NEWS
The International Society
for the Study of
Dissociation
Y O U R S O U R C E F O R U P - T O - D AT E I N F O R M AT I O N O N C O M P L E X T R A U M A A N D D I S S O C I AT I O N
From the President
Mainstream Recognition of Dissociation:
Quixotic Folly or Central Mission of ISSD?
“Everyone is much more simply human than otherwise”
I
n his account of the founding of
ISSD, Rick Kluft (2003) writes that
most of the pioneers who helped
form the society came to “share a realiza-
tion already all too plain to Connie
Wilbur – that regardless of the quality of
one’s contribution, whoever works with
MPD will be regarded as outside the
mainstream of the mental health sci-
ences” (p. 10). The word mainstream
leapt out at me recently as I read this
passage… The theme of this year’s ISSD
International Fall Conference is “Moving
Dissociation into the Mainstream.”
The disparity between this annual con-
ference theme and Dr. Kluft’s caveat gave
me a new appreciation for why he chose
to open his account of the history of
ISSD with a reference to Don Quixote.
Are those of us with an interest in disso-
ciation merely tilting at windmills? Is it
folly to believe that dissociation will ever
be a topic that the mainstream will rec-
ognize as legitimate, relevant, and worthy
of serious study?
Dr. Kluft’s point about the marginal-
ized status of DID in the realm of mental
health science is indisputable. There are
few diagnoses in the DSM whose very
existence is questioned as widely. The
level of skepticism is especially disheart-
ening given that it seems to persist
regardless of an impressive body of
empirical evidence in support of the
validity of DID (Gleaves, May &
Cardeña, 2001).
There are some who conclude that
interest in dissociation will always be
limited, and that we therefore simply
Volume22, Number 5 September/October 2004
Inside:
New DSM V Task Force . . . . . . . . . . . . . . . 3
Forensic: Who’s in Jail? . . . . . . . . . . . . . . . 6
Dissociation in Literature . . . . . . . . . . . . . . 8
ferent from concluding that the study of
Steven Gold, Ph.D. dissociation in general, as opposed to
DID in particular, will and can never gar-
ner mainstream interest and acceptance.
The challenge here is that it is hard
enough to arrive at a consensually vali-
dated definition of DID, but infinitely
more difficult to identify and articulate
– Harry Stack Sullivan the more general and abstract construct
of dissociation. This objective requires
must resign ourselves to the fact that
identification of phenomena that are
ISSD is fated to existence as a “niche”
agreed to be manifestations of dissocia-
organization. Although this type of think-
tion, and then identifying the features
ing is understandable, to accept this type
that these disparate manifestations had in
outlook would be tragic. It would almost
common. Work in this area has long
certainly be a self-fulfilling prophesy, and
been in existence. Conceptual systems
would ultimately lead to abdication of
such as the BASK (behavior-affect-sensa-
our responsibility – indeed, of our mis-
tion-knowledge) model of dissociation
sion – as an organization. Many of us are
(Braun, 1988) and the dimensions of dis-
painfully aware that there exists a vast
sociation that form the conceptual scaf-
collection of people seeking treatment for
fold upon which the SCID-D (Steinberg,
dissociative problems unsuccessfully
1994) is built (amnesia, depersonaliza-
because so few professionals receive
tion, derealization, identify confusion and
training in dissociation that demand far
identity fragmentation) are examples of
outstrips supply. We also know from
these efforts. We need however to contin-
empirical research that many more spend
ue to develop models such as these,
years in inappropriate and ineffective
explicating, for example, what amnesia,
treatment because their dissociative diffi-
derealization and identify fragmentation
culties go undetected. In the final analy-
have in common that marks them all as
sis, our charge as an organization is to
forms of dissociation.
change this state of affairs, an objective
2) To effectively educate those outside
that will never be attained if we adhere to
the organization, we need to approach
restricted aspirations.
them not from our point of view, but
So, how do we bring awareness of dis-
from theirs.
sociation to the mainstream despite the
One of the pitfalls of membership in a
enduring skepticism? Here are a few sug-
specialty organization is that it is easy to
gestions.
forget that other people do not know
1) We need to clarify the construct of
what we know. Since we share a common
dissociation rather than relying on
perspective, knowledge base, and lan-
defining it in terms of its specific mani-
guage, we lose sight of the fact that they
festations.
are not shared by others. We are so used
There is a sense in which, as Dr. Kluft
to talking to each other that we some-
asserts, the study of DID may always lie
times slip into the assumption that what
outside the mainstream. This is true sim-
we consider obvious is also evident to
ply in the sense that DID is a specialized
professionals outside our organization
topic most likely to be of interest to a rel-
and to the general public. I am amazed
atively small sector of mental health pro-
how often I have heard members of ISSD
fessionals with expertise in its assessment
say “but everybody knows that” about
and treatment. However, this is vastly dif-
continued on page 2
1
President continued from page 1
established principles in trauma and dis-
sociation that are common knowledge
within ISSD but far from widely known
elsewhere.
A vivid example of this phenomenon
occurred just recently in a discussion in
an ISSD task force formed to review and
update the Guidelines for Treating
Dissociative Identity Disorder (Multiple
Personality Disorder) in Adults. One of the
task force members suggested that we
remove the following sentence from a
draft of the guidelines: “The patient is
not a collection of separate people shar-
ing the same body.” The argument for
deleting this sentence was, “but everybody
knows that.”
Coincidently, within 24 hours of this
discussion, the previous (July/August
2004) issue of the ISSD News was posted
on the ISSD web site. In the
“Publications of Interest” column, an arti-
cle titled “Delusion, Dissociation and
Identity” was summarized. The synopsis
indicated that the authors of this article
criticize “the metaphysically extravagant
‘multiple persons’ view” of DID. Here,
apparently, was an entire article in an
academic journal devoted to disputing a
misconception about DID that several
members of the task force had assumed
need not even be mentioned in the
guidelines because “everybody knows
that.” Some members of the task force
were astounded.
Much of what keeps dissociation out-
side the mainstream is misconceptions
such as that placing credence in the
validity of dissociation entails believing
that alters in a DID system are separate
people. If we are to be effective in our
educational mission it is critical that we
make the effort to take on the perspective
of those we are trying to reach and
address them from that vantage point.
On the day that “everybody knows” what
we know, there will be no need to dis-
cuss how to bring dissociation into the
mainstream; it will already be there.
3) We need to “think outside the box” of
what we already know to discover con-
nections between dissociation and other
areas of study.
A momentous advance in the field of
dissociation occurred with the publica-
tion of Peter Barach’s (1991) article,
“Multiple personality disorder as an
attachment disorder.” This article took
the well established literature on a funda-
mental process in psychological develop-
ment, attachment, and proposed how it
related to DID. A quick search on the
keywords “dissociation” and “attachment”
in PsychINFO yields over 90 citations of
works that have subsequently furthered
exploration of this relationship by
authors such as Ruth Blizard, Elizabeth
Howell, Bessel van der Kolk, Daniel
Siegel, Giovanni Liotti, Allan Shore,
Philip Bromberg, Pamela Alexander and
Karlen Lyons-Ruth.
In parallel fashion, others have
explored the relationship between the
field of neuropsychology and dissocia-
tion. However, we will only come to rec-
ognize the connection of dissociation and
basic knowledge in other fields (and con-
sequently deepen our understanding of
dissociation) if we move outside the areas
of dissociation and trauma with which
we are so comfortable and familiar, and
delve into other domains. Imagine, for
instance, the untapped resources in social
psychology, systems theory, sensation and
perception and cognitive psychology for
clarifying the nature of dissociation, and
how integration with those areas can
help render dissociation more relevant to
mainstream concerns and studies.
4) We need to be open to recognizing
manifestations of dissociation in main-
stream, everyday life.
A marvelous series of examples of dis-
sociation in everyday life can be found in
the just published special issue of the
Journal of Trauma & Dissociation (volume
5, issue 2) on “Dissociation in Culture.”
An interchange between a couple in
counseling dramatically illustrates how
dissociation can operate in everyday life.
I want to emphasize that neither member
of this couple meet criteria for a diagno-
sis any more severe than an Adjustment
Disorder. The wife is addressing the
counselor:
“He doesn’t care! He doesn’t listen! [To
her husband, beginning to tear up:] You
don’t listen!”
“How was I to know there was regular
2
coffee in the house?” the husband replies,
his voice tinged with a vague mixture of
desperation and resignation. “We never
keep regular coffee in the house. Caffeine
gives you migraine headaches.”
“Have you looked in the pantry lately?
We have bags, cans and jars of regular
coffee! I keep it in the house for guests.
My God! What house do you live in?
How do you manage not to see what’s in
front of your nose every day?”
The situation she is referring to began
with an interchange with two overnight
houseguests the evening before. She and
her husband were sitting in their living
room with their guests the previous
evening. ”I told them clearly,” she
admonishes her husband. “I made a
point of it. ‘We don’t drink regular coffee.
I bought the red can of regular coffee for
you so you can make it for yourselves
when you wake up in the morning. It’s in
the refrigerator.’ You were sitting less
than two feet from me! How could you
not have heard me? Do you know what
could have happened to me if I had
drank that cup of coffee you made from
the red can? I would have been laid up
all day with a migraine! You don’t listen!
You just don’t care!”
“I didn’t know you were talking to me!
I thought you were talking to them…”
He trails off, looking, if this is possible,
even more desperate and resigned than
he was a moment ago.
“You were sitting less than two feet
from me!” she repeats. “Do I mean that
little to you? How is it humanly possible
not to have heard what I was saying
when you were sitting right next to me!”
This interchange could be lifted direct-
ly out of the extremely successful best-
seller Men Are From Mars, Women Are
From Venus (Gray, 1992). It typifies what
Gray describes as men’s tendency to
retreat into their “cave.” There is no
doubt that observations such as these hit
a mainstream chord; this is precisely why
the book sold millions of copies.
Dissociation is already in the main-
stream. We just have to open our eyes to
see it. Then we have to convey to the
mainstream – from its vantage point
rather than ours – what it is that we see.
For references see page 10
ISSD Creates New
DSM V Task Force
T he ISSD Executive Committee (EC)
recently passed the following motion:
“That the Executive Committee of the
ISSD commit the Society to a 7-year ini-
tiative to participate in the DSM-V
process and to influence the content of
DSM-V.” As part of this initiative, the EC
voted to create an ISSD DSM-V Task
Force. The co-chairs of the task force are
Paul F. Dell, Ph.D. and Daphne Simeon,
MD.
