MENTAL INJURY AND DISSOCIATION

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

The consequences of trauma for a person are that the foundations and contours of his life change, the ability to live in the present worsens, as constant efforts are made to reconcile the trauma that happened in the past with the present and future. The key points that make the experience traumatic is that the person feels helpless and lacks the resources to deal with them. Dissociation is one of the available ways to deal with trauma.

Dissociative states allow you to break out of the rigid framework that reality imposes, to bring dramatic memories and affects outside the framework of everyday consciousness, to change the perception of the Self and create distance between different aspects of the Self and increase the threshold for the sensation of pain. Dissociation, protecting a person at the time of trauma, jeopardizes his ability to process this trauma, which leads to the development of a number of psychopathological conditions.

There are 5 types of primary trauma

- Type I, impersonal / accidental / catastrophic / shock trauma, is an injury that lacks a specific condition. Also included in this category are sudden onset medical disorders and illnesses, as well as treatment and rehabilitation that cause physical and emotional pain.

- Type II, interpersonal trauma that is inflicted by other people in order to satisfy their own needs through the exploitation of other people. Trauma of this type can be single or limited in time (in the case when the abuser is a stranger), but it can be prolonged in time and repeated if the perpetrator and the victim are somehow connected. The interpersonal context of the primary trauma is important in terms of the severity of the symptoms - the symptoms are more severe if the person committing the crime is close and meaningful to the victim - a pattern called the trauma of betrayal.

- Type III, identity trauma based on unchanging individual characteristics (race / ethnicity, gender, gender identity, sexual orientation) that are the cause of criminal assault.

- Type IV, community trauma based on the group identity, religion, tradition, culture that is the cause of the violence.

- Type V, ongoing, multi-layered and cumulative trauma based on revictimization and retraumatization.

There are different types of secondary trauma. Secondary trauma occurs and causes additional trauma most often in combination with type II trauma, when the victim reaches out to others for help but does not receive it, or when the victim is blamed and shamed for being the victim. Type II trauma is usually committed by a parent when one of them is abusive and the other is oblivious to it [1].

The term dissociation comes from the Latin word "dissociation", which means separation, separation.

Dissociation is the process by which certain mental functions, which are usually integrated with other functions, operate to some extent separately or automatically and are outside the sphere of conscious control and memory reproduction processes.

The characteristics of dissociative states are:

─ changes in thinking, in which archaic forms dominate;

─ violation of the sense of time;

─ feeling of loss of control over behavior;

─ changes in emotional expression;

─ changes in body image;

─ impaired perception;

─ changes in the meaning or significance of actual situations or situations that took place in the past;

─ feeling of “rejuvenation” or age regression;

─ high susceptibility to suggestions [2].

There are seven main adaptive functions of dissociation.

1. Automation of behavior. Thanks to this, a person gets the opportunity to focus on more important aspects of a situation or a complex task.

2. Efficiency and economy of the efforts undertaken. Dissociation allows for an economical use of efforts, thus increasing their efficiency. The dissociative process allows you to reduce to an acceptable level the stress caused by conflicting or redundant information, which makes it possible to mobilize efforts to solve a particular problem.

3. Resolution of intolerable conflicts. In a conflict situation, when a person lacks the necessary means for its immediate resolution, conflicting attitudes, desires and assessments are, as it were, divorced by means of a dissociative process. Thanks to this, being in a conflict situation, a person has the opportunity to take coordinated and purposeful actions.

4. Escape from the oppression of everyday reality. Dissociation underlies many religious practices and phenomena, such as, for example, mediumship, shamanistic practices, the phenomenon of spirit possession, glossolalia, etc.

5. Isolation of catastrophic experiences. The dissociative process isolates the experience of traumatic situations that are accompanied by intense negative emotions. In this case, the perception of a traumatic situation is split into separate fragments.

6. Cathartic release of some emotions and affects. Some emotions, affects, feelings and impulses, the experience of which is taboo in a particular culture, can be expressed only in the context of special rituals, ceremonies and rituals. Participants in such rituals release and express taboo emotions, feelings and impulses in the context of a dissociative state, which could be likened to a kind of "container" containing aggressive impulses, feelings associated with frustration or unfulfilled desires. A person gets the opportunity to express these feelings directly or in symbolic form, without feeling shame or guilt in connection with the violation of the framework of social restrictions or the censorship of the "Super-Ego".

7. Strengthening "herd feelings". Dissociation plays an important role in rallying large groups of people facing a common danger, as well as in the sphere of influence of the so-called "charismatic" leaders and authoritarian leaders [2].

