EXPANDINGTHE
PSYCHOANALYTIC VIEW
OF THE INTRAPSYCHIC:
PSYCHIC CONFLICT IN
THE INSCAPE
John Allison O'Neil . M.D., FRCPC
John Allison O'Neil, M .D., FRCPC, is a psychiatrist and psy-
choanalyst in Montreal, where he is an Assistant Professor
of Psychiatry at McGill University.
For reprints write John A . O'Neil, M .D ., 4064 Wilson Ave .,
Montreal, QC H4A 2T9, Canada.
ABSTRACT
Dissociation theory and psychoanalysis have to some extent emerged
as conflicting paradigms to explain mental illness, a conflict which
perhaps reaches its peak over the Oedipus Complex . Psychoanalytic
theory has generally been unable to accommodate itself to dissocia-
tion, and psychoanalysts have instead relegated it to the status of
historical curiosity or mistake, tried to assimilate it into more con-
ventional psychoanalytic theory, or neglected it altogether . There is
thus a paucity ofpsychoanalytic accounts of many dissociative themes,
and, when present, they are generally misrepresented . Dissociative
pseudo-hallucinations and other inter-alter communications are gen-
erally misinterpreted as psychotic phenomena, flashbacks as con-
version symptoms, and inscapes (internal landscapes) as the world
of internal object relations . Two cases of DID illustrate classic oedi-
pal conflict played out in the inscape . The paper concludes that trau-
matic etiology and oedipal conflict need not be contradictory ; that
multiplicity cannot be assimilated by current psychoanalytic theory;
that current psychoanalytic theory remains pertinent to the treatment
of all patients, including dissociative ones.
INTRODUCTION : DISSOCIATION AND
PSYCHOANALYSIS
Dissociation theory and psychoanalysis have to some
extent emerged as conflicting paradigms to explain mental
illness . To the clinician versed in trauma, dissociation and
hypnosis, psychoanalysis appears not yet to have figured out
what to do with dissociation - continuing to neglect, down-
play or misinterpret it . At the same time, in dissociation-ori-
ented meetings and literature, there is an expressed appetite
for certain psychoanalytic themes such as splitting, enact-
ment, perversion, attachment, narcissism, and transference-
countertransference . In hindsight, greater familiarity with
the psychoanalytic therapeutic frame and alliance, includ-
ing its principle of abstinence and non judgmental stance,
might have mitigated the False Memory debacle . On the
other hand, with even further hindsight, long-standing psy-
choanalytic denial of the reality of trauma, especially through
the uncritical invocation of the Oedipus Complex (e .g.
Simon, 1990), may be understood as having promoted the
uncritical invocation of forgotten childhood sexual abuse in
reaction.
The general stance of this paper is that dissociation can-
not be accommodated by prevailing psychoanalytic theory.
But this is not to say that psychoanalytic theory should be
rejected in work with dissociative patients . It is rather to sug-
gest that while it maybe mistaken about the nature and caus-
es of dissociativity and especially of multiplicity in patients,
it is quite adequate in understanding many non-dissociative
aspects of patients, aspects which are fully present in disso-
ciative patients as well.
The dissociation paradigm will be briefly contrasted to
the psychoanalytic paradigm regarding etiology, psychic
structure and psychic stages (scenes), and this will be fol-
lowed by clinical vignettes demonstrating classic psychoan-
alytic dynamics (including oedipal dynamics) in patients with
dissociative multiplicity, as played out in their respective
inscapes.
ETIOLOGY AND THE OEDIPUS COMPLEX
Freud 's purported abandonment of the so-called "seduc-
tion theory" in favor of the Oedipus Complex (Laplanche
& Pontalis, 1973) has been, at one extreme, hailed as the
founding moment of psychoanalysis, the discovery of the
Unconscious and, at the other extreme, condemned as a
defensive, conformist fabrication (e .g., Masson, 1984).
Recent scholarship (e .g., Blum, 1996) clarifies the mythic
character of both extremes, finding some fault with Freud,
but finding more fault with selective misreadings of him.
The structure of the oedipal situation is that the boy has
sexual wishes for his mother, and thus murderous wishes for
his rival, his father ; father responds by threatening him with
castration, the basis of the incest taboo . The boy represses
his wishes into his Unconscious (see below under "Phase 2") ,
and identifies with his father's prohibition, which becomes
the nucleus of his Superego (see below under "Phase 4").
When this fails to work properly, the boy becomes a pervert
(see below under "Phase 5") . As his attachment to father
increases, a negative oedipus operates as well, with the boy
wishing to remove mother to have father for himself.
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Curiously, the process does not work quite as well for
the girl . First of all, the negative oedipus may come first, as
mother is the primary attachment figure for both sexes . Then
the girl has sexual wishes for her father, colored by her penis
envy : she wants her lost penis "back" but will settle for hav-
ing father's baby instead . So sexual desire is specifically ori-
ented to getting pregnant . She also has murderous wishes
for her rival, her mother . Mother cannot respond by threat-
ening her with castration, however, because girls are already
castrated, so she can only threaten the loss of her love . As a
result, incest is less taboo for a girl, repression is incomplete,
and she is more prone to perversion . Her identification with
mother 's prohibition is less compelling, so her Superego is
weaker : she has a weaker conscience . So the theory goes in
its narrowest, most concrete interpretation.
In a different light, perhaps first explored by Marcuse
(1961), the oedipal scene is reinterpreted when Libido and
Aggression are complicated by the Life and Death Instincts.
Libido includes the child's attraction for the parent, and
Aggression includes both the murderous wish and the cas-
tration threat . Curiously, Death motivates Libido, and Life
(Eros) motivates Aggression . In terms of Death and Libido,
the boy is attracted to mother, but the attraction is lethal -
being swallowed up by the big mother 's vagina and return-
ing to her womb, to pre-life, death, Nirvana . In terms of Eros
and castration, the boy is rescued by big father, warning to
castrate him if he tries to claim the mother . So now the boy
may claim that he and mother want to be together, and are
able to, and indeed would, if only the big father had not
threatened him with castration . Thereby life and self-esteem
are preserved, as the boy identifies with father, has an affec-
tionate relationship with mother, and hopes for a future mate
that will be his alone.