DSM-V will probably be published in
2012; the writing of the new DSM is
scheduled to begin in 2007. Prior to the
development of DSM-V, the American
Psychiatric Association will also publish
another revision of DSM-IV-TR in 2007.
This interim version of the DSM is neces-
sitated by the fact that the United States
will switch from using the International
Classification of Diseases-9 (ICD-9) to
using ICD-10. The interim version of
DSM-IV-TR will contain the alphanumer-
ic coding for ICD-10. This interim ver-
sion of DSM-IV-TR may also contain
revised text (but not revised diagnostic
criteria, etc.).
The ISSD DSM-V Task Force will
undertake a variety of activities. Most
importantly, the task force will convene a
Dissociative Disorders Research Planning
Conference. The Research Planning
Conference has four major purposes: (1)
for dissociative disorders researchers to
achieve some consensus about what
should happen in DSM-V; (2) to summa-
rize the data in support of each of the
dissociative disorders, especially as those
data bear upon diagnostic criteria, phe-
nomenology, the validity of the dissocia-
tive disorders, and researchers’ ideas
about DSM-V; (3) to identify unsettled
research issues, lacunae in the literature,
and empirical weaknesses of the dissocia-
tive disorders literature that bear upon
researchers’ and ISSD’s emerging goals for
the DSM-V; and (4) to identify and
design the crucial studies that need to be
conducted in support of those goals for
DSM-V.
The American Psychiatric Association
(APA) is currently engaged in pre-DSM-V
planning. In particular, the APA is spon-
soring 11 DSM-V research planning con-
ferences—a Research Planning Methods
Conference that was held at NIMH in
February and ten topical research plan-
ning conferences:
(1) Personality Disorders
(2) Substance Use/Reward Dependence
Disorders
(3) Deconstructing Psychosis
(4) Comorbidity of Depression and Anxiety
(5) Stress and Fear Circuitry Disorders
(6) Dementia and other Cognitive
Disorders
(7) Externalizing Disorders of Childhood
(ADHD, Conduct Disorder, ODD)
(8) Obsessive-Compulsive Spectrum
Disorders
(9) Somatic Presentations
(10) Public Health Issues
The DSM-V Steering Committee has
encouraged researchers to conduct addi-
tional research planning conferences that
cover additional topics or areas. The
ISSD-sponsored Dissociative Disorders
Research Planning Conference will be
one of those additional conferences. In
keeping with the other 10 research plan-
ning conferences, the Dissociative
Disorders Research Planning Conference
will be co-chaired by an American
research psychiatrist (Daphne Simeon)
and an international research psychiatrist
(Vedat Sar from Turkey).
ISSD’s DSM-V Task Force will sponsor
a DSM-V-related plenary session at the
2005-2010 ISSD fall conferences. In
addition, ISSD members are encouraged
to contribute their ideas about the disso-
ciative disorders and DSM-V to the task
force. Ideas should be sent to:
DSM5ideas@aol.com. Ideas that are sub-
mitted will be discussed in future issues
of the ISSD News.
There was not a creature in the
world to whom she spoke with
such unreserve…not anyone, to
whom she related with such con-
viction of being listened to and
understood, of being always
interesting and always intelligi-
ble…all those little matters on
which the happiness of private
life depends…
Jane Austen
3
DDPTP Registration
Open
T he Dissociative Disorders
Psychotherapy Training Program
(DDPTP) continues to enjoy wide accep-
tance among members and non-members
alike. The course is given at 17 locations
throughout the USA, Canada, England,
Germany and the Middle East: Boston,
Chapel Hill, Chicago, Cincinnati, Duisburg,
Leeds, Haifa, Houston, Los Angeles,
London, Montreal, New York, Philadelphia,
San Francisco, Tucson, Toronto, and
Washington DC.
This year we are piloting an advanced
course in Cincinnati and San Francisco.
The former location will also have the stan-
dard course. Additionally, our Online
course remains popular. We already have
13 registrants, so make your move now, if
you are interested. Classes for most sections
begin in late September.
A full description of course offerings is
available at www.issd.org under ‘Training
and Conferences’. Please recommend this
course to your colleagues, or take it your-
self, if you always wished you had more
time to tune yourself to the literature on
the dissociative disorders. The co-directors,
Liz Bowman, Rich Chefetz, and Steve
Frankel, invite your participation!
Welcome New
Component Group
I t is with great pleasure that we
announce the addition of a new ISSD
Component Group – the Rocky
Mountain Trauma Society.
ISSD Component Group status has
been conferred upon the Rocky
Mountain Trauma Society effective
August 5, 2004. The group is located in
Denver, Colorado, and consists of 56
members, four of whom are also ISSD
members. For additional information
about the group, contact ISSD member
Peter A. Maves, PhD, at:
petermaves@aol.com.
ISSD would like to welcome this group
to our roster of Component Groups and
extend our best wishes for a successful
experience.
Love is what you’ve been
through together. Thurber
International Prof. Eli Somer Ph.D.
University of Haifa, Israel
Column email: somer@research.haifa.ac.il

The Italian contribution to the

understanding of dissociation
nor of cases of severe childhood trauma

T
he sensitive responsiveness of the parent to a child is traditionally regarded as
the most important determinant of attachment security in the infant (Isabella, associated with other disorders (anxiety
1993). Such close affectional bonds is conceived as a universal human need disorders, borderline personality disor-
(Bowlby, 1980). Fonagy suggested that secure attachment is the basis of the acquisition der, mood disorders and even schizo-
of metacognitive or mentalizing capacity, and that attachment formed in abusive fami- phrenia).
lies can cause a variety of psychological impairments (Fonagy et al., 1996). Important Italian researchers tried to test whether
research and writing on disruptions in normal attachment processes and on the devel- unresolved loss or trauma in non abusive
opment of dissociative pathology are currently underway in Italy. One of the prominent mothers’ lives was linked to dissociative
contributors to this field is Giuseppe Miti, MD. Dr. Miti translated the DES into Italian disorders in their adult children. The
and authored the book “Personalità Multiple,” among many other publications. He is assumed links were as follows: frighten-
on the faculty of the Italian Society of Cognitive-Behavioral Therapy (SITCC), the ing/frightened mothers (suffering from an
founder of the Italian Association for Research on the Psychopathology of Attachment, unresolved major loss or trauma) would
and a member of ISSD. His report follows. induce a disorganized/disoriented attach-
ment pattern in their infants that, inde-
pendent of overt trauma, would predis-
Attachment and dissociation pose these children to the development
of a dissociative disorder in adulthood.
Giussepe Miti, MD these infants display disorganized attach- A few cogent controlled studies con-
Forlanini Hospital, Rome, Italy ment patterns by showing both approach ducted in Italy corroborrated the hypoth-
giuseppe.miti@libero.it and avoidance behaviors toward the care- esis that early disorganized attachment is
giver. Disorganized attachment may also linked, throughout development, to a

S
ince mid 80s, dissociation has
become a focus of interest among
Italian scholars, particularly in rela-
tion to Bowlby’s attachment theory. The
growing body of studies around Mary
Ainsworth’s Strange Situation model and
Mary Main’s Adult Attachment Interview
(AAI) suggests that disorganization of
early attachment represents a risk factor
for the development of psychiatric disor-
ders involving dissociation or a propensi-
ty towards dissociative experiences.
The behavior of thousands of children
around the world in the Strange Situation
reflects three principal patterns of attach-
ment: A (avoidant), B (secure), and C
(anxious-resistant). In all the samples
examined, one group of children, repre-
senting approximately 8%, does not fit
into any of these categories and has been
defined as attachment pattern D.
Children in this group tend to show con-
tradictory behaviors toward their moth-
ers expressed as incomplete and pointless
movements. During the standard experi-
mental sequences of brief separations
from and reunions with the caregiver,
present as disoriented attitudes of the
infant toward the caregiver (e.g., trance-
like states during interactions with the
caregiver).
On the other hand, in various coun-
tries where studies have been conducted
using the AAI, results demonstrate a link
between unresolved parental trauma (a
mental state classified as U, Unresolved)
and their children’s disorganized attach-
ment pattern. These studies have led to
hypothesized risk factors for the develop-
ment of dissociative disorders (DD). It is
not only abusive caregivers’ behavior
(linked to the child’s early traumatic
experiences), but also simply frightened
and/or distressed parental behaviors that
can be harmful to a child. Parental abuse
of children mediated by attachment dis-
organization is a widely recognized risk
factor for DD, though it may be over-
stressed in North America as the main
contributor to the development of DD.
Child abuse alone does not explain the
existence of comparatively rare cases of
dissociative disorders where no history of
childhood trauma can be reconstructed,
propensity toward dissociation (Pasquini,
Liotti, 2000; Liotti, Pasquini, 2002; Miti,
Chiaia, 2003). These studies not only
contribute to a fuller understanding of
the etiology of the Dissociative Disorders;
they also provide further understanding
on what impact attachment disorganiza-
tion has on the complex and often dra-
matic therapeutic relationships these
patients tend to establish with their ther-
apists. Some observations on the thera-
peutic implications of this attachment
style can be found in Liotti, Mollon &
Miti (in press). Essentially, although the
restoration of the integrative functions of
memory, consciousness and identity
requires the working through of trauma,
our research data help us focus the treat-
ment on developmental, relational and
self-regulation processes. Developmental
psychopathology research suggests that
an important curative vehicle for the
treatment of dissociative psychopatholo-
gy lies in the therapeutic relationship and
should be guided by knowledge on dis-
organized attachment.
For references see page 10

4
Component Group
Bylaws Change
I n response to a proposal submitted by
the ISSD Component Group
Committee, the Executive Council, at its
June 27, 2004, meeting, voted to elimi-
nate the requirement that all officers of
Component Group boards be ISSD mem-
bers.
While working on the online ISSD
Component Society/Study Groups Guide
and reviewing the organizational struc-
tures of current ISSD Component
Groups, it had become obvious that there
was a wide variety of Component
Groups. Some are big, some are small,
some are very formal and highly orga-
nized, others are very informal and not
organized. Some meet in person, some
only meet via electronic media.
Since it was not a requirement that
Component Groups even have a Board or
elected officers, the Executive Council
decided that the requirement was prohib-
itive for the development of new
Component Groups and inhibitive for
maintaining Component Group status,
since groups change and members come
and go. If a non-ISSD member wishes to
volunteer or accept the responsibility of a
Board or elected position, it was decided
that person should be allowed to do so
and encouraged to join ISSD – not be
required by mandate.
