治療論 英訳 推敲 5

 Trauma and the origin of aggression

Issue of the actuality of trauma is related to another important problem: where does the aggression of the patients come from? What Freud considered the repression of sexual and aggressive drives would cause neurotic symptoms. The aggression is considered as a drive and therefore inside of the patient. However, if we acknowledge the actuality of trauma, we need to consider the origin of the aggression somewhat differently.

One of the papers that deal with the origin of aggression was the “Confusion of Tongues” paper in 1936. He discussed the issue of the “identification and introjection of the aggressor”. However, what he discussed was not exactly the way the victim turns to be another aggressor. He rather described the process of the victim’s identification with the aggressor’s wishes and desires in a masochistic way. He states that the most destructive is the victim’s Introjection of the guilt feelings of the adult (p162) and the resultant masochism of the victim (Frankel, 2002). Ferenczi stressed rather the way that the victim hurt him/herself instead of aggressing others.

Frankl explains as follows. While discussing the identification with the aggressor, Ferenczi mainly talks about concordant identification based on Heinrich Racker’s classification of the two types of identification process (Racker, 1968). However, there should be another type of identification: complementary identification where the victim identifies with his aggressive nature and becomes the one. Okano 2018) also discussed this process in his argument of his discussion of “shadowy personality”. It is of interest to mention the notion of the same name proposed by Anna Freud (1936). This notions describes more closely to the way this complementary identification with the aggressor.

Frankel, J. (2002).  Exploring Ferenczi's concept of identification with the aggressor: Its role in trauma, everyday life, and the therapeutic relationship. Psychoanalytic Dialogues, 12(1), 101–139.
Howell, E (2014) Ferenczi’s Concept of Identification with The Aggressor: Understanding Dissociative Structure with Interacting Victim and Abuser Self-States. The American Journal of Psychoanalysis 74(1):48-59.

Okano (2019) The origin of so-called “shadowy personalities” in patients with dissociative identity disorder. European Journal of Trauma & Dissociation. 3(2): 95-102.

Freud, A (1994) [1936]. Das Ich und die Abwehrmechanismen (6th, reprint ed.). Frankfurt: Fischer Taschenbuch Verlag. 
Racker,H (1968) Transference and countertransuference. New York: International Universityies Press.

Let us look at the way modern analysts conceive the issue of aggression in DID. Dissociative personalities with aggressive nature have been described generally as “the internal persecutor” or “persecutory personality” by various authorities (Kluft, Putnam, Ross, Howell, van der Hart etc). Putnam states that some persecutor personalities can be recognized as introjects of the original abuser (1989, p.108).Van der Hart et al（2006）states that the persecutory part of the personality is at least one type of EPs (emotional part of personalities) and that has some protective role, and recommends clinicians that they pay respect to them (2006, p.312). Howell (2011) also stresses defensive purposes when one of these “persecutory personalities” are formed and states: “Having persecutory and abuser identity states is like having an internal Al Qaeda or Taliban that punishes you for the slightest infraction of bizarre and arcane rules. It involves being emotionally attached to inner and perhaps outer persecutors, even though you were tortured by them”(2011, p.211).

Howell further states that the “system depends for its safety, on the inhibition of expression or the exclusion from consciousness of powerful overwhelming affects, such as terror and rage.”(Howell, 2016, p.211). According to these experts DID’s aggression is generally understood as a result of internalizing what was initially external and it is expressed in a self-destructive and masochistic way. This is a process where the actual trauma is transformed into the aggression and in that sense, internal and external processes are both involved. 本当かいな。

Putnam, F (1989) Diagnosis and treatment of Multiple Personality Disorder. The Guilford Press.

治療論 英訳 推敲 4

 2． The actuality of trauma during infancy and early childhood.

