A THIRTY-TWO-YEAR-OLD man was driving on an icy road late at night when his car suddenly skidded out of control, spun around and around like a ride in an amusement park, and finally slammed into a tree, pinning him against the wheel.
“I saw it all happening,” says the man, “as if I were a bystander watching from the side of the road. I saw myself turning around in the car and heading straight for the tree, and I was sure I was going to die. But for some strange reason, I felt no emotion. I wasn’t scared because it didn’t seem real. It was like watching a slow-motion car crash in a movie. A minute seemed like an hour, and I could see details clearly, even specks of dust on the windshield. But the tree looming up in front of me seemed small and far away. When the crash thrust me against the wheel and the horn started blaring, I snapped out of it and reached for my cell phone to call for help.”
A fifty-seven-year-old woman was rushed to the hospital for emergency triple-bypass heart surgery. On the operating table she went into cardiac arrest. She recovered, but at the time she thought she was going to die. As people often do during near-death experiences, she had an out-of-body episode, a common manifestation of a dissociative symptom (the dissociative nature of near-death experiences is covered at length in Chapter 15). The woman describes the event this way:
“I floated out of my body and hovered in the air, looking down on the doctors and nurses working on me. I felt detached from what was going on. It was like watching a medical show on TV. One of the doctors was pounding on my chest with big paddles, and I thought, ‘I’m not going to make it.’ I should have been frightened, but instead this wonderful feeling of peace came over me. Time stood still. Scenes from my childhood of happy times that I’d forgotten all about passed before me in quick succession, and I felt that I was actually reliving them. Pleasant memories of my husband, my children, and my grandchildren flew by, too. I felt sad leaving them, but I had complete peace of mind. I saw myself already entering a new life filled with joy.”
A twenty-eight-year-old secretary was working at her desk in the Alfred P. Murrah Federal Building in Oklahoma City on April 19, 1995, when a bomb exploded, killing 168 people and injuring hundreds more. Severely burned and bleeding from flying glass, she was able to make her way out of the building to safety.
“I felt that what was happening around me was like a scene from a war movie,” she says. “I was observing it, but I wasn’t participating in it. It all seemed so strange and unreal. I saw my burns and the blood pouring out from a deep gash on my arm, but I didn’t feel any pain. I was numb, and everything around me was a blur—the noise, the screaming, the smoke. My thoughts started moving a mile a minute, thoughts like where was the nearest exit, how could I get there, how much time did I have before the whole building collapsed. I felt myself moving automatically, almost like a robot walking through a fog, and the next thing I knew, I was outside.”
All of these accounts describe episodes of dissociation experienced by normal people in response to a life-threatening traumatic event. Believing that they were in extreme danger or were about to die, these people dissociated—that is, they activated altered states of consciousness that helped them marshal the inner resources to cope with a situation that otherwise would have been overwhelming. During these altered states they experienced a number of phenomena:
a sense of detachment from oneself and one’s body
feelings of unreality
a numbing of emotions
a sharpening of one’s senses
changes in perceptions of the environment
a slowing of time
a quickening of one’s thoughts
automatic or robotic movements
a revival of buried memories as if one were reliving them
Survivors of life-threatening trauma convey these phenomena in images that are familiar to anyone who has looked death in the eye. “I floated out of my body” and “It was like watching myself in a movie” are common ways of describing the feelings of disconnection and unreality that diminish the threat of death by allowing the person facing it to view the scene as a detached observer. “I felt numb” and “It didn’t seem real” depict the characteristic lack of emotion. Saying that “everything around me was a blur” or that threatening objects seemed “small and far away” describes the dulling of certain perceptions of the environment that many survivors experience along with a heightened perception of others or the ability to “see details clearly.” Such stock phrases as “Time stood still” and “Every minute seemed like an hour” speak to the familiar slowing of time, whereas speeded-up thoughts are “moving a mile a minute.” These thoughts are usually directed at “the nearest exit,” toward which the survivor moves automatically, like “a robot walking through a fog,” then arriving at a safe place without any knowledge of how she got there. And, finally, there is the rapid retrieval of memories “I’d forgotten all about,” so vivid that the person has the feeling of “actually reliving them.” This commonplace near-death, my-whole-life-passed-before-my-eyes phenomenon, technically known as “panoramic memory,” distracts the survivor’s attention from the gravity of the situation and helps her maintain her serenity. Panoramic memory may also be a way of searching for data from past experiences that might be of help in the current situation.
