Dissociation as a psychic division along natural lines : an exploration in adult psychotherapy

Abstract

The phenomenon of dissociation has been understood in many different ways since it was first linked, by both Freud and Janet, to the condition of hysteria in the late 1800s. Bion (1958) observed the dissociative mechanism in his schizophrenic patients at a point when they were displaying an improved mental state. Hence, Bion, considered dissociation to be a relatively benign and creative mechanism that resulted in natural divisions of the psyche. The researcher used Bion’s description of dissociation to achieve a better understanding of the intrapsychic configuration arising from dissociation in the context of Dissociative Identity Disorder (DID). Following Bion’s digestive model of mental growth, these psychic divisions were further examined in terms of their overall nurturing or poisoning physiological functions. These functions determined the trajectory of mental growth in the participant. These dynamics were illustrated through clinical material derived from a patient who was still in long-term psychotherapy with the researcher at the time of writing this study. This single case study was, however, restricted to approximately six-and–a-half years. In response to impaired maternal containment, exacerbated by ongoing sexual abuse and mental pain, DID had evolved as a complex defence system in the participant. For the participant, dissociation became a habitual way of defending against mental pain and in this way formed her personality structure. The hermeneutic cycle was applied to the research material in which the findings were first understood at an empathetic, descriptive level and then at a deeper more interpretative level. Ricoeur’s (1982) concept of distanciation facilitated a more objective interpretation of these findings. The findings of this study are therefore presented at two levels of understanding. The participant showed some capacity for symbolic thinking, and emotions of guilt and concern for others, indicating a potential for depressive position functioning. However, her system of internal object relations conformed more to part-object relationships than to whole object relating. Although these internal part-object relations provided an illusion of protection against terrifying feelings, this psychic arrangement compromised normal psychic integration in the participant. There was evidence to show that the internal system of part-objects resulted in a thought disturbance for the participant and consequently could not provide sustained nurturance to her psychic system. Given that elements of both paranoid-schizoid and depressive modes of functioning were noted, the participant was positioned at the onset of the depressive position in terms of mental functioning.