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.

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Taking stock

Former teachers in Country X have blogs. I’ve been reading one of them today. Previously, I had read a few others. Mostly, I’m combing through for small details that might give me some idea of what to expect: How populated does the town I’m going to seem to be? What does that suggest about what I might be able to buy without travelling a long distance? (They have 2-minute noodles.) How cold does it look like it is? (Cold.) Is there electricity? (In the evenings.) And running water? (Couldn’t tell.)

What I read instead was a cheery, upbeat blog about the beauty and wonder of the country and the joy of teaching students years behind grade level with tools no more sophisticated than chalk and stones, despite such problems as contracting typhoid.

It was not encouraging.

I am neither that cheery nor that upbeat and I have serious doubts about surviving in a place where that kind of attitude might be required.

So I began to take stock of myself and my expectations—which consequently meant I couldn’t sleep. Which is also why I’m up writing at this hour.

I don’t expect to have a particularly good year. It might be wonderful. It might not be. I don’t know about that part. But I expect it to be difficult, exhausting, frustrating, and sometimes overwhelming. And then I realized I expect that because all of my life has been difficult, exhausting, frustrating, and sometimes overwhelming. Same experience, different country.

To be specific, I expect I will be horribly, miserably cold. Feeling cold will trigger intense, physical and emotional memories of the freezer. I will feel depressed and hopeless a lot while still needing to teach and interact with others as a professional six days a week.

I will fall sick—at least as often as usual, very likely more often. And being sick will remind me of other things that have happened to me that made me ache all over. So I’ll have to deal with that, while also having no doctor to consult about whether and what medication to take: in other words, I’ll need to make important health decisions while thinking maybe I’d be better off dead.

This is all part of my new approach to life: life has been difficult for me, it is difficult, it will be difficult.

Shit.

Sometimes I don’t like this straight grappling with reality. Sometimes cheery, upbeat and avoidant seems like a lot more fun—or at least less torturous—and I feel like going back to the old mindset again of minimizing, denying, or trying to solve every potential problem I anticipate.

But there are only so many thermals you can fit in a suitcase and there is only so much that over-the-counter painkillers can do for you. These are problems I can’t solve. Cold was triggering to me the last time I really felt it. There isn’t any particular reason I shouldn’t expect cold to be triggering to me next week when I arrive in Country X. When I came down with a bit of an achy, stuffy cold last week, I was reminded of things I didn’t want to be reminded of. I did feel despair. It was difficult to motivate myself to do what I needed to do to prepare for the next move. I can probably expect that to happen again too.

This will be a difficult year for me. Most years are.

Life after Sobibor

As I read Dov Freiberg’s account of his survival in Sobibor and after, I am struck repeatedly by the similarities of our own internal experiences despite the differences in what we endured or how we escaped.  (For more on my background, see Towards a Unified Theory of Evil.)

Dov Freiberg.  Credit: Yad Vashem Photo Archive.
Dov Freiberg. Credit: Yad Vashem Photo Archive.

Just as Freiberg dreamed repeatedly of being again in the place of his captivity, of being caught and returned, or of attempting escape all over again, I dreamed for years of escaping from my parents’ house.  I dreamed of packing and leaving, of flight through new and strange areas, and of hiding.  Like Freiberg, it took time to be able accept that I could no longer be kept in captivity and that I was finally and unquestionably free of my torturers.   My dreams were as exhausting as they were terrifying, just as escape was.

And just as Freiberg was repeatedly haunted by a profound sense of aloneness as he negotiated a world without family, I am as well.

What surprises me most is how Freiberg ends his account:

“That same day, in January 1948, forty years ago, a new chapter opened in my life: a chapter nevertheless full of wars and conflicts, of battle fronts…a chapter in which I, Dov ben Moisheh and Rivkah Freiberg, the Last of the Freibergs, survived and can work and produce and raise a family in Israel and be like any other human being.”  (The Last of the Freibergs.)

Despite a heroic part in the revolt at Sobibor, and terrible years of suffering in which he displayed tremendous courage and a continued ability to remain human and decent, Freiberg’s goal was not to attain some form of recognition or power, but to have an average life.

And that has been my goal as well.  Such hard work?  Such tremendous suffering?  So that you can do what most other people do as a matter of course?  But, yes, that was the goal all along.  I didn’t work so hard to survive so that I could save the world.  I survived so that I could get up in the morning, eat breakfast, and have a cup of coffee in peace.

