Using the past to fertilize but not determine the future: Reflections on dissociation in the International Society for the Study of Trauma and Dissociation

It does not seem too much of a stretch to see the history of the International Society for the Study of Trauma and Dissociation (ISSTD) over the past three decades as facing similar challenges to those that at least some of our traumatized clients have faced. We came into the world 34 years ago packed with possibility, vigor, and hope. Our founding mothers and fathers were full of joy and excitement at our birth and full of expectation and enthusiasm for our fertile and healthy future. Our first few years were positively explosive, numbers built, clinical insights proliferated (e.g., Bowman, Blix, & Coons, 1985; Braun, 1988; Caul, 1984; Coons, 1984; Kluft, Braun, & Sachs, 1984; Ross, 1984; Spiegel, 1984), and research expanded from case observations to larger clinical series (e.g., Coons, Bowman, & Milstein, 1988; Kluft, 1984; Putnam, Guroff, Silberman, Barban, & Post, 1986). Yet our growth and exuberance met a painful and head-on challenge in the form of the recovered-false memory debate and the ritual abuse controversies. This began in the early 1990s and continued with ferocity through the mid-1990s. During this time period (and to some extent after it), standard professional debate about the existence of child abuse; organized perpetrator abuse, especially that involving satanic rituals; and dissociative disorders moved from conferences and the pages of journals to courtrooms, politically charged professional schisms, and personal attacks (e.g., the picketing of therapists’ offices, removal from or non-renewal of academic appointments, and orchestrated media defaming). The crux of these battles revolved around the ability of the human cognitive system to forget and then later remember (either cued or uncued) memories of earlier abuse (e.g., Brown, Scheflin, & Hammond, 1998).

In working through those confrontations and the wounds they left, we as a clinical and research society have been able to gain from a more sophisticated view of memory and the impact of trauma and dissociation on it (Belli, 2012; Brewin, 2014; Freyd & Birrell, 2013; Huntjens, Dorahy, & Van Wees-Cieraad, 2013). The intricacies of human autobiographical narratives, mixed with life events, symbolic representations, fantasies, and the impetus to make sense of real experiences in a manner that coheres with how a person views his or her self at that moment, are also much better understood (e.g., Conway, 2005; Habermas, 2015). In addition, we have progressed in our awareness of the cruelty one person can inflict on another (Middleton, 2013; Shaw, 2014), the complexity of trauma bonds and attachment behavior (Muller, 2010; Sachs, 2013), the pain of social stigmatization (e.g., Floris & McPherson, 2015), and the dynamics of abuse disclosure acceptance (Miller & Cromer, 2015). We continue to learn about trauma and dissociation and also about our self as a professional society.

In continuing this growth, I would like to highlight two areas at an organizational level in which dissociation might currently operate in ISSTD: The first involves amnesia for individuals who have left the Society or have been cut off for whatever reason; and the second involves the compartmentalization of different aspects of our identity that experienced or inherited the pain, shame, rage, insidious and divisive blame, disgust, or amnesia of the memory wars and ritual abuse controversies that threatened the organization’s existence. For the first, I briefly draw on a personal observation from a social and political context where significant change and development occurred (i.e., the movement toward increased dialogue and harmony in Northern Ireland). For the second, I draw on the internal structure of dissociative identity disorder (DID) to explore three possible dissociative parts of ISSTD that manifested during and since the memory wars.

Organizations and individuals: Lest we forget

In 1998 a historic event took place in Northern Ireland with the signing of the Good Friday agreement, a treaty that would pave the way for peace and stability after a brutal, bloody, and chronic conflict that began in the late 1960s (Powell, 2009). This agreement was signed by all major parties and ensured that those groups that had engaged in armed conflict would move their organizations and their memberships toward nonviolent diplomacy and that all groups would move toward a middle ground. They would take a path that previously had been outside their way of operating. Once this Agreement was signed, political hope and the desire to move forward with haste meant that while individual organizations could not always move as fast as each other, they tended to move faster and make changes more rapidly than many of their members were able to accommodate. That is, changes within the organization, brought about by external and internal forces, and the adjustments it had to make to adapt to the changing circumstances were often too fast for many members, or the organization was moving in directions that no longer represented these members’ beliefs, aspirations or approaches to bring about social change. These individuals often felt like they no longer had a voice in the organization and the organization’s voice no longer reflected theirs. Consequently, it was not uncommon for therapists who were working with members or even ex-members of these groups to hear them lament of feeling left behind, unrepresented, unvalued, and even betrayed. Crises, and the changes and adaptations that come from them, can take organizations in a different direction than a percentage of their individual members.

