Management of Malevolent Ego States

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The Management of Malevolent Ego Statesin Multiple Personality Disorder

John G. Watkins, Ph.D.Helen H. Watkins, Ph.D.

ABSTRACT"Malevolent" personalities create tremendous problems to both the patient and the therapist. The dangers of possiblehomocide and other acting-out by such angry states multiply the difficulties in achieving personality integration. Suchoriginally developed to protect the individual. They represent a defense for the abused child who was confronted with awith which he could not cope. Suggestions by the therapist that the treatment goal is "fusion" constitute a threat to theof alter personalities, and mobilize their resistance.Ego-state theory holds that"dividing" lies on a continuum, rangingnormal, adaptive differentiation (as represented by different moods) to pathological dissociation (as represented by truedisorder). Between lie covert "ego-states" which are organiZtltions of behavior and experience separated by

boundaries. In this theory, treatment of Multiple Personality Disorder involves reducing the rigidity of thes and moving them down the continuum until they become ego-states-such as are found in normal subjects underFrom this point ofview malevolent alters need not be threatened with non-existence, but are promised continued selfnessidentity within a larger organizational framework. Such an approach lowers their resistance to treatment, and "integration"is not the same as ''fusion'') is more easily attained. The therapist becomes their "friend" rather than their "enemy."

Multiple Personality Disorder (MPD) is perhapse most interesting and challenging of disorders for thepast such cases have been conas extremely rare (American Psychiatric Ass0-ion,198O). However, recent studies (e.g., Braun,Coons & Milstein, 1986; Kluft, 1985; Putnam,ff, Silberman, Barban, & Post, 1986; Ross, Norton,Wozney, 1987; Schultz, Braun, & Kluft, 1985) have

demonstrated that this condition is much morethan previous ly thought. DSM-III-R (Ameriric Association, 1987) no longer describes itThe First through Fourth International Conferon Multiple Personality/Dissocia tive States (1984-included apprOximately 400 scientific presentaon patients with MPD. A high percentage of thein those reports had been misdiagnosedr considerable per iods of time before coming to theof the clinicians who ultimately recognized thetheir circumstances. Putnam et at. (1986)r cohort of 100 MPD patients had aver6.8 years between their first mental health evalusymptoms related to MPD and receiving anA position which seems to have guided earlierin this field is that the "normal" self is a unity.was no t understood in terms of normaltheory. This attitude resulted in manyan "either-or" positionfollows: "Normal" individuals do not have "dionalities. They represent the bulk of the

population. In a few extremely rare cases the ego"splits" and only then forms a "multiple personality."More practitioners are beginning to think of

divisions within a personality as being quite common,but with differing degrees of severity (Beahrs, 1982). We(Watkins & Watkins, 1979, 1981, 1982; Watkins &Johnson, 1982) have gathered increasing evidence thatthe dividing of the personality lies on a continuum,ranging from normal adaptive differentiation at one endto pathological maladaptive dissociation at the other,where the true multiple personality disorder occur. Thein between regions on the continuum consists of "egostates," covert patterns of behavior an d experience,usually accessible only under hypnosis.Hilgard (1977, 1986) initiated hypnot ic deafness insubjects. After they failed to respond to loud noises heasked the following question: "Although you arehypnotically deaf perhaps there is some part of you thatis hearing my voice and processing the information. Ifthere is, I should like the index finger of your right handto rise as a sign that this is the case." In some subjects,the finger rose. He described this as due to a covert"cognitive structural system", and called it "the hiddenobserver." He found that the hidden observer alsorecorded an awareness of pain in a hand renderedhypnotically analgesic that was immersed in circulatingice water. Hilgard considered the hidden observer as ametaphor and at tha t t ime (1977) held that it was not "a

secondary personality with a life of its own."reprints write to: John G. Watkins, Ph. D., 413 Evans Street, Missoula, Montana, 59801

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Using Hilgard's verbalizations, we (Watkins &1980) activated hidden observers ints formerly treated by ego-state therapy.and had been studied overns. They were tested after the establishmentand hypnotic analgesia in the rightOur studies indicated that hidden observers areo states that we find in theon the differentiation-dissociationThey do not emerge spontaneously as doe personalities. They can be activated overtlyh hypnosis, but they can exert unconsciousence on the personality that is normally overt.s in that they partition off various personaltions, can be unaware of one another, can beor in conflict with one another and, like truepersonalities, may give themselves names.

