I noticed something surprising as a young clinical psychologist. A few of my patients forgot the most significant topics discussed in the previous visit. The client’s memory had been wiped clean as soon as he took a sidewalk step outside.
Let’s break the experience down. We are dealing with various methods of avoidance:
In behavioral avoidance, we stay away from or delay something. Not attending a party, not making a phone call, and side-stepping confrontation all fit the category.
Now think of the failure to recall segments of a penetrating conversation, a separate class of dodging. It is a kind of return to the state of ignorance we inhabited before the talk with the doctor, with an emphasis on the word ignore. This type of avoidance is a more internal, mental event.
Here are examples of the latter:
Dissociation:
One of the signs of dissociation is the fracturing of recollection. Parts of an individual’s lived-experience are compartmentalized, detached, put into a psychic safety deposit box. The mind drifts from ugliness, anxiety, or grief. In effect, the person walks for a while in daylight darkness. “Losing” the feelings and ideas raised in-session is an illustration of the phenomenon.
The occurrence doesn’t signify intention. The “disappearance” is automatic and unconscious: daydreaming, for example, to the point of losing awareness of time passing.
We all “space out” on occasion, but the recurrent loss of the therapeutic thread between sessions is noteworthy. A treatment obstacle exists.
Self-distraction:
Those who take on the unbuffered fury of every problematic life episode become like an unbending tree in a gale, lacking the flexibility to endure its impact. Self-distraction can be a way of moving aside from the indomitable force, at least for a while. Imagine it as akin to taking a breath, gaining strength, and coming back prepared to manage whatever taxes you.
Even so, because psychotherapy must unsettle the client’s internal climate enough to help him change, he mustn’t distract himself most of the time. If after-session contemplation of the therapeutic issues passes in a breeze of internet surfing, work, or socialization, so will the chance for progress.
However much these psychological defenses might be needed, they can also enact a cost. The fraction of the world we evade or forget leaves a smaller world for us to inhabit. Moreover, our acceptance of a miniaturized comfort zone implies a fear that we lack the abilities, resilience, and toughness to stand up to the larger cosmos.
The individual thus shrinks from all the glorious, dazzling, and frightening complexity of the real world. The universe of what is possible contracts: all the foods, adventures, types of people, behaviors, and opportunities for learning vanish. Existence is narrowed and diminished. Walls are built.
Here is an example. I treated many men who didn’t want annual physical examinations. They avoided physicians because they wished to block bad news (illness).
Quite a few of these men demonstrated bravery elsewhere in their lives. In this situation, nonetheless, they escaped reminders to lose weight, stop smoking, exercise, restrict their diet, and reduce drinking. They ignored troublesome coughs and chest pains. Any real malady was no less present, but the fantasy of make-believe health was maintained.
These people willed themselves “blind” rather than taking responsibility for their well-being.
Such individuals evaded conversations reminding them of their mortality and bodily vulnerability. By making a decision not to submit to medical evaluation, they reduced the freedom to know whether they were ill, defeat illness, and display courage in confronting the limitations and hardships connected with disease.
Excuses hid the truth of their existence, the truth of their avoidance of truth:
- “I’m too busy to go to the doctor.”
- “He’s just going to tell me X, and I already know it.”
- “Doctors only want your money.”
- “My insurance won’t cover the appointment.”
- “Yeah, I’ll go, but not until next month.”
Whenever we duck taking responsibility for our welfare, we give up a portion of the capacity to shape the world to a different and more pleasing form. Whether alert to what we are doing or not, a choice occurs: to claim as our own the disturbing recognition of our inner and outer world or to bury it.
New knowledge, once aquired, always offers us a question: what are you going to do now and in the future in light of what you know?
As the existential philosopher, Jean-Paul Sartre wrote, “If you want x, you will have to (do) y.”
These awarenesses and choices are disagreeable. Otherwise, everyone would make them with ease. They are thrust upon us by the condition of being human. If we keep recognition of our current and past evasions underground, we thereby enlarge the risk of unseen catastrophes, as we do if we walk across the street without looking both ways.
Then, with our eyes ignorant of danger, we are inclined to consider these calamities a matter of hard luck or destiny. External forces appear to have destroyed our dreams. We tell ourselves we couldn’t have changed the outcome.
