240

THE DISSOCIATION OF DISSOCIATION

by MARIO RENDON, M.D. New York, December 1973

UMAN beings have needs. These needs, as well as the way in which they are fulfilled, are of a historical nature; they change in character, pass and give rise to new needs and new modes of dealing with them. The basic need of our primitive ancestors, like that of many animals today (as well as some humans), was to gather food to survive for the day and thereby perpetuate their everyday existence. This is the overwhelming need in infants and the period in which this need predominates has been called the oral period. The matter of needs, and how they are fulfilled, is relative to time and place. There has been a lot of progress between hunting and collecting vegetables on one hand and having the food delivered and paying by check on the other. The opposition of the first finger, the ability to construct instruments and instruments for instruments, the development of language, thought and thought of thought, as well as the progressive development of our brain-all these have made possible what we call the human, the historic or the civilised, in man’s detaching himself from nature. Rules and regulations by social groups serve as guidelines for the individual to follow in contending with his animal instincts but they also have

~1

created new needs. In our culture a child starts to confront these needs in what has been graphically called the anal period. From then on a continual interplay between the individual and his society will have as an outcome an adult person with the concept of a self and a role, or rather a series of roles, in a series of cultural groups contained in a society. There would have to be an equilibrium between the way in which the individual assimilates and accommodates to the society in which he finds himself and vice versa. Drawing on the principle of homoeostasis we can say that every society produces the particular forms of deviance it needs to maintain its equilibrium, and that such elements of deviance, incongruity or pathology are found to a minor degree also in so-called normal individuals. To know one’s place in the world, one must communicate and understand; one has to be acknowledge as what one is and one’s experiences have to be validated for one’s security. Thus one feels the need to belong to a group that provides that necessary confirmation or validation. Transcultural psychiatry, as well as family therapy, has demonstrated that the more one’s behaviour is considered within the context of one’s social group, the more intelligible it is. Taken out of context, on the other hand, behaviour may become unintelligible Bleuler seemed to he aware of this when he stated : behaviour which to us appears bizarre and which, therefore, becomes decisive for the diagnosis, may be the outcome of ethnic peculiarities or of a specific attitude towards life. For example, the actions of hysterics who rome from the Far Eastern countries sometimes appear as bizarre to us as the schizophrenics of our own country.2 It seems that children are born all over the world with basically the same equipment of organs and functions, and yet, as adults, they are completely different in many ways. That difference is due to the process of acculturation. Measured with our instruments, Nepalese children averaged IQ’s of 100 at age 6, but the

241 to 75 by age 13.3 Were they retarded? One would be inclined to yes, if these children had the same needs that our 13-year-olds have, but they do not. According to Piaget,4 our 13-year-olds of the upper and middle classes have already reached the stage of formal operational thinking which the Greeks only reached in adulthood. Were the Greek children retarded? Again, one might think so if they were measured in the context of our children’s needs, but that would be an absurd extrapolation. It has been said that identity is to our times that sexuality was to Freud’s.5 Sexuality is an obvious need and the vicissitudes of its repression have been amply documented, but is there a similar need for identity? And if so, is it a new need? Identity seems to have been taken for granted, with a few exceptions in philosophy and literature, until somewhere in the middle of the last century when postHegelian philosophers did not spare identity the criticisms to which all institutions and concepts were being subjected. It was then when Marx and Feuerbach and Kirkegaard were talking about alienation : the process of becoming a stranger to one’s self. In the field of clinical psychiatry, Charcot was then describing the breaking up of hysterics’ consciousness into diverse elements which he called dissociation,6 and Janet similarly described hysteria as a ’malady of personal synthesis’.7 Morton Prince discussed disintegration as being synonymous with dissociation8 and Bleuler used ’splitting’ instead of ’dissociation’ or other authors’ similar concepts such as ’fragmentation,’ ’disintegration’ and ’sejunction’.9 It is possible that both philosophers and clinicians were talking about the same phenomenon although at different levels. The philosophers may have been talking about the social ingredient which the clinicians so clearly observed in extreme forms of deviance. As a clinician, I should like to take up the subject of dissociation again, and I hope at least to raise new questions as to its significance, particularly in the interface between society and identity. &dquo;Ale owe to Freud the present understanding of the mechanisms of dissociation, particularly his concept of repression, which he called the cornerstone of his theory of neuroses.10 The internalisation of society in the form of the superego was responsible for the phenomena of repression.ll Recent studies of the brain have postulated a possible basis for dissociation in the brain structure itself and its dual composition of palaeocortical and neocortical structures. According to these studies, the limbic system or visceral brain is largely pre-conscious or unconscious, and predominantly involved with emotions, feelings, affective states. It would be the seat both of what Freud called the id and of primary process thinking. The cerebral hemispheres, on the contrary, are available for consciousness, thinking, realitytesting ; they are rational, logical and verbal, and affected by ego functions and secondary process thinking.12 Philogenetically, then, dissociation may be correlated with the development of the neo-cortex in the brain and also with the appearance of superior forms of social organisation. But it is possible that dissociation itself has changed historically and that hysteria and schizophrenia as illnesses, for example, are only forms of progressive dissociation. It is true that both hysteria and schizophrenia have been used historically as wastebaskets for the unintelligi~blel3 and, parodying an earlier statement, I would venture to say that schizophrenia is to our times what hysteria was to Freud’s, with the exception that hysteria is still prevalent today in underdeveloped countries and also in illiterate and rural communities. As a practitioner in a large metropolitan hospital in New York City, I have been in a position to scores