It was therefore decided that the
Bylaws be changed and that each
Component Group be required to have a
designated ISSD Contact Person that: is
a current member of ISSD; will function
as a liaison between the Component
Group and ISSD; will be responsible for
maintaining ISSD standards, goals, and
adherence to the ISSD mission statement;
will be responsible for submitting the
annual Component Group report. It was
believed that eliminating the current
requirement would allow groups to form,
develop, expand, meet ISSD mission
goals, and encourage members to join
ISSD through witnessing and/or experi-
encing the collaborative efforts of the
Component Group and ISSD – what
seems to me to be a more natural pro-
gression towards ultimately increasing
ISSD membership.
For further information on this change,
please contact the Component Group
Committee Chair, Dennis S. Pilon,
ACSW, BCD, at: DSPilonTRC@aol.com.
For more information on how to estab-
lish a Component Group in your area,
visit the ISSD website’s Online
Component Society/Study Group Guide
at: http://www.issd.org/Component/
studygroupguide.htm.
Building Our Future and
Making a Difference, Together!
Development
Campaign 2004
Nears Completion
T he first year of our five-year
Development Campaign to raise
$250,000 will be complete at year’s end.
Many of you have given generously, some
extraordinarily so, to create the financial
base we need to bring our exciting goals
to fruition. These goals include the con-
tinuation and expansion of our programs
to educate mental health professionals
and students about dissociation and
chronic traumatization, the education of
community gatekeepers, and the creation
of The Center for the Study of Chronic
Traumatization, our new research compo-
nent.
For those of you who have not yet
given, NOW IS THE TIME TO ACT. If
you were to donate, each month, the
average cost of one psychotherapy ses-
sion, ISSD would be in a powerful posi-
tion to meaningfully and effectively pur-
sue our goals. What would it be worth to
you to end the marginalization of our
field? A half-session per month?
Anything at all that you give will help
us level the playing field.
Not only will these funds allow ISSD
to pursue our goals, it will put us in a
better position to solicit much larger
amounts of money from foundations and
granting agencies. We know that these
additional funding sources consider the
breadth of support of membership a sig-
nificant factor. When you make a contri-
bution, you make a statement of your
commitment that others take as a serious
vote of confidence in achieving our goals.
5
You have several choices to complete
your contribution:
•Send a check to ISSD now;
•Go to our website and make your
donation online (www.issd.org);
•Add your contribution to your annual
Membership Renewal fee when it
arrives in the mail; and
•Contact Headquarters to discuss special
payment arrangements.
We know you already are passionate
about this cause or YOU would not be a
member of ISSD.
Let’s Take it to the Next Level!
Tom Tudor, Ph.D.
Chair, Development Committee
Rich Chefetz, M.D.
Co-Chair, Development Committee
ISSD NEWS
60 Revere Drive, Suite 500
Northbrook, IL 60062
847-480-0899/fax:847-480-9282
E-mail: info@issd.org http://www.issd.org
Editor Executive Director
Don Fridley, Ph.D. Richard Koepke, MSW
Founding Editor Administrator
Bennett G. Braun, M.D. Charlotte L. Rich
ISSD EXECUTIVE COUNCIL 2003-2004
President
Steven Gold, Ph.D.
Past President
Richard A. Chefetz, M.D.
President-Elect
Fran S. Waters, MSW, DCSW, LMFT
Secretary/Treasurer
Su Baker, M.Ed.
Directors
Ruth Blizard, Ph.D.
Paul F. Dell, Ph.D.
Catherine Classen, Ph.D
Ellert R.S. Nijenhuis, Ph.D.
Clare Pain, M.D.
Gary Peterson, M.D.
Eli Somer, Ph.D
Subscription Rates: If you are interested in
subscribing to ISSD News, contact ISSD
headquarters at 847-480-0899 for member-
ship information. Subscriptions are available
only as a benefit of ISSD membership.
Opinions expressed in articles contained
herein are those of the authors, not necessar-
ily of the International Society for the Study
of Dissociation (ISSD) or of its individual
members. ISSD encourages contributions
representing a diversity of viewpoints and
disclaims any responsibility for making a
substantive review or assessment of the
accuracy or validity of the contents thereof.
©2004 International Society for the
Study of Dissociation
Printing courtesy of Sheppard Pratt Health Systems
Forensic Forum: Who’s in jail?
A. Steven Frankel, Ph.D., J.D.
Philip J. Kinsler, Ph.D.,
Co-editors
Philip J. Kinsler, Ph.D.
a brother or uncle in the local jail for
alcohol, domestic violence, and theft
related actions.
Mr. R came to the attention of the
author through his public defender. The
remembered his birthday while he was
‘in the joint.’ So, he was sitting on his
bunk cuddling with the first stuffed ani-
mal he had ever owned, a Christmas gift
from jail volunteers. A guard took it away
from him as contraband. He sunk into
sadness and withdrawal and easily
becoming emotionally upset, varying
from rages to tears to elective mutism.

T
he incarceration rate in the United
States has more than tripled since
1980. In 1998, 283,800 people
with mental illness were incarcerated in
U.S. prisons and jails. This is four times
the number of people in state mental
hospitals throughout the country.1
Approximately 16% of male prison
inmates and 57% of female inmates are
reported to have suffered physical or sex-
ual abuse or both in childhood.2 More
than 114,000 state prison inmates were
on psychotropic medications as of June
30, 2000. There are almost 19,000 pris-
oners in 24-hour mental health facilities
within prisons. 179,200 state prison
inmates and 547,800 probationers have
reported a mental illness. About 44% of
men and 87% of women with abuse his-
tories, who later were incarcerated, spent
time in foster care. Thirty percent of male
and 70% of female prisoners grew up
with a serious substance abuser in the
home. Seventy percent of State and 57%
of Federal prisoners report prior regular
substance abuse.3
As I do my forensic work, I am often
struck that the persons I examine for
court purposes have the same life histo-
ries as those I see in my trauma practice.
They have led horrible lives of multiple
abuse and neglect… and often turned to
alcohol and other substances early in life
to obtain a kind of ‘substance facilitated
dissociation.’ I want to provide a few
vignettes of some of the people I see
within the criminal justice system, and
then describe some opportunities-chal-
lenges-responsibilities for those of us
working with severe abuse survivors.
The Case of R.R: The Combination
of Substance Abuse, Family
Dysfunction, Mental Disorder, and
Intellectual Limits
Many would dismiss RR as merely an
alcoholic and a professional thief. He
came from a family that was ‘legendary’
in the community; one could always find
attorney called in the author because Mr.
The Case of Ms. C.G.: The Sequelae of
R was simply refusing to speak to her. He
Trauma in the Life of the
was mute, appeared sad and lonely and
Developmentally Delayed
was sometimes in tears. He had been
In a symbolic turnabout, the state
arrested for a home intrusion—he
women’s prison in Vermont is actually
entered an occupied home and tried to
located on the grounds of the old State
steal electronics to sell in exchange for
Hospital. Ms. G was incarcerated there
alcohol. The occupants heard him, and
on charges of burglary, forgery, and mari-
the male member of the couple confront-
juana possession. She was living in a
ed Mr. R and a physical fight ensued. In
motel with a man more than double her
this fight, handfuls of Mr. R’s hair were
age—a man with a long criminal history
pulled out of his scalp. About a third of
of ‘uttering forged instruments.’ Ms. G
his head was a raw red bald spot. He had
reported that this man would ‘take her
received special permission from the
SSI checks’ and ‘always complain about
prison to wear a bandanna over it so that
money.’ She insisted that it was her idea
he would not be mercilessly teased by
to steal and cash checks from a neigh-
the other inmates, leading to fighting.
bor…but once she did so she was ‘hand-
Physically, he was a skinny, narrow-faced
ing D… hundred dollar bills.’ She told
man perhaps five feet three and one hun-
the examiner that ‘it was her responsibili-
dred thirty pounds… a perfect target. His
ty to give him money… my mother
attorney reported to Dr. Kinsler that a
always supported all my fathers.’
guard said that R was ‘crying over a
The author was brought in to assess
stuffed animal.’ It was unclear whether
Ms. G’s need for a cognitive facilitator,
the presenting issues were depression,
courtroom and probation accommoda-
regressed behavior, inability to cope
tions, and to make treatment planning
intellectually, or simple refusal to cooper-
recommendations that were sensitive to
ate, with attempts to malinger mental ill-
the interface between her cognitive issues
ness or cognitive disability.
and the ‘fallout’ from her life history. She
An evaluation was conducted at the
provided me with the following account
regional jail, as Mr. R was considered too
of her family background, which was
dangerous to be out on bail. The exami-
largely confirmed through documentary
nation was replete with poignant
records:
moments. When Dr. Kinsler met him ini-
Ms. G reported that she grew up in a
tially, he asked what R liked to be called.
chaotic and multiply abusive family; her
Mr. R replied he didn’t care. Dr. Kinsler
mother had a chronic problem with alco-
insisted that every person had a right to
hol and drug abuse and with ‘going to
decide this. Mr. R lifted his head, previ-
the bars,’ in Ms. G’s words. She became
ously hanging down without eye contact,
involved with men from the same
and said ‘Mr. R…….’ He had always pre-
lifestyle. As a child Ms. G was exposed to
viously been called ‘Little R,’ a diminu-
intense and repeated family violence
tive and somewhat insulting name for a
throughout her childhood. She reported
33-year-old. He sat up a bit straighter
seeing her mother ‘punched, slapped,
and made a bit of eye contact.
kicked’ on a ‘daily basis.’ She said she
He told Dr. Kinsler that he was refus-
saw her mother ‘smashed in the face with
ing to talk to his attorney because he
bottles.’ She learned to ‘pretend it was a
couldn’t. He was ‘too upset.’ It turned
nightmare; pretend it was a bad dream.’
out he was upset about the fact that not
The children often did not go to school
one single individual from his family had

6
because ‘because my mom was too
embarrassed by all the bruises and black
eyes to take us.’
As if this was not an abusive and
neglectful enough beginning, when Ms.
G was eight years old, she was repetitive-
ly sexually abused over a two-year period
by a neighbor and friend of her step-
father. This man also abused other neigh-
borhood children. The police became
involved, and came to Ms. G’s home,
informing the mother what had hap-
pened to her. Ms. G felt that her mother
became enraged at her. Her life was so
horrid that she ‘set fire to a highchair for
one of her dolls and put it under her
bed, hoping to burn to death.’ She was
nine or ten years old.