Maybe, but maybe not.
No one escapes trouble, but some number of calamities are preventable given enough time to prepare. That is, if one chooses to see and accept the freedom to push the boundaries of our knowledge of our psychological world to something closer to full size.
Therapists are wise to take sensitive issues slowly, lest they overwhelm the client, and trigger the tendency to “put away” enlightenment (insight) revealed in the office. Even so, no healer believes he can instill fortitude in another person to face his dilemmas where sprouts of courage don’t exist to be nurtured.
If buds are present, however, the counselor becomes something like the gardener who tends to his plants. His job is to enrich the soil and shelter them from part of the wind and cold.
Then, in the best case, the developed vegetable life — now independent — uproots itself, discovers it has legs and walks into a fuller animal life on his own.
In the end, freedom — the path to growth — is not free.
Whatever our life is to be, whatever it was, whatever historical harm we suffered, the life now and ahead is ours.
We must forever choose to make it.
———
The first image is Papagenato, imported by Archive Team. Next comes Gaze -3, an oil painting by Rajeskharen Parameswaran. The bulldog is called Barlow in Hiding by Andrew Smith. Finally, a Hide Pose by Peter Trimming. All were sourced from Wikimedia Commons.
Dr. Gerald Stein 
One of the many (I should highlight the word many) things I love about your blog is some days when I just need the day to end your blog comes into my inbox and is dated to the following day. : )
It always makes me smile!
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Thank you for the praise, Carolyn. WordPress, the platform many bloggers use, is responsible for dating what you see. Wish I’d thought to do it. I’m glad it pleases you.
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I dissociate when I am too afraid of what the therapist will think, document, and say. I dissociate when I am too afraid of something too painful, significant, or even “insignificant” (minimizing). I dissociate when known and unknown triggers greet me with Death’s 💋 kiss. I dissociate without even knowing that I am dissociating.
My various parts of self are dissociated from me because I am not happy with myself and with how others treat me or have the potential of treating me. I am fragmented because some parts were hurt badly, other parts were disbelieved, other parts were bullied, other parts were used and gaslit, other parts were discriminated against, and other parts were not even pleasing in my own eyes.
I try not to dissociate when I accept all of my flaws and traumatic memories, but I fear my life will be ruined if all revealed itself at once, like hurricane, instead of steady rain. Even if there are 🌈 rainbows amid the storms, the former has the potential to kill, whereas the latter steadily cleanses the earth and its inhabitants. I am afraid of the tempest and the hurricane. I am not afraid of rain. I just want to know the forecast ahead of time, and I want the climate monitor (i.e., the therapist) to keep the rain from flooding and crushing me. I just want all of my concerns allayed. Maybe then my conscious avoidance and unconscious dissociation will be healed and/or properly managed.
Until then, I remain afraid.
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I’m delighted you wrote this, gb. It is the kind of description that can only come from someone who is both psychologically-minded and able to write from the perspective of what it is like to be dissociative. You identify both the benefits and costs of the Dissociative Identity Disorder defensive. Your words capture the so-very-human desire to get a proper “weather forecast” before going outside to face the unknown. I know you have demonstrated much courage in your life. I expect it will yet carry you through.
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Thank you, Dr. S. I’m in therapy again, but it takes me a while to get to know the therapist before I engage fully. For now, I keep in mind my dissociation and all of my other post-traumatic symptoms. Anticipatory anxiety is something we all feel from time to time – the feelings we get when we are about to embark on a new job interview; or wonder if our performance evaluation on the job will render us inept and incompetent; or wonder if our new therapist, romantic relationship, or friend will say and/or do something that will be less pleasing to the mind, body, and/or soul. However, with dissociation and post-traumatic stress of any kind, I feel that the antiticipatory anxiety is much more pronounced. Post-trauma, the body is now acclimated to detecting trauma – even when trauma isn’t there – so anticipatory anxiety is met with both the conscious need for forecasts and the unconscious need for trauma survival tools – i.e., dissociation as a comination of avoidance (flight) and alternative engagement (fight mixed with freezing the core person, who isn’t feeling up to the task of promoting oneself enough to fight with that part of self). Confused, the potential trauma offender (whether intentional or not), doesn’t recognize the switch in the dissociator (at least not fully), so the relational engagement continues until all anxieties quell in the mind, even if not in real life.
