Dまた推敲 ②

Historical overview

The controversy around the notion of dissociation dates back to Freud. The more we explore his views on dissociation, the deeper we are impressed about how much Freud attempted to distance himself from this idea. It was already obvious in the “Studies of Hysteria” that he co-authored with Joseph Breuer, far before his well known conflict with Pierre Janet on the topic. What is remarkable is that Freud’s attitude toward dissociation as well as dissociative patients replicates itself in current psychoanalytical sessions as was demonstrated by the initial short vignette.
 When Freud realized that many hysterical patients suffered from childhood abuse and trauma, he prompted Breuer into writing the book with him. Freud proposed that there are different types of hysteria, such as “hypnoid hysteria” as well as “retention hysteria” and “defense hysteria”. However, his dissatisfaction with Breuer's idea of hypnoid (dissociative) state was obvious in the same book. In the last chapter of the “Studies of Hysteria” (Freud, 1895, p.286)
Now both of us, Breuer and I, have repeatedly spoken of two other kinds of hysteria, for which we have introduced the terms ‘hypnoid hysteria’ and ‘retention hysteria’. It was hypnoid hysteria which was the first of all to enter our field of study. I could not, indeed, find a better example of it than Breuer's first case, which stands at the head of our case histories. Breuer has put forward for such cases of hypnoid hysteria a psychical mechanism which is substantially different from that of defense by conversion. In his view what happens in hypnoid hysteria is that an idea becomes pathogenic because it has been received during a special psychical state and has from the first remained outside the ego. No psychical force has therefore been required in order to keep it apart from the ego and no resistance need be aroused if we introduce it into the ego with the help of mental activity during somnambulism. And Anna O.'s case history in fact shows no sign of any such resistance.
I regard this distinction as so important that, on the strength of it, I willingly adhere to this hypothesis of there being a hypnoid hysteria. Strangely enough, I have never in my own experience met with a genuine hypnoid hysteria. Any that I took in hand has turned into a defence hysteria. It is not, indeed, that I have never had to do with symptoms which demonstrably arose during dissociated states of consciousness and were obliged for that reason to remain excluded from the ego. This was sometimes so in my cases as well; but I was able to show afterwards that the so-called hypnoid state owed its separation to the fact that in it a psychical group had come into effect which had previously been split off by defence. In short, I am unable to suppress a suspicion that somewhere or other the roots of hypnoid and defence hysteria come together, and that there the primary factor is defence. But I can say nothing about this. (Studies of Hysteria,1895, p285., stress added by Okano)
Freud did not forget this issue and later made it clearer even in “Dora’s case”, as follows.
…I should like to take this opportunity of stating that the hypothesis of ‘hypnoid states’—which many reviewers were inclined to regard as the central portion of our work—sprang entirely from the initiative of Breuer. I regard the use of such a term as superfluous and misleading, because it interrupts the continuity of the problem as to the nature of the psychological process accompanying the formation of hysterical symptoms. Fragment of an Analysis of a Case of Hysteria (1905) P27 Underlined by Okano
 Why was Freud so much opposed to the idea of “hypnoid state” that he later considered  “superfluous and misleading”? Because the latter presupposes the splitting of the mind, which, according to him was not a dynamic explanation. Freud’s stance is clearer in his statements found in the “Psychoneuroses of Defense" (1894), in which he chose also Janet as a target of his criticism of the same nature.
Let me begin with the change which seems to me to be called for in the theory of the hysterical neurosis.
Since the fine work done by Pierre Janet, Josef Breuer and others, it may be taken as generally recognized that the syndrome of hysteria, so far as it is as yet intelligible, justifies the assumption of there being a splitting of consciousness, accompanied by the formation of separate psychical groups.1 Opinions are less settled, however, about the origin of this splitting of consciousness and about the part played by this characteristic in the structure of the hysterical neurosis.
According to the theory of Janet (1892-4 and 1893), the splitting of consciousness is a primary feature of the mental change in hysteria. It is based on an innate weakness of the capacity for psychical synthesis, on the narrowness of the ‘field of consciousness (champ de la conscience)’ which, in the form of a psychical stigma, is evidence of the degeneracy of hysterical individuals.
In contradistinction to Janet's view, which seems to me to admit of a great variety of objections, there is the view put forward by Breuer in our joint communication (Breuer and Freud, 1893). According to him, ‘the basis and sine quâ non of hysteria’ is the occurrence of peculiar dream-like states of consciousness with a restricted capacity for association, for which he proposes the name ‘hypnoid states’. In that case, the splitting of consciousness is secondary and acquired; it comes about because the ideas which emerge in hypnoid states are cut off from associative communication with the rest of the content of consciousness.2
I am now in a position to bring forward evidence of two other extreme forms of hysteria in which it is impossible to regard the splitting of consciousness as primary in Janet's sense. In the first of these [two further] forms I was repeatedly able to show that the splitting of the content of consciousness is the result of an act of will on the part of the patient; that is to say, it is initiated by an effort of will whose motive can be specified. By this I do not, of course, mean that the patient intends to bring about a splitting of his consciousness. His intention is a different one; Freud, “Psychoneuroses of Defense" 1894, p.46, stress added by Okano.

