Spotlight On Italy

 

How the Interest in the Study of Dissociation Grew in Italy During the Past Two Decades

Written by Giovanni Liotti, M.D.

From ESTD Newsletter Volume 5 Number 1, March 2016 > read the original article in our newsletter

During the past twenty years, the interest in the study of psychological trauma and dissociation, formerly neglected, grew as steadily in the Italian community of psychopathologists and psychotherapists as it did in many other European countries.  Italian clinicians, both in the cognitive-behavioural and in the psychodynamic traditions, begun – after more than half a century since the publication of the famous clinical studies on multiple personalities by Enrico Morselli and Beppino Disertori (cf. Ellenberger, 1970, Chapter 3) – to write again not only papers on dissociation for national and international scientific journals, but also books dealing extensively with this topic.

Leading italian publishers issued, during the last two decades, eight books on trauma and dissociation authored by contemporary Italian writers. These publishers also translated into Italian (and they did it quite timely after the original publications in 2006 – 2014) important books on this topic authored by Dutch, American, and Australian scholars. The editorial success of these Italian and translated books may have paved the way for the first Italian translation of Pierre Janet’s L’automatisme psychologique, more than a century after his first publication in France. Janet’s critical analysis of Freud’s theories, presented at the XVII Congress of Medicine that had been held in London in the year 1913, was also translated into Italian with a wide Preface that acknowledges the relevance of the Janet renaissance in contemporary dynamic psychiatry (Orbecchi, 2014). A comprehensive anthology of Janet’s once deservedly famous clinical cases, translated for the first time into Italian, is now in print.

The resurgence of the interest for the study of dissociation among Italian clinicians manifested itself in the wide audiences collected by workshops and conferences on psychological trauma and trauma-related disorders: for instance, each of the two Rome Conferences on Attachment, Trauma and Dissociation (to which leading experts from all over the world are invited to present every year) attracted an audience of over one thousand professionals. Workshops on the psychopathology and psychotherapy of dissociative and other trauma-related disorders are organized, on a regular yearly basis, also in Venice and Naples. Teaching courses on EMDR and sensorimotor interventions are easily available in Italy, and quite a number of young professionals are being trained in them. The basic knowledge of the principles of the phase-oriented psychotherapy for adult patients with a history of complex trauma in their developmental years is provided in the majority of the post-graduate schools of cognitive psychotherapy throughout the country, and in a number of post-graduate schools of different orientations.

When clinicians and researchers involved in the study of the pathological responses to psychological trauma happen to wonder in what contributions to their domain of inquiry they might have found their origins in Italy, it is likely that some of them will think of the study of the role played by infant attachment disorganization in the genesis of dissociation. Since the author of these notes happens to have been, almost by chance, the first clinician struck by the idea that there may exist a link between early disorganized attachment and dissociative processes and symptoms (Liotti, 1992) – a hypothesis that was later supported by longitudinal studies (Ogawa et al. 1997; Dutra et al., 2009) – maybe he could be forgiven for the immodesty of narrating here how the idea first came to his mind.

Just before arriving in London, in 1987, to attend a conference titled “The Fruits of Attachment Theory” and held in celebration of John Bowlby’s 80th birthday, I had had a session in Rome with a severely dissociative patient (let us call her Mia) who had been in psychotherapy with me for over three years. Mia, while reporting, during that session, memories of her unhappy relationship with her mother since she was a little child, revealed to me that she was feeling a wish to get up from the comfortable armchair she was sitting on and lie down on the floor. It had been impossible to find out an explanation for the intrusive image of her lying on the floor that accompanied Mia’s talking during our face-to-face conversation of that session.

During the workshop preceding the conference, Mary Main showed to the audience (about twenty invited professionals interested in attachment theory) a video of the Strange Situation Procedure, portraying a baby (whose attachment has been regarded disorganized) who stopped approaching her mother on her return after a brief separation to lie down immobile on the floor. Mary Main had, just before showing the video, explained her findings that this and other types of disorganized attachment behaviors were linked to maternal behaviors she labeled as frightened and/or frightening to the child. Mary had also explained the reasons for regarding as multiple and incoherent the representations of self-with other that compose the internal working model underpinning disorganized attachment behavior (Main, 1991).

When I looked at the baby interrupting her approach to the mother and lie down on the floor, all the pieces of the puzzle concerning my last session with Mia, which were lingering in my memory while I was looking at the video, came together. Mia’s description of her mother fitted perfectly with the picture of the vulnerable frightened mothers of some disorganized infants provided by Mary Main. Mia’s multiple and dissociated self-representations could be matched with the multiple and reciprocally incompatible models of the attachment relationship hypothesized by Mary Main as typical of children whose attachment is disorganized. Mia’s reported “wish” to lie down on the floor during the session reflected, perhaps, an archaic implicit memory of one of her experiences during early attachment interaction with her mother. Finally, the trigger of this archaic, implicit memory could have been the activation, during the clinical exchange, of Mia’s attachment system, now directed toward her therapist instead than toward her mother.

When I was back to my office in Rome from this memorable visit to London, I began enquiring regularly, during my clinical exchange with dissociative patients, on every feature of their attachment relationships with their parents, looking for hints of disorganization. The inquiry seemed to support the hypothesis that, during their developmental years, most of my dissociative patients had histories of attachment compatible with what we begun to know about attachment disorganization thanks to the research studies conducted by Mary Main and her collaborators, and by other groups of researchers headed by Karlen Lyons-Ruth and by Alan Sroufe. This is how I came to suggest, in my first paper on the topic, that attachment disorganization could play an important role in our understanding of dissociation (Liotti, 1992).  

Nobody could assess to what extent my papers and my presentations to workshops and conferences in Italy, all focused on attachment disorganization and its sequellae, contributed to the revival of interest in the dissociative disorders and in the related domain of psychotraumatology in my country. Even if such assessment were possible, everybody will agree that it would be utterly useless. My aim in writing this note was not to call attention to my personal contribution, which is confined to the very modest task of putting together, for limited clinical usages, the really important discoveries, in basic theorizing and research, of geniuses such as John Bowlby and Mary Main. The work of these geniuses is, in my opinion, key in the understanding of the relational roots of dissociation. I thought that a good way to illustrate why I hold this opinion in a single page was to report an episode showing how Bowlby’s and Main’s thinking illuminated the mind of a clinician that was wandering in the darkness of a patient’s dissociative mental processes.

 

References

Dutra, L., Bureau, J., Holmes, B., Lyubchik, A. & Lyons-Ruth, K. (2009). Quality of early care and

childhood trauma: a prospective study of developmental pathways to dissociation. Journal of Nervous and Mental Disease, 197, 383–390.

 Ellenberger, H.F. (1970). The discovery of the unconscious. New York: Basic Books.  

Liotti, G. (1992). Disorganized/ disoriented attachment in the etiology of the dissociative disorders. Dissociation, 5, 196-204.

Main, M. (1991). Metacognitive knowledge, metacognitive monitoring, and singular (coherent) vs. multiple  (incoherent) model of attachment: findings and directions for future research. In: C.M. Parkes, J. Stevenson-Hinde and P. Marris (Eds), Attachment across the life cycle. (pp. 127-159). London: Routledge.

Ogawa, J.R., Sroufe, L.A., Weinfield, N.S., Carlson, E.A. & Egeland, B. (1997). Development and the fragmented self: Longitudinal study of dissociative symptomatology in a nonclinical sample. Development and Psychopathology, 9, 855-879.

Orbecchi, M. (2014). Prefazione. In: P. Janet, La psicoanalisi. Torino: Bollati Boringhieri.