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THE INFLUENCE OF "" ONACASEOF MULTIPLE PERSONALITY DISORDER

Edison B. Ronquillo,Jr., A.C.S.\\'.,

Edison B. Ronquillo,Jr., A.C.S.W., is a clinical social work­ designed as: eratKingsboroPsychiatric Center,WilliamsburgOut-Patient Unit, and a graduate student studying for his doctorate in The core ofthe beliefsystem lies in the assumption New York City. that spirits are able to influence and affect the lives of people in the material world, that is while on For reprints write Edison B. Ronquillo,Jr., A.C.S.W., 83-40 earth. Spiritists believe that spirits have both the Austin Street, Apt. 1U, Kew Gardens, New York 11415. ability to make people physically and emotionally ill and the power to cure them. (Ruiz & Langrod, ABSTRACT 1982, p. 36)

MultiplePersonality DIsorder (MPD) has been studied through indi­ In this case the systems of Espiritismo impacted vidual case studies and large scale clinical studies. The author, in on how the patient and family perceived the condition of presenting a Hispanic case ofMPD, cites needed attention forfur­ MPD. They often used the word possession; this term can be ther research into ethno-cultural phenomena which can interplay defined in relation to multiple personality as follows: with the phenomenology and dynamics ofMPD. The articlefocuses on the relationship ofa beliefsystem practiced or believed l7y many ...a clear differentiated alternate identity, whether Hispanics which is ''Espiritismo'' () and the syndrome human or otherwise, that seems to take over the ofMPD. Etiological and belief system factors are ~lucidated in the person... However, the proposed analogybetween case study. Assessment and treatment considerations that empha­ possession and multiple personality (Kenny, 1981), size cultural sensitivity are highlighted. is limited, not onlyby the exclusionwithin the mul­ tiple personality literature of the transcendent INTRODUCTION form of possession...but also by other important differences. For instance, the etiology of multiple Multiple personality disorder is distinguished from the personality overwhelmingly involves childhood other dissociative disorders in that alter personalities take abuse; such association within possession has not executive controloverthe personanddisplaydifferentbehav­ been established: (Cardena, 1988, p. 11) . ior patterns. Challenges to the rarity or implied non-exis­ tence ofmultiplepersonalitydisorderarebeingprofessionally Ethno-culturalvariablesare ofincreasinginterestin research; disputed (Putnam, 1989). DSM-IIIprovided MPDwith its own this article attempts to contribute to this area ofconcern. diagnostic category in 1980. Research on this syndrome has "The data on ethnic and socioeconomic status are proliferated since then. Scientific attention to MPD is gain­ scanty, butsufficientto allowone to conclude thatMPD occurs ing momentum. Relatively large scale clinical studies have across all major racial groups and socioeconomic settings. been done (Putnam, Guroff, Silberman, Barban, & Post, Although most cases involve whites, black (Ludwig, 1972; 1986), and the future for continued research in this area Solomon, 1983; Stern, 1984; Coons & Sterne 1986) and appears promising. Hispanic (Allison, 1978, Solomon, 1983) MPD victims have MPD has its own unique historydating back to the 1700s. been described" (Putnam, 1989, p. 57). Phenomena such as , possession, The relevance of ethno-cultural variables in research mediumships, , and have all at are imperative (RogIer, 1989). The study ofMPD needs to one time been discussed in connection with the syndrome. incorporate a sensitivity to ethno-cultural influences upon In most recent years there has been growing attention to the disorder. I am specifically referring to ethnic groups, the influence of cults and their impact on MPD (Van their cultural contexts, belief systems and in what manner Benschoten, 1990). these variables influence the etiology and outcome ofMPD. This present article emphasize in what manner The traditional Hispanic religious-cultural beliefs espiritismo (spiritualism) shapedthe phenomenologyofthe addressed in this article are practicedworldwidewith a heavy MPD suffered by a Hispanic female. The origin ofspiritual­ concentration in and the United States. The ism can be tracedback to the 19thcenturyspiritistwhowrote two major belief systems practiced are Espiritismo and under the pseudonymofAllan Kardec. Spiritualismhasbeen Santeria, which is also a spiritist tradition. Espiritismo devel-

