This piece was published as my 2023 presidential editorial in the Journal of Trauma and Dissociation, Volume 24, Issue 1
For many years, I’ve had a Google news alert set up for “dissociative identity disorder”. Google automatically sends me a daily email notifying me of global news items that mentioned DID in the last 24 hours. Ever since I subscribed, the same pattern has been evident: the majority of news items mentioning DID do not involve science, mental health or crime reporting, as you might expect, but are instead summarising the plots of television shows and movies. It seems that, in the public sphere, DID features more often as a fictional plot device than it does as a factual condition experienced by approximately 1% of the population. Too often, these portrayals of DID are hackneyed pantomimes of “split personalities” (see the many justified critiques of M. Night Shamalan’s “Split” movies e.g. (ISSTD, 2017) that overlook much of what is unique about the life histories of people with DID. So many stories are told about DID that are not of DID. Many if not most of these shows and movies continue to obfuscate what DID reveals about the development of the human infant in conditions of hostility and adversity. They are unable to represent the substratum of suffering and malevolence that makes DID a necessary adaptation for too many.
Awareness of DID and its fictionalisation have long gone hand-in-hand. Even as dissociation became the subject of scientific study in the late 19th century, it was a novel – Robert Lewis Stevenson's 1886 book The Strange Case of Dr. Jekyll and Mr. Hyde – that would bring the possibility of multiple personalities to public attention (Simeon & Loewenstein, 2009). Throughout the 20th century, popular and dramatic (although not fictional) accounts of multiple personality such as The Three Faces of Eve (Thigpen & Cleckley, 1957) and Sybil (Schreiber, 1973) laid the groundwork for both public and clinical understandings (and misunderstandings). Even the backlash against the dissociative disorders field can be understood as a fictionalising movement, attempting to consign the condition back to the realm of the imagination (Cheit, 2022; Conway & Pilgrim, 2022; McMaugh & Middleton, 2022). People with DID have been routinely accused of mimicking the condition based on books and movies, while children disclosing the kinds of abuses that give rise to DID have been labelled as watching too many horror movies (Campbell, 1995). Today, the relationship between the facts and fantasies of dissociation continues to be debated with the rise of children and young people self-diagnosing as DID based on their immersion in social media, and their exposure to ‘influencers’ who present with the condition (Giedinghagen, 2022).
As the facticity of DID becomes ever more concrete through neurobiological (Reinders & Veltman, 2021) and epidemiological (Kate, Hopwood, & Jamieson, 2020) research, this editorial reflects on the tension between the facts and fantasies of dissociation, and how we might navigate through the conflicted epistemic terrain of dissociation and responses to it. There is no doubt that DID is coming “out of the shadows at last” (Reinders & Veltman, 2021), and so too are the dynamics of neglect, abuse and exploitation that give rise to it (Simeon & Putnam, 2022). Recognition of the prevalence, severity and diversity of child maltreatment and its impacts into adulthood have expanded considerably. Membership of the International Society for the Study of Trauma and Dissociation is the largest that it has been in over two decades, and demand for our educational and training offerings has never been so strong. Nonetheless, a consistent response to dissociation remains elusive across health, welfare and other settings where people with dissociative conditions – and, often enough, supportive professionals - are regularly encountering misunderstanding and disbelief. In my context here in Australia, the dissociative disorders are rarely acknowledged in public policy documents on mental health, violence and child abuse (Salter et al., 2020). Recognition of dissociative symptoms and disorders in clinical settings is highly variable, while people with dissociative conditions experience entrenched obstacles in the criminal justice and family law courts (Salter et al. 2020). Against the ongoing marginalisation of people living with dissociative conditions, it is tempting to insist on the objective reality of dissociation rather than its less tangible phenomenological and cultural aspects.
However, the conflicted status of dissociation in mental health and other fields reflects something of the character of dissociation itself, and its incongruous position within foundational cultural and scientific frameworks. To have knowledge of dissociation is to have knowledge of psychological forces that are fundamentally pre-cognitive and pre-rational. Many people are at least dimly aware that we share our mind with elements of what Bromberg (2003) called “not-me”: thoughts, feelings and memories that we have not chosen, that we do not control, and that feel fundamentally alien to those parts of our mind that we are comfortable identifying with as “me”. This encounter between the “me” and “not-me”, in which we look in our own psychic mirror and see elements of our mind that we do not recognise or understand, but cannot escape, is the very crux of horror and dread, and hence instinctively disavowed or imputed onto something other than the self (Alford, 1997). Where it is represented at all, dissociation often surfaces within inverted or indirect symbolic registers, as something that can only be acknowledged by through processes of denial, splitting or projection (“DID does not exist”, “I’m a rational sceptic opposing the hysterical believers”, “this so-called victim is actually a perpetrator of false allegations”) or through fantasy (in which the zombie, alien or vampire serves as a receptacle to represent “split off” and apparently monstrous parts of self).