This second point that Itzkowitz raises might also invite a “turn” in our conceptualization of the mind in psychoanalysis. In Freud’s drive model, the goal for psychoanalysis was to make unconscious conscious with an assumption that repressed sexual and aggressive drives in the child need to be dealt with. Freud established this theory after he rejected the actuality of the sexual trauma that a child experiences in 1897. If we accept and acknowledge the actuality of trauma, the whole basis of Freud’s theory might need to be looked at from a different angle. Howell & Itzkowitz states (2016a), “Even Freud’s most influential theories- for example, the Oedipus complex - can readily and easily be deconstructed in terms of the underlying motifs of the most heinous type of child abuse; infanticide, murder”. (Ross, 1982, 2016a, p8)

However actual trauma and its fantasy might not always be clearly distinguished from each other and quite often both of them can co-exist in the patients’ history. In Freud’s own case histories, such as Dora (1905) and “Wolfman”(1907), both trauma and fantasy are described. In these cases, actual trauma and its transformation and elaboration on a fantasy levels both need to be looked into to fully understand its implications. Furthermore, an “actual trauma” itself could also have a dual nature: its objective reality and its subjective meaning. As Howell states “trauma may refer both to an objectively catastrophic event and to something that feels subjectively upsetting” (Howell, 2011,.P74)

In order to handle the dual nature of trauma, i.e., its actuality vs. its elaboration on a fantasy level, Howell and Itzkowitz introduced new concepts related to dissociation. In their paper “Is trauma analysis psychoanalysis?”, they stress the ubiquity of trauma (“Everywhereness of trauma”) and discuss the “dissociative nature of human mind”(2016b, p.37). They quote Bromberg and state; ”repression enables a person to live with less interference from unacceptable impulses and desires as well as from extremely upsetting and unpleasant memories” (Bromberg, 2006). In contrast, Dissociation occurs when the experience was so overwhelming that it could not be emotionally borne or consciously formulated.

Thus, they suggest that in order to handle dual nature of trauma, dissociation as well as repression need to be used. They also suggest that this might require a different type of unconscious “dissociative unconscious” which they explain “is characterized by gaps in our CS experience”. This “dissociative unconscious” while "unconscious experiences in these gaps continue to exist as living experience in that self-state (Howell & Itzkovitz, 2016. p.38).

What their ideas suggest is that the dual nature of trauma would require both types of mental mechanism; “dissociative unconscious” mobilized when the actuality of trauma is so intense and defense mechanism of dissociation is mobilized instead of repression, besides dynamic unconscious which has to do with repression which handles unbearable desire and fantasy. These two types of defense and unconscious might be at work so long as there is “everywhereness” for both trauma and fantasy.

 

治療論 英訳 推敲 3

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.

 

治療論 英訳 推敲 ２

 Fairbairn, Winnicott, and Sullivan.

Before moving on to discussing modern psychoanalytic discussion of dissociation, I would like to briefly summarize the stance taken by three major figures in the early part of the history of psychoanalysis: R.Fairbairn, D. Winnicott, and HS. Sullivan.

Fairbairn’s theory of a schizoid mechanism is closely linked with splitting and dissociation that was discussed by Janet, Morton Prince, etc. As Fairbairn goes (1952),

… So far as the manifestations of dual and multiple personality are concerned, their essentially schizoid nature may be inferred from a discreet study of the numerous cases described by Janet, William James, and Morton Prince … The personality of the hysteric invariably contains a schizoid factor in greater or lesser degree, however deeply this may be buried. (p. 5.)

 

Unfortunately, Fairbairn’s notion of dissociation was not specific enough, and was discussed interchangeably with "schizoid," and "splitting” (van der Hart, et al., 2009), lacking a focus on its unique nature of division in psychic organization. Although schizoid problems became one of the main focuses of the British object relations theory, it developed apart from the concept of dissociation originally described by Breuer in his notion of “hypnoid” phenomena and double consciousness.

Winnicott, one of Fairbairn’s contemporaries, also discussed dissociation in many contexts of his analytic theories. Winnicott distinguished a healthy and natural dissociation from trauma-related dissociation (Goldman, Abram, p. 339), the former being the basis for the true self, while the latter is a defensive maneuver when traumatic situations occur.

