Book and film reviews - 2012

 

EMDR and dissociation: The progressive approach

By Gonzalez, A., & Mosquera, D

(2012).Charleston, SC: Amazon Imprint; 283 pp

 

Book reviewed by Onno van der Hart

From ESTD Newsletter Volume 3, Number 1, December 2012

Many therapists and their clients with complex dissociative disorders—DID and DDNOS subtype 1--are experiencing the benefits of including EMDR procedures in their therapies. That is, these therapists do not merely apply the standard EMDR protocol, but integrate these procedures within the framework of phase-oriented treatment (e.g., Gelinas, 2003): the current standard of care for these disorders (ISSTD, 2011). Following Pierre Janet’s original proposals, phase-oriented treatment is usually described in terms of three treatment phases: (1) stabilization, symptom reduction, and skills training; (2) integration of traumatic memories; and (3) personality (re)integration and rehabilitation. There is clear understanding that in complex cases there often is a recurrent need to return to previous phases as the treatment progresses.

              While, indeed, many therapists using EMDR make great advances in the field of treating clients with complex dissociative disorders, the cutting edge with regard to the development of treatment approaches integrating EMDR procedures seems to be represented especially by the two Spanish main authors of this book, Anabel Gonzalez and Dolores Mosquera, as well as their colleagues-- Andrew M. Leeds, Jim Knipe, Roger Solomon, Sandra Baita, Natalia Seijo, and Janine Fisher—who have accompanied them in writing most of the chapters. These authors are strong adherents of the standard of care regarding phase-oriented treatment, but they also join those critics who state that phase 1 treatment often may take too long before the actual treatment of traumatic memories, and thus of EMDR proper, is started. Indeed, if EMDR and dissociation: The progressive approach makes one thing clear, it’s that various innovative procedures, presented as “gradual interventions,” in many cases may significantly shorten this basic treatment phase.

              The authors remain true to the theoretical model of EMDR, i.e., the adaptive information processing (AIP) model, but they also follow the wisdom of Luber and Shapiro (2009), who stated: “When we are dealing with the most debilitated patients, it is most important for us to incorporate the wisdoms of other fields” (pp. 227-228). Thus, in integrating EMDR with phase-oriented treatment, the authors refer to many sources about understanding and treating clients with complex dissociative disorders, including the neurobiology of dissociation; ego state theory (with special attention to an adaptation of George Fraser’s imaginative meeting place); attachment theory; Richard Kluft’s writings on the treatment of DID, including the gradual or fractionated integration of traumatic memories; and Anthony Ryle’s Cognitive Analytic Therapy, with its emphasis on identifying and working with reciprocal role procedures—among dissociative parts and between client and therapist. Their main complementary conceptual framework is the theory of structural dissociation of the personality (TSDP; Van der Hart, Nijenhuis, & Steele, 2006) and some of its sources. I acknowledge that I am one of its authors and thus may have a partisan position in reviewing this book. Thus, the authors of EMDR and dissociation: The progressive approach frequently refer to Pierre Janet’s pioneering studies on dissociation and his psychology of action, including the notions of synthesis and realization that together constitute the integration of traumatic experiences. They also follow Charles Myers’ basic distinction, in traumatized individuals, between the apparently normal [part of the] personality (ANP) and the emotional [part of the] personality (EP). As ANPs individuals fulfil tasks in daily life and avoid the traumatic memories and the EPs. As EPs they are fixed in traumatic memories and live in trauma time, that is, they expect the same threat experienced during their traumatization to still be present. The authors also follow TSDP’s distinction of levels of complexity of (structural) dissociation of the personality, with clients with DID having the most complex dissociative personality structure.

