Summary speakers The Self behind the Self Thursday May 21th, 2015 Theatre Odeon Zwolle Andrew Moskowitz Could schizophrenia be a dissociative disorder? Three historical enigmas (and one contemporary one) From the time the concept of schizophrenia was first proposed by EugenBleuler in 1908, there have been numerous surprising links to dissociation. Bleuler’s term schizophrenia is strongly linked to dissociation not only in name and definition, but also in the related concepts st of splitting and complexes. Kurt Schneider’s 1 rank symptoms of schizophrenia, particularly various forms of voice hearing, were heavily weighted in all major diagnostic systems for the past 1/3 of a century, despite evidence for their frequency in Dissociative Identity Disorder. And Gregory Bateson’s long disparaged double bind theory of the etiology of schizophrenia shows striking similarities to new conceptions of disorganized attachment, which are linked to the development of dissociation. Finally, studies of voice hearing over the past several decades show robust correlations with measures of dissociation, in a wide range of clinical and non-clinical populations. Are all of these connections simply coincidences? Or do they suggest that schizophrenia could possibly represent some variant of a dissociative disorder? Bio Andrew Moskowitz, Ph.D., is Professor of Clinical Psychology at Aarhus University in Denmark, and head of the Attachment, Dissociation and Traumatic Stress (ADiTS) research unit. He has published widely on historical, theoretical and empirical connections between psychological trauma, dissociation and schizophrenia, and is the lead editor of the influential book, 'Psychosis, trauma and dissociation: Emerging perspectives on severe psychopathology' (Wiley, 2008), which is going into its 2nd edition. He is on the executive board of both the European Society for Trauma and Dissociation (ESTD) and the International Society for Psychological and Social Approaches to the Psychoses (ISPS). Onno van der Hart Dissociative psychosis implies a division of the personality amendable by psychotherapy Although Dissociative Psychosis (DP) is not not currently recognized as a formal diagnostic category or syndrome, specialists in the field of trauma-related dissociation have argued that doing so has great clinical value. Originally called hysterical psychosis, this syndrome has been documented in a number of traumatized patients with diagnoses ranging from posttraumatic stress disorder to dissociative identity disorder (DID). From the perspective of the theory of structural dissociation of the personality it has been proposed that for a psychotic disorder or episode to be recognized as DP, it should be embedded in a dissociation of the personality, and, by definition, dissociative symptoms should be present. Psychotic symptoms are dissociative in nature when they pertain to goal-directed actions or other important features of one or more emotional parts of the personality that the patient as apparently normal part of the personality can, therefore, not control. In this presentation the dissociative nature of DP will be described, as well as its various forms and ways of resolving the psychosis using psychotherapy (often including elements of hypnosis). Bio Onno van der Hart, PhD, is emeritus professor of psychopathology of chronic traumatization, Utrecht University. He has a small psychotherapy practice in Amstelveen, the Netherlands, and he is involved in consultation, teaching and research in the area of diagnostics and treatment of patients with complex trauma-related disorders, including the dissociative disorders. With Ellert Nijenhuis and Kathy Steele, he wrote The haunted self: Structural dissociation and the treatment of chronic traumatization. New York/London: Norton, 2006. With Suzette Boon and Kathy Steele, he wrote Coping with trauma-related dissociation: Skills training for patients and therapists. New York/London: Norton, 2011. His website is: www.onnovdhart.nl Colin A. Ross Catatonia, autism, dissociation, and cross-cultural syndromes In this talk, Dr. Ross will describe the overlap and similarities between catatonia, autism, dissociation, and cross-cultural syndromes. The DSM-5 criteria cannot differentiate some cases of childhood-onset schizophrenia, with predominant negative and catatonic symptoms from autism. Dr. Ross hypothesizes that there may be a subgroup of autism cases which represent a trauma-freeze response, just as is true for catatonia. Additionally many crosscultural syndromes are widely regarded as being dissociative in nature, but include an array of catatonic symptoms; Dr. Ross will present evidence that “cross-cultural syndromes” can be observed in Caucasian, English-speaking American patients with dissociative disorders, and that catatonic symptoms are very common in this population. Thus, there is more overlap between these symptom categories that is commonly appreciated. The relationship between trauma, dissociation and catatonia will be illustrated through case examples from the nineteenth century Salpetriere hospital, plus a current case example. Bio Colin A. Ross received his M.D. from the University of Alberta in 1981 and completed his psychiatry training at the University of Manitoba in 1985. He has been running a Trauma Program in Dallas, Texas since 1991 and consults to two other Trauma Programs in Michigan and California. He is the author of 27 books and 180 professional papers and is a Past President of the International Society for the Study of Trauma and Dissociation. Yolanda Schlumpf Neurobiological findings in dissociative identity disorder In accordance with the Theory of tructural Dissociation of the Personality (TSDP), dissociative identity disorder (DID) is a severe form of posttraumatic stress disorder and encompasses different dissociative subsystems of the personality. A primary classification is the “Emotional Part” (EP) and the “Apparently Normal Part” (ANP). Tw of MRI studies and an eye-tracking study, in which DID patients were measured as ANP and EP, will be presented. The studies demonstrate that EP and ANP have different biopsychosocial reactions to supra liminally und subliminally trauma-related cues (i.e., facial stimuli). In line with TSDP, as EP but not as ANP, patients emotionally engaged in these stimuli and were hypervigilant. Furthermore, the perfusion pattern in a task-free condition (i.e., resting-state) was also dependent on the dissociative part which was dominant during theme asurement. The reactions of genuine DID patients could not be mimicked by actors. The findings contradict the view that DID phenomena involve suggestion, fantasy proneness, and role-playing. Ellert R.S. Nijenhuis Enactive trauma therapy: Laying down a path in walking together Trauma, dissociation, psychosis: third-person concepts crafted to capture and grasp perplexing first-person phenomena. Technical tools to physically judge "objects of investigation", they cannottell“what it is like” to be traumatized, to dissociate, or be psychotic. That understanding takes a first-person perspective, an “I” who has and phenomenally judges his or her experience. Grounded in this basic insight, enactive trauma therapyis the collaboration of two intrinsically embrained, embodied, and environmentally embeddedliving systems to create new actions and new meaning. One system is the injured individual who engages a first-person perspective (a phenomenal “I”) and second-person perspective (a phenomenal “I-You” relationship). The other system is the therapist who encompasses and ideally integrates his or her first-person, second-person (empathic phenomenal judgment grounded in an “I-You” relationship), and third-person perspective. This dance of two lifeworlds takes attunement, resonance, timing, sensitivity to balance, movement and rhythm, as well as dedication and courage to follow and lead. Bio Ellert R.S. Nijenhuis, Ph.D., is a psychologist, psychotherapist, and researcher. He engaged in the diagnosis and treatment of severely traumatized patients for more than three decades, and now teaches and writes extensively on the themes of trauma-related dissociation and dissociative disorders. He is a research consultant at ClieniaLittenheid, Switzerland, and is co-director of Psychotraumatology Institute Europe, Duisburg, Germany. His publications include the book Somatoform Dissociation. With Onno van der Hart and Kathy Steele he coauthored the book The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization. The first two volumes of the trilogy The Trinity of Trauma: Ignorance, Fragility and Control will be released in the spring of 2015.
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