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An Interview with John Kihlstrom, Ph.D on Hypnosis, Dissociation and Trauma

David Van Nuys, Ph.D. Updated: Feb 27th 2009

download this podcast read the transcript

John Kihlstrom, Ph.D.In this edition of the Wise Counsel Podcast, Dr. Van Nuys interviews John Kihlstrom, Ph.D. about Hypnosis, Dissociation and the Dissociative Disorders. Dr. Kihlstrom is a clinical psychology researcher and professor at UC Berkeley who is well known for his experimental work concerning dissociation. He first became interested in hypnosis as an undergraduate student at the University of Pennsylvania where he assisted researcher Martin Orne with the development of a hypnotic susceptibility questionnaire designed to predict people's different experiences of hypnosis. As he became professionally involved in clinical research, his interest shifted towards the dissociative disorders; clinically significant conditions characterized by memory and identity problems that result from dissociation. Hypnosis and the dissociative process that unifies the dissociative disorders are similar if not identical mental processes, so Dr. Kihlstrom's interest in dissociation was a natural extension of his original interest in hypnosis.

In the simple terms, to dissociate means to "space out" or to go into a trance (like a hypnotic trance). When this occurs, the normal and continuous flow of a person's memories and experience gets altered. How memory becomes altered depends on the intensity of the dissociation taking place. Very mild forms of dissociation involve nothing more than losing a train of thought as in normal "spacing out". More involved forms of dissociation can involve memory loss, known technically as "amnesia". In the most severe cases of dissociation, a persons' identity or sense of self becomes altered. A smooth and continuous identity depends on access to an unbroken record of experiential memories, so when memory becomes very broken up, so too can identity.

The DSM recognizes four types of dissociative disorders. These are, in descending order of severity (with the most severe first), Dissociative Identity Disorder (DID; formerly Multiple Personality Disorder), Dissociative Fugue, Dissociative Amnesia, and Depersonalization Disorder. The more severe dissociative disorders, exemplified by Dissociative Identity Disorder have captured the public's imagination in popular film depictions such as the "Three Faces of Eve", "Sybil" and more recently, "The United States of Tara". Despite the fact that the best available evidence suggests these conditions occur rarely, since the 1970s and 80s numerous therapists have reported treating many severely dissociative patients. Many people frequenting online mental health community support websites also claim to have severe dissociative disorders like DID, leading some people to think that these disorders (or at least DID) occur far more commonly than researchers recognize.

Dr. Kihlstrom suggests that the dissociative disorders' popularity has to do with their having "romantic" (e.g., tragic and dramatic and even mythic) qualities and because they force us to confront fundamental and fascinating questions about the nature of identity. He is skeptical about the notion that the dissociative disorders are common, however. Kihlstrom acknowledges that the incidence rate of reported cases of dissociative disorder reported has skyrocketed in recent decades, but is cautious about interpreting what this fact means. The rise in diagnosis could reflect an actual increase in the rates of occurrence of these conditions, or it could be due to systemic overdiagnosis of these conditions by therapists and patients who find these conditions compelling and who are consequently motivated to see them occurring even when the underlying actual phenomena being observed might be more accurately characterized by alternative diagnoses such as borderline personality disorder or schizoaffective disorder.

Conventional clinical wisdom suggests that a precondition of the more severe dissociative disorders like DID is significant childhood trauma. A causal relationship is implicit in this "wisdom" to the effect that early trauma is thought to cause later dissociation in susceptible people. Dr. Kihlstrom has specifically examined whether evidence in support of this causal assumption could be generated in the lab. Importantly, he has concluded based on years of doing such research that trauma is not a precondition for developing dissociation disorders.

The idea that trauma causes dissociation disorders probably came out of early retrospective (backwards looking) research studies and case histories where someone with a dissociation disorder was asked about past events in their lives. Frequently, dissociative patients would self-report that they were abused or traumatized in some fashion. Problems with this retrospective methodology are numerous, however. Because there is a cultural idea that trauma causes dissociation, patients may have been motivated to see themselves as having been traumatized. Much of this retrospective research used very loose criteria in defining trauma, so much so that many non-traumatic events qualified as trauma when they shouldn't have. Also, little of the reported past trauma was documented.

