Structural dissociation and the divided self

Military physicians treating shell-shocked soldiers in the First World War kept seeing the same thing. A man would be composed and going through the motions of duty one moment, then flung back into an active war zone the next. One person, two ways of being, depending on which part was in the foreground. Those war doctors gave the two states their lasting names, and a century later the observation has grown into one of the more provocative theories in the trauma field.

The pattern was older than its trench-era names. Pierre Janet had been describing it since the 1880s, framing trauma as producing symptoms of “too little” or “too much” (Janet, 1904, as cited in van der Hart et al., 2010, p. 77). On the “too-little” side are the numbness and the eerie sense that the whole thing happened to “not me.” On the “too-much” side are the flashbacks, the nightmares, and hyperarousal.

Van der Hart, Nijenhuis, and Solomon (2010) gathered observations like these into the theory of structural dissociation of the personality, putting forth their central claim that the personality does not stay whole in the face of trauma. It divides into subsystems that go on operating semi-independently, what they call being “unduly divided in two basic types of dissociative subsystems or parts” (p. 76).

The part of a person that goes to work, raises the kids, pays the bills, and can even talk about the trauma without getting overwhelmed is what became known as the Apparently Normal Part. This is the part that keeps daily life running, and as the Apparently Normal Part the individual “is fixated in avoidance of traumatic memories and often of inner experience in general” (p. 80). The other part became known as the Emotional Part. This is the part that holds the trauma itself, including the terror, the freeze, the smells and sounds and bodily sensations of the event, experienced as if it’s still happening now.

The high-functioning person with PTSD and the person with a severe dissociative disorder sit on one continuum, differing mainly in how many parts there are and how walled off they have become from each other.

The progressive move in the theory is that it’s not limited to the more conspicuous dissociative disorders that clinicians encounter less often. The authors argue that “all trauma-related disorders, including posttraumatic stress disorder (PTSD) as the most simple one, are recognized as being dissociative in nature” (p. 77). The high-functioning person with PTSD and the person with a severe dissociative disorder sit on one continuum, differing mainly in how many parts there are and how walled off they have become from each other.

The paper quotes a piece of testimony from Charlotte Delbo, who survived Auschwitz and decades later could deliver public lectures about the camp. The self who had been in the camp, she said, "isn't me, isn't the person who is here, opposite you" (Langer, 1991, as cited in van der Hart et al., 2010, p. 79). She was describing two first-person perspectives inside one person, each with its own memories, its own sense of what is real, and its own relationship to time. The self that lectured had no access to the feeling of the camp, and the self that lived in the camp had no access to the present.

She was describing two first-person perspectives inside one person, each with its own memories, its own sense of what is real, and its own relationship to time.

The authors organize structural dissociation along a spectrum. In its simplest form, the version they tie to ordinary PTSD, there is one everyday self and one traumatized part. When the trauma starts earlier in life, runs chronic, and comes from the people meant to provide care, the structure grows more elaborate. The traumatized part of the personality divides into more than one Emotional Part, each holding a different piece of the experience. In the most severe presentations the everyday self fractures as well. One principle that runs through structural dissociation theory is that the more overwhelming and chronic the trauma, the more the personality divides in order to survive it.

The authors describe this model as “an open theory, that is, in continuous development” (p. 89), and some of its finer neurobiological claims remain contested in the research. Its clinical usefulness, though, has never depended on every detail of the brain science being settled. It gives therapists and survivors a precise way to understand their patterns and self-experience.

What keeps the division in place, sometimes for decades after the danger has passed, is what Janet called the phobia of traumatic memories, "the essence of which seems to be an avoidance of full realization of the trauma and its effects on one's life" (Janet, 1904, as cited in van der Hart et al., 2010, p. 82). The traumatized part feels dangerous to the everyday part, which learns to keep its distance, and that distance is what stops the memory from ever being metabolized. The writer Aharon Appelfeld, another Holocaust survivor, caught the texture of it when he wrote "The moment any memory or a shred of a memory was about to float upwards, we would fight against it as though against evil spirits" (Appelfeld, 1994, as cited in van der Hart et al., 2010, p. 82).

“The moment any memory or a shred of a memory was about to float upwards, we would fight against it as though against evil spirits” (Appelfeld, 1994, as cited in van der Hart et al., 2010, p. 82).

If the trauma lives inside a part of the self that the rest of the system has spent years holding at bay, then forcing contact with that material before the system is ready can do real harm. The authors write that if you treat such a patient as though they were a simple PTSD case, "a veritable Pandora's box may be opened and therapeutic and adaptive disaster may ensue" (p. 81). On EMDR specifically, the approach these authors practice and teach, they warn that premature exposure to traumatic memories "is ineffective at best and causes severe decompensation of the patient at worst" (p. 88). This is why phase-oriented treatment is indispensable. You stabilize first, slowly building the survivor’s capacity to regulate and to stay anchored in the present. You approach the traumatic memories only when the system can bear the contact. And the long arc of the work is integration.

Integration happens when the trauma enters into relationship with the rest of the self, to the point where the survivor can say something close to “that happened to me and I am aware of how it helped shape who I am” (van der Hart et al., 2010, p. 87). The event moves from present tense to past tense. The authors, borrowing from Janet once more, define mental health itself as “a high capacity for integration, which unites a broad range of psychological phenomena within one personality” (Janet, 1889, as cited in van der Hart et al., 2010, p. 86).

Survivors find integration by slowly building steadiness and presence while engaging with the trauma material, until the part of them frozen in the event and the part running an ordinary life stop avoiding each other and begin to cooperate.

References

van der Hart, O., Nijenhuis, E. R. S., & Solomon, R. (2010). Dissociation of the personality in complex trauma-related disorders and EMDR: Theoretical considerations. Journal of EMDR Practice and Research, 4(2), 76–92. https://doi.org/10.1891/1933-3196.4.2.76