In psychology, the term for detaching from reality is “dissociation.” There is a spectrum on which we all detach. Right now, as I write, I lose awareness of the dog snoring, my cold feet, the vague discomfort in my seat; I am dissociating from the physical world around me. This is a mild, and useful, form of dissociation. When people are feeling stressed, they often seek relief in dissociative activities that focus their mind on the present, and hence away from what is causing the stress: reading a good book, watching a movie, playing a computer game, making a snack — these and many other normal activities can be methods of dissociation. Of course, overindulging in any of these activities can create problems; binge behavior tends to stymie one’s ability to get things done that need to be done. In more extreme cases, alcoholics who have “blackouts” may awaken with bruises or broken bones, and have no memory of how they got them, or even any memory of getting drunk. Curiously, those memories may return when drinking again. A milder but similar form of dissociation is something I frequently hear from couples who have had an argument, yet neither can remember the content of a fight or the details of what they said.
The most extreme example of dissociation is found in dissociative identity disorder (DID), formerly known as multiple personality disorder. People with DID dissociate from their normal lives to such an extreme that they are actually experiencing life in personalities different from their own. While we all feel like different people at different times, people with DID actually are different people at different times. Their different identities may have distinct voices, behaviors, memories, and even allergies.
However it is employed, dissociation is always intended to serve a purpose, and is a tool that enables people to function. It helps manage stress and the sometimes overwhelming array of sensory input that surrounds us. There are countless ways to dissociate when we are feeling uncomfortable, some of them unhealthy (taking drugs, binge eating or drinking) and some of them more ordinary (listening to music, cooking, painting a picture). Some careers seem to foster dissociation: A surgeon I know tells me that when he is in the operating room hour after hour, he has no awareness of noises, the problems in his family, or the discomfort of standing for so long. He loses connection to the reality around him as he focuses entirely on the skin, muscles, and organs that he is dissecting. Sleep, hypnotic states, and studying are also activities that can result in disconnection from some of the reality that surrounds us.
Robert Falconer, psychologist and co-author of “Many Minds, One Self,” says that “dissociation is an essential and necessary skill. You can’t concentrate unless you can dissociate. Working on a paper, you need your analytical brain on line and you need to ignore your body. And if you are making love you don’t want your analytical brain in charge, it is going to mess things up. The ability to dissociate seems to be correlated with the ability to concentrate.”
However, he goes on to point out that, “just as cell growth and replication are necessary to life process but when out of control become cancer, dissociation when out of control can interfere with living a healthy life … Our bodies’ ability to create heat and keep us warm is healthy, but overstimulated can become a lethal fever. Same with dissociation.” When people engage in suicidal behavior, binge drinking, binge eating, or binge screen time, they are dissociating in a way that becomes unhealthy for them. Having a glass of wine with dinner may help relax a person after a hard day; having four or five glasses is dangerous. Playing a game of computer solitaire between work tasks can be a helpful break; playing solitaire for hours on end can make it tough to get one’s work done.
A few years ago I ran into a psychoanalyst whom I had known as a strikingly handsome, heavyset man. Now he was slim, toned, and muscular. He told me that his weight had been fluctuating for years. When in a relationship, he would balloon up, and when alone he would again become svelte. “What happened?” I asked. “You’re married again, yet you’re toned and fit.”
“In the past when in relationships,” he replied, “I felt that I had to disconnect from myself in order to please my partner. I had learned as a young child that my survival depended on avoiding conflict with my violent older brother, and the pain of having an emotionally absent, overworked single mom who didn’t or couldn’t protect me or adequately feed us.
“There was usually flour in the house, and some sugar and eggs, so I learned to make simple cookies. While eating the cookies behind the locked door of my bedroom, I felt safe; hours would go by, and I had no sense of time passing or how many cookies I had eaten. Looking out of my window, I had very little sense of being in my body. It was the comfort zone of my childhood. I learned as a young child that whenever I felt afraid, it helped to dissociate and find comfort in food. Consciously, I didn’t know I was eating. I didn’t even taste it. Yet I felt warm and safe. I needed to create a fake, safe reality to protect myself from my brother’s brutality, from the overwhelmingly lonely, painful, and frightening reality that was my world. The choice was dissociation or despair.”
