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The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization (Norton Series on Interpersonal Neurobiology) By Onno van der HartEllert R. S. NijenhuisKathy Steele ( W. W. Norton )
Release Date: 2006-11-10
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List Price: $49.95
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Product Description
A new way of dealing with chronic trauma from leaders in the field.
Life is an ongoing struggle for those who have been severely traumatized. Here, leading trauma experts present a theory and practice for dealing with chronic trauma. Recognizing the structural dissociation (splitting away of part of the self) that often results from trauma and proposing a plan for action that a survivor must implement in order to put his or her haunted past to rest, this book will be of interest to researchers as well as clinicians.
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This book is a gift to those of us who work with human suffering. And for another, a fascinating memoir by a compassionate and ( newbooksforyou )
brilliant psychiatrist, I recommend That's How the Light Gets In: Memoir of a Psychiatrist by Susan Rako, M.D. The title comes from a song by Leonard Cohen: "There is a crack, a crack in everything. That's how the light gets in." Rako's book is remarkably candid, freshly insightful, and wonderfully well-written. It is a great read. The writing just flows.
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The Haunted Self - An Indispensible Guide and Resource for Clinicians ( leonarddp41 )
Treating people with dissociative disorders is a very difficult enterprise for which most mental health professionals are poorly prepared. Education programs neglect the area and even otherwise reputable textbooks are unhelpful. Many members of the community and even quite senior mental health professionals display a lack of understanding and even scepticism and antagonism to the very concept of dissociation. This is directed towards those who suffer from dissociative disorders and those who try to treat them. Thus sufferers are often isolated from effective help and clinicians also are isolated, poorly prepared and often at a loss as to how to embark on the complex task of therapy when they do encounter people with such problems.
"The Haunted Self" provides a scholarly, comprehensive and practical work for everyone interested in the area and is particularly helpful as a guide and a resource for poorly isolated clinicians. It is a wonderful work of creative synthesis of 150 years of work in the field of dissociation. While not neglecting the work of more contemporary thinkers, the authors own their great debt to the work Pierre Janet carried out 100 years ago. With some important exceptions, Janet's brilliant insights into the field of "hysteria" and dissociation have been neglected in the English speaking world. The authors' enviable command of European languages gives them access to his and other important works not published or neglected in English.
The book provides an excellent balance of the theoretical and the practical. It is set out in 3 sections. The first deals with the authors' concept of structural dissociation, the second deals with chronic traumatisation and links it to Janet's theories while the third sets out an approach to treatment.
Traumatic experiences at any age can have serious consequences and this is covered in the book. In childhood,in particular, early trauma such as abuse and neglect, of a physical, sexual or emotional nature, exert pervasive, destructive effects, which may extend far into adult life. The authors point out that children have pathetically inadequate resources with which to cope with the horrors to which, tragically, they are sometimes subjected. They refer to Janet's concept of their having an inadequate "mental level" i.e. integrative capacity to cope adaptively with these experiences. They coined and developed the term "structural dissociation" to describe the complex response to such abuse.
The authors develop the concept of of "action systems." These are psychobiological responses which can be divided into two major groups - those in response to attractive stimuli and those which defend against noxious ones. Traumatic situations in childhood often evoke both responses simultaneously e.g. a response to an abusive caregiver in which fear and attraction are mingled giving rise to intolerable conflict. Such intense feelings and the unbearable terror and arousal produced by trauma are referred to as "vehement emotions."
The book describes the impact of these powerful feelings in producing a loss of integration and cohesion in the personality. As a result intolerable feelings and memories are segregated from complete awareness and traumatised people move between different identity states. In some states they are locked into traumatic events which are constantly re-experienced with their associated overwhelming emotions. In other states they are cut off from the memories and experiences of the trauma and are phobic and avoidant towards anything that threatens to remind them of the trauma and of the internal states which carry the trauma experiences.
Charles Myers' work with soldiers from World War I is recalled. He described splits into what he called "Apparently normal personalities" and "Emotional personalities" in response to combat trauma giving rise to structural dissociation.
