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The Stranger In The Mirror

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Chances are that you will spend time with someone who suffers from dissociation today. Do you know how to help them? Do you even know who they are? If you are like me, the answer was "no" to both questions before reading this excellent, important book.

Dissociation is defined by the authors as "a state of fragmented consciousness involving amnesia, a sense of unreality and feeling, of being disconnected from oneself or one's environment." One of the extreme forms that this disorder can take is as someone who exhibits multiple personalities. If you ever saw the movie, Three Faces of Eve, that is what is being described here in extreme form. Most people with this condition are experiencing these personality complexities inside their minds, and the external manifestation can appear to be absent-mindedness or a strange reaction to common occurrences.

The actual diagnosis of this mental condition needs to be done by a trained clinician, but there are helpful questionnaires in the book to help you determine whether such a clinician should be sought for you or someone you know. You need to have pretty broad-based and severe symptoms before you have this disorder. Based on broadscale survey research led Dr. Steinberg, it is estimated that 14 percent of the population in North America have this condition. The sufferer usually goes untreated or is treated for a symptom of the disorder, such as depression or panic attacks. The condition is often misdiagnosed, as well, as schizophrenia.

Dissociation "is a healthy adaptive defense used almost universally by people in response to overwhelming stress or life-threatening danger." So, if you've experienced some aspects of dissociation, that's good. What's bad is if these characteristics are present all of the time in extreme ways. I thought the questionnaires were unusually good at differentiating normal, healthy dissociation from the qualities of this disorder.

The book contains three lengthy case histories that show in detail how the disorder can be manifested, and how difficult it is to diagnose and treat. Many mental health professionals will benefit from reading this book, as encouragement for bringing their knowledge up-to-date. When Dr. Steinberg began her research, it was thought that dissociation was relatively uncommon, yet it is reaching epidemic proportions.

The incidence of dissociation is often related to childhood abuse. In relating this information, the authors expose some common myths about childhood abuse. One of the most important is the belief that children would remember such occasions. In fact, the amnesia of dissociation often prevents these memories from surfacing. This abuse most often occurs in alcoholic households. The abuse effects can be complicated by having occurred involving more than one generation in a family.

If you are like me and are fascinated by reports of alien abductions, out-of-body experiences, and near-death experiences, you will be interested that the authors point out that these recollections can be manifestations of dissociation. The alien abductions can turn out to be subverted memories of childhood abuse, for example. The authors are open minded, however, and do not attempt to qualify all such memories as being dissociation.

Treatment occurs though emphasizing personal comfort, more communication, cooperation, and connection. This requires having the patient employ these resources as well as encouraging those who know the patient to use them. Unlike many extreme treatments used in the past for mental conditions, these are gentle and should be appreciated by anyone.

I liked this book for its ability to connect our rapidly-expanding depressed population to a tangible set of causes and treatments. Not every depressed person has dissociation, but many do. Rather than just treat them with drugs, this therapy can provide valuable emotional support and connection to improve the quality of life in other ways.

After you have finished reading this book and sharing with people whom you think would benefit from it, think about circumstances where temporary dissociation can be helpful. It would be wrong to deny yourself the benefits of dissociation when you need it. Mental disciplines like meditation are helping you create dissociation in one sense. Decision-making processes are also helping you depersonalize so your rational mind gets a chance to clear away harmful levels of emotion. When you are first injured in a car accident, you will probably not feel much pain. Pain-killing body chemicals are part of that, but dissociation is too.

Take control over your mind and your life!

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.

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!

Steinberg's book is a helpful 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, anxiety, and psychosis. 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) such as post-traumatic stress disorder. Steinberg's criteria are similar to those included in the DSM-IV and to the Dissociative Experiences Scale and Somatoform Dissociation Questionnaire developed in the 1980s.

An aura of hocus-pocus 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, child victims create alter identities from altered states of consciousness, so they can be "someone else" or "somewhere else" or "sometime else" during abuse, compartmentalize the weird from the normal, and stifle powerful, ambivalent feelings towards abusive loved ones. (Abusers often reinforce this with threats and make-believe.) 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 whereabouts of Satan remain 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 and drugs. 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. The remarkable later work of Pavlov with his poor dogs was largely unknown in the West until the 1960s.) The main thing wrong was a certain Victorian reticence. Otherwise, leading psychiatrists and psychologists were on the right track. 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 in combat, 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 fad misdiagnoses today are increasingly anxiety 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 a few 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 and borderline personality treatments such as desensitization, DBT, EMDR, and hypnosis.

