the DISSOCIATION issueI thought that one of the most important topics to discuss for program survivors is the topic of Dissociation, as it is a subject of focus for anyone who has endured a traumatic experience. However I think it is a particularly important subject as it relates to troubled teen programs, and there are many issues of which Dissociation is at heart of the matter. There are a few questions/ issues that I find come to attention:
1. Dissociation has been an explanation for mental illness and for the hypnotic state that pre-dates Psychoanalysis, yet only recently has received general acceptance.
2. Dissociation is the influential precursor to Freud’s Psychoanalysis, with remarkable impact such as on Freud’s theory of the unconscious/ conscious mind, yet Psychoanalysis had initially rejected the concept of Dissociation. However it survived in less dominant fields.
3. Dissociative reactions, such as PTSD, or even Dissociative Identity Disorder, that can result from extreme situations faced in troubled teen programs, and possible unevaluated or misinterpreted symptoms.
4. The creation of Dissociation as an intended therapeutic aim in considering certain program histories and influences, and the implications of ‘dissociation/ re-association’ approaches in forced therapy concerning identity and personality formation, particularly in adolescents.
So I think it is an issue with several controversies, and I also think it is a pretty interesting subject. I am also curious if others will identify with dissociation as an experience and/ or possible intention of their program. For now I’m going to quote some articles that hit upon some broader points in this regard in order to get more specific.
“The National Center for Post-Traumatic Stress Disorder
PTSD RESEARCH QUARTERLY
VOLUME 8. NUMBER 3 ISSN 10.50-1835 S1MMER 1997
TRAUMA AND DISSOCIATIONCharles R Marmar, M.D.
Department of Psychiatry,
University of California, San Francisco and
Department of Veterans Affairs Medical
Center, San Francisco
The past decade has witnessed an intense reawakening of interest in the study of trauma and dissociation. In particular, the contributions of Janet, which had been largely eclipsed by developments within modern ego psychology and cognitive behavioral therapy, have enjoyed a resurgence of interest. Putnam (1989) and van der Kolk and van der Hart (1989) have provided a contemporary reinterpretation of the contributions of Janet to the understanding of traumatic stress and dissociation. Recent research on the interrelations among trauma, memory, and dissociation is presented in a forthcoming book by Bremner and Marmar.
Paralleling the resurgence of interest in theoretical studies of trauma and dissociation, there has been a proliferation of research studies addressing the relationship of trauma and general dissociative tendencies. Chu and Dill (1990) reported that psychiatric patients with a history of childhood abuse reported higher levels of dissociative symptoms than those without histories of child abuse. Carlson and Rosser-Hogan (1991), in a study of Cambodian refugees, reported a strong relationship between the amounts of trauma the refugees had experienced and the severity of both traumatic stress response and dissociative reactions. Spiegel and colleagues (1988) compared the hypnotizability of Vietnam combat veterans with PTSD to patients with generalized anxiety disorders, affective disorders, and schizophrenia, as well as to the normal comparison group. The group with PTSD was found to have hypnotizability scores that were higher than both the psychopathological and normal controls.
Recent empirical studies have supported a strong relationship among trauma, dissociation, and personality disturbances. Herman and colleagues (1989) found a high prevalence of traumatic histories in patients with borderline personality disorder. A profound relationship has been reported for childhood trauma and multiple personality disorder (MPD). Kluft (1993) proposes that the dissociative processes that underlie multiple personality development continue to serve a defense function for individuals who have neither the external nor internal resources to cope with traumatic experiences. Coons and Milstein (1986) reported that 85% of a series of 20 MPD patients had documented allegations of childhood abuse.
Similar observations have been made by and Putnam and colleagues (1986), who reported rates of severe childhood abuse as high as 90% in patients with MPD. The nature of the childhood trauma in many of these cases is notable for its severity, multiple elements of physical and sexual abuse, threats to life, bizarre elements, and profound rupture of the sense of safety and trust when the perpetrator is a primary caretaker or other close relationship.