No doubt the crises that have faced the ISSTD and the ways it has adapted to manage and survive have left disillusioned and wounded a number of individual members. Some also left the field and the Society because of fear about professional safety and maintaining a livelihood evoked by external threats (e.g., the memory wars), dangers that the Society is not able to protect all of its members from. Our task as an organization is to remember these members with compassion and dignity, and cherish the learnings and lessons they have provided for us. Where possible, we need to welcome them back into the Society and ensure that they and the nature of the Society as it was then are as much a part of the organization’s legacy and collective memory as the survival strategies and changes that we were required to adopt, and the directions and growth that followed. I acknowledge their contribution on behalf of the Society.

The dissociative identities of ISSTD

We are now well over a decade on from when the external attacks of the memory battles and ritual abuse controversies began to wane in intensity. We might see the internal makeup of our society at this point in our history as akin to three dissociative identities in a DID patient. I use a DID metaphor to provide a framework for reflection and to promote discussion rather than to reify our society into crystalized distinct groups that do not exist. Individual members may identify with none, one, or more of these ‘identities’. One identity (or grouping of members) experientially lived through the memory and ritual abuse controversies. They hold the memories and feelings of those battles, of buddies ‘killed’ in action, of what they lost and learned. They bear the scars and hold onto the pain because they experienced it, but also in the service of not wanting to overwhelm other parts of the self. They keep it in. This lived experience identity is older and wiser and may be set in its ways, hardened under the molten furnace of combat.

Another identity has some coconsciousness with the lived experience identity by having inherited the knowledge of what was experienced but not being toned with the same affect or burdened by the wounds. This identity, which we may refer to as known inherited experience, is made up of members who either watched the wars from a distance (e.g., older Society members who practiced in centers and/or countries outside the hotspots) or joined the Society in the years following, when the immediate impact of the experience was passed down, particularly in verbal, narrative form but also to some degree in print. This identity knows but does not fully experience the magnitude and sacrifice of the lived experience identity. It has a safe, intellectual distance from lived experience but knows enough to not want to go through similar circumstances firsthand. It avoids dwelling long on the affective aspects of lived experience and may even question or critically appraise the methods and practices of that identity that attracted attack. This known inherited experience identity had the good fortune to learn from the mistakes of lived experience, as well as the developing data, clinical insights, and sounder science-practice knowledge that lived experience would have benefited from and paved the way for. Known inherited experience is limited potentially by fear of not wanting to recreate the path tread by lived experience. Its cognitive-affective tone is warily optimistic but fears that big steps might open up new frontiers of battle and old hurts.

The final identity is rather amnestic for the other two. Its development was forged out of earlier experiences but it is not knowingly completely aware of, and knowledgeable about, the experiences, including the battles that left the raw affect and scars in lived experience and the fears of known inherited experience that stepping too far forward professionally might bring up old wounds or create fresh ones. This identity we might call unknown inherited experience. It is made up of members who were minted well after the heat of the memory wars and ritual abuse controversies died out, or those who have moved more recently into the field from other areas. This identity has the exuberance of youth and new challenges and is not burdened down, fearful of, or even jaded by clinical experiences in the trenches of the early to mid-1990s, nor does it fear recreating them. This identity has little awareness of that time and the sociopolitical landscape that made it up. The experiences of lived experience and known inherited experience are like a scent that drifts up and around unknown inherited experience, but unknown inherited experience remains somewhat oblivious to it as it lingers in a manner that can’t quite be identified or articulated. This identity has less fear and a greater sense of optimism about what is possible, which may be more akin to the early years of our existence before exposure to the trauma of the memory wars. Yet it is unknowingly influenced by that experience.

