Mr. Hammer, an inmate at the United States Penitentiary, was charged with the first degree murder of cellmate Marti. Marti was strangled with a cord braided from a bed sheet while tied down at each limb. Hammer had used the ruse that Marti 'would be transferred to another prison if he were injured by Hammer in the cell.
The case went to trial. The defense presented testimony that Hammer suffered from dissociative identity disorder (DID). A psychiatrist identified four alter personalities: 1) Jocko, a violent personality, 2) Tammy, a female personality, 3) Wilbur, a child personality, and 4) Jasper, a chimpanzee.
A rebuttal witness said that Hammer did not suffer from dissociative identity disorder and could thus be held criminally responsible for the murder.
Hammer's attorney began cross-examination of the rebuttal witness. Before it was completed, however, Hammer notified the court that he wished to plead guilty to the charge of murder. The court had psychiatrists evaluate Hammer" to determine his competency to plead guilty. They concluded that Hammer was logical and coherent. He entered a guilty plea.
In the penalty phase, the jury recommended a sentence of death. Hammer had discharged his attorneys before the penalty phase began and the court found him competent to represent himself at this phase of the trial. He had for example, quoted Seneca and Nietszche in support of his desire to accept and speed the death penalty. The jury was not aware that Hammer still faced 1,210 years imprisonment from two previous convictions in state court.
Holding: Evaluation of Hammer was conclusive that he was competent to waive his right to counsel, proceed pro se and to decline to file an appeal of the death penalty sentence. This even though it would speed the time of his execution, sooner than it would have otherwise been. Knowing and intelligent waiver of counsel means the defendant knows what he is doing, not that the choice is a wise one.
Alter Personalities in the Forensic Setting
- Personalities can be products of imagination
- Personalities activated by exposure to trauma
- Previous similar dissociation history exists
- Severe trauma history a requirement
- Impact on appreciation of wrong varies
 | David Fink, Ph.D. Assistant Clinical Professor of Psychiatry Thomas Jefferson University |
Dr. Fink comments: Dissociation is a psychophysiologic response to overwhelming and inescapable trauma. In the face of traumatic events the individual draws on an innate dissociative capacity (a capacity to autohypnotize, or enter a trance state) and uses this capacity to buffer himself initially from the event itself, and subsequently from flashbacks. Dissociation is often associated with either partial or total amnesia for the event. If the trauma is limited rather than recurrent, or if the individual is able to develop more mature coping skills, then the use of dissociation is short lived. If, however, the trauma is repetitive, then dissociation becomes a first line of defense and DID can develop.
The consequence of the reliance on dissociation as a primary coping strategy is-the development of a divided mind. One part of the mind experiences and holds the traumatic memories, but is split off and often unknown to other parts of the mind. This division insulates one from consciously recalling the, traumata. However, division also makes processing impossible and leaves the individual vulnerable to recurrent flashbacks, dissociation and reliving. In the most extreme instances, different parts of the mind, alters, are activated by reminders of trauma totally unbeknownst to the other parts. In this instance a full range of behaviors can be carried out without the right hand knowing what-the left hand is doing.
One of-the most confusing aspects of DID, and one that often leads to incredulity or dismissal, is the issue of the believability of the various alters. In Hammer, one of the defendant's alters is an animal, reportedly a chimpanzee named Jasper. One could seize upon this detail, and dismiss the diagnosis as fanciful. That, however, overlooks the reason DID develops in the first place.
The psychological function of an alternate personality is to deal with or escape an unbearably traumatic reality. All alters are products of the imagination. They are not meant to be realistic but rather to serve a psychological defensive function and are often characterized by attributes that are unrealistic or larger than life. While certain alter types such as children, protectors, helpers, comforters and aggressors are common, they are by no means the only alter types and more imaginary or idiosyncratic alters are routinely part of the clinical picture.
In order to make the diagnosis of DID an extensive longitudinal history is essential. This should include: a review of the nature and extent of dissociative events, including trance states, fugues, and observed alter state changes antedating any criminal charges; external corroboration of dissociative experiences, including review of any physical evidence such as personal writing; or journals chronicling state changes and questions about memory disturbance or amnesia.