A parallel dynamic exists for the girl . In terms of Death
and Libido, the girl is attracted to father, but the attraction
is dangerous - being penetrated and ripped by the big father.
In terms of Eros and prohibition, the girl is rescued by moth-
er forbidding both her and father from trying . So now the
girl may claim that she and father want to be together, and
are able to, and indeed would, if only the big mother had
not forbidden it, were not in the way, and so forth . Thereby
life and self-esteem are preserved, as the girl identifies with
mother, has an affectionate relationship with father, and
hopes for a future mate that will be hers alone . However,
even in this revised version, the girl 's dynamics still play sec-
ond fiddle to the boy's.
Given such variations on the theme, the oedipal dynam-
ic emerges as a general schema underlying all triadic con-
flicts, as opposed to dyadic ones . Two 's company, three 's a
crowd . Jealousy requires a trio . The first triad in a child's life
is with its parents . Leaving etiology aside, dissociative patients
have many triadic conflicts, and thus have oedipal dynam-
ics.
PSYCHIC STRUCTURE AND MULTIPLICITY
Cause brings effect . Etiology begets structure . The prob-
lematic feature of dissociative pathology is the inaugural ques-
tion of western philosophy : the One and the Many (Copies-
ton, 1946) . Thales (ca . 600-545 B .C.) said the One was Water,
and he was promptly recognized as the first "philosopher,"
the first lover of wisdom . How can what seems to be many
really be one? How can what is one manifest as many? just
what is it that there are many of, and what is it that remains
one throughout? What follows is a brief trip through a num-
ber of psychoanalytic constructs to see to what extent they
can accommodate multiplicity, and in what way they remain
useful even when they cannot.
Phase 1 : The Prepsychoanalyiic Freud - Dissociative Splitting
Dissociation, multiplicity, trauma, and hypnosis all fig-
ured very centrally and undisguisedly in the Freud of Breuer
and Freud, Studies on Hysteria (1899-95/1955) , where his first
use of splitting ("spaltung ") was, in a dissociative sense, the
vertical splitting of consciousness:
The splitting of consciousness which is so strik-
ing in the well-known classical cases under the
form of "double conscience" [French ; "dual con-
sciousness" in English] is present to a rudimen-
tary degree in every hysteria, and that a tenden-
cy to such a dissociation, and with it the
emergence of abnormal states of consciousness
(which we shall bring together under the term
"hypnoid") is the basic phenomenon of this neu-
rosis . In these views we concur with Binet and the
two Janets [Pierre and Jules].
(Breuer & Freud, 1893/1955, p .12)
Unfortunately, with subsequent psychoanalytic devel-
opment, this "dissociative " period came to be dismissed as
pre-psychoanalytic, and dissociation was dismissed, relegat-
ed to the status of a historical curiosity or mistake, or neglect-
ed altogether . Since then, there have been few attempts to
reinstate the study of dissociative pathology within psycho-
analysis, but there have been attempts to reduce it to any
psychoanalytic concept other than dissociation.
Dissociation was abandoned by clinical psychiatry as well
as psychoanalysis . Splitting in clinical psychiatry became asso-
ciated with schizophrenia [schizo = split ; phren = mind],
while hysteria continued to be described in both dissocia-
tive and conversion forms . Overall, the concept of dissocia-
tion fell into disuse.
A century later, we are still left with the legacy of the
vocabulary and ideology of that era . When consciousness is
split, does one get two halves or two wholes? Is multiplicity
many fractions or many wholes? The last century was obsessed
with laws of conservation : mass and energy could neither be
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EXPANDING THE PSYCHOANALYTIC VIEWOF THE INTRAPSYCHIC
created nor destroyed, and so the idea of creating many out
of one would be anathema to many . Multiplication, howev-
er, better describes multiplicity as such, while division bet-
ter describes somatization and specialization of function.
"Split " connotes dividing a whole into two halves, but the
French for splitting is clivage and cleavage,in English the mean-
ing can go either way, occurring, need it be said, between
two whole breasts . Indeed, "cleave" means both "hew, cut
asunder, split "and "stick fast, adhere " (Onions, 1966) . When
something is halved, we tend to say cleft, as in cleft palate,
but when doubled, we tend to say cloven, as in cloven hoof
or clove of garlic.
The other conundrum is how to go from two to many.
Division or fragmentation metaphors, such as desaggregation
and dissociation, go beyond two to many, but only in the direc-
tion of many fractions that cannot add up to more than one.
In violation of conservation, the original multiplying expres-
sion, dedoublement de la personnalite, happily connotes a num-
ber of things, apart from simple doubling (Larousse, 1990) :
you dedouble a cloth when you unfold it or open it up ; you
dedouble a jacket when you remove its doublure or lining, in
other words, when the doublure comes out ; but a doublure is
also an understudy, stand-in or stuntman . So dedoublement
allows for a second whole hiding within the first whole to
come out.
Phase 2 : The Topography : Repression and Conversion
Psychoanalysis stripped hysteria of its dissociative core,
and the vertical dissociative split was rotated 90? to become
the horizontal split of the topography between the
Preconscious (Pcs) and the Unconscious (Ucs), caused by
repression . Conversion symptoms were understood to arise
out of conflict between these layers (Freud, 1915/1957).
There was also the minor horizontal split between Pcs and
Conscious (Cs), caused by inattention . Freud used the let-
ters rather than the words when intending to denote parts
of the psychic system . Repression was understood to be a
dynamic forgetting, and so needed work (working-through)
to be undone (Freud, 1914/1958) , whereas inattention could
be addressed with a reminder.
