Afterword to Developmental Pathway to Dissociation
Written by Andrew M. Leeds, Ph.D.
As a clinician, I have dedicated myself to the study and treatment of all forms of trauma for more than 30 years. This however was not my initial orientation in the field. My original interest was in the nature of consciousness and the relationship of consciousness with the physical universe. Starting clinical work in the mid-1970s, my early humanistic work began with somatic approaches, mindfulness (Vipassana), Gestalt, hypnosis and guided imagery. It was only after being traumatized in a head-on car crash in 1979 that I turned my attention toward an interest in trauma. I uncovered my first case of MPD (now DID) in 1986, began my studies in dissociative disorders and became a member of the ISSTD. Since 1991, I have integrated the Adaptive Information Processing Model and the EMDR approach into my clinical work. My efforts to understand the complexities of my client's responses to my therapeutic interventions (i.e. my clinical blunders), led me into the study of attachment theory, the theory of structural dissociation of the personality, and the developmental neurobiology of systems for emotional self-regulation.
I am well-aware of the role of trauma in the development of complex dissociative disorders. Working with adult survivors I have witnessed countless hours of the recounting of sadistic maltreatment treatment of infants and children. I am equally mindful of the central role of neglect in the failure to develop essential neurobiologically mediated action systems for attachment, self-regulation and a cohesive sense of self. Watching the slowly growing recognition in our field of the impact of trauma following the inclusion of posttraumatic stress disorder in the DSM III (1980), I have long felt that the role of neglect has been given inadequate attention as the poor step-child of trauma. Since my training in EMDR, I have witnessed hundreds of individuals making good recoveries from traumatic experiences, while survivors of neglect (and neglect plus trauma) respond much more slowly. I keep thinking we need to do better.
Reading Peter Barach’s 1991 article “MPD as an Attachment Disorder” in the late 1990s gave form to what I had previously felt but could not fully articulate. “One may view “Multiple Personality Disorder (MPD) as an attachment disorder complicated by the sequelae of "active abuse" (specific acts which cause physical or sexual harm).... From this perspective the resolution of the attachment disorder, rather than the resolution of the effects of sexual and physical trauma, causes the extended and turbulent nature of the psychotherapy of more complex cases of MPD” (p. 117). From these cogent words I felt an immediate recognition and validation of clinical experiences which have implications well beyond the treatment of individuals who meet criteria for DID. The effects of neglect need to be understood and treated on their own terms and attachment theory was one way to approach this. Disorganized-disoriented attachment is an important part of the story of maladaptive forms of dissociation, but it is not the entire story.
Bowlby saw detachment as the result of a deactivation of the system of attachment behavior. By defensively excluding from awareness "... the signals, arising from both inside and outside the person, that would activate their attachment behavior and that would enable them both to love and to experience being loved" (Bowlby, 1988, pp. 34-25), children experiencing prolonged separations can block attachment behaviors and their associated affects. Once established as a defensive process, detachment then becomes the child's characteristic coping style” (Barach, 1991, p 118).
Such prolonged separations can be psychological as well as physical. The longitudinal studies summarized in Dutra, Bianchi, Siegel and Lyons-Ruth, (2009) highlight the impact of central aspects of psychological neglect on young adult dissociation (as measured by the DES II). Pathological dissociative processes are increasingly recognized as central factors in a wide range of disorders. Psychological neglect and subsequent detachment (found in both avoidant/dismissing and disorganized attachment) need to be conceptualized and addressed not only in relationship to traumatizing experiences, but as distinct phenomena.
The struggle continues to bring adequate recognition and response to the existence and impact of childhood trauma into academic and clinical psychology and practice, public policy and other spheres of life. At the same time we need to recognize that neglect carries its own distinct signature and imprint. Here I believe we can do better.