The motivation to malinger a dissociative illness in order to avoid responsibility for a crime is a critical concern. In distinguishing true DID from malingering a number of caveats are helpful. First, DID is a condition born of abuse. It is the goal of these patients to keep their trauma secret and hidden. The condition is rooted in shame. As a result, patients tend to be introverted, shame-ridden and reluctant to talk about the details of their trauma. In addition, their switching of alters tends to be related to certain specific stressors or cues and is as a result predictable. Alters are formed to perform certain critical functions and their emergence is always related to some dynamic purpose which can be traced to an aspect of the original traumas.
In contrast, the malingerer is motivated to impress the examiner with the severity of his symptoms and tends to exaggerate and amplify the clinical picture. As a result there is a tendency to over reveal and impose the details of trauma. There is also an exaggeration of alter qualities in a flamboyant way. "Alters" for the malingerer are caricature and lack depth. The consistency of characteristics over time is also far less stable; the malingerer will often get tangled up in inconsistencies of his own fabricated story. In addition, switching often seems unrelated to any original trauma or longstanding psychological process and more related to the alleged present day offense.
A thorough exam with attention to the well established criteria and features of bona fide DID can reliably differentiate genuine from malingered illness. The subsequent viability of DID as an insanity defense will then turn on questions concerning the extent of the autonomous function of the various alters, and the extent of the amnestic barriers between alters. This analysis enables the examiner to address whether the alters so distorted the individual's perceptions of reality that it became impossible for him to understand the meaning or wrongfulness of his acts.
Dissociative Identity Disorder/
Multiple Personality Disorder Flaws
- No world psychiatry consensus
- Classic historical cases suggest misdiagnosis
- Impossibility of extended clinical evaluations of each personality type
- Contamination by therapist enthusiasm and researcher cultivation
- Clinical impossibilities-e.g. based on memories of trauma during first year of life.
 | Harold Merskey Editor-In-Chief Pain Research & Management Magazine |
Dr. Merskey comments: If the court had found Dissociative Identity Disorder (DID) or Multiple Personality Disorder (MPD) to be present, would the insanity defense still be valid?
Verdicts of not guilty by reason of insanity are known in the United States on the basis of the presence of MPD. However, opinion as to the validity of this diagnosis is changing within the U.S.A. This-change is clearly identifiable in a recent article in the American Journal of Psychiatry by H.G. Pope Jr. and colleagues. In a questionnaire survey of 367 psychiatrists 82% responded, of whom 15% felt that if the DSM-IV were to be revised today DID should not be included at all, 43% felt that it should be included only with reservations, and 35% felt it should be included without reservations. Thus, the authors 'conclude that DSM-IV fails to reflect a consensus of Board-Certified American Psychiatrists regarding the diagnostic status and scientific validity of DID.
The growth in diagnosis of MPD from one case every two years in the world literature to hundreds and thousands of cases annually in the United States and Canada appears to be closely related to publicity and to the activities of a number of psychiatrists and psychologists who diagnose large numbers of cases with large numbers of personalities. The rest of the world, apart from occasional pockets influenced by these two countries, shows indifference or ridicule for the diagnosis. Most cases of MPD have appeared in the 20th century under circumstances that are strongly suggestive of production by suggestion by clinicians or therapists, or the influence of the media. A study of the classic historical cases, where suggestion might be expected not to be present, indicates that the principal cases were either misdiagnosis of patients with rapid cycling bipolar disorder who were regarded as having "dual consciousness" or individuals who were hypnotized and then given names and personalities deliberately.
Further, there is astonishing inconsistency between criteria put forward by different recognized specialists with regard to the features to expect. The World Health Organization International Classification of Diseases 1992 revision even expressed doubt as to whether the condition exists at all.
The diagnosis hardly carries face validity. DSM-IV allows that patients may have up to 100 or more than 100 "personalities or fragments of personality." One enthusiast has achieved two patients with more than 4,000 personalities or personality fragments. One does not know how, the clinical interviews for these cases can be conducted and kept in order. Face validity goes out of the window with the suggestion that individuals have different personalities which are of the opposite sex, other racial types, or non-human. Not only chimpanzees but also rabbits, lions and the devil have been invoked.