Winnicott suggests that the primitive agony that happened in the past is not part of his personal history if he or she was not ready to accept it. The assumption here is that there is only one subject, the patient, who went through the experience but never experienced it, who would eventually take that experience in and integrate it in the past. There is no particular hint that there could have been some separate and independent subject which experienced the primitive agony on behalf of the patient as the primary agency. Thereby, despite his major contribution to the analytic discussion of the notion of dissociation, Fairbairn and Winnicott’s idea of dissociation was manly dealing with what van der Hart called type (1).

H.S. Sullivan’s discussion of dissociation is also worth examining to do justice to the pioneering nature of his view, which waited such a long time to be accepted into the mainstream of analytic theories. However, the stress Sullivan put on this notion in his theorizing was remarkable. “[F]or Sullivan, dissociation, not repression, was the primary defensive maneuver, because he understood the primary danger to be the revival of intolerable experience, not the breakthrough of primitive endogenous fantasy” (Stern, Dell, p. 653). Sullivan and interpersonal school theorists discuss dissociation primarily in the context of trauma theory. Sullivan’s conceptualization of “good me,” “bad me,” and “not me” is of special interest. Among them, “Not me” is only directly experienced in a severe nightmare or observed in a dissociative state (Sullivan, 1953). This experience is never learned because of the pain that it involves and is only experienced in primitive states (or what he calls the “prototaxic” or “parataxic” level). We might be able to speculate that Sullivan’s idea of dissociation might have reached a state where a subject (“not-me”) is independent of the main subject (“me”), perhaps on the level of the type (2) as van der Hart delineated.

治療論 英訳 推敲 １

 　　“Dissociative Turn”and its Implications in Psychoanalysis

 　Historically, dissociation is a topic that Sigmund Freud did not particularly welcome in his psychoanalytic theories. This was against the background of his conflict with Joseph Breuer, Pierre Janet and Sándor Ferenczi. Since then, as Glover (1943) expressed, the term dissociation has a “chequered hisoty”(p.12) in psychoanalysis. However, since Steven Marmer (1980) took “a first step in posing a psychodynamic formulation for multiple personality (p.455), there seems to be a “growing chorus of American thinkers” “who hopes to rescue dissociation from obscurity” in the theory of psychoanalysis (Goldman, 2012. p. 338). The topic of dissociation has been discussed in an increasing number in the psychoanalytic literature. A psychoanalytic research engine (Pepweb) indicates that its number doubles in each decade for the past 40 years (405 between1980~1989, 935 between 1990~1999, 1629 between 2000~2009, and 2461 between 2010~2019). This movement can potentially invite some major reorganization in the psychoanalytic literature, that Sheldon Itzkowitz (2015) referred to as the “dissociative turn.” So, what is it about his “turn”? In his compacted paper with the same title, Itzkowitz (2015) mentions as follows.

Glover, E. (1943) the concept of dissociation. Int. J.Psychoanal,, 24:7-13.
Marmer, S. (1980) Psychoanalysis of Multiple Personality. Int. J. Pssycho-Anal. 61,439-459.

The actuality of trauma during infancy and early childhood is recognized as a key factor leading to the emergence of dissociative process, the potential dissociative structuring of the mind and the mind being characterized by multiple, discontinuous, centers of conscious. Therapeutic goal in the psychoanalytic work with fragmented patients is to establish communication and understanding between the dissociated self-states (p.145) .

This statement can potentially have enormous implications for the psychoanalytic way of conceptualizing human mind. However, Itzkowitz did not elaborate on any particular ways in which the “turn” should occur and in what direction. In this article, I attempt to elaborate on what Itzkowitz might mean from my own standpoint.

1．Mind being characterized by multiple, discontinuous, centers of consciousness.

2．The actuality of trauma during infancy and early childhood.

3．Establishing communication and understanding between the dissociated self-states as the Therapeutic goal.

治療論 英訳 ７

 Discussion

In this paper I discussed what Izkowich refers to as “the dissociative Turn” and considered what might be its theoretical and clinical implications. I indicated that this issue originated from the way psychoanalysis started in the end of the 19^th century. Freud encountered splitting of consciousness through Breuer and chose to go along monopsychism. He might have felt that he needs to choose either monopsychism or polypsychism and picked the former. His choice might have been right in that it resulted in this prosperity of the psychoanalytic movement. However, some analysts might have encountered dissociative cases and polypsychic state might be a real condition of human being and made his/her own “turn”, such as Ramle-de Groot (1981).

