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

by Robert I. Simon

  Reaping the Whirlwind of Child Abuse

  Children of abuse become future abusers. This does not occur in every instance, of course, because there are many who are determined never to repeat the abuse of their own childhoods. Surprisingly, studies show that 70% to 90% of abused children do not abuse their children as parents. But the fact is that the vast majority of abusers were themselves abused as children. What is it that perpetuates the cycle of abuse? Abused children model their behavior after that of the abusing parent by means of a psychological mechanism called identification with the aggressor. By becoming like the abusing parent, the child seeks to transform his or her helpless and terrifying dependency on an unloving parent or caretaker into power over others who take on the dreaded position of victim. This process of identification is facilitated by the child’s perception that he or she is blameworthy and that the parent is always right. Many abused children internalize the identification with the abusing parent and direct it at themselves. This often results in physical complaints (somatization), depression, self-mutilation, or destructive lifestyles. One of my patients who had been severely abused as a 9-year-old child did not develop M PD, but later blamed himself for everything that went wrong with his life—an orgy of negative omnipotence. Instead of feeling anger at others when it was clearly appropriate to do so, he turned the anger on himself, flagellating himself, as it were, with merciless blame. Although he was aware of his persecutory side, he was unaware of carrying around within himself the abusive parent. Long-term psychotherapy enabled him to gain control of his self-inflicted abuse.

  The wind is sown with abuse of children, and the whirlwind is reaped when those former children abuse the next generation. The cycle of sowing and reaping the child abuse whirlwind seems endless and full of despair. For the abused child, the consequences can be enormous, depending on the type, severity, and frequency of abuse. These consequences affect every important aspect of a person’s life—physical health, psychological health, and basic life choices of career, marriage, and lifestyle. Childhood abuse and neglect increase the likelihood of that person’s arrest as a juvenile by 53%, as an adult by 38%, and for a violent crime by 38%. As adults, females tend to remain victims of abuse, whereas males tend to become abusers. The ability to make proper, adaptive life decisions and to sustain careers, good personal relationships, and stability in the community can all be severely damaged by child abuse.

  The human condition gives rise to fundamental fears in us, such as helplessness, loss, physical-mental deterioration, and extinction. Although individuals may vary widely in their perceptions of and reactions to these existential fears, and although the hurly-burly of our lives may distract our attention from them for a while, these fears are inevitable. In children who have been psychologically, sexually, or physically traumatized at a time in their lives when they are most vulnerable, these primal fears become greatly heightened. For many abused people, whether in childhood or after they become adults, their life contains little pleasure and even less joy. In attempts to master their terror, some of these traumatized children grow into adults who, in turn, victimize other children. Often, they sexualize the abuse in efforts to deny or to rationalize the painful origins of their behavior. W.H. Auden wrote in his poem “September 1, 1939,”

  I and the public know

  What all schoolchildren learn, Those to whom evil is done Do evil in return.

  One of the highly psychologically damaging varieties of childhood abuse comes as a consequence of parents or caregivers who alternate between loving and abusing the child. Not all child abusers reject their children. Some child abusers love their children but, because of intense ambivalence, simultaneously hate them. Parents with poor parenting skills who were abused themselves or who become intoxicated with alcohol or drugs may harm children that they otherwise love. Children become totally bewildered by these utterly conflicting behaviors, further fostering the tendency to split off or dissociate the memories of their abuse.

  Child abusers deal with the child as though he or she has no individual identity, and exploit the child exclusively for their own gratification. This kind of abuse is referred to as soul murder. Soul murder deprives the child of a personal identity and of the ability to experience joy in life. It is characterized by sometimes brutal, sometimes subtle acts of abuse against children that makes them act like whipped dogs—bonding them emotionally to their abuser because they can turn to no one else. The end product of the abuse is a tragic psychic and spiritual annihilation of the child’s core self.

  Soul murder is the defining kind of child abuse that we find in the background of most people who have M PD. As suggested earlier, 97% of people with M PD were abused during childhood. Of the remaining 3% of MPD patients, some appear to have the innate ability to dissociate, and others present with M PD symptoms after encountering lifethreatening experiences such as a near drowning.

