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Book Reviews   |    
Dissociation of Trauma: Theory, Phenomenology, and Technique
Reviewed by Colin A. Ross, M.D.
Psychiatric Services 2001; doi: 10.1176/appi.ps.52.9.1263
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by Ira Brenner, M.D.; Madison, Connecticut, International Universities Press, 2001, 270 pages, $40 softcover

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This book will be of little interest to those who are not psychoanalysts. The title is misleading: the book contains very little on the phenomenology of dissociation and very little on specific treatment techniques. For instance, the Dissociative Experiences Scale is mentioned only once in the book, and no research data of any kind are summarized or presented.

The author describes prolonged therapies and lengthy inpatient admissions. For example, in one instance he writes, "Analysis continued in this vein for more than six years, with minimal change in [the patient's] overall functioning and intrapsychic life."

The treatment methods described in this book cannot be applied in hospitals as they operate today and cannot be billed to managed care organizations or Medicare. No third-party payer would approve, for example, a treatment in which the client sleeps for all of every session for months: "Repeating a pattern from childhood, her analysis was notable for her tendency toward tiredness, which often progressed to falling asleep for an entire session. Her sleep seemed blissful and satisfying. During times where erotic transference issues were in ascendance, she slept for months."

The therapy method the author describes appears to be regressive. There is an overemphasis on abreaction of trauma, which is linked to severe symptoms, destabilization, hospital dependency, and acting out. Of one case, the author says, "Our work for the first several years was stormy. Chaos and anxiety prevailed with literally scores of hospitalizations lasting anywhere from overnight to several weeks at a time."

The cases described in this book involve sexualized acting out that goes on for years. In one outpatient session a patient had a spontaneous orgasm and urinated on herself. In another case, the author writes, concerning the patient's alter personality, "When 'Susie' described being forced to ingest a noxious mixture of semen and bodily waste products as part of a perverse group ritual, 'she' became nauseated and tried to rid 'her' system of the memory of these substances. 'Her' revulsion and sense of urgency was so great that 'she' just wanted to take a knife, cut 'her' stomach open, and remove the toxins as quickly as possible."

The patient had a long history of severe self-mutilation, which would surely be exacerbated by abreaction of childhood events, whether the memories were true or false. In the same case, the author writes, "The patient's headlong confrontation with her past overwhelmed her at times, and powerful, conscious urges to cut her arteries and bleed to death seemed like her only way out."

The definition of dissociation proposed in the book is metapsychological: "Dissociation is described here as a defensive altered state of consciousness due to autohypnosis, augmenting repression or splitting."

The book is not based on the empirical literature and does not give enough detail on phenomenology or treatment techniques to be useful for most clinicians who treat trauma and dissociation.

Dr. Ross manages trauma programs at hospitals in Dallas, Los Angeles, and Grand Rapids, Michigan.

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