Disentangling Animal Defenses From Dissociation: Part II

We have no idea where our animal defenses end and our dissociative symptoms begin. The more that I immerse myself in this area, the more I am surprised that the dissociation literature hasn’t thought more deeply about animal defenses. Animal defenses are mentioned here and there in the literature, but they are seldom subjected to a rigorous analysis vis-à-vis clinical dissociation. Probably the best existing discussions are those of Ogden, Minton, and Pain (2006) and Van der Hart, Nijenhuis and Steele (2006).

Let’s begin with a central distinction: Animal defenses are survival-oriented; clinical dissociation is not. Animal defenses protect our survival, our biological existence. Clinical dissociation protects our mind and our self. True, there are times when protecting mind or self may result in saving our lives, but biological survival is not what clinical dissociation is all about. Now let’s examine a second crucial distinction.

Dr. Livingstone, I Presume

In 1871, British explorer and national hero, David Livingstone, had been in Africa and out of touch for seven years. The New York Herald sent a reporter, Henry Stanley, to find him. After an 8-month search, Stanley found him. He greeted Livingstone with the famous words, “Dr. Livingstone, I presume.”

David Livingstone wrote an articulate account of his own tonic immobility during a near-lethal encounter with a predator:

I heard a shout. Starting and looking half round, I saw the lion just in the act of springing upon me. I was on a little height; he caught my shoulder as he sprang and we both came to the ground below together. Growling horribly close to my ear he shook me as a terrier does a rat. The shock produced a stupor similar to that which seems to be felt by a mouse after the first shake of the cat. It caused a sort of dreaminess, in which there was no sense of pain nor feeling of terror, though quite conscious of all that was happening.It was like what patients partially under the influence of chloroform describe, who see all the operation, but feel not the knife. This singular condition was not the result of any mental process. The shake annihilated fear, and allowed no sense of horror in looking round at the beast. This peculiar state is probably produced in all animals killed by the carnivora; and if so, is a merciful provision by our benevolent Creator for lessening the pain of death. (Livingstone, 1957, p. 12, emphasis added)

The crucial point in Livingstone’s account is that this state of mind took away all pain and fear, but it did not take away his awareness of what was happening. Livingstone remained “quite conscious of all that was happening.”

We saw this same mental awareness a few weeks ago when we examined evolution-prepared dissociation (e.g., what happens during a sudden fall from a great height). During the fall, time slows down and mental and sensory acuity become quite pronounced. Some of you described this sudden change of consciousness as a “hyperfocus” and as “the opposite of dissociation.”

The literature on tonic immobility in animals emphasizes a similar point:

it is now well established that…subjects in TI [tonic immobility] continue processing information and remain aware of events occurring in their immediate vicinity.” (Gallup & Rager, pp. 59-60)

It takes but a moment’s thought for us to realize that an evolution-prepared, animal defense must PRESERVE awareness and the ability to process what is happening. Your survival is not helped by being unaware of what is happening when you are being attacked by a predator.

Clinical dissociation, on the other hand, does not have the same ‘regard’ for our ability to think while we are dissociating. In Depersonalization Disorder, the disconnect from our normal emotional contact with self, body, and world is so profound that it impairs concentration and thinking. Similarly, many other forms of clinical dissociation impair the person’s ability to reason and problem-solve while he or she is dissociating.

If we were to speak of clinical dissociation as having a “mission,” it would certainly be the opposite of the mission of the starship Enterprise (“to boldly go where no man has gone before”). The mission of clinical dissociation is to avoid, block, or escape from pain and distress. And, because its priority is to escape from pain, both awareness and the ability to think are readily sacrificed when doing so provides an escape from pain.

Freud once said something similar about repression:

The psychical apparatus is intolerant of unpleasure; it has to fend it off at all costs, and if the perception of reality entails unpleasure, that perception — that is, the truth — must be sacrificed. (Freud, 1937, p. 237)

A Plea For First-Hand Accounts

There is much more to consider about the relationship(s) between animal defenses and clinical dissociation, but  I think that this is a good stopping place for today.

Our earlier discussion of evolution-prepared dissociation was greatly facilitated by your first-hand accounts. Your personal stories highlighted the clear state of mind that accompanied your falls and car accidents.

Today, I leave you with another request for personal accounts — of dissociation during maltreatment. Specifically, would you be willing to describe (1) the nature of your awareness of what was happening (i.e., clear, fuzzy, unaware, gone away, out of body, etc.), and (2) the extent of your ability to think clearly during the dissociative event(s).

Posted in animal defenses, dissociation, evolution-prepared dissociation, first-person accounts, Tonic immobility | Tagged , , , , , | 19 Comments

Disentangling Animal Defenses From Dissociation: Part I

We need to disentangle the phenomena of animal defenses (e.g., freezing, hyperfocus, tonic immobility, etc.) from the phenomena of clinical dissociation (depersonalization, derealization, amnesia, etc.). Animal defenses have been built into us by natural selection; as such, their phenomena are normal. On the other hand, natural selection did not build clinical dissociation into us (see Dell, 2009); clinical dissociative experiences are abnormal.

I am convinced that our empirical data on both peritraumatic dissociation and chronic dissociation are an undifferentiated mixture of (1) genuine dissociative symptoms and (2) the operation of normal animal defenses.

A Personal Comment About UnderstandingDissociation.com

I spent the last 6 days in Atlanta, attending the Board Meeting and the annual conference of the International Society for the Study of Trauma and Dissociation (ISSTD). During that time, I was too busy to make any new posts as I was completing my term as President of ISSTD. Now, I’m done. Free at last, free at last, thank God Almighty, I’m free at last!  🙂 Well, not exactly. Now I’m the Immediate Past President (an actual position, with a one-year term of office, on the ISSTD Executive Committee ).

Anyway, today I’m back home in Norfolk and we can renew our blog-ular (bloggish? blogite? bloggy?) discussions. The last 4 posts have addressed flashbacks. We are definitely not done with that topic, but my sense is that we need a break from it for a while.

Let’s talk about animal defenses and dissociation. During a delightful conversation with Steve Frankel in Atlanta (Steve is a PhD/JD –clinical psychologist/lawyer — from the San Francisco area), I learned that Steve is very interested in tonic immobility. Tonic immobility is an animal defense whose primary manifestation is total paralysis (such that the animal may appear to be dead — but is anything but). I, too, have a longstanding interest in tonic immobility (my computer contains 250 pages of notes on the topic). Steve and I plan to work together on this topic so that we can give a presentation about it next year at ISSTD in Montreal and, hopefully, commit our thoughts to paper for publication.