  In the vast majority of cases, then, M PD develops as a way for people to cope with severe child abuse. When the child cannot assimilate the contradictory images of a loving parent or caretaker and the fact of being sexually or physically abused, the child feels helpless and unable to escape. A bewildering mind warp occurs. A young child tends to view self and others in all-or-nothing, good-and-bad terms. The idea that fair and foul can be mixed together is totally foreign to the mind of a child of 7 or 8. The abused child, overwhelmed with the terror, horror, and pain of the abuse, as well as with the inability to comprehend it, often copes psychologically by leaving the scene of the assault. Children do this by various means. Some M PD patients, for instance, describe autohypnotically focusing on an object or on a stream of light to mentally transport themselves to a favorite peaceful place such as the seashore or a pleasant wooded spot. When they are so transported, another part of the personality is left behind to personally experience the physical and emotional pain of abuse—and, not incidentally, to be the receptacle of the bad memory. Other patients dissociate from the abuse experience by mentally floating to the ceiling or to a corner of the room and watching the abuse from there, as if it were happening to someone else. By such mental mechanisms, the immense physical and psychological pain of abuse is temporarily escaped.

  Memories of abuse couple with the intense feeling states of extreme fear, terror, and helplessness. These feelings are split off from consciousness by the psychological mechanism of dissociation. Dissociation can be thought of as a “horizontal” separation, in which the memory and the intense emotional trauma are split from one another. Thus disconnected and defused, like dynamite sticks from their fuses, the traumatic memories and feelings can be stored safely out of awareness, unless an external or internal trigger reconnects and ignites them. Severe psychological trauma may predispose persons to dissociate. By contrast, repression is a “vertical” separation mechanism that banishes unacceptable ideas, fantasies, feelings, impulses, or memories from consciousness, or that keeps in the unconscious dangerous thoughts and feelings that have never been consciously recognized or felt. Psychological conflict is often a precursor of repression. Repressed material is not subject to voluntary recall, although repressed memories may sometimes emerge in disguised form. Suppression, the conscious, temporary setting aside of a painful memory, may be a way-station to permanent, unconscious removal of the memory through repression. All of these psychological defense mechanisms, as they are called by therapists, work together to keep painful memories, feelings, and conflicts out of a person’s awareness. These active mental defenses must be distinguished from ordinary forgetting. Our minds simply do not retain the day-to-day massive influx of data and information flooding into our brains every second. The vast volume of this influx is dumped. It is simply a myth that our brains record everything that has ever happened to us.

  As with a piece of flotsam that is carried down a river, snags on the river bank, and gradually sinks into the mud, childhood memories and associated feelings of abuse become separated—dissociate—and are carried downs
tream and become buried in the back channels of the mind. It is not until some abuse survivors are in their 30s and 40s, and in therapy for depression, anxiety, or other personality disorders, that they are able to unearth or recall their abuse. For some, like Saul on the road to Damascus, revelation will come in a single blinding moment. In abuse sufferers, a stunning flashback is often triggered by a seemingly innocuous event, as in the following case:

  One lazy summer afternoon, a patient was lying on her living room couch and looking quietly at a picture on the wall. In one corner of the picture, she noticed some shrubbery at the edge of a lake. In a horrifying instant, she recalled having been sexually abused by her father on the farm where they lived. It had happened when she had accompanied her father on a walk through the farm’s wooded area. Stunned, she recalled that her father had attempted sexual intercourse with her behind some bushes near the farm’s lake. Paralyzed by the flood of terror that accompanied her newly found memory of the abuse, she lay motionless on the couch for hours.

  More than the memories themselves, patients are very frightened and are loathe to reexperience the death-gripping terror and paralytic feelings that accompany memories of sexual abuse. If the right combination of thoughts, feelings, or situations is struck, terrifying memories of abuse long forgotten can be unlocked.

