Kathryn Levison, BA
For decades, dissociative psychologies, especially DID (Dissociative Identity Disorder, sometimes referred to as Multiple Personality Disorder), have been viewed by many as the most exotic of all mental illnesses. Biopics like The Three Faces of Eve and Sybil and fictional depictions like Hitchcock’s Psycho and M. Night Shyamalan’s Split offer awareness, but they aren’t necessarily the norm.
The truth is that almost everyone uses mild forms of dissociation, and it doesn’t always involve stress or danger.
- “Zoning out” while working out at the gym or other repetitive activity that frees up your mind.
- “Running on auto-pilot” while driving somewhere you go regularly, your mind wanders, and you can’t remember how you got there.
- “Losing time” because you’re captivated by a book or a movie or thoroughly immersed in an activity or hobby you love.
- Purposely ignoring your body’s signals to use the restroom or stopping to eat — even delaying sleep — when you’re on a tight work deadline or want to make it to your vacation destination.
Dissociation as a temporary coping mechanism is vital to survival
The ability to disconnect from an overwhelming situation is an ingrained survival technique. Dissociation can be a blessing as a temporary measure, especially when it’s either a conscious decision or an unconscious reaction to an event, the details of which can be retrieved at least in part. It’s a way to avoid feelings and buys a person time to find a safe space to express potentially disabling emotions.
One example of dissociation as a helpful tool is “going numb” to get through a funeral or a car accident then falling apart at home.
Sometimes, too, not remembering specific details is a blessing that does not require therapeutic dissection.
When dissociation becomes a problem
When dissociation is debilitating, it’s time for treatment. Regularly losing time that can’t be accounted for or recalled with a bit of thought, being told things that can’t be remembered — anything that involves “doing without feeling” to the extent that daily living is disrupted is something that needs to be addressed.
Dramatic and disabling dissociative reactions that cause severe issues often prompt a person to seek therapy. But many people are hesitant to get professional help for the same core reasons that trigger dissociation.
Ambivalent feelings toward help are OK
Because many of those who suffer from dissociation have suffered severe mistreatment from people who should have protected them, they don’t always trust authorities.
Some have also tried “regular” therapy and had a negative experience because the therapist didn’t have enough training or experience with dissociation. The person may have been open and honest only to discover that they weren’t ready or that the therapist wasn’t prepared to help them with the emotions that surfaced in the session.
The other issue is that, unfortunately, “mental illness” is still a stigma. However, movements like BC2M (Bring Change to Mind), founded by actress Glenn Close whose sister has bipolar disorder, are starting to make a difference with articles like “Dealing with Dissociation.”
It’s also understandable that people don’t like to be “labeled,” and the language of psychology doesn’t always help. Fortunately, there has been a paradigm shift — a fundamental change in approach and assumptions — particularly in dissociative psychology.
Consider keeping these definitions in mind.
- Symptoms are clues — pieces of information that indicate something is amiss.
- Triggers are cues — mini-guides as to where to start to unravel the root cause of the symptom clue.
- Words like dissociation are descriptions — they don’t define your worth or personal integrity.
The clinician uses terms like these to understand how a person handles their world. There is usually an adaptive reason — a means of survival — behind the person’s learning to cope by dissociating.
Also, keep in mind: “Disorder” is not a condemnation
Webster defines disorder as “a state of confusion” or a “disruption” in function. If you limp after an injury, you have “a gait disorder.” If your thyroid is underproductive, you have “an endocrine disorder.”
In psychology, having a “disorder” just means that something in a person’s functioning is confused or disrupted enough to require attention and treatment. On the other hand, some people find dissociation as “ego-syntonic” — serving a benevolent purpose that doesn’t feel foreign to the personality.
Dissociation isn’t a problem until it gets out of hand
Harry Stack Sullivan described one of the most unsettling phenomena as “not-me.” He defines not-me as a situation when overwhelming feelings of anxiety, dread, and sometimes horror lead to over-reaction, emotional crises, even nightmares — or what feels like the type of nightmare consistent with the “split personality” aspect of dissociative experiences.
The episode “The Core of It” in the series Lie to Me illustrates an example of the core personality remembering something that an alter experienced as if it was a vision.