Peritraumatic Dissociation. The studies reviewed dearly demonstrate the relationship between traumatic life experience and general dissociative response. One fundamental aspect of the dissociative response to trauma concerns immediate dissociation at the time the traumatic event is unfolding. Trauma victims not uncommonly will report alterations in the experience of time, place, and person, which confers a sense of unreality of the event as it is occurring. Dissociation during trauma may take the form of altered time sense, with time being experienced as slowing down or rapidly accelerated; profound feelings of unreality that the event is occurring, or that the individual is the victim of the event; experiences of depersonalization; out-of-body experiences; bewilderment, confusion, and disorientation; altered pain perception; altered body image or feelings of disconnection from one's body; tunnel vision; and other experiences reflecting immediate dissociative responses to trauma. We have designated these acute dissociative responses to trauma as peritraumatic dissociation.
Although actual clinical reports of peritraumatic dissociation date back nearly a century, systematic investigation has occurred more recently. Wilkinson (1983) investigated the psychological responses of survivors of the Hyatt Regency Hotel skywalk collapse in which 114 people died and 200 were injured. Survivors commonly reported depersonalization and derealization experiences at the time of the structural collapse. Holen (1993), in a long-term prospective study of survivors of a North Sea oil rig disaster, found that the level of reported dissociation during the trauma was a predictor of subsequent PTSD. Koopman and colleagues (1994) investigated predictors of posttraumatic stress symptoms among survivors of the 1991 Oakland Hills firestorm. In a study of 187 participants, dissociative symptoms at the time the firestorm was occurring more strongly predicted subsequent posttraumatic symptoms than did anxiety and the subjective experience of loss of personal autonomy.” -
http://mirecc.stanford.edu/pdf/ptsd/Tra ... iation.pdf “
Dissociation
Excerpted from Compton's Interactive EncyclopediaThe unconscious is like a great holding area or reservoir of unprocessed events. Anything we don't or can't assimilate consciously goes there. The unconscious holds irrelevant things such as images of strangers we see on the street. It also holds important things that need to be brought into conscious awareness but may be too big to fit our existing system (conscious mind). There are times when people are unable to fully assimilate the significance of an overwhelming experience such as a car accident. One of the passengers calmly calls an ambulance, administers first aid, and reroutes oncoming traffic. Once the ambulance arrives, she falls apart and cries hysterically. In order to take care of the immediate priorities, she dissociated her feelings and emotions temporarily….
Children rely extensively on adults for interpretation. Their developing comprehension is largely fashioned after that of their parents or caregivers. If caregivers are emotionally damaged, their own skewed view of the world is imposed upon their children.
Unresolved issues in the parents' unconscious are misinterpreted for the child. This is a common phenomenon known as projection. For example, if parents feel shame but cannot admit it, they may deny it, separate themselves from it, disown it, dissociate from it, and project it onto their children. They then condemn their children as being shameful. In psychology this is described as retaliatory defense. In other words, the shame the parents have within themselves but cannot accept is expressed by shaming the children. In fact, the less parents are able to accept the "monster" within themselves, the more readily they are able to see it in their children.
Emotionally troubled parents frequently reinforce skewed interpretations with abuse. If the abuse is extreme, as practiced by destructive families, a child's conscious world becomes overwhelmed. The extreme abuse is dissociated into the unconscious, but it cannot be made to fit, even in a misinformed way. The trauma remains dissociated. To survive, children tap into extraordinary coping skills, fashioned from within their own unconscious.
Clinical (Amnestic) DissociationOur instinctive reactions to an assault are fight or flight. However, neither works when children are abused by sadistic adults. The only option left is to freeze, and take flight through the mind. A common initial coping mechanism is to escape the body. It is the beginning of clinical (amnestic) dissociation, which allows a shutting out of an unbearable reality. It is held unassimilated---in effect, frozen in time. A dissociated experience can be split up to store the emotions separate from bodily sensations, and the sensations separate from the knowledge of an event. In dissociating an experience, children split off a part of their self to hold the trauma. In some cases the dissociated aspects of self, immediately or over time, form their own and separate sense of self….
