The Twentieth Century 325multiple personality, and his paper, written at the end of the
nineteenth century and during the first several decades of
the twentieth century, provided examples of both. His case
history of Miss Beauchamp is cited as a classic example of
multiple personality (Prince, 1975). The essential diagnostic
feature of multiple personality is the apparent existence in the
individual of two or more distinct personalities that alternate
in dominance. Each personality appears complex and inte-
grated, has memories unique to that personality, and displays
patterns of behavior, emotional expression, and ways of in-
teracting socially that differentiate it from the other personal-
ities. The personalities seem often to be opposites; a retiring,
highly moralistic person may on occasion behave in a self-
advertising and outrageously amoral manner. The transition
from one to another of the personalities is often sudden and
associated with apparent psychosocial stress. The original
personality has no knowledge of the others, whereas the sub-
personalities are usually aware of each other.
The problem with all cases of multiple personality that
have been highly publicized is that the extra personalities are
initially brought forth by the psychotherapist, usually while
the client is in a hypnotic trance and therefore suggestible.
The names of the additional personalities may be suggested
by the therapist. It is unclear whether each personality pre-
existed or was constructed and shaped by the clinician.
Spanos (1986) suggested that multiple personality is not
a disease, but a role learned in response to situations in
which this behavior is useful and considered appropriate. He
attributes the astonishing increase in frequency of reported
multiple personalities to the increased use by mental health
professionals who encourage patients to adopt this role. We
note that the motivation to present multiple personality is par-
ticularly intense when a client has been accused of a serious
crime and hopes to transfer responsibility for the crime to an
alleged alternate personality.
THE TWENTIETH CENTURY
The twentieth century saw the development of major changes
in the treatment of psychopathology and in the understanding
of the biological and psychological processes that are invol-
ved in its development.
Treatment Approaches
One significant development involved attempts to treat the
patient by direct intervention in the structure and function of
the nervous system. Brain surgery was among the first of
these interventions.
Brain SurgeryIn 1890, Swiss psychiatrist G. Burkhardt, assuming that the
causes of specific kinds of abnormal behavior were located
in particular parts of the brain, removed parts of the cortex in
patients with hallucinations and other symptoms, hoping to
eliminate symptoms. He claimed that the treatment improved
patients, but he came under criticism from his colleagues
and abandoned the technique (Goldstein, 1950). Others per-
formed surgery on mental patients, including an Estonian
neurosurgeon who, in 1900, cut the connections between the
frontal and parietal lobes, but with no detectable improve-
ment in patient condition (Valenstein, 1986).
Not until the 1930s did brain surgery occur to any signifi-
cant extent. In 1935, two Portuguese physicians, Egas Moniz
and Almeida Lima, performed an operation using a procedure
that came to be known as prefrontal lobotomy (Moniz, 1937).
Walter Freeman and James Watts (1948) later modified the
method in the United States. By 1950, more than 5,000
lobotomies had been performed in the United States. An esti-
mated tens of thousands of such operations were performed
worldwide between 1948 and 1952. The surgery was per-
formed initially on patients with chronic schizophrenia, but
was later extended to patients with other psychiatric disor-
ders, as well as to criminals (Valenstein, 1986) and to hyper-
active children (Masson, 1986). In the course of time other
related forms of brain surgery such as transorbital lobotomy,
and cingulotomy were developed.
These procedures, collectively referred to as “psy-
chosurgery,” became the focus of scientific and ethical
controversy. Ethical concerns centered on the irreversible
damage done to the psychological functioning of the patient
and extended as far as the actual circumstances under which
the operations were performed, sometimes in the physician’s
office on an outpatient basis, often by physicians who were
not qualified neurosurgeons. On one occasion Freeman
administered a transorbital lobotomy in a motel room, first
anesthetizing the patient by administering electroconvul-
sive treatment (ECT) to produce coma (Valenstein, 1986).
Freeman ultimately lost his surgical privileges at a California
hospital following the death of a patient during surgery. By
that time, psychosurgery was already in decline, partly be-
cause of the extreme ethical questions raised, and partly
because emerging new medications provided safer, more ef-
fective and humane alternatives.Fever TherapiesIn 1887, Austrian psychiatrist Julius Wagner-Jauregg pub-
lished a paper on the therapeutic effects of fever on cases of