Bad Men Do What Good Men Dream: A Forensic Psychiatrist Illuminates the Darker Side of Human Behavior (26 page)

In
State v. Milligan
, the issue was more complicated. The 26-yearold man was arrested for a series of campus rapes. During pretrial incarceration, his behavior was inconsistent, and his attorneys decided that a psychiatric evaluation was needed. A variety of clinicians agreed that William Milligan had M PD. He was initially found incompetent to stand trial, but later he was deemed restored to competence and the trial proceeded. Further examination revealed that Milligan had committed the rapes while under the control of one of his alternate personalities, who was a lesbian, and that Milligan had not been aware of this alternate personality or of “her” actions. In fact, he was not generally aware of these other personalities, and on the rare occasions when he did become aware of them, he attempted suicide. Milligan was found not guilty by reason of insanity and was transferred to a psychiatric facility. It was determined that the alternate personalities had formed during his childhood to protect Milligan from severe abuse at the hands of his stepfather.

In the last case,
Rodrigues v. Hawaii
, a 23-year-old Marine was charged with three counts of sodomy and one of rape. Rodrigues, who pleaded not guilty by reason of insanity, was examined by five psychiatric experts. Four of them agreed on a diagnosis of M PD. The treating psychiatrist testified that Rodrigues manifested three personalities. “Rod” was his main or host personality. “David” emerged when Rodrigues was 16 and acted as a referee between Rod and the third personality, “Lucifer,” who had come into existence when Rodrigues was 3. The treating psychiatrist testified that it was Lucifer who was in charge at the time of the offenses. The psychiatrist further asserted that although Rod and David knew that the sexual acts were wrong, Lucifer did not care if they were right or wrong. Similarly, Rod and David had the capacity to conform their conduct to the law’s requirements, but Lucifer did not care about his conduct or about the consequences.

The trial judge granted Rodrigues’ motion for acquittal by reason of insanity, but the verdict was reversed by the appellate court, which declared that M PD, by itself, does not automatically equate with insanity. Sanity was an issue for the jury to decide. The Supreme Court of Hawaii then ruled that MPD cannot be regarded in the same fashion as any other insanity defense and that “each personality may or may not be criminally responsible for its acts, [so that] each one must be examined under the…competency test.” The court’s analysis is reminiscent of Benjamin Franklin’s admonition, “We must hang together or assuredly we shall all hang separately.”

The Hawaii decision in the Rodrigues case reflects a growing tendency for the courts to view the person with M PD as if he or she were several people, each responsible for his or her own behavior. That is what happened in the case with Sarah (described at the beginning of this chapter): each personality was sworn in separately to testify. Unfortunately, this position, which is increasingly being taken by the courts, has an important drawback: it intrinsically accepts a central symptom of M PD, the disavowal of one’s actions—and this can have the result of legally exculpating someone from responsibility for a heinous act.

In a bizarre twist, MPD was used as a defense in a rape case in which the criminal defendant testified that an alternate personality did it. He was charged with breaking into the apartment of a woman he met in group therapy and forcing her to have oral sex and then raping her. The defendant denied the charges, claiming that the sex was consensual between “Spirit,” one of 30 personalities that inhabit his body, and “Laura,” one of the woman’s many personalities. Quoted in court papers, the defendant told investigators that “Spirit loved Laura.” As noted earlier, a diagnosis of M PD does not preclude the main personality or any of the alters from being found criminally responsible if, in fact, the individual or any of his or her personalities committed the offense. The legal outcome of this case is unknown.