              The authors emphasize the importance for clinical practice of TSDP’s basic tenet that survivors maintain their trauma-related dissociation of the personality, and thus their various symptoms, by a series of phobias and related psychological defenses. As observed by Janet already, the basic phobia is the phobia of traumatic memories. Related phobias are, among others, the phobia of dissociative parts, the phobia of mental actions such as having particular emotions, body sensations, thoughts, fantasies, and needs, and the phobias of closeness, abandonment, loss, and rejection, particularly with regard to the therapist. One of the authors’ most important contributions pertains to their proposal that systematically and gradually overcoming these phobias will facilitate the integration (“reprocessing,” in the language of EMDR’s AIP model) of traumatic memories. They present many original and effective EMDR applications that, in a respectful and dynamic way, speed up the resolution of these phobias—often described in this book in terms of blockages or stuck points—and approaching the integration of traumatic memories in a gradual but highly efficient way. In this regard, they appropriately use the metaphor of the peeling of an onion in describing their highly recommendable approach to the treatment of traumatic memories.

              Overcoming these dissociative phobias is combined with a wide range of related interventions, such as improving self-care, fostering co-conscious among dissociative parts, applications of the widely known EMDR approach of resource installation and development, and the enhancing higher-order mental functions, including increased reflection instead of reflexive actions, mentalization, and mindfulness. In this regard, the authors present an intriguing discussion about the difference between a postulated Adult Self—having parallels with the notion of Healthy Adult Mode in schema therapy--and ANP. This Adult Self is understood as the future integrated self (Korn & Leeds, 2002); in other words, the eventually fully integrated or unified personality of the client, which indeed is able to function at higher mental levels. Thus, by definition ANP is not yet that Adult Self, with its sustained capacity for higher-order functioning. However, the authors also equate a high functioning ANP—with which the client either enters therapy already or develops in the course of therapy with this Adult self:

              In our approach it is the ANP, as Adult Self, which will implement all actions

regarding the internal system, borrowing and finally integrating different aspects from other parts. (p. 85)

Thus, on the one hand the authors clearly distinguish the Adult Self—as the fully unified and high functioning personality--from an ANP, and on the other hand they equate a high functioning ANP with this Adult Self. This is confusing. (In a parallel manner, the Healthy Adult Mode in schema therapy is still a part of the not fully integrated or dissociative personality, thus perhaps can also be best described as a high functioning ANP.)    

              One of the didactic strengths of this most important book consists in the many, highly instructive clinical vignettes and verbatim reports of applications of the presented theoretical notions and therapeutic procedures and related interactions between client and therapist. This strongly helps therapists in becoming more able to apply them in their own clinical practice. Furthermore, the various drawings included in this book are great and have a nice humorous (but respectful) touch. This is especially the case in the chapter describing the various reciprocal roles in therapy.

              In conclusion, EMDR and dissociation: The progressive approach constitutes the cutting edge of the developing and highly fruitful integration of EMDR procedures in phase-oriented treatment of clients with complex dissociative disorders. As EMDR practitioners may sooner or later encounter such clients in their clinical practice, I believe that reading this book is mandatory for all of them. In the same line, it should have a major place in the advanced EMDR training courses regarding the dissociative disorders and, I would add, other complex trauma-related disorders, which after all are also dissociative in nature—whether labeled as such or not. Moreover, it should inspire non-EMDR clinicians specialized in the treatment of complex dissociative disorders to become acquainted with EMDR and to become inspired by the clinical wisdom brought together in this book. 

 

References

Gelinas, D. J. (2003). Integrating EMDR into phase-oriented treatment for trauma. Journal of

              Trauma & Dissociation, 4(3), 91-135.

International Society for the Study of Trauma and Dissociation (2011). Guidelines for treating

dissociative identity disorder in adults, third revision. Journal of Trauma & Dissociation, 12(2), 115-187.

Korn, D. L., & Leeds, A. M. (2002). Preliminary evidence of efficacy for EMDR resource

development and installation in the stabilization phase of treatment of complex posttraumatic stress disorder. Journal of Clinical Psychology, 58, 1465-1487.

Van der Hart, O., Nijenhuis, E. R. S., & Steele, K. (2006). The haunted self: Structural

              dissociation and the treatment of chronic traumatization. New York: Norton.

 

Nostalgia for the light

Patricio Guzman, 2010

 

Film reviewed by Orit Badouk Epstein

From ESTD Newsletter Volume 3, Number 1, December 2012

Would we ever consider a connection between astronomy and trauma, between the notion that the present time is a mental invention, a linguistic construction and that we really belong to the Milky Way and not just Earth? – In this poetic and unique documentary, narrated as an essay, the director Patricio Guzman, through the lenses of the biggest telescope in the world, examines a link between astronomy and atrocity in the Atacama dessert in Chile.

