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The Dissociative Mind in PsychoanalysisReview - The Dissociative Mind in Psychoanalysis
Understanding and Working With Trauma
by Elizabeth F. Howell & Sheldon Itzkowitz (Editors)
Routledge, 2016
Review by Benjamin Beit-Hallahmi, Ph.D.
Jun 21st 2016 (Volume 20, Issue 25)

This book contains 22 chapters, including three authored by the two editors, and one by Elizabeth F. Howell alone.  Most chapters are scholarly, arguing theoretical points and citing authorities in psychoanalysis and psychiatry. Chapter 21 presents a summary of research regarding the validity of the dissociative identity disorder (DID) diagnosis, its etiology and its treatment. Other chapters report clinical cases, and appear less focused.  The book is really a symposium, with the contributors presenting some very personal approaches, and  no theoretical coherence is reached. Within the psychoanalytic literature, the approach is quite eclectic, with citations ranging from Erich Fromm, through Sándor Ferenczi , Melanie Klein, to Bion, Fonagy, and W.R.D. Fairbairn. Some contributors use the term 'multiple self-states' to denote what has been known as personalities or 'alters'.

Much space is devoted to the issue of continuity with Freud's well-known early writings about repression and hysteria, the Freud-Breuer pre-history of psychoanalysis.  More than once, references are made to Freud's rejection of the so-called "seduction theory", which then him led to regard fantasies and wishes as causing neurosis, rather than real events.

One source that is never  mentioned is Freud's best-known treatment of trauma (Freud, 1922), "Beyond the Pleasure principle", where Freud discussed the compulsive tendency of the traumatized  to re-experience the  trauma,  contrary to the natural reaction of avoiding pain.  This challenge led Freud to speculate about the human drive to masochism and the death instinct. What Freud reported, and what we all know, is that trauma victims are often unable to forget their painful experiences. What this book emphasizes is how trauma is repressed or dissociated.

What is the actual phenomenon? "Dissociative disorders are characterized by a disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior. Dissociative symptoms can potentially disrupt every area of psychological functioning." (DSM-V, p. 291). This description corresponds to what has been reported since the nineteenth century and will be accepted by most as phenomenologically relevant.

The next step is understanding the development of such experiences. The editors offer the following interpretation:

"Dissociation protects the mind from the unthinkable, the unimaginable,  and the unbearable helplessness to stop events that trigger feelings of terror , annihilation and non-being"  (p. 30, by Howell & Itzkowitz). This sounds compassionate and therapeutic, but trying to introduce dissociation in this way in 2016 assumes that readers have never heard of this concept and are not familiar with  relevant  publications. While the contributors are eager to acquaint us again with the fine points of writings by Pierre Janet in the nineteenth century, they  refuse  to  discuss the more recent and controversial history of dissociation.  When and how did the controversy arise?

For 100 years, dissociative disorders were considered real, but extremely rare. Then, in the 1980s, there was a three-pronged epidemic that shook up psychotherapy in English-speaking countries. First, there was a wave of claims about memories of sexual abuse, recovered during psychotherapy.  At the same time, there was a meteoric rise in the number of individuals diagnosed with multiple personality disorder (MPD), later known as DID.  While before 1980 the number of cases in the literature was under 100, by 1995 there were tens of thousands of such cases. The number of reported personalities in one body skyrocketed and the record was 4,500. Ninety five percent of the cases were diagnosed in North America, and 95% of them were women. Thigpen and Cleckley, the psychiatrists who published the famous case of Eve in 1957, denounced the new epidemic and described the newly reported cases as fake (Thigpen & Cleckley, 1984). No one listened, and dissociation became a cause and a movement.

The International Society for the Study of Multiple Personality and Dissociation was founded in 1984  by Bennet Braun and colleagues. The ISSMPD was responsible for the next stage of the epidemic. The assumption was that MPD or DID was the result of a massive childhood trauma. Leaders of ISSMPD started educating the public about an underground intergenerational network of Satanists, responsible for killing thousands of children every year, which was the source of this  childhood  trauma. Children born into Satanic families witnessed their siblings, or others, being sacrificed, and were subject to other forms of abuse. The resulting trauma led to dissociation.  The concepts of "Recovered memory", "Satanic Ritual Abuse" (SRA), and multiple personality disorder  (MPD) became inseparable (Nathan  & Snedeker, l995).  The therapists who were telling the world about dissociation, trauma, and Satanism were supposedly relying on evidence from clients who, during intensive treatment, recovered memories of childhood abuse. Because almost all cases of  recovered memories,  DID, and SRA were of women, the cause was embraced by leading feminists such as Catherine McKinnon and Gloria Steinem. Bennett Braun was publicly honored by Steinem for his contribution to the life of women.

As the twenty-first century began, the epidemic seemed to fade. There were precipitous declines in the frequency of reports about recovered memories, multiple personalities, or Satanists at work. If all these phenomena are real, how can we explain such a decline in their prevalence? The end of the dissociation epidemic is especially puzzling. Why has the diagnosis  become  so rare again? Large fluctuations in the prevalence of particular diagnostic labels must cause concern.  One reason might be the large sums of money, in the tens of millions,  paid out by insurance companies to former DID-SRA therapy clients, who went to court to pursue their therapists. Bennet  Braun, the person most identified with the dissociation cause, was the target of some of the best-known legal cases.

