Three Problems with Dissociation

Print Friendly, PDF & Email

Bryan T. Reuther, PsyD

Bryan T. Reuther, PsyD

In the minds of clinicians and researchers, the term ‘dissociation’ conjures up a variety of intriguing and controversial phenomena; it should therefore come as no surprise that some have complained that the term is vague and imprecise (Cardeña, 1994; Frankel, 1994; Spitzer, Barnow, Freyberger & Grabe, 2006). Complaints notwithstanding, there is little disagreement that dissociation has been, and will remain, an important part of human psychology (Erdelyi, 2005), particularly as a reaction to trauma. Moreover, dissociation challenges the assumption, and the very nature of, unity in human experience. Consequently, dissociation deserves serious attention from scientists, clinicians, and theoreticians – both for its own sake and for advancing our understanding of fundamental structures of human psychology.

The aim of this paper is to bring into view three problems that any adequate understanding of dissociation will need to address.  In order to articulate these problems, I will draw from relevant figures and moments in the history of dissociation. I refer to the three problems as the motleyness problem, ontological problem, and normative problem, respectively. My main point is that if we do not have adequate answers to these problems then our conception of dissociation, especially a rich phenomenological articulation, will remain vague and imprecise. I will conclude with some thoughts about how to proceed.

I. The Motleyness Problem

In psychology, the term ‘dissociation’ has come to encompass a wide range of different phenomena, including daydreaming, depersonalization, derealization, dissociative amnesia and dissociative fragmentation—and this is far from an exhaustive list. While all are considered forms of dissociation, each is characterized by a distinctive presentation and phenomenal character. For example, the phenomenology of depersonalization, such as an ‘out-of-body’ experience, is quite different than the phenomenology of identity fragmentation in dissociative identity disorder (DID). In this section, I will briefly sketch the development of how the term ‘dissociation’ became the label of so many distinct phenomena, and how this generates a problem—the motleyness problem—that an account of dissociation needs to address.

The vast majority of dissociation researchers and clinicians credit the French psychologist-philosopher Pierre Janet for the discovery of dissociation—although dissociative phenomena certainly existed prior to Janet’s discovery, notably theorized in terms of animal magnetism and spirit possession.[1]Janet (1907) identified dissociation as the major feature of cases of somnambulism and hysteria, with the assertion that the model of somnambulism was the basis for more complex cases of hysteria. Somnambulism in the late 19thcentury went beyond mere sleepwalking to include states where a person would speak and act as though they were conscious, yet not recall what occurred during that time (the person would be amnestic to what occurred while in the somnambulic state). Janet (1907) understood somnambulism to involve the “dissociation of an idea, that has emancipated itself from the ensemble of consciousness”(p. 173).For Janet, the hallmark of somnambulism was this division of consciousness, and the formation of two separate conscious streams: the conscious and subconscious. The subconscious stream formed around an idéefixe, or ‘fixed idea’, which was often the result of an extremely stressful or traumatic event. This fixed idea would not be integrated into the ‘normal’ consciousness and persist in various levels of complexity. Thus, for Janet, dissociation is a failure of integration, with the result being the formation of these subconscious ideas.

While Janet established the role played by dissociation in the pathologies of somnambulism and hysteria, on the other side of the Atlantic, the American physician Morton Princeexpanded the scope of dissociation along both pathological and nonpathological lines. In his 1906 book, Dissociation of a Personality, he described ‘Miss Beauchamp’ as developing four personalities, building upon the complexities of the divisions in personality. Elsewhere, Prince (1929) described forms of ‘absentmindedness’ or ‘abstraction’, which could be roughly approximated to forms of ‘spacing out’ or a kind of ‘loss of present awareness’, as forms of nonpathological dissociation. Prince’s work began to expand what was considered dissociation beyond what Janet initially intended.[2]

The late 20th century brought about a revitalized interest in dissociative phenomena in the form of multiple personality, experiments in hypnosis, and an increasing interest in altered states of consciousness. During this time, the conception of dissociation shifted from structural divisions of consciousness (from the time of Janet and Prince) to include phenomenal or experiential separations and disconnections. The move to include phenomenal disconnections was one of the factors that lead to the theorizing of the continuum model of dissociation, which resulted in a wide variety of nonpathological altered states of consciousness, such as daydreaming, trance-states, ‘spacing-out’, and fantasizing to be included as forms of dissociation. For some critics, this expansion of the range of dissociative phenomena was seen as problematic. Detractors such as Onno van der Hart and Martin Dorahy (2009) describe this diffusion as “conceptual drift” that renders dissociation as “ill-defined” with “almost any psychologically derived breakdown in integrated functioning” to be considered dissociation (p. 19). They also point out that a broad, inclusive definition of dissociation incorporates phenomena which exhibit no clear developmental pathway, adding to the complexity and ambiguity. Even those that support the more inclusive definition agree that the term is imprecise term and could benefit from conceptual clarity (Cardeña, 1994; Frankel, 1994; Spitzer, Barnow, Freyberger & Grabe, 2006).  It is with reference to these concerns and objections that we can speak of a “motleyness problem.” Therefore, a satisfying account of the range of dissociation would help make sense of, and delimit, the range of phenomena that are grouped under this heading.

