Am J Psychiatry 1996; 153:64-70
Copyright © 1996 by American Psychiatric Association
Dissociation: the clinical realities
FH Frankel
Department of Psychiatry, Beth Israel Hospital, Boston, USA.
An attempt was made by the authors of DSM-III to restrict its focus to the
experimental, the observable, and the measurable. The intention was to free
the nosology from the influence of unproven theories, and the philosophy
was driven largely by the importance of research being able to identify
diagnostic categories to facilitate the study of homogeneous groups. So it
is of interest that the authors accepted dissociation-an ambiguous event
linked to an explicit theoretical concept that had been introduced by
Janet-as the basis for classification of clinical presentations that were
formerly included under the rubric of hysteria, a similarly unclear
category. Since DSM- III, there have been an increasing number of reports
of dissociative experiences and dissociative identity disorder (formerly
known as multiple personality disorder), but neither of these clinical
presentations seems able to withstand the concern that it is dramatically
influenced by environmental cues, e.g., the expectations of the therapist.
Thus, a restricted phenomenological perspective does not fully appreciate
the distorting potential of suggestibility and imagination on the nature of
the emerging clinical picture. These factors might well have contributed to
and laid the conceptual groundwork for the growth in the number of reports
of dissociation.
