Julie Miller's Mental Health Blog

Archive for the ‘"D" is for Dissociation’ Category

Now that you may have begun to notice that you dissociate, on occasion or lots, you will be asking, “whatever do I do about it?”

Understood.  Certainly if you find dissociation impacting on your life, you can be certain that treatment will help.  Treatment in the form of psychotherapy, and maybe seeking a psychiatric evaluation for possible medications, are recommended.

Learning how to ground (coming back from dissociation and staying present) is an important task in recovery.  You cannot heal from trauma or other issues without being present.  Grounding skills including any of the following:

1.  Noticing the here and now – where are you?  what day is it?  what time is it?  what year it is?

2.  Feel your feet on the ground, your seat in your chair, your back against the chair, etc.  Be present in this moment.

3.  Notice your body, feel the sensations present.  Notice the sensation of your lungs filling with air, the sensation of saliva in your mouth.

4.  Take a drink of water, notice the sensation of it in your mouth and how it feels as you swallow.

5.  Touch something cold, a cold bottle of water, a piece of ice, etc.  Notice the sensation of cold against your skin.

6.  Try to dig through the bottom of your shoes with your toes, notice the sensation of your toes against the inside of your shoes.

7.  Go to your “safe place,” or “peaceful place,” or “happy place” in your mind and notice how imagining yourself there feels in your body – the sights, sounds, and smells of that place.

8.  Make contact with others – talk to a friend, say what’s really happening for you right now and ask for support.

These are but a few possible skills you could try and practice.  What other ones do you know?  Ideas?  Ask around – if you have friends who also experience dissociation, ask what they do.  Read a book.  Do a search online.  Whatever works for you is what works.  There are no right or wrong answers, only choices.

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Why do some people dissociate?

Dissociation is a defense.  It does something for you.  It protects you, keeps you from being overwhelmed, just like denial, minimizing, intellectualizing, rationalizing, etc.  These things are also a defense, and keep you from getting overwhelmed.  They also eventually out-live their usefulness if you are stuck in them, just like dissociation.

Once these defenses become habitual,  however, you lose the power of choice.  The defense becomes automatic, a subconscious decision made by your central nervous system (CNS).

When you are very young, there aren’t you don’t have a lot of resources, skills, experiences that can help you a difficult situation without getting overwhelmed.  A small child has limited ability to understand why Daddy is yelling, or Mommy is crying.  The child may become very frightened, and because of things going on in the house (substance abuse, depression, abuse, etc.), no one can be present for the child to help protect and soothe him or her.

Hence, the child must find a way to soothe and protect themselves.  The CNS automatically shuts down some of the “lights” in the brain if the system becomes overwhelmed.  It’s a lot easier for a child to get overwhelmed than an adult, given that a child does not have all the resources, experiences, and skills of an adult.  Sometimes it doesn’t take much for a child to get overwhelmed, and if no caretaker is available to help comfort & soothe, dissociation often functions to comfort & soothe.

I’ve spoken to many clients who say they can’t remember a time when they didn’t dissociate.  They needed it as a child for protection, and the dissociation has continued into adulthood.

Because dissociation is on a continuum, recovery from it varies according to severity.  We’ll talk about that next time.

Typically, although not always, dissociation is

Most people experience some form of dissociation at one time or another.  Dissociation is on a continuum, and at the bottom end of that continuum, most people have the experience, once in a while, of driving a car and suddenly realizing that you don’t remember what happened during part of the trip.  Occasionally, you are listening to someone talk and suddenly realize that you did not hear part or all of what was said.  “I’m sorry – could you please repeat that?  I got distracted….”

Day dreaming (for brief periods on occasion) or taking that “mini mental vacation” is actually an important part of how our central nervous system takes care of us.  Maybe you come home after work and just “veg-out” by doing something mindless, watching TV, or even just staring at the garden.  No problem.

The difficulty with dissocation comes in when it interferes in your life.  Maybe you can’t stay present in a group because someone talked about some experience you had, and it sent you off into “space,”  just being  “blank.”

You might find yourself in a place and have no idea how you got there.  You may find yourself dressed in clothing that you don’t remember putting on.  You may be approached by people that you do not know who calls you by another name or insists you have met them before.

You may have no memory for some important events (like a wedding or graduation).  You may look in the mirror and not recognize yourself.

You may remember a past event so vividly that you feel as if you are reliving the event. While watching television or a movie you may become so absorbed in the story that you are unaware of other events happening around you.

You may feel as if you are looking at the world or yourself through a fog so that things appear far away or unclear, including yourself or the sense that you exist.

You can see how these experiences might interfere with life.  The more often they occur, the more impact they have on your life, your family, your friends, your work, yourself, etc.

As with many issues, awareness is the first step.  Recovery is possible, uncomfortable and even painful, but possible.  Working with a good therapist who has experience working with dissociation can help provide support, guidance, and practice in awareness and alternative coping skills.

Next time, I’ll address why dissociation can become a part of one’s life.

I often hear clients say, “Oh, yeah, I dissociate myself all the time.”  When I ask what that means to them, they talk about “dissociating” themselves from other individuals whom they don’t like, or isolating from family and friends.

That makes sense in the way the word is used in the vernacular; however, it doesn’t really reflect what is meant in the mental health field by the term “dissociation.”

The DSM defines dissociation as “a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment.”

Basically, to translate from the DSM, dissociation is a way in which we experience alteration in our perceptions of the world and ourselves, including who we are, where we are, what date or year it is, and how present we feel in the moment.

Think of it as a protective device – this may sound silly, but maybe even a “cloaking device.”  Remember the Star Trek episodes, especially with the Romulans, who had a cloaking device but the good guys didn’t?  The cloaking device was used by the Romulans to be invisible to Capt. Kirk and his ship.  The Romulans wanted to hide, right?  Capt. Kirk was the enemy, a threat.  The Romulans were in there, but they couldn’t be perceived by the Capt.

We can use dissociation like a defense, to hide from our emotions or sensations that are “a threat,” meaning that they are such uncomfortable experiences for us that we have to shut them off immediately.  You might see a connection here to substance abuse – an immediate shut-off valve.

So when Capt. Kirk (aka, “unwelcome feelings or sensations”) approaches the Romulans, and the Romulans are not in a friendly, open mood to accepting him, the cloaking device (aka “dissociation”) goes up.

The particular forms of that cloaking device vary, and are on a long continuum that starts with where most of us are – the occasional day dream, a little mini mental vacation, not remembering getting from one stop light to the next, but doing so safely.  These are pretty much within normal limits, and most of us experience this kind of dissociation at one time or another.

As we move up the dissociative continuum, the alterations in perceptions, identity, consciousness and memory increases and becomes more problematic. It continues to be a defense, however, against emotions or sensations the individual experiences.

Next time, specific examples of dissociation…