Dissociation is often misrepresented
Dissociation is a word that gets tossed around a lot and can really be taken out of context. It gets weaponized, both by popular culture and by the medical profession (I see you, DSM!) as something that means someone is very impaired, someone who has “multiple personalities”. Note: that term is incredibly outdated and inaccurate. We think of movies like “Sybil” and TV shows like “United States of Tara.” These media depictions sensationalize the experience of dissociation and dehumanize those who experience it. These depictions do not account for the fact that dissociation is a normal human experience and a healthy coping mechanism at times!
Dissociation is a normal human experience
We all dissociate. We check out, space out, forget things as a way to self-soothe, pass the time, alleviate boredom, relax, cope with distressing emotions, whatever. If you’ve ever driven somewhere and said to yourself, “I don’t even remember driving here,” you’ve dissociated. If you’ve binge-watched Real Housewives to forget about your crappy workday, you’ve dissociated.
Dissociation exists on a spectrum from mild to severely impairing
Dissociation exists on a spectrum. Significant dissociation – the kind that can be impairing to your daily life – forgetting major events, losing track of major chunks of time, having people tell you about something you did that you cannot remember, having very few or no memories of a certain part of your life (often childhood) – is usually a result of prolonged trauma. That does not mean it is pathological! Quite the opposite. Dissociation, when used as a coping mechanism for trauma, is a strength, and a sign of the incredible creativity of our nervous systems. How could a child, who is abused horribly by a family member at night, get up and be marginally present at school the next day, if they did not develop some capacity to separate those experiences, to block them from their consciousness?
What happens in the brain when dissociation occurs?
So what happens in the brain when this kind of dissociation occurs? Parts of self that are entirely cut off from one another are formed. There is the part – or parts – of self that is experiencing the trauma, and then there is the part – or parts – that is totally disconnected and unaware of what is happening. This is a protective measure. Sometimes clients will tell me, “when my abuser would attack me, I would just float on the ceiling above my body, so I couldn’t feel what was happening.”
Significant dissociation can be troubling, disabling, and dangerous
This kind of dissociation, however, can be extremely troubling, particularly when it is no longer serving as a protective coping strategy. The abuse has ended, but the disconnection, memory loss, and lack of presence linger. Clients will tell me that they end up in places they do not remember going to, receiving calls from people they do not know, but who clearly know them, having no memory of large chunks of time. They can struggle to pay attention to and connect with others, and often tell me that they don’t feel “present” in their daily lives. They can end up in extremely dangerous situations.
Can significant dissociation be treated?
Is there any way to treat this kind of significant dissociation? Absolutely. I am an EMDR therapist. EMDR is one of the most empirically supported treatments for overcoming the symptoms of trauma. However, if you experience significant dissociation, it is essential that you work with an EMDR therapist who has advanced training in working with dissociation and complex PTSD. Preparation for EMDR must be thorough and ideally be approached from an ego states or internal family systems/parts work approach. Ego states and parts work – connecting with all of the different parts of self, even the wounded and frightening parts – creating safety and compassion for those parts, and creating co-consciousness between the adult parts and child parts, can do wonders in fostering a sense of integration and presence. Once that work is well on its way, EMDR trauma processing can begin, and with a much higher chance of success. This is the treatment model that I use in my practice, and I’ve seen it do amazing things.
More resources
Want to know more? The International Society for the Study of Trauma and Dissociation is the oldest and most respected source of information on these topics:
https://www.isst-d.org/resources/dissociation-faqs/
My favorite podcast, Notice That, has several episodes on dissociation and on parts work and ego states:
Do these themes resonate? Does this sound like it could be you? If you’re in the state of PA, I can help. Check out my website: www.integritaswellnessllc.com