People in life-threatening circumstances have reported experiencing these phenomena so repeatedly that we now understand them as part of the normal human trauma response—a healthy coping device in everyone’s psychological repertoire. As a natural reaction to trauma, dissociation has the remarkable capacity to intensify alertness greatly while splitting off from awareness emotions that would paralyze or unhinge the person. The sense of unreality and distorted perceptions of the environment, blurring some features and accentuating others, distance the endangered person from the more terrifying aspects of the situation. Feeling that the clock has stopped in the outside world gives the person the latitude to focus on quickening thoughts of self-preservation. The numbing of emotions stills anxiety and wards off panic, allowing the person to perform automatically, as if some higher power had taken control. In all, these perceptual alterations combine to enable someone in grave danger to defy death or, failing that, to accept it gracefully.
By dissociating, the man in the auto accident was not done in by fear and had the presence of mind to reach for his cell phone and call for help when he returned to a normal state. The woman in cardiac arrest achieved a state of extraordinary calm and peacefulness by dissociating from the straits she was in and was able to accept what she thought was imminent death with equanimity. And the young woman in the Oklahoma City bombing incident used dissociation to block out the horror around her, allowing her to concentrate on escaping from the building before it collapsed.
From these examples we can see what an ingenious adaptive device dissociation is to a life-threatening trauma. To help us survive, certain perceptions, feelings, sensations, thoughts, and memories related to the trauma are split off from full awareness and encoded in some peripheral level of awareness. Miraculously, dissociation alters reality but allows the person to stay in contact with it in order to help himself. This duality is evident in the metaphors people use to describe their feelings of detachment from reality during dissociative episodes. They repeatedly use the phrases “as if” and “it was like”—“I saw it all happening as if I were a bystander,” or “It was like watching a medical show on TV.” Their language clearly shows that although people in a dissociative state feel that what is happening to them is not real, on another level of awareness they know that it is. When they return to a normal state, the dissociated material is less accessible, but it might be lying in wait to resurface.
My pilot study group for the SCID-D, the interview test I developed for diagnosing dissociative disorders, included normal subjects as well as people who had been diagnosed with various psychological disorders. The findings revealed a surprising fact: dissociative episodes are very common among normal people even when they’re not in any danger.
Usually these episodes are a reaction to stress. “I was having a day when the pressure of my job really got to me,” reports Annette, thirty-six, a trial lawyer and the mother of two young children. “I could hardly drag myself out of bed in the morning, thinking of all I had to do. When I was getting dressed, I looked in the mirror and thought, ‘Who is that? Do I know you?’ The person I saw looking back at me was totally unfamiliar. I knew it was me, and yet it wasn’t me. It was scary, so I snapped myself out of it and finished getting dressed in a hurry. It never happened again.”
Josh, a twenty-nine-year-old stockbroker, describes a similar dissociative response to nerve-fraying stress he once had. “I was sitting at my computer in the office, watching intraday trading on a day when the market was fluctuating wildly. The phone didn’t stop ringing. My clients were going crazy. Orders were flying at me left and right: buy, sell, put, call. I looked around me and saw everybody else going through the same thing. Then a funny thing happened. I knew these people, saw them every day, but they didn’t look real to me. The whole scene didn’t look real. It was all very strange, like something out of a dream. That only lasted maybe thirty seconds or so, and then I was back to normal, taking another order on the phone.”
