CSAR

Dissociation, Lack of Association, and Multiplicity

by Elizabeth Howell

In situations of trauma and extreme adversity, dissociation is initially adaptive and protective, even fostering survival. Victims of rape, near-drowning, mountain climbing accidents, serious automobile accidents, natural disasters, and war trauma, to name a few, may become numb, go into neutral gear (Terr, 1994), float to the ceiling or sky, and so on, in involuntary ways. At such times dissociation allows people to separate themselves from the experience of the trauma. As Van der Kolk notes (1996), “during a traumatic experience, dissociation allows a person to observe the event as a spectator, experience no, or only limited, pain or distress; and to be protected from awareness of the full impact of what has happened” (p. 192). The capacity for dissociation can also be soothing in times of unbearable stress. For example, many highly dissociative patients report they have found ways to voluntarily ‘disappear’ from traumatic experiences by going into a trance state, becoming lost in the wallpaper, or mentally going into a mouse hole in the wall.

However, when the trauma goes on too long, occurs too frequently, or happens too early in a person’s life, and the person is too alone in it, a structural dissociative organization develops, and along with it affective dysregulation, unrecognized emotions, and even amnesia. This, then, is pathological dissociation. Further, although depersonalization that occurs at the time of the trauma may be adaptive, its persistence over time is problematic. (Many traumatized patients are highly depersonalized. Often you won’t know unless you ask.)

In traumatizing environments, neglect is also present. One feature of neglect is a lack of parental facilitation of association of separate emotional and behavioral states. Frank Putnam (1997) has spelled out in his DBS (discrete behavioral states) model how infants start out life with unlinked behavioral states, such as sleep, awakening, awake alertness, fussiness, and so on. In a facilitating environment, parents help the child to label states of mind, which helps to link them. Trauma also impedes the associative linking of self-states.

But when we speak of dissociative disorders, it is not just pathological dissociation, and lack of association, but also multiplicity that is at issue. The capacity for multiplicity fostered the survival of human groups (Slavin & Kreigman, 1992), and is needed in most social interactions. Multiplicity allows us to enact different roles, such as student, teacher, mother, father, daughter, son, victim, rescuer, persecutor, and so on. Normally, people’s minds are patterned into a multitude of organizations in accordance with experiences, feelings, thoughts, and fantasies about significant others. And this patterning reflects different aspects of many people in many relationships. As Steven Mitchell (1991) noted, “because we learn to become a person through interactions with different others and through different interactions with the same other, our experience of self is discontinuous, composed of different configurations, different selves with different others” (p. 128). Thus, it is not just that we have dissociated experiences, but we also have multiple self-states, in accordance with roles and context. The inevitability of trauma, especially some relational trauma, along with the psychic splits it occasions, requires a psychic structure that encompasses dissociation. Considering both dissociation and multiplicity, none of us is a unity but rather a highly organized aggregation of more or less interconnected self-states, functioning more or less in harmony, or more or less dissociatively.

In dissociative disorders and dissociation-based problems in living, both dissociation and multiplicity are relevant. In double-bind situations of contradictory attachment, such as child abuse by a parent or caregiver, dissociative multiplicity allows the child’s attachment to and love of caretakers, both vital to survival and psychological wellbeing, to endure in a separate psychic compartment relatively undisturbed despite experiences such as abandonment or abuse that might otherwise be psychologically ruinous. Attachment, as Bowlby (1969) has observed, is an evolutionary blueprint that serves survival. The baby stays close and attached to its mother in times of fear and danger because that is protective against predators. What happens, though, when the caretaker is also the abuser? The child moves toward the caretaker, who is the source of the danger, to maintain the attachment that provides the hope of safety. Dissociative multiplicity allows one dissociated self-state to experience love and attachment, while another or other self-states hold the terror, distrust, rage, inaccessible to the self-state that loves. Thus dissociative multiplicity protects the traumatized person from unbearable knowledge, preserving sanity.

 

Elizabeth Howell, Ph.D., a psychoanalyst and traumatologist who specializes in the treatment of dissociative disorders, is on the Editorial Board of the Journal of Trauma and Dissociation, is an adjunct Clinical Associate Professor for the New York University Postdoctoral Program in Psychotherapy and Psychoanalysis; faculty and supervisor, Trauma Treatment Center, Manhattan Institute for Psychoanalysis; faculty for the psychoanalytic program of National Institute of Psychotherapies, and faculty for Psychotherapy Training Program: Diagnosis and Treatment of Dissociative Disorders, of the International Society for the Study of Dissociation (ISSTD). She is an Honorary Member of the William Alanson White Psychoanalytic Society.

She has written numerous articles on trauma and dissociation, and her award-winning books include The Dissociative Mind; Understanding and Treating Dissociative Identity Disorder: A Relational Approach; and The Dissociative Mind in Psychoanalysis: Understanding and Working with Trauma (co-edited with Sheldon Itzkowitz), which has been nominated for a Gradiva award.  In 2017 she received the Lifetime Achievement Award from the International Society for Trauma and Dissociation.  She runs reading and consultation groups and is in private practice in New York City.

 

References

Bowlby, J. (1969), Attachment and Loss, Vol. 1: Attachment. NewYork: Basic Books.

Mitchell, S. (1991). Contemporary perspectives on self: Toward an integration. Psychoanalytic Dialogues, 1, 121–147.

Putnam, F. (1997). Dissociation in children and adolescents. New York: Guilford Press.

Slavin, M. & Kriegman, D. (1992), The Adaptive Design of the Human Psyche: Psychoanalysis,

Evolutionary Biology, and the Therapeutic Process. New York: Guilford Press.

Terr, L. (1994). (1994), Unchained Memories. New York: Basic Books.

Van der Kolk, B. (1996). The complexity of adaptation to trauma: Self-regulation, stimulus discrimination, and characterological development. In: Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society, ed. B. van der Kolk, A. McFarland, O. van der Hart&L. Weisaeth. New York: Guilford Press, pp. 182–214.

 

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