Dissociation

We hear about trauma a lot. As our understanding of mental health disorders evolves, we have learned that trauma doesn’t just happen to those serving in combat, or even those who are in life threatening situations, trauma is our own personal reaction to a situation that we find distressing and unable to cope with (put very simply!)

When we hear that someone has experienced “trauma” we automatically think of PTSD. Again, this is a diagnosis that we are starting to wrap our heads around and when someone tells us they are experiencing PTSD we can kind of understand what that means. But there are many ways that we cope with trauma, and one of those ways is through dissociation.

These disorders involve experiencing a disconnection from thoughts, memories, surroundings, actions and identity. This is detachment from reality, but not a loss of reality like you would see in psychosis.

Dissociation is not something many of us will have heard of, or understand, and it is a complex reaction to trauma. As with most mental health disorders, no two people will experience dissociation in the exact same way, the story I share with you today is one person’s experience with this.

As I explained, dissociative disorders usually develop as a way to cope with trauma, this often develops in early childhood as a reaction to abuse, or living in a frightening or unpredictable environment. In order to keep difficult memories at bay a child may continue to dissociate as a response to stressful situations throughout life.

When I sat down to interview Angela, I will be honest, I did not picture her as someone with this type of disorder. She is a nurturing, cool, calm and collected highly intelligent woman who works in healthcare, and that right there, is the whole problem with the perception of mental health. Even when we think we don’t have these pictures in our minds of who experiences mental health issues, we are all conditioned to assume that someone successful and well respected couldn’t possibly have a mental health disorder.

I often begin these meetings asking people what motivated them to share their story now, and Angela explained to me that she wants to be a mental wellness advocate. She then went on to mirror my initial thoughts, “I’m not someone you would look at and say “she has mental health problems.” Mental health problems are a fact of life. They’re a part of the human condition, and they teach us so that we can grow.”

Growing up in a small town in Eastern Canada, she explains the complex dynamics of her childhood and community, “There was a lot of passive aggressive bullying behavior, nothing overly violent, though I was bracing myself quite a bit,” she said, “There was a lot of putting people down. It didn’t help that I was a sensitive kid, an exquisite empath. I felt the pain and vulnerability of the person who was being targeted, and I felt the delight of the bullies as they took self-esteem and peace of mind like it was lunch money.  When you experience that consistently, it starts to wear you down”.”   Angela goes on to say how she believes that this led to trapped feelings and she said this impacted her greatly as a sensitive child. “By the time I got home from school, I would have to run it off.”

When we went on to discuss her family she explained, “My childhood in many ways was very nurturing,” she said, “In other ways it was dysfunctional. But that’s not out of the ordinary, right? We all joke about the dysfunctions within our families.” When asked how that has impacted her, she said, “I have residual rage, confusion, and shame, and that’s been a real energy drain over the years.”

Angela said that her understanding of her childhood came much later in life, “I had a discussion with my best friend just a few years ago about the fact that I had to deal with something, because my history seemed so normal by appearances, but I was having textbook symptoms of abuse,” she explains. “I had a couple of repressed memories surface, but they didn’t seem like things big enough to be a repressed memory. Not the kind of thing you’d expect to see in a textbook. Still, I needed to sort them out, because my reactions to them were pretty textbook”

“I hope I am able to give something unique here,” said Angela, “you could never make a movie out of my life, it is not that dramatic, but my responses to it have been.”

Angela talked about her earliest memory of dissociation being around Grade 7/8 but said that it seemed like normal behaviour to her at that point.

She recalls a defining moment being in 2014/2015 when she was in a long-term relationship. “My partner was picking up on it, but not understanding in an empathetic way at the time,” she said. “There was a lot of shame and embarrassment from my end, and a lack of understanding from his end.”

Her partner at the time would notice changes within Angela and she describes the 6 main changes that would happen within her when she began to dissociate.

  1. Something would shift
  2. Her choice of words would change
  3. Body language would change
  4. Mannerisms would change
  5. Tone of voice would change
  6. There would be no empathy left, “It was all about me.”

Angela compares dissociation to an eating disorder in that it is, “protective at the time, but you get stuck in a cycle that is very difficult to get yourself out of”.

When asked to describe what it is like to dissociate, she goes into great detail, having spent years studying this particular disorder to better help her understand, “the senses go offline,” she explains. “It’s an unintentional, protective mechanism.”

“The perceived threat has to be recognized before dissociation can stop,” she said. “The situation, conversation or person has to stop/leave, before your nervous system can come out of dissociation, and before your rational mind can come back online”.

Put simply, “we dissociate when we feel trapped,” said Angela.

