Dissociation and integration

I have an understanding of what dissociation is and how it works that differs somewhat from mainstream psychological ideas. I have mentioned this, but I thought I would explain in more detail.

The standard definition is that dissociation has to do with a separation from an awareness of reality. But what is reality? It’s so many things. There are a thousand bits of sensory input from the external world—some of them important, some of them not. There are sensations in the body, how your skin feels, your heart beating, the sensations in your core that are your enteric nervous system and are part of how you experience of emotions. Then there are your thoughts, the pictures playing out in your mind or the verbal chatter of your mind making sense of things or imagining the future or remembering the past or just commenting on life. That’s all reality. Inside and outside of you is reality. It’s a lot of stuff, and normally we focus our attention on some elements of this reality that seem to be important and away from elements that seem to be unimportant. We cannot possibly maintain our conscious attention on it all, because it is too much to pay attention to at once.

We control our attention. All of us have only so much stimulation we can process and respond to at one time, and we do what we need to do in order to keep it in a range of what is possible and comfortable for us. Dissociation is this control of our own attention.

During traumatic experiences and later, the degree of mental and sensory stimulation is too much, and we shut certain things out of our awareness in the same way we normally do, but to a greater extent. This gets the degree of input down to a manageable level, so that what we are taking in is at a level of intensity we can make sense of and respond to. The more intense the experience, the more constricted we need to make our awareness.

We might shut out stimuli that are very painful so that we aren’t saddled with trying to respond to the pain in addition to doing what the moment demands of us—carry on a conversation, think about maths or whatever—or we might shut out everything but the pain so that we can deal with the pain and not what amounts to trivia. Or we might shut out one kind of pain so that we can attend to a second kind of pain. The stimuli are still being recorded. The knowledge of those stimuli is going somewhere, but we aren’t giving it our conscious attention and it isn’t being processed in the same way as what we are giving our conscious attention to in that moment.

If this goes on very regularly, you end up with a very fractured experience of life. You have a fractured experience of yourself, your past, and the world around you. This fractured experience does not occur separately from your social experience and development. If you are a child, and your personality is developing, your sense of self is going to occur in the same fractured way. So awareness of certain kinds of experiences, certain thoughts or certain feelings, is going to be separated from other kinds of experiences, and they are going to feel like different senses of self.

This creates problems.

It creates flashbacks, for one. As we move through life, we are automatically comparing the present experience to other experiences in the past to see which experiences it might be like so that we can use that information about past experiences to help us be successful in the present in how we respond. At the same time, we are discarding experiences that might at first glance seem similar but aren’t.

But trauma is in bits. The process of mining the past for comparable experiences becomes very difficult, because the memories aren’t rich enough or integrated enough to yield discomfirming details.

I’ll use my bathroom floor as an example. So, as most of you know, my bathroom floor is a kind of pebbly concrete that has been painted red. When I go in the bathroom, I see the floor first. It’s quite bright and noticeable. The most intense memory I have of red, pebbly surfaces involved murder and blood. It’s the first experience that comes to mind for comparison.

When this memory wasn’t processed at all, there was no way for my mind to discard walking into the bathroom as being quite unlike witnessing a murder. The rest of the pieces of that memory of murder weren’t processed. They were either totally unsorted—recorded, but not organized in any way—or stored separately. So every time I walked into the bathroom, the closest bits of that memory arose and presented themselves for sorting and processing and making sense of. Which was, of course, too much. I dissociated them again. And the process continued. It went on for quite a long time this way, until finally the memory was processed and integrated and not stored in a fractured way and so I can automatically discard murder as a memory quite unrelated to walking into the bathroom.

Dissociation of that kind also means you keep experiencing the world in a fractured way. The whole world becomes my bathroom—a possibly related experience that prompts memories of intense, overwhelming trauma—and it continues to be necessary to keep your attention restricted in order to keep life to a manageable level of input. So, it’s self-preserving.

One of the things I have done that has been helpful is to use this deliberate control of my attention to help me process the trauma. I went in the bathroom, and I didn’t pay attention to everything. I continued only paying attention to as much of the stimuli as I could and not more than that. I changed what it was that I paid attention to, but I didn’t try to do more, because biologically I can’t. I focused only on the emotion from the traumatic memory and on my attempt to regulate that emotion. About 1/100 of my attention was on scrubbing the laundry—that is what happens in the bathroom that involves looking at the floor for the longest stretches of time. But everything else was on the emotion and on my attempt to regulate. I shut out the pictures of what happened and the sounds of what happened. I shut out most of my awareness of the laundry. I definitely didn’t let my mind trot on to to worrying about what to fix for breakfast or for how the day was going to go. I kept controlling my attention so that it was focused on the piece that was going to help me.

