Dissociative Identity Disorder Cases: Famous and Amazing
There are many famous dissociative identity disorder (DID) cases, probably because people are so fascinated by the disorder. While DID is rare, detailed reports of DID have existed since the 18th century. Famous cases of dissociative identity disorder have been featured on the Oprah Winfrey show, in books and have been seen in criminal trials. (See Real Dissociative Identity Disorder Stories and Videos and Celebrities and Famous People with DID )
A Dissociative Identity Disorder Case in Court: Billy Milligan
In 1977, Billy Milligan was arrested for kidnapping, robbing and raping three women around Ohio State University. After being arrested, he saw a psychiatrist who diagnosed him with DID (See how DID is diagnosed ). It was argued in court that Milligan wasn't guilty as, at the time of the crimes, two other personalities were in control -- Ragen, a Yugoslavian man and Adalana, a lesbian ( Understanding Dissociative Identity Disorder Alters ).
The jury agreed with the defense and Milligan became the first person ever to be found not guilty due to dissociative identity disorder . Milligan was confined to a mental hospital until 1988 when psychiatrists felt that all the personalities had melded together.
An upcoming film, The Crowded Room , will be based on his famous case of dissociative identity disorder.
Famous Cases of DID: Kim Noble
Kim Noble was born in 1960 and, from a young age, was physically abused. As a teenager, she suffered many mental problems and overdosed several times.
It wasn't until her 20s that other personalities began to appear. "Julie" was a very destructive personality that ran Noble's van into a bunch of parked cars. "Hayley," another personality, was involved in a pedophile ring.
In 1995, Noble received a DID diagnosis and has been getting psychiatric help ever since. It's not known how many personalities Noble has as she goes through four or five personalities a day, but it is thought to be around 100. "Patricia" is Noble's most dominant personality and she is a calm and confident woman.
Noble (as Patricia) and her daughter appeared on The Oprah Winfrey Show in 2010. In 2012, she published a book about her experiences: All of Me: How I Learned to Live with the Many Personalities Sharing My Body.
A Dissociative Disorder Case Study
In 2005, a dissociative identity disorder case study of a woman named "Kathy" (not her real name) was published in Journal of the Islamic Medical Association of North America.
Kathy's traumas began when she was three. At that age, she would have terrible nightmares during which her parents would often entertain leaving the child to cry for hours before falling asleep only to awake a few hours later frightened and screaming.
At age four, Kathy found her father in bed with a five-year-old neighbor. At that time, her father convinced her to join in on the sexual activity. Kathy felt guilty and cried for several hours only stopping once she began to attribute what had happened to an alternate personality, Pat. Kathy would insist on being called Pat during the abuse the father committed for the next five years.
At age nine, Kathy's mother discovered Kathy and her father in bed together. Her mother insisted on the child sleeping in her bed every night thereafter leading to a sexual relationship with the child. Kathy could not accept this and created another identity, Vera, who continued the relationship for another five years.
At age 14, Kathy was raped by her father's best friend and began calling herself Debbie. At that time, she became very depressed and mute and was admitted to a hospital (read why some go to dissociative identity (DID) treatment centers ).
According to the case study, "she showed a mixture of depression, dissociation and trance-like symptoms, with irritability and extensive manipulation which caused confusion and frustration among the hospital staff."
At age 18, Kathy became very attached to her boyfriend but her parents forbid her to see him. Kathy then ran away from home to a new town. However, she could not find a job and her need of money drove her to prostitution. She began to call herself Nancy at this point.
The alternate personality Debbie rejected Nancy and forced her to overdose on sleeping pills. It was then that Kathy was admitted to a psychiatric hospital and given the diagnosis of multiple personality disorder (as it was known at the time). (More on the history of dissociative identity disorder here.)
Kathy is now 29, married, and continues to struggle with mental health problems including dissociative episodes.
APA Reference Tracy, N. (2022, January 4). Dissociative Identity Disorder Cases: Famous and Amazing, HealthyPlace. Retrieved on 2023, November 21 from https://www.healthyplace.com/abuse/dissociative-identity-disorder/dissociative-identity-disorder-cases-famous-and-amazing
Medically reviewed by Harry Croft, MD
Video on Childhood Sexual Abuse and DID
Treatment of child sexual abuse and sexual abuse recovery, abusers induce multiple miscarriages after victim gets pregnant, my personal cutting story, what is verbal abuse, self-harm in adults: self-injury not limited to teens, how do you tell someone you self-injure.
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Dissociative Identity Disorders in Korea: Two Recent Cases
Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea.
Although dissociative identity disorder (DID), the most severe of the dissociative disorders, has retained its own diagnostic entity since its introduction in the DSM-III, cases of DID are rarely seen in South and East Asia, likely due to the higher prevalence of possession disorder. We report two patients with DID who were recently admitted to our inpatient psychiatric unit and demonstrated distinct transitions to several identities. Their diagnoses were confirmed through a structured interview for dissociative disorders and possible differential diagnoses were ruled out by psychological, neuroimaging, and laboratory tests. The rapid transition to a Westernized, individualized society along with an increase in child abuse, might contribute to an increase in DID, previously under-diagnosed in this region.
Dissociative identity disorder (DID) is rarely reported in Asia. It is so uncommon that some authors have speculated that DID is a culture-bound syndrome primarily found within Euro-American cultures. 1 In fact, DID does appear in Asian countries, though its prevalence is much lower than that in Western countries. The prevalence of DID in the clinical population ranges 1 to 5% in North America, Europe, and Turkey, 2 but only 0 to 0.5% in India, Bangladesh, and China. 3 , 4 , 5 Only two case studies of DID have been reported in academic journals of South Korea. 6 , 7 Here, we report two recent cases of Korean patients who experienced multiple childhood traumas and displayed several alternate identities.
A 20-year-old Korean male was transferred from the military hospital and admitted to an intensive psychiatric ward due to complaints of episodic violent behaviors toward fellow soldiers and changes in character and personality, which began at the onset of his military service two months earlier. Four months prior to admission, the patients returned home after six years of study abroad. His parents reported that the patient's behaviors differed from those of a visit one year prior, when he was shy and timid. After his return to Korea, the man appeared very confident and told his parents he would fare well in military service. In addition, he was very forgetful, often losing his belongings. The patient was on one occasion found by police in an alley far from his house, and he could not remember how he got there. Shortly after these incidents, the patient reported to the army for mandatory military service. At training camp, he seemed passionate and outgoing, quite different from his usual identity.
On several occasions, he only spoke English, which is not his native language. One incident involved a violent assault, in which the man injured another soldier. Alarmed by his emergent psychiatric problems, the military sent him to a psychiatric unit, where the staffs observed several different personalities. After one week, the military psychiatric staff decided to send him to a specialized civilian psychiatric hospital.
During the course of one month of hospitalization, seven alters were observed. The main host was very quiet and intimidated. John, an arrogant and uncooperative personality speaking only English, appeared on several occasions during the interviews. Another violent alter appeared twice when the patient thought of his childhood. During the transition to the violent alter, the patient broke a window with his fist and tried to hit his physician. Another alter named Cho appeared once. Cho introduced himself as the patient's story watcher and teller. Cho insisted he knew the host and other alters very well. He spoke both Korean and English, depicting the host as a "pity thing," the violent as a "thirsty killer," and the arrogant alter, John, as a "shit." While talking, Cho produced automatic writing with his left hand, of which he did not seem to be aware. We observed an additional three alters including a five-year-old boy, a mother-like personality, and a "metro-sexual swagger" alter. Cho was aware of the transition processes and he emphasized that there were more identities, although they were not observed during the hospitalization.
Laboratory tests including drug use screening and brain computerized tomography (CT) scan indicated no abnormalities of the host ego. Electrocardiogram (ECG) indicated "normal sinus rhythm." Interestingly, when retested as an alter, "Cho", the ECG indicated a "right bundle branch block." Cognitive impairment or malingering was ruled out through a full psychological battery, and no other psychiatric comorbidities were found. A structured clinical interview for DSM-IV dissociative disorder (SCID-D) confirmed the current diagnosis of DID.
In the SCID-D, the patient scored the severe category in amnesia, depersonalization, derealization, and identity confusion and identity alteration with additional fulfillment of mood change, age regression, and internal voice. He demonstrated the existence of alternate personalities with distinct names, ages, and character traits. Each alter took complete control of the patient's behavior, resulting in such occurrences as finding himself in a strange place, losing or discovering possessions in spots different from where he remembered leaving them, and speaking English. The patient also reported total amnesia during the domination of an alter.
The patient reported repeated childhood physical and emotional abuse and neglect by his parents. Each time he accessed these memories, he became agitated and transitioned to a violent alter. The treatment focused on stabilization, including affect regulation, grounding exercise and imagery techniques. Treatment made him more grounded and relaxed and decreased the frequency of alter emergence, particularly the violent alter. After one month of hospitalization, the patient was discharged.
A 19-year-old female was admitted to our inpatient unit with episodic irritability and violence. These episodes first began one year prior to admission, after a severe conflict with her mother. The patient became agitated and panicked, with sweating and tremors; she then showed violent behaviors, including the destruction of household items and furniture. Thereafter, when she quarreled with others or her mother, the patient frequently experienced unrestrained irritability and violent behaviors. The patient did not recall these emotional episodes or behaviors.