I still doubt my diagnosis of DID. My first discussion with my new therapist centered around that fact. The VA holds my records from the past and relative present. Some see my “integration” as never having ever had DID because they cannot see my overt switching, progress from the past, and/or the signs typical of what has been sensationalized in the news, higher education, and elsewhere. Quoting from “United States of Tara,” “I’m not a performing monkey in heels.” –I’ll never forget that line, since that is what it feels like whenever I try to describe my dissociative disorders to professionals, if not safe non-professionals. I’m not an actor, a cry for attention, a desperate lonely person, or a delusional psychotic. I’m a person with a traumatic past who *unconsciously* (not psychosomatic, not attention-seeking, not malingering, not culture-bound, not factitious) utilized dissociation as a survival mechanism, an adaptive coping skill during trauma, a maladaptive coping skill post trauma (or when no trauma remains present).
I used to like surprises, but not anymore. Gift-giving, birthdays, celebrations, and awards are all great – and even singletons (or those with unfractured, unshattered selves) can experience out-of-body sensations when receiving something overstimulating, like an award. But not those with trauma and dissociation symptoms. For me, the fear of the unknown, the unstated, and surprises mean that there are alterior motives – something that will produce more trauma, shock, and/or stress. “What will they want in return?” is the question I ask myself automatically whenever I receive gifts, awards, or any other accolades. For all I’ve known is unhealthy give-and-take. Even in the service, the “reward” for being a member of the armed forces as a minority female enlistee is met with the expectation of sexual favors, sexual harassment, sexual innuendoes, and more psychological trauma than one can imagine. If I was ever resilient from my childhood traumas, the reinforcements of military sexual trauma have undone all of my resilience. Instead of being a courageous hero – even to my own self – I’m a coward who feels unsafe in her own skin, an eunich (sp?) who no longer finds pleasure in anything sexual, a person with constant anticipatory anxiety.
When it comes to healing my traumas and resulting symptoms such as dissociation, all I ask is for a steady pace, climate control, sheltering tools for the upcoming storms, and some forecasts. Or am I just an alterior motive for research? Or am I just a testing of theories that the therapist enjoys endulging in? Or am I just a test of a clinical psychology mentor’s predictive outcomes? –What exactly do therapists want from me, if not solely for me to get better at a pace I can handle without being so retraumatized that I wind up with iatrogenic effects of their ineffectual treatments of me as a client, mentee, student, or otherwise? A little forecasting and much understanding of my condition – with an opened mind and a little less speculation – will go a long way for my healing.
If my DID was “created” by a past bad therapist who actually did make a ton of suggestions, and if my DID is, itself, an iatrogenic effect, I’m still living with the symptoms today – as a polyfragmented person, according to one of my many diagnoses and the explantions for that particular kind of DID. I’m still in need of treatment for those symptoms that were, again, not something that is fictitious, conscious, culture-bound, or otherwise. Whether those symptoms are iatrogenic in nature or not, they are still there – just like when a patient goes in for surgery or pharmaceutical treatments and has a resulting iatrogenic condition that was caused from the wrong treatment(s) – the physiological symptoms are nonetheless treated, diagnosed, and most of all, believed. Not so much with DID, sadly.
