Finally! An Instant Cure for Paranoid Schizophrenia: MPD

Richard A. Gardner*

ABSTRACT: In recent years there has been a dramatic increase in the number of reported cases of multiple personality disorder.  It is claimed that these MPD patients were sexually abused as children and developed "alter" personalities to cope with the trauma and therefore had no memories of the abuse until therapy  Some of these MPD patients, however, are actually paranoid schizophrenics whose paranoid delusions and hallucinations are interpreted in terms of the alleged repressed childhood abuse.  There are many reinforcements for both patient and therapist in the MPD diagnosis.  It substitutes a hopeless situation with one for which there is the promise of cure; is much more socially acceptable; includes social, psychological, and financial payoffs inherent in the "victim" status; and provides an opportunity far lawsuits against the parents.
  

We are living in a time when the multiple personality disorder (MPD) diagnosis is very much in vogue.  "Experts" on the disorder, who are sprouting up everywhere, tell us that MPD has been traditionally underdiagnosed and is much more widespread than previously realized.  One of the reasons, we are told, why MPD has been ignored has been reluctance, and even refusal, by therapists to even recognize that most (if not all) of these patients were sexually abused as children.  Their "dissociated" thoughts, feelings, and experiences associated with their sexual abuses have become foci for the development of alternative personalities ("alters"), which made life more bearable for them (in childhood and subsequently).

In recent years, as an extension of my involvement in child sexual abuse, I have evaluated adult women who claimed they were sexually abused in childhood by their father and/or other relatives.  Certainly many of these women provided valid descriptions of bona fide sexual abuse.  However, there are others who, I am convinced, were never sexually abused by their alleged perpetrators.  This is especially true for those whose memories were allegedly "repressed" and then uncovered in treatment with an "expert" in helping patients recover memories of childhood sexual abuse.  Many such women have been given the MPD diagnosis.

On the basis of those women with belated recall of sex abuse that I have directly interviewed, those whose parents have come to me (and whose accusing daughters have refused interviews), and what I have read in the recent literature on this subject, I am convinced that many (I did not say all) of these women are paranoid schizophrenics and that the MPD diagnosis provides them with a more socially acceptable label.  After all, if one is schizophrenic, then one has to deal with a chronic psychiatric illness that may be lifelong.  Because schizophrenia is generally considered to have a high genetic loading, the likelihood of "cure" by any known psychiatric method is minimal and the prospect of transmitting the disease to one's children and grandchildren is real.  MPD, in contrast, is allegedly "curable" by proper psychotherapeutic technique in the hands of those who claim to be skilled in the treatment of this disorder.  Accordingly, the MPD diagnosis substitutes a hopeless situation with one for which there is hope and the promise of cure.

Furthermore, to be called "paranoid" or "schizophrenic" is to be called "crazy."  In contrast, these days MPD is a socially acceptable disorder, an affliction that is widespread (even though many do not realize they have the disease).  MPD patients also enjoy the benefit of being considered victims.  In a world in which victims are held in high regard — where they are constantly clamoring for our understanding and sympathy — joining the ranks of victims is a source of esteem enhancement and group identity for many.

Then there is the money factor.  Victim compensation funds (both for the patient and the therapist) are widely available.  Social security benefits can be obtained for rape victims, regardless of age and the time gap between the time of the rape and the onset of treatment.  Clinics that devote themselves to the treatment of the sexually abused are likely to get significant money from local, state, and even federal sources.  Accordingly, although therapists who diagnose paranoid schizophrenia may not have a paying customer, those who see the same phenomenon as MPD can guarantee themselves an annuity.

Moreover, one is not likely to be successful in a lawsuit against one's parents for having transmitted schizophrenia genes to their children.  A woman is far more likely to be successful in a lawsuit against her father for having sexually abused her in childhood and she can even sue her mother as an accomplice.  Many lawyers are happy to take such cases (if, of course, the father has the wherewithal to pay off).  Obviously, such lawsuits are not seen among the indigent.

At this point I elaborate on the ways in which the two most prominent symptoms of paranoid schizophrenia — paranoid delusions and hallucinations (most often auditory) — become reworked into an MPD diagnosis.  My focus here is on a particular subsegment of the false accusation population, namely, those who use the false accusation as a method for denying the more pathological diagnosis of paranoid schizophrenia.
  