39 DISSOCIATIO:\, Vol. IV. No. 1, ~Iarch 1991 THE INFLUENCE OF "ESPIRITISMO"

oped in the 1870s from Europe and its beliefsystem entails sociative disorderssuchas MPD in Hispanics, Rendon (1974) spirits being reincarnated several times. Santeria is the wor­ andSteinberg (1990) warn thatdissociative phenomenamay ship of saints. It originated in Nigeria and w~s br?ught to also bemisdiagnosedas schizophreniain this groupofpatients. Hispanola during the slave trade. The syncretIc mIxture ?f Santeria involves the Mrican Yorba and its Cathohc METHOD Saints (Berthold, 1989). The concept ofillness and health have different m~an­ The data base obtained on the case to be presented was ings to diverse cultures. The traditional belief systems Just from case notes, collateral, and family sessions. A sodium described will influence Hispanic patients' perception ofan amytal interview (Marcos & Trujillo, 1978), was done with illness and their usage of treatment centers. "Several stud­ the consent of this patient and was written up with transla­ ies have expressed concern with the paucity ofappropriate tion into English. Therewas also a consultationmeetingwith mental health services to the Hispanic, and in particular to a spiritualist. Puerto Rican communities, (LatinoTaskForceonCommunity Limitations ofthe material are that data were obtained Mental Health Training, 1974; Miranda, 1976; Padilla, E.R., from one case (N = 1), with various facets of the study rely­ & Padilla, A.M., 1978) clinicians providing services may not ingon the memoryofthepatient, family, andcollateral sources. be culturally attuned to the clients whom they are serving. There were idiosyncratic aspects in the life of this patient This results in underutilization of available services as well and thus one must be cautious with generalizations. as a less than optimal treatmentresponse." (Ruiz &Langrod, Furthermore, the material was reviewed retrospectively. 1982, p. 35; See also Abad, Ramos, & Boyce, 1974; Ghali, 1977; Minzio, 1974) CASE DATA and multiple personalityhave begun to be stud­ ied cross-culturally (Krippner, 1987). In the article "Cross­ Identifying Infonnation and History Cultural Approaches to Multiple Personality Disorder: The patient under consideration is a Spanish-speaking Practices in Brazilian Spiritism," there is mention that not Hispanic female who was 48 years ofage at the start oftreat­ much analogy can be found between mediumistic posses­ ment. She had resided in the United States for twenty-five sion (the incorporation ofbenign spirits) and MPD, but that years, and during those years she made periodic trips back there appears to be a closer resemblance to the "involun­ to her country of origin. The patient was under treatment tary possession" ofindividuals and MPD. Anotherstudyfrom with the author for an eighteen-month period during 1987 a different part of the world, but still relevant, was an arti­ and 1988. Initially she was treated intensely for two months cle presenting an MPD case in India and comparing this with during a psychiatric hospitalization. She was then followed hysterical possession state (Varma, Bouri, & Wig, 1981). In as an outpatient once a week with the possibility of being Indiathe possession statewas more common, andwas attribut­ seen more frequently when in crisis. ed to be related to the religious beliefs of polytheism and Dolores (a pseudonym) informed the author that she . was unemployed and her parents were deceased. In the past Cultural beliefsystems can also impacton the treatment she had worked as a seamstress. She had presently separat­ practices. There canbeexorcisms, healingsessions, andmedi­ edfrom herspouse ofelevenyears. The husbandwas a believ­ umisticseances. Krippnerreports, "Mostspiritistpractitioners erand practitionerofEspiritismo. The patient admitted hav­ (and their clients) have never heard of MPD, as such, and ing beliefs in Espiritismo, but felt this was in conflict with treat people with dissociative reactions with the same ritu­ her religious (Christian) beliefs. The patientin the past had als and brews that have been used for centuries" consulted with espiritistas (spiritist mediums). (&-ippner, 1987, p. 276). These herbsand devotional objects Dolores was born in a politically unstable Latin coun­ can be found throughout stores often referred to as botani­ try. Her parents were first cousins, and they were economi­ cas (Schwartz, 1988). cally disadvantaged. She was raised in rural sections of the In the literature one can find articles pertinent to the country. Her parents had eleven children. Dolores and her treatment of Hispanics (RogIer, Malgady, Costantino, & fraternal twin were born afterfive othersiblings. The patient Blumenthal, 1987) and writings on spiritualism often asso­ described her family as quite religious, but knew her father ciated with (Kardec, 1857). also was a believer in Espiritismo. The patient was told by The data base on articles written about Hispanics and family that when an infant she was unable to breast feed. dissociation (Alonso &Jeffrey, 1988) is growing. One ofthese Thefatheris said to have taken hertovarious doctors. However, articles, "The Ataque and Multiple Personality Disorder" the only one who was able to "cure" the malnourishment (Steinberg, 1990), reports that to date there has been only was an espiritista. Dolores reported that during dissociative one published report ofMPD in Hispanics, that by Martinez­ states the face of this espiritista would come forth in her Taboas (1989). Due to cultural differences, the misdiagno­ . sis of a range of psychiatric disorders may occur more fre­ Throughout her life, Dolores endured numerous trau­ quently among Hispanics than the population in general mata. She dates the first trauma at age eight. The trauma (Adams, 1984; Marcos, 1979; Mukerjee, Skukla, Woodle, & involved abduction and sexual penetration by a male who Olarte, 1983; Rendon, 1974). was nota relative. Doloresstates she was abductedfor a three­ Although there are no studies on the incidence of dis- year period. She states that although her family knew her

