Patrick Lemoine, MD | MedScape | April 6, 2017
Global Manifestations of Dissociation
Dissociation is a very specific and often unsettling clinical phenomenon. It’s the altered state of consciousness that occurs in people who have suffered trauma at some point in their lives and who, very often, also have what is referred to as a “borderline state” or “borderline personality disorder.”
It’s an especially interesting topic, because all of the world’s cultures describe and use altered states of consciousness—whether it’s whirling dervishes, Jews at the Wailing Wall, Christians with the Rosary, shamans, meditating lamas, or the use of psychotropic substances among certain South American tribes. In each case, there is a phenomenon referred to generally as a “trance,” which is also used in medical hypnosis.
In all of these cultures, a trance is a way to go gather information, regardless of whether the place where the information is sought is called the unconscious, the world of spirits, or limbo. It’s about seeking information elsewhere than in ordinary, everyday consciousness.
There’s another altered state of consciousness that I think is important: rapid eye movement (REM) sleep or dreaming. Once again, we use this to gather information. For example, when I do a crossword puzzle and have gone as far as I can with it, I go to sleep. The next morning, I complete the puzzle like magic. Somewhere, in my private library, I’ve gotten the solutions to the unsolved clues.
If we accept the fact that trances, meditation, and REM sleep are altered states of consciousness, we can try to better interpret, understand, or even use dissociations.
Pathological Dissociative States
Pathological dissociative states are observed in cases of severe trauma in men, but are most common in young girls. Curiously, many who have suffered trauma and exhibit dissociative states are lucid dreamers who know when they’re dreaming and are able to guide their dreams.
But the problem is that sometimes—perhaps in public, or often when they’re alone—they can fall to the floor into epileptiform convulsions and generalized tremor. If they’re in a public place, emergency medical services are called and the individual is hospitalized and possibly given injectable drugs, one more ineffective and dangerous than the next. On top of it, they’re ridiculed every time—so for them, experiencing pathological dissociative states is hell.
People who have suffered trauma very often have recurring nightmares and flashbacks about the event. In fact, these dissociative states are merely extreme flashbacks where the individual tries—in vain, unfortunately—to find a solution to their trauma. It doesn’t work. It’s like when you’re sending an email, but the attachment is too large. Your computer just jams and spins. The individual doesn’t manage to process the information and let it settle. So what can we do as clinicians?
Such techniques as medical hypnosis and eye movement desensitization and reprocessing (EMDR)—the standard treatment for this type of posttraumatic stress disorder—can be very effective. EMDR involves sending a message, an oversized attachment, via the “cerebral Internet” from the overly emotional networks to the more rational ones in order to archive the trauma.