During the course of hospitalization, four alters, including the host, were observed. Whenever the patient talked about childhood experiences, a 15-year-old girl named "Eunju" appeared. Before transitions, the patient experienced severe sweating and tremors. She did not recognize others, including her therapist and did not allow others near her. The patient was emotionally irritable and sobbed for nearly two hours in a typical sitting. She displayed a withdrawn posture before the transition back to her original identity, and had not recollection of her after. The patient also had a five-year-old-girl alter with childish speech. This alter began to appear relatively late during hospitalization, when the frequency of appearances of the violent alter gradually diminished. This young alter whines for her mother to come and comfort her at night. Another alter was a 30-year old woman with controlling nature. This alter was aware of the other identities, including the host ego, and expressed deep sympathy for their immaturity and suffering. Nevertheless, there were no signs of direct communication among the alters.
Laboratory tests including drug use screening and brain CT scan indicated no abnormalities of the host ego. Cognitive impairment or malingering was ruled out from a full psychological battery, and the patient met the criteria for diagnosis panic disorder with agoraphobia. The patient met diagnostic criteria of SCID-D, her symptoms falling into the severe category in amnesia, depersonalization, derealization, identity confusion and identity alteration with additional satisfaction of mood change and age regression. The patient met the diagnostic criteria for dissociative identity disorder in DSM-IV. She had distinct alternate personalities, each of which took complete control of her behavior, experienced episodes of severe amnesia during the domination of an alter, and was not influenced by either substance or any general medical condition.
The patient was a survivor of childhood emotional abuse and neglect from both parents. She remembered a time when she was left home alone at without food for several days. Treatment focused on stabilization, using affect management skills training and ego state therapy. The frequency of transitions to other altars gradually decreased, as did feelings of helplessness. The patient was discharged after the irritable alter remained absent for two continuous weeks.
Both patients' diagnosed were confirmed through a structured interview (SCD-D), and both patients demonstrated transitions to other personalities during one month of hospitalization. Full psychological assessments, brain imaging studies, and laboratory tests were performed to rule out any influence of medical conditions, substances, or other psychiatric disorders. The two previously reported case reports of DID in Korea did not confirm the diagnosis through a structured interview, and in one case, alters were identified during hypnosis. 6 , 7 Thus, our cases have better diagnostic validity than the previously reported cases in Korea. Additionally, our first patient demonstrated physiological changes during the alteration of identity, including horizontal eye movements, automatic hand writing with the opposite hand, and abnormal ECG findings.
Not surprisingly, both patients experienced repeated childhood physical abuse and neglect. Their violent alters appeared only when childhood traumatic event was remembered or recalled through emotional triggers, suggesting the role of the alter as a part of the ego created to deal with unacceptable experiences with overwhelming emotions on behalf of the original ego. 8
During the last 15 years, no other of DID cases were diagnosed at our inpatient psychiatric unit prior to these two cases in 2014. Previously, the lower frequency of DID in Asia was believed to be due to a relatively higher prevalence of possession disorder, reflecting a strong cultural influence of polytheism and shamanism in the region. 1 It is also likely that, in Korea, patients with possession disorder are more frequently seen in psychiatric practices, and as such, clinicians are less familiar with DID. 9 Increased public awareness of mental illness and decreased psychological barriers to seeking psychiatric help 10 might have contributed to recent increase in DID cases.
In sum, the recent social transition of Asian countries from traditionalism and collectivism toward Westernization and individualism, increasing awareness of dissociative phenomena in Korea, and possibly increasing recognition of child abuse and neglect recognition of child abuse and neglect 11 might influence the increasing rates of DID. Mental health professionals from Asian regions who have rarely encountered patients with DID require specialized training to recognize and manage this chronic, often misdiagnosed, and difficult to treat condition.
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Review article, dissociative identity disorder and the law: guilty or not guilty.
- 1 Department of Psychology, Canadian University Dubai, Dubai, United Arab Emirates
- 2 Department of Early Childhood Education and Care, Oslo Metropolitan University, Oslo, Norway
Dissociative identity disorder (DID) is a dissociative disorder that gained a significant rise in the past few decades. There has been less than 50 DID cases recorded between 1922 and 1972, while 20,000 cases are recorded by 1990. Therefore, it becomes of great significant to assess the various concepts related to DID to further understand the disorder. The current review has a goal of understanding whether an individual suffering from DID is legally responsible for the committed crime, and whether or not he or she can be considered competent to stand trial. These two questions are to be raised in understanding DID, by first shedding a light on the nature of the disorder and second by examining the past legal case examples. Despite the very nature of the disorder is characterized by dissociative amnesia and the fact that the host personality may have limited or no contact with the alters, there is no consensus within the legal system whether the DID patients should be responsible for their actions. Further to that, courts generally deny the insanity claims for DID suffering patients. In conclusion, more studies in the field are suggested to incorporate primary data into research, as the extensive reliance on secondary data forces us to believe the conclusions that were previously made, and no opportunity to verify those conclusions is present.
Dissociative identity disorder (DID) is classified by DSM-V as “presence of two or more distinct identities or personality states, each with its own patterns of perceiving, thinking, and relating to the environment and the self” where “at least two of these identities or personality states recurrently take control of the person’s behavior” ( American Psychiatric Association, 2013 ). The fact that the DID patients’ multiple identities not only perform differently on personality tests, but also on IQ tests was long since discovered by the predecessor studies in 1950s. It has been also shown that the identities may also differ in age, gender, preferences, and even handwriting (see Figure 1 ; Thigpen and Cleckley, 1954 ). Such gigantic difference between the identities and the fact that some identities may not be aware of others’ doings raises the question of legal responsibility of a person suffering from DID should a law be violated by one of the identities within him.
Figure 1. The letter sent to the psychiatrists involved in the case of Chris Sizemore by the patient, Mrs. Sizemore. The sudden change in the handwriting can be observed in the last paragraph of the letter.
Another legal issue concerned with DID is competence to stand trial. As minor identities may “come out” during the process of the trial, and the dominant identity may have no awareness and/or memory of the actions and events that took place under control of minor identities, it becomes unclear of whether the person under trials is able to completely understand all the happenings during the trials. If that is the case, the question may arise as of person’s competency to stand the trial, not even the legal liabilities that he must incur given the crimes committed. To this aim, the initial attempt will be the examination of the clinical and neuropsychological characteristics of DID by the screening of recent studies that contributed to a better understanding of the disorder. This will provide a foundation for the framework that would in its turn attempt to define whether DID should be in all instances considered a valid reason for the person’s incompetence to stand trial or the person’s legal non-liability for the crime. Subsequently, the current review will examine the existing cases in which the DID patients had to face trials and the sentences they were or were not given. The paper will also attempt to formulate the conditions under which such patients are proven insane, based on the above-mentioned cases. The paper will then analyze the existing materials covering the encounters of DID patients who have committed crimes with the courts and the law enforcement system in general. A further emphasis will be given to the criteria that the courts use when dealing with issue of calling an DID patient to the legal liability. The extent to which the existing laws protecting criminals with mental issues can be applied particularly to DID patients will constitute a part in the current paper. Based on the review performed, the comparison will be made on how well the suggested framework aligns with the current tendencies in law enforcement on sentencing or not sentencing patients suffering from DID.
Current review will only focus on the analysis of secondary data due to the rarity of legal cases concerning DID patients. Therefore, the amount of cases will be too limited to find distinctive patterns in the features of DID symptoms, and the framework suggested will not be as comprehensive, hence, it will not be able to provide reasonable suggestions to the users. Despite using the secondary data as a source of information for the analysis, it must be noticed that the amount of trials involving DID is still very limited. Therefore, another focus of the paper will be on finding the traits in the symptoms of the DID patients not violating the law and hence not standing a trial.
Dissociative Phenomenology and Dissociative Identity
Dissociative identity disorder, formerly called multiple personality disorder, was first classified in DSM-III-R ( American Psychiatric Association, 1987 ). As it has been seen more commonly in the past 20 years among patients, DID remained as an Axis I disorder in DSM-IV-TR with the renaming of multiple personality disorder to DID ( American Psychiatric Association, 2000 ). Both in DSM-III-R and DSM-IV-TR the diagnostic criteria were laud and clear for that times, but in the context of the current information regarding DID they seem quite sketchy. Unsurprisingly, in 1999, in a survey of board certified psychiatrists in the United States only 21% reported that there is an evidence for DID’s scientific validity ( Gharaibeh, 2009 ). Apparently, the lack of consensus was not an issue in the legal system but also among the mental health care professionals as well. In an effort to overcome this issue, in 2013, American Psychological Association Work Group has proposed slight changes in the diagnostic criteria for DSM-5, in which “the symptoms of disruption of identity may be reported as well as observed, and that gaps in the recall of events may occur for everyday and not just traumatic events” ( American Psychiatric Association, 2013 ). Furthermore, as time progressed, more scientific evidence is being provided by the recent studies scrutinizing the experience of dissociation and its manifestation as DID, leaving little room for any clinical disagreement.