I am a great believer in ‘killing two birds with one stone’ (My cats just alerted: “Burd?Burd? Where burd? I can haz burd?”). Today, I will accomplish two things. I will begin to work on my project with Steve by describing these fascinating phenomena to you –the community of UnderstandingDissociation.com.

Animal Defenses

In 1988, Fanselow and Lester published a seminal paper on animal defenses. This article built on the prior work of Ratner (1967). Fanselow and Lester proposed that there is a continuum of predatory imminence. Put simply, they (and many others since then) proposed that many species of animal automatically exhibit a series of different animal defenses as a predator comes closer and closer.

1. Pre-encounter Defensive Behavior. During periods when an animal has not recently encountered a predator, it is not defensive and is free to forage for food, and so on. At most, the animal may constrict its roaming to areas that it ‘believes’ to be safe from predators.

2. Post-encounter Defensive Behavior. When an animal detects a predator in its vicinity, it undergoes a dramatic change in behavior — freezing — in a location that reduces its visibility to the predator. While frozen, the animal is in a state of very high alert. All of its senses are heightened, but its sensitivity to pain immediately decreases. Its breathing is rapid and shallow. The animal is highly attentive to its environment.

3. Circa-strike Behavior. As a predator is about to strike, the animal’s behavior undergoes another dramatic shift. In fact, the animal may successively exhibit three quite different responses, each designed to survive this encounter with the predator. First, the animal will probably shift into explosive escape behavior. If unable to escape the predator, the animal is likely to struggle, fight, and bite. Finally, if fighting is of no avail, the animal may suddenly enter a state of tonic immobility. This immobility (as if dead) will sometimes inhibit the predator’s attack, allowing the animal to escape, perhaps injured but still alive.

4. Recuperation. The animal retreats to a safe place where its spontaneous analgesia subsides.  The animal then rests and tends to its injuries.

Do Humans Have ‘Animal’ Defenses?

Yes, we do. In previous posts, we discussed what I have called evolution-prepared dissociation — an ‘animal’ defense which is specific to us humans. Similarly, there have been a few publications that have addressed tonic immobility in humans, especially in some rape victims (e.g., Suarez & Gallup, 1977; Marx, Forsyth, Gallup, Fusé, & Lexington, 2008).

On the other hand, there is a problem. Although we have some data which shows us what these phenomena look like in human beings, the truth is that we really know very little about this topic. There are far too few studies of animal defenses in humans. We simply do not know how similar (or different) our human ‘animal defenses’ are to those of other animals.

Please understand that this caveat is neither trivial nor pro forma. There are important reasons to shine a bright light on these potential differences. Forty years ago, Robert Bolles (1980) proposed that there are species-specific defense reactions. Species-specific means that there may be important differences in the fine details of an animal defense from one species to another. In short, there is every reason to carefully study human ‘animal defenses’ to learn how they may differ from those of other species.

What Do Our Own Experiences Tell Us?

In previous posts, we discussed a form of evolution-prepared dissociation that humans frequently experience at a time of extreme danger to survival: calmness, absence of fear, hyperfocused attention, time slows down, thought speeds up, enormous mental clarity, superb problem-solving, anesthesia. Several of you described such experiences.

Today, I am asking about a very different kind of evolution-prepared dissociation: tonic immobility. Have you had an experience of suddenly being unable to move when you could not escape an assault or likely death? If so, please describe your subjective experience in detail (if you can), but describe the trauma itself with as little detail as possible.

Your experiences of tonic immobility may be uncomfortable to ‘go near,’ so please (1) be careful in your remembering, and (2) choose your words judiciously if you describe such an experience in a Comment.

Posted in animal defenses, dissociation, evolution, evolution-prepared dissociation, first-person accounts, peritraumatic dissociation, Tonic immobility | Tagged , , , , , , , | 26 Comments

Are Flashbacks Just Memories?

Today’s post is really Trying To Forge a Deeper Understanding of Flashbacks: Part III. My choice of the above title, however, nicely encapsulates today’s topic and avoids the mind-dulling repetitiveness (“O, the wretched monotony!”) of continuing to use the same title.

A few days ago, I said that flashbacks have at least four striking features:

1. Flashbacks are experiential, marked by a sense of reliving, accompanied by sensations and affects).

2. Flashbacks are distinctly fragmentary.

3. Flashbacks are autonomous and involuntary.

4. Flashbacks are frequently associated with dissociative amnesia.

I addressed only reliving last time. Today, (unfortunately?) more of the same — but from a very different perspective.

Memory Researchers Say, ‘There Is Nothing Special About Flashbacks’

To oversimplify, there are two kinds of academic challenges to the clinical concept of flashbacks. First, there are those who appear to hold an ideological grudge against the concept of flashbacks. These grudge-bearing ideologues often selectively ‘cherry pick’ scientific findings, cheerfully omit or distort scientific findings, and may use thinly veiled ad hominem arguments. I refer to this contingent as skeptics. Their views are not the topic of today’s post.

Second, there are researchers who believe that well-accepted findings about memory are quite capable of explaining flashbacks. Their logic and empirical studies are eminently reasonable, straightforward, and are usually well done. I refer to them as memory researchers. Today, I will begin to discuss a program of research by Dorthe Berntsen at Aarhus University in Denmark.

Most memory research is about voluntary memory — memories that we search for and deliberately retrieve. Berntsen’s research is about involuntary memoriesmemories that just “happen.” These memories come from ‘out of the blue.’ They are spontaneous and unbidden.

I have just finished reading Berntsen’s book Involuntary Autobiographic Memories (2009):

Often memories of past events come to mind in a manner that is completely unexpected and involuntary. They come with no preceding decision to remember, with no plans and no commitment. They may suddenly pop up in response to stimuli in our environment or aspects of our current thought.” (Berntsen, 2009, p. 1)

Sound familiar?  Hmmm. You can readily see why this scholar and researcher of involuntary memory would ask, ‘Are the flashbacks that clinicians talk about any different from this?’

Momentary aside: Many of you will immediately recognize that Berntsen’s question reflects the eternal tension between clinicians and nonclinical academics. Clinicians describe dramatic clinical phenomena and propose theories and mechanisms to explain them. Nonclinical academics then say, “Yes, but… [a] ‘How is this different from what we already understand very well to be a natural phenomenon of X,’ or, somewhat more harshly, [b] ‘You are really talking about X and you clearly have not kept up with the excellent, well-replicated research about X,.’ or contemptuously, [c] ‘You guys have no idea what you are talking about (but we true academics do) and we pity the havoc that you are wreaking upon your clients!” Thus it has always been. And, one assumes, always will be.

