In the 1980s, Robert B. Oxnam developed some serious problems. He was an alcoholic and prone to sudden, frightening rages, both of which had his marriage on the rocks. He was also bulimic, and after separating from his wife, he spent two or three nights per week in a lonely "addiction ritual" that "required several specific ingredients -- two packs of cigarettes, Polish sausage, a gallon of ice cream, a two-pound bag of peanuts, a bottle of scotch and a pornographic movie on the VCR." Most disturbing of all, he suffered from strange blackouts, often at moments when a canceled appointment left him with unexpected free time. On a trip to Taiwan, he had "zero memory of what I did for almost three days." When he came to, he discovered what appeared to be cigarette burns on his arms.
After six months of treatment, the psychiatrist Oxnam consulted diagnosed him with multiple personality disorder, or MPD, a condition that has since been renamed dissociative identity disorder, or DID. (Oxnam and his doctor, Jeffery Smith, still call it MPD, "out of habit.") Oxnam's new memoir, "A Fractured Mind: My Life With Multiple Personality Disorder," describes his years of coping with the illness, which is not yet entirely cured.
In fact, Oxnam's various personalities cheerfully take turns narrating the book, and give it one of the most peculiar introductions among modern memoirs. A sample: "We have whittled it down to three remaining personalities through a process of 'integration.' The three who remain -- Robert, Bobby, and Wanda -- made a joint decision to proceed with this book, and all three of us agreed to very clear rules about how it would be written How can readers possibly believe this story? For a while we all fretted about this issue. We vowed to tell the story as accurately as we could, letting each personality speak for him or herself."
Remarkable as this corporate voice may be, what most sets "A Fractured Mind" apart from the small but sensational genre of MPD accounts is Oxnam him- er ... themself. The vast majority of those diagnosed with MPD are women, often lackluster and passive individuals, presenting with a host of chronic and nonspecific emotional and physical ailments. Oxnam, despite his disturbed behavior, was nothing if not high-functioning. He was president of the prestigious Asia Society for over a decade, made frequent appearances on national television as a China expert, and escorted such luminaries as the first President Bush, Bill Gates and Warren Buffet on informational tours of China. One of his "alters" (as the alternate personalities are called) even made him famous in an entirely different context -- as "Bottleman" in Central Park's informal rollerblading scene, renowned for his ability to skate while balancing as many as three bottles on his head.
In short, as a public figure perfectly capable of commanding attention in other ways, Oxnam makes an ideal advocate for MPD/DID sufferers -- something those who believe in the disorder sorely need. As even the author and Smith (who contributes an epilogue) feel obliged to acknowledge, the diagnosis may be listed in the DSM-IV, but it's controversial. For every Dr. Smith there is another putative authority who insists that MPD/DID is "iatrogenic" -- that is, an otherwise nonexistent condition induced by the suggestive powers of therapists. Others describe it even more harshly as a murky combination of fake and fantasy, nurtured by patients who are "in love" with the illness.
There were reported cases of MPD before the 1950s, but very, very few of them -- one estimate finds only about 100 in the first half of the 20th century. Bestselling books like "The Three Faces of Eve" (1954) and "Sybil" (1973) -- both of which were made into popular movies -- led to a boom in diagnoses, tens of thousands in the years after "Sybil" appeared. This, naturally, lends credence to the argument that the disorder can be "learned" by exposure to books and films that show how people with MPD supposedly behave. Then, in the 1980s, MPD became entangled in what can only be called a nationwide therapeutic craze following a boom in public discussion of the prevalence of child sexual abuse.
Without a doubt, incest and the sexual abuse of children are more widespread than was acknowledged before the 1970s, though how common it may be still isn't clear. In the second half of the century, grown women and men who had been tormented for years by conscious, intrusive memories of such abuse gathered the courage to go public with their stories in memoirs and media appearances. Some therapists became convinced that repressed memories of similar abuse lay at the root of the chronic problems plaguing other patients. They developed a battery of techniques -- persistent questioning, hypnotism, even drugs -- to draw forth those "memories."
The recovered-memory movement boomed in the 1980s. Books like "The Courage to Heal" insisted that incest was ubiquitous, and a sensational, credulous media spread the word. The idea that psychopathology is rooted in unconscious memories of childhood events had solid precedence, after all: It is enshrined in the work of psychiatry's founder, Sigmund Freud. Eventually, though, these "recovered" memories evolved into bizarre, epic sagas involving networks of adult fiends: The result was the satanic ritual abuse frenzy that has reminded so many of the witch hunts in 17th century Salem, Mass.
Several high-profile ritual abuse trials centered on day-care centers (most notably, the McMartin Preschool case), and involved the testimony of very young children questioned by therapists and public officials who specialized in coaxing out reports of molestation. The statements they supplied were so elaborate and grotesque -- including mass murders, sex with zoo animals, feats of inhuman strength, rocket ships and networks of underground tunnels -- that they defied the hard evidence and sometimes even the laws of physics. Records revealed that the officials who examined the children had used leading questions and baldfaced suggestions to get these yarns.