Dr. Kihlstrom talks about using a prospective research method (instead of a retrospective method) in order to try to compensate for the difficulties associated with this problematic retrospective self-recall methodology. Using prospective methodology, Dr. Kihlstrom started with traumatized patients who were not previously dissociative and followed them over time to see if some of these patients went on to develop amnesia for their traumas. When this did not happen he interpreted this to suggest that trauma probably was not causing dissociative symptoms like amnesia to occur. Similar lines of reasoning and experiment also supported this interpretation. Dr. Kihlstrom notes that the typical clinically significant response to trauma, namely Post-traumatic Stress Disorder (PTSD), involves the inability to forget trauma and not amnesia. He also notes that cases where amnesia does occur in the aftermath of trauma can typically be explained by taking into account the full inventory of complicating factors present during the trauma. For instance, in the case of amnesia in the aftermath of rape, such amnesia might be accounted for as an side-effect of victims' intoxication, or as a complication of head injury sustained during the rape. Trauma or abuse may be present in the past histories of patients with dissociative disorders, but, in Kihlstrom's view, such trauma history is more likely incidental than causal so far as dissociation is concerned. The true cause of dissociative disorders remains unknown, in his view.

Dr. Van Nuys and Dr. Kihlstrom talk about the controversial concept of recovery of repressed sexual abuse memories. Not surprisingly, Dr. Kihlstrom holds that such recovered memories are untrustworthy, and particularly so when hypnotic methods are used to bring them into a patient's awareness. He notes that 1) hypnotic methods inherently involving suggestion, and that 2) there is a widely accepted and emotionally compelling myth that everyone receives from the culture that trauma causes dissociation. In the context of these two observations, it is all too easy for a hypnotherapist to suggest an interpretation of the past that did not actually occur, and/or for a patient to produce a "memory" of a past event that is based more on a compelling cultural myth than on actual events. It is impossible to know whether a recovered memory is an accurate representation of an event or if instead the memory is really a fantasy that feels true like a memory because it makes sense emotionally and mythologically/culturally.

To make the point about the unreliability of hypnotically recovered memories he describes the results of a study his mentor did years ago. College students were hypnotized and given the suggestion that they age-regress. While under the influence of the trance state, these students acted like children and drew pictures which the researchers saved and later compared to pictures each student had drawn when they were actually children which they got from the student's parents' attics. There were no substantive similarities between the actual- and age-regressed images suggesting that the college students were not actually accessing childhood memories and behavior patterns so much as they were imagining what it was like to be children from an adult perspective. In other words, you can get a very convincing portrayal of a child when you hypnotize someone and ask them to go back in time, but this portrayal is the adult's imagination and interpretation being realized and not an actual recovery of older memory material.

According to Dr. Kihlstrom, there is research support for the concept of post-hypnotic amnesia (e.g., where a suggestion has been made during a trance that the subject forget something). What is particularly interesting about post-hypnotic amnesia, however, is that it affects the explicit memory system, but not the implicit memory system. Neuroscientists have identified two distinct types of human memory which they have labeled implicit and explicit. Explicit memory is conscious, episodic memory for events; the normal kind of memory people think of when they think of memory. Implicit memory is unconscious and is involved in learning to do procedures (like tie a shoe or play the piano). A hypnotic suggestion to forget an event might cause a person to forget that event, but it won't cause that person to forget new procedures learned during that event. This same pattern of explicit memory amnesia but continuing-to-function implicit memory is also frequently observed in brain damaged patients with organic amnesia (such as the famous and recently deceased patient HM who experienced anteriograde (forwards in time) amnesia (e.g., an inability to form new memories) after surgery to address severe epilepsy. HM could not consciously remember anything new post-surgery, but he could learn new procedures just the same.

As the interview winds down, Dr. Kihlstrom spends some time differentiating the four different dissociative disorders.

The mildest and most common form of dissociative disorder is known as depersonalization disorder. This is something that happens to people during times of great stress where they experience a weird sensation that they have somehow changed and have become alien to themselves. A companion disorder involves "derealization" or the sense that the world has somehow weirdly changed and become alien. When depersonalization is transient it is not thought of as a disorder but rather a stress response. It is only when depersonalization becomes chronic that it becomes diagnosable.

