We use the terms trauma, crisis, major stressor and related terms as essentially synonymous expressions to describe circumstances that significantly challenge or invalidate important components of the individual’s assumptive world.
Calhoun and Tedeschi: The Foundations of Post Traumatic Growth
Dissociation is a symptom this commonly seen when a complex trauma pattern of brain functioning is present. It indicates an altered state of awareness. The narrowed field of consciousness that is present is often accompanied by amnesia.
Repression, on the other hand, occurs in a normal state of consciousness. This involves an active process of pushing memories, thoughts and emotions out of conscious awareness.
When our social environment is good enough during the period when we are developing, and growing up, then we are able to rapidly, and fluidly, change between the various emotional states that are needed if we are to respond appropriately to ever-changing environmental triggers.
When this developmental environment has not been good enough, we can become overwhelmed by the constant change in our emotional state and a protective state of dissociation can become a part of our emotional repertoire.
When dissociation occurs there is a partial, or complete loss of integration between the factors that contribute to our normal mental functioning. It is this cognitive and emotional integration that allows us to negotiate our present physical and social circumstances.
Dissociative states can cause impairment in many areas:
- Memories of past events.
- Memories of past emotional experiences.
- Awareness of personal identity.
- Awareness of immediate sensations.
- Control over our bodily movements.
The classical presentation for dissociative disorders is seen in conversion and somatoform disorders. Here symptoms can have a sudden onset, and will often present as physical abnormalities reflecting the individual’s understanding of how the body works. The filmed studies of “shell shock” victims from the first world war, show just how dramatic (and bizarre) such presentations can be. these states are often accompanied by “la belle indifference”, an apparent lack of any concern about the symptoms demonstrated.
It has been suggested that this lack of emotional concern may represent a useful evolutionary development, where an animal “switches off” in the presence of mortal danger so as to avoid becoming distressed by the process of dying, and so is able to continue to try to stay alive rather than become paralysed by fear.
Whatever the evolutionary cause of such a response, these disorders present abruptly and are often secondary to clear-cut traumatic events. When attachment trauma and the relationship betrayal trauma of abuse are involved, a state that involves more emotional dissociation with fewer physical symptoms is often seen rather than the more physical presentation seen with more obvious life threatening events.
These disorders usually present abruptly, and are often secondary to traumatic events.
Insoluble relationship and interpersonal difficulties are common precursors leading to a clear-cut disconnection between feelings, thoughts and behaviours. This inability to fully integrate strong, current experiences is psychogenic in nature, and is closely related in time to the triggering event. Emotional symptoms such as fear, confusion, loss of a sense of control, and aggression, are common, and seem to arise secondary to an overwhelming and inexpressible tension that arises between a personal sense of self and intolerable emotions or events that challenge this.
One study carried out in Holland, suggests that up to 16% of consultations with general practitioners were for physical complaints that were part of a dissociative somatoform disorder.
Where there are fewer obvious somatic symptoms, the dissociative presentation is more like the freeze element of the fight or flight response. An altered state of awareness has occurred in which the parasympathetic nervous system’s response to danger has overridden the sympathetic nervous system response.
Abuse, neglect and attachment trauma are all capable of triggering such events, which reflect states of both under arousal and over arousal. Abuse provides excessive stimulus to the developing child’s nervous system, and results in over arousal; neglect is a state of under-stimulation and is accompanied by low levels of arousal.
Dissociative states can cover a full spectrum from momentarily staring into space, to a full fugue state, where the sufferer can travel long distances in an apparently unaware state in an attempt to escape from an intolerable situation. One case I remember from my training was that of a grave-digger, who turned up in our local Emergency Department with no apparent recollection of where or who he was. As the preceding events slowly came back to him, we pieced together the story – his wife had found out about an affair he had been having, the stress of her discovering this and her subsequent reactions leading to his presentation to a hospital several hundred miles from home.
There are distinct advantages to such a dissociative state:
- When we disengage from strong stimuli in the world we are protected, at least to some degree, from their emotional impact.
