The Stranger In The Mirror (Paperback)

While the author does address basic treament goals and strategies, the prime usefullness of this book is it's explanation of what dissociation is, not how to change it.

Dissociation is often overlooked in typical psychiatric assessments. This is due to various factors. For one, there seems to be an ever-increasing reliance on medication as the primary (if not sole) treatment for emotional and mental health problems; there is often ignorance of dissociation, and sometimes even derision and disdain masquerading as skepticism vis-à-vis dissociative disorders. How refreshing, then, is Dr. Steinberg's distinguishing surface and hidden symptoms. She contends that many cases of depression, bipolar mood disorder, anxiety, attention deficit and even ostensible schizophrenia (often popularly confused with multiple personality) are outward manifestations of inward dissociative processes that can be treated with the therapeutic techniques she advocates. She states: " . . . we can prevent the tragic waste of life of many creative people with [severe dissociative disorders] by teaching them how to communicate with their different sides and integrate them instead of trying to suppress them with drugs alone. Research has shown that people spend seven to ten years or more in ineffective treatment, often shunted haplessly from one therapist to another until their dissociative disorders are correctly diagnosed." (p. 297).

She has developed a tool for diagnosing dissociative disorders, a structured interview called the SCID-D. At times, The Stranger in the Mirror reads as if it were an infomercial for the SCID-D, and Steinberg seems to imply that there has been no other comparable instrument. Thankfully, that is not so; yet having another objective measurement of this controversial condition may contribute to silencing some of the skeptics.

Steinberg's lack of historical perspective is surprising but forgivable, considering that the book has considerable therapeutic value otherwise and that providing a literature review was clearly not its primary purpose. (Those readers wishing for an extensive review of over 100 years of literature on dissociation should consult Colin A. Ross' Dissociative Identity Disorder) Still, her flat assertion that in 1981 "dissociation . . . was a relatively new concept" (p. ix) is simply not true. Writing in 1934, C. G. Jung credited Janet and Prince before him "for our knowledge today of the extreme dissociability of consciousness," and he said that "fundamentally there is no difference in principle between a fragmentary personality and a complex." He also referred to what he termed autonomous feeling-toned complexes as "splinter psyches."

Another criticism of the book is in her treatment of the paranormal. Although she, like Jung before her, sees dissociation as normal and not necessarily pathological, she is rather quick to conclude that out-of-body-experiences (OOBE's) past-life memories, near death experiences (NDE's) and other such borderland phenomena are "most likely, not events that actually happened, but yet another example of the power of the human mind to protect itself by creating imaginative metaphorical symbols for memories of unthinkable childhood trauma." (p. 293). This may often be so, and her caution is a welcome alternative to either wide-eyed credulity or knee-jerk skepticism, but she by no means accounts for all the data. For example, although the literature on OOBE's contains many accounts of experiences precipitated by shock or trauma, there are also innumerable exceptions. Still, no one who accepts the possibility of an OOBE would deny that, by definition, a type of dissociation is involved. Religion writer Alan Spragget in 1967 even referred to OOBE's as "somatic dissociation." Also, evidently Steinberg is unaware of Dr. Ian Stevenson's studies of children who spontaneously report verifiable past life recollections. Whether these cases prove reincarnation is a separate matter, but they hardly seem reducible to "screen memories" of past abuse. The one work on past life therapy she cites is Brian Weiss' Many Lives, Many Masters. She argues plausibly that the patient portrayed in that book had a dissociative identity disorder rather than recollection of literal past lives. She attributes what progress that patient made to the fact that Weiss' therapy "acknowledged and worked with her hidden parts and did not discount them" (p. 290) but sees Weiss' not recognizing an underlying dissociative disorder as prohibiting the patient's further integration. Should she read another work in this vein, Steinberg would do well to choose Roger Woolger's Other Lives Other Selves. His approach to past lives amounts to an elaboration and extension of Jung's theory of complexes, and, as with more conventional forms of trauma therapy, stresses that the literalness of the memories is less significant than their symbolic resonance with the patient's core conflicts.

In spite of the above criticisms, I have enthusiastically recommended The Stranger in the Mirror to colleagues and clients and will continue to do so.