Repression and conversion remain serviceable concepts
when applied to an individual host or alter . Even if a trau-
ma is dissociated from the host into an alter, it may still be
repressed in that alter, in whom a partial somatic flashback
may function as a token, index or reminder of what was
repressed . The partial somatic symptom may have secondary
symbolic elaboration, as a compromise formation expressive
of conflict, in accordance with the classic psychoanalytic idea
of conversion . But somatic symptoms are often simply par-
tial and undisguised, and psychoanalytic interpretation of
symbolic significance may then be in the service of denial
rather than insight - a "fallacy of misplaced abstraction" as
opposed to the oft-invoked "fallacy of misplaced concrete-
ness ."
Understanding dynamic forgetting within an alter is one
thing ; accounting for the alter's genesis is quite another.
"Repression" can clearly not pretend to do both.
Phase 3 : The Vertical Splitting of Representations
Following the horizontal split of the topography, Freud
then returned to a kind of vertical splitting - the splitting of
self and object representations into good and bad (Brook,
1992) . Representations are objects of consciousness of which
one is conscious (or unconscious) - and so this was not the
dissociative splitting of consciousness itself . The technical
term "object " has come to mean anyone other than the ego.
It had originated from "object of the drive" or "object of
desire " and thus most often meant an other person, or per-
son's body part.
This kind of splitting was developed conceptually by
Melanie Klein (1946/1984) who fleshed it out with other sem-
inal concepts, such as her part-objects, paranoid-schizoid, and
depressive positions, and projective and introjective identi-
fications . These concepts remain eminently applicable espe-
cially to the dynamics of borderline personalities, and to hosts
or alters who are characterologically borderline (certainly
not all are) . Klein 's contribution led from the concept of
internal self and object representations to the idea of rep-
resentations of the relations of self and object, or internal
object relations . Object relations theorists (e .g., Fairbairn,
Winnicott, Guntrip, and Bion, among others) help us under-
stand the interpersonal schemata operative in any patient,
underlying her attitude toward others in the world, and espe-
cially to us in the transference . By extension, the theory helps
us understand the interpersonal schemata operative in any
given host or alter, underlying her attitude to others in the
world and to her alters, and especially to us in the transfer-
ence (Baker, 1997).
But can the splitting of representations explain multi-
plicity? No, for two reasons . First, a split is into two, not many.
Kleinian splits are invoked to explain all manner of part-
objects and part selves, but these manifest polarity : self/
object, good/bad, male/female, etc ., whereas alters gener-
ally do not (though they may) . Secondly, hosts and alters
are intentional subjects or agents, entities capable of utter-
ing "I ." Indeed, one may profitably regard "alter" as short
for "alter ego," literally "other I ." A given "I" has intention-
al objects which are its respective self and object represen-
tations . In other words, a representation, even of the self, is
an object of thought, and not a thinker, not a subject or agent
or "I ." Klein herself was confused in this regard (Hinshel-
wood, 1991) , because she made no clear distinction between
a split self representation and a split ego between a split object
and a split subject or agent . My view is that patients exist with
severe borderline pathology, with internal worlds charac-
terized by highly split part-objects and part-self representa-
tions, who do not have dissociative identity disorder . But
patients with multiplicity (overt or covert) also exist whose
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O'NEIL
internal subjects (alters) are misinterpreted as internal
objects, engendering years of futile therapy.
Internal subjects and objects may overlap . Klein's theo-
ry also is concerned with how the person develops through
introjection of or identification with objects or part-objects.
The theory can apply to an alter, and it is clear that many
alters are modeled after real others or aspects of real oth-
ers, both perpetrators and admired figures. Thus a given alter
may do double duty as an internal object representation and
as an agent (internal subject). A core question in dissocia-
tion theory is "Which comes first?" Is an object representa-
tion or introject somehow secondarily imbued with agency,
with subjectivity? Or is an alter created who secondarily iden-
tifies with an object representation through classic identifi-
cation with the aggressor (A 1936/1966) or, less com-
monly, identification with an admired or envied figure? My
view is that the latter occurs, and that the former argument
is circular - it begs the question (see also under "Phase 6,"
below).
Phase 4 : Structural Splitting
By structural splitting I mean the split between the Id,
Ego, and Superego (S . Freud, 1923/1961) .The structural
theory is generally interpreted as having supplanted the topo-
graphic model of theory (see "Phase 2" above). In the topo-
graphic theories the ego (small "e") was in the Pcs-Cs and,
among other things, was responsible for defense mechanisms.
But then Freud recognized that defenses were also dynam-
ically unconscious. That is to say, he found that he needed
to work to get people to recognize not only what they
repressed, but how they repressed
seemed to belong in the Ucs, not the Pcs-Cs
interpreted dynamically unconscious guilt in some of his
analysands, and so needed to put some of the conscience
into the Ucs. So he gave the Ucs two levels. The sub-base-
ment he called the Id, which remained the source of impuls-
es. Above that he partitioned the Ucs into unconscious Ego
(defenses and repressed contents) and unconscious
Superego (the source of unconscious guilt). He then
allowed this new division to carry up through the old systems
Pcs and Cs, so that Ego and Superego could be side by side
at each level (despite the name "which literally
means "above the ego").
This division is mostly functional . Various mental fac-
ulties are allocated to various structures . But it is personal
as well . The Superego is something like the little angel telling
the Ego to be good over one shoulder, while the devilish Id
tells the Ego to be bad over the other . And regardless of the
language, "Ego " must remain "I" - the subject of the verb,
as opposed to "me" or "self' or "myself' or any object of the
verb ; what Braude (1991) would call an "apperceptive cen-
ter ." This division might seem to apply if the alters of a given
patient happened to be functionally distinct in exactly the
right way, (e .g., pure impulse, pure rationality, pure moral-
ity, pure guilt, etc .) just as stopped clocks tell the right time
exactly twice every 24 hours . As we noted above, however,
working even with the average alter generally requires deal-
ing with different apperceptive centers, different "I's," each
of whom requires the working through of her own uncon-
scious defenses against unconscious mental contents, her own
impulses, defensive style, cognitive ability, and a moral code.
In general, in other words, a given alter has its own Id, Ego,
and Superego . This suffices to reject structural splitting as a
viable explanation for alter generation or for relations
between alters.