II. The Ontological Problem

With the motleyness problem pertaining to the number of different phenomena called dissociation, a related challenge for dissociation theory is to identify whatis being dissociated. The term ‘dissociation’ suggests some kind of division or sundering—but what exactly is the thing that is being divided?  I shall refer to this as the ontologicalproblemof dissociation, since it relates to the mode of unity, and hence the mode of being that makes dissociation a possibility in human psychology. Sorting out what is being dissociated is important not only for conceptual clarity, but also in practical application, especially insofar as the therapeutic goal is to integrate or unify dissociated parts.

The classical dissociationists Janet and Prince conceived of both consciousness and personality as the underlying unity that was susceptible to dissociative division. Janet (1907) also referred to the emancipation of the “system of ideas and functions” which itself is ambiguous, but was likely more of a functional description of the dissociated parts he was observing (p. 332).  A central assumption of these ontologies is the focus on privileging internal, psychological structures, and the divisions that occur to these psychological structures.

One of the most explicit representations of the heterogeneity of ontological commitments in dissociation theory can be found in the account of dissociation and dissociative disorders found in the Diagnostic and Statistical Manual of Mental Disorders, fifth-edition (DSM-V). The DSM-V defines dissociation as “the splitting off of clusters of mental contents from conscious awareness” (p. 820) and the “disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior (p. 291). Here, we see the DSM-V present a variety of ontological commitments forwhatis being dissociated. Moreover, terms such as ‘consciousness’, ‘identity’ and ‘body representation’—to name a few—are difficult to define, have rich philosophical and psychological histories in their own right, and remain ambiguous, driving home the challenge to a cohesive and consistent account of dissociation. Implied in the DSM-V’s description is the assumption that there exists a normal integration, which raises the question of how to determine what this normal integration of ‘consciousness’, ‘memory’, ‘emotion’ (and other terms on this lengthy list) actually looks like.Given this, a reasonable goal for a model of dissociation should be to provide an account of how these different dissociated parts come together. On this point the DSM-V’s account is quite lacking.

III. The Normative Problem

According to Janet, any division in consciousness or personality should be considered pathological; so-called normal people do not exhibit these divisions. Moreover, these divisions are seen by Janet as the result of traumatic experiences.  However, as mentioned earlier, Prince’s project involved theorizing nonpathological forms of dissociation, a trend that continues today (Butler, 2006). This presents us with our third challenge: to distinguish normal from the pathological forms of dissociation, particularly in the context of trauma.

The current debate—really an updated version of Janet and Prince’s positions—is whether dissociation should be classified along a dimensional continuum, incorporating phenomena ranging from normal/everyday experiences such as daydreaming as well as pathological forms, or whether it should be understood as a categorical, strictly pathological phenomenon. Probably most significant in the narrower categorical camp is the theory of structuraldissociation(Steele, van der Hart, & Nijenhuis, 2009). This model depicts two parts of the personality, which includes the apparently normal part (ANP) and the emotional part (EP). A key part of this model is it has a single etiology—traumatic experiences. Structural dissociation theorists argue that only the pathological division of the personality in an ANP and EP should be called dissociation, and the others that are mapped onto the continuum (e.g., daydreaming, ‘spacing-out’, etc.) would be better labeled as ‘alterations in consciousness’.

Of course, the DSM-V provides the general criterion “symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning” to determine pathology in all dissociative phenomena. However, we must keep in mind that just because these dissociative experiences are defined in the DSM-V, this does not mean that they are necessarily pathological. The DSM-V excludes the diagnosis of DID if the ‘symptoms’ are “part of a broadly accepted cultural or religious practice” (p. 292). This provides evaluative latitude for determine pathological dissociation in the context of cultural practices. In fact, dissociation may take on an adaptive or therapeutic role, especially in response to trauma, as a way of “not knowing” harmful information (Barlow & Freyd, 2009).Even if the DSM’s strategy of determining pathology is useful, distinguishing what might be adaptive or therapeutic from pathological is important. Moreover, the stigma that may accompany the designation of pathology, especially in the context of an adaptive response, is also a concern. The take-home message is that a theory of dissociation has to have the resources to adequately delineate among the normative and pathological, along with the nuanced distinction of the adaptive/therapeutic role.

