The author has interviewed and reviewed the cases of over 100 patients with a suspected diagnosis of multiple personality disorder (MPD). He finds it clinically useful to think of a continuum of character pathology in which dissociative and defensive altered states predominate. At one end of this continuum is MPD, which he considers a lower-level dissociative character. He redefines dissociation as a defensive altered state, due to autohypnosis, which augments repression or splitting. Depending on the degree of integration of the ego, it may result in a broad range of disturbances of alertness, awareness, memory, and identity. Four vignettes are presented which illustrate a transient hypnoid state, "characterological" dissociation in an upper-level dissociative character, and two cases of MPD, including one emerging in analysis.

The role of perverse sexuality as an organizing influence in "multiple personality" is explored in this paper. Following a brief review of psychoanalytic thinking on sexual trauma and perversion, the author discusses his own views on dissociation and "multiple personality." A clinical case is then presented in which transsexualism, homosexuality, and sadomasochistic heterosexual practices were manifested during altered ego states. Analysis of the transference revealed the centrality of sadomasochism in this patient. It is hypothesized that various perverse structures may be formed within these seemingly autonomous, amnestic states, in order to contain anxiety and encapsulate the aggression which resulted from early psychic trauma. Issues relating to diagnosis, countertransference, reconstruction, and psychoanalytic technique are discussed also.

This review has focused on the characterological features of dissociative identity disorder (DID), extending the "state versus trait" debate to the realm of the dissociative disorders. A number of different theories are presented describing DID as a variant of, on a continuum with, or being comorbid with the narcissistic and the borderline personality disorders. It is then hypothesized that DID is best considered a distinct characterological entity. Two theories are put forth, which describe a personality disorder whose predominant defense is dissociation. The more developed model which possibly has more explanatory value is the "dissociative character." In this schema, DID would be considered a lower-level dissociative character, utilizing primitive forms of dissociation in which splitting is enhanced by an autohypnotic defensive altered state of consciousness. These altered states originate in response to the overstimulation of external trauma, but get reactivated in the service of here-and-now intrapsychic conflicts. Recognition of this dual quality of dissociation seems helpful in psychodynamic treatment, which allows for analysis of the defense and analysis of the content of these states. The nature of the content of what is "in dissociation" appears to have a dreamlike quality to it that may correspond to previous trauma but also be subject to some secondary revision. There is clinical evidence to suggest that "dream work" of the ego is operative in both the representation of a separate self in dreams and in alter personalities. Another organizing influence which contributes to seemingly separate identities is that of perverse sexuality. It appears that a number of dissociated sexual pathways may be followed in the same individual, which encapsulate aggression, childhood trauma, anxiety, and a sense of self. When this exceedingly complex psychic structure is successful, it may then free up some ego to proceed with aspects of healthy development.

The notion of standing on “solid ground” is most reassuring. However, it is a myth, because we now know that the surface of the earth is composed of tectonic plates that float and move. Similarly, the notion that our climate is stable and fixed is also a myth. We now know that we are living in a time of great flux, and as science tell us, we have a role its fate. Psychological defenses against the affects and anxieties associated with awareness of this progressive upheaval fuel the current sociopolitical debate about “climate change.” Maladaptive attitudes, rooted in ignorance, fear, superstition, and religion, will be looked at from a developmental perspective and applied to large‐group psychology. Just as young children are incapable of realizing that their violent actions could actually hurt their mothers, many adults refuse to believe that their actions could actually hurt “Mother Earth.” In addition, the possible role of transmitted ancestral memory of earlier global catastrophe is also taken into consideration. As such, it may be an unrecognized factor that may complicate large‐group responses to this most pressing problem.

In this paper, the author considers that the large-group dynamics in certain war-torn, hot spots throughout the world are symptoms of a "geopolitical identity disorder." He extrapolates from the model of the severely traumatized psyche in dissociative identity disorder in which there is so much intolerable emotion, destructive aggression and conflict that different selves with different identities develop which are unable to recognize how interdependent and related they actually are. In the most extreme cases, one dissociated self tries to kill off "the other" in order to gain exclusive control of the body and make it comply with his or her wishes and vision. In actuality, however, such an attempt is a dissociated suicide plan with lethal implications. This model is applied to the Palestinian/Israeli situation where there is a deadly battle over the land. A clinical vignette is offered to illustrate these ideas and offer possibilities for help.