40 RONQUILLO

whereabouts, they could not intervene because of political gressed, she began to recall and attempt some resolution of pressures. The tragic aspect ofthe history was first revealed themes involving rage, anger, and vengeance. Her difficul­ under sodium amytal. The following are excerpts from the ties with strong affect were apparent in her interpersonal interview: relationships. VVhen Dolores could not handle a stressor, her dissociative states would occur and an alter personality D: I am afraid ofbeing left alone. would become dominant. T: Do you think something will happen to you? Belowfollows a synopsis ofother traumatic events in the D: Yes, like when I was a young girl. life of this patient: T: How young? D: Eight. • The death of a brother when she was age five. T: VVhathappened? • The rape of a sister. D: I was sexuallyabused. I stayedwith thatman, a politi­ •A strong history of violence in the family. A sister cian, for three years. My parents could not do any­ killed her own first spouse, for which she was incar­ thing. cerated. Upon release she remarried and the sec­ T: Is this the man that enters your body? ond husband murdered her. This precipitated the D: Yes, it is the same person. first psychiatric hospitalizationforbothDoloresand her female fraternal twin. Dolores also recounted later that she was witness to tor­ tures and deaths which were politically motivated. She was Personality System repeatedly informed by her abuser that should she reveal Dolores was found to have a total of four alter person­ the truth ofsexual violation, then the same atrocities would alities. Alternate personalities were mainly called forth in befall her and her family members. Dolores felt that the non-hypnotic states (an exception being during the sodium experiencescliniciansmightdescribe as dissociation occurred amytal interview). The sodium amytal interview had been first when she was eight years ofage. conducted to further confirm the diagnosis ofmultiple per­ The sodium amytal interview also dealt with issues of sonality disorder to gain further access to her mind's Espiritismo. VVhat follows are the excerpts on this theme: repressed psychological content. With the exception ofthe child personality (which was only identified under sodium T: Can you tell us about this other woman who amytal) the author met with all the alternates in the per­ comes into you? sonality ~ystem under non-hypnotic states. D: She is very liberal, outgoing and likes men. There In retrospect it is the assessment of this author that in is another one who likes only women. Women are addition to Dolores, only Flor met the full criteria for an more trustful than men. There is a child who was enduring persona thatgained frequent executive control of my unborn baby. Since I never really had any chil­ the body. The other three personality alters, Esperanza, dren I attempt to use my dolls as the children I Encarnacion, and Edmundo are assessed to have been per­ never had. There is also a man who is very good­ sonalityfragments (Braun, 1986). lookingandeducated. Eachone possesses mybody. Dolores, thehostpersonality,was ashy, soft-spokenfemale They are spirits. I have no control over them. who lived a ratherpuritanicallifestyle. Shefrequentlyreport­ T: VVhy your body? ed headaches, feeling confused with intermittent memory D: Because they need my body to express themselves. lapses. She longed for motherhood and expressed her love T: Do you believe in Espiritismo? ofchildren. Dolores began to share her hate ofFlor during D: Yes, when I was a baby I was very sick. None of the the therapy process, and considered the alternate as her doctors would help me. A man, an espiritista, was opposite. Florwasdescribed as a beautifulblondewho enjoys able to help me. I see the face of this man often. wearing plenty ofjewelry. She said that her life is to seek T: Do you know about Anna Esse? love. She was flirtatious and attracted to men. She drank, D: She is a beautiful spirit with many gold chains and smoked, andwas sexually promiscuous. Ultimatelyshe seeks I have used her for some of my works (Trabajo). vengeance onmen andwanted to destroyDolores. This alter evidencedaggressive impulsestowardchildren. Flordescribed Dolores was married a total offour times. She implied herself as an only child and said that she "comes from a far­ that it was an alternate who married two of the respective away place." spouses. All of Dolores' children are deceased. The losses Encarnacion was a homosexual female, who, outofrage were repetitive traumatic episodes. Two twins died at birth, for men, sought comfortwith women. Edmundo was a male another child died ofhydrocephalus at age two, and the last personality. He was described as a tall, attractive, well-edu­ child died at age three from a motor accident. The last child cated man who confided that he wanted Dolores only for died twenty-eight years ago. himself. Esperanza was described as a little girl who enjoys Recollection of these deaths was quite painful and playing with dolls and attempts to recreate the childhood Dolores developed strong amnestic barriers concerning the joys she missed. She seeks to be rescued from her torment­ loss of the children. In terms of the marriages Dolores did ed past. not initially recall marital data, but as the treatment pro-