I felt the emotion in my body and I controlled my breathing. Mostly that is what I did to regulate my emotional state. It’s hard to do a lot else when you are in the bathroom and the floor is wet with laundry water. Sometimes I stood up, because that helps with the emotions too. (Being close to the ground is its own trigger.) But mostly I controlled my breathing, because that helps me stay calm. If I were in a different situation or had had more soothing skills, I might have done something else, but what I had was breath control, so I did that. I did that nearly every day for about six months.

Outside of the bathroom, I went on working with that memory. I shut out my awareness of where I am now, and I only thought of maybe one element of the sensory experience, one thought, one emotion, and I went on doing something to try to keep the emotional intensity down in an artificial way. I controlled my breath, or I wrapped myself up in blankets, or I cuddled a hot water bottle, because those things are calming. I kept using my attentional controls to help me process only the amount of the memory that could be successfully processed until I finally had an integrated, whole memory that my mind now understands is quite different than walking into the bathroom.

And I think that is how you recover from trauma. You do something to lower the intensity of the emotions of the trauma—you do a lot of self-soothing and self-regulating—and you focus your attention very carefully so that it is on what needs to be processed but not more than that. Your attention is on only two things: one piece of the trauma and on the self-soothing. Until the trauma memories get sorted. But I am convinced that this is where it is mostly at, from the standpoint of what one needs to do: self-soothing or self-regulating and attentional controls.


The right to feel fear (and other unpleasant emotions)

I felt like killing myself last night.

I was a little surprised, as I hadn’t felt that way since I’d arrived in Country X. I’ve been here a month now.

So, I went to bed thinking, “Now what set that off?”

I don’t know what did even now. I had some strange dreams, but nothing answered the question. I’m not even sure that trying to sort through my day and my thoughts for what set off my reaction is an effective approach. I have started to think it just keeps my focus on everything that might be wrong, including problems I hadn’t noticed before, and I end up with much more to be anxious about.

But I do feel anxious today. Almost debilitatingly so. I mean, I got through the day, but I didn’t buy cilantro today at the vegetable market because I’d never done that before, and each new thing I need to do makes me even more anxious.

I have spent a lot of years trying to find ways to soothe anxiety. Most of them have not made any noticeable difference. But I realized this afternoon that that is definitely the wrong approach. Trying to conquer anxiety is like trying not to think about white bears. The harder you try, the worse it gets. Anxiety is something else just to roll with. Now, maybe that isn’t the answer for everyone. But I think it’s the answer for me.

On the one hand, integration is about acceptance. Acceptance involves feeling what is there to feel—whether the feeling is pleasant or unpleasant.

And on the other, fear is something I could not afford to feel as a child. If I felt it, I might show it, and you can’t let a sociopath see your fear. Then he knows all the more clearly how to torture you. So fear is something that was taken away from me as a child: it is a part of the human experience I lost. Of course, I did feel fear, but that needed to be carefully shuttered off from my awareness. Part of being a person is being afraid sometimes, so today I feel afraid. It isn’t such a great feeling, but it’s mine.

Addendum: I wrote this the day before yesterday, and I do know now what set of my suicidal thoughts Fatigue, it turns out, is an important trigger for this kind of thinking for me. There are other triggers, but fatigue is a big one. It’s essentially a flashback to moments in my childhood when I just wanted to give up and let my father’s torture kill me.

Virtual Villagers and Other Allegories

Ever played Virtual Villagers? It’s a Sims-style game where you get 5 villagers and you have to figure out how to feed them, keep them well, and build various things. It’s not fascinating, but it’s not the worst way to kill some time.

The bamboo enclosure.
The bamboo enclosure.

There are five of them. The last one, True Believers, is fairly creepy–at least for someone with a cult-upbringing (like me). You have to “convert” the “heathens.” Yeah. Seriously.

I bring this up only because the Villagers in question have been “captured” by said heathens and are imprisoned in a bamboo-looking kind of enclosure. One of the first challenges of the game is to take the enclosure down. Which is actually incredibly easy.

As far as I remember, you drop a Villlager on it, and that’s what he or she does. Starts taking it apart. If you set two of the Villagers on the task, it’s down within hours.