One of the frightening things about dissociation is that the person who is experiencing it, doesn’t notice it is happening, “It takes skill and help from a loved one to find out how dissociation looks and feels for you.”

I asked Angela to walk me through an experience with dissociation, to explain it to me in a way that someone with no knowledge of this disorder would understand.  “A great example is in a previous relationship I had, which was not abusive, but certainly had its dysfunctional moments. There were times when I felt trapped in a situation unable to leave it, calm it down, or get it resolved.”

“At first, I would get very quiet. I’d choose my words very carefully, and monitor my movements very carefully, not moving very much at all, except for a few subtle telltale twitches. I would breathe very shallow,” she explained. “This is a nice example of what freeze mode can look and feel like”. Freeze mode is a term that Angela uses to describe a state of her nervous system when under stress.

“Then, I would try to leave or talk myself out of the situation, so flight mode would take over,” she explains. “My ability to be rational would be offline at this point.”

“Then, if I couldn’t escape the situation, fight mode would take over. If you heard me, you would hear me shouting something like ‘YOU NEED TO STOP. I HATE THIS!‘ And I would start to use blaming language”.

“I wasn’t trying to be malicious,” she explained. “I was just so full to capacity that I couldn’t self-regulate. The inner child takes over, and the inner child is completely self-centered”.

She describes herself as taking on a child-like demeanor as she dissociates. “My manner of speaking, the words I chose, even my body language would be different. To an outsider I would look like a drama queen. My partner would say “stop with the drama”, and rightly so, but that just made me feel more shame, which made the feeling of being trapped even worse”.

Dissociation ends when the situation resolves itself, and for Angela, the resolution of an argument would “bring her senses back online.”  Raised voices, and particularly yelling, is a significant trigger for her, and very much increases the likelihood that her nervous system will move into dissociation. She wanted to make it clear that she is grateful for the relationship that’s being discussed here.

I asked her what happens once her senses come back online. She takes a deep breath and it is obvious that this is a difficult thing to re-live. “It sucks when the expression of emotion comes back,” she said. “I cry when I am out of dissociation, and not a regular lady cry,” she laughed. “It is a deep cry with coughing, it can last around 10 minutes and I try to avoid being seen or heard when this is happening.”

“It feels in my body, highly dramatic, like a storm,” she recalls. “Then I am very tired after.”

“In dissociation we are two separate entities and only one is functioning, and to reintegrate after that separation is exhausting and the exhaustion lasts for about a day after.”

After the crying has finished, she finds she needs to sleep and then have a big workout the next day to release her stress energy. She said of this routine, “It gets me back to my rational, creative thinking and allows me to be socially ‘elegant.’”

Using exercise to help her cope has been an effective tool, but has also come at a great expense to her health, “I have over-trained four times,” she said. “If I didn’t do yoga now, I would have fibromyalgia.”

She explains that people need to have a balanced approach to their mental health and that counselling is potentially one aspect, exercise is another, but that things like music and art are also good outlets.

Newly married, Angela describes her husband as, “the greatest man I’ve ever met.” She goes on to say, “He is intelligent enough to be able to understand it. It has only happened twice with him and neither of those times were his fault.”

As I begin to wrap up the interviews, I usually ask what the interviewee wants people to understand about their mental health disorder.

“I want people to understand that the adult is no longer able to self-regulate.  The inner child takes over and the child’s job in that moment is to do whatever it takes to protect the adult,” she said.

Talking about the future of mental health, Angela said it is important that we start to teach our children how to tune into the 5 senses and learn the basics of how the nervous system works.

Working in healthcare, she tries to educate children how to identify their feelings through using certain words like, “stormy, buzzy, numb.” She said this is how they learn to check in with their own nervous system, but more importantly, it teaches them that they have control over it. “I talk about the nervous system to kids, the same way I do to adults,” she said. “We need to give them the knowledge and understanding and we should start talking to them about it as soon as they can talk!”

Lastly, Angela had this to say, “I want people to understand that the experience and perception of situations is the deciding factor of whether or not a person gets traumatized, not the situation itself, so people need to reserve their judgements.”

Depression

In the last article, I mentioned how essential it is for those suffering from mental health disorders to have a supportive community surrounding them. This community can be friends, coworkers, neighbours, but most often it is the immediate family that step up to support and guide. When this doesn’t happen, it can create an even more dire situation for the person suffering. Without feeling loved, supported and understood, the person can fall into a deeper depression and could easily feel as though there is no reason to go on.

Today’s article tells the heartbreaking story of a wife and mother who has had to go on a mental health journey without the support of her husband.