As a result of these studies we have come increasseparating process lies on aruns from undifferentiated personality,adaptively differentiated covert patterns (suchthe different roles we take during a work hour asparty hour), to the unconscious ego-statee manifest only under hypnosis, topersonalities (such as those whichbut of whose existence theare aware). As we reach the end of theum where true multiple personalities are diagpersonality segments emerge spontaneouslyd view other such segments as objects (''he'', "she" or). Hypnosis can activate them, but is not necessary.y, (especially the primary state) usually have variousat least some of the others beforede them acquainted with one another.The difference between t rue multiples, intermediand those minor personality separationswould call simply "adaptive differentiations" isqualitative one, but rather the degree of separationby the relative rigidity or permeability ofWe find that when patients, originally true mul

es, have apparently been integrated they are notarily fused. Some of the segments may disappearare no longer functionally relevant. Manyto exist at covert levels and are accesunder hypnosis. In other words they behavewe have activated in normalsubjects and have become indistinfrom such subjects.As an analogy, after the Ovil War the confederated "sovereign" state of Alabama returned to the

It continued to exist in name and content but red acted like a sub-entity within a more general federalThis is how we find the hypnoticallybehaving within our normal re

Bower (1981), in his studies on "mood-dependentlearning," has shown that early memories can be reactivated i f they are imbedded in a mood state which isthe same as a current one or in one of the same naturethat is hypnotically induced. Once the mood has beenestablished in the current situation the patient can beregressed to a similar one in the past, and the memoriesin that past tend to appear. His studies give experimental support for the hypnotherapeutic technique of "theaffect bridge" (Watkins, 1971).Ego-state theory suggests that in creating a moodwe make more likely the activation of an earlier egostate in which that same mood was experienced. Whenthe earlier state becomes executive it brings with itmemories of the events it experienced then.There is some confusion here because Bower didnot use the word "state" as we do in "ego-state." A

mood "state" is a general feeling, as in the expression, "astate of depression swept over the country." An "egostate" is a personality segment enclosed within a boundary which is relatively more or less permeable. It hascontents (like the "state" of Montana).I f an individual who is a true multiple (hence, onewhose ego states appear overtly spontaneously) is madeangry, it is likely that the particular alter that usuallyfeels and expresses the subject's anger will appear andassume the executive position. And, i f it is so activated,this alter will have available to it the memories that havebeen a part of its experiential existence, and which may

not be available to other alters. Ego-state theory thusoffers a somewhat different rationale to explain Bower'sresults.We are presented with the question as to whetherintegration really requires the elimination of boundaries,the fusion of contents, and the destruction of all uniqueidentity since such a condition does not appear necessary in our normal research subjects. We realize thatmany of our colleagues do not conceptualize such adifference between integration as we define it, (a working-together of sub-ego states under an over-all unifyingjurisdiction, as in the United States of America), andfusion, which, we define as the elimination of theboundaries and fusing of their contents, So they nolonger function as entities. We acknowledge that otherscientific investigators define these terms differently, butthe scope of the current presentation does not permit usto address this. One alternative set of definitions isoffered by Kluft (1987).Multiple personalities are very difficult to treat,and at times appear incomprehensible. The alter personalities that cause therapists and patients alike thegreatest problems are those that are destructive in theirbehavior, and are often termed malevolent. Loadedwith rage, they may be both suicidal and homicidal.

They slash the patient, strike at others, initiate bizarrebehavior and threaten all, including the therapist(Watkins & Watkins, 1984). No wonder that clinicians

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ten wish the malevolent personal ity could be elimiOther personalities may be cooperative, helpfulructive. Often the therapist speculates: "I fwe could get rid of that fellow known as Evil Onewould quiet down, be more tractable, and letwith the task of therapeutic integration."It is not surprising that patients who manifestmay be regarded as possessing "demons,"ch, within certain fundamentalist religious subculOne of ourendured forcible "exorcism" in her church. Her

improved temporarily, but worsened in theIn fact, our therapeutic task was made trere difficult by this exorcism, since the dee ego states felt that they no longer could trus tIn order to deal with such entities in therapy wehow they came about and why they are

us go back to ego-state theory. Multipledisorder is an originally adaptive defensehas gone astray. Normally, one's personalitythrough a putting-together or "integration"or taking-apart, called "differentia" The child learns one set of behaviors appropriateand another for the playing field. All of us arect to normal mood changes. It is only after thisof entire blocks of behavior and experiencemes so severe they no longer communicate withwe diagnose multiple personalityThe various "alters" then alternate in takingof the body.Ego-state theory regards this transition fromdaptive dissoas lying on a continuum-like most psychologi