To Ms. G’s great credit, she and one
other neighbor child were able to stand
up to the grueling court process. Though
the ‘case went on for years,’ eventually
the ‘man went to jail for twenty years.’
Not surprisingly, Ms. G has a long his-
tory of psychological struggles. In addi-
tion to chronic suicidality, she has suf-
fered with flashbacks, nightmares,
extreme agitation, and with literally claw-
ing herself, clawing her face at night dur-
ing flashbacks. She has a history of
choosing older, highly exploitive men,
and being used by them. And, she has
always had multiple cognitive issues.
She was evaluated in another state in
1997, and found to have a Verbal IQ of
73, a Performance IQ of 72, and a Full
Scale IQ of 72 on the WAIS-R, all in the
2nd to 3rd percentile. She was also diag-
nosed with a developmental reading dis-
order. She had very significant adaptive
behavior deficits—she was unable to
manage her own money, Ms. G’s mother
would have to pick out what she needed
when they went shopping, and the moth-
er also had to do her laundry. Ms. G has
not been able to hold a steady job, and
has felt overwhelmed when she has tried
such roles as working at Burger King or
in a sheltered workshop.
The evaluation Dr. Kinsler performed
assessed both cognitive and trauma-
based symptoms. The TSI™ [Trauma
Symptom Inventory™]4 indicated that
Ms. CG suffered with severe trauma
symptoms; her highest peak was on the
dissociation scale.
The cognitive testing occurred after
what was a grueling day for Ms. G: she
had an upset with other inmates; her cell
was moved triggering feelings of not
being safe; and she had just recited the
extremely upsetting family history sum-
marized above. She appeared childlike
and regressed through the cognitive test-
ing and highly self-critical. She would
say ‘I must be stupid’ when she did not
get an answer. She was accompanied to
the testing by a support person; this per-
son spontaneously asked ‘Was she in a
child state while she was taking those
tests?’ Her behavior was seen as quite
suggestive of dissociative processes, with
these behaviors dramatically affecting her
intellectual results.
What do these statistics and vignettes
mean to those of us who treat dissocia-
tive patients? Here are some basic
thoughts about opportunities, challenges,
and responsibilities:
1. There is a seriously underserved
population within our prison systems
who are not receiving services for their
trauma based symptoms and behaviors.
The author has had a conversation with a
state director of prisoner mental health
who denied the need for or efficacy of
trauma therapy, and stated they were
afraid of ‘opening up’ prisoners—as if
their trauma based problems were not
already splashed all over the facilities.
There are opportunities to serve particu-
larly traumatized men within these set-
tings; to design programs that combine
trauma and substance abuse treatments;
and potentially to reduce domestic vio-
lence, recidivism, and enormous financial
and social costs—by getting involved in
the treatment of prisoners. There are jobs
to be had, programs to be designed, and
research to be conducted within these
traditionally ignored settings. Many
behavior change programs within
Corrections departments are delivered by
corrections officers with little training,
not mental health professionals. So, don’t
ignore those Department of Corrections
ads, and perhaps expand your vision of
where you can deliver effective trauma
treatment.
2. Prison settings are highly judgmen-
tal—no surprise—and it is challenging
but worth it to get corrections officers,
defense attorneys, and prosecutors to
look at trauma based symptomatology,
7
not just ‘bad behavior.’ In the RR case
above, we actually were able to convince
the judge and prosecutor that what Mr. R
really needed was DBT. He was trans-
ferred to the State Hospital where he
went through two sequences of DBT
treatment and is now, to the best of our
knowledge, successfully completing an
intense substance abuse treatment pro-
gram.
3. There may well be differences in
how trauma and dissociation work for
people who wind up in the prison sys-
tem. In evaluations of several hundred
prisoners within the last five years, the
author has seen only 1-2 cases of appar-
ent DID—but hundreds of cases of de-
realization, de-personalization, and ‘sub-
stance aided dissociation.’ There is a
research agenda here for those with these
interests.
In a recent project within the State of
Vermont, we tracked all the admissions
into the Public Defender system within
three counties over an 18 month period.
A remarkable 67% were multiple abuse
survivors, most often survivors of physi-
cal abuse, witnessing family violence, and
parental alcoholism. They were not
screened for dissociation. Probably the
last thing readers of the ISSD News need
is another population that needs their
help—and yet, our prisons are becoming
the mental health facilities of last resort,
and it is our responsibility to try to be
helpful here, also.
References
1 Ditton, P., Bureau of Justice Statistics, Special
Report, Mental Health and Treatment of
Inmates and Probationers, July, 1999, NCJ
174463
2 Harlow, C., Prior Abuse Reported by Inmates
and Probationers, Bureau of Justice Statistics
Selected Findings, April 1999, NCJ 172879.
3Kinsler, P., Saxman, A., & Fishman, D., The
Vermont Defendant Accommodation Project,
Psychology, Public Policy, and Law, V. 10,
Number 1-2, Marsh/June 2004, 134-161;
see Table 1, pp. 136-137.
4 Briere, J., Trauma Symptom Inventory,
Psychological Assessment Resources,
Odessa FL., 1995
“Now that we have seen each
other,” said the unicorn, “if
you’ll believe in me, I’ll
believe in you.” Lewis Carroll
Critical Issues: Trauma, Dissociation and Modernism Michael Cotsell Ph.D.

We are fortunate to have Dr. Michael Cotsell Ph.D. providing us with a Psychology (1890). 3 James worked on his
different perspective on dissociation. Dr. Cotsell is a professor in the masterpiece for nearly a decade, so it is a
English Department at the University of Delaware. He has been interest- striking fact that he extensively revised
ed in the phenomenon of dissociation as it has been portrayed in litera- and reinforced his text in the light of
Janet’s L’Automatisme and articles by
ture. He provides us with an excellent view of how dissociation is seen by
Alfred Binet published less than a year
other than professional therapists. I hope you enjoy the article as much before his own work. What James took
as I have. You may contact Dr. Cotsell at mcotsell@udel.edu from Janet can be briefly suggested by his
Donald Fridley Ph.D., ISSD Editor subheading: “Thought turns to Personal
number of cases of successive (i.e. alter- Form.” 4 He also included numerous

I
t is important to understand the con-
text of Pierre Janet’s first great work
L’Automatisme Psychologique (1889)
(Psychological Automatism, but still not
translated into English).Eugène Azam’s
(1822-99) studies from 1858-93 of a
famous case of multiple personality,
Félida X, had provoked both the utilitari-
an Hippolyte Taine and Janet’s scientific
mentor, Théodule-Armand Ribot, to
argue that “the various states in which
direct intuition of the self …[were] lost”
by Félida demonstrated that the mind
was essentially an automatism. In con-
trast, Janet’s uncle, the philosopher Paul
Janet, read such evidence as a case of “an
extension of dreams or somnambulism”
which affect “the fundamental self.”
As Jacqueline Carroy and Regine Plas
have pointed out, Janet’s L’Automatisme
was a response to the controversy over
Azam’s work. Proceeding with the scien-
tific methodology recommended by his
mentor Ribot, the view of “automatism”
developed by Janet in L’Automatisme yet
defended his uncle’s philosophical per-
spective on mind. Thus the case of Félida
occasioned, Carroy and Plas declare, “a
turning point for French psychology.”1 I
will go further than that and say that
Janet’s groundbreaking work provided a
defining point for modern western cul-
ture.
Janet drew on his research with twen-
ty-seven patients at Le Havre between
1882 and 1888, some of which he had
discussed in a series of articles in the
1880s. His considerable descriptive and
analytic powers make his case histories
enormously interesting. He was able to
discern consciousness even in extreme
cases of catalepsy. He also described a
nate) personalities, and the different
types of “désagrégation psychologique”
(i.e. dissociation). Here, for instance, is a
description of the emergence, under hyp-
notism, of an alter of the patient Lucie
that so impressed William James that he
included it in his Principles of Psychology
(1890):
“Do you hear?” he asked. “No,” was
the unconsciously written reply. “But
to answer you must hear.” “Yes, quite
so.” “Then how do we manage?” “I
don’t know.” “There must be someone
who hears me.” “Yes.” “Who?”
“Someone other than Lucie.” “Ah!
Another person. Shall we give her a
name? “No.” “Yes, it will be more
convenient.” “Well, Adrienne then.” 2
L’Automatisme is crucial text for a number
of reasons. First of all, Janet used the evi-
dence of the subconscious to establish
the modern recognition of the reality,
complexity and multiplicity of the mind,
including the persistence of the past in
the present. Second, Janet made the cru-
cial break between mind and somatic
determinism as well as what William
James would call “the succession of
things perceived” (associationism). Third,
Janet provided the basis for understand-
ing and treating trauma (past injury) and
dissociative disorders (including hyste-
ria). His superb case histories and analy-
sis in this and later works underlie all
subsequent work in dissociative studies.
America’s greatest philosopher, William
James, had made similar cases against
automatism and deterministic association
in essays published in the early 1880s,
which he subsequently included in his
enormously influential Principles of
accounts of multiple personality in his
work. It is thus the attack on biodeter-
minism and mechanical associationism
along with the analysis of pathological
disassociation that makes the term “dis-
sociationism” doubly appropriate for the
perspective of Janet, James and their col-
leagues. With James’s own famous ninth
chapter, “The Stream of Thought,” in
mind, we might almost say, that Janet
and James stand at the modern discovery
of “life”.
The consequences of the work of Janet
and James and their associates for
European and American culture leading
up and into Modernism were enormous.
The Decadents of the fin de siècle, of
course, delighted in wicked doubles
(Jekyll and Hyde) and evil hypnotists
(Svengali). Doubles are, however, also to
be found in serious modernist drama,
including in Ibsen and Eugene O’Neill.
Then, as Modernism proceeded, the dou-
ble was typically supplemented and
replaced by more complex portrayals of
multiplicity, as in Joyce’s Ulysses (1922)
or with the self-contradictory characters
of O’Neill’s Long Day’s Journey into Night
(written 1939-41).
