Down Alice's Rabbit Hole: Extreme Dissociation as a Matter of Life and Death: Commentary on Paper by Debra Rothschild

I am honored to have been asked by the editors of Psychoanalytic Dialogues to discuss Dr. Rothschild's excellent paper.

Dr. Rothschild presents a patient, Sarah, who was a survivor of extreme trauma, diagnosed with Dissociative Identity Disorder (DID). The central focus of her paper is on how the concept of “integration” relates to self-awareness and the recognition that one exists as a “self.” She argues that this awareness relies on the capacity for reflection, which she views as intimately tied to locating oneself in time and space. I would like to compliment Dr. Rothschild, because it is clear that she was very helpful to her patient on her arduous treatment journey to healing. Sarah was fragmented; she lived in terror of being exterminated, and was fearful even of existing and being seen. Her terror required the therapist's constant attention to create a safe environment which facilitated a more affect-modulated experience for Sarah. The therapist paid particular attention to Sarah's fear of the therapist in the transference and was a stable presence around which Sarah could begin to form herself. At the end of the paper the idea is presented that Sarah improved because she felt loved1 and accepted. It was in this more emotionally contained state that Sarah became able to “stand in the spaces” (Bromberg, 1998) and be aware of the complexity of her inner experience.

In my discussion, I emphasize elements of the treatment that were present but not fully discussed in Dr. Rothschild's paper.

The following is a poem that I wrote in the mid-1990s about what survivors of extreme trauma are asking from their therapists.