Dissociation as a root cause

As Karla Mc Laren says in her book, Language of Emotions, emotions nearly always arise in clusters. It’s rare that neat well-behaved emotions come up one at a time, patiently waiting their turn to be felt. No, life is messier than that and of course when emotions such as anger, fear and sadness come up together, we can easily become flooded, especially the younger we are, and so we leave the premises as Tara Brach says. The premises being our body and mind.

Leaving the premises is another way of saying dissociation. Currently, there are distinctions between psychic and somatic dissociation which reflects the current mind/body split. But where does psychological dissociation begin and where does somatic dissociation end? I think it’s impossible to say this person has 48% psychic dissociation and is 52% somatically dissociated, that is, if anyone is ever 100% dissociated. All we can really look at is how dissociation, in any form, adversely impacts the life of someone and help them accordingly.

Paul Dell, for example, calls psychological dissociation, ‘clinical' dissociation and somatic dissociation, ‘animal defenses’, at least from my understandings of his writings. Dell argues that clinical/psychological dissociation is 'abnormal' whereas animal defenses are 'normal' and part of our evolution. I think both phenomena mirror the evolutionary development of our brains, bodies and minds and are normal and adaptive when we are faced with threat. Issues arise when dissociation, both psychological and somatic, becomes chronic and persistent. The mind, brain and body are linked in an interconnected system, when they are treated separately, disaster can result, especially for the person suffering.

Humans are animals the last I checked. These distinctions illustrate just how far removed we’ve become from our animal nature, body and instincts, which has done our nervous systems no favours whatsoever. If a wild animal does not discharge the freeze response (tonic immobility), if they survive being eaten by a predator, they remain in a startled and hypervigilant state which makes their chance of survival very poor. Remaining hypervigilant, they perceive threat where there is none and become less sensitised to real and present threat. This hyperaroused state also creates exhaustion, so when they do need to act, they don’t have the energy or stamina to outrun the predator. The exact same thing happens to what we call ‘civilised’ humans who have been traumatised. Too many of us have lost our knowledge and ability to shake vigorously after receiving a shock, to howl, cry and scream when we’ve lost a loved one and so on. Many of us have had to learn to keep it all in to survive and not rock the boat.

This mind/body split is also mirrored in current measurement scales for psychic and somatic dissociation. There is the well known Dissociative Experiences Scale (DES) which measures psychological dissociation. Out of 28 questions, there is one nod to the body, question 13. Then there is the Tonic Immobility Scale* and the Somatoform Dissociation Questionnaire (SDQ20), which both measure somatic dissociation. There have been some steps forward in the field, a recent paper by Nijenhuis (2017) recommended that conversion disorders be recategorised as dissociative sensorimotor disorders in DSM-5. (He uses the terms cognitive-emotional and sensorimotor dissociation in this paper in place of psychic or somatic dissociation).

*Click on image to see larger view of Tonic Immobility Scale

I know there is debate over whether dissociation is a process or a state, I think it can be both. I haven’t yet heard a term that better describes leaving our bodies and minds and the resulting split, or splits, that can result (what Nijenhuis and van der Hart (2011) refer to as structural dissociation of the personality). I believe that anxiety arises when we’re overwhelmed by years worth of stuff, it’s a compounded state consisting of unfelt emotions (and physical sensations etc), that we’ve dissociated from, consciously and unconsciously.

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So many ‘disorders’ stem from dissociation and trauma, which is why I believe it is so important to normalise the terms themselves and the experience of them. They are the root cause for so many so-called different ‘disorders’. All of us are somewhere on the dissociation continuum, as we are on any continuum. Who among us hasn’t been hurt (traumatised) or wanted/needed to avoid (dissociate from) pain?  Isn’t it about time that we started looking for and healing the root cause instead of being blinded by symptoms? Isn’t that what science is supposed to do? Concepts like dissociation can really frighten people, but with education and normalisation they don’t have to.

So, where do you start on your healing journey, wherever you find yourself? You start slowly, taking one step at a time. As Martin Luther King Jnr says: A journey of a thousand miles, begins with one step. You start by being as kind as possible to yourself as you go inside to reconnect with what remains unexperienced so you can experience it as slowly and as gently as you need to. Don’t forget to resource and support yourself wherever and whenever you can. This isn’t about pushing through and going fast, in fact the more urgent you feel, I think the more slowly you should take things or you risk being overwhelmed and even retraumatising yourself.

References
Bernstein, E. M. and Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale, Journal of Nervous and Mental Disease 174(12): 727-735.
Fuse, T., Forsyth, J. P., Marx, B., Gallup, G. G. and Weaver, S. (2007). Factor structure of the Tonic Immobility Scale in female sexual assault survivors: An exploratory and confirmatory factor analysis, Journal of Anxiety Disorders 21(3): 265-283.
Nijenhuis, E.R.S., Spinhoven, P., Van Dyck, R., Van der Hart, O., & Vanderlinden, J. (1996). The development and the psychometric characteristics of the Somatoform Dissociation Questionnaire (SDQ-20), Journal of Nervous and Mental Disease, 184, 688-694.
Nijenhuis, E. R. S. and van der Hart, O. (2011). Dissociation in trauma: A new definition and comparison with previous formulations, Journal of Trauma & Dissociation 12(4): 416-445.
Nijenhuis, E. R. S. (2017). Ten reasons for conceiving and classifying posttraumatic stress disorder as a dissociative disorder, European Journal of Trauma & Dissociation 1: 47-61.