At the same time, the enormous psychoanalytic struc-
tural literature on the Superego may apply to intra-alter, alter-
alter and alter-therapist dynamics that feature conflict among
impulses, defenses, prohibition, punishment and guilt . More
particularly, just as is the case for internal object represen-
tations, a so-called "harsh superego " may be reinterpreted
as an alter defensively identifying with an aggressor, or author-
ity figure . With such a correction, the specific psychoanalytic
literature on the harsh superego may be found to apply in
a given case (Howell, 1997).
Phase 5 : The Fetishistic Splitting of Reality
For the self-styled "classical" psychoanalysis or psycho-
analytic Ego Psychology of the United States, the repertoire
of available concepts to apply to dissociation is quite limit-
ed . Dissociation itself is dismissed as prepsychoanalytic, the
topographic model is eclipsed by the structural theory, and
Klein is regarded as a heretic . Freud's Thanatos or Death
Instinct is rejected as well (in part, at least, because Klein
embraced it) . One remaining recourse, perhaps the only one,
is to Freud 's brief and late paper, Splitting of the Ego in the
Process of Defense (1940/1964) . This sort of splitting of the
Ego is of the fetishist's attitude to reality as a whole (Brook,
1992) . One attitude is realistic : women have no penises, cas-
tration has taken place, and so "my " penis is in danger . The
other attitude is based on wishful thinking : women have
penises, so castration has not taken place, and thus "my" penis
is safe ; and in any case, even if women don't have penises,
at least they have high-heeled shoes . Thus, the fetish . Such
attitudinal splitting has cleavage, in the sense of just two con-
tradictory attitudes in close juxtaposition -- the real and the
perverse.
A host or alter might be perverse, and in fact it is not
unusual to find perverse dynamics in a multiple (e .g.,
Brenner, 1996) . Such perversion maybe considered as lying
on a continuum . At one end would be the activation of innate
perversion, especially of sado-masochism, along "classical"
lines . At the other end would be identification with or intro-
jection of the perversion of the perpetrator . Under either
interpretation, this sort of perverse ego splitting remains a
serviceable concept in the treatment of dissociative patients,
and may help explain the special perverse characteristics of
a given alter, or perverse dynamics in the transference-
countertransference.
The splitting of one 's attitude to reality, so as to hold,
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EXPANDING THE PSYCHOANALYTICVIEW OF THE INTRAPSYCHIC
concurrently, two incompatible versions of reality, may be
extended beyond perversion . In fact it is a therapeutic goal
that one hopes to achieve with each alter . Take the exam-
ple of an alter exhibiting "Rip Van Winkle Syndrome ." She
insists that she is eight years old, and that this is 1976 . We
hope to induce "splitting of the ego in the process of defense"
so that she can know, at one and the same time, that she is
now eight years old in 1976, and that she is also now "real-
ly" 30 years old in 1998 . Another example would be for a
host or alter to know, at one and the same time, that she is
sitting in a chair in trance in her therapist 's office, and also
sitting in a special chair in a work room in the presence of
her alters projecting images on a screen that all can see.
Once again, this sort of splitting can apply to a given alter,
but cloven attitudes can hardly explain the genesis of alters
each of whom utters a distinct "I ."
Phase 6 : Federn 's Ego States
It iscurious that Paul Federn was dubbed "Apostle Paul"
by his colleagues for his religious devotion to Freud and the
psychoanalytic movement, because he then went on to ana-
lyze Edoardo Weiss, who analyzed Jack Watkins . In the pro-
cess, his germinal heresy regarding "ego states" took root,
sprouted, and flowered . But this occurred only in non-psy-
choanalytic soil . It did not occur in the Italian psychoana-
lytic society that Weiss founded, nor in the American
Psychoanalytic Association . Watkins, a psychologist non-physi-
cian, was not permitted to join the American Psychoanalytic
Association . This is just as well . His creative genius was there-
by spared the crushing embrace of psychoanalytic orthodoxy.
In my view, contemporary ego state theory, as developed
by Watkins (1997), best describes the majority of dissocia-
tive patients, as well as the dissociative component of patients
who would generally not be clinically diagnosed as disso-
ciative . Interestingly, their recent book (1997) has an intro-
duction by Ernst Federn, the son of Paul Federn . But ego
state theory no longer easily connects to mainstream psy-
choanalytic theory . And while ego state theory may best
describe multiplicity, that is not to say that it explains it . As
with Klein, the problem has to do with subjects and objects.
Federn conceived of there being a variety of mental
objects, comparable to Kleinian self and object representa-
tions, and these could then be invested with more or less
ego energy or cathexis . But "energy" is also a mental object,
in the mind of the theorist, and calling it "ego energy " (in
whatever language) hardly explains its character as subjec-
tive agency . We do not generally converse with energy.
Of all Freud's explanatory metaphors, the energic or eco-
nomic one is the least tenable in general . Steam engine
metaphors hardly apply to nervous systems . Contemporary
versions of the metaphor invoke information-processing, but
also miss the point . While information can be thought, it can-
not think . Information can, however, be duplicated or pro-
liferated, so that information-processing at least provides a
metaphor for alter genesis other than splitting.
PSYCHOANALYTIC SCENES AND STAGES
In the psychoanalytic tradition, psychic conflict is
thought to be played out in part along typical story-lines or
narratives, such as the oedipal drama (see above) . Another
narrative is the Family Romance (Freud, 1909/1959), in
which the child believes herself to have the wrong parents
- she is really a royal princess and her imprisonment in the
home of her current step-parents is a dreadful mistake and
injustice - the basis of many fairy gales.
Narratives are also condensed into particular "snapshot "
scenes . The oedipal narrative has a snapshot scene which
Freud (1918/1955) calls the "primal scene" in which the child
witnesses sexual relations between her parents . Tradition has
extended this to the birth scene, in which the child witnesses
the delivery of her sibling rival, and the deathbed scene, in
which the child witnesses the dreaded or desired illness or
death of whomever.
