Complex Trauma: Dissociation, Fragmentation, and Self Understanding
For those of us working in the field of complex trauma, one of the most exciting events of 2017 was the release of Healing the Fragmented Selves of Trauma Survivors by Dr. Janina Fisher. The book is a wonderful summary and synthesis of the current state of knowledge in trauma research enlivened with wisdom, insight and deep compassion for the victims of abuse. Dr. Fisher draws together neurobiological research, psychological theory, and a productive, if sometimes painful, process of trial and error in which dozens of committed therapists sought out better ways of helping survivors of trauma.
Unfortunately, many people suffering from the after effects of a traumatic childhood have summoned up the courage necessary to start a course of therapy only to be forced to stop because confronting their repressed or partially repressed memories caused a breakdown or personal crisis that made it impossible to continue with therapy. While it can be argued that therapy on the “it must get worse before it gets better” model nevertheless helped many people, the desirability of finding a less painful model is obvious. Dr. Fisher describes both the new, improved model for trauma therapy and the process by which it came about, which is itself a fascinating story. The book is, I believe, required reading for anyone in the psychology profession, but is also aimed at victims of complex trauma, especially those starting therapy, and can be profitably read by anyone who has friends or family members with complex trauma, or anyone with an interest in the subject.
To do the book justice would be impossible within a single article, but I will attempt to describe some of its main features. As the subtitle, ‘Overcoming Internal Self-Alienation’, indicates, a central theme of the book is the phenomenon of dissociation, which is found in so many survivors of trauma and not only those who meet the criteria for Dissociative Identity Disorder (DID) found in the DSM-V. Dr. Fisher discusses the different ways that dissociation or alienation manifests itself in people who have been through extended periods of trauma and explains a biological mechanism for these symptoms which makes sense in the light of contemporary neuroscience and the study of human and animal behavior.
The human brain is a remarkable machine, refined by millions of years of evolution for survival. Perhaps its most remarkable feature is its ability to learn and adapt to different environments. Most animals will struggle if placed in a environment only slightly different to that to which they are adapted, but, a mere 50,000 years after leaving Africa, human beings have learned to not only survive, but to thrive in environments as diverse as the Canadian tundra, Amazon rainforest, Gobi Desert and the Himalayan mountains. While all animals develop by responding to stimuli, the ability to adapt to a variety of different situations in humans in unparalleled. To our enduring sorrow, one of the most extreme, but far from rare, situations that humans have to develop coping mechanisms for is abuse at the hands of a caregiver.
Dr. Fisher explains the mechanism by which abused children, kidnapping victims and other victims of complex trauma cope with the most horrific forms of violence and cruelty by dissociating, that is to say separating the part of their personality that experiences the abuse from the parts that experience other aspects of life. This is particularly essential when the abuse happens at the hands of a primary caregiver who is also responsible for providing food, shelter and physical protection. In such a situation, the abused has to learn to function in a dual way, seeing one and the same person both as a threat and a source of essential goods. Dissociation — the fracturing of the personality into different parts — is the easiest, perhaps the only possible, way of doing this. Since even the healthiest and most well adjusted person has a variegated personality (you probably act somewhat differently at a party to the way you act at work, or, if you don’t, you probably should), the abused person can be described as drawing on a normal part of the brain’s toolkit in a extreme and, ultimately, damaging way as the only path to survival.
Understanding how trauma produces dissociative symptoms points to the way to the solutions. Dissociation is not, properly speaking, the result of a damaged brain, but the result of a learning process. A learning process, it is true, that should never have had to have happened, but nevertheless something that is in itself a positive. The way out of complex trauma is to recognize the different fractures of your personality not as a wound, but as a badge of survival — not as something that should be excised, but as parts of you that require reintegration. The path to healing, Dr. Fisher explains, is found in genuine self-love, in the desire to care for each part of your personality. Dissociative episodes can be painful, frightening, and disturbing, often highly so, but hating a part of yourself only prolongs the agony.
What I find most fascinating about Dr. Fisher’s book is the way she shows that complex trauma victims can progress better in therapy when they have a good understanding of their fragmented personality, what caused it and what sustains it. This reminds us of a fundamental difference between mental health and other areas of medicine. An operation or pill works just as well regardless of how well you understand its mechanism. It is true that the placebo effect is powerful and indicates a connection between belief and healing, but this only requires that you believe the treatment works, not that you have any understanding of how it does so. Psychotherapy, by contrast, is often more effective when the person in therapy develops an understanding of how his or her thoughts operate. Indeed, an important part of therapy (though not the only part!) is the communication of knowledge in order to generate self understanding. In this respect, therapy bears a close relationship to philosophy and many religious traditions, in particular those based on meditation and self reflection. Mindfulness, of course, is the most cited example of a psychological technique that developed from a religious (specifically a Buddhist) source, but the observation applies more widely.