Ribot realized that Janet’s evidence of
the intensity of traumatic memory con-
tradicted his own law of memory (that
memories uniformly fade with time) and
revised his work accordingly. His Illnesses
of the Memory and Illnesses of the Will,
both influenced by Janet, were published
in Russia in 1900. From them the great
modernist actor and director Konstantin
Stanislavski in part derived his idea of
“affective memory” or “emotional memo-
ry,” the guiding idea for actor training of

8
the twentieth century. So as well, the
philosopher Henri Bergson (1859-1941),
who attended high-school with Janet,
was similarly prompted by Janet’s revela-
tions to propose his distinction between
internal duration and external time (Time
and Free Will, 1889, etc.), an argument
that had a profound influence on Marcel
Proust’s exploration of the heuristic char-
acter of intense memory in À la recherche
du temps perdu (Remembrance of Things
Past) (1913-27).
The work of the intense Swedish
dramatist August Strindberg (1849-1912)
lies behind all of subsequent modernist
drama. Thus, in relation to trauma, it is
worth quoting the familiar words from
his well-known preface to A Dream Play
(1901):
The personalities split, take on a
duality, multiply, vanish, intensify,
diffuse and disperse, and are brought
into focus. There is, however, one
single-minded consciousness that
exercises a dominance over the char-
acters: the dreamer’s.
Strindberg wrote to a friend quoting a
passage from the case history of Ansel
Bourne in James’s Principles. The phe-
nomena of multiple personality,
Strindberg remarked, might explain, “the
strangeness of our existence, our double
life, obsessions, our nocturnal life, our
bad conscience, our groundless fear, our
persecution mania, which is perhaps not
a mania but we are persecuted.” 5
Following from Strindberg, the
German expressionist play (which so
strongly influenced O’Neill and his
American contemporaries) is typically
written from the internal perspective of
the protagonist (the Ich, the I, the soul).
The expressionist play was thus a return
to allegory (a language of part-selves),
but a modern nightmare allegory unsup-
ported by a stable, shared world-view or
rational order. The central figure often
appears in an agony or ecstasy of protest
or alienation or rebellion and his or her
most characteristic expression is the
famous schrei or cry (familiar from
Edvard Munch’s famous painting “The
Scream” of 1893).
Another influential movement for
Modernism was Symbolism. Arthur
Symons (1865-1945) in The Symbolist
Movement in Literature (1899), following
the French poet Jules Laforgue (1860-
87), wrote of dédoublement (the splitting
of the self) as a characteristic of
Symbolism. Rémy de Gourmont (1858-
1915), another poet advocate of
Symbolism, headed an essay “The
Dissociation of Ideas”. T. S. Eliot, one of
the very greatest figures of Modernism,
read Symons, and hence Laforgue, on
whom he based his early style. Eliot was
also an undergraduate at Harvard in
1906 when Janet delivered the lectures
which became The Major Symptoms of
Hysteria (1907). He went on to read
Janet, James and Morton Prince, and to
attend the classes of Bergson and perhaps
Ribot and Janet in Paris. Thus his great
poem, The Waste Land (1922) may well
be called an epic of trauma and dissocia-
tion. Consider the lines describing the
aftermath of a seduction:
On Margate Sands,
I can connect
Nothing with nothing.
The broken fingernails of dirty
hands. (Part 3, ll.300-3)
The great themes of the dissociationists
were both the subconscious and con-
sciousness. James’s chapter “The Stream
of Thought” is famous for its suggestive-
ness of heightened awareness of both the
internal and external worlds (which
James would argue could not be con-
ceived apart). For Janet the goal of thera-
py was consciousness, defined as a com-
bination of “mental force” and “mental
vitality”: “presentification” he called it. 6
The intertwined themes of subconscious-
ness and consciousness run throughout
the modernist novel from Henry James
(who uses the term consciousness 85
times in The Wings of the Dove (1902)
and whose late stories such as “The Turn
of the Screw” (1898) explore uncon-
scious states, through the German
Thomas Mann, another author influ-
enced by Bergson, to Gertrude Stein
(James’s pupil at Harvard), James Joyce,
Virginia Woolf, Faulkner and others. It is
not hard now to see the connections
between interior monologue or stream of
consciousness and trauma in Woolf or
Faulkner. 7 We may also note that Joyce’s
first great work, Dubliners (1914) was, as
he said, based on the theme of “paraly-
9
sis”. Janet was not alone in connecting
paralysis with hysteria, but his chapter
“Paralysis” in the Major Symptoms of
Hysteria is a major statement on the sub-
ject. Again, is not Franz Kafka (1883-
1924) the great novelist and story-teller
of trauma and dissociation?
Similarly, in all of the great innovations
in art of the time, there is evidence of the
influence of the philosophical and psy-
chological arguments of the age of Janet.
Futurism (consider Umberto Boccioni’s
“States of Mind” series (1911-13) in
MOMA), Expressionism (of course) and
Cubism all speak of both a freedom from
realism (that had been underpinned by
the psychology of association) and trau-
ma and traumatic dissociation. Guernica
(1937) is alone evidence of Cubism’s
capacity for representing trauma.
What tipped the dissociationist culture
of the late turn of the century into the
modernist culture of trauma was
undoubtedly World War I. It may be said
that until then, the stresses and opportu-
nities of industrial and urban uprooted-
ness, the city, the experience of mass
society, the starker experience individual-
ism, secularization, mechanization, impe-
rialism, and the obsessive insistences on
restrictive morality and religion that
sought to defend against these pressures
had been bearable. But the War declared
it all unbearable, unredeemable by what
Ezra Pound referred to as “two gross of
broken statues,/ … a few thousand bat-
tered books” (“Hugh Selwyn Mauberley,
1920, ll.94-5). Both “shell shock” and the
horror of the war itself therefore gave
trauma a new appalling relevance. If
internal conditions after the conflict were
also violent and shattering, as, in differ-
ent degrees they were in Germany, the
former Austro-Hungarian Empire, Italy,
or the US, the relevance was still greater.
In America, recall, this was the age of the
“Red Scare” and the Klu Klux Klan. The
War underlined what Boris Sidis had
always seen: the traumatizing capacity of
social conditions. Of one patient he
noted, “Born in New York, of parents
belonging to the lowest social strata, he
was treated with severity and even bru-
tality.” Of an immigrant from Poland,
Sidis wrote: “He dreams of being cap-
continued on page 10
Critical Issues continued from page 9
tured by robbers and is in danger of
being killed or even being skinned alive.
Occasionally he dreams of his parents
captured and assaulted by brutal, terrible
looking men.”8 In his Philistine and
Genius (1911), he presented modern civi-
lization as an almost wholly traumatizing
environment: “Our civilization is a mere
gloss,” he declares. “Look at our sweat-
shops; the poverty of the masses; the vast
numbers incarcerated; child labor”: “We
are stock blind to our own barbarities.”9
But what, you may ask, of Freud? You
certainly should, for in departments of
literature and cultural studies throughout
the country there are only two figures in
the history of dynamic psychiatry: Freud
and Lacan (though to be fair to my col-
leagues, what university psychology
department teaches Janet?) Freud did not
initiate sexual liberation, though (as the
seventies showed us) sexual liberation is
likely to lead to the recognition of sexual
trauma. What Freud did do was reveal
sexual disfunction in the family. It
remains true, however, that almost every
modernist resists Freud’s subsequent
“suppression of trauma” in two important
ways: one, by insisting on the reality of
incest, and, two, by emphasizing the for-
mative influence of the mother over the
rivalry with the father. Modernists, and
particularly women modernists, uniform-
ly rewrote Freud. They did so with the aid
of the vocabulary of dissociationism. When,
with the ascendancy of the Freudians,
that vocabulary ceased to be available,
Modernism ended. Neither it, nor the
possibilities for the appreciation of the
psychological self, nor the recognition of
environmental psychological impinge-
ments including trauma, nor the social
and political responsibilities they
demand, returned until our own time.
Despite all we have learned in recent
years, however, it seems there remains
much to do. Consider that another of the
great dissociationist psychologists was
James’s pupil, W. E. B. Du Bois (1868-
1963), who made the first great analysis
of race, trauma and dissociation. Why
does the ISSD not give a prize in his
name? It always dismays me when I read
and teach Judith Herman’s wonderful
Trauma and Recovery (1992) that it con-
tains no discussion of the Civil Rights
Movement. After all, what white novelists
and dramatists in recent years can match
African-Americans for the candor and
depth of their explorations of both the
trauma of race and of incest?
As well, dissociative studies remain
threatened by varieties of somatism and
certain postmodernisms. Our psychologi-
cal practice lacks the supporting philo-
sophic structure of the age of Janet,
though if we observe that in a key figure
like William James dissociationism—
thanks to his colleague, Charles Sanders
Pierce (1839-1914)— goes along with
the emergence of pragmatism and semi-
otics, we may have the basis of an alter-
native. There remains much to develop,
much to urge on a public which has con-
sumerism and the industries of trance,
both liberally greased with libido, to dis-
tract it; much to defend against the
health insurance industry. Trauma is a
“constant variable.” Half the world goes
on in states of trauma and degrees of dis-
sociation. There is much to suggest that
societies themselves (now in global rela-
tions) can be analyzed as systems of the
production and regulation of trauma and
dissociation. More than ever, we need the
clinical vision and culture of dissociation-
ism. More than ever we need that con-
sciousness Janet recommends.
References
1 Jacqueline Carroy and Regine Plas, “How
Pierre Janet used Pathological Psychology to
Save the Philosophical Self”, Journal of the
History of Behavioral Sciences 36:3 (2000),
231-40.
2 Principles of Psychology (Chicago and
London: Encyclopedia Britannica and the
University of Chicago, 1952), 148.
3 James, “Are We Automata,” Mind 4 (1872),
1-22; “On Some Omissions of Introspective
Psychology,” Mind 9 (1884), 1-26.
4 Principles, 147.
5 Michael Meyer, Strindberg (New York:
Random House, 1985), 348.
6 The best study of late Janet in English is
Björn Sjövaal, Psychology of Tension: An
Analysis of Pierre Janet’s Concept of “Tension
Psychologique” (Upsala: Scandanavian
University Books, 1967
7 Louise De Salvo, Virginia Wolf: The Impact of
Sexual Abuse on her Life and Work (Boston:
Beacon Press, 1989).
8 Boris Sidis, “Studies in Psychology,” Boston
Medical and Surgical Journal 156 (1907),
9 Sidis, Philistine and Genius (New York:
Moffart and Yard, 1911), 13, 22, 36.
10
International continued from page 4
References
Bowlby J. (1980). Attachment and loss. Vol. 3:
Loss: Sadness and depression. London:
Hogarth Press (Italian translation:
Attaccamento e perdita. Vol. 3: La perdita della
madre. Torino: Boringhieri, 1983).
