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In Elizabeth Howell's first book, The Dissociative Mind (2005), she gave a splendid overview of the topic of dissociation, broadly considered. Now,
in her new book, she has zeroed in on the most severe end of the dissociative spectrum. It is an impressively comprehensive yet nuanced guide for the understanding and treatment of patients with dissociative identity disorder (DID). The first half of the book is an excellent summary of relevant theory, while the second half focuses cogently on several clinical topics.
Psychoanalysis has come full circle—Freud discovered his theory of the mind while treating some patients who probably suffered from DID; analysis then suffered from a long intervening period during which analysts believed DID was rare or iatrogenic. Today most analysts in the U.S. acknowledge the existence of DID, and have treated one or more patients who have it. One of us vividly recalls his hunger for guidance on technique when he realized a patient he had treated intensively for years had DID. Howell's book provides just this sort of guidance.
Howell begins her book with an unusually candid “Personal Note” that discloses a significant autobiographical source of her deep interest in helping survivors of childhood abuse. Her sister was sexually abused in childhood by their father; her brother was sexually abused by a teacher. Howell feels their abuse contributed to their deaths at fifty-seven and at forty-three, respectively.
Next Howell writes eloquently about how the very topic of dissociation has historically been dissociated by the psychoanalytic community. Even today, she notes, there remains a dissociative split when it comes to how clinicians conceptualize trauma and its effects. The pivotal issue is whether the clinician recognizes the existence of DID and the causative role of severe childhood trauma.
Recognizing DID does make a difference in treatment. Cross-gender alters are common. Howell writes of a male patient whose female alter sought sex-ch