Posted by alexandra_k on March 27, 2005, at 16:56:13
aka:
System Indeterminacy and Interpretive Constraints.
Am trying to adapt this for a seminar.
Comments, suggestions, criticisms etc etc most welcome :-)Dissociative Identity Disorder (DID) has generated a great deal of controversy within and across the disciplines of psychology, psychiatry, and philosophy. Within mainstream psychology and psychiatry two dominant theories of DID have emerged as providing an account of etiology, a conceptualization of alters, and a proposed course of treatment. While accepting one of the positions on a single aspect of the disorder (such as etiology) does not logically commit one to that same theories position on another aspect of the disorder (such as treatment), theorists typically consider that one is forced to choose between these two ‘rival accounts’ taken as package deals. I shall begin with a summary of these received views before I go on to offer an alternative conceptualization of the alters that are the distinctive feature of this diagnosis.
1.1 The Post-Traumatic Model
The post-traumatic account originated from the work of theorists / clinicians in the 1980’s. Braun, Kluft, Putnam, C*ons (go go automated asterisking heh heh), and Bliss are cited by Ross (1989 p. 50) as important figures in re-establishing clinical interest in DID (formerly Multiple Personality Disorder) as a legitimate phenomenon. These theorists have gone on to write seminal work on the disorder in the form of papers and treatment manuals. While there are points of difference in emphasis and detail between supporters, there seems to be a general consensus on an overall view that has come to be known as the Post-Traumatic account. Gleaves, (1996 pp. 42-59) has recently written in defense of this account and I will focus largely on Gleaves rendering as he writes in clear opposition to the alternative theory and he seems to be fairly representative of the Post-Traumatic line.
According to the Post-Traumatic model alters originate in childhood when individuals with a diathesis for dissociation encounter severe, repeated trauma (Gleaves, 1996 p.2). The child is thought to dissociate aspects of their experience from conscious awareness as a protective coping strategy. If the experiences were accessible to consciousness, or impinged on the child’s consciousness then their functioning would be severely impaired. As an example, an abused child may need to dissociate from abuse in order to behave trustingly to an abuser at other times in order to ensure that primary needs, such as those for food and shelter are met (Gleaves, 1996 p. 2). Because the strategy is successful (in that in enables the child to cope) the dissociation is reinforced. Because of the extreme and repetitive nature of the abuse the child comes to dissociate more often, and in these times their behavior is governed by these alternative states.
It is a distinctive and defining feature of the disorder that these states develop an internal consistency and coherence of their own (DSM IV-TR, 2000 p.529). Alternative identities are thought to function to ‘contain memories’ of different kinds of experiences, and to act in ways believed to be required for the benefit of the child. One alter may be a passive and helpless recipient of abuse with access to distressing memories. Another may take responsibility for deriving pleasure from the abuse so as to behave in a manner that pleases abusers. Another may come out to ‘fight back’ by taking active steps to use force to protect the child’s body. Because different alters have different protective functions they have access to different memories, emotions, and goals; and thus they behave in distinctively different ways.
On this account alters are conceptualized as dissociated aspects, fragments, or parts of the greater self that is their summation. Dissociation is thought to be a highly creative and adaptive strategy that enables a child to deal with child-hood abuse that they otherwise cannot escape. It is thought to become maladaptive when it continues once the abuse has stopped, and the behavior of alters causes distress to the ‘main personality’, or alter who presents for treatment. The goal of treatment is the integration or fusion of these dissociated aspects into one largely integrated and consistent self of the sort exhibited by individuals without the disorder.
poster:alexandra_k
thread:476320
URL: http://www.dr-bob.org/babble/write/20050321/msgs/476320.html