I may be more integrated today than ever, but that doesn’t mean that I don’t dissociate in other ways. One thing that therapists don’t understand about DID – however it came about – is that it can easily be replaced with another form of dissociation, in many of the same ways that addicts replace one addiction for another. To heal fully is to not replace one maladaptive behavior with another, but to get to the crux of the matter – that which you’ve alluded (or is it elluded?) to in your post: the avoidance. I cannot possibly heal if I simply agree with the therapists on every point they make, because that pleasing-the-other principle becomes a form of dissociation, not a form of true healing for me. I may not “switch” as much, so the therapist is happy and sees “progress,” but for me, I’m left with increasing trauma memories coupled with increasing alternative forms of dissociation such as leaving therapy prematurely, changing the subject, performing better emotionally when I’m crying under the surface, becoming a workaholic to avoid dealing with true engagements and trauma processing, and overly focusing on coping skills (which both therapists and clients alike are guilty of) in order to avoid processing traumatic memories. Coping skills can easily turn into a form of dissociation, in many of the same ways that clandestine and special ops utilize a conscious, forced form of dissociation to deal with traumatic capture, POW disituations, traumatic torture, and otherwise. Coping skills becomes like workaholism and maladaptive distractions whenever trauma processing – the sharing of details, the sharing and expressing of emotions in a safe place – is avoided. Perhaps therapists cannot handle hearing and/or seeing trauma processing, or perhaps therapists have unresolved issues of their own. Perhaps therapists weren’t prepared for the natural trauma processing that takes place when “safety” is felt through coping skills and otherwise, and when their need to process trauma is met with more “dissociation” whenever the therapist stops the emotions from continuing, or stops the client from expressing traumas. If there’s a “correct way” to express emotions and trauma memories – with or without details – then that should be explained, and the forecast for all types of treatments should be made – lest the client finds herself (or himself) in perpetual states of anticipatory anxiety and resulting dissociation/avoidance/distractions/etc.
Although I feel like a coward, I know deep inside that I’m courageous enough for expressing the truth about how I feel, for continuing forward (even when I take two steps back at times), and for trying (even when I don’t feel like it). I want to face the storm, and I have some of the tools, but along with those tools are dissociation – the kind of tool that will pretend the storm isn’t even there, and that someone else is battling the storm while I suffocate from my own dissociative delusions in an “alternate reality.”
I want to feel whole and engaged, not hidden and judged. I wanted to feel belonged, not ostracized. I want to feel human, not robotic. I want to heal, not be a research subject for testing a theoretical treatment. I want more clarity on what my treatments are, and I want reinforcements along the way – I want the weather forecast daily, not just in the beginning of the week or year. My storms are many, but I need the therapist to understand the signs well enough in order for me to give me an appropriate forecast when their treatments affect my own personal climate changes.
I want to be someone that I’m not, someone else who is stronger and more courageous. –That thought comes from a place of self-hate, self-discrimination, and internalized perpetrators. To accept my parts is to say that I am strong and courageous enough to handle what comes to me in life, and to say that each part of me – not just the “core me,” but the other parts of my self – are equally accepted, for they are me, too. Behind their courageous acts and delusional personas is me – frightened, afraid to engage, afraid to disclose, afraid to remember, afraid to move forward and on, afraid to remain suspended and yet afraid to grow. There are so many fears, but many of those fears can be quelled with some meaningful forecasts. 🙂
Thank you, Dr. S, for seeing courage in me – even when I either don’t see it in me or when a part of me boasts about courage I don’t really feel I fully have – at least not most of my parts. 🙂
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By the way, my new therapist seems great. She stated that we’ll go at a pace that is comfortable for me, which really helps. She seem knowledgeable about a lot of things, so we’ll see how that all progresses. I’m barely getting to know her. See her for the second time this Thursday. I shared a bunch on my first visit with her, so after thinking about a ton of things, I have to explain some things to her – some of what I shared or overshared.
Dissociation and avoidance are tough issues for me, and I know it. I’m trying really hard to face everything. It’s the emotions of it all that are most painful, apart from the memories.
My therapist asked me on our first visit whether I knew the reasons behind lost memories and time, in relation to trauma. I wasn’t sure how to truly answer that question, even though I’ve read many scientific articles. She explained how some of our traumas are so horrific that it can affect many different aspects of memory, including the good memories. I explained to her that that would explain why I cannot even recall memories prior to my military service, including my officer friend who asked me if I recalled another friend of ours (I couldn’t, but I lied and said I faintly remembered since it had been over 20 years ago), and how we all hung out and had a great time. I was really happy that they said that to me over FB, before I deleted my FB account in lieu of hopefully a new FB account in the future, but for the life of me, I cannot recall those good times pre-military. I wish I knew the me before that time, and how much I enjoyed life and my friends. I cannot recall most of my friends or their names. I avoid them because it is embarrassing and I don’t want to hurt their feelings for my not remembering. There are many reasons why I deleted my FB account, or why I keep changing my names online, but dissociation is one of those reasons – that, and PTSD.
