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Letter to the Editor   |    
Hughlings Jackson and Dissociation
MARLENE STEINBERG, M.D.
Am J Psychiatry 2001;158:145-145. doi:10.1176/appi.ajp.158.1.145

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 (611).

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.

Meares R: The contribution of Hughlings Jackson to an understanding of dissociation. Am J Psychiatry 1999; 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]
 
+

References

Meares R: The contribution of Hughlings Jackson to an understanding of dissociation. Am J Psychiatry 1999; 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]
 
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