AKRON, Ohio — "The Minds of Billy Milligan," "Sybil" and "The Three Faces of Eve" are books about only three people, but they contain details of myriad personalities.
While the works have done much to publicize the existence of multiple personality disorder, the syndrome went virtually unrecognized until the last quarter-century and still is challenged in the medical profession.
There is an increasing acceptance, however, according to Dr. Moshe Torem, head of the University of Akron's psychiatry and behavioral sciences department.
The cause of the disorder is believed to be child abuse, particularly sexual abuse.
Problem Is Widespread
Recent studies, when averaged, show that at least 25% of all adult women and 10% of the men in this country experienced some form of sexual abuse as children, Torem said.
Perhaps 4% of such victims suffer repeated abuse during crucial developmental stages and fall prey to multiple personality disorder, experts say, although this may be an underestimate.
William Milligan, who has been diagnosed as having 24 personalities, says he was a victim of rape as a child.
Milligan was committed to state custody in 1978 after being found innocent by reason of insanity of raping three women abducted near the Ohio State University campus in Columbus.
During therapy, court hearings and interviews, Milligan told of repeated sexual abuse by his father, who allegedly forced the youth to dig his own grave and buried him alive. Milligan said his father threatened to return him to the ground and leave him to die if the youth ever told anyone of the abuse.
His father has denied the accusations.
Doctors say Milligan coped with the abuse and his disjointed life by relegating pain to part of his mind, in a personality known as David. Other abuse was handled by lesbian "Adalana," and deaf "Shawn" endured beatings in silence.
Dr. Cornelia Wilbur of Lexington, Ky., one of nine psychiatrists who have confirmed Milligan's multiple personality disorder, also fused the 16 personalities of a patient known as Sybil, later the subject of a book and television play.
Doctors say Sybil also was the victim of sexual torture as a child.
Chris Sizemore, subject of "The Three Faces of Eve" (1957), was diagnosed as having 22 personalities. She was traumatized as a child by witnessing a series of violent, bloody events.
Sizemore was successfully treated, has written a book, "I Am Eve," and is working on another. She attended an April conference on multiple personalities hosted by Torem and Akron General Medical Center.
Can Be Cured
"She is living testimony that the disease can be completely cured," Torem said. "Sybil also is testimony."
Milligan remains in state custody after nearly 10 years, though he freed himself for about five months by escaping last July 4 from the Central Ohio Psychiatric Hospital in Columbus.
Milligan had been under the supervision of a hospital administrator who has said publicly that he does not believe in multiple personalities.
"It's not a matter of believing or disbelieving; that's for religion," Torem said. "This is science. This is a matter of looking at the facts and forming your conclusions using a scientific method."
Torem, who attended medical school in the 1960s and performed his residency in the mid-1970s, is not surprised by the lack of recognition accorded to multiple personality disorder. He believes he may have overlooked incidences of the affliction before he diagnosed his first case in 1980.
"In school I was told, 'This disease is so rare that you will never see a case in the whole lifetime of your career, so it would be a waste of time to study it,' " he said.
Misunderstanding may have led some people to confuse multiple personality disorder with schizophrenia--"two totally different diseases," Torem said.
Schizophrenics sometimes are known as "split personalities." People with multiple personality disorder can have many personalities, with the average being nine or 10, experts say.
Schizophrenia can be treated with anti-psychotic drugs. While some types of medicine can be helpful in treating multiple disorders, the disease does not respond to anti-psychotic drugs. Treatment generally is psychotherapy in conjunction with hypnosis, Moshe said.
Multiple personality disorder is caused by child abuse; schizophrenia is inherited.
"Schizophrenia can happen in the best of families, even if you had all the loving care in the world," Torem said. "Schizophrenia is a genetically inherited disease of the brain. It runs in families, like diabetes."
Voices Inside, Not Outside
Another distinction, Torem said, is that schizophrenics often believe they hear voices coming from outside their heads, while victims of multiple personality disorder usually hear voices within their minds.