The prison in my head is still coming down.

This morning a neighbor came for coffee. She brought cookies. She’s nice that way. She’s also a terrifically good cook.

Was it the coffee?
Was it the coffee?

We covered a lot of ground over that coffee. Cafe La Llave must be good stuff. Or maybe it was the cookies. Whatever it was, I told her rather bluntly that I had been trafficked for sex as a child. I would talk about it in softer terms, but I don’t know how. There is simply no easier way to say it. So I told her, not the details or the stories I’ve shared in some of my posts, but the bare fact of it.

She teared up when I said that. And later, she said if I needed anything…

She’s a nice person, like I said.

I couldn’t manage to tell her, as I have said much more easily in this space, that she had already given me what I needed. Because what I need–what I think we all need–is for someone to simply be with us. And she was with me.

I didn’t say either, while she teared up at the thought of my suffering, that being able to speak about it pulls down the prison in my head. Being able to speak means that it is over. It means it is safe to speak, there will be no consequences for it. It means the prison has been torn down and the jailers have gone away.

There is nothing greater she could do for me than that.

Thank you to all of you who are with me while I tear this prison down.

Distress Tolerance: Part 2

Since I shared with you my decision to tackle my terror of writing and before that my terror of cleaning house, I thought I should let you know the outcome.

The world is a beautiful place. Oh, and I recognize my hands as belonging to me. Life is good.

It took two days to get there. Writing, it turns out, terrifies me quite a bit more than dusting the furniture. Perhaps I would have gotten there faster, but I had a cold. And coldy brains just don’t work as well.

Yesterday did not go as well as today. I was coldier. Or maybe it just took me a while to get the hang of it. But today I’d say has been a success.

I began in the same way I approached cleaning house: in 10-minute increments. But I found tolerating distress while writing is harder than tolerating it while cleaning. Not more painful, perhaps, but more difficult in a practical sense. Because writing uses a lot of the brain. And so does distress. Cleaning, not so much. You can get all choked up, dissociate, have flashbacks, start thinking about ways to take revenge on your perpetrators all while giving the sink a good scrub. Do those things while writing and you often find yourself not writing anymore.

Also, cleaning has a clear end in sight. Even though I was working in 10-minute increments, there was no defined endpoint for when I should actually stop writing if I continued to be able to get through each set of 10 minutes. Endpoints help with motivation. They keep us focused on a task. Endpoints are good. I didn’t have one, and that made it harder too.

So, today, I changed it up a little. Ten minutes first. Then 20. Then 40. Then 80. Eighty provided an end-point. If you can handle doing something for an hour and 20 minutes, you are probably good to go. Or at least that was my reasoning. And it did help. I stayed more focused. I dissociated less. I kept writing through the distress.

Interesting things happened. First of all, I was okay for eight minutes. Eight minutes into it was when the anxiety began to set in. Funny, isn’t it? I have a remarkable sense of time, although I can get lost in it as well as anyone else. Still, I know pretty well how long a minute is, how long 10 minutes is. And I imagine my mom must have had an average. Eight minutes to get up out of bed (she was always in bed), use the bathroom, head down the stairs, and into my room. From whence the screaming and throwing things began.

So the challenge became getting to the eight-minute mark and then waiting for the anxiety to subside. And it did. Eventually. Not quickly. But eventually.

What’s interesting to me about distress tolerance as a therapeutic technique is that it makes your mind cease to be the enemy. In PTSD, you are no longer in danger, but your mind continues to be an unpredictable place. Distress tolerance doesn’t change the distress, but it means the distress ceases to be terrifying. And that reduces a great deal of the feeling of overwhelming powerlessness that is the core of the problem. You still cannot stop the distress. You can’t make it go away. But you can outlast it.

I believe distress tolerance also unlinks the chains of a fear structure, so that particular triggers no longer activate self-propelling sequences of memories and thoughts that maintain an association between those triggers and terror. In that sense, and I wasn’t expecting this, it is more effective than thought-stopping (which also has its uses.)

It works because the thought and the emotions simply stays where it is, rather than getting routed to something else–say a comforting image of a loved one or a favorite place–that may eventually link back to the terror again and in that way keep the structure intact. (Since so many things do link back to terror.)  In distress tolerance, you simply stay in the same place. So that the link becomes trigger->terror->nothing. The associations don’t link back to anything that can then re-activate the terror.

