The science of psychology doesn’t really know what causes multiple personality, now called Dissociative Identity Disorder. Before the book Sybil in 1973, there were only about 75 cases of this disorder in recorded history, mostly between 1876 and 1920, with only 8 reported between 1960 and 1970. One expert now estimates 40,000 diagnosed cases. Some believe multiple personality is finally receiving the attention it deserves. Other experts see it as a fad diagnosis popular in the recovered memory movement.

After the famous cases of Eve and Sybil received publicity, some patients went from therapist to therapist until they found one who believed them. The vast majority of psychologists and psychiatrists have never seen a single case, while a very small minority of clinicians report the great majority of cases. And special hospital units collect huge amounts of insurance money to treat the disorder. It is not unusual for the treatment of one multiple personality patient to cost $1 million. One case cost $2.75 million. When one woman reached her $1 million insurance limit, the hospital dumped her into a state facility, which then determined she had no significant mental illness and discharged her.

Some experts argue psychotherapy causes multiple personality through comments, leading questions, suggestions, encouragement, excessive probing, argument, and hypnosis. They point out the average time in therapy before the diagnosis of multiple personality is six or seven years. Supporters of the diagnosis give several explanations for this delay. First, patients are ashamed of their symptoms and afraid to trust authority figures because of their childhood abuse. Also, most therapists have little training in diagnosing this problem and the bureaucracy of psychology is very slow to change. Finally, the supporters say society cannot deal with sadistic incestuous abuse and its implications for the family and for power and sexual relations.

Critics of the diagnosis also make the following points, however. The great majority of patients are white people with good finances or health insurance allowing access to prolonged work with therapists in private practice. No case descriptions seem to be of lower class, poor, or homeless patients. If trauma caused multiple personality, one would expect many more cases involving black people because available statistics suggest blacks are more likely to suffer traumas than whites. In addition, multiple personality is a North American epidemic, with only occasional cases reported elsewhere by therapists with American training or similar viewpoints. In England, Europe, and other parts of the world, the diagnosis is rare. Because of this, the International Classification of Mental Disorders of the World Health Organization doesn’t include the disorder.

Many patients say they couldn’t believe the diagnosis of multiple personality but they finally learned to accept it. Of course, those who refuse to go along would simply leave the therapist. Most patients show no symptoms of multiplicity before treatment and don’t know they have the disorder until the therapist helps uncover it. The most troubling symptoms—switching between adult and child personalities, howling like an animal, speaking as the devil, slashing their wrists, inflicting burns on themselves, or voicing desires to kill the main personality—don’t normally appear until after a great deal of therapy.

Recovered memory therapists may see evidence for multiple personality in many common things like headaches, depression, poor concentration, mood swings, ambivalent feelings, forgetfulness, or daydreaming. They see evidence for it in talking aloud to yourself, missing part of what someone is saying, hostile fantasies, or bad habits you can’t control. They even see it in being called a liar, meeting people who insist they have met you before, having no memories for periods of your life history, drug abuse, sexual feelings or behaviors causing guilt, or uncharacteristic actions.

They believe cure comes only from uncovering all the personalities, the histories of each, and the trauma that led to the formation of each, so the person can finish the feelings and integrate the alternate personalities. These therapists probe endlessly, encouraging you to label different feelings and conflicts or parts of yourself (sadness, parts that enjoy playing with children, etc.) as separate personalities. If you complain, they may accuse you of being in denial or threaten that healing is impossible without letting all the personalities out. The most common way to uncover evidence of multiplicity is hypnosis, with leading suggestions and requests for the alternate personalities to come forth, but searching for alter egos in therapy or through hypnosis or barbiturates may become a self-fulfilling prophecy.

Even the character of multiple personality seems to have changed following the recent lore of the diagnosis. People didn’t consider childhood abuse the cause until after the book Sybil in 1973 and subsequent movie. Cases before 1920 were only occasionally associated with child abuse. Now most patients report histories of childhood sexual abuse and many tell increasingly bizarre tales of satanic ritual abuse. In some treatment centers, 80% of multiple personality patients recover memories of ritual satanic abuse.

Before the 1940s, most cases reported had only two or three personalities. Many early cases showed transitional periods of sleep, and often convulsions, between alternate personalities. In recent decades, the average number of alters is 15 or more, with no sleep or convulsions between them. Now many therapists report clients with over 200 personalities, including some that are animals, inanimate objects, or demons. One expert claims a case with more than 4,500 alters, an improbable number that seems difficult to measure.

In the first cases, therapists rarely reported the existence of a self-destructive alter personality that tries to cut, burn, or mutilate the person or commit suicide. In the last decade, however, the rate of destructive alters in multiple personality cases seems to have grown from perhaps around 20% to nearly 50%. Many experts argue these changes come from the preconceived notions of recovered memory therapists, people who promote the diagnosis, and their organizations.

Recovered memory therapists often mistakenly believe most clients are victims of sexual or ritual abuse or that common symptoms such as depression, anxiety, eating disorders, or fears of fires, knives, blood, dying, animals being hurt, coffins, cemeteries, snakes, or spiders are evidence of sexual or ritual abuse. A client not remembering abuse does not convince some therapists; they see this as evidence of repression, the burying of memories until there is no conscious awareness of them. These therapists view doubts about what they say as denial and evidence of repression, so they go on to use a variety of faulty techniques to probe for memories.