It has been with some surprise that I have discovered that the world I have escaped into is not a world full of good people, in contrast to the evil world I grew up in.  The real world is a mixed world.  It is one populated by many good people, some evil people, and countless others who work and raise kids and post hoaxes on Facebook without thinking too much about their lives or the world.

Sometimes this world disappoints me.  Was this really so worth fighting for?  Does it remain worth fighting for?  Is an ordinary life worth so much struggle?  But, yes, it is, because it is a world in which I have choices.  And remaining a principled, caring person does not come only as a tremendous act of will and at the price of terrible suffering.  It’s something I can do everyday, without having to risk life and sanity over.

Moreover, an ordinary life is sublime.

Further reading:

Freiberg, Dov.  (1988).  The Last of the Freibergs.  http://www.jewishgen.org/yizkor/Freiberg/Freiberg.html#TOC

Freiberg, Dov.  (2007)  To Survive Sobibor.  New York: Gefen.

Sobibor Testimony of Dov Freiberg.  (2004, May 31).  Axis History Forum.  http://forum.axishistory.com/viewtopic.php?t=51471

Why I Hate Halloween

Spooky and Magical, by S. Dhamyja.

I hate Halloween.

I’ll tell you why.  Starting sometime in September and now in July, the Halloween costumes and decorations and candy go up in stores all over the country, and as the orange factor increases, so does my fear level, thoughts about suicide and worthlessness, and general, overall nasty internal state.  I also usually get the flu.

This is a good year.  All I’ve come down with is one of those snotty, itchy rhinoviruses that will have me looking like Rudolph by morning.

In Choice, I describe the reasons I feel this way.  That day in the garage with my dad was Halloween, and it’s not that the whole thing replays itself in my mind every year.  Bits of it do.

Fear does.  What I thought.  And that overwhelming, horrific confrontation with evil.

Hangman’s noose. Wikipedia.

Because the thing about people like my dad–who has a marked sense of grandiosity–is that they require others to support their delusions about themselves and the world.  Reinforcing for them whatever warped ideas they might have can be a matter of life and death.

Sometimes, if a madman like that is your captor, the pull to mirror the beliefs and emotions of someone upon whom you are entirely dependent is simply too strong.  We are, after all, social beings, wired to think to at least to some extent what other people think.

But there is also this other element.  The insertion of reality into the grandiose fantasy of a narcissist or sociopath is a dangerous undertaking.  Survival is important.

So if my dad thought I had brought a mock execution upon myself, so be it.  If he thought I had no worth and no value, that was okay too.  If he had thought I was a potato, I’m pretty sure the nightmares I used to have at this time of year would involve being dug up from underground, baked, and served with butter and sour cream.

Thoughts are a part of what happened.

I’ll tell you what what conclusions I have come to about all of this now that this is all out in the open for me and I can start to make sense of it for myself.

I think I’m a person.  My therapist says from time to time I’m a good person.  I’m not so sure about that.  It also really isn’t the point for me.

I’m a person, which means that I have choices–at times very narrow ones, and now much less constricted.  I have the freedom to make either good or bad choices, to behave like either a good or bad human being, and maybe often like a little of both.

I have the freedom to fail and to make mistakes, to do the best I can at life which may at times mean falling short of the mark.  No one will hang me for it.

You have no idea how long it has taken or how difficult it has been to get to this place.

Growing up with Borderline

Photo credit: Good Houskeeping

I have a vivid memory of standing in my crib and watching my sister being shoved against the wall so hard blood came out of her head.  I can’t figure out the mechanics of the blood, or how a wall can make someone bleed without cracking the skull, but I’m sure about the blood.

When you have a parent who is extremely emotionally volatile, experiences intense and inappropriate anger, has an intolerance of others behaving like separate human beings because it makes her feel abandoned, and sometimes has complete breaks with reality, being a toddler can get pretty violent.

“With borderline personality disorder, you may have a severely distorted self-image and feel worthless and fundamentally flawed. Anger, impulsiveness and frequent mood swings may push others away, even though you may desire to have loving and lasting relationships.”  (The Mayo Clinic)

Now imagine that person with a child who says “no” every third word, has temper tantrums, says she doesn’t want something just because the parent does want it, is impulsive and into everything.  Disaster.