It seems that there is no rule which will prevent the expansion of cases to clinical impossibilities. Enthusiastic therapists have dredged up MPD along with satanic ritual abuse and memories from childhood dated to ages from which memory is impossible (i.e. before the age of three) thus bringing the condition into further doubt. Therapists have used the same process to produce memories of past lives or alien abduction so that with all these fanciful results the diagnosis falls into a reductio ad absurdum.
What are courts to do? The individuals to whom the diagnosis is applied (or who would opt for it themselves) fulfill certain social expectations and a socially constructed role. Meanwhile, the diagnosis has not only been used in defense but also in the prosecution of others to support claims that individuals were so traumatized by past events that they "dissociated" and forgot them until they miraculously recovered them.
 | Richard Rogers, Ph.D. Professor of Psychology University of North Texas |
Dr. Rogers comments: Four major issues must be considered in evaluating the authenticity of DID: (a) reliance on hypnosis, (b) iatrogenic presentations, (c) malingering, and (d) other deception. Each of these issues is briefly outlined.
Hypnosis.
Because non-host personalities rarely occur during the assessment, examiners often use hypnosis to uncover alter personalities. Hypnosis for forensic purposes is controversial. Because many defendants are hypersuggestible, there is the very real possibility of contaminating or even creating memories. In addition, hypnosis is vulnerable to faking. Defendants may successfully simulate a hypnotic trance or engage in deception while hypnotized.
Iatrogenic Presentation.
Through intensive treatment efforts, clinicians sometimes create iatrogenic (medically induced) DID. According to Beahrs (Bulletin of the Amer. Acad. of Psych and Law, 22, 223-237, 1994), clinicians can unwittingly solidify dissociated personality fragments that can lead to "an escalating spiral of symptomatic distress, destructive behavior, and regressive unraveling of the personality" (p. 225). When patients with severe borderline personality disorders and traumatic histories are subjected to multiple hours of hypnosis several times per week, the likelihood of iatrogenic DID increases substantially.
Malingering.
The convenience of the DID "It-wasn't-me" defense greatly concerns both the courts and experts; the defendant does not need to create a longstanding disorder (e.g., schizophrenia) but simply asserts that the symptoms are typically not present. Rather, responsibility is attributed to a submerged personality that is often not observable. The unobserved personality overrides the defendant's intentions and nullifies his will. With mental health professionals embarrassed by their duping in the Bianchi case (Los Angeles Hillside Strangler), forensic experts are especially sensitive to feigned DID.
Other Deception.
Lewis and Bard (Psychiatric Clinics of North America, 14, 741-756, 1991) underscore an overlooked issue regarding deception among identities. Some personalities may deceive each other and the examiner. One purpose may be to attack the host personality and his credibility. It is even possible for one personality to masquerade as a second personality. Credibility problems magnify when statements by different personalities cannot be verified.
Four take-home observations:
1. Systematic comparisons of persons with genuine versus faked DID are virtually nonexistent. Therefore, the assessment of malingering should emphasize the genuineness of symptoms rather than the DID diagnosis itself.
2. The genuineness of dissociative amnesia can be assessed through a variety of specialized methods. One promising approach is the use of Symptom Validity Testing adapted to episodic memories (see Frederick, Carter, & Powel, Bulletin of the Amer. Acad. Psych and Law, 23,231-237,1995). This method allows forensic experts to make likelihood estimates regarding the veracity of claimed memory loss.
3. The genuineness of symptoms can often be assessed via standardized measures. One of the best-validated measures for this purpose is the Structured Interview of Reported Symptoms (SIRS; Rogers, Bagby & Dickens, Odessa, FL: Psychological Assessment Resources, Inc., 1992). Unpublished data suggests that college students, attempting to feign DID, may endorse an unlikely number of symptoms of the SIRS; however, these data are limited in their clinical applicability.
4. Inpatient evaluations offer the most systematic observations for verifying DID. The availability of professional staff provides a unique opportunity to evaluate dissociative symptoms and especially the spontaneous emergence of non-host personalities.