Current definition of dissociation refers to a detachment from one’s sensory experiences, thoughts, feelings, sense of identity or personal history, that occur in reaction to a traumatic experience ( Pollock et al., 2017 ). Dialectical in nature, on one hand it serves as a coping strategy that allows individuals to distance themselves from a trauma that may otherwise be unbearable, on the other it prevents an integration between the trauma and personal narrative, which is a must for the recovery. By manifesting itself in various forms, in depersonalization and derealization an individual has difficulty in processing information about the self and the reality at the present time. In dissociative amnesia the traumatic memory is reserved away from one’s memories and can only be recalled by dissociative flashbacks. In DID, the traumatic information is stored in different parts of the identity, so called alters. Among the others DID manifests the most complex clinical portrait, that is predisposed by prolonged childhood trauma ( Ozturk and Sar, 2016 ). According to Loewenstein and Putnam (1990) , the stories of male and female patients had a root from the past where 60% of females had causes related to sexual abuse whereas, 17% of male patients suffered from violence or rape in childhood. In description, DID is characterized by the coexistence of the host and alter identities that are fragmented from each other with limited or no communication. A recent theory identified 13 alter identities, namely, the apparently natural, helper, persecutor, child, gay/lesbian, messenger, abuser (perpetrator), leader (guide, wise), objective (neutral), reversible, talented, suicidal-depressive and potent female, all of which have varying awareness by the host personality. Furthermore, three forms of awareness of the personalities by the host personality were identified: (1) mutual amnesic, (2) unidirectional amnesic, and (3) co-conscious. Although there might be a co-conscious awareness between an alter and the host personality, the degree of recognition between the alter personalities is quite limited. This is due to the fact that each alter contains varying degrees of awareness of the traumatic memories and experiences his or her subjective reality accordingly, resulting in a dissociative barrier ( Ozturk and Sar, 2016 ; Ozturk, 2021 ).
Several comorbidities are reported among patients with DID, including major depression, somatization disorder and borderline personality disorders, which are among the most commons. Auditory hallucinations, dissociative amnesia, flashbacks and childhood abuse/neglect are other features seen in patients with DID, which are overlapping with the symptoms of other conditions such as PTSD and Schizophrenia. Particularly, Schizophrenia and DID overlap in psychotic symptoms, Schneiderian first rank symptoms in particular, as well as in their traumatic antecedents. However, the differentiation between DID and schizophrenia can be made along several criteria. For instance, poor reality testing and insight of the disorder are observed in schizophrenia, whereas both reality testing and insight remains intact in DID. Unlike schizophrenia, visual hallucinations are quite rare among patients with DID. Schizophrenia is characterized by loose associations with inappropriate affect, however, DID patients manifest conjectural associations with appropriate affect. Still, many patients receive different diagnoses because of lack of awareness of this condition ( Tschoke et al., 2011 ). As for the etiopathology of DID very little is known and the studies in this field are just a few. However, there is recent evidence demonstrating neuroanatomical differences between DID patients and health controls. The research revealed that cortical and subcortical volumes in the hippocampus, amygdala, parietal structures that are responsible for perception and personal awareness as well as frontal structures, which is responsible for movement execution and fear learning were significantly smaller in DID patients. Furthermore, in DID patients larger white matter tracts were detected, which is involved in information communication between somatosensory association areas, basal ganglia, and the precuneus. It was concluded that such neuroanatomical differences might be responsible for some of the symptoms of DID such as host dissociation and neurotic defense mechanisms ( Blihar et al., 2020 ). Apparently, more studies need to be conducted in order to reveal the etiopathology of DID for the recognition of the disorder both legally and clinically.
Despite the complexity of its nature, there are promising treatment models proposed by various professionals, who have a long-standing experience with DID patients (e.g., Kluft, 1999 ; Pollock et al., 2017 ). Trauma Based Alliance Model Therapy (TBAMT), for instance, provides a detailed theoretical framework in conceptualizing DID and proposes an evidence-based psychotherapy intervention techniques with a detailed psychotherapy protocol. By proposing an eclectic approach, TBAMT highlights the critical importance of forming therapeutic alliance with the host and all of the other alter personalities. This is for the fusion of each of the alter with the host personality so as to neutralize the traumatic experience by integrating the trauma related autobiographical memories of the alters, which the degree and the content varies for each of them ( Ozturk, 2021 ).
As can be concluded, within the last decade, the scientific advancements in understanding of DID has improved significantly. Integration of the recent clinical findings in the legal system would contribute to a consensus regarding whether claims for NGRI-DID can be accepted. Still, there is an incomprehensible challenge in the forensic assessment of DID patients claiming for the reason of insanity for crimes based on a dissociated state ( Farrell, 2011a ).
Dissociative Identity Disorder in the Courtroom
In order to understand the complexities of DID and its relationship with law, one should start the examination by starting from its history ( Table 1 ). The first encounter with DID has taken its place in 1815, when a patient, Mary Reynolds, who, according to Rayna L. Rogers, “might sleep eighteen hours a day and then awaken with large discrepancies in her memory, penmanship and disposition” ( Rogers, 1991 ). The first case of DID that has attracted significant public attention was that of Chris Sizemore, a story of a female patient diagnosed with DID, presented in 1954 by Thigpen and Cleckley. In this case, patient suffering from DID had two very distinctive identities, named by the psychiatrists as Eve White and Eve Black. In Eve’s case, Eve White could be considered as a dominant personality, as Eve Black’s appearances were relatively rare prior to the beginning of the treatment. Eve White and Eve Black had remarkably different behavioral traits. Furthermore, Eve White had no memories of actions done by Eve Black, while Eve Black had a complete awareness of Eve White’s expriences. Thigpen and Cleckley (1954) discussed an event, recalled only by Eve Black and the patient’s relatives, on how Eve committed a prohibited act, specifically she was “wandering through the woods to play with the children of a tenant farmer.” In this particular act, Eve Black only appeared to commit the wrongdoing and let Eve White take on the punishment that followed. The case of Eve becomes an argument that would support protecting DID patients from facing the legal liability for the illegal actions committed. If the person (in the above case Eve White) has no memory of the wrongdoing that cannot be explained by the regular forgetfulness, she may not be considered liable for the crime. However, it must be noticed that while Eve White must be considered innocent, Eve Black could not be exempted from the liability, if we consider two of them as separate identities. Eve Black herself is a sane personality that could appreciate the wrongdoing and the consequences that would follow. During the years ahead, this method was proposed and adopted with some courts that have faced DID patients. These courts have classified the distinct identities of DID patient as separate identities, and therefore sentenced only one or several identities that were in a way or other committing to a crime. Steinberg et al. (1993) examined the results of DID patients facing trials and have demonstrated the reasoning applied by the Supreme Court of Hawaii, that deals with DID suspects in a way that “each identity may or may not be criminally responsible for its acts, each must be examined under the ALI (American Law Institute) Modal Penal Code competency test.”
Table 1. Court cases where DID was claimed as a basis for NGRI.
This method of judging several identities, however, contradicts itself. On one hand, only the personality that has committed a crime will be sentenced to a punishment. However, as all the identities in case of DID share one common physical body including the innocent ones, are subject to the punishment given by the court. Saks (1995) has proposed a theory of general non-responsibility of individuals with DID. Saks’s theory treats identities within an DID patient as separate identities, and therefore claims that courts must not hold DID patients responsible for the crimes unless all the identities existing within a person are involved in a crime, meaning they were either committing a crime or could have interfered and prevent the crime but did not. As per Saks, such theory would correlate with the system of jurisprudence that holds that “ten guilty people should go free rather than one innocent person be jailed” ( Sinnott-Armstrong and Behnke, 2000 ). The research conducted by Farrell (2011a) suggests that courts in general do not accept NGRI-DID (not guilty by reason of insanity due to DID) as a justification for non-responsibility. The reasoning for the rejection of DID as a reason is based on several factors. First one is based on the reason that “scientific evidence failed to meet reliability standards.” Second, abnormal states of consciousness is an insufficient allegation to correspond to a mental disorder that could meet the criteria of M’Naghten Rules (i.e., defendants did not know the nature or quality of their actions or, if they did know, they did not know that what they were doing was wrong) ( Farrell, 2011b ). In response to this, Nakic and Thomas (2012) reported that the British courts that are more indulgent to the diagnosis of DID have used several approaches to assess criminal responsibilities of DID cases. The alter in-control approach is used to assess the mental state of the alter identity, who was in control when the crime was committed. In the each-alter approach all of the alter identities are assessed for their criminal responsibility. Finally, the host approach examines whether the host personality was unable to evaluate the nature and quality of the conduct committed by the alter. The utilization of the aforementioned approaches will be illustrated in some of the following case examples.
Getting back to the courtrooms, the case of Juanita Maxwell that took place in Florida in 1979 was considered as one of the most unusual at that time. Maxwell was working as a hotel maid and was arrested because of the blood on her shoes and a scratch. Apparently, one of the hotel guests, Inez Kelley, was brutally beaten, bitten, and choked to death. Later on, the murderer was diagnosed with DID where she had six identities. In addition, the identity who committed the crime was called Wanda Weston that was asked to stand trial. People were impressed because Juanita was a soft woman with calm behavior, however, Wanda seemed to be more aggressive and violent ( McLeod, 1991 ). Furthermore, she was even laughing when admitted that she killed a person. As she was a woman suffering from DID, the court found her non-guilty and sent the patient to a psychiatric hospital. In 1988, Maxwella was arrested again for committing two bank robberies and claimed that it happened due to not receiving a proper treatment. By that time, Maxwell had seven identities, but Wanda was still pinned as the culprit of the crimes. Finally, she pleaded “no contest” and was released from prison for time served ( Levy et al., 2002 ).
