula to fi nd out more about this friend and determine whether she would give her consent for this consultation. Paula denied knowing anyone named Sherry, so Dr. Harpin did

not return the call. It did strike him as odd, however, that someone knew that he was Paula’s therapist.

Two weeks after receiving this call, Dr. Harpin decided to use hypnosis in an attempt to explore the frequent gaps in Paula’s memory. They had used hypnosis on one previous occasion as an aid to the process of applied relaxation, and it was clear that Paula was easily hypnotized. Unfortunately, it didn’t help with the mem- ory problem; Paula couldn’t remember anything else about the time she had lost.

Upon waking out of a trance, Paula complained of a splitting headache. She gazed slowly about the room as though she were lost. Dr. Harpin was puzzled. “Do you know where you are?” he asked. She said she didn’t know, so he asked if she knew who he was. Rather than providing a quick answer, she glanced around the room. She noticed his professional license hanging on the wall, read his name, and fi nally replied, “Yes. You’re Dr. Harpin, the one who’s working with Paula.” This switch to her use of the third person struck Dr. Harpin as being odd and roused further curiosity about her state of mind.

“How do you feel?” “Okay.”

“Do you still have a headache?” “No. I don’t have a headache.”

The way she emphasized the word “I” was unusual, so Dr. Harpin said, “You make it sound like somebody else has a headache.” He was completely unprepared for her response:

“Yes. Paula does.”

Pausing for a moment to collect his wits, Dr. Harpin—who was simultane- ously confused and fascinated by this startling exchange—decided to pursue the identity issue further.

“If Paula has a headache, but you don’t, what’s your name?” “Why should I tell you? I don’t think I can trust you.” “Why not? Don’t you want to talk to me?”

“Why should I? You wouldn’t talk to me when I called last week!”

Dr. Harpin fi nally remembered the call from Sherry, who had wanted to talk to him about Paula’s case. He asked the woman, once again, what her name was, and she said, “Sherry.” After they talked for a couple of minutes, Dr. Harpin said, “I’d like to talk to Paula now.”

“Oh, she’s boring.”

“That doesn’t matter. She’s my client, and I want to talk to her to see how she feels.”

“Will you talk to me again?” “Yes.”

“Why should I believe you? You wouldn’t talk to me before.” “Now I know who you are. Please let me talk to Paula.”

At that point, she closed her eyes and waited quietly for a few moments. When her eyes opened, Paula was back and her headache was gone, but she could not remember anything about the past half hour. Dr. Harpin was stunned and incredulous. Although he was aware of the literature on dissociative identity disorder (DID) and a few well-known cases, he could not believe what Paula had said.

When Paula appeared for their next appointment, she still could not remem- ber anything that had happened and seemed just as she had before this remark- able incident. Dr. Harpin decided to attempt to discuss with Paula a traumatic incident that had happened a number of years ago. Paula had frequently men- tioned a day when she was 15 years old. She couldn’t remember the details, but it was clearly a source of considerable distress for her and seemed to involve her father.

Dr. Harpin asked Paula to describe what she could remember about the day: where they were living at the time, what time of year it was, who was home, and so on. Paula fi lled in the details slowly and as best she could. Her father had grabbed her, hit her across the face, and dragged her toward the bedroom. No matter how hard she tried, she couldn’t remember anything else. Paula said that she was getting a headache. Dr. Harpin suggested that she lean back in the chair and breathe slowly. She paused for a moment and closed her eyes. In a few moments, she opened her eyes and said, “She can’t remember. She wasn’t there. I was!” Sherry was back.

Paula’s appearance had changed suddenly. She had been very tense, clutch- ing the arms of the chair and sitting upright. She also had had an annoying, hacking cough. Now she eased down in the chair, folded her arms, and crossed her legs in front of her. The cough was completely gone. Sherry explained why Paula couldn’t remember the incident with her father. As Sherry put it, when Paula was dragged into the bedroom, she “decided to take off,” leaving Sherry to experience the pain and humiliation of the ensuing rape. Dr. Harpin translated this to mean that Paula had experienced a dissociative episode. The incident was so extremely traumatic that she had completely separated the experience and its memory from the rest of her consciousness.

After discussing the rape in some detail, Dr. Harpin decided to fi nd out as much as he could about Sherry. She provided only sketchy information, admit- ting that she was in her thirties but denying that she had a last name. Sherry’s attitude toward Paula was contemptuous. She was angry because Paula had so frequently left Sherry to experience painful sexual encounters. They discussed numerous incidents dating from Paula’s adolescence to the present, but none of Sherry’s memories traced back prior to the incident with Paula’s father. Since

that time, Sherry was apparently aware of everything that Paula had done. Paula, on the other hand, was completely oblivious to Sherry’s existence.

Toward the end of this conversation, Dr. Harpin asked whether it was Sherry or Paula who had been responsible for the beer bottles Paula found in her car. Sherry said, “Oh, we did that.” Intrigued by the plural pronoun, Dr. Harpin asked whom she meant to describe, and the patient said, “Oh, Janet and I.”

“Who’s Janet?”

“You don’t want to talk to her. She’s always angry. You know how ado- lescents are.”

