What Happened To You? – On Dissociation

(One in a series of posts on Bruce Perry & Oprah Winfrey’s 2021 book, What Happened To You?)

I’m thankful for lots of things in What Happened To You?. One is the thoughtful, nuanced, and insightful discussion about dissociation. (Dissociation: “a disconnection between a person’s thoughts, memories, feelings, actions or sense of who he or she is.“)

First, dissociation is an adaptive response to fear. It can save your life. “If a soldier in combat simply went down the arousal continuum—and got to the flee and then fight stages—he would jump up and get shot. In order to maintain access to parts of his cortex—to think and behave in the ways he was trained to keep him alive in combat—he needs to dissociate to a certain degree.” It can improve your performance. “Being able to partially dissociate…is key to success in competitive sport or high-pressure performances in the arts. The terms ‘flow’ and ‘in the zone’ are used to describe some of these partial dissociative states.” And in the form of daydreaming, it’s a healthy coping mechanism. “We reflect on the past and imagine the future, making dissociative disengagement a key part of daily life…. Dissociating itself is a good thing.” (pp. 170-171)

Like many good things, it’s when it’s carried too far that problems arise. Perry quotes psychologist Virginia Satir: “we feel better with the certainty of misery than the misery of uncertainty.” Cutting, head-banging, “acting out”, and other repetitive self-harming behaviors are often the result of an adaptive response to trauma. “…(D)issociation releases opiods (enkephalins and endorphins), your own painkillers. If a person…with a sensitized—overly reactive—dissociative response cuts themselves, they release a lot of opioid. It’s almost like taking a little hit of heroin or morphine.” We do these things because in stressful situations they feel good (or at least, better than the alternative), and because they are comfortingly familiar. (p. 174)

The therapeutic solution to maladaptive dissociation isn’t to try to undo what’s already happened. “You can’t get rid of the past.” The solution is “more about building new associations, making new, healthier default pathways…. And that takes repetition, and time.” (p. 183)