This story is in no way designed to criticize her husband, but to show how the caregivers need to be educated and supported too, as they take on the daunting task of helping someone they love. Often when we are thrust into the role of caregiver, we struggle with our own insecurities and wonder how we can possibly help someone in need.

This interviewee has chosen to remain anonymous; names have been changed and certain details changed or omitted to protect the identities of those involved.

When I sat down to meet with Sarah, she came across as a softly spoken, well put together woman in her 50’s. Her nails were impeccably painted red and she held her hands tightly in her lap, nervous and reserved. I started the interview the same way I always do, asking them if they would mind taking me back to the beginning, back to their childhood.

“I grew up in a dysfunctional and unstable home as a child,” Sarah explains. “Mom and Dad were together, but my father had a really bad temper.” She recalls never feeling secure as child, or loved.

“I have three older brothers, they experienced physical abuse from my father, I never remember being hit, but there was a lot of verbal abuse directed at me,” she said.

She describes growing up in poverty, and explained how there were times where there wasn’t food in the home. Sarah talks about visiting neighbours homes and feeling the disconnect between her life and their lives, “I would go to their house and they would have pretty things and nice lunches,” she remembers, “It seemed so special, they had pretty homes, ours was ragged.”

Growing up in a family where her father controlled most aspects of their life she said she always felt like something wasn’t right and couldn’t turn to her mother for help or support.

“Mom was very docile, and she allowed Dad to behave the way he did,” she explains, “She wasn’t much help, I didn’t feel protected by her as a child.”

Sarah as an adult has been able to better understand the behaviour of her parents and the dynamic of the household, “My parents desperately needed help, but they couldn’t help me, they couldn’t even help themselves.”

We went on to discus when she realized she had mental health problems and she says she became aware of it, even as a young child, but that there wasn’t a lot of education or understanding of things like depression when she was growing up, “I was a melancholy child, I kept to myself a lot,” she remembers, “The dynamics in the house would stress me out, it would build, I would get angry and cry and then I would feel some release.”

This pattern of getting upset, angry, crying and then feeling some release, was the theme throughout her childhood. She explains how she used running and exercising as a tool to cope, but that she would follow it up with binge eating, “It was totally ridiculous and unhealthy, but I didn’t know what other skills to use to cope.”

An educated woman, Sarah went to Wilfred Laurier University to obtain her Bachelors in Psychology, and then got married and stayed home to raise her two children. She told me that this was one of the hardest times in her life.

“That was a rough period, staying home,” she says, “My husband worked all the time and there were marital issues.”

She noticed early on in her marriage, that her husband had extremely high standards for her and that he didn’t understand or sympathize with the dysfunction of her childhood. “I didn’t know how to cook and take care of the house,” she explains, “I wasn’t taught that as a child.” When I asked her how her husband would respond to her she said, “He would tell me, you’re an adult now, grow up.”

During this time of being home raising their children, she said she experienced high levels of anxiety and lots of crying and low moods. She felt like she was experiencing “mini nervous breakdowns” on a regular basis, which only further frustrated her husband. She said how she would try to hide her emotions from her husband, but that it was getting harder for her to function. She remembers times where her husband would put her down for her inability to function, “he would say things like, if I need someone to clean the house, I can get a housekeeper, I don’t need you.”

She also recalled the hurt she felt after gaining weight taking anti-depressants. As someone who had always been self conscious, she was upset at the changes in her body during that period of her life. “My husband would say he didn’t like my body after I gained weight,” she explained, “I’d go to the gym, I’d try to eat healthily, but he essentially rejected me, even for my appearance, which just made me feel worse about myself.”

After a period of counselling and coping with a chronic back injury that left her in constant pain, she was diagnosed with clinical depression. She was so desperate around 2007, that she drove herself to Homewood in Guelph, but was unable to get treatment there as she didn’t have a referral.

She did eventually get a referral to Homewood where she stayed for five weeks and was able to go home at weekends to be with her family. After returning from Homewood and completing the five weeks her husband had made a big decision, “His exact words were that he didn’t love me anymore and that he was going to do his own thing.”

From 2007, ‘til now, Sarah and her husband live under the same roof, but they live separate lives. “I have had to build my own life without him, it has been extremely hard,” she said, “My girlfriends say I should go out on my own, but I don’t think I can emotionally handle it at this stage of my life.”

During the interview, I asked her if she still loved her husband, despite him leaving her in her biggest time of need, “I do still love him,” she answered, “If he came to me and said he wanted to work on things, I would be a little reluctant, but I would probably say yes.”