The implementation of a strategy for avoiding a situation in which a damaging factor is acting is a normal reaction of the psyche to a traumatic experience. In the case when physical withdrawal is impossible, the psyche undertakes a maneuver of division into fragments of the usually integrated self. Life can continue due to the fact that unbearable experiences are split into separate segments, which are then distributed to various parts of the psyche and body. However, this leads to a violation of the integration of unified elements of consciousness (cognitive processes, sensations, imagination, motor skills, emotions).

Dissociation allows a person who has suffered terrible pain to take part in external life, but this requires a large internal cost from him. An essential component of dissociation is aggression, when one part of the psyche aggressively attacks another part of it.

Most experts distinguish between minor or normative and basic or pathological forms of manifestation of dissociation. Many authors consider these differences within the framework of the concept of the dissociative continuum, according to which dissociative phenomena are located between the poles of a hypothetical continuum, represented, on the one hand, by moderate forms of dissociation, and, on the other hand, by pathological dissociation (an extreme variant of dissociation and the most characteristic dissociative disorder - dissociative disorder identity).

Thus, the range of forms of dissociation extends from very simple to extremely complex divisions within the personality. A child who grows up in a dysfunctional environment learns to take the violence and cruelty around him for granted and to perceive them as an integral part of himself. At the same time, the externally normal elements preserved - an outwardly normal personality - help him to survive, adapt to the situation and cope with it [2, 3].

If in the human psyche there is a separation between the only outwardly normal part of the personality (the outwardly normal part of the personality (VNL) seeks to engage in daily duties, participate in everyday life and avoid traumatic memories) and the only affective part of the personality (the functioning of the affective part of the personality (AL) is rigidly determined by systems defense of flight, fight against hypervigilance, etc., which were activated during trauma), his state is classified as primary structural dissociation. Primary structural dissociation meets the diagnostic criteria for “simple” forms of acute stress disorder, post-traumatic stress disorder, and dissociative disorder.

Most often, this separation occurs in connection with a single traumatic event, although it can also occur in victims of child abuse in the form of the phenomenon of the "inner child" or the so-called "ego state". In primary structural dissociation, VNL is the “main owner” of the personality. All elements of the personality system belong to VNL, with the exception of the segment that comes under the jurisdiction of another dissociative part - AL. The AL sphere during primary structural dissociation is characterized by a much smaller volume than at more complex levels of dissociation, which depends on the proportion of traumatic experiences that are not integrated into the VNL.

VNL is somewhat similar to the personality before the injury, but also different from it. The level of VNL adaptive functioning also varies. The mental efficiency of the VNL of an individual who has experienced a trauma may be too low to coordinate the activity of certain systems of actions and their components. The lower this efficiency, the more likely it is that the individual will resort to substitutionary actions instead of activating tendencies that require a high level of mental efficiency. When VNL is dominant, the person both consciously and unconsciously avoids stimuli associated with traumatic memories (that is, VNL exhibits a phobia in relation to traumatic memories and associated stimuli). This phobic avoidance serves to maintain or enhance amnesia, anesthesia, and blockage of emotional responses. This helps VNL to get involved in everyday life, discarding what was hard to integrate. Some trauma survivors may function relatively normally as VNL for years, while their AL remains inactive or dormant. They exhibit relatively high levels of mental effectiveness, except that they are unable to integrate traumatic experiences. Such VNLs have a highly developed ability to inhibit AL activity. But not all people who have suffered mental trauma are able to maintain this level of functioning. In these cases, AL is a source of constant invasions of traumatic experience in the VNL, and also dominates in the sphere of the individual's consciousness, thus disrupting the functioning of the VNL as a whole.

AL remains fixed on past traumatic experiences and associated tendencies for action. Therefore, AL is limited by the rigid framework of traumatic experience and its attention is focused on the possible emergence in the present of the threat factors of the past traumatic situation.

In the affective sphere of AL of a traumatized person, fear, anger, shame, despair, and disgust often prevail, while AL may lack the awareness that the traumatic event is in the past. Thus, for this part of the personality, the present appears as a non-integrated past.

AL can remain in a latent state or inactive for a long time, but sooner or later its reactivation occurs, this can happen under two conditions: when “triggers” are active and when VNL can no longer hold AL.

