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Running head: DISSOCIATION AND TRAUMA Hysterical Neurosis:
Dissociation in Response to Psycho-Physiological Trauma ?
A Brief Inquiry Hysterical Neurosis: 2 DISSOCIATION AND TRAUMA
Dissociation in Response to Psycho-Physiological Trauma ?
A Brief Inquiry
Students of dissociative phenomena in psychological problems, the capacity of human
beings to drive the pain of trauma into the realm of psychological oblivion (e.g.
unconsciousness) will find the views of Judith Herman (1997) rather interesting. Herman
(1997), an M.D., a psychiatrist, and an avowed feminist, has studied the violence and abuse
heaped upon women in considerable depth. In 1976, she wrote a paper on incest with Lisa Hirschman, at a time when the sexual abuse in families was not a common topic (Herman, 1997).
In the decades afterwards, she continued to study sexual and domestic violence in women.
However, in time, she would come to note the ?commonalities?between rape survivors and
combat veterans, between women and political prisoners, between the survivors of vast
concentration camps created by tyrants who rule nations and?[the] hidden concentration camps
created by tyrants who rule their homes? (Herman, 1997, p. 3).
In examining these seemingly disparate tragedies, Dr. Herman would come to believe that
what linked these events, personal and political, beyond the obvious variable of tragedy, was ?the
central dialectic of psychological trauma? (Herman, 1997, p. 1). In short, in all of these
occurrences, a conflict would occur ?between the will to deny horrible events and the will to
proclaim them aloud? (Herman, 1997, p. 1). Moreover, ?the dialectic of trauma gives rise to
complicated, sometimes uncanny alterations of consciousness?which mental health
professionals?call ?dissociation?? (Herman, 1997, p.1). Charcot, Freud, and Janet, and
subsequent clinicians called the bitter fruit of dissociative phenomena, hysteria, whose genesis
was abuse, trauma, denial, and repression (Herman, 1997). DISSOCIATION AND TRAUMA 3 Later, when the medical histories of combat veterans, almost all exclusively male were
examined, the damage of trauma and repression would be noted in such conditions as posttraumatic stress disorder. In time, crime victims, police officers and emergency responders
would be found to be susceptible to the stress of trauma, with the potential for stress-related
disorders, dissociative disorders, and the like. The purpose of this paper is to examine the
centrality of trauma in the genesis of such conditions of post-traumatic stress disorder, hysteria,
and dissociative identity disorder, a variant of hysteria. It will draw, principally from the work of
Judith Lewis Herman (1997), and her linkage of various behaviors and psychological problems
and suffering with trauma, abuse. Other authors will be examined as well, but in this paper,
Herman (1997) has pride of place with respect to this rather critical health problem.
Abuse, Trauma, and Psycho-Physiological Disorders
John Caffey, M.D., a radiologist working at Columbia University wrote a paper in 1946,
explaining that some infants and children were x-rayed and demonstrated ?unexplained multiple
fractures?[and] an increased number of victims with subdural hematoma?[that is] blood under
the skull? (cited in Crosson-Tower, 2010, p. 12). Clearly, children were being abused by modern
standards, but the medical and social conventions of the day would not permit Dr. Caffey to say
so explicitly. Therefore, he couched his explanations, somewhat cautiously: ?In one of these
cases, the infant was clearly unwanted by both parents and this raised the question of intentional
ill treatment of the infant; the evidence was inadequate to prove or disprove this point? (Caffey,
1946, cited in Crosson-Tower, 2010, p. 12).
Somewhat less cautiously, Kempe, Silverman, Steele, Droegemueller, and Silver (1962),
would also examine the clinical reality that Caffey (1946) described almost 20 years earlier. In
this, they showed a greater willingness to consider the matter in greater depth. Moreover, as a DISSOCIATION AND TRAUMA 4 result of working in a more relaxed cultural and academic milieu, these researchers probably
were willing to face the matter more directly. They named the violence and injuries that Caffey?s
young patients showed on x-rays by the term Battered Child Syndrome, a condition in minors
when they had apparently been victims of severe physical abuse, generally at the hands of a
parent or foster parent (Crosson-Tower, 2010; Kempe et al.,1962).
Kempe et al. (1962), also examined 302 cases of child abuse in 71 hospitals. Here, they
found that ?33 of these children subsequently died and 85 suffered permanent brain injury?