I find Berntsen to be enlightening and enriching because she belongs to the first of these three groups of academics.

Berntsen cites Hermann Ebbinghaus (1885), the revered psychologist who pioneered and inspired all subsequent research on human memory. Ebbinghaus stated that there are three kinds of memory, one of which is involuntary. Thus, like Ebbinghaus, Berntsen claims that “involuntary memory is a basic mode of remembering of the personal past” (p. 3, emphasis added).

This mode of remembering is associative and, Berntsen suggests, the evolutionary forerunner of voluntary memory. In keeping with her evolutionary perspective, she concludes that involuntary memory is “unlikely to be specific to humans’ (p. 18). So — other species, too. A very basic mode of remembering.

Special Mechanisms

Nonclinical academics regularly disagree with clinicians about the nature of clinical phenomena. On the one hand, clinicians tend to posit the existence of a special (pathological) mechanism which generates the clinical phenomenon in question. On the other hand, nonclinical academics typically claim that no special mechanism is needed because well-studied universal mechanisms (in this case, the mechanisms of involuntary memory) are quite capable of producing that particular clinical phenomenon (in this case, flashbacks).

A few days ago, we examined Chris Brewin’s explanation of flashbacks. Yup. Brewin uses a special mechanism to explain flashbacks — namely, a pathologically weak connection between (1) overly strong imagistic-sensation memory (S-reps) and (2) weak or nonexistent verbal-contextual memory (C-reps). Thus, according to Brewin, there are (1) fragmented imagistic-sensation memories of the trauma and (2) an impaired narrative of the trauma. As a clinician, Brewin’s model makes a lot of sense to me.

But now, along comes Berntsen (and other memory researchers) who insist that flashbacks are nothing special. Flashbacks, they say, are involuntary, autobiographical memories that predictably follow a trauma. Oh, in case you’re wondering, Brewin is well aware of Berntsen’s research. She and other memory researchers are extensively cited by him in the article that we discussed a few days ago (Brewin, Gregory, Lipton & Burgess,   2010).

Let’s examine Berntsen’s work. Is her account of involuntary autobiographical memories a better (i.e., simpler) explanation of flashbacks than our typical clinical formulations?

Involuntary vs. Voluntary Autobiographical Memories

Berntsen discusses memory in terms of encoding, maintenance, and retrieval. She firmly asserts (and adduces research data which seems to support her claim), that voluntary memory and involuntary do not differ in their encoding or their maintenance. She argues that the only difference is the way they are retrieved.

Memories are voluntarily retrieved via an intentional, top-down, frontal lobe-driven search procedure. In contrast, memories are involuntarily retrieved via a bottom-up, automatic, associative process to a cue that is (usually) encountered quite by accident.

Associative retrieval endows involuntary memory with several notable features. In contrast to voluntary memories, involuntary autobiographical memories are more often specific (i.e., they refer to a particular episode), more often distinctive, tend to have greater relevance to the person’s life story, and more often produce an identifiable emotional impact and/or a noticeable physiological reaction (Think: reliving). In addition, these memories are quicker; they have a shorter latency in response to the cue that triggers them. These features of involuntary autobiographical memory are not just theoretical speculations; they have been demonstrated empirically in study after study.

What Triggers Involuntary Autobiographical Memories?

Berntsen divides her answer to this question into three parts: (1) factors that influence retrieval in both voluntary and involuntary memory, and (2) factors that are substantially unique to involuntary autobiographical memory, and (3) factors that research has shown to be highly associated with the occurrence of involuntary memories.

1.Factors common to both kinds of recall. Berntsen is at pains to enumerate the retrieval factors that are common to both kinds of autobiographical memory. I think she emphasizes these factors because she wants to counter clinicians’ claim that flashbacks are special and different — for example, that the mechanisms of flashbacks are different from those of other forms of memory. She discusses Brewin, Dalgleish & Joseph’s (1996) Situationally Accessible Memory (SAM) system which supposedly stores only memory that “was not fully consciously processed at the time of the event” (Berntsen, 2009, p. 151) — that is emotions, bodily sensations, or fragments of perception (Think: flashbacks). Berntsen says, perhaps with a certain degree of asperity:

This is a radical idea that contradicts what is generally known about attention during encoding and subsequent memory…” (p. 151).

In any case, Berntsen lists several factors that influence the accessibility of both voluntary and involuntary memories: the recency of the event, its emotional intensity, whether it was emotionally positive, its frequency of rehearsal (i.e., how often the person talked or thought about it), its degree of life impact, its novelty, and its distinctiveness. She reviews the experimental evidence which demonstrated these factors to be associated with increased retrieval of such memories, both voluntarily and involuntarily.

2. Factors that are disproportionately conducive to involuntary recall. Based on her research, Berntsen identifies three factors that are especially conducive to triggering an involuntary autobiographical memory: (1) a very infrequent cue that matches only one past event; (2) a cluster of simultaneous cues, several of which simultaneously match aspects of a particular past event; and (3) a commonly occurring cue that evokes a memory that involved that cue as part of a novel or quite distinctive context.

3. Factors that are highly associated with involuntary recall. Finally, Berntsen summarized the results of her research on the correlates of involuntary autobiographical memories. Cues were especially likely to trigger an involuntary memory if they matched a particular part of the memory content. The most frequent triggers of these memories were specific objects, activities, people, and themes.

Berntsen also found that certain states of mind were more likely to evoke involuntary recall. Most generally, involuntary recall is more frequent when a person is relaxed or in an unfocused state of awareness. Also, certain states of mind seem to sensitize the person to cues that might relate to one’s life situation (e.g., current concerns, important unfinished personal business, or a recent especially powerful event). Berntsen concluded that, if a person has a current concern that is highly pressing, then even very vague cues may activate memories that relate to that concern.

Final thoughts

Those of us who know a bit about flashbacks must recognize that many of the above points are associated with flashbacks. Now, we also know that these points are associated with all manner of involuntary autobiographical memories. Berntsen and other memory researchers contend that they have explained flashbacks (without needing to invoke any special mechanisms).

Have they? What do you think? Is there anything about flashbacks that the above account does not adequately explain?

More to come.

