Beyond the Impasse - Reflections on Dissociative Identity Disorder from a Freudian-Lacanian Perspective.

Reitske Meganck

doi:10.3389/fpsyg.2017.00789

Abstract

Dissociative identity disorder (DID) is a widely contested diagnosis. The dominant posttraumatic model (PTM) considers early life trauma to be the direct cause of the creation of alter identities and assumes that working directly with alter identities should be at the core of the therapeutic work. The socio-cognitive model, on the other hand, questions the validity of the DID diagnosis and proposes an iatrogenic origin of the disorder claiming that reigning therapeutic and socio-cultural discourses create and reify the problem. The author argues that looking at the underlying psychical dynamics can provide a way out of the debate on the veracity of the diagnosis. A structural conception of hysteria is presented to understand clinical and empirical observations on the prevalence, appearance and treatment of DID. On a more fundamental level, the concept of identification and the fundamental division of human psychic functioning are proposed as crucial for understanding the development and treatment of DID.

Highlights

James was 24 years old when he consulted a therapist, as his girlfriend discovered his adulterous behavior and a number of substantial purchases of which he wasn’t aware
While the link between multiple personalities and hysteria was lost in the latter half of the twentieth century, when the DSM’s descriptive and symptomatic approach to diagnosis came to dominate, we should not forget that it was within theories on hysterical mechanisms that the idea of dissociation came to the fore: in short, dissociation was considered as the basic mechanism in hysteria (Janet, 1889/1973, 1911/1983; Breuer and Freud, 1895/1955)
As we argue here, it seems to create the opposite: whole parts of subjective experience are rendered hidden and repressed, as focusing on alters supports the notion that they are bad and should not be part of the subject’s experience. Considering both the posttraumatic model (PTM) and the socio-cognitive model (SCM) in detail, I argued that both models hint at important mechanisms to understand DID: the role of trauma on the one hand and the role of the underlying subjective structure on the other

Summary

INTRODUCTION

James was 24 years old when he consulted a therapist, as his girlfriend discovered his adulterous behavior and a number of substantial purchases of which he wasn’t aware. While the link between multiple personalities and hysteria was lost in the latter half of the twentieth century, when the DSM’s descriptive and symptomatic approach to diagnosis came to dominate, we should not forget that it was within theories on hysterical mechanisms that the idea of dissociation came to the fore: in short, dissociation was considered as the basic mechanism in hysteria (Janet, 1889/1973, 1911/1983; Breuer and Freud, 1895/1955) Before exploring this further, I first elaborate the idea of the divided subject as a possible framework to understand dissociative symptoms on a more structural level. The knowledge produced by another (such as a diagnostic label) never covers the truth underlying the subject’s dividedness, this does not preclude that the subject identifies with the answer, with the knowledge produced by the other placed in the position of the master

A REAPPRAISAL OF THE ARGUMENTS

CONCLUSION

ETHICS STATEMENT