Dissociative amnesia involves the forgetting of a circumscribed portion of memory. A person forgets the events that occurred during a big chunk of time, but not who they are (e.g., their identity).

Dissociative Fugue is a more severe form of dissociative amnesia in which the amnesia involves the loss of identity as well as memory for events. In cases of fugue a person may (or may not) take on a new identity. A key feature of fugue is that the person often goes traveling and is ultimately found living in a different city.

Dissociative Identity Disorder is the most severe form of dissociative disorder, involving the person alternating between various different identities each of which has its own set of circumscribed autobiographical memories.

Dr. Van Nuys closes the interview with a commentary, shared by myself (Dr. Dombeck), to the effect that he (we) will have to revise our understanding of the relationship between trauma and dissociative disorder in light of Dr. Kihlstrom's comments here. We both had the understanding that substantive dissociative disorders like DID generally involve (and have been caused by) significant trauma, and we both will need to be disabusing ourselves of this notion in light of what we have learned. You live and you learn.

Links Relevant To This Podcast:

About John Kihlstrom, Ph.D.

John Kihlstrom, Ph.D. John F. Kihlstrom, Ph.D. is a Cal Berekely professor, researcher, and world-renowned expert on dissociative disorders. He earned his bachelor's degree in psychology from Colgate University, where he was introduced to hypnosis research by William Edmonston. He continued his studies at the University of Pennsylvania, working with Martin Orne, Frederick Evans, and Emily Carota Orne. He received his PhD in psychology, with a concentration in personality and experimental psychopathology, in 1975, and completed a clinical psychology internship at Temple University Health Science Center. He has been a faculty member at Harvard University (1975-1980), the University of Wisconsin (1980-1987), the University of Arizona (1987-1994), and Yale University (1994-1997). He is now Professor in the Department of Psychology at the University of California, Berkeley, where he is also a member of the Institute for Cognitive and Brain Sciences and the Institute for Personality and Social Research. He currently directs the undergraduate Cognitive Science program at Berkeley. Kihlstrom is perhaps best known for his hypnosis research, for which he has received many awards (see http://socrates.berkeley.edu/~kihlstrm/HypMemMaster.htm), and his 1987 Science paper on "The Cognitive Unconscious" is generally recognized as a landmark in the revival of scientific interest in unconscious mental life (see http://socrates.berkeley.edu/~kihlstrm/UcsMindMaster.htm). A researcher who is interested in keeping clinical practice on a solid scientific base, he is an authority on "hysteria" and the dissociative disorders (see http://socrates.berkeley.edu/~kihlstrm/DissDisMaster.htm), and a critic of "the trauma-memory argument" and "recovered-memory therapy" (see http://socrates.berkeley.edu/~kihlstrm/trauma.htm).

    Reader Comments
    Discuss this issue below or in our forums.

    interesting read - mark powlett - Jul 17th 2013

    Thanks for this, I see there is much debate about the article and I enjoyed reading that as much as the article itself !

     

    Faulty logic - Jo - Mar 31st 2013

    There seems to me to be some very faulty logic at the basis of this.  If you take a group of people who are known to have been through trauma and follow them through to see if they develop dissociation, surely you will find that 100% of them don't.  Why?  Because they were known to have been through trauma.  They weren't dissociators.  Those of us whose brains choose dissociation to help us survive hell don't even know we've been through trauma until it bursts out as we get older via flashbacks etc.  I spent 30 years with horrific symptoms thinking there was just something psychologically wrong with me.  I had all the symptoms of sexual abuse without any knowledge of it, so I never realised I'd been abused.  Why?  Because my brain dissociated so I could carry on. 

    Who am I to take issue with anything J.K. has to say on DD? - I.A. Dissociator - Oct 16th 2012

    IMHO when it comes to issues of hypnosis and dissociation J.K. is the Guru. But being great does not make him infallible. He studied \"traumitized patients who were not previously dissociative and followed them over time to see if some of these patients went on to develop amnesia for their traumas.\" Talk about selection bias - - He studied \"patients?\" With all the constant reminders how could they possible forget? Maybe if they weren\'t be treated and studied they might have developed amnesia. Actually the fact that they every acknowledged being traumatized at all makes them a less likely candidate for dissociative amnesia. The ones who forget tend to be the ones who never spoke of it. The very nature of the beast precludes scientific study, with one exception--posthypnotic amnesia.

