Kerry Dawkins, 2019

The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization, by Onno van der Hart, Ellert Nijenhuis and Kathy Steele (whom I’ll call HNS), posits that post-traumatic stress disorder, dissociative identity disorder and other trauma- and dissociation-linked psychiatric disabilities arise from ‘structural dissociation’, or the brain’s inability to fully integrate adverse experiences. Underlying HNS’ work is the idea that multiplicity is a kind of disordered mental process – a ‘failure’ to integrate trauma – that must be cured through the de-individuation of system-members. Admittedly, The Haunted Self was written in 2007, six years before the adoption of the DSM-5 and its updated DID criteria or changes in therapeutic practice that are less focussed on cure. In the DSM-5, DID can only be diagnosed if multiplicity – or the trauma that precipitated it – causes distress to the person or system seeking diagnosis. Despite its age, though, there are still people citing The Haunted Self as an authoritative source to explain trauma-based multiplicity. The continued use of The Haunted Self as an explanation for, and a guide for treatment of, trauma-based multiplicity was the catalyst for my writing this critique.

For HNS, trauma is ‘structural dissociation of the personality’, in which abuse survivors’ mental organisation becomes incoherent and scattered. Their conceptualisation of dissociation and its origins is based primarily on the work of Pierre Janet, a French psychologist and philosopher who worked in the 19th and early 20th century. HNS consider multiplicity ‘tertiary structural dissociation’, in which patients have several ‘emotional parts’ and ‘apparently normal parts’. Emotional parts are aspects of the personality or system-members who have expressive difficulties and intense emotions, whilst apparently normal parts are system-members or aspects who are generally able to communicate with the general public.

HNS’ thesis lies on a number of unspoken assumptions:

  1. Under every deviant person is a hidden normal person who can be freed through intense therapy.
  2. Multiplicity of any kind is just another kind of maladaptive dissociation.
  3. Members of plural systems aren’t real people and don’t deserve to be treated as individual people, despite exhibiting the characteristics of individual people. ‘Emancipation’, or the behavioural independence of system-members, is portrayed as ‘avoidance of integration’. The pronoun ‘it’ is consistently used to refer to so-called parts. Over and over again, our lack of personhood is reiterated. They don’t even consider that individual system-members can process the system’s trauma without subsuming themselves into the illusory Real Personality.
  4. A system’s current state – the is – is verbally conflated with the ought, or HNS’ desired state – a ‘fully integrated’ single personality that no longer expresses any kind of plurality. HNS have therefore used an informal logical fallacy to make their point. Just because you think something ought to be doesn’t mean it is. Normative statements are not the same as descriptive ones, but they seem to see them as one and the same.

These assumptions are unquestioned and are probably not even noticed. Most adherents of medical frameworks may not even realise that they are operating on a set of tacit assumptions, but that doesn’t diminish the harm of those assumptions. Because they’re operating from a closed system of information that doesn’t allow new interpretations of trauma, dissociation and plurality, people like this are disinclined to listen to people’s direct experiences. This is a frequent problem amongst medical professionals working in the mental health and developmental disability fields; because their patients have ‘broken brains’, their narratives are intrinsically invalid.

These assumptions colour the way HNS advise clinicians who work with traumatised patients. The treatment goals in The Haunted Self are simply warmed-up integration evangelism: focussing on normalising the patient’s mental processes rather than focussing on their quality of life as the patient themself defines it. Plus ça change, plus c’est la même chose. Non-plurals who experience a scattered self-concept may benefit from integrating dissociated parts of their experience, but the authors also insinuate that the members of trauma-based plural systems are also dissociated parts that must be integrated into the supposed ‘real individual’ behind them. HNS recognise that system-members can have strong self-concepts – what they call ‘emancipation’ – but HNS are emphatic that they are still parts of an idealised true individual, not proper people in and of themselves. We are turned into pseudo-people who can be suppressed and stripped apart to be rebuilt into a Real Person, and this process is apparently beneficial even if it causes psychological harm to the system. HNS even fall into the ‘types of alters’ stereotypes, like protectors, inner self helper and persecutors.

HNS emphatically repeat that trauma-based systems are composed of ‘parts of the personality’, not groups of people working together towards a common goal. System-members’ names are placed in scare quotes. The focus is on The Individual, even when they themselves claim that their patients never developed a singular sense of self in the first place – HNS say that there is no original personality in structural dissociation. They routinely refer to DID as a set of deficits, rather than a neutral or potentially beneficial mechanism that systems use to offer each other mutual support after being severely traumatised. People traumatised severely enough to experience any flavour of dissociation are characterised as having ‘inadequate mental skills’ (HNS, 2007). It’s a depressing, impoverished way to see systems, whether or not they originated through trauma.

