Facing the past: Dissociation and ‘serious mental illness’
Dissociation is a common, yet frequently overlooked, factor in “serious mental illness.” Although usually associated with dissociative disorder diagnoses, high levels of dissociation are also found in individuals diagnosed with posttraumatic stress disorder, schizophrenia, and, to a lesser degree, borderline personality disorder. Mental health scholars Jon G. Allen, PhD, Dick Corstens, MD, and Andrew Moskowitz, PhD have separately been at the helm of several studies exploring and giving evidence for the strong link between dissociation and hearing voices, confused thinking, disorganized speech, strange beliefs, identity disturbances, and other anomalous experiences.
The greater the level of dissociation, the more difficulty one has in benefiting from psychological or drug treatments. But, what is dissociation?
The academics who are often looked to for definitive answers do not agree on its precise definition. In its most simplistic aspects, dissociation might be considered to be akin to disconnection. But, dissociation is so much more complicated and difficult to define, as evidenced by the great lengths scholars and mental health professionals will go to in their attempts to provide some understanding while never quite managing to completely do so.
This may be because words defy what dissociation truly is: an experience.
Dissociation is numbness and nothingness; it is a feeling of being lost; it is floating on a cloud that threatens to suffocate; it is automatic speech and action without awareness or control; it is looking at the world and blinking to try to remove the blurry fog; it is hearing and seeing the immediate world and simultaneously feeling very far away; it is raw fear; it is unfamiliarity in familiar places; it is possession; it is being haunted everyday by unknown monsters that can be felt but not seen (at least not by others); it is looking in the mirror and not knowing who is looking back; it is fantasy and imagination; and, above all else, it is survival. Dissociation is all of these things and none of them at once.
While clearly the concept of dissociation cannot be strictly defined, the phenomenon itself can easily be recognized by one who is familiar with it. And yet, few mental health professionals are trained to identify it, let alone understand it. Why?
This is a question I have been trying to answer for many years. In large part, dissociation does not provide any favors to the biomedical concept of disease, especially as it appears in psychosis, and so it is not a focus within such a paradigm. This is because dissociation is a normal human reaction to overwhelming chronic stress and/or trauma, not a disease process. It serves to defend the self against stress and trauma by disconnecting the mind from its capacity to perceive what is too much for the person to bear.
Trauma, especially that which is inflicted on a child by caregivers, is something that is often denied by both society and the individual experiencing it. To deny the effects of early chronic stress (trauma really only being one type of stress that is narrowly defined by society) as it is exhibited in present-day difficulties due to diagnosis is itself dissociation.
When one enters into a dissociative state, the entire brain shuts down except the areas vital to survival, and those related to emotions and speech. Fear of a terrifying past that enters into the presence may impede the actions of awareness, inhibition, or differentiation of internal and external reality. The past is the only reality that exists.
Additionally, when memories are formed in a state of dissociation, the brain maps these events in such complicated and foreign ways that manifestations of these memories in the present is usually exhibited in extraordinarily bizarre and confusing behaviors and experiences. Whether it is hearing voices, having altered personality states, or believing that the CIA is spying on you, dissociated memories serve to create a living horror story that would surely terrify any audience. Drugs might serve to damp down the fear, alcohol might ease the pain, but nothing can truly rid a person of the wicked and vile fragments of memory other than facing the past.
Whatever diagnosis might be given, when one is suffering from the effects of dissociation, one must be provided trauma-informed care. Trauma and dissociation lie at the root of most “serious mental illness.” It is a very individual process as far as who can fully heal from terror and how to do so. It is certainly an ongoing, possibly life-long journey with many hills and curves along the way, but a journey that one must go on to escape.
What is universal, however, is that nobody can or should do it alone. A caring other who can withstand not only the narrative of a horrid past, but also the creative ways in which the person has managed to deal with this past in the present is an absolute necessity. An other who is grounded when one is in another world; an other who is solid when one is fragmented shards floating in the wind; an other who STAYS, physically and emotionally, without judgment; an other who can tolerate not knowing even when one is begging and pleading for an answer; an other who is an equal; an other who does not violate, harm, or oppress; an other who is curious but not voyeuristic; an other who can guide and model without needing to be authoritarian or expert; an other who is not perfect, and is not afraid to show it; an other with all, any, or most of these qualities is what is needed to reign in the dissociative processes to manageable levels and to provide one with some semblance of “self.”
This is a tall order, and not one that is inherent in many therapists. But they do exist, as do extraordinary others who are not trained at all, and can be found with some effort and perseverance.
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This is an excellent blog Noel. The point that dissociation does not fit the biomedical model is particularly important and insightful.
Volkan, Karon, and Searles all wrote about severe unmitigated terror being at the root of dissociation leading to experiences of psychosis. I remember Searles wrote about working with “schizophrenic” clients whose minds were composed – to him – of thousands of unintegrated shards so that from one moment to the next their entire identity could seem to change.