Dissociation cloaks itself in irrationality to avoid being known, and, by and large, this has been a highly effective form of camouflage, particularly in an environment like ours that conflates knowledge with cognition and rationality. The political frameworks of liberal democracy are not sympathetic to dissociation. After all, liberal democracies are founded on the demand that laws, state institutions and society at large should functional according to a rational basis. Under liberalism, rationality is often understood in terms of what can be proven, measured and known (Bernstein, 2009), whereas dissociation emerges from conditions of secrecy, lies and distortion, and it presents in strange and unexpected ways. Knowledge of dissociation can appear, then, as a contradiction in terms, and dissociative people are a poor fit within the rationalised structures of liberal democracies. As feminist and other critics have observed (Hunter, 2016), liberalism assumes an autonomous individual whose choices are governed by rational self-interest. Bureaucratic systems of health, welfare and criminal justice have all instantiated this idealised subject at their core, and insist on the instrumental processing of human beings as interchangeable units. In such an environment, dissociation is more than the pea under the mattress; it is the monkey wrench that jams these systems full of individuals, families and communities who do not respond to “standardised” treatment, who do not “reform” or “behave” when punished, and who generally do not do as they are told. Such explosions of apparent irrationality are then disciplined through sanction, producing a spiral of escalating human need and state harm that simultaneously promotes and obscures dissociative processes and pathologies.
So the study of dissociation is not only the study of forces that wish not to be studied, but also of intersubjective forces that operate contrary to dominant logics of knowledge. The science and treatment of dissociation is somewhat inevitably an audit of failures: failures of safeguarding and protection, of identification and recognition, of responsibility and accountability. Little surprise, then, that for many years, the scientific and professional field of dissociation was treated as an unruly throng to be domesticated through lawsuits, mockery and exile (Crook, 2021; Orr, 2021). As the study of dissociation began to build a picture of the human mind as a network of self-states whose interconnections could be damaged, lost or unformed (Bromberg, 2012; Howell, 2013), a range of actors (from psychology to sociology and journalism) mobilised in defence of the image of the rational liberal subject as a singular, indivisible entity, and to preserve their view of the social order as transparent and free from barbarous violence. Sceptical researchers, clinicians and journalists persistently conflated the study of dissociation with irrationality and hysteria (Salter & Blizard, 2022). They insisted that the light of scientific inquiry would dispel the shadows conjured by children and adults diagnosed with dissociation, who described betrayals and abject abuses of a kind deemed implausible under the civilising influences of modernity. A notable irony is that the same scientific positivism mobilised in defence of the rational liberal subject has persistently undermined it. Rather than dispelling dissociation, scientific research and clinical literature has instead illuminated its depths, and in doing so, provided frameworks for thinking about the unthinkable and engaging dissociative children and adults in rapport-building, relational repair and psychological re-association.
Dissociation is always simultaneously individual and social. It emerges out of a dialectic between the micro and the macro, the individual and their family/community (Ozturk & Sar, 2006), and between the family/community and its broader social and political environment and history (Atkinson, 2002; Vaughans, 2016). Those experiences that are most chronically dissociated and split off by individuals are those that cannot be recognised or addressed within their social and relational context. Progress in the dissociative disorders field inevitably pushes against those psychosocial structures that make dissociation necessary in the first place. However, this dialectic between individual and social dissociation is not fixed and is being disrupted by ongoing scientific and moral paradigm shifts. Burgeoning research into dissociation is part of a larger movement towards a social neuroscience, which have destabilised individualistic notions of human biology and psychology that position the human being as autonomous and self-determining in the classic liberal mode (Meloni, 2014). Social neuroscience has instead emphasised the centrality of the relationship with caregiver/s in early infant life, identifying not only relational but also intergenerational determinants of psychological wellbeing. These “biosocial” developments reformulate traditional oppositions between body and mind, individual and society, and psychology and the social sciences (Meloni, 2015) and reject simple biomedical ontologies in which “real” psychiatric conditions are brain-based pathologies that develop separately from social and cultural factors.