The case of Thomas Huskey that took a place in Knoxville, brought up a broader question of whether DID is a valid defense for the crime. The man viciously killed four women after forcing them to have sex. In addition, he audiotaped himself with a loud and angry voice during the murder. Lawyers claimed that even though Huskey may have been speaking, the words were coming from an alter ego that took control of his actions ( Haliman, 2015 ). Moreover, the defense attorneys claimed that the tape of other personality so-called Kyle is not a proof that Thomas – a soft-spoken and calm man – committed any crime. Prosecutors asked an expert, Dr. Herbert Spiegel, to evaluate the presence of multiple identities and how each could impact the actions made by one human. Interestingly, the vocabulary, tone, and manner of talking were completely different in both identities when the professionals agreed it was the voice of the same person. One of the psychiatrists claimed Huskey was just a good actor and had an incredible ability to manipulate people ( Appalachian Unsolved, 2017 ). The court had only two options: whether find him guilty of the crime or non-guilty due to DID and signs of insanity. No matter how attorneys tried to defend Huskey, the majority of jurors came to a conclusion that he needs punishment for his crimes, and he is currently serving a 64-year sentence.
Speaking of “alter approach” (the approach under which the courts decide on person’ responsibility based on sanity or insanity of the alter in control during the crime), many courts have judged based on these criteria. In case of Grimsley, a woman accused of drunk driving and pleading for NGRI-DID, the court have concluded that “there was only one person driving the car and only one person accused of drunken driving. It is immaterial whether she was in one state of consciousness or another, so long as in the personality then controlling her behavior, she was conscious, and her actions were a product of her own volition. The evidence failed to indicate that Jennifer was unconscious or otherwise acting involuntarily” ( Sinnott-Armstrong and Behnke, 2000 ).
A possible reason that can explain the courts’ tendency to reject the NGRI-DID is the social response to the successful defenses based on that reason. The case in 1978, at which the defendant, Billy Milligan, who was a serial rapist, was found innocent for the reason of insanity (NGRI-DID), found an extreme outrage in the society. Since then, it was a very rare phenomenon to see courts accepting DID as a justification for insanity. Undeniably, the social response to DID hinders the objective judgment of DID-diagnosed patients for their legal responsibility. Certain psychiatrists do not believe in the DID at all, and there is a great suspicion over the ease of malingering DID in order to plead for insanity. The reason behind the thinking is the extreme complexity of symptoms that leads to the difficulty in the scientific evaluation of the patient’s disease.
The research conducted by Nakic and Thomas (2012) presents the case of Goering Orndorff, a woman who has killed her husband and altered a crime scene in a way that the scene presented her actions as a self-defense. During the process of the trials, specialists were asked to evaluate her competency to stand the trial due to the existence of dissociative symptoms. Some of the experts have agreed on DID diagnosis being applied to Mrs. Orndorff and presented their opinions during the trial. However, it was later revealed that the crime scene was intentionally altered, and that Mrs. Orndorff has told her cellmate that she attempts to malinger the DID in order to plead for insanity defense. With the account of all these facts, the court has found her guilty and sentenced her to 32 years of imprisonment. The later motions for new hearing proposed by the defense, were rejected by the courts.
Even though the people diagnosed with DID seem as no danger to the society at first, the statistics conducted by clinicians shows that nearly half of the patients had violent behavior ( Webermann and Brand, 2017 ). Since there is a sign of aggressiveness, the probability of committing a crime is relatively high and hard to be prevented due to a dissimilar behavior under each of the identities. At the same time, psychiatrists claimed that criminals tend to malinger DID in order to be defended by the law of insanity ( Saks, 1995 ). However, faking DID is considerably difficult because the person should be able to completely separate characters and fully control the actions and mind over a prolonged time. According to the case of Ms. Moore, there were two identities that acquiesced in the crime and found responsible for their actions. First of all, Billy Joel was a personality that actually terrorized a group of children and even ended up beating one of them to death. Then, there was the other identity so-called Marie Moore that would actually call herself pretending it is Billy with children’s daily instructions. Moreover, she even deflected the police when under suspicion. In this case, Ms. Moore could not be diagnosed with DID because both of her identities knew about the crime and actually took an action. Apparently, she was not mentally stable and could still have some mitigation but her claim of suffering from DID was completely rejected ( Moore, 1988 ).
Nevertheless, people diagnosed with DID can put not only themselves in trouble but also confuse the others around them by an abnormal change of mood and behavior. The case of Mark Peterson took place in Oshkosh in 1990, however, the psychiatrists found a progressive disorder where the number of identities was increasing and even represented changes of age in the majority of them ( Possley, 2014 ). Mark Peterson was a victim of dealing with a woman diagnosed with DID where she agreed to have intercourse with a 29-year-old man. The identity that emerged during that time was 20 years old when the other 6-year-old identity was watching from a different perspective. Later on, Mark was charged and convicted of second-degree sexual assault because it is illegal to have an intercourse with someone who is mentally ill. In addition, at the time of the incident in June woman had 21 identities, when later during the trial in November prosecutors discovered that this number has increased to 46. Even though Peterson was never retried for the crime after the overturned a month later verdict, the case brought up questions about how to deal with DID victims that claim to be assaulted during the presence of one of the identities.
Another cause of concern, as in the case of Peterson, is taking into consideration how to deal not only with DID patients who committed a crime but also how to punish the people who were interacting illegally and harmed one of the identities ( Possley, 2014 ). The action can be done by one identity and it will be considered acceptable when the other identity will look at that as a crime. However, the same human might not remember doing any of these since the switch of the identities happens naturally and the memory of past actions usually do not interfere with one another. Meanwhile, the prosecutors tend to end the trial faster in order not to put the victim in the position of psychological trauma all over again.
Discussion and Analysis
The literature review suggests a general tendency from the courts’ side not to accept the DID propositions and hence exempt the person from the responsibility on the basis of NGRI-DID. The major reasons for the tendency were lack of reliability of scientific methods in diagnosing DID, the possibility of a suspect to malinger DID in such a way that certain specialists will give the desired diagnosis (Ms. Orndorff’s case), the social response to the successful defense based on NGRI-DID, and the immaterial fact of DID, as related to the legal responsibility (the alter in control being sane and competent to stand the trial). Moreover, the case of Maxwell clearly showed that the person can commit the crime again when the society will hardly accept the decision of non-guiltiness. Therefore, the prosecutors tend to find criminals responsible due to the past experience and research done on DID.
The complexity of DID is also supported through the differences in the opinions on the reliability of the tests administered with the purpose of diagnosing DID. It has been suggested by Steinberg that the introduction of Structured Clinical Interview for DSM-III-R (SCID) and the Schedule for Schizophrenia for Affective Disorders and Schizophrenia (SADS) has increased the reliability in diagnosing disorders such as DID ( Steinberg et al., 1993 ). The case of Ms. Orndorff, however, has happened in 2000 and suggests that the diagnostic capabilities in terms of DID were still lacking and hence insufficient to accurately diagnose DID.
As was mentioned before, the courts do have a tendency to deny the NGRI-DID claims for the DID patients that commit crimes. However, it becomes interesting to check on whether similar illnesses, such as epileptic seizures, face the same level of denials in the courts. Epileptic seizures resemble DID in terms of legal responsibility in a way that during a seizure, a person may engage in “actions such as picking at the clothes, trying to remove them, walking about aimlessly, picking up things, or mumbling” ( Farrell, 2011b ). Of greater importance is the fact that “following the seizure, there will be no memory of it” ( Farrell, 2011a ). As the actions performed during a seizure are involuntary, the person is unable to appreciate the actions or the consequences that follow, and has no memory of the events, not explained by the regular forgetfulness, the court should consider the person insane at the moment of committing a crime. Farrell elaborates on three cases of successful defenses on the basis of “non-insane automatism” (the definition under which courts nowadays classify epileptic seizures). In all cases, the courts have declared the defendants not guilty of the crimes, as their actions were involuntary, and the defendants had no memory of the events.
It is interesting in the light of above-mentioned cases to see the drastic difference in the courts’ opinions about the similar illnesses in terms of legal responsibility. In both cases, the defendants have no memory of the actions committed. However, it must also be presented that DID patients generally have an identity within them that was aware of the wrongdoing and also carries the memory of that wrongdoing, while under epileptic seizures there is not a single trace that would suggest that the defendant has a memory of a wrongful conduct. One could also argue that while considering the epilepsy-suffering patient, we are concerned with a single identity that is a subject to a biological illness and therefore, it becomes easy to say that the person’s actions were indeed involuntary, while considering the DID, we are talking about totally different identities with their own mindset within a single individual with a very limited information regarding its etiopathology. It means that the court can be reasonably confident in the reliability of epilepsy truly belonging to an individual, while an DID patient can potentially malinger the illness. Even though a few studies have emerged within the last a few years investigating the neurological correlates of DID, the research in this domain is still in the stage of infancy.
Taking a look at the root causes of the DID, it is found that severe psychological trauma or prolonged abuse in the childhood are the most possible reasons that cause the brain to trigger the self-defense mechanisms and protect itself through the dissociation of identities. As the effect of DID is not happening on its own and is occurring following a severe trauma, it should be considered a mental illness and thus be a sufficient reason for claiming the person to be not guilty by the reason of insanity (NGRI-DID). Moreover, both genders can be exposed to any kind of assault or negative experience in the childhood and the tendency of being diagnosed with DID of those victims is correlated. Both men and women showed similar types of identities and behavior that leads to the conclusion that crimes can be done by anybody regardless of their sex ( O’Boyle, 1993 ). Therefore, the framework of how to justify or punish the person who committed wrongdoings should be the same for both male and female.