Lie to Me was a series rooted in the work of Paul Ekman, a psychologist and world expert in deception who uses unconscious micro-expressions to determine a person’s actual emotional state.
The show starred Tim Roth as Dr. Cal Lightman, head of The Lightman Group, a fictionalized version of the Paul Ekman Group. Lightman applies Ekman’s scientific techniques to solve fictional cases that usually involve criminal activity. In the episode “The Core of It,” Lightman is approached by Tricia, a conservative law student with a distinctive wrist tattoo.
She tells Lightman that she saw a murder in a vision and knows it happened, but the police don’t believe her, then asks, “Am I telling the truth?” Lightman studies her face for a moment.
“Yes, you are.”
During the investigation, Lightman and his partner, psychologist Gillian Foster, determine four separate personalities involved with the vision.
- Tricia: presumed to be the core personality because she sought out Lightman for help.
- Jessie: the first alter, identified by Tricia’s tattoo, who lives the life of a prostitute.
- Sophie: a vulnerable young girl and one of two who know the whole story. Sophie also leads Lightman to Tricia’s real-life brother, Gavin, who reveals the root of Tricia’s dissociation as familial abuse
- R.J.: a mute male alter who protects the others, Sophie in particular
The sequence of events in the vision followed those of the real-life murder. The murderer killed Jessie’s prostitute friend. Under trauma, Tricia dissociated from Jessie into Sophie, who witnessed the murder. R.J. appeared to protect Sophie and also knows the whole story.
With Lightman’s prompting, R.J. uses the alter’s shared consciousness to show Tricia the event. Tricia emerges to tell Lightman the killer’s identity: the manager of the rundown hotel frequented by Jessie and other prostitutes.
Knowledge is power
The key to unraveling the intricacies of dissociation and finding healing hinges on three critical points:
- Knowing more about the psychological roots and physiology behind unnerving symptoms can help them feel less foreign and frightening.
- Knowing how dissociation has come to function in the present can empower you to recognize when dissociation is serving an adaptive purpose versus when it might be limiting or interfering with your life.
- Knowing that there is, indeed, hope available in the practice of psychoanalytic psychotherapy can be the first step toward healing.
Dissociative Symptoms: A Brief Review
There are as many symptoms and variations on symptom themes as there are people, but there are common threads. All these unconscious responses let the person “do” something so that they don’t have to “feel” the agony of what’s been buried.
Different ways people can dissociate
Psychologists use four general categories to sort out the person’s situation: Behavior, Affect, Sensation and Knowledge.
- Behavioral dissociation: A type of paralysis that results from the inability to escape danger. One example is what’s known as “trance-driven self-mutilation.” Think chewing fingernails or pulling out hair in a kind of daze.
- Affective dissociation: The person remembers and talks about a traumatic situation without showing much emotion or acting with la belle difference — showing no genuine concern for symptoms no matter how severe.
- Sensory dissociation: The mind remembers — rather, does not remember — how the body reacted to the abuse. Having no sensation in parts of the body that can’t be explained by any physical means is referred to as “conversion anesthesia.”
- Cognitive dissociation: Information about the trauma is blocked because the person went into a “fugue state.” Sleepwalking is one way of looking at this type of amnesia.
Aspects of Amnesia
Gaps in a person’s memory are one of the most troublesome symptoms of dissociation and may include:
- Inability to remember significant periods of time in childhood or adolescence.
- Forgetting everyday events. The more debilitating situation includes forgetting skills like using a computer or blanking out when it comes to a memorized piece of music. (Important note: Dissociative forgetting of music or lines to a play is not the same as stage fright.)
- Finding evidence of things they don’t remember doing.
- A feeling of losing chunks of time in the present.
- Discovering strange objects in a closet or drawer.
- Thinking they threw something away only to have it reappear.
- Finding unrecognizable handwriting samples or a change in style that can’t be explained. For instance, shaky handwriting can be attributed to nerves or caffeine. Exceptionally tiny writing can be a way to cram more material on one page, like a student taking detailed notes.
- Finding themselves in a different place than they last remembered — often having no idea how they got there. (Back to the sleepwalking analogy.)
- Not being able to remember things they have done.
- Changes in behavior with no apparent cause.