Why did not Freud accept the idea of dissociation?

I consider that the reason why Freud so much loathed the notion of dissociation came from his dilemma of dealing with two antithetical issues, which cannot be handled together by their own nature. One is the drive theory that supposes that an internal factor mainly determines how the mind works, and the other is a perspective that multiple external factors, such as sexual trauma, which also affect human mind.
Freud was essentially a drive theorist. He cannot think about human mind without drive as its primary motivating force (hence the notion of “drive”). This theory is inherited to Freud from traditional theory of mind, dating back to Mesmer’s animal magnetism, or even further before, such as Hippocratic notion of humorism. Humorism posited that an excess or deficiency of any of bodily fluids affects human’s mental condition. Freud’s theory of libido is considered to be right on the track of this humorism, with his peculiar spin of sexuality.
On the other hand, he maintained the theory of sexual trauma, even after he “abandoned” the so-called “seduction theory”. Freud continued to believe that seduction can still be seen in the patient’s childhood, but it is significant only because it increased the child’s libidinal excitation without discharge. In other words, external events play a role mainly because they influence the internal condition. Thus Freud succeeded in uniting two antithetical factors into a single coherent theory. In order to make this theory plausible, the “apparatus” of mind should be intact in performing its dynamic mechanism. It allows excessive libidinal excitation due to seduction which mobilizes the defense mechanism of repression, which results in symptom formation in later life. What Freud did not take into account is a state where trauma is so damaging to the mind that the “apparatus” can no longer maintain its functional integrity, resulting in catastrophic phenomenon, such as splitting of mind and “hypnoid state” that Breuer conceptualized. 
  Even though Freud himself was distancing himself from the notion, dissociation has been discussed in a very limited way in psychoanalytic parlance. Obviously, dissociation was also discussed outside of psychoanalysis, but rather in a different way. Van der Hart summarizes the difference as follows;
The core of the difference between this psychoanalytic view of dissociation and the non psychoanalytic views that were prevalent in the late 19th and early 20th centuries is the following. Non-psychoanalytic investigators conceptualized dissociation in terms of two types: (1) integrated functioning that temporarily gave way in the face of stressors, and (2) the concomitant development of a separate, split off, psychic organization, personality, or stream of consciousness. This separate organization was made up of the unintegrated perceptual and psychological elements of the traumatic event. This personality organization operated outside of the individual's conscious awareness and could be accessed by various means including hypnosis and automatic writing. It was the division (dissociation) of consciousness (or the personality) that caused such hysterical (dissociative) symptoms as amnesia and contractures. For non-psychoanalysts, dissociation referred not only to the process of failed integration, but also to a psychical organization or structure (i.e., a dissociative psychic organization). Early Freudians, on the other hand, limited their view of dissociation solely to the first aspect (i.e., the process of failed integration, which, for the analysts, was motivated by the ego in the service of defense).van der Hart, Paul Dell ed. "Dissociation Book" p.14)

This statement points to the fact that although Freud might have acknowledged that splitting of mind can occur, it is as a result of an “act of will of the patient”, i.e. that two split-off minds are still under the control of the ego. The separated part would never develop into an independent ego with its own will. I would like the reader to bear in mind this point, which is crucial to the point I am going to make in this communication and especially the notion of the Dissociation (dissociation with capital D).