Sunday, 3 June 2012

Book review: Attachment, Trauma and Multiplicity

Attachment, Trauma and Multiplicity: Working With Dissociative Identity Disorder Edited by Valerie Sinason

Review by Harold Merskey

This volume contains an introduction and one chapter by Ms. Sinason, a message, short pieces with dedications by two DID mothers for their daughters, and a DID patient’s statement on her marriage, followed by 16 chapters by different authors for each of whom a biographical note is provided.  

They range from Peter Fonagy, Ph.D. F.B.A., Freud Memorial Professor of Psychoanalysis, University College London, as well as Director of the Sub-Department there of Clinical Health Psychology; and Dr. Felicity De Zulueta, an Honorary Consultant Psychiatrist in Psychotherapy, Maudsley Hospital; to a Detective Chief Inspector, Clive Driscoll, who has completed 29 years of service in the Metropolitan Police during which time he worked within a variety of units including a Child Protection Team and general CID studies.  

There are also two Professors of Psycholog besides four members or Fellows of the College including Dr. De Zulueta.  The headings include Multiple Voices Versus Metacognition: An Attachment Theory Perspective by Professor Fonagy; Traumatic Stress Disorder and Dissociation: Traumatic Stress Service in the Maudsley Hospital by Professor De Zulueta; The Shoemaker and the Elves by Ms. Sinason.

There are four parts to the volume, Part I - Mapping the Territory: Childhood Aetiology, Attachment Research, Attachment Patterns, Abuse, Dissociation, Dissociative Identity Disorder and Culture: Part II - Attachment Focus: mainly theory: Part III -  Attachment Focus: mainly practice, and: Part IV -  Other frames of reference which include linguistic, diagnostic, forensic and historic issues.  The final chapter is an interview with the late Professor Flora Rheta Schreiber, the author of the landmark book “Sybil”.

This volume is entirely devoted to a  sometimes child-like presentation (by the patients) of purported dissociative states.  The “abuse family” is described by Adah Sachs, an analytic psychotherapist who “...lectures widely on trauma and dissociation, and maintains a small private practice”.   The chapter of Dr. Joan Goodwin of Galveston, Texas is titled Snow-White and the Seven Diagnoses.  There is throughout an uncritical acceptance of the validity of Dissociative Identity Disorder.  

I was distressed to learn from a healthy list of Clinical and Support links that “The largest mental health charity, MIND, has a helpful booklet on “dissociation” for patients and their  
friends and families”.   

No one cites among the references any critical statement by a professional society such as the Royal College with respect to Recovered Memories although belief in the latter is incorporated throughout the volume.  Brandon’s name is singularly absent along with the almost equally forthright statements of the Canadian Psychiatric Association and the  Australian Psychological Association or any discussion of the critical views of current theories of dissociation.  Perish the thought - all that critical stuff has been substantially ignored.

The legal risks of false accusations  and the disastrous outcomes of treatment in many developed countries,  especially in the United States, are not to be found in the book although there are three pages by Phil Mollon, Ph.D. on memory and DID and a passing mention of false memory in three other places.  

The evidence for outcomes with “DID treatment” fails to come to grips with any of the serious flaws in the dissociation theory and “Dissociative Identity Disorder”, or for that matter with the very poor results of its treatment compared with normal management of similar patients under other diagnoses.

It is a book for believers only.

Attachment, Trauma and Multiplicity: Working With Dissociative Identity Disorder,
Ed, Valerie Sinason 
Routledge: Hove East Sussex, 2011, 2nd. Edition pp. 226.
(ISBN 978-0-415-49179-2 (hbk) 978-0-415-49181-5 (pbk)

Harold Merskey
London ON