IV. Concluding Remarks and Looking Ahead

The aim of this paper has been to articulate three problems that have been generated by the history of engagement with dissociative phenomena, and by its contemporary analysis. Taken collectively, these three problems help frame a challenge that a minimally adequate accounting of dissociation should meet.  First, such an account should define the class of phenomena that are understood as dissociative and shed light on the unity that belongs to that class. Second, such an account should be clear about what thing or things exhibit division when dissociation is at work. Finally, such an account should help clinicians to make sense of the distinction among normal, pathological, and therapeutic instances of dissociation.

There exists an extensive body of theoretical and scientific literature that address dissociation, and this work may help to address these problems. But to date there is no clear consensus about how the three challenges can or should be met. Perhaps there may be value in looking beyond the current models and ontological commitments to find a reasonable solution to capturing the phenomenological richness and complexity of dissociation.

Acknowledgements: I would like to thank Professor Wayne Martin and Doctors Jon Cleveland and Tyson Bailey for their extremely helpful comments. Special thanks to Doctors Steve Gold and Amy Ellis for the endless conversations about dissociation.

[1] In the interest of space, I will focus on Janet as the starting point for dissociation. Although, we must keep in mind the relevance of prior work, especially in the fields of animal magnetism and spirit possession. Janet (1925), for example, credited the French magnetist Amand-Marie-Jacques de Chastenet, Marquis de Puységur’s description of somnambulism as a precursor to his own theory of dissociation.
[2] Prince was not the only one to think along these lines. Other notable figures that also contributed to the expansion of dissociation included William James and Frederic Myers.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5thed.). Arlington, VA: American Psychiatric Publishing.

Barlow, M.R. & Freyd, J.J. (2009). Adaptive dissociation: Information processing and response to betrayal. In P. F. Dell & J. A. O’Neil (Eds.), Dissociation and the dissociative disorders: DSM-V and beyond (pp. 3-26). New York: Routledge.

Butler, L.D. (2006). Normative dissociation. Psychiatric Clinics of North America. 29, 45-62.

Cardeña, E.T. (1994). The domain of dissociation. In S.J. Lynn & J.W Rhue (Eds.) Dissociation: Clinical and theoretical perspectives. pp 15-31. New York: Guilford Press.

Erdelyi, M.H. (2005). Dissociation, defense, and the unconscious. In D. Speigel (Ed.) Dissociation, Culture, Mind, and Body. Washington DC: American Psychiatric Association.

Frankel, F.H. (1994). Dissociation in hysteria and hypnosis: A concept aggrandized. In S.J. Lynn & J.W Rhue (Eds.) Dissociation: Clinical and theoretical perspectives. pp 80-93. New York: Guilford Press.

Janet, P. (1907). The major symptoms of hysteria: Fifteen lectures given to the medical school of Harvard University. New York, NY: MacMillan.

Janet, P. (1925). Psychological healing, volume 1(Trans. E. Paul & C. Paul). New York: MacMillan (Originally published as Les medications psychologiques(2 volumes) in 1919).

Prince, M. (1906). The dissociation of a personality: A biographical study in abnormal psychology.New York: Longmans, Green, and Co.

Prince, M. (1929). Clinical and experimental studies in personality. Cambridge, MA: Sci-Art.

Spitzer, C., Barnow, S., Freyberger, H.J. & Grabe, H.J. (2006). Recent developments in the theory of dissociation. World Psychiatry, 5(2), 82-86.

Steele, K., van der Hart, O., & Nijenhuis, E. R. S. (2009). The theory of trauma-related structural dissociation of the personality. In P. F. Dell & J. A. O’Neil (Eds.), Dissociation and the dissociative disorders: DSM-V and beyond (pp. 239-258). New York: Routledge.

van der Hart, O. & Dorahy, M.J. (2009). History of the concept of dissociation. In P. F. Dell & J. A. O’Neil (Eds.), Dissociation and the dissociative disorders: DSM-V and beyond (pp. 3-26). New York: Routledge.

Bryan T. Reuther, PsyD, is currently an Assistant Professor of Human Services at Indian River State College in Fort Pierce, Florida, where he teaches in both the Human Services and Psychology Departments. He received his Master of Science and Doctorate degrees, both in clinical psychology, from Nova Southeastern University located in Fort Lauderdale, FL, where specializing in trauma psychology. He also holds a Bachelor of Arts degree in Psychology and Criminal Justice from the University of Central Florida. He has published papers in the Journal of Theoretical and Philosophical Psychologyand the American Psychological Association’s Handbook of Trauma. His research interests include understanding the existential significance of trauma, psychotherapy integration, and the philosophical underpinnings of psychological theories.