Trauma, Dissociation, and Being Grounded
[Insights from Psychotherapy, 01]
I. Introduction
History of trauma and dissociation
The trauma-dissociation link has been investigated in the clinical setting since at least the mid-19th century (Scalabrini et al., 2020).[1] Rightfully so, it has been a topic of interest and of importance. But there has seldom been any consensus on how to understand, define, and treat trauma and its related disorders. It has also been learned, in recent years, that the phenomenon of trauma is much more ubiquitous than previously assumed (Van der Kolk, 2015, p. 1). Since 1980, when post-traumatic stress disorder (PTSD) was included in the DSM-III as a result of the Vietnam War, clinical research, experience, and theory has spread in many directions in an attempt to come to terms with the experience of trauma. Quickly emerging is the neurological investigation of trauma and its symptoms. It has also been found in recent years that dissociative experiences and disorders are intimately connected with trauma, particularly a traumatic experience dealt by the hands of a fellow human (termed “trauma of human agency”; Mucci & Scalabrini, 2021). It is here where phenomenology can be useful. In this paper, we will perform a preliminary phenomenological framing of dissociative symptoms as they relate to trauma of human agency, always keeping in mind contemporary (and rapidly advancing) neuroscientific research.
Defining trauma
The definition of trauma has, at best, been elusive. As our purpose here is to understand how trauma relates to dissociation, we will look at some definitions in which the interface between the two is encountered. However, for the scope of this article, the following definition will suffice: trauma is a loss of meaning and identity due to an overwhelming stimulus and dissociation is a lack of integration which comes about in response to an event that disrupts a narrative or overloads the organism’s ability to integrate the experience.
19th century physician Pierre Janet understands the trauma-dissociation interface as “[the inability] to integrate the traumatic memories… It is … as if their personality which definitively stopped at a certain point cannot enlarge any more by the addition of new elements” (cited in Scalabrini et al., 2020). Following this line of thinking (disintegration of autobiographical coherence), Scalabrini & Mucci (2021) categorize trauma-dissociation into three levels: (a) lack of attunement between caregiver and child; (b) active abuse and neglect of child; © intergenerational or cultural trauma.
II. The phenomenology and neuroscience of dissociation
Trauma and dissociation
In R. D. Laing’s 1959 The Divided Self, Laing states that there are two fundamental existential-ontological positions: one of ontological security, the other of ontological insecurity. The position of ontological security indicates a person who resides in a stable, predictable, and consistent ‘world’; the experience of ontological insecurity is one wherein a person inhabits an unstable, unpredictable, and inconsistent ‘world’. The person whose world is ontologically secure can develop a ‘being-in’ his/her own body; there is integration between mind/body and coherence in autobiographical narrative. However, the individual who occupies the ontologically unstable world has no such opportunity to develop this integrated response to his/her world. In order to regain mastery over one’s unstable world, the individual adopts defensive mechanisms. Among these is depersonalization, or splitting, in Laing’s preferred terminology. Phenomenologically, this looks like an objectification of self (and perhaps other) and detachment of the ‘self’, or imagination. Laing refers to this position as the unembodied self.
There is an astounding amount of research suggesting that dissociation is a common response to trauma when other mediating factors are present (e.g., emotional dysregulation, etc.: Fani et al., 2015; Briere, 2006). This makes an investigation of one useful for understanding the other. Current neuroscientific research suggests disrupted integrative activity in four areas: “i) emotion processing and memory (e.g. amygdala, hippocampus, parahippocampal gyrus and middle/superior temporal gyrus); ii) interoception regulation (insula); iii) self-referential processes and iv) emotional/cognitive regulation” (Scalabrini et al., 2020, p. 3). The anterior insula is the hub primarily responsible for intero-exteroceptive processing, the area mostly associated with coherence of self-identity and self-understanding in relation to the world. A hindered insula translates to an inhibited integration in and between brain regions, and, more generally, between brain and world.[2]
There is thus a clear parallel between Laing’s splitting of the self and Scalabrini’s disintegration of the self which occurs in the dissociated subjectivity.
