The Stranger In The Mirror

Rating:
Summary: Flawed Yet Still Invaluable
Review: Dr. Steinberg's book has significant flaws but is still an invaluable resource for therapists and their clients who wish to understand and recover from trauma-based dissociation. She defines dissociation as "a state of fragmented consciousness involving amnesia, a sense of unreality, and feelings of being disconnected from oneself and one's environment." Aimed at the general reader, Steinberg's and co-author Schnall's prose is lucid, compassionate and contains much practical insight. She provides many self-help suggestions for communicating with and nurturing the dissociated parts of oneself. The book also includes a screening instrument to help identify the presence and potential need for further assessment of what Steinberg considers the five core dissociative symptoms: amnesia, depersonalization, derealization, identity confusion, and identity alteration. She stresses that dissociation may be mild, moderate or severe; normal or abnormal; adaptive (healthy, promoting adjustment) or maladaptive (unhealthy and interfering with adjustment, growth and stability) and that having one or more dissociative experiences does not automatically mean one has a dissociative disorder. One chapter even bears the title "A Healthy Defense Gone Wrong." Transient dissociation may occur in response to heightened stress. Dissociative disorders, such as dissociative identity disorder (formerly known as multiple personality) develop in response to overwhelming (or traumatic) stress, such as childhood sexual abuse.

Dissociation is often overlooked in typical psychiatric assessments. This is due to various factors. For one, there seems to be an ever-increasing reliance on medication as the primary (if not sole) treatment for emotional and mental health problems; there is often ignorance of dissociation, and sometimes even derision and disdain masquerading as skepticism vis-à-vis dissociative disorders. How refreshing, then, is Dr. Steinberg's distinguishing surface and hidden symptoms. She contends that many cases of depression, bipolar mood disorder, anxiety, attention deficit and even ostensible schizophrenia (often popularly confused with multiple personality) are outward manifestations of inward dissociative processes that can be treated with the therapeutic techniques she advocates. She states: " . . . we can prevent the tragic waste of life of many creative people with [severe dissociative disorders] by teaching them how to communicate with their different sides and integrate them instead of trying to suppress them with drugs alone. Research has shown that people spend seven to ten years or more in ineffective treatment, often shunted haplessly from one therapist to another until their dissociative disorders are correctly diagnosed." (p. 297).

She has developed a tool for diagnosing dissociative disorders, a structured interview called the SCID-D. At times, The Stranger in the Mirror reads as if it were an infomercial for the SCID-D, and Steinberg seems to imply that there has been no other comparable instrument. Thankfully, that is not so; yet having another objective measurement of this controversial condition may contribute to silencing some of the skeptics.

Steinberg's lack of historical perspective is surprising but forgivable, considering that the book has considerable therapeutic value otherwise and that providing a literature review was clearly not its primary purpose. (Those readers wishing for an extensive review of over 100 years of literature on dissociation should consult Colin A. Ross' Dissociative Identity Disorder) Still, her flat assertion that in 1981 "dissociation . . . was a relatively new concept" (p. ix) is simply not true. Writing in 1934, C. G. Jung credited Janet and Prince before him "for our knowledge today of the extreme dissociability of consciousness," and he said that "fundamentally there is no difference in principle between a fragmentary personality and a complex." He also referred to what he termed autonomous feeling-toned complexes as "splinter psyches."

Another criticism of the book is in her treatment of the paranormal. Although she, like Jung before her, sees dissociation as normal and not necessarily pathological, she is rather quick to conclude that out-of-body-experiences (OOBE's) past-life memories, near death experiences (NDE's) and other such borderland phenomena are "most likely, not events that actually happened, but yet another example of the power of the human mind to protect itself by creating imaginative metaphorical symbols for memories of unthinkable childhood trauma." (p. 293). This may often be so, and her caution is a welcome alternative to either wide-eyed credulity or knee-jerk skepticism, but she by no means accounts for all the data. For example, although the literature on OOBE's contains many accounts of experiences precipitated by shock or trauma, there are also innumerable exceptions. Still, no one who accepts the possibility of an OOBE would deny that, by definition, a type of dissociation is involved. Religion writer Alan Spragget in 1967 even referred to OOBE's as "somatic dissociation." Also, evidently Steinberg is unaware of Dr. Ian Stevenson's studies of children who spontaneously report verifiable past life recollections. Whether these cases prove reincarnation is a separate matter, but they hardly seem reducible to "screen memories" of past abuse. The one work on past life therapy she cites is Brian Weiss' Many Lives, Many Masters. She argues plausibly that the patient portrayed in that book had a dissociative identity disorder rather than recollection of literal past lives. She attributes what progress that patient made to the fact that Weiss' therapy "acknowledged and worked with her hidden parts and did not discount them" (p. 290) but sees Weiss' not recognizing an underlying dissociative disorder as prohibiting the patient's further integration. Should she read another work in this vein, Steinberg would do well to choose Roger Woolger's Other Lives Other Selves. His approach to past lives amounts to an elaboration and extension of Jung's theory of complexes, and, as with more conventional forms of trauma therapy, stresses that the literalness of the memories is less significant than their symbolic resonance with the patient's core conflicts.