As far as why it made the world seem like a more beautiful place and why I recognize my hands as being mine again, it’s a little harder to explain. And I’m tired now. I still have a cold, and it’s time to try dusting again. So that will need to wait for another day.

But you should really check out Quratulain Balouch. She’s awesome.

Tackling More Fears

Last weekend, I tackled cleaning house. Today, I’m thinking about writing.

They are the two activities that seem to frighten me the most, after taking a shower. And I think I’ve finally gotten the shower thing under control.

My mind is a funny place. Maybe all minds are, but I would hate to speak for your mind if that weren’t true. What’s funny about it is how literal it is. I seem to have grown up in a culture that expected metaphor and “deeper” meanings. But the shower scares me because I don’t want to be six and have to give a man a blow-job in there. Cleaning scares me because I don’t want things thrown at me while I’m doing it. And writing scares me for very similar reasons. It’s not really all that complicated. It’s not deep or metaphorical at all.

You might expect writing to scare me because I am afraid I will fail at it, or I think people won’t like what I write.

Perhaps all I needed was a brief knot-tying tutorial.
Perhaps all I needed was a brief knot-tying tutorial.

Well, I’m sorry to break it to you, but I have failed at a lot of things before. You have no idea how many times I failed at tying my shoe. I still have scars from falling down and skinning my knees. As a runner, I was an utter failure. Walking didn’t always go well for me either. (I had the broken arm to prove it, when I tripped in a “walking race” in second grade. I lived through that. I can live through a blank page. I can even live through 200 pages of absolute crap.

And as far as what everyone thinks? It’s nice, of course, to be liked. It’s nice to be thought well of. But let’s be real for a second here. I don’t like everyone else out there either. Why should everyone like me?

No, my fear of writing is entirely about a fear of physical assault.

My mother had two obsessions when I was growing up: cleaning house and reading (which later became writing). More specifically, that I should be cleaning and not reading (or writing).

It’s not that the house had to be clean. It wasn’t. It was, in fact, a total disaster most of the time. It was about controlling my time. She was obsessed with my cleaning. If she was unhappy about something, it was probably because I hadn’t cleaned the bathroom. Or taken out the trash.

A good book takes you out of reach.
A good book takes you out of reach.

If I didn’t allow her to control my time, I didn’t love her. And that led to screaming, and then throwing things, and sometimes real physical violence. Or suicide. The reaction looked like this: You didn’t clean the house -> You don’t love me -> I should die.

Of course, there was a deeper problem. There is some degree of depth and metaphor here. I won’t deny all of it. Cleaning represented my enslavement and the extent to which I was merely an object used to accomplish tasks–either domestic work or prostitution. In a sense, there was no real difference between them. My parents simply had different ends to which they preferred to use me. But use me they did.

So, I actually spent more time trying not to clean than actually clean. But either way things got thrown at my head.

It may be harder to see what she had against my reading and writing. She actually started it all: reading to my sister and me at night, taking us to the library every week for years and years, keeping books by the dozen all around the house. But what I did was different. Non-sanctioned. Rebellious even. It had to be stopped.

Because if I was lost in a good book or writing a really great scene in a story (according to me, at least), then I obviously had a life and mind of my own. I was more than just an object if I had thoughts worth writing down or was spending my time imagining things she didn’t even know about. My mind made me something more than merely a slave, available to serve her. It made me a human being.

That had to be stopped. And it was. Usually with a command to go and clean something. And that’s how the throwing things comes in.

Distress Tolerance

Distress tolerance is a component of Dialectical Behavior Therapy. It’s just the idea that there is a value in simply being with a feeling–not thinking about the feeling, not analyzing the feeling, just naming it and then being there with it.

I did a lot of that today. I cleaned my house. I like to do this on the weekends. I suppose a lot of people do.

But it’s complicated for me. House-cleaning is intimately tied up in my mind with suicidal ideation–my own, and my mother’s. Doing the laundry makes me want to cut my wrists. Dusting is enough to get me thinking about buying a gun. Cleaning the toilet is a dance with death.

So it’s tough. And some weekends I spend the entire time just trying to cope with the fallout of that, and still end up with unfolded laundry on Sunday night. It’s tedious. And for someone who prefers order and tidiness, it’s frustrating.

So, today I thought, “I’ll just do it for ten minutes. If I can handle that, I’ll do it for another ten. If I can’t, I’ll stop. “I set a goal for myself I believed I couldn’t fail, knowing that success is always more motivating than failure.