For mental health professionals, the DID book of Colin Ross is the best, 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 phobia. This one fact cuts through all the confusion of the last 25 years on the subject and demolishes the medical and historical misinformation pushed by such ideologues as Elizabeth Loftus, Sally Satel, Frederick Crews, and Richard McNally. Dissociation is real and has been part of psychiatry for over 150 years. The literatures on combat trauma, cults, and brainwashing, not familiar to most mental health professionals, 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 overtook the ideologues.

Unfortunately, in a media- and journalism-saturated society, it is possible for academics, literary critics (!), and talking heads with no clinical knowledge but dogmatic prior beliefs to pose as medical experts. Modern medicine has seen similar, earlier struggles, like the 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.

Everyone dissociates. When you drive home on auto pilot and don't remember the trip, when you walk into a room and can't remember what you went in there for, when someone is in an accident and goes into an altered state where they keep functioning even though injured until they're safe again, getting help and can experience the pain.

This books describes the author's diagnostic tool for evaluating dissociative experiences. She has developed a matrix of five categories of dissociation and five levels of severity. She stresses that if the dissociation is causing problems for an individual, the condition responds well to appropriate treatment no matter what the severity.

One goal is to de-stigmatize persistent dissociative conditions and to remind all professionals that everyone should be treated with respect, no matter what behaviour they exhibit. No one's personality should be treated as a freak show.

Another gaol is to encourage everyone to take care of themselves, to nurture their inner environment for a healthier life and she provides some great ideas on how to do that.

I believe the author accomplishes these goals. This is a very readable, fascinating, helpful book.

This book is fantastic. Both my husband & I have read it and now my sister and father are reading it. As Steinberg & Schnall explain, there is a continuum of dissociation. Everyone has some mild form of dissociation and at the other end of the continuum is DID (formerly MPD). I have severe dissociation but I don't know for sure if I have DID. My husband and I live with this every day. As hard as I have tried to explain the illness to my husband, for whatever reason(s), it was not clear. Finally, I was able to go to the library one day and borrow this book. He read it and then I read it. My husband & I tend to read completely dissimilar books but this book was readable, understandable, and enlightening to both of us. For people with dissociative disorders (not necessarily DID), this book helps you realize that you're not alone. For anyone who interacts with people (i.e. pretty much the whole world) this book should be mandatory reading. You never know why someone is reacting the way they are to a circumstance. This book shows you how to be open minded and understanding of other people's idiosyncracies without needing to understand why they have the idiosyncracy. The world would be a much calmer, more pleasant place if we all had the compassion that this book helps bring out.

This a remarkable book that you can't afford to miss reading if you have any questions about what makes us tick psychologically. It's beautifully written,provocative, fascinating, and extremely readable,and makes complex concepts easy to understand, particularly for people who have hidden parts of themselves. The three in-depth case histories alone are worth the price. They read like suspenseful, incredibly intimate detective stories, and make you feel as if you're a fly on the wall of the psychiatrist's office. You come away from them uplifted by the power of the human mind to save itself. If you liked Sybil or The Three Faces of Eve or even Nurse Betty, you'll love this book.

The self-tests to rate your symptoms are also eye-opening. I found out that I do dissociate at times--zone out when I'm bored or feel as if I'm outside myself watching myself at times, but that it's perfectly normal in my case. But it was shocking to learn that many people who do have a dissociative problem are being mistreated for depression,attention-deficit disorder, panic attacks, and mood swings--which is probably why they're not getting better.

The Chapter on "Men and Dissociation" does a lot to explain why some men are one person when they're drunk, and another when they're sober. And the "Aliens From Inner Space" Chapter on past lives, near-death experiences, and UFO abductions is the first I've ever read that gives a convincing medical explanation for these phenomena.

I bought this book because I was puzzled by the behavior of a close friend who, I now realize, is a dissociative. She read it, too, and was helped by it enormously. If you could give six stars to a book, this one would be it.

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.

To express the impact this book has had on my life goes beyond words. It absolutely turned my life upside down and started me on a journey toward wholeness and healing, after years of being misdiagnosed, and spinning my wheels. I recommend this book first and foremost to anyone with chronic mental illness. The quizzes at the end of the chapters are extremely helpful as a preliminary assessment of where one might lie on the dissociation continuum. This book should be required reading for everyone training in a mental health or medical field.

As a person who experiences dissociation first hand, I found THE STRANGER IN THE MIRROR excellent. Dr. Steinberg's approach to treatment is a terrific resource for trauma survivors, those who love them, and those who work with them. Not only is the subject matter presented in a compassionate manner, it is also very interesting. Since it reads like a novel one is able to painlessly learn a lot of information. I highly recommend this book!