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One Crime, Multiple Personalities



In 1997, Billy Milligan was arrested and charged with kidnapping, robbing and raping multiple women in Ohio, USA. He was the first person to successfully use multiple personality disorder as an insanity defence in the courtroom. The policemen reported evidence of him 'talking to different people at different times' when he was arrested. One of the rape victims even told the lead investigator that Milligan had a German accent, even though he was born and raised in the United States. Another victim commented that 'He was sometimes so nice to me, that I would consider dating him in a different circumstance." All of these supporting evidence which pointed to his dissociative identity led the judge to resolve the plea to insanity in his favour. Even though this was a rare instance, the case of Billy Milligan raised an essential question regarding the 'alter-in-control' insanity plea raised by people with multiple personalities. They claim that since the 'alter-personality' was in charge of their behaviour during the offence, the other 'innocent personalities' should not suffer the consequences and should be set free. For hundreds of years, these claims have raised serious medico-legal challenges for forensic psychiatrists, mental health clinicians, legal professionals, the media, and the public. In this blog post, I will argue against the prevailing criminal laws for people with multiple personality disorder.

Dissociative Identity Disorders, also known as 'Multiple Personality Disorder' is a common mental condition where two or more personality states are present in one individual. Each of these personalities might have a distinct name, personal history and characteristics. Recent studies and research has shown a high correlation between crime and dissociative states of personality. A study that tracked 21 reported DID cases found that 47% of men and 35% of women reported engaging in criminal activity, including 19% of men and 7% of women who committed homicide (Farrell 2011). With such a high statistical correlation between crime and the incidence of DID, it becomes imperative to have clearly set laws which define punishments for people with multiple personalities. 

However, this task is monumental. This is mainly because the diagnosis of dissociative identity itself is tricky. The DSM-4 does not state the symptoms of the disorder very clearly, which leads to an invalid and unreliable diagnosis. The high comorbidity of dissociative disorders with borderline personality disorders, depression, anxiety and Post- Traumatic-Stress disorders (PTSD) makes the diagnosis more complicated and confusing (Kluft 2010). 

According to the section 84 of the Indian Penal Code, a legally insane person who is incapable of knowing the nature and degree of the offence he committed cannot be held guilty for it (Ramamurthy 2019). It is imperative to understand that the wording used here is 'legally insane' and not 'medically insane' as it is inclusive other psychiatric disorders like schizophrenia, paranoia, bipolarity or mania. However, the question of the inclusion of dissociative personality disorder (DID) in "legally insane" is highly debatable and controversial. Some experts believe that only if the alter personality was in control of their actions and behaviour at the time of the offence, then they can be classified as criminally insane and won't be acquitted (Saks 1991). However, it is contentious and challenging to determine if a person is in control of their behaviour if there is so medical or scientific way to measure it. To this end, many courts throughout the world have introduced specific insanity tests. If either one of the personalities of the person with DID passes this test, then he/she can be regarded as 'legally insane'. Even though these tests foster better validity of the diagnosis, the question of how these insanity tests can be standardised among different cultures remains unanswered.

It is equally important to assess ethical and practical considerations which play along when people with multiple personalities are held guilty and sent to prisons or other types of correctional facilities. Such people fail to get the medications or medical support they need and hence, their condition often deteriorates (British Medical Journal). The presence of risk factors like improper nutrition available, social shame associated with prison, victimisation by fellow inmates and isolation from friends and family often make the mental and physical condition of a person worse. Even after their release, they must be given social support and proper mental health services for them to function normally and adjust back to their daily lives. 

According to my understanding of the disorder, I believe that psychiatrist's evaluation should be primarily considered as this disorder has multiple biopsychosocial consequences which a non-trained mental health professional may not be able to understand. To this end, I would suggest the establishment of a psychiatric evaluation committee which can recommend and psycho-educate the council on matters which involve the prosecution of psychiatric patients. This committee can be given advisory jurisdiction over the cases where the defendant raises the insanity plea for any psychiatric disorders (which is not limited to DID). Apart from advising on the status of the insanity plea, this committee could also ensure the provision of additional support factors and adequate mental health services for psychiatric patients who are sent to correctional facilities. 

Hence, it can be reasonably concluded that the current legislature on criminal proceedings for people with dissociative identity disorders needs to respect ethical considerations as well as, serve justice to the society.  




References

Farrell, H. M. (2011). Dissociative identity disorder: No excuse for criminal activity. Current Psychiatry, 10(6), 33.
Kluft, R. P. (2010). Multiple personality disorder'. Stress consequences: Mental, neuropsychological and socioeconomic, 60.
Mentally Ill Offenders In Prison. (1985). British Medical Journal (Clinical Research Edition), 290(6466), 447-447. Retrieved from www.jstor.org/stable/29518202
Ramamurthy, P., Chathoth, V., & Thilakan, P. (2019). How does India decide insanity pleas? A review of high court judgments in the past decade. Indian journal of psychological medicine, 41(2), 150.
Saks, E. R. (1991). Multiple personality disorder and criminal responsibility. UC Davis L. Rev., 25, 383.

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