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In this article, I will attempt to develop ideas that I began to consider in an earlier article (Gedo, 2000). I will draw upon my clinical experience with archaically organized persons at Chestnut Lodge Hospital, somewhat better organized analysands and therapy patients, and my own dissociative experiences. The earlier article explicated my notion that dissociation and disavowal* could fulfill multiple psychological functions, in line with Waelder's notion (1976) of multiple function. For instance, these vertical splits in consciousness may allow the patient simultaneously to Not Know some painful memory or feeling, and yet also to Know it. Dissociation can ward off overwhelming affect while allowing its repetition on a visceral level (e.g., in a flashback). While such repetitions can be painful or terrifying, they also create some order and predictability and are an attempt at mastery—that is, they are negentropic attempts at adaptation. Dissociation may also serve to keep other people at a distance and thus to avoid threatening feelings of dependency and closeness. At the same time, they leave the person vulnerable and in need of external assistance. That is, these symptoms can express an interpersonal “need-fear dilemma” (Burnham, Gladstone, & Gibson, 1969). Patients also use these primitive mechanisms to evoke feelings of helplessness, confusion, doubt, and rage in the therapist; such projective identifications allow the therapist to experience affect states that presumably are similar to those the patient experienced around the traumas which originally led to the dissociative defenses.
Periodically throughout a long-term intensive therapy with previously traumatized persons, and especially during its early phases, we struggle