(Crosson-Tower, 2010, p. 12). Finkelhor (1981) studied 700 households in Boston, and his
findings were somewhat eye opening. Somewhere ?between 9 and 52 percent of the females and
between 3 and 9 percent of the males had some sexual abuse exposure? (Finkelhor, 1981, cited in
Crosson-Tower, 2010, p. 130). These numbers revealed that child abuse was a problem of
pervasive chronicity in American life; the various research findings also revealed that the study
of trauma has often led researchers ?into realms of the unthinkable and foundered on
fundamental questions of belief? (Herman, 1997, p. 7).
Secrecy and silence, according to Herman (1997) are the tactics by which assailants seek
to protect themselves from justice and the wrath of victims. This secrecy can also confound the
response of caretakers and first-responders, and medical providers. In short, there are times in
history when the culture and social conventions inhibit honest scientific inquiry. At such times,
researchers are unable and unwilling to examine the horrific nature of trauma and its aftermath
with unflinching honesty. By way of example, note the caution bordering on conspiratorial
silence that Freud and others, including Caffey (1946), to a lesser extent, demonstrated in
describing the abuse of infants at the hands of their parents (Crosson-Tower, 2010; Herman,
1997). DISSOCIATION AND TRAUMA 5 Silence and invisibility: The elements of conspiracy. A de facto refusal to grapple with
uncomfortable scientific realities can have tragic consequences for victims of crime ad trauma in
various periods of history. Researchers studying the reality and effects of psychological trauma
?must constantly contend with this tendency to discredit the victim or to render her invisible?
(Herman, 1997, p. 8). In do doing, the victim and her champions are once again returned to
pride of place within the discussion of the central dialectic of trauma (Herman, 1997). An
honest evaluation of trauma and its effects ?requires a social context that affirms and protects the
victim and that joins victim and witness in a common alliance? (Herman, 1997, p. 9).
In the twentieth century, for example, there were three times, in particular, in which ?a
particular form of psychological trauma has surfaced into public consciousness? (Herman, 1997,
p. 9). In all those instances, the inquiry into the specific forms of trauma and its aftermath
required a political movement, in order to gain any social traction (Herman, 1997, p. 9). These
problems were hysteria in the 19th century; the second was shell-shock or combat neurosis, a
condition that was noted in England and the United States after World War I, culminating in the
recognition of post-traumatic stress disorder, as a result of the American involvement in Vietnam.
Finally, the awareness of sexual and domestic violence is the most recent trauma to be
recognized (Herman, 1997).
Hysteria: Sexuality and dissociation in the 19th century. Hysteria, the Greek word,
hysteron, meaning ?womb,? was a condition thought to afflict only women (Herman, 1997).
This thinking would turn out to be untrue, though at the time: ?most physicians believed it to be
a disease proper to women and originating in the uterus? (Herman, 1997, p. 10). Hysteria was
observed to consist of symptoms that could afflict patients physically (e.g. hysterical blindness,
paralysis, and the like), or through dissociative phenomena: amnesia, fugue states, DISSOCIATION AND TRAUMA 6 somnambulism, and most curious of all: multiple personality disorder or dissociative identity
disorder. Nevertheless, the business of examining hysteria in a rational, medical setting would
not take place until the late 19th century in Paris, France (Herman, 1997).
The Great Taxonomist of Hysteria -- Jean-Martin Charcot
Modern research into hysteria begins with a famous French neurologist, Jean-Martin
Charcot. Working at the Salpetriere, a famous French asylum in Paris in the late 1800s, Charcot
stripped a medical condition of its association with witchcraft and demonology (Herman, 1997).
His intellectual boldness was notable, and he would be succeeded by some rather significant
students including: William James, Pierre Janet, and, of course, Sigmund Freud (Herman, 1997).
Something of a 19th century rock star of medicine, Charcot?s researches and lectures were all the
rage in Paris. In his Tuesday Lectures, luminaries from the world o the theater, literature,
medicine, even ??actors and actresses?all full of morbid curiosity?? flocked to Charcot?s
lectures and demonstrations, in order to see themselves the ?young women who had found refuge
in the Salpetriere from lives of unremitting violence, exploitation and rape? (Herman, 1997, p.
Charcot is famous, too, because he took these wretched creatures seriously, to a point.
Not only did the Salpetriere afford the patients safety from their abusers, as performers of a
fashion, ?the asylum also offered [the patients] something close to fame? (Herman, 1997, p. 10).
