Physically I’m Here… Mentally I’m Far, Far Away
Dissociative experiences can be a harmless and even euphoric part of life. This can look like getting lost in your favorite song, watching a beautiful sunset in complete awe or being so engaged in a meditation session that nothing else matters to you in that moment. On the other end of the spectrum, however, maladaptive dissociation can have detrimental impacts on a person’s wellbeing and functionality if left untreated and misunderstood.
Dissociation can severely impair peoples’ ability to effectively integrate their thoughts, memories and emotions with their experience of reality and perception of their identity.[1] The result in such extreme cases is often a highly fragmented sense of life and self-identity that can lead to mental health problems such as depression, anxiety and suicidal thoughts. Understanding the difference between so-called “healthy” and “unhealthy” dissociation is a critical first step for determining whether someone should seek help.
What is “Healthy” Dissociation?
Compared to other psychological defenses, dissociation is unique in that milder versions can be invoked voluntarily. For example, the ability of absorption to be consciously learned and applied combined with its psychological defensive capacity makes it an ideal therapeutic strategy.[2] Absorption consists of disconnecting from one’s current circumstances (both external and psychological) and becoming immersed in another focus. Absorption in music, nature and other positive foci can relieve emotional distress when a person is experiencing emotional or even physical pain.[3] While absorption itself involves some degree of dissociation, it is not indicative of pathological dissociation and can have many advantageous effects.
In her book, Everyday Music Listening: Absorption, Dissociation and Trancing, Ruth Herbert describes absorption in music as a therapeutic practice that may involve “multi-sensory blending” and “heightened awareness”.[4] She argues that everyday listening can be not only pleasurable or relaxing, but transcendent in a way that is comparable to religious rituals and mindfulness meditation — all of which frequently prompt a state of dissociation. The multitude of ways in which individuals can remold, reinterpret or redirect their own consciousness through absorption in positive foci certainly exemplifies the human brain as a powerful tool in constructing our reality. Healthy dissociation — that is, when one can control it and choose when to do it — has incredible promise in both therapeutic approaches and consciousness research more broadly. So… How can dissociation become a chronic or even debilitating problem, characteristic of the dissociative disorders?
A Very Fine Line
Milder forms of dissociation often provide a defensive function which dislocates affect from ideas, diminishing the impact of disturbing emotional states.[5] For example, a dissociative episode may help foster a state of indifference or neutrality towards a stressful situation. Up to 75% of people experience at least one depersonalization/derealization episode in their lives, with only 2% meeting the full criteria for chronic episodes.[6] Yet, most clinically-noted dissociative episodes typically involve severely dysfunctional behavior, perpetuating the notion that dissociation is not applicable to the overall population.[7]
Upon examining typical manifestations of dissociation as defense mechanisms conducive to survival, we see that dissociation is the “freeze” part of the flight, fight and freeze emergency systems. Taken alone, this is a completely natural mental response to discomfort, stress and adversity. However, the tendency to rely on this “freeze” reaction can be the birthplace of dissociative disorders. Once individuals have learned to use dissociation to cope with an aversive event, dissociation can presumably become automatized and invoked on a habitual basis in response to even minor stressors.[8] Thus, even seemingly isolated experiences of dissociation can become chronic manifestations characteristic of dissociative disorders. It is therefore important that researchers and therapists take note of this link as to not overlook acute, nonpathological episodes in a clinical framework.
The Trauma-Dissociation Link
At some point in life, most people will endure some degree of heartbreak and loss. However, to live through true trauma is a completely different experience. The physical and mental shock of trauma elicits the brain’s immediate survival instincts — one of which being dissociation.[9] The vast majority of people who develop dissociative disorders have experienced repetitive, overwhelming trauma in childhood. Those who have experienced physical and sexual abuse in childhood are at increased risk of dissociative identity disorder (DID). Among people with dissociative identity disorder in the United States, Canada and Europe, roughly 90 percent had been the victims of childhood abuse and neglect.[10]
Severely dissociative symptoms are manifestations of an automatic defense mechanism that serves to mitigate the impact of highly aversive or traumatic events. The idea of dissociation serving a defensive function can be traced back to Pierre Janet’s 1889 pioneering investigations of dissociative phenomena.[11] In the context of trauma, dissociation can be one of the ways your brain protects us in the face of adversity – both in the present moment and for the future. In a traumatic situation where someone might need to react quickly and instinctively to escape danger, dissociation serves as a way to mentally “check out” so that stress and fear does not overwhelm their mind. Also taking preventative measures, our brains do not want us to relive the shock of a traumatic experience, so it leaps into survival mode, taking steps to conceal or numb what happened. But… If dissociation is a natural response meant to protect us from trauma, how does it become something disordered that requires treatment?
