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  Now I noticed at least one voice engaged in active thinking—the voice that most often talked when I turned inside out in Lynn’s office. The voice muttering “It’s better without Keith. I really need a lot of private time right now” concerned me when I thought about ways to remind Keith that he loved me. The voice mumbling “I’m bad. Nobody could really like me” when Lynn rescheduled the appointment made me certain that it was time to get out of therapy.

  But I was sad at the prospect of not seeing Lynn anymore. She seemed more like a real person than had any of the previous therapists, and I felt guilty about turning inside out in her office. I had just been playing that game to release pressure and had deceived her into thinking I had multiple personalities.

  This would be my last visit. If I explained to Lynn what was going on, she’d understand that I really didn’t need to see a social worker. She could give the time to somebody who needed it.

  I told Lynn my real name so that I could help her understand the game.

  “Today’s the last day,” I said, “and I’m just going to talk to you as the person I really am.” I tried to be earnest enough so that she’d know I was serious, but light enough so that she’d feel free to tell me to stop that nonsense.

  “You ought to feel really special,” I said extravagantly. “I hardly ever tell anyone that my name is Renee. But if you’re going to understand the game I play, you’ve got to separate me from the voice I made up that said to call her Jo.”

  Lynn nodded, but seemed more cautious than she had the other times I had seen her. “I do feel flattered that you’ve told me your name, Renee,” she said, without even smiling. “Could you talk in the Jo voice for me, just so that I’ll know the difference?”

  I sighed. This was going to be complicated to explain. “I heard that voice say that nobody would ever like her,” I said. “It’s as though she felt bad that you canceled the appointment and then she got mad because she felt bad and so I just can’t make it happen now. But it’s just a game anyway.”

  “Renee,” Lynn said gently, “this is a little confusing, but I think that you’re describing a lot more than a voice there.”

  I groaned. I was trying to own up to the game I had been playing, and Lynn was taking this as more evidence for her diagnosis.

  “How could a voice feel bad or get mad?” Lynn asked.

  “It was just me pretending to feel that way,” I said, feeling flustered. I couldn’t believe that Lynn was even bothering to argue. What did she care? “I know everything that’s happened in here, but sometimes I just feel too lazy to stop it.” The more I tried to explain, the more confused and humiliated I felt. “It’s kind of a habit,” I finished, feeling as lame as I sounded. That wasn’t what I meant but I didn’t know what to say. “I screwed up!” I said. “I’m sorry.”

  “It’s OK, Renee, you haven’t done anything wrong,” Lynn said. “Whatever it is, we can handle it together, but I think that’s going to take longer than this session. So, for right now, why don’t you not worry about quitting therapy and tell me more about the voices. It really is OK to tell me about it.”

  “It’s just a game,” I said again, but I felt less frightened. Lynn really wanted to help me, and she wasn’t upset with me for having wasted her time. “I sort of relax and let my inside out.”

  “And when your inside comes out, it speaks in a different voice that you made up.”

  I nodded a couple of times and gritted my teeth, grateful that Lynn was beginning to understand. I was still a little afraid that she might get angry and throw me out of her office.

  “The voices must go with characters,” Lynn said. “Don’t worry about how it sounds. Just tell me about the characters that you’ve been presenting to me.”

  “Well, there’s the one who introduced herself the first day and told you about her father’s death. That’s Jo. That part is always so serious! She really likes Steve and is glad that Keith wants a divorce.

  “And there’s a little girl whose name is Missy. She knows that it’s bad to come outside, but somehow in here it occasionally happens. She likes it when you touch her, but she’s afraid to talk.

  “And there’s one more. You’ve talked to one other voice: Joan Frances. She thinks that her mother is great. When Jo says that her father was great, Joan Frances thinks she has to stick up for her mom.

  “I don’t know why I say those things, but when I do, I feel really bad and then tell you the truth. I love Keith, not Steve. Nancy and Ray never really felt like parents to me.”

  Lynn smiled at me. “That’s why so much of what I said in here seemed contradictory,” I said, smiling a little. “I really didn’t mean to lie.”

  “I know, sweetie,” Lynn said. “I don’t think that what you were doing counts as lying.” Her eyes were kind and soft, but her body rocked in concentration.

  “Help me understand how the game is played,” Lynn said. “Where does Renee go when Missy comes out?”

  “I go inside, but I’m nearby,” I said. “It’s like I’m at the back of a theatre, watching a play. But if I get bored watching, without really meaning to, I leave the theatre and go inside another room in my head. Sometimes a question or some sort of warning bell calls me out. When I come back, I know what happened, but I don’t feel like I really did anything.”

  Lynn listened thoughtfully. She acted as though she believed me. “That voice you call Jo, why can’t she remember like you? Why does she seem so confused and uncertain?”

  I felt triumphant and finally able to make my point. “It’s because she’s just a voice, or like a character in a play. I’m the real person.”

  “In your game,” Lynn said, “do the voices look like anything?”