Finally, psychic conflict, in a story-line or typical scene,
is thought to be played out on a variety of stages : in the exter-
nal real world and in the transference, in dreams, fantasies,
and phantasies (unconscious fantasies) . These vignettes
add the dissociative internal landscape, or inscape, as a dis-
tinctive stage for the play of psychic conflict.
The inscape is an autohypnotic internal landscape pop-
ulated by the patient 's alters (Young, 1994) . The alters typ-
ically have distinct bodies in the inscape, with inter-alter con-
sensus as to what each one looks like . Some DID patients have
reported having access to such inscapes (presumably through
autohypnosis) prior to any treatment . If a dissociative patient
seems to have no inscape, guided hypnosis or guided imagery
may provide one, for example, as developed by George Fraser
(1991) in his Dissociative Table Technique . But in my expe-
rience even this therapist initiative typically arrives in a space
connecting to a seemingly "ready-made" extended inscape,
simple or elaborate, whose "inhabitants" (alters) claim that
it preexisted the hypnotic intervention . The space and
extended inscape will also have idiosyncratic features, per-
plexing to the patient and therapist, which later (even years
later) prove to have dynamic significance.
The temptation to reduce the inscape to the psychoan-
alytic world of internal objects ought to be resisted . The
inscape is experienced by the patient as distinct from exter-
nal reality, dream or fantasy . It can be conscious, unlike a
phantasy . It has continuity over time (inertia), like reality.
The inscape is a double challenge to psychoanalysis . First, it
constitutes a patient authored psychic structure, whereas psy-
choanalytic structural and object-relational concepts are ther-
apist-authored, for application by the therapist on the
patient . Secondly, while patient-authored, exactly what spe-
cific psychic structure is the author remains unidentified.
"Ego" will not do, given the problem of ego multiplicity, and
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no other psychoanalytic structure is equal to the task . Despite
this multiplicity of the ego, however, and of corresponding
internal bodies, the inscape also constitutes a single psychic
context of unity underlying the multiplicity . The inscape does
for the internal world what the single physical body does for
the external.
ILLUSTRATIVE CLINICAL MATERIAL
Now on to part two - clinical material from two disso-
ciative patients that illustrate classic psychoanalytic themes.
While psychoanalytic theory cannot yet accommodate dis-
sociation, dissociation theory can assimilate psychoanalytic
theory . This is just as well, because the patients we treat have
not been tutored in either tradition . Both patients happen
to be separated, with children, and work as college academics.
Patient Number One
Prior to the session, the various alters and the inscape
have been operative for a few years . In the inscape there is
a meeting room with a semi-circular table and six chairs . Off
this room there is a corridor, with three doors on each side.
The five alters each have a room . The first door to the left
has not yet opened . X is a young girl, generally dressed for
a party - bouncy and upbeat . NoName is a sullen boy . Yis a
wispy, fragile, doll-like figure, as if made of corn husks, with
no feet . She is dressed in the traditional garb of the patient 's
ethnic group and floats across the floor . DarkOne is a small,
dark, charred boy, as if burnt and shrunken . Tree oscillates
between being a girl split up the middle and a tree, always
freshly split, its exposed white wood always wet and glisten-
ing .
The Session
Pt.: Saturday evening I went out for a walk -
found a baby rabbit and brought it to town
with me . It was so small and so perfectly
formed - like a newborn - like my newborns.
OK, it's time to go inside.
The patient enters trance on her own . She describes
Y, No Name, X, Dark One and 7 ree emerging from
the corridor and taking their seats . The focus is
on Y, described as hollow, empty, fragile, sad,
neglected. She sees an image of Y on the screen to
the left.
Pt.: She's not afraid of the dark . She just doesn 't
like being on the outside of the circle . It's
like somebody is shaking her and screaming
at her - right in the face - it's scary.
Dr . 0 : We 'd wonder - if this is a memory - what
happened before that . .
Pt.: It's from inside a room, because she's out-
side a room . On the left, being shaken . On
the right, there's a room - just a door - it's
not her room - she was curious - she must
have been in the room.
Dr . 0 : Let's see if we can be with her when she
was first curious.
Pt.: It's dark . It 's night-time . She has her long
nightgown on . She hears noises . She goes out
in the big hallway- it's long and wide . It must
be the chalet . It's very dark. There are bang-
ing noises coming from the room across the
hall from her room . I think its Uncle's room.
The corridor's dark, and there's light at the
bottom of the door . She opens the door and
goes inside . Uncle and a woman are on the
bed . She asks about the banging : "What's all
the banging noise?" Uncle says "It doesn 't
matter - get out of here!"
Y: [In a young voice] The hall's dark . I don't
want to go back in the hall . Uncle's girlfriend
gets out of bed on the other side and puts
on her housecoat . I say, "I want uncle to take
me back . Not you . He's big and strong and
safe and the hallway is dark ."But the woman
grabs me and I don't understand why uncle's
mad at me and she pulls me and throws me
out of the room and shakes me and shakes
me and says, "Don't you ever do that again!
Just stay in your own room! And don 't tell
anyone you were in the room!" She's mad.
But I don't know what's wrong . I just want
to know what the noise is about . She 's shak-
ing me just like a rag doll . She's meaner than
uncle . I don't understand why they're so
angry . Uncle is my best friend . She's shak-
ing me . She's not shouting, but it's scream-
ing in my head . And she opens my door and
gives me a smack on the bum and closes the
door after me . "Just stay there!" she says.
Dr . 0 :So now you're back in your own bedroom?
Pt.: I can't see inside the room . Y just crawled
into her bed and curled up and made sure
all the covers were covering her.
Y: [In a young voice] When people shake me
like that I get empty inside so it doesn 't hurt
- and if I didn't do that people would shake
me harder and harder . I don't like that lady
197
DISSOCIATION, Vol. X, No . 4, December 1997
IT IF T INT' A Y HICI
 
p
198
because when she's there I don't get to see
uncle . She 's sweet when others are there . But
she 's like a witch when others aren't there
and she looks like a fairy princess . Tall, long
blonde hair, dresses pretty, but not really a
nice fairy- she's a witch . She fools everybody.