Posted in evolution, flashbacks, PTSD, skepticism, trauma | Tagged , , , , | 11 Comments

Forging a Deeper Understanding of Flashbacks: Part II

Flashbacks have at least four striking features:

1. Flashbacks are experiential, marked by a sense of reliving, accompanied by sensations and affects).

2. Flashbacks are distinctly fragmentary.

3. Flashbacks are autonomous and involuntary.

4. Flashbacks are frequently associated with dissociative amnesia.

In this post, I will focus solely on the first of these — the experiential/reliving quality of flashbacks.

Why Are Flashbacks Experiential Rather Than Cognitive?

Perhaps the best current answer to this question comes from Chris Brewin in England (Brewin, Gregory, Lipton & Burgess, 2010). Brewin is one of the leading cognitive psychologists in the world. He has been studying PTSD and its intrusive symptoms for the last 15 years or so (see also Brewin, Dalgleich & Joseph, 1996). Brewin proposes that humans have two memory systems for episodic and autobiographical memory: (1) a contextual memory system that represents an event via abstract, contextually-bound representations of the event (“C-reps”), and (2) a low-level sensation-based memory system that represents events via their sensations (“S-reps”).

Although Brewin prefers to characterize these two memory system in terms of whether the context of the event IS associated with the memory representation (C-reps) or IS NOT associated with it (S-reps), he is basically talking about the difference between verbal memory and imagistic sensation memory. In a nutshell, Brewin says that both of these memory systems are part of our normal functioning. They work together.

An extreme event (i.e., trauma), however, may produce very strong imagistic sensation memory (S-reps) and weak/disconnected or even absent verbal contextualized memory (C-reps) of the event. Brewin refers to this situation as “pathological encoding.”

Brewin’s explanation of flashbacks. If a person has:

(1) a weak/disconnected or absent verbal contextual memory of an event (C-rep), AND

(2) a strong imagistic sensation memory of the event (S-rep), THEN

(3) whenever the the imagistic sensation memory is activated, “it is vividly re-experienced in the present” (Brewin et al., 2010, p. 224). AND,

(4) if the verbal contextual memory is completely absent, it will produce “extreme reexperiencing, in which all contact with the current environment is temporarily suspended” (p. 225) [i.e., a dissociative flashback]

Brewin also considers flashbacks to be adaptive:

Flashbacks are an adaptive process in which stored information can be re-presented and processed in greater depth once the danger is past” (p. 221)

From this point of view, PTSD develops when a person fails to process the information contained in the S-reps. Brewin is quite clear in stating that such a failure is AN ACTIVE PROCESS which prevents integration of the information and perpetuates the flashbacks:

“If flashbacks are to persist. there must be mechanisms to perpetuate this lack of integration. PTSD sufferers show marked behavioral and cognitive avoidance and find their intrusions (or certain parts of them) too unpleasant to attend to, which could plausibly account for the fact that the corresponding C-rep [verbal contextualized memory] remains incomplete.” (p. 225)

I think that Brewin’s model has a clean and simple elegance. In terms of the parsimony that is highly valued in science, Brewin’s model is quite nice. Nevertheless, I have a few reservations.

1. Brewin considers flashbacks to be adaptive. This position has always bothered me and, perhaps, I now understand better why I feel that way. Certainly, part of this idea –that flashbacks are adaptive — must be correct. Certainly, we have an innate tendency to find consistency in our minds and to resolve things that don’t fit. The part of this that bothers me is that flashbacks are NOT the same as normal intrusive thoughts (which Horowitz talked about in terms of “the completion principle” and coming to terms with major life events). Flashbacks are not cognitive; they are experiential. Flashbacks are not thoughts; they are (often) a bit like sticking your finger in an empty light bulb socket. I find it hard to consider electric mental shocks to be ADAPTIVE.

2. Brewin states that flashbacks are caused by pathological encoding of an event. By this, he means that an event can be so extreme that it produces very strong imagistic sensation memory (S-reps) and weak/disconnected verbal contextual memory (C-reps). So far, I like this description of flashbacks a lot. My apprehension is about the next step in Brewin’s reasoning. In his view, all that is needed for a flashback to occur is for the imagistic sensory memory to be activated. Boom! Flashback!

I feel a bit like Peggy Lee — “Is that all there is?” Is there no other factor involved? I feel like something is missing. I feel this even more strongly when Brewin uses this same formula to explain dissociative flashbacks. According to Brewin, if the verbal contextual memory is completely absent, then any activation of the S-rep will cause a flashback that produces a complete loss of contact with the here-and-now.

What is the something else that might be missing? In nondissociative flashbacks, I think the missing piece is affect — usually fear. Have you noticed that both flashbacks and their treatment (i.e., some form of prolonged exposure) operate according to the model of a simple phobia. I think that flashbacks are a perverse positive feedback loop among the amygdala and the decontextualized S-reps (and perhaps the insula as well). This is basically a phobic reaction to the images and sensations associated with the traumatic event. In short, I think flashbacks are driven by a ‘pulsing’ amygdala.

I also think that there is something missing in Brewin’s explanation of dissociative flashbacks — namely, a hypnotic brain. I would be willing to bet that dissociative flashbacks only occur in PTSD patients with high hypnotizability. High hypnotizability is a normal trait, but I think a flashback operates as something of an implicit ‘suggestion’ to remember/reexperience the event. If this is correct, then  dissociative flashbacks are a binary phenomenon (flashback + hypnotic response). Elsewhere, I have described this binary phenomenon in terms of the flashback ‘hijacking’ a normal ability (i.e., high hypnotizability) or a normal mechanism (i.e., a hypnotic brain).

Time to end this post. It has gotten too long.

But, for the research mavens in our midst, there is a bonus round.

RESEARCH IDEAS: There are surprisingly few empirical publications on flashbacks. There are even fewer articles on the phenomenology of flashbacks.

1. If PTSD patients who report having dissociative flashbacks are compared to PTSD patients with no history of dissociative flashbacks, will these two groups differ in their hypnotizability?

2. What is the difference, if any, between the flashbacks (that are experienced in the first month after trauma) of those who go on to develop PTSD and those who do not develop PTSD?

3. What is the difference, if any, between the flashbacks of trauma survivors who develop Acute Stress Disorder (ASD) and those who do not?

4. What is the difference in the flashbacks that are experienced by PTSD patients with low dissociation scores vs. those that are experienced by PTSD patients with high dissociation scores?

5. What is the difference in the flashbacks that are experienced by PTSD patients with high hypnotizability and those that are experienced by PTSD patients with low hypnotizability?

