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Paley, A.N. (1988). Growing up in Chaos: The Dissociative Response. Am. J. Psychoanal., 48(1):72-83.

(1988). American Journal of Psychoanalysis, 48(1):72-83

Growing up in Chaos: The Dissociative Response

Ann-Marie N. Paley, M.D.

The past few years have seen renewed interest in the role psychological trauma plays in the genesis of psychiatric illness. Childhood physical abuse, sexual abuse, and witnessed violence are increasingly recognized as important in the genesis of borderline personality disorders and multiple personality. In my practice I have treated five women from extremely chaotic and violent backgrounds. What distinguishes these patients is their having developed a neurotic adaptation which uses dissociation as the major defense. This paper will examine their form of neurotic adaptation, in both its theoretical and clinical implications.

Case Presentations

To characterize these women's childhoods as “growing up in chaos” is not hyperbole.

Ms. A. is the second of nine children. There is a five year gap between the elder four children and the younger five. During this time, the father was absent from the home, which Ms. A. suspects was due to incarceration of hospitalization. The father was an alcoholic whose violent rages towards his wife and children resulted in occasional visits from the police and frequent trips to the maternal grandmother's home for sanctuary. Ms. A. refused to cry when her father hit her. “I wouldn't give him the satisfaction.” “If he went to beat one of the kids (her younger siblings), I'd try to make him stop. Sometimes he'd beat me instead.” The physical abuse stopped when Ms. A. was sixteen and her year younger brother responded to a beating by beating their father. The brother was ejected from the home at rifle point, but the physical abuse stopped. Ms. A.'s mother is recalled as having spent “a lot of time sitting in a chair and staring,” child care and household chores being relegated to her older daughters. “I remember in fourth grade feeling bad because my blouses weren't ironed.

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