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Dissociative States with Abnormal Temporal Lobe Eegmultiple Dissociative States With Abnormal Temporal Lobe EEG Multiple Personality and the Illusion of Possession M-Marsel Mesulam, MD \s=b\Twelve patients with clinical and EEG this is difficult to prove since EEGs She is successfully attending a graduate manifestations reminiscent of temporal were not obtained and since hyster- course in journalism and holds a part-time lobe epilepsy reported symptoms of dis- oepileptic convulsions were considered job. Although there is no family history of she suffered head sociative states. In seven of these common in cases of dissociative state. epilepsy, reports having trauma with apparent loss of consciousness the clinical picture was consis- This is based on 12 cases with a patients, report at the age of 1 year. tent with whereas the clinical reminiscent of multi¬ multiple personality, picture The EEG was abnormal on two consecu¬ other five had the illusion of supernatural ple personality and supernatural pos¬ tive determinations. One showed transient possession. These cases suggest that in session. These patients had EEGs that sharp waves and theta slowing over the left selected instances dissociative states displayed different degrees of abnor¬ temporal leads, and the second showed may constitute complex behavioral mani- mality, suggestive of focal electrical intermittent sharp waves over central festations of chronic limbic epilepsy. disturbance predominantly in the regions bilaterally and independently dur¬ (Arch Neurol 1981;38:176-181) temporal lobes. The apparent associa¬ ing drowsiness and light sleep, with a on the left side. Results of tion between these rare syndromes predominance and focal disturbances of cortical elec¬ neurological examination revealed no ab¬ normalities. such as trical in of the brain experiences, activity regions Clinical as well as the of a "Pjissociative the limbic notes, reports multiple personality and demonic related to system may pro¬ boyfriend, indicate that three autonomous possession, are enigmatic and rare vide an insight into etiological mecha¬ personalities, with different tempera¬ phenomena that are often attributed nisms. ments and responding to different names, to psychiatric causes. Although the REPORT OF CASES intermittently take hold of her conscious¬ etiological mechanisms remain con¬ ness. "Edna" (primary personality, the Each of the 12 cases reported here was woman troversial, a between patient) is an intelligent young relationship seen at the Behavioral Neurology Unit, these two conditions has been who is conscientious, dependent, and sug¬ sug¬ Boston, an outpatient clinic with a special the dominant second on clinical ~3 An asso¬ gestible. "Linda," gested grounds.1 interest in the psychiatric manifestations personality, gives free expression to hostil¬ ciation of these dissociative states of epilepsy and other neurological disor¬ and has tortured animals with has been but ity apparently epilepsy implied, ders. In the period of approximately one and entered fights. "Hanna" has a diminu¬ not elaborated. For example, pro¬ year during which these 12 cases were tive role and personifies gullibility, imma¬ longed fugue states with behavioral seen, 307 patients were referred to the turity, and sexual vulnerability. The switch alterations and subsequent amnesia Behavioral Neurology Unit, and the ques¬ from one personality to another is abrupt tion of was raised in may appear as a sign or even as the psychomotor epilepsy and complete. For instance, toward the end clinical manifestation of 61 of these. The EEG recordings were of a psychiatric interview with Linda, only psycho- with the standard ten to 20 motor performed Edna suddenly emerged and apologized for epilepsy.4" Furthermore, par¬ electrode Hyperventila- the abnormalities in the EEG scalp placement. having missed appointment, claiming oxysmal tion, photic stimulation, sleep tracings, and total amnesia for the previous hour. Linda have been described in at least one nasopharyngeal leads were obtained from apparently behaves as a co-conscious case of Al¬ multiple personality.7 virtually all the patients. The EEGs were observer when Edna is in control, but can¬ though the clinical descriptions sug¬ performed and interpreted by independent not interfere with ongoing activity. Edna, gest that many additional cases in the observers. on the other hand, denies direct awareness earlier literature were also epileptic,8 Multiple Personality of Linda, but surmises the latter's experi¬ ences through written notes that they Case l.