6. What is the difference in the flashbacks of ASD patients with high hypnotizability and those of ASD patients with low hypnotizability?

7. What is the difference between the flashbacks of persons with DID and the flashbacks of persons with PTSD only (and are there two identifiable subgroups among the PTSD patients — dissociative and nondissociative)?

Note: The key issue in each of the above research questions is the phenomenology of the flashbacks. Not all flashbacks are the same. There is a great need for all kinds of phenomenological research on flashbacks.

Skepticism About Trauma and PTSD

Graduate students who are interested in such research topics are counseled to beware of skeptics in academia. Graduate students should know that there are some academics with highly jaundiced views about the reality of trauma, the reality of flashbacks, and the very existence of PTSD. These skeptics can be found in some clinical psychology programs in the US and especially in academic settings in the UK. Even Chris Brewin, a very well-respected British researcher of PTSD, found it necessary to title his recent book: Posttraumatic Stress Disorder: Malady or Myth. ‘Nuf said for now.

Posted in Acute Stress Disorder, dissociation, dissociative identity disorder, dissociative subtype, flashbacks, PTSD, research ideas, skepticism, trauma | Tagged , , , , , , , | 10 Comments

Forging a Deeper Understanding of Flashbacks: Part I

I believe that experienced trauma therapists (Think: PTSD specialists) possess an approximate, rather cognitive understanding of flashbacks. On the other hand, I am certain that dissociative disorders therapists (Think: DID specialists) have a much richer grasp of flashbacks, but I don’t think that their richer grasp adds up to a truly rigorous understanding. Not yet, anyway. I guess what I’m saying is that we all probably know less about flashbacks than we think we do. And much of what we do know consists of the hard-won clinical insights of individual therapists — insights that are seldom written down (and thereby made available for general discussion)..

Let’s try to forge a better understanding of flashbacks. This is obviously a very difficult task or it would already have been accomplished. By the way, I, too, find this task to be very difficult.

The Stress of Major Life Events

When I was a graduate student in the early 70s, the Holmes and Rahe Stress Scale was quite popular (Holmes & Rahe, 1967). The scale consists of 43 life events, each with an assigned stress value. The most stressful event is Death of a Spouse (with a stress value of 100). Strikingly, even positive events are stressful (e.g., raises in salary, outstanding personal achievements, vacations). Holmes and Rahe reported that increased stress was associated with an increased incidence of illness.

At about the same time, Mardi Horowitz was studying the intrusive thoughts that follow major life event. Horowitz found that major life events, whether positive or negative, were always followed by intrusive thoughts (about the event). According to Horowitz’ model, these thoughts keep intruding into conscious awareness until the person has cognitively assimilated the event and, ideally, fully accomodated to the event’s personal implications.

Sound familiar? But remember, we’re not talking trauma here. Just major life events. These intrusive thoughts are not flashbacks. They are simply automatic, unbidden thoughts about a big change in your life. Think about: Winning the Lotto. Guaranteed to produce intrusive thoughts for quite a while!

Intrusive thoughts after a major life event are absolutely normal. Major life events always have implications for oneself, one’s future, and one’s place in the world. Consequently, each of these understandings about self and world (and, sometimes, a whole lot more) needs to be recalibrated. Horowitz called this process of recalibration the completion principle. The essential idea here is that intrusive thoughts continue to recur until the person finishes accomodating to the major life event.

Note: The Janet scholars in our midst will note a distinct affinity between Horowitz’ ideas and Janet’s ideas about realization and personification.

In any case, many clinicians have applied Horowitz’ model to flashbacks. Interestingly, many clinicians come to this idea on their own — without having read Horowitz. After all, Horowitz’ model is a very sensible and appealing idea. But, I’m not sure how well the model applies to flashbacks. Maybe yes, maybe no. I’m still on the fence about this one.

The Difference Between Intrusive Thoughts and Flashbacks

Let’s get one thing out of the way. The kinds of intrusive thoughts that follow a major life event are absolutely normal. In fact, I think evolution has shaped the functioning of our neocortex such that Horowitz’ completion principle is built into us. But — there are, indeed, many kinds of abnormal intrusive thoughts.

Good places to find people suffering from abnormal intrusive thoughts? People with obsessive-compulsive disorder. Schizophrenics. People with anorexia nervosa.

In this section of my blog post, however, I am not talking about OCDs, schizophrenics, or anorexics. I am talking about you and me and our normal reaction to major life events — automatic, unbidden, intrusive thoughts about that event until we come to terms with it.

OK. How are flashbacks different from these normal intrusive thoughts? First of all, flashbacks are not thoughts. They are perceptual (imagistic, sensory, and emotional). Thoughts involve both language and awareness-of-the-self-that-is-thinking. Both of these may be lost during flashbacks.

With normal intrusive thoughts, there is always a clear connection between self and the intrusive thought. We own that thought and accept it as mine. The ‘work’ that needs to be done with intrusive thoughts is to fit that major life event — and its personal implications — into our understanding of ourselves and our world. Said differently, we need to accommodate our existing narrative (i.e., our understanding) of self and world to this new information. As we sometimes say about a new idea, “I need some time to wrap my mind around this.”

Flashbacks Exist Outside Language

As humans, we have language and a human consciousness. We live in a narrative world. Our very human existence is inseparable from language. Humans live a narrative existence. That is what it is to be human. We live within language. Flashbacks lie outside language. They are perceptual — imagistic, sensory, and emotional.

Psychologists and philosophers occasionally talk about “raw, sensory data.” But the notion of raw, sensory data is largely a fiction. We don’t perceive raw sensations. What we perceive is already, preconsciously, sorted/arranged into some familiar object or category. We perceive objects and categories — not raw sensations.

I apologize for getting all philosophical on you, but I think this particular point is crucial for understanding flashbacks. Intrusive thoughts come to us already formed into language. Flashbacks don’t. Flashbacks are fragmented images, sensations, and affects. In order for a flashback to finally stop, we must bring those fragments into language. We must develop a narrative of what happened.

OK, this is a good stopping point. What do you think about flashbacks existing outside language?

Posted in dissociation, evolution, first-person accounts, flashbacks, PTSD, trauma | Tagged , , , , , , , | 40 Comments

What Are Flashbacks and Why Do They Happen?

Experienced trauma therapists know that persistent flashbacks are incredibly toxic; they frequently cause counter-productive coping, escalating depression, suicidality, clinical emergencies, and hospitalizations. Today’s question is not how to manage flashbacks, but something much more fundamental: “What the heck are they?” We know what they look like. We know their clinical impact. We have a fair idea how to help our patients with them. But what are flashbacks, really? Why do they happen? What is their function? Do they even have one?

