Drawing on the pioneering work of Janet, Freud, Sullivan, Fairbairn, and Sullivan and making extensive use of recent literature on dissociated experiences and states, Elizabeth Howell develops a comprehensive model of the dissociative mind. Dissociation, for Howell, suffuses everyday life; it is a relationally structured survival strategy that arises out of the mind's need to allow interaction with frightening but still urgently needed, usually loved, others. For therapists dissociated self-states are among the everyday fare of clinical work and gain expression in dreams, projective identifications, and enactments. Pathological dissociation, on the other hand, is a subtype of the more general process; it results when the psyche is overwhelmed by trauma and signals the collapse of relationality and an addictive clinging to dissociative solutions. Of special note is Howell's discerning use of attachment theory. She examines the relationship of segregated models of attachment, disorganized attachment, mentalization, and defensive exclusion (Bowlby) to dissociative processes in general and to particular kinds of dissociative solutions. Enactments are reframed as unconscious procedural ways of being with others that are linked with segregated systems of attachment. Clinical phenomena associated with splitting are assigned to a model of "attachment-based dissociation" in which alternating dissociated self-states develop along an axis of relational trauma. Later chapters of the book examine dissociation in relation to pathological narcissism; the creation and reproduction of gender; and psychopathy. Elegant in conception, thoughtful in tone, broad and deep in clinical applications, The Dissociative Mind takes the reader from neurophysiology to attachment theory to the clinical remediation of trauma states to the reality of evil. It is a masterful overview and creative synthesis of a literature that reaches back to Janet and Freud and extends forward to the writings of Philip Bromberg, Donnel Stern, Anthony Ryle, and others. No less impressive is Howell's sustained effort to understand dissociative processes in terms of attachment concepts and relational theory, which takes theorizing about dissociation to a newly integrative level. The capstone of contemporary understandings of dissociation in relation to development and psychopathology, The Dissociative Mind will be an adventure and an education for its many clinical readers. "For a clinician, reading Elizabeth Howell's The Dissociative Mind is not unlike the first time one plays poker for real money--it evokes a transformation in reality that, in Piaget's language, is "conserved" permanently. A foundational shift takes place in the clinician's way of experiencing and thinking about what he or she is doing with patients that honors dissociation as not just something the mind does, but as intrinsic to the relational organization of selfhood. Howell's book is so authoritative in its scholarship, so incandescently lucid, and so intimately true, that I believe its contribution will help to shape our understanding of the mind's normal development and its therapeutic growth for many years to come."--Philip M. Bromberg, Ph.D., Author, Standing in the Spaces: Essays on Clinical Process, Trauma, and Dissociation (TAP, 1998). "Elizabeth Howell's new book is instantaneously indispensable. Clinically astute, scholarly, well organized, and a pleasure to read, the volume shows how the concept of dissociation bridges psychoanalysis and traumatology. Every significant historical and contemporary contributor to psychodynamic dissociation theory is covered, and Howell adds important new insights of her own. The book will immediately become a mainstay for a wide audience of clinicians and students."--Donnel Stern, Ph.D., Author, Unformulated Experience: From Dissociation to Imagination in Psychoanalysis (TAP, 1997) About the Author: A psychoanalyst and traumatologist, Elizabeth Howell, Ph.D. has written extensively on topics at the interface of psychoanalysis and dissociation. She serves on the Board of Editors and is Book Review Editor of the Journal of Trauma and Dissociation.
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