I know I have to stay away from her.
Pt.: She's crying in her bed . I'm rubbing her back
under the covers and telling her that she
didn't do anything wrong - that the lady
shouldn't have scared her . Uncle and the
woman were so angry because they're not
married . She's not supposed to be in his
room . Everybody else is downstairs . They
don't want to get in trouble . Grandma
doesn 't like the girlfriend . She 's French and
not ethnic . Too fresh . I'm back at the table
now.
Dr . 0 : And how does Y look?
Pt.: Like she understands better . X kicks when
you say something bad about uncle . Uncle
is her friend . She knows uncle yelled at her
but she doesn't want us to talk about it . It's
OK to talk about his girlfriend, she's jealous
of her . No Name just laughs . It's not a nasty
laugh . Just like Old King Cole . A merry laugh
-with her and not at her- because she wants
to protect uncle . He knows she has to do that.
He doesn't get mad at her . OK - they're
going now . They all go on their own except
X . X asks me to walk her to her room . I tell
her the light is on - she won 't be scared . Ha-
ha! She wants to be walked to her room like
a princess, which I do . OK - I'm ready . I'll
come back on my own.
The patient exits trance on her own, and "returns"
to the office.
Pt.: That's how I became the flower girl at their
wedding - in exchange for keeping the
secret - dressed up in a fancy gown . They're
still married . She 's still an incredible manip-
ulator . Uncle was the youngest son and the
apple of grandma's eye ; the older ones mar-
ried ethnics . His girlfriend was tall and
blonde and gorgeous and didn't kowtow to
grandma . X holds, on her conscious level,
the good memories . That's what she's for.
Dr . O : . . . and identifying with the princess .
Pt.: Ha-ha-ha . Right! She dresses just like uncle's
girlfriend . It never occurred to me!
Dr . O : . . . while the bad memories are with Tree
and No Name.
Pt.: Yes. I thought X had real had uncle memo-
ries, and that No Name then took them over
and left her with fake good uncle memories.
But both were real . He was good to her . He
got her things . He treated her as something
special . I was twelve when his daughter was
born . Up to then, I was his favorite he 'd
always have presents for me . It's the hardest
part to reconcile . My tendency is to do all or
nothing . But it is a fact that there were good
positive things about him . It is a fact that
there were nasty terrible things about him.
X holds one extreme image, and No Name
the other . Part of me doesn't want to down-
play the positive by saying that he just gave
me presents to get into my pants . I want to
think that I deserved what he gave me, with-
out any ulterior motives . Y just reminded me
- of being curled up in the bed - of the rab-
bit we found - we put him in a wool blanket
and covered him and he burrowed, and I pet-
ted him and he calmed down.
DISCUSSION
The session begins and ends with the baby rabbit, snug-
gling in the blanket to feel warm and safe . The focus is on
Ys emptiness and on her dislike of being outside the circle,
whatever that means . X hears a noise in the dark . She is not
afraid of either the noise or the dark, and is determined to
investigate - to intrude . She does not like being outside the
circle . She opens uncle 's bedroom door, and witnesses a pri-
mal scene - uncle in bed with her rival . She acts naive . They
tell her to leave . She asks her big, strong safe uncle to leave
the bed and escort her back to her room . She has to deal
with her rival instead, switches to Y, and is shaken like a rag
doll . She becomes empty and vacant as a defense . Shoved
into her room, she curls up in bed, like the baby rabbit . She
switches back to X, and contemplates the darker side of her
rival - she is illegitimate somehow, not what she seems, an
alien intruder, she doesn't belong . This is a twist on Freud's
Family Romance . Not that the patient is a princess, wrong-
ly misplaced into a common family, but that girlfriend is too
common for the noble family, posing as a princess . Uncle
rightfully belongs to X, the true princess . But girlfriend is
what uncle wants . So X resorts to modeling herself after the
fake princess . Maybe then uncle will come back to her . This
is what Anna Freud, likewise someone's favorite daughter,
DISSOCIATION, Vol . X, No. 4, December 1997
O'NEIL
called Identification with the Aggressor (1936).
Back in the meeting room, the traumatic alters, NoName
and Tree, chuckle at X for her pretenses . They recognize
the partial truth of her fantasy . The oedipal drama, displaced
from parents to uncle and his girlfriend, is there . It is not
the whole story . It is not the main story . But it is part of the
stony.
The main story is that both father and uncle repeated-
ly seduced and raped the patient throughout her childhood.
That accounts for her multiplicity, which in turn accounts
for a dissociative variation on dynamics that are routinely
found in non-dissociative patients
scene had given rise to some elements of the inscape, the
bodily constitution of Y, and X's taste in fashion
sistent
if not by uncle, then at least by the patient herself.
Patient Number Two
This is a brief overview of therapy, followed by a close
focus on two sessions.
When first assessed five years previously, the second
patient presented with a history of depression, alcoholism,
and non-prescription medication abuse . She was intermit-
tently self mutilating, giving herself shallow razor cuts to fore-
arms, abdomen, and thighs . She had been treated with antide-
pressants and anxiolytics for years ; she had had one
prolonged course of psychoanalytically-oriented psy-
chotherapy and a few admissions to hospital for serious sui-
cide attempts . The patient was adopted at birth.
The patient also presented with significant dissociative
symptoms . These included the auditory hallucination for as
long as she could remember of two voices who would com-
ment on her actions, console her and tell her what to do
(including instructing her to self-mutilate) . The patient also
suffered from lost time.
The patient had an exuberantly elaborate inscape,
which evolved with the therapy . The voice that told her to
self mutilate also evolved with the therapy . It had the appear-
ance of a skeleton figure wearing a black cape and hood . In
time, his hands, which had been bony and with claws, became
her adoptive father's hands, and he became a protective fig-
ure . There was one intense extended dissociative episode dur-
ing which the patient mistook her purse for her newborn
baby, and commented, "I'll never give her up the way my
birth mother did . I gave birth to her last night by Caesarean
section ." In hospital, she was found to have inflicted a very
shallow cut across her lower abdomen . A day later, she resta-
bilized, and was discharged.
