Multiple Personality Syndrome: A Pathological Phenomenon on Crossing the Threshold (From Das Goetheanum 19; 287-9. English by A. R. Meuss, FIL, MTA.) Judith Krischik

JAM Vol. 12, Nr. 4 An interview with psychiatrist Marko van Gerven, M.D., director of the Bernard Lievegoed Clinic, Bilthoven, Holland

Marko van Gerven has been treating people with multiple personality syndrome (MPS) for nine years, initially in his private practice and for the last five years at the Bernard Lievegoed Clinic in Bilthoven. He began our conversation by describing the different handwritings of a multiple personality. Nine years ago a woman came to see him who complained of gaps in her memory (amnesia). She also showed him things she had written which looked as if they were by a number of different people. He was unable to explain this and consulted a graphologist. A lay person would consider the writings to be utterly different; they ranged from a child's writing couched in simple language to male handwriting. However, the graphologist judged them all to be by the same hand.

The handwriting samples and the different voices used by the patient made the psychiatrist feel uncertain. He did not know what to think and asked himself if the patient was consciously or unconsciously fantasizing or telling lies to other people, including himself. Her amnesiac states weakened her and caused anxiety, but apart from them she was hyperactive and full of energy. He could not visualize her life situation as she was training for different things at the same time and following two occupations.

One day she came to his office in the Gestalt of a young child, having lost all orientation and being deeply shocked. At the end of the session, van Gerven asked: Where's your mother? The patient then sat in the waiting room waiting for her mother. After a time she was gone, and he thought he had lost her as a patient. He said he was just as taken aback as the "lost child" and experienced the child as "competing" with the "real" patient. For the first time he shared the patient's state of extreme anxiety. "The patient's fear of losing control became my fear. As an adult, she was afraid of the child emerging, and I, too, was really afraid. What child was this? Why was it here? I wanted to speak to the real patient and not a childlike construct."

He did not know at the time that this situation, which both of them felt to be threatening, was also a demonstration of trust. From then on he was gradually permitted to know the patient's personality states -including the weak ones and the young children, which will only come out when they no longer feel threatened. Each of the personality states or ages had its own name, age, voice, gender, appearance, character, mission, etc. Ten to twenty such states are average; the 147 ages shown by Liz Bijnsdorp, one of Marko van Gerven's patients who wrote about her experiences after she was cured, are indicative of complicated MPS. One of the first stages of treatment is to get to know them, then to "classify" them. "A fairly superficial classification is in aggressive ages, social and depressive ages, in men, women and children," van Gerven explained. "A much more important classification, in my opinion, is based on relating them to certain traumatic experiences in the biography."

Traumatic experiences such as sexual abuse and parental violence are the points of origin for the different ages. The therapist has to realize that the group of personality states grouped around a trauma has different levels. You do not bring the suppressed trauma fully to light in one go, but in stages. A group will only recall the whole event for the therapist - and itself - when there is no longer any danger in doing so. The group helps the traumatized child to bear the experience and the memory of it and to cope with it. Apart from this protective function there is also an actively aggressive aspect of the group. This holds considerable danger for others and for the individual with MPS. Psychologists speak of the patient introjecting the perpetrator. The image of the perpetrator is made part of one's own reality, and the suffering one has undergone is now directed against the environment or oneself. The victim becomes the perpetrator. These potential perpetrators are further personality states that often lie deeply hidden. A therapist has to know this when undertaking treatment.

Common experience of splitting

Marko van Gerven does not talk of persons or ages, which are the usual terms in his profession. They suggest autonomous personalities with individual powers of expression and presentation. As could be seen from the handwriting samples, they only exist at a superficial level. He prefers to speak of soul states. Anthroposophic concepts and images of the physical and soul worlds provide a tool that helps him to feel his way toward an explanation of this disease of our age which has to be considered in close connection with humanity crossing the threshold. What does it mean to speak of "possession," a term that was widely applied to this disease even in the 19th Century, or to be more scientific and speak of unconscious processes taken from a repertoire of behavioral variants? According to van Gerven: "Each of us experiences a wide range of soul states. We all have aspects of the small child in us. But we have these states more or less under control when healthy; during the night the situation is very different. Rudolf Steiner described how we enter into a sea of ethers and call for a god to help us in our fear of dissolving in it. At the second stage, in the astral world, a soul that has entered into night with no religious feeling will crumble away. It is then not able to gain orientation from the seven soul or planetary forces. Falling apart is normal experience during sleep in the present age."