Let me count the names

Can you think of any physical disease where people might have insults hurled at them just because they had the physical disease? I certainly can’t. People would think it cruel and unkind, yet it’s okay for people with mental illness to be insulted and derided. It’s even called ‘joking’ by some. The sheer amount of insults hurled at anyone who has a mental illness speaks for itself, this is a short list and it’s only in English. The name calling and consequent shaming, illustrates the fear and ignorance of mental illness (or indeed any condition related to mind and brain health such as intellectual disabilities) is still alive and kicking. Ask anyone how the stigma affects their day to day life and unfortunately, they and their families will have plenty of stories.

In the case of schizophrenia and bipolar disorder (formerly known as manic depression), people are/were called schizophrenic and manic depressive, which I think is absolutely appalling. I can think of only one physical disease in which that happens which is diabetes, people who have this condition are often referred to as diabetics. Are people their illness now, is there nothing else to them except the illness?

Many so-called mental disorders are actually caused by trauma. Just imagine stigmatising someone because they’ve been through tough times? Hard to believe that that could happen isn’t it? But maybe that’s because many people haven’t made the link between adverse experiences and poor mental health. They might still believe the outdated claim that it’s a “chemical imbalance”. So where does the chemical imbalance originate from then? You’ll get very few satisfactory answers to that simple question in mainstream medicine. Or maybe it’s because the shame of mental illness goes so deep that we prefer to deflect and project our fears that it could be us onto others. Name calling, it’s sad to say, is only part of the stigma, discrimination in all its different forms can really inflict untold suffering.

Another major cause of mental illness is inflammation, especially in our gut which is intimately tied to our brain, the health of our gut affects our brain’s health and vice versa. And what is one of the biggest sources of inflammation? Stress; biological, emotional, environmental etc. So traumatised people are especially vulnerable to any chronic disease, both mental and physical, because their stress levels are usually high, as the ACE study and many other studies have showed.

I have never heard someone with schizophrenia say “I am schizophrenic”, instead they usually say “I have schizophrenia”, it’s others who usually refer to them as schizophrenics, and surprisingly a lot of them are mental health professionals. Leaving space for who you are beyond any diagnosis or label is crucial. This isn’t about being politically correct, as that terrain is always changing, it’s about how we see people who are suffering with mental health issues and how they feel as a result. And more importantly, how they feel as a result of how they see themselves.

When I’m tapping, I often use ‘I am’ and ‘I feel’ sentences which I find really useful. Take the statements, I am bad or I feel bad, for example. Feeling bad is (hopefully) temporary, whereas I am bad, is permanent. It’s a belief, a “truth”, but not “the” truth. It’s always good to differentiate between ‘I feel’ and ‘I am’.

An important ingredient in resolving trauma

I think one of the most important ingredients in recovering from trauma is having support, and there is plenty of research to back this up. While having a sense of support and community can include animals and nature, among other things, I don’t think we can discount the importance of having the warmth and tenderness of a relational home that another human being can provide. Whatever internal and external resources we have, no matter how small or insignificant they might seem initially, we need to acknowledge and build upon all of them.

Without enough support and resources, our nervous system will find it too unsafe to discharge any trauma that it has been holding, which makes total sense when you think about it, after all its job is to protect us. This is especially true with early and developmental trauma, not only is support sometimes missing completely, or in part, there is often also neglect and abuse to contend with and this can and does stunt our growth and development.

However, as Peter Levine says, trauma is not a life sentence, it can be resolved. But at the same time it’s also important to acknowledge that developmental trauma is more complex than shock trauma because of the fact that our nervous system has been on high alert from a young age and our system has developed all sorts of strategies for coping, some healthy and some not so healthy. Developmental trauma affects everything, our view of ourselves, the way our brains and bodies develop, our relationships, everything, so persistence is definitely needed with resolving complex trauma.

By growing any support and resources, you can make your healing journey easier and more pleasant. You don’t have to be fixing yourself every moment of every day, that’s exhausting and depleting. You’re not broken, you’re hurt. You might feel broken but it is not your identity. Taking a break whenever you can, having fun, laughing, going for a walk, having a bath, is really important to lessen your stress load. Don’t wait until you feel overwhelmed, do something for yourself daily.

When you’re in physical and emotional pain, it can feel quite urgent to fix it or make it go away. So be kind to the part that feels that desperation to be free from pain. The great thing about tapping is that you can tap on anything and everything, just start with however you’re feeling right now. Don’t worry about being “negative” or “positive”, just be true to how you feel and tap on that, then watch your system release stress with yawns, sighs, burps and so on. Tapping on the truth of how you feel is extremely powerful.

