To Be, and Not To Be: The Concept of Multiple Function and Dissociation

TO BE A CLINICIAN IN OUR TIMES is to be aware of the ubiquity of disavowal and its still more primitive variant, dissociation, in the psyches of our patients and, through them, in ourselves. At Chestnut Lodge, where we work intensively with severely troubled persons, we are occasionally afforded the opportunity to observe the developmental vicissitudes of dissociative phenomena across a long-term treatment. This essay reflects my experiences in therapy that I conducted with Ms. Q for 8 years, until she moved out of state. My aim is not to detail the case, but to reflect on our work, and particularly on Ms. Q's extensive use of disavowal and dissociation, through the prism of Waelder's (1930) concept of “multiple function.”

Ms. Q transferred to Chestnut Lodge from a hospital in her home state. She had been engaged in treatment for a decade, including one long-term and many brief hospitalizations. She suffered from a severe mood disorder characterized by occasional bursts of manic grandiosity and paranoid thinking, alternating with more typical states of depression, emptiness, and self-destructive preoccupations. She also evinced posttraumatic symptoms, which included flashbacks, sometimes lasting several hours; dissociative episodes in which she became unaware of her surroundings, her thoughts, or her own actions; delusions of