    Using hypnosis we can very effective create amnesia for painful intrusive memories. Years later we can take a trauma victim with intrusive memories (with PTSD symptoms) and using hypnosis \"help them\" create an amnesia. As they say, all hypnosis is self-hypnosis. Surely they could as just as effectively (perhaps with greater ease) self-hypnosed their dissociation at the time of the trauma.

    I an not a recognized expert. I have no official credentials. And everything I say can easily be discounted as the ravings of a lunitic. You see besides having been blessed with a highly sensitive nature, much of what I know about PTSD and DD comes from having witnessed a traumatic event, years later forgetton it using posthypnotic amnesia, and as a consequence developed a dissociative disorder. Oh my gosh, I\'m just another emotional nut case!

    Sometimes anedoctal evidence is all we can get. Memory repression result from trauma (or associated feelings) does occur. Likewise, false memories can be constructed with and without the aid of therapists.

     

    A pearl before swine - Daniel K. - May 18th 2011

    Thank you for making this available. I've stubled upon this interview while searching for information on DID. My interest was fueled by the TV Show "United States Of Tara". Mark Dombeck provided a link to this interview in his essay about United States of Tara and I'm happy I clicked on it.

    It always feels nice to replace half-thruths, emotionally compelling myths and blatant misrepresentations of reality picked up on TV with something more tangible. I am not well read in this field of study and haven't been exposed to opposing opinions/theories. However, I consider myself quite rational and able to assess the quality of arguments and argumentation. This interview delivered everything I expect from someone holding a Ph.D title: Sound reasoning, logic and scientific approach. He expains very well why he rejects the conventional view, he discusses methodology and even gives perspective by pointing out that subjective statements can very well be influenced by culture. I am on a life long quest to picture a map of "reality", you gave me some more puzzle pieces, thank you.

    I read the comments and am shocked that no one mentioned Hitler yet. After all NWO, MK Ultra, Patriot Militia, Illuminati, secret behavioral experimetns etc. already entered the conversation. As you pointed out, "correlation is not causation". I've said this so often in my life that at this point I am not sure whether some people are just unable to grasp the concept or are willfully chosing not to.

    Another thing I noticed is how emotionally involved most of the commenters are and how little sense they make. Dear commenters, if you disagree with Dr. Kihlstrom point out exactly why and try to disprove him on the grounds of his arguments and argumentation. Claiming he justifies child abuse is not only completely untrue but also not an argument. Personal experiences and anecdotal reasoning can't possibly disprove anything Dr. Kihlstrom said, don't even try.

    To add to that - - Oct 24th 2010

    Sorry - I got off topic because I was responding more to one of the comments.

    That there are adults willing to abuse children is obvious.  If the recent happenings in Haiti/Dominican Republic are not sufficient evidence, I'm sure that there are many more cases.

    The problem is multifaceted.  There certainly are child abusers.  How those children cope might be different in different cases.  Isn't it sufficient to say some people dissociate post trauma and some don't without having to discredit those who have and whose recovered memories are extreme?  I would hate to think that all "recovered memories" are false, but I would find it even more repulsive to use a theory about dissociation, recovered memories etc. to discredit individuals who have very likely been through some type of hideous experiences.  I don't know that Kilhstrom is saying this outright as one of the other posters implied, but that would be a severe consequence.  If the problem is worked backwards - not from victims to uncovering the truth about covert experiments but rather from outing the covert experiments to find the real victims and give them the justice and reparations that they deserve perhaps it would be a moot issue.

    Trauma survivor - - Oct 24th 2010

    I'm one of those people that might get referred to as "mind control victim" but I see it more like unethical behavioral experimentation.  I didn't get raped by satanists nor do I believe a secret sect of police, firefighters, New World Order Illuminati or anything like that has been behind my abuse and experimentation. Those appear to be cover stories used on victims of trauma who are probably dissociating and quite vulnerable to suggestibility by the very persons behind this.