Though my friend’s insights were sharp and clearly thought out, insight and understanding in themselves rarely seem to change behavior. He went on to explain, “I have understood for years why I was overweight, but I couldn’t seem to control my eating. The part of me that was disconnecting and finding comfort in food was not going to give up easily. The shift finally came when I started to appreciate rather than shame that part of me that had learned so skillfully to protect me. I gave conscious thought to the little boy in me who felt so frightened and alone, and I imagined bringing him into my wonderful life today. In therapy I learned to check in with that boy, and assure him that I am (hence, he is too) now safe and loved, and that I will never let anyone hurt ‘us’ that way again. I will not betray that inner child by bringing him into frightening relationships. I have a wonderful partner who understands. Our conflicts are free of raised voices and threats. I am happier than I have ever been.”
As with my friend and his abusive brother and neglectful mother, the root of severe dissociation is trauma. I think of a woman I knew when I was training in New York City. An IV drug user who supported her habit through prostitution, she had had a horrific, frightening, painful childhood. Now she had a serious infection. When we wanted to draw blood, she became frantic and terrified. She refused to have blood drawn for days, but when her physical symptoms worsened, she finally agreed. Because she had injected her own veins so many times as a drug user, it was a difficult procedure, and it took many, many needle sticks to get blood. But to my surprise, she sat and watched the whole process without making a sound. She looked at the needles as if they were going into someone else’s arm, apparently feeling no fear or pain. In that moment, she was dissociating from her fear of having her blood drawn, just as her IV drug use was a way of dissociating from her memories of the rough life she’d lived.
When the world is frightening and overwhelming, disconnecting from our selves is an essential coping skill. Like a rock that fractures along unseen internal fault lines, the human psyche fractures when traumatized. Rather than being teammates, our normally integrated parts become fragmented and alienated from one other. If you are curious about the extent to which you have a tendency to disconnect from the world around you, I have found the Dissociative Experiences Scale – II useful. Find it here: http://traumadissociation.com/des.
As for my psychoanalyst friend, years have passed, and he remains happy and is taking care of his body with consistent healthy eating. The technique that he used to manage his dissociation and comfort the frightened voices in his inner world come from Internal Family Systems Therapy. (See bit.ly/OnMyMindIFST.) The theory outlined in “Many Minds, One Self,” posits, as many cultures do, that psychically we are not unitary beings, but rather have an internal array of parts or subpersonalities within us. The model of a healthy person is not something all fused into one, but more like a team or an orchestra.
It seems clear that dissociation can be a saving grace for people who are experiencing extreme trauma or distress, but dissociation itself can become a problem. When this happens, appreciating the helpful role that dissociation has played in one’s life may be key to bringing about behavioral change, as it was with my friend when he wanted to stop eating dissociatively.
As I wrote this column yesterday morning, I suddenly realized that far more time had passed than I had set aside to write. I had completely lost track of time, and if I didn’t hurry, I would be late for work. Usually my inner clock is sharp. As I dissociated, I was lost in the writing world. The experience reminded me of the dangers of too thoroughly disconnecting. Yet it is oddly comforting to be lost in an alternative world for a while.
Disconnecting from the reality around us is an essential tool for living. Detaching from one reality in exchange for another can be a great stress reliever, and even fun or spiritually enlightening. We must always remember, however, that when we disconnect too thoroughly from our day-to-day reality, it gets in the way of living a healthy life. But regardless, when horrific trauma occurs, dissociation allows us to keep functioning and survive. It is valuable, and needs to be appreciated as such.
Dr. Charles Silberstein is board-certified in general, addiction, and geriatric psychiatry, and is the psychiatrist at Martha’s Vineyard Hospital. He writes regularly about issues Islanders have with mental health.