The second section focuses on Janet's theories in relation to trauma. As the authors say, "the inclusion of Janet's work is not a romantic flight into history. His ideas on actions are most helpful and practical in understanding the plight of trauma survivors"
And so they are although, initially, I myself had to exert a fair amount of effort to understand and start to apply these concepts. I think most people unfamiliar with Janet's work would have similar problems but the effort is very worth while. Interestingly, although clinicians brought up with other theoretical models may share my problem, I have found that the concepts, are easily grasped and make perfect sense to people struggling with trauma related disorders. Concepts such as synthesis, presentification, personification and action tendencies and their hierarchies are discussed in depth and applied to clinical problems.
The final section on treatment begins with a useful section on assessment. It then outlines a three phase approach to treatment. The first phase involves stabilisation and symptom reduction, the second the treatment of traumatic memories and the third personality integration and rehabilitation.
Those who read The Haunted Self will quickly discern that it is the work of highly skilled clinicians not simply theorists. All who have battled with the problems of trauma affected people will recognise that the authors have travelled the same paths and will find their guidance very valuable.
I have stressed the worth of this excellent book to clinicians but a number of my more sophisticated patients have also found reading it very valuable. It is certainly a wonderful validation of this body of work that it does make so much sense to those very people who have to live their lives with the consequences of trauma.
David Leonard
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Excellent Read
This is a must read for counsellors working with dissociative clients. It is well-written, easy to understand (although the problem of dissociative disorder is very complex) and gives practical advice and strategies.
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This book is just wonderfull!
This book is just wonderfull! I deeply enjoyed reading it - and much more :) - applying its concepts and practical guidelines into the complex clinical work with traumatized individuals. Myself, psychotherapist, child and adolescent psychiatrist in Ukraine - I found this book most clinically useful book I have read in few last years about trauma-related disorders. It gives clarity into this very complex dimensions of inner and outer lives of chronically traumatized individuals and it helps to empathically understand their suffering. From this empathic understanding well-paced and well-structured therapy can take place. And from my clinical practice I saw how useful and effective are concepts and practical therapeutic guidelines from this book. So I highly recommend this book for everyone working in the field of trauma-related disorders, and I also highly recommend this book to publishers for translations and publication in other languages. This knowledge must become widely available so we can better assist traumatized individuals in their inner healing. Special thanks to authors for their great work!
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an important and fascinating book
What an exceptional book! The step-wise didactic clarity and innovative content of The Haunted Self alone would suffice to justify making the book required reading material for all health professionals encountering trauma victims. However, it is also a remarkably thrilling reading experience, reminiscent of the "haunted-house" stories of my youth. One finds oneself led to familiar areas through "hidden stairways" and suddenly comes to perceive and comprehend things from unexpected angles.
As a psychiatrist specializing in trauma as a clinician, a lecturer and a researcher for nearly 20 years, I found this book to be a fitting and eloquent summary of over 25 years of innovative thought, thorough research and ongoing re-assessment of the theoretical and clinical applications of Trauma-Related Structural Dissociation of the Personality by Van der Hart, Nijenhuis and Steele, whose ongoing publications in leading journals I have followed avidly. The theoretical basis is coherently and systematically presented in the opening section, followed by a section which concisely and didactically addresses the clinical applications, from guidelines for patient assessment and formulation of the treatment plan, and then deals in detail with each stage, with ample guidance and clinical examples. The lay-out of the book also conveniently enables selective reading of independent sections and topics. There is a refreshing undercurrent of humility to the book - the reader feels encouraged to examine and comment freely.
Without seeking to replace or compete with other trauma theories or treatment modalities, the authors present an over-arching and unifying conceptual approach to comprehending the psycho-biological underpinnings of a highly variable and challenging population of patients, who quite commonly present with a complex and confusing array of atypical and changeable clinical and therapeutic issues, only partly addressed by current diagnostic criteria and treatment guidelines.
The structural conception of dissociation enhances ones understanding not only of PTSD and Complex PTSD, Dissociative Identity Disorder and cases of severe protracted physical and sexual abuse, but clarifies the contribution of trauma to Borderline Personality Disorder, Somatoform Disorders and certain physical syndromes characteristically associated with emotional trauma and stress.
Dr Mike Matar, MD (Psych)
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