Sarah credits two good friendships for helping her though the depression, and says she went to live with one of her friends for a month after missing her medication for a few days and relapsing. Along with their support she shares the following things that have helped her:

  1. Ongoing counselling
  2. Exercise
  3. Reading
  4. Social get togethers with friends (even though she is more introverted.)
  5. Her faith/Church support

Even though she has come a long way, she says there are still situations that cause her a great deal of anxiety. “I don’t like to be alone for too long, I don’t like long weekends, my husband is gone all the time and I feel like I have been left alone,” she explains, “I hate New Years, I feel like the whole world is celebrating except for me.”

Sarah is an incredibly strong woman who has been on a difficult journey, but she remains optimistic for her future and acknowledges the strength she has demonstrated through her depression. “I can get through this, I have been successful in putting my life back together and believing in myself,” she says, “I can have a life of my own, even without my marriage.”

She loves the work she now does with young children as an Early Childhood Educator and she feels that it is a rewarding job. “It can be a tough job if you really care about the children,” she explains, “But, children are so innocent in their love and they give back to you as you give to them.”

Her final advice for anyone reading this is, “I don’t want to come off as if I don’t understand, but I do believe it takes an active approach to treat depression. There are cases where medication can give life back to a person, but you also need to take care of yourself spiritually and physically, be proactive and treat the whole person.”

She hopes that now she is experiencing a long period of stability in her life, sharing her story will help give back and let others know that they aren’t alone and that they can’t give up! “We have to always be working on this, we can’t stop even if we think we are cured, this is a life long journey.”

PTSD

When I began working on this series, one thing I really wanted to convey was that mental health issues do not discriminate. Mental health disorders do not care what gender, ethnicity or religion you are, or even what job you have.

Today’s story perfectly demonstrates the power and prevalence of mental health disorders and how we do not have the ability to always see it for ourselves, even when we work within the mental health field. This should make us realize more than ever, that it is the responsibility of our communities to look out for, support and protect one another.

Jodie, is married and a mother to a 3-year-old daughter, and she is a mental health professional herself. She has been in the counselling and treatment field for around 14 years and has worked with people experiencing, grief, eating disorders, sexual abuse, trauma and more. Despite her extensive knowledge in the field of mental health, when she experienced a traumatic and life altering event, she began to show signs and symptoms of Post Traumatic Stress Disorder (PTSD) that impacted her life greatly.

A self-confessed “empath” or “highly sensitive person,” Jodie speaks about her love for her chosen profession and her passion for helping others is evident in the way she speaks. She also acknowledges that being a counsellor has its own challenges.

“It can be a very tough job, especially with burnout, compassion fatigue and vicarious trauma,” said Jodie. “This is ok in your younger years when you haven’t necessarily experienced a lot of your own trauma, but it can really affect or impact the compassion you can give to other people when you start to have some of these experiences for yourself.”

Jodie and her husband experienced a parent’s worst nightmare just after their daughter’s first birthday. This chain of events would change their lives forever and Jodie even admits that she still feels the after effects of the event 2 years later.

“Our daughter had just turned one and she got sick and spiked a fever very quickly.  She had a febrile seizure and went unconscious,” explains Jodie.

“She was foaming at the mouth in my husband’s arms, right in front of me, she shook, her eyes rolled back and she went limp and unconscious.”

As a result of her losing consciousness, she started to turn blue.

Jodie dialed 911 while her husband immediately started performing CPR on their daughter.

In the mental health profession, a lot of discussion takes place over each individual’s fight or flight response when faced with a traumatic event. Jodie says she experienced the flight response.

“I could not bear seeing that picture that I could not undo in my head. I actually ran outside and started yelling for help and for someone to come and save my dead baby.”

She explains how she sat on the front lawn, in tears, on the phone with 911 dispatch. At that point a neighbour ran over and went into the house to help her husband. “I stayed on the phone,” she says. “I felt an extreme amount of guilt for that response.”

“It was not a choice, it was just what my response was in that situation, I have taught for many years about fight or flight, you would think I would give myself a break.”

Her husband continued to do CPR on their daughter and removed her clothing to bring down her temperature. The neighbour grabbed cool towels to help.

As she sat on the front lawn, she says a few moments later she heard her daughter crying.

“It was the best sound I have ever heard in my life.”

As her mind and heart continued to race with the events that were unfolding, she describes herself as having an out of body experience and goes on to say that she couldn’t fully comprehend the amount of pain she was in.

“For a moment in time, I thought my child was dead.”

“Never in my life had I had any sort of low mood, or depressive symptoms, but when I thought my child had died, I thought, there is no way I can go on. There is no way I can get through this. How can this even be true?”

