by Sarah
Most mental health professionals link dissociation to some form of child abuse, usually holding that the more severe the abuse or the longer it was endured, the more severe dissociation will be. The question, then, is why some people who endure abuse do not develop dissociative disorders and why some who do not endure abuse do develop dissociative disorders.
I have wrestled with this question since my first realization that I dissociate. Like many people, I did not recall anything awful happening during my childhood. Unlike many people, I have not uncovered many memories of abuse in therapy or on my own. I have even been told by therapists that there is nothing in my history which would warrant my having a dissociative disorder. Yet the signs are all there inside of me: inconsistent ways of relating to the same person over time, sudden mood swings, occasional periods of time loss, and, most indicative, many pictures in my mind of people who look nothing like me but who symbolize my experiences. How were these to be accounted for in my life?
After much thought and study in the areas of trauma, abuse, and disability, I have come to believe that it is not the abuse itself that causes one to develop a dissociative disorder, but it is the effect of the abuse on a person's feelings and sense of self which leads to the development of the use of dissociation as a coping mechanism. Severe abuse can cause a person to feel that her life is threatened, and in order to protect herself she develops "subpersonalities" or "alters" which are responsible for carrying on in various roles to help her manage the confusion and do her best to please the abuser and, in her mind, minimize the chances that she will be abused again.
Other traumas may have similar effects on a person's sense of self and thus place her at risk for developing trauma-based disorders. Survivors of abuse comprise a large portion of the population of people who have experienced trauma, especially as a child and on an ongoing basis, and are probably most likely to be those with whom a therapist is dealing with. However, the fact that dissociative disorders are seen most often in survivors of abuse does not make abuse the only causal factor. I believe that there are additional causal factors and that it is vital that they not be ignored. The prevalent assumption that if a person dissociates he/she must have experienced abuse and that if abuse was not experienced then there is no cause for a dissociative disorder to have developed may keep people whose situations may demonstrate otherwise from seeking and/or receiving effective intervention. I would like to encourage mental health professionals to reexamine the definition of trauma and the causal relationships between various traumas and dissociative disorders. I will share about my own experiences and beliefs here in the hope that it will encourage research in this area and appropriate therapy for people with dissociative disorders which may not have been provoked by abuse.
Many things can subject a child to overwhelming feelings of fear, inadequacy, anxiety, guilt, shame, depression, anger, confusion, isolation, and even despair. These, I believe, are the elements of trauma. The key word is overwhelming--the sense that the situation is out of one's control and ability to escape. Trauma can occur at any point in life. The age at which trauma is experienced, the duration or chronicity of traumatic experience, availability of social support networks, and possession of skills which permit control over oneself and/or the environment in ways which enable avoidance or minimization of exposure to the traumatic event all affect the individual's ability to "weather the storms of life". If a person experiences trauma and is able to recover and heal from the experience, the trauma builds strength. If, however, the person experiences trauma again before having healed from the wounds of the first trauma, the effect is a weakening of the emotional and, often, the physical, immune system. For people with a strong determination to live, the depletion of these reserves demands the employment of new coping mechanisms.
I was born 12 weeks prematurely and was taken away and placed in an incubator without having been touched by my own mother. In those days, it was not common practice for parents to spend time in the neonatal intensive care unit (NICU) with their very vulnerable babies. I spent 80 days in the NICU, during most of which I was in the incubator receiving oxygen. Because I was born during a family move, my parents completed the move and drove 150 miles once a week to visit me, looking at me through the nursery windows. I went home weighing 5 pounds and 1 ounce. I went home to parents who held me and tried very hard to provide a stable, loving atmosphere for me.
Despite their efforts, I developed a dissociative disorder. Despite having a very in tact autobiographical memory of most events of my childhood, I see people inside my head who represent me at different stages of life. They do not all look or talk like me, but they all represent something about my personal experience. I have been dealing with this puzzle on my own for the most part, and the following is my theory about why this could take place for me.
