Chapter 1 Dissociative Disorder in the Modern Era (4)

Concept of dissociation: its“auxiliary line”effect and“bulldozing”effect

Things are coming and going out of fashion, and that applies also in psychiatry. Working in the mental health field for thirty years, I saw it with my own eyes. I would like to ask ourselves：“Why at a certain point of time some concept catches on and get a lot of attention from clinicians and media?”. A good example is Asperser’s syndrome. I cannot imagine any day where a group of psychiatrists get together and never discuss the topic regarding Asperser’s at all. Nowadays, many psychiatrists often stop and wonder if some of the diagnostically puzzling cases that they met in the past had any implications of developmental disorder, such as Aspergers’.
My answer to my own question mentioned above is as follows: some aspects of the new disease concept could have been popping up here and there under the clinicians’ eyes in many apparently different psychiatric disorders, and the new concept provides ‘aha!’experience to them. Another good example is the borderline personality disorder (BPD). Some patients with manic depressive illness or obsessive compulsive disorder etc, or apparently health young person impulsively cut their wrist or overdose. They get emotional and show difficulty getting along with others. These people puzzled and confused many clinicians who had no idea how to diagnose these people until the notion of BPD came up. They jump to it and it caught on in the 1960s~70s. Once the notion of BPD is documented and established, it made clinicians see better and understand better these people.
In this sense, creation of a new clinical concept (let us call this “A”) is like drawing an auxiliary line while solving a geometry quiz. A single line makes everything all the sudden clear. Many clinicians are already aware that there is some unnamed condition which encompasses so many different clinical contexts. When a notion A is proposed, suddenly that unnamed condition has its substance and gives many clinicians a sense that they grasped something tangible.