The Flock

by Joan Frances Casey

  Lynn read narratives I wrote about my past and about my time in therapy with her and with Gordon. During my frequent trips home, she and I walked the lakeshore and she told me what her experience of our therapeutic relationship had been. I marveled at our special love story; she marveled at how reading the narrative and remembering her own experiences gave her insights into herself and her current work.

  “It’s not done yet,” I said. “I want us to tell our story.”

  Lynn demurred. “I’m a clinician, not a writer. I can’t even find the time to produce a professional paper to express some of what I’ve learned.”

  “If you help me tell the story, I’ll do the writing.”

  Lynn agreed and Gordon joined in. We read journal entries, Lynn’s clinical notes made on napkins, Gordon’s insights recorded on navigational charts. We listened to tapes of the Flock in treatment, to tapes of Gordon and Lynn brainstorming what to do next. And as with the folktales that knit any family together, Gordon, Lynn, and I told one another the stories of my birth and growth.

  39.

  December 3, 1988, a blinking light on the hotel-room phone in Charlottesville, Virginia, led to a message to call Lynn. I was attending a seminar in public policy. Lynn and Gordon, I knew, were visiting a therapist friend in southern California who also treated multiples.

  My heart pounded as I dialed the phone. Why had Lynn called? It had been years since she had called me when she and Gordon were out of town. I was no longer in treatment and needing the reassurance that she would be coming home to me, her emotional infant.

  I hadn’t told her my itinerary. How had she found me in this Charlottesville hotel? What would be so important that she would track me down? And what stroke of luck had made her able to get a message to me an hour before I had planned to check out?

  Lynn had found me by calling my sister. Carol and I had finally become friends in the past few years. My sister now knew about my past, and she was the one person I kept informed about my present as well. She always knew where to find me.

  My fear dissolved once I reached Gordon and Lynn. They had no special reason for their call. Oh, rehashing the struggles of treating their first multiple as they talked with their friend had made them a little nostalgic, but they really just called to tell me that they loved me. They wanted to say that, though they wouldn’t have done anything differently in healing the Flock, they were sure glad I was all grown up now.

  We discussed plans for our upcoming visit. A week hence, they would fly from California to visit me in New Mexico. This would be their first trip to the isolated college town I now called home. They looked forward to meeting my colleagues, and the three of us looked forward to a week of relaxed closeness. I envisaged walking miles of mountain trails. Lynn, Gordon, and I would talk about their multiples and treatment techniques, about my research and students, about sailing, about the magic of our family. And we all looked forward to celebrating the book contract we had gotten on The Flock.

  They called to say they were proud of me, now solidly integrated. They were proud of the Joan Casey the three of us had created together.

  As Gordon and Lynn passed the phone between them, we talked for an hour, reaffirming the wonder of our relationship, which had started in such pain and sickness and continued in such joy and health. The three of us had long ago decided that, in some way we didn’t understand, the bonds we shared transcended the seven years we had spent together. We renewed our cosmic promise to share our next life as well. (Lynn was adamant that next time around I get to be the mother!)

  —

  TWO DAYS LATER LYNN and Gordon died. They had taken their friend’s sailboat out and gotten caught in a sudden violent storm. The boat was found pounding itself against a rock outcropping. Their bodies washed ashore two miles apart.

  I had made a stop in Richmond to visit my mother and sister before returning west. My sister and I were shopping when Lynn and Gordon died. Even now I think I should have felt something. Even now I think that, if I had been more alert, I would have felt the world tilt slightly at their passing.

  Later that night, at my sister’s house, I received a message to return an urgent call from Lynn’s daughter Marianne. I didn’t need to dial the phone to guess that Lynn and Gordon were dead.

  I listened calmly as Marianne told me what the Coast Guard reported, and I talked with her about the people I should call. I made as many of those calls as I could handle, and then sat on the porch with Carol.

  We talked, drank wine, and were silent. Carol knew what Lynn and Gordon meant to me.

  She cried my tears that night. My grief was too deep for tears, my need for understanding too strong to absorb the emotional impact. Steve had wept when I called him. Dr. Caul, a psychiatrist friend of Gordon’s and Lynn’s and mine, had taken some time to absorb what I said and then called back to offer what comfort he could.

  I held Carol that night while she cried for my lost parents. I celebrated then the biological start I had that had led me to Lynn and Gordon. I celebrated the bonds and the cosmic wisdom that had deposited me with my sister at the time of my surrogate parents’ death.

  Back home in New Mexico, I received a postcard that Lynn and Gordon had mailed to me the morning of their final sail. “We’ll see you soon,” the postcard read.

  —

  LIFE WITHOUT GORDON AND Lynn has often been hard, and sometimes close to unbearable. I lost the therapists who had given me health, and the parents who had, through their years of reparenting, given me life.

  So many times I want to call them, telling them of a new victory; so often I want their soothing voices to help me through some crisis. Recently I realized how frequently I say with regret, “They would have loved this!” and I suddenly thought that it might be no accident that Gordon and Lynn would enjoy so much of my world. I like to think that they have a cosmic hand in my life, leading me toward things and people good and nurturing.