In spite of the above criticisms, I have enthusiastically recommended The Stranger in the Mirror to colleagues and clients and will continue to do so.

Rating:
Summary: Fantasic - A Must Read!!
Review: I read this book in three days. It is a little clinical at times, but easy to follow. It is extremely detailed and really helps to sort all of this out in a clear manner. The only disappointment is that the section "Inside Stories" didn't include anything about men. I thought that the section on men was a little too short. However, compared to what is out there, this is fantastic. This book really helped me to stop feeling crazy and that this is very normal for what we have been through. The book is full of hope. It educates the reader on what is happening now. The author is incredible and should be praised for helping us pull it together. It is a scary place to be, but she has helped me to understand and be more comfortable with DID.

Rating:
Summary: Important, but only one slice
Review: Steinberg's book is a useful selection of her own cases and diagnostic criteria for dissociative identity disorder (DID), formerly known as multiple personality disorder. In my opinion, the standardized criteria are the most valuable part of the book. (They form a subset of complete criteria published elsewhere.) They should be as much part of the professional training of mental health workers as the better-known criteria for depression and anxiety. The only drawback is that she concentrates mostly on full-blown DID (fully developed personality alters) and doesn't give much space to more limited and more common dissociative disorders (DDs). Steinberg's criteria are similar to those included in the DSM-IV and to the Dissociative Experiences Scale developed in the 1980s.

Yet an aura of hocus-pocus (demon possession?) still surrounds DDs, and many mental health professionals are scared away from the subject. The terrible abuse often suffered by DD victims is not easy to think about or accept. The "identity" part of DID is a disorder of the imagination - on top of an automatic dissociative defense, victims create alter identities from altered states of consciousness, so they can be "someone else" during abuse. (Abusers often instigate this with their own forms of make-believe, coercion, and blackmail.) The result is freaky, although similar in many ways to brainwashing and cults. In addition, a powerful, though medically unsound, reaction developed in the 1990s against the political and legal misuse of trauma by fringe elements of the mental health profession, witch-hunters looking for Satan and radical feminists crusading against patriarchy. (In the West, patriarchy is as dead as the dodo. The status of Satan remains unclear.) Steinberg's book is a useful corrective to this reaction, insofar as it keeps DID victims and their loved ones from being intimidated by misinformed bullies.

After the diagnostic criteria, the most important service Steinberg renders is to clarify why dissociation is often missed. As mental health screening has improved, DD sufferers are caught more often, but then misdiagnosed by being labeled with their secondary problems - typically, mood and anxiety disorders, but also obsessive-compulsive behavior and fuzzy "personality" problems. Standardized diagnostic criteria are essential to identify DDs and differentiate them from other conditions.

Here emerges the major flaw of Steinberg's book, her lack of historical awareness. DDs, together with post-traumatic stress and borderline personality disorder, were well-known 100 years ago. All three were lumped under the label of "hysteria" and often treated, with some success, using hypnosis. The main thing missing in those days was an understanding of the physiological basis of stress. (Hormones were discovered in 1915, and the "fight-or-flight" response, the key to stress, in the 1930s.) Otherwise, leading psychiatrists and psychologists were on the right track, including the treatment of combat trauma in both world wars. Then several developments derailed good medicine. The best-known is the rise of psychoanalysis. Reversing his brilliant start with Studies in Hysteria, Freud and followers claimed (although not consistently) that traumatic memories were really childhood fantasies or expressions of a speculative "death instinct." Military psychiatrists eventually rejected such ideas when applied to soldiers, once they accepted that every man, no matter how well trained and led, has his limit. Why should this not hold all the more of abused children, isolated and unprepared? Truly, this was an elaborate strategy of ignoring or blaming the victim.

But the most important misstep came after 1920 from the then-new concept of schizophrenia. Certain dissociative symptoms sound superficially like schizophrenia, and a reign of misdiagnosis descended. This reign continues, except the fashionable misdiagnoses today are increasingly depression and manic-depression. The focus on symptoms that can be treated by the band-aid of psychoactive drugs is also very strong. The cure of DDs requires intensive psychotherapy that typically lasts three to five years. (Many DD patients are misdiagnosed for 10+ years.) However, if carried to its end, the therapy is almost always successful, and patients achieve a complete fusion of alter states. But before that can happen, patients have to endure a long road of reconditioning and personality re-integration. These techniques overlap with post-traumatic stress treatments such as desensitization, EMDR, and hypnosis.

For mental health professionals, the DID book of Colin Ross is the best in the field, followed by James Chu's Rebuilding Shattered Lives. Ross explains the history of DID and how the recent "false memory" controversy is not new. The keys to traumatic amnesia are dissociation and alteration of consciousness under chronic helplessness, not "repression" in the Freudian sense, which is closer to obsessive thinking. This one fact cuts through all the confusion of the last 25 years on the subject. In particular, it demolishes the medical and historical misinformation pushed by ideologues such as Elizabeth Loftus, Sally Satel, Frederick Crews, Elizabeth Showalter, and Richard McNally. Dissociation is real and has been part of psychiatry for almost 150 years. The literatures on combat trauma, cults, and brainwashing, which most mental health professionals are not familiar with, cover much of the same ground, including selective and complete traumatic amnesia. The recent wars in Bosnia and Kosovo have produced another chapter of related medical forensics and prosecution of war crimes. (The medical forensics are presented in publications from NATO and the war crimes tribunal at the Hague.) Even more recent is the priestly child sex abuse scandal, where the same issues appeared again. Just when the ideologues seemed triumphant, terrible events, caused by terrible people, overtook the ideologues.