Feedback from others
Shifts in identity may be evident to family members and outside observers. However, the person can also be so detached from reality that it seems like an alternate personality.
Speaking, acting, dressing, food preferences, hobbies — anything drastically different can look like something or someone has taken over. More confusing to the observer is when everything reverts “back to normal.”
Spouses of people who dissociate may say, “Yesterday, she said one thing. Today she’s saying the exact opposite.” This can lead to the person being accused of “lying” when the reality is that they genuinely don’t remember.
Physical & psychological feelings
The person may think their body feels odd or different — feeling like a child or feeling like the opposite sex.
They may refer to themselves as first-person plural (we) or third person (he, she, they), but not know why.
Important note: The dissociative plural is not the same as the current they/them pronouns used to indicate gender neutrality.
Depersonalization refers to the person feeling detached as if they’re watching themselves in a movie, or the image in the mirror may be a complete stranger.
They also might not be able to control what they think, say, feel, or do. Like the strange image in the mirror, these things can feel foreign, as if they’re not part of who the person is.
Conscious vs. unconscious dissociation
During conscious dissociation, the person knows they’re emotionally detached but may not know why. They also might not voluntarily come out of the dissociative state until the crisis has passed.
For instance, one patient reported that she “went numb” when her grandmother died when the girl was only thirteen years old. At that tender age, the pain of losing this loving, significant relationship was too much to handle. The patient’s dysfunctional family provided no outlet for her grief, so she compartmentalized her pain, only to have it color other relationships.
But with the help of a supportive therapist in the safety of a counseling session, she was finally able to access the agony and free herself from the shackles of legitimate but ultimately debilitating dissociation.
If the memory is buried so deeply as to be inaccessible with unconscious dissociation, the person may develop a dissociative disorder that requires professional intervention. Unresolved trauma can result in what clinicians define as dissociative amnesia, dissociative fugues (dreamlike states that can involve losing time), and depersonalization to the point of feeling as if nothing is real. However, if gone unchecked long enough — or if the trauma is so painful that the person “splits” into disparate personalities — this is where depth psychology can often effect a cure.
A skilled psychotherapist can also parse out symptoms and spare the patient more pain due to an inaccurate psychological diagnosis that leads to treatment for the wrong condition.
History of Dissociation in Psychology: Freud vs. Modern Viewpoints
As far back as 1889, the French psychiatrist Pierre Janet understood the core of dissociation when he wrote, “certain happenings would leave indelible and distressing memories – memories to which the sufferer was continually returning and by which he was tormented by day and by night.”
Freud argued against Janet and felt that dissociation was a defense that served to eliminate threatening or overwhelming thoughts and experiences from conscious awareness. He was right to an extent, but he had little to contribute even though many of his peers recognized dissociation as a separate disorder.
Due to Freud’s focus on repression and developmental issues, a lack of deeper research led to confusion and the psychological community’s tendency to overlook critical symptoms.
Modern psychoanalytic viewpoints
Some clinicians interpret dissociation less as alterations in consciousness and more like what’s known as defensive splitting — reverting to seeing things as all good or all bad much like small children handle their worlds.
Because of this viewpoint, therapists don’t always ask the right questions to distinguish between splitting — separating experiences and emotions that had previously been processed and incorporated into a person’s thinking — and dissociation of things that were always held in separate parts of the psyche.
Professional organizations are now on board
The ISSTD — International Society for the Study of Trauma and Dissociation — is one of the oldest organizations to promote advanced scientific, clinical, and societal understanding about the consequences of chronic trauma and its effects that lead to dissociation.
The Society of Clinical Child and Adolescent Psychology in Division 53 of the APA (American Psychological Association) encourages scientific study and public awareness and also offers specialized training in dissociation for practitioners.
Physiology of Dissociation: Mind over Memory
For the last three decades, the rediscovery of dissociation has given psychoanalysts and depth psychologists an appreciation of the influence of organized unconscious forces. Neuroscience has also played a significant role in defining how trauma affects the mind’s ability to separate and compartmentalize painful experiences. We also understand why and how trauma damages memory.
The power of the human mind to organize unconscious forces is astounding. It can segregate and compartmentalize intolerable feelings and experiences to the point that the dissociative person wonders, “Am I making this up? Or is it a real memory?”