Paranoia

The Ubiquity of Paranoia

Paranoia is much more common than is generally appreciated.  Many believe that paranoids are to be found mainly in mental institutions, locked up in closed wards.  This belief is in itself a delusion.  For every paranoid in a mental hospital, there are probably hundreds "on the outside," and many are not even recognized as being mentally ill.  Crichton-Miller, the English psychiatrist, once said (Kolb & Brodie, 1982):

For every fully developed case of paranoia in our mental hospitals, there must be hundreds if not thousands, who suffer from minor degrees of suspicion and mistrust; whose lives are blighted by this barrier to human harmony; and who poison the springs of social life for the community (p. 446)

Paranoia may fuel worthy causes, resulting in ostensible stability and even social respectability.  The paranoid anger is vented on those who are considered to be causing and perpetuating various social abominations.  Sometimes constructive things come out of these movements.  There are others, however, whose paranoia blurs their reality, and they distort significantly the object(s) of their indignation.  They may view a situation as worse than it is, misconstrue events, and attribute malevolent motives when they are not present.  Their own coworkers, then, may find them less useful to the movement.
  

The Content of Paranoid Delusions

The content of paranoid delusions is not created de novo in the brain of the patient.  Rather, the material is derived from ambient social phenomena that may serve as a focus for the paranoid's preoccupations.  In 1692, in Salem, some of the people who believed that they (or others) were possessed by witches were most likely paranoid.  (I am not claiming that all who believed this were paranoid, only some.)  In the World War II era, Nazi spies were frequently incorporated into paranoid delusions.  Although there certainly were Nazi spies in the United States, it is not likely that a network of them devoted themselves to spying on paranoid patients, especially those in mental hospitals.  In Germany at the same time, Jews were commonly incorporated into the delusions of paranoids, Adolph Hitler being the most famous example.  During the cold war many paranoids considered themselves to be persecuted by Russian spies.  Without doubt, the McCarthy hearings contributed to the development of delusions involving impending persecution by Communists.  Again, there certainly were Russian spies in the U.S., but they certainly were not as numerous as paranoids believed them to be and they certainly were not devoting themselves — 24 hours a day — to spying on these particular patients.  Not surprisingly, since the end of the cold war, fewer paranoids are being persecuted by Russian spies.  They have been replaced in the 1980s and 1990s by sexual harassers and sexual abusers.  Once again, paranoids are incorporating into their delusional systems the ambient scapegoats, the people who all agree are worthy of scorn and denigration.

There is no question that some of the women who are accusing their fathers of having sexually abused them as children are paranoid individuals who have selected from society the in-vogue scapegoat to serve as the target for the paranoid rage.
  

The Projection Element in Paranoia

Central to the paranoid mechanism is projection.  Because of guilt and other ego-debasing mechanisms, paranoids do not wish to accept the fact that they themselves may harbor within them certain socially unacceptable urges.  Accordingly, by projecting them onto others, they can consider themselves free of these undesirable thoughts and feelings.  This mechanism can involve unacceptable sexual feelings.  The sexually inhibited person may say: "It is not I who has sexual feelings toward him; it is he who has sexual feelings toward me."  And this is one of the elements that may be operative in the false sex-abuse accusation.
  

The Oversimplification Element in Paranoia

Most problems are complex and most solutions are not easy ones.  The paranoid solution generally involves an oversimplification of a problem that promises a quick and easy solution.  This is one of the elements in paranoid prejudice.  Such people are essentially saying, "If we only get rid of those people, all our problems will be solved."  Although history has repeatedly shown that this is not the case, the delusion still persists.

A woman who has suffered with a wide variety of psychological difficulties throughout the course of her life is likely to embrace a simple solution that promises to cure all of her problems.  If she can come to believe that her father's sexual abuses of her in early childhood were the cause of all the difficulties she has had in her life, she has a simple explanation and, presumably, a simple solution.  Such women commonly say, "Now everything is understandable.  Now I understand why I have all these years of grief.  Thank God I finally met Ms. X, my brilliant counselor, who has shown me the path to cure.  All the other doctors I've been to missed the obvious.  What a terrible waste of money.  All that unnecessary grief for nothing.  Now I'm finally on the path to healing."
  

