Handbook of Dissociation: Theoretical, Empirical, and Clinical Perspectives. - book reviews

Journal of Parapsychology, The, Sept, 1997 by Carlos S. Alvarado

During the last few decades, the study of dissociation has progressed immensely at the research and methodological level. Such an interest has also been reflected in the study of parapsychological experiences as seen in the work of Richards (1991), Ross and Joshi (1992), Zingrone and Alvarado (1994), and Pekala, Kumar and Marcano (1995). However, regardless of these exceptions, there is little connection today between students of dissociation and students of parapsychological phenomena. This has occurred in spite of the fact that the origins of paraPsychology are intimately related to the concept of dissociation, as seen in the early work of the Society for Psychical Research with hypnosis and trance mediumship.

The Handbook of Dissociation reviewed here provides an opportunity for parapsychological researchers and other students of human behavior to become acquainted with a concept and a literature that was common knowledge (considering the time periods) to early psychical researchers such as Edmund Gurney, Frederic W. H. Myers, and Charles Richet. Part 1 of the handbook, "Foundations," consists of three papers: 1) the history, phenomenology, and epidemiology of dissociation, 2) European studies of dissociation, and 3) studies conducted with nonclinical populations. This last chapter, written by one of the editors, William Ray, is a welcome addition to a book devoted almost exclusively to clinical concerns.

The second section, "Developmental Perspectives," focuses on incest, child abuse, and on the occurrence of dissociative disorders in children. A section on theoretical models includes discussion of neurobiological aspects of dissociation, the relationship between hypnosis and dissociation, and an information-processing approach to "emotional" dissociation. The paper on hypnosis by Jonathan Whalen and Michael Nash questions the validity of the association between hypnotic susceptibility with trauma and measures of dissociation. Unlike most other chapters, in this one the authors are concerned with methodological issues such as confounding variables and point out that the effect sizes of the relationships are unimpressive. Their approach differs from many of the other authors of the handbook in that most of them write as clinicians, while Whalen and Nash write as researchers.

This is followed by sections on the assessment of dissociation (diagnostic issues, use of scales, psychophysiological studies), on particular diagnostic classifications (depersonalization and derealization, amnesia and fugue, dissociative identity disorder [DID, formerly Multiple Personality Disorder], acute stress disorder, and responses to traumas and abuse). Marlene Steinberg's paper on the scales used to study dissociation should be of value to researchers in selecting appropriate instruments to quantify dissociative experience and relate them to other variables. However, one wishes this paper had included a more complete coverage of the work done with these instruments in terms of validation. It is also puzzling to see that this paper, and the rest of the book, ignores recent criticisms of the validity of the factors of the Dissociative Experiences Scale (DES), probably the most widely used instrument to study dissociation. Comments about this problem appeared in the journal Dissociation (Carlson & Putnam, 1993) and should be included in any discussion of the factors of the scale. Another methodological issue ignored in this chapter, in the book, and in the field as a whole, is the transparent nature of dissociation scales and the context of testing. Scales such as the DES are generally administered without buffer items and in situations where the psychological set of the testing context may affect the results.

Finally, there are two sections about therapy (e.g., psychodynamic therapy of DID, hypnotherapy with post-traumatic stress disorder [PTSD], psychopharmacology), and on special topics consisting of sadistic ritual abuse and legal and ethical problems in the treatment of dissociative disorders.

This book is an excellent reference source to many areas of dissociation, especially regarding clinical implications. This is certainly a reflection of the need to alleviate the plight of those suffering from PTSD, DID, and other conditions. From this perspective, there is much to learn from the chapters of Jean Goodwin and Roberta Sachs on child abuse and dissociation disorders, of Etzel Cardena and David Spiegel on diagnosis, definitions and comorbidity of dissociative disorders, and from the review of particular diagnostic classifications, such as Richard Kluft's discussion of DID.

But, regardless of all the advantages of this work, the book has some weaknesses that should be mentioned. First, a handbook on dissociation should have included chapters about the critical tradition that argues for iatrogenesis and false memories in the creation and development of DID and other dissociative disorders, since they are widely discussed and taken seriously by many in the psychological and psychiatric communities. Granted, some discussions of these issues appear in Kluft's chapter about DID and elsewhere. But this handbook should have followed the example set by students of dissociation such as Martinez-Taboas (1995), who devoted a chapter in his recent book on DID to discuss the case for and against the iatrogenesis hypothesis, giving space to the arguments of the most prominent supporters of such ideas. My impression is that many in the field of DID (and dissociation studies in general) think that discussions of false memory syndrome and iatrogenesis are tendentious and the argument of the ignorant. But, regardless of the validity of these positions, one should not forget that these arguments are espoused by many individuals and that a better case for dissociation studies can be made if the topic is discussed in detail. In this sense I see a parallel between parapsychology and dissociation studies. Although it can be debilitating to devote too much time to critics, one should always be aware that a public presentation of one's controversial findings is always more credible if one shows that the counterarguments have been considered and dealt with.