Psychological Concepts and Dissociative Disorders
Dissociation has returned to the psychiatric vocabulary and with a vengeance. Once a curious process implicated in rare cases of psychogenic amnesia, fugue, and multiple personality disorder (MPD) observed around the turn of the century, then more recently revived (by E. R. Hilgard, among others) in theories about hypnosis and related states, it has become a fundamental explanatory concept in analyses of syndromes ranging from posttraumatic stress disorder to eating and borderline personality disorders. Where Freud once built psychoanalysis on the doctrine of repression, dissociation now figures prominently in the debate over recovered memories of childhood trauma. In this book, based on a symposium held at Dalhousie University to honor D. O. Hebb (who was fascinated by the dissociative disorders), Klein and Doane have collected a diverse assortment of papers that seek to demystify dissociative phenomena, and to make good on Hebb's insistence that experimentalists should take notice of clinical material and his intuition that dissociative processes would prove to be a gold mine for theory and research.
There was a time, around the turn of the century, when dissociation was a major concept in psychopathology. The issues of the Journal of Abnormal Psychology were filled with clinical and experimental studies of multiple personality and other dissociative phenomena. Then there was virtually nothing, until Thigpen and Cleckley (1954) and Osgood and Luria (1954), published their work on “The Three Faces of Eve.” And then there was almost nothing again for another 30 years, until an explosion of published work began in 1984—presaged by the listing, for the first time, of dissociative disorders as a freestanding category in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) (American Psychiatric Association, 1980).
What happened to dissociation? Obviously, dissociation suffered the same fate as all other mentalistic concepts in the ravages of the behaviorst revolution in psychology. Once psychology narrowed its focus to the functional relations between environmental stimuli and observable responses to them, mental states, dissociated or not, were beyond the pale. But the fate of dissociation was decided before Watson, and certainly before Skinner, when dissociation theory and its advocates (Pierre Janet in France, Morton Prince in the United States) fell before the onslaught of Freud, psychoanalysis, and the concept of repression. The reasons for the triumph are still not well understood. Certainly it was not because psychoanalysis had more scientific validity, or more clinical effectiveness, than dissociation theory or treatments based on it. But we can see repression overtake dissociation in John Barresi's chapter in the present volume: a fascinating analysis of B.C.A., a woman with multiple personality disorder who was being treated by Morton Prince. Prince was adamantly opposed to psychoanalysis, and the pages of the Journal of Abnormal Psychology, which he owned and edited (with the assistance, from 1910 to 1921, of Ernest Jones, Freud's hagiographer), were filled with brutal criticisms of the theory and technique. But Barresi shows, through an analysis of previously unpublished correspondence between B.C.A. (in all three of her alter egos!) and Prince, that Freudian concepts quickly appeared in the formulation of the case and that B.C.A. herself attributed problems to unwanted sexual emotion aroused when she, a somewhat neurasthenic widow, had been kissed by a drug addict (long story there: read the chapter).
So why all the interest in dissociation now? Richard Kluft, in his chapter, notes that interest in hypnosis and in MPD seem to go hand in hand. Certainly there has been a revival of hypnosis research, and in this book Kenneth Bowers outlines a cogent theory of dissociation inspired by his studies of hypnosis. But the hypnosis revival really began in the 1960s, long before the dissociative disorders reappeared on the scene. One milestone was the publication of Sybil (Schreiber, 1973), a fictionalized treatment of an actual case of MPD, which captured the attention of nonprofessionals and began the process by which MPD has become an important part of American culture. A more important factor, according to Kluft, was the rise of feminism and increased attention to the problem of childhood sexual abuse. It is commonly believed that childhood trauma lies at the heart of MPD—though the evidence for this, reviewed comprehensively in a chapter by Brian Doan and Susan Bryson, is not at all convincing. A third factor was the Vietnam War and the growing recognition of, and interest in, posttraumatic stress disorders—themselves commonly believed to be essentially dissociative in nature.
Kluft dismisses the possibility that MPD and other dissociative disorders might be diagnostic fads, but there are some aspects of the current revival that contribute to this impression. Chief among these is the apparent ease with which MPD is diagnosed these days, in light of the paucity of experimental studies of MPD and other dissociative disorders. In the “golden age” of dissociation, there were many such studies. More than 10 years into what might be called a “second golden age,” MPD is much more talked about than studied. In this volume, Mary Jo Nissen and her colleagues review an experimental study of memory in MPD, focusing on the transfer of implicit memory across interpersonality amnesia in a single case; Pierre Flor-Henry reviews an EEG study of two cases, but does not, unfortunately, provide comparisons among their alter egos; Frank Putnam offers some case data on state changes in MPD, and both Gordon Bower and Carolyn Szostak and her colleagues discuss mood-dependent memory as a laboratory model of the disorder. These chapters are very interesting, but even though hundreds if not thousands of MPD cases have been reported since 1974, fewer than two dozen have been subjected to any kind of experimental investigation. Moreover, as George Fraser's chapter makes clear, the dissociative spectrum contains a large number of phenomena beyond MPD, such as psychogenic amnesia, fugue, glossolalia, and the out-of-body experience, all of which remain virtually untouched by experimental investigation.
In this book, the contributors have taken an important step in demystifying these syndromes, and Hebb would have been pleased by the symposium held in his honor. But the book also underscores the gap between clinical description and theoretical speculation on the one hand and hard empirical evidence on the other. The dissociative disorders, and dissociation in general, will not make its way into the mainstream until this gap is closed.
Raymond M. Klein, professor of psychology at Dalhousie University (Halifax, Nova Scotia, Canada), is past president of the Canadian Society for Brain, Behavior and Cognitive Science (1993-1994); coauthor, with T. Taylor, of the chapter “Categories of Cognitive Inhibition With Reference to Attention” in D. Dagenbach and T. Carr (Eds.) Inhibitory Processes in Attention, Memory and Language; and coeditor, with P. Jusczyk, of The Nature of Thought: Essays in Honor of D. O. Hebb. Klein has served on the editorial boards of the Journal of Experimental Psychology: Human Perception and Performance (since 1977) and the Canadian Journal of Psychology.
Benjamin K. Doane, staff psychiatrist at Victoria General Hospital in Halifax and professor of psychiatry and former head of the Department of Psychiatry (1975-1981) at Dalhousie University, is author of the chapter “Clinical Psychiatry and the Physiodynamics of the Limbic System” in The Limbic System: Functional Organization and Clinical Disorders, which he coedited with K. E. Livingston. Doane served as a member of review committees of the Canadian National Health Research and Development Program and the Canadian Medical Research Council during the 1970s and 1980s.
John F. Kihlstrom, professor of psychology at Yale University (New Haven, Connecticut), is coauthor, with D. J. Tataryn and I. P. Hoyt, of the chapter “Dissociative Disorders” in P. J. Sutker and H. E. Adams (Eds.) Comprehensive Handbook of Psychopathology (2nd ed.); author of the chapter “One Hundred Years of Hysteria” in S. J. Lynn and J. W. Rhue (Eds.) Dissociation: Theoretical, Clinical, and Research Perspectives; and coeditor, with F. J. Evans, of Functional Disorders of Memory. Kihlstrom is recipient of a Distinguished Scientific Award for an Early Career Contribution to Psychology from the American Psychological Association and a Morton Prince Award from the Society of Clinical and Experimental Hypnosis.
|0010-7549||© 1995 by the American Psychological Association, Inc.|
|Previously published in Contemporary Psychology: A Journal of Reviews, October 1995, Vol. 40, No. 10, 949-950|
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