The Three Faces of Eve/Evan

The Similarities Between Trans Issues & The History of Multiple Personality Disorder

Photo Credit: Rach Teo vis Unsplash

Though trans issues would seem like a niche issue for most Americans (and most populations in general), the topic has somehow risen to become one of the most contentious issues in U.S. political life. From banning drag shows for those under 18 to the Dylan Mulvaney controversy to potential boycotts of J.K. Rowling to the recent mass shooting in Nashville, trans issues have dominated headlines for the past two years.

During this time, conservatives have argued that the sudden surge in trans-identifying people – youth especially – has all the hallmarks of a social contagion. Progressives, in contrast, have countered that a bigger spotlight and rise of social acceptance of trans people have allowed those who would have previously hidden their true identities to embrace them.

Whatever the cause, the rise of trans identities, especially in young girls, has been astronomical. According to data from the U.K.’s NHS, the number of referrals to the NHS Gender Identity Service (GIDS) has risen over 3263% from 2009 to 2019. The increase in referrals from adolescent girls over that period, in particular, is 5337%.¹

However the sudden explosion in popularity of a mental health disorder is actually not a new phenomenon. As noted by Michael Shermer, a presidential fellow at Chapman University, on Twitter earlier this month, the 1970s and 1980s saw a similar brouhaha about another psychological diagnosis: Multiple Personality Disorder. 

The Rise of Multiple Personality Disorder

Multiple Personality Disorder is a psychiatric condition characterized by the presence of two or more distinct personality states or identities within one individual. Each personality state reportedly has its own way of perceiving, thinking, and relating to the environment, and the transitions between these states are often accompanied by memory gaps or blackout periods. 

The first case of Multiple Personality Disorder was documented in 1791, when a German botanist named Eberhardt Gmelin recorded a German woman with a French noble alter-ego. The disorder was further popularized by Robert Louis Stevenson’s The Strange Case of Dr. Jekyll and Mr. Hyde, published in 1886. However, it should be noted that, in the story, Dr. Jekyll took a serum which caused the creation of Mr. Hyde; it was not a pure psychological construction.

During this time and for decades after, the total number of Multiple Personality Disorder diagnoses remained small; in fact, medical literature suggests that there were just around 76 cases from 1880 to 1944. The analysis, which looked at the collection of studies published on Multiple Personality Disorder, noted that in those 76 cases, a vast majority of patients, around two-thirds, had two personalities, which were “not cognizant” of each other. Of the remaining patients, “most” had three personalities (via The Comprehensive Handbook of Psychopathology).²

However, both the number of cases and the characteristics of the disorder were soon to change. Perhaps not-so-coincidentally, the 1950s heralded in a new interest in mental health, and books like The Bird’s Nest and The Three Faces of Eve – which was later turned into an Academy Award winning film – put the disorder on the map for many Americans. 

But it was in the 1970s that a true shift occurred, with the 1973 publication of Sybil: The Classic True Story of a Woman Possessed by Sixteen Different Personalities. The book was a wild success, selling around five million copies. It was soon turned into a television special starring Sally Field; around 40 million Americans watched the two episodes, per Shermer. 

Following the release of Sybil, the number of reported Multiple Personality Disorder cases shot up dramatically. In fact, in The Comprehensive Handbook of Psychopathology, John F. Kihlstrom noted that there were more cases of Multiple Personality Disorder in the 1970s than all the cases from 1811 onward combined. There were 6,000 cases by 1986, and “treatment centers” just for Multiple Personality Personality started popping up around the country – a sign of both its popularity, and – perhaps cynically – its financial potential. Kihlstrom noted that just one center in Texas had as many as 500 patients.³

Most interestingly, the characteristics of the disease changed. Though the history of the disorder rested on 76 cases – hardly a large number – the number of personalities took a dramatic change:

“The majority of new cases listed by Greaves (1980) and Boor (1982) had three or more personalities, and the cases registered by Putnam et al. (1986) presented 13.3. Ross (1997) reported an average of 15.7 alter egos in a series of 236 patients,” Kihlstrom wrote. 

Moreover, it wasn’t just the entertainment media that spurred attention on Multiple Personality Disorder. One scientific paper by Joel Paris showed that medical literature also seemed to be consumed by the psychological disorder:⁴

“The number of articles on MEDLINE concerning multiple personality or DID increased during several decades: 39, between 1970 and 1979; two hundred twelve, between 1980 and 1989; three hundred ninety one, between 1990 and 1999; but leveling off to 179, between 2000 and 2009.”