Relational trauma
What is missing so far is the inclusion of a major aspect of human experience: what Heidegger calls Being-toward-others (Being and Time, §26). According to Heidegger, we live and operate in a meaningful lifeworld; the horizons of knowledge and action are given in context and informed by the people of our community. For example: when I buy a glove, it “is not only my glove; it is the glove I bought from the clerk at the shop owned by So-and-so, and fashion authorities this recommended this design” (Polt, 1999, p. 60). Thus, all of our acts and stamps of identity always refer to a community of which we are a constitutive part. Heidegger further argues that one cannot ‘know oneself’ through detached introspection, but only within his or her social context (Heidegger 1927/2010, §26). In other words, Dasein’s world is ‘always already’ embodied: “culture and temporality are not things that Dasein encounters out in the world. Instead, they are always already a part of Dasein’s being-in-the-world” (Kelly, 2018, 23). An integrated, embodied self sees its own internal states in the other and can thus orient itself. It can then develop the relationship between internality and externality: if an infant sees her happiness reflected in her mother, she learns, over time, that happiness is a celebratory feeling. If, however, her happiness is met by inconsistent or unpredictable responses, she will never be able to recognize what it means to be happy.[3] Interestingly, dissociative symptoms are far more common as a result of ‘human agency’ trauma rather than natural disasters (Mucci & Scalabrini, 2021). ‘Relational trauma’ is what is referred to as a series of neglect, abuse, disrupted attachment, or lack of attunement between caregiver and child. From a neurological perspective, verbal structures do not develop in a child before the age of two. This means that the first two years of caregiving is nonverbal, including caressing, touching, rocking, and attending to the infant’s needs (Armstrong, 2019). If, for whatever reason (parents’ own attachment or attunement style; drug use; political displacement; etc.), the caregiver is not providing the infant with a stable and safe social orientation via attachment and attunement, the child will find itself untethered to its body and the social world — two prominent constitutive elements of subjectivity. This opens up the subject to an ontological insecurity, marked by neurological anomalies like disrupted functioning of the corpus collosum, abnormal insula activity, and miscommunication between the amygdala and the hippocampus. Thus, for the relationally traumatized individual, identity, narrative, and Being-in-the-world-with-others is radically disrupted. Dissociation (in its many forms, e.g., depersonalization/derealization/dissociative identity disorder, etc.), or ‘splitting’ of self from self, becomes the existential position of the subject. Dissociation is fundamentally a defense against this uncertainty of reality. In relational trauma, the self in relation to other is disrupted; the internal states of the subject are not mirrored — or witnessed — in the other. And since the self derives its own internality from its social world, it fails to develop the self-reflective ability in a relationally traumatizing environment (i.e., the disruption in the functioning of the anterior insula — ontological insecurity).
III. Clinical Implications
What does all this mean for the clinician and his work with dissociative patients? It means, foremost, that the primary goal is to establish a secure attachment between client and therapist (Armstrong, 2019). Becoming attuned to the traumatized dissociative patient will do two things: (a) provide them with a sense of social safety and orientation, (b) which will allow them to begin to explore the meaning of their own emotions, body, and ultimately their own trauma. It is within the boundary of attunement between self and other that one can begin to reintegrate the traumatic memory into one’s horizons of meaning. The role of the therapist, before any other technique, should be that of regulator (Mucci & Scalabrini, 2021). The attuned clinician then uses their role as a mechanism for change.
IV. Further Research
There is much left to be said here. First, more generally, it is advisable that counseling psychology and psychotherapy continue to utilize the vocabulary and tools that phenomenology offers to continually reframe theory and technique. Second, more work needs to be done on finding effective treatments for dissociation as understood as an unembodied/disintegrated subjectivity. Third, to the awareness of the author, there is little to no literature on the multicultural implications and applications for dissociation more broadly. Fourth, the reader most probably sensed weaknesses in two areas of the present study: (a) a more thorough investigation of what it means to Be-in-the-world-with-others, and (b) the actual link between dissociation and relational trauma: that is, why is dissociation a defense and how does it come about in relation to trauma of human agency? These weaknesses need to be explored in more detail, as there was no room for it here.
References
Armstrong, C. (2019). Rethinking Trauma Treatment: Attachment, Memory Reconsolidation, and Resilience. New York, NY: Norton.
Briere, J. (2006). Dissociative Symptoms and Trauma Exposure. The Journal of Nervous and Mental Disease, 194(2), 78–82. doi: 10.1097/01.nmd.0000198139.47371.54.
Fani, N., King, T. Z., Powers, A., Hardy, R. A., Siegle, G. J., Blair, R. J., Surapaneni, S., van Rooij, S., Ressler, K. J., Jovanovic, T., & Bradley, B. (2019). Cognitive and neural facets of dissociation in a traumatized population. Emotion, 19(5), 863–875. https://doi-org.dml.regis.edu/10.1037/emo0000466
Heidegger, M. (1927/2010). Being and Time. (Stambaugh, J., trans.). Albany, NY: State University of New York Press.
Kelly, M. (2018). A critical phenomenology of trauma. [Master’s Thesis: George Washington University].
Laing, R. D. (1959/1969). The Divided Self. New York, NY: Penguin.
Mucci, C., & Scalabrini, A. (2021). Traumatic effects beyond diagnosis: The impact of dissociation on the mind–body–brain system. Psychoanalytic Psychology, 38(4), 279–289. https://doi.org/10.1037/pap0000332
Polt, R. (1999). Heidegger: An Introduction. Ithaca, NY: Cornell University Press.
Scalabrini, A., Mucci, C., Esposito, R., Damiani, S., & Northoff, G. (2020). Dissociation as a disorder of integration — On the footsteps of Pierre Janet. Progress in Neuropsychopharmacology & Biological Psychiatry, 101. https://doi.org/10.1016/j.pnpbp.2020.109928
Van der Kolk, B. (2015). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York, NY: Penguin
[1] Not to mention the literature and philosophy that has been wrestling with this seemingly fundamental condition of human experience that predates the field of psychology by millennia.
[2] There is also, in dissociated patients, disrupted corpus collosum functioning, meaning there is damaged communication between the two brain hemispheres (Armstrong, 2019).
[3] Indeed, the inability of the borderline disordered patient to emotionally regulate and self-soothe is similarly neurocognitively to dissociative disorders (Scalabrini et al., 2020).
