Drawing on the pioneering work of Janet, Freud,
Sullivan, and Fairbairn and making extensive use of
recent literature, Elizabeth Howell develops a
comprehensive model of the dissociative mind.
Dissociation, for her, suffuses everyday life; it is a
relationally structured survival strategy that arises
out of the mind's need to allow interaction with
frightening but still urgently needed others. For
therapists dissociated self-states are among the
everyday fare of clinical work and gain expression in
dreams, projective identifications, and enactments.
Pathological dissociation, on the other hand, results
when the psyche is overwhelmed by trauma and signals the
collapse of relationality and an addictive clinging to
dissociative solutions. Howell examines the relationship
of segregated models of attachment, disorganized
attachment, mentalization, and defensive exclusion to
dissociative processes in general and to particular
kinds of dissociative solutions. Enactments are reframed
as unconscious procedural ways of being with others that
often result in segregated systems of attachment.
Clinical phenomena associated with splitting are
assigned to a model of ?attachment-based dissociation?
in which alternating dissociated self-states develop
along an axis of relational trauma. Later chapters of
the book examine dissociation in relation to
pathological narcissism; the creation and reproduction
of gender; and psychopathy. Elegant in conception,
thoughtful in tone, broad and deep in clinical
applications, Howell takes the reader from
neurophysiology to attachment theory to the clinical
remediation of trauma states to the reality of evil. It
provides a masterful overview of a literature that
extends forward to the writings of Bromberg, Stern,
Ryle, and others. The capstone of contemporary
understandings of dissociation in relation to
development and psychopathology, The Dissociative Mind
will be an adventure and an education for its many
clinical readers. |
|