Excerpted From the April, 2000 NESSD Newsletter
Dear NESSD Members and Supporters:
The annual Psychological Trauma Conference organized by Bessel van der Kolk was held in Boston last weekend, and NESSD was well-represented among the participants. Richard Jacobs, an active member of this society for many years, co-presented a Case Conference workshop; Debbie Korn presented on EMDR and Resource Installation at another very well-attended and enthusiastically praised workshop; Lana Epstein and I gave a Dissociative Disorders workshop which attracted a standing-room-only audience; and Bessel, also a member of NESSD, successfully wove together the biological and clinical presentations in his major address and as the moderator of discussion. A very moving prologue to Frank Putnam's presentation on his longitudinal study of sexually abused girls described his exodus to Cincinnati after his lab at NIMH was abruptly shut, a victim of the fallout from so much dissociative disorders-related litigation. (In a conversation with fellow presenters later on, he spoke of how reluctant he still feels to talk about dissociation publicly.)
Paradoxically, though, the conference was also permeated with references to dissociative symptoms as a characteristic feature of Chronic PTSD, with mention of dissociative defenses as adaptive reactions to trauma, with remarks about the similarity between the freeze reaction and dissociation. So, even though expertise in dissociative disorders has made many of the founding fathers (and mothers) in this field very vulnerable to discredit and to litigation, the understanding of dissociation and its central role in adaptation to childhood trauma has grown and found its way into the mainstream. This phenomenon is clearly very good news for those of us who find that, while DID patients still appear in our practices in small numbers, DDNOS patients and those with Chronic PTSD accompanied by many dissociative symptoms or patients who have traumatized child and adolescent ego states appear in very large numbers. By and large, most of them have received less than optimal therapeutic treatment because their previous clinicians either did not recognize the dissociative symptoms at all or only recognized them in the most severe and dramatic DID presentations. I know this because I myself was once one of those clinicians who did not recognize or understand dissociation when I encountered it. A patient of mine from those years recently came back to see me because her symptoms had simply not abated much at all despite many attempts at treatment and many attempts to just live her life without treatment. Now, of course, I know to immediately suspect dissociation when I encounter a patient who has had many years of therapy with reasonably good therapists and who has a life that is healthy, safe, and meaningful and who still cannot seem to progress in treatment. And sure enough, all the signs of ego states or parts of self organized into a cleverly constructed and even more cleverly disguised system were there -- all the same signs which had been there fifteen years ago when I diagnosed this patient with Borderline Personality Disorder and tried to treat her in a Kernbergian manner. She cried (rare for her) remembering how painful it was to carry that diagnosis, how sick and crazy it made her feel. Then she began to blossom as she went about creating a level of internal safety and connection as good as that she had already created with her husband and her children.
One of my personal hopes as President is that NESSD can begin to play a different kind of role in the mental health community now that treating dissociation is understood as an integral part of trauma treatment, not a different and "far out" treatment of the most severely damaged and dramatic survivors of trauma. There will always be a place in our organization for teaching about DID and encouraging thoughtful, responsible treatment of the complex dissociative disorders, but I believe that we have a mission to accomplish which will reach many more clinicians and many more patients: the mission of teaching mental health professionals to recognize the subtler manifestations of dissociation, especially those which have a profound effect on the ability of the therapist to make sense of the patient and the patient to make use of the treatment. I want to invite our membership (and our colleagues who are not members) to let me and other Board members know how you see the role of NESSD in the mental health community, how NESSD could contribute to the organizations and patients with whom you work. Please visit our web site at www.nessd.org or email me directly at DrJJFisher@aol.com.
I look forward to hearing from you.
Janina
[Return to President's Letters Page]