解離の発生と利用について言語化した1例

A Case of A Woman who Described in Words the Origin and Purpose of her State of Dissociation

　【抄録】解離の発生と利用を詳述した1例を報告した。初診時26歳の既婚女性で，多彩な身体症状と解離状態を呈した。解離には，防衛的・適応的な自己催眠様状態と破綻的・不適応的な混乱状態がみられた。前者は「ボーツとして，話しかけられても気がつかないが，料理や運転はそのまましている」というもので，対人的接触を犠牲にして，情動の暴発を抑え，習慣的行動を能率的に遂行していた。「いじめにあって身につけた。考えてしまうのをやめようと努力したらこうなった。感情的なものを麻痺させる。このほうが楽。一点を見つめていると入ってしまう」と述べ，半ば意図的に誘発し利用する側面もうかがわれた。自己催眠様状態は解離の原初的形態であろうと考えた。

　A case is reported of a woman who described in words the origin and purpose of her state of dissociation. The patient was a 26 years old housewife. She presented many somatic symptoms and dissociative states. There was a spectrum in dissociative states. One was the self-hypnoid state which was defensive and adaptive. She described it as follows.'I felt vacant, and made no response when someone talked to me. But I could cook and drive more skillfully than usual.' Another was the confused state which was catastrophic and unadaptive. She could not control her emotions, and there were explosions of uncontroled emotions. She would begin to cry or get angry suddenly, and she had even tried to strangle herself. When the intensity of the psychological stress increased, the severity of dissociation also tended to increase.

　She was brought up in a family, in which the grown-up members were on bad terms with one another. She acted as a go-between among them. She began to dissociate her own feelings, giving priority to the feelings of others. She was bullied by her classmates while she was in school, and this precipitated her tendency to dissociate. The bullying was worst when she was in junior high school. She was neglected by most of her classmates. In this period, she acquired the ability to dissociate. It was a kind of self-hypnoid state. She could get into it through watching some fixed point persistently, especially when she was in an uncomfortable situation. She described this as'a kind of escape', and'it began when I tried to stop thinking'.

　By inducing the self-hypnoid state half intentionally, the patient could numb her emotions and prevent their explosions, and she could carry out some of her indispensable daily tasks automatically and efficiently. This self-hypnoid state was considered to be the original form of dissociation, which had the potential to develop into more severe forms of dissociation.