The influence of Pierre Janet’s
Views in the Field of Psychotraumatology
Onno VAN DER HART
Reprinted from : VAN DER HART, O. (2006). The influence of Pierre Janet’s Views in the Field
of Psychotraumatology. Janetian
Studies, Actes des conf. du 27 mai 2006, No Spécial 01, pp. 54-63.
Worldwide, the influence on Pierre Janet’s pioneering work
is probably most recognized and visible in the field of psychotraumatology, in
particular among scientists and clinicians who are interested in the
relationship between trauma and dissociation. However, with his approximately
20,000 printed pages, Janet has so much more to offer to modern psychology and
psychiatry, such as his dynamic psychology and his psychology of action. The Institut Pierre Janet, in particular its
President, Isabelle Saillot, is doing wonderful work in bringing these largely
unknown domains of knowledge to the foreground. Likewise, Serge Nicolas, one of
the founding members of the Institut
is wonderfully active in republishing Janet’s works in a series of inexpensive
books through his publishing house, L’Harmattan. At the General Meeting of the Institut today, various speakers will
testify to the wide range of subjects related to Janet which are of current
interest. They come from
In this brief report, I discuss a few trends and
developments that took place in 2005 up to the present which relate to Janetian
psychotraumatology research and clinical practice.
Janet as the Pioneer on Trauma-Related Dissociation
In an important book, The Dissociative Mind, published in 2005, the American
psychoanalyst and traumatologist Elizabeth F. Howell, PhD, wrote: “Janet
(1859-1947) is the primary theorist on whose shoulders we stand when it comes
to dissociation” (p. 50). Furthermore, she stated, “Most of our theories of
PTSD confirm with, if they are not actually based on, Janet’s ideas” (p. 12).
Thus, Howell dedicates 14 pages to Janet’s views on trauma and dissociation
(pp. 50-64), and one of her conclusions is:
Janet’s work is now in the
process of major excavation and revivification. In the final analysis, Janet’s
theory of trauma and dissociation may be much more applicable that Freud’s
theory of repression. (p. 64)
The recognition of Janet’s clinical observations and
theoretical notions about trauma and dissociation indeed have received wide
recognition, especially among those clinicians and researchers dealing with
survivors of chronic traumatization. This recognition is symbolized, for instance,
by the International Society for the Study of Dissociation (ISSD), which
presents the annual Pierre Janet Writing
Award to an individual for the best clinical, theoretical or research paper
in the field of dissociative disorders. Furthermore, at ISSD’s annual meeting,
one of the highlights is the Pierre Janet
Memorial Lecture. This year’s annual meeting will include a workshop on
Pierre Janet.
Pierre Janet Translation Project
While work of Janet is currently being translated into
Russian and Japanese, perhaps the single most important development related to
the—future—impact of Janet’s work in the field of psychotraumatology is the
translation project initiated by the International Society for the Study of
Dissociation in collaboration with the Institut Pierre Janet. The first
work chosen to be translated is L’automatisme
psychologique: Essai de psychologie expérimentale sur les formes inférieures de
l’activité humaine (AP) (1889). The
translator is Paula Ann Monahan, who, during this meeting, will report in more
detail about the project. Already for years many non-French reading
professionals have expressed great interest in such a translation. In fact,
previously there have been several aborted attempts to translate AP. Given the
support from ISSD, which includes a Task Force and a Scientific Advisory Board,
chances are high that a complete English translation will be available some
day. I predict that this will be a major breakthrough internationally. After
all, a former Editor of the American Journal of Psychiatry, John C. Nemiah, MD,
wrote in a 1989 Editorial:
The recent festivities
celebrating the bicentennial of the French Revolution have overshadowed the
remembrance of another occurrence in French history that, from a scientific
point of view at least, is perhaps of equal magnitude—the publication in 1889
of Pierre Janet’s L’automatisme
psychologique. (p. 1527)
The 2005 Meeting of the Pierre
Janet Gesellschaft
On 3 and 4 May, 2005, the first international Pierre
Janet Symposium organized by the Berlin-based Pierre Janet Gesellschaft e.V.