Indeed, contemporary research on the ways in which trauma, dissociation and attachment processes are shaped by inequalities of gender, race, sexuality and other social structures are raising urgent questions about the psychological costs of politics as we know it (Gómez & Gobin, 2020; Hall, 2021; Keating & Muller, 2020). Running alongside these developments, many of those forms of abuse that have been linked to severe dissociation – child sexual exploitation, in particular – are now front-of-mind for policy makers. In the 1980s and 1990s, scepticism about dissociation was synonymous with scepticism about child sexual exploitation. According to sceptics, “multiple personalities” emanated from the same imaginary place as children’s disclosures of organised sexual abuse (Salter, 2013). Founding member of the “false memory” movement, Dr Ralph Underwager, claimed in court that child protection interviews were an invitation for children to confabulate testimony of sexual exploitation since, according to him, the “fantasy world of children is filled with mayhem, murder, cannibalism, blood and gore” (Struck, 1986). Widespread disbelief in children’s testimony, expressed through the language of “false memories” and “moral panic”, laid the groundwork for the establishment of an internet with few safeguards to protect children or disrupt sexual exploitation (Salter & Whitten, 2021). Today, the internet is swamped in millions of images of children being sexually abused and tortured. Authorities are overwhelmed by reports of online child sexual exploitation, which is becoming more common and severe with each passing year (Salter & Whitten, 2021). Victims present with the expected dissociative and traumatic syndromes (Silberg, 2021).
Progress in the dissociative disorders field, it would seem, is made most effectively by holding binaries in tension - “fact” and “fantasy”, body and mind, individual and society, even science and politics – and finding ways to productively synthesise apparent oppositions. Dissociation is, after all, the very stuff of fantasies made in a collision with intolerable facts. It involves the use of imaginative capacity to cope with, defer acknowledgement of, and indirectly symbolise encounters with realities that cannot be mentalised. The fact that human beings need dissociation in the first place – the fact that many infants are born into relational conditions that are deeply aversive to their basic needs – is perhaps the most intolerable fact that induces dissociation individually and collectively. The dissociative disorders field has made extraordinary progress in the study and treatment of individual dissociation, and has pioneered new insights into the psychosocial and political aspects of dissociation. The next frontier is: how do we implement these insights in the world outside the clinic? How do we promote systems and institutions that are not only trauma informed and dissociation sensitive, but that are, in Freyd’s (2018) terms, “courageous”: actively opposing processes of denial and betrayal and offering reparative experiences? The dissociative disorders field has always been a socially and politically engaged one, and as our core concerns go mainstream, the expansion of our key insights beyond the clinic is both a pressing challenge and an unprecedented opportunity.
References
Alford, C. F. (1997). What evil means to us. Cornell University Press.
Atkinson, J. (2002). Trauma trails, recreating song lines: The transgenerational effects of trauma in indigenous Australia. Spinifex Press.
Bernstein, J. H. (2009). Nonknowledge: The bibliographical organization of ignorance, stupidity, error, and unreason: Part one. KO KNOWLEDGE ORGANIZATION, 36(1), 17–29.
Bromberg, P. M. (2003). One need not be a house to be haunted: On enactment, dissociation, and the dread of “not-me”—A case study. Psychoanalytic Dialogues, 13(5), 689–709.
Bromberg, P. M. (2012). The shadow of the tsunami: And the growth of the relational mind. Routledge.
Campbell, B. (1995). Moral panic. Index on Censorship, 24(2), 57–61.
Cheit, R. E. (2022). Hyping hypnosis: The myth that made Capturing the Friedmans persuasive. Journal of Trauma & Dissociation, 1–13.
Conway, A., & Pilgrim, D. (2022). The policy alignment of the British false memory society and the British psychological society. Journal of Trauma & Dissociation, 23(2), 165–176.
Crook, L. (2021). The rocky road to false memories: Stories the media missed. In V. Sinason & A. Conway (Eds.), Trauma and memory: The science and the silenced (pp. 29–35). Routledge.
Freyd, J. J. (2018, January 11). When sexual assault victims speak out, their institutions often betray them. The Conversation. https://theconversation.com/when-sexual-assault-victims-speak-out-their-institutions-often-betray-them-87050
Giedinghagen, A. (2022). The tic in TikTok and (where) all systems go: Mass social media induced illness and Munchausen’s by internet as explanatory models for social media associated abnormal illness behavior. Clinical Child Psychology and Psychiatry, 13591045221098522.