In the time before Charcot, women diagnosed as hysterical were essentially considered to be
malingerers. Thus, the researches of Charcot would ?restore?dignity to the topic? (Herman,
1997, p. 11). Charcot termed hysteria, the great neurosis (Herman, 1997). He was meticulous in
his observations; he was exacting in his description of hysterical symptoms, particularly when
they were physical in nature (e.g. motor paralyses, convulsions, and amnesia). DISSOCIATION AND TRAUMA 7 In the 1880s, Charcot ?demonstrated that these symptoms were psychological, since they
could be artificially induced and relieved through the use of hypnosis? (Herman, 1997, p. 11).
Indeed, the ability to replicate hysterical symptoms in the laboratory would be demonstrated
again nearly a century later in a slightly different context. In the 1950s, the American
government through the Central Intelligence Agency would replicate what Charcot found:
government therapists were able to create multiple personality in the laboratory with mind
control, abuse, use of drugs like LSD, and unethical uses of hypnosis, to create super-spies and
super assassins called the Manchurian Candidate (Ross, n.d., p. 1).
The results in this instance were not necessarily therapeutic, unfortunately (Ross, n.d.).
In fact, there appears to be a high degree of malpractice and ethical lapses on the parts of some of
the researchers in regard to their human subjects. For example, trauma based problems were
found to occur in some experimental subjects (Ross, n.d.). Reports of suicide also occurred
when ?thousands of prisoners and mental patients were subjected to unethical mind control
experiments by leading psychiatrists and medical schools? (Ross, n.d., p. 2). These were the
infamous studies and experiments conducted in such activities as Operation Bluebird, Operation
Artichoke, and MKULTRA (Ross, n.d., pp. 2-3).
Returning to Charcot and his work, it is curious that while Charcot ?paid minute attention
to the symptoms of his hysterical patients, he had no interest whatsoever in their inner lives?
(Herman, 1997, p. 11). In this sense, Charcot was the cold, dispassionate scientist whom
Herman (1997) likens to a taxonomist, cataloging, studying, as if his patients were inanimate
objects. This tendency, however, led to an interesting scientific competition, as it were, between
two of Charcot?s most important disciples: Janet and Freud. The competition was the ambition
of both Freud and Janet to surpass Charcot?s accomplishments by not simply describing hysteria, DISSOCIATION AND TRAUMA 8 phenomenologically, but rather by ?demonstrating the cause of hysteria? (Herman, 1997, p.11).
Unlike their mentor, it was insufficient for either Freud or Janet to simply describe or catalogue
the symptom picture of hysteria. Indeed, in a competitive spirit, both researchers would race to
discover the etiology of hysteria (Herman, 1997). In the process, it was not enough to simply
replicate symptoms as Charcot did; Freud and Janet would both find it necessary to investigate
hysteria and dissociative phenomena at a deeper level than Charcot routinely did.
In pursuit of their goal, these investigators found that it was not sufficient to observe and
classify hysterics. It was necessary to talk with them. For a brief decade men of science
listened to women with a devotion and a respect unparalleled before or since. Daily
meetings with hysterical patients, often lasting for hours, were not uncommon (Herman,
1997, pp. 11-12).
The emergence of psychotherapy. In the process of studying hysterical phenomena,
Freud and Janet went further than Charcot, and in the process they gained valuable insights into
the genesis of hysteria. They also did something equally else of considerable importance: Freud
and Janet virtually invented the profession of psychodynamic psychotherapy in the process,
while racing to be the first to uncover the mystery of hysteria. In this they were successful; both
Freud and his collaborator, Josef Breuer in Vienna, and Janet in France both arrived at the truth
of the matter: ?hysteria was a condition caused by psychological trauma? (Herman, 1997, p. 12).
In response to the violence and abuse of sex crime, domestic violence, or child abuse, or the
violence of war:
Unbearable emotional reactions to traumatic events produced an altered state of
consciousness, which in turn induced the hysterical symptoms. Janet called this
alteration in consciousness ?dissociation.? Breuer and Freud called it ?double DISSOCIATION AND TRAUMA 9 consciousness.??Both Janet and Freud recognized the essential similarity of altered
states of consciousness induced by psychological trauma and those induced by
hypnosis?Both Janet and Freud recognized that that the somatic symptoms of hysteria
represented disguised representations of intensely distressing events which had been
banished from memory?Breuer and Freud, in an immortal summation, wrote that
?hysterics suffer mainly from reminiscences? (Herman, 1997, p. 12).