It is in its excess that it becomes pathoical. Differentiation assists an individual to copeof his environment. But, when thesees are so great as to become severe traumas, thecontinuum from minorwe are quite conscious),of behavior and experience that areby increasingly impermeable walls, to theof pathological dissociation. They may do soor often in sudden splits. The segments nowon the character of separate and warring personaliIn between these are more covert entities which arebelow the threshold of awareness, hence, uncons. We call these intermediate dissociations "ego

We define an ego state as a body of behaviors andbound together by some common principled separated from other such entities by boundariesmore or less permeable. This definitione personalities. The characteristicego states from true multiple

ities is that in true multiples the states areby very rigid, impermeable boundaries, and

March 1988

they can appear spontaneously without being hypnotically activated. It is a matter of degree. We find covertego states commonly in normal individuals who arefairly good hypnotic subjects, since the hypnotic state isalso a form of dissociation.We believe that when the small child is confrontedwith abuse, punitive or sexual, and when he/she is notpermit ted to protest, talk back or express anger withoutsevere retaliation, the coping mechanisms of the personality have only three choices: psychosis, death ordissociation. If the ego can be relieved of its rage byrepressing it into a personality segment that is thenwalled off, the child may be able to play the "good-girl"or "good-boy" role with hopes of receiving affection-orat least lessening the abuse. Of the three possibilitiesdissociation is the most adaptive, but it lays the basis forforming an unconscious destructive, malevolent egostate divorced from normal super-ego controls. When

later the repression breaks down, this state emerges,takes over executive control of the body, and vents itsrage on the patient or others.The key to the therapeutic handling of a malevolent alter is to remember that this destructive state wasoriginally created by the child so that it could survive,physically and/or psychologically. It is an extremeform of defense or coping mechanism. Since it cameinto existence to protect the survival of the child, itsgreatest fear (and hence source of resistance) lies in theconviction that you, the therapist, are out to eliminate it,to destroy its existence. Through transference you areperceived by the alter as an abuser. No wonder therapists who do seek that end (including religious exorcists), will be strenously resisted in every way possible.Such personalities are usually quite alarmed if thetherapist suggests that he is seeking to fuse the personality. To the secondary alters this means their execution.As one pu t it, "Are you going to grind us all up into agoulash?" We seek to achieve an integration with ourpatients, but this is not the same thing as a fusion into aoneness. Every person has a need for survival, so alsodo alters (who are part-persons).The first rule for the therapist is never to make an

enemy of the malevolent personality-or any of theothers. It is wise not to have favorites, even though itmay be difficult to like some of the personalities. Building relationship, communication, understanding, andtrust with each of the alters as far as possible is tremendously important. Attempts to eliminate a destructivepersonality by suggestion often result in the appearanceof an even more malevolent entity, loaded with thesame unresolved rage plus additional anger and distrustat the therapist 's hostility toward it.When an aggresive "Maralou" and a mild, affectionate ''Lynne'' personality were fused by suggestionsmade under hypnosis, Lynne disappeared. However,two weeks later another M-L split occurred as "Medusa" and "Love." The differing characters of these per-

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sonalities were well represented by the names they gavethemselves.When one of us (JGW), who was a consultant onthe Hillside Strangler case, gave Steve (the murdering,rapist personality) recognition and credit for beingintelligent, it ceased threatening him, became cooperative, and revealed just which girls he had killed an dwhich ones his cousin Angelo Buono had killed. Thisconfession was a significant revelation in solving thecase (Watkins, 1984).We must go ou t of our way to convey our belief to

the angry alter that it came originally to protect thechild, and we give it praise and recognition for thisaccomplishment. We seek at all times to discover andsatisfy the needs of each personality and to show it howthose needs can still be met while changing its behaviortoward the patient. We encourage it to initiate cooperative integration with other states rather than retreat intopathological dissociation and isolation. By helping themalevolent alter to meet its ow n needs we undercut itsdestructiveness toward the main personality.

A patient of mine (HHW) had a very toughunderlying personality called "Ramblin' Rose." Ramblin' Rose was a bartender in a small western town anddeeply resented that the patient was getting a collegeeducation, declaring that "She has no business here."

