On Brenner's “The Dissociative Character”

November 21, 1994

Ira Brenner's “The Dissociative Character” (JAPA 42:3) presents an interesting conceptualization of a continuum of dissociative disorders, ranging from a higher-level mild hypnoid state to a lower-level multiple personality disorder (MPD). The clinical material has a dramatic, gripping quality that lends credence to his formulations. Nevertheless, clinical material may be misleading if viewed from a restricted perspective. A narrowed vantage point imposes three significant errors on Brenner's presentation.

Dissociation, Brenner argues, “develops as a primitive, adaptive response of the ego to the overstimulation and pain of external trauma” (p. 841). Although this derivation is frequently noted in the psychiatric literature (Putnam, 1985; Spiegel and Cardena, 1991), it has been increasingly challenged. It appears (Wilson and Barber, 1983;Lynn and Rhue, 1988;Frankel, 1990;Nadon et al., 1991) that dissociative capacities bear a striking resemblance both to high degees of hypnotic susceptibility and to a facility called fantasy proneness. While some evidence suggests that these latter cognitive dexterities are sometimes seen in individuals who report early trauma, it is important to recognize that the great majority of these people do not report such trauma or show demonstrable psychopathology. In addition, because they are highly suggestible, many questions have been raised about the validity of their self-reports or recovered memories of early abuse (Orne and Bauer-Manley, 1991; Lindsay and Read, 1994; Loftus and Ketcham, 1994; Tillman et al., 1994). In brief, there is substantial evidence to indicate that dissociation need not be a response to trauma and that its clinical appearance is more an indication of suggestibility than of psychopathology influenced by trauma.

Implicit in Brenner's interpretation of clinical material is the notion that the manifest ideational content of altered (e.g., dissociated, hypnoid, hypnotic, dream) states bears a clearl