In order to deal with the symptoms caused by hysteria, Freud and Janet believed that
healing could be promoted ?when the traumatic memories as well as the intense feelings that
accompanied them were recovered and put into words? (Herman, 1997, p. 12). In short, therapy
required a re-remembering, cognitively and affectively, which was not always easy for either
patient or therapist. Janet referred to this technique as psychological analysis; Freud and Breuer
referred to their technique as abreaction or talking cure.
Freud, Breuer, Anna O., and the talking cure. It is important to note that there was a
distinction between Freud and Breuer and the so-called talking cure. It was actually Anna O.,
Breuer?s patient who used that term; in fact, it was she who invented it. This means Anna O.,
whose real name was Bertha Pappenheim, helped cure herself to a great degree. Bliss (1988)
described Anna o. as a ?severe hysteric who suffered a galaxy of conversion symptoms-probably
an undetected multiple personality? (p. 36). However, Breuer recognized that Anna O. could on
her own, with no prompting, enter what he called hypnoid or self-generated hypnotic states.
What is fascinating about these states is that once Anna was in one of them, she could
explain how and why the symptom was generated, something she could not do when she was in
normal consciousness (Bliss, 1988). As soon as the forgotten episode was remembered, the
feelings and symptoms around it were healed. Breuer, thus, concluded ?the basis of hysteria DISSOCIATION AND TRAUMA 10 was the existence of these hypnoid states that had the power to create an amnesia. In turn, the
amnesia created an unconscious so that the individual then had three, rather than the normal two
states of mind? (Bliss, 1988, p. 36). Freud would eventually reject Breuer?s view, something to
be discussed later, but the key was that hypnosis, the altered state was attributed to be the
fundamental vehicle by which the later illness was organized (Bliss, 1988). Anna O., herself,
would describe these self-hypnotic trances that afforded her a cure as chimney sweeping or the
Freud, the investigator. Breuer would eventually leave the psychotherapeutic profession
to Freud in Vienna. As an investigator of human suffering, Freud was ?a man of?such
passionate curiosity that he was willing to overcome his own defensiveness, and willing to
listen? (Herman, 1997, p. 13). Freud heard horror stories involving sexual assault, abuse, and
incest; he found incidents of trauma violation in the childhoods of his patients. ?By 1896, in the
Aetiology of Hysteria, he stated: ?I therefore put forward the thesis that at the bottom of every
case of hysteria there are one or more occurrences of premature sexual experience, occurrences
which belong to the earliest years of childhood?I believe that this is an important finding??
(Herman, 1997, p. 13).
The scientific metanoia of Freud on hysteria. Freud found what later investigators
would discover: sexual abuse was much more prevalent than anyone had realized. However,
something curious happened after 1896; Freud would privately repudiate the traumatic theory of
hysteria. The reason: social convenience, perhaps, and not scientific truth. Freud?s
correspondence lays bare how ?he was increasingly troubled by the radical social implications of
his hypothesis. Hysteria was so common among women that is his patients? stories were true,
and if his theory were correct, he would forced to conclude that??perverted acts against DISSOCIATION AND TRAUMA 11 children? were endemic? (Herman, 1997, p. 14). In short, child abuse was more common than
anyone realized. This was problematic as an accusation. ?This idea was simply unacceptable. It
was beyond credibility? (Herman, 1997, p. 14). Something tragic happened now: Freud stopped
listening to his patients, as he did in the case of Dora, ?the last of Freud?s case studies on
hysteria? (Herman, 1997, p. 14). Out of the ruined traumatic theory of hysteria, Freud sought an
alternative paradigm to explain the phenomenology of dissociative illness. His approach,
however, according to Herman (1997) was scientifically unacceptable: he ignored the facts, and
in the process, he ignored his patients in a critical way (Herman, 1997). In seeking to craft an
alternative view to understanding hysteria, one that was more socially and personally acceptable
to himself and others, Freud invented psychoanalysis in the process (Herman, 1997).
In order to account for the clinical manifestations of hysteria, and the prevalence of
sexual symptomatology that accompanied this syndrome, Freud now concluded that it was really
the victim who wanted the sexual activity, no matter how young, albeit unconsciously. This had
the effect of excusing the actual perpetrators in these cases from any social opprobrium or even
guilt in the legal sense. Herman (1997) is especially critical of Freud?s intellectual turn of mind;
in her view, it constituted an attack on his female patients, to an extent. ?The dominant theory of
the next century was founded in the denial of women?s reality. Sexuality remained the central
focus of inquiry. But the exploitative social context in which sexual relations actually occur
became invisible? (Herman, 1997, p. 14).
