Dissociation and the Dissociative Disorders: Past, Present, Future – An interview with the Editors
Something exciting for our field has been quietly brewing over the last four years. The book-lovers and nerds among us will be delighted to hear that one of the most important books for our field, and one of the largest, is now available as a second edition. Yes, Dissociation and the Dissociation Disorders: DSM-V and beyond, edited by Paul Dell and John O’Neil, has undergone an important revision. Somewhat irreverently known as ‘the bible’ of the field, Dissociation and the Dissociative Disorders was published in 2009, and a fair bit has changed since then.
The second edition, like a lot of good things, has been a truly collaborative undertaking with over 70 authors involved, and explores theoretical, conceptual, empirical, and clinical issues related to all aspects of dissociation and the dissociative disorders. This behemoth has been lovingly and very patiently nursed into existence by three dedicated and over-worked editors, Martin Dorahy, Steve Gold & John O’Neil.
In this edition of ISSTD News Warwick Middleton interviews the editors about this project (which he jokingly calls ‘The New Testament’) to explore how such a giant collaboration is planned and undertaken.
Warwick: Thanks for coming together. What we’re setting out today, is to get an overview of your immense book project. I am totally in awe of you all. Just the idea of coming together to produce a book with 49 chapters and over 70 authors fills me with horror really (laughter). But you’ve pulled it off! I would like to start out, just for our readers’ benefit, to get a snapshot of each of you in your professional work, your past editing, and your involvement with the ISSTD.
John: I retired from University and hospital affiliations back in 2018, but I’m still in full-time private practice. My patients are limited to DID and OSDD-1, either therapy or follow-up for patients in therapy who were in therapy with someone else. I have gone to almost every ISSTD conference since the early 90’s. We spent about a decade doing the all-day intro course – myself, Su Baker (my wife), Jim Chu and Audrey Wagner. I guess the current major thing is the Professional Training Program (PTP). Su and I have been teaching in the PTP for about a decade or so now.
Past experience with Editorial Projects? Well, I guess I got my feet wet doing all of the desktop editing and publishing for all of the ISSTD annual conferences … that’s my editorial stuff for ISSTD, which isn’t the same as my editorial stuff for the original “big book”, which was big, and still is. In that regard, I definitely played second fiddle to Paul Dell. I guess the best understanding of the original book is the preface that Paul and I wrote which gives the whole background with regard to John Curtis and the annual meetings of the ISSTD where we had the whole idea of a consensus task force that never arrived at a consensus!
I think one of the really helpful things in the evolution of dissociation is that we still haven’t arrived at a consensus. So, we still have plenty of work to do.
Warwick: Martin, what are you doing now, your past editorial work, and your involvement with the ISSTD?
Martin: Since early 2009 I have worked at the University of Canterbury (Christchurch, New Zealand) on the clinical psychology training program. Before that I had worked in the National Health Service in Belfast, Northern Ireland, and had a connection with Queen’s University. I’m full-time at the Uni here and have a private practice which has some dissociative and complex trauma people, and some longer-term psychotherapy cases that have relational trauma backgrounds, but with a more characterological flavour than a major dissociative flavour.
In terms of editorial work, the first thing I got involved in was a book with Eric Vermetten and David Spiegel, called “Traumatic Dissociation, Neurobiology and Treatment”. Then, around that time, I was having a closer connection with Andrew Moskowitz and got involved in a project he was heading up called Psychosis, Trauma and Dissociation. We finished the second edition in 2019. Then I did a book with yourself and Vedat Şar, on global oppression. We also did a book, you and I, together with Adah Sachs entitled “The Abused and the Abuser: Victim – Perpetrator Dynamics”, that came out in 2018.
With regard to ISSTD, I first got involved in the late 90’s and had a little bit of involvement in a few committees and then got a bit more heavily involved in what was and remains, the David Caul Postgraduate Research Award, with Lisa Butler. I still remain on that committee. I got involved in a few more bits and pieces over the years and eventually had my arm twisted to run for the president-elect position. I was on the Board at that point and then on the Executive, and in 2017 was the President. I still remain on the Scientific Committee and also on the International Task Force.
Warwick: And Steve?
