The Dissociative Mind in Psychoanalysis: Understanding and Working with Trauma
It is no secret that between psychoanalysis and trauma theory, a big rift exists. This rift makes it difficult to treat trauma patients in psychoanalysis. Concepts such as repression do not work with patients whose inner world is a turmoil of anxiety and unbearable affects. In my own training during the eighties as a psychoanalyst, I learnt that a real trauma was a contraindication for psychoanalysis. Psychoanalysis was for the treatment of neuroses and their concomitant unconscious fantasies, and not for the consequences of real events, be it from exposure to war, sexual violence, or for the second generation survivors of the Holocaust. Still, psychoanalytic theory has a lot to offer us; in working with traumatised patients, in the form of concepts such as transference, countertransference, and techniques to understand and contain unconscious affects such as unbearable anxiety, shame, and guilt. This rift was in part due to Freud's abandonment of his trauma/affect theory in favour of the role of sexual phases, fantasies, and the concept of repression. It is also due at least according to this wonderful book to the dissociation in the psychoanalytic world of the incidence and prevalence of real trauma. When dissociative disorders became known in the Netherlands, at the end of the eighties, we were at a loss in mainstream psychoanalysis. Personally, I can remember that my teachers were very much against the concept of dissociation. They called it a deviation even a defection from the "real" theory. They claimed they had never come across a patient with multiple personalities. And so I kept my mouth shut about my own dissociative patients who did not seem to exist in my teachers' eyes. Luckily, in those days, a new intersubjective and relational way of thinking gained importance in psychoanalysis, thanks to the work of Ira Brenner, Donnel Stern, Jessica Benjamin, Elizabeth Howell, and Philip Bromberg, among others. They treated patients with dissociative disorders; they wrote about them and even tried to theorise about them within the confines of psychoanalytic theory. They By review byNelleke Nicolai* BOOK REVIEW: