The instructor in Paula's human sexuality course suggested that she talk to a psychologist. Severalfactors 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 first two exams had been As, 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 sufficiently 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 first child. All of this led her professor to believe that Paula needed help. Fortunately, she was inclined to agree with him because there were a number of things that 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 18 years of age and a daughter who was 15. For the past 5 years, Paula had been taking courses at the university and working part time at a variety of administrative assistant positions on campus. She and her daughter lived together in a small, rural community located about 20 miles from the universitythe 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 difficulties. She threatened suicide frequently and had, on several occasions, made some attempts to harm herself. In addition to these emotional difficulties, 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 hung over. 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, particularly 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 adolescent. 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, however, 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 discuss 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 first 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 lectures. 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 headache 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 find 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 remember 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 saying that a woman named Sherry had called. She had identified herself as a friend of Paula's and had said that she would like to discuss the case. Before responding directly to this request, Dr. Harpin decided to check with Paula to find 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 memory 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 finally 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. Harpinwho was simultaneously confused and fascinated by this startling exchangedecided 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 finally 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 last half hour. Dr. Harpin was stunned and incredulous. Although he was aware of the literature on dissociative identity disorder (DID) and a few wellknown cases, he could not believe what Paula had said.

When Paula appeared for their next appointment, she still could not remember anything that had happened and seemed just as she had before this remarkable incident. Dr. Harpin decided to attempt to discuss with Paula a traumatic incident that had happened a number of years ago. Paula had frequently mentioned 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 filled 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, clutching 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 find out as much as he could about Sherry. She provided only sketchy information, admitting 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 adolescents 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, and soon there was another dramatic change in Paula's appearance. She fidgeted in her chair, pulled at her hair, and began to bounce her leg continuously. She was reluctant to talk, but adopted a coy, somewhat flirtatious 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 presumably 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 fist clenched close to the side of her mouth almost as if she were sucking her thumb, she turned sideways in the chair and peered at Dr. Harpin bashfully 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."

"Why do you think you're bad?"

"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."

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 fit closely with some of the published cases of DID, but he had never really believed that this sort of thing happened, except in fiction. 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 complex set of problems. His contacts with Paula continued to deal largely with daytoday crises.

He asked Paula if she had read any of the wellknown books or watched any of the popular films dealing with DID (which was formerly called multiple personality). She had not. Because she was not familiar with other examples of this phenomenon, it seemed unlikely that she had simply invented the alter personalities as a way of attracting attention or convincing others of the severity of her problems. In an attempt to help Paulawho was not aware of the altersunderstand the problems that she faced, Dr. Harpin asked her to read The Three Faces of Eve, the book on which the famous film was based. She reacted with interest and disbelief. What did it have to do with her situation? She was still completely 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.

Dr. Harpin also used video recordings to help Paula understand the problem. With her consent, he recorded her behavior during a sequence of three therapy sessions. She alternated among the various personalities several times during the course of these meetings. Paula was then asked to view the video clips 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 identification 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 find it again at her house. Her parents and daughter denied knowing anything about the gun. Recognizing that Paula was frequently unaware of things that she did as the other personalities, Dr. Harpin discussed the gun with Sherry and Janet. Both denied any knowledge of these incidents. Sherry finally suggested that it might be someone else.

At the beginning of the next session, Dr. Harpin decided to use hypnosis in an effort to see if he could identify more alters. While Paula was in the trance, he asked if anyone else, with whom he had not yet spoken, was able to hear what he was saying. This was when Heather emerged. She was presumably 23. It was she who had been bringing the gun to Paula's house, and it was she who had been calling Cal. Heather told Dr. Harpin that she was in love with Cal. If she couldn't marry him, she wanted to kill herself. This was the first alter with whom Sherry did not have coconsciousness, and her existence explained several important inconsistencies in Paula's behavior and gaps in her memory.

Heather's affection for Cal illustrates another important characteristic of the dissociative identity phenomenon. There were important, and occasionally radical, differences among Paula, Sherry, and the other alters in terms of tastes and preferences as well as mannerisms and abilities. Heather loved Cal (she couldn't live without him), but the others hated him. In fact, Paula's most remarkable reaction to video recordings of her own behavior centered around one conversation with Heather. Paula insisted that it was not she. "I would never say those things!" she said. Paula's attitude toward her parents was also at odds with those of some of the alters, and this inconsistency undoubtedly explained some of the erratic shifts in her behavior and relationship with other people. Sherry didn't like Paula's children and was inconsiderate in her behavior toward them. She frequently promised them things to keep them quiet and then failed to honor her commitments.

Social History

Paula grew up in a small rural community. She had one older brother. Her mother was an outspoken, dominant woman who maintained firm control of the family. Both parents were strict disciplinarians. The parents of Paula's mother lived nearby. This grandfather was the only sympathetic adult figure throughout Paula's childhood. When Paula was upset, her grandfather was the only person who was able to console her and stop her crying (although she never dared to tell him about the things that her father forced her to do).

Paula's father was a shy, withdrawn, unaffectionate man who did not have many friends. For the first few years of her life, he ignored her completely. Then, when she was 5 years old, he began to demonstrate physical affection. He would hug and kiss her roughly, and when no one else was around, he would fondle her genitals. Paula didn't know how to respond. His touches weren't pleasant or enjoyable, but she would accept whatever affection he was willing to provide.

When she was 15, their sexual encounters started to become violent. The pretense of affection and love was obviously dissolved; he wanted to hurt her. In one incident, which Paula and Dr.Harpin had discussed repeatedly, her father dragged her into his bedroom by her hair and tied her to the bed. After slapping her repeatedly, he forced her to have intercourse with him. The incest and physical abuse continued until she was 20 years old.

Paula's mother was a strict disciplinarian who often punished Paula by putting her hands in scalding hot water or locking her in a dark closet for hours on end. Mrs. Stewart did not realizeor seem to carethat her husband was abusing Paula sexually. If she did know, she may have been afraid to intervene. Mr. Stewart may also have abused his wife as well as his daughter, but Paula could not remember witnessing any violence between her parents.

Perhaps in an effort to tear herself away from this abusive family, Paula pursued relationships with other men at an early age. Many of these men were older than she, including teachers and neighbors. The longest relationship of this sort was with Cal, the owner of a small construction business. Paula was 16 and Cal was 31 when they started seeing each other. Although he took advantage of Paula sexually, Cal was a more sympathetic person than her father. He did listen to her, and he seemed to care for her. On numerous occasions, Cal promised that he would marry her. For Paula, he was a "rescuer," someone who offered a way out of her pathological family situation. Unfortunately, he didn't come through. He married another woman but continued to pursue Paula's affection and sexual favors. She continued to oblige, despite the strong feelings of anger and betrayal that she harbored.

A few incidents that occurred while Paula was in high school were probably precursors of the memory problems and dissociative experiences that she later encountered as an adult. They suggest that the problem of alter personalities began during adolescence, although it was not discovered until many years later. People sometimes told Paula about things that she had done, things that she could not remember doing. Most of these involved promiscuous behavior. Paula was particularly upset by a rumor that went around the school when she was a sophomore. Several other girls claimed that Paula had been seen in a car with three men. They were parked in a remote picnic area outside town, and Paula presumably had intercourse with all of them. She couldn't remember a thing, but she also didn't know where she had been that night.

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