Many psychiatrists tend to question whether the person is really suffering from DID or trying to pretend in order to have NGRI-DID. However, involving only one specialist might not be enough as we all are human beings and think subjectively based on our past experience and beliefs. The case of Thomas Huskey was advised by the psychiatrist that already had strong beliefs that the murderer is just a great actor, therefore, he did not attempt to search for the root cause of the behavior that was hard to explain at that time ( Haliman, 2015 ). Moreover, involving a few professionals is no longer enough since the opinion can differ based on individual observation, however, even the final judgment can be affected by groupthink. Based on the case of Ms. Moore, it was easier to find her guilty since both identities were directly involved in the action, so even the presence of other minor identities would not justify her wrongdoings. In particular, she was not even diagnosed with DID during the trial and was found responsible regardless of her mental illness ( Moore, 1988 ).
Regarding the doubts over the reliability of measures for the assessment of DID, there are so far very few mechanisms available to psychiatrists that can be used in an attempt to evaluate patient’s dissociative disorders. It has been found that the long interviews used during the evaluation allow for emerging of different identities present within an individual. The long aspect of the interviews and evaluation also reduce the possibility of patient malingering the diagnosis. Kluft (1999) stated that “simulated DID presents crude manifestations of the disorder, such as stereotypical good/bad identity states and a preoccupation with the circumstances individual hopes to avoid by obtaining an DID diagnosis.” Kluft also suggested that it is difficult for the individual to maintain the voice, set of body gestures, and memory for every personality that he or she is trying to simulate. Hence, it can be suggested that the actual possibility of malingering DID is extremely challenging, and that cases of malingered DID will be very rare compared to correctly diagnosed DID.
Speaking of suggesting the framework for deciding on person’s liability on the basis of DID, the diagnosis has proven itself to be so complex that no universal method can actually be applied. However, there is a set of actions that should be done in order to assess the responsibility for the crime committed. Initially, an evaluation of the patient should be performed by several independent psychiatrists. The DID in our opinion should only be considered valid when all the psychiatrists involved agree on the opinion that the defendant is suffering from DID. Based on the diagnosis, the question of competency to stand trial must be answered. Then, the court should select the appropriate method for assessing the responsibility. The “host-alter” method is best when there is a dominant personality present, and the crime was committed by the alter identity. The “alter-in-control” method should be used when there is no clear evidence of the dominant identity. If the method used provides a result that supports the fact that the identity evaluated is insane at the time of committing a crime, the defendant should be considered not guilty.
The paper does carry certain limitations. The main limitation lies in the fact that no primary sources of data were used. The nature of literature review exempts researchers from direct interaction with the patients. This is even true for the previous research that our paper is based on. The existing literature primary deals with evaluating the cases that have already happened, and not evaluating the currently open cases. It brings us to the need to believe the judgments of previous psychiatrists involved in the cases, not being able to actually see the patients and whether or not the researchers would agree on the diagnosis and the responsibility with the psychiatrists involved. The suggestion for future research that arises from this limitation is to attempt to conduct the study that would be based on the primary data by conducting interviews with specialists and patients involved or conducting observations. Case study method could be suggested.
Secondly, the paper primary deals with the cases from the Western region. It raises the question of the ability to generalize the results to the other region, as different cultures have different approaches toward legal judgments. It would hence be interesting to see the results of similar studies in the Asian and Eastern regions to compare whether these regions possess the similar views on the topic of multiple personality disorder. The future research on the above-mentioned areas of the world will therefore be of importance and value to the field of literature currently available.
The research has identified few critical areas in the field of DID that have not yet been addressed by the previous research and are also not addressed by our research. Previous research has either involved case studies of non-criminal DID patients, or analysis of criminal DID patients that was done after the trials have been concluded. However, it is of great importance to conduct the study that would examine the criminal DID patients while trials and evaluations are still ongoing. Such study would tackle the limitations present in our paper, as well as ones from previous research.
Future researchers are also encouraged to compare the courts’ views on DID with other disorders, similarly to our paper’s comparison of DID to epileptic seizures. Such studies are of interest to the field of psychology, as they may change the opinions on the diagnosis from the law enforcement agencies, if they see that similar disorders are treated differently, just like DID and epileptic seizures. Moreover, the research paper was focused on the cases that happened in the West and under its legal environment. The further research is suggested to look at the wider aspect of countries and nationalities, however, the availability of secondary source data as of now is really limited.
Dissociative identity disorder is a complex and controversial disorder which has seen opposing opinions on the existence of the disorder itself and concepts associated with it, such as the legal responsibility of the defendants suffering (or appearing to suffer) from multiple personality disorder.
The paper has examined the existing literature on the topic of multiple personality disorder and has found a general courts’ tendency to not accept DID as a reason to justify the defendant’s insanity and hence not to exempt the person from the legal responsibility. In part, such tendency is explained by the negative social reaction to the cases where defendants were found not guilty by the reason of insanity (see Milligan’s case). Another explanation for the tendency is the controversial and subjective nature of DID and differences in the opinions held by psychiatrists when evaluating a person on whether DID diagnosis could be given.
Based on the existing literature, the paper has suggested the basis for the framework on which the legal systems can standardize their approach toward DID. It has to be noted, however, that the framework still cannot be made universal, because the symptoms and traits existing differ from one patient to another (for example, the existence of the dominant personality). The induction of hypnosis during the course of treatment makes the issue even more complex, as we have seen from the case of Eve, where Eve White was a dominant personality until hypnosis sessions began and Eve Black learned to emerge at her will.
Based on the found secondary source data, the progress of developing the legal framework has improved when the awareness of DID keeps increasing, respectively. The courts tend to find DID criminals responsible for their actions due to the social factor and previous evidence. The approach of judgment is not related to the gender of the person since both male and female share the same types of identities. Even though the evaluation of DID is done by the psychological measures, the questions whether some people actually fake this disease keep appearing. Therefore, the involvement of the latest methods and a group of psychiatrists during the trial showed a positive effect on the final judgment.
SK: conceptualization and supervision. SK and NB: data curation and writing – original draft. SK, NB, and EP: methodology and writing – review and editing. All authors have read and agreed to the published version of the manuscript.
Oslo Metropolitan University provided the fund for covering the open access publication fees.
Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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Keywords : DID, dissociation, legal, responsibility, NGRI-DID
Citation: Kabene SM, Balkir Neftci N and Papatzikis E (2022) Dissociative Identity Disorder and the Law: Guilty or Not Guilty? Front. Psychol. 13:891941. doi: 10.3389/fpsyg.2022.891941
Received: 08 March 2022; Accepted: 23 June 2022; Published: 09 August 2022.
Copyright © 2022 Kabene, Balkir Neftci and Papatzikis. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
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Famous Cases Of Dissociative Identity Disorder
Think back to a time where you had a bit too much to drink. The next day, could you remember what your drunken self had done? Now, remove the alcohol. If you still drew a blank, you would have something in common with these famous cases of dissociative identity disorder .
Dissociative identity disorder (DID), formerly referred to as multiple personality disorder, is when a person manifests two or more distinct personalities that switch off controlling the body. The "blackout" periods are where the dissociative part comes in. Often the personalities have no memory of what went on when other personalties were in charge. In other words, the individual may have no clue that the other personalities even exist.
Usually, there is a dominant personality and one or more "alters." Which personality is dominant can actually change over the years. Sometimes the alternate personalities appear as hostile, foreign invaders to the dominant personality, and can be mistaken for cases of demonic possession. Real cases of DID are extremely rare, and are almost always the result of extreme trauma or abuse. The disorder serves as a psychological coping mechanism in which the psyche compartmentalizes the trauma. Ultimately, the disorder is a failure to integrate various memories, personality traits, identity, and consciousness into a single, multidimensional persona.
These are real people with dissociative identity disorder. All of their stories are true, and well documented. Beyond the sensationalism of tales like Dr. Jekyll and Mr. Hyde is a very real psychological concern that, while rare, can be extremely difficult to live with.
Juanita Maxwell's Alter Committed Murder
Juanita Maxwell has no memory of beating 73-year-old Inez Kelly to death with a lamp in 1979. Wanda Weston, however, remembers the incident with glee. She admitted as much during the murder trial . The catch: Juanita and Wanda happen to occupy the same person.
Maxwell had been working as a maid at the hotel where Kelly was staying. According to Wanda, Kelly had borrowed her pen, but refused to give it back. Wanda went into Kelly's room, and when the older woman asked her to leave, killed her.
After Maxwell's alter was coaxed out during her trial, the judge ruled that she was not guilty due to insanity. Maxwell was committed to a mental institution.
Herschel Walker Has A Personality That Excels At Football
Former NFL running back Herschel Walker wrote about his struggle managing multiple personalities in his book, Breaking Free . As a child, Walker was overweight and had a speech impediment. He thinks that he first began developing DID as a coping mechanism . The highly motivated "warrior" was one of Walker's alters who drove his physical fitness and football ability. Another alter, "the hero," was his public face. For years, he managed the disorder without really understanding what it was. He doesn't even remember receiving the Heisman Trophy.