-This is a 19-year-old, left- exchange. handed woman. She has never had a con¬ Edna and Linda have distinctly different Accepted for publication June 30, 1980. vulsion. Brief "absence" attacks were styles of speaking. Edna has a high-pitched From the Behavioral Unit Neurology and Bul- since the of 12 At the uses and con¬ lard reported age years. voice, frequently stereotypes and Denny-Brown Laboratories of the Har- the that could and writes with her left hand. vard Neurological Unit, Beth Israel Hospital, present, only experiences tractions, Boston. conceivably be attributed to seizures are Linda, on the other hand, speaks in a Reprint requests to Neurological Unit, Beth poorly defined episodes of visual blurring low-pitched and gutteral tone, uses precise Israel Hospital, 330 Brookline Ave, Boston, MA and distorted color perception. These last articulation without stereotypes or con¬ 02215 (Dr Mesulam). ten to 60 minutes and occur once a week tractions, and writes with her right hand. Downloaded From: by a Northwestern University User on 07/20/2018 Edna projects an image of naivete and chiatrist at knife-point for several hours spontaneously emerge to talk to him. Each submissiveness, whereas Linda imparts a and was then amnesic for the event. When personality announces its intended age, sense of authority and self-importance. she reverted to her customary self and and the patient's overall behavior changes These two personalities communicate by heard about this, she apparently felt such accordingly. For example, the younger per¬ writing notes to each other. The following remorse that she brought her psychiatrist a sonalities have a better command of Ger¬ notes were written alternately, but appar¬ vial of her own blood. The emergence of man than of English, show a preference for ently with many hours intervening, by multiple personalities was observed by a the music of the 1950s (although she now Edna and Linda on the same sheet of former roommate, who described two enjoys only classical music), write better paper. abrupt deviations from the patient's usual with the left hand, and act in a manner a childish more is cus¬ Edna (neat, left-handed script): How self. One represents little girl, petulant and immature than the other a tough, and threatening for the patient. These transforma¬ come you do better than me in practically angry, tomary person. the self is tions are not without For every course... ? Although customary inconsistency. Linda (less legible, right-handed script, amnesic for the activities of the other instance, a personality who declared her¬ it has indirect of self to be 6 years old would write and speak apparently written many hours later when personalities, knowledge their with a much too advanced for she captured consciousness): Scholastic existence because the personalities vocabulary write notes to each other, as in case 1. that age. The patient is completely amnesic endeavors come naturally to me. was for these and her husband is the Edna: You aren't that smart though. I The patient given carbamazepine, episodes but no to treatment could be sole source of information this wouldn't want to trade with ever. response concerning you ascertained. unusual phenomenon. On the other Because you are a cruel monster I'll never hand, This case forms a transition be¬ the additional personalities probably share envy you. co-consciousness with the customary self, Linda: Sour grapes my child; we under¬ tween multiple personality and multi¬ since they can be called into existence, stand one another only too well. I will ple fugue states. In contrast with always be dominant. 1, the different virtually at will, by her husband. The vari¬ patient personalities ous personalities apparently do not com¬ do not seem to have an recur¬ The patient was given phenytoin, carba¬ orderly municate with each other by note. The mazepine, phénobarbital, and psychothera¬ rence or autonomous existences. In¬ patient calls the other personalities "little py. Although the dissociative episodes stead, there are periods of acting-out people," believes that they are each inde¬ decreased on this regimen, the contribu¬ that are then not available to the pendent personalities who happen to share tion of each therapeutic component to the consciousness of the customary self. a common body, and does not appear par¬ overall improvement is impossible to This type of criminal fugue has some¬ ticularly mortified at being the source of so assess. times been described as typical of singular a phenomenon. The EEG is consistent with an multiple personality in epileptics.8 In Phénobarbital decreased the episodes of seizure disorder even dizziness and loss of consciousness, but did underlying some instances, her altered states are no convulsions ever not alter the dissociative phenomena. though have sufficiently prolonged that she can occurred. The of The number of different presence autonomous find herself in a different city, with a personali¬ with commu¬ ties is and the personalities individual different
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