Resistance to Alteration by Logic and/or Confrontation with Reality

There are strong psychological forces within the individual that compel the person to maintain the belief, no matter how much at variance it may be with reality.  Therefore, those who try to alter the belief of paranoids by logic, argument, and confrontations with reality suffer nothing but frustration and a sense of futility.  When the father, mother, and other family members try to convince the accusing woman that her beliefs are false and that some of the elements in her scenario are absurd and even impossible, their arguments fall on deaf ears.  Or, if she does feel the need to respond, she provides some kind of an explanatory justification that may be as implausible as the original scenario.

Also, paranoids are notorious for their avoidance of such confrontations and provide a never-ending stream of justifications for not involving themselves in such conversations.  They and their therapists (some of whom are equally paranoid in a folie deux relationship with their patients) commonly say, "There was no point in even confronting him; he would deny it anyway, so why waste time."  When they are willing to discuss their accusations, they are often ingenious in providing rationalizations to justify their distortions.  This principle is well demonstrated by an anecdote from my residency days.  It is the story about a man who comes to a psychiatrist.  The following interchange takes place:

Psychiatrist: How can I help you?
Patient: Doctor, I'm dead.
Psychiatrist: Let me ask you this.  Can a dead man bleed?
Patient: Of course not.  A dead man can't bleed.
Psychiatrist:

(takes a pin, pricks the man's finger tip, and expresses a drop of blood): What do you think about this (while pointing to the drop of blood on the man's fingertip)?

Patient: (after a long pause): Well, what do you know.  This is the first time in the history of the world that a dead man has bled!

Paranoid women who accuse their lathers of sexually abusing them provide similar rationalizations to support the maintenance of their delusion.  When their mothers try to convince them that the accusation has no basis in reality, they will claim that the mother is only trying to protect the father in order to preserve her marriage.  It is a no-win situation when one tries to change a paranoid's mind regarding the validity of a delusion.
  

Low Self Esteem in Paranoia

Paranoids basically suffer with deep-seated feelings of insecurity.  This is one of the factors contributing to the need for projection.  People with stronger egos are willing to tolerate socially unacceptable impulses within themselves and have enough compensatory assets to counterbalance personality weaknesses and socially unacceptable thoughts and feelings that they may harbor.  Paranoids do not have the ego strength to do this.

Not only does this problem contribute to the mechanism of projection — wherein they project out onto others their own inadequacies (or presumed inadequacies) — but this weakness contributes to their inability to admit that they were wrong.  Admitting that one makes mistakes requires a certain degree of ego-strength.  And this is one of the reasons they are so resistant to logic, arguments, and confrontations that might demonstrate that their thinking is awry.  For a paranoid, such an admission is tantamount to admitting that one is "crazy," and this, of course, is very difficult for anyone to do.

The feelings of low self-worth may also be compensated for by the individual's developing the belief that he or she is more astute than others regarding the ability to appreciate the significance of subtle information.  Paranoids often consider themselves quite skillful in detecting innuendo, slights, and trifling disparagements that pass others by.  They pride themselves on their ability to detect hostility in everyday inadvertencies.  For women who promulgate false sex-abuse accusations against their fathers, they may, in retrospect, pride themselves on their new-found sensitivity to the most subtle manifestations of sexual abuse, manifestations that others were too blind and/or stupid to detect.  In the extreme, this compensatory mechanism for ego-enhancement may result in grandiosity and an all-pervasive feeling of superiority.  This feeling of superiority, then, serves to strengthen the individual against those who inevitably react with hostility to the paranoid's accusations.  A vicious cycle then ensues in which those who disagree and argue with the paranoid unwittingly contribute to the strengthening of the paranoia and its derivative symptoms.
  

Release of Anger in Paranoia

Generally, these are very angry women.  When the problems generating anger are not resolved, anger builds up and presses for release.  Society always provides targets that facilitate such release, and these change with the times.  Various rules and regulations are set up that strictly define which areas of release are acceptable and which are not.  Some of the more common vehicles for release in our society are competition, gossip, worthy and noble causes, sports (both as a spectator and as a participant), family squabbles, and violent themes in books, television, and cinema.  Family members are safe targets for such pent-up anger because they are often captive and are less likely to retaliate as strongly as strangers.  As mentioned earlier, the socially sanctioned targets change with the times and place.  Paranoia provides a justifiable vehicle for the release of anger.  If one has the delusion that the hated person should justifiably be scorned and punished, one need not feel guilty about using that person as a scapegoat.