It is worth remembering that Freud himself did not hide that he himself could have been a similar situation like her. In a later stage of his analytic career, Freud stated as follows.

 Depersonalization leads us on to the extraordinary condition of “double conscience”, which is more correctly described as “split personality.”But all of this is so obscure and has been so little mastered scientifically that I must refrain from talking about it anymore to you. (Freud, 1936, p.245)

It is very fortunate that current analysts might not need to make an exclusive choice that Freud faced: which of monopsychism or polypsychism reflects the truth of human mind.

Here I reiterate beautiful statement of Bromberg.

A noticeable shift has been taking place with regard to psychoanalytic understanding of the human mind and the nature of unconscious mental process- away from the idea of a conscious/preconscious/unconscious distinction per se toward a view of the self as decentered, and the mind as a configuration of shifting, nonlinear ,discontinuous states of consciousnesss in an ongoing dialectic, with the healthy illusion of unitary selfhood.（Bromberg, 1998. p. 270.）

Lampl-de-Groot, J (1981) Notes on Multiple personality. Psychoanalytic Quarterly, 50;614-624

Bromberg, P (1998) Standing in the Spaces. Psychology Press, New York, London.

治療論 英訳 ７

 4.      Establishing communication and understanding between the dissociated self-states as the Therapeutic goal

There are many discussions as regard to the purpose of the treatment of dissociative disorders. Richard Kluft in his psychoanalytic understanding of DID asserted that to establish“integration”and“fusion”is the final goal of the treatment. Following his clinical advice and suggestions, many analysts consider that the integration as the long term outcome of DID. However, recently more diverse ideas have been proposed, indicated by his statement that we saw at the beginning. Itzkowitz further states that “the goal of the working through process is not necessarily the consolidation of self-states into a single, integrated individual … [But to help] the person understand and negotiate meaningful forms of relatedness with these heretofore unknown parts of herself. A sense of unity or wholeness, even if illusory…..（p.152）”.
  Modern analyst Bromberg speaks in a very similar tone. He 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).
  Thus, these authors integration against understanding and negotiating relatedness with the parts. However, prioritizing mutual understanding of the personalities over integration requires a new look at the analytic tenet. Although psychoanalysis “analyzes” human mind Freud acknowledged that “psycho-synthesis” is thus achieved in analytic treatment as the final result.
 "As we analyse...the great unity which we call his ego fits into itself all the instinctual impulses which before had been split off and held apart from it. The psycho-synthesis is thus achieved in analytic treatment without our intervention, automatically and inevitably." (Freud, 1918, 161).

Freud, S. (1918). "Lines of Advance in Psycho-Analytic Therapy" SE. XVII. p.161

治療論 英訳 ６

 Trauma and the origin of aggression

Issue of the actuality of trauma is related to another important problem: where does the aggression of the patients come from. What Freud considered the repression of sexual and aggressive drives would cause neurotic symptoms. The aggression is considered as a drive and therefore inside of the patient. However, if we acknowledge the actuality of trauma, we need to consider the origin of the aggression somewhat differently.

One of the papers that deal with the origin of aggression was the “Confusion of Tanges” paper in 1936. He discussed the issue of the “identification and introjection of the aggressor”. However, what he discussed was not exactly the way the victim turns to be another aggressor. He rather descrived the process of the victim identifies with the aggressor’s wishes and desires in a masochistic way. He states that the most destructive is the victim’s Introjection of the guilt feelings of the adult (p162) and the resultant masochism of the victim (Frankel, 2002). Ferenczi stressed rather the way that the victim hurt him/herself instead of aggressing others.