When Is Dissociation Not a Defense?

My previous post challenged the concept of dissociation-as-a-defense by asking, “Are flashbacks dissociative?” Our discussion of this question produced an unanticipated (at least by me) outcome.

Therapists (including me) repeatedly insisted that some flashbacks (i.e., those characterized by a complete loss of contact with the here-and-now) are unquestionably dissociative. On the other hand, therapists had almost nothing to say about the fact that flashbacks are not a defense. Their comments suggest that, for them, the most salient feature of flashbacks is the patient’s complete loss of contact with present-day reality.

In contrast to therapists, dissociative individuals had a very different point of view. These ‘insiders’ insisted that flashbacks are not dissociative. In fact, they pronounced flashbacks to be “the opposite of dissociation.” I take this to mean that they are highly aware of the defensive, protective function of dissociation. And why not? After all, they have a personal stake in the matter. Flashbacks have all the subtlety of being blindsided by an 18-wheeler. They know damned well that flashbacks represent a failure or collapse of their dissociative defenses.

Neuroimaging Studies of Flashbacks and Dissociative Symptoms

Functional magnetic resonance imaging (fMRI) studies of PTSD patients have repeatedly shown startlingly different patterns of brain activity during flashbacks versus during acute incidents of dissociation. In these studies, PTSD patients and trauma-exposed persons without PTSD listened to scripts of their worst trauma and visualized the trauma while being scanned in an fMRI machine.

This procedure triggered flashbacks and hyperarousal in about 70% of the PTSD patients, and an episode of acute dissociative distancing in the remaining 30%. In the lead article of the July issue of the American Journal of Psychiatry, Ruth Lanius and colleagues reviewed this body of literature and analyzed its implications (Lanius, Vermetten, Loewenstein, Brand, Schmahl, Bremner & Spiegel, 2010).

The flashback/hyperarousal PTSD patients exhibited a pattern of brain activity which indicated a failure of corticolimbic inhibition. Specifically, the flashback/hyperarousal PTSD patients exhibited (1) an abnormally low activation in the ventromedial prefrontal cortex and the rostral anterior cingulate, and (2) increased activation of the limbic system, especially the amygdala and the right anterior insula.

Translation: The brain regions associated with modulation of arousal and regulation of emotions were largely shut down, while the brain regions associated with emotion, fight/flight responses, and the experience of these reactions were highly activated.

The PTSD patients with dissociative distancing exhibited a pattern of brain activity which indicated excessive corticolimbic suppression. That is, they exhibited (1) an abnormally high activation the dorsal anterior cingulate and the medial prefrontal cortex, and (2) decreased activity in the amygdala and right anterior insula.

Translation: The brain regions associated with modulation of arousal and regulation of emotion were abnormally activated, while the brain regions associated with emotion and its experience were substantially inactivated.

A Dissociative Subtype of PTSD

Lanius and colleagues concluded that there is a dissociative subtype of PTSD which is quite different from the more common re-experiencing/hyperarousal type of PTSD that is so well described by the DSM-IV criteria for PTSD. Both types of PTSD undergo flashbacks, but only the dissociative subtype frequently experiences a spontaneous dissociative distancing of the memory of the trauma. Moreover, as one ‘insider’ member of our community of dissociation aficionados has noted, and as Lanius et al. also reported, a person who has the dissociative subtype of PTSD may simultaneously experience a flashback and a dissociative distancing from that flashback.

Finally, as that same aficionado wryly asked, if we are going to call flashbacks a form of dissociation, does dissociative distancing from a flashback = “dissociating from the dissociation”? Flashbacks and dissociative distancing really are very different. And it is very confusing to call both of these things “dissociation.”

Finally, it may be worthwhile to know that Lanius and colleagues define dissociation as “detachment from the overwhelming emotional content of the [traumatic] experience” (p. 640). This is certainly a reasonable description of dissociative distancing (but a very poor description of a flashback).

Final Comment: Well, we have covered a fair amount of material about the relationship between flashbacks and dissociation, but we still don’t know exactly what a flashback is. And we certainly don’t know why they occur.

PS. I know they are triggered by a reminder of the trauma. The important question is,“Why does the reminder of trauma trigger a flashback (instead of just a memory)?”

Posted in alterations of consciousness, defense, dissociation, dissociative subtype, DSM-IV, evolution, evolution-prepared dissociation, first-person accounts, flashbacks, neurobiology, PTSD, published/presented research, repression, trauma | Tagged , , , , , , , , , , , , , | 27 Comments

Are Flashbacks a Dissociative Symptom?

Dissociation is generally considered to be a defense mechanism because it distances us from painful or unacceptable realities (e.g., depersonalization, derealization) or it makes a painful reality disappear entirely (i.e., dissociative amnesia). Today’s thought question is: “Are flashbacks dissociative?” Do flashbacks protect us from a painful or unacceptable reality?

Hmmm. This is definitely an interesting question. PTSD patients seldom celebrate the ‘comforting’ or ‘protective’ nature of their flashbacks. 🙂

The Current Draft of DSM5 Insists That Flashbacks Are Dissociative

In contrast to DSM-IV, DSM5 may claim that  flashbacks are a dissociative reaction. In the current working draft of DSM5, the list of intrusive symptoms for PTSD includes flashbacks — described as follows:

Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.)…” (www.dsm5.org, emphasis added)

Many dissociation experts have long argued that flashbacks are a dissociative symptom. These experts consider DSM5’s understanding of flashbacks to be a significant advance from DSM-IV. But is it? Is it an advance? Is it even correct?

Four Other Models of Dissociation


If dissociation protects a person from something painful or unacceptable, then flashbacks certainly cannot be an example of dissociation. On the other hand, according to several other descriptions or models of dissociation, flashbacks are definitely dissociative. For example, DSM-IV states that:

“The essential feature of the Dissociative Disorders is a disruption in the usually integrated functions of consciousness, memory, identity, or perception.” (DSM-IV-TR, p. 519, emphasis added)

Yup, flashbacks are definitely disruptions of the usually integrated functions of consciousness, memory, and perception.