There is always a powerful incentive to decline responsibility in the litigation context, in which life, death, large sums of money, and personal reputations are at stake. In a treatment situation, a psychiatrist usually accepts an M PD patient’s reality: that he or she experiences multiple personalities. Both therapist and patient strive toward integrating these personalities and toward having the patient assume responsibility for the behaviors of all of the personalities. In a litigation situation, however, the patient usually seeks a psychiatrist’s assistance not for the purpose of treatment, but rather for help in mitigating punishment or possibly exonerating the patient of unlawful behavior. The legal situation presents all sorts of difficulties for forensic examiners of an alleged M PD sufferer. For instance, there is the problem of conclusively demonstrating whether the alternate personalities—if they exist—are aware or unaware of one another, have or do not have control over one another, or are able or unable to distinguish right from wrong. Courts ordinarily do not accept amnesia as a defense in criminal cases, and, of course, amnesia is a vital aspect of what happens to a person with M PD. People who suggest for the first time at a trial that they are afflicted with M PD generally have a hard time convincing the court. A person who has been previously diagnosed with M PD can more effectively cite the illness as a defense in court, especially if the person can show that an experienced clinician treated him or her for the disorder before the criminal act occurred, or that a clear connection has existed between the host personality and a long-standing antisocial personality alternate that took control of the host and committed the criminal act. If a psychopathic alternate personality is truly present in a person with M PD, it most likely has appeared in the past and has committed antisocial acts that have been documented.

Multiple Personality Disorder, Hypnosis, and Malingering

Studies show that M PD symptoms can be fabricated. Even the experienced forensic examiner can have difficulty distinguishing faked from true MPD. Particularly in criminal cases, the possibility that MPD is being faked must always be considered. Also, an examiner must keep in mind the possibility that a person may have M PD and also malinger.

Ross Michael Carlson

The issue of possibly malingered MPD was the center of the case of 19-year-old Ross Michael Carlson, who forced his parents out of their car, ordered them to lie face down by the roadside, and then shot them in the head with a .38 Special. In one of the longest and most controversial criminal cases in the history of Colorado, Carlson pleaded insanity on the basis of M PD. His lawyers argued that because of the disorder, Carlson was not really present at the scene of the crime. Carlson alleged that he had no memory of the crime at all; that it was “Black,” the protector, one of seven alternate personalities inhabiting Carlson’s body, who pulled the trigger in the execution-style murder of his parents. Carlson never came to trial. Following the murders and his arrest, Carlson spent 6 years of psychiatric hospitalization in a criminal facility before he was found competent to stand trial. However, Carlson died of acute leukemia before the legal proceedings could begin.

Psychiatrist Michael Weissberg served as an expert witness in the case. He examined both Carlson and the evidence. He noted that Carlson had never displayed any prehomicidal alternate personalities. Moreover, there was no evidence to corroborate Carlson’s contention that he switched from one personality to another. For instance, his eyes did not roll upward in the movement known as
Spiegel’s sign
, which is frequently seen in MPD patients when a personality switch is taking place. But seamless switches of personality do also take place, so the absence of the sign was not incontrovertible proof against M PD. Carlson also did not manifest loss of time, amnesia, or other symptoms associated with M PD. But M PD is hard to prove or disprove: there are no blood tests, X-rays, or other objective ways of discerning it. You cannot see, smell, or touch M PD. These factors are what give rise to the seasoned attorney’s contention that M PD is a perfect “boutique” disease for the defense when no other exculpatory possibility is available.

Dr. Weissberg resisted pressure to use hypnosis in examining Carlson. Memories retrieved under hypnosis are more vulnerable to distortion and elaboration than are memories elicited through ordinary conversation. Contrary to the belief of laypersons, hypnosis can distort true memories and create false ones. Dr. Weissberg knew that descriptions of crimes developed under hypnosis are highly questionable. Many courts will not admit hypnotically enhanced memories as evidence. So Dr. Weissberg looked for other clues in Carlson’s environment, and found some. He learned that shortly before the murders, Carlson had checked out library books that dealt with MPD. He also learned that Carlson had been born out of wedlock to religious parents. Dr. Weissberg theorized that his parents came to hate Ross as a reminder and projection of their own wickedness. In his book
The First Sin of Ross Michael Carlson
, Dr. Weissberg concluded that Carlson had been faking M PD. He speculates that instead, Carlson was really an emotionless psychopath who acted out the parents’ death wish, absolving “his parents of nineteen years of guilt as he meted out their ultimate punishment.”

Kenneth Bianchi

One of the most controversial and infamous cases in which MPD was alleged as a defense was that of Kenneth Bianchi, the so-called Hillside Strangler of Los Angeles. Bianchi and his cousin Angelo Buono were accused of raping and murdering at least 10 young women whose nude bodies had been left strewn along hillsides during a 4-month killing spree in 1977–78. Seven psychologists and psychiatrists examined Bianchi. Some offered opinions for a diagnosis of MPD and some against.

