Understanding Dissociation.com launched one week ago. Since then, it has logged 500+ Hits, 41 Comments (albeit nearly half of them mine as I respond to your Comments), and 19 subscriptions by email. A good start, I think.
Because I am convinced that it takes a community to understand dissociation, I believe that the true riches of UnderstandingDissociation.com reside among and between its Comments. The Comments show the effects of my posts on your thinking about dissociation. And, because, my Comments address the core ideas in your Comments, the real ‘action’ lies in that give-and-take between the Comments.
Read the Comments to the previous post and allow them to enrich your own thinking! Go ahead. Click on “Are You Aware of the Disagreements About Dissociation?” (below) and read the responses that were submitted by our nascent community.
Participate in all of the fun and take in all of value that is on offer. Our community of dissociation aficionados grows and matures the more that you learn and the more often that you share your thoughts with the rest of us. Remember: UnderstandingDissociation.com is a community!
Is Dissociation a Many-Splendored Thing?
I need to make a brief statement about the theory of structural dissociation. I have focused my blog posts on this model not because I disagree with it (I actually agree with about 80-85% of it), but because the structural model of dissociation is, by far, the most clearly stated position in the field.
Experience has shown me that even more clarity arises when a very clearly stated position is closely examined or challenged. Clearly stated positions always seem to repay the effort that you put into thinking about them — even if you wind up disagreeing with them in the end.
Perhaps the clearest statement of the structuralists’ view of dissociation is “Dissociation versus alterations of consciousness: Related but different concepts” (Steele, Dorahy, van der Hart & Nijenhuis, 2009). This is an excellent account which I highly recommend. In that chapter, Kathy Steele, Martin Dorahy, Onno van der Hart, and Ellert Nijenhuis make several essential points:
- There is serious conceptual confusion about dissociation.
- If an alteration of consciousness is not caused by a dissociated structure of the personality, then that alteration of consciousness is not dissociative.
- It is very difficult to distinguish structural vs. nonstructural alterations of consciousness. In fact, our measures of dissociation (e.g., DES) indiscriminately mix the two together in their test scores.
- The continuum model of dissociation (wherein normal forms of ‘dissociation’ lie at one end and pathological forms lie at the other end) is incorrect.
- Persons with structural dissociation routinely experience nonstructural alterations of consciousness as well.
- All trauma-related disorders (Think: especially PTSD) are rooted in structural dissociation.
Of the six points listed above, I can heartily sign on for five of them. But I don’t think that empirical evidence supports the structuralists’ last contention.
My bottom line: I think that some persons with PTSD have structural dissociation, but I think that other persons with PTSD do not.
So, your turn. What do you think?
You asked for opinions about if PTSD always involves structural dissociation. I think it might depend on the nature of the trauma itself. Was it a one-time event or recurrent? Did it occur during childhood or as an adult? Did it involve betrayal by primary caregivers?
I think we can say that all Complex PTSD involves some degree of structural dissociation. I don’t think single incident adult-onset trauma would necessarily always involve structural dissociation, but I’m not sure about that.
If somebody experiences an earthquake and then feels the ground vibrate when a train passes by, is it an emotional part of the self that starts to panic and the executive part that does the reality testing and self-reassurance? If that is the case, then I’m having trouble thinking of any examples of PTSD that would not involve structural dissociation to some degree. Can anybody give me an example that would not involve any structural separation of action systems of daily living and defense?
A couple of thoughts: The type of trauma may contribute to WHETHER the person gets PTSD. It might contribute to whether the person develops simple or complex PTSD. But I don’t think the type of trauma has much to tell us about whether or not PTSD always involves structural dissociation.
Your doubts as to the certainty that PTSD always involves structural dissociation make a lot of sense after the discussion in the next post about the evolutionary link between trauma and dissociation. A few ideas this brings to mind:
1) people who develop PTSD had to have had “masked” structural dissociation all along, and the event that triggered the PTSD was the proverbial last straw (thus PTSD would still involve structural dissociation)
2) structural dissociation can occur in adulthood, even with people who may have had Secure Attachment (thus PTSD would still involve structural dissociation)
3) it’s entirely possible that structural dissociation isn’t involved and the PTSD is framed within a different system, perhaps evolution-prepared dissociation, hyper-focus, etc.
