Spanos’s book
is an exploration of the recent perplexities that the phenomenon of multiple
personalities has generated in the psychological literature (see Hacking 1995,
Rewriting the Soul). Similarly to Hacking, Spanos claims that multiple
personality disorder (MPD) is a socially constructed condition. This book is
nevertheless thoroughly original, thanks to the rigorous method with which MPD
is disclosed as an illusion, or better as a collective delusion that involves
the therapist/hypnotist, the patient and the social context in which they
operate. The strategy used by Spanos relies on an innovative account of
hypnosis, a scrupulous analysis of the reconstructive nature of memory and an
interesting comparison between dissociative phenomena occurring in different
cultures.

The book is
very clearly written and engaging in all its parts, with no exception. It is
instructive reading not just for those who are fascinated by the case of
multiple personality, but for anybody interested in the history of mental
illness, in the legitimacy of the procedures of psychotherapy and in the
phenomenon of hypnosis. It should appeal to psychologists and philosophers
alike, as it sheds light on the complex causal interactions between individuals
embedded in a hierarchical social exchange and on the role that shared
expectations play in our attempts to preserve our self concept.

The
phenomenon Spanos focuses on is the explosion of MPD cases in North America
since the 1970s. Many patients, mainly women exhibiting depression and
antisocial behaviour, start engaging in psychotherapy to improve their
condition. Most women are not aware of the cause for their general feelings of
dissatisfaction and inadequacy. Typically the psychotherapist asks them
questions about possible traumas in their past and, even when prompted, they
cannot recollect anything of importance. At this stage, the therapist uses
hypnosis to bring about an age regression and asks them more specific questions
about possible traumas, in particular sexual abuse in childhood. Gradually, the
patient starts ‘remembering’ episodes of abuse, vaguely at first and then in
full details. Under the pressure of the therapist, and influenced by other
reports of MPD, the patient also engages in the enactment of different
personalities. This behaviour is rewarded by the therapists, whose expectations
are fulfilled, and provides an explanation for the dissatisfaction and
inadequacy felt previously by the patient. As a result of this procedure, the
patient starts feeling better, even though the ‘discovery’ of abuse causes
dramatic changes in her life (e.g. the patient starts blaming her own family
for what she thinks happened in her childhood).

This process
raises some challenging questions. Does the patient’s body really host
‘alters’? Is the remembered abuse a trauma that really happened in the
patient’s past? Is psychotherapy successful in virtue of its revealing
repressed memories via hypnosis? Spanos is very sceptical about the causal
relation between early abuse and MPD and about the role that hypnosis plays in
the recollection of ‘lost memories’. His criticism is very powerful, because it
is supported by a very convincing series of experiments that tend to show how
hypnosis is not an altered state of consciousness and does not cause in the
patient any loss of control on movements or perceptions. There is no clear
evidence that hypnosis is useful in the discovery of repressed traumas.
Spanos’s claim is that the patient does what the hypnotist says, and that
hypnotic behaviours are nothing but goal-directed enactments, directed to the
satisfaction of the requests of the hypnotist as authority figure. Given this
deflationary account of hypnosis, it is not difficult to view so-called lost
memories as memory distortions: "clients may reconstruct their memories to
make them consistent with what they perceive to be the wishes of the therapist
or what they believe will win the therapist’s approval or sympathy" (page
67).

The other two
main moves in Spanos’s argument consist in (1) drawing a parallel between MPD
cases and cases of alien abduction or past-life regression, where the role of
the therapist/hypnotist is similarly dubious, and (2) comparing recent MPD
cases with other dissociative phenomena in other cultures, as for instance
spirit possession in Christian societies before the 19th century. Both therapy
and exorcism are for Spanos institutionalised procedures by which the patient
is taught how to think of herself.. This does not mean that the patients
‘fake’ the shifts of personalities or the possession, but that they "come
to adopt a view of themselves that is congruent with the view conveyed to them
by their therapist" or the exorcist (page 246).

Although Spanos
convincingly exposes the limitations of psychotherapy, as the science of
‘creating’ the conditions it claims to cure, there are many questions still
awaiting an answer. Not all the phenomena related to the manifestation of MPD
are shown to be theatrical enactments, and the cause of the dissatisfaction and
inadequacy that patients suffer from still needs to be disclosed. This book is
not aimed at offering an alternative explanation for the phenomena commonly
referred to as MPD, but just to remind us that in science it is evidence that
has the last word. If there is no independent evidence that hypnosis can reveal
a forgotten past, then psychotherapists need to be very cautious in drawing
serious conclusions from its application.

© 2002 Lisa Bortolotti

Lisa
Bortolotti studied philosophy in Bologna (Italy), London and Oxford (UK)
before starting her PhD at the Australian National University in Canberra. Her
main interests are in philosophy of mind, philosophy of psychology,
rationality, mental illness and animal cognition.

Categories: Philosophical