No wonder we periodically have news stores splashed all across our tablets and the front page of newspapers about mothers who kill their children.  Toddlers and borderlines don’t mix very well.

A ramp leading down into the Hudson River, where LaShanda Armstrong drove herself into the water along with her 4 young children.

But back to my story.  I doubt very much my older sister remembers being shoved against the wall at 3 or 4.  Most of us don’t remember being that age too well.  Clear narrative memories for most people are only just beginning around then.  I’m fortunate, perhaps, and unusual in that I do remember events from very, very early in my life.  But whether we remember them or not, what happens to us as toddlers and pre-school age children profoundly affects us.

It seems to me if you have a parent with borderline personality disorder, the “terrible twos” can go one of two ways.  You can suppress your normal development and remain enmeshed with your parent long after it would have been healthy for you to start the process of individuation, or you can proceed with normal development but tolerate the intense, negative emotional reactions of your parent.

Not all borderlines are violent with their children–at least that’s what I’ve been told.  But at a very minimum an unhappy person with borderline personality disorder will cry a lot, punish offending loved ones with the silent treatment, or threaten to self-harm–which is usually just as frightening to children as being harmed themselves.

What occurred to me this morning is that my sister responded to her developmental crisis by care-taking and sacrificing her psychological development.  When mommy got mad, my sister was sorry, gave hugs, cried and made up.  I ran.  I knew I was expected to do what my sister did and help mommy feel better, but I couldn’t do it.  I ran, and I kept running really, until I got to where I am now.  Which is geographically not so far, but psychologically the other side of the moon.

When I was a bit older–at 2 and a half or so–I actually did save my mother’s life.  When my mother climbed into the bathtub and slit her wrists, I went next door and got our neighbor.  The neighbor made a call.  Paramedics came, and my mom was hospitalized for 2 or 3 weeks.

I live with the knowledge that, in my mother’s mind, that was the wrong response.  I wasn’t supposed to get help.  I was supposed to fix her myself, although I was barely out of diapers and was just figuring out how to read.

That is often what borderlines want.  They want their loved ones to jump in and do the fixing themselves–not call in the professionals.  I’m sure the reasons for this are complex, among them that they don’t actually want to get better, and “fixing” doesn’t usually involve any real change.

I want to tie one more thread in with this.  I’ve been in therapy on and off for a long time–I’m sure you can see why–and some of this was couples therapy with a partner I now think was also borderline although of a slightly different make-up (less volatile, more self-absorbed).  A theme I recall is that we tend to fall back on the strategies that worked for us as children.

Like the Cowboy Junkies said, “I’ve heard a man in a crisis/Falls back on what he knows best/A murderer to murder a thief to theft.”

That’s true.  If we ran in a crisis, we will tend to keep running.  If we allowed ourselves to become enmeshed, we will do that.  I ran for help.

Not bad.

References:

Child in Crib. (2010, May24).  From “Baby Cribs: Safety Do’s and Don’ts.”  http://www.goodhousekeeping.com/cm/goodhousekeeping/images/child-in-crib.jpg

Lyrics Time.  (2012).  Cowboy Junkies Lyrics.  “Firs Recollection.”  Retrieved from:   http://www.lyricstime.com/cowboy-junkies-first-recollection-lyrics.html

Mayo Clinic. (2012).  Borderline Personality Disorder.  Retrieved from:http://www.mayoclinic.com/health/borderline-personality-disorder/DS00442

Shaw, Amir.  (2011, April 14).  Mother Drowns 3 Children, Self; 4th Child Flees.  RollingOut.Com: Digital Urban Voice.  Retrieved from: http://rollingout.com/politics/black-mother-drowns-3-children-self-4th-child-flees/

Because It’s so Damn Hard

It’s Thursday, and I feel I have some answers.

In my last post, I had some questions for myself.  Among them, why I’m so frequently such a disappointment to myself and seem to fall short of not only what I’d like to be able to do but sometimes what other people would like me to be able to do as well.

The answer, I realize, is astonishingly simple: Because it’s so damn hard.  Not just one thing in my life, but nearly everything.

I teach, for example, in a low-performing, high-poverty school run by psychopathic idiots.  Seriously.  I don’t think there is anyone in the district with any amount of power who doesn’t have a diagnosable personality disorder.  Anyone who doesn’t is unlikely to last long.

