Our book group selection is The Haunted Self: Structural Dissociation and Treatment of Chronic Traumatization by van der Hart, Nijenhuis and Steele. The authors are all officers in the ISSD, the International Society for Study of Dissociation. ( http://www.isst-d.org/index ) The book is the most exhaustive (and somewhat exhausting) definition and description of what dissociation is and how to treat it.
Years ago, Joanne Twombly introduced me to the writers’ concept of dissociation. Here is a simple version. Start with a whole personality the PreTraumatized Personality (PTP). In Primary Dissociation or Simple PTSD, the personality splits into an Apparently Normal Personality, the part that takes care of the activities of daily living: relationships, work, caregiving, play. This ANP doesn’t think about the trauma much and may even have forgotten about it. The other side of the split is the Emotional Personality (EP). The EP holds the experience of the trauma. When people are in their EP, they may be experiencing the flashbacks, emotions or cognitions of the traumatic event. They may be activated (mobilized) or shut down (immobilized). The ANP experiences the EP as "not me", an unwanted traumatic experience. So in Primary Dissociation, the PreTraumatic Personality splits into an Apparently Normal Part and an Emotional Part.
In Secondary Dissociation, complex PTSD or Borderline Personality, you have one ANP and more than one EP. The EP’s are split into different mobilized or immobilized "action systems": possibly mobilized states that "freeze", "fight", "flee", "cling" or "panic" or immobilized states that "shut down", "submit", "numb", or are in the post-trauma "recuperative" state.
In Tertiary Dissociation, DID or DDNOS, there is more than one ANP (e.g. the worker, the nurturer, the organizer) and several EPs. In this configuration, there is more separation between the parts of personality, which may not be aware of each other. There may be parts that are subsets of ANPs or EPs, such as a flight part that is 2 years old, and one that is a teenager. In DID, the parts may not know that they are part of a whole. They may in fact compete with, fight, or collaborate together.
I use this way of looking at PTSD and dissociation all the time. When I meet a new client, I watch for the state changes between ANP and EP. And I get extremely alert when discussing trauma histories when the switches are dramatic and fragmented.
As an EMDR therapist, I like how the Structural Dissociation model dovetails with Francine Shapiro’s Adaptive Information Processing model. The first model describes the split and the second describes how we have the innate capacity to heal that split.
What is it like to read The Haunted Self? It’s readable. And it’s difficult for me. The authors, two of whom are European, see dissociation and therapy through the lens of Pierre Janet (1859-1947). Janet and his successors use different psychological constructions than I know. The language is different ("action systems" for behavior). I spent a lot of time translating Janetese into American psychological language.
The authors describe every possible subset of dissociation and give names for every possible dissociative state and behavior. In every section I’d have a small "Aha!" when they named a phenomenom that I’d seen, but hadn’t named.
Chapter 11, Assessment of the Traumatized Patient, has a wonderful template for intake, leaving nothing out. I’m just starting to read about the treatment of dissociative disorders, I’ll get back to you next weekend with that.
I have some complaints. They go on too much. There aren’t enough examples. They manage to make an interesting topic dry. As someone who has worked with dissociation for many years, and who has been familiar with the basic concepts of Structural Dissociation, I’m, so far, not learning a lot. Though I haven’t found one concept with which to disagree and I have learned some new names for recognizable phenomena.
Next week, I’ll tell you what I think about their ideas on the treatment of dissociation, and share with you what the group thinks about this book.