Etymologically, the word “trauma” means “damage” or “wound”. Even professionals often mix things up, and “trauma” is quite commonly used to refer to an experience or event in a person’s life. However, “trauma” should be used to refer specifically to the emotional damage an event has caused in a person. This becomes much simpler if, in looking for a definition, we return to Pierre Janet’s ideas. ”Emotional trauma” refers to psychophysical damage manifested as a splitting of the personality.”
It is also essential that the concept of “structural dissociation” is understood precisely and internalised. Countless authors and even professionals use the term in different, contradictory and/or ambiguous ways. Furthermore, the official definition of dissociation is too vague in disorder classifications, and I am not the only one who has this opinion. In this book – as in the field of trauma treatment in general – the word “dissociation” is used in diverse ways. For me, it means precisely the splitting of one’s personality: that is, structural dissociation. I will now try to express in a simplified way what this means in practice.
Structural dissociation is manifested in such a way that, in connection with traumatisation, one’s personality becomes split into parts that experience both themselves and the world in different ways. The personality is divided into at least two parts as the result of an unbearable emotional state that has a powerful and paralysing effect on one’s capacity to act. One of the two parts of the personality consists of a defensive reaction triggered by a life-threatening situation and traumatic memories of it; it is called the “emotional part of personality” (the EP). The other part is characterised by an effort to continue living as if the damaging experience had never occurred; it is called the “apparently normal part of personality”(the ANP). This splitting of the personality in response to severe psychological damage seems to be the original meaning of “dissociation” – a meaning I have absorbed while following in the footsteps of Pierre Janet and Onno van der Hart.
In the spirit of Janet, we can say that emotional trauma is triggered by a failure in the process of synthesising one’s personality. There is no cause-and-effect relationship between trauma and dissociation: they are the same thing, though expressed in different terms.
Structural dissociation is the most important trauma-related common denominator uniting the stories of this book. Still, the stories are all different, just as every life story is different. Adopting the original meaning of the concept of dissociation may increase both the concept’s explanatory value and its consistent use in everyday work with patients.
At best, this rather simple definition can be shared by professionals and patients alike and will, in that case, guide daily practical work on traumatisation. This means that a traumatised person will finally feel that he or she is seen as a whole being: that is, the various parts of his/her personality are gradually met, taken into consideration and understood in therapy. Then they can also participate safely in interactions between people.
As I understand it, dissociation – and structural dissociation to be precise – was Janet’s single most important concept. This view is supported both by the countless successes I have had in treating traumatised people, and by my own experience of healing. Apparently, the internalisation of this dissociation model is even a pre-condition for healing. Indeed, the theory on the structural dissociation of the personality has helped me grasp in a completely new way what traumatisation and its effects are all about, what kind of approach is needed to analyse and understand the life of a traumatised person, and how the person can be treated. Professor Onno van der Hart and his colleagues have been concerned with the meaning of “dissociation” for a long time, speaking in favour of a consistent meaning for the concept all over the world.
The same basic division (ANP – EP) can also be found in post-traumatic stress disorders (PTSD). However, it is manifested in a clearer and more complex form in dissociative identity disorders (DID). The set of symptoms a traumatised person shows is explained by a characteristic and dynamic alternating pattern between the different parts of the personality. Professionals working with traumas have been familiar with this alternation for at least for 150 years. I have examined the surprisingly diverse implications of this relatively simple phenomenon and its effect on psychiatry in my book Katkennut totuus.
The theory of traumatisation is a construct that is continuously evolving. A great indication of this is the model for the trinity of trauma introduced by Ellert Nijenhuis in his recent book Trinity of Trauma (2015 & 2017), in which EPs can be divided into two main categories. In its simplicity, Nijenhuis’s redefinition is ingenious and immediately applicable to practice. When the light dawns on both therapist and patient, the expressions on their faces cannot be misinterpreted.
I could even claim that a traumatised person cannot be understood wholly and sufficiently without the concept of structural dissociation. Still, it is equally essential to remember that every person is unique. We should not make the mistake of trying to be prescient.
We reach a completely new level of understanding of the stories of this book – and of all life stories dealing with a variety of emotional injuries – when they are analysed using the two most important theories dealing with trauma treatment. The first is the theory on the structural dissociation of the personality described earlier. The other is the polyvagal theory, which explains how the autonomic nervous system works and how people defend themselves when threatened. A sense of security is the most important condition for healing, and I consider it, at present, to be a scientific fact that the autonomic nervous system is vitally important in producing a sense of security. The capacity of the autonomic nervous system to act is shaped by experiences, which explains why traumatised people often have distinct problems defending themselves properly (Leikola et al., 2016). As gestalt therapist Kurt Lewin has wisely noted, “Nothing is as practical as a good theory”. Here we have at least two of them.
In addition to structural dissociation, traumatised people move between a range of “altered states of consciousness”. This applies to people with severe childhood traumas in particular. These altered states of consciousness aim at the same thing as the structural dissociation of the personality: derealisation, a concept to which I will return later in this introduction. Alternations of consciousness can equally well lead to a narrowed field or a depressed level of consciousness. Typically, they are manifested in practice in such a way that the person does not feel present, or an outsider feels that the person has vanished and can no longer be contacted. The reactions are, in a way, subconscious ways of avoiding the knowledge of what has happened in the past, what the experience means, and how it has affected one’s life (Van der Hart et al., 2004).
Thus, the organism has, in the course of evolution, acquired many ways of avoiding awareness of harmful scenes of the past. But the cost of such avoidance is high, as all the contributors to this book show in an analytical way. Both in this book and in other writings on dissociation, such intense alternations between states of consciousness are also referred to by the term “dissociation”.
There is infinite variation in the manifestations and depths of the structural dissociation of the personality and in the relations between the parts of the personality. On the other hand, due to the basic biological structure of human beings, we can expect to find certain characteristic parts of the personality. Mechanisms, or emotional operating systems, that are common to all mammals (see, e.g., Panksepp, 1998) guide human behaviour both in ordinary situations and in situations where we are defending ourselves against danger. What it all boils down to is how integrated – and thus cooperative – these mechanisms are.
Psychiatrist, therapist, author, expert by experience
From Introduction / Five Survivors, a Hundred Lives book