Defining (Structural) Dissociation: A Debate

Defining (Structural) Dissociation: A Debate

Definitions matter and can have a significant impact on a field. They can guide clinicians and researchers to what should be their focus and what is irrelevant. But, to use a cliché, definitions can also be a double-edged sword. Perhaps what the definition asserts as valid has been framed in an empirically or ethically indefensible way. The previous psychiatric definition of homosexuality as a disease easily comes to mind. Or what is considered to be outside of the boundaries of the definition may unjustly perpetuate a falsehood, as in the past notion that “hysterical” (i.e., somatoform and dissociative) symptoms by definition were caused by an errant uterus and thus could only be found among women (Veith, 1965). As Rhoda Unger (1983, p. 26) has remarked, descriptions (and definitions) are always evaluative and come from a particular point of view. As cognitive-behavioral theory holds, they are cognitions that shape our experiences and affective responses. As such, they should be subjected to scrutiny of their unspoken underlying assumptions and the consequences of adopting them, as has occurred in the commentaries of this issue. Definitions are too powerful to ignore.

Thus, whenever someone proposes a new or modified definition of a canonical term such as dissociation, the field should pay attention and discuss it, especially when the authors have such long and important track records as Ellert R. S. Nijenhuis and Onno van der Hart. At the invitation of the journal editor, Jennifer Freyd, we invited distinguished authors to contribute their reactions to the target paper, we wrote our own reactions, and we let Ellert and Onno have the last word.

We will let the reaction papers, which have a number of commonalities, speak for themselves, but we wish to say a few words about the contributors.

Just a few years after receiving his doctorate, Richard J. Brown, a British clinical and research psychologist, has already established himself as a major force in the conceptualization of dissociation, especially as it relates to conversion disorder. Lisa D. Butler is a Canadian psychologist and academic living and working in the eastern United States who has contributed to previous definitions and theoretical discussion of dissociation. Paul F. Dell is an American psychologist who has long been interested in the diagnostic classifications and definitions of dissociative disorders and who has also proposed a definition of dissociation. He recently coedited a state-of-the-art overview of dissociative disorders. Laurence J. Kirmayer, a cross-cultural psychiatrist residing in Canada, has drawn attention to the complex and often neglected cultural dimensions underlying assumptions about and research on psychiatric disorders across the globe. Ellert R. S. Nijenhuis treats severely traumatized persons at the Outpatient Department of Psychiatry of Mental Health Care Drenthe, Assen, The Netherlands. He is author of the Somatoform Dissociation Questionnaire and coauthor with Onno van der Hart and former International Society for the Study of Trauma and Dissociation president Kathy Steele of The Haunted Self, a book on structural dissociation theory. Onno van der Hart is professor of psychopathology of chronic traumatization at Utrecht University, Utrecht, The Netherlands, and a psychotherapist at the Sinai Center for Mental Health, Amsterdam. He is also a scholar of Pierre Janet and past president of the International Society for the Study of Trauma and Dissociation.

And as for us …

Elizabeth Bowman is an American psychiatrist whose early work focused on religious and spiritual aspects in dissociation. Her more recent work on conversion (dissociative) seizures attests to the importance of definitions, as these seizures are classified as somatoform in the United States and dissociative elsewhere in the world.

Etzel Cardeña, a Mexican psychologist living in Sweden, has discussed the domain of dissociation and its manifestations in Western and other cultures besides researching acute dissociative reactions. His relevant research includes somatic and posttraumatic forms of dissociation, hypnosis, and altered states of consciousness and anomalous experiences in general.