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In the late 1970s, a young man named Billy Milligan, became a controversial public figure for being the first person in U.S. history, who was found not guilty of committed several crimes (including kidnapping, armed robbery, and raping three women), by reason of insanity, due to his suffering from multiple personality disorder. From the first moment Milligan was arrested and indicted, the results of his mental examinations made his face appearing on the covers of magazines and the front pages of newspapers. In the process of preparing his defense, the psychiatrists found that Milligan manifested as many as twenty-four distinct personalities, a rare case of extreme multiple personality disorder. Milligans attorneys presented an insanity defense, claiming that two of his twenty-four different personalities are the ones who committed the crimes and that is without Milligans knowledge. Milligan was the first person whose legal representatives successfully presented insanity defense based on the diagnosis of multiple personality disorder. Although there was no awareness nor attention given to this disorder back in the 1970s, Milligans case raised a number of difficult psychiatric and legal questions. What is multiple personality disorder? How can the psychiatrists diagnose and what is the ways of treatment to the patients? How can this disorder be treated in the courtroom? What is the criminal justice responsibility in multiple personality cases?
Multiple personality disorder (MPD) nowadays known as Dissociative identity disorder (DID), DSM-5 (American Psychiatric Association 2013) has described DID as a perturbation of identity characterized by two or several separated personality states and this disorder is the result of extreme trauma or abuse. Population studies (in Europe, North America, Turkey) have found that DID is a comparatively common psychiatric disorder, manifest in about 1%-3% of the population in general.
Dissociative identity disorder may consider as a hard illness to diagnose. The psychiatrists may observe or the patient may inform that there are certain syndromes are present, that these personality states illustrate discontinuity in sense of self, followed by changes in behavior, emotion, memory, consciousness, perception, realization, sensorimotor functioning and frequent gaps in recalling everyday events, which lead to forgetting important personal information of every single personality living inside the patient. The diagnose will be done with a complete physical examination and medical history. Although no laboratory tests can diagnose DID medically, different diagnostic tests such as X-rays, CT scans, or MRIs might be used to abolish medication side effects or physical illness. If the physician did not find any physical illness, the patient may be transfer to a psychiatrist or psychologist, psychiatric social worker. They will do a clinical interview to be familiar with the full picture of the patients experiences in the past and current functioning.
The treatments goals for DID are to reduce symptoms, guarantee the safety of the patient and those around him or her, and reconnect the various personalities into one incorporated, well-functioning identity. Moreover, treatment aims to help the patient safely process painful memories and expand new coping skills, life skills, relationships and recall optimal functioning. The best treatment process relies on the patient, the temper of any identifiable triggers, and the seriousness of the symptoms. There are many ways of treatment for DID but most likely the treatment will be by psychotherapy, which is the main treatment for DID. There is no medication to treat dissociative identity disorders themselves. However, patients with DID, particularly those with anxiety or/and depression, might benefit from treatment with anti-anxiety or antidepressant medications. Patients with DID usually respond well to treatment. Nonetheless, the treatment of DID can be painstaking and a long process. This usually starts by empowering and identifying all the personalities to help them integrate into a fully functioning whole.
When it comes to the courts treatment of DID, courts have different ways of dealing with such a disorder. First is freedom with mandated periodic treatment, when the person with DID is not guilty by reason of insanity and that is only if the personality that was in charge at the time of the criminal act was not the host personality, which is the real personality, the experts will look at the mental state of the personality and if the personality did not know what she/he was doing, the host personality will be criminally insane, taking Billy Milligan as an example. Second, prison or forced confinement in a mental institution, the person with DID is guilty as charged if the host personality and the alters committed the crime with the help of each other. Giving an example of Thomas Lee Bonneys case, he was arrested for committing a murder of his own daughter by shooting her 27 times. His defense attorneys claimed that Bonney suffers from multiple personality disorder and one of his personality, an evil personality, was in control of his body at the time of the shooting act. After deliberations weather Bonney criminally insane or not, he was found guilty of first-degree murder for shooting his daughter.
I shall argue, the test of insanity to find whether the host personality was in charge or aware of the action or not, is not enough. As it seems to show DID is a complicated, different level of insanity the person who suffers from this disorder might legally consider insane just because he was not conscious in the criminal act and that does not necessarily mean the host person is crazy. Courts must clearly state how the insanity defense applies to patients with DID. They must put a standard different from the few courts that have considered this disorder. Instead of that, a person with DID should be found irresponsible if any of the disconnected alter did not know about or participate in the crime. The courts choice should not be completely separated from metaphysical questions of the personal identity. Courts in this case, have to decide which person did the crime and if that person is responsible before they determine whether they can punish that person or not. Thus, it is necessary at first to fully understand the nature of alter personalities and that only happens if the patient himself understand the personalities he has. As I previously mentioned, treatment would help the person who has DID to safely recall the painful memories that he suffered and lead him to face this illness. Also, to help with developing coping skills, and to merge the different personalities into one functional person.
It is true, that there is a guilty alter. But the question is what about the other innocent alters? A guilty persons mental state is a very necessary element of all the crimes. In order to be charged of a particular crime, there must be proof that the person who committed the crime have the required state of mind when the crime was committed. Those states are intentional, knowing, reckless, and negligent. But in DIDs case the person cannot have an intentional state if he/she does not have knowledge of his/he act. Of course, this means that a guilty person will be out there freely. But the criminal law system prefers to not punish a guilty person over punishing an innocent person and punishment of innocent people is seen as one of the worst kinds of injustice. From William Blackstones perspective it is better to let ten guilty people go free than to punish one innocent person . Thus, it is the criminal justices commitment to not punish innocent people requires them to not find multiples to be responsible. That is why, the experts who testify the insanity should and must examine each alters, not only the host or the alter that was in charge at the time of the criminal act.
Dissociative identity disorder raises number of issues, courts and psychiatrists should start acting in developing the ways of dealing with it. To reach the goals of achieving justice, achieving security in society, and legal stability, these are the main goals of the criminal justice system which lead only to one thing that is to punish only the blameworthy. Also, to give the DID patients the needed treatment and to make them feel whole again as a one independent identity.
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