Although these people were in no life-threatening danger, the stress overload made them feel as if they were dangling over the edge of an emotional precipice and triggered a momentary trauma response. They felt as if they had to escape, and they did it by detaching themselves from their body or the world around them in much the same way that a person in an auto accident or some other cataclysmic situation goes out-of-body or sees the environment as unreal.
The SCID-D gives a clear picture of the difference between normal people who are experiencing dissociation, whether in response to life-threatening trauma or to less calamitous stress, and those diagnosed with a dissociative disorder. “Normals,” like Annette and Josh, experience episodes that are brief, are rare, and have a minimal effect on their ability to function socially or on the job. People with a dissociative disorder, on the other hand, have episodes that are persistent, recurrent, and disruptive to social relationships or job performance.
Normal people rate their dissociative episodes on the “mild” end of the spectrum in terms of duration, frequency, and the amount of distress and dysfunction they cause. By contrast, those who have a dissociative disorder rate their episodes as “moderate” or “severe.” People with DID, the most extreme form of the dissociative disorders, have the highest ratings for all of the symptoms, including the one that defines their illness—identity alteration or the assumption of different personalities.
Another striking difference between normal and abnormal dissociation is related to memory. The life review or panoramic memory phenomenon experienced by normal people dissociating in a close brush with death does not occur in people with a dissociative disorder. Instead they have amnesia for traumas and persistent and recurrent episodes of unaccountable “lost time” or large memory gaps for a period in their lives that may stretch for years. Though the life review for normal people is composed mostly of pleasant, long-forgotten memories spilling out disconnectedly like cards from a shuffled deck, for people with a dissociative disorder the intrusive memory fragments are alarming, terror-filled, repeated “flashbacks” or replays of the trauma itself long after the event has passed.
“Mental clouding” is another cognitive difference that distinguishes normal dissociation from abnormal. Normal people experience a speeding up of mental processes in times of extreme danger, whereas people with a dissociative disorder often suffer mental confusion. Their amnesia may cause them to “blank out” at times and may interfere with their ability to recall important personal information. Knowledge or skills they’ve acquired may also intermittently be forgotten as if they suddenly vanished without a trace through a trapdoor. A person who was a skilled pianist for many years, for example, may be dumbfounded to sit down at the piano and suddenly not know how to play at all.
On an emotional level there is a distinct difference, too. For normal people facing a life-threatening trauma, the numbing or dulling of feelings they experience is gratifying because it keeps their fear and anxiety under control and enables them to stay calm. For people with a dissociative disorder this emotional numbness has the opposite effect of heightening their anxiety to the point of panic at times. Their feeling of inner deadness, of lifelessness and emptiness inside, can be terrifying at its worst—if not a continuing cause of depression. For them the inner deadness is associated with a disconnection from the dreadful traumas they experienced in childhood.
Essentially the difference between normal and abnormal dissociation is a matter of too much of a good thing. An adaptive, even life-saving, response to a traumatic event posing grave danger to a person somehow persists and recurs long after the danger has passed and becomes maladaptive. How and why does this happen?
In terms of processing incoming information, research on rats has shown that the brain is like a post office with two different tracks for local and out-of-town mail. All information from the outside world is first received by the thalamus, the brains sensory-input center. From there messages can be sent along either one of two separate systems of nerves: one going to the frontal cortex of the brain, where conscious thinking and analysis take place, and the other going to a thimble-size bit of tissue at the base of the brain called the amygdala. Fear determines which set of sensory information goes where.
When danger is perceived, fear-inducing information is split off from the rest of the input in the thalamus and in twelve milliseconds is sent to the amygdala for emergency processing. Instantaneously, before we’re aware of having given it a thought, the amygdala sets off the trauma response. This tiny nerve center sends messages along the neural pathways running out from it to increase heart rate, blood pressure, and respiration; lower body temperature; and otherwise press our bodies into full-scale counterattack mode. It does this blindly, without the capacity to judge the seriousness of the threat and decide on the most appropriate course of action from a number of options. Not only that, the amygdala stamps its own fear-driven images on the bundle of traumatic information and stores it in a different memory bin from the one where factual information processed by the thinking part of the brain is kept.