  Sarah, whose story introduced this chapter, was a victim of extensive child abuse, a fact brought out at the time of the trial of Mark Peterson. Born and orphaned in Seoul, Korea, she was adopted at the age of 8 months by American parents, who raised her in Iowa City, Iowa. At the trial, Sarah testified that she had difficulty remembering her childhood, but that she did recall physical abuse from her father and mental abuse from her mother. Since age 4, she had heard “babbling” voices in her head, and as an adolescent she experienced severe mood swings and amnesia. Often, she felt compelled to place a blanket over her head and to hide in dark places. Her already compromised mental condition worsened at age 21, when she found her adoptive father crushed under a van.

  The medications she received for severe anxiety and depression did not seem to help. With her mother, she moved to Oshkosh, Wisconsin, but was unable to keep her jobs as a dishwasher and a bakery sales clerk. Because of her illness, it was determined that she was unable to work, and she began to receive income from Social Security. She moved into her own apartment with her poodle, P.J., and her cat, Monster, though she maintained a friendly relationship with her mother. Sarah’s illness was finally identified as M PD. Her rape occurred shortly thereafter.

  At her trial, a psychiatric expert on MPD testified to the authenticity of Sarah’s mental illness. In many ways, her disorder was typical, the expert noted, with the six main personalities exhibiting a full range of consistent behavior and memories, from the self-destructiveness of Ginger, Shadow, Patty, and Justin, to the protectiveness of Franny.

  If her disorder was typical, however, her involvement with the law was atypical. Most often, when MPD cases reach the courts, it is because the destructive personalities of an individual with MPD have caused harm to others by committing assault, rape, or murder. The actual incidence of criminal acts perpetrated by persons with M PD appears to be quite small. Most of the time, the victims harm themselves in various ways.

  Multiple Personality Disorder: A Controversial Diagnosis

  Although the history of M PD runs parallel to the history of modern psychiatry, the diagnosis of MPD was first officially recognized by the American Psychiatric Association in 1980, as one of a group of stressinduced disorders that also now includes posttraumatic stress disorder, dissociative disorders, and somatization disorders. In the latest version of the official American Psychiatric Association diagnostic manual, the MPD diagnosis has been renamed dissociative identity disorder. Except when making a formal diagnosis, most clinicians use M PD as the preferred diagnostic term.

  The clinical syndrome of dissociation into multiple personalities has been known about since the nineteenth century, and was noted in the work of Jean-Martin Charcot and Pierre Janet in Europe. In the United States, since the time of Benjamin Rush, the father of American psychiatry, eminent clinicians have had to deal with the complex issues now associated with the diagnosis of M PD. One source estimates that 1% of the U.S. population has some form of M PD. In psychiatric hospitals, the percentage of inpatients with M PD is thought to be about 20%, although MPD is often misdiagnosed as anxiety, depression, or schizophrenia. There are, however, well-qualified, experienced psychiatrists who doubt its existence. In Sarah’s case, Dr. Harold Treffert, director of the Fond du Lac County Health Care Center in Wisconsin, testifying as an expert for the prosecution, said that “Multiple personality disorder is a very, very rare condition. Because of TV talk shows, it has become the disease of the month and plea of the year. It’s a condition that’s fairly easily induced in a very suggestible patient.”

  Such doubts are also expressed by juries and judges in court cases in which the victim or, more often, the accused claims to have MPD. Disbelievers in the MPD diagnosis maintain that the disorder is a fiction that has been created by zealous, trauma-seeking therapists who play upon the naïveté of suggestible, hysterical patients. On the other hand, proponents of the MPD diagnosis point out that it is a psychiatric entity noted by doctors for hundreds of years, which cannot be suggested to individuals because it is too complex and multifaceted to be induced by mere suggestion. They assert that mental health professionals who doubt the existence of M PD are resistant to recognizing the presence of severe childhood abuse in the backgrounds of M PD patients and the specific kinds of psychological damage that abuse can cause in adulthood.