The main element of the relationship between VNL and AL is the avoidance of awareness, in the first place, awareness of the traumatic experience. As for the VNL of the trauma victim, this dissociated part of the personality, using its resources and energy, tries to restore and maintain a normal life after the trauma, as well as to avoid AL and associated traumatic memories. Each intrusion of elements of traumatic experience, which the VNL does not expect and does not want, only reinforces the fear of this dissociated part of the personality. Thus, this phobia over time has more and more influence on the functioning, as a result of which the past becomes for the VNL, less and less "real", "as if all this did not happen to me." Avoidance strategies for PNL can eventually develop to the extreme, becoming rigid and unconscious, further limiting the life of the trauma survivor.

VNL distributes its efforts in two directions: it tries to solve the problems of daily life, and also avoids the stimuli associated with trauma. For example, VNL may avoid relationships that are reminiscent of trauma and go headlong into work.

Sometimes AL invasion is not obvious. In these cases, VNL experiences non-specific symptoms that are incomprehensible to itself, such as irritability, hyper- or hypo-arousal, depression, anxiety, rage, insomnia, self-destructive impulses and unconscious enactment of traumatic events. For a long time, the cause of these symptoms may remain hidden from VNL. But, sometimes she manages to understand the connection between these symptoms and the phenomena of AL invasion.

Dissociative personality organization can be much more difficult, especially in the case of chronic child abuse or neglect. If one VNL and two or more AL predominates in the psyche of an individual, his condition is classified as secondary structural dissociation. As a rule, more severe forms of trauma are associated with more dissociative symptoms. Secondary structural dissociation meets the diagnostic criteria for “complex” PTSD, traumatic borderline personality disorder, complex dissociative disorder, and unspecified dissociative disorder.

ALs in secondary structural dissociation are fixed on traumatic experience, have a set of beliefs and assessments associated with trauma, they are also responsible for the invasion of traumatic memories, emotional and sensory elements of traumatic experience into the VNL. Many ALs associated with child abuse and neglect develop insecure attachment patterns that interfere with or alternate with ANL's attachment patterns, creating conflicting forms of relationship described as disorganized / disoriented attachment.

Adults can develop complex forms of traumatic structural dissociation during prolonged and repeated traumatic events, such as war, politically motivated persecution, imprisonment in a concentration camp, prolonged captivity, genocide. It is noted that secondary structural dissociation after trauma in adulthood occurs more often in those people who were already traumatized in childhood. Research shows that childhood trauma is a major risk factor for complex PTSD in adults.

Secondary structural dissociation of the personality can be of very different degrees of complexity. The simplest form includes two AL - usually experiencing and observing AL - and VNL, the activity of which encompasses most of the individual's functioning. In other cases, the division of personality can be much more fractional and include several or many ALs, manifested in different orders and forms and differing in manifestations of a sense of autonomy, the presence and specificity of personal characteristics, such as name, age, gender.

AL, which first appeared in childhood, over time can become complex and autonomous compared to the only AL, which appears in adult individuals during primary structural dissociation of the personality.

AL during secondary dissociation can become so independent that they can completely master the consciousness and behavior of a person. However, the actions of these ALs often do not meet the requirements of adaptation to the realities of the present. Their key tendencies, as a rule, are associated not with the systems of everyday life, but with specific subsystems of protection against threats to physical well-being (especially from a person) - flight, struggle, submission, as well as with shame, despair, anger, fear, childhood overwhelming AL. needs for attention and care. They usually resort to primitive defensive tendencies. When several ALs develop, different aspects of the traumatic experience corresponding to one or more traumatic events are concentrated in different ALs.

During secondary structural dissociation, there are different combinations of AL, each of which is characterized by its own level of development and autonomy. In addition, NLD victims of chronic childhood traumatization are more likely to have maladaptive coping strategies than those who experienced a traumatic situation in adulthood and functioned at a fairly high level before the injury.

Chronic childhood trauma affects the functioning of VNL, because the consequences of early trauma affect all systems of actions responsible for daily affairs. If ALs develop and gain more autonomy, then it becomes more difficult for a single VNL to cope with their interventions and regulate relations between different parts of the personality.

If during the primary dissociation of the personality, the traumatic experience completely belongs to a single AL, which is completely immersed in these experiences, then during the secondary structural dissociation, the activity of different ALs mediated by different protective subsystems, as a rule, is directed to strictly defined stimuli or aspects of the traumatic experience. Some AL can be fixed on traumatic memories, while others - on psychic defenses that prevent awareness of the traumatic experience.

In some cases, secondary structural dissociation develops after a traumatic experience in adulthood reactivates the unintegrated traumatic experience of childhood. In this case, the traumatic reaction in the present is complex and consists of reactions to a new and a past traumatic event. VNL uses AL as protection from certain mental elements, leaving them thoughts, emotions, fantasies, needs, desires, sensations that are unacceptable or intolerable for VNL [3].

