7 ..9
Despite its eventual name of acute stress disorder, and its inclusion within the anxiety disorders, all the symptoms within this diagnosis are of dissociation.
Exploring psychiatric nosology more generally, Dr. Ross pointed out that patients often display a range of psychiatric conditions – for example, a person may have a personality disorder, OCD, phobias, PTSD, somatic disorders, and depression (and other possibly other conditions). This co-morbidity is so common that it seems statistically highly unlikely that the various psychiatric conditions are truly independent categories of disease. Many of them would at one time have been collectively described as ‘hysteria’. Dr. Ross argued that most psychiatric symptoms can be understood as different forms of dissociation, showing either intrusion or withdrawal. Thus traumatic flashbacks, hallucinations, OCD, thought insertion etc. are all forms of intrusion. Amnesia, numbing, thought withdrawal, negative symptoms of schizophrenia etc. are all forms of withdrawal. The content and type of intrusion or withdrawal determines the disorder category. One recurrent observation was that when a person with DID achieves integration, their previous OCD disappears. Linked to this, he pointed out that when a person is in the grip of OCD, he or she is not in an adult state of mind but is like a child in an overwhelmed ego state, engaging in magical thinking as a means of controlling anxiety. He suggested that SSRIs function to increase dissociation (and referred to research indicating that the purported serotonin reuptake inhibition explanation is spurious). Elaborating on his theme (at the Cardinal Clinic conference), he concluded that patients collectively would have a good legal case for class action for malpractice against the psychiatry profession on the grounds of the non-scientific and often harmful nature of its procedures. [Please note that he is a psychiatrist!]
The medical model, and the assimilation of psychotherapy to a ‘health care profession’ involve a category error. A ‘medical’ person can be expected to ‘diagnose’ and ‘treat’ specific ‘diseases’, and to be able to provide predictive ‘prognosis’ of that disease, as well as prescribe the correct medicine and dosage. The NICE guidelines, IAPT, stepped care models, HPC, the provision of expert opinion in court, and so forth, all rest on such assumptions. The psychological ‘health care professional’ will provide therapeutic services according to empirically validated protocols, just as NICE prescribes. Freud’s secular pastoral work was not of this kind. Psychoanalytic truth indicates that we cannot genuinely ‘diagnose’ psychological distress – we can only be open to what is gradually communicated as our client becomes willing to do so. When I had a consultation with my first analyst, as a young man of 23, I asked her what she thought was wrong with me – she replied: “I haven’t a clue what’s wrong with you – it will take an analysis to find out!”.