Thus, in the recantation of his earlier findings and understanding, Freud insured that the
heroic age of hysteria was effectively over. ?Hypnosis and altered states of consciousness were
once more relegated to the realm of the occult. The study of psychological trauma came to a
halt? (Herman, 1997, p. 14). The scientific world, for reasons that were apparently aesthetic and 12 DISSOCIATION AND TRAUMA intellectual, as well as political, social, and cultural (Herman, 1997) was not ready to hear of the
violence and assaults against children and women, sexually and psychologically. That battle
would be for another day.
Herman (1997), however, reckons this to be a tragedy, in large part, because it cast adrift
the women and girls, even male patients, in a therapeutic sense. They would now have to
contend with the issues of sexual abuse without support. Sex crime in families would once again
become enshrouded in the veil of secrecy and silence. Healing and assistance could only come
in the form of an appropriate therapeutic paradigm by which abuse would be recognized and
treated. Moreover, this necessitated the rise of another paradigm that would end the tyranny of a
tyrannical, sexually-controlling patriarchy; a paradigm that would empower women as equals in
social and cultural life; and, finally, a paradigm that would recognize hysteria and dissociative
illness as much a problem of culture as it was an issue of psycho-emotional processes and
psychopathology (Herman, 1997). That paradigm, however, was almost a century away.
A commonality links rape victims, domestic violence victims, and combat veterans. This
linkage is the violence of trauma. The central dialectic of trauma reflects the movement to shout
the violence of trauma to the heavens, and, conversely, to confine trauma-studies to the Hades of
scientific oblivion, to a kind of intellectual amnesia, where the victim and the crimes of the
perpetrators are forgotten and ignored. The dialectic of trauma can have deformative effects on
human will and health; trauma can cause bizarre alterations in consciousness, definable and
treatable syndromes, for example, hysteria, with its mysterious conditions including dissociative
identity disorder, combat neurosis: shell shock and post-traumatic stress, and other curious
symptomatology. DISSOCIATION AND TRAUMA 13 The roots of trauma lie in the violence and neglect that usually begins in childhood.
From the time of Freud till the late 20th century, a veritable conspiracy of silence surrounds the
condition of trauma, particularly as it affects women and children, at the hands of family
members. Trauma gives rise to such conditions as hysteria, researched, initially, by Jean-Martin
Charcot, and his two famous pupils, Pierre Janet and Sigmund Freud. Charcot would prove that
the symptoms of hysteria were essentially psychological, and they could be produced artificially
through hypnosis, for example. In the 1950s, the Central Intelligence Agency, in the process of
fighting international communism and the Cold War would also produce multiple personality and
other hysterical behaviors in the laboratory, in the course of conducted in government-sanctioned
operations such as Operation Bluebird, Artichoke, and MKULTRA.
Charcot?s work was somewhat taxononomical in nature; it was descriptive and
phenomenological. However, this approach to the human being was not sufficient for Charcot?s
pupils, Janet and Freud. A massive rivalry sprang up between these two researchers. It was
insufficient for either Freud or Janet to simply describe or catalogue the symptom picture of
hysteria. Indeed, they would both race to discover the etiology of hysteria, that is, they wished to
know the cause of this ancient illness. In time they would be successful, though there were
differences along the way. Breuer saw hypnotic states as being the chief vehicle for the later
condition; Freud saw sexuality and defense mechanisms. In time, Freud would turn the sexual
theory on its head, blaming, in effect, the child and female victims, themselves. In the process, a
brilliant period of psychotherapy and theorizing came to an ignominious end. (January 2012) 14 DISSOCIATION AND TRAUMA
Bliss, E.L. (1988, September). A re-examination of Freud?s basic concepts from studies of
multiple personality disorder. Dissociation, 1(3), 36-40. Caffey, J. (1946). Multiple fractures in the long bones of infants suffering from chronic subdural
Hematoma. American Journal of Roentgenology 56, 163-173.
Crosson-Tower, C. (2010). Understanding child abuse and neglect (8th ed.). New York, NY:
Pearson Education, Inc.
Finkelhor, D. (1971). Sexually victimized children. New York: Free Press.
Herman, J. (1997). Trauma and recovery: The aftermath of violence ? from domestic abuse to
political terror. New York, NY: Basic Books ? Perseus Books Group.
Kempe, H., Silverman, F., Steele, B., Droegemueller, & Silver, H. (1962...
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