Patient presented as unusually distraught. First sign of regression was evident last month when he insisted he had been in Dresden during the war. After steadily abandoning some of his emerging personalities over the past year, this was the first time he acquired a new one. His description of the firebombing of the city was historically accurate. He wept as he described the carnage, all the while speaking German. I asked him where he learned to speak with such fluency. “Dresden, of course,” he said. Then he reproached me for asking “a stupid question.” It was the first time I heard such irritability.

Our session today left me bewildered. He has clearly decompensated. I may be unable to help. I sense he’s beginning to lose trust in me, and I’m beginning to distrust him. There are moments when he is testing. Fair enough. And others when he is taunting, like today. Unlike the last session, he was polite, even calm, as he assumed another new personality and confessed to killing his twin brother. “Doctor, this is confidential,” he said. “Anyway, fratricide isn’t like a real crime.”

“Not a real crime?” I said. Still calm, he slowly shook his head and said I just couldn’t understand. He then explained that conventional rules don’t apply if you are raised by a wolf. He said he and his brother were suckled by a she-wolf for nearly a year, and his brother was always greedy. “Always took more,” he said, “and grew fatter and bigger and stronger.” I asked if that was the reason he killed him. “No, no, he was just a baby,” he said. “You can’t kill a little baby just because he’s hungry.” He looked at me quizzically, and said again that I couldn’t understand. “Tell me you were raised by a wolf, Doctor, and then we can talk.”

NB: Patient is a textbook example of DID. Today he manifests an unusual variety of unrelated identities including one in which he confessed to murdering his twin brother.
After a long silence, I tried to reengage by asking him if he had any regrets. “He was teasing me,” he said, “about the wall. Mockery cannot go unpunished. And since you asked, no regrets.” He exhibited a smile of satisfaction, perhaps challenging me to show my disapproval. Instead, I changed the subject by asking him about his weekend. The question triggered an unexpected reaction, a change of posture and a deepening of his voice.

“Sunday was Fathers’ day,” he said. “We hate it. We didn’t have a father. We had a vicious abusive stepfather. Don’t you remember? I told you all the unspeakable details. Doctor, don’t you write this stuff down? Why do you keep asking?”

Patient had changed to his primary identity as a mathematical genius destined to save the world. I suggested we change the subject and asked him about his government work. He seemed confused, said he couldn’t remember anything since the weekend. “My memory is shot,” he said. “Don’t know how I got to Vienna. I must have flown, but I can’t remember.”

Patient recognizes his multiple competing identities and understands we’re trying to integrate them. But after months of progress, the emergence of his new identities is a mystery to me. So, I asked him to tell me more about his child identity.

“Killing my brother over a stupid wall? It all began with a dispute over the location of the city. We decided to resolve it through a contest of augury.” I interrupted him to ask the meaning of augury. He ignored me and continued with the story. One brother had seen twelve auspicious birds, the other only six, so the first claimed the approval of the gods.

His voice changed back to his child identity. “So, with the gods on my side, I continued building on the Palatine Hill. Did I kill my brother Remus? Well, yes, that’s what I said. But others say no. My memory is kaput, so don’t believe anything I say.”

“Romulus? You are Romulus?” I said to confirm his new identity-the founder of Rome, rescued from the Tiber River by a wolf, and raised by a shepherd.

“Yes,” he said, “my father abandoned me, left me to die. My stepfather beat me, left me to die. My employer in loco parentis is suffocating my spirit with foolish excuses and irrational delays, which has left me to die. I must escape.”

He thanked me for my patience, said he had a flight to catch, and departed with an upbeat salutation in German: “Auf Wiedersehen.”