What is dissociation?
Dissociation is essentially the lack of integration of mind and body, and is a coping mechanism all humans use, some more often or more intensely than others. Dissociation is arguably one of the most creative and intelligent ways our bodies and minds help us survive.
How do I know if I dissociate?
Dissociation exists on a spectrum. There is one end of the spectrum with more commonplace dissociation: spacing out, missing an exit on the highway because your brain was somewhere else, zoning out while your teacher is talking, “ending up” at the place you were traveling to without remembering much of the trip because you were on autopilot, etc. Across the continuum are these examples happening quite frequently to the point where it is getting in the way of your functioning and/or you don’t have much of a sense of control over it. On the more highly dissociative end of the spectrum you may have moments where you (depersonalization) or the world around you (derealization) don’t seem real, not recognizing yourself in the mirror, you leave your body, don’t or can’t feel emotional or physical pain, unaccounted hours go by and you sort of “come to” unaware of what you were doing or thinking. Some people on the more severe end of the spectrum find evidence that they have done things they do not remember doing, more on that later.
Why do people dissociate?
The more frequent or severe dissociative symptoms tend to develop as a result of being exposed to an overwhelming event or series of events with little to no possibility of escape. This is why dissociation is very common in survivors of child abuse, because children have very little control over their environment and ability to escape or protect themselves, especially if their own family members that they live with are the source of the unsafe/abusive treatment. Powerless situations such as this leave the internal resource of “going away” or “going somewhere else” as the only viable option for survival, whether it is a conscious choice or, quite often, an automatic survival response. Many clients describe experiences where abuse was occurring but they were up in the corner of the room or hovering above their body watching from the outside. When this works for someone as a means to survive a stressful event in childhood, the body is aware of its history of success, and dissociation can become habitual, even when danger is not present.
The Fight, Flight and Freeze Response
In his book on healing from trauma called Waking the Tiger, Dr. Peter Levine provides an excellent description of the biological/evolutionary underpinnings behind the freeze response. The freeze response is a dissociative response, also called the immobility response. The freeze response is the third response to the two more well-known responses: fight and flight. When an animal assesses that fighting or fleeing during a perilous situation are both hopeless, the body will kick the freeze response into gear to survive.
Has your cat ever brought a bird into the house for you as a lovely gift? Have you noticed that oftentimes the cat will drop the bird on the kitchen floor and it will look dead, until a few moments later it springs to life, flapping its wings chaotically? If this sounds familiar, you have in fact witnessed the freeze response! The bird’s freeze response does two things: 1. it numbs the bird’s physical pain so that it does not physically suffer during the attack, and 2. if the bird appears dead, the cat will stop physically attacking it which will prevent fatal injury, and once the predator gets back to its home, the bird has a better chance of escape.
It is important to note the bird is not playing dead. Playing dead implies choice. The freeze response is an automatic bodily response the bird had no choice in, and it most likely saved its life. It is also important to note that humans are animals. Many clients find solace in learning this information after expressing regret or shame that they did not or could not scream, move, say no, run, fight, etc. during abuse. Chances are the immobility response revved up and most likely helped them survive.
What is Dissociative Identity Disorder (D.I.D.)?
D.I.D. exists on the extreme end of the dissociative spectrum. It is defined by the DSM-V as:
“Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption of marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.
Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The disturbance is not a normal part of a broadly accepted cultural or religious practice.
The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).”
When the dissociative coping mechanism is learned or relied upon from a very early developmental age to survive severe trauma, the body and mind can become quite unintegrated. It is a highly effective, creative and intelligent way our bodies and minds survive hopeless situations by psychologically separating off thoughts, feelings, memories, and perceptions of the traumatic experience. This often allows the child to function as if the trauma had not occurred. This fragmentation of the trauma can create internal fragmentation of parts within the person. Different parts may hold different components of the memory, different emotional responses to the event, different physical sensations, some parts may feel angry and resentful while some might feel passive and believe that they are deserving of abuse, some parts might still feel like that child being abused. Once again, highly resourceful, but not without consequences. As you can imagine, if a part still feels like the child being abused and the adult survivor of child sexual abuse goes to have consensual sex with a partner, this fragmented part can feel extremely triggered and unsafe. The mechanism can also cause the person to be unable to recollect the event at all, which can undoubtedly create a lot of confusion as to why the severity of emotional and mental symptoms are occurring. One of my favorite Jeanette Winterson quotes depicts this dilemma well:
He: What’s the matter with you?
Nothing was slowly clotting my arteries. Nothing slowly numbing my soul. Caught by nothing, saying nothing, nothingness becomes me. When I am nothing they will say surprised in the way that they are forever surprised, ‘but there was nothing the matter with her.’
Not only can this create confusion for the survivors of trauma, it can create confusion for non-trauma-informed healthcare professionals treating them. Creating Sanctuary by Dr. Sandra Bloom, M.D. is a wonderful account of her realization that most of the people she was treating in her acute care psychiatric unit in a general hospital near Philadelphia were survivors of traumatic experiences, typically beginning in childhood, and how knowledge of trauma’s impact on body and mind are paramount in any effective healthcare.
If you fall somewhere on this dissociative spectrum and the symptoms are getting in the way of your functioning or others report that it is, worry not. Awareness and a name to label this pattern is a first important step in healing. Know that it is normal. Know that it is completely treatable. If the more frequent or intense dissociative symptoms or features of D.I.D. ring true to you or someone you love, know that you do not have to navigate the healing process alone. The next step is finding a clinician that will assess where you are on the dissociative spectrum and help you learn skills to ground yourself to the present, better control your ability to dissociate, and reprocess those old memories so they don’t run your show in the present. Choose a trauma-informed therapist, preferably one who has experience with these symptoms and that is trained in EMDR. If you are in the Vancouver, BC area, learn about me and my practice. I’d love to meet and work with you.
For D.I.D. I can recommend the book Got Parts? by ATW for further, digestible information. There is a lot more to know about D.I.D., but it would be most helpful to learn about it one-on-one with your professional therapist as it relates to you and your symptoms, as opposed to in general terms. As you begin to feel safer in the present and more integrated within yourself, you will begin to see how incredibly resourceful and resilient you are. If you have questions or concerns about anything you’ve read, please do not hesitate to reach out to me in the contact section.
Helen Thomas MC, RCC, LPC