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D is for Dissociation

By Malika Noor Mehta

During an essay writing competition in my 3rd-grade class, a student of mine, Meera (name changed) wrote about her experience with sexual assault. Through fragmented sentences and misspelt words, she described how a man four times her age had “touched” her. The word “rape” was not a part of her vocabulary yet.

The stigma surrounding mental health and a culture of victim-blaming prevented Meera from receiving the professional help she needed to cope with this experience. As Meera’s teacher, I witnessed the dire effects of silencing a survivor. Meera would zone in and out of discussions. She would lose track of time. Sometimes, she wandered out of class unexpectedly but was unable to recollect herself moving at all. Sometimes, she sat quietly in a corner, withdrawn and sombre. Other times, she lashed out at her peers, clearly unaware of the impact of her own actions. Even though I did not know it at the time, I was witnessing and working with a child who was suffering from a phenomenon called Dissociation.

The human psyche is immensely resilient. It fights for us when we suffer trauma. It finds ways of preventing us from falling apart. It creates defence mechanisms to protect us from a pain that could ultimately prove too unbearable. One of the ways in which our psyche preserves us is through disconnecting from the negative experience, through dissociating.

What is dissociation?

The word ‘Dissociation’ finds its roots in psychoanalysis, a set of therapeutic theories and techniques originally put forth by Austrian neurologist, Sigmund Freud. Trauma is directly linked to dissociation. When a painful event threatens our being, the psyche disconnects from this unwanted experience. Dissociation prevents the mind from contemplating the meaning behind this event and stops the body from living or reliving the physical pain. Professor Neetu Sarin, a psychoanalytic psychotherapist and professor at Ambedkar University Delhi, explains dissociation as a “rupture of the self” where the “continuity of identity is not maintained.” “Dissociation is a defence against complete self disintegration,” she states.

The symptoms of dissociation vary. While the concept itself is culturally and perhaps, even medically, nuanced, the Mayo Clinic describes three major dissociative disorders.

1. Dissociative Amnesia:

Our memories are precious, preserving treasured thoughts and experiences. Yet, on the flip side, memory forces our mind and body to relive the trauma over and over again. Dissociative amnesia causes memory loss, erasing information particularly around the time of trauma. This form of amnesia could erase a specific event (physical combat, rape, a natural disaster), or may cause complete memory loss where individuals cannot recall several aspects of themselves. In rare cases, an individual may experience a particular form of amnesia called Dissociative Fugue where the person finds himself in a place with no recollection of how he got there. Fugue states occur unexpectedly and could last anywhere between a few hours to a few years.

2. Dissociative Identity Disorder (DID):

Dissociative Identity Disorder (DID), previously known as multiple personality disorder, is where an individual exhibits two or more distinctive personalities. In DID, each personality could possess its own gender, voice, gestures, temperaments, personal history etc. The various personalities, embodied within a single individual, may or may not know or be aware of one another. The individual himself may experience this discontinuity of identity by hearing separate voices in his head. In mainstream media, and occasionally, in certain communities, DID is understood as spiritual possession. The American Psychiatric Association, one of the premier organizations in the field of mental health today, makes a point to acknowledge this socio-cultural perspective without negating the medical basis for DID.

3. Depersonalization-Derealization Disorder (DDD):

In DDD, individuals experience a sense of detachment from self, as if you’re observing yourself from outside your own body. You observe your own actions, thoughts and emotions from a distance – this is depersonalization. Individuals experiencing derealization may feel muddled, or foggy as if one is living in a dreamlike state. Time may slow down or speed up, making the world seem somewhat unreal. Individuals could experience derealization and depersonalization separately, or they may go through both disorders together. DDD could last a few minutes, a few hours, or come and go over several years.

How are dissociative disorders treated?

The first step in healing from dissociation is finding a mental health professional who is willing to actively engage with trauma. Dissociation is inherently about disconnection. In order to treat the disorder, actively creating connections is critical. The manner in which this connection form is subjective, but often, it does not rely solely upon the spoken word. Professor Sarin explains that “Language will always fall short in the treatment of dissociation.” Healing occurs through active emotional engagement where communication occurs in all its forms – listening, speaking, observing, moving, or simply embracing the space that silence creates.