In recent years, many women have found that men can serve as useful targets for their hostility.  There is no question that women have been terribly subjugated since the beginning of civilization and that the process is still going on in just about every part of the world.  There is no question that the women's liberation movement is, overall, a constructive force in human progress.  However, every movement has its fanatics and zealots, and the women's movement is no exception.  Most women have some justification for feeling angry at men in general.  If scapegoatism is to work, it is important that the scapegoat be close by.  And this is an important element in prejudice.  One can be intellectually prejudiced against people who live thousands of miles away, but they are not available as targets for the release of anger.  Accordingly, one must find a scapegoat close by, even in the next house or neighborhood.  Husbands and fathers satisfy this proviso quite well.

Those who believe that the best way to deal with their anger at men is to destroy every man in sight are certainly not making constructive use of their anger.  Actually, such women do the women's movement much more harm than good, give it a bad name, and work against its progress.  Such use of men as scapegoats is a form of bigotry.
  

Sexual Factors in Paranoia

For many (if not most) women, their father was once the most important person in their lives and, at the time of the accusation, may still occupy the number one (or possibly the number two) level in the hierarchy of men who have influenced them.  If one looks over the last 15 to 20 years with regard to what has been going on in the field of sex-abuse accusations, it might have been predicted that false sex-abuse accusations toward husbands (which started in the 1980s in the context of child-custody disputes) would spread to fathers.

Contrary to popular opinion, children are capable of having strong sexual urges.  Although there is generally an intensification of such urges around the time of puberty, they are present earlier and have the capacity to be intensified — even to adult levels.  Children's sexual urges are generalized, and children have to learn which individuals are "proper" to involve themselves with in the particular environment in which they are raised.

In our society, where the incest taboo is quite strong, little girls have to learn that their fathers are off limits when it comes to the expression and gratification of their sexual feelings.  The suppression and repression of such feelings may produce some clinical and behavioral squelching, but the sexual urges may press for release nonetheless.  One way of dealing with them is via the mechanism of projection: "It is not I who harbor strong sexual desires toward my father; it is he who has strong sexual desires toward me."  The next step is to have the fantasy that these desires were realized in reality.  Paranoids, because they have impairments in reality testing and significant compromises in their ability to differentiate between fact and fantasy, are likely to convert this fantasy into a delusion.

One could argue that these patients provide some of the most convincing evidence for the existence of the "Oedipus complex," evidence far more compelling than Freud ever enjoyed in his lifetime.  However, calling all this craziness an "Oedipus complex" or "Electra complex" adds no new information.  In fact, the use of such terms tends to oversimplify, and to distract one from a wide variety of other factors operative in the phenomenon being considered.  Freud considered these particular desires to be the central element in the development of most psychoneurotic problems.  I am in disagreement with him on this point, but I do agree that these intrafamilial sexual urges do play an important role in our lives.  Of importance here is that such urges may contribute to a patient's professing that a parent sexually abused him or her in childhood.  Elsewhere (Gardner, 1992) I describe in greater detail my views on childhood sexuality and the Oedipus complex, views derived from over 35 years of experience working directly with children.  (To the best of my knowledge, Freud only treated one child: Little Hans.)
  

The Expansion and Spread of Paranoia

Paranoia tends to expand with regard to the complexity of the delusional system and spread to include an ever-increasing number of people.  Whereas the delusions may start with a single individual, they frequently spread to others.  For many of the women who accuse their fathers of sexual abuse all family members and friends are divided into two categories: those who agree that the sex abuse has taken place and those who do not.  The woman may consider all individuals who support the father's position to be capable of aiding and abetting his abuse — even at present.  Although, as an adult, she considers herself strong enough to resist any present advances, her children would certainly not be able to protect themselves.