(Society), founded in 2001, took place in
Janet’s Views and the Theory of
Structural Dissociation of the Personality
Pierre Janet’s views on
trauma-related dissociation, such as expressed in AP (1889), Les névroses et idées fixes (1898), L’état mental des hystériques, sec. ed. (1911), and Les
médications psychologiques (1919/25), as well as his psychology of action
(e.g., Janet, 1926, 1928, 1938), are most important in the development of the
theory of structural dissociation of the personality that Kathy Steele, Ellert
Nijenhuis and I developed in recent years. In 2005 we published a long article
on phase-oriented treatment of patients with complex trauma-related disorders
based on this theory (Steele, Van der Hart, & Nijenhuis, 2005), and in
September 2006 our book, The haunted
self: Structural dissociation and the treatment of chronic traumatization
will appear (Van der Hart, Nijenhuis, & Steele, 2006).
Briefly, this theory takes as its point of departure
Janet’s (1907) definition of hysteria,
which, in our view, pertains to a wide range of trauma-related disorders,
including posttraumatic stress disorder (PTSD):
Hysteria is a form of mental
depression characterized by the retraction of the field of personal
consciousness and a tendency to the dissociation and emancipation of the
systems and functions that constitute personality. (p. 332)
Given the fact that Janet emphasizes the dissociative
nature of hysteria, we believe that the term refers to the dissociative
disorders in a generic sense, thus not only the DSM-IV dissociative disorders
but also PTSD, trauma-related borderline personality disorder, and many of the
DSM-IV somatoform disorders. According to the theory of structural
dissociation, traumatization consists of an essential dividedness of the
personality between one or more parts that primarily engage in functions of
daily life and reproduction (i.e., survival of the species), and one or more
parts that are fixated on traumatic memories and that engage in animal-defence
like reactions when exposed to real or perceived threat (i.e., survival of the
individual). The different parts of the personality exert different functions,
driven by evolutionary derived action systems such as attachment, exploration,
play, and defense, and manifest in particular mental and behavioral action
tendencies.
Inspired by Pierre Janet’s psychologie de la conduite, the psychology of action sheds light on
the breakdown of integrative capacity during traumatization, which implies the
development of structural dissociation. It describes the trauma survivors’
mental and behavioral actions that maintain this structural dissociation and highlights
the specific actions that they need to execute in order to increase their
integrative capacity, resolve the dissociation, and become more adaptive in
meeting daily life challenges. Thus, both theoretical approaches and the
phase-oriented treatment model1 based on these theories provide the
basis for effective treatment. Among other things, they describe each treatment
phase in terms of overcoming specific phobias. Phase 1, stabilization and symptom reduction, is geared toward overcoming
phobias of mental contents (i.e., a range of internal conditioned stimuli),
dissociative parts of the personality, and attachment and attachment loss with
the therapist. Phase 2, treatment of
traumatic memories, is directed toward overcoming the phobia of traumatic memories,
and phobias related to insecure attachment to the perpetrator(s). In Phase 3, integration and rehabilitation,
treatment is focused on overcoming phobias of normal life, healthy risk-taking
and change, and intimacy. In clinical practice, especially with regard to
complex traumatization, these phases are flexible and recursive, involving a
periodic need to return to previous phases.
Although in our most recent work we also attempted to
integrate elements of Janet’s psychology of action, it needs to be emphasized
that we have probably only scratched the surface. Janet’s works contains so
much richness, that we, and hopefully many colleagues with us, will further
explore these sources and integrate them with modern developments in clinical
practice, theory and research.
Janet’s Views and Sensorimotor
Psychotherapy
A milestone in the trauma field is the forthcoming
publication of the book, Trauma and the
body: A sensorimotor approach to psychotherapy, co-authored by Pat Ogden, Kekuni
Minton, and Clair Pain (2006), from the
Part I explores the theoretical foundation and
rationale for sensorimotor psychotherapy interventions, drawing on the
century-old insights of Pierre Janet as well as the work of contemporary
experts in the areas of trauma treatment, neuroscience, attachment, affect
regulation, dissociation, and the body. (p. xxvi)
In Part II of their book,
Misunderstandings about Janet’s
Position on Dissociation
The ongoing interest in Janet’s views on dissociation
is colored by a number of misunderstandings that are being repeated throughout
the years.
The first misunderstanding is illustrated, for
instance, in another positive Editoral in the American Journal of Psychiatry.
More than two decades after Nemiah wrote his Editorial, David Spiegel, MD, also
referred to AP when he mentioned Janet’s “dissociationist model of
psychopathology” (Spiegel, 2006):
Two papers in this issue of
the Journal provide important new
findings regarding the prevalence and neurobiology of dissociative disorders.
This form of psychopathology has been a stepchild in American psychiatry for
centuries, included uncomfortably at best in the family of mental disorders.
