UnderstandingDissociation.com seeks to advance our understanding of dissociation and its relationship to trauma. To that end, I will present my own thoughts as well the latest thinking from the literature, recent presentations, and discussions at conferences.
I anticipate that your comments will rapidly cause hidden ‘vaguenesses’ about the concept of dissociation to surface. Points of disagreement will be identified. These, in turn, will push us all to think more clearly.
Our conversation will inevitably suggest specific research projects. I will encourage both established researchers of trauma and dissociation and graduate students to consider these research ideas.
Finally, UnderstandingDisssociation.com is designed to educate and ‘spread the word’ about trauma and dissociation. Clinicians who want to learn about dissociation (or who want to learn more about dissociation) are strongly encouraged to comment and ask questions.
So, where to start? Let’s have some fun and go to the movies.
Have you seen The Kids Are All Right, the current film with Annette Benning, Julianne Moore, and Mark Ruffalo? It’s one of the first four star movies of 2010. Well worth seeing. And great fun!
I mention The Kids Are All Right because it contains a wonderful portrayal of dissociation. I won’t give away what happens in the film — I hate it when reviewers ruin cinematic surprises by disclosing critical events in the film. I don’t even like Spoiler Alerts. So, no spoiler alerts here. No spoilers at all.
I think that Annette Benning and Julianne Moore are two of our finest actresses. Somewhere during the film, one of them encounters a situation that is psychologically threatening — and deeply destabilizing. Then, for exactly the correct reason (i.e., profound psychological threat), she experiences an episode of derealization (and, presumably, depersonalization as well).
Suddenly, her life and her environment become strange. She is disconnected (or, at least, profoundly distanced) from all that is going on around her. Sounds become distant and fuzzy. The length of this episode is brief (a minute?), but the psychological distance that she travels in this moment is great. Cinematically, very well done!
This episode of derealization reminds me of a significant fact about movies. I have seen derealization in other films — e.g., ones that portray a person suddenly in the midst of lethal gunfire (e.g., Saving Private Ryan and other films).
Bottom line: Many directors and script writers seem to be quite aware that life threatening danger can trigger an acute episode of depersonalization/derealization. I suspect that directors and script writers understand these matters better than many mental health professionals.
When Is Dissociation Not Dissociation?
In the dissociative disorders field, we live in interesting times. Do you remember the Chinese curse? “May you live in interesting times!”
The proponents of the structural model of dissociation — Ellert Nijenhuis, Onno van der Hart, and Kathy Steele — would insist that the episode of derealization in The Kids Are All Right is not dissociation. Why? Because this episode of derealization is almost certainly not a manifestation of a dissociative part of the personality. That is, it isn’t caused by structural dissociation. In other words, no structural dissociation, no dissociation at all. Just something that looks like dissociation, but isn’t.
There is a lot of this going around these days — disagreements about what is and what isn’t dissociation. I have made such statements myself. What do you think about this? Is the derealization in The Kids Are All Right (or on the beach during the D-Day invasion in Saving Private Ryan) dissociation? [Comments strongly invited] Note: To comment (or to read others’ comments) on this post, click on the word “Comments” immediately below in gray.
Understanding Dissociation 
Paul,
What a great way to get your point across. The blog is great, and the use of movies very non-threatening and reachable by we average people!
Hi Doug,
Great to have you as the first to comment on the blog. Glad you like the use of movies. I love film and I hope that the movies can serve as a common language for us all.
Paul,
Congratulations on starting this blog. I agree with Doug. Great use of movies as a point of entry for asking one of the key questions.
The DSM-IV-TR lists Depersonalization as a dissociative disorder so it (and derealization) must be “dissociation” even when they are present in a person without a structural division of the personality, i.e. in a transient and temporary state of derealization or depersonalization that does not reflect underlying structural dissociation of the personality.
But I also agree with the idea set forth by Onno van der Hart, Ellert Nijenhuis, and Kathy Steele that the construct dissociation has been overly diverted from its historical meaning as a division in the personality into referring to almost any alteration in consciousness.
Vulnerability to states of depersonalization and derealization may turn out to be founded on early developmental experiences as described in longitudinal studies referenced in a great chapter by Dutra et al. in your recent book “Dissociation and the Dissociative Disorders: DSM-V and Beyond” and summarized on my recent blog post on “Developmental Pathways to Dissociation.” http://bit.ly/avDAK8 In that case maybe there is a “hidden” structural division lurking behind such states.