- Numbing of our sensory input will minimise the effects that any associated emotions might have upon us.
- It allows us to avoid the experience of strong and unpleasant emotions.
- Profound emotional detachment allows us to keep functioning under extreme stress. This is one of the reasons why military special forces training is so rigorous – to train soldiers to perform their jobs even under extreme stress.
- Restricted emotional responses help to prevent potential overload, allowing us greater clarity to cope with the demands of our current dangerous predicament.
- A state of profound dissociative detachment provides a psychological escape route. Allowing us to escape from an intolerable situation when there is no physical avenue of escape open to us.
The parasympathetic nervous system activation accompanying such states, results in conservation of energy which is then available to be used later, when escape might become possible. There is also a state of withdrawal, one in which our behavioural responses become inhibited, this allows us to become partially invisible, after all predators to react to movement, so may then chase and eat someone else, or absent from the present predicament.
There are two main components to the Vagus nerve’s parasympathetic output.
- The Ventral system. This is the more recent component in evolutionary development. It facilitates our social interactions by helping us to interpret social signals such as facial expressions, gestures, sounds and other elements of communication.
- The Dorsal system. This is older in evolutionary terms, and acts to shut down metabolic activities in times of intense social stress. It’s activity underlies such behaviours as freezing, feigning death, and hiding.
The brain functions as an integrated whole, but some aspects of its workings are concentrated in different hemispheres. In dissociative states there is relatively increased activity in the some of the right hemisphere functions, and a relative reduction in activity in some functions of the left hemisphere.
This relative increase in the activity of the right hemisphere that is seen during periods of dissociation results in an impaired ability to understand verbal (and other) signals, this means that only avery literal interpretations of meaning are possible. Reduced ability to carry out this emotional interpretation leads to loss of the emotional meaning of the words, this can result in up to 90% of the meaning being missed. This loss of a full understaning allows a much more rapid response to incoming information – which might be the difference that saves our life.
Dissociation is an extreme response to extreme circumstances.
When we are exposed to emotionally distressing of threatening stimuli this reduced integration of stimuli has significant survival implications, but this is at the cost of a restricted sense of self, a narrowing in our focus and awareness, and separation of the conscious elements of our emotions and thinking that permit a full appraisal of the situation.
When developmental trauma has occurred, such disruptions to our thinking and feeling selves results in maladaptive coping strategies. It is these maladaptive coping strategies that can make is hard for others to appreciate the significance and severity of the difficulties that can be present. Somebody who has developed very effective coping mechanism that perhaps involve self harm, can be seen as attention seeking and having a self-inflicted disorder.
These maladaptive responses can be very rigid, and do not change easily in the light of new experience. Because of the way they have arisen they also tend to be both highly defensive and personal in nature. This means that there are strong responses to perceived threats – often with minimal, partial stimuli, which may be unclear to the person who is dissociating. These coping mechanisms can become automatic and closed, meaning that there is little ability either for them to adapt to changing circumstances, or to come under a degree of voluntary control.
Disruptions to our thinking and feeling selves results in maladaptive coping strategies.
Dissociation is an extreme response to extreme circumstances. The consequent failure to bring together our thoughts, emotions and behaviours into one integrated whole both underlies the presentation, and contributes to its persistence.
Treatment for this kind of difficulty are aimed at helping to reconnect these disparate mental elements. They are, by necessity,multimodal offering a mix of physical, cognitive and behavioural treatments. These can coer the full spectrum from medication to massage, but the mainstay is a psychotherapeutic approach.
Interestingly, many of the effective programmes for these conditions include a large element of mindfulness. Regular mindfulness practice, even for short periods, can produce neurological changes that are in direct opposition to those that are seen in the traumatised brain.
Although, on its own, mindfulness is may not be enough to help well established trauma, the demonstrated effects on brain functioning, in direct opposition to the changes seen in trauma, would be another excellent reason why mindfulness should be taught in schools.