            Loss seems to symbolise itself in all forms and shapes. This extraordinary documentary looks at the image of the interior of a telescope where like disco lights, the stars can be seen brightly and clearly. Simultaneously in the same spot in the highest desert and driest place on Earth, where no rainfall has ever been recorded, we are shown how astronomers investigate the sky while women sift through the sand for evidence of loved ones who were murdered by Pinochet’s brutal dictatorship.

            The film emphasises that astronomy is really a study of the past, telling us where we come from and where we might be heading to, in Guzman’s words: ‘It’s a philosophical reflection on the relationship between human life and the life of the cosmos, on human memory and the memory of the stars- of infinity’. He explains: ‘As human beings, we are the inheritors of generations upon generations, going back to prehistory, and the matter of our bodies is a matter of the stars. We belong to the Milky Way- that’s our home, not just the Earth’. When interviewing Gaspar Galaz a softly spoken astronomer we are informed: ‘The present doesn’t exist’. The combination of the speed of light and human reflexes means that everything that we perceive and experience happened in the past.

            In this intriguing cosmic wonder the Director and Narrator points us towards another reality where the Atacama was also the site of a concentration camp created in 1970, and where 60,000 political prisoners were held, many of whom later disappeared. Guzman interviewed some of the relatives- who like Sisyphus, tediously having to roll a rock up and down a hill, forty years on some of the woman relatives still go and walk in this dry land to dig for the remains of their dead relatives; ‘I wish the telescope didn’t only look into the sky but can also see through into the Earth so that we could find them’ says Violetta Borris the sister of a missing person. With piercing melancholia, Guzman then goes to interview Valentina, a young mother who is both an astronomer and a daughter of political prisoners who disappeared. Valentina tells Guzman that ‘astronomy has given another dimension to the pain, the absence and loss; I tell myself that we are all part of a current, of energy, a recyclable matter. I feel that nothing really comes to an end’. 

            In this enchanting collaboration between the Earth and the sky, Guzman successfully tries to merge the search for the stars and the search for the dead in the ground.  By doing so, he painfully tries to reconcile between the mourning process and grief of Chile’s unresolved past trauma. The film beautifully reflects upon the relationship between human tragedy and the life of the cosmos. Despite all, the viewer is left with some sense of cosmic hope, which does not necessarily belong to any religion or any belief system. This film is not only visually stunning and a magnificent creation that looks into the quantum levels of our existence, but it also aims to deepen our understanding of disputes over history and finding ways towards resolving the conflictual and dissociative memory of a nation.

 

Trauma, dissociation and multiplicity: Working on identity and selves.

By Valerie Sinason

Routledge, 2012

 

Book reviewed by Giovanni Liotti

From ESTD Newsletter Volume 2, Number 4, September 2012

 The theme of identity and self has been for centuries (indeed, for more than two millennia) a crux and a crucible for philosophers and scientists. And, although the theme is admirably framed in Sinason’s book by contemporary clinical knowledge on trauma and dissociation, the complexity and unsolved dilemmas inherent to philosophical and psychological conceptions of identity and self may remain in the minds of readers as they work through the contributions she has collected.  This complexity may be the source of rejection by readers who do not like seriously to consider the challenge of dissociation in their clinical practice.  But it is also the source of fascination and extreme interest to others.  This reviewer, it should be stated in advance, belongs to the second category.

The clinical reflections on identity in the chapters of this book have numerous ramifications, as such reflections always do, in the domains of philosophical anthropology, contemporary neuroscience (Sacks, 2004) and general psychology – I would also add great western literature and theatre to the list. And, in the limited space of a critical review, so many ramifications prevent any synthesis of how the sense of identity and identity alteration are dealt with in various chapters. I wish, however, to quote a sentence in the closing pages of the book that very cleverly hints at the great thought-provoking power of the clinical approach to theme of identity: “Depersonalization is an experience that preserves the essence of the Self” (p. 200).