And I could handle it. Again and again, I could. I did think about suicide. I did feel I couldn’t keep doing washing the dishes or folding laundry. But I made it to the end of ten minutes every single time. My house is swept, dusted, wiped down, clean. I have clean dishes to eat with and clean clothes to wear. And it’s only Saturday. Early Saturday evening. I haven’t done this well in months.

In fact, after about 30 minutes of setting the timer in 10 minute increments, something magical happened. For the first time in my life, I felt in control of my own mind, my own feelings, my own life. I thought, “This is terrible. This is absolutely horrible. But I can stand it. I can stand my feelings. I can stand the memories. I can stand the thoughts that go with them. I can stand it all for ten minutes, and I think I can stand it for hours. I am free. Absolutely free.”

My trauma didn’t disappear. That wasn’t the magic. I still remember dishes being thrown at my head. I still feel consumed by despair at my life having no meaning or value. I still have visions of my mother slicing her wrists in front of me. None of that has changed. The magic was only being able to stand it. Because what you can stand no longer controls you.

PTSD and Nervous System Arousal

After traumatic experiences, our nervous systems are on high alert. In Post-Traumatic Stress Disorder (PTSD), the nervous system remains that way. Symptoms of hyperarousal include exaggerated startle responses, difficulty sleeping, impulsivity, and a general sense of being “on edge.” (Post-Traumatic Stress Disorder (PTSD), NIMH.)

Sympathetic and parasympathetic nervous systems.
Sympathetic and parasympathetic nervous systems.

Other sources contend that the periods of hyperarousal alternate with periods of hypoarousal and parasympathetic dominance.  Unlike the sympathetic nervous system, which is responsible for activities that need to be done immediately (fight or flight), the parasympathetic system takes care of necessary but less urgent bodily functions such as digestion and sexual activity. According to Robert Scaer, “[t]his may well be an innate biological reflex designed to reestablish homeostasis, the rhythmic and balanced fluctuation of all biological systems, be they endocrinological, neurophysiological, metabolic or immunological (Antelman et al, 1997).” If IBS is part of your trauma symptoms, then you know what I mean.

So, a part of the persistence of PTSD symptoms may be the mind and body attempting to find a happy medium again, but instead remaining trapped in cycles of arousal and stasis. It isn’t just that we are overwhelmed by excessive emotion during traumatic experiences, but our nervous systems are overwhelmed by too much arousal and too great a response to stimuli.

Because hyper-arousal is often part of the traumatizing experience in the first place, the symptoms of PTSD can mimic the original trauma and contribute to an ongoing sense of powerlessness. Just as we were unable to control the traumatizing event, we can feel unable to control our minds afterwards.

Being able to reset our level of arousal to a more comfortable–and functional–level may be part of the cure for sufferers of post-trauma symptoms. Mindfulness, meditation, yoga, and breathing exercises can help us to lower our levels of arousal when we are too keyed up. Exercise, social interaction, and some hobbies can help us raise our arousal when we become too depressed.

What can be difficult for long-term sufferers is that these states of extreme nervous system stimulation and suppression can become what we are used to. Being constantly on alert can feel normal, but it isn’t good for us. It isn’t good for our bodies, and it isn’t good for our minds. So sometimes we are left to guess at what might be comfortable if circumstances had been different. Learning how to be still, how to relax, and even how to sleep have been some of my greatest challenges in this process of getting better.

Feast or famine...Photo credit: Getty Images.
Feast or famine…Photo credit: Getty Images.

Another hurdle in maintaining a more optimal level of arousal is just that we, as a culture, have a tendency to manage stress and over-stimulation in a “feast or famine” kind of way. We work like crazy and then take a day off. We spend the holiday from hell with our toxic families and then stay in bed the next day. But that isn’t necessarily how it’s done best.

What we need most is to keep ourselves at a level of arousal that won’t burn out our pituitary glands. We need frequent “tune-ups.” I wrote recently that I’ve started doing some “gentle” yoga in the mornings when I first wake up. (It’s mostly stretching–which my body badly needs given how tense it so often finds itself–and deep breathing.) And I do some progressive relaxation every few hours throughout the day on most days.

I used to think these kinds of activities were stupid. They aren’t a cure. They don’t address the underlying trauma. But it makes ordinary life a little bit easier to manage. It makes the harder work of really healing more possible. And in our overstimulating, always “on” world, I think more of us need to do this than ever.