Haven’t seen The Kids Are All Right but now I have a reason to.
Hi Andrew,
Thanks for connecting today with UnderstandingDissociation.com!. I am not willing to grant DSM-IV authority in defining what is and what is not dissociation. As you know, the International Classification of Diseases (ICD-10) disagrees with DSM-IV. ICD-10 explicitly insists that depersonalization disorder is not a dissociative disorder. I find these official systems of classification (i.e., DSM and ICD) to be profoundly conservative and insufferably political.
On the other hand, like you, I have great respect for the thinking and publications of Onno, Ellert, and Kathy. I am convinced that they have it exactly correct when they insist that many different kinds of alterations of consciousness (apparent phenotypes [i.e., ‘look-alikes’] of dissociation) are indiscriminantly, willy nilly, lumped together under the overinclusive heading of “dissociation.” These many, similar-appearing alterations of consciousness are certainly not all the same. I am sure that they many of them have quite different underlying mechanisms.
Finally, I have read your blog post on “Developmental Pathways to Dissociation” at http://bit.ly/avDAK8. I have no doubt that there are important things going on in infant-parent dialogue and attachment systems, but I worry about exactly what that is. We do not really know because our primary measures of dissociation (e.g., DES, MID, SCID-D, and DDIS) are all based on the subjective experiences of the person being assessed. That is all that those instruments can measure — subjectively experienced alterations of consciousness. And those alterations of consciousness have many causes, probably only some of which deserve the label “dissociation.”
Bottom line: We have a huge problem with measurement of ‘dissociation.’
As someone who experiences both depersonalization as well as dissociation, I am in total agreement with your first paragraph. I am certain that this blog will provide some invaluable information, and perhaps even some new ways of approaching the incredibly wide spectrum of dissociation and its classification.
Susa, you have some special ‘insider’knowledge of all that we discuss. I hope you will send some ‘insider’ comments our way.
I believe that regarding my personal history, that parental neglect of the infant predated any overt sexual/physical abuse, major dissociation, and fracturing of the identity… but that being said, I do recall that in later years, the parents recanted fond memories of that infant alone – rocking herself back and forth in her crib while holding and rubbing her feather pillow – eyes glazed, and finally falling to sleep. Dissociation?
I will for certain be reading more about the attachment/dissociation connection.
Susa,
As is the case with all discussion that is open to major trauma survivors (especially those with lots of dissociation), I ask that your comments about abuse be no more specific than what you have already said — which is fine. Rocking back and forth with eyes glazed? Definitely self-soothing (as is so typical of neglected infants). Perhaps dissociation, too. In all honesty, I am not sure. Bottom line: Definite self-soothing (and self-assisted coping behavior to facilitate change to a more comfortable state — sleep).
Thank you for your input, Dr. Dell. Certainly, I would never refer to specific abusive events, but I do appreciate that you underscored that very important point. I know personally about intense triggers, and my intent is to only speak in objective generalities. (Yes, I am uber acquainted with depersonalization).
I will mainly be reading, learning, and thinking about topics discussed here… bouncing them around in this brain to determine if and how they apply to me and my system.
Yes, rocking is a potent sign of dissociation. It helps the process…Why do we, as a scientific community, fail to study this in child abuse and other trauma survivors, combat veterans and civil war victims? Of course nobody wants to admit that they rock (as an adult) when overcome by stressors, because rocking is usually associatee with psychoses or MR. Thank you for saying it…rocking needs to come “out of the closet” and shed of its usual connations. Your depiction is quite accurate, and it is a phenonenon that is far more common than most people realize. The idea, BTW, that rates of dissociation in general are greater for the US than other countries, is hightly correlated with cultural ideas about trauma and its sequelae.
Thank you, Teresa. I appreciate your input and validation. I suspected that it was dissociation (even at that young age) although the behavior had significant autistic characteristics.
Hi Paul,
Sorry my tongue in cheek comment about the DSM-IV-TR was not more transparent. Like you, I too am skeptical about the political processes that lie behind both the DSM and the ICD diagnostic manuals and find it necessary to turn to independent scholars for informing my understanding of dissociation. I agree with you that subjective measures have significant limitations. Shedler, et al. (1993) in “The illusion of mental health” describe some of these limitations and how they apply to the clinical validity of treatment outcome studies.