Grandchildren, who previously may have had a loving and warm relationship with their grandfather, are now removed entirely from the opportunity to have any contact with him — even by mail and telephone.  Gifts are returned with the excuse that these are likely to be sexual "bribes," the purpose of which is to entice the grandchildren into sexual encounters.  And his wife, as one who has openly supported her husband's denials, is considered to be similarly untrustworthy.  Because she "looked the other way" or was "too stupid to see what was going on" when the accuser was molested as a child, the woman now suspects that her mother would be similarly incapable of preventing her husband from perpetrating similar abuses on her grandchildren.  The accusing woman's siblings, (i.e., the child's aunts and uncles) as well, who have not come forth to align themselves with the accusing woman, are similarly distrusted and viewed as potential facilitators of her father's sexual abuse of her children.  Many of these women go into hiding, take refuge in selected shelters (where they are likely to find a significant segment of paranoids, the justification for such centers notwithstanding), move to distant states, and cut off entirely any and all communication with the accused father and his extended family and friends.
  

Paranoia and the Legal System

People who are angry to the degree described here often want to wreak vengeance on those whom they believe have abused them.  Our legal system (both civil and criminal tracks) provides a ready and willing vehicle for gratifying this morbid desire.  On the civil track, they can demand punitive damages and payment for their "therapy."  Because the trauma has been "enormous," the amount of money that can provide compensation is generally an amount equal to the total value of the assets of the father.  And because the therapy must be intense and prolonged (no one can predict how long — it may be lifelong), then payment for such treatment is also justified.  In some cases the blackmail element here is easily seen.  I have seen letters written by such women in which their fathers were told that if they did not come forth with the indicated amount of payment, the daughter would consider herself to have no choice but to press criminal charges, with the threat of years of incarceration.

On the criminal track, too, such women will find willing accomplices in the legal apparatus.  There is a sea of prosecutors and district attorneys who are quite happy to enjoy the notoriety that comes from bringing "justice" to these "perverts."  And the public media, as well, are happy to provide these individuals with the notoriety (and future promotions and salary increments) that they crave.  In most states the punishment for sexual abuse of a child is Draconian, far above and beyond the punishments meted out for most other crimes (including murder).  Life sentences for fondling little girls are commonplace, and there are hundreds (and possibly thousands) of individuals who have been convicted of such a crime — some of whom may very well be guilty but many of whom, I am convinced, are not.  In either case, their punishments are far beyond what was visualized by the Founding Fathers when they framed the U.S. Constitution, which was designed to protect an accused individual from "cruel and unusual punishment."
  

Conclusion

It would be an error to conclude that I believe that all adult women who promulgate false sex-abuse accusations against their fathers are paranoid.  Rather, I believe that some (and possibly many) of them are, but it is too early to know approximately what percentage of these accusers fall into this category.  Some are preparanoid and may be moving along the paranoid track, with the false sex-abuse accusation enhancing movement along that path.  Certainly, there are other types of psychopathology in women who promulgate a false sex-abuse accusation.  I have focused here on the paranoid element because I consider it quite common.  These women will have demonstrated significant degrees of psychopathology in the earlier years of their lives, long antedating the outbreak of the psychopathology associated with the sex-abuse accusation.
  

Hallucinations

Auditory Hallucinations and "Alters"

Auditory hallucinations are far more common than visual, the latter being more likely associated with organic brain disorders.  Therefore, the term "hallucination" will refer to auditory hallucinations unless otherwise specified.  Often, an hallucination is a concrete symbolization of a delusion.  Also, like the delusion, the projection element is often operative.

In order to qualify as a bona fide hallucination, there must be an associated impairment in reality testing, to the point where the experience becomes egosyntonic.  So real are hallucinations that schizophrenic patients commonly enter into discussions and even arguments with their own hallucinatory material.  Voices perceived as coming from within (to be clearly differentiated from the patient's own inner thoughts, which do not have an auditory component) warrant the label hallucination just as much as voices that are considered to come from without (Kolb & Brodie, 1982).  This is an important point with regard to the relationship between these inner hallucinatory experiences and the so-called alters.  The alters of many hallucinating, paranoid schizophrenic women are basically internal type, auditory hallucinations.  Calling them "alters" rather than auditory hallucinations (which is what they really are) is one of the great psychiatric and psychological rationalizations of the late 20th century.  One would think that well-trained psychiatrists and psychologists should know better, and recognize a schizophrenic when they see one.
  