  Life has led me to become the parent of a little boy who was himself abused. I have my own family now, complete with a husband as strong and gentle and wise as Gordon. How proud they would be.

  My son recently asked me how I had learned to be such a good mom. He reminds me from time to time that I’m newer at being a mother than he is at being a child.

  I told him that he and I are alike in that we both took a little more time than most people to find our real families. My true family had taught me how to love and nurture. Because of that, I can love and nurture him.

  My life is a testimony to Lynn’s and Gordon’s love.

  Afterword

  The story of Joan Frances Casey is remarkable—and not unique. By some estimates, one percent of the population suffers from Multiple Personality Disorder. Although Freud recognized and described this disorder, the American Psychiatric Association only recently—in 1980—included Multiple Personality Disorder in its official diagnostic manual, and the psychiatric community as a whole still does not fully accept it. Indeed, because the disorder is so frequently misidentified, an average of six years may elapse before a multiple receives the correct diagnosis. Clinicians may not know that hearing voices inside the head does not always signify a psychotic process, but rather, as in the case of multiple personality, represents non-thought disordered dialogues among the various alternate personalities. Assessment is often biased in the direction of schizophrenia, depression, borderline disorders, or mania—entities that clinicians have been familiarized with in their training programs. Both psychodynamic and biologically oriented training programs may inadvertently add to this tendency to misdiagnose multiples in the following ways.

  Many psychodynamic training programs teach a system of diagnosis and treatment consistent with traditional Freudian beliefs that exclude real trauma and focus rather on the imaginary or fantasied notions that underlie or accompany many of the neuroses. Analytic neutrality is viewed as a valuable aid in unraveling the mysteries of the transference. Few programs are currently staffed with those
trained in teaching the treatment of dissociative disease, which is a result of real rather than imagined traumas. It seems unacceptable to many clinicians that Multiple Personality Disorder is a consequence of unconscionable acts by adults in charge. It seems equally awkward for many of these clinicians to abandon their neutral analytic postures long enough to provide the proper warmth, attachment, and flexibility to actually sit through the revivifications of these traumas. Multiple Personality Disorder is still not considered by many to be a legitimate post-traumatic stress response to chronic, overwhelming, life-threatening danger beginning in early childhood.

  Thus, although Multiple Personality Disorder is a very real entity, it may be relegated to a conceptual framework that negates this basic truth. In many biologically oriented psychiatric training programs, clinicians become much more comfortable diagnosing conditions that respond to pharmacologic agents—anxiety that improves with anti-anxiety agents, depression that dissipates with antidepressants, mania that is controlled with lithium, and schizophrenia that is improved with antipsychotics. In Multiple Personality Disorder each of the alternate personalities may exhibit simultaneously many of the symptoms that individually these drugs are intended to treat. The drug of choice for multiples seems to be talk—the kind of talk that permits each of the separate traumas to be identified and relived, this time in the company of a safe, healing presence.

  Compelling scientific evidence for Multiple Personality Disorder has been derived from studies of brain and nervous system functioning. Topographic EEGs, IQ and other cognitive performance assessments, vision tests, and tests on cardiovascular function have been reported to be significantly different in alternate personalities sharing the same body.

  Immunologic and inflammatory responses may also differ between personalities. A patient of mine, Tony, housed an alternate personality whose job was to “never feel pain.” Once, Tony appeared in my office shortly after sustaining bee stings to one eye. The eye was very red and swollen. I arranged an emergency opthalmologic consultation but before sending him off to the eye specialist asked if I could speak with the alternate who never experienced pain. That personality appeared, we talked briefly, and it was soon time for Tony to keep his emergency appointment. One hour later I received a call from the opthalmologist who, in an effort to suppress his irritation with me, claimed that he found absolutely no evidence of redness or swelling. The next day Tony returned to my office with his eye swollen shut; I encouraged no alternates to emerge and sent Tony back to the specialist. Soon the doctor called, incredulous, and asked how I could have predicted yesterday that this man would have been stung by bees today. A colleague at the Yale School of Medicine pointed out, in discussing this case, that it takes twenty to thirty minutes to mediate an immune response and that perhaps the alternate who experienced no pain had a different immunological constitution.

  Similarly, it is usual for alternates to have different gastrointestinal responses to the same food. One patient whose original had ulcerative colitis and consumed large quantities of Librax to control abdominal pain and diarrhea could not eat spicy food, but had a complete remission of all symptoms within twenty to thirty minutes after the appearance of an alternate who had a perfectly healthy gut and could eat anything. Thus, it is clear that Multiple Personality Disorder is far from being an imaginary condition, and that individuals with this disorder share a number of common features.