Muddying the issue is that many psychologists also began propagating the theory that Multiple Personality Disorder was a result of severe childhood trauma, and therapy sessions focused on finding “repressed” memories of abuse, incest, or other hideous crimes. It should be noted that several studies have suggested a link between childhood trauma and Multiple Personality Disorder; however, the primitive therapy of the 1970s and 1980s resulted in a spate of false accusations and made up memories. 

“Questionable therapy practices associated with a diagnosis of [Multiple Personality Disorder] destroyed lives,” Paris succinctly summarized. 

By the 1990s, the number of those affected by Multiple Personality Disorder – renamed Dissociative Identity Disorder, or DID – had reached a whopping 40,000 cases. But then, the numbers suddenly dropped. 

One potential reason is the sudden onslaught of lawsuits that targeted therapists for their questionable practices when treating DID.

“A California therapist was successfully sued by a father unjustly accused of sexually abusing his daughter (Johnston, 1997). A psychiatrist at the University of Chicago who ran a unit for the treatment of dissociative disorders was sued and lost his license (Grinfeld, 1999). A mother whose ex-husband had been accused by their daughter (who is a clinical psychologist) founded the False Memory Foundation to combat misuses of therapy to support claims of abuse based on recovering traumatic memory (McHugh, 2008),” wrote Paris.

The lawsuits served a purpose other than to attack therapists; they also highlighted the shoddy and untested ways in which patients in distress were being treated. In fact, studies showed that the treatment for DID had never been shown to be successful. 

When it emerged, in 2011, that the story of Sybil was a complete fabrication, and the woman with the supposed sixteen personalities had been pressured by her therapist to create the alter-egos, it was the nail in the coffin for the “fad” of DID.

The Similarities

Though the history of DID/Multiple Personality Disorder does not prove that today’s gender dysphoria crisis is a social contagion, it should give proponents pause. Like DID, gender dysmorphia exploded following popularization of the disorder, though this time it was on online forums and social media apps versus books and television specials. 

Like DID, clinics have become hotbeds for gender transition, like the Tavistock Center in the U.K. and the Boston Children’s Hospital in the United States.

Lastly, there is the potential similarity that both DID and gender dysphoria diagnosis stemmed from misidentifying other trauma or mental health issues. As noted, studies have pointed out the correlation between DID and childhood trauma (though this does remain contested). Though unethical therapists in the past may have used this correlation to create bombastic and untrue backstories, it is not out of the question that less headline grabbing abuse did occur. As summed up in the abstract of a 1996 scientific paper by D.H. Gleaves:⁵

“​​No reason exists to doubt the connection between DID and childhood trauma. Treatment recommendations that follow from the sociocognitive model may be harmful because they involve ignoring the posttraumatic symptomatology of persons with DID.”

For gender dysphoria, a staggeringly large number of girls referred for gender treatment have a co-diagnosis of autism. In fact, the Tavistock Center’s own statistics revealed that 48% of patients at the The Tavistock & Portman Gender Identity Service (76% of whom are adolescent girls) either have a diagnosis of or show traits of autism.⁶ To add some perspective, the rate for ASD in girls in the general population is less than 0.7%, per Johns Hopkins.⁷ Rates of anxiety and depression are also substantially higher in trans-interested youth versus the general population.⁸ Because of this, critics claim that gender affirming care is being applied when the truly needed care is psychological counseling and help with autism. 

In other words, it is possible that gender dysphoria is being diagnosed instead of the actual problem: anxiety, depression, or autism.  This does not necessarily mean that trans people do not exist; rather, skeptics argue that the number of true trans-identifying people is just far lower than current data would suggest.

Like with DID, parents and previous patients have started filing lawsuits against their doctors and therapists, and it remains to be seen how those will impact the trans movement. However, what will likely be the big test on trans issues is how gender-affirming therapy works out in the long run. If therapy is shown to be useless or harmful, as it was with DID, it is tough to imagine how the movement will persist. However, with the large scale of the movement so far, let us hope that there are as few casualties as possible should this be the case.

1. https://tavistockandportman.nhs.uk/about-us/news/stories/referrals-gender-identity-development-service-gids-level-2018-19/

2. https://www.ocf.berkeley.edu/~jfkihlstrom/Sutker_2001.htm

3. Ibid

4. http://psyc21301fa2017.courses.bucknell.edu/files/2017/08/Paris-2012.pdf

5. https://pubmed.ncbi.nlm.nih.gov/8711016/

6. https://www.dailymail.co.uk/news/article-6401947/How-NHS-childrens-transgender-clinic-buried-fact-372-1-069-patients-autistic.html

7. https://publichealth.jhu.edu/2020/us-autism-rates-up-10-percent-in-new-cdc-report

8. https://archive.is/xBdSD