The dissociative spectrum - Mechanisms of Mind - PART I

Mapping the Mind - Rita Carter 2010

The dissociative spectrum
Mechanisms of Mind
PART I

The best way to view dissociation, then, is as a spectrum. At one end there is the everyday, entirely normal neglect of background distractions. Then there are states such as daydreaming and fantasy. The teenager who doesn’t hear the call to dinner because they are concentrating on a computer game, the film-goer who weeps at a sentimental ending, the child who doesn’t hear the teacher because she is lost in a daydream… these people are all dissociating. Far from being unhealthy, though, they are in some ways engaging more fully and completely in the world than if a single integrated personality was obliged to be present at all times.

Edging along the spectrum there is adaptive dissociation — an abnormal state such as physical or emotional distancing or numbness which occurs in frightening or otherwise traumatic situations. Similar states can be deliberately induced by various types of ritual and drugs.

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Beyond here on the spectrum dissociation becomes pathological. This is the realm of the Dissociative Disorders, which include MPD. This book is not about these conditions, but there is a thin and moving line between adaptive dissociation — a healthy and useful trick of the brain that gives us mental flexibility and maintains a degree of separation between our personalities — and the disorders. There is therefore a danger of sliding from one to the other.

Dissociative disorders can be divided into two categories: chronic detachment and compartmentalisation. Chronic detachment is a state in which, even in normal circumstances, a person feels distanced from, or has some strange perception, either of themselves or the rest of the world. When they are detached from themselves it is known as depersonalisation and when the detachment is from the rest of the world it is called derealisation.

Depersonalisation is often described by those who have experienced it as feeling like a puppet or a robot. ’The first time it happened was when I was walking home after visiting my mother in hospital,’ reports Cherie. ’She was really poorly that day and I think I had finally realised that she was going to die. As I turned into our road I realised I couldn’t feel my feet touching the ground. It was as though I faded out somewhere around the knees.

’And I had this odd sensation — I have had it in dreams but never before while I was awake — that I was watching myself from outside. I met some neighbours as I got to my door and when I spoke to them it seemed as though my voice was coming from somewhere to the side of me.’

If Cherie’s odd sense of detachment had limited itself to the period around her mother’s death it would merely have signalled adaptive dissociation kicking in to protect her from the full impact of her loss. The trouble is that Cherie has gone on feeling distanced from herself, sometimes for days at a time, even though it is now years since her mother’s death and her life is objectively secure and pleasant. Dissociation has become a sort of default mode — a habit so deeply ingrained that she is no longer able to snap back into the here and now or reactivate her normal sense of self. She has slipped beyond the crucial point on the dissociative spectrum where detachment ceases to be a survival mechanism and becomes dysfunctional.

’I feel as though I’m living behind a sort of screen, watching the world move by, but not really part of it,’ she says. ’I can’t engage with people on the other side — it seems sometimes as though they are mouthing things at me and I can work out what they are, but they don’t mean anything. And sometimes I am not sure whether things really happened or not. It is like living in a waking nightmare, except that I can’t even feel the fear. If I’m in a situation where I know I ought to feel something I sort of work out what it should be and then act out feeling it. But inside I feel nothing.’

Derealisation is different from depersonalisation in that the person usually feels fairly normal in themselves but perceives the outside world as distant, or crushingly close, or in some other way distorted and weird. Geoffrey, for instance, started to experience derealisation during his final few months at university, when he was working through the night on a cocktail of caffeine, amphetamines and internally generated adrenalin. It culminated in an alarming experience during one of his final exams:

I looked up and suddenly felt the ceiling was on top of me. Then the room expanded again, and all the people in it seemed tiny, like little ants toiling away over their desks. I felt enormous, though. I looked down at my hand, with the pen in it, and it seemed to swell until I thought it would just take over the room. I must have made a noise, or looked funny, because the invigilator stood up and started walking towards me. That kind of snapped me out of it. I tried not to look at the other people and just kept writing. When I looked up next the people had gone back to normal size, but the feeling of unreality hung about for several hours.

Like depersonalisation, isolated episodes of derealisation — especially when they have an obvious cause like Geoffrey’s pre-exam drugs regime — do not signify a disorder; it is when derealisation becomes habitual that there is room for concern.

Compartmentalisation is generally regarded as more extreme than detachment, and it also produces different symptoms. This is the term used to describe the complete separation of personalities seen in MPD, and also the kind of amnesia where a person ’forgets’ entirely who they are. ’Hysterical’ blindness and paralysis — now called ’conversion disorders’ — are also a form of compartmentalisation. So are the ’flashback’ memories seen in Post Traumatic Stress Disorders. What all these states have in common is that particular bags of memories are completely cut off from all the other memories, so when they are triggered, they are experienced in isolation.

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Abnormal dissociation — the danger signs

Deliberately picking up a book or turning on the TV when an unpleasant but necessary task needs doing.

Constantly imagining a future scenario instead of living the present.

Suddenly ’coming to’ and realising you have not heard what someone has been saying because you have been daydreaming.

Forgetting important appointments because you have been too ’absorbed in something else’.

Acting out daydreams (e.g. speaking fantasy dialogue aloud) in public.

Finding yourself somewhere with no idea how you got there.

Finding things among your belongings that you don’t recognise.

Seeing yourself as though from the outside.

Failing to recognise friends and family who should be familiar.

Feeling that the world around, or people or objects in it, are not real.

Feeling that your body does not belong to you.

Hearing voices that give you instructions or comment on your actions.

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Extreme dissociation is generally rather disturbing when it happens unbidden — it is the sort of experience that can make a person feel they are going mad. Yet it can also be pleasurable or even ecstatic, and a vast recreational drug industry has grown up largely to provide dissociation on demand.

What seems to make the difference between pleasure and discomfort is the intention or assumptions that a person has in their mind when they dissociate. People who take drugs for reasons other than to get high (morphine, for example, for pain relief) often describe the psychological side-effects as unpleasant, even though very similar effects (that is, effects on brain function) are described by experienced drug users as euphoric. Similarly, the dreamlike effect of detachment may be very pleasant if you are having a long lie-in on a Sunday morning and can allow yourself to drift along the top edge of a dream. If you have overslept, however, and find yourself unable to pull out of the dream despite being aware of the need to, the half-waking, half-dreaming state may be quite nightmarish.

The very pleasantness of dissociation in some situations is what sets many people off on the road to a dissociative disorder. The younger a person is when they learn to dissociate the more likely they are to develop a dissociative disorder in later life. Some people are naturally more inclined to get hooked on dissociation than others. These are probably the people who are genetically inclined towards it in the first place — studies of twins who have been brought up apart show that they tend to be more alike in this respect than would be expected if their shared genes had nothing to do with it.3