Review of Awakening the Dreamer: Clinical Journeys by Philip M. Bromberg

The current paradigm shift in psychoanalysis and related sciences is generating more powerful models of psychopathogenesis and treatment. Toward that end, in Awakening the Dreamer Philip Bromberg masterfully integrates psychoanalytic, developmental, trauma, and neurobiological data to explore the bottom-line defense of dissociation. In this review I offer a neuropsychoanalytic perspective of the origin of pathological dissociation, focusing on the enduring impact of this early defense against attachment trauma and its growth inhibiting impact on the development of the biological substrate of the human unconscious, the right brain. Patients with a history of abuse or neglect frequently access pathological dissociation in response to relational stressors to block the emotional pain that accompanies overwhelming affective states. And yet there is a cost. The characterological use of this affect regulating strategy induces a failure of integration of the higher right hemisphere with the lower right brain, thereby inducing an instant collapse of both subjectivity and intersubjectivity in the short term and a blockade of emotional development in the long term. Bromberg's creative book is an excellent example of how effective clinical work with such patients incorporates the current paradigm shift from not only cognition to affect but also repression to dissociation.