answer

dropped

242

large number of adolescents with different forms of hysteria among lowerimmigrants, particularly from the Caribbean area. To this end, I have previously published a reportl4 in which I state that many of these hysterical youngsters were diagnosed as schizophrenics because of lack of cultural empathy or because of what is actually the same thing, ethnocentrism. 15 Early historical forms of dissociation were probably embedded in magic and then in religion. Thus bewitchment, possession, trances, faith healing, religious conversion and religious experiences of different kinds may have been only various degrees of dissociation in previous cultural settings. Ricardo de San Victor described three degrees of ascendance to God in the Middle Ages which he called elatio, , sublevatio and alienatio; they are different degrees of dissociation.16 The projection mechanisms involved in religious belief were first delineated clearly by Feuerbach.17 Today there still exists possession, as well as different forms of spiritualism, candomble, and other religious remnants of previous cultural forms, mainly in the third world ;18 also present today are culture bound forms of dissociation such as Amok, Whitiko, Pibloktog, Latah, Imu, Susto, Koro, Hsieh-Ping, etc., some of which have been considered schizophrenia and others hysterical psychoses. Dissociation in everyday life has been described since the classic clinicians of the last century started working on the subject: absentmindedness, daydreaming, fantasising, dreaming, forgetting, parapraxis, joking, trances, fugues, twilight states, hypnotic states, and so on. Dissociation is a very necessary ingredient in today’s diplomacy and the pervading, socially accepted passive-aggressiveness. It is also a normal requirement for the increasing number of ’roles’ and ’games’ that a person I in this society has to play. Sometimes these games seem to make no sense or to have lost the clear meaning that they had in previous societies. It is as if dissociation had taken a further step and dissociated itself from its meaning. We can think, for example, of the traditional wedding ceremony in the context of today’s sexual and marital practices; all the symbolism contained in the ritual is completely alien to the happenings of today and yet, many people still have to deal with it, and see a

class

I

most

likely in a dissociated From the &dquo;normal&dquo;

manner.

we move into the mildly abnormal: passive-aggressive personalities, hysterical episodes, depersonalisation, multiple personalities, identity crisis and identity confusion; finally come the grossly abnormal forms of hysterical psychoses and, I believe, reactive and process schizophrenia, as the last stage. Identity and adolescence are closely interrelated; like schizophrenia, they are topics of our time. Although identity is a lifelong changing need (Erikson’s sameness in change), adolescence is the period when its major crystallisation occursl9 and thus the period in which we can see its multiple forms and metamorphoses. Of all the forms of identity disturbances, I believe only schizophrenia is getting serious consideration today and I believe that transient psychotic and even neurotic forms such as dissociative hysteria, depersonalisation and culturally bound syndromes are being dumped in the basket of the unintelligible: Schizophrenia. I believe that a diagnosis at a critical period may serve as a &dquo;rite de passage&dquo; and this may be the case of schizophrenia in adolescence. As sociologists have demonstrated,2~ initiated deviants may increasingly commit themselves to their role. We have the responsibility of preventing this. Erikson says : Young patients can be violent or depressed, delinquent or withdrawn, but theirs is an acute and possibly passing crisis rather than a breakdown of the kind which tends to commit a patient to all the malignant implications of a fatalistic diagnosis. And as has always been the case in the history of