Am I even close to what you’re thinking? LOL
In my clinical experience, flashbacks act rather like slivers do; both are trying to work their way out. That is to say, the body’s innate tendency is to heal and push out that which doesn’t belong there, or metabolize it. When I was 9 I had a very long sliver, and we went to the ER to have it removed. Voila! Out. But 3 weeks later, and a few weeks after that, I’d feel this shock of electricity that would indicate another piece had worked its way to the surface, rendering it removable with tweezers.
In traumatic memory, the raw unprocessed traumatic BASK material is held apart, sequestered, either in a preexisting structure (DID) or a lean-to or maybe an encapsulated blister made for the occasion (PTSD) to contain the material. The innate healing tendency causes the material to move toward resolution. Nightmares and flashbacks are the electric shocks that indicate its getting closer to the surface. But if the capacity of the processor is smaller than the volume or intensity of material, the person can’t do it readily. An industrial strength processor is needed, like EMDR or another procedure, coupled with a healing resource present (therapist usually), the material can be tweezed and resolved.
Your model of flashbacks makes a fair amount of sense. I think that many therapists would agree with what you have written. I also agree that the human mind has an innate tendency toward resolution. Mardi Horowitz called this “the completion principle.” And yet, all of this leaves me unsatisfied and wanting more. Are these Chinese flashbacks? 🙂
I still want to know why some of us have flashbacks instead of intrusive THOUGHTS. How does this happen? How do we go from a big unsettling event to flashbacks? And why flashbacks instead of something else (e.g., intrusive thoughts)?
Finally, it needs to be said that flashbacks are not just a symptom of PTSD; they are also, in and of themselves, quite toxic and pathogenic. If they continue, if they occur too often, they make the person much sicker and much more dysfunctional.
Thank you for saying flashbacks are toxic and pathogenic. And thank you for asking these difficult questions.
The instrusive thoughts I have experienced in my complex PTSD demand to be reconciled with the narrative of my life. They force to me admit how much suffering there was in my emotions of the past that I usually try to avoid. I have used avoidance to escape mourning the abuses of my person and my emotions in childhood. Thus, when I get physically worn out, the memories come; they are clear and unbidden. They are unpleasant little shocks. They are like the small slivers that had to be removed at home.
The flashback that forced me to see the Trauma with a capital “T” that all other traumas surrounded was followed by two weeks of physical distress. I saw as I did as a child during the trauma time. I saw shadows on the walls at night, and was afraid to be in my bed. I even wet the bed (in my 30s). There were psychosomatic pains. My whole life, there have been about 3-4 “set” of pain cycles that have run through my body, which I have associated as various medical complaints. Now I see these as trauma-related; after the flashbacks they ran in quick successive cycles like I was a washing machine going through “back pain,” “headaches,” “sciatic nerve pain down left leg,” etc. As these pains used to come separately, I had experienced them as separate. Now they ran for less than an hour and then simply “switched” to another pain, I saw them as linked to the trauma that had been unearthed violently in the flashback that occurred and forced me to look at what had been troubling me daily for three months, and in my life for 30 years.
Because I experienced a host of troubling stimuli and other flashbacks (the “shadows”) or memories (whatever those were) and sealed off ego state that came with the flashback that had to be acknowledged I opted to use anxiety medication in order to return to work and function.
I agree that someone who suffers from PTSD of any kind does not value the unseating that flashbacks cause. They spear one of the horse of one’s life as if in a violent duel. On the other hand, instrusive memories may be upsetting and cause some pain, they allow sufficient equilibrium to manage the content with some processing, crying, grieving, and reflection about what the memories mean in context of identity, development, current coping and self concept, etc. Flashbacks hurt so badly that just stabilizing is hard work; it is more difficult to manage the raw, terrorizing content.