2. ICD-10

Clinicians in the United States are guided by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Clinicians everywhere else are guided by the World Health Organization’s International Classification of Diseases (ICD-10). According to ICD-10:

“the common theme shared by dissociative (or conversion) disorders is a partial or complete loss of the normal integration between memories of the past, awareness of identity and immediate sensations, and control of bodily movements.” (World Health Organization, 1992, p. 151, emphasis added)

By this definition, flashbacks are unmistakably dissociative; they are a partial or complete disruption of normal integration.

3. Dell and O’Neil (2009)

OK. That’s what the two ‘Bibles’ say, How do other sources define dissociation? In 2009, John O’Neil and I published a large edited volume whose purpose was to bring clarity to dissociation and the dissociative disorders. In the book’s preface, we offered a three-paragraph definition of dissociation. That definition begins with this sentence:

The essential manifestation of pathological dissociation is a partial or complete disruption of the normal integration of a person’s psychological functioning. (Dell & O’Neil, 2009, p. xxi, emphasis added)

After reading what DSM-IV and ICD-10 had to say on this matter (above), the Dell and O’Neil definition has to feel distinctly familiar. And again, according to this definition, flashbacks must be classified as dissociative.

4. Dell (2006)

Finally, bear with me as I present one final definition of dissociation — my own definition from 2006:

“the phenomena of pathological dissociation are recurrent, jarring intrusions into executive functioning or sense of self by self-states or alter personalities.” (Dell, 2006, p. 8, emphasis added)

Note that this definition of dissociation has two parts. According to the first part, flashbacks are certainly dissociative because they are recurrent jarring intrusions into executive functioning. On the other hand, according to the second part of the definition, flashbacks are dissociative only if they are caused by self-states or alter personalities.

The difference between my 2006 definition of dissociation and the three preceding definitions is that my 2006 definition goes beyond description and phenomenology. Namely, it defines dissociation in terms of a specific mechanism — a self-state or alter personality that intrudes into conscious functioning.

This is where an annoying narrator would say: “The discerning reader will have noticed …”  I’ll try to avoid being that annoying, but there is an important point to be made here.

The point is this: In 2006, when I added that mechanism to my definition of dissociation, I added a structural model of dissociation to the DSM-IV and ICD-10 accounts of dissociation.

Translation: Disruptions of normal integrated functioning are dissociative if, and only if, they are caused by a self-state or alter personality (i.e., caused by a dissociative structure of the personality).

Aha! Now the fun really begins. We have a new question: Are flashbacks caused by dissociated structures?If they are — and Van der Hart, Nijenhuis, and Steele insist that they are — then:

(1) the flagship symptom of PTSD (i.e., flashbacks) is a dissociative symptom, and

(2) PTSD itself is a dissociative disorder.

The proponents of structural dissociation firmly insist upon both of these points: flashbacks are dissociative and PTSD is a dissociative disorder. But.. The Powers That Be in DSM5-land do not think that PTSD is a dissociative disorder — and I agree with them.

Worse, I think that both the structuralists and the DSM5 Powers That Be are wrong about flashbacks. Although some flashbacks seem to be distinctly dissociative, I think it is a big mistake to classify all flashbacks as dissociative.

Posted in defense, depersonalization, derealization, dissociation, dissociative disorders, DSM-IV, DSM5, first-person accounts, flashbacks, ICD-10, PTSD, repression, structural dissociation | Tagged , , , , , , , , , , , , | 59 Comments

Persisting Peritraumatic Dissociation Is Different From Evolution-Prepared Dissociation

Evolution-prepared dissociation provides a hyper-clear picture of the dangerous circumstances that evoked it. In contrast, non-evolution-prepared peritraumatic dissociation does precisely the opposite — it distances, obscures, pushes away, avoids, hides, and blocks a clear picture of the dangerous circumstances that evoked it. Researchers’ failure to distinguish between these opposite kinds of dissociation has prevented us from obtaining a clear empirical picture of (1) these two kinds of dissociation, and (2) their respective relationships to posttraumatic psychopathology (i.e., acute stress disorder [ASD], PTSD, and the dissociative disorders).

Evolution-Prepared Dissociation

As noted in UnderstandingDissociation.com’s last post (and in comments from several of you), evolution-prepared dissociation involves accelerated mental processing, a hyper-focus on the details of the dangerous situation, a subjective slowing of time, and a dissociative suppression of fear, pain, and other disruptive emotions. This ‘package’ of responses is a ‘gift’ that natural selection has given us. It is highly adaptive and it maximizes our ability to take effective action and, thereby, survive an imminently lethal situation.

Peritraumatic Dissociation

Note: “peritraumatic” literally means ‘near or around the time of the trauma.’  Contrast evolution-prepared evolution with DSM-IV’s description of peritraumatic dissociation:

“a subjective sense of numbing, detachment, or absence of emotional responsiveness; a reduction in awareness of his or her surroundings; derealization; depersonalization; or dissociative amnesia…” (American Psychiatric Association, 2000, p. 469)

This view of peritraumatic dissociation is inseparable from the idea that dissociation is a defense mechanism. For example:

“Dissociation leads to inner distancing and is thus to be regarded as a fundamental withdrawal mode enabling the person in question to phase out the unbearable reality for the moment and pretend that it has never happened.” (Breh & Seidler, 2007, p. 54)

Research on Peritraumatic Dissociation

Neither the researchers of peritraumatic dissociation, nor the instruments that they use to measure it, have drawn a clear distinction between defensive peritraumatic dissociation (which seeks to avoid reality) and adaptive evolution-prepared dissociation (which shines a bright spotlight on reality)! No wonder the research on dissociation that occurs near or around the time of the trauma (i.e., both kinds of dissociation) has produced modest and inconsistent results. Specifically, instruments that indiscriminately mix defensive peritraumatic dissociation with adaptive peritraumatic dissociation produce scores that are only modestly related to subsequent PTSD symptoms (Effect size = .34-.36). This effect size is significant, but not especially impressive.

On the other hand, researchers who have distinguished between immediate peritraumatic dissociation and peritraumatic dissociative symptoms that persist for weeks have found a very different result. Their multivariate statistical analyses show that immediate peritraumatic dissociation is unrelated to subsequent PTSD, whereas persisting peritraumatic dissociative symptoms are highly related to subsequent PTSD (Briere, Scott & Weathers, 2005). Similar results have been reported by other researchers (Halligan, Michael, Clark & Ehlers, 2003; Murray, Ehlers & Mayou, 2002; Panasetis & Bryant, 2003) .

It is important to note, however, that peritraumatic dissociation (whether immediate or persistent) is not the whole story when it comes to developing PTSD. That is, the same studies that revealed the importance of persisting peritraumatic dissociative symptoms also showed that

(1)many persons with no peritraumatic dissociation go on to develop PTSD, and

(2) many persons experience peritraumatic dissociation, but do not develop PTSD.