The bubble burst. Law enforcement authorities confirmed that there was absolutely no evidence that satanic cults devoted to raping and eating babies roamed the land. Adults who had been convinced that they suffered such abuse -- or less gothic ordeals -- during childhood began to question their therapists' diagnoses. An organization for accused family members, the False Memory Foundation, formed to champion the claim that all "recovered" memories resulted from manipulative therapeutic practices. Even the credibility of Freud and his theory of repressed memory was attacked in the pages of the New York Review of Books by the literary critic Frederick Crews.
At the pinnacle of the craze, multiple personality disorder became a fad diagnosis among those who fervently believed in the reality of ritual abuse. This represented no great leap; as the millions of readers of "The Three Faces of Eve" and "Sybil" knew, suppressed memories of severe childhood trauma cause MPD. The disorder is considered to be an extreme version of a common psychological coping mechanism: dissociation or emotional detachment. Unable to bear the agony of his or her experience, the child was understood to divide internally into two persons: one, recessive and usually childlike, who would retain the traumatic memory, and another who would continue to grow up and become the dominant, operative self. Apparently, splitting is habit-forming, with more personalities appearing during periods of great stress. Some "multiples" claim to have hundreds of alters. Oxnam reports having once had 11.
The diagnosis of MPD was tarnished by the implosion of the ritual abuse and recovered memory hysteria of the 1980s and 1990s. Most dramatically, one prominent therapist specializing in the disorder, Dr. Bennett Braun, was sued by a former patient for persuading her that she contained 300 separate personalities and was the cannibal high priestess of a satanic cult. Some of the continuing skepticism about MPD is warranted: The theory of repressed memory -- a theory that many researchers reject as being completely unproved -- lies at the heart of the definition of the disorder. In other ways, the stigma is unjustified, since a condition that at the very least closely resembles MPD had been observed decades before the recovered memory craze took place.
In the 1950s, the repressed memory of being made to kiss a dead relative's corpse was considered enough to cause Eve to split; by 1973, the ante had been upped, and the trauma that fractured Sybil was pure Grand Guignol, a series of sadistic torments perpetrated by her mentally ill mother. This escalating sensationalism in MPD narratives does bear a suspicious resemblance to the way that reports of ritual child abuse grew more and more lurid until they finally beggared belief. MPD creation stories, like tales of ritual satanic abuse, often seem to be the stuff of gruesome playground legend. ("Sybil" was passed around and hugely popular among my 12-year-old friends.) But even the ritual abuse debacle could trace its remote origins to the necessary public acknowledgement of real child abuse hidden within families.
The traumas said to be at the root of Oxnam's condition belong more or less to the "Sybil" range on the atrocity spectrum, but "A Fractured Mind" is exceptional in not lingering over them or even attempting to identify Oxnam's abusers. (You can make an educated guess, though.) MPD narratives, like Freudian case studies, tend to be structured like penny-dreadful detective stories, reaching their climax in shocking revelations of unfathomable cruelty. They feed our culture's morbid preoccupation with extreme child abuse, particularly sexual molestation -- an obsession that, however real the problem, has little to do with legitimate concern about child welfare.
"A Fractured Mind," to its credit, eschews the tabloid approach. Instead it focuses on the effects of his condition on Oxnam's life, work and relationships, and in this, for all its strangeness, it steps away from the fringe. The book does follow the familiar structure: 1) odd behavior leading to the seeking of treatment; 2) revelation of an unsuspected alternate personality to the therapist; 3) gradual appearance of additional alters; 4) exposure of the core infantile alter and its terrible memories to the therapist and the previously oblivious dominant personality. But all this gets accomplished about halfway through the book, whereupon the focus shifts to Oxnam's efforts to achieve "integration."
Architectural metaphors abound in accounts of MPD. For Oxnam, his mind was a castle with "Bob" above the front gate, running things unaware of the presence of the alters. The alters, each with his own room, included Tommy, a raging, violent teenager; Robbey, the efficient if slightly soulless worker; Robert, a professorial intellectual; Bobby, an exuberant, misbehaving child usually kept in the dungeon; a sexy female librarian whose face is always hidden; and a reclusive clock collector named Lawrence. Each alter except for Bob had at least partial awareness of the others. In a sinister black castle nearby lived Eyes, who saw everything but could not speak, and the Witch, the spiteful, punitive figure associated with Oxnam's abusers. With treatment, she is eventually transformed into the benevolent Wanda.
What goes on among these personalities resembles nothing so much as office politics, which isn't surprising, perhaps, when you consider Oxnam's professional life. "It's infuriating," Robert complains of the then-dominant personality, Bob. "I've got lots of good ideas but so little gets through The Asia Society presidency? I would run it totally differently from Bob." Bob, having learned of these gripes, retorts, "Let Robert try to raise money for a ten-million-dollar budget and cope with a bunch of bickering staff, trustees and donors at the same time." When the two personalities decide to merge, they conduct the process like a business deal. Oxnam compares communications between alters to "instant 'mental email'" and the "file transfer process" in a computer.