Some children maintain a complete split between their everyday life and the abusive episodes. They may be seen smiling when posing for family photographs. Perpetrators often use such photographs to prove there is nothing bad going on….
Clinical DiagnosisAftereffects of trauma are still being researched, and diagnostic terminology continues to evolve. Some existing terms are being retired and new terms are being proposed. In keeping with evolving trends and thinking, we will use the term post-traumatic reactions to indicate the overall condition; and the terms post-traumatic fear, dissociative experience, and dissociative identity to indicate the most prevalent reactions. Professionals are recognizing that post-traumatic reactions exist on a continuum, and many survivors use more than one coping strategy to survive. Trying to arrive at an exact diagnosis using existing terminology can be complex. It is sometimes more confusing than helpful to try to find the right "label."
The current list of specific diagnosis includes but is not limited to PTSD, also know as Post-Traumatic Stress Syndrome (PTSS); various dissociative disorders, which include Depersonalization Disorder, Dissociative Fugue, Dissociative Amnesia, and Dissociative Disorder-Not Otherwise Specified (DD-NOS); Dissociative Identity Disorder (DID), formally referred to as Multiple Personality Disorder (MPD); and catatonia or catalepsy….” -
http://www.hiddenhurt.co.uk/Articles/dissociation.htm -
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Dissociation - Current List of Specific Diagnosis (2003) (Excerpted from Compton's Interactive Encyclopedia)
Post-Traumatic Stress Disorder (PTSD) The development of characteristic symptoms following a psychologically distressing event that is outside the range of usual human experience. The characteristic symptoms involve re-experiencing the traumatic event, avoidance of stimuli associated with the event or numbing of general responsiveness and increased arousal. This group of symptoms was initially recognized in conjunction with other types of trauma. Professionals noticed that some survivors of car accidents had reactions similar to those of soldiers returning from combat. In the past this group of symptoms was alternately called shell shock, battle fatigue, or combat neurosis.
With PTSD, aspects of the traumatic event are dissociated, but the event is not forgotten. Treatment usually focuses on processing the unassimilated parts of the trauma by giving expression to it, thereby healing the aftereffects. The trauma may be re-experienced through dreams, behaviors, emotions, and bodily responses. Sometimes the trauma or aspects of it are re-experienced through flashbacks, nightmares, night terrors, and/or startle responses. Although symptoms of PTSD may feel frightening and are a cause of great distress, they are the body/mind's attempt to heal. The trauma is breaking through into conscious awareness, where it can be assimilated and healed. (DSM-IV)
PTSD is characterized by:
-recurrent or intrusive distressing recollections of an event( images, thoughts, perceptions)
-re-experiencing the trauma of the event through dreams or flashbacks
-feelings of emotional numbness and detachment from others
-irritability or exaggerated startle responses, or hyper-vigilance
-sleep difficulties
-anger or anxiety
-difficulty concentrating
-physiological responses to situations or events that symbolize or resemble the original stressful event or situation.
Symptoms of the disorder may occur within hours of the stressful event. Or they may not appear until months or years later” -
http://www.hiddenhurt.co.uk/Articles/diss2.htm -
“This is a prepublication version of the version published in the Journal of Traumatic Stress, 2005, 18(5).