Some examiners used suggestive leading questions during the course of their interviews with Bianchi, both with and without hypnosis. Other examiners did not distinguish between their roles as therapists and as forensic experts. In treating a patient, a clinician usually accepts and works with the patient’s perceptions of reality rather than attempting to independently verify the patient’s story. In evaluating the patient for legal purposes, the clinician considers many information sources in conducting a diagnostic evaluation that can clarify and illuminate such strictly legal issues as competency to stand trial or criminal responsibility for actions.

Testifying for the prosecution, Dr. Martin Orne spoke of observing the lack of a prior history of dissociation, the overly dramatic presentation of Bianchi’s alternate personalities, and their inconsistent presentation. Dr. Orne concluded for the court that Bianchi did not have M PD. He argued that Bianchi had been clever enough to defeat hypnosis and had also been able to con other psychiatrists into believing that he was not mentally responsible for the murders. Dr. Orne reminded the court that “contrary to popular assumptions, it is possible for untrained, naïve subjects to simulate deep hypnosis and fool even very experienced hypnotists by behaving in ways they think the hypnotist wants.” He recalled for the court having advised Bianchi that real MPD sufferers always have at least three personalities. Up to that point, Bianchi had only claimed one alternate personality, “Steve.” Later, on the day that Dr. Orne gave this information to Bianchi, “Billy” emerged—a con artist, a bounder who squirmed out of tight spots by lying. Dr. Orne concluded that Bianchi was sick but he was not legally insane. He diagnosed Bianchi as having “an antisocial personality disorder with sexual sadism,” and described him as a man with a “perverted sexual need which allows him to obtain gratification from killing women.” Bianchi was convicted and sentenced to prison; he later admitted that he had lied about having MPD.

This case and the others expose a fundamental difference between the litigation and treatment situations that affects the diagnosis of MPD. In litigation, what is sought is an external result—money, guilt or innocence, life or death. In treatment, what is sought is assistance in achieving an internal result, in becoming well. In this latter situation, then, the person presenting with M PD-like symptoms has no reason to fake the disorder. Persons with real M PD usually deny and conceal their symptoms, whatever the context. In fact, many M PD patients dissimulate their symptoms, either consciously or unconsciously, because they fear humiliation, embarrassment, or being thought of as “crazy” by others. Moreover, it is too horrible to recover memories of abuse and face the fact that one could be treated so miserably by parents or caretakers. For a child, it is unbearable to be hated by persons who are supposed to love you.

M PD patients tend to avoid help and to act against their own best interests. So dissimulation or the hiding of MPD symptoms is more common than simulating them, even in the litigation context. For the purposes of the courtroom, the diagnosis of MPD is made significantly more difficult because certain personality alternates mimic others or camouflage themselves behind more palatable others. Sometimes they deviously act together in a conspiracy to hide their own multiple existences, which, of course, renders it more unlikely that the forensic expert will diagnose M PD. In still other cases, the alternate personalities cannot agree on how to dissimulate, and symptoms may erupt that are initially more typical of psychosis than of M PD, such as audible thoughts or voices, or the expressed feeling that the person’s body is under the control of outside forces. Such symptoms can naturally lead to a wrong diagnosis.

In the treatment situation, M PD patients receive an average of 3.6 erroneous diagnoses before they obtain the correct diagnosis. It takes, again on average, 6.8 years between the time of their first mental health assessment of symptoms that might be attributable to M PD and the accurate diagnosis of the problem. In the courtroom, there is no luxury of time or leeway for wrong diagnoses. But because the process of correct diagnosis requires time and sufficient latitude for exploration, limitations imposed by litigation may lead to either an erroneous overdiagnosis or an underdiagnosis of MPD among litigants and criminal defendants. It is known, however, that M PD has a disproportionately high representation in the forensic population. This situation is further complicated by those persons available (or unavailable) to submit corroborating or controverting evidence. Lack of corroboration of a patient’s M PD symptoms, for instance by family members, may be evidence that M PD does not exist in that patient. But it may also result from the patient’s family having been involved in the childhood abuse that provoked the M PD into existence. Ultimately, the forensic examiner must rely on an intimate knowledge of the clinical presentations of MPD to make an evaluation for the court.