10.19.2015

PTSD and Dissociation

I've been meaning to write about this for awhile; sometimes I just think this blog gets so heavy (if you think that's bad, imagine what it's like inside my head.)  But it's important for me to talk about these things for a few reasons: one, it removes the stigma and explains so much about those of us dealing with mental illness, and two, it's something that people really do need to know--I had no idea, for years, how my 'mental fog' wasn't just me being stupid.  It was my brain's response to years of trauma, both physical and emotional.  Keep in mind I'm not a professional here...I'm just trying to help make sense of this from my own point of view.  I love learning about why my brain does the things it does.



WHAT IS DISSOCIATION?
It's defined very simply--a "disconnection."  You hear all the time about people, specifically in sexual assault situations, saying something along the lines of "I felt like I wasn't even there.  I was a spectator/I was out of my body/I couldn't say no or fight back."  This is a pretty severe example, but it's nonetheless a good example of what it means to dissociate.  Maybe you've been drooling at the wall during a lecture and somebody says your name, and you snap out of it, realizing that all noises for the past five minutes were a dull roar?  You were dissociated.  And it happens to all of us, and it doesn't only happen in traumatic situations.  After a long hard day at work, you might hop in your car or on the train and then end up at your house without remembering the steps it took you to get there.  Again, you've experienced dissociation.  I like to use "detachment" to explain it--you can still operate or function in some way (you're still breathing, possibly seeing, etc) but whatever is happening around you, you are detached from.

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WHAT'S THE BIOLOGY?
Everyone, even those lucky enough to be far from the grimy hands of PTSD and other disorders, have heard "fight or flight."  We have little reptilian almonds (amygdalae) far in the back of our head, and they rule our fear response.  When a zebra sees a lion attacking, the zebra's heart begins to pump blood faster, supplying the muscles with oxygenated blood so the animal can run as fast as possible.  Blood vessels dilate.  Muscles tense.  Adrenaline helps with fast decision-making, and a whole bunch of other hormones are pumped out including cortisol and testosterone--"hyperarousal."  All this, to help save the life of the zebra, whether it's outrunning the lion or kicking its teeth in as hard as possible.  But what happens after fight or flight? What happens when the lion tackles the zebra and sinks its teeth into its neck?  That's where dissociation comes in.  The animal goes limp, its eyes glaze over, it looks drugged or totally out of it--"hypoarousal."  Our best theories are that the brain recognizes there is a threat and our other coping mechanisms aren't going to work, so it does what it can to protect itself.

WHAT'S IT LIKE?
So, now that I've explained the gist of it, I wanted to explain something else that a lot of people have been confused about.  Firstly, as I said before, you don't have to be in a traumatic situation to dissociate.  In my case, it's a response to my PTSD.  Something that throws me mentally back into the past will either put me into hyperarousal or hypoarousal, depending on the situation.  But what I really wanted to say is, dissociation has different 'levels', it's not always a blank, thousand-yard stare.  I dissociate really easily so only the slightest perceived connection to trauma has me slipping into a trance.  And that's what it can feel like, but every stimulus is different.  For example, months ago a situation with a coworker had me so stressed I couldn't be in the same room with her without fully dissociating.  I was out of it and felt drunken, but managed to talk and walk and nod and smile as usual--there was only a mental disconnect, unnoticeable to others. Other times (particularly if someone is touching me) I can become completely catatonic, and can't even speak, or open my eyes (or if they are open, I can't see.)

MY THOUGHTS 
My therapist pointed out recently that I spend more time on some level, dissociating, than I spend in my own body, and it's sadly true.  Any social situation, any time I'm making eye contact with a patient or an employee at work, any wrong word or triggering smell or sometimes for no discernible reason, and I shut down on some level.  It doesn't take a lot to make me uncomfortable considering that I'm only perfectly comfortable when I'm home, alone, with my cat and pajamas.  Anything outside of that and I will (unknowingly) dissociate in order to start protecting myself.  I was confused about why I could live like this and not know it, but according to her, that's par for the course in heavily traumatized patients.  You learn to fake normalcy while being disconnected in order to appropriately interact with people (because that catatonic stare is not good in job interviews...)

So in my life, it has its positives and negatives.  Dissociation allows me to function despite my hypersensitivity to just about everything and everyone, it is a way for me to shield myself against what my poor, confused PTSD brain thinks are major threats.  It's a cozy blanket of dumb that I feel I have no control over, most of the time.  There are obvious downsides.  I can't remember good conversations with friends.  I have a hard time connecting on a deep level to events, people, and places.  I am not processing my traumatic experiences and instead, numbing them so that I can get out of bed like a functional person.

I was pretty upset when I learned about dissociation and its role in my life, its HUGE role in my life, but I've chosen to be thankful for it.  I don't know that I would be able to do a lot of things without that ability to mentally unplug, and for all intents and purposes I'm a very functional person on the surface.  Any time I get angry for being so forgetful, or for freezing up, or yet another babbled conversation I sound idiotic in, I try to remember that my brain is trying to help me, to protect me.  Maybe it has ill effects, but it has good intent, and that means a lot to me.

2 comments :

  1. Thank-you for this helpful and important post. I truly learned and enjoyed reading it. I'm sincerely sorry for your "loss" of being in moments but with more therapy and learning you'll start to have less times of loss and more times of authenticity.

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  2. You get me... you really, really get me. I struggle with PTSD and I think a lot of people don't understand that that even means. When they see those 4 letters, they think "military accident" and not "young woman who was in an emotionally and physically abusive relationship".

    I have several triggers and a lot of them are location based. Last year I drove back to an area I used to live in and I had a mental breakdown. I spent the couple of hours in that town either hyperventilating or mentally checking out completely. I don't even remember leaving.

    There's an area nearby where I currently live where I used to pick up and drop off my daughter for visitation and I have a hard time going over there. It was really hard for me because my boyfriend's brother lived over there and he'd want to go see him and I quickly found out that I couldn't be there. His brother moving elsewhere was the biggest relief to me...

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