The Wish-Fulfillment Element

Hallucinations can be wish fulfilling.  Probably one of the more common examples is the hallucination of a recently deceased loved one.  Here there is often both a visual and an auditory component to the hallucination.  These are generally considered to be less pathological than those that do not have such an obvious purpose.  Another example would be the woman who hears the voices of an old lover who abandoned her many years previously.  He repeatedly professes his affection and amorous inclinations.

For MPD patients the repressed wishes being gratified are sexual, which Freud referred to as Oedipal.  The "alters" of the paranoid women being discussed here describe in exquisite and ever-expanding detail the wide variety of sexual encounters they had with the accused father.  These voices, we are told by MPD experts, have nothing to do with schizophrenic hallucinations; rather, they are the wailing voices of abused women, victims of abominable acts perpetrated against an innocent child.  This explanation is supported by these women's therapists who tell us: "If a person has a thought about a sexual encounter with a person, it must be true because where else would it come from?"  And, if the "thought" is an internal auditory phenomenon (heretofore referred to as an auditory hallucination), it is now relabeled an alter and the schizophrenic consideration evaporates.  We see here an example of the folie deux relationship often seen between these women and their therapists.
  

Diminution of Guilt

Hallucinations, via the projective mechanism, diminish guilt.  It is as if the patient is saying: "It is not I who harbor within me all these unacceptable impulses, it is he out there who is the pervert."  Patients who hallucinate the ubiquitous odors of disinfectants (odors that appear to be everywhere) are basically attempting to disinfect themselves from thoughts and feelings which they feel guilty about and consider noxious.  The patient who feels continuously that the world smells is basically projecting outward his or her own feelings of body putrification.  The patient who hears others calling him "sex pervert" is basically an individual who feels guilty about his own sexual impulses and needs to project them outward.  The MPD women are basically saying: "It is not I who want to have sex with him; it is he that wants to have sex with me.  In fact, his sexual cravings toward me are so enormous that he cannot control his impulses and raped me repeatedly throughout the course of my childhood, starting at the age of six months."

Alters can diminish guilt in other ways.  An alter can assume responsibility for taking legal action.  On the civil track, it is the alter who is suing for megabucks to pay for the therapy and provide compensatory damages.  It is the same alter (or another one) who reports the accused parent to the police in order to put the person in jail as a "therapeutic" maneuver.  The patient herself may not feel guilty about this because it is not she but the abused alters who are wreaking vengeance on the accused.  (This is yet another benefit of having an MPD diagnosis as opposed to the diagnosis of paranoid schizophrenia.  This maneuver is also a testament to the capacity of patients and their therapists to deceive themselves.)
  

Enhancement of Self-Esteem

Hallucinations often involve esteem enhancement.  Being singled out from 5.3 billion people on earth for a visit by God is certainly an esteem-enhancing experience.  This is especially the case if God takes out a significant time from His (Her, Its) very busy schedule to spend significant time talking with the patient.  For MPD patients who have allegedly been sexually abused, the belief that one's father has singled her out for special attentions, in preference to all other members of the family, even the mother and siblings, is ego enhancing.

Hallucinations (equals alters) can provide compliments, encouragement, and praise for the legal actions taken against the accused parent.  They therefore aid and abet the pathological acting out of the delusional/hallucinatory system.  And they also provide positive reinforcement for such acting out, thereby ostensibly enhancing self-esteem.  I say ostensibly because the pathological esteem enhancement ultimately ends up producing just the opposite kinds of feelings.
  

Capacity to Spread

As is true for delusions, hallucinations have a tendency to spread, expand, and become elaborated upon as the patient becomes progressively sicker.  For these "MPD" patients suffering with paranoid schizophrenia, this phenomenon takes the form of an endless quest for the discovery of more and more alters, sometimes numbering in the hundreds.  Generally, it is the therapist who embarks upon this voyage of discovery which, for most patients, never ends.  There are always new alters to be uncovered, alters allegedly buried ever more deeply in the patient's unconscious.  Of course, such searches enrich the therapist because until all the alters are discovered, the healing path cannot be embarked upon.  Joining sex-abuse survivor groups, engaging in weekend marathons with other sex-abuse survivors, and proselytizing for the rights of victims not only entrenches these delusions but enhances the likelihood that other people's alters will be brought into one's own collection.  I refer to this as the cross-fertilization process.
  