Volkan wrote about how a horrific event or series of horrific events, such as sensing murderousness in a caretaker, being in a war, being raped or beaten, being extremely hungry for a prolonged time, or being in a very painful surgical operation – any of these events could cause the mind to fragment so that one part became regressed and infantile (the infantile psychotic self) and the other adult psychotic part surrounded but could not contain that part. In such a state, the person would seek endlessly to cure, tone down or correct the all-bad affect, but without an external link to a trusted helpful person this process would fail and repeat in a circular manner.
As you said, resolving such a state requires facing such terror directly with someone who can tolerate the severe all-bad feelings, and experientially reframing the terrifying experience, and may require borrowing their ego functions for a while while doing so. Of course the drugging and lack of therapy in the current system precludes having the ability to do this a lot of the time, but there are alternatives.
Thanks again for this piece.
Thanks, Matt, for your comment. Searles is one of my favorite authors in this field. He has many wise words and observations! Of course, so do the others – he’s just my favorite. Hopefully some of that wisdom starts to return to the system as a whole sometime soon…
Very nice article. I disassociate all the time. Especially if I become stressed. My doctors, yes doctorS, have told me bipolar and BPD. I am not sure if anyone really knows. I hate my meds I take and really want to stop taking them. I am simply FLAT. But back to you and your article. Thank you for being so gracious and helpful.
Hello Noel, this has been a very insightful and helpful post. I very much agree.
In my case it was an “ordinary” person and not trained professional the only one who helped me heal from a fragmented, destructive and dark self by showing me with a lot of patience and creativity each and every step of the way. Very very similar to the points you have highlighted. I never imagined how I could trust myself and walk through situations without drowning in them.
After I learned to do this with him holding my hand (like a baby learns to walk slowly with support, encouragement and seeing others do it) I went off and started doing it on my own, to the point where I now feel I can accept and work with whatever is in front of me as if it were a task and not a traumatic experience.
Letting go of dissociation and getting lost in it is 100% possible. I would also say that in my experience, the conventional mental health system has little to no idea of how to do this.
correction: *not getting lost is 100% possible
Hi Veronica,
I’m so happy to hear that you were able to find someone to support you through your journey. It’s so important for people to hear about others’ experiences and to know that it is possible to find relationship and to move beyond trauma. Thank you for reading and sharing. In solidarity-
Hi Noel,I recently had my first dissociative and derealization episodes and am waiting to contact my Dr I’m not sure I’ll treat it because I’m already on so many meds.
But you did help me realize what my symptoms were.
THANK you so much great description. Keep up the good work.
Hi Noel,
The way you described dissociation in this piece is truly one of the best. I’ve been suffering from dissociation, delusions, and depression for years after a weed induced panic attack. I’m very high functioning, and currently looking into somatic therapy and holographic breathing as ways to override ego states that get in the way of healing so as not to feel the deep pain. Psychotherapy has not helped me completely heal the trauma that keep me in these states. I’ve always wondered about the link to dissociation and psychosis, so thank you for the infinitely valuable insight. I really wish I could pick your brain and learn more, it’s gives me hope.
Thank you, Sergio, for your comment. I’m glad to hear that this resonates with you and hope you find the healing you are looking for. I don’t think any one thing is ever quite enough, and body-based approaches are too often overlooked. Best of luck to you and well-wishes!
‘The greater the level of dissociation, the more difficulty one has in benefiting from psychological or drug treatments.’
How does dissociation make it harder to heal from trauma?
And why does someone need to be totally present to help someone fully heal from these states? I’m glad you see the benefit of somatic based therapies, I would think that’d be the absolute best method, mainly for dissociation. What do you think are the most adept therapies for this kind of healing?
Have you ever experienced it? I ask because the way you described dissociation is so spot on (esp the feeling possessed) that I cried reading it.
Thank you for suggesting that having a caring other is essential. I am that caring other but I am continually overwhelmed with my partner’s anger and accusations when something I do triggers episodes of dissociation in her. I recognize that those triggers are related to traumatic events in her childhood but there are so many different kinds of triggers that I am unable to avoid setting off something in her that takes her into another place where I cannot reach her, in spite of my attempts to help. It is getting more intense and I have no idea of what kinds of things might be effective to ground her. Is there any training for caring others?
Hi Michael,
I’m sorry to hear that you are struggling. It can be hard to love someone in so much pain. As a rule, I don’t give out advice to people whom I don’t know and don’t have a working relationship with. I hope you understand. Having said that, in general, it is always important to take care of oneself first and foremost. I don’t know of any specific caregiver support groups or trainings, though I’m sure there are some forums or subReddits that you might find to be helpful. My apologies that I don’t have much more to offer you, except, perhaps, many healing wishes for you and your partner.