Nothing remains of this fallen-apart state when the night has passed. It is different, however, for MPS patients. Marko van Gerven told of MPS developing in children who were sexually abused before reaching their seventh year, that is, at a time when the ether body is still developing. Children abused after their seventh year show different personality disorders such as post-traumatic stress reactions or a borderline psychosis that is neither neurosis nor psychosis.

A child facing parental violence with no protection will also be unprotected as it enters the world of the spirit at night. Thinking of the incompletely-developed ether body we get a hint of how dissociation, splitting of the child's personality, occurs. He explained: "The child has these experiences, which are anything but normal. Not being normal, they are not inscribed in his biography in the normal way. Under normal conditions the experience is imprinted in the physical body as an image. I believe the terrible experiences of such a child are imprinted not only in the physical but also in the ether body."

The strange thing about experiences imprinted in the ether body is that the associations they arouse are accompanied by emotional "reflexes" such as tremors, sweating, shock and (psychologic) compulsive actions that are always the same. At the same time fear and anxiety begin to grow. The patient is not only afraid of sexuality but also of men in general or of unexpected events. The ether body, being plant-like, typically makes its contents grow. This means that the egoless memory complexes take on a phantom life of their own. The moral traumatization which is added to physical traumatization thus causes splitting even in the ether body. At night the individual, who is no longer whole, enters into the soul world. "As we said before," van Gerven added, "the astral world has a tremendous dynamic and tendency to split. In the etheric world the phantoms are possessed by etheric entities, that is, by elementals. That is one thing, m the soul world they are ensouled by higher entities. We can imagine all kinds of things that happen there. The soul world holds our drives and desires, feelings and actions, both good and bad; it also holds the dead, souls which prior to birth are looking for physical bodies, and much more. You become an entity with foreign thinking, feeling and will intent."

Marko van Gerven has gained insight into dramatic destiny links, although, for the sake of his patients, he would not like to see them published. There was one occasion, for instance, when a member of the family who had died took possession of the patient's soul state which had taken on a life of its own; it proved difficult to release the soul state in the course of treatment. The patient has been relieved of this particular fear.

How is it possible to tell what is genuine experience and what a patient merely picks up from an untrammeled soul world? How much soul world reality lies in something which has not been a genuine experience? Is it mere fantasy or are forces erupting into the biography from outside? "Here, the tales of ritual abuse frequently heard in America and in Holland are of interest. So far it has never been possible to establish factual proof, at least by the police, so from where do patients get these tales? They can describe them in extraordinarily vivid detail for which history provides a basis in reality: for instance, the human sacrifices in Central and South America - residues of which exist in the soul world."

In the present time, Amsterdam is a center for organized child prostitution. People with such impulses take their drives into the soul world, and these astral waste products can find their way to children unable to defend themselves. The alien destinies and alien suffering have to be taken account of and processed in the course of treatment. Accepted meanings of terms like "fantasy," "reality," "things experienced and remembered" become vague and seem too limited for describing the complex human soul, especially in morbid states.

In America, parents have been sentenced for allegedly having sexually abused their children. Later, it turned out that the children had "imagined" it all. Sexual abuse is increasing at an alarming rate today. "Half the female psychiatric patients were sexually abused as children or young girls, van Gerven commented. How can one really comprehend what parents are doing to their children? One big question I have concerns the nature of incest. What are the karmic relationships between parents and children in such a case?"

Marko van Gerven speaks of the anthroposophic child psychiatrist, Michael Meusser, treating families where incest had been practiced. "The situation in Holland at the time was that everyone said: sexually abused children must be protected; take them away from their families! Michael Meusser did everything possible to keep those families together and solve the incest problem within the family without resorting to the law. I found this unbelievable," van Gerven added. "Here the opportunity arose to take serious account of the karmic relationships that exist in every family."

MPS patients recreate their biographies

For Marko van Gerven there is only one person, the patient. Without exception, every soul state is an expression of the sick soul and differs from the rest even at the physical level. The personality states do not like it if he speaks to them of this; they are firmly convinced that they exist. "We are standing before a mirror and the patient describes her appearance: 'My eyes are brown,' she says. I say to her, 'No, that isn't true. Look!' for she really has blue eyes. If you are lucky, she begins to feel doubt. The soul states live in a state of illusion. As treatment progresses they learn that they cannot possibly have both black and blond hair or be both female and male. They must learn to accept this."