When confronted with her early appearance tosave the patient, Ramblin' Rose replied, "Of course, Ihad to come out. She couldn't save herself." I said,"Then if you came to save her, you must love her." Theinterpretation completely devastated Ramblin' Rose'stough-guy role. She became almost incoherent. Thisundermining of her defensive structure was the beginning of a new, cooperative an d less destructive involvement in the treatment on her part. She now couldbecome protective in a more constructive way, asillustrated by the following week's session. The patientcame this hour complaining, "What are you doing tome! I went to a bar last weekend to get drunk an dRamblin' didn't come out. I just sa t ther bawlin' like ababy!"I hypnotized her and asked Ramblin' Rose for an

explanation. She replied, "Aw, don't worry, I waswatching. If she had been in trouble, I would have comeout. I just decided she has to learn to be responSible forher own behavior." In fact the patient did stop gettingdrunk; and she did become more responsible.Sometimes the malevolent alter will inflict pain on

the primary personality because, '1f I don't hurt her theworld will hurt her more." This belief may havestemmed from a punitive parent whose discipline wasmore sadistic than corrective. Such an alter representsan introjection of the abuser. A cruel internal alter continues the punishments the patient suffered duringchildhood by a cruel external parental abuser.One must be careful about manipulating destruc-

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tive personalities because it is very easy to lose theirslowly developing feelings of trust. Sometimes, however, one must take that chance. We had secured theagreement of a suicidal multiple personality disorderpatient to stay overnight as an inpatient at theuniversity's health service. Shortly afterward a malevolent alter emerged an d phone4 us to say that it was incontrol. It planned to take the patient out of the hospitalgo home, and commit suicide. We asked to talk with onof the more constructive personalities and requestedthat it remain out until the next morning. It did so. Thenext morning the suicidal personality awakened in asomewhat more constructive mood, wondering why itwas still in the hospital.

Our goal is not the elimination of the malevolentpersonality, but the controlled release of its anger and itintegration back into the personality as a good citizenamong cooperating bu t covert ego states. We havefound that abreactions are the best procedures for accomplishing this, and we have described elsewhere thetactics for initiating and working-through therapeuticabreactions (Watkins, in press: Watkins and Watkins,1978). However, simply activating the angry state andhaving it directly release its anger does not seem to bethe most effective tactic.Originally, the anger was created in the mainpersonality by the abuse heaped upon it, with which itcould not cope. Accordingly, i t repressed that anger andpain into a dissociated secondary state that was createdfor that purpose. Once having accomplished this maneuver, the main personality becomes free of the pain

and anger. This mechaism is illustrated in the followingconversation (Watkins and Johnson, 1982) recordedbetween a primary personality and a malevolent alter:Mary, '1 have hate. I've learned to hate because of thepain I've gone through."Rhonda: ''Well what pain have you gone through?"

Mary: "The pain of ridicule an d teasing andcriticism and failure. It's all been on me. But then Iturned it around, an d I turned it on you."Rhonda, the original main personality, had escaped the"pain" by dissociating it into Mary. She can no longereven remember experiencing it herself and cannotunderstand why Mary is angry with her.

For best results the dissociative process should bereversed. The malevolent state must be induced torelease its anger through the internal boundary back intothe primary personality, and the primary one must beinduced to accept it, and, through an abreaction, releaseit outward to the external world. This procedure isdifficult to do since the original personality could nothandle that rage in the first place and dissociated it.Now, however, in alliance with the therapeutic self(Watkins, 1978) of a constructive practitioner, andwithout the original abuser present, it often can acceptand express the anger.

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The problem with the malevolent personality ishe rage as its life blood. As one alter putto the primary personality, '1 have to hurt you. If II wouldn' t exist." The trick (i.e., the crucial) is to convince the alter that it will"family of self' and be an

and contributing member of thatWe promise each alter that we will not try to kill it

It can "die" if it wants to (and some do),an important but covertstate within the family of self, no longer isolatedis uaually very suspicious and disbeg of such statements at first since it may have end the opposite attitude with earlier therapists.h alters often protest to the therapist, "You're tryingget rid of me."In time, it comes to believe us. Our relationship

It becomes cooperative and no longerour therapeutic efforts. We seek to be itsand angry alters have had few friendsbrunt of rejection bothand without. On the surface they are scornfulry child fromthey yearn for acceptance andhow to gain that throughtive rather than destructive behavior. This isdo when the patient must cope withand punitive family members in the real life