Some time later, the patient encountered her birth moth-
er in the inscape as a giant woman whose dress was both regal
and vulgar . As a yellow bird, she pecked away at the birth
mother . She told her she was not a queen, just a dumb teenag-
er who got pregnant, that she was glad she had given her up,
and that her adoptive mother was far better, even if she did
take every opportunity to tell people that the patient was
adopted.
Subsequently, the patient found herself on a lonely road
being attacked by a large black vulture that pecked at her
skin and made her bleed . She interpreted the situation as a
dead end formed by her adoptive mother's mandates and
injunctions - that she was a good adopted girl who did not
cry, or scream, or hit, or do bad things.
Following this, the inscape became a more convention-
al work room, in which fairly conventional group work went
on among eight relatively stable but imaginatively disguised
ego states, four post-traumatic ego states to the left, includ-
ing the hooded one, and four functional-adaptive states to
the right . Then the patient overdosed again . We discovered
that all those in the conference room were dying, because
the patient wanted them dead rather than having to deal
with their problems.
The patient encountered a large fire-breathing dragon
that was reducing her inscape to a charred ruin . When it
exhausted its flames, the patient climbed on its back,
removed a few scales and lowered herself inside, There she
found two girls, three and thirteen years old respectively,
whom she identified as herself at those ages, and left with
them through the dragon's mouth . The three humans
hugged, and the dragon rapidly fell to pieces.
Now for the first time there were characters which the
patient identified as herself, undisguised, from times in her
childhood . Viewed as objects, they would be considered as
internal self representations from the past ; viewed as sub-
jects, they would be considered as young ego states.
The conference room was restored to normal . The bal-
ance of the inscape was replaced with green grass and flow-
ers . The girls eventually aged and coalesced into the patient
at twenty . All eight of the conference room alters' issues were
worked through and the alters were integrated in various
ways, except for the hooded one . In the process, two of the
disguised post-traumatic alters became unveiled to reveal
nine-year-old and five-year-old versions of the patient . The
twenty-year-old came in from her campfire in the woods, and
the younger girls eventually coalesced into her, after explo-
ration of all their issues.
Then we reached a new impasse . The patient reported
having been very depressed after her previous session, angry,
frustrated, and discouraged . Unable to cry, she had slashed
her legs badly, trying to get the tears out with her blood, some-
thing she had not done for a few years . "I know the prob-
lem, I just can't write the last chapter! 1 need your help!" she
said .
Responding to some deep clinical intuition, I replied,
"I don't believe I can help - I give up . We've missed some-
thing, and I don't know how to help you find it . All I can
suggest is that you go inside and give up for the two of us ."
She was furious with me, but went inside . She found that the
hooded one was likewise at a loss . So she announced that
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DISSOCIATION, Vol . X, INo
EXPANDING THE PSYCHOANALYTICVIEW OF THE INTRAPSYCHIC
the three of us were at a loss, and that all three of us gave
up .
The room started to burn . Fire collected in the middle
of the room, then died down . A huge, black, ugly vulture
arose from the fire . The vulture put out its claws, and they
became her father's hands . The beak opened, mother 's face
appeared in the open beak, and said, "You can't have him?
You'll never have him! He's mine!"
The hooded one tried to protectively pull her away, but
she demands, "Why did you keep him away? "
Mother responded, "Because he's mine - not yours -
mine - never yours!"
The patient replied, "I hate you! " The vulture burned,
the fire went out . The patient felt terrible, but said what she
has never before been able to say:
It wasn't just that mother had father . I hate him.
He was never strong enough to stand up for him-
self . I hate my mother in a wicked way . I hate my
father in a sad way . I feel so sad . When he died I
got sick . He never understood . We were the per-
fect little family . He was never separate from my
mother, never an individual . I hate him for not
caring enough for me to be stronger . Mother was
always there . I never got to know him . Then he
died . I never had the chance . I guess he loved
me . Mother said he did . I think he said he did
once . He probably did . But it was conditional -
like "I guess I love you if your mother says so ."
Imagine looking forward to a spanking because
that's the only private time you have with your
father! He never knew . He never knew how much
I needed him to hold me and tell me he loved
me . And then he just died.
The patient protested that she could not go on . She want-
ed to die . I went on proclaiming my impotence . She protest-
ed in outrage, then said:
Wait, a little child is walking towards me . A six-
year-old in a white dress . She hugs me . "You'll feel
better if you hug me," she says . I pick her up in
my arms . I bury my head in her golden hair . She
says, "You can cry for little children, so cry for me ."
I put down the little girl . I hold her hand, stroke
her hair, there are tears running down my face
on the inside.
In the office, the patient 's face crunched up in pain, but
without tears . I interpreted that I was as disappointing as her
father - I just could not come through in the end . I was help-
less in the face of whether she chooses to live or to die . She
came back to the office from her trance state, and left with-
out a word.
There followed an exchange of e-mail, in which she crit-
icized me bitterly for callous incompetence, announced she
was quitting therapy, and added:
I will not give up on myself, even if I also am at a
loss . It seems very strange that I would have more
faith in myself than you have in yourself . I am sorry
that so many years of working together should
end like this.
I replied by e-mail that I was glad she had not given up
on herself, and did not believe that she was at a loss . In the
following session, she said she felt awful for two clays, like
killing herself, but she would not do that to her children.
She felt like cutting herself, but that would be ridiculous.
She had concluded that I didn't care . She had decided that
she did care, and did not "give a flying fuck " if I cared or
not . Since then there had been much improvement, much
to thank me for . She felt more empowered, had done her
best each day, had worked on the inside with the child, cry-
ing with the child, telling her about her father and his death,
and they felt sad together . At work, everything was under
control . She had had no trance states . She had even had
moments of happiness . "Maybe I'll move to Barbados," she
said .