Today, it is clear that the DID-SRA enterprise victimized individuals and families. Elizabeth Gale,  treated by Bennett Braun,  entered therapy in 1986 for mild depression and then was made to believe that she had MPD, and  was active in an intergenerational satanic cult. She was also made to believe that she had bred babies for the Satanists,  who were sacrificed after birth. With the approval of Bennett Braun, she went through a tubal ligation at age 31  so that she would no longer harm children. In 2004, Ms. Gale received a settlement of $7.5 million (Gale V. Rush).

In 2001, the American Psychiatric Association expelled Bennet Braun from membership, "after Dr. Braun was found to have provided incompetent medical treatments unsupported by usual standards of practice; violated ethical boundaries with the patient, including inappropriate sexual behavior and exploitation; and seriously breached patient confidentiality with the media" (see www.physicianspractice.com).

Scores of court cases made it clear that the stories about Satanist rituals were invented by therapists and fed (often forcefully) to their clients. This is how Ewing Werlein, Jr., United States District Judge for the Southern District of Texas, described the actions of DID-SRA  therapists  in 1999: "These Defendants diagnosed and/or treated  various of these patients as members and/or victims of clandestine "Satanic cults" that committed horrendous crimes (e.g., murder, rape, cannibalism, etc.) upon their own members and their children. The evidence consistently revealed, however, that while these Defendants in different ways regularly encouraged their patients to divulge tales of such brutal crimes, which thereby perpetuated their insurance-paid "treatments," Defendants never reported any of these supposed crimes to the police for investigation"(United States of America   v. Judith A. Peterson, et al.).

The editors of this volume may want us to believe that these bizarre actions are merely part of a bygone history, but this is not the case. At least two contributors invited to write chapters in this book are sticking to the SRA delusion.

Richard Kluft, author of Chapter 13, in 1989 expressed concern about a "hidden holocaust" perpetuated by Satanic cults (Kluft, 1989, p. 192). In 2014 he stated "I remain troubled about the matter of transgenerational satanic cults" (p. 12) and  advocated moderation: "There is every reason to argue that many reports of satanic ritual abuse were ill founded, and to doubt the extent of what these reports alleged. There is also good reason to avoid going to the extreme of dismissing them completely" (p. 9) (see www.academia.edu/6496435).

Here is some of what Valerie Sinason, author of Chapter 19, reported in 2011:"… Sinason talks of a popular ritual in which a child is stitched inside the belly of a dying animal before being 'reborn to Satan'. During other celebrations, "people eat faeces, menstrual blood, semen, urine. There's cannibalism." Some groups have doctors performing abortions. "They give the foetus to the mother and she's made to kill the baby." "And the cannibalism -- that's foetuses?" I clarify."Foetuses and bits of bodies." "Raw or cooked?" "The foetuses are raw." "Not even a bit of salt and pepper?" I ask. "Raw. And handed round like communion. On one major festival, the babies are barbecued. I can still remember one survivor saying how easy it is to pull apart the ribs on a baby. But adults are tougher to eat" (Storr, 2011).

Child abuse is real, sexual abuse is real, incest is real, MPD may be real in some cases. Claims about SRA are different, because they are delusions, without any basis in reality.  It is not a matter of opinions or judgment. If you believe, as  Richard Kluft and Valerie Sinason do, in an underground religion worshipping Satan, without one shred of evidence ever been found, then something is terribly wrong with your reality testing. Letting you treat troubled individuals demonstrates severe negligence. 

 

References.

Braithwaite, J. J., Hulleman, J., Samson, D., & Apperly, I. (2011). Cognitive correlates of the spontaneous out-of-body experience in the psychologically normal population: Evidence for a role of temporal-lobe disturbance, body-distortion processing, and impairments in own-body transformations. Cortex47, 839--853.

Freud, S.  Beyond the Pleasure Principle (1922). In   The Standard Edition of the Complete Psychological Works of Sigmund Freud,  18,   1-64 . London : Hogarth Press.

Gale V. Rush-Presbyterian-St. Luke's Medical Center et al., Cook County, IL. Circuit Court. No. 03 L 12779.

Kluft, R.P. (1989). Editorial: Reflections on allegations of ritual abuse. Dissociation, 3,191-193.

Nathan, D.  & Snedeker, M. (l995). Satan's Silence: Ritual Abuse and the Making of a Modern American Witch Hunt. New York: Basic Books.

https://www.academia.edu/6496435/_Speak_Memory_Psychiatric_Times_21_March_2014_debate_on_role_of_American_psychiatry_in_the_satanic_ritual_abuse_moral_panic_of_the_1980s_and_1990s_?auto=download

http://www.physicianspractice.com/dissociative-identity-disorder/lawsuit-raises-questions-about-apa-liability-insurance-program

Storr, W. (2011). The mystery of Carole Myers. The Guardian, December 10. In http://www.theguardian.com/society/2011/dec/11/carole-myers-satanic-child-abuse

Thigpen, C.H.  & Cleckley, H.M. (1984). On the incidence of multiple personality disorder: A brief communication. International Journal of Clinical and Experimental Hypnosis32, 63.

United States of America   v. Judith A. Peterson, et aI, Crim. No. H-97-237, U.S. Dist. Ct., So. Dist. Texas, Houston Div.

 

© 2016 Benjamin Beit-Hallahmi

 

Benjamin Beit-Hallahmi is professor emeritus of psychology at the University of Haifa and senior research associate at Trinity College, Hartford, CT.  Among his publications: Psychoanalysis and Theism (2010), and Psychological Perspectives on Religion and Religiosity  (2015).


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