Frankl explains as follows. While discussing the identification with the aggressor, Ferenczi mainly talks about concordant identification based on Heinrich Racker’s classification of the two types of identification process (Racker, 1968). However, there should be another type of identification: compementaly identification where the victim identifies with his aggressive nature and becomes the one. Okano also discussed this process in his argument of his discussion of “shadowy personality”. It is of interest to mention the notion of the same name proposed by Anna Freud (1936). This notions describes more closely to the way this complementary identification with the aggressor.

Frankel, J. (2002).  Exploring Ferenczi's concept of identification with the aggressor: Its role in trauma, everyday life, and the therapeutic relationship. Psychoanalytic Dialogues, 12(1), 101–139.
Howell, E (2014) Ferenczi’s Concept of Identification with The Aggressor: Understanding Dissociative Structure with Interacting Victim and Abuser Self-States. The American Journal of Psychoanalysis 74(1):48-59.

Okano (2019) The origin of so-called “shadowy personalities” in patients with dissociative identity disorder. European Journal of Trauma & Dissociation. 3(2): 95-102.

Freud, A (1994) [1936]. Das Ich und die Abwehrmechanismen (6th, reprint ed.). Frankfurt: Fischer Taschenbuch Verlag. 
Racker,H (1968) Transference and countertransuference. New York: International Universityies Press.

Let us look at the way modern analysts conceive the issue of aggression in DID. Dissociative personalities with aggressive nature have been described generally as “the internal persecutor” or “persecutory personality” by various authorities (Kluft, Putnam, Ross, Howell, van der Hart etc). Putnam states that some persecutor personalities can be recognized as introjects of the original abuser (1989, p.108)。Van der Hart et al（2006）states that it is at least one type of EPs (emotional part of personalities) that has some protective role, and recommends clinicians that they pay respect to them（2006, p.312）Howell (2011) also stresses defensive purposes when one of these “persecutory personalities” are formed and states: “Having persecutory and abuser identity states is like having an internal Al Qaeda or Taliban that punishes you for the slightest infraction of bizarre and arcane rules. It involves being emotionally attached to inner ands perhaps outer persecutors, even though you were tortured by them”(2011, p.211).

Howell further states that the “system depends for its safety, on the inhibition of expression or the exclusion from consciousness of powerful overwhelming affects, such as terror and rage.”(Howell, 2016, p.211). These descriptions indicate that DID’s aggression is generally understood by experts as a result of internalizing what was initially external and expresses it in a self-destructive and masochistic way. This is a process where the actual trauma is transformed into the aggression and in that sense, internal and external processes are involved.

Putnam, F (1989) Diagnosis and treatment of Multiple Personality Disorder. The Guilford Press.

治療論 英訳 ５

 2．     The actuality of trauma during infancy and early childhood.

This second point that Itzkowitz raises might invite again a “turn” in our conceptualization of the mind in psychoanalysis. In Freud’s model, the goal for psychoanalysis was to make unconscious conscious with an assumption that repressed sexual and aggressive drives in the child need to be dealt with. As is well known, it was a result of Freud’s rejection of the actuality of the sexual trauma that a child experiences, in 1897. If we accept and acknowledge the actuality of trauma, the whole basis of Freud’s theory can be overturned. As Howell & Itzkowitz states (2016a), “Even Freud’s most influential theories- for example, the Oedipus complex - can readily and easily be deconstructed in terms of the underlying motifs of the most heinous type of child abuse; infanticide, murder”. (Ross, 1982, 2016a, p8)

However, in reality, actuality of trauma and its existence as a fantasy might not always be clearly distinguished from each other and quite often both of them can co-exist in the patients’ history. In Freud’s case of Dora and Wolfman, both trauma and fantasy are described (Freud, 1905, 1918).

Furthermore, what the issue of the actuality of trauma urge us to consider is the subjective nature of the experience of trauma besides its objective reality. As Howell states “trauma may refer both to an objectively catastrophic event and to something that feels subjectively upsetting” (Howell, 2011,.P74)

In regard to the actuality of trauma, Howell & Izkowitz (2016a) venture into discussing “Is trauma analysis psychoanalysis?” in a straightforwardly. They stress the ubiquity of trauma (“Everywhereness of trauma”) and discuss the “dissociative nature of human mind”(2016b, p.37). They quote Bromberg ”repression enables a person to live with less interference from unacceptable impulses and desires as well as from extremely upsetting and unpleasant memories” (Bromberg, 2006）” In contrast, Dissociation occurs when the experience was so overwhelming that it could not be emotionally borne or consciously formulated.

