2020年10月22日木曜日

治療論 英訳 4

 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. Deeply steeped in 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, 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. indicating a need for a notion of spectrum or continuum between these two positions.

As stated earlier, in in the state of DID, different personalities appear and behave like independent subjects, each with its own initiative and sense of subjectivity, as van der Hart’s type (2) dissociation assumes. These subjects are not necessarily split off for defensive purposes, unlike personalities that are dynamically related to each other in dissociation.

Instead of basing ourselves on the the dichotomy of van der Hart’s type (1) and (2) we should understand these conditions in terms of a spectrum between dissociation and 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. 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.