Steve: I retired from teaching after about 40 years of training doctoral level psychologists in September of 2020. Since then, I’ve continued in private practice, both clinical and forensic. All of my forensic work is doing expert witness testimony in the areas of trauma and dissociation. Most of those cases are criminal and most of the criminal cases are death penalty cases. I’m in practice with one of the chapter authors in the book, Michael Quiñones. The two of us had become very interested in using various altered states, including hypnosis and psychedelic assisted therapy, to work with traumatized and dissociate individuals. Michael and I are going to be writing a book in that area for the American Psychological Association. In terms of ISSTD, I think the first conference I attended was in Montreal in 1997. And then I think the next year’s conference was in Miami. Until recent years I was attending almost every year. I was president of ISSTD in 2004.
In terms of editorial work, Jan Faust and I were co-editors of a journal called “The Journal of Trauma Practice”, which later was renamed “The Journal of Trauma Psychology”. Then in 2009, I was very much involved with the Trauma Division of the American Psychological Association, was President that year, and was asked to start the Trauma Division’s journal called, “Psychological Trauma: Theory, Research, Practice, and Policy”. I was the editor of that for nine years. Following that, I was asked to serve as Editor-in-Chief of the “APA Handbook of Trauma Psychology”.
Then there’s this project. It has been an immense project and certainly the “APA Handbook” was an immense project. I’m solemnly promising myself I will never edit anything again. (laughter)
Martin: I’ve had a similar thought myself! I hope I maintain it. (laughter)
Warwick: You’re all obviously immensely qualified to come together as an editorial group on a project like this. Can I just ask, and anyone can answer from this point on: how this project came to be and how you three ended up together?
John: Routledge wrote to Paul Dell and myself asking us to come up with a second edition. The first edition had sold well enough that they wanted to come up with a second edition. And Paul had already achieved Steve’s wisdom in deciding not to. (laughter) We both decided that whoever should take it over needed to be younger. But also, we looked over the entire list of contributors to the first edition, which is about 70 authors. And we looked for two people that we thought: number one – would be up to the task, and who obviously had competence, but perhaps most importantly, they didn’t have an axe to grind. We thought that Martin and Steve were both level-headed enough, they didn’t have an axe to grind, and consequently, would be up to the task of covering the extremely broad range that the book involved.
And then we asked Martin and Steve and they both, to their chagrin, said, “Yes”. (laughter)
Martin: It was a very nice email. It must have been!
Warwick: How did the philosophy of the book, because it’s obviously a somewhat different sort of animal to the previous edition, take shape?
John: My hope is that the book is different because the field has moved.
Steve: Following up on what John just said, in seeing the book take shape, one of the things I’m most pleased about is the diversity of opinions. I consider it a great compliment to have been thought of as someone who didn’t have an axe to grind, because I think that’s tremendously important. And all this diversity of opinion to me means that we’re not going to fall into foreclosing on what dissociation is, and what is not dissociation, how it should be treated… I’ve been concerned at times that there’s kind of been a premature consensus on those questions.
And at the same time, the rest of the world, the rest of the sceptical mental health world, is very fervently jumping on the dissociation bandwagon… which is really exciting.
Martin: I guess in some ways that’s what we all hope the book will do, as the first one did, that it will go beyond the dissociative disorders field and perhaps even beyond the trauma field and start to influence various trainees, various professions, in ways that allow dissociation to be understood and accepted.
Warwick: It seems like there are a lot of topic areas in the new book that didn’t appear in the old book, a lot of authors who appear in the new book, that weren’t in the old book. … When you came together, you decided that this is not just getting the same authors and getting them to update their chapters. This is a very different sort of thing.
Martin: One of the things we did want to do is to allow the first edition to remain of interest and of importance, so it would stand alone. We didn’t want to just replace it. We had a lot of conversations about what it would look like. … John’s and Paul’s efforts to have a solid conceptual, theoretical foundation in the book drove the way we were thinking. We didn’t really want it to be just simply a revision of the first one.
We looked carefully at the various chapters. Some of those, such as the dissociative subtype of schizophrenia, for example, or even the chapters on chronic relational trauma disorders or dissociative hallucinosis were really interesting conceptual ideas and suggestions, but a lot of them hadn’t moved much in terms of research work or conceptual advances between the first edition and this one, and so they continue to stand alone as they were. We wanted address emerging issues in the field over the past ten or so years.
Warwick: Was it hard to decide about certain areas, which obviously were precious to the people involved in those areas?
Martin: (laughter) We had a lot of conversations about this and the long list of chapters that we had initially devised was quite enormous, to the point that the publisher actually said, “You might want to do this over two volumes.” We thought about that, for about ten or 15 seconds. (laughter) We then scaled things down and went back to the original (one volume) format.
Warwick: How did you three divide up the workload of this enormous undertaking?
