Challenges of dissociation
It is a storm that does it. The clap of thunder, in my mind a gunshot. I lie face down, body pressed flat against the pavement, my reflex so fast that I have no memory of dropping. I am very close to the road, but do not notice. Traffic no longer exists for me, the cars distant flashing colours. Floating, I feel no fear.
Benefits
Dissociation has a number of ‘benefits’ for me
One of the main ones being reduction of physical and emotional pain
Challenges?
I have found that dissociation can also pose particular challenges
The deeper and longer the dissociation, the greater the difficulties it creates
There is a significant difference between
Mild and severe episodes
Episodes which last for minutes or for hours
“I am floating
My vision, hearing and depth perception may distort
Noise seems a long way away and speech difficult to understand
I have stumbled on stairs because I feel like I am floating and cannot judge where my foot is in relation to the ground
Rapid decision making becomes difficult
Instructions can become confusing
Motion creates particular challenges
If I am moving while dissociated
Objects appear closer or further away than they actually are
It is difficult to judge speed
The scenery can lose shape and become a multicoloured blur
I experience a feeling of
Remoteness as if I am separate from my body
Total calm as if nothing can possibly go wrong
“I am not afraid”
My dissociation numbs emotions such as fear
Reduced ability to recognise and respond to danger
Dissociated, I once calmly watched the flames of a large fire move towards me, totally unafraid
“Self-harm? What harm? I don’t feel any pain”
When I self-harmed it was sometimes severe because
My dissociation dulls physical and emotional pain
Little incentive to stop self-harming
Blood looked far away, as though it belonged to someone else
It seemed like it was someone else who was self-harming
Actions became robotic – rhythmic and fascinating to watch
As the dissociation ended, I realised the severity of the injury
“I have now complicated your treatment plan”
I have sometimes refused medical treatment because of fear of dissociating
I can dissociate before, during or after treatment
May not be able to follow specific instructions
It can become an effort to speak so it is difficult to ask questions
If asked I may tell you that I feel no pain but then suddenly experience pain later
This pain can lead to another episode of dissociation
“I am no longer dissociating, and I am now distressed”
I may experience acute physical pain
I have dissociated during some examinations/procedures
I become distressed hours later, post dissociation – long after I have gone home
I may only remember snapshots of the procedure, which then turn into flashbacks – which retraumatise me
I may become disorientated and become lost after I leave
My distress used to occasionally lead to self-harm
Medical World…This is What Would be Helpful For Me
Understand dissociation
The signs of dissociation are very person specific – please do not generalise
Think of it positively - Recognise that it is a survival mechanism. Not a disease
Train medical staff to recognise possible dissociation and sensitively respond to it
Instead of shaking or shouting at me to bring me out of it, please speak quietly, slowly and calmly to me
Collaborate
Discuss with me
What the signs of my dissociation are so that you can recognise it
What my specific triggers are
Strategies to reduce the risk that I will dissociate (many people who experience dissociation are aware of what helps them – it is very individual)
Work with me
It may be possible to work around some of my triggers
e.g., it may be possible to reduce the number of staff standing around my bed
Talk to me during treatment
It doesn’t matter what you talk about - the sound of your voice helps keep me present
Arrange a follow-up appointment if I have dissociated during an examination/treatment - to debrief
Please know that I am very grateful for any effort that you make to understand my world and work with me
Be Warned…
I do not disclose willingly to medical staff, employers, friends, that I dissociate
It is often difficult to explain what dissociation actually is
Fear that I will be ‘written off’ as mentally ill or an attention seeker
I do not want to inconvenience people
Wariness of how people may respond to me while I am dissociating
What I Do, Do
Whether it be in a medical setting, or not
I try to be self-aware. I have learnt to:
Avoid known triggers, where realistic
Recognise the ways in which dissociation impacts my ability to function
Am mindful of the safety of myself and others
I carefully consider employment options, sports, etc
.e.g., structured activities are safest
I use technology
e.g., navigation apps on phones are useful post-dissociation if I find that I am lost
I am lucky. I do not remember the face of the man who helps me up. Only his blue shirt. He thinks that I am dazed. No, I have dissociated. Too near the road.
Original version written April, 2019; modified March, 2020