  The key to the controversy may lie in the fact, noted previously in this chapter, that severe childhood abuse or trauma is invariably found in the backgrounds of M PD patients. To some people in psychiatry, the epidemic of child abuse is also a fiction. Dr. Paul R. McHugh, emeritus chairman of the Department of Psychiatry at Johns Hopkins University, is a persistent critic of the plethora of child abuse allegations and the overuse of the M PD diagnosis. His critiques are worth exploring. Dr. McHugh claims that the flood of MPD cases reflects a prevailing social trend based on political hot buttons of the 1980s and 1990s, “particularly those connected with sexual oppression and victimization. Just as an epidemic of bewitchment served to prove the arrival of Satan in Salem, so in our day an epidemic of MPD is used to confirm that a vast number of adults were sexually abused…during their childhood.”

  Dr. McHugh has used polygraphs and extensive interviews with self-reported victims of child abuse and other informants to disprove allegations of child abuse. Both the symptoms that surfaced in the women of Salem 300 years ago and those today associated with M PD patients, Dr. McHugh argues, are really manifestations of hysteria, but not of a distinct psychiatric disorder. He believes that the symptoms of MPD can be explained by reference to hypnosis because “they are generated in a therapeutic, suggestive way, and they are eliminated in a way that shows their hysterical nature.” Dr. McHugh is concerned because so often when a diagnosis of MPD is made, child abuse is then asserted, and soon afterward family members “are being accused of the worst kinds of sexual perversions with little children.” To buttress his allegation, he points out that statistics show true abusers to be more commonly stepfathers than biological fathers, which is just the opposite of the patterns of abuse reported by MPD patients.

  A second critic of the M PD diagnosis was Dr. Martin Orne. Until his death in 2000, he was a professor of psychiatry at the Institute of the Pennsylvania Hospital and an internationally recognized expert on hypnosis. Dr. Orne believed that the eliciting of childhood memories of sexual abuse in the treatment of MPD patients ruined the lives of people accused of having molested these patients. This ruination took place without any separate validation or evidence to support the allegation of abuse.

  On the other hand, proponents of the MPD diagnosis point out that the diagnosis is based on established criteria developed o
ver time by the American Psychiatric Association. Its existence has been discussed by many prominent and highly credible psychiatrists, among them Drs. Richard J. Lowenstein and Richard P. Kluft.

  Dr. Lowenstein is medical director of trauma disorders services at Sheppard and Enoch Pratt Hospital in Towson, Maryland. He charges that the original nineteenth-century concept of hysteria was sexist and reflective of a male view of female personalities, and that to call all symptoms hysteria is to fall into an old trap. Furthermore, Lowenstein writes, “there isn’t any evidence that the full syndrome of M PD can be created by suggestion.” If there is some question about the ways in which childhood abuse is remembered and dissociated, he points out that this, not the existence of MPD, is still the area of ongoing research. He believes that those who oppose the M PD diagnosis and seek to discredit it are doing so to minimize the extent and damage done by child abuse in our society.

  Dr. Kluft, clinical professor of psychiatry at Temple University School of Medicine, argues that “a therapist who dismisses the [alternate] personalities as unworthy of attention is avoiding serious scrutiny of much of the patient’s mental life. It is a mistake to be preoccupied with alters as entities in themselves…but it is an equally serious error to suppose that engaging the alters reinforces the patient’s psychopathology.”

  My own sense of the truth is that MPD is underdiagnosed, not overdiagnosed. As a psychiatrist, I have treated a number of patients with MPD and have spoken with many colleagues who have themselves seen many MPD cases. But I have also spoken with many colleagues who have never seen a case of M PD and who remain skeptical of its existence. In fact, MPD is hard, not easy, to diagnose accurately, and its existence may only be recognized in a patient years after that patient’s treatment has begun. Several reasons can lead to the delay. According to Dr. Kluft, only about 20% of M PD patients spend the main part of their lives in an open MPD state. Another 40% may present signs that suggest M PD to the alert clinician but that may be missed by many therapists. The remaining 40% of patients diagnosed with M PD are so designated only after exploration done in the absence of signs that would strongly suggest it.