Treating Children When a Parent is Diagnosed with Multiple Personality Disorder

What We Learned From James, Lillian’s Son 

James was ten years old when he was first referred to me by the psychiatrist who was treating his mother Lillian, for multiple personality disorder.

A large boy who looked more like a 12-year-old, James was a timid and soft-spoken child. James' shyness, along with his larger size and the fact that he was soiling himself daily in school, made him an easy target for bullies. As a result, James had little contact with others outside of his family - a family immersed in the dynamics of multiplicity.

During the four years I treated James he lived at home, in foster care, and a residential treatment facility for children before relocating to the home of his grandparents in Ohio. Each new relocation took its toll.

As James’ therapist, I was involved with treatment at many levels. While James was my primary patient, much of our time together included close family members, as well Lillian’s various personalities who interacted regularly with James and revealed themselves during our therapy sessions. During the time James came to see me for treatment, none of Lillian's personalities were aware of one another, so my role also included bridging the information gaps between multiple relationships that were evolving between James and various personalities.

Gaining the trust of James, his family and the personalities was essential to my role in providing James with advocacy in order to protect his mental and physical well-being.

Virtually all of James' family members treated Lillian's personalities as separate individuals. James, his father Jimmy, and his older two brothers all became accustomed to Lillian's disappearances, her various personalities, her suicide attempts and her revolving door hospitalizations.

Different relationships with different personalities

James had different relationships with each of Lillian's personalities depending on their age, temperament, and degrees of caring toward him. Some personalities, like Sarah Ann and Rachel Ann, were teenagers. Others, like Amy and Mary, were younger than James and were playmates. Lee and Esther were much older and acted as mentors or disciplinarians.

At various sessions, Amy, Esther, Lee and of course, Lillian were invited to attend therapy with James. Needless to say, these sessions were fascinating. Most importantly they provided James with a mechanism for communicating his needs and fears within the safety of a therapeutic relationship while at the same time providing me, as the therapist, with the opportunity to become a trusted adviser to the personalities themselves. Therapy became a bridge between the realities of James' life within the family and the outside world.

During my time as James’ therapist, I worked to safeguard James in the world beyond his family. I advocated for James with the committee for special education, kept contact with his caseworker from social services, served as a mandated reporter, met regularly with the clinical director and James' teachers at his residential school and coordinated his care with Lillian’s psychiatrist.

Building Resilience

Therapy sessions focused on enhancing resiliency by teaching James strategies for managing his relationship with Lillian’s various personalities.

These strategies also served the purpose of helping James develop a sense of mastery over the elements in his world.

At one point I encouraged James to write a guide for children who lived with a multiple personality disordered parent. Working on this guide served as a mechanism for helping James to step outside of his family by becoming an adviser to other children in similar circumstances.

Acting on this suggestion James shared the following: "I can't remember how I found out about the personalities. Dr. Alabiso says it might be good to let other children know how they could find out if their mom or dad had personalities. First see if your mom has got any kind of hobby that you never seen before like carving or sewing. Then, when she is doing it ask her, her name. Try to find out if she has a different accent. The hobby part I learned from Lee. It's good to talk to personalities so they will trust you." (Written by James, 11/20/81)

Later James related, "When my mom was going to the hospital a lot dad wanted me to know the family had a problem and I'm part of the family. He said he needed me to know why mom didn't know we already ate sometimes and why she was gone without telling anyone where she was going. He said everyone should try to help Mom. When she left and disappeared he would go and look for her.”

Having been bullied by peers, James found refuge in playing with Amy - Lillian's six-year-old personality. James recalled meeting Amy when he was in first grade and remembers that as he grew older, Amy stayed the same age. During therapy sessions James and Amy often conversed while coloring together. They spoke of their experiences in coping with Lillian's other personalities.

Lillian’s Concerns and Frustrations

Family therapy sessions helped James to develop the ability to manage his relationship with his mother. Lillian’s journal entries reveal her concerns and frustrations.

Journal entry, 1978: "I love James but I can see things he does wrong and I want to really hurt him just once so he'd know he had to listen. What if I hit him and couldn't stop?”

Journal entry, December 1, 1979: "James saw Dr. Alabiso today. They asked me to join them. James got out a note he kept in a secret hiding place in Dr. Alabiso's office. He said he was afraid Mom was going to be kidnapped. He is afraid that when I go away that I won't come back... Dr. Alabiso suggested a secret signal between us that when he is scared he will twiddle his thumbs.”

Protecting James

As James’ therapist, my role included protecting James, which sometimes meant managing the intentions of Lillian’s hostile and dangerous personalities. When Rose, Lillian’s most disturbed and dangerous personality, attempted to kill James in the name of protecting him, the decision was made to arrange for out-of-home placement for James.

While it was a difficult decision to remove James from his family home, my responsibility was to keep James safe from Rose. I also recommended that Lillian not be allowed to visit James unless his father was present, a challenging requirement as Jimmy made his living as a long-distance truck driver and was often away from home.

Lillian's journal entry on 1/10/82 demonstrates her understanding of the danger: "He (Dr. Alabiso) is telling James that Rose can’t be trusted - that she's not like Esther - someone who James knew was mad when she was mad. Dr. Alabiso said to James that Rose does not like kids."

Shortly after Rose threatened his life, James was placed in a residential treatment school for children, for his protection.

I met with Lillian to explain that I recommended James return home only after Rose was integrated, a process that took many months to occur. We also scheduled therapy sessions with James, Lillian and Jimmy to ensure James’ safety after his return.

Danger of Breaking Down

The therapist must be alert for signs that a child's resilience is in danger of breaking down. At one point during his therapy, James began to claim that he too had other personalities - a warning sign that his resiliency was fading. James became angry and confused and began to draw pictures of burning buildings, signaling that his ability to control his anger was approaching a breaking point. While in the residential school, James began to skip classes and put his fist through a window, cutting his arm and hand - all behaviors that could have led to a psychiatric hospitalization.

Unfortunately, when James needed support the most, his family relocated to another state due to his father's employment.

The support system that James needed to bolster his resiliency was broken. Separated from his mother who was hospitalized, his father who was constantly on the road, older siblings who had moved out of the family home and his therapist, James was sent to live with his paternal grandparents in Ohio. 

The Complex Role of the Therapist

My time spent with James taught me invaluable lessons about the role of the therapist who works with the child of a parent with multiple personality disorder. It’s a complex, multi-faceted role. The therapist needs to be therapeutically agile, acting as both an individual therapist and a family therapist. The therapist has to gain the trust of the personalities who are interacting with the child. The therapist needs to establish a safe and reliable therapeutic environment in which the therapist serves as a bridge between the child and the parent’s personalities. As well, the therapist works to secure connections between the child and the world outside of multiplicity. Ultimately, it’s a role that calls for advocacy and serves to protect the child's mental and physical well-being.