Fonagy P., Leigh T., Steele M., Steele H.,
Kennedy R., Mattoon G., Target M. &
Gerber A. (1996). The relation of attach-
ment status, psychiatric classification, and
response to psychotherapy. Journal of
Consulting and Clinical Psychology, 64, 22-31.
Isabella R.A. (1993). Origins of attachment:
Maternal interactive behaviour across the
first year. Child Development, 64, 605-621.
Liotti, G., Mollon F., & Miti, G. (in press). A
chapter in G. Gabbard, J. Beck & J.
Holmes, eds., The concise Oxford textbook of
psychotherapy, Oxford University Press.
Liotti, G., Pasquini, P. & The Italian Group
for the Study of Dissociation (2000).
Predictive factors for borderline personality
disorder: Patients’ early traumatic experi-
ences and losses suffered by the attachment
figure. Acta Psychiatrica Scandinavica, 102,
282-289.
Miti, G., Chiaia, E. (2003). Patterns of attach-
ment and the etiology of dissociative disor-
ders and borderline personality disorders.
Journal of Trauma Practice, 2, 19-35.
Pasquini, P., Liotti, G. & The Italian Group
for the Study of Dissociation (2002). Risk
factors in the early family life of patients
suffering from dissociative disorders. Acta
Psychiatrica Scandinavica, 105, 110-116.
President continued from page 2
References
Barach, P.M. (1991). Multiple personality dis-
order as an attachment disorder.
Dissociation, 4(3), 117-123.
Braun, B.G. The BASK model of dissociation.
Dissociation, 1(1), 4-23.
Gleaves, D.H., May, M.C., & Cardeña, E.
(2001). An examination of the diagnostic
validity of dissociative identity disorder.
Clinical Psychology Review, 21 (4), 577-608.
Gray, J. (1992). Men Are From Mars, Women
Are From Venus. New York: HarperCollins.
Steinberg, M. (1994). Interviewer’s Guide to the
Structured Clinical Interview for DSM-IV
Dissociative Disorders. (Revised).
Washington, DC: American Psychiatric
Association.
However much we describe
and explain love, when we fall
in love we are ashamed of our
words. Explanation by the
tongue makes most things
clear, but love unexplained is
clearer. Rumi
ISSD’s 21st Conference News
Philip J. Kinsler, Ph.D.
Christine A. Courtois, Ph.D. excited to see that our conference has early registration is Oct. 16, after which
Conference Co-chairs grown into a poster session after many the price does go up, so register early to
Su Baker, M.Ed. years without. avoid extra costs.
Conference Manager Our venue for the 21st conference is Some of you may be attending for the
equally exciting. We are returning to first-time and feel a little intimidated,
New Orleans, one of the favorites of con- even though the feedback that we get

A
lready it is fall, the time of the
ference attendees. After a day’s intellectu- every year is that the conference atten-
ISSD Annual Conference in New
al stimulation (and this year we have dees are warm, welcoming and very
Orleans. Mark your calendars.
some evening programs and activities as approachable. In order to help new
This conference, as always, promises to
well), “laissez les bon temps roulez”, as attendees, a “conference guide” service is
be broad-ranging and innovative. The
they say in the Big Easy. available. A “conference guide” is some-
program addresses theory, research, and
We are happy to see, at the time of one who has attended ISSD conferences
clinical application and includes an inter-
this writing (early August), that registra- in the past and will be a friendly face to
national array of presenters from many
tion has already started and the hotel has help you “find your way” around the
countries including Australia, Austria,
been making reservations for rooms. conference offerings and networking and
Belgium, Canada, Germany, Greece,
Please remember that the deadline for social occasions. You and your “guide”
Israel, Italy, the Netherlands, New
guaranteed rates at the JW Marriott is can meet by e-mail before the conference
Zealand, Northern Ireland, Norway,
to get to know each other a bit and
Russia, South Africa, Spain, Sweden,
define what the expectations are – it is
Turkey, the UK and the USA. This
year’s contributors are also diverse in
Moving Dissociation open and up to the new attendee and
terms of experience level and areas of into the Mainstream guide to decide how much time they will
spend together.
interest, providing a mixture of senior
And while on the topic of guides, we
and more novice researchers and clini- JW Marriott Hotel need people who have attended at least
cians, including graduate students.
They hold the promise of making this Nov. 18-20, 2004 New Orleans, LA one or two ISSD conferences in the past
and who can help out a new attendee.
a conference that advances the scope
The commitment of time is decided on
of understanding of dissociative
Oct. 31. However, since we have only a by the two of you – so please consider
process and disorder, all directed at mov-
certain number of rooms, please reserve being a “conference guide”. For more
ing it into the mainstream of professional
early – the last time that we were at the information on being a guide or finding a
and public awareness.
hotel, we ran out of available rooms, and guide, please contact Ellen (Rusti) Klein
As in the past 5 years, we will have a
even though we have increased our num- at rustik@bellsouth.net.
one and a half hour Town Hall meeting.
ber of rooms set aside, it is possible that We also need volunteers to help out
This year, we are leaving the agenda and
we will overbook again this year. You can with a variety of tasks, such as working
discussion up to you – our ISSD mem-
make your reservations by calling the at the registration or CME/CEU desk,
bers and conference attendees (members
New Orleans JW Marriott registration collecting tickets at the luncheon or
or not). We encourage everyone to con-
desk at 1-504-525-6500. You must men- President’s reception, turning off and on
tribute their comments and questions at
tion that you are with the ISSD confer- tape recorders during presentations of
the Town Hall. Once again, John O’Neil,
ence, not only to receive the low confer- patient videos, etc. In exchange for half-
MD, FRCPC will be the moderator and
ence rate, but also to count toward the price registration, volunteers are expected
we expect that there will be lively discus-
“room block” which we must fill. (So if to be available about half the time of the
sion and new initiatives coming out of
you have some other cheaper access to conference, but often not at times of pre-
the meeting. If you are going to be a
rooms at the hotel, please still ask to be sentations (though there will be some
first-time conference attendee, you will
part of the ISSD room block.) If you wish need for volunteers during times of pre-
find that the Town Hall meeting is a real
to share a room and don’t have a room- sentations). If you are interested in vol-
highlight of the conference.
mate, we can help you out. Contact Ellen unteering, contact Su Baker at
Immediately after the Town Hall and
(Rusti) Klein for roommate matching ser- subaker@videotron.ca or subaker@john-
just before the President’s Reception, for
vice at rustik@bellsouth.net. Please abbott.qc.ca for more information. This
the first time in many years, we will have
remember that this is only for those stay- is a first-come, first-serve selection with a
a poster session. Please pay a visit to it
ing at the JW Marriott. limited number of positions available, so
and feel free to discuss the posters with
Also remember that the deadline for don’t delay!
the presenters, some from as far away as
Russia, Australia and Norway. We are Hope to see you in New Orleans!!!
11
Publications of Interest: Recent Books and Articles
Kathy Steele, M.N., C.S.
Stephanie Dallam, R.N., M.S.F.N.P.
Co-editors
Bowins, B. (2004). Psychological
defense mechanisms: A new perspec-
tive. American Journal of
Psychoanalysis, 64(1), 1-26.
Approaching psychological defense
mechanisms from the perspective of an
evolved strategy, it is proposed that most
of the classical defense mechanisms
described in the psychoanalytic literature
represent a form of cognitive distortion
with some also containing strong ele-
ments of dissociation. Frequently con-
ceived of as pathological, these psycho-
logical phenomena actually constitute
overlapping spectrums with milder mani-
festations being common and highly
functional, and more severe variants less
common and typically dysfunctional. For
instance, dissociation provides the capac-
ity to adaptively detach from disturbing
emotional states, and cognitive distor-
tions place a positive ego-enhancing spin
on experience.
Reprints: B. Bowins
Email: brad.bowins@bellnet.ca
Brosky, B. A., & Lally, S. J. (2004).
Prevalence of trauma, PTSD, and dis-
sociation in court-referred adolescents.
Journal of Interpersonal Violence, 19,
801-14.
This study examines the prevalence of
trauma, PTSD, and dissociative symp-
toms in adolescents. The sample consist-
ed of 76 females and 76 males, between
the ages of 12 and 18, referred to the
Child Guidance Clinic of the Superior
Court of the District of Columbia for a
psychological evaluation. Results of the
study suggest a high prevalence of trau-
ma in both genders; however, females
had significantly higher rates than those
reported in males. Similarly, female ado-
lescents demonstrated significantly high-
er prevalence rates of PTSD symptoms.
There was a low prevalence of dissocia-
tive symptoms across both genders.
Reprints: B. A. Brosky, Woodburn Center for
Community Mental Health, Annandale, VA
22209 Email: bevbrosky@cs.com
Dalenberg, C. J., & Palesh, O. G.
(2004). Relationship between child
abuse history, trauma, and dissociation
in Russian college students. Child
Abuse & Neglect, 28, 461-74.
This study examined the relationship
between violent trauma, child abuse his-
tory, and dissociative symptoms in 301
Russian undergraduate students from
Moscow State Linguistics University.
Scores on dissociation and its subfactors
were significantly higher in the Russian
sample compared to the normative US
group. The best predictors for dissocia-
tion were experiencing a violent trauma,
child abuse history, and/or the experience
of a fearful event. Those participants with
a prior child abuse history were more
symptomatic after adult trauma than
those with no such history. The authors
conclude that the relationship between
trauma/abuse and dissociation is unlikely
to be a result of suggestion by therapists
or media exposure, since the correlation
appears in a Russian population who are
relatively unexposed to these suggestive
sources.
Reprints: C. J. Dalenberg, Psychology
Department, Trauma Research Institute,
Alliant International University, 10455
Pomerado Road, San Diego, CA 92131
Email: cdalenberg@mail.cspp.edu
DePrince, A. P., & Freyd, J. J. (2004).
Forgetting trauma stimuli.
Psychological Science, 15, 488-92.
Previous work reported in this journal
suggested that the cognitive capacities of
high dissociators are impaired under
conditions of focused (selective) atten-
tion, but not under conditions of divided
attention, compared with the cognitive
capacities of low dissociators. Using a
directed-forgetting paradigm, the current
study demonstrated that under divided-
attention demands, high dissociators
have impaired memory for words associ-
ated with trauma (e.g., incest) but not for
neutral words, as compared with low dis-
sociators. In addition, high dissociators
reported significantly more trauma histo-
ry and significantly more betrayal trauma
(abuse by a caregiver) than low dissocia-
tors. These results are consistent with the
12
proposal that dissociation may aid indi-
viduals with histories of betrayal traumas
to keep threatening information out of
awareness.
