Haunted and Harassed: Perception, Memory, and Decision-Making in the Dissociative Patient
This year’s Pierre Janet Memorial Lecture coincides with the anniversary of Janet’s 150th birthday. Janet stated in 1935, “Depending on our point of view, we see things one way or another.” Successful therapy involves helping patients to become ever more proficient and adaptive in actions related to decision-making. Being more adaptive involves an increased ability to be flexible, to change our positions, and to adjust our points of view (i.e., perspectives), as well as the ability to realize the need to stick to a certain position, when faced with life’s challenges. In patients with complex dissociative disorders, haunted by their traumatic past and harassed by both internal and external pressures, this capacity for flexible decision-making often is compromised. The internal pressures which dissociative patients experience include the often conflicting and relatively rigid actions and perspectives of different dissociative parts. Parts stuck in the traumatic past are typically unable to engage in reflective decision-making, in particular when they perceive stimuli that relate to their original traumatizing events. When this happens, the present and the traumatic past become confounded; impulsive and reactive decision-making ensues (even conditioned responses can be regarded as involving decision-making). Such decision-making re-engages their incomplete and unsuccessful actions from the original traumatizing events. When reactivated simultaneously, various defensive perspectives and related action tendencies of dissociative parts (flight, fight, submission, etc.) lead to indecision, rapid switching, and other maladaptive actions.

Calling upon memory, current perception predicts the future and participates in decision-making. Our perspectives of ourselves, our world, and our relation to the world are influenced by motivational or action systems. Most of these epigenetic systems (attachment, sociability, play, energy regulation, etc.) guide our functioning in daily life; one major system (defense), however, deals with physical threat. This may require immediate, conditioned, or reflexive decision-making. Many other situations demand that decision-making include reasoning and reflection (e.g., decisions or judgments about the perspective or combination of perspectives, and related action systems, that is most adaptive. Various theoretical approaches distinguish these two levels of decision-making (i.e., reflexive vs. reflective). Janet developed a complex, hierarchical model of action tendencies, which can serve as a guide for clinicians in helping their patients to develop more adaptive decision-making. Theoretically, integration of the personality should advance an individual to his or her highest levels of decision-making.

Onno van der Hart, Ph D, is Honorary Professor of Psychopathology of Chronic Traumatization at the  Department of Clinical and Health Psychology, Utrecht University, the Netherlands, and a psychologist/psychotherapist at the Sinai Center for Mental Health, Amstelveen, the Netherlands. He is a clinical consultant of the Center for Post-Trauma Therapy and Trauma Education, Helsinki and Oulu, Finland. He has a partiuclar interest in the history of dissociation, and Pierre Janet's pioneering studies have a major influence on his work. With Ellert R. S. Nijenhuis and Kathy Steele he developed the theory of structural dissociation of the personality, work which culminated in the book, The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization (New York/London: W.W. Norton & Co, 2006). In 2008 he received the Lifetime Achievement Award from  the International Society for the Study of Trauma and Dissociation (ISSTD). He is a Past-President of the International Society for Traumatic  Stress Studies (ISTSS), is a former Vice-President and Fellow of ISSTD, and serves on the Editorial Board of the Journal of Trauma & Dissociation.