MPS patients, too, have only one I. Part of their I, however, the lower self or everyday I, has split, together with its physical, ether and astral bodies, and therefore developed incompletely. The higher self continues to be intact, as the core of being. "I always seek to address the higher I in therapy van Gerven stated. "This is only possible if one goes beyond the everyday level where only the lower self is active. I come to know my I by gaining insight into the background to my biography, my encounters and actions. As a therapist I must help the patient to fill all the gaps in his memory, finding pieces that have been deposited in the different soul states and literally hidden there. This alone will give the patient a biography again; he will have re-entered the stream of his own development. The self, too, will then have reached a higher level."

The disease, which manifests in amnesiac episodes, oddly enough includes situations where one is unable to forget. Memory becomes almost photographic, even if the actual memories are fragmented and are not immediately accessible. Such precision of recall is, in itself, abnormal; it provides further evidence of morbidity in the ether body for, in health, it takes care of memories being forgotten. Forgetting is the outcome of processing or digesting.

Marko van Gerven spoke of patients following a path of initiation. The aim of therapy is to connect the memories of the different soul states to create a continuous, conscious stream of memory. Ultimately this means total integration of those soul states. Some ages will sneak away, others will integrate; the ages themselves are afraid of dying. Integration of all the patient's soul states is preceded by their cooperation. Once they have got to know and accept each other, collaboration becomes possible. Patients who have recovered - van Gerven knows some who achieved total integration in three years - are now impressive, powerful personalities.

"To achieve total integration," he explained, "it is important that therapy is not just verbal. The patient must get in touch with his body; massage and art therapies are tremendously helpful in this, above all eurythmy therapy." Time was short, so van Gerven did not say much about the therapeutic techniques he uses. However, it is customary to use hypnosis with MPS patients for this addresses the different personality states and their memories directly. He commented: "Hypnosis is a big question where I am concerned. I have found that one uses hypnotic techniques more or less willy nilly; it is almost automatic. I do not give hypnotic suggestions and, in fact, have no training in hypnosis. You talk quietly and soothingly to the patient - and only realize afterwards that you have been using hypnosis. We must not forget, however, that hypnosis has its dangers and complications. It always involves two people, and the hypnotist also brings his astral body with its wishes and will intent into the situation. This is undoubtedly a vast problem."

Crossing the threshold calls for a new psychology

As a lay person one may ask oneself how psychologists can describe or seek to explain the MPS syndrome when they do not have concepts such as the different aspects of the human being, the soul world, etc. and are unable to accept the existence of a world that lies beyond the physical? How can we explain a situation where one personality state exhibits a high temperature and the moment another personality state appears on the scene the temperature has gone? Physical effects of this kind have been frequently recorded, but there has been no explanation for them.

Sigmund Freud, who saw MPS patients at the beginning of the century, put the phenomenon down to childhood fantasies. His diagnosis was generally accepted for decades. A change finally came in the early 1970's when, in America for instance, the "Sybill" case was published and aroused considerable interest not only among psychologists. It took another ten years before MPS was included in the American Psychiatric Associations Handbook and therefore internationally accepted as a syndrome.

The search is on for scientific concepts of "possession," a term used before the "birth" of psychology as a science. Marko van Gerven felt this to be one of the reasons why MPS is still the subject of dispute. In Germany and Switzerland the condition is largely unknown and considered rare. Psychologists, psychiatrists and psychotherapists seem to have a premonition that their whole scientific edifice will be shaken if the syndrome is accepted and may need to be re-thought.

In the Netherlands, where the American influence is stronger, the condition has been under discussion for some years. Psychologist Onno van der Hart, now a Professor at Utrecht University, started to publish papers on MPS in the late 1980's. Since then about 175 specialists have been working together and exchanging views on the subject. Marko van Gerven is one of them, and he took further training with Onno van der Hart. One outcome of the group's work has been a study on MPS with definite suggestions on how the work may be furthered; this was done at the request of the Department of Health. Next year, the group will extend its work beyond the borders of Holland and hold an international MPS congress.

Many questions arise for anthroposophic psychiatrists. Even though, compared to their colleagues, most of them are a-religious, anthroposophy does provide them with a starting tool. Even among them the disease must first be discovered before it can be explored in anthroposophic terms. The Bernard Lievegoed Clinic, one of the few in the anthroposophic field, is clearly an exception. MPS patients have been treated there since the Clinic opened five years ago, working in close contact with psychiatric departments of other hospitals in Holland. Marko van Gerven, head of the Clinic, hopes it will be possible to open a further MPS ward in the near future.

Judith Krischik