Reprints: Anne Deprince, Department of
Psychology, Room 340, Frontier Hall, 2155
S. Race St. Denver, CO 80208
Email: adeprince@nova.psy.du.edu
Erdinc, I. B., Sengul, C. B., Dilbaz, N.,
& Bozkurt, S. (2004). [A case of incest
with dissociative amnesia and post
traumatic stress disorder]. Turk
Psikiyatri Dergisi [Turkish Journal of
Psychiatry], 15, 161-5.
The authors present a case study of an
adolescent who was found wandering
around aimlessly. She could not remem-
ber anything about her identity or per-
sonal history. No sign of intoxication or
infection was detected and her physical,
laboratory, and neurological examinations
were normal. EEG and CT were also nor-
mal. After the family was found and
revealed a history of sexual and physical
abuse, the patient was diagnosed with
dissociative amnesia. Psychometric evalu-
ations supported this diagnosis. As the
dissociative symptoms began resolve,
PTSD symptoms became more apparent.
After she described her traumatic memo-
ries, PTSD symptoms began to recede.
This case presentation demonstrates the
relationship between childhood physical
and sexual abuse and dissociative disorders.
Reprints: No information provided
Garcia-Valdecasas Campos, J.,
Herreros Rodriguez, O., Vispe Astola,
A., & Gracia Marco, R. (2004). [Based
on one case of dissociative disorder: A
conceptual review]. Actas espanolas de
psiquiatria, 32(2), 123-6.
The authors describe a clinical case of a
patient diagnosed with dissociative disor-
der and provide a review of the diagnosis
of dissociative disorder and its polemics.
The authors discuss concepts such as dis-
sociation and hysteria, their historic evo-
lution and their relationships. Some
modern cognitive theories on dissociative
disorders and their relationship or oppo-
sition to psychodynamic theories are pre-
sented. The authors conclude that at the
present time important questions must
be solved in the area of dissociative dis-
orders in order to progress in the psychi-
atric knowledge of dissociative processes.
Reprints: J. Garcia-Valdecasas Campos,
Hospital Universitario de Canarias,
Tenerife, Canary Islands
Email: jose_valdecasas@hotmail.com
Glisky, E. L., Ryan, L., Reminger, S.,
Hardt, O., Hayes, S. M., & Hupbach,
A. (2004). A case of psychogenic
fugue: I understand, aber ich verstehe
nichts. Neuropsychologia, 42(8), 1132-47.
This paper reports a case of psychogenic
fugue in which the individual lost access
not only to his autobiographical memo-
ries but also to his native German lan-
guage. Neuropsychological, behavioral,
electrophysiological and functional neu-
roimaging tests converged on the conclu-
sion that this individual suffered an
episode of psychogenic fugue, during
which he lost explicit knowledge of his
personal past and his native language. At
the same time, he appeared to retain
implicit knowledge of autobiographical
facts and of the semantic or associative
structure of the German language. The
patient’s poor performance on tests of
executive control and reduced activation
of frontal compared to parietal brain
regions during lexical decision were sug-
gestive of reduced frontal function, con-
sistent with models of psychogenic fugue
proposed by Kopelman and Markovitsch.
Reprints: E. L. Glisky, Department of
Psychology, University of Arizona, P.O. Box
210068, Tucson, AZ 85721
Email: glisky@u.arizona.edu
Goldstein, L. H., Deale, A. C.,
Mitchell-O’Malley, S. J., Toone, B. K.,
& Mellers, J. D. (2004). An evaluation
of cognitive behavioral therapy as a
treatment for dissociative seizures: A
pilot study. Cognitive and Behavioral
Neurology, 17(1), 41-9.
The authors conducted an open prospec-
tive trial on the effectiveness of cognitive
behavioral therapy as a treatment of
adults with dissociative seizures (i.e.,
“pseudoseizures”). Twenty patients diag-
nosed with dissociative seizures were
offered treatment comprising 12 sessions
of cognitive behavioral therapy. Principal
outcome measures were dissociative
seizure frequency and psychosocial func-
tioning, including improvement in
employment status and mood. Measures
were administered before treatment, at
the end of treatment, and at a 6-month
follow-up. Cognitive behavioral therapy
was associated with a highly significant
reduction in seizure frequency and an
improvement in self-rated psychosocial
functioning. These improvements were
maintained at the 6-month follow-up.
There was also a tendency for patients to
have improved their employment status
between the start of treatment and the 6-
month follow-up period.
Reprints: L. H. Goldstein, Department of
Psychology, Institute of Psychiatry, De
Crespigny Park, London
Email: l.goldstein@iop.kcl.ac.uk
Grant, J. E. (2004). Dissociative symp-
toms in kleptomania. Psychological
Reports, 94(1), 77-82.
Many patients with kleptomania report
an altered state of consciousness during
acts of theft. The purpose of this investi-
gation was to clarify a possible link
between kleptomania and dissociation.
Twenty-six treatment seeking adult out-
patients who met DSM-IV criteria for
kleptomania were administered the
Dissociative Experiences Scale and com-
pared to 22 normal controls. The patients
with kleptomania had scores that differed
significantly from those reported by nor-
mal controls.
Reprints: J. E. Grant, Department of
Psychiatry and Human Behavior, Butler
Hospital/Brown Medical School, 345
Blackstone Blvd., Providence, RI 02906
Email: Jon_Grant@Brown.edu
Haugaard, J. J. (2004). Recognizing
and treating uncommon behavioral
and emotional disorders in children
and adolescents who have been severe-
ly maltreated: Dissociative disorders.
Child Maltreatment, 9, 146-53.
Somatoform disorders are likely to occur
more frequently in children and adoles-
cents who have been severely maltreated
than in others. The symptoms of somato-
form disorders in children are reviewed,
strategies for distinguishing somatoform
disorders from other disorders are exam-
ined, and treatment strategies are
explored.
13
Reprints: Jeffery J, Haugaard, Van
Rensselaer Hall, Department of Human
Development, Cornell University, Ithaca,
NY, 14853 Email: jjh15@cornell.edu
Keck Seeley, S. M., Perosa, S. L., &
Perosa, L. M. (2004). A validation
study of the Adolescent Dissociative
Experiences Scale. Child Abuse &
Neglect, 28, 755-69.
The purpose of this study was to further
the validation process of the Adolescent
Dissociative Experiences Scale (A-DES).
The A-DES discriminated between the
sexually abused and nonabused adoles-
cents. However, in post hoc analyses, the
A-DES did not discriminate between
PTSD adolescents and those with other
psychiatric diagnoses. The authors con-
cluded that the A-DES items are internal-
ly consistent, and the A-DES shows
promise for screening adolescents for
pathological dissociation.
Reprints: Susan M. Keck Seeley, Marion City
Schools, 163 E. Center St., Marion, Ohio
43302
Kremers, I. P., Spinhoven, P., & Van
der Does, A. J. (2004).
Autobiographical memory in
depressed and non-depressed patients
with borderline personality disorder.
The British Journal of Clinical
Psychology, 43(Pt 1). 17-29.
This study investigated the specificity of
autobiographical memories among
depressed and non-depressed patients
with Borderline Personality Disorder
(BPD) (n = 83), compared with
depressed patients (n = 26) and controls
(n = 30). The influence of childhood
trauma, intrusions of traumatic events,
avoidance of intrusions, dissociation and
depression on memory specificity was
also studied. The results showed that of
the borderline patients only the subgroup
with a co-morbid diagnosis of depression
had trouble remembering specific events
from the past. Trauma, intrusions, avoid-
ance of intrusions and dissociation seem
to be unrelated to the specificity of auto-
biographical memories in BPD.
Reprints: I. P. Kremers, Department of
Psychology, Leiden University, The
Netherlands
Email: kremers@fsw.leidenuniv.nl
continued on page 14
Publications of Interest
Continued from page 13
Koopman, C., Carrion, V., Butler, L.
D., Sudhakar, S., Palmer, L. & Steiner,
H. (2004). Relationships of dissocia-
tion and childhood abuse and neglect
with heart rate in delinquent adoles-
cents. Journal of Traumatic Stress, 17,
47-54.
This study examined the relationship of
dissociative symptoms, abuse and
neglect, and gender to mean heart rate
(HR) in 25 female and 16 male delin-
quent adolescents. Dissociative symp-
toms and abuse and neglect were
assessed by structured interviews.
Participants were randomized to one of
two conditions, to describe either their
most stressful life experience or their free
association thoughts. Greater dissociative
symptoms were associated with lower
mean HR, whereas abuse and neglect,
being a girl, and participating in the free
association task were associated with
higher mean HR. The finding that high
levels of dissociative symptoms may be
related to a suppression of autonomic
physiological responses to stress support
Bremner’s conceptualization (J. D.
Bremner, 1999) that dissociative symp-
toms comprise one of two subtypes of
the acute stress response, differing physi-
ologically as well as subjectively from a
predominantly hyperarousal or intrusive
symptom response.
Reprints: C. Koopman, Department of
Psychiatry and Behavioral Sciences, Stanford
University School of Medicine, Stanford,
California 94305-5718
Email:. cheryl.koopman@leland.stan-
ford.edu
Maaranen, P., Tanskanen, A.,
Haatainen, K., Koivumaa-Honkanen,
H., Hintikka, J., & Viinamaki, H.
(2004). Somatoform dissociation and
adverse childhood experiences in the
general population. Journal of Nervous
& Mental Disease, 192, 337-42.
This study examined the relationship
between childhood trauma and somato-
form dissociation in the Finnish general
population (N = 1739). The prevalence
of high somatoform dissociation
(Somatoform Dissociation Questionnaire
≥ 30) was 9.4%. The results revealed a
strong, graded relationship between an
increasing number of adverse childhood
experiences and high somatoform disso-
ciation. Unemployment, a reduced work-
ing ability, and a poor financial situation
were also associated with high somato-
form dissociation.
Reprints: P. Maaranen, Department of
Psychiatry, University of Kuopio, P O Box
1777, Kuopio 70211, Finland
Matsumoto, T., Azekawa, T.,
Yamaguchi, A., Asami, T., & Iseki, E.
(2004). Habitual self-mutilation in
Japan. Psychiatry & Clinical
Neurosciences, 58, 191-8.