This may be the case more now than in the past, but has probably been the case to at least some extent for more than a decade. In other words, the whole time my students have been in school.  So on top of the usual problems in a high poverty school, and on top of any family problems at home, the kids have to deal with school leaders who have inappropriate or poor psychological boundaries and the propensity for verbal abuse and inconsistent behavior.  It doesn’t help.

So my job is really, really hard.  Any teaching job is hard if you do it right.  Teaching in that environment is unbelievably hard.  And it’s not that I don’t feel I can manage it.  I cope.  It’s just that I can’t always do my job well.  There is simply too much to do and too many challenges to overcome in each 24 hour period.  Some things I just screw up.

Also, there’s this thing I’m trying to do in my head so that things can get kind of okay in there.  That’s hard.  Trauma is hard to deal with.  It’s really hard to do at the intensity and pace I’m trying to do it at and have been for about two years.  (I’m not getting any younger, and I am fed up with this.)  So, I don’t always do that well either.  Or, I take on too much to really be able to handle, and something else in my life suffers because my head has gone cock-eyed again.

This may be a lesson for everyone else out there dealing with something really and truly difficult–a nasty divorce, bereavement, recovery from drug addiction.  Take it on, that tough issue, full throttle if you need to.  Some things can’t be dealt with in any other way.  But expect less of yourself somewhere else.  You aren’t Wonder Woman.  You will not be able do it all.  Expect to screw up, and try to screw up where it counts less.

The other lesson in this may be the greater the challenge you take on, the more often you should expect to fail at it and everything else.  Don’t let this disturb you.  Just keep going.  You’ll get there.

At least I think so.

Kandahar, Artificial Legs, and the Science of Hope

For me, “normal” is achieved only through colossal effort.  I think that’s true for a lot of people.  For some of us, life–just getting through the day–is terribly, terribly difficult.

A couple of things give me hope.

This is one of them.

In Kandahar, a 2001 film by Iranian director Mohsen Makhmalbaf, a young woman journeys through the Afghan desert in order to save her sister, who has become so overcome with despair that she has decided to commit suicide at the time of an upcoming solar eclipse.

Nafas, the main character, periodically speaks into a tape she is preparing to give to her sister in order to provide her with hope and a reason to live.  One of the statements she makes into it is this:

I have come to believe that if someone who has lost a leg does not become a champion runner, it is their own fault.

A still from the film Kandahar. Source: Cinema: Five Great Iranian Films.

What I think she means is that, having witnessed individuals overcome incredible hurdles and hardships, she has become convinced that almost anything is possible for human beings to achieve.  If we don’t, it’s because we haven’t tried hard enough.

She may be literally correct.  In an episode of Brain Fitness: Frontiers from WGBH, a scientist relates the story of a man living in Mexico who is completely paralyzed by a stroke, but over time is able to relearn how to walk.  When the man passes away, an autopsy reveals that the portion of his brain normally responsible for motor control was completely destroyed and never recovered from the damage of the stroke.  The task of walking was “learned” by a different part of his brain.

Source: Brain Health and Puzzles

Not long ago, a blogger commented on one of my posts that I could not just “unlearn” trauma.  But “unlearning” is really closing down one neural pathway in favor of a new one.  I can.

My brain, like everyone’s, is plastic and can be reshaped by the experiences I give it.  It’s just a matter of giving it the right experiences.

I am a champion runner.

References:

Brain Health and Puzzles.  (2007).  Brain Plasticity: Brain Architecture.  Retrieved from: http://www.brainhealthandpuzzles.com/brain_plasticity.html

Brain Plasticity: What is It?  Learning and Memory.  http://faculty.washington.edu/chudler/plast.html

Castro, J.  (2011, February 22).  Understanding the Brain’s “Brake Pedal” in Neural Plasticity.  Scientific American.  Retrieved from: http://www.scientificamerican.com/article.cfm?id=understanding-the-brains

Naficy, Hamid.  (2012, July 12).  Cinema: Five Great Films.  PBS: Frontline.  Retrieved from: http://www.pbs.org/wgbh/pages/frontline/tehranbureau/2012/07/cinema-five-great-iranian-films.html

Sherin, J. and C. Nemeroff.  (2011, September).  Post-Traumatic Stress Disorder: The Neurobiological Impact of Psychological Trauma.  Dialogues in Clinical Neuroscience.  Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182008/