The Psychiatry Blog by John Deri, M.D.

Dissociation refers to the splitting off of painful experience from awareness.  Dissociation is the hallmark of trauma.  A child experiences abuse or neglect as an unbearable catastrophe.  Dissociation is the psychic defense of last resort.  Unable to cope or to flee, the child simple “spaces out.”  People sometimes refer to this state as “going out of body.”

In the context of the original traumatic situation, this defense preserves the child’s sanity.  Unfortunately, dissociation tends to persist as the primary mode of psychic functioning throughout the lifetime of the individual.  Such people have great difficulty in knowing or communicating what they are feeling.  These deficits lead to an impoverishment of the person’s emotional life.  Such people tend to experience themselves as ephemeral, or insubstantial.  They usually have great difficulty in achieving or sustaining intimacy in their relationships.

Causes

There has been speculation regarding both biological and psychological causes of dissociation.  From a neurologic standpoint, studies have shown a decreased corpus callosum in traumatized people.  The corpus callosum connects the two hemispheres of the brain.  The right hemisphere processes emotional experience.  The left hemisphere includes the language region of the brain, in most people.  A constricted connection between the two hemispheres could result in a limited capacity for recognizing and articulating emotional states.

From a psychological point of view, Joyce McDougall, a French psychoanalyst, believes that dissociation is the effect of exposure to overwhelming emotion that threatens to attack an individual’s sense of integrity and identity.

Within a developmental context, a child acquires the capacity for emotional experience, regulation and expression, through the parent’s capacity for attunement to the child’s emotional state.  If the adult is incapable of recognizing and distinguishing emotional expressions in the child, it can impair the child’s capacity to experience his own emotional states.

Treatment

Psychotherapy offers a reparative experience for a person suffering from dissociation.  Suffering is actually a misleading term.  Many dissociated people are unaware of their own dissociation.  Often, such a person seeks psychotherapy due to a spouse’s frustration with them.

Working with a profoundly dissociated person in psychotherapy is challenging.  The engine for psyche change is psychic distress.  If the distress itself is dissociated, there may be minimal motivation to engage in psychological work.  Moreover, it is difficult to establish an emotional connection of any depth with a dissociated person.

Often a starting point involves gradually drawing the person’s attention to her state of dissociation.  The therapeutic process is one of symbolically reparenting the child.  The therapist, unlike the actual parent, is able to register and to articulate her patient’s emotional states.  Through repeated interactions in which the therapist is able to service this function accurately, the patient gradually internalizes the process.  As she incrementally acquires the capacity to recognize what she is feeling, the therapy gains traction.

As a person develops increasing awareness of his own emotional states, both present and past experiences come to life.  It becomes possible to narrate, to process and to release the previously frozen residue of early trauma.  As parts of the self that had been dissociated become available for integration, the personality becomes richer, more complex, more textured and more vibrant.

Dissociation makes people feel like ghosts or robots.  Experience has an “as if” quality.  Integration of a full range of feelings gives rise to a robust, embodied passion for life.

As Walt Whitman wrote in “Song of Myself”:

“Urge and urge and urge, 

Always the procreant urge of the world.”