Recovered memory therapists don’t understand how memory works and may use hypnosis, truth serum, barbiturates, support groups, free association, guided visualizations, age regression, trance writing, body manipulation and massage, dream work, imagery exercises based on dreams, and artwork to uncover lost memories. All of these techniques can lead to false memories, especially with unhappy, suggestible clients who may be prone to fantasy. (This is a form of self-fulfilling prophecy—when people’s actions and expectations lead to the predicted result.)

The therapist’s suggestions, phrasing of questions, tone of voice, comments, emotions, arguments, and leading techniques cause the client to imagine scenes, then details, then elaborate stories. Clients who need to feel special may unwittingly respond to their therapist’s interest and fascination by creating more details and confusing fantasy and reality in the trance-like states produced by many of the above techniques. Support groups run by recovered memory therapists encourage troubled people to participate by sharing memories and reward them with attention, companionship, warmth, and a sense of belonging. Many people go to a group without clear memories and then get them during the meetings.

Many multiple personality patients and therapists participate regularly in workshops and conferences on the topic, in self-help and therapy groups focused on it, and have access to national newsletters on it. The idea of therapists causing multiple personality disorder is not far-fetched when you consider how many alien encounters and past life regressions clients uncover using faulty techniques.

Many psychologists note speaking to alters or showing much interest in them rewards them and makes psychotherapy less effective in treating symptoms such as depression or alcoholism, but that directing the client’s attention away from the alter personalities leads to their decline. One former multiple personality client asked her therapist, “Don’t you think it is odd that no one is getting better and that everyone wants to go out and kill themselves after they get into therapy with you?” Even experts who support the diagnosis of multiple personality agree excessive preoccupation with exploring alternate personalities, therapist fascination, the overuse of journaling, or pressure to uncover traumas prematurely are serious clinical problems that can worsen the disorder.

Some clients, including Sybil, have admitted playing the role of multiple personality to please the therapist and feel relieved when a new therapist doesn’t want to emphasize these patterns. When Sybil and her psychiatrist Dr. Cornelia Wilbur were unable to make progress in therapy, Dr. Wilbur referred her to Dr. Herbert Spiegel for diagnosis and additional therapy. He also worked with Sybil later when Dr. Wilbur went on summer break. At first he didn’t understand when Sybil would say, “Do I have to become Helen or can we just discuss this?” She explained “When I’m with Dr. Wilbur, she wants me to be that person.” Dr. Spiegel left it up to her and found that Sybil didn’t. Dr. Spiegel feels these personalities were “created by the therapist.”

Dr. Spiegel reports no mention of the diagnosis of multiple personality until after Sybil quit therapy with him and the author of Sybil, Flora Schreiber, and Dr. Wilbur began collaborating on the book. When Schreiber asked for Dr. Spiegel’s files and cooperation and mentioned the diagnosis of multiple personality, Dr. Spiegel objected to the diagnosis. Schreiber argued the book would never sell without the diagnosis, Spiegel refused to cooperate, Schreiber became very angry and left, and both Schreiber and Dr. Wilbur wouldn’t talk to Spiegel after that. Dr. Spiegel says Sybil’s mother was definitely schizophrenic, but the sexual abuse had never been corroborated. Sybil made some profoundly unlikely claims, including detailed incidents from the ages of six weeks and six months, times when ordinary brain development would not maintain such complex memories.

Eve admitted she was “having fun being a multiple.” After uniting into one personality, she wrote “the magic had gone out of my life.” Eve changed her story of originating trauma several times, as can be seen by reading her books, but her doctors could not find any trauma terrible enough to cause the disorder. She had seen two dead bodies in her early years, and relatives asked her to touch her dead grandmother at age five, a custom believed to help in ending grief. Her parents, by all accounts, were extraordinarily supportive and loving.

One psychiatrist used hypnosis and other suggestive techniques to convince a woman of many horrible things. She thought she had childhood physical and sexual abuse, was in a satanic cult, ate babies, was raped, had sex with animals, was forced to watch a young friend’s murder, and had 120 personalities, including angels and a duck. The psychiatrist also performed exorcisms on her, one lasting 5 hours. When she realized the memories were false, she sued and settled out of court for $2.4 million.

If the foolish techniques of recovered memory therapists actually cause multiple personality disorder, psychologists cause these patients to deteriorate, which in some cases even leads to suicide. Why would anyone want to make up stories of ritual satanic abuse or multiple personalities? First, these troubled, unhappy people may want the special concern, attention, and emotional support that come with the diagnosis, both in therapy and elsewhere. Many multiple personality patients also claim experiences of ESP, clairvoyance, reincarnation, astral travel, poltergeists, and similar phenomenon.

These insecure people may also need the sense of belonging they find in the workshops and support groups. These claims also give a framework to explain the anger or rage, pain, and emotional abandonment these patients may feel. It is easier to tell dramatic stories of abuse than it is to talk about your real problems, honestly study yourself, and take responsibility for and work on your personal problems. Finally, the techniques psychologists use may simply confuse them into thinking their stories are true.