Pierre Janet’s dissociationist model of psychopathology ([Janet, 1889]) was
influential in Europe but was eclipsed in the
Spiegel’s statement is a recognition of the importance
of Janet’s “dissociationist model of psychopathology.” Spiegel is right that in
AP Janet used the term désagrégation
(as it is spelled correctly), or rather désagrégation
psychologique. However, he was mistaken, like Perry and Laurence (1984)
before him, that “dissociation” is a poor translation.2 Both before
(e.g., Janet, 1887) and after (e.g., Janet, 1904/11) the publication of AP,
Janet used this term (e.g., Janet, 1887, 1904), thereby following a French
tradition that perhaps originated with Moreau de Tours (1845), who used both
terms interchangeably (Van der Hart & Horst, 1989).
Thus, a second, frequently made, misunderstanding
pertains to the error, dominant in the work of the philosopher Ian Hacking
(1995), that it was Janet who first coined the term dissociation.
A third misunderstanding is the idea that Janet in
later years disavowed his dissociation theory. This misunderstanding also
originated with the writings of Hacking (1995, 1998) and is subsequently
adopted by clinicians and scientists with a bias against the DSM-IV
dissociative disorders, in particular dissociative identity disorder (DID;
formerly multiple personality disorder) (e.g., Barry-Walsh, 2005; McNally,
2003). Both in earlier and more recent work we have refuted this claim (Dorahy
& Van der Hart, 2006; Van der Hart, 1996, 2005). Even in a book published
one year before his death, Janet indicated his life-long positive interest in
dissociation (Janet, 1946):
[t]hese divisions of the
personality offer us a good example of dissociations which can be formed in the
mind when the laboriously constructed syntheses are destroyed. The unity, the
identity, and personal initiative are not primitive characteristics of
psychological life. They are incomplete results acquired with difficulty after
long work, and they remain very fragile. All constructions built by the work of
thought belong to the same genre: Scientific ideas, beliefs, memories,
languages can be dissociated in the same way, and the end [product] of
illnesses of the mind is the dissociation of tendencies as one observes in the
most profound insanities. (p. 160)
This text reads, in the original, as follows:
Ces divisions de la personnalité nous offrent un bon
example des dissociations qui peuvent se former dans l’ésprit quand les
synthèses édifiées laboreusement se détruisent. L’unité, l’identité, l’initiative
personelle ne soit pas des propriétés primitives de la vie psychologique, ce
sont des résultats acquis difficilement et incomplètement après un long travail
et restent très fragiles. Toutes es constructions édifiées par le travail de la
pensée sont du même genre, les idées scientifiques, les croyances, les
souvenirs, les langages peuvent se dissocier de la même manière et le terme des
maladies de l’esprit est la dissociation des tendences que l’on observe dans
les démences les plus profondes. (p. 160)
A fourth misunderstanding, again originating from
Hacking, is that Janet was dismissive of multiple personality by equating it
with bipolar disorder. Janet, however, stated that multiple personality, or
rather double personality, is the hysterical (i.e., dissociative) variant,
which is both a suble and highly significant difference (see for more detailed
discussions of this issue: Dorahy & Van der Hart, 2006; Van der Hart, 1996,
2005).
A fifth, and most important misunderstanding abounds
in the field of trauma and dissociation at large. While Janet (1907) clearly
distinguished between retraction of the field of consciousness and dissociation
in his definition of hysteria (see above),
most students of dissociation have overlooked this difference and have
regarded retraction of the field of consciousness, as well as other alterations
in consciousness, as forms of dissociation (e.g., Bernstein & Putnam,
1986). Subsequently, these alterations in consciousness have been labeled normal dissociation, and phenomena more
exclusively related to dissociation as an undue division of the personality as pathological dissociation (Waller,
Putnam, & Carlson, 1996). In various publications we have argued that such
views seriously confound the concept of dissociation and our understanding of
dissociation, and hamper adequate research in this area. We have proposed that
the solution is to revisit Janet’s views on dissociation and regard alterations
in consciousness and dissociation as different but related phenomena (Steele,
Dorahy, Van der Hart, & Nijenhuis, in press; Van der Hart, Nijenhuis, &
Steele, 2004, 2006).
A sixth misunderstanding, also common in the field of
trauma and dissociation, is that dissociative symptoms (such as amnesia) are
only psychoform in nature, i.e., solely refer to mental functions. As referred
to above, dissociative symptoms also pertain to bodily functions, hence are
somatoform in nature. Janet’s extensive observations as well as those of many
of his contemporaries make this abundantly clear (e.g., Janet, 1889, 1911).