41 DISSOCIATIO;\', Yol. IY, ;';0. r. March 1991 THE INFLUENCE OF "ESPIRITISMO"

Psychodynamic Assessment ofPersonality Components manifestations. Her personal belief was that she was pos­ Theflirtatious female and the homosexualfemale alters sessed. preserve the sexuality and aggressive tendencies. The little The present spouseofDolores, Mr. S., was approximately girl preserves the child-like qualities, but equally the tor­ the same age as his wife, and a devout believer and practi­ ment. The male alter dominants Dolores' body just as the tioner ofEspiritismo. He was always meticulous in his attire, male who abused her. The domination of the abuse is sym­ and upon describing his wife, one got the impression he was bolicallyevident.ltappearsthat, therefore, oneofthe patient's referring to a child. It is ofnote that his father is a medium, defense mechanisms is identification with the aggressor, the and Mr. S. also identified himself as a medium. During ses­ aggressorbeingthe personwho abused herandsubsequently sions with the couple the following data were revealed. was the stimulus for her developing a male alternate per­ Mr. S. sufferedfrom a chronicpulmonaryconditionwhich sonality. Dolores, the host personality, maintains the "soft­ he claimed interfered with sexual relations. The couple had er" qualities, but is often rigid in her thoughts. had no formal courtship. Dolores states it was not she who married Mr. S. He reported they were separated upon her Issues Relating to Espiritismo request, although at the time they were making attempts to During sessions Dolores discussed how she had attend­ salvage the marriage. ed spiritist meetings in the past. She described how the spiri­ In discussing the illnessofhiswife, Mr. S. statedhisaware­ tist mediums used their powers either to create or to allevi­ ness ofthe different personalities: "I believe she has four or ate problems. The ability to work with spirits five." He said that he wants to be with Dolores, but that he is thought to be at the disposal ofthe espiritista. This patient had developed a communication processwith the other per­ also perceived that she had some of these powers in using sonas. He said that Dolores' male personality is dominant, .spirits, i.e., Anne Esse, to assist her in performing spiritist and that this is the personality that has knowledge ofall the works (Trabajo) on others. personal dataon the altercomponents. Mr. S. described hav­ In this case, some ofthe alter personalities were similar ing access to the alters, and talked ofexperiencing a group to the folklore figures, and these were considered spirits dialogue with them. He believed that as a medium he could invading the body. Theseentitieswere discussed by thepatient, summon these spirits, and that it was spirits (espiritus) that family, and collateralsources. The following folklore figures had invaded the body ofhis wife. were expressed within the context of Espiritismo: Mr. S. described the receptiveness ofhis wife to the spir­ its as her being a "caballo." Literally translated, Mr. S. was Anne Esse is known to love only women. She was indicating that his wife is "like a horse" whom the spirits described as beautiful, playful, and wears pearls. mount and enter. He perceived that a true personality trans­ When she seeks out men it is onlyfor entrapment. formation was possible only if Dolores maintained her eyes This can be described differently in dif­ consistently closed during the "switching." He stated that ferent Latin subcultural groups. "spirit eyes" do not need to be open in order to view. The husband verbalized that if a complete transformation did Papa Candelo is the spirit offire who is very strong not occur, then his wife experienced what he described as in his powers. Heenjoyssmokinganddrinkingalco­ a "revelation." This was seen as an evil spirit that seeks entry hol. He uses foul language. A spiritualist informed into the body for a momentary vision but quickly departs. the author that ifCandelo enters the body the per­ The person then remains to take the blame for the spirit's son will display the habits and behavior ofthe spir­ misdeed. it. Mr. S. maintained that western medicine impeded the formation ofthe spirit into the body. He clarified thatwater Anne Esse was a spiritgoddess frequently mentioned by (agua), if ingested by the "possessed" body supplies ener­ Dolores. During dissociative states Dolores would see her­ gies to the spirits and should be avoided ifattempting to dis­ self as a beautiful blonde who wore muchjewelry. card a spirit (despojo). The Flor alter sought love but with a hidden agenda to entrap men. The spouse of the patient expressed that the ANALYSIS OF THE INFLUENCE habits ofdrinking, smoking, and foul language of this alter OF ESPIRITISMO ON THE CASE was the entrance to the body ofPapa Candelo. During one ofthe marital sessions the patient dissociated, and behaved Dolores' MPD could not be understood or treated from in this manner. I attempted to have the entity identify itself, a psychological analysis alone. It was essential to compre­ but it would not. The spouse stated that to get the spirit to hend the beliefsystem ofEspiritismo in order to work effec­ identify itselfwas similar to a "confession" by the spirit. tively with the patient and her family. The family members The patient, spouse, and family believed that the con­ continued to reinforce the Espiritismo belief system, and dition of MPD was best explained by possession, possession considered Dolores' body possessed by spirits. Dolores con­ implying thatexternalforces enterthe body. Thefamily often tinued to consult a traditional espiritista and members of reinforced these belief systems by indicating that Dolores the community supported this. Dolores perceived that her was a believer ofEspiritismo and had become possessed by problemsand symptoms arose andwere maintainedby exter­ spirits. During sessions, the patient manifested MPD clinical nal forces rather than internal fragmentation. .