Trapped in Limbo Between Past and Present
Binks & Ferguson (2013) note that while at the moment of the traumatic event dissociation is highly adaptive and protects the psyche from pain and feelings of helplessness and humiliation, individuals who cope with trauma by dissociating are vulnerable to using this method to cope with future stressors.[12] This becomes especially problematic in cases of childhood/adolescent trauma, as these time periods are integral junctures in the development of more persistent personality pathology.[13] Exposure to trauma during these critical periods exacerbates the likelihood of establishing dissociation as a habitual coping mechanism for the rest of life.
Dissociation is paradoxical in that it can relieve trauma survivors of the immediate pain they are in, but can also become a danger in, and of, itself. In the long-run, habitual dissociation established as a standardized defense mechanism early in life produces detrimental consequences. An account of dissociation from the perspective of a childhood trauma survivor illustrates why: “Dissociation makes surviving the abuse much easier… But it also makes living as an adult so much harder.”[14] Contorting the timeline of when trauma is experienced, dissociation keeps someone trapped in a sort of limbo between past and present. It challenges their ability to fully heal and transcend childhood levels of emotional maturity. In turn, dissociation threatens the agency a person has over their own life and, ultimately, the beauty of actually living as opposed to merely surviving.
The Double-Edged Sword
There are many promising avenues for future research in the realm of therapeutic dissociation, keeping in mind that dissociation in the context of mindfulness is vastly different from habitual dissociation evoked as the primary response to trauma. This distinction lies in the agency we have over the dissociation – that is, choosing to dissociate to enhance the experience of living vs. dissociating merely to survive. In this way, dissociation is a double-edged sword, possessing a great potential in encouraging wellbeing when we can control it, but perhaps an even greater potential for danger when it controls us.
If you feel you may be dissociating at unhealthy levels and/or in a way that is interfering with fully living your life, please reach out to a licensed mental health professional (e.g., a psychotherapist, psychologist or psychiatrist) to discuss possible therapeutic options and treatment modalities. Cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) are both common forms of psychotherapeutic treatment for all dissociative disorders.[15] To learn more about types of dissociative disorders and effective treatments, feel free to refer to our encyclopedia entry on dissociation.
Contributed by: Sara Wilson
Editor: Jennifer (Ghahari) Smith, Ph.D.
REFERENCES
1 American Psychiatric Association. (2022, October). What are Dissociative Disorders? Psychiatry.org. Retrieved 27 May, 2023, from https://www.psychiatry.org/patients-families/dissociative-disorders/what-are-dissociative-disorders.
2 Bowins, B. E. (2012). Therapeutic Dissociation: Compartmentalization and Absorption. Counseling Psychology Quarterly, 25(3), 307-317.
3 Ibid.
4 Becker, J. (2014). [Review of Everyday Music Listening: Absorption, Dissociation and Trancing, by R. Herbert]. Ethnomusicology Forum, 23(2), 266–268. http://www.jstor.org/stable/43297432.
5 Bowins (2012)
6 National Alliance on Mental Illness. (2023). Dissociative Disorders. Retrieved 27 May 2023, from https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Dissociative-Disorders.
7 Bowins (2012)
8 Giesbrecht, T., Lynn, S. J., Lilienfeld, S. O., & Merckelbach, H. (2008). Cognitive Processes in Dissociation: An Analysis of Core Theoretical Assumptions. Psychological Bulletin, 134(5), 617-647. https://doi.org/10.1037/0033-2909.134.5.617.
9 Gillette, H. (2021, August 3). Trauma-Related Dissociation: Symptoms, Treatment, Coping, and More. Psych Central. https://psychcentral.com/pro/coping-with-trauma-through-dissociation.
10 American Psychiatric Association.
11 Giesbrecht et. al., (2008)
12 Binks, E., & Ferguson, N. (2013). Religion, trauma and non-pathological dissociation in northern ireland. Mental Health, Religion & Culture, 16(2), 200-209. https://doi.org/10.1080/13674676.2012.659241.
13 Shiner, R. (2023, April 4). Emergence of Personality Disorder in Adolescence: New Findings and Their Implications for Treatment. YouTube. https://www.youtube.com/watch?v=K00Xdcjd7_E&t=416s.
14 Beauty After Bruises. (2023, April 21). Dissociation and Survival vs. Living: A Survivor’s Story. Beauty After Bruises. https://www.beautyafterbruises.org/blog/survivorstory.
15 Cleveland Clinic. (2022, October 24). Dissociative Disorders: Causes, Symptoms, Types & Treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17749-dissociative-disorders.