-
Dissociation: An Insufficiently Recognized Major Feature of Complex PTSD-
Onno van der Hart - Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
Ellert R.S. Nijenhuis Cats-Polm Institute, Zeist and Mental Health Care, Assen, The Netherlands
Kathy Steele -Metropolitan Psychotherapy Associates Atlanta, Georgia
[/b]Abstract
The role of dissociation in (complex) PTSD has been insufficiently recognized for at least two reasons: the view that dissociation is a peripheral, not a central feature of PTSD, and existing confusion regarding the nature of dissociation. This conceptual paper addresses both issues by postulating that traumatization essentially involves some degree of division or dissociation of psychobiological systems that constitute personality. One or more dissociative parts of the personality avoid traumatic memories and perform functions in daily life, while one or more other parts remain fixated in traumatic experiences and defensive actions. Dissociative parts manifest in negative and positive dissociative symptoms that should be distinguished from alterations of consciousness. Complex PTSD involves a more complex structural dissociation than simple PTSD.” [/b]-
http://www.onnovdhart.nl/articles/jts_c ... 20ptsd.pdf -
“Dissociation is a partial or complete disruption of the normal integration of a person’s conscious or psychological functioning.[1] Dissociation can be a response to trauma or drugs and perhaps allows the mind to distance itself from experiences that are too much for the psyche to process at that time…
HistoryThe French philosopher and psychiatrist Pierre Janet (1859–1947) is considered to be the author of the concept of dissociation.[12] Contrary to most current conceptions of dissociation, Janet did not believe that dissociation was a psychological defense.[13][14][15] Psychological defense mechanisms belong to Freud's theory of psychoanalysis, not to Janetian psychology. Janet claimed that dissociation occurred only in persons who had a constitutional weakness of mental functioning that led to hysteria when they were stressed. Although it is true that many of Janet's case histories described traumatic experiences, he never considered dissociation to be a defense against those experiences. Quite the opposite. Janet insisted that dissociation was a mental or cognitive deficit. Accordingly, he considered trauma to be one of many stressors that could worsen the already-impaired "mental efficiency" of a hysteric, thereby generating a cascade of hysterical (in today's language, "dissociative") symptoms.[12][16][17][18] Despite this, clinicians have routinely preferred Freud's motivational explanation of dissociation as a defense against pain or displeasure to Janet's explanation that dissociation is due to constitutionally-impaired mental efficiency. Clinicians' preference for the Freudian explanation is directly reflected in today's most popular understanding of dissociation; namely, that dissociation is a defense against trauma.
Although there was great interest in dissociation during the last two decades of the nineteenth century (especially in France and England), this interest rapidly waned with the coming of the new century (Ellenberger, 1970). Even Janet largely turned his attention to other matters. On the other hand, there was a sharp peak in interest in dissociation in America from 1890 to 1910, especially in Boston as reflected in the work of
William James, Boris Sidis, Morton Prince, and William McDougall. Nevertheless, even in America, interest in dissociation rapidly succumbed to the surging academic interest in psychoanalysis and behaviorism. For most of the twentieth century, there was little interest in dissociation. Discussion of dissociation only resumed when
Ernest Hilgard (1977) published his neodissociation theory in the 1970s and when several authors wrote about multiple personality in the 1980s.
Carl Jung described pathological manifestations of dissociation as special or extreme cases of the normal operation of the psyche. This structural dissociation, opposing tension, and hierarchy of basic attitudes and functions in normal individual consciousness is the basis of Jung's Psychological Types.[19] He theorized that dissociation is a natural necessity for consciousness to operate in one faculty unhampered by the demands of its opposite.
Attention to dissociation as a clinical feature has been growing in recent years as knowledge of post-traumatic stress disorder increased, due to interest in dissociative identity disorder and the multiple personality controversy, and as neuroimaging research and population studies show its relevance.” -
http://en.wikipedia.org/wiki/Dissociation -
“
DissociationPierre Janet originally developed the idea of dissociation of consciousness from his work with hysterical patients. He believed that hypnosis was an example of dissociation, whereby areas of an individual's behavioural control separate from ordinary awareness. Hypnosis would remove some control from the conscious mind, and the individual would respond with autonomic, reflexive behaviour. Weitzenhoffer describes hypnosis via this theory as "dissociation of awareness from the majority of sensory and even strictly neural events taking place."
http://en.wikipedia.org/wiki/Hypnosis -
…. I found the above to be an important wide angle to begin with. I will follow with more specific issues of dissociation and what that could mean in programs…..
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