I have a nifty little coping reaction that kicks in anytime I’m feeling dreadfully stressed, unsafe, traumatized, or in highly-charged emotional or physical situations. I can leave my physical and emotional body behind. Effortlessly, I slip outside of myself, into a grey place away from any feeling. Whatever is happening to my body or my mind might be painful but I’m already so far away. I no longer have a sense of self, have severed any connection to my environment, and have blocked the streams of consciousness that connect me to the unfolding incident. These periods can last minutes, hours, days, or years.
To be clear, I can still function reasonably well during these periods—I can socialize and work. But I’m operating on something akin to autopilot. I’m not fully engaged in anything I’m doing, feel as though I’m watching it from afar, and time stops working properly.
What’s happening to me in those instances is something called dissociation. According to the Mayo Clinic, dissociation involves experiencing a lack of continuity between thoughts, memory, actions, and identity. Dissociation or dissociative disorder usually develops as a reaction to and result of trauma and symptoms can range from amnesia to alternate identities. Times of stress can worsen symptoms of dissociation.
According to the DSM-V, there are three major dissociative disorders people can experience:
Dissociative amnesia: This type of dissociation is a forgetfulness that’s more severe than normal forgetfulness, and can’t be explained by another medical condition. People with dissociative amnesia may not be able to recall information about themselves, people in their lives, or events, especially from traumatic times. For example, a soldier engaged in intense combat may not actually remember details from that period of violence.
Dissociative identity disorder (DID): Most people know this disorder as multiple personality disorder. DID is characterized by switching between alternate identities. People with DID may feel the presence of more than one person inside their head, each with their own history, name, mannerisms, gender, distinct traits, and varying familiarity with the other personalities. People with DID often experience dissociative amnesia or fugue states. Though rates of prevalence are exceptionally low—studies estimate just 0.01 to 1 per cent of the general population has DID, Hollywood loves characters with this affliction. It appears in everything from Law & Order: SVU to M. Night Shyamalan’s Split.
Depersonalization-derealization disorder: These are the dissociative symptoms I’m most familiar with. Though I haven’t been diagnosed with this disorder, depersonalization and derealization are also symptoms of borderline personality disorder (BPD), which has been suggested as a diagnosis. Depersonalization involves an ongoing or an episodic sense of detachment from reality and the feeling of being outside oneself. Derealization happens when the world gets foggy and dreamlike, time loses any linear feel, and everything seems a little unreal. Symptoms can be distressing to those experiencing them.
I personally don’t find depersonalization and derealization overly distressing. If anything, it’s a vast improvement to whatever is happening to me in real life. Unfortunately, dissociation is an involuntary and unhealthy escape from reality that can cause problems with functioning in daily life. While it works well as a coping method in the moment, it severely limits my enjoyment of life and those events I’m dissociating from aren’t necessarily wiped from my subconscious. In my experience, they can reemerge as traumatic memories in the future.
To mitigate the effects of dissociation, I rely on three dialectical behavioural therapy (DBT) skills. Regular readers will recall that DBT was created by Marsha M. Linehan in the 1980s to treat BPD. Whereas the widely-practiced cognitive behavioural therapy (CBT) focuses on changing unhelpful thoughts or behaviours, DBT emphasizes accepting unhelpful thoughts or behaviours and finding techniques to cope with symptoms while focusing on interpersonal skills.
One of the DBT skills I turn to when I’m dissociating is the TIPP skill. TIPP stands for Temperature, Intense Exercise, Paced breathing, and Paired muscle relaxation. I’ve written a newsletter about using the TIPP skill to cope with panic attacks, and those same skills can be used to cope with dissociation. I find splashing my face with cold water (Temperature) or attempting Paired muscle relaxation techniques to be effective in offsetting some of the symptoms of depersonalization and derealization.
When TIPP skills prove ineffective or are too daunting to practice, I utilize Wise Mind ACCEPTS, a distraction skill for times of crisis. In DBT, Wise Mind is the intersection of Emotion Mind and Logic Mind. It’s a space that allows a person to see the value in the influence of both emotions and logic and use them in equal measure to influence perception. Alternately, Wise Mind can be thought of as bringing the left brain (analytical and methodical) and right brain (creative and intuitive) together to find a middle path. Wise Mind ACCEPTS involves participating in any of the following distractions, while checking in to try to move into or nearer to Wise Mind:
Activities: Distracting myself from being dissociated through activities like watching Netflix, going for a walk, reading, playing The Sims, or listening to music have all helped me. Other tactics include playing sports, eating a good meal, calling a friend, or basically anything that takes my mind off of the symptoms of dissociation.
Contributing: I’ve been really lucky to find volunteer work with Toronto Cat Rescue that helps pull me to reality. Socializing with a kitty is so enjoyable and generates a lot of positive feelings. Contributing in any way, being thoughtful, or surprising a loved one are great ways to distract and create some positive emotions.
Comparisons: I only engage in comparisons when I’m sure I’m in a Wise Mind state. When I am, it can be useful to compare how I’m currently feeling (or rather, not feeling) to a time I felt differently to remind myself that all feelings pass.