Popular MPD narratives have tended to capitalize on the freakishness of the material -- the spooky transitions from one alter to another, the radical differences between the personalities (unsurprisingly, "The Three Faces of Eve," as the 1950s version of the disorder, featured a slutty temptress lurking inside a prim housewife), and the ghastly trauma unearthed by the therapist/detective. "A Fractured Self" signals a change in the official characterization of MPD, from a bizarre affliction to a common trait taken to a pathological extreme. "Everyone I know reports feeling differently and acting differently in different places with different people," Oxnam writes. He just takes it a little -- make that a lot -- further.
"Having different parts is not the exclusive province of multiples," Smith writes in his epilogue, "but having amnestic or memory barriers between parts of the self is." In a rather elegant metaphor, he explains, "We could describe a house in two ways, either as a collection of rooms or as a collection of walls. Both are true, but one cannot construct a house out of rooms. Only walls can be constructed, and rooms are the result We see rooms, and it is easy to forget that their existence is really a consequence of there being walls." In other words, it is the memory barricades that define MPD, not the personalities themselves, however colorful.
The credibility of Oxnam's account resides in these walls. The memory gaps and blackouts he experienced before seeking therapy, the appalling discovery that he'd been shoplifting from a favorite merchant for years, the fact that while sailing a boat he could not remember or discuss any aspect of Chinese politics -- these are the aspects of his story that suggest he really did inhabit a partitioned self. (Alcohol abuse is a less comprehensive but more commonplace possible explanation.) It also supports their case that Smith has never used hypnosis on Oxnam or attempted to "call forth" alters, as the least scrupulous therapists often do.
Still, it doesn't help that neither Oxnam nor Smith acknowledge the powerful role of suggestibility in patient-therapist relations. Oxnam admits that some "sick" people do "fake" having MPD. But critics of the diagnosis mostly don't accuse the afflicted of "faking" their condition. They argue that vulnerable, eager-to-please patients caught in a dangerous feedback loop with a charismatic therapist can come to wholeheartedly believe in a complete untruth (especially if hypnosis is involved). Tellingly, it is exactly those therapists who specialize in MPD and are on the lookout for its symptoms who seem to stumble across the most cases of what is supposed to be a very rare condition.
Most problematically, Smith never really addresses what he must know are valid questions about the legitimacy of repressed memories. He asks, referring to news reports of child abuse, "How is it that we can read about dreadful things happening to children almost daily, and then be told that adult recall of the same kinds of experiences is deluded?" But responsible critics of recovered memory don't claim that all adult memories of abuse are bogus, only ones "recovered" through dubious therapeutic practices. If a patient can be persuaded to believe that she is a cannibal devil worshipper who has molested her own children, then those who reasonably question less outlandish memories obtained with the same methods shouldn't be dismissed as apologists for child abusers. Implanting bogus memories of abuse is tantamount to abuse itself, and a responsible psychiatrist should admit as much.
After a breakthrough in his recovery, Robert finds himself released from the castle and sitting in a beautiful meadow with the remaining alters, Bobby and Wanda, discussing their situation. Then he pauses to explain that the meadow itself, even the appearances of the alters is really just a metaphor: "To make this affective environment intelligible, I have resorted to physical descriptions, as if the three alters were actually real outside people -- saying, for instance, 'Wanda stared at me, so deeply that I knew I had no choice but to listen.'"
It's a disorienting passage because in its own way, MPD is a surprisingly literal disorder, one that insists that someone who doesn't behave consistently must really contain more than one self. In that case, what's to say the MPD itself isn't a kind of metaphor, or theater? Critics of the diagnosis like to point out that the disorder only ever crops up in therapy -- the patient's relatives and friends invariably report never having noticed the famous "transitions" between alters or the supposedly radical changes in manners and appearance that follow.
Maybe MPD only really comes into existence when a certain rigid kind of person is confronted by a therapist. Perhaps when such a patient is forced for the first time to account for a lifetime of avoidance and compartmentalization, the manifestation of multiple personalities seems like the best way to explain themselves to this powerful new authority figure. An ordinary middle-aged man who has a fling with a young woman when his wife is out of town may say, "I don't know what got into me"; Robert can claim that Bobby, who "never gave up his self-image of a single young man," took over. Does the distinction really matter that much?
"A Fractured Mind" may indeed represent an attempt to redeem the diagnosis of MPD/DID, to present it in a less alien light and to separate it from the excesses of the recovered memory craze. In some ways, Oxnam's story is far more plausible than "Sybil," a book that was eventually discovered to be largely fraudulent. But by demonstrating how someone with MPD isn't so drastically different from the rest of us "singletons," Oxnam risks showing that he isn't different at all.