Dissociation or Forgetting?

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.

 

See also…https://shirahvollmermd.wordpress.com/2012/06/07/dissociation/

Dissociation

Olivia, twenty-two, comes three times a week, but from session to session, I never know who I am going to see. Sometimes we laugh together, as she amuses me with funny stories. Other times, she rages at me, although I am never quite sure what I did that triggered her upset. Other times, she is profoundly sad, but again, I am never clear about the trigger. If I remind her of how different our dynamic feels to me from session to session, she says “I know, but I can’t help it.” Her knowing, at first made me think that this is not dissociative, but over time, I have begun to wonder that as coping with stress can be so difficult, that for some, developing different personality styles is a way of coping, similar to dissociation where, often because of severe trauma, one has to “leave” oneself in order to cope with the devastation. Olivia’s quickly shifting relating styles makes me wonder about her history of trauma where she might have felt the need to have different senses of herself, with little threads of continuity, in order not to process the pain of disappointment in her important relationships with her early caretakers. Dissociation is taking denial one step further. Bringing her personalities together, helping Olivia develop internal continuity is our work. This internal continuity is critical for self-confidence and trust in oneself. Peter Fonagy in London has said this multiple times in his work on mentalization. One must be able to think about oneself in a cohesive way in order to enjoy one’s life and not chronically suffer from painful confusion. Olivia knows she needs help with her confusion. That is a good first step.