  “Missy is an ugly little girl, about five. She has fuzzy brown hair and skinny arms and legs. Jo is an ugly twenty-five-year-old. Jo has brown, stringy hair and a long face, like this,” I said, mimicking Jo’s expression, “and she’d spend her life in shirts and jeans unless I came out to get dressed in the morning. Joan Frances wants to look like her pretty mother and sister, so she likes to put on makeup and always sits up straight.

  “And, of course, you can see me. I’m pretty and younger than Jo and Joan Frances—I’m only nineteen—and my hair is soft and wavy. Surely you can see the difference.”

  “OK, Renee, let me tell you what I think,” Lynn said. “I know that you want to believe that you have control over all of this, but I really don’t think you do. You get scared about what the others do because sometimes you’ve been forced to realize that you don’t have control.

  “I do feel really special that you’re letting me close enough to help you with all of this. And I’m going to have to ask you to trust me even a little more. What you want is to never again worry about losing control to one of those voices, right?”

  “Right,” I said, but felt trembly, scared of what Lynn might do now that she knew the truth.

  “You’ve told me about the game,” she said. “Now let me play. Our time is up for today, but next time, just relax and let the ‘inside out’ if you can. And try to stay close enough to watch without interfering with anything. I think you might be surprised at what you learn.”

  “I need to think about it,” I said as I got up to leave.

  “But you’ll come back?” Lynn asked.

  “Sure, I guess so,” I said.

  “I think you are a very remarkable woman,” she said.

  I left Lynn’s office that day unable to sort it all out. I knew that Lynn was likely to be furious when she fully comprehended the game, but I felt intrigued too. I had never had the chance before to understand why the pressure built up inside or why I got suicidal without wanting to die. Lynn seemed confident. I guess I did trust her a little.

  At the start of the next session, Lynn met me in the waiting room and put her arm around my shoulders as we walked back to her office. Once inside, she said, “I’m tremendously proud of you for giving this a try. Do you think you can re
lax and let Jo out?”

  “I guess so,” I said, took a deep breath, and slipped in.

  Jo found herself face to face with a sympathetic but determined therapist. “I’m sorry that we missed an appointment, Jo,” Lynn said, “but I’m glad to see you.”

  Jo said nothing, uncomfortable with Lynn’s new directness.

  “Did anyone ever call you Missy?” Lynn asked.

  “My father,” Jo said with surprise.

  “How about Joan Frances?”

  “That’s what my mother calls me,” Jo answered and wondered if Lynn had had a conversation with her mother.

  “Does the name Renee mean anything to you?” Lynn asked.

  Jo blushed and wondered where Lynn had heard that name. She had never told her mother about Renee Montecalm. “That’s a name I made up myself,” Jo said.

  When Jo was nine years old, she decided that she wanted to spend her life hiding away and writing books. “I knew that my books would have a limited audience and wouldn’t earn enough to support me, so I decided that I’d write for money as well, but I didn’t want to publish that under my own name. Renee Montecalm is my pseudonym, but I actually imagined her as more.

  “Now it seems childish,” Jo explained to Lynn, “but at the time I thought commercial writing would damage my credibility as a scholar. The ‘Renee’ that I dreamed of was bright, witty, social. It was kind of a flashy veneer to protect the real me from dealing with the public.”

  “It’s not at all childish,” Lynn said. “What you’ve described is exactly what’s happened.”

  Jo looked at her, silent but afraid.

  “You’ve got Renee and Missy and Joan Frances too, who all help protect you,” Lynn said reassuringly. “You’re so unsure of things because these personalities handle a lot of your life when you’re not looking.”

  Jo looked squarely back at Lynn. “That’s crazy,” she said.

  “No, not at all,” Lynn responded, “it’s very creative. I’ll prove it to you. Tell me what was going on during the hour before you came in here.”

  Jo felt the blankness stab at her, the familiar lack of answer and accompanying panic. The room swam before her and she closed her eyes.

  Joan Frances, who lacked Jo’s amnesia, twisted the panic into cool anger. She glared briefly at Lynn before she responded with a slight smile of derision.

  “I spent the last hour before my appointment ordering supplies for the Biology Department. It was requisition number four-oh-oh-seven. The order included a dozen dissection kits, some tubing, and more animals than I care to list. I left the office, got my car out of the parking lot, and drove here. I parked at a meter in front of the building. And if I don’t leave on time, I’ll get a ticket.”

  “I am impressed,” Lynn said. “You have good recall, Joan Frances.”

  She smiled thinly in return. I gave Joan Frances’s anger a wide berth as I struggled back out. I needed to talk to Lynn for a minute before I left.

  “Wow,” I said, grinning sheepishly at her.

  “Renee,” Lynn said, “so what do you think now?”

  “I guess maybe you’re right,” I said. “Maybe they do think independently of me, but I think it’s happening because you let it. If you just said stop, it would.”

  “No, sweetie, it’s not like that,” Lynn said. “You don’t have that control and neither do I, but together you and I will find a way to figure it out.”

  “I’m not so sure about that,” I said with a flash of insight. “Joan Frances doesn’t even have as much control as I have, but she’s pretty sure that her mother will make this stop.”

  Joan Frances got to the car before she got a ticket and hurried back to the apartment. She was filled with a sense of dread. Her mother would be furious if she knew about this. But if Joan Frances tried to conceal it, her mother would find it out. She always did. And, either way, her mother might disown her.