How trauma affects the brain on a physical level
Science has provided essential insights into how trauma affects the brain physically. Mark Solms and Oliver Turnbull, pioneering researchers in neuroscience and its relation to psychoanalysis, found that glucocorticoids — naturally occurring steroids — are secreted during traumatic experiences.
If the event is powerful enough, glucocorticoids can shut down the hippocampus — the area of the brain considered the center of emotion, memory, and the autonomic nervous system — to the extent that episodic memories are impossible. This is the root of a person’s inability to remember “being there.”
Other crucial memory-related aspects are also often crippled
- Semantic memory: The brain’s ability to remember and assign meaning in language and/or logic can be lost.
- Somatic-procedural memory: The person can lose touch with bodily sensations, their behavior, and the actions of others involved in the traumatic episode. There can also be gaps in visual images that would otherwise confirm “I was there.”
- Amygdala involvement: This almond-shaped mass in each hemisphere connects to emotions. If the amygdala is crippled, the brain may not store enough data to identify the triggers that result in dissociative experiences.
If the trauma is severe enough to hinder some or all of these essential brain functions, the foundation for a person’s first-hand knowledge that “I was there when it happened” may never be stored at all. When this happens, some memories that seem obvious will never be recovered.
Trauma affects specific organs in the brain
If the limbic system is distorted –the complex network of nerves that affect instinct, mood, and basic emotions like fear, pleasure, and anger — the survival drives of hunger, sex, dominance, and caring for offspring can be compromised. This is one explanation for the paralysis that traps a person in a toxic situation.
Abnormalities of the corpus callosum — the band of nerve fibers joining the brain’s two hemispheres — can hinder the memory crucial to connecting emotions and events.
Interference with the development of the cerebellar vermis can directly affect “I was there” if the mind shuts down memories of changes in posture, movement, and the cardiovascular system’s reactions to trauma with physical sensations like increased heart rate.
The mixed blessing of modern science
We now know that the effects of trauma aren’t confined to the psycho-emotional realm. Trauma distorts the perception of the situation, impairs memory, and sets the stage for the confusion of facts and fantasy. This constellation often lingers years after the original episode that triggered dissociation.
The downside is that patients aren’t the only ones who work to put the dissociative pieces back together. Therapists can also have traumatic histories.
The upside to working with a psychoanalytic psychotherapist is that the clinician has undergone the same process as their patients to uncover and work through internal struggles.
When your psychoanalytic psychotherapist says, “I understand how it feels to work on these things,” they mean it.
Roots of Dissociative Psychology
A common thread in many dissociative cases is childhood abuse. This can include sexual abuse, but there are also issues with personal interactions.
Richard Kluft, director of the Dissociative Disorders Program at the Institute of Pennsylvania Hospital, proposed a Four Factor Theory regarding dissociation. According to Kluft, all of the following must be present for dissociation to occur.
- Seriously traumatic events have compromised the person’s ability to adapt to everyday stressors.
- The person’s psychological substrates must be involved. (Substrates refer to how the central nervous system affects the psyche.)
- The person must have what’s known as “the fixation of dividedness.” They’re stuck feeling all alone, their only defense being to dissociate painful feelings. This is a direct result of the fourth factor.
- No one protected the child.
Dissociation can be “a family legacy”
Caregivers of dissociated people may be dissociative.
- The caregiver may have used dissociation to handle their own childhood abuse.
- Alcohol and other drugs can result in an altered state where the caregiver doesn’t remember what they did to their child. An intoxicated parent will do things that they’d never imagine doing sober.
- When caregivers catch themselves abusing their child, the terror and shame can trigger dissociation.
When parents experience amnesia — whether it’s a learned coping mechanism or is related to substance abuse — not only do they traumatize the child even more. They also can’t help the child understand what happened because they don’t know, either.
Fortunately, more people are willing to talk about their abuse and seek help to break the pattern.
What Triggers Dissociation?
Because human beings mature, not at the same rate, but within the same general progression — infancy, childhood, adolescence, adulthood — trauma severe enough to trigger a dissociative episode can be seen as one way the immature organism adapts to survive the situation.
Common triggers for people susceptible to dissociation
- Violent media imagery.
- An ordinary event or experience that “pushes just the right button” and brings the original trauma to memory.
