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How Many People in One Brain?

“There’s me before my morning double espresso and me afterward”

 

I’m always happy to get a phone call from my good friend Reb Arik, a pleasant, levelheaded fellow who serves as the mental health askan for his small, Jerusalem-based chassidus.

“What can I do for you today, Reb Arik?” I asked as I answered the phone.

“Oooh, Reb Yaakov! So happy to catch you. Listen, I have a bit of a crazy question to ask you if you don’t mind.”

“If I didn’t want to answer your questions then I wouldn’t have answered your call, Reb Arik. How can I help?”

“Good point, Reb Yaakov. Yes. Logic. Rationality. Seichel iz a tayereh zach,” he said. “Okay, tachlis… what does it mean — multiple personalities? I mean, I’m no psychologist, but the whole thing doesn’t really make sense. I mean, how could there be multiple individuals within the same body? Sounds more like an easy way out of dealing with huge levels of distress that are too hard to integrate.”

“Oy vey,” I thought out loud, recalling the dozens of challenging cases I’d seen of young men and women who had shown up at the emergency room with a diagnosis of Dissociative Identity Disorder — often referred to by its pop-culture name of Multiple Personality Disorder. The cases all involved patients with very complex personality disorders. Some were antisocial and malingering — trying to gain something from claiming their behavior and difficulties were the result of being “taken over” by the other personality, and others were the victims of irresponsible new age-type mental health professionals who had convinced their patients of the diagnosis.

The diagnosis of Multiple Personality Disorder peaked in popularity in the 1970s, around the same time as the release of a book (and later a film) — through the eyes of a psychiatrist — about the psychiatric tracking of a woman with an alleged 16 different personalities. Around the same time, workshops began popping up in the psychiatric community to train MPD therapists, who were suddenly finding these symptoms in many of their patients. (In 2011, an investigative journalist claimed the entire story was a hoax perpetrated by the woman’s psychiatrist, in order to generate attention and create an entire “multiple personality” industry.)

In cases I’d been involved with, it seemed that patients who self-diagnosed this disorder had been given the suggestion by an enthusiastic therapist or “knowledgeable” friends, or were really suffering from borderline personality disorder or other profound difficulties in coping abilities and stresses of life and relationships.

These were patients who came in reporting the bizarre phenomenon that at different times there were different personalities — called “alters” — that controlled the singular body’s actions. These “alters” had their own age, postures, and personalities, which controlled the person’s behavior and thoughts at various times.

Even in the field of psychiatry where diagnosis was already rather gray and without perfect scientific rigor, dissociative identity disorder was being bandied about without exceptional research and sensationalized in a few Hollywood movies.

And it’s really a shame, because although “alters” can create a certain drama, they also create a mask to the real, deeper issues, contribute to psychiatric regression, and usually mean negative response to real — if painful and difficult — treatment.

“I have to be honest, Reb Arik,” I said quite frankly. “I don’t believe it really exists,” I answered as I had a flashback: I was sitting with the best teachers in the field at the Massachusetts Mental Health Center during a supervisory case conference close to a decade ago.

As I looked across the room at four Harvard Medical School professors of psychiatry with close to 200 years of experience under their collective belts, I remember that three of them emphatically agreed as I posed the question, “With all due respect, you don’t really think that dissociative identity disorder exists… do you?”

The fourth professor — the most honored and senior of the bunch at the ripe age of 86 — smiled and said, “Of course it exists: There’s me before my morning double espresso and me afterward.”

As I fondly recalled Dr. Zaltzberg’s wit, I returned to the conversation with Reb Arik. “No Reb Arik. I don’t believe it really exists as a life of its own. But how about filling me in on your case?”

“I hear, Reb Yaakov. So this is the story: We have a young girl who’s gone through a very serious trauma. She’s been telling a lot of different people different things and we wanted an expert to tell us how to help her. She went to Professor Weinstock and he diagnosed her with multiple personality disorder. She really connected to that, but ever since, things have gone from bad to worse. According to her, sometimes we’re talking with Rivky and sometimes we’re talking with Freyda Blima. Then when she refuses to get out of bed in the morning, she tells us we’re dealing with Perel.” Reb Arik went into a lot more detail, until I got a clearer picture.

“And you don’t want to mess around with Perel because she isn’t afraid to break things?”

“How’d you know, Dr. Freedman?”

“Wouldn’t you want to blame someone else every time you got mad and trashed your parents’ home? Listen, Reb Arik, the idea of independent multiple personalities goes against all rationality, although it’s not hard to understand how severe trauma would want to make a person ‘blank out’ of his reality and assume the personality of someone else. The question is basically, did this girl’s traumatic stressors really force her mind to split into multiple identities, each with its own set of specific memories, or is taking on another persona the neshamah’s easy way out for her to cope? It doesn’t seem to me that there are separate people living inside her single brain. You don’t have to be a neurologist to understand how unlikely that is. By the way, the excuse of a ‘separate personality’ doesn’t hold up in court. In fact, it’s rarely diagnosed as an independent condition anymore, ever since insurance companies stopped paying for MPD treatments and patients began to sue their MPD therapists for malpractice.”

“You’re right. I hear. Ridiculous,” said Reb Arik. “That’s what I told the family. But you have to understand that Professor Weinstock, who did the diagnosis, has a good name by the askanim.”

“Listen Reb Arik, I’m not telling you he’s a bad guy or even a bad doctor, I’m just telling you that this particular case, at least the way you described it, it smells a little like Shabbos gefilte fish on Wednesday night. But if the family is willing, I’d be happy to her for a second opinion”

Arik laughed. “Thanks, Reb Yaakov. This is a tough situation but you are reaffirming my thoughts here. Using your kop is a good thing.”

“Always happy to help you Reb Arik.”

A few hours later, while I was sitting with a patient, Reb Arik came back and left a bag on a chair in the waiting room, which I found before closing up for the evening. In it was a copy of the Rambam’s Moreh Nevuchim with his rebbi’s peirush printed at the bottom of each page.

The sefer was inscribed, “To Dr. Freedman: Seichel iz a tayereh zach, even by psychiatric diagnosis. Your friend, Reb Arik.”

Identifying details have been changed to protect the privacy of patients, their families, and all other parties.

Jacob L. Freedman is a psychiatrist and business consultant based in Israel. When he’s not busy with his patients, Dr. Freedman can be found learning Torah in the Old City or hiking the hills outside of Jerusalem. Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com

 (Originally featured in Mishpacha, Issue 775)

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