Examples include dissociative anesthesia, paralysis, contracture,
pseudo-epileptic seizures: symptoms which have been wrongly labeled as conversion symptoms. There is increasing
understanding in the field that this error needs to be corrected (Kihlstrom,
1992; Nemiah, 1991; Nijenhuis, 1999; Van der Hart et al., 2004, 2006). The
ICD-10 (WHO, 1992) has already made this correction by renaming conversion
disorder as dissociative disorders of
movement and sensation.
Lacunae in the Trauma Field regarding Janet’s Views on
Trauma and Dissociation
Although Janet’s influence in the trauma field, as
mentioned above, especially among clinicians and researchers dealing with
survivors of chronic childhood traumatization, it needs to be emphasized that
there are large domains within the trauma field where this is not the case.
PTSD seems to be the trauma-related disorder about which is most frequently
written, but it is only a minority of authors that refer to its dissociative
nature, let alone to Janet’s work. This is most noticeable in the major
contributions of cognitive-behavioral therapy (CBT). For instance, in the 472
pages book, Cognitive-Behavioral
Therapies for Trauma (sec. ed.), edited by Follette and Ruzek (2006), there
are only three places where dissociation—mostly as a mental avoidance strategy
only—is mentioned. However, there is still hope: The first, historical chapter
contains an acknowledgment of Janet’s pioneering work (Monson & Friedman,
2006):
… Pierre Janet was also
instrumental in bringing a psychological approach to posttraumatic reactions,
and his writings include some precursor elements of CBT. Indeed,
cognitive-behavioral theories of traumatic reactions find their roots in
Janet’s writings about the categorization and integration of memories. He
contended that people develop meaning schemas based on past experiences that
prepare them to cope with subsequent challenges. When people experience
“vehement emotions” in response to frightening experiences, their minds are not
capable of integrating the events with existing cognitive schemes. When the
memories cannot be integrated into personal awareness, something akin to
dissociation occurs. Janet also introduced the notion of patients experiencing
a “phobia of memory” that prevents the integration of traumatic events. The
memory traces linger as long as they are not translated into a personal
narrative. In his conception of trauma, synthesis and integration are the goals
of treatment, which was in contrast to the psychoanalytic goals of catharsis
and abreaction prevalent at the time (Janet, 1907). (pp. 3-4)
Although not completely
correctly referenced, these statements should inspire CBT clinicians to study
the original sources.3
John Briere, one of authorities in the CBT who do
focus on dissociation, does not mentioned Janet even once in his new book, Principles of trauma therapy: A guide to
symptoms, evaluation, and treatment (Briere & Scott, 2006).
One of the saddest and astonishing states of affairs
is that Janet’s works on trauma and dissociation still remain extremely
undervalued in the French-speaking world of psychotraumatologists, including
his home country,
However, there are signs that this sad state of
affairs is slowly but unmistakenly changing. For instance, apart from Crocq’s (2003)
article, the May 2005 issue of the Revue
Francophone du Stress and du Trauma contains two articles in which some of
Janet’s important ideas at least are recognized (Andreoli & Damsa, 2005;
Graux & De Soir, 2005). I predict that future issues of the Revue will show an increase in number of
references to Janet. Another example is that recently an increasing number of
workshops are being held in
Finally, the Institut
Pierre Janet, dynamic and still young, will play a major role in the
further dissemination of Janet’s contributions—incidently, not only in the
field of trauma and dissociation. The same goes for the republications of
Janet’s books and other works, which will allow those who are becoming more
interested to dig up unexpected treasures.
NOTES
1 Current phase-oriented treatment of complex
trauma-related disorders also harks back to Janet’s pioneering publications on
treatment (Janet, 1898b, 1919/25; cf., Van der Hart, Brown, & Van der Kolk,
1989a,b).
2 Perry and Laurence (1984, p. 10) mentioned that in AP,
“Janet proposed a theory of désagrégation
(often translated into English incorrectly as dissociation).” Since then, many North American scholars, e.g.,
Kihlstrom, Tataryn, and Hoyt (1993), have repeated this error.
3 A fine study on obsession and depression integrating
Janet’s original views and treatment principles and modern CBT has already been
published in German [Hoffmann, 1998]; an English translation would be very
welcome. The general affinity of
cognitive behavioral approaches with the Janetian conception of psychotherapy
is discussed in a German article (Heim & Bühler, 2003).
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