- Bodily states like intolerable pain or sexual arousal that feels confusing.
The good news: triggers are valuable diagnostic & treatment tools
Following Rudolph Loewenstein’s lead, most clinicians in the field consider these responses to be “windows of diagnosability.” Psychoanalytic psychotherapists don’t usually use a couch, but they do apply the Freudian art of attentive listening. There are myriad cues and clues, both in the things the patient doesn’t say as well as what the patient does say.
The patient’s reactions and responses in the relationship with the clinician are also invaluable. The more trust the therapist can engender, the more likely the patient will feel free to — well, feel.
Therein lies the healing: In the safety of sessions with a skilled and caring psychotherapist, the person can, little by little, let the most frightening emotions start to rise to the surface. It’s very much a case of, “Once you can name it, you can begin to heal it.”
Dissociation’s link to self-hypnosis
People who use dissociation as their primary defense mechanism are essentially virtuosos in self-hypnosis and enter spontaneous hypnotic trances. But shifting into an altered state of consciousness under stress isn’t possible for everyone.
To learn to dissociate automatically, the person has to have the constitutional potential to go into a trance. Otherwise, trauma may be handled in other ways, such as substance use or various forms of acting out — exhibiting improper and unrestrained actions as a way to reduce stress.
Why resolved dissociation can resurface
One of the things that can drive people back into therapy is the situation where dissociation was resolved after the person got away from the family or relationship of origin.
But then the person has a child, and when that daughter or son reaches the age when the parent was abused, the dissociative coping pattern reemerges.
Dissociation: more common now, or just correctly diagnosed?
Because dissociative processes occur in all of us, some psychologists think that they’ve never treated a patient who dissociated into multiple personalities. The internal shifts can be dramatic for the person, but to an outsider, the changes can look like minor variations.
One leader in the field, psychoanalyst Nancy McWilliams, learned that one of her students suffered from dissociation. But even to McWilliams, “switching” looked like minor mood changes
Because depth psychology focuses on trust, today’s psychoanalytic psychotherapists have more experience and support when it comes to working with people who have developed enough confidence to disclose their body and mind’s ability to display different and distinct identities.
What can hinder an accurate diagnosis
Outside of depth psychology, some people with dissociative personalities are diagnosed with schizophrenia or borderline personality disorder. While the confusion is to be expected in any field that’s had a profound paradigm shift, this kind of diagnostic error can cost a patient not just a lot of money but years of treatment for the wrong issue.
Part of the diagnostic problem is that usually, the therapist sees only one alter — one personality — in a particular session. A therapist with less experience may look at an identifiable alter such as a frightened child and view the change in non-dissociative terms such as “a passing regressive phenomenon” — the technical term for a patient “falling apart” during a session when they uncover or reexperience a painful event.
Psychoanalytical Psychotherapy for Dissociative Psychologies
While modern psychology has gained significant tools and insights across the spectrum, psychoanalytic psychotherapy is specifically helpful with dissociative issues because of the dynamics of depth psychology.
Healing is in the relationship
One of the first things established in psychoanalytic therapy is the relationship between patient and therapist. The good news for people seeking treatment is that it falls to the therapist to create a safe space.
It’s very common to find that a dissociative patient has survived because, over time, one person after another saw something special and tried to be a positive influence. This is very much the job description of a psychoanalytic psychotherapist:
“Find the good and help it flourish.”
How clinicians view their dissociative patients
Some might think it’s challenging to work with dissociative disorders because so much is hidden. But psychoanalytic psychotherapists often report that their work with dissociative patients is very gratifying.
Dissociative people also have inherent qualities that help their psychotherapists develop genuine affection and concern:
- Dissociative people are often quite lovable.
- Patients who crave relationships can find it easier to form strong attachments that engender hope for healing.
- Even those who present a clear, “Please help me but don’t come near me” mindset can, over time, open up to the therapist who provides a consistently safe environment and loyalty to their patients’ wellbeing.
The goal of therapy for dissociation
The objective of psychoanalytic psychotherapy is to help a person sort things out and offer tools to handle hard times better.
The goal of healing for one who dissociates is not to dismantle the creative apparatus the person’s mind used to help them survive. Instead, it is to recalibrate the machinery, so to speak, so that dissociation is always a positive tool.