    That being said, I don't doubt that there are pedofiles and bizarre abuse groups out there.  But that's something else.

    My "harassers" have gone to extremes to "recreate" a previous traumatic experience.  That suggests to me that this experimentation is scripted and falls along the lines of studies of trauma, dissociation, and hypnotic or other suggestibility.  It reeks of MK Ultra type experiments but who knows what agency/cies put us on this list. (I'm not the only one in my family to have suffered under this guise.)

    I suffered through a miserable childhood of extreme emotional and constant physical abuse.  There were long periods of isolation coupled with normal socialization with my peer group. I was falsely accused of things, and constantly placed in what I now understand to be double-bind situations.  I was very religious as a child and in addition to that was hyper-aware that the situation I was in was not normal.  Rather than the daydreaming of regular children, I dreamed of escaping and having a normal life.  If I didn't dissociate or become sociopathic or develop PTSD it's not because what I went through wasn't that bad.  It's because I processed it as it was happening, suffered through it and always had the idea that I would escape, which eventually I did.  I didn't become attached to the parent who was responsible for this (I was more attached to the parent who did not save me.)  But I also treated her with civility.

    Unfortunately my escape wouldn't be for long.  Subsequently I underwent things that people refer to as "trauma conditioning" - this included several covert druggings, one rape/sodomy, witnessing of fake crimes, victimized by real crimes, constant false accusations, constant attempts to corrupt (those seem to be part of the exeperiment), unfair treatment, manipulation of my circumstances - school, financial, ability to get work done (that one appears to be something like transcranial magnetic stimulation since it leave physical symptoms that I can like to that.  Previously I don't know what had been used besides the constant trauma and harassment.)

    The most recent attack included elements of stalking - mostly on the internet - hacking, interference with USPO, telephone and email, death threats, vandalism to my car, threats to harm my child, something like electrocutions in my home including a violent attack to my genitals, and the side effects/symptoms of whatever they are using.  This was timed to coincide with a moment in which I was preparing my doctoral dissertation for defense and receiving news of the terminal illness of one of my parents.  I was left unable to work, unable to contact certain people about this, in financial death, harassed by said parent from the past and with no justice (I finally got a case number but it is obvious I'm being stonewalled.)

    The harassers have used 'mind control cult tactics' but this is just for the cover story.  I went to the internet of course and found some definitions and terms for what I was experiencing, but those groups are mostly fakes and re-traumatized victims (e.g., more paranoid due to the lies told in the groups).  This is akin to UFO type millenarium groups of the 70s.... again linking it to MK Ultra -type experimentation.  Those groups are then gently shoved into certain political factions that are internet based and of a particular kind of conspiratorial thinking that is linked to right wing groups.

    We are made to believe that no one cares.  I'm sure if people (even those in government) really know the abuses we have undergone, they would be horrified.  The fact that my communications have interference is proof of that.

    On one hand the groups try to get victims to think this is worse than it is.  Many have adopted end of the world religious scenarios as well as NWO takeovers.  (I don't believe in a NWO, but certainly the OWO has something to do with this.)  I didn't allow my belief system to be stretched into that.

    On the other hand, if I "survived" intact so far - that is, despite many carefully orchetrated forms of abuse and violations and still made it within inches of a doctoral degree - without a major dissociative illness, amnesia or the intrusive thoughts of PTSD, that doesn't mean I haven't suffered.  I don't think the article condones child abuse, but my concern is that there is a misplacement of the concept of suffering.  My suffering is not to be measured simply to the degree that I suffered brain trauma or whether I had a nervous breakdown.  In order to survive ordeals, I allow myslef full suffering then ignore the elements causing the suffering.  But just because I didn't come out "more" damaged doesn't mean that I suffered any less than someone who developed a disorder.  One could almost say that I suffered more.

    That being said, it appears that those of us who survived previous "behavior modification" illegal, unethical and abusive experimentation are then put to the test with even more abuse.  The Mengeles' thinking:  cut off her feet, if she walks, cut off her legs.  If she still tries to walk, cut off her knees... all the while screaming "WALK!"

    One can only hope in the harassers/experimenters reading my assessment of what they have done will cause them secondary PTSD, but I am afraid they are too sociopathic, narcissistic, arrogant and delusional to be saved that way.