If possible, it is most beneficial to convert thec


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Hilgard, E.R. (1977; revised edition, 1986). DIVIDED CONSCIOUSNESS; MULTIPLE CONTROLS IN HUMAN THOUGHTANDACTION. New York: Wiley.Kluft, R.P. (1984). Treatment of multiple personality disorder. In Braun, B.G. (ed.), SYMPOSIUM ON MULTIPLE PERSONALITY,PSYCHIATRIC CLINCS OF NORTH AMERICA. 7,9-29.Kluft, RP . (1985). The natural history of multiple personality disorder. In Kluft, RP . (Ed.),CHILDHOOD ANTECEDENTS OF MULTIPLEPERSONALITY. Washington, D.C.: American Psychiatric Press.Kluft, R.P. (1987). An update on multiple personality disorder. HOSPITAL AND COMMUNITY PSYCHIATRY, 363-373.Putnam, F.w. (1984). The psychophysiologic investigation of multiple personality disorder. In Braun, B.c. (ed.), SYMPOSIUM ON MULTIPLE PERSONALITY, PSYCHIATRIC CLINICS OF NORTH AMERICA..1, 171-193.Putnam, F.W., Guroff, J.J., Silberman, E.K., Barban, L., & Post, RW. (1986). The Cliniad Phenomenology of Multiple Personlity Disorder .JOURNAL OF CLINICAL PSYCHIATRY, 285-293.Ross, C.A., Norton, G.R, & Wozney, K (1987). Multiple Personality Disorder: Analysis of 236 Cases . In Braun, B.G. (Ed.), DISSOCIATIVE DISORDERS: 1987, Chicago: Rush.Schultz, R, Braun, B.G., & Kluft, R.P. (1985, October). Creativity and the Imaginary Companion Phenomenon: Prevalence and Phenomenol-ogy in MPD. Paper presented at the SECOND INTERNATIONAL CONFERENCE ON MULTIPLE PERSONALITY/DISSOCIATIVESTATES.Watkins, J.G. (1984), The Bianchi (L.A. Hillside Strangler) azse:Sociopath or Multiple Personality? INTERNATIONAL JOURNAL OFCLINICAL AND EXPERIMENTAL HYPNOSIS. g 67-101.Watkins, J.G. (in press). Abreactive techniques. In VOLUME II. HYPNOANAL YTIC TECHNIQUES; THE PRACTICE OF CLINICALHYPNOSIS., New York: Irvington Publishers.Watkins, J.G., an d Johnson, RJ . (1982). WE, THE DIVIDED SELF. New York: Irvington Publishers.Watkins, J.G., an d Watkins, H.H. (speakers). (1978) (Cassette recording). Ne w York: Psychotherapy Tape Library.Watkins, J.G., an d Watkins, H.H. (1979). The Theory and Practice of Ego-State Therapy. In H. Grayson (Ed.), SHORT -TERM APPROACHES TO PSYCHOTHERAPY, (pp. 176-220). New York: National Institute for the Psychoterapies an d Human Sciences Press.Watkins, J.G. , an d Watkins, H.H. (1979-80). Ego states and hidden observers. JOURNAL OF ALTERED STATES OF CONSCIOUSNESS5,3-18.Watkins, J.G., an d Watkins, H.H. (1980) I.Ego-states and hidden observers. II , The woman in black and the lady in white (cassette recording and transcript), New York: Jeffrey Norton.Watkins, J.G., and Watkins, H.H. (1981). Ego-state therapy. In RJ. Corsini (Ed.), HANDBOOK OF INNOVATIVEPSYCHOTHERAPIES (pp 252-270. New York: John Wiley &Sons.Watkins, J.G., an d Watkins, H.H. (1982). Ego -state therapy. In L.E. Abt & I.R. Stuart (eds.), THE NEWER THERAPIES: A SOURCEBOOK (pp . 127-155). New York: Van Nostrand Reinhgold.Watkins, J.G., and Watkins, H.H. (1984). Hazards to the Therapist in the Tretltment of Multiple Personalities. In Braun, B.G. (Ed.),SYMPOSIUM ON MULTIPLE PERSONALITY, THE PSYCHIATRIC CLINICS OF NORTH AMERICA, 7, 111-119.

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Management of Malevolent Ego States

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