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6560739 Dissociative Experience and Cultural Neuroscience Kirmayer

6560739 Dissociative Experience and Cultural Neuroscience Kirmayer

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02/04/2013

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ORIGINAL PAPER
Dissociative Experience and Cultural Neuroscience:Narrative, Metaphor and Mechanism
Rebecca Seligman
Æ
Laurence J. Kirmayer
Published online: 23 January 2008
Ó
Springer Science+Business Media, LLC 2008
Abstract
Approaches to trance and possession in anthropology have tended to useoutmoded models drawn from psychodynamic theory or treated such dissociativephenomena as purely discursive processes of attributing action and experience toagencies other than the self. Within psychology and psychiatry, understanding of dissociative disorders has been hindered by polemical ‘‘either/or’’ arguments: eitherdissociative disorders are real, spontaneous alterations in brain states that reflectbasic neurobiological phenomena, or they are imaginary, socially constructed roleperformances dictated by interpersonal expectations, power dynamics and culturalscripts. In this paper, we outline an approach to dissociative phenomena, includingtrance, possession and spiritual and healing practices, that integrates the neuro-psychological notions of underlying mechanism with sociocultural processes of thenarrative construction and social presentation of the self. This integrative model,grounded in a cultural neuroscience, can advance ethnographic studies of dissoci-ation and inform clinical approaches to dissociation through careful consideration of the impact of social context.
Keywords
Dissociation
Á
Dissociative disorders
Á
Trance
Á
Possession
Á
Healing
Á
Cultural psychiatry
R. Seligman (
&
)Department of Anthropology, Northwestern University, Evanston, IL, USAe-mail: r-seligman@northwestern.eduL. J. KirmayerDivision of Social & Transcultural Psychiatry, Culture & Mental Health Research Unit, JewishGeneral Hospital, McGill University, Montreal, Canada
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Cult Med Psychiatry (2008) 32:31–64DOI 10.1007/s11013-007-9077-8
 
Introduction
Dissociation is a term used to describe both a set of behaviors and experiencesinvolving functional alterations of memory, perception and identity as well as thepsychophysiological processes presumed to underlie these phenomena (Spiegel andCarden˜a1991). Dissociative experiences have typically been thought to exist on acontinuum, ranging from everyday experiences of absorption like ‘highwayhypnosis’through more intense and prolonged forms of dissociative experiencesuch as depersonalization and derealization, to more profound dissociativephenomena that include various forms of dissociative amnesia and alterations inidentity (e.g., Dissociative Identity Disorder (DID, formerly Multiple PersonalityDisorder or MPD) (Kihlstrom2005). Current emphasis on the relationship betweendissociation and trauma-related pathology has given renewed momentum to thestudy of dissociative responses within the psychiatric literature.Aroundtheworld,dissociativeexperiencestakeplaceinthreemaincontexts:(1)inresponse to acute stress or trauma; (2) in socially sanctioned rituals and healingpractices that are associated with religious meaning systems, or in artisticperformances; and (3) as spontaneous fluctuations in ordinary conscious experiencethat often go unrecognized or unmarked unless they resonate with local systems of meaning (Kirmayer and Santhanam2001). It is oftenassumed thatdissociationacrossthese different settings involves the same underlying psychophysiological mecha-nisms. However, this remains uncertain given the state of current knowledge aboutboth the mechanisms and functions of dissociation. For the most part, theanthropologicaldiscussionsofdissociativephenomenainculturalcontext(e.g.,tranceand healing, possession states) have remained separate from the clinical andexperimental literature on dissociation. In this paper, we bring these two literaturestogethertoconsiderwhattheyhavetocontributetoeachother.Anthropologicalstudiesof trance, possession and healing can benefit from the models available in currentresearchondissociationandhypnosis.Inturn,understandingdissociationinsocialandcultural context offers clues to its underlying cognitive and social mechanisms andchallenges the tendency to see dissociation as evidence of psychopathology.Theoretical approaches to dissociation fall under two main paradigms that wewill call the ‘‘psychiatric-adaptive’’ and the ‘‘anthropological-discursive.’’ From thepsychiatric perspective, dissociation is thought of mainly in terms of psychologicalfunction and neurobiological mechanism. The experience of dissociation is assumedto be a direct product of an underlying neurological mechanism that is triggeredfunctionally. The anthropological paradigm, on the other hand, treats dissociation asprimarily a social and rhetorical phenomenon: dissociation is a way of creatingsocial space or positioning for the performance and articulation of certain types of self-experiences in particular cultural contexts.For the most part, these two paradigms are non-overlapping. Most psychiatricapproaches to dissociation do not explore the social meaning of dissociativeexperience and how meaning influences its adaptive or maladaptive consequences inthe context of trauma or other life circumstances. Most anthropological approachesto dissociation focus on the discursive functions of dissociation and do not considerthe emotional context and biological mechanisms of dissociative experiences.
32 Cult Med Psychiatry (2008) 32:3164
 123
 
The contrast between the discursive and psychopathological accounts of dissociation parallels the long debate in the field of hypnosis between state androle theories (Hilgard1969,1973; Bowers1991; Kirmayer1992).
1
Briefly, statetheories have argued that there is a discrete psychophysiological or cognitive stateof ‘trance’ that characterizes hypnosis (Gruzelier and Brow1985). Hypnotic trancehas both a distinctive experiential quality and, presumably, unique cognitive,attentional or information processing features that mark it off from other states of consciousness and modes of functioning. In contrast, role theorists have argued thatthe phenomenon of hypnosis (including behavior viewed as evidence of trance)reflects socially scripted performances with no discrete or unique mode of information processing or alteration in consciousness (Chaves1997). To a largeextent, this controversy hinges on definitions of ‘role’ and ‘state’—on how large ashift in functioning must be to warrant recognition as a different ‘state’ and whetherthis shift resides in some discontinuous psychological or physiological process or is(merely) socially marked.These dichotomous paradigms assume, in accordance with the long tradition of mind-body dualism, that there is some great division between brain state and socialrole—that they reflect separate, unrelated processes. On the contrary, we argue thatstate and role—our metaphorical understandings and experiences of shifts inconsciousness—are continuous and mutually reinforcing (Kirmayer2006). Ourmodel of dissociation, discussed at length below, treats it as the product of normalprocesses that regulate the flow of attention and information related to things such associal role performance and discursive practices related to self. In this view,dissociation is a type of cognitive resource-management strategy that is sometimessocially marked and sometimes not. Thus, dissociative experiences may be
highly
socially scripted, yet have a neurobiological substrate that is not ‘‘merely’’ sociallyscripted, and can occur in forms that are independent of, contradict, or subvert socialscripts.In the following sections, we briey review what is known about non-pathological dissociation. Then we describe the two paradigmatic approaches tounderstanding dissociation in depth, identifying the strengths and weaknesses of each and evaluating what they have to offer one another. Next we review the currentliterature on neurobiological mechanisms and elaborate our own model forconceptualizing the interaction of psycho-bodily and socio-cultural factors indissociation. Our goal is to lay the groundwork for a comprehensive, culturallyinformed understanding of both dissociative processes and experiences thataddresses the shortcomings of both the anthropological and psychiatric paradigms.
Normative Dissociation
The psychiatric and anthropological approaches to dissociation share a tendency tofocus almost exclusively on its most intense or dramatic forms (Lynn2005).
1
For a thorough discussion of the relationship between hypnosis and dissociation see: Hilgard1986;Kirsch and Lynn1998; Spiegel1988; Spiegel and Cardena1991; Butler1996among others. Cult Med Psychiatry (2008) 32:3164 33
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