The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization (Norton Series on Interpersonal Neurobiology)

Phobia of attachment is often paradoxically accompanied by an equally intense phobia of attachment loss. It manifests in desperate feelings and behaviors that motivate the individual to connect to another person at all costs. Typically, different parts of the personality experience these opposite phobias. They evoke each other in a vicious cycle, with a perceived change in closeness or distance in a relationship resulting in the well-known “borderline” pattern of “I hate you— don’t leave me,” more recently described as disorganized/disoriented attachment (D-attachment, e.g., Liotti, 1999a)

When survivors associate an increasing number of stimuli with the traumatic experience and memory through stimulus generalization, they may start to fear and avoid more and more of inner and outer life. For example, when survivors as ANP have intrusive traumatic memories and associate this aversive intrusion with EP, they develop a phobia of this dissociative part. The survivor as EP can become phobic of ANP when that part is perceived as ignoring or harming (i.e., neglecting or abusing) EP in some way. In fact, survivors can become anxious and avoidant of any mental action, such as having particular feelings, sensations, and thoughts that are consciously or unconsciously associated with the original traumatic experience(s).

Behavioral and mental avoidance strategies which maintain structural dissociation, are needed to prevent what are perceived as unbearable realizations about one’s self, history, and meaning. Subsequently, additional phobias ensue from the fundamental phobia of traumatic memory.

Trauma-related phobias are thus treated in a specific order such that patients experience a gradually developing capacity to engage in purposeful and high quality adaptive actions, both mental and behavioral; that is, attain higher levels of mental efficiency. Increasingly more complex and difficult experiences (past and present) then can be tolerated and integrated, and improvement in daily living can be achieved

Therapists who work with chronically traumatized individuals will readily recognize that such patients are often extraordinarily fearful of mental actions as well as external stimuli that remind them of the traumatic experience.

According to Janet (1904/1983b, 1935a), the core phobia in traumarelated structural dissociation consists of an avoidance of the synthesis and full realization of the traumatic experience and its effects on one’s life; the phobia of traumatic memory

The lower their mental level, the more individuals must rely on substitute actions that may protect against overwhelming emotions and thoughts, but that are at odds with integration of traumatic memories and associated dissociative parts

The mental level of survivors remains low when they have significant relational and emotional skills deficits

The first type of action involves integrating an experience with an explicit, personal sense of ownership: “That happened to me, and I think and feel thus and so about it.” The second type of action is that of being firmly grounded in the present and integrating one’s past, present, and future. It manifests in acting in the present in the most adaptive, mindful manner.

Both ANP and EP lack full realization of the present, are unable to live fully in the present. They also lack complete realization of their traumatization, that it is over, and often have been unable to realize a multitude of other experiences, leaving much unfinished business.

Synthesis. A major integrative mental action is synthesis, in which we bind (link) and differentiate a range of internal and external experiences within a moment and across time. Synthesis includes binding and differentiating sensory perceptions, movements, thoughts, affects, and a sense of self. For example, we know how one person is like another (binding), but also the ways in which he or she is different (differentiation), and how our present situation is similar to but also different from our past

Much synthesis occurs automatically and outside conscious awareness. Our capacity for synthesis fluctuates along with our mental level. For example, when an individual is fully awake, synthesis will be of a higher quality than when he or she is tired. Synthesis provides for the individual’s normative unity of consciousness and history. Alterations of consciousness and dissociative symptoms can emerge when synthesis is incomplete