For most of my life, I have experienced a specific phenomenon when I feel most isolated from others. I feel as if I am enclosed in a space. Others have the power and ability to get me out or reach in to where I am. I, however, have no power or ability to reach out to them. I actually have a physical sensation that if I were to attempt to move, I would be restrained by things that would spring back at me from the outer edges of the structure I was in.
Of course, I know that I am not confined in this way, but the feeling is very strong and causes me to feel very hopeless. I believe that this is a trigger of hopeless feelings that I may have experienced as an infant in the NICU, when I was not able to summon others to meet my needs by crying loudly or possibly even to control my own movements due to being restrained in order to keep me from disconnecting any IV or monitors. I have also had the experience of seeing a very tiny infant in my mind who was crying with no response from an adult. Again, this image was accompanied by feelings of extreme hopelessness.
I do not know whether my first dissociative experience could have occurred in the hospital or whether it happened when I moved from the unnurturing environment of the NICU to the nurturing environment of home. I have no doubt that going home created a vast amount of confusion for me. I do not suppose that the fact that an infant lacks the ability to describe an experience in words means that she doesn't have the experience. I can believe that it would be difficult to reconcile the conflicting messages about what the world was like.
Likewise, I don't suppose that the NICU environment is very nurturing. Lack of touch and comfort are enough to cause emotional damage. Being in an environment where medical interventions, bright lights, and loud noises are part of the daily routine adds to the picture. For a long time I thought that I was crazy for thinking these things. Then I read the following in Elaine Aron's book, The Highly Sensitive Person.
When holding is not adequate, when the infant/body is intruded upon or neglected--or worse, abused--stimulation is too intense for the infant/body self. Its only recourse is to stop being conscious and present, thereby developing a habit of "dissociating" as a defense. Overstimulation at this age also interrupts self-development. All energy must be directed toward keeping the world from intruding. The whole world is dangerous.
As I grew older, other things occurred which caused the feelings I mentioned above. I was diagnosed at the age of 5 months with an eye condition related to premature birth which resulted in my having a severe visual impairment. Nothing was done to stimulate my remaining vision until I began responding to lights on my own at the age of 18 months. I have retained a very minimal amount of vision which is very useful to me; however, having a severe visual impairment affected many areas of my life.
Eventually, I began to realize that other children could do things that I could not or was not allowed to do. I can recall with the help of one of those people in my head distinct feelings of hopeless isolation at the age of 7 after moving into a new home and hoping to find playmates. Such feelings of isolation were very common for me after that point in my life. I know that I began to create imaginary playmates, comforters, etc, shortly after that move and that I have never grown out of this habit.
I also experienced many conflicting messages about the role I was supposed to play in various groups. I was to be independent, but I was also forced to rely on others for assistance in getting from place to place, for information about the environment, etc. I was supposed to be outgoing and participate in conversations, but I participated at all the wrong times and was sometimes told that I was interrupting. I was never taught about timing or other aspects of effective communication. In a group where many people are talking, I still experience much frustration regarding timing my entrances into the discussion and find myself retreating to my inner world and even preferring not to associate with more than one or two people at a time.
During my childhood and adolescents, I also experienced a certain amount of teasing by peers because of my lack of knowledge of the correct ways of doing certain things. I began to socialize with those children who enjoyed socializing with me and to identify with them and see myself as similar to them. Many of these children had learning disabilities, mental retardation, and autism. Consequently, some of the people in my head also have these disabilities.
By the time I was 8 or 10 years old, there was a definite and widening gap between my intellectual ability and my social skills and interests. While other children were reading at a 4th or 5th-grade level, or even an occasional 6th-grade level, and playing ball, riding bikes, and eventually becoming interested in experimenting with hair styles and makeup, I was reading on an 8th-grade level and playing with dolls. I continued playing with dolls for many years and eventually had to be convinced that it was inappropriate for me to have a dollhouse in my room at age 16. By this time, the gap between my academic and emotional abilities was very wide. I wanted to do the same things that my peers were doing, but I had no interest in or knowledge about relating to members of the opposite sex. In fact, only now, as an adult, am I becoming very interested in relating to them. At times I wonder if I will ever close this gap.