An astrologer had said she was supposed to meet her
ideal mate that year . She had to start making herself avail-
able . How much longer would the therapy go on? She had
told her daughter that with therapy she would be much more
content with herself and with her own body . Joking, she said,
"Don't touch yourself more, but get more in touch with your-
self," and laughed . I asked if she has been touching herself
more . Yes, she was feeling sexier . She had to find someone.
I was not her type . By Chinese astrology, she was a pink, vir-
gin, stubborn, perfectionist pig, while I was an unimagina-
tive, stubborn bull . I had tried to manipulate her, but had
not been very good at it . I had been impotent in the past,
but she had not said so . The child inside brought a flood of
emotion which surprised her . She did not know if she would
have let me do the work more nicely or more safely, as she
was a very difficult patient.
Over the following weeks, the little girl and the hooded
one both integrated into her . The inscape ultimately dissolved
into pale gray in every direction . The patient terminated.
She remains in touch and remains at her academic post, with
no depression, self-mutilation or substance abuse . At times
she misses her inscape, but is happy to have exchanged it
for a more stable real world.
DISCUSSION
The first calamity of this second patient's childhood was
abandonment by the birth mother . The second was a fail-
ure of mirroring by the adoptive mother, expressed espe-
cially through the repeated back-handed compliment of the
patient 's being a wonderful adopted daughter . These pro-
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DISSOCIATION, Vol .4, December 1997
O'NEIL
vide a background of primary narcissistic deficit for the fore-
ground classical oedipal dynamic of a girl competing with
her mother for father's love . Loss appears with her father's
death.
The patient is quite atypical for classic DID in many
respects . Her history revealed no early childhood sexual
abuse, though there was physical abuse by her brother . Only
two alters ever took control of the body, and these for only
very brief periods . There were many internal personages, only
some of whom were typical post-traumatic or special-func-
tion alters, while others were clearly internal object repre-
sentations of other real people, and many remained of unde-
termined type.
A dissociative solution to her developmental challenges
both protected her high functioning in general, and aggra-
vated her acute decompensations . As for any classic neurotic
symptom, elements of the inscape were compromise for-
mations which both revealed and concealed their signifi-
cance . One recurrent symbol was father's hands, showing
up early on the hooded figure, and reappearing very late in
place of the oedipal vulture's claws . Another recurrent sym-
bol was the oral-aggressive bird - the patient pecking at her
birth mother, the vulture pecking at the patient, the drag-
on burning with its breath, the oedipal vulture pecking at
the patient with her sharp dismissals . Another was birth
through incision - the purse-baby by C-section and the two
girls in the dragon 's belly.
What to treat first? Conflict, deficit or trauma? Classic
Freudians treat conflict which is in any case ubiquitous . Kohut
(1977) recommends treating deficit first (when significant-
ly present), after which classic Freudian conflict may take
care of itself (or, if it doesn 't, may then be taken care of) . I
generally treat trauma first (when significantly present), then
deficit and other attachment issues, and then conflict . Kohut
claims that after resolving deficit, classic oedipal issues may
arise in an exuberant, celebratory way . In this case, classic
oedipal issues arose highly symbolized in the dissociative
inscape, then, after only two days of acute sturm and drang,
became exuberant and celebratory (with no suggestion of
hypomania).
CONCLUSIONS
Psychoanalysis Applied to Dissociative Disorders
Regarding etiology, the Oedipus Complex and trau-
matogenesis need not be seen as incompatible, as oedipal
dynamics may be reinterpreted as a general schema for
understanding triadic relations, which again are present in
all patients, including dissociative ones.
Concepts of psychic structure, dissociation, multiplici-
ty, trauma, and hypnosis are fully present in the early Freud,
though he subsequently retracted them . Psychoanalysis
would benefit from a rehabilitation of this "prepsychoana-
lytic" phase .
Virtually all current psychoanalytic concepts may be
applied to an individual host or alter, including repression,
conversion, Id, Ego, Superego, perverse splitting, self and
object splitting, object relations, etc . Certain concepts - espe-
cially splitting, projective identification, object relations and
enactment - may be applied as well to relations between
alters, and to the transference.
The Superego concept may apply to select alters, espe-
cially to those who have identified with the perpetrator.
Splitting of one's attitude to reality may be regarded as
a therapeutic goal for each alter, especially those who pre-
sent with "Rip Van Winkle Syndrome" and for internal group
work.
Typical psychoanalytic narratives and scenes occur in dis-
sociative patients, not only on typical psychoanalytic stages
but also in the inscape.
The Limits of Psychoanalytic Applicability
Leaving aside the early Freud, current psychoanalysis has
not yet begun to account for dissociation, especially for the
genesis of an alter . It is doubtful that an object representa-
tion or introject is somehow secondarily imbued with agen-
cy or subjectivity . Rather, an alter (alter ego, other I) is cre-
ated who secondarily identifies with an object representation.
The psychoanalytic penchant to interpret from the per-
spective that everything is symbolic may lead to misinter-
pretation of undisguised partial somatic flashbacks.
All psychoanalytic structural concepts are generic, apply-
ing to everyone, and for the analyst ; whereas an inscape con-
stitutes an individualized psychic structure, by and for the
patient, irreducible to the world of internal objects.
Ego state theory originates in the work of Federn and
Weiss, but has been developed independently of psycho-
analysis by the Watkins . Psychoanalysis would profit from its
reincorporation.
Clinical Illustrations
Clinical material from two dissociative patients illustrates
classic psychoanalytic themes played out in dissociative
inscapes.
The first vignette illustrates jealousy, a primal scene, oedi-
pal desire acted out, punishment and prohibition from the
rival, the Family Romance, and identification with the
aggressor.
The second vignette illustrates early maternal aban-
donment, a failure of mirroring, and classical oedipal dynam-
ics . The inscape includes post-traumatic or special-function
alters, as well as internal object representations of real peo-
ple . Elements of the inscape are symbolic compromise for-
mations which both reveal and conceal their significance.
Resolution of trauma and neglect set the stage for a very brief
resolution of oedipal conflict, followed by exuberance and
celebration . a73
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EXPANDING THE PSYCHOANALYTIC VIEWOF THE INTRAPSYCHIC
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