This may sound an oxymoron, does it not? An oxymoron is an inherently self-contradictory assertion: it is an intelligent (oxy -) stupidity (-moron). It may also be a quite productive stimulus for scientific thought. Just think of the oxymoron that underpins quantum theory, a great achievement of modern physics: light is both continuous (a wave) and discontinuous (a particle). Or think of this other Janetian and Freudian oxymoron: a significant part of mind (i.e., consciousness, to which mind was equated in the nineteen century’s philosophy and psychology) is unconscious.

To be able to remain within the limits of a review, however, I must focus on the key idea hinted at by one word in the book’s subtitle:  perhaps it is better to think of “selves”, rather than “self”, and not only while clinically dealing with identity alteration. Contributors to the book explicitly or implicitly agree that the intuitive, universal notion that each human being is a single self is misleading or false. The self in this view is conceived as an entity rather than as a mutable, and in this sense always discontinuous, process. The dissociative identity disorder illustrates, in the dramatic light of psychopathology, the multi-faced and discontinuous nature of the self-as-process that is less evident in other clinical populations and in healthy people.

The clinically relevant consequence of such ideas is that the aim of psychotherapy, integration of dissociated or split self-states, must be understood as a “harmonious interaction” among the normally multiple self-states (p. 4), not as the achievement of a really unitary self which, it is hypothesized in the tradition of the relational model in psychoanalysis (Mitchell & Aron, 1999), is a substantially illusory even if universally widespread intuition.

Each chapter of the book is preceded by a passage written by someone who knows from the inside – by personal experience - what trauma, dissociation and multiplicity are. Often these passages are lines of poetry, which reminds one of the assertion of Josif Brodsky, the Nobel Prize for Literature, that poetry is a major road to a possible synthesis between two seemingly antagonistic states of the human mind; pain and reason. Another way of conjugating pain and reason, the clinical chapters of the book suggest, is psychotherapy, provided that it involves an authentic sharing of experience and meaning.

When dealing with problems of identity, as in the treatment of the dissociative identity disorder, it is safer to bear in mind the possible normal multiplicity of “self”, and this book explores the main mental functions and processes involved in creating the allegedly illusory sense of a unitary self. It also explores how this seeming unity is so deeply modified in chronically traumatized children and adults such that the illusion is broken. These mental functions and processes are:

Ø  the representation and the experience of the body (Chapter 4 by Mary Sue Moore, and Chapter 7 by Susie Orbach),

Ø  verbal language (Chapter 3, authored by Valerie Sinason),

Ø  memory (Chapter 5, written by John Morton),

Ø  consciousness (Ellert Nijenhuis’ chapter 8),

Ø  the distinction between me and not me (dealt with in Chapter 2, on auditory hallucinations, co-authored by Moskowitz, Corstens and Kent, and in the dialogue between Richard Chefetz and Philip Bromberg reported in chapter 9),

Ø  defence (Chapter 6, by Margaret Wilkinson).

The history of, and the reasons for, the foreclosure of dissociation and multiplicity in classical psychoanalysis (Chapter 1, by Phil Mollon) introduce complex, controversial but always fascinating arguments – often illustrated by quite interesting clinical material. 

The readers of a previous book edited by Valerie Sinason (Attachment, trauma and multiplicity: Working with dissociative identity disorder, Routledge 2002, 2nd edition 2011), and devoted to reflections on the same diagnostic category, will notice that in this new book attachment ceases to be a privileged focus of attention in the exploration of trauma and dissociation. The reason for the relative neglect of attachment theory and research in many chapters of this book is, in my opinion, that the study of attachment processes involves always a radically relational outlook on human experience.  An outlook informed by the idea that subjectivity is always to be understood, ultimately, as intersubjectivity does not easily match with most existing psychological theories of bodily experience, consciousness, self-knowledge, memory, differentiation between me and not me, verbal language and defence, that focus more on the individual mind. Constructs and procedures elaborated for over a century by psychologists and psychoanalysts studying self-knowledge and memory for the most part neglect the intrinsic social relatedness of the human mind that Daniel Stern (2004) has aptly captured with the phrase “implicit relational knowing”. Relational knowing is in principle bidirectional and reciprocal, involving both self and the other.  As a consequence of this historical neglect of intersubjectivity, when reflecting on self-knowledge, memory, consciousness, defence and body schema – and even when reflecting on the eminently social reality we call verbal language – we all are poorly equipped to take into account, even when we wish to do so, the intrinsically intersubjective nature of the typically human higher order mental actions. This is why attention to attachment processes is relatively modest in many of the book’s chapters – notwithstanding the relevance of these processes for the understanding of dissociation and multiplicity as has been evidenced both by clinical studies and empirical research (see, as an instance of the latter, the recent prospective study by Dutra et al., 2008), and as well notwithstanding the adherence to the relational model of the clinical contributors and the great interest and expertise of Valerie Sinason in the relations between attachment and dissociation.

