In psychology, we often use the term dissociation, which means, in simple terms, sometimes we disconnect from reality. Everyone experiences some level of dissociation from time to time. Here’s an example: If you have ever found yourself driving your car on “auto pilot,” arriving at your intended destination, but without much memory of the process, this was a form of dissociation. You may have been deep in thought and disconnected from the world around you, yet some part of you was functioning to get you where you were going.
Everyone experiences this form of dissociation, but for others, dissociation can be much more complex, even frightening, depending on its severity. When psychologists speak about dissociation, they often are speaking about it in more “pathological” terms.
More complicated forms of dissociation are often associated with a traumatic event or chronic trauma. We have come to understand that the ability to dissociate is actually a tool for psychological survival. If a person undergoes a singular traumatic event, such as a severe car accident, or witnesses a perceived life threat, the mind becomes overwhelmed by the threat or fear of the situation.
Without getting extremely technical, it is best said that the mind is capable of splitting the traumatic event or experiences off from the person’s experience as a whole. The victim of a car accident has a sort of amnesia around the trauma lasting permanently or slowly returning over time. This is a very adaptive survival skill.
A singular traumatic event is bad enough, but in therapeutic settings, we often encounter individuals who have survived what we call complex trauma — trauma that has been ongoing for a considerable amount of time. This may be seen in cases of domestic abuse, or childhood physical, sexual, or emotional abuse or neglect. Unfortunately, the younger the individual at the time of trauma, the more the survival dissociation occurs.
When an adult with a trauma history enters treatment, therapists must be alert to potential dissociative coping mechanisms. Initially, it is difficult to tell if dissociation is present unless specific questions are asked, as the client is often very capable and functional in many aspects of life. As such, the dissociative functioning may only occur during times of stress or incidences that trigger a trauma response.
The ability to dissociate is the brain’s survival mechanism kicking in to protect the person. However, regular use of dissociation, when we are no longer in harm’s way, leads to difficulties in life and changes from adaptive to maladaptive. When this happens dissociation prohibits healthy ways of being.
A client may initially enter therapy with complaints of depression or anxiety, but with further examination it may become clear the brain is continuing to assist the person in surviving a trauma that is no longer happening — much like a war veteran who has difficulty distinguishing a horn honking from a gunshot.
Medication may be useful for symptom relief for such emotions as anxiety and depression, but not to integrate trauma responses. When dissociation is identified, the approach may be to begin to incorporate therapeutic trauma protocols to help the survival brain become more integrated with the reasoning part of the brain. Working through trauma in therapy can take a great deal of time — sometimes years.
The good news is that with effort and the right team of mental health professionals, a healthy functioning life filled with joy can be expected.