Dissociative disorders
are really interesting and in Clinical Psychology
I'v got a colleague Dr. Ellis and he says it in a way that makes me think, I like the
way he says it.
He talks about clinical psychologist as having
this really odd interest: on the one hand we see people suffering and
we have great compassion for that and on this
shoulder we have this sense of Wow,
that's terrible. I'm sorry you're suffering through that,
what can I do to help and on the other side you're like Wow, that's interesting.
That is really interesting because it's so unusual.
I'm curious. I'm intellectually curious. I want to know more about it. Well dissociation
is something all of us sometimes experience but usually in small bouts
and
sometimes disturbing and sometimes not disturbing.
You have these little experiences and you are like, that was weird but you don't make
anything of it and it doesn't persist so you let it go.
But for other people dissociation, meaning a detachment of one's consciousness
or sense of identity from one's experience
becomes problematic and disrupts their
life because their memories are disrupted
or their sense of identity is disrupted or their sense of connection to reality is
disrupted.
Not in such a way that is so profound that reaches levels of schizophrenia.
We'll see that there's specific criteria for schizophrenia.
And I worked with a patient once that they had a dissociative disorder and
his experience was not always dissociative,
but for long periods of time he would feel like he's walking through a dream
and he couldn't convince himself that he wasn't in a dream. Like the
reality you and I are living right now and might agree we're sharing for him
being a shy person he wasn't sure he wasn't dreaming right now.
Right, and so we talked about ways that he could reassure himself that he was in a
waking state of conciousness
because it just seemed dreamlike to him. It didn't seem
as concrete as most of us experience waking reality.
Dream reality to me is an alternate reality.
I mean if you are in a dream state for example does that not feel
really real until you wake up and go oh, wow, that was just a dream.
But in the moment that you were in it, you ever have that thing were you are drifting off
and all of a sudden you fall and your whole body jumps? Yes.
That's because your body is reacting to the thought as though it was a real
actual occurrence, right. Its automatically responding to the fall
or the trip or whatever
even though you're laying down. So that
experience inside your mind is so potently real that your body is responding to it
but usually you're a deep sleep
and your body doesn't respond to your dreams. But you wake up
most people can clearly distinguish between their sleeping reality or
draining quote-unquote reality and their waking reality which is the one we
all share together.
We've already talked about dissociative fugue. We talked about it in the memory
chapter so you should already be familiar with that term.
Losing memory from personal identity that is way too extensive to be
attributed to any natural process is not due to substance
abuse or something like that and the person
often times will have unexpected travel from home. They just leave.
They don't remember who they are. They don't remember where they live and they wander off,
and sometimes start new identities.
Which then form as cohesive as prior identities, or seem to at least.
And sometimes they come out of it in days or weeks or months and sometimes
not
for years and sometimes they don't come out of it it seems. It's very rare
but it's very interesting when it happens. It's not fraud.
If you go and say, "oh gosh I owe somebody a lot of money or I'm going to go
to jail, or I'm going to have to go in to military service and I'm trying to avoid that
and I fake my own death and go start a new identity" that's not dissociative fugue,
that's fraud, right.
That's a motivated, calculated behavior
designed to achieve an outcome.For this set of circumstances, the person seems
to just snap
out of who they were and not really connect with that prior identity.
Most people have also heard of multiple personality disorder
but we don't call it that anymore. We call it dissociative identity disorder.
Where the person does have multiple
distinct personalities that take over
control of their conscious existence
alternately throughout the day or week.
No real predicting when it will come or go. You've seen the Dr. Jekyll/Mr.
Hyde
stories done time and again and all kinds of dramas
but is that dramatic. Somebody becomes
somebody else and for those around them it's very disconcerting.
I've never treated anybody with this it's also exceedingly rare
but I watched somebody in a session be treated you had this
and he had multiple personality that he exhibited.
He exhibited three different ones inside the hour that I watched and they
flipped in to whole different persons.
Almost like character acting, right. Almost like if you were an actor
you are just changing roles.
Changing roles he had a female personality, male personalities
younger personalities, older personalities but they were different
and they may or may not be aware of one another, which is
the dissociation: not connected, not integrated.
This is rare but one thing that does seem common to the development is severe
abuse in childhood. Severe emotional,
physical or sexual abuse seems to be a common thread
in people who suffer from this. Where we look at all of us, we all have different
personalities we exhibit in different situations..
I'll go on stage and I'll be very different than I would be at a dinner table with
my grandparents, right.
So, it's not that I am a different person, I just engage in different
actions that if you saw me those two different times would look like very
different
manifestations of personality but are really integrated
and choices I make. Here there's seemingly a lack of integration
that it just goes from one to another and the person doesn't seem aware of
the change and thus is not able to control it and it can be very detrimental to
their
to their lives obviously.