Interestingly, two chapters, where consideration of attachment processes plays a major role, deal with the dissociated experience of the body in traumatized children and adults (Chapters 4 and 7). Bodies represented as lacking hands (nothing can be used to hug), bodies that have lost the usual sense of continuity and reliability, bodies that have been “seen” from the above by their owners as in the near death experience of extreme trauma, emerge when attachment processes seriously fail to provide security, or to soothe mental pain. This suggests that, rather unexpectedly, the study of bodily experience may be less hindered by intrapsychic theories in considering the crucial role of intersubjectivity in human experience, with respect to the study of memory, self-knowledge and consciousness.

The clearest and most stimulating contribution, in this book, to our understanding of how attachment and intersubjective processes are involved both in the pathogenesis and in the successful treatment of the dissociative identity disorder is to be found, in my opinion, in the final chapter, co-authored by Richard Chefetz and Philip Bromberg.  Serious and repeated empathic failures in child-parent interactions, where parents react to a class of infant and child communications as if they have no meaning at all, creates a dissociative barrier between (1) the mental states that the child acknowledges as Me in later intersubjective experience, and (2) those  that he or she regards as Not Me. Early relational trauma and attachment disorganization is a widely studied example of severe misattunement or total failure of intersubjective sharing in specific domains of parent-child interaction.  Therapists’ interventions, then, must be focused on skilfully creating occasions not for aiming at an illusory “fusion” of dissociated ego states into a single rock-like identity able to remain the same in different interpersonal contexts, but at establishing a harmonious relationship between Me and Not Me states in the intersubjective experience of both patient and therapist.

My remarks on the relatively scarce attention paid to attachment processes in many of the chapters should not be understood as negative criticism of this thought-provoking and informative book. On the contrary, I mean to suggest that a major step forward in the study of trauma and dissociation will be achieved when we become able to conjugate with attachment studies those makers of identity and self (selves) that we find in body schema, perception, verbal language, memory, consciousness, and the capacity to distinguish me and not me. Taken together, the two books edited by Valerie Sinason are a broad hint that this is the direction we should take in order to achieve a better understanding of the roots of pathological multiplicity and the way of dealing with it in psychotherapy.

 

References

Dutra, L., Bureau, J.F., Holmes, B., Lyubchik, A., & Lyons-Ruth, K. (2009). Quality of early     

     care and childhood trauma: A prospective study of developmental pathways

     to dissociation. J Nerv Ment Dis, 197(6), 383-90.

Mitchell, S.A., & Aron, L. (1999). Relational psychoanalysis: The emergence of a tradition.

      Hillsdale, NJ: The Analytic Press.

Sacks, O. (2004). In the river of consciousness. The New York Review of Books, 51, 1.

Stern, D.N. (2004). The Present Moment in Psychotherapy and Everyday Life. New York:     Norton.     

 

Martha Marcy May Marlene

Director Sean Durkin (2011)

 

Film reviewed by Orit Badouk Epstein

From ESTD Newsletter Volume 2, Number 4, September 2012

After fleeing an abusive cult in the Catskills Mountains in Upstate New York, the young traumatised Martha tries to reconnect with her sister. Haunted by painful memories and flashbacks, Martha (mesmerizingly acted by Elizabeth Olsen), struggles to adapt to living with her sister Lucy and her sister’s husband, Ted.

