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Comments on a paper given by Paul Dell at International Society for the Study of Dissociation Conference in 2002.

I listened to a taped talk by Paul Dell titled ‘What the heck is dissociation anyway?’ (paper delivered at the International Society for the Study of Dissociation Conference, 2002) and felt really excited – here was a guy who understood. He included a lot of technical information regarding the diagnostic manuals used by the medical professions, and then focussed on research from published papers on what people with dissociation actually experienced.

Dell started with the well known classic picture of DID: ‘a person with DID switches from one personality to another, each personality has its own identity and the host personality has amnesia for the activities of the other personalities.’ This classic picture of DID is clearly depicted in DSMIV and is widely known in the general culture. Dell believes that the classic picture of DID is skewed to the point of being a very poor representation of DID.

The diagnostic manuals (DSM, and to some extent the ICD), concentrate on switching and amnesia in their diagnosis of DID. But Dell states that this switching and amnesia is happening for a very small amount of time. Putting two of his comments together, the amount of time switching occurs might average less than half of one per cent. In addition, Dell says ‘People are not confused because they switch. They are often unaware of the switching. Rather, they are confused by what they are experiencing when they do not switch. If the everyday self is not aware of the switching and lost time, then it isn’t a problem. Diagnosis is therefore difficult if the symptoms insisted upon for DID are so infrequent (and often going undetected by the patients themselves).’

Dell has concentrated on the subjective, phenomenological experience of chronic dissociative symptoms. He says that from a subjective perspective, dissociative symptoms are startling invasions of one’s mind and one’s experience. His definition of dissociation is as follows: dissociative phenomena are unbidden, jarring intrusions into one’s executive functioning and one’s sense of self. Research has shown that for 40% of the time DID patients are struggling with these jarring intrusions, and Dell surmises the ratio of intrusions to switching may be in the order of 100:1. Therefore, Dell believes, the classic picture of DID has ignored the experiential core of DID.

The DSMIV says that the domain of dissociative phenomena is bounded by consciousness, memory, identity and perception. ICD10 says that the domain of dissociative phenomena is bounded by memory, identity, sensation and bodily movements. But in fact there is no human experience that is immune to invasion by dissociative symptoms. They can occur as body sensations, feelings, impulses, actions and thinking. These come pushing through from the split off parts of the self that are frozen in time, holding trauma, pain, troubling or compelling thoughts, feelings, somatic energy, and the whole range of human experience.

The essential difference between partial and full dissociation is the person’s contemporaneous awareness of his or her actions. Full dissociation entails amnesia. During partial dissociation, dissociative individuals have contemporary awareness of all other dissociative intrusions. They feel them, they know them, they’re weird and they say “I feel like I’m losing my mind”. With the exception of amnesia, all dissociative events are partial. And, in a person with DID the overwhelming majority of dissociative events are partial, not full.

Dell’s emphasis on the jarring intrusions rather than the amnesia is most welcome. The distressing intrusions are what cause most DID patients to seek help. The amnesia they may not know about, but with the help of a therapist any unremembered events can be reclaimed as dissociated parts of the self feel safe enough to come to the surface, and the everyday self feels safe enough to allow release and resolution.

Extra thought: Without (or before) the jarring intrusions into their minds and bodies, people who have successfully used (full) dissociation as a defence/coping mechanism are functioning ‘OK’ and do not have a disorder. It is the jarring intrusions that cause the dissociation to become a disorder.