The professional and social environments that unknown inherited experience is cutting its teeth in are vastly different from those that characterized the formative years of our other two identities. Controversy about ritual abuse, unretrieved memories of child maltreatment, and the existence of complex psychiatric manifestations of severe and chronic child abuse has not fully given way (Wilgus, Packer, Lile-King, Miller-Perrin, & Brand, 2015). However, in the past 20 years the backlash against the existence of child abuse and neglect has largely passed and the reality that adults mistreat children at staggering levels and in multiple ways has proliferated social consciousness rather than languished. Royal commissions into child sexual abuse have been notably opened in Ireland and Australia, and pressure mounts for similar investigations in other countries. Awareness of the magnitude and impact of child abuse has been assisted by the increased speed and connectedness of social media and the groundswell it can create. Throughout the world child abuse at the hands of not only parents and other care providers but also public figures in media, entertainment, and politics has been acknowledged, with many perpetrators charged.¹

The psychobiological reactions to trauma, including most importantly dissociation, although still activating some debate, are more muted and less contentious. For example, throughout our history the psychiatric legitimacy and naturally occurring reality of DID has been challenged and argued (e.g., Gleaves, 1996; Lilienfeld & Lynn, 2015; Lilienfeld et al., 1999; Reinders, Willemsen, Vos, Den Boer, & Nijenhuis, 2012). Yet numerous studies in different areas have now shown that cognitive, affective, and neurobiological findings in DID participants do not mimic results in control samples and those who are trained to simulate DID (e.g., Huntjens, Verschuere, & McNally, 2012; Reinders et al., in press).² This suggests that DID results are not a product of simulating or malingering, such that these as universal explanations are no longer part of the serious scientific understanding of DID.

The vagaries and complexity of human autobiographical memory encoding and retrieval have become better understood in the past 20 years. In that time ISSTD members, whether those more prototypically making up the lived experience, known inherited experience, or unknown inherited experience identities, have also become more aware of the centrality of shame in the effective treatment of complex trauma and dissociative disorders (e.g., Chefetz, 2015; Freed & D’Andrea, 2015; Kluft, 2007). Shame may underpin dissociative processes or give rise to dissociative structures designed to curb their felt experience. Among other drivers, this shame may derive from a sense of not feeling acceptable, wanted, or loved; from actions engaged in that attracted negative attention; and from awareness of a part of self that is deemed unacceptable.

Toward integration

We invite our dissociative patients to carefully and courageously face their pain, rage, desolation, and shame. My hope for the future of ISSTD is that we do not lose opportunities to face and work through our walled-off collective intolerable affects and that as an organization we begin to heal those that linger. This means first recognizing our dissociative identities that emerged out of pain, rage, shame, and other overwhelming feelings or became organized around ways to avoid such affects. I suggest for the current purpose that at least the three noted here exist. Shame may make it difficult for each to speak openly. Lived experience bears the scars of the memory wars and ritual abuse controversies, external attacks that threatened our existence. Alongside feelings of strength and pride at having come through that period, this identity may have internalized shame about some of the actions that left the organization and field vulnerable to attack and how it functioned and reacted during that time. It may also believe that other parts do not want to know or listen. Known inherited experience may feel ashamed of not doing enough to support lived experience in the aftermath, never quite understanding and never really wanting to know, sensing that diluted information may provide a buffer against a similar experience. For unknown inherited experience sights are set squarely on the future, and in moments of reflection shame may arise from not knowing the past, being blank to it and therefore feeling inferior to the other identities, as if something were missing (e.g., being unfamiliar with the sacrifices made and the hard lessons fought for). Shame arises from never taking the time to notice, identify, appreciate, and respect the scents of the past that waft around. Here selective inattention may provide a buffer against the pain of lived experience.