From this two-track memory system—one track for emotionally charged material and the other for factual information—we can see a physiological basis for dissociation. The way the brain separates out emotional memories from factual ones is a forerunner of the splitting off in dissociation, in which the fragmentation is more complex and extensive—not only are emotionally charged memories split off, but so are parts of one’s very sense of self.
Normally, as we’ve seen, this detachment during a transient episode of dissociation in response to a life-threatening event, such as an auto accident or cardiac arrest, is immensely helpful. For some people exposed to intense trauma or severe and ongoing abuse in childhood, the dissociative response becomes fixed and automatic. The enormous stress related to the traumatic memories makes it exceedingly hard for the brain to defuse and integrate them when there is no longer any threat of danger. So triggers keep the danger signals raucously blaring and blaring like a burglar alarm tripped by someone who doesn’t know how to turn it off.
One example of this jarring repetitiveness can be seen in how the “replay button” operates in normal people as opposed to those with posttraumatic stress disorder (PTSD), an illness that is primarily dissociative in nature. In the aftermath of a traumatic event, people commonly replay memories of it over and over again. Repetition helps them drain the power from the trauma until it loosens its grip, and they can put it aside. This is a healthy use of the mechanism for a limited time. The person with PTSD gets trapped in the machinery, and the replay continues indefinitely with no abatement of the original terror. Intrusive images and memories of the trauma recur obsessively in nightmares and flashbacks and are so terrifyingly real that the person experiences them not as memories, but as events in the present.
For people whose trauma response system is out of control, the past becomes indistinguishable from the present. Any reminder of the trauma can set off a Pavlovian reflex, as it does in the shell-shocked combat veteran who hears an automobile backfiring in the street and runs into a closet to hide. Over time any stressor, even one not remotely reminiscent of the trauma or abuse, can trigger a similar response.
Living in a continual state of battle alert or hypervigilance erodes emotional stability. Nameless fears and anxiety abound in people with a dissociative disorder, and they become caught up in a desperate struggle to control the spin cycle of their emotions, constantly revolving from high to low. Since they’ve lost the ability to regulate their emotions, they often overreact to stress, with either temper tantrums or panic attacks, and dissociate in an effort to numb their emotions and quell their anxiety. They may also try to numb their emotions with drugs or alcohol and channel their anxiety into food obsessions or self-mutilation rituals. This habitual dampening of their feelings may eventually bring about physiological changes in the brain, impairing its ability to process emotions and leading to a sense of sadness and hopelessness characteristic of depression.
When people who have DID seek therapy, the problem that looms large is usually the one that is treated—the panic attacks, the mood swings, the obsessive-compulsive behavior, the depression. Their out-of-control trauma response, the real villain, is often ignored because many clinicians are not trained to look for the dissociative symptoms that signal its dysfunction. Also, people with DID may find their dissociative symptoms difficult to describe or may have memories so fragmented by trauma or abuse that they no longer remember what actually happened to them.
Sexual abuse is so ravaging to a child’s psyche that dissociation, meant to be a defense, holds the child hostage, and the survivor is made a prisoner of its symptoms. A child who is sexually assaulted by a parent the young person trusts implicitly and totally depends upon for protection is facing unimaginable terror. The jumble of fear, love, rage, pain, and shame at the forbidden sexual excitement can shatter the soul.
Overwhelmed by the assault, the ego passively allows itself to fall apart, saying, in effect, “This is too much pain for any one person to survive, so I’ll split off a part of myself and create another person to help me bear it.” This is different from repression, in which the ego expels inner threats from consciousness and preserves the person’s sense of self intact. In dissociation the ego falls to pieces and causes the person to experience the self as more than one. Repressed material kept out of awareness is unlikely to reemerge as a separate personality, but the dissociated part of the mind can be experienced as a separate center of consciousness capable of organized thinking—in other words, a personality.
