While schizophrenics can be managed with medication, they cannot be cured, Torem said. Multiple personality victims, on the other hand, "have an excellent prognosis, with many cases where full integration (of personalities) and cures are achieved."
Skepticism continues, however, partly because of the public's interpretation of the disease's name.
To many people, Torem said, the term evokes an unbelievable, fairy-tale image of several people existing in one body, rather than the very real situation of several personalities struggling within one mind.
Result of Trauma
Public acceptance of the disorder might be increased, he said, if people realized it is a form of post-traumatic stress disorder, which is best known as an affliction suffered by some Vietnam War veterans.
The stigma attached to both child abuse and the Vietnam War compels victims to hide their problem, complicating it further.
"A child suffered repetitive abuse. He couldn't run away, couldn't fight it or flee from it, so he floated with it; he used internal escape. Part of his personality shut off to deal with the depression, pain, hurt, and another part of the child went on as if nothing had happened," Torem said.
"If (trauma) happens early in life and continues through crucial developmental stages, you have split ego states that develop in a parallel track and they don't communicate with each other. You have a barrier of amnesia between these states."
Bright and Creative
Dr. Bill Smith, chief clinical psychologist at the Menninger Foundation in Topeka, Kan., said the mechanism behind multiple personalities is the same as the one that gives creative writers a basis for developing unusual characters.
"Most who develop this disorder are bright and highly creative. The figures they come up with are often creative and highly embellished," he said.
"Multiple personality is sort of a caricature of the normal process where individuals have a repertoire of selves. We all have sort of an angry self that we keep under control, and maybe a rebellious self, a more flamboyant, exhibitionistic self.
"Sometimes these 'selves' will come out more under the influence of drugs or alcohol, perhaps at a party. They are different sides of us that get activated under certain circumstances, but we still know it's us.
"The multiple personality is so extreme that the selves have no knowledge of each other; they are unaware of the existence of the others."
Smith said most multiple personality victims develop more than four personalities. The process becomes self-perpetuating, he said, as a victim learns to hide "undesirable" traits, such as anger, greed or promiscuity, outside his or her central personality.
"It continues with anger, greed, and so on, as more unacceptable parts of the person--or parts of the person the parents cannot tolerate--all get channeled off into fantasy-created, submerged selves.
"In a family where literacy and academic achievement are actually discouraged, the person may develop a highly intelligent, highly literate personality" that is kept hidden from critical parents, he said.
Smith said psychologists find a much higher incidence of multiple personality disorder among females than among males.
Abuse More Common
"Little girls are more likely to be abused and be victims of incest than are little boys," he said. "Also, since MPD almost always involves an antisocial side, male multiples end up in prison, while female multiples end up in hospitals, because society still is much less likely to prosecute females.
"Unfortunately, if we can't always adequately diagnosis MPD in mental hospitals, it certainly isn't going to be diagnosed in prisons."
If victims are good enough at hiding abusive family lives and the ensuing problems, their reward may be accusations that their disorder is really a hoax. Even "believers" often doubt whether the condition can be cured. In Milligan's case, doctors' efforts to gain his freedom caused public outrage and fears that his violent behavior would recur.
Will Seek Help
Torem said problems are possible, but such fears are irrational. Even if they do have a relapse, people with the disorder "at least know that they need to get help to cope."
The Ohio Legislature is debating a bill that would abolish the plea used by Milligan, innocent by reason of insanity, and replace it with "guilty but mentally ill."
Some people advocate that offenders who use the new plea should be forced to serve time in prison after they are treated for their mental illness.
"Who's going to want to get better to go to prison?" Torem asked. "Mental illness interferes with judgment, and ability to see right or wrong. Such people cannot be held accountable for actions they take while they are sick.
"After they are treated for their illness, they are entitled to their freedom."
Milligan once noted that if he had pleaded guilty to the rapes, he could have been granted his freedom after seven years.
"Do you know how many rapists and assassins are released every year, with no form of treatment, to go out and do it again?" Torem asked. "Psychopaths are much more dangerous to the public than people with MPD."