42 DISSOCL\.TIO\'. rol. Ir. \'0. I. ~Iarch 1991 ~f:\ I~ RONQUILLO

Espiritismo was evident in Dolores' life from childhood tent ofalter personalities' behavior patterns. A second is to through adulthood. Her introjected and internalized belief investigate why MPD Hispanics are not easily identified with­ system ofEspiritismo was fragmented and aspects of it sub­ in the mental health system. Is it possible that a significant sequently personified in alter behavior patterns. Her disso­ number of MPD Hispanics are seeking treatment with the ciative fragmentation was shaped by both repetitive traumas traditional cultural folk healers, i.e., espiritistas, Santeros? andstronglyheldbutdichotomizedbeliefsin bothChristianity and Espiritismo. A PSYCHO-SOCIAlrCULTURAL As described previously, some cultural folklore figures TREATMENT APPROACH appear to have influencedthe alter's behavior patterns; the spouse was convinced ofthe similarities of these spirits and Studies on cultural factors (Ruiz & Langrod, 1976) have the personality transformations Dolores suffered. The spir­ recommended that in treatment the clinicians need "...to itguide ofAnna Esse is very similar to the Flor alternate. Mr. take into account the values, beliefs and idiosyncracies of S. perceived that the habits not pertaining to Dolores as he the groups that are being worked with, if they plan to be understood her, such as smoking, drinking, and the use of effective." (Ruiz & Langrod, 1982, p. 38). It has also been foul language, were associated with the spirit of Papa reported that the very nature of an illness is influenced by Candelo. In the sodium amytal interview the patient also cultural expectations and meanings (Comas-Diaz, 1981). said thatthe childalter maybe the spiritofherunborn child. In the treatmentofDolores, a treatment plan thatincor­ The patient believed that it was spirits who had entered her poratedbothherpsychological and culturalprofilewas devel­ body, and that those entities needed her body to express oped. As the therapist I began to read extensively on MPD themselves. in order to facilitate the assessmentofthe psychological influ­ At this point I will briefly reflect upon the spiritist ences (i.e., trauma, repression, internal fragmentation, ofSanteria. This is mentioned in order to provide another defense mechanismsandsymptoms). Itwas also vital to ascer­ viewpointthatmightinfluence theformation ofan alterper­ tain the cultural influences (i.e., country of origin, socio­ sonality, i.e., an opposite sex alternate personality. A cul­ political factors, beliefsymptoms, including the subsequent tural-religious analysis in this area can possibly be found in primary beliefofspirit possession). The spiritist beliefcom­ thesanteriabeliefwhichhonorsandworshipsinterchangeable plicated Dolores' clinical profile. Repetitively I, as the ther­ dual sex , i.e., Santa Barbara and Chango. apist, discussed the clinical manifestations and tried to work with dynamics and the influence ofthe past on the present. Neither does the stunning fact that some of the However, the notion ofpossession remained compelling to Orishas () change sex in the syncretic mixture the patient and her family. bother the Santeros. Since Santeria is intermixed Within a framework ofbeliefthat the cause for the mul­ with spiritualistic beliefs, they explain the change tiple personalities was the invasion of the body by external by arguing that their gods existed before all other forces, Dolores was well defended when I encouraged her beings, and that after their mythical deaths they to deal with internal issues. Prior to the case of Dolores, I returned to earthreincarnated into newbodies. The had some knowledge of the Espiritismo belief system. idea ofreincarnation is an intrinsic partofSanteria However, my efforts on her behalf called for further exam­ (Gonzalez-Wippler 1987, p. 30). ination of this beliefsystem. I proceeded to consult with an espiritista and went to a spiritist meeting in an attempt to This sex gender dichotomy is over-determined by many further appreciate Dolores and her alters. The spiritist con­ factors among which are: (1) internalization and introjec­ sultation and the field observation of a spiritualist meeting tion ofcultural beliefsystems; (2) trauma and repression of assisted me in the assessment process and in taking a ther­ libidinal states; (3) fragmentation and dissociation; (4) per­ apeutic stance with the patient and her family. To be cul­ sonifications both from within the patient's culture and by turally attuned was imperative. The spiritist consultant was identification with the aggressor. Numerous psychodynam­ convinced that Dolores was possessed, and he strongly rec­ ic and socio-cultural variables may influence the phe­ ommended I take precautions against the evil spirits. The nomenology of alter personalities. recommendation was that I place a glass on my desk filled It is clear that the belief system of Espiritismo has col­ with water and white flower petals. I dealt with his sugges­ ored Dolores' perceptions of her illness and the form in tion by respectfully listening. which itexpressed itself. Although it is inappropriate to gen­ In the treatment sessions Dolores manifested certain eralizefrom a singlecase, Dolores' situationsuggestswe should fears and resistances with strongethno-cultural dimensions. take into account the variables of ethnicity, belief systems, She feared that I would not understand her belief system, and the usual phenomenaofMPD, and treatthesewith equal Espiritismo, and would perceive her statements as invalid. respect. She feared the loss of control and the violation of bound­ At least two lines offurther exploration are suggested. aries. Dolores was fearful that my respect for her would be Thefirst is to studywhethera significantsample ofHispanics diminished and tarnished by alters' behaviorwhich she per­ with MPD (who are believers in traditional-religious prac­ ceived as unbecoming to a dona (lady). Dolores was afraid tices such as Espiritismo and Santeria) are personifYing the thatI would lose patience, andsubsequentlyrejecther. These internalized beliefs of the folklore figures within the con- fears were a replica ofthe experience ofpast rejections from