The young child who is being sexually and emotionally abused or physically beaten is afraid that she will either die or go insane. She can’t run and she can’t hide. She can’t even confide in anyone about the abuse for fear of retaliation. Since physical escape is impossible, the child escapes mentally. She floats out of her body, imagining that somebody else is being raped or beaten, and turns off her emotions, saying, “This isn’t happening to me.”
As the abuse goes on, dissociation becomes routine. The child continues to detach and float outside her body and create an imaginary person inside her to carry the abuse memories. Though a normal child may have an “imaginary friend” at age four or five who goes away, for the abused child the imaginary friend becomes fixed and continues throughout life. With habitual dissociation other distinct parts of the person may come along, each with its own name, memories, thoughts, feelings, abilities, chronological age, handwriting, manner of dress, and so forth, and may take control from time to time, often without the person’s awareness. What was once a healthy adaptive defense on rare occasion is now an automatic response to everyday stress or any trigger suggestive of the abuse memories—and it never goes away.
For most people, brief, mild episodes of dissociation are a part of everyday life. Take memory, for example. Automatically driving a car and not remembering the ride, because only a split-off part of the mind was on the road, probably happens to normal people every time they drive home from work. Another common experience is the frustrating “tip of the tongue” phenomenon. When pressed, we can’t recall a familiar name, only to have it pop back into consciousness when we’re not thinking of it.
Multiply these quirks a thousandfold, and you might get some idea of how the memory of a person with a dissociative disorder has been impaired. People with DID may look whole on the outside, but inside their sense of self and connection with the outside world has been splintered into bits and pieces. Every day is a quietly heroic struggle, not only to keep unthinkable memories hidden from consciousness, but also to conceal frightening symptoms from others. No matter what their level of education or socioeconomic background, all these people have an extravagantly rich and creative inner world. Not surprisingly, many high-functioning multiples are gifted writers and artists, who, as they heal, are able to find an aesthetic outlet for the sealed-off rage and pain they have not allowed themselves to feel.
Not every abused child becomes a multiple, but a history of childhood abuse has been found in more than 90 percent of all diagnosed multiples. Although more women than men are diagnosed with DID, it’s believed that many adult males with DID are undiagnosed. Men often attempt to deal with problems on their own rather than seek treatment for them. They may relieve stress and inner symptoms by drinking, using drugs, or engaging in compulsive sex. Since drinking alcohol, using drugs, or being sexually overactive may be socially acceptable initially, it may take longer for a man to enter into treatment and have his psychological issues evaluated. Frequently it takes a sudden loss—the death of a child, the breakup of a marriage, getting fired—to impel a man to seek treatment. If men were as treatment-oriented as women, just as many men as women would probably be diagnosed with a dissociative disorder.
It’s not hard to understand why dissociative symptoms are so widespread, considering that as many as one in three women and one in five men in the United States were sexually abused or exploited before age eighteen—more than 70 million people—are highly vulnerable.
Especially at risk are the 28 million children of alcoholics in America who grow up in homes where violence, abuse, or neglect is often the norm. Add to that the unusual kinds of traumatic incidents we have in modern life—terrorist bombings of buildings or airplanes, mass shootings in the subway or in schools—and you begin to get the picture.
The pressure on college students today makes them another group who tend to get high scores on dissociative screening tests. In a 1984 study 34 percent reported episodes of depersonalization or feelings of being unreal or separate from one’s own body, apart from times when they were under the influence of drugs or alcohol and were more likely to have them. One study of five hundred university students taking an undergraduate psychology class produced the bombshell that 12 percent—about one in eight—had at least once dissociatively cut, burned, or similarly harmed themselves. So prevalent is self-mutilation among young women, in fact, that campus cutters have dubbed it “the new anorexia.”
Dissociative symptoms and the disorders they might signify need to be taken seriously, but they can’t be dealt with realistically until we dispel the myths about them. Since the field of dissociation has been so demonized and misrepresented to the public, what you “know” about the disorder probably isn’t true.