In ‘Critiquing the Requirement of Oneness over Multiplicity’, the psychologist Kymbra Clayton (2005) provides a trenchant critique of the idea that oneness itself should be the ultimate goal for treatment. She also argues that the compulsory unitary self is socially constructed, not an absolute requirement for mental health. The DSM-IV, current at the time of The Haunted Self’s publication, describes DID as a ‘failure to integrate various aspects of identity, memory and consciousness’ (American Psychiatric Association, 1994, p. 484, in Clayton, 2005). The clinicians Clayton cites focus on appropriateness and compliance with therapists’ and psychiatrists’ courses of treatment, rather than trauma support that allows for more patient autonomy. Normalisation through fusion is the desired telos, even when that fusion may itself produce distress and PTSD symptoms (Putnam, 1989, & Ross, 1989, in Clayton, 2005). Colin Ross, a psychiatrist who specialises in DID, said in 1997 that ‘the goal of treatment of MPD is not palliation. It is cure’ (in Clayton, 2005). HNS are barely different to Ross in their view of trauma-based multiplicity. For example, one member of a DID system expressed worry over their therapist’s efforts to persuade them to fuse, describing it as potentially ‘murdering my inner people’. HNS’ focus seems to be on what the therapists want, rather than what their clients want. There is an insinuation that systems cannot engage with deeper thoughts, have insights into their behaviour or face their trauma head-on without fusing themselves into an idealised single personality. This is disablist, disempowering nonsense.

In contrast to the strict adherence to the medical model that HNS, Ross and their ideological allies espouse, Clayton cites postmodernist thinkers who suggest that multiplicity may actually be a valid, alternative way of being, similar to our own system’s views. Like HNS, Clayton wrote during the era of the DSM-IV, which declared multiplicity pathological regardless of its actual effect on systems’ functioning. The assumptions that HNS espouse, and that Clayton criticises, are less entrenched in more recent literature, but the continued promotion of HNS’ work means their minor variation on the likes of Colin Ross remains influential.

HNS’ model of DID therefore adds very little new to the conversation about plurality. Whilst they do integrate a number of different trauma-related conditions under a seemingly cohesive umbrella, they have failed to question some of the frameworks in which their model is situated. The same Integration Evangelism, focus on normalisation over quality of life and dehumanisation of plural systems and their individual members permeates The Haunted Self. I don’t think HNS intend to dehumanise or ‘other’ people, but they have done. I agree with HNS that people with extensive trauma histories must receive treatment that helps them to cope with their pasts and face their present and future with confidence, but that goal is not synonymous with forced normalisation that may or may not improve people’s lives.

Related articles on this site

Dissociation and Assumptions, Plurality and Complexity, Taking the Evangelists to Task, Engendered and Ensouled, Three Problems with Medical-Model-Only Thinking

References

American Psychiatric Association. (1994). Diagnostic and statistical manual of psychiatric disorders, fourth edition (DSM-IV). In Clayton, K (2005). Critiquing the Requirement of Oneness over Multiplicity: An Examination of Dissociative Identity (Disorder) in Five Clinical Texts. E-Journal of Applied Psychology, Clinical Section, 1(2): 9-19.

Clayton, K (2005). Critiquing the Requirement of Oneness over Multiplicity: An Examination of Dissociative Identity (Disorder) in Five Clinical Texts. E-Journal of Applied Psychology, Clinical Section, 1(2): 9-19.

Putnam, FW (1989).Diagnosis and Treatment of Multiple Personality Disorder. In K Clayton (2005). Critiquing the Requirement of Oneness over Multiplicity: An Examination of Dissociative Identity (Disorder) in Five Clinical Texts. E-Journal of Applied Psychology, Clinical Section, 1(2): 9-19.

Ross, CA (1997), Dissociative Identity Disorder: Diagnosis, Clinical Features and Treatment. In K Clayton (2005). Critiquing the Requirement of Oneness over Multiplicity: An Examination of Dissociative Identity (Disorder) in Five Clinical Texts. E-Journal of Applied Psychology, Clinical Section, 1(2): 9-19.

Van der Hart, O, Nijenhuis, E & Steele, K (HNS) (2007). The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization. New York: WW Norton & Company.