Trauma and dissociation
In this second section I will talk briefly about my interest
and clinical research on Trauma and dissociation. Unlike shame and social
phobia that I was interested in from the beginning of my career, trauma and dissociation were topics that I
inevitably had to deal with in my clinical practice. By the late 80s, when I
moved to the United States, trauma-related disorders such as PTSD and
dissociative disorder were attracting the attention of American clinicians. The
Menninger Clinic was admitting a growing number of traumatized people, and
clinicians were struggling to learn more about these disorders. This new
movement began to change the minds of analytically oriented clinicians at
Menninger who were initially reluctant to acknowledge conditions such as
dissociative identity disorders. My initial case of psychotherapy in my training
happened to have different personalities inside of her, but I failed to notice
them until more than one year into our psychotherapeutic work. When that patient switched to another personality in front
of me, I felt that nothing that I learned in the analytic institute was helping
me understand and deal with the situation. This
was how I began to learn more about psychotherapy outside the realm of
psychoanalytic orientation. I struggled to develop the ability to understand
and treat traumatized people by resorting to techniques outside of the
analytically correct way of treating patients, including the use of hypnosis. However, my training in the TIP helped me also in putting
the issue of trauma and dissociation in the context of psychoanalysis. As I had
a chance to read volume after volume of the standard edition of Freud’s original work in the institute’s classes, I had the
chance to look at the issue of trauma from a psychoanalytic standpoint and I finally
came to believe that there were many seeds in Freud’s writings in various
contexts which could have been applicable to the understanding and treatment of
trauma-related disorders.
The topic of dissociation and clinical work with
dissociative patients became one of my life works since that time and I am always
haunted with a question of how traditional psychoanalysis comes to term with
the issue of dissociation, a notion that Freud accepted and then discarded before
he developed psychoanalytic theories. I have a pointed interest in whether a
dissociative personality should be addressed as an independent and emancipated
individual, or a partial or “fragmentary” existence.
Recently I published a paper titled Problem of “otherness” in dissociative disorder
in the European Journal of Trauma and Dissociation in 2019, where I discussed that the general trend among
current clinicians is considered to
not fully validate the uniqueness
and autonomy of dissociative identity. I realized that this trend stems from the era of the Freud–Janet controversy where Freud did not accept split personality or
“double consciousness” while Janet did. I discussed the conceptual ambiguity of the splitting of the
mind in the sense of division vs. multiplication (Division is where two minds are connected while in
multiplication they are separated, according to John O’Neil). Consequently, we tend to consider dissociation as
a defensive and intentional act, at least when it was initiated, with an
understanding that dissociative identities are not structurally separated from
each other, but are rather internally and dynamically connected to each other,
and that a dissociative identity is somewhat causative to and responsible for
another identity’s thoughts and behaviors. I consider that these two ways of understanding the
nature of dissociative identity are still equally valid, but we should move toward
acknowledging the dissociative identity as an independent existence. In
discussing this issue in this article, I presented a hypothesis of the
neurobiological correlate of dissociative identity based on the ‘‘dynamic core’’ model proposed by G. Edelman
and G Tononi. I proposed that the neurological correlate of dissociative
identity disorder is conceived as a simultaneous and multiple existence of a
‘‘dynamic core’’, which represents each dissociative identity as a unique and
wholesome existence in the conscious.
My current interest is how psychoanalytic understanding
and neurophysiology are connected and integrated. As psychoanalyst Sheldon
Izkowitz proposed the notion of “dissociative turn”, the concept of
dissociation prompts us to reorganize and take a fresh look at psychoanalytic
theories which are based on dissociation-free theories. Recently many pioneers
such as Phillip Bromberg, Donnel Stern, Elizabeth Howell, Sheldon Izkowitz
discusss dissociation in the context of psychoanalytic literature which can
further be informed by non-analytic conceptualization such as brain biology and
trauma theory which then enrich analytic understanding of human mind.
