Review of “A Life in Pieces,” by Richard K. Baer

The following book review appeared originally in The Daily Telegraph and is copyright 2008 by Matt Ruff:

Towards the beginning of A Life in Pieces, psychiatrist Richard K. Baer finds himself doubting some of the stories his new patient is telling him. Rather than succumb to skepticism, he dismisses the doubts as irrelevant. “As a practical matter for therapy,” he writes, “it matters less what actually happened… These are the images in Karen’s mind, and they, and the feelings associated with them, are real to her… I don’t have to decide exactly what happened; I just need to understand what Karen thinks and feels.”

In a memoir whose subtitle promises a “harrowing true story,” this is a curious intellectual stance to adopt. Even from a purely therapeutic perspective, not all mental images are created equal. When a woman claims, for example, to have been the victim of a Satanic pedophile cult, I’d say it’s the facts and not just her feelings that matter.

Baer meets 29-year-old Karen Overhill when she comes in seeking treatment for depression. She reveals a childhood history of physical and sexual abuse by her father, grandfather, and others. Although Karen has problems with her memory, her descriptions of the abuse are vividly detailed—and increasingly bizarre.

She recounts one incident in which she was brought to a funeral parlor in the middle of the night and made to lie naked on an embalming table. While strange men caressed her body, her father stabbed her repeatedly in the abdomen with needles. On other nights, she says, she was taken to a local factory and used as the centerpiece of an obscene religious ritual. Baer, again plagued by doubts, writes: “The question of how much of this is ‘true’ always comes up as I listen to Karen’s horrific stories. But she always tells her stories in a way that is utterly convincing: with pain, depression, and wretchedness.”

There are more reliable tests. Given the amount of trauma Karen claims to have suffered—she describes being pierced with coat hangers and fishhooks, carved with knives, beaten with hammers and baseball bats—a medical exam ought to go a long way towards corroborating her stories. I would also look into the record of the trial in which Karen’s father was convicted of molesting Karen’s niece, to see if it sheds any light on what Karen herself experienced. Such investigative follow-up is important, because while Karen is clearly damaged, she may also be delusional or making things up, and that has implications for her treatment. By putting “truth” in scare-quotes, Baer makes it impossible to know what is really going on with his patient.

Which brings us to Karen’s multiple personality disorder. This condition, now known formally as dissociative identity disorder, remains controversial, and many people reject it out of hand as too fantastic to be real. For the record, I am not one of those people. But Baer’s amateur-hour approach to the subject and his seemingly unshakeable credulity make this particular case very hard to credit.

Noting Karen’s complaints that she often “loses time” and her tendency to refer to herself as “we,” Baer concludes that abuse has caused her personality to fragment. Though he admits he has no experience in treating MPD, he does not seek advice or a second opinion from a more qualified psychiatrist. He also doesn’t share his diagnosis with Karen, fearing she won’t be able to handle it. Only after he receives a letter supposedly written by one of Karen’s other selves does he feel it’s safe to proceed—with Karen directing the treatment.

Karen presents the doctor with a list of her alternate personalities, including capsule descriptions of the function each one serves. This is a remarkable display of self-awareness, but Baer accepts it at face value: “I now know there are at least eleven distinct alternate personalities… This is intensely interesting to me, yet it’s important I not show any excitement, lest she be alarmed or think she has to do more of this to please me… [I]t’s a real psychiatric adventure.”

Adventure soon wins out over restraint. Baer allows Karen to call him at home at all hours; their frequent late-night conversations contribute to the breakup of his marriage. When Karen can’t pay her bills, Baer starts treating her for free.

One day Karen recounts a newly remembered incident of abuse involving a Catholic priest. She says the memory was triggered by a movie she saw called Primal Fear. In the film, Edward Norton plays a man charged with killing an archbishop who abused him; he is acquitted on the grounds that he has multiple personality disorder. Karen liked Primal Fear, but was bothered by the revelation that Norton’s character faked his MPD. She worries Baer might think she’s faking. She asks him: “Do you think I’d lie to you?”

“It hadn’t really occurred to me,” he replies.

That I can believe.