Stern and Bromberg
In recent psychoanalytic literature, there are two major figures in the analytic discussion of dissociation: D. Stern and P. Bromberg and their works are relevant to be discussed in this context. The current notion of dissociation proposed by them is characterized by their unique understanding of what is not conscious. Stern states: Freud accepted without reservation the idea that the mind - and, therefore, the unconscious is composed of fully formed contents. (Stern, 2009, p.655.) Stern discusses that in traditional psychoanalysis the repression model assumes that there is one truth in the unconscious that corresponds to one objective reality. He calls this notion “correspondence theory” and proposes a different mechanism of the mind at play in dissociation.
Bromberg asserts that the issue of
trauma is crucial in understanding the human mind, and dissociation plays a
significant role in this context. Bromberg considers that trauma continuously
occurs throughout developmental stages. Basing his theory on the work of Sullivan,
he understands dissociation as a mechanism mobilized “where drastically incompatible emotions or perceptions are required to
be cognitively processed within the same relationship” (Bromberg, 1994, p.
520). Bromberg made it clear that although the notion of conflict has been
playing an important role in neurotic people, dissociative patients suffer from
not having conflict. He further states that due to trauma, a part that Sullivan
referred to as “not-me” grows, and in a therapeutic environment that is “safe,
but not too safe” (2012, p. 17), that not-me part gets integrated into the
system.
Bromberg’s work on dissociation was
characterized by its introduction of the notion of enactment in its context
(1993) and this idea drastically enlarged the scope of dissociative
understanding in psychoanalytic filed. Through enactment what has been dissociated is
experienced and gets integrated to the self. In a therapeutic relationship, the
therapist can experience a part in the patient that is enacted, while what is
dissociated and gets enacted by the therapist can be experienced by the
patient. Thus, Bromberg considers dissociation as basically an interpersonal
phenomenon (Bromberg, 1996). This theory assumes that what is dissociated is
still within the individual somewhere in his/her mind. Dissociative parts are
“unsymbolized aspects of the patient’s self” (ibid., p. 520) which is conveyed
to the other in a projection-like mechanism. In other words, Bromberg’s
interpersonal model of dissociation appear to remain on the level of van der
Hart’s type (1) dissociation. However. I believe his, and Stern(2009)’s theories
indicate another potential understanding of dissociative phenomena: the
possible co-existence of two or more subjectivities. Is it not possible that
what has not been experienced and not formulated for a subject (S1) could have
already been experienced and formulated for another subject (S2, or another
part of the personality)? Stern states that the “not-me” described by Sullivan
is basically maintained as an unformulated experience (Stern, 2009, p. 660).
However, when Sullivan referred to a dissociated part as “not-me,” it might be
“not-me” for the S1, but at the same time “me” for S2.
According to Stern’s understanding, quite often, severe
trauma might not be experienced and therefore gets dissociated. That is true
for the S1 that was “present” at the traumatic moment. However, this theory
does not preclude a possibility that somewhere else in his psyche another
subject, S2, has been present and has actually experienced that trauma. Stern and
Bromberg did not discuss that point, as psychoanalytic tradition would not
allow, or even anticipate, the co-existence of two subjectivities in the same
psyche, although current psychiatry clearly indicates that such coexistence of
S1 and S2 can be what is occurring in patients with DID.
Here, we are invited to understand
dissociation on a larger scale involving two or more subjectivities, and I
would write this type of dissociation as “Dissociation” borrowing Itzkovich’s idea). This Dissociation is
roughly equivalent to van der Hart’s classification of type (2) dissociation.
Bromberg also promotes respect for the
uniqueness of each personality and the attitude of “finding and directly
engaging the patient's dissociated voices as discontinuous but individually
authentic expressions of selfhood” instead of resorting to the promotion of
premature integration (Bromberg, 1998, p.199). This statement speaks more to
the position that van der Hart’s type (2) dissociation would promote. Thus,
Bromberg’s position is related to both type (1) and type (2) depending on the
context.
Bromberg’s and Stern’s discussion indicate
a need for a notion of spectrum or continuum between these two positions. Instead
of basing ourselves on the dichotomy of van der Hart’s type (1) and (2) we
should understand these conditions in terms of a spectrum between these two
types of dissociation. A condition with two subjects (e.g., S1 and S2) who feel
distinctly separated from each other while also feeling that they were once
united in the past might be located somewhere in the middle in that spectrum. Whether or not we understand a particular
case, identification of dissociation versus Dissociation depends on our
clinical understanding of the case. However, we should bear in mind that in
some cases, treating S1 and S2 as a dissociated but singular person can be
misleading and potentially not helpful for the therapeutic alliance.