After Walker retired from football, his different personalities started to become jumbled. He fell into depression, at one point playing Russian Roulette with himself. Walker's wife, Cindy Grossman, left him after an episode where he pointed a gun at her head. It was at this point that Walker sought psychiatric help and was diagnosed with DID.
The Real "Three Faces Of Eve"
The book and 1957 film The Three Faces of Eve were based on the real case of Chris Costner Sizemore . Sizemore, who died in 2016, actually had 22 distinct personalities. In the book and film, she was portrayed as having only three: Eve White, Eve Black, and Jane.
In reality, Jane's emergence was not the end of Sizemore's suffering . Jane, like Eve White and Eve Black, died, being replaced by ever more personalities . There was the Banana Split Girl, who would only eat said dessert, the Spoon Lady, who collected spoons, and many more. The personalities also ranged in skill sets; some could drive, and others couldn't.
It wasn't until four years of therapy with her eighth doctor, Tony Tsitos, that Sizemore was able to start integrating her personalities. She once said she had a dream where "the personalities were in a kind of Greek arena. They all joined hands and then walked behind a screen and then everything disappeared. They have never come back."
Is it possible to cure DID? In the case of the patient known as Karen Overhill , the answer was yes. When she was 29 years old, Overhill was referred to Dr. Richard Baer for treatment for her depression. Throughout their sessions, she began revealing how she had been abused by both her father and her grandfather. Dr. Baer treated Overhill for over 20 years as he slowly discovered the truth: she had 17 different personalities.
By using hypnosis and visualization, Dr. Baer was able to help Overhill reintegrate her personalities into one functioning whole. He wrote about her fascinating case in Switching Time: A Doctor's Harrowing Story of Treating a Woman With 17 Personalities . Overhill contributed some of her letters, journal entries, and art to the book.
Kim Noble Has Four Switches Per Day
Imagine keeping over 100 different personalities straight. That is the life of Kim Noble , told in the autobiographical book All Of Me .
Noble was born in 1960 to two unhappily married factory workers in England. Her childcare was outsourced to friends and family, and at some point between the age of one and three she suffered from extreme and repeated abuse. It was at this point that her psyche splintered, completely compartmentalizing the trauma.
Her condition went undiagnosed through adolescence, even when she was put on suicide watch in a psychiatric hospital after frequent overdosing. In her 20s, a sudden switch resulted in her plowing a van into a line of parked cars. This resulted in another mental health examination, and the diagnosis of schizophrenia.
After being released from the mental hospital, Noble somehow ended up caught up with a pedophile ring. When she reported it to the police, she started receiving threats of retaliation. A man threw acid in her face, someone lit her bed on fire with her in it, and while she escaped, her house was completely gutted. She has no recollection of the incident.
In 1995, Noble was finally diagnosed with DID. Her dominant personality is named Patricia, and under her care, Noble has become an artist and lives with her daughter.
Shirley Mason Made Up Her DID
One of the most famous cases of DID ever recorded is likely a lie , according to a new book, Sybil Exposed , by Debbie Nathan. The book and miniseries Sybil - starring Sally Fields - follows the life of a woman who has DID. It was supposedly a true story, but it seems that the real-life Sybil, Shirley Mason, faked her condition.
Mason initially sought psychiatric attention because she was emotionally unstable. She became attached to her physician, Dr. Connie Wilbur, who had a fascination with multiple personality disorder (as DID used to be called). To get more attention, Mason came in one day and starting claiming to be a different person, talking in a childish voice and changing her mannerisms.
On one occasion, Mason tried to admit that she was faking it, but her confession was dismissed as part of her psychosis. Interestingly, therapist Herbert Spiegel, who saw Mason from time to time, also said that she was probably malingering (faking it) in 1997.
Louis Vivet's Alter Couldn't Walk
Louis Vivet was one of the most extensively studied cases of DID in the early days of psychiatry. Vivet lived in the latter part of the 19th century. His youth was marked by abuse and neglect, and at eight years old, he was sent to a house of correction.
By the age of 17, Vivet was a functioning and intelligent man. While working in the field one day, a viper wound itself around his arm. This event frightened him so much that he lost consciousness and began having violent convulsions that evening. These attacks returned several times, eventually resulting in the paralysis of his legs.
Vivet was sent to Bonneval Asylum in 1880. On April 23, he suffered a severe bout of epileptic fits, losing consciousness at times. When he recovered about 50 hours later, he had regained his ability to use his legs. His mannerisms completely changed as well. He was then released as healthy. He eventually wound up in another asylum, where he continued to have epileptic fits, and alternated between being able to walk and not being able to.
Doctors studied him extensively, performing experiments and hypnosis to try and draw out the different personalities he manifested. In total, Vivet manifested at least three and up to ten different personality states.
Truddi Chase Had 92 Personalities
When Truddi Chase was just two years old, she moved out to the country with her mother and stepfather. At this time, she was sexually abused by her stepfather, and the trauma ultimately caused her DID.
For years, Chase was able to suppress her memories by holding them in alternate personalities that rarely came to the surface. Each of her 92 personalties served different roles and held different memories. One personality named Black Catherine held most of her rage. Another personality, Rabbit, held the pain.
Chase wrote a book about her life, When Rabbit Howls . Her life was also turned into a made-for-TV movie called The Voices Within: The Lives of Truddi Chase starring Shelly Long, and Chase was interviewed by Oprah as well.
The Strange Case Of Mary Reynolds
Mary Reynolds was born in 1785 and moved from England to Pennsylvania as a child. She had a solemn and melancholy demeanor and spent a lot of time in religious devotion.
At the age of 19, she became blind and deaf for six weeks. Three months after that, she suddenly forgot how to read and write, though she eventually taught herself again. Then, Reynolds's demeanor changed, and was described as "buoyant, witty, fond of company and a lover of nature." After five months, she changed back to her original self, and alternated between the two types for 16 years. When Reynolds reached her mid-30s, the second personality took over once again, and she remained "buoyant and witty" until her death at age 61.
Reynolds was studied by Dr. Samuel Latham Mitchel, who published an account of her " double consciousness " in the 19th century.
Eberhardt Gmelin's Diagnosis Of "Exchanged Personality"
The first well-documented case of what would later become known as DID was studied by Eberhardt Gmelin in 1791. The case involved a 20-year-old woman living in Stuttgart, Germany. She was divided into two personalities, the "French Woman" and the "German Woman." The French Woman spoke perfect French, behaved like a French aristocrat, and knew about the German Woman.
The German Woman, in contrast, had no idea of the French Woman's existence, and spoke German with a French accent.
Robert Oxnam Didn't Know He Had DID
In the 1980s, the scholar Robert Oxnam suffered from alcoholism, bulimia, and blackouts, and his marriage was failing. In 1990, during one routine session with his psychiatrist, Dr. Jeffery Smith, Oxnam's entire demeanor changed. Suddenly, it was not Oxnam in front of Dr. Smith, but an angry little boy named Tommy.
As a young boy, Oxnam suffered sexual and physical abuse and from that he developed DID. He has identified 11 distinct personalities, including Tommy; Bobby, a troublemaker who enjoys rollerblading; The Witch, a frightening presence; and Baby, who holds the memories of Oxnam's childhood trauma. Oxnam wrote a book about his experience called A Fractured Mind .
Ansel Bourne Had Dissociative Fugue
One day in the mid-19th century, a man named A.J. Brown arrived in Norristown, PA, and opened a small shop. Around two months later, Brown woke up and had no idea where he was. It turns out that Brown was really one Ansel Bourne , a preacher from Rhode Island.
Bourne had dissociative fugue, a condition similar to DID. It's a condition in which a person loses all memory of his identity and personal past, but essentially goes on functioning in an automatic state. Dissociative fugue can last a few months, or a lifetime.
- Dissociative identity disorder
- Mental Health & Illness
Lists about common mental illnesses and disorders and the many people around the world and throughout history who have lived with them.
6 minute read
Dissociative Identity Disorder
Two famous cases.
Also referred to as multiple personality disorder, a condition in which a person's identity dissociates, or fragments, creating additional, distinct identities that exist independently of each other within the same person.
Persons suffering from dissociative identity disorder (DID) adopt one or more distinct identities which co-exist within one individual. Each personality is distinct from the other in specific ways. For instance, tone of voice and mannerisms will be distinct, as well as posture, vocabulary, and everything else we normally think of as marking a personality. There are cases in which a person will have as many as 100 or more identities, while some people only exhibit the presence of one or two. In either case, the criteria for diagnosis are the same. This disorder was, until the publication of DSMIV, referred to as multiple personality disorder. This name was abandoned for a variety of reasons, one having to do with psychiatric explicitness (it was thought that the name should reflect the dissociative aspect of the disorder).
The DSM-IV lists four criteria for diagnosing someone with dissociative identity disorder. The first being the presence of two or more distinct "identities or personality states." At least two personalities must take control of the person's identity regularly. The person must exhibit aspects of amnesia—that is, he or she forgets routine personal information. And, finally, the condition must not have been caused by "direct physiological effects," such as drug abuse or head trauma.
Persons suffering from DID usually have a main personality that psychiatrists refer to as the "host." This is generally not the person's original personality, but is rather developed along the way. It is usually this personality that seeks psychiatric help. Psychiatrists refer to the other personalities as "alters" and the phase of transition between alters as the "switch." The number of alters in any given case can vary widely and can even vary across gender. That is, men can have female alters and women can have male alters. The physical changes that occur in a switch between alters is one of the most baffling aspects of dissociative identity disorder. People assume whole new physical postures and voices and vocabularies. One study conducted in 1986 found that in 37 percent of patients, alters even demonstrated different handedness from the host.