The Next Question About Dissociation

The next big question about dissociation at this point in our discussion is: “How and why does peritraumatic dissociation persist in some people? And perhaps become chronic? And why and how does peritraumatic dissociation persist a bit for some individuals, but then ultimately subside without any psychopathological after-effects?

What do you think?

Posted in Acute Stress Disorder, defense, depersonalization, derealization, dissociation, dissociative disorders, evolution, evolution-prepared dissociation, measures of dissociation, peritraumatic dissociation, PTSD, published/presented research, trauma | Tagged , , , , , , , , , , | 12 Comments

The Evolutionary Link Between Trauma and Dissociation

As a clinician who wants to understand dissociation, I keep bumping into two fundamental questions:

1. What is the relationship between trauma and dissociation?

2. What is the relationship between dissociation and PTSD?

I ended my last post with a question about dissociation and PTSD (i.e., “Do all persons with PTSD have structural dissociation?” — as the proponents of structural dissociation contend). Let’s defer consideration of that question for now. Instead, let’s address the most basic issue of all– the relationship between trauma and dissociation.

Trauma-Dissociation Skeptics and Deniers

If you do not read the academic literature on trauma and dissociation, you may not know that there is a contingent of skeptics in academia who insist that there is no causal connection between trauma and dissociation. These skeptics often seem to ‘cherry pick’ scientific findings in order to support their preconceptions. These ‘guys’ remind me of the people who insist that there is no global warming or who reject Darwin and evolutionary theory. In any case, I will not talk about these skeptics today. I just wanted to make sure that you know these skeptics exist.

Evolution-Prepared Dissociation

Evolution produced the original link between trauma and dissociation. Natural selection, however, is never really about trauma or dealing with trauma. Natural selection is about survival (and reproduction).

So, the original link between trauma and dissociation was actually a link between (a) imminent threat of death (i.e., survival) and (b) a sudden alteration of information processing that involves dissociation. The threat of immediate death triggers a shift to an altered (and accelerated) form of information processing: rapid thinking, very high mental acuity, a slowed sense of time, and an automatic dissociative silencing of pain, fear, and other emotions that could interfere with survival-related thought and action. These survival-related shifts maximize the person’s ability to act decisively and effectively.

Survival-related dissociation is not a recent evolutionary development. Its origins do not lie in the human neocortex, but in the paleomammalian brain — the midbrain (e.g., periacqueductal gray) and parts of the limbic system. I emphasize the subcortical location of this evolution-prepared dissociation because it is probably very different from the dissociation of persons with a major dissociative disorder (which, I think, is largely located in the neocortex).

What Does Evolution-Prepared Dissociation Look Like?

The first, and still one of the best, accounts of evolution-prepared dissociation (although not labeled as such) was published in 1892 by Albert Heim in a Swiss mountain climbing journal. Heim interviewed dozens of mountain climbers who had survived potentially lethal falls. Ninety-five percent of them described some version of the following experience:

[N]o grief was felt, nor was there paralyzing fright of the sort that can happen in instances of lesser danger (e.g., outbreak of fire). There was no anxiety, no trace of despair, no pain; but rather calm seriousness, profound acceptance, and a dominant mental quickness and sense of surety. Mental activity became enormous, rising to a hundred-fold velocity or intensity. The relationships of events and their probable outcomes were overviewed with objective clarity. No confusion entered at all. Time became greatly expanded. The individual acted with lightning quickness in accord with accurate judgment of his situation… Men who had fallen from great heights were unaware that their limbs had been broken until they attempted to stand. (Heim, 1892/1980, pp. 130-131)

The next contribution to our understanding of evolution-prepared dissociation did not occur for another 80 years. In the late 1970s, Russell Noyes, a near-death researcher, interviewed many people who had near-death experiences (e.g., falls, accidents, near-drownings, etc.). Here is one such account (of a person who was driving at 60 miles per hour when the steering on his car failed):

My mind speeded up. Time seemed drawn out. It seemed like five minutes before the car came to a stop when, in reality, it was only a matter of seconds. I remember that my sense of touch and hearing became more acute…. My mind was working rapidly and reviewed information from driver’s education that might bear on what I should do to save myself…. While all this was taking place I felt calm, even detached. (Noyes, Kletti & Kupperman, 1977, p. 376)

The Essential Features of Evolution-Prepared Dissociation

It is crucial to appreciate that evolution-prepared dissociation is utterly biological. It is ‘hard-wired,’ and not psychological. It is not a defense. It has been built into all of us by natural selection.

Evolution-prepared dissociation has six characteristics:

1. It is about danger, threat to life, and survival.

2. It is automatic and near-instantaneous.

3. It is just one component of an organized response to an immediate threat to survival.

4. It is a brief, time-limited phenomenon (which ceases as soon as the danger is over).

5. It is a subcortical response (i.e., from phylogenetically old areas of the brain).

6. It is completely normal. There is nothing whatsoever that is pathological about evolution-prepared dissociation.

How Does Evolution-Prepared Dissociation Relate To Chronic Dissociative Symptoms?

I believe that evolution-prepared dissociation is the original root of human dissociation. But — and this is a big but — I also believe that evolution-prepared dissociation is not the chronic dissociation of persons with posttraumatic and dissociative disorders. Chronic dissociation seems to be a phenomenon of the human neocortex. Still, there may (or may not be) important links between chronic dissociative symptoms and the mid-brain structures of evolution-prepared dissociation.

Peritraumatic Dissociation

The closest approximation to evolution-prepared dissociation in the literature is the concept of peritraumatic dissociation. I will explain in a future post my thoughts about the relationship between evolution-prepared dissociation and peritraumatic dissociation.

OK. I hope that this post has given you a lot to ‘chew on.’ What do you think? Don’t hold back. Let yourself really think about these ideas — and share your thoughts with our little community of dissociation aficionados. By the way, personal reports of your own experience with evolution-prepared dissociation are welcomed.

Posted in defense, dissociation, evolution, evolution-prepared dissociation, first-person accounts, peritraumatic dissociation, PTSD, research ideas, skepticism, structural dissociation, trauma | Tagged , , , , , , , , , , | 38 Comments

It Takes a Community To Understand Dissociation

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?

Posted in alterations of consciousness, dissociation, measures of dissociation, PTSD, structural dissociation | Tagged , , , | 6 Comments