243

psychoanalytic psychiatry, what was first recognised as the common dynamic pattern of a group of severe disturbances (such as the hysterias of the turn of the century) revealed itself later to be a pathological aggravation, an undue prolongation of, or a regression to, a normative crisis &dquo;belonging&dquo; to a particular stage of individual development. Thus we have learned to ascribe a normative &dquo;identity crisis&dquo; to the age of adolescence and young adulthood.21

Finally, it is also Erikson who has stated that ideology is the guardian of identity.22 The multiplication of ideologies, as well as the ideologisation of the nonideological because of lack of true ideology, seems to be a matter that ought to today. Our adolescents are certainly concerned about it and they are desperately looking for an ideology. No study of identity in any society is complete, I believe, without a thorough scrutiny of the ideology or ideologies involved-this

concern us

is also

our

task.

NOTES

1.

Laing,

R. D. and

Esterson,

A.:

Sanity,

Madness and the

Family, (New York : Basic

Books, 1971).

2. Bleuler, E.: Dementia Praecox or the Group of Schizophrenias (New York: International University Press, 1950), p. 324. 3. Elkind, D. and Sameroff, A.: "Developmental Psychology," Am. Rev. Psychol., 21 (1970), 191-238. 4. Inhelder, B. and Piaget, J.: The Growth of Logical Thinking from Childhood to Adolescence, (New York : Basic Books, 1958). 5. Sommers, V. S.: "The Impact of Dual Cultural Membership on Identity," Psychiatry, 27 (1964), 332-344. 6. Freedman, A. M. and Kaplan, H. I. (eds.): Comprehensive Textbook of Psychiatry, (Baltimore : The Williams & Wilkins Co., 1967), p. 885. 7. Janet, P.: The Major Symptoms of Hysteria, (New York: Macmillan, 1920), p. 332. 8. Prince, M.: The Dissociation of a Personality, (New York: Greenwood, 1969), p. 75. 9. Bleuler: op. cit., p. 363. 10. Freud, S.: An Autobiographical Study, Vol. XX, Part 3 of the Standard Edition of the Complete Psychological Works of Sigmund Freud, edited by James Strachey, (1925). 11.

Freud, S.: New Introductory Lectures on Psychoanalysis, Lecture XXXI, Standard Edition, (1933). 12. Freedman and Kaplan: op. cit., p. 887. 13. McCord, W.: "The Personality of Social Deviants," in Study of Personality, an Interdisciplinary Appraisal, ed. by Norbeck (New York : Holt, Reinhardt, Winston, 1968). Lewis, W. C. and Berman, M.: "Studies on Conversion Hysteria," Arch. Gen. Psychiat., 13 (1965), 275-282. 14. Rendon, M.: "Transcultural Aspects of Puerto Rican Mental Illness in New York," Int. J. Soc. Psychiat., in press. 15. Lack of cultural empathy is probably based originally on the we-they phenomenon which has as its basis a schizoid division or dissociation of good-bad. 16. Abbagnano, N.: Diccionario de Filosofia, (Mexico: F.C.E., 1963), p. 402. 17. Feuerbach, L.: The Essence of Christianity, (New York : Harper, 1957). 18. Bustamante, J. A.: "Cultural Factors in Hysterics with Schizophrenic Clinical Picture," Intl. J. Soc. Psychiat., XIV 2 (1968), 113-118. 19. Erikson, E.: Identity, Youth and Crisis, (New York : Norton, 1968). 20. Feuerbach: op. cit. 21. Erikson: op. cit ., p. 17. 22. Ibid., p. 133.

The dissociation of dissociation.

240 THE DISSOCIATION OF DISSOCIATION by MARIO RENDON, M.D. New York, December 1973 UMAN beings have needs. These needs, as well as the way in which...
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