Some of the measures used in the developmental attachment research I mentioned above are observational and behavioral. Video studies of affective displays and microexpressions, QEEQ and fMRI can offer additional windows into the “discrete states” and shifts between states underlying dissociative and non-dissociative processes.
Historical and political forces often significantly influence the impact of what science reveals. Perhaps due to the social experiences that shape it, the nature and definition of dissociation remain more subject to these social forces than to empirical inquiry alone.
I look forward to seeing how your blog develops. Thanks again for offering such an interesting start to an important subject.
Hi Andrew,
Objective measures of phenomena that correlate with subjective experiences of ‘dissociation’ are, in my opinion, very helpful. They provide the possibility of distinguishing among alterations of conscious that are, subjectively, indistinguishable from one another. I am sure that you are right about the influence of historical and social forces — both on the manifestations of dissociation and on our cultural and scientific views of it.
Hi Dr. Dell.
Thanks for all your work that precedes this blog (the MID, etc.) and for this new blog. I enjoy integrating modern or old movies as a way to illustrate the impact of trauma and how the individual may cope with that overwhelming experience by dissociating.
I hope the supposed to be release already DSM-V gets here soon and that it incorporates the points you and others have contended well.
I have a quick question for you re: the MID. I have the MID Excel version 3.1 and was wondering if you have revised it (not that I think it needs it) or not. If so, what could I do to begin using the newest version.
Just for context: I have been working with trauma and dissociation for almost 5 years now as a licensed professional counselor (for almost 13 years now) after completing levels I and II EMDR training, as well as a lot of reading, and participating in a great consultation group focused on trauma and dissociation here in Houston, Tx.
Anyway…I’ll keep my eye out for your response as well as making this blog known to my other colleagues who get to work with clients experiencing trauma and dissociation.
Thanks for all your time, knowledge and willingness to move this topic into the forefront.
looking forward,
David House
Hi David, I will send you updated MID stuff when my laptop comes back from the shop. Little change, but I will send you the latest. Houston, huh? I worked in Galveston for years and used to be part of the Houston-Galveston Family Institute. Anyway, welcome to UnderstandingDissociation.com!
Thank you for all of your efforts on this subject. It isn’t easy to figure out, whether you’re on the “inside” or the “outside”!
Hi there,
If I understand your question, I am on the “outside” (i.e., I don’t dissociate). On the other hand, if you click on About (see above), you can read about who I am and my hopes for this blog. Thanks for connecting. Whether you are “inside” or “outside,” you are welcome here.
Hello 🙂 I didn’t ask a question, just made a comment, and as usual my words meant multiple things simultaneously. “Inside” and “outside” (to me) can refer to others within my skull or outside of it, or might mean when one part or another is active “outside” or only “inside”. I’m sorry, didn’t mean to make it complicated. You seem like a wonderful person and I’m sure this will be a great blog. I’ll hush now =)
Thanks for the feedback and affirmation. You’re not bad yourself. I’ll try to restrain my wonderfulness. 🙂
Hi Paul,
I am very excited about your blog and am looking forward to reading more. Thank you for creating another resource for professionals, students, and those struggling with trauma and dissociation.
As for your question, when situations like the scene you describe occur in my life, I do use the term dissociation to describe them. But that’s only because I have Dissociative Identity Disorder and so I use the word “dissociation” freely to describe all manner of symptoms. Much the same way someone with Borderline Personality Disorder might categorize their symptoms as simply “borderline.” I also tend to get depersonalization and derealization confused.
Thanks again. I’m really happy to have this new resource.
Holly
Thanks, Holly. Welcome aboard!
Hi Paul,
I love the website! I saw your email on the dissociation listserve and had to try it out. It’s a nice adjunct to the book (dare I say “tome”?) you and John O’Neill edited – and it weighs less too! I love the book too, and use it for teaching psychiatric residents about working with dissociated clients. I am following the “what is dissociation” question with great interest. And you are right in your description of clinicians who just deal with what is presented by clients and don’t worry so much about the definition. I have seen so many variations on the theme of dissociation, I rarely try to categorize what I am seeing. I look forward to the discussions on this blog.
