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In ‘“Janet vs Freud” on traumatization: A critique of the theory of structural dissociation from an object relations perspective’ [BJP 32(4) 436-55], Joan Lesley and Sverre Varvin express concern that the theory of structural dissociation of the personality has taken hold in Norway, and has caused undue and unnecessary confusion regarding treatment of clients with dissociative disorders. According to the authors there is no need to change treatment models for subjects with dissociative disorders who might well be treated with psychoanalytic methods.
Lesley and Varvin first offer a summary of the theory of structural dissociation of the personality. Next they criticize this theory and its practice. Finally they present two cases that in their view had been wrongly treated using ideas of the theory and practice they criticize, but that fared well following psychoanalytic treatment based on object relations theory.
While their recapitulation of the theory of structural dissociation is quite comprehensive in some regards, it also entails several misunderstandings. For example, the theory is not mechanistic as Lesley and Varvin state. Further, there is a lack of a deeper appreciation of the implications of the theory of structural dissociation (see below for detailed comments). Lesley and Varvin cite Etzel Cardeña, a well respected researcher for his criticism that it is hard to conceive of trauma as a division of the personality. Further they cite Paul Dell for other critical remarks, thus finding ammunition for their criticism, from within the field, so to speak. However, while Cardeña and Dell criticize the definition of structural dissociation of the personality, they do not seem to question the theory and the existence of dissociation of the personality in trauma as such.
An important aspect of the current interest in dissociative disorders in Norway is an interest in psychological trauma in part for historical reasons. There is the groundbreaking research of Leo Eiti