Saturday, April 29, 2017

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.

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.

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