Gómez, J. M., & Gobin, R. L. (2020). Black women and girls &# MeToo: Rape, cultural betrayal, & healing. Sex Roles, 82(1), 1–12.
Hall, H. (2021). The role of discrimination and social defeat on black mental health. Attachment: New Directions in Psychotherapy and Relational Psychoanalysis, 15(1), 88–97.
Howell, E. F. (2013). The dissociative mind. Routledge.
Hunter, R. (2016). Contesting the dominant paradigm: Feminist critiques of liberal legalism. In M. Davies & V. E. Munro (Eds.), The Ashgate research companion to feminist legal theory (pp. 13–30). Routledge.
ISSTD. (2017January23). ISSTD Statement on the Movie ’Split’. ISSTD News, retrieved from: https://news.isst-d.org/dissociative-identity-disorder-individuals-societal-threat-or-societal-victim/
Kate, M.-A., Hopwood, T., & Jamieson, G. (2020). The prevalence of dissociative disorders and dissociative experiences in college populations: A meta-analysis of 98 studies. Journal of Trauma & Dissociation, 21(1), 16–61.
Keating, L., & Muller, R. T. (2020). LGBTQ+ based discrimination is associated with PTSD symptoms, dissociation, emotion dysregulation, and attachment insecurity among LGBTQ+ adults who have experienced trauma. Journal of Trauma & Dissociation, 21(1), 124–141.
McMaugh, K., & Middleton, W. (2022). The history and politics of ‘false memories’: The Australian experience. Journal of Trauma & Dissociation, 23(2), 177–190.
Meloni, M. (2014). How biology became social, and what it means for social theory. The Sociological Review, 62(3), 593–614.
Meloni, M. (2015). Epigenetics for the social sciences: Justice, embodiment, and inheritance in the postgenomic age. New Genetics and Society, 34(2), 125–151.
Orr, M. (2021). False memory syndrome movements: The origins and the promoters. In V. Sinason & C. A (Eds.), Trauma and memory: The science and the silence (pp. 17–28). Routledge.
Ozturk, E., & Sar, V. (2006). The “apparently normal” family: A contemporary agent of transgenerational trauma and dissociation. Journal of Trauma Practice, 4(3–4), 287–303.
Reinders, A. A., & Veltman, D. J. (2021). Dissociative identity disorder: Out of the shadows at last? The British Journal of Psychiatry, 219(2), 413–414.
Salter, M. (2013). Organised Sexual Abuse. Glasshouse/Routledge.
Salter, M., & Blizard, R. (2022). False memories and the science of credibility: Who gets to be heard? (Vol. 23, pp. 141–147).
Salter, M., Conroy, E., Dragiewicz, M., Burke, J., Ussher, J., Middleton, W., … Noack-Lundber, K. (2020). “A deep wound under my heart”: Constructions of complex trauma and implications for women’s wellbeing and safety from violence. ANROWS. Retrieved from: https://www.anrows.org.au/publication/a-deep-wound-under-my-heart-constructions-of-complex-trauma-and-implications-for-womens-wellbeing-and-safety-from-violence/
Salter, M., & Whitten, T. (2022). A comparative content analysis of pre-internet and contemporary child sexual abuse material. Deviant Behavior, 43(9), 1120–1134.
Schreiber, F. R. (1973). Sybil: The true story of a woman possessed by 16 separate personalities. Regnery Chicago.
Silberg, J. L. (2021). The child survivor: Healing developmental trauma and dissociation. Routledge.
Simeon, D., & Loewenstein, R. J. (2009). Dissociative disorders. In L. W. Roberts, J. G. Hoop, & T. W. Heinrich (Eds.), Clinical psychiatry essentials (pp. 239–256). Wolters Kluwer.
Simeon, D., & Putnam, F. (2022). Pathological dissociation in the national comorbidity survey replication (NCS-R): Prevalence, morbidity, comorbidity, and childhood maltreatment. Journal of Trauma & Dissociation, 1–14.
Stevenson, R. L. (1886). The Strange Case of Dr Jekyll and Mr Hyde. Longmans, Green & Co.
Struck, D. (1986, December 29). Little found to substantiate accounts of bizarre, satanic child abuse. The Baltimore Sun.
Thigpen, C. H., & Cleckley, H. M. (1957). The three faces of Eve. McGraw-Hill.
Vaughans, K. C. (2016). To unchain haunting blood memories: Intergenerational trauma among African Americans. In J. Salberg & S. Grand (Eds.), Wounds of history: Repair and resilience in the trans-generational transmission of trauma (pp. 246–262). Routledge.