The Multiple Personality Syndrome and criminal defense.

After years of disrepute , Multiple Personality Syndrome (MPS) has become the focus of considerable attention. 15 Grouped in the third edition of the American Psychiatric Association's Diagnostic and Statistical Manual (p. 259) with the dissociative disorders, the diagnostic criteria are: "(A) Existence within the individual of two or more distinct personalities, each of which is dominant at a particular time. (B) The personality that is dominant at any particular time determines the individual's behavior. (C) Each individual personality is complex and integrated with its own unique behavior pattern and social relationships." One of us (AF) had the opportunity to work in a forensic capacity with two individuals suffering from MPS who previously had come to legal attention. In this article we discuss some of the unique problems that arose in our work with the individuals and that are likely to arise when others suffering from MPS enter the criminal justice system. There can be no clinical entity more open to skepticism in both clinical and legal context; the very notion of multiple individuals inhabiting one body violates our sense of person and smacks of the crudest sort of demonology. Therefore, the psychiatrist presenting such material in the courtroom must be unusually well prepared to defend his or her position. Yet, the validity ofMPS as a clinical entity, whatever its relevance may be, is beyond question6 bringing to the fore a host of issues. The prevalence of MPS is unknown and may be higher than is commonly assumed;7 malingering is obviously of major concern and must be rigorously excluded. The diagnostic manual states, .• Usually, transitions occur in a dramatic manner." MPS may burst spontaneously on the startled forensic psychiatrist or, as in one case of which we are aware, the shift may occur in a manner that creates the greatest kind of embarrassment in the courtroom; alternatively, a second personality may be actively pursued in the case of criminal behavior that appears to be absolutely contrary to a suspect's otherwise exemplary life. While Ludwig, et al. 8 have pointed out that differing personalities within MPS may suffer from a panoply of psychiatric conditions, we consider here only true MPS, malingering, and personality disorder of schizoid or paranoid type.