By this point, Dr. Harpin knew that Sherry found it easier than Paula to switch back and forth among these personalities, so he encouraged her to try. Sherry agreed, somewhat reluctantly, and soon there was another dramatic change in Paula’s appearance. She fi dgeted in her chair, pulled at her hair, and began to bounce her leg continuously. She was reluctant to talk, but adopted a coy, somewhat fl irtatious manner. She claimed to be 15 years old.

Several sessions later, Sherry presented Dr. Harpin with a request. She said that she and Janet were extremely concerned about Caroline, who was presum- ably only 5 years old and had been crying a lot lately. Sherry and Janet wanted Dr. Harpin to talk to Caroline. He agreed to try. Sherry closed her eyes and effortlessly transformed her posture and mannerisms to those of a little girl. She pulled her legs up onto the chair and folded them under her body. Holding her hand in a fi st clenched close to the side of her mouth almost as if she were suck- ing her thumb, she turned sideways in the chair and peered at Dr. Harpin bash- fully out of the corner of her eye. She seemed to be rather frightened.

“Will you talk to me, Caroline?” Dr. Harpin began.

After an extended pause, Caroline asked, “What’s your name? I don’t know you.” Her voice seemed higher and weaker than it had been moments before.

“I’m Dr. Harpin.”

“Do you know my mommy and daddy?”

“No. But I’m a friend of Sherry’s. She asked me to talk to you. Do you know Sherry?”

“Yes. She watches me. She takes care of me.” “Do you know Janet?”

“She’s big. She has fun!” “Do you know her very well?” “Not really. She gets mad easy.”

“Sherry told me that you’ve been feeling sad. Why is that?” “I’m a bad girl.”

“Mommy told me I’m bad. That’s why she has to punish me.” “I don’t think you’re a bad girl.”

“Yes I am. If I’m not bad, why would they punish me?” “What do they punish you for?”

“I don’t know. They just do. They hurt me. Once I pinched my brother when he took my toy puppy. Then they took my puppy away, and they won’t give it back! Grandpa gave it to me. He’s good to me.”

At their next session, Dr. Harpin asked Paula if she remembered ever having a stuffed puppy when she was a child. A fond smile of recognition followed sev- eral moments’ refl ection. She had indeed had such a toy. He asked if she knew what had happened to it. She insisted that she had no idea. It had been almost 30 years since she remembered seeing it, but she agreed to look around in the attic of her mother’s house.

Much to everyone’s surprise, Paula was able to fi nd the puppy, which was known as Jingles because of the sound made by a small bell sewn into its tail. Unfortunately, it became the source of considerable aggravation for Paula. The fi rst day she found it, she left it in the living room before she went to bed. When she woke up in the morning, Jingles was in bed with her. This happened two nights in a row. On the third night, she locked the puppy in her car, which was kept in the garage, and went to bed. Once again, the puppy was in bed with her when she woke up in the morning. She was annoyed and also a bit frightened by this strange turn of events. In subsequent sessions, Sherry provided the following explanation for what had happened. Caroline would wake up in the middle of the night crying, wanting to hold her stuffed animal. In an effort to console her, Sherry would then retrieve Jingles from the living room or garage. Of course, Paula would not remember what had happened.

Thus far there were four names: Paula, Sherry, Janet, and Caroline. The clinical picture was as fascinating as it was unbelievable. Dr. Harpin felt that he needed help as much as his client. In his 15 years of clinical experience, he had never seen a case that resembled Paula’s in any way. It fi t closely with some of the published cases of DID, but he had never really believed that this sort of thing happened, except in fi ction. Surely it was the product of the therapist’s imagination, or the client’s manipulative strategy, he had believed. He sought advice from colleagues about a plan for the treatment of this com- plex set of problems. His contacts with Paula continued to deal largely with day-to-day crises.

He asked Paula if she had read any of the well-known books or watched any of the popular fi lms dealing with DID (which was formerly called multiple per- sonality). She had not. Because she was not familiar with other examples of this phenomenon, it seemed unlikely that she had simply invented the alter person- alities as a way of attracting attention or convincing others of the severity of her problems. In an attempt to help Paula—who was not aware of the alters—under- stand the problems that she faced, Dr. Harpin asked her to read The Three Faces

of Eve , the book upon which the famous fi lm was based. She reacted with inter-

est and disbelief. What did it have to do with her situation? She was still com- pletely unable to remember those times when she spoke as if she were Sherry, Janet, or Caroline. Later, however, there were times when Sherry discussed the book with Dr. Harpin, and Janet was also reading it. To make matters more con- fusing, they all seemed to be reading at a different pace. Paula might be two thirds of the way through the book, but Janet—an adolescent who did not read as quickly—was aware of only the fi rst part of the book.

Dr. Harpin also used videotape to help Paula understand the problem. With her consent, he recorded her behavior during a sequence of three therapy ses- sions. She alternated among the various personalities several times during the course of these tapes. Paula was then asked to view the tapes and discuss her reactions to her own behavior. Again, she was surprised, interested, and puzzled, showing no signs of previous awareness of this behavior. She would often ask, “Did I say that?” or “Who am I? What am I?”

Another unusual set of circumstances led to the identifi cation of still another personality, Heather. Paula had complained on numerous occasions that a loaded shotgun, which belonged to her father, kept appearing at her house. She had no use for guns, and their presence upset her, so she would take the gun back to her father’s house. Several days later, she would fi nd it again at her house. Her parents and daughter adamantly denied knowing anything about the gun. Recognizing that Paula was frequently unaware of things that she did as the