The purpose of the present study was to
clarify the relationship between bulimic
behavior, dissociative phenomenon and
sexual/physical abuse histories in
Japanese subjects with habitual self-muti-
lation. Subjects consisted of 34 female
outpatients who had cut their wrists or
arms on more than 10 occasions. Two
age-matched groups, which consisted of
31 general psychiatric outpatients and 26
non-clinical volunteers, served as con-
trols. The habitual self-mutilation group
had significantly higher scores on the
Beck Depression Inventory-II, Bulimia
Investigatory Test of Edinburgh, and
Adolescent Dissociative Experience Scale
than either of the two control groups (P
< 0.001). Furthermore, the habitual self-
mutilation group more frequently had a
history of illicit psychoactive drug use (P
= 0.001), shoplifting (P < 0.001), suicide
attempts (P < 0.001), overdosing with
medicine (P < 0.001), sexual abuse (P =
0.011), and childhood physical abuse (P
= 0.001) than the general psychiatric
controls. These results are consistent with
those in Western studies and support an
association between habitual self-mutila-
tion and sexual and/or childhood physi-
cal abuse in Japan.
Reprints: T. Matsumoto, Department of
Psychiatry, Yokohama City University School
of Medicine, Yokohama, Kanagawa, Japan
Email: toshi-lancia@nifty.com
McNally, R. J. (2004). Is traumatic
amnesia nothing but psychiatric folk-
lore? Cognitive Behaviour Therapy,
33(2), 97-101.
Some psychotherapists believe that cer-
tain experiences are so overwhelmingly
traumatic that some victims become inca-
pable of remembering their worst trauma
14
except under special circumstances (e.g.,
therapy) many years later. Unfortunately,
clinicians who endorse this concept of
traumatic amnesia often misinterpret the
very studies they adduce in support of it.
More specifically, they misinterpret other,
unrelated memory phenomena as evi-
dence for traumatic amnesia, such as
ordinary forgetfulness, psychogenic
amnesia, organic amnesia, incomplete
encoding of traumatic experiences, non-
disclosure of remembered trauma, and
simply not thinking about something for
a long time. The purpose of this article is
to dispel confusions rampant in this literature.
Reprints: R. J. McNally, Department of
Psychology, Harvard University, Cambridge,
Massachusetts 02138
Email: rjm@wjh.harvard.edu
Merckelbach, H., & Jelicic, M. (2004).
Dissociative symptoms are related to
endorsement of vague trauma items.
Comprehensive Psychiatry, 45, 70-5.
Current psychiatric literature suggests
that dissociative symptoms originate from
aversive childhood events. However, this
view is largely based on cross-sectional
studies that do not rule out a scenario in
which dissociative tendencies contribute
to self-reports of childhood trauma. In
two studies, the authors tested one par-
ticular implication of this scenario, name-
ly, that dissociative symptoms are related
to endorsement of vague rather than spe-
cific items about childhood trauma. In
study 1 (N = 43) and study 2 (N = 127),
nonclinical participants completed stan-
dard measures of dissociation, childhood
trauma, and fantasy proneness.
Correlational and regression analyses
were performed on the data. Fantasy
proneness and responses to broad trauma
items, but not responses to factual trau-
ma items predicted dissociation levels.
This pattern of findings shows that the
link between trauma and dissociation is
considerably more complex than is often
assumed. As well, it suggests that at least
in nonclinical samples, dissociative
symptoms may breed endorsement of
vague trauma items.
Reprints: H. Merckelbach, Department of
Experimental Psychology, University of
Maastricht, The Netherlands
h.merckelbach@psychology.unimaas.nl
Sawa, T., Oae, H., Abiru, T., Ogawa, T.,
& Takahashi, T. (2004). Role of imagi-
nary companion in promoting the psy-
chotherapeutic process. Psychiatry &
Clinical Neurosciences, 58(2), 145-51.
An imaginary companion (IC) has been
considered to be a transitory phenome-
non sometimes seen in the normal devel-
opmental process of children. In recent
years, however, it has been observed that
ICs are related to various disorders, and
their clinical significance is again attract-
ing notice. Although an IC may in certain
ways aggravate the patient’s symptoms
and regression, an IC may also serve to
advance the therapy, for example by indi-
cating the location of the patient’s trou-
bles, or acting as an intermediary
between the therapist and patient. In
cases of dissociative (conversion) disor-
ders, it is generally difficult for patients
to verbalize their troubles, but the pre-
sent patients gained insight into them-
selves by closely examining their ICs. It
is concluded that by incorporating ICs
into the therapeutic strategy as a pres-
ence supporting the patient’s growth, it is
possible that the psychotherapy may pro-
ceed more smoothly.
Reprints: T. Sawa, Department of
Psychopathology and Psychotherapy,
Postgraduate School of Medicine, Research
Center of Health, Physical Fitness and
Sports, Nagoya University, Nagoya, Aichi,
Japan Email: stakako@med.nagoya-u.ac.jp
Manuscripts Wanted
T he Journal of Trauma and Dissociation
is currently soliciting articles for sub-
mission. At the present time, we are partic-
ularly encouraging submission of clinically-
oriented manuscripts (e.g., case studies,
clinical review papers, treatment approach
discussions). Mentoring for first time
authors is available. Information for
authors interested in submitting to JTD can
be found at the following website:
http://www.issd.org/indexpage/jtdauthorsin-
fo.html. Manuscripts and inquiries can be
sent to James Chu, MD, Editor, at
james.chu@earthlink.net.
The Journal of Trauma and Dissociation
is dedicated to publishing peer-reviewed,
scientific articles in the areas of psychologi-
cal trauma and its sequelae, including dis-
sociation and posttraumatic stress disorder.
ISSD Professional Seminar Project
A
s a result of the very successful 2004 Spring Seminars in Los Angeles and
New York City, the ISSD Executive Council has decided to further expand
this project and looks forward to offering similar events at four potential
sites in 2005.
At the June 27, 2004 Executive Council meeting, a proposal submitted by the
ISSD Professional Seminar Project Committee was adopted to develop a “four tier”
plan, based on requests and feedback from the Executive Council, interested ISSD
members, and 2004 Seminar attendees. Each of the four approaches are designed
to include one or more of the following goals:
• introducing the concept of dissociation
• educating professionals about the effects of chronic traumatization; spreading
knowledge about ISSD
• facilitating increased ISSD membership
• increasing attendance at the ISSD Annual Conferences; assisting in the develop-
ment and/or revitalization of Component Groups.
The “Four Tier” Plan
Tier 1 This approach will offer one-day Professional Seminars in cities prior to
the ISSD Annual Conferences (i.e. 2005 – Toronto; 2006 – Los Angeles; 2007
– Baltimore; etc).
Tier 2 This plan combines “encore” presentations of Professional Seminars in
places that have previously hosted an event (i.e. 2005 – Los Angeles & New
York City), along with other big cities (i.e. Chicago, Boston, Washington DC,
Atlanta, Miami, St. Louis, New Orleans, etc.) depending on how many semi-
nars are approved by the Executive Council each year.
Tier 3 This approach offers Professional Seminars in smaller locations (i.e.
Minnesota, Indiana, Kentucky/Ohio, S. Carolina, etc) where it is determined
there is a need for professional education and increased awareness of ISSD.
Tier 4 This plan attempts to respond to requests from interested parties (i.e.
Puerto Rico, Brazil, Europe, small cities in the USA, etc) that have resources
and manpower to assist in the seminar management in those locations.
In keeping with this approved “four tier” plan, we are pleased to announce the
tentative schedule for the 2005 Professional Seminars:
February 11, 2005, Torrance, California
Allan Schore, PhD, & Richard Chefetz, MD, presenting on
“Integrating Neuroscience and Clinical Practice:
Mind and Body in the Treatment of Psychological Trauma”.
March 18, 2005, Atlanta, Georgia
Christine A. Courtois, PhD, & Joyanna Silberg, PhD, presenting on:
“Trauma, Dissociation, and Clinical Practice:
Childhood and Adult Manifestations of Psychological Trauma”.
April 2005, Toronto, Ontario, Canada
details to be announced.
May 2005, New York City, NY
details to be announced.
San Juan, Puerto Rico
details to be announced.
Watch your ISSD News and the ISSD website for future developments. If you or
your Component Group/organization would like to see an ISSD Professional
Seminar in your area, and you have suggestions for facilities and/or speakers,
please submit your ideas to the committee.
Further information can be obtained from the ISSD Professional Seminar
Project Committee by contacting Dennis S. Pilon, ACSW, BCD at:
DSPilonTRC@aol.com.
15

Marginalia
What is therapy? Below is our standard answer.
It is the story of their becoming human together.
Gilgamesh (H. Mason, translator)
But what is therapy really? Does it do anything fundamen-
tal or transcendent? Do even therapists believe that it really
and truly works? And if we sort of believe that it sort of
works sometimes, how does that happen?
The answer, among the many possible, that we have
been thinking of recently has to do with relationship, con-
nection, love if we can allow such an explosive word into
our deliberations. The Kohutians tell us that if we can find
a way to function in a person’s psychic universe as a self-
object then every psychic activity will be stabilized.
Once attached to a reliable self-object, the individual’s
decision-making becomes firmer and clearer, the energy
and capacity to act increases, and the capacity to act effec-
tively and to experience oneself as having succeeded bol-
sters self-esteem which has already been enhanced by hav-
ing a self-object and so forth. This is an elegant explana-
tion, which lends itself to spiral diagrams replete with
numerous lovely arrows, but surely there is more to it than
that. What does it take to become a workable self-object?
As a bare minimum the requisites include utter goodwill,
unwavering respect and scrupulous fairness and honesty.
We go back to the poets for the rest of the story.
Jean Goodwin
Reina Attias
In this matter it would be well to trust rather to
friendship than to great wisdom.
J.R.R. Tolkien
In our work it can be truly said that in our best
moments of dispassionate and objective analyzing
we love our object, the patient, more than at any
other time and are compassionate with his whole
being. Hans Loewald
Love is the highest form of understanding. When
we truly love we understand with an insight that
nothing can transcend and nothing can equal.
Frank Lloyd Wright
Ignorance and bungling with love are better than
wisdom and skill without. Thoreau
I suppose the story of my life is a search for love.
But more than that, I have been looking for a way
to repair the damages I suffered early on and to
define my obligation, if I had any, to myself and my
species. Marlon Brando
Send your ideas about what it is about therapy that
helps people get better to jmgoodwin@ aol.com.

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