We now need to move these dissociative identities toward communication and ultimately integration. Unknown inherited experience needs to hear the struggles, pains, traumas, and triumphs of lived experience. Lived experience needs to be assured of a climate of compassion, trust, recognition, respect, and openness from both known and unknown inherited experience. Known inherited experience must be encouraged to voice its ongoing fears and its past regrets and feel proud of being the bastion of support that carried the Society through the rebuilding process. Unknown inherited experience holds the torch toward the future and must from the learnings of its forebears and the energy and enthusiasm it possesses be the fuel that drives the Society forward. It can let go of its shame over not knowing by becoming aware.

Several steps are being taken to bring about greater integration. We are an international society, so an oral traditional of verbal communications is not able to service our needs. We need written platforms that distill the experiences of each dissociative part. ISSTD is increasing its modes of written communication, now providing several outlets, including our more empirically driven Journal of Trauma & Dissociation, the clinically driven E-Journal, and finally our newsletter. I would strongly invite you as a member of our society, regardless of which of the three identities you more or less feel connected to, to take stock of your lived or inherited experience of the memory wars and ritual abuse controversies from the 1990s. The E-Journal and newsletter in particular provide places, therapeutic spaces if you will, for greater integration within our society. I would encourage members to use these forums for correspondence and communication about what they experienced, what lessons we learned, where we made mistakes, how and why people left the Society, what sacrifices those and others made, and what we taught the trauma field.

We as a whole need to own our part in the memory wars and ritual abuse controversies by acknowledging that at least some practices and ideas from that time were too loose, ill-informed, or based on limited information, as the empirical and clinical literature was not there to fully guide us. In that context we may at times have allowed our enthusiasm to cloud our judgement. In addition, we may have left unsupported and undefended very competent and ethical colleagues who were under attack. We also need to accept that we were attacked (and to varying degrees are still getting attacked) for knowledge and techniques that remain clinically sound and have been scientifically supported. The most pertinent of these is the legitimate existence of DID and the severe relational trauma in the histories of many cases. To further this endeavor the Society is working on constructing a written narrative of the experiences and outcomes of the memory wars from members who might be considered to reflect lived experience, known inherited experience, and unknown inherited experience. It is hoped that such a project will catalogue our unique and shared experiences as therapists and researchers in the field of trauma and dissociation.

Conclusion

My hope and motivation is to create an ISSTD in which our history knowingly lives on, our future integrates the past but is neither frightened of it nor solely directed by it, and our present is safe enough that we are prepared to risk sharing our experiences. If we accept, rather than compartmentalize, the fact that as a society we are capable of compassion, mistakes, humanity, cruelty, thoughtfulness, ineptitude, collectivism, determination, indifference, optimism, hubris, concern, narcissistic vulnerability, courage, shame, and genuine generative and shared pride, our past and present will not fall under the stability-weakening fissures of dissociation. Our identity will incorporate the pain, shame, fear, determination, and scars of lived experience and known inherited experience, along with the forward-focused exuberance of unknown inherited experience, to create a more flexible, freely operating international society that can respond spontaneously to present crises and plan advancements and expansion to better serve our patients and the scientific field we represent. Our society’s growth can bloom from a fully acknowledged past.

Acknowledgments

I thank four anonymous International Society for the Study of Trauma and Dissociation colleagues for very helpful comments on previous drafts of this work.

Notes

^1. Despite the acceptance of widespread child abuse in public and professional contexts, it should also be recognized that although studies of dissociation, or those including dissociative measures, increasingly pepper mainstream psychiatry and psychology publications, dissociative disorders have only a foothold in the psyche of general mental health science and practice. Future steps that will build on current efforts to remedy this include randomized controlled trials of dissociative disorder treatments; conceptual frameworks that unify different definitions and understandings of what dissociation is (e.g., Van der Hart, Nijenhuis, & Steele, 2006); methodologically sophisticated studies demonstrating in unison the prevalence, impact, and financial cost of dissociative disorders; and strategic political rallying of health, mental health, and social care systems and those that drive them.

^2. For example, in a reanalysis of work examining recognition of prior learning across reported amnesic identities in DID, Lee, Lodewyckx, and Wagenmakers (2015) found that the DID results were not consistent with participants faking DID (i.e., malingering group) or those who had no awareness of the retrieval material (amnesic group). The DIDs appeared to be an independent group not subsumed by these other groups.