Nancy
Hi Nancy,
Welcome to UnderstandingDissociation.com! You have reduced my quotient of slowly growing concern. My second post, to which you have replied, is much more analytic/conceptual than was my first post (which attracted a fair number of comments). The lack of comments to this post (with the exception of Lynette) left me worrying that my own deep interest in the question of “What is dissociation?” might be just an unshared autistic preoccupation. Thanks for commenting!
dr dell,
thanks for this website. your brief description of the history of the concepts of dissociation vs. repression was elegantly presented.
you wrote: “The proponents of the structural model of dissociation — Ellert Nijenhuis, Onno van der Hart, and Kathy Steele — would insist that the episode of derealization in The Kids Are All Right is not dissociation. Why? Because this episode of derealization is almost certainly not a manifestation of a dissociative part of the personality. That is, it isn’t caused by structural dissociation. In other words, no structural dissociation, no dissociation at all. Just something that looks like dissociation, but isn’t”.
i had one thought re: this question, which is that perhaps we can think of the distinction between “structural dissociation” and a “dissociative episode” as somewhat analogous to the distinction between “big T” and “small t” trauma. simply put, just as i can have a traumatic experience (but not develop full-blown ptsd, for example), i can experience a dissociative episode or event without becoming “dissociative” in the structural sense of the term. i think of certain forms of “spacing out” as “mini-dissociative episodes”, but i in no way believe that people who do this on occasion (i.e. all of us) are d.i.d. or anything like that. said another ways, we can all cope via “dissociation” from time to time, but we do not all habitually rely upon dissociation.
while i recognize (from your post) that some folks would insist, for the sake of conceptual clarity, that a different term than “dissociative” be used to describe the scene from the movie you allude to, i prefer to keep the term, in part because i believe, with hs sullivan, that we are all “far more human than otherwise”. simply put, i prefer to think of something we can all experience as a way of empathically understanding (at least to some extent) what we all do not experience.
Hi Ken,
You have put your finger on an important point, I think. There are many events that have a dissociative ‘look’ or ‘feel’ to them, buy they neither come from, nor precipitate, structural dissociation. What to call these dissociation look-alikes is more and more of a problem. The more that we focus carefully on these look-alikes, the more we can see that they are different from one another. And, if they are meaningfully different from one another, then it becomes increasingly confusing to call them all by the same name (i.e., “dissociation”). The proponents of structural dissociation call one phenomenon “structural dissociation” (and the “manifestations of structural dissociation”). They lump all the remaining ‘dissociation-like’ phenomena under the heading of “alterations of consciousness.” I am sympathetic to their effort to think (and speak) more clearly about these matters. I do, however, think that we need additional analysis (and identification of additional subtypes) of their large waste basket category — alterations of consciousness.
Paul,
This is a wonderful blog. Thank you for starting it. It challenges us all to grapple with theory so we can develop a greater understanding of dissociation.
I like Ken’s idea of distinguishing between structural dissociation and dissociative episodes that are not structural in nature. I do not think that it is necessary to restrict our definition of dissociation to structural dissociation, but I agree that some experiences that are called dissociation are other types of alterations of consciousness.
I do think that the scene from the movie that you described is a form of dissociation, because I define dissociation more broadly as any defensive disconnection from the self, the body, particular emotions, specific experiences, current location or present time, etc. Therefore, for me, depersonalization and derealization are forms of dissociation but the self-soothing Susa described I would probably categorize as autohypnotic trance phenomenon.
Maybe Susa will chime in again because more details might help to clarify how I would characterize her rocking. I would want to know if she is doing more than shifting her state of consciousness from awake to asleep. For example, while rocking and before falling asleep, does she perceive herself as going away from that time and place or not?
I agree with the strength-based survival mechanism view of dissociation. I’m not comfortable with Janet’s view of dissociation as weakness. It seems to me that new neurobiology concepts would support my point of view. If I understand it correctly, it is now believed that we all start out with a multiplicity of discrete states of mind that gradually become more cohesive and seemless with good-enough attachments to our primary caregivers. If that is the case, then it is only with early betrayal trauma and/or insecure attachment that some or all of the discrete states of mind would become more and more separate as a means of coping with an unbearable reality. This would also be in partial agreement with the continuum point of view, except there would be no “normal” dissociation in this conceptualization.
Thank you for the vehicle for me to further clarify my thinking.
Best wishes,
Andrea
Andrea, welcome to UnderstandingDissociation.com!
You said: “I do think that the scene from the movie that you described is a form of dissociation, because I define dissociation more broadly as any defensive disconnection from the self, the body, particular emotions, specific experiences, current location or present time, etc.”
This is nicely worded. I think most of us will find your definition of dissociation to fit well with the understanding of dissociation that we all ‘grew up with.’ And that colloquial understanding of dissociation (1) is certainly different from that of the structuralists, and (2) may turn out to be right or wrong (or more useful or less useful).
