Dissociation and Dissociative Disorders
"I can't remember what I'm doing in the basement—I think I came down to get something."
"Wow, I'm home already. But I don't remember driving all this way; the last thing I remember is that stop light half an hour from here!"
"The hand hurts all the time...it burns. How did I hurt it?"
"Yesterday…..yesterday, I think I went to work, but….I can't remember exactly."
"The dream, it's always the same, bright lights, loud noises, I wake sweating, my heart pounding."
"You know, I can't seem to remember anything that happened to me from first grade through fifth grade. It feels strange...."
Dissociation is a process of separating one part of your inner self from the others. The example you have probably heard about most is post-traumatic-stress disorder—commonly seen in war veterans who suddenly begin to have flashbacks, to waken in the night shaking, sweating, screaming, who avoid certain people or places, who begin to withdraw from their loved ones. In cases like these, the memory of some wartime event or events, which at the time were too terrible for the individual to process spontaneously, have been splintered off, stored in an isolated place in memory—becoming inaccessible to the normal process of thinking about and dealing with stressful events, and eventually becoming intrusive—essentially leaking into daily life in an uncontrolled way. We call this type of storage "state-dependent memory", and in this extreme case, such memories are inaccessible except when your defenses are down or something recalls the conditions under which they were stored.
How Traumatic Memories Work
We all have instances of state-dependent memory and learning in our daily lives—something we were struggling to recall suddenly comes to us clearly when we are in a location that is similar to where we originally had the experience, or when a similar smell or sound triggers it, or even when we enter a similar mood or chemically altered state! Memories are stored as a package deal and are associated in our minds with things that happened concurrently. In the case of trauma, the hugeness of the trauma blocks out anything else, and for some individuals, it causes the memory to be stored immediately and completely in a "safe place" and ostensibly forgotten—until something taps into it. In the process of experiencing trauma, the body tends to shut down, freeze, as it were, and this also contributes to the production of memory that lacks a sense of completion. If the event were processed consciously the way we process most stressful events—by talking it out, by thinking it over, even completing whatever acts of protection or defense might have protected us, it would remain available for further processing until it began to hurt less. But when a memory is stored in isolation and never processed, dissociation has occurred and physical and/or psychological symptoms are likely to ensue.
Trauma and Dissociation
Dissociation of memory, dissociation of parts of our behavior, dissociation of aspects of personality are all things about which most of us read, but experience only in minor instances—spacing out and not hearing the phone ring when we are engrossed in a novel or not remembering why we walked over and opened the fridge or looking blankly at a familiar face and having no name to put to it. But for some, the tendency to dissociate is a pattern; they may even be born with that ability to segregate certain thoughts, emotions, and behaviors very effectively from others. This can be a useful trait if you are in the middle of a trauma and need to act rationally to stay alive or need to distance yourself from the event even to live through it, but it can be a problem later when you suddenly discover that what you had "forgotten" by storing it in isolation from everything else, still exists and affects your behavior. For most people, a car accident, often a traumatic experience, haunts their minds quite often at first, replaying itself with less and less impact until eventually it can be thought about without a racing heart. For individuals who have dissociated the crash, though, there is a different experience—that of not remembering much of anything about the event but being haunted by it at random instances--always with the same intensity of emotional and physiological arousal. Alternatively, the individual may develop physical symptoms that somehow are reminiscent of the traumatic event--a leg pain that never resolves despite being medically healed, a twist to the posture as if still escaping from the burning car, etc.
Dissociating to Cope with Extreme Trauma
Less common are instances of dissociation of entire aspects of the self—what was once called "multiple personality disorder" is now more accurately termed "dissociative identity disorder", indicating the similarity with PTSD. In the case of DID, individuals who have experienced severe trauma split off the aspect of themselves which was traumatized in an attempt to survive. They may also split off various other aspects over time—aspects developed as coping mechanisms to continued trauma. The individuals experience amnesia for the time periods surrounding the dissociated aspects of their lives. Dissociative disorders can involve entire personalities or simply voices or thoughts that appear to come from another aspect of the self. Dissociative symptoms include amnesia, periods of time unaccounted for, feeling unfamiliar with one's surroundings or even one's own body, and symptoms of the body such as inexplicable pain or numbness or feeling as if one has forgotten how to perform everyday tasks.
Client-Centered Trauma Treatment
The ability to dissociate is a trait—an aspect of personality. It can be used adaptively, to survive trauma, or maladaptively, to avoid feelings. Memories previously dissociated often cause problems in current behavior, when the immediate need to defend oneself has expired. The purpose of therapy for dissociative responses is to create a safe space in which to process the traumatic material as appropriate and reduce the need for defensive responses. It is important to realize that painful memories are repressed for a reason. Sometimes they do not surface during therapy, even under hypnosis, or they surface gradually. This is one of the mind's many ways of protecting itself, and the work is done with respect for the safety needs of the client. The experiencing of severe symptoms is one way of determining that the work of processing trauma needs to be done to stop the problems that are occurring. Observation of the changing pattern of symptoms guides the client and the therapist as to how to proceed. Sometimes once begun, the process continues to unfold safely and gradually without further assistance. Other times professional guidance is necessary for a longer time. The safety and comfort of the client is primary in planning a course of treatment for dissociative symptoms.
Client Safety Is the First Goal of Trauma Therapy
When we discuss dissociation, the topic of "repressed memory" inevitably arises. While there continues to be debate even amongst professionals about whether memories can indeed be repressed, the existence of dissociative disorders presents strong evidence that they can. The more significant issue is whether such repressed memories should be uncovered and if uncovered, what should be done about them. The short answer is that many repressed memories, though not all, should indeed be uncovered in the name of creating a more adaptive pattern of functioning in the individual. Some people heal from repressed traumatic memories without recalling them completely. Others need to remember in greater detail to produce the rethinking process described above that helps decrease the emotional impact of the memory of the event. Others need to work through the physical aspects of the trauma and allow their bodies to feel safely defended. Some combination of these concepts can help most people heal from traumatic experiences.
When clients inquire about therapy for depression or anxiety or even for processing trauma, they are not taken into treatment to seek repressed memories. If, during treatment, it becomes clear that there is a memory or dissociation that is interfering with the client's functioning or ability to recover, then and only then will the repressed or dissociated material be sought for active therapeutic intervention. Dr. Low at the Center for Conscious Living is experienced in the safe, effective treatment of dissociative symptoms using a variety of techniques such as clinical hypnosis, sensorimotor psychotherapy, and rational-emotive behavior therapy. I invite you to phone and discuss your options for treatment.