Identifying the roots of their personal triggers can help a person know what to do when they feel themselves slipping away.
Therapy can offer positive applications of dissociation
Just as some artists — painters, writers, composers — can create in different styles, the analogy of “wearing different hats” applies to those who learn to use creative dissociation to their advantage.
Therapists can help a person understand that their altered personalities are really “different ways of being you.” This commonsense approach can strengthen the individual’s experience of “being one while feeling like many.”
Eventually, the different parts can integrate into one person who has access to all the memories, feelings, and coping skills. In addition, uncovering those negative experiences that were isolated to the point of being inaccessible can help the person learn to handle life’s stressors in creative ways without feeling guilty.
For instance, the little child aspect of the personality can giggle at cartoons and marvel over holiday lights. “The protector” can take over when it comes to tasks and interactions the person finds difficult or unpleasant. Even though the person will still be physically ripping out the weeds or dealing with those who tend to trigger memories of abuse, the mind can help so that the heart doesn’t have to take the hit.
Why Psychoanalytical Psychotherapy is the best option
Because psychoanalytic psychotherapists undergo their own treatment to make sure any potential issues are sorted out before they go into practice, they are more likely to help a person bring their daily mental processes into the therapeutic relationship.
In addition to the supporting organizations mentioned earlier — the ISSTD and Division 53 of the APA — there is now significant literature on accessing a person’s alter personalities and reducing the barrier of dissociative amnesia.
A skilled clinician can not only distinguish a disorder from a normal response to trauma. They also invest in their clients by providing the safe therapeutic space crucial to help develop the trust and courage that’s essential to peel away the outer layers and begin to process the origins of their pain.
Psychoanalytic psychotherapists are invested in their patients
These clinicians work with patients for months and sometimes years. This allows the hidden parts of a dissociative person to build up the courage and reveal experiences that the self-state — the part of the person that came for therapy — doesn’t know or remember.
Analytic therapists are also more likely than other professionals to have worked with people who have revealed their multiplicity.
The psychoanalytic approach helps prevent misdiagnosis
When a person with a dissociative issue is diagnosed as borderline or schizophrenic, this mistake can cost a patient years of misguided treatment — and a lot of money.
Even though this confusion is expected whenever a field of study experiences a positive paradigm shift, psychoanalytic psychotherapists can grasp dissociation with an “experience-near” sensibility. This means that the therapist knows first-hand how treatment feels and can genuinely empathize with their patient’s internal experiences.
A final encouraging word: seeking help for dissociation demonstrates Moral Courage
The root of dissociation is hiding the horrific — obscuring disturbing events with dissociative symptoms. When dissociation becomes a lifestyle, the stress to survive can be too much for one person to bear. Alternative personalities may be the only way the mind — and the heart — can survive, no matter the negative effect on the person’s life.
People willing to face things that parents and caregivers did — deeds that can only be described as too absurd, repulsive, outrageous, or reprehensible to remember — are nothing short of heroes.
Theodor Reik, commenting on his mentor, Sigmund Freud’s, opinion of what’s required of psychoanalysts — and psychoanalytic psychotherapists — couldn’t have said it better:
“Moral courage gives us the power to face unpleasant truths within ourselves and in others [and] secures us the strength to persevere.”
About the Author
Having enjoyed a successful career as a musician in the Chicago suburbs, Kathryn Levison shifted gears after experiencing first-hand the power of quality psychological counseling. However, life had other plans, and her goal of pursuing the advanced credential required to offer that same hope to others was put on hold. Many years and two cancer surgeries later, she again sought help, this time from esteemed psychoanalyst Norman Ellman. Seeing in her what his mentor, Theodor Reik, saw in him, Dr. Ellman first unleashed Kathryn’s latent gift for creative writing and then incorporated informal training into her analysis with an eye toward her own analytical practice. After his death, life intervened once more, so today, instead of a couch, Kathryn uses a pen to both entertain and encourage. While she loves nothing more than spoofing Sigmund Freud and all things analytical, Kathryn has also written award-winning biographical prose. Her most rewarding — and challenging — project to date is a co-authored memoir of paternal incest and maternal psychological abuse, published one gut-wrenching, soul-mending chapter at a time.
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