43 DISSOCIATIOt\". Yol. [Y. \'0. I. ~[arch 1991 THE INFLUENCE OF "ESPIRITISMO"

family, friends, and significant community members. Personality Disorder (pp. 1-28). Washington, DC: American It proved crucial to listen and to suspendjudgment so Psychiatric Press. that Dolores could express herselfin her own way, and grad­ Cardena, K (1988). Thephenomenologyofpossession:An ambigu­ ually begin to trust. Subsequently, she felt more understood ous flight? Paper presented at the Fifth International Conference on concerning both her illness and her cultural beliefs. the Study of and Alternate Modes ofHealing. Rafael, CA The beliefsystem does nothave to be reciprocalbetween (pp.2-26). patient and clinician. What is pertinent is comprehending a cultural phenomenon, rather than classifying a belief as Comas-Diaz, L. (1981). Puerto Rican espiritismo and psychother­ or non-existent. I have witnessed clinical situ­ apy. AmericanJournal ofOrthopsychiatry, 51 (4), 636-645. ations in which a patient is talking about spirit beliefs and Coons, P.M., & Sterne, A.L. (1986). Initial and follow-up psycho­ the professionalrespondsin ajudgmentalmanner. Listening logical testing on a group ofpatients with multiple personality dis­ and understanding can make the difference for effective order. Psychological Reports, 58, 43-49. treatment. Ghali, S.B. (1977). Cultural sensitivity and the Puerto Ricans. Social CONCLUSION Casework, 55 (2), 459-468. Gonzalez-Wippler, M. (1987). Santeria: African in Latin The mental health professions work with a multitude of America. New York: Original Publications. human problems, amongwhich are childabuse cases. Child abuse is one of the social problems believed to be a major jorge, A. Traditional religious practices in the Hispanic American com­ contributorto theformation ofMPD (Putnam, 1989; Putnam munity. Unpublished Bibliography, State University, OldWestbury. et aI., 1986; Wilbur, 1985). To strengthen our clinical tools Kardec, A. (1857). . (Anna Blackwell, Trans.). we must begin to further examine ethno-cultural variables S.Paulo, : Luke. and how these factors can impact on MPD. We must also learn how to distinguish between cultural formats and Kardec, A. (1986). The book on mediums. (E.A. Ward, Trans.). New patients' idiosyncratic behaviors. Such efforts will enhance York: Original Publications. our knowledge base on both the etiology and the treatment Kenny, M.G. (1981). Multiple personality and . of MPD. , 44, 337-358. ACKNOWLEDGEMENT Krippner, S. (1987). Cross-cultural approaches to multiple per­ sonality disorder. Practices in Brazilian spiritism. Ethos, 15 (3), 273­ The author is grateful to Etzel Cardeiia, Ph.D., and Thomas 295. Ferraro, Ph.D., for comments on an earlier draft ofthis arti­ LatinoTaskForce on CommunityMental Health Training. (1974). cle.• Latino CommunityMental Health. Los Angeles: Spanish Speaking Mental Health Research and Development Program.

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