Emotions: When I’m numbed out sometimes it can be beneficial to provoke an internal emotional reaction unrelated to my current situation to snap back to some semblance of feeling. Pixar films are a trusted resource for this skill (it’s impossible for me to get through the opening sequence of Up without crying), but any emotional books, music, or films can do the trick.
Pushing away: Since I’m highly “pushed away” during dissociation, the value I gain from this skill is more about not fighting or being frightened by what’s happening to me.
Thoughts: Similar to Activities, if I can find a relatively pleasant line of thinking, this skill helps distract me from my dissociation making it easier to cope with. However, this is a skill I only practice when I’m sure I’m in a state of Wise Mind.
Sensations: By biting a lemon or holding something cold or highly textured, I can start to reengage with my body while effectively diverting my attention to the sensations I’m experiencing.
If TIPP and Wise Mind ACCEPTS just aren’t working during a dissociated period, which happens when my periods of dissociation are intense, I use the Self Soothing skill. Using the five senses, I can help ground myself and reengage with my body and emotions. I used to practice the 5-4-3-2-1 grounding skill (five things you can see, four you can touch, three you can hear, two you can smell, one you can taste), but found it hard to be mindful during the exercise, instead feeling like I was crossing items off a grocery list. These days, I just try to engage one sense at a time in a simple and focused manner.
Vision: Sometimes my vision exercise can be as basic as lighting a candle and watching the flame flicker, dedicating all of my attention to its dance. A nice walk down tree-lined streets or analyzing a flower in my garden will start to reengage my sense of sight, pulling me back from my grey place.
Hearing: During a walk, I listen for the sounds of the city, the birds hiding in trees, the leaves rustling in the wind—anything that brings me back to the present moment. Listening to soothing music and even singing helps with my dissociation.
Smell: My favourite smell is the smell of fresh air, but any scent that’s soothing (incense, lemon oil, flowers, cookies) can create some really pleasant internal reactions.
Taste: When I’m dissociated, I have no hunger and no taste in my mouth. However, my body is still very much human and will react to taste. Drinking a soothing drink, chewing gum, making a favourite meal from childhood, or a dessert, are all effective ways to engage with this self-soothing exercise.
Touch: A powerful method to ground and alleviate symptoms of dissociation is through touch. Skin is the body’s largest organ, after all. A hot bath works excellently, as does self-massage, splashing my face with cold water, or holding an ice pack to my forehead.
Unfortunately, I still occasionally experience periods of dissociation, during which it just seems impossible use any skills, and I’ve come to accept this might always be the case. In those times, I try to ensure I’m in a safe environment with little opportunity for long-term consequences, where I can wait for the symptoms to diminish.
Mad History
This issue: Shirley Mason aka Sybil
By Source, Fair use
DID has always been a particularly controversial diagnosis within the mental health community—so much so that some doctors doubt it even exists. This notion was not helped by Shirley A. Mason, also known as Sybil. Mason was an American art teacher born in 1923 purported to have DID, who inspired the book, Sybil: The True Story of a Woman Possessed by 16 Different Personalities, and two movies of the same name. Mason’s diagnosis and treatment under Cornelia B. Wilbur has been the source of much criticism.
In her book, Sybil Exposed, writer Debbie Nathan, concedes that Mason was an emotionally unstable woman. However, Nathan found that Mason became unusually attached to her psychiatrist, Wilbur, who had a keen interest in DID. "Shirley feels after a short time, that she is not really getting the attention she needs from Dr. Wilbur," Nathan said in an interview with NPR. "One day, she walks into Dr. Wilbur's office and she says, 'I'm not Shirley. I'm Peggy.' ... And she says this in a childish voice. ... Shirley started acting like she had a lot of people inside her."
Wilbur was floored, and began interviewing Mason regularly while the patient was under the influence of sodium pentathol to help the suggestible woman uncover a series of alters. Wilbur teamed up with Flora Rheta Schreiber to write a book about her patient. Schreiber, according to Nathan, expressed doubts about the veracity of Mason’s DID in her papers, but already had a book contract in place. Even Mason herself tried to come clean, writing a letter to Wilbur, admitting she didn’t have multiple personalities, but at this point her psychiatrist was too invested to let it go. Wilbur shared meals with her patient, paid her rent, and was cared for by Mason at the end of her life. Her book about Mason’s alleged illness would go on to sell six million copies around the world.
Recommended Reading
In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness
By: Peter A. Levine
In an Unspoken Voice is an extensive look at trauma, fear, and what happens when our biological responses to these stimuli are thwarted. Levine’s book is an important primer on better understanding dissociation, its relationship with the biological impulses that govern our fear response, and the strategies necessary to reengage with traumatized bodies. Blending biology, neurology, and body conscious psychotherapy, In an Unspoken Voice demonstrates how mindfully expressing our instinctual responses to trauma can help us become more whole. This book also features some worthwhile strategies for coping with dissociation through Somatic Experiencing.
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