It is a common experience to “space out,” and no doubt everyone does this occasionally. We space out, zone out, tune out. These unclear, confused, foggy, or somewhat disconnected states can be seen as one end of the dissociation spectrum, and may only mildly interfere with our sense of ourselves, and of the world. When this experience becomes more extreme and leads a person into psychological or physical danger, psychotherapy is indicated. Dissociation can be seen as a disconnection from oneself, or a discontinuity of the experience of self, and it falls on a continuum from mild to severe. It often develops as a method for dealing with psychological or physical pain, and it may function as an escape from things that might otherwise be uncomfortable, overwhelming, unbearable, or that may even feel annihilating.
People who have suffered serious trauma at any time in their lives frequently dissociate. As one moves farther away from feeling like a whole person, grounded in the present moment, the experience of dissociation becomes more extreme. At this end of the spectrum, one’s actual perception of the world becomes more distant and more unreal. Things may look far away. It may seem like looking though the wrong end of a telescope, like watching the world on television or through a plate of glass. People in a dissociated state may feel like they are floating above themselves, seeing their body as an inanimate object, or as another person. They may look in a mirror and not recognize who they are looking at; they may have no experience of pain. The whole world may look foreign or unrecognizable, or it may seem to be disappearing. In the extreme, people describe everything as going white or totally blank. For some who dissociate, blackouts can be common. This type of experience can range from being unclear about what’s been going on for a period of time, to having no idea whatsoever (“losing time”). People may find themselves somewhere and have no idea how they got there, or talk to someone and realize that they have no idea what they have been saying.
Dissociation is not just related to experience in the external world, it is also fundamentally a disconnection from oneself. In the extreme, dissociated individuals may function and experience themselves as two or more selves with unique memory sets, distinctively different body states, and even with different names for each. Because there may not be communication between these self states, people can come to doubt their own sense of reality and question their sanity. They may not be sure whether something they remember really happened, or if they just dreamed it.
Dissociation is frequently associated with post-traumatic stress disorder (PTSD). PTSD can result from surviving overwhelming and disorienting events such as war, sexual or physical abuse, or other forms of extreme victimization. People with PTSD experience flashbacks in which they experience an event from the past so vividly that they feel they are literally reliving that event. The terror and physical distress that was part of the original experience exist in the present moment, and the individual loses connection with his or her place in time. Not only is this profoundly disorienting, it can be dangerous if the individual responds to what seems to be happening. Dissociation born of trauma can represent the mind’s essential and impressive creativity: it serves to protect the traumatized individual from an experience that is too terrible to bear or experience. The individual “leaves,” and the experience is broken away from consciousness. These fragmented experiences may haunt the traumatized person, surfacing as strange half-remembered details, or nightmares, or inexplicable body states.
It is an important task of psychotherapy to help the traumatized individual integrate these disconnected aspects of self. Of course this is not an intellectual exercise; it may be easy to know the temporal facts from a purely rational perspective. It is the emotions that become confused in time and it is the emotions that need to be worked through and resolved. Quite understandably, addressing what once felt unbearable can be painful and daunting, and the work must not push too hard or the person is at risk of simply being retraumatized or finding themselves stuck, once again, in an overwhelming and intolerable place.