Dissociating Damage

Abstract

Dissociation is a defense often mobilized against the pain and helplessness engendered by traumatic experiences such as rape, incest, and combat. This use of dissociation is different from the traditional understanding of defense mechanisms in that it provides protection from immediate experiences rather than unconscious memories or wishes. However, the price paid for this defense is subsequent fragmentation manifested by amnesia, fugue, and other dissociative symptoms which underly many of the DSM-III symptoms of post-traumatic stress disorder. While defending against the unbearable sense of physical helplessness during trauma, such patients subsequently re-experience it as a loss of control over their state of mind. Studies linking hypnotizability with the occurrence of dissociative responses to trauma are reviewed, especially the recent literature describing multiple personality disorder as an extreme form of posttraumatic stress disorder. In this unusual population, repeated parental abuse mixed with concern results in their internalizing the imposed conflicting views of themselves using dissociative symptoms. Guidelines for employing hypnosis in the psychotherapy of such trauma victims are presented.