Martin: John was very clear about his other commitments and where he was in his life. He was really a support for us and edited a number of chapters and was a sounding board, in terms of guidance. Steve started this project having just finished his own contextual book, a revision, and massive expansion, of his earlier work. I think it sort of evolved. It was very fluid and alive.
John: I think it’s fair to say that Martin did the most. Steve did the next most. And I did a little bit.
Steve: No question that Martin did the most. We gravitated to the areas that most interested us. One of my interests in being involved in the project was to learn more about the breadth of the field and to learn more about areas of the field that I hadn’t been exposed to as much previously.
Warwick: What was it like for you working with all your 70-plus co-authors?
Steve: Martin definitely took the lead on this. So, he may disagree with me here because he might’ve been in the vanguard, but it seemed to me that this project had less of a quality of ‘herding cats’, than some of the previous projects like this that I’ve been involved in.
One of the things Martin kind of led me into doing is this – my first draft for this book was pretty treatment-oriented and Martin redirected me, which I really appreciated, to being less treatment-oriented, and more theoretical.
So, there was some degree of having to reorient certain authors [to be] more theoretical, which is important, because what it means is the book is about basic questions, basic issues, definitional issues – what dissociation is, and is not. I’m really pleased with that. I think what that allowed for was a diversity of opinions without things seeming kind of adversarial. I think that’s the area where people really become maybe overly impassioned and disagree with each other a lot. So, there was a diversity without a sense of clashes.
Warwick: Do you have a sense of what issues are essentially unresolved, but are of major importance?
John: In the Preface to the first edition there were a number of issues that Paul and I highlighted, which I think remain open. They have not been resolved. One of them has to do with surface and deep. Like whether you’re talking about dissociation at the sign and symptom level or at the underlying structural intrapsychic level.
Another has to do with active and passive. In other words, to what extent dissociation is something that happens to the victim, let’s say, or something that the victim does in order to cope with what’s going on.
Another polarity is the normal dissociation – pathological dissociation divide. Another one has to do with faculty dissociation versus multiplicity. I think an interesting recent one is the whole idea of compartmentalization versus alterations in consciousness, which I just find hilarious in the best sense of the word, as it replicates the division between hysterical neurosis and depersonalization neurosis, which you’ll find in DSM-II. So, the whole field continues to evolve. I think most of the old dichotomies continue to be recycled and continue to bring up new information but without settling for one or the other.
Martin: What dissociation is [defined as] possibly remains problematic and possibly that is as it should be. … At some point someone with an enormous brain is going to put this all together and find the kernel in it, and then we’ll all go “Hallelujah!”. It doesn’t feel that we’re quite there yet.
Warwick: One of the things that I am just enormously impressed with was, given the sheer magnitude of the tasks, is that you have delivered on time. How did you manage that?
Steve: I’m going to credit Martin with that again, because he used the iron fist in a velvet glove! (laughter) He was really good at insisting that people move along and get things done in the most collegial, gentle way, and it got results.
John: Because I think the project is what, four years long in total?
Martin: We got the publication contracts in 2019. We started very early in 2020 with the authors.
John: One of the things I find most extraordinary is that the huge bulk of all the texts were in before Christmas 2020. I have to second everything that Steve said about Martin. It blows my mind.
Warwick: Well, it blew my mind. I remember when this started and I got an email from Martin on the day, I think, we were just going into lockdown. Every time you turned on the news, it was doom and devastation. And there’s an email from Martin saying, “Would you like to write a chapter?” I needed a chapter at that point in time like… (laughter)
Martin: We were assisted in this process though, by all of us coming from the school of hard knocks. We agreed that it would not be sensible to have all the chapters come in at roughly the one time. And, so, we had this two-tiered process, where with revised chapters, we wanted them in by the tenth of January last year [2021], with most of them in before that, and then new chapters by August, I think. One or two authors found that a little bit hard to understand, but generally everyone was fully on board with us.
Warwick: What are your hopes for this book?
John: My hope is that it does at least as well as the first edition, such that Routledge comes back asking Martin and Steve for a third edition. (laughter) I’ll be very happy when Routledge comes begging for a third edition.
Martin: I’m with John. I mean, I would like to see it sell a few copies. That would be the most helpful thing. I have seen this project, as I saw the first edition, as a way to try and educate well beyond the dissociative disorders field, to influence training programs and people early in their careers, but also people later on in their careers who [are] open-minded enough to begin to contemplate some phenomena in a different way [to how they] previously have.
Warwick: Your thoughts Steve?