  All individuals with Multiple Personality Disorder were abused as children; most often this occurred in environments where there was little or no opportunity for protection, retreat, or repair. Commonly sexual assault, by one or both parents or some primary caretaker, occurred repeatedly. While Joan avoids graphic detail in her descriptions of abuse at the hands of her parents, she, like other multiples, did not have a consistently loving adult to rescue her. Ultimately, she created her own protectors from within. Each of these secondary personalities fulfilled a precise psychological function for her such as expression of anger, discharge of sexual or aggressive impulses, keeper of painful memories. The alternates were of different age, sex, and even parentage from the original personality. Only together could all of these alternates provide one another with the necessary tools to live adult life safely.

  Thus, Multiple Personality Disorder represents an extreme version of the human propensity for self-preservation. It seems that the psychological equivalent of “fight or flight” in many abused children who are literally too small to do either is to dissociate into other states so that the original is “not there” and is temporarily insulated from fear and pain. This dramatic coping system requires unusual vigilance and extraordinary responsiveness to one’s environment. You have to go before it’s too late, you have to be cagey because sometimes you have to pretend to be there when you’re not. Most of this sequence happens without conscious awareness—you remember being scared and then you remember nothing. The coping system remains in place long after the trauma has ceased and causes profound difficulty for the patient as he or she enters adolescence and adulthood.

  Typically, the original personality is unaware of alternate personalities. The alternates, however, may be very much aware of the activities and attitudes of the original. Though they cannot decide when to appear, their presence is elicited often unpredictably in response to environmental triggers encountered in the daily course of events in the life of the original. For the original, this may mean constant confusion as moments, hours, days, or even years are lost to the emergence and “occupation” of alternate personalities. For the alternates, life can hold relentless frustration with the original, who may be perceived as helpless or incompetent. The tension between the original and alternates is reminiscent of an internal civil war. Battles may take the form, for example, of auditory hallucinations (personalities arguing) or the unexplained appearance of injuries (slash wounds, body burns, nail bed maceration, and a host of other self-inflicted mutilations) sustained when an alternate punishes the original.

  Each alternate may exhibit symptoms, such as depression or auditory hallucinations, that in isolation may suggest other disorders, such as major depression or schizophrenia, indicating the need for medication. However, drug treatment rarely improves these symptoms in multiples. An intense relationship built on trust with a therapist who guides the patient into new modes of expression through talking and through safe exposure to experiences is optimal. Revivification, or the actual reliving of traumatic experiences, is a necessary part of this therapeutic process.

  Lynn Wilson was completely immersed in Joan’s case. My training with Dr. Cornelia Wilbur, the psychiatrist who treated the well-known multiple Sybil, and my own experience have taught me that the kind of treatment provided by the Wilsons is ideal. Though therapeutic encounters lasting hours or days are unconventional by the standards of the psychiatric community, where patients are seen in an office for fifty-minute sessions between one and four times per week, I have found that anything less than six hours per week is difficult for both patient and therapist. There must be enough time to allow triggers to surface in the environment. There must be enough time to both elicit and interact with specific alternates. A brief session may be too stressful, provoking the unsafe emergence of alternates outside the session. Suicidal threats and acts of self-injury made by the patient outside sessions are a poignant index of how unsafe this work can be. Thus, I embrace Lynn Wilson’s work with Joan as one model for the treatment of multiples. Few therapists, however, can provide this level of treatment intensity, but when adequate resources are available, this kind of work can be highly rewarding.

  There is nothing new about twenty-four-hour-a-day therapy and containment for patients with severe disorders. Typically, however, such care is provided in the hospital by a number of staff—psychiatrists, nurses, and other therapists. Lynn Wilson’s near-constant availability to Joan essentially reproduced the holding environment of the inpatient setting while making it possible for Wilson to meet the emotional needs of vari
ous personalities and to judge when the timing was right for the calling forth of specific alternates.

  Some of Joan’s personalities were nonverbal, others passive, some hostile. One of Joan’s alternates repeatedly smashed her head against a wall to the point of causing bleeding and potential damage to her skull and brain. Lynn Wilson was there to witness the blood and agony, and play midwife to the delivery of the horror that accompanied the revivification of earlier traumas—traumas that Joan was forced to experience again and again if the healing was to take place.

  Many experts in Multiple Personality Disorder believe that longer sessions are more effective than conventional, briefer patient-therapist contact. Sybil’s treatment with Dr. Wilbur took eight years before integration was achieved. Joan’s integration occurred after four years; this is impressive in view of the fact that successful integration of multiples may take between eight and twelve years. Lynn Wilson was able to devote part of her life to and share her family with Joan; the work was effective and quite rapid. When the correct diagnosis is made and the therapist skillful, treatment can be successful in the majority of cases. These experiences can be deeply rewarding for patient and therapist, though it is a treatment that often exhausts both.

  On reading an advance manuscript of this book, one of my patients, who had not yet accepted the diagnosis of Multiple Personality Disorder, was astonished to observe the similarity of her experiences and Joan’s. My hope is that others struggling with the heroic challenge of the treatment of Multiple Personality Disorder will find Joan Casey and Lynn Wilson’s story a great inspiration to their work.