The Psychoanalysis Of Dissociative States, The Sense Of Safety And Self Blame In Victims Of Childhood Sexual Abuse*

The integration of dissociated states, the lack of a sense of safety and the tendency of the victim to blame herself are three issues frequently met with in the analysis of people suffering from childhood sexual abuse. I use her throughout this paper only because many of the victims are women. The paper addresses these three fundamental issues. Integration of Dissociated States The first issue I want to address is the integration of dissociated states. DSM III-R (APA, 1987) defines dissociation as a disturbance in the normally integrative functions of identity, memory, or consciousness. If this occurs primarily in identity, the person's customary identity is forgotten and a new identity may be assumed or imposed. Dissociation augments repression and splitting (Brenner, 1994). It is an elaboration of splitting leading to the constellation of ego alien ego states. It develops as a primitive, adaptive response of the ego to the overstimulation and pain of external trauma and may result in disturbances in awareness, memory and identity. This defense results in a vertical split stimulating corresponding ego states alternately enacted but not integrated (Shengold, 1989). Dissociation exists on a continuum with multiple personality disorders representing the most extreme form of this kind of process (Brenner, 1994; Burland &amp