If only I could remember the good times, then maybe I’d be able to suss out all of this trauma mess. I am glad my friends said I had a great time, and they seemed happy, but I felt more sad because I wish I could feel as happy with those memories as they are. I must have been a great person back then. I feel like a strange, disgruntled hermit now. I also feel like I look like a turtle. I try to make the most of my slow-going-turtle-meets-hermit days, but it is quite debilitating.
On top of all the dissociation, my body does respond to suppressed emotions and unresolved traumas, I believe. I have migraine auras, sometimes with migraines (but sometimes without), vision changes, GERD, IBS, chronic fatigue syndrome (CFS/ME), post-exertional malaise (PEM), heart palpitations, panic disorder, insomnia, sleep apnea, many symptoms affiliated with Gulf War Syndrome (now called something else, but may have been considered contageous, especially if I was sexually assaulted in the military and contracted it from a person who served during the Gulf War, as I was enlisted during the Gulf War era myself), problems with my pelvic bone region (that was service-connected), inability to run (from service-connected injuries), obesity, a nodule on my left thyroid (3mm), two STIs, some sort of reproductive disease/illness, past diagnoses of endometriosis, past diagnosis of ulcers, past diagnoses of precancerous moles, past diagnoses of strep, past diagnoses of chicken pox during childhood, past diagnoses of pneumonia, some strange shot that I received in the military that others didn’t receive all because they thought that I was a “Pacific Islander” by ethnicity/race (even though I wasn’t, though they confused that with my being part Japanese and coming from Hawaii post recruitment; I believe that extra shot that others didn’t receive during the Gulf War era was what worsened all of my conditions and made me more prone to PTSD and all of the symptoms mentioned above), some issues with calf swelling, some issues with skin disorders (including acne and otherwise), some issues with joint problems, flatulence issues, hearing my heartbeat in my ears, occasional ringing in my ears, occasionally being sensitive to light, occasionally seeing floating star-like things when overwhelmed physically, past experiences with losing time, occasional brain fog, feet problems (some service-connected), occasional issues with veins that throb, occasional issues with muscles or head twitching (possibly an undetected neurological issue), occasional issues with sentence completion, occasional issues with short- and long-term memory recall, feeling bloated and full all the time even without consuming food or beverages, feeling physically tightened and locked all the time (inability to relax), feeling overwhelmed and depressed most of the time, feeling derealized and depersonalized (either separately or at the same time) when leaving my home or engaging with others (a rather recent experence that occurred after I was retraumatized by my past clinical psychology mentor as well as since I had decided to seek treatment at the VA; both are really hard for me to handle yet I’m trying to handle it and desensitize), and many more other symptoms that I cannot recall at the moment.
The ACE studies fail to look at resilience in childhood and only latent issues upon experiencing adulthood (including early or emerging adulthood) traumas and non-traumatic adverse “lifetime” or “adulthood” experiences, such as homelessness, poverty, and unconventional losses (which can be considered traumatic). ALE (or adverse lifetime experiences) should be studied instead, since there are many people who had relatively good childhoods but poor adulthood lives, especially in terms of emerging adulthood traumas such as military sexual trauma, combat trauma, civilian-based criminal sexual assault, sexual harassment, other forms of harassment, discrimination, grief and loss issues, traumatic accidents, medical traumas, relational losses, ecological losses, socioeconomic losses, reputational losses, time losses, workplace bullying, neighborhood or household violence exposure, secondary traumatic stress (including not being believed when disclosing criminal victimization), etc. Although dissociation is more likely to occur with a history of childhood abuse, there are some people like me who were resilient throughout their childhood (perhaps due to undetected dissociation), as evidenced by passed polygraphs and psychiatric evaluations (such as the tests I took to enter police and military training prior to my traumas from the military), but whose adulthood traumas undid all that resilience, brought about or worsened or made more overt the dissociative experiences that came as a result of adulthood traumas, among other post-traumatic symptoms. Yes, I’m now affected by both adulthood and childhood traumas, but without adulthood traumas, I believe I would have been a healthy and resilient adult without post-traumatic sequelae. We will never know without research being done on those areas and on those people outside of clinical and lab settings, though no one is interested in the population of resilient persons – at least as a comparison group, when compared to the clinical population and some control group without any histories of severe trauma.
