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The American Journal of Psychiatry, VOL. 158, No. 1

Letter to the Editor | January 01, 2001

Hughlings Jackson and Dissociation

MARLENE STEINBERG, M.D.

Am J Psychiatry 2001;158:145-145. 10.1176/appi.ajp.158.1.145

Article

References

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To the Editor: Russell Meares, M.D., is to be lauded for resurrecting the rich model of the mind mapped out by neurologist John Hughlings Jackson a century ago (1). However, his review of recent dissociation research suffers from significant lacunae. In point of fact, by suggesting that Jackson’s overlooked contribution can cure what now ails the field, Dr. Meares created a compelling but misleading narrative.

Curiously, Dr. Meares cited studies from the 1960s and 1970s in support of his belief that today’s investigators use the term "dissociation" too loosely. He thus neglected to mention new tools and the wealth of recent scientific investigations that have refined our understanding of dissociation (2). For example, clinicians now routinely use both the Dissociative Experiences Scale (3) to screen for symptoms and the Structured Clinical Interview for DSM-IV Dissociative Disorders (4, 5) to evaluate the severity of specific dissociative symptoms and to diagnose dissociative disorders. Furthermore, because of these reliable and valid measures, researchers have been able to document the precise nature of dissociative symptoms in hundreds of publications (6–11).

In the final analysis, although Jackson’s work is of historical interest as we continue to reformulate the mind/brain nexus, scientific advances in the past two decades have already rendered dissociation considerably less elusive.

References

Meares R: The contribution of Hughlings Jackson to an understanding of dissociation. Am J Psychiatry1999; 156:1850– 1855

Steinberg M, Schrall M: The Stranger in the Mirror: Dissociation: The Hidden Epidemic. New York, HarperCollins, 2000

Bernstein E, Putnam FW: Development, reliability and validity of a dissociation scale. J Nerv Ment Dis 1986; 174:727–735[PubMed][CrossRef]

Steinberg M: Structured Clinical Interview for DSM-IV Dissociative Disorders—Revised (SCID-D-R). Washington, DC, American Psychiatric Press, 1994

Steinberg M: Interviewer’s Guide to the Structured Clinical Interview for DSM-IV Dissociative Disorders—Revised (SCID-D-R). Washington, DC, American Psychiatric Press, 1993, 1994

Steinberg M: Handbook for the Assessment of Dissociation: A Clinical Guide. Washington, DC, American Psychiatric Press, 1995

Bowman ES, Coons PM: The differential diagnosis of epilepsy, pseudoseizures, dissociative identity disorder, and dissociative disorder not otherwise specified. Bull Menninger Clin 2000; 64:164–180[PubMed]

Carrion VG, Steiner H: Trauma and dissociation in delinquent adolescents. J Am Acad Child Adolesc Psychiatry 2000; 39:353–359[PubMed][CrossRef]

Nijenhuis ERS, Spinhoven P, Van Dyck R, Van der Hart O, de Graaf AMJ, Kroppert EAM: Dissociative pathology discriminates between bipolar mood disorder and dissociative disorder. Br. J Psychiatry 1997; 170:581

Steinberg M, Cicchetti DV, Buchanan J, Rakfeldt J, Rounsaville BJ: Distinguishing between multiple personality disorder and schizophrenia using the Structured Clinical Interview for DSM-IV Dissociative Disorders. J Nerv Ment Dis 1994; 182:495–502[PubMed][CrossRef]

Steinberg M: Advances in the clinical assessment of dissociation: the SCID-D-R. Bull Menninger Clin 2000; 64:146–163[PubMed]