Shirah Vollmer MD

The Musings of Dr. Vollmer

Dissociation or Forgetting?

Posted by Dr. Vollmer on October 30, 2012

Memory, Freud said, was crucial to mental healing. That which we can remember, we can then “work through” so as to be more realistic in our expectations of others. How then, do we encourage memory in our patients? Originally, hypnosis was designed to pull out repressed memories, like a blunt instrument carving out repressed images, hopefully leading to a catharsis, or a discharge of deeply rooted emotions which could not make their way to the surface without a psychotherapeutic intervention. Freud was unsatisfied with this technique of hypnosis, so he turned to free association as a means of discovering what the person “failed to remember.” Freud said “the forgetting of impressions, scenes, events, nearly always reduces itself to ‘dissociation’ of them. To the lay public, the word ‘dissociation’ implies deep pathology where one has to split off any memory so as to not cope with the emotional sequelae. Child sexual abuse is the common trigger for dissociation, yet here (1914 Freud) is saying that any emotion which overwhelms the ego will be dissociated, and hence separated from conscious thought. Bringing these dissociated thoughts back to consciousness, through the work of therapy which triggers long-repressed memories, allow for the healing between pain and circumstance; this allows for a more meaningful catharsis than one brought about by hypnosis. In other words, integration is the cure for dissociation, since dissociation takes up large amounts of mental energy, thereby hijacking the brain, leading to an obstruction to creative output. With the value on integration, it is no wonder that patients sometimes get worse before they get better. Yet, in today’s society of quick-fixes, it is hard to get patients to tolerate this journey. Herein lies the art of psychotherapy. Sometimes muscles hurt in an effort to get stronger. The brain is no different.


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8 Responses to “Dissociation or Forgetting?”

  1. Holly said

    That is very true, what you write, about how patients can get worse (or feel worse, at any rate) before they get better. As an analysand, I have felt tangible gains in particular realms of my life over the years in analysis, but have also felt stuck for a long period of time in not being able to make the desired behavioral changes on a specific issue that I have been struggling with. Yes, there is definitely more self-awareness in my motivations and my feelings, but to make that quantum leap from understanding to action, that is the difficult part. Thanks again for a helpful post.

    • Shirah said

      Hi Holly,
      Thanks for chiming in with your personal experience. I agree that there is a “quantum leap” from understanding to action, but it is in this leap that life long changes occur. One could imagine that if one is going to change the way one interacts with their world, then a “quantum leap” would make sense, as a necessary step. Suffice it to say, I am making a plea for patience with the therapeutic process. Having recently heard Malcolm Gladwell tell a tale of his father coming in from the garden, happy with himself that he solved a math problem he had been thinking about. Ten year old Malcolm asked him how long he was thinking about this problem. His father responded “fifteen years”. Great accomplishments take time. Thanks again.

  2. Shelly said

    So how can one tell is getting better if one is feeling worse? The therapist will always claim that the patient is getting better by opening the lid to Pandora’s box. The patient will say that the pain is not worth journey. Perhaps the issue is that the fit with the therapist is not right and that’s why it hurts? What if it’s the therapist’s style that hurts and not the repressed memories? How can one tell the difference?

    • Shirah said

      As usual, Shelly, you bring up a key issue. The patient and therapist need to try to distinguish between dealing with unconscious ugliness versus a “bad fit”. The road is not clear, but intuition is our guide. Thanks.

      • ashanam said

        I think progress is how you tell the difference. If you feel worse, but how you think about it feels closer to the truth–to the full, complex picture with both its positive and terrible elements–then you are still on the right track. If nothing is changing–you feel worse, and you are thinking about things in the same unhelpful, incomplete way in which you have generally thought about them before, then there is a problem. The goal of integration is authenticity. Authenticity has a recognizable quality, even if it remains uncomfortable. At least that is what has worked for me.

        Thank you for reblogging this.

  3. Danny said

    Great series of posts on analytic concepts , enjoyed reading

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