Dissociation and Conversion

The term dissociation originated in the 19th-century work of Pierre Janet, who proposed one of the earliest systematic accounts of the psychopathological mechanisms underlying somatoform phenomena. Although more than a century old, many of Janet's ideas concerning the organization of mental processes remain popular (albeit implicitly) within contemporary cognitive psychology. According to Janet, personal knowledge is represented by an integrated network of associated memories, which are accessible to consciousness through the operation of attention. This process of attentional selection is responsible for synthesizing the contents of conscious experience by which the execution of volitional actions is coordinated (Fig. 1). In this view, the synthetic functions of attention are disrupted in hysterical patients, rendering them susceptible to a breakdown in psychological integration in the face of extreme trauma. Traumatic experience initiates the separation or dissociation of memories from the main body of knowledge by an amnesic barrier. Although these dissociated memories or 'fixed ideas'' are prevented from entering consciousness by the amnesic barrier, they may be automatically activated by external events. The activation of dissociated memories in this way is responsible for the generation of hysterical symptoms (Fig. 2) that, because they are produced without conscious control, are essentially nonvolitional phenomena. According to Janet, this automatic activation of fixed ideas is a process of suggestion, with the underlying deficit in attention being akin to a state of hypnosis.

Shortly after the publication of Janet's account of hysteria, the dissociation model was extended by Josef Breuer and Sigmund Freud with the introduction of the conversion concept. According to Breuer and Freud, the process of dissociation occurs when the subject attempts to regulate his or her experience of negative affect by defensively suppressing (or repressing) the conscious recall of memories associated with personal trauma. In the conversion model, this repression of negative affect serves as the primary determining factor in the generation of hysterical symptoms rather than the dissociation of memories per se. According to Breuer and Freud, emotions are associated with high levels of neural energy that must be discharged if the energetic balance of the brain is to be preserved. By avoiding negative affect through the repression of traumatic memories, however, this discharge of neural energy is prevented. In order for it to occur, negative affect is transformed or ''converted'' into a somatic (i.e., hysterical) symptom, which allows the individual to discharge emotional energy without recalling the traumatic memories

Figure 1 Organization of the cognitive system as described by Janet (1924).

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