Unfortunately, in a media- and journalism-saturated society, it is possible for academics and literary critics (!) with no clinical knowledge but strong, prior beliefs to pose as medical experts. Modern medicine has seen similar, earlier struggles, like the dogmatic rejection of germs. Steinberg's book is a guide for perplexed onlookers, patients, and concerned friends and relatives, backed by the only authority that counts in science: experience.

Rating:
Summary: Everyone Should Read this book!!!
Review: Subtitled Dissocation, the Hidden Epidemic, this one should actually be entitled Are You Multiple, Too? In short, it provides a series of questionaires that will help you judge the degree of dissociation you suffer. Then, after doing so, it helps you rate your symptoms from simple to severe. And it recommends that you can be treated, even if your symptoms are severe. It highlights the stories of some people people who fell into this category and used therapy to haul themselves out.

That's it. No practical skills, only the urging to go to a therapist and have your self generated diagnosis confirmed.

Beh.

This book did have a few good points. One, it mentioned both the indentity sexual confusion many multiples suffer. Two, it detailed how some multiples in denial might prefer to believe their experiences to be the result of past lives. These things it merely documents, however. How you deal with them is between you and your therapist.

With the hefty price tag this one sported, I really can't recommend it. I already knew I was multiple, so it was very useless to me.

Rating:
Summary: Powerhouse of a Book -- a MUST READ!
Review: This book blows the lid off of the widespread misunderstanding and misinformation out there about a common disorder that we all share to some degree or another. If you've ever been in an accident, or ever been the victim of any other type of high-stress event, you've experienced dissocation as the defense mechanism that allows you to cope with the attednant trauma. Reading this book will help you identify and understand the symptoms you experienced. Dr. Steinberg's research actually reveals that even the most normal, well-adjusted people dissociate on a regular basis as a defense mechanism. Problems arise only when it is taken to an extreme.

Dissociation is simply a protective response hard-wired into our psychological makeup that allows us to cope with high stress situations and events. This book makes it clear that the fact that you dissociate doesn't mean you are turning into Sybil. The self-test included in the book helps you understand this. Based on years of research by an acclaimed figure in the field, the clear and lucid writing make a complex and difficult subject accessible to a general audience. The case histories included in the text make for fascinating reading, and allow the reader to see how therapy actually works in a person's life.

It's almost criminal how many people are misled, even by mental health professionals, about the nature and significance of dissociation: it seems that many people being treated for anxiety and depression actually suffer from severe dissociation. This very informative book makes a significant contribution to the general understanding of this subject, and everyone everyone who wants to be in the know about themselves should read it immediately!

Rating:
Summary: A must read for all
Review: This book drags you into it. I found myself going back to it again and again, I was through the first hundred pages and thought the easy reading and understand of this book in unbelievable. I didn't think I would be able to read it norless understand it. I had to take that chance and was I shocked when I relized it was on my level. This is a must read book for all. I found myself all throught this book, and at times we found ourselves. Thank You so much for this information it has given me a better understanding after years of talking with a therapist on some of the insanity that my life has taken me through.

Rating:
Summary: Long overdue
Review: This book is an excellent addition to the growing body of literature on dissociative disorders. Thoughtful and expansive, it explains the 5 aspects of dissociation. Quizzes let the reader know if a professional assessment is indicated. Three case histories bring theory into experience.

While the author does address basic treament goals and strategies, the prime usefullness of this book is it's explanation of what dissociation is, not how to change it.

Rating:
Summary: Dissociation explained
Review: This book is an excellent addition to the growing body of literature on dissociative disorders. Thoughtful and expansive, it explains the 5 aspects of dissociation. Quizzes let the reader know if a professional assessment is indicated. Three case histories bring theory into experience.

While the author does address basic treament goals and strategies, the prime usefullness of this book is it's explanation of what dissociation is, not how to change it.

Rating:
Summary: clarity and support
Review: This book was extremely helpful to me, but it does have some limitations. "The Stranger in the Mirror" is mainly a self-diagnostic book to understand dissociative disorders. The limitation is that it doesn't include self-management of symptoms. Nonetheless, I still found this book to be invaluable for understanding the different kinds of dissociation, and the degrees to which it is a part of my life. It is great to read a book that focuses solely on dissociative symptoms, and goes into such depth. After reading this book I was able to understand the forms of dissociation that I struggle with, and that there really is hope to someday transcend depersonalization/derealization. In addition to this book I recommend "Getting Through the Day: Strategies for Adults Hurt as Children" and "The Post-Traumatic Stress Disorder Sourcebook".