In order to treat people with dissociative disorders, it is important that the therapist herself develop a reservoir of emotional resilience. “When the self begins to reintegrate, it will be painful. The person may begin to realize the gravity of the experiences he or she has been through. As a therapist, we must be able to engage with the client’s experience and not push those experiences away. Making a person whole is a lot of psychological work,” explains Professor Sarin.

Yet, even within the intimacy developed between client and therapist, the relationship must remain controlled within healthy boundaries. As Professor Sarin says, “I try to listen to myself as I listen to my client speak; I try to remain porous to my client’s experiences.” A healthy therapist will look after her own emotional needs while simultaneously working with her client. She will seek therapy, herself. It is this domino effect that ultimately serves the client best as the therapist is emotionally bolstered through external, professional help, and is therefore capable of holding space for someone working through dissociation. This process allows the therapist to function with inherent empathy (as distinct from sympathy), creating a deep connection with the client – a connection that perhaps draws the client back to the present moment.

Socio-cultural Resilience

In India, we tolerate paradoxes – or at least, we used to. In times when medical science was not as advanced as it is today, the human brain found other ways of comprehending the concept of dissociation. We used poignant cultural phenomena to explain the complexities of this condition to ourselves. We examined it, pondered it, found non-medical terms to describe it. We gave dissociation space within the social fabric of our country.

Madness. Hysteria. Possession. Theatrics. These are terms often associated with dissociative disorders. While it is easy to dismiss these terms as regressive and politically incorrect, it is important to note that the human brain always finds ways of making sense of the incomprehensible, and through this process, finds ways of accepting the uncomfortable. Professor Sarin calls this “socio-cultural resilience.”

Inherent in this concept is the paradox of dissociation – both, a medical disorder and a cultural quagmire. For generations, we lived with this paradox. We did not demand that the concept be siloed into one category or the other. In today’s day and age, however, we crave clarity. We do not tolerate the paradox – the idea that dissociation has its roots in medicine and psychology as well as spirituality and religion.

Professor Sarin explains that such paradoxes are what allow cultures and countries to retain multiple truths. She explains that not everything is solved through therapy, through medicine, through categorizing concepts into neat boxes. For a mental health professional to truly help someone dealing with dissociation, this professional must understand the cultural context within which the client lives. It is within this context that the person will find a support system, one that will help him or her reconnect with the present moment. If dissociation is viewed differently with this cultural context - Madness. Hysteria. Possession. Theatrics - then using language that resonates with the individuals there is fundamental to helping the client heal. Ultimately, dissociation is best treated through an amalgamation of cultural sensitivity and psychological intervention.

In the end, it is always about connection

During my interview with Professor Sarin, she noted that “not every bad experience in our lives is traumatic. When there is consensual language and the ability to share, dissociation need not occur. It is the negation of pain, the lack of a consensual language around the experience in the family or community that leads to trauma.” At this point, the only way the person is able to survive is by disengaging with the experience itself.

Human beings are social creatures. We search for affirmation. We search for connection. We search for a shared language. We search for common ground.

Often, this affirmation comes from the ones we cherish and love. Sometimes, it comes from strangers. Wherever it comes from, it is required to survive. It is the shield we have against the trials and tribulations that life invariably throws our way. My young student, Meera, found this shield in the form of art. She began to express her trauma through music, drama and painting. Where words failed, art in all its form succeeded. Of course, Meera is still on her recovery journey but through the language of art, and the support of peers and teachers, Meera found the will to fight for her own survival.


About the Author

Malika Noor Mehta is a mental health entrepreneur. Before the pandemic, she was engaged in creating a fellowship program that placed mental health counsellors in low-cost schools in Mumbai. Her interest in mental health stems from her teaching experience at Teach for India and her time in Jordan and Greece, creating trauma-sensitive education programs for Syrian refugees. She holds a Master in Public Policy from the Harvard Kennedy School of Government. In her free time, she loves to write and take photographs.

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