Şar Vedat
Department of Psychiatry, Koc University School of Medicine (KUSOM) Istanbul, Turkey.
Front Psychol. 2017 Feb 17;8:216. doi: 10.3389/fpsyg.2017.00216. eCollection 2017.
The nature of consciousness and the autonomy of the individual's mind have been a focus of interest throughout the past century and inspired many theories and models. Revival of studies on psychological trauma and dissociation, which remained outside mainstream psychiatry, psychology, and psychoanalysis for the most part of the past century, has provided a new opportunity to revisit this intellectual and scientific endeavor. This paper attempts to integrate a series of empirical and theoretical studies on psychological consequences of developmental traumatization, which may yield further insight into factors which threaten the integrity of human consciousness. The paper proposes that an individual's experience of distorted reality and betrayal precipitates a cyclical dynamic between the individual and the external world by disrupting the developmental function of mutuality which is essential for maintenance of the integrity of the internal world while this inner world is in turn regulated vis-à-vis external reality. Dissociation -the common factor in all types of post-traumatic syndromes- is facilitated by violation of boundaries by relational omission and intrusion as represented by distinct effects and consequences of childhood neglect and abuse. Recent research conducted on clinical and non-clinical populations shows both bimodal (undermodulation and overmodulation) and bipolar (intrusion and avoidance) neurobiological and phenomenological characteristics of post-traumatic response. These seem to reflect "parallel-distinct structures" that control separate networks covering sensori-motor and cognitive-emotional systems. This understanding provides a conceptual framework to assist explanation of diverse post-traumatic mental trajectories which culminate in a common final pathway comprised of partly overlapping clinical syndromes such as complex PTSD, dissociative depression, dissociative identity disorder (DID), or "borderline" phenomena. Of crucial theoretical and clinical importance is that these maladaptive post-traumatic psychological formations are regarded as processes in their own right rather than as a personality disorder innate to the individual. Such mental division may perform in that internal detachment can serve to preserve the genuine aspects of the subject until such time as they can be reclaimed via psychotherapy. The paper attempts to integrate these ideas with reference to the previously proposed theory of the "Functional Dissociation of Self" (Şar and Öztürk, 2007).
意识的本质和个体心灵的自主性在过去一个世纪一直是人们关注的焦点,并激发了许多理论和模型。对心理创伤和解离的研究复兴,在过去的大部分时间里,这些研究处于主流精神病学、心理学和精神分析之外,这为重新审视这一学术和科学探索提供了新的机会。本文试图整合一系列关于发育性创伤心理后果的实证和理论研究,这可能会进一步深入了解威胁人类意识完整性的因素。本文提出,个体对扭曲现实和背叛的体验,通过破坏相互性的发展功能,在个体与外部世界之间引发了一种循环动态,这种相互性对于维持内部世界的完整性至关重要,而这个内部世界又反过来相对于外部现实受到调节。解离——所有类型创伤后综合征的共同因素——是由关系性遗漏和侵入所导致的边界侵犯所促成的,童年忽视和虐待的不同影响和后果就体现了这一点。最近对临床和非临床人群的研究表明,创伤后反应具有双峰(调制不足和调制过度)和双极(侵入和回避)的神经生物学和现象学特征。这些似乎反映了“平行-不同结构”,它们控制着覆盖感觉运动和认知情感系统的不同网络。这种理解提供了一个概念框架,有助于解释各种创伤后心理轨迹,这些轨迹最终汇聚成一条共同的最终途径,该途径由部分重叠的临床综合征组成,如复杂性创伤后应激障碍、解离性抑郁、解离性身份障碍(DID)或“边缘性”现象。至关重要的理论和临床意义在于,这些适应不良的创伤后心理形成本身被视为过程,而不是个体固有的人格障碍。这种心理分裂可能表现为,内部分离可以用来保护主体的真实方面,直到它们可以通过心理治疗被重新找回。本文试图参照先前提出的“自我功能解离”理论(沙尔和奥兹图尔克,2007年)来整合这些观点。