As one social worker once told me (bless his heart), I’m an “outlier.” I felt sorta proud of that title and distinction. I told myself, “Yes, I sure as heck am an outlier.” Nevertheless, I hold many similar symptoms as others who are either mentally ill or mentally healthy. I’m grateful for not feeling so alone, and for people who can relate to me. I’m also grateful for your posts and understanding, Dr. S.
For now, I feel like a half-baked, disbelieved, controversially integrated person with lingering dissociative identity disorder symptoms – regardless of their origin(s) or onset. I just want to be healed and/or managed. Is that too much to ask? I also want to be believed. I feel lost without someone believing and then understanding me. I feel lost in general.
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The interest and “belief” in DID, from the point it was MPD, has waxed and wained. For what it is worth, it took me a year of treating one woman before I realized she was MPD. This happened in the early ’80s.
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The picture of the squirrel reminds me of the saying, “Some days you feel like a nut….” Hee hee. I always think of that phrase whenever I see my friendly neighborhood squirrels being squirrely. I can so relate to them – and the nuts they eat. 🙂
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This reminds me of a question one sees on so-called “know yourself” sites, asking you what kind of animal you would be if not human.
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LOL, Dr. S. …about the “know yourself” sites and that squirrel pic.
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I suppose another way to put it would be this. “No. Yourself?” A descent into the nonsense of the question and the absurdity of the world.
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Hee hee.
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That second picture looks sad, and it resonates with me. Only one eye showing, and being behind some iron-like structure, as if imprisoned, coupled with what looks like drying yet hidden tears stuck to the woman’s face – totally captures a sense of avoidance. The pooch looks scared, too. The first picture, however, reminds me of women who are put in a position of hiding – by their culture’s beliefs or otherwise, but that could also be my Eurocentric interpretation. Removing my absence of knowledge in such cultures, and only seeing the eyes of the woman depicted in the first picture, it does capture a sense of hiding the self. Overall, I like the pictures you chose for this post. 🙂
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Thank you, gb.
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Another insightful article, Dr. Stein. Overcoming my inner demons has always been a daunting task. I’ve learned to take little steps at a time and to keep moving forward. Avoidance and Negation are no friends of mine, to be sure!
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Having read your blogs, I have no doubt that you face the demons more than most. I’ll bet most of them lose the battle with you!
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You give me too much credit, Dr. Stein 🙂
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Either I overestimate you OR I compare you to the rest of humanity and realize the bar you surpass is not that high! 😉 I hope your holidays are lovely, Rosaliene.
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Thank you for this timely post, doctor. I’ve read quite a lot of books, taken quite a lot of notes and jotted down quite a lot of ‘insights’ now and then. However, it became clearer to me that I don’t remember much of that at all. Knowledge and insights acquired in the last minute get lost in the next seconds. How I am living and how I’m coping with living remain the same all these years. The more it remains the same, the more I hate myself for it, and the more I dissociate myself from reality and living, and the more frantic I become for an ‘ultimate’ solution. Every fiber of me (the fire within) is used to attempt to flee, not to go into this dissatisfactory reality that I feel so powerless in. Of course this kind of dissociation and distracting cannot be willed during sleep, hence the consistent nightmares of impending catastrophes or being murdered.
“A fear that we lack the abilities, resilience, and toughness to stand up to the larger cosmos”. Yes, it is exactly this fear that is the root of all the avoidance, forgetting and ignoring, despite how detrimental they are. This fear is so dominant and overwhelming that I feel the need to use every psychological defense I have to block it out. But at night it always comes back to me to keep me from sleep. I used to attribute my fearful state to lack of ultimate answers, or lack of guidance, or lack of “love” or unconditional regard, or lack of childhood security support. But really, who or what can really actually gift me those ‘abilities, resilience and toughness”? It feels like something in my heart is missing, that I have a tank empty of fuel. Could it be my dissociation that is keeping me fueling that tank?
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I cannot answer the question, Danny, but I can respond to “ultimate answers.” First, those who are religious believe they have these. I am not advocating religion here, nor am I criticizing it. Assuming, however, that you don’t have faith, I might suggest you think about smaller than ultimate answers. Tasks that stretch you just a bit. You may find out that you become capable of these steps. Eventually, you might take bigger ones. Good luck. P.S. I don’t have ultimate answers for myself.
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