The title of this book, which lays out a groundbreaking approach to the theory and therapy of psychological trauma, is, like much that lies inside, both evocative and precise. To be haunted is to be ‘much visited by spirits, imaginary beings, etc.’, according to the Oxford English Dictionary, which is exactly the position taken by the authors in their conceptualisation of the after effects of severe trauma. While recognising the trauma survivor's experience of shadowy ‘others’ in their internal world, Van der Hart et al take great pains to avoid reifying these spirits as persons or personalities - a delicate balancing act indeed.
The field of psychological trauma and dissociative disorders, closely linked with childhood abuse, is often criticised (at times caustically) by the mainstream psychiatric press for fuzzy thinking and soft-hearted values. However, this carefully reasoned, cogently argued and well-written book - the fruit of decades of clinical experience and research by the Dutch psychologists Onno van der Hart and Ellert Nijenhuis, and their long-time American collaborator Kathy Steele - should go a long way toward dispelling that view.
The theory of structural dissociation, solidly grounded in both evolutionary psychology and learning theory, places dissociation - narrowly defined as a schism in the personality (i.e. excluding transient disturbances in consciousness) - at the centre of trauma disorders, including not only post-traumatic stress disorder (PTSD) and dissociative disorders but also borderline personality and somatoform disorders. Van der Hart et al's basic premise, consistent with recent neurobiological and psychological research, is that severe acute traumatisation bifurcates the personality into one part that attempts to avoid all reminders of the traumatic event and another that is immersed (and cannot escape from) the trauma. As avoidence/numbing and intrusive symptoms are both considered central to the diagnosis of PTSD, this is not surprising. However, the authors go beyond this and suggest that rudimentary forms of identity can coalesce around these experiences, and that these symptoms map on to behaviour patterns or action systems that are evolutionarily primed and centred around either defence against threat or daily life activities. After C. S. Myers, they have called the ‘daily life’ part the ‘apparently normal’ part of the personality, and the ‘threat-oriented’ part the ‘emotional’ part of the personality. Basic tenets of learning theory, particularly classical, operant and evaluative conditioning, provide the bricks and mortar for this theory, helping to explain how more complex forms of dissociation (termed secondary and tertiary structural dissociation to distinguish from the simple schism seen in acute PTSD) can develop from the more chronic and extreme forms of traumatisation associated with dissociative disorders and borderline personality disorder.
Along the way they resurrect much of Pierre Janet's psychology. The second part of the book comprises a detailed exposition of his important psychology of action, along with a much-needed modernisation of some of Janet's important concepts, such as psychological force and psychological tension (as mental energy and mental efficiency, respectively). This part will be of particularly interest to trauma researchers and historians. The end of the book is a step-by-step, practical guide to working with chronically traumatised individuals, which should be of enormous interest to all trauma clinicians. As the authors have almost two-thirds of a century of therapeutic experience between them, this section includes very valuable and sensible clinical advice. They emphasise a careful and thorough assessment process, and, like many others in the field, consider extended Phase 1 preparation (skills building, stabilisation) to be crucial prior to any exploration of traumatic experiences. While others in the trauma field have proposed a similar phase approach (beginning with Janet, the authors' note), theirs includes innovations such as utilising Janet's notions of a mental economy and conceptualising various intrapsychic and real world difficulties as phobias.
The Haunted Self is, without a doubt, one of the most important books to come out of the trauma field in many decades and should serve to revitalise and transform the field. It should be read not only by clinicians working in the trauma field and interested researchers, but also by trauma sceptics as the theory (the authors are at pains to point out) is eminently testable and can be empirically judged by those who doubt its implications. Last, but certainly not least, The Haunted Self provides a welcome opportunity to reconsider the relevance of Pierre Janet's theories, which continue to provide rich clinical and theoretical insights.