  That evening, Joan Frances called her mother. She mentioned offhandedly that she was seeing a therapist, and her mother reacted as she had feared.

  “That’s a waste of time,” Nancy said. Her anger was clear even through the phone lines. “Look at me. You don’t see me running to a therapist with every little crisis. My stepfather abused me—you’ve seen the scars on my back from the beatings—and I came through it without a therapist.

  “Your father treated me like dirt, but I still took care of him when he was dying. I see really sick people every day, and I’ve learned from them that I can’t go around feeling sorry for myself. You’re a very lucky girl, and it’s time you realized that. It’s time you stood on your own two feet.”

  Joan Frances told her mother that she was right and shakily called the clinic’s after-hours number. She left a message for Lynn to call. “I can’t see you anymore,” Joan Frances said when Lynn returned the call. “There’s nothing wrong with me. I have to stop feeling sorry for myself.”

  Lynn said, “I’m here. I want to see you. I can help you. I think that you should come in for your appointment.”

  CASE NOTE    May 1, 1981

  Ms. Casey has become quite dependent on evening phone calls. “Missy,” who is afraid to speak when she’s in my office, is the most frequent caller, although I usually end the conversation by finding “Jo” on the line, and sometimes I talk to these two along with “Renee” and “Joan Frances” during a single phone call. I am continually surprised that I have no difficulty in distinguishing which one I am talking to.

  There is a problem, however, in getting to me through the hospital on-call service. I am particularly concerned because of my upcoming trip to New Orleans. I have made arrangements to let the hospital know of my whereabouts each night so that I can be notified of any calls, even though I am told that when Ms. Casey reaches the on-call number, she says that I am not to be bothered. It’s as though she expects to find me at the other end of the line and feels confused that I’m not there.

  I feel strongly that it is important to remain accessible even during my trip. I am not sure that she really understands when I am away and when I am in town.

  “Missy” is not in touch with outside reality. She doesn’t seem to have the resources to tell the on-call operator anything more than her first name. I find the next day only that “Missy” called for me, that this “very confused person” hung up when asked for further information, such as her last name or whether this was an emergency. The problem with the on-call operator is compounded by the fact that Missy refers to herself not in the first person but, rather, as “you,” as though she has no sense of identity aside from the references provided by other people. For example, she tells the on-call operator “You want to talk to your friend Lynn.”

  When she does get through (with, I suspect, the helpful intervention of another personality), and I call her back, Missy tells me secrets that she won’t yet talk about in the office. She has told me that she did not want to grow up to be a woman like her mother, so she “prayed to God every night to make you a boy. Until God makes you a boy, you’re not going to get any bigger.”

  Missy is giving me information that is vital in my understanding of this patient; e.g., she was supposed to have been a boy, and is told by her mommy and daddy that she remembers things all wrong. She tells me that she’s not allowed (by the other personalities?) to talk to people face to face. She also hints that there are many things she knows that the “other girls inside” consider dangerous to tell. If she is unable to reach me, she may withdraw completely.

  —

  I COULDN’T UNDERSTAND WHY Lynn would ruin her vacation by staying in touch, but she did, three times via telephone from New Orleans. At our first session after she returned, I told her that she was making a mistake. She was only encouraging Jo and Missy to think that they had someone to depend on. I knew it was good for them to learn that people couldn’t always be available—other people had their own lives and their own problems. If Jo and Missy didn’t understand that by now, it was time they fi
gured it out.

  Even Jo told Lynn that she didn’t have to be so nice. “People can’t be there just because I need them,” Jo said. “My father taught me that! My parents were separated when I was in high school. My father insisted that I live with my mother, and then he refused to give me his phone number or tell me where he lived. No one has ever been there constantly for me. I don’t know why you’re doing this.”

  6.

  DIARY    May 7, 1981

  I will keep case notes concerning Ms. Casey’s progress as required by the unit, but feel more free to explore my personal and clinical reactions in writings that are less subject to the scrutiny of others. I don’t think I’m being paranoid. I feel like a pioneer, but I also am beginning to feel misunderstood.

  Some of my colleagues and even my supervisor seem concerned about the amount of attention I’m giving Jo. Yesterday, during the staff’s case-reporting session, Harry suggested that Jo might be manipulating me by telling me secrets over the telephone. I think he was surprised that I bristled in response. I told him that I knew she was becoming dependent on me. And I explained (rather testily, I admit) that Jo came into my office with her pathological dependency; I didn’t create it. I said that it was only natural that the dependency would be expressed if I was providing adequate treatment.

  Later, in private, I apologized to him; I had reacted defensively at the meeting because I had been informed that some of the staff “didn’t believe in MPD.” I told Harry that I wanted his approval for any unorthodox treatment techniques and that I wanted to talk with him about the case, but didn’t want it open for peer review right now. I need to be able to explore treatment ideas without defending the diagnosis at every turn.

  I am well aware that Jo, in all of her various parts, is testing me to see if I’ll come through with what I promise. Despite Harry’s concern, I am being very careful not to promise more than I can give.