All of these things have worked together, along with the isolated incidents of sexual and emotional abuse, to shape who I am and how I deal with life. I believe that it is the constant inner conflict between hope and hopelessness, choosing whether to seek friendships or to retreat and be happy spending time alone, independence and dependence, combined with threats to my emotional well-being imposed at various points in my life and the gap between intellectual and social/emotional skills which have caused me to solidify the habit of dissociating. I believe that it is the pressure to appear normal and behave in consistent ways which has prevented me from developing a more severe form of dissociation in which I would have no communication between one part of myself and another. My selves have been forced to work together over the years and to share information about past events as well as the present.
What I have found to be most helpful for me in the healing process is to allow myself total freedom of expression through writing. It is not uncommon for me to write from the point of view and using the name of a person in my head. Often in this process, I begin to accept, to own, the feelings related to whatever I am writing about. It is important to me to explore the feelings related to remembering certain events as I look at them from an outsider's point of view. Many therapists are concerned solely with functioning in the present. However, present actions are governed by patterns which have developed over a lifetime. Therefore, functioning in the present is maximized by healing the traumas of the past which have led to dysfunctional habits and/or lifestyles.
To a certain degree, the assertion that one can choose his responses and feelings is true. However, I believe that it is only true to a limited degree. The brain and emotions are part of the body, just as the arms and legs, the heart, etc, are part of the body. No one would dream of continuing to live or expecting to function as well with a broken arm as they could function with a healed arm. Likewise, we cannot expect to live in the same way with a broken spirit. God promises healing for the broken in spirit. If we continue to expect ourselves to function normally and to not need to heal from emotional hurts, if we continue to assert that emotional pain is caused by a choice made to focus on the negative aspects of life and that simply by choosing to ignore those aspects the pain will go away, we deny our need for God's healing and love in our lives. The choice to make is the choice to do whatever it takes to substitute unhealthy coping methods with healthy ones. This cannot be done if the past is ignored.
It took a while for me to find a therapist and therapy which worked for me. One of the tenets of the work my therapist does is the idea that a person will not be able to accept the need to change without being accepted as he/she is. As my therapist and friends have provided me this acceptance, I have been able to accept the idea that learning new coping skills would be a helpful thing.
Because of several factors which made staying in therapy difficult for me, I worked through many of my issues alone before 1998. I had found that many therapists were unfamiliar with some of the issues which caused anguish for me and didn't seem to understand why they had such an impact on me. As I prepared to begin therapy again in early 1998, I decided that I would attempt to collect some resources to present to my next therapist. One of the positive effects of my search was that I read a lot and began to identify with things which I was reading. I began to collect quotations and to write responses in a journal. The result has been that I have begun to make leaps of progress which I never made before. I began to understand myself and to sort through memories and to understand how certain behaviors and beliefs developed. Combining what I learned from this reading with new skills which I am learning in therapy and with elements of my spiritual life, I am beginning to appreciate the person that I am.
My hope in writing this page is that it will help people to begin thinking about the variety of situations that may cause a person to experience trauma. It is common to search for abuse or loss in the history of a person experiencing dissociation or related symptoms. Sometimes it's wise to look further. Disasters, threats of abandonment, frequent moves, a family member's serious illness, disability, extreme poverty, instability at home due to odd parental working hours... All of these things can create an unstable situation for a child which may create a need for adaptive coping strategies. Therapy that is too narrowly focused may at best miss the mark and keep the person searching for years while the symptoms continue to disrupt life and at worst cause the person to feel stigmatized because she is not "normal" in spite of this supposed lack of a traumatic history when in fact her life history has been significantly traumatic.