Statistically, sufferers of DID have an average of 15 identities. The disorder is far more common among females than males (as high as 9-to-1), and the usual age of onset is in early childhood , generally by the age of four. Once established, the disorder will last a lifetime if not treated. New identities can accumulate over time as the person faces new types of situations. For instance, as a sufferer confronts sexuality in adolescence , an identity may emerge that deals exclusively with this aspect of life. There are no reliable figures as to the prevalence of this disorder, although it has begun to be reported with increased frequency over the last several years. People with DID tend to have other severe disorders as well, such as depression , substance abuse, borderline personality disorder and eating disorders , among others.
In nearly every case of DID, horrific instances of physical or sexual child abuse—even torture—was present (one study of 100 DID patients found that 97 had suffered child abuse ). It is believed that young children, faced with a routine of torture and neglect, create a fantasy world in order to escape the brutality. In this way, DID is similar to post-traumatic stress disorder , and recent thinking in psychiatry has suggested that the two disorders may be linked; some are even beginning to view DID as a severe subtype of post-traumatic stress disorder.
Treatment of dissociative identity disorder is a long and difficult process, and success (the complete integration of identity) is rare. A 1990 study found that of 20 patients studied, only five were successfully treated. Current treatment method involves having DID patients recall the memories of their childhoods. Because these childhood memories are often subconscious, treatment often includes hypnosis to help the patient remember. There is a danger here, however, as sometimes the recovered memories are so traumatic for the patient that they cause more harm.
The stories of two women with multiple personality disorders have been told both in books and films. A woman with 22 personalities was recounted in 1957 in a major motion picture staring Joanne Woodward and in a book by Corbett Thigpen, both titled the Three Faces of Eve. Twenty years later, in 1977, Caroline Sizemore, the 22nd personality to emerge in "Eve," described her experiences in a book titled I'm Eve. Although the woman known as "Eve" developed a total of 22 personalities, only three could exist at any one time—for a new one to emerge, an existing personality would "die."
The story of Sybil (a pseudonym) was published in 1973 by Flora Rheta Schreiber, who worked closely for a decade with Sybil and her New York psychiatrist Dr. Cornelia B. Wilbur. Sybil's sixteen distinct personalities emerged over a period of 40 years.
Both stories reveal fascinating insights—and raise thought-provoking questions—about the unconscious mind, the interrelationship between remembering and forgetting, and the meaning of personality development. The separate and distinct personalities manifested in these two cases feature unique physical traits and vocational interests. In the study of this disorder, scientists have been able to monitor unique patterns of brainwave activity for the unique multiple personalities.
There is considerable controversy about the nature, and even the existence, of dissociative identity disorder. One cause for the skepticism is the alarming increase in reports of the disorder over the last several decades. Eugene Levitt, a psychologist at the Indiana University School of Medicine, noted in an article published in Insight on the News (1993) that "In 1952 there was no listing for [DID] in the DSM, and there were only a handful of cases in the country. In 1980, the disorder [then known as multiple personality disorder] got its official listing in the DSM, and suddenly thousands of cases are springing up everywhere." Another area of contention is in the whole notion of suppressed memories, a crucial component in DID. Many experts dealing with memory say that it is nearly impossible for anyone to remember things that happened before the age three, the age when much of the abuse supposedly occurred to DID sufferers.
Regardless of the controversy, people diagnosed with this disorder are clearly suffering from some profound disorder. As Helen Friedman, a clinical psychologist in St. Louis told Insight on the News, "When you see it, it's just not fake."
Arbetter, Sandra. "Multiple Personality Disorder: Someone Else Lives Inside of Me." Current Health (2 November 1992): 17.
Mesic, Penelope. "Presence of Minds." Chicago (September 1992): 100.
Sileo, Chi Chi. "Multiple Personalities: The Experts Are Split." Insight on the News (25 October 1993): 18. Sizemore, Chris Costner. I'm Eve . Garden City, NY: Doubleday, 1977.
Sybil [video recording].
Thigpen, Corbett H. The Three Faces of Eve. New York: Popular Library, 1957.
The Three Faces of Eve [videorecording]. Beverly Hills, CA: Fox Video, 1993. Produced and directed from his screenplay by Nunnally Johnson. Originally released as motion picture in 1957.
"When the Body Remembers." Psychology Today (April 1994): 9.
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- What Is a Case Study? | Definition, Examples & Methods
What Is a Case Study? | Definition, Examples & Methods
Published on May 8, 2019 by Shona McCombes . Revised on June 22, 2023.
A case study is a detailed study of a specific subject, such as a person, group, place, event, organization, or phenomenon. Case studies are commonly used in social, educational, clinical, and business research.
A case study research design usually involves qualitative methods , but quantitative methods are sometimes also used. Case studies are good for describing , comparing, evaluating and understanding different aspects of a research problem .
Table of contents
When to do a case study, step 1: select a case, step 2: build a theoretical framework, step 3: collect your data, step 4: describe and analyze the case, other interesting articles.
A case study is an appropriate research design when you want to gain concrete, contextual, in-depth knowledge about a specific real-world subject. It allows you to explore the key characteristics, meanings, and implications of the case.
Case studies are often a good choice in a thesis or dissertation . They keep your project focused and manageable when you don’t have the time or resources to do large-scale research.
You might use just one complex case study where you explore a single subject in depth, or conduct multiple case studies to compare and illuminate different aspects of your research problem.
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Once you have developed your problem statement and research questions , you should be ready to choose the specific case that you want to focus on. A good case study should have the potential to:
- Provide new or unexpected insights into the subject
- Challenge or complicate existing assumptions and theories
- Propose practical courses of action to resolve a problem
- Open up new directions for future research
TipIf your research is more practical in nature and aims to simultaneously investigate an issue as you solve it, consider conducting action research instead.
Unlike quantitative or experimental research , a strong case study does not require a random or representative sample. In fact, case studies often deliberately focus on unusual, neglected, or outlying cases which may shed new light on the research problem.
Example of an outlying case studyIn the 1960s the town of Roseto, Pennsylvania was discovered to have extremely low rates of heart disease compared to the US average. It became an important case study for understanding previously neglected causes of heart disease.
However, you can also choose a more common or representative case to exemplify a particular category, experience or phenomenon.
Example of a representative case studyIn the 1920s, two sociologists used Muncie, Indiana as a case study of a typical American city that supposedly exemplified the changing culture of the US at the time.
While case studies focus more on concrete details than general theories, they should usually have some connection with theory in the field. This way the case study is not just an isolated description, but is integrated into existing knowledge about the topic. It might aim to:
- Exemplify a theory by showing how it explains the case under investigation
- Expand on a theory by uncovering new concepts and ideas that need to be incorporated
- Challenge a theory by exploring an outlier case that doesn’t fit with established assumptions
To ensure that your analysis of the case has a solid academic grounding, you should conduct a literature review of sources related to the topic and develop a theoretical framework . This means identifying key concepts and theories to guide your analysis and interpretation.
There are many different research methods you can use to collect data on your subject. Case studies tend to focus on qualitative data using methods such as interviews , observations , and analysis of primary and secondary sources (e.g., newspaper articles, photographs, official records). Sometimes a case study will also collect quantitative data.
Example of a mixed methods case studyFor a case study of a wind farm development in a rural area, you could collect quantitative data on employment rates and business revenue, collect qualitative data on local people’s perceptions and experiences, and analyze local and national media coverage of the development.
The aim is to gain as thorough an understanding as possible of the case and its context.
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In writing up the case study, you need to bring together all the relevant aspects to give as complete a picture as possible of the subject.
How you report your findings depends on the type of research you are doing. Some case studies are structured like a standard scientific paper or thesis , with separate sections or chapters for the methods , results and discussion .
Others are written in a more narrative style, aiming to explore the case from various angles and analyze its meanings and implications (for example, by using textual analysis or discourse analysis ).
In all cases, though, make sure to give contextual details about the case, connect it back to the literature and theory, and discuss how it fits into wider patterns or debates.
If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.
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McCombes, S. (2023, June 22). What Is a Case Study? | Definition, Examples & Methods. Scribbr. Retrieved November 20, 2023, from https://www.scribbr.com/methodology/case-study/
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21st century bias —
People think white ai-generated faces are more real than actual photos, study says, 'hyperrealism' bias may impact medicine and law enforcement. can you spot the fakes.
Benj Edwards - Nov 14, 2023 10:55 pm UTC
A study published in the peer-reviewed journal Psychological Science on Monday found that AI-generated faces generated with three year-old technology, particularly those representing white individuals, were perceived as more real than actual face photographs, reports The Guardian . The finding did not extend to images of people of color, likely due to AI models being trained predominantly on images of white individuals—a common bias that is well-known in machine learning research.
In the paper titled "AI Hyperrealism: Why AI Faces Are Perceived as More Real Than Human Ones," researchers from Australian National University, the University of Toronto, University of Aberdeen, and University College London coined the term in the paper's title, hyperrealism, which they define as a phenomenon where people think AI-generated faces are more real than actual human faces.
In their experiments, the researchers presented white adults with a mix of 100 AI-generated and 100 real white faces, asking them to identify which were real and their confidence in their decision. Out of 124 participants, 66 percent of AI images were identified as human, compared to 51 percent for real images. This trend, however, was not observed in images of people of color, where both AI and real faces were judged as human about 51 percent of the time, irrespective of the participant's race.
