dissociative identity disorder, Empowerment Project DID 101, Informative and educational writings, Uncategorized

Why the theory of Structural dissociation is ableist

Anyone who has watched a DID youtube video, or read a few posts in a support group, has seen it pass by: The theory of Structural dissociation, written by Ellert Neijenhuis, Onno van der Hart, Suzette Boon and Kathy Steele. 

It’s good to know that in 1987, the writers of this theory already referred to us as parts, not personalities or alters, as the common terms were back then. Now, you might think this was progressive, ahead of its time — but was it really? 

I want to start by setting a few things straight.
It was actually, psychologist and psychiatrist Charles Samual Myers, who in 1916 wrote about Apparently Normal Part (ANP) and Emotional Part (EP) after acute trauma in WW1. So it is fair to say that the theory of Structural dissociation borrowed these terms, not introduced them, as is readable in the haunted self. (page 4)

We read in the same book (page 7) ‘’Structural dissociation involves hindrance or breakdown of a natural progression toward integration of psychobiological systems of the personality that have been described as discrete behavioral states.’’ (Putnam, 1997).
This is what most people refer to when explaining that we are not broken, not split off. We are all born with different states and early childhood trauma survivors can’t integrate in early childhood due to that trauma. But as you can see it was actually Putnam in 1997 who introduced this idea. 

It is also good to realize that the theory of Structural dissociation is neither about DID, nor is it about alters, as many of us Plurals know them. They speak of ‘dissociative parts of the personality’, caused by trauma. Nota bene, not early childhood trauma, trauma in general. As this theory also explains single trauma, repeated trauma in adulthood and (early) childhood trauma. It is used to describe changes that are diagnosed as (c)PTSD, trauma related borderline personality disorder, DID and more.

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As you can see in this image, all types of Structural dissociation have EP and ANP elements which Myers talked about.  In other words, the theory puts forward that all traumatized people have ‘dissociative parts of the personality’ as this is just the collective name for the EP and ANP. Thus, plurality does not just happen in DID, as many people with DID like to claim. As we read on page 6, ‘’In severe cases of secondary and in all cases of tertiary dissociation, more than a single part may have a strong degree of elaboration’’ (e.g., names, ages, genders, preferences.)’’

From which we can conclude that OSDD, complex PTSD, borderline personality disorder or extreme stress may also have alters as we Plurals know them, or at least as the ‘dissociative parts of the personality’, which this theory calls us. – From a Plural perspective, I do not understand the differences, besides being integrated less in DID (or tertiary Structural dissociation) compared to more integrative capacity in secondary Structural dissociation of the personality. 

If DID is not Plurality, then why have such a thing as a DID diagnosis? What is the difference then between complex PTSD and DID, if not the Plurality? – More on this topic next time!

The haunted self states that Structural dissociation has become chronic in those patients with trauma-related disorders. (page 12.) Which, first and foremost, means that Structural dissociation is not a (trauma-related) disorder on it’s own, as some people claim these days. 

However, I point this quote out for a different reason. The theory of Structural dissociation idolizes integration. And although they say that ‘’no one has to go away’’, they also clearly explain to therapists, to not engage with us ‘dissociative parts of the personality,’ unless absolutely needed. Instead it is suggested that the therapist speaks whenever possible, through the ANP fronting. We the Plurals, then have the most integrative capacity, which basically means we can integrate the experience best. Which should be encouraged by the therapist at all times. I can understand how it is useful that ‘everyone’ listens in during therapy. But this should not be the case when we express ourselves! 

Text continues under the image.
This is from the ‘case formulation’ session at the conference on Structural dissociation and early childhood trauma in Ede by uitgeverij Mens, 2019. Included with fair use for educational purposes only.

To me, it sounds as if they want to make us all like OSDD, where one part regularly fronts and others speak through them. And although I think there is a dissociative spectrum, I do not think that changing the diagnostic criteria we meet from the diagnosis of DID to OSDD will lead to ‘healing.’ And in DID, in particular, requiring all communications to relay through one particular (perhaps malleable or favored) ‘alter’ that sounds a lot like silencing to me. Because the therapist (or any other outside person,) can never know (for sure) whether the part who is presenting, is truly conveying all information which is coming from inside. This book talks a lot about shame, but forgets that our ANPs might not feel comfortable repeating what those EPs just said inside, and that the information may be so overwhelming for them as to cause them to have intense dissociative symptoms. Half-truths might reach the therapist.