Let’s see what others say. You have clearly articulated what is probably the dominant, and most familiar, current understanding of dissociation — defensive disconnection or distancing from one or more aspects of body, self, or world.
Hello Andrea,
I don’t have any personal recall of the infant’s rocking – only what was told to me by the parents. There is still a strong connection with a feather pillow even now. I suppose that the rocking while scratching/rubbing the feather pillow was self-soothing as well as a means to dissociate. The comforting of the pillow > self soothing > dissociation > sleep. Self induced hypnosis > dissociation. Not to say that this is the process during all dissociation events, however – just the one that most closely resembles what the parents described with the infant’s behavior. Most of my dissociative instances are much different.
Susa
Hi Susa,
Thank you so much for responding to my question. If I understand you correctly, you are saying that the infant rocking started as self-soothing, then induced a trance state and then caused the infant to fall asleep. It was not clear to me if you were saying that the trance state developed further into a dissociative state prior to sleep or if you were saying the trance state was a dissociative state. I’m wondering if you can clarify this further.
I know your knowledge of the infant’s experience is second-hand, but I’m wondering if you might have a sense of this from what you’ve been told. Is your sense that the infant became completely cut off from awareness of self, body and/or world while in this trance state or was it more of a narrowing of focus? And if it was a narrowing of focus, did it progress further into full disconnection from self, body or world after the trance, but prior to sleep?
Hopefully, the distinction I am trying to make is clear. I believe it could be very helpful to our understanding of dissociation.
Thanks for your help.
With appreciation,
Andrea
Hi Paul,
I’ve read the Nijenhuis, van der Hart, Steele concept of dissociation and have to admit that I don’t find some of their distinctions regarding dissociation to add much to my daily work with clients. I tend to think of dissociation as a way to not be present in some capacity in the here and now, which would include daydreaming on one end of the spectrum and DID at the other extreme. I realize this is an older conceptualization of dissociation, but it continues to fit with my experience of client work. As a fellow Eneagram 5 and Myer-Briggs INFP, I am right there with you trying to understand and explain dissociation.
Hi Nancy,
You know what they call INFPs? Therapists! The theory that you prefer — you call it “an older conceptualization of dissociation” — is the theory that governed the field when Eve Bernstein Carlson and Frank Putnam developed the Dissociative Experiences Scale (DES). There is a whole second disagreement about that theory — the continuum theory (as opposed to the taxon theory).
In my view, your basic ‘take’ on dissociation is that it is a defense (i.e., “a way to not be present…in the here and now”). As for the structural theory, perhaps one of its proponents will ‘drop in’ and say a few words about it.
Just had a laugh – amazon.com’s email to me today recommended a book by Paul F. Dell. Love it!
Congrats Paul… As your colleague and friend for these many years, I am happy to read your studied view and hear the many comments about dissociation. An informed and friendly blog to engage in this dissociation discussion. An inviting venue to increase our understanding of us human beings. As you know, I, too, use movies to assist me in this complex arena.
Hi Dr. Dell,
I’m doubly on the outside. I’m neither a professional nor someone with DID. I’m a husband who is doing everything within his power to help his DID wife heal as completely and quickly as possible. It’s been quite a ride so far. Very hard for both of us. But I also get the extreme pleasure of seeing these insiders heal and develop and grow.
Thank you for taking time from your busy schedule to do this. I hope you are able to continue to do so.
Sam
LOVE the blog! I developed PTSD after a life-threatening, prolonged childhood illness and suffered for years in silence with depersonalization, derealization, and disassociation as a child. As other sufferers will understand, I thought my symptoms meant I was crazy, dreaded my experiences, and told no one. At 18 when I finally went into therapy, I was stunned to discover that there was a name to everything I was feeling. Knowledge is power. Thank you for devoting time to exploring these issues in greater depth! If there was more information concerning these psychological defenses, I might never have suffered needlessly for years in silence. Thank you again, and I look forward to future posts!
I’m not sure if you’re still writing, but I would like to just let you know how nice it is to see your blog here. In my childhood and teen years, I used to experience brief bouts of, what I now know was, derealization. I always kept it to myself because I didn’t want anyone to think I was crazy. Now, as professional who specializes in PTSD using EMDR, I come across this quite often. Thank you for your contribution to this topic!
Hi !!! I was wondering if the blog is still going on, maybe not here but somewhere else ???