Researchers used real and synthetic images sourced from an earlier study , with the synthetic ones generated by Nvidia's StyleGAN2 image generator, which can create realistic faces using image synthesis. It's worth noting that StyleGAN2 was released in 2020, and AI image synthesis has progressed rapidly since then—but newer AI models were not involved in the study.
The research also showed that participants who frequently misidentified faces showed higher confidence in their judgments, which the researchers say is a manifestation of the Dunning-Kruger effect . In other words, people who were more confident were more often wrong.
A second experiment, with 610 adults, involved participants rating AI and human faces on various attributes without knowing some were AI-generated, with the researchers using "face space" theory to pinpoint specific facial attributes. The analysis of participants' responses suggested that factors like greater proportionality, familiarity, and less memorability led to the mistaken belief that AI faces were human. Basically, the researchers suggest that the attractiveness and "averageness" of AI-generated faces made them seem more real to the study participants, while the large variety of proportions in actual faces seemed unreal.
Interestingly, while humans struggled to differentiate between real and AI-generated faces, the researchers developed a machine-learning system capable of detecting the correct answer 94 percent of the time.
The study's findings raise concerns about perpetuating social biases and the conflation of race with perceptions of being "human," which could have implications in areas like locating missing children , where AI-generated faces are sometimes used. And people being unable to detect synthetic faces, in general, may lead to fraud or identity theft.
Dr. Zak Witkower, a co-author from the University of Amsterdam, told The Guardian that the phenomenon could have far-reaching consequences in various fields, from online therapy to robotics. "It’s going to produce more realistic situations for white faces than other race faces," he said.
Dr. Clare Sutherland, another co-author from the University of Aberdeen, emphasized to The Guardian the importance of addressing biases in AI. "As the world changes extremely rapidly with the introduction of AI," she said, "it’s critical that we make sure that no one is left behind or disadvantaged in any situation–whether due to ethnicity, gender, age, or any other protected characteristic."
Answer key for image above. Which ones are real? From left to right top row: 1. Fake, 2. Fake, 3. Real, 4. Fake. From left to right, bottom row: 1. Real, 2. Fake, 3. Real, 4. Real.
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Identifying COVID-19 Policies and Practices That Juvenile Justice Systems Should Maintain Long-Term
The COVID-19 pandemic dramatically interrupted the full spectrum of juvenile justice system activities, processes, and structures in the United States, from intakes to reentry. Across the country, juvenile justice practitioners responded to this public health crisis by implementing emergency policies to mitigate disease spread and maintain programming to the extent possible given public health orders and staff absenteeism. As the upheaval created by the pandemic subsides and the country “returns to normal,” the juvenile justice field will benefit from a comprehensive assessment of the policies implemented and changed during the pandemic, with a specific eye toward what worked well, what did not, and the root causes for successes and challenges. It is clear that juvenile justice practice will not fully return to its pre-pandemic status, and in many cases will integrate changes in policy and practice brought about by the pandemic. Because decisions about the COVID-19 response have typically been made at the state level, aggregating and analyzing information across states and across practitioners within the juvenile justice continuum is a difficult but important undertaking.
Our 2021 National Institute of Justice (NIJ)-funded project—Juvenile Justice Responses to the COVID-19 Pandemic—involves several research activities, including listening sessions, a systematic literature review, policy scan, and case studies.
Through these research activities, we aimed to answer three questions:
- How have juvenile justice systems responded to the COVID-19 pandemic? How have juvenile justice systems changed policies related to transfers between and releases from juvenile residential place facilities?
- How are different policy responses associated with youth and public safety outcomes (e.g., educational attainment, mental and physical wellbeing, recidivism, intakes, releases)?
- For policies associated with positive outcomes for youth or improved public safety, what resources are needed to sustain these policy changes in the long term?
Our team conducted listening sessions with a broad range of juvenile justice system practitioners to learn from their experiences during the pandemic and to identify policies and practices that juvenile justice systems can and should maintain in the long term (even as COVID-19 is now endemic). The goal of these listening sessions was to discuss policies and practices related to juvenile intakes, transfers, and early releases from juvenile residential placement facilities, as well as those intended to protect public safety and ensure the safety, health, appropriate supervision, and long-term success of youth. We also asked practitioners to identify possible best practices for rapidly responding to similar threats that may emerge in the future—such as other public health emergencies and natural disasters—to ensure juvenile justice systems have an experience-based guide that reflects important lessons learned for making difficult but effective decisions in emergency situations.
Approved for public release
This project was supported by Award No. 15PNIJ-21-GG-03267-RESS awarded by the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect those of the Department of Justice.
- Document Number: IPD-2023-U-036550-Final
- Publication Date: 11/14/2023
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Definition of did
past tense of do
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“Did.” Merriam-Webster.com Dictionary , Merriam-Webster, https://www.merriam-webster.com/dictionary/did. Accessed 21 Nov. 2023.
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Michigan State University study shows pets did not make people happier during pandemic
By DeJanay Booth-Singleton
November 7, 2023 / 8:57 PM EST / CBS Detroit
EAST LANSING, Mich. (CBS DETROIT) - It has been over three years since people started isolating in their homes due to the pandemic. And during that, many are believed to rely on their pets to get through tough times.
A new study from Michigan State University found that despite having your pets around to get through the pandemic, "pet ownership was not reliably associated with well-being."
"People say that pets make them happy, but when we actually measure happiness, that doesn't appear to be the case," said William Chopik, an associate professor in MSU's Department of Psychology and co-author of the study. "People see friends as lonely or wanting companionship, and they recommend getting a pet. But it's unlikely that it'll be as transformative as people think."
Researchers evaluated 767 people over three times in May 2020. Researchers asked an open-ended question and looked at several measures of well-being.
The study found that pet owners reported their pets made them happy and helped them feel more positive emotions; however, they expressed worry for their pet's well-being and having them interfere with remote work.
The results also showed there was no difference in well-being between pet owners and non-pet owners. It did not matter the type of pet, the number of pets, or the personalities of the owners.
Researchers suggested that people without pets were able to find other things that make them happy, thus showing their well-being to be no different than pet owners during that time.
"Staking all of your hope on a pet making you feel better is probably unfair and is maybe costly given other things you could do in your life that could improve your happiness," Chopik said.
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Iowa teen sentenced to life in prison for killing Spanish teacher over a bad grade
DES MOINES, Iowa — An Iowa teen convicted in the 2021 beating death of a high school Spanish teacher was sentenced Wednesday to life in prison with a possibility of parole in 25 years.
A judge sentenced Jeremy Goodale for his role in killing Nohema Graber, a 66-year-old teacher at Fairfield High School. Goodale, 18, and a friend pleaded guilty earlier this year to first-degree murder in the beating death of Graber.
The two high school students used a bat to kill Graber after stalking her as she took her daily walk in a large park in Fairfield, a small Iowa city about 100 miles southeast of Des Moines.
Before being sentenced, Goodale apologized to the teacher’s family, the community and his own family.
“I’m sorry, truly sorry. What I’ve taken can never be replaced,” Goodale said, at times through sobs. “Every day I wish I could go back and stop myself, prevent this loss and this pain that I’ve caused everyone.”
Prosecutors said Goodale and his friend Willard Miller, both 16 at the time, decided to kill Graber because of a bad grade she had given Miller. Prosecutors have said Miller first suggested the two kill Graber after becoming worried that the poor grade would prevent him from participating in a study abroad program.
Judge Shawn Showers ticked through 25 factors he had to consider before issuing his sentence of life with a 25-year minimum. He said it was clear Goodale was remorseful and didn’t consider the repercussions of killing Graber, but Showers noted the teen is a smart person who could easily have stopped it from being carried out.
The judge’s decision matched a requested sentence by prosecutors. Goodale’s lawyer had said he should be sentenced to life with no mandatory minimum sentence before he is eligible for parole.
The two students were charged as adults, but because of their age they were not subject to an Iowa requirement that those convicted of first-degree murder serve a mandatory sentence of life without parole.
In July, Showers sentenced Miller to life in prison with a possibility of parole after 35 years in prison.
Goodale and Miller pleaded guilty in April to killing Graber. After killing Graber, they used a wheelbarrow to move her body to a spot near railroad tracks, where they covered it with a tarp and placed the wheelbarrow and a railroad tie over the tarp.
Graber was born in Xalapa, Mexico. After graduating from high school, she worked as a flight attendant and later earned her license as a commercial airline pilot. Following her marriage, she moved to Fairfield in 1992 and later got a teaching certificate. She had worked at Fairfield High School since 2012. Her husband, Paul Graber, died of cancer after his wife’s death. The couple had three children.
Speaking before Goodale was sentenced, 10 members of Graber’s family gave victim impact statements or had statements read by a court official. During those statements, Goodale appeared to struggle to maintain his composure and hold back tears.
Tom Graber, the brother of the victim’s husband Paul, said the killing devastated their family and hastened his brother’s death. He said Goodale sounded and looked remorseful in his court statement, but he questioned the authenticity of those statements.
“I must say your actions to me undercut that,” Graber said. “You’re now an adult. You’re over the age of 18, and yet you have your counsel to represent you ... arguing on your behalf to escape punishment for this horrific crime. That doesn’t sound like remorse to me.”