When the paramedics arrived, she remembers continuously asking them if her daughter was going to be ok and she describes the 10-minute ride to the hospital as feeling like hours. The whole trip, she was worried that her daughter would have another seizure and the fear of losing her baby stayed with her long after the initial event.

Jodie says her biggest fear moving forward was, “what if it happens again and I’m the one there, and I can’t respond like my husband?” She explains that she was also worried about other people who may care for her child and not know how to act if another seizure were to happen.

Two days after her daughter’s seizure, Jodie returned to work, something that she admits she would do differently looking back as she understands that early intervention after traumatic events provides the best outcome. Her decision to return to work, was partly made due to the fact that she has a great support system there and she felt that telling her story may help her heal from the experience.

“I kept telling the story and seeing people’s reactions was horrible. Some would cry, others would be in shock and not know what to say, but I was almost telling the narrative as an outsider, so I would say it, but I wasn’t really emotionally tied to it,” explains Jodie, “This made me realize that no matter how many times I talked about the situation, it wasn’t helping me heal.”

During this time, her anxiety skyrocketed and she began to worry more and more about her daughter sleeping and would go into her room during the night.  She describes how her daughter even making certain noises would produce a physiological response within her. “Looking back, I should have taken medication or seen someone,” she says. “You keep thinking that you will be fine and that it is normal.”

She explains that the feeling she was left with was, “go on, suck it up, walk it off, your baby is fine now.”

The pattern of checking her daughter throughout the night continued, and she would regularly monitor her temperature, breathing and blanket placement during the night. At this time her daughter seemed to have a hard time falling asleep at night and Jodie says she seemed extremely stimulated before bed certain nights. It was discovered that she was having Petit Mal Absence Seizures and their daughter underwent neurological testing to find out what was going on.

Certain Doctors she spoke to during this time explained that their daughter would have a difficult time regulating her temperature and that fevers would likely come on very quickly, leaving Jodie concerned. “Lot’s of my friends had kids who had fevers when they were sick, you didn’t necessarily worry that this would happen,” she said, “Every time she is sick with a fever, I worry that she is going to have another seizure.”

Jodie and her husband are thankful for the support the hospitals and medical staff have shown their family but she explains, “this is our reality now.” Their reality also includes an increased risk that their daughter will develop epilepsy, something Jodie and her husband will remain vigilant about.

When talking about the signs and symptoms of PTSD, Jodie said the symptoms affect much more than people realize, “the symptoms add up and take a toll on your body, that is a period of time I can’t get back.” She said the biggest things she noticed was, parental anxiety and sleep issues that affected her mood and energy. She describes PTSD as something that looks different in everyone.

Some common symptoms are;
*Anger
*Sleep Disturbances
*Anxiety
*Worry
*Flashbacks
*Routines/checks you do to make you feel better
*Sadness
*Burnout
*Being triggered

Jodie talks about her own triggers surrounding the event and recalls how doing a CPR class at her workplace left her feeling numb and unable to finish her CPR test.

“Until I went through grief in my own life, I functioned quite well therapeutically,” she explains, “After, I found it hard to work on some of the topics that I had done for so many years. I did it, but at the expense of my own self.”

This realization led to her making a move from front line mental health response and into a prevention and education role, enabling her to use her skills through teaching and coaching.

When asked about defining moments on this journey, she credits “authentic and genuine care” from her friends (some of whom are therapists) being one of the key factors in helping her move through this traumatic experience. She wants people to know that, “it is ok not to be ok.”

Jodie believes that people feel a lot of shame when it comes to talking about their symptoms and the common belief is that life goes on. She acknowledges that it is uncomfortable talking through these things and feels like those thinking patterns lead us to believe that we have to move on with our life, therefore avoiding the symptoms we are living with.

What makes PTSD particularly complex is that symptoms can often show up a long time after the event, making it harder for the person suffering to link the incident and the symptoms together as they feel the event is historic. She explains how she experienced this, “I would cry a lot at work, but I was crying about the wrong things, I wasn’t zoned in on what was really the problem.”

She has some advice for those who may be going through this themselves, “Write down your symptoms, keep a daily track, check in with yourself every day and ask yourself, what is my body telling me?”

When talking about the future of mental health, Jodie is a firm believer in education. “Mental Health literacy is needed for the future, in schools and workplaces,” she goes on to speak about the role family and friends can play, and says that the best thing they can do for a friend or loved one, is let them know that their response to their trauma is normal and expected. She also suggests providing some options for mental health support so that they know where to go when they are ready.

“It’s not weak to get help, it’s crucial.”