Rambling thoughts on “normal dissociation” and health.

What is ‘good mental health’? I know I don’t have it, I know I’m aiming for it, but I don’t know what it is. Is it one of those terms like the word normal which has so many meanings in so many contexts to so many individuals that it’s almost impossible to define?

Some aspects of my condition are obviously not symbolic of good health – panic attacks, for example are not healthy, nor is depression, paranoia or being so spaced out you don’t know where or who you are. Those things we can all do without but there are some aspects of my condition that I can’t help but wonder about.

Dissociation is a natural mental function, it serves to protect you and helps you multi-task. On a simple level and one that everyone can understand, dissociation is what allows you to drive home at the end of the day whilst thinking about a million other things that you need to do, have done, will do, people to talk to etc etc. When you get home you can’t remember the journey at all, why? because you didn’t need to be fully conscious to make that journey, you’ve made it so many times it has drilled into your subconscious and unless something out of the ordinary happens like a crash or a traffic jam or a diversion, you don’t need to give it your full concentration and you can think about other things. That is a form of multi-tasking, also known as auto-pilot. Your brain can do many things at once, but only one or two things at a time can be in the spot-light of conscious thinking.

On a more complex survival level, dissociation kicks in during any shock to the system such as trauma or grief. If the worst happens, such as a family member dying suddenly, the grief can be overwhelming. This is natural and you need to go through that grief, but you can’t straight away because there’s the funeral to plan, the legalities to sort through, people to speak to, all of this requires you to function and if that tidal wave of grief hits you, you won’t be able to function for some time. So you dissociate from it. Most people say they go into shock, they go numb, they “just get on with it”. If you didn’t do that you wouldn’t survive the legal and social processes that come with a death in the family, I guess the measure of a persons mental health comes from the balance between dissociation and feeling; after the funeral, when they can finally give in to their grief – are they able?

Many other factors will dictate what is healthy and what isn’t; social class, gender, age, culture, religion, ethnicity, all of these will determine how much you are expected to show and express or hide and deny, reactions to painful situations will vary from person to person but the expectation and required self-control will be dictated by the society that suffering individual is in. I often think what would my life have been like if I had lived in different age? Society today is both open and judgmental, I’m encouraged to talk about my problems but I’m not guaranteed acceptance, however if I can ignore the criticism and just be myself I will be applauded. I can raise awareness and speak openly on this blog but if I reveal my identity I risk confrontation and rejection from some of those who know me. It is a society of extreme contradiction where everyone can be themselves yet everyone is held to a strict code of normality based on what is considered “healthy”.

600 years ago my life would have been seen in an utterly different light. After my young experiences I would have been encouraged to forget, to hide, to deny the feelings and pretend it never happened. The controlling and abusive relationship I went through several years ago would have been considered normal, unfortunate that I couldn’t have affection but no cause for complaint. The ending of that relationship would have been scandalous rather than cause for celebration. I may not have been