Concluding Comments

It may very well be that there has never been a time when paranoid schizophrenics have enjoyed so much secondary gain from their symptoms.  In collusion with an army of mental health professionals, representing all levels (especially psychiatrists, psychologists, and social workers), they not only gain social approbation from a significant segment of society, but have opportunities for financial remuneration never before enjoyed by psychotics.  And a whole network of other professionals are joining in because of the obvious benefits (especially financial) to be derived from such participation.  Lawyers well know how much money there is to be made from these sex-abuse victims, especially in association with their lawsuits against their fathers.  Prosecutors, district attorneys, and judges enjoy notoriety as they gain the reputation of cleansing society of these old perverts.  The media is having a heyday with these women as they consider it part of the "healing process" to expose their perverted fathers to the public and describe in detail the sexual abominations they were subjected to, throughout the early years of their lives, at the hands of their fathers.  Their therapist generally encourages such public exposure as part of the process of "healing."  Police, prosecutors, and district attorneys can then demand increasing funding because of the ever increasing flow of cases in this category.

Paranoid schizophrenics who are incorporating sex abuse into their delusions, who are then being given the MPD diagnosis are indeed victims.  They are not the victims of their delusional abusers; they are the victims of those who label them with the MPD diagnosis.  Wrong diagnoses do patients more harm than good.  In this case the wrong diagnosis causes enormous grief for the family members who are often subjected to cruel treatment, destruction of family support systems, and even sadistic lawsuits.  These patients' victimization in this way also deprives them of proper neuroleptic medication, medication that in some cases might be useful.  These patients are also victims of the supporting network of people who profit from convincing these sick people that they have MPD.

About 25 years ago I recall reading articles by psychiatrists who were treating paranoid schizophrenics by entering into their delusional systems and joining in with them on their journeys through fantasy land.  Although this method of treatment never gained widespread popularity (happily so, because it could not but entrench such a patient's pathology), the psychiatrist (hopefully) was not delusional.  Today, the same thing is going on with one big difference: many of the therapists here are delusional and the two journey through the MPD fantasy land searching for more and more alters.  And this is viewed as progress.  Perhaps my medical school classmates were right, after all, when they said that only the craziest people in the class who went into psychiatry.

It may very well be that there is such a disorder as MPD.  Since 1957, when I first began treating psychiatric patients, I have not seen one such patient that I considered to justify the diagnosis, although a colleague did present one at grand rounds during my residency training.  And it may even be the case that some people who have MPD have gotten that way because they were sexually abused in childhood.

I do not know the true prevalence of MPD.  Perhaps it is nonexistent and is entirely iatrogenic as McHugh (1993) so compelling argues.  He considers it an entirely iatrogenic illness similar to the "hysteroepilepsy" described by Charcot, a disease that appeared to evaporate when people stopped labeling it and paying attention to it.  Perhaps it does arise de novo (without the suggestion of mental health professionals) in a small percentage of cases.  I do know that I personally, in over 35 years of practice, have never seen one.  I am very dubious about the notion that it is a widespread phenomenon, especially because all those whom I have come across who were given the label appeared to have compelling evidence for a wide variety of other diagnoses (of which paranoid schizophrenia is only one).

Whatever the prevalence of MPD there is no question that a parallel phenomenon is taking place, namely, the use of the MPD diagnosis by paranoid schizophrenics and their therapists for the purposes described here.  Whatever the prevalence of true sex abuse (from common to widespread), there is no question that the parallel phenomenon of false sex-abuse accusations exists, and it has been my purpose to describe one subcategory of the false sex-abuse accusation phenomenon and the functions it serves for this category of false accusers.
  

References

Gardner, R. A. (1992). The Psychotherapeutic Techniques of Richard A. Gardner, M.D. (2nd Ed.) (Paperback). Cresskill, New Jersey: Creative Therapeutics, Inc.

Kolb, L. B., & Brodie, H. K. H. (1982). Modern Clinical Psychiatry (Out of Print)(Out of Print). Philadelphia: W.B. Saunders Co.

McHugh, P. R. (1993). Multiple personality disorder. Harvard Mental Health Letter, 10(3) 4-6.

* Richard A. Gardner, M.D. is Clinical Professor of Child Psychiatry at Columbia University, College of Physicians and Surgeons in New York City.  [Back]

 

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