     

    Attempts to silence Kihlstrom - Roy - Jul 14th 2010

    A previous commentor stated that "hundreds of thousands of people know that this document is justification for child abuse". Regretably, very few people know that there are organized campaigns to harrass, intimidate and ultimately silence researchers such as J Kihlstrom by falsely claiming that their work is intended to justify child abuse. These campaigns are conducted by fraudulent abuse or mind-control claimants and their sympathizers, allied with the Patriot Militia movement, and are part of a criminal conspiracy to promote the idea that our governments and public institutions including law enforcement are controlled by secret societies of satanic pedophiles, for the purpose of inciting domestic terrorists like the Hutaree. Convicted stalker Diana Napolis was an early operative of this criminal network.

    Times, they are a changing - - Mar 25th 2010

    I would like you to know that in academic, clinical and general populations your opinions are now being seen for what they are...opinions.

    There is a great deal of evidence to support that severe dissociation is a response to overwhelming stress and child rape is overwhelming and traumatic. You must not be reading any academic journals and neurobiology based research in the last 10 years.

    This document gives evidence of your ignorance more than anything else

    Hundreds of thousands of people know that this document is justification for child abuse.

    Dr. Dombeck's Note: You seem to take from the interview the idea that Dr. Kihlstrom doesn't think that rape is traumatic. My sense is that this is not the case. What Dr. Kihlstrom is saying that goes against conventional wisdom, however, is that dissociation is not caused by severe trauma. Trauma might preceed dissociation, or not, but because all four of the following cases have been observed: 1) traumatized people who dissociate, 2) traumatized people who do not dissociate, 3) non-traumatized people who dissociate, and 4) non-traumatized people who dissociate -- it cannot reasonably be concluded that dissociation is *caused* by trauma. The two may co-occur, but it does not appear to be the case that the one necessarily must preceed the other. As the old saying goes, "correlation is not causation"

    Information on the false memory syndrome - Memory debate - Mar 25th 2010

    These web pages have scientific information on the memory debate.

    http://childabusewiki.org/index.php?title=Recovered_Memories

    http://childabusewiki.org/index.php?title=Dissociative_Identity_Disorder

    http://childabusewiki.org/index.php?title=False_Memory_Syndrome

     

    Invalidating to trauma vitctims - - Dec 30th 2009

    Reading the title of this commentary, i thought it was going to be about dissociative disorders.  What I heard was a lot about repressed memories etc.  I was severely physically abused by my father.  Often when it happened, I left my body.  I even laughed because my father put so much effort into beating a 'me' that simply wasn't there.  Now I do have trouble with dissociation and have loss of time etc.  it's become a greater problem with age and life stresses.  My brother, a few years younger than me was psychologically abused, but wasn't beaten.  When I spoke up about the abuse, he vehemently denied it happend and accused me of recovering a suppressed memory, even though i'd told  people Iw as being beaten and left home to escape it.  My brother claims to have no memory of violence.  So it happende + he's forgetten/  Disscoiation post  trauma  symptoms can coexist.  Please listen to people.

    Martin Orne - Kerrie - Jun 23rd 2009

    Mmmmmmm.

    Martin Orne-MK Ultra, "dirty psychology" FMSF and John Kihlstrom.

    What do all these have in common?

    Pseudo science (comparing apples and bananas) and "blaming the victim" by saying their reality doesn't exist."All fantasy"

    Shades of Freud repudiation of the 'seduction theory'.

    Another load of BS from a well credentialed VSP (very stupid person).

    controversial - - Mar 18th 2009

    The controversy surrounding recalled memory in traumatic events is highly controversial. I feel presenting this subject in a one sided manner, as has been presented here is irresponsible. There is considerable research that specifically contradict Kihlstoms point of view. Kihlstrom is bias in his research and does not account for situations where victims do not receive adequate support or report the trauma, leaving the victim to deal with the traumatic memories on their own and unable to  precess them in the "normal way." This concerns me because this puts the credibility of all victims at risk and there is already enough re-victimization in our justice system/society to take Kihlstroms research as fact. Reevaluating our previous point of view should only be considered after careful scrutiny and reviewing all the facts from both sides of this controversy.

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