Steve: What I really hope is that with this book, we won’t just be speaking to ourselves, that it will reach beyond folks who already think of themselves as specializing in dissociation. [And] that people who are relatively new to the field will also recognize that there is a diversity of opinions and there isn’t, “This is the truth!” [I hope that] it will encourage a lot of thought, instead of a lot of assumption.
Warwick: How will the critics of our field react to a book like this?
Martin: The idea of [dissociation being a] legitimate psychological phenomena can be a challenge for at least some people, although others seem a bit more open.
Warwick: It seems like an awful lot of very well cross-referenced, researched material is hard to just dismiss. It’s growing and building on a very solid foundation. I’m just wondering whether the only thing left for them to do, is to ignore it?
Steve: Well, they’ve been ignoring it for decades now. I know that I have a habit of being overly optimistic. I think about what the Zeitgeist was around the first book … the hope was, “Let’s just try and make sure that they keep dissociation in the DSM.” Now it just seems like things are very different. I remember when the PTSD diagnosis first came out, and there was a lot of talk about, “I don’t know if this is a real thing.” [There was] a very long period of scepticism about whether there really was such an animal as PTSD. And that’s been the case with dissociation since it resurfaced in the late 20th century. And I just think there’s a lot less scepticism than there used to be. [It’s] almost gone. The “False Memory Syndrome”, hopefully is going the way of the dinosaurs.
Warwick: What was your final word count? I know it’s in excess of “War and Peace” (587,287 words).
Martin: The revision, because they asked us for the word count on each chapter, actually is 595,619.
Warwick: Just by way of participant observation, having been edited by Steve and Martin [for this book], I just never had a more positive editorial experience with editors being attuned and gently guiding me into improving a paper. I assume that many others had a similar experience?
Steve: I wouldn’t say it was unanimous. (laughter) It was very interesting. And I, and certainly as an author, I understand this, you know. You hand your baby over to somebody and they want to do plastic surgery on it! (laughter) It’s not always something you appreciate. But there were people who were very appreciative and very responsive, and I think really understood from the beginning that a lot of our investment was in seeing to it that what they wanted to say was as clear to the reader as possible.
I think there were authors who didn’t quite get it at first, like on the first pass through, that that’s where we were coming from. But they came to understand that we’re on their side and our overriding concern was, “Let’s make sure that your ideas come across to the uninitiated with as much clarity as possible.”
John: We went through that with the first edition too. The one that most comes to mind is Philip Bromberg, who was outraged that Paul told him he was going to go through the text, sentence by sentence, and edit. … And then Paul sent him the edit. Bromberg replied back that he much preferred the edit to his original. (laughter) He started off being outraged that anyone would edit his work and then, when he saw Paul’s clarification, he changed completely. Then there were others who got upset. It was variable, a mixed bag.
Warwick: At this point, I was just going to ask each of you whether you had any other reflections on anything to do with this book? I’m not tying you down to anything. Is there anything you wanted to say?
Martin: One thing that immediately comes to mind for me is just to mention, in part because John had mentioned Philip Bromberg, that the book is dedicated to three people who are no longer with us, who were in the first edition – Philip Bromberg, Giovanni Liotti, and Susie Farrelly. It’s important just to note that.
Steve: I was just thinking that my overriding impression, without the product, is that it’s very much like a mosaic. It’s like a Seurat painting, where there are all these diverse individual parts that together make a somewhat coherent picture. … It reminded me of the first client that I worked with who I recognized had DID and she spoke about her own inner experience being analogous to having read a book about various theories, conspiracy theories, about the Kennedy assassination. At the end of the book was the sentence, “And it’s all true.” What she meant was, all of this disparity, is me… I kind of think that it’s true about our field, that if you stand back and look at the whole, there’s more consistency, there’s more coherence, certainly than I realized going into the project. Not that there’s agreement. These pieces that look disparate can be seen as coming together to make a coherent whole.
John: I’m just enjoying what Steve just said. I guess one thing I would say is, for every definition of dissociation that I’ve ever read, I have encountered a real patient who contradicts it. So, that just keeps the whole thing open.
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We are grateful for Warwick, Martin, Steve and John in giving their time to this interview. Dissociation and the Dissociative Disorders: Past, Present, Future is now available for pre-order from Routledge, with the book shipping after September 30, 2022. See here for more information:
The book will also be available from Amazon: https://www.amazon.com/Dissociation-Dissociative-Disorders-Present-Future/dp/0367522780
If you choose to shop with Amazon, remember to use your Amazon Smiles to raise money for ISSTD!