            This compelling and eerie thriller-drama takes us behind the scenes of an apparently idyllic farming community which soon enough is revealed to be a sex-based cult, where a high level of control is maintained. Evening meals are taken in silence; women eat apart and after the men; food and thoughts are all rationed. At the start, the cult leader welcomes the newcomer Martha, with a deceptive and creepy kindness, making her feel special and the chosen one; ‘you look like Marcy May’.

            The film reflects upon the typical aspects of cult manipulation and mind control such as the sharing of the name Marlene between all the female members of the community whenever they deal with the outside world. This is a classic and deliberate example of identity confusion and is one of the many common steps that cults use to break down new members and programme them. This confusion is often helped by the absence of clocks, watches or calendars so that members lose track of time and don’t know how long they’ve been somewhere. Cults often cut people off from society, re-name them and tell them that their old lives were the wrong way to live.  As in many cults, we see in the film the use of stealing, violence, rape, sexual exploitation, pet killing and murder as a way of binding people together.

            Martha’s depersonalised self-state exhibits the usual symptoms of PTSD: waves of flashbacks, acting out some of the cultish behaviour such as changing beds in the middle of the night at her sister’s house and stealing food. The film does not break up Martha’s past stay in the cult from her present time with her sister, so that everything appears to be happening at the same time. In this way both viewer and heroine get a feeling of confusion and disorientation through the film’s narrative structure, just as we witness with some of our clients. The film excels in mirroring the heroine’s fractured mental state. Her world is disjointed: “How far are we” she asks her sister, “from what, yesterday?” The film blurs the boundaries between past and present and from reality to remembering: “Do you ever have that feeling that something is a memory or something is a dream?”

            In a minimalistic style, the film makes a sensitive attempt to depict cult deprogramming but Martha’s broken bond with her sister appears to prevent such efforts.  We don’t know much about the sisters’ early attachment, all we gather is that after their mother’s death Martha was left to fend for herself, feeling uncared by her older and busy sister. Lost in the world, she fell into the hands of a cult, where she felt part of something meaningful; ‘you need to share yourself don’t be selfish’.

            More than any other previous film on the subject, this movie accurately demonstrates the unhinged and twisted yet seductive mind of a cult leader; ‘Death is beautiful because it creates awareness, death is pure love’.

            Depending on how one reads the undecided ending, this film is nothing but a true account of a mind colonised by a dangerous cult leader and his followers. Running away from the cult, Martha is struggling to resolve the two belief systems of her sister’s world, the world of reality, and the world of Marcy May Marlene. She clearly has not broken free and the viewer is left with a feeling that you can escape a cult but you can’t escape yourself in it.

 

Healing the Unimaginable: Treating Ritual Abuse and Mind Control

By Alison Miller

Karnac, 2012

 

Book reviewed by Orit Badouk Epstein

From ESTD Newsletter Volume 2, Number 3, June 2012

Whichever school of therapy we preach or practice: psychodynamic, humanistic, integrative, attachment based, cognitive etc, we want to believe that our methods and approaches can help our clients alleviate their symptoms and help them function better in life.

In working with DID and more specifically with survivors of ritual abuse and mind control, the research shows that we are still struggling to get it right and we are all in the process of learning how to work effectively with this complex client group, which has the highest drop-out rate in treatment.

            Alison Miller’s recent book has delivered a much needed extra ingredient that is crucial to the understanding of the treatment of survivors of ritual abuse and mind control. These survivors often display an array of confusing symptoms which at times can be bewildering to a layman as well as to professionals.

            The book argues that treating survivors of ritual abuse and mind control will never be enough without understanding the nature and style of programming the client was exposed to. By doing so we are able to understand better the profound effect that mind control and programming has had on our clients. We also have the advantage of deprogramming them in a way, hopefully relationally, that proves that most of it is mind trickery using lies, deceit and terrorisation.  The information Alison Miller provides us with is particularly valuable to those of us who work with clients who are still currently maintaining contact with their abusers. This is the main reason why our success rate with this client group does not tend to be great. Working like a brilliant detective, Alison provides a set of keys to every programming lock used by the abusers. The book covers significant dates, self harm, suicide training, false memories, cult simulations, impersonation of therapists and much more. This book illuminates where we can go wrong and sheds light on how this can be avoided.