In order to further elaborate on this dissociative nature of self, they propose the idea of “dissociative unconscious”. The dissociative UCS then is characterized by gaps in our CS experience.

Yet the "UCS" experiences in these gaps continue to exist as living experience in that self-state (Howell & Iz, 2016. p.38).

If I summarize what they are saing, actual trauma creates “dissociative unconscious” as a gap of memory due to actual trauma that consciousness cannot hold, but it can be lived by another existence of consciousness. Here, we come back to the issue of one mind versus multiple minds that we discussed in 1.

Bromberg, P (2006) Awakening the dreamer.Clinical Journeys. Mahwah, NJ. Analytic Press.

Howell, EF, Itzkowitz, S. (2016a) Is trauma-analysis psycho-analysis? In Howell, E. F., & Itzkowitz, S. (Eds.). (2016). The Dissociative Mind in Psychoanalysis: Understanding and Working With Trauma. New York, NY: Routledge. (7~19).

Howell, EF, Itzkowitz, S. (2016b) The Everywhereess of trauma and the dissociative structuring of the mind. The Dissociative Mind in Psychoanalysis: Understanding and Working With Trauma. New York, NY: Routledge. (33~43).

Howell, EF, Itzkowitz, S. (2016)

Freud, S. (1918 [1914]) From the History of an Infantile Neurosis, SE, 17, pp.1-122.

Howell, E 2011 Understanding and Treating DID.  A Relational Approach. Routledge.

 

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.

治療論 英訳 ３

 Although this statement is generally accurate, I consider that in the history of psychoanalysis, some analysts discussed the type (2) in van der Hart’s typing. If we go back to Ferenczi’s seminal paper “Confusion of Tangues” we are convinced that he was one of the first among Freud’s disciples who was impressed by the splitting of consciousness. He did not hide his amazement about the way novel psyche is produced as though it is under the influence of some kind of magic.

Sándor Ferenczi (1949). Confusion of the Tongues Between the Adults and the Child—(The Language of Tenderness and of Passion)　International Journal of Psycho-Analysis, 30:225-230

We talk a good deal in analysis of regressions into the infantile, but we do not really believe to what great extent we are right; we talk a lot about the splitting of the personality, but do not seem sufficiently to appreciate the depth of these splits. If we keep up our cool, educational attitude even vis-a-vis an opisthotonic patient, we tear to shreds the last thread that connects him to us. The patient gone off into his trance is a child indeed [emphasis added] who no longer reacts to intellectual explanations, only perhaps to maternal friendliness; without it he feels lonely and abandoned in his greatest need, i.e. in the same unbearable situation which at one time led to a splitting of his mind and eventually to his illness;（p.227）

The same anxiety, however, if it reaches a certain maximum, compels them to subordinate themselves like automata to the will of the aggressor, to divine each one of his desires and to gratify these; completely oblivious of themselves they identify themselves with the aggressor. Through the identification, or let us say, introjection of the aggressor, he disappears as part of the external reality, and becomes intra- instead of extra-psychic;（p228）

It is more remarkable that in the identification the working of a second mechanism can be observed, a mechanism the existence of which I, for one, have had but little knowledge. I mean the sudden, surprising rise of new faculties after a trauma, like a miracle that occurs upon the wave of a magic wand,' or like that of the fakirs who are said to raise from a tiny seed., before our very eyes, a plant, leaves and flowers. Great need, and more especially mortal anxiety, seem to possess the power to waken up suddenly and to put into operation latent dispositions which, un-cathected, waited in deepest quietude for their development. （229）

Eventually it may arrive at a state which-continuing the picture of fragmentation-or re would be justified in calling atomization. One must possess a good deal of optimism not to lose courage when facing such a state, though I hope even here to be able to find threads that can link up the various parts. 229