Dissociative identity disorder is the most common dissociative disorder. Dissociative identity disorder is characterized by sudden switches between different configurations of personality traits - subpersonalities that are perceived as a whole personality-twin. There can be from two to a hundred or more such doubles, they can know about the presence of each other, and there can be a certain relationship between them, but at each moment one personality is manifested. Each personality has its own memory and characteristics of behavior (gender, age, sexual orientation, manners, etc.), exercising complete control over human behavior at the time of its appearance. After the end of the episode, both the person who was active in it and the episode itself are forgotten. Therefore, a person may not be aware of his second life until he accidentally encounters its evidence (strangers refer to him as a friend, calling him by another name, unexpected evidence of his “other” behavior is discovered).

In most cases of dissociative identity disorder, the person has been abused during childhood. Most often this is sexual violence of an incestuous nature, in addition to various combinations of oral, genital, anal sexual violence, violence was used against these people using various "tools" to penetrate the vagina, anal and oral opening. People with Dissociative Identity Disorder have gone through all kinds of savage torture with a variety of weapons. Frequent testimonies of people suffering from dissociative identity disorder are references to repeated incidents of confinement in a confined space (locked in a toilet, in an attic, placed in a bag or box, or buried alive in the ground). People with dissociative identity disorder also report various forms of emotional abuse. In childhood, these people, as a rule, were the objects of ridicule and humiliation, the child, without being subjected to physical violence, could live in a state of impending threat of physical violence (with the child, his favorite animals could be killed as an illustration of what he can expect). A high percentage of people diagnosed with dissociative identity disorder in childhood witnessed the violent death of their parents or others, in most of these cases, the murder of the parent was committed by the other parent of the child.

The main distinguishing feature of dissociative identity disorder is the presence of alters who alternately take control of a person's behavior. An alter-personality is defined as an entity with a strong, stable and well-rooted sense of self, which also has a characteristic and consistent pattern of behavior and feeling in response to a given stimulus. This entity must have a certain range of functioning, emotional responses, and a significant history of its life. The number of alter personalities in people with dissociative identity disorder significantly correlates with the number of traumas of a different nature that a person experienced in childhood. In the personality system of almost all people with dissociative identity disorder, there are personalities that correspond to the childhood period of life. Usually there are more children's personalities than adults, these children's personalities seem to freeze in time. In addition, people with dissociative identity disorder have “persecutors” alter personalities who seek to kill a person, as well as suicidal alter personalities who want to kill themselves, there are also protective and helping alter personalities, alter personalities who store information. about the whole life of a person, alter personality of the opposite sex, altar personality, leading a promiscuous sex life, obsessive-compulsive alter personality, substance abuse alter personality, autistic and physically handicapped alter personality, alter personality with special talents and skills, alter personalities imitating other alter personalities.

It is assumed that children may develop several types of dissociative reactions in response to trauma, similar to dissociative identity disorder. Gradually, the development of dissociative states occurs, each of which is characterized by its own special sense of I, as the child again and again develops this or that state, which helps him to avoid traumatic experiences and actualize e patterns of behavior that he is not capable of being in a normal state. consciousness. Each time a child enters a dissociative state again, new memories, affective states and behavioral elements are associated with this state through the formation of a conditioned connection - this is how the "life history" of this particular alter-personality is formed.

In childhood, the behavior of all people consists of a number of discrete states, but with the support of caring people, the child becomes able to control behavior there is a consolidation and expansion of the I, different aspects of which are associated with different needs - this is how an integrated personality is gradually formed.

The development of people with dissociative identity disorder goes in a different direction. Instead of integrating the I, which manifests itself in various behavioral acts and states, they have a multitude of I due to the formation of alternative personalities from a number of dissociative states. In the context of mental trauma, dissociation helps the child, but in adult life it leads to impaired adaptation, since memory, self-perception and behavior are impaired [4].

Literature:

1. Lingardi V., McWilliams N. Guide to psychodynamic diagnosis. Volume 1, 2019.

2. Fedorova E. L. Multiple personality in the history of Western psychological knowledge of the 18-20th centuries. Dis. … Cand. psychol. sciences. Rostov n / a, Rostov State University, 2001.

3. Van der Hart O., Nijenhaus ERS, Steele K. Ghosts of the Past: Structural Dissociation and Therapy of Chronic Trauma Sequelae, 2013.

4. Patnem F. V. Diagnosis and Treatment of Multiple Personality Disorder, 2004.