These are some tapping phrases (see EFT shortcut diagram here) that you might start with:

Even though I feel desperate to … I completely accept how I feel

Even though I feel I don’t have any support*, I completely accept how that makes me feel

Even though I feel broken because … I accept myself anyway

*Be really specific here and look for both internal and external resources, whatever they may be; books, music, exercise. We can often feel unsupported if we don’t have close relationships with others, but support can come in a variety of ways and you can always reassure yourself that you’re moving towards connecting with others when it feels safe/comfortable enough for you.

Tapping script for pushing through

Following on from last week's post, try this script for feeling the need to push through, sometimes at a high cost to your mental and physical health. Diagram for EFT Shortcut

Even though it’s too dangerous to stop trying, I completely accept how I feel

Even though I have to keep going because … I completely accept how I feel

Even though if I stopped trying, I fear … would happen, I completely accept this fear

Top of head: It’s not safe to stop
Eyebrow: But maybe I could take a break every now and then
Side of eye: That feels …
Under eye: I don’t trust that things will get better if I don’t keep trying
Under nose: But maybe I could try one thing at a time
Under chin: And not overwhelm myself by trying to do everything
Collar Bone: I could simplify things
Under arm: And take it easier on myself

Top of head: This urgency
Eyebrow: To get better
Side of eye: I understand it
Under eye: Because I don’t want to suffer
Under nose: But I’m suffering by struggling with too many things as well as everything else
Under Chin: I need to pare things down
Collar bone: To a manageable amount so I don’t get overwhelmed
Under arm: I’m still moving

Top of head: Just more slowly
Eyebrow: And that feels …
Side of eye: It’s ok to be kind to myself
Under eye: Or is it?
Under nose: Whose permission do I need to be kind to myself?
Under chin: Mine or someone else’s?
Collar bone: Can I get this permission?
Under arm: Because I know the value and power of kindness

Top of head: Whenever I’ve felt it
Eyebrow: It has felt good
Side of eye: Do I deserve to feel good?
Under eye: There’s no right answer here
Under nose: I can tap on however I feel
Under chin: Because it’s the truth
Collar bine: And the truth will set me free
Under arm: Even if it’s initially painful

Top of head: I know it’s more painful to live a lie
Eyebrow: I’m willing to tap on how I really feel
Side of eye: There’s huge power in honesty
Under eye: It lifts a weight from me
Under nose: And I feel freer
Under chin: To be me
Collar bone: I’m learning who I am
Under arm: And that feels …

Why pushing through doesn’t work

In our rush to feel better, we want to go as fast as we can, which is completely understandable. But that can backfire. We often end up flooded and overwhelmed, what some might call an abreaction. But really, what’s actually happening is too much is coming up too soon and it’s too much for our system to handle.

Stuff that we’ve buried for years and even forgotten or didn’t know was there and stuff that we’re truly sick of dealing with. If we keep going fast, or pushing through, or trying to be strong, or trying to fix ourselves at all costs, or trying to do it perfectly we’ll end up retraumatised and even more afraid of the sensations that our bodies contain. A loop is created and it starts to feel like we can’t break out of it because our bodily sensations and emotions become even more intolerable. That’s why prolonged unresolved chronic stress is very often more traumatising than the original experience which caused the stress.

So, slower is better, and faster, in the long run. Not slower for the sake of it, not slower to make the practitioner more money, not slower for any other reason than the fact that you make greater progress if you take it easy and slow way down when things get too much. And while you’re at it, be kind to yourself. Treat yourself like you would a good friend. There is all sorts of research showing the power of compassion and kindness.

What I really like about pendulation (from somatic experiencing developed by Peter Levine) is that it helps us to stay in our bodies, even a small part like our little toe, and even when we’re overwhelmed. This is no mean feat when we feel flooded because leaving our body often feels like the only viable option. Pendulation helps teach us that some part of our body feels okay to inhabit, which is very calming and reassuring and helps activate our parasympathetic nervous system. It also helps us to rewire our brain, we learn that being in our bodies, or some part of it, feels ok, calm, grounding and even safe, which helps create new neural patterns. For anyone that has suffered from early developmental trauma this is an absolute life saver because dissociation is so often the only way out of intolerable pain.

Like anything, pendulation takes practice. If you can’t find a place in your body that feels good, find something else, a song, a pet, a friend. If you’re working with a therapist they can be that calm and grounded space you can go to in order to discharge any traumatic tension. Dipping in and out of the trauma, by pendulating your attention back and forth between the overwhelm and calm in your body,  helps the activated traumatic energy dissipate, and by doing so, you’re staying out of the trauma vortex according to Levine, which can so easily swamp and overwhelm you. This not only resolves trauma, it helps build resilience and hope and all the while you can tap on anything that arises too.