The writers of this theory explain dissociation as experiencing separation in simple terms and in more difficult terms use the meaning of the term dissociation, formulated by Pierre Janet (1859–1947), ‘’Structural dissociation is a particular organization in which different psychobiological subsystems of the personality are unduly rigid and closed to each other. These features lead to a lack of coherence and coordination within the survivor’s personality as a whole.’’ (Preface Haunted self) 

They explain integration as ice cubes melting and the water coming together, or dams breaking and water coming together. Which to them equals no one goes away. Everyone is still there, it’s just one body of water now. To me, it sounds more like soup, because not everyone in a system is the same, like with water. So you throw in your EPs and ANPs (and those are very limited terms for our diversity!) and then you have a soup. Although soup is great, it is not the same as the loose ingredients. A potatoe is a potatoe. A carrot is a carrot. But potatoe-carrot soup is something new and different. You cannot remove the potatoe from the soup, it is no longer a whole potatoe. And potatoe-carrot soup cannot do the same things the original potatoes and carrots could do.

We know from a 6 year follow up study that only 12.8% of participants were able to reach integration as described in the theory of Structural dissociation. (page 4: https://sci-hub.tw/10.1080/20008198.2017.1344080?fbclid=IwAR0E63AbRiL1gm5voP9J_TqgUAi6U5CkNlflwwwldD2Uo5UZeIiganE3hBU )

That is a very low percentage. In any scientific research for medicine or therapy for example, a 12.8% positive outcome would not be tolerable. Yet the whole theory of treatment within Structural dissociation is based on it.

A chronic disorder, often debilitating, with a much-respected and idolized healing option with only 12.8% success rate, sounds ableist to me. Favoring OSDD over DID comes from singular normative biased thinking. The haunted self has a chapter dedicated to phobia of dissociative parts. Maybe the writers, should re-read the chapter and apply it to their own way of thinking. It also sounds to me, as if clinicians say something else to our face, then what they write in their books. Especially when it comes to alter integration or final fusion as Kluft calls it. 

Although I do not think personalities is the right term for us, nor is the word parts. It is derogatory, dehumanizing & it is taking away from our autonomy, roles and authenticity as individuals. And so I often wonder whether the alter integration they desire, equals just not being Plural anymore in the minds of the writers of Structural dissociation. If it does, it makes sense to diminish us to parts. And it also makes sense to claim “no one has to go away”, if they never believed we are separated in the first place. After all, it is the ‘experience of separation’, not actual separation, as they say, we did not split off. So was using the term ‘parts’ in 1987 progressive, or a step to further diminish, gaslight and silence us?

Here is my problem with how the DID community treats this theory. From the community feedback it seems that many of you do not want integration, as explained in this theory. And you cannot cherry-pick the sweet parts, when it comes to theories like this. Especially not when integration is so interwoven with this theory. The theory of Structural dissociation is often presented as truth in our communities, even though this theory is not widely accepted, not acknowledged, not proven (or provable) and hence just a theory like any other  – there are many theories about DID. 

You also cannot say you like the application of this theory for DID, but not for borderline and vice versa. The theory comes as a package deal by explaining a progression of Structural dissociation. I think many people did not read all of the haunted self, as it’s long and dry. And even though most quotes from this article come from the first few pages, it is information many do not know. I read the book twice and followed a conference with its writers. I hope this article explains things, to those who endorse this theory without having actually read it. There are many more questionable things about this, but I cannot address them all.
Obviously it is not needed to throw away the baby with the bath water either, that is not what I am proposing. What I am proposing though, is that you take a second look at the theory you endorse and why

Because if you just like the part about how we are not split off, but born with different self-states you can quote Putnam. 

And if you like the idea of PTSD consisting of EPs and ANPs, you can quote Myers. 

And if you like integration, you can quote theory of Structural dissociation. 

Thank you for investing the time to read this article. Please feel free to leave comments or feedback in the comment section. We hope you learned something new. If you want to support our work, we accept donations. – Together we are stronger. Power to the Plurals!

7 thoughts on “Why the theory of Structural dissociation is ableist”

  1. I am not sure what happened with me.
    I know in 1991 I was referred to NIMH and under Frank Putnams guidelines I was given diagnoses of DID. I really would like to have my records. For though I went twice a week to a Barbra Oppenheimer I have no memory of the therapy.
    I do remember I left therapy because after two years any hidden trauma I wanted to leave it alone.

    Liked by 1 person

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