            The book is not only comprehensive and accessible to all (although for survivors it has a warning that it may contain triggers) but a real page turner. It is written with skill and a deep understanding by someone who has a deep appreciation of and concern for the subject matter, always putting the client’s needs first.

            Alison Miller’s astute logic and courage in getting into the mind of the mind controller is an inspiration. Her bravery in tackling this subject head-on goes beyond the boundaries of that of an ordinary therapist.

Shame

Director Steve McQueen, 2011

 

Book reviewed by Orit Badouk Epstein

From ESTD Newsletter Volume 2, Number 2, February 2012

In a recent BBC interview, the director Steve McQueen was challenged that unlike other substance abuse such as drug or alcohol, where the addict suffers cravings and withdrawal symptoms, sex cannot be defined as an addiction per se, to which McQueen replied: ‘Anything that rules ones life destructively where everything else becomes secondary and ruins his/her life can be defined as an addiction.’ (January 19th 2012)

            As with his previous powerful and bold film ‘Hunger’, McQueen’s unflinching style does not shy away from the brutal reality of the grittiest issues the human condition presents us with. ‘Shame’ is a film about sex addiction, self destruction and shattered attachment. New Yorker Brandon (Michael Fassbender) is a sleek looking likable yuppie who seemingly leads a successful career. However, his addiction to pornography, casual sex, paid sex and compulsive masturbation increasingly takes over his life. As with all addictions, the release of his addiction provides him with a means that he can avoid a real relationship. The only real relationship Brandon has is with his messed up sister Sissy (Carry Mulligan), who unlike her apparently self controlled brother, is needy and impulsive, she has no boundaries and is self-harming. Their failed attempts to connect with each other, seems to trigger them both and brings the worst out in each other.

            Shame and humiliation deeply buried under guilt, is at the forefront of Addiction.  Shame means that you feel bad for what or who you actually are. Shame sometimes results from being used in an unacceptable or degrading manner such as the shame about feeling physical excitment whilst one is being molested. The tormented addict’s tendency to defend against shame is to numb and forget the pain of the haunting memories and flashbacks of their abused childhood.  Shame is a painful emotion because it involves self loathing and critical judgment of oneself that leads to feelings of humiliation, inadequacy and isolation.

The profound loneliness and emptiness, where there is nowhere else to take his pain, is beautifully portrayed in slow motion, through the skyscrapers of New York’s grey urban alienation. To that account, short relief can work wonders; artificially helping regulate the inner chaos and depression, even if for a few hours. From beginning to end the film implicitly focuses on the siblings’ re-enactments in the present, unspoken yet haunting, subtly hinting about their shared abused past.

            Brandon’s gaze and daydreaming in front of the computer watching porn movies, shows us how dissociated he is, cut off from reality, whilst his addicted part-self masters control in a world of his own. This use of addiction to suppress and mask unbearable feelings of horror and pain,  reminded me of one of my DID clients who once told me: ‘There is something pure about watching people having sex on screen, when I watch them doing it, I feel safe as they can’t touch me and I can’t touch them.”

            McQueen’s has a breathtaking knack for detail which accurately captures the mindset of a sex addict.  The monotonous movements of his body, the mechanical way in which he goes about getting his sexual prey, the pain on his face whilst f***,  pushes eroticism to the side and  is a far cry from pleasure seeking . Another male client told me: ‘It’s like there is a hunter inside me. He is ruthless. He has no emotion; he is on a mission, he needs to f***. He needs to f*** now. He knows how to find the best body for that. There is no eye contact, if she/he looks at me. It’s over, done with’.

            Shame is not only about addiction, it’s also about broken attachment and search for intimacy. Brandon’s sister Sissy’s neediness for him infuriates him; her lack of boundaries drives him to distraction.  She shames him by sleeping with his boss; she humiliates him by catching him masturbating. They obviously share a traumatic past; she is a constant reminder of that past. He thinks he is in control of his life but she is there to point out the contrary. He denies her feelings, she won’t let go of him: “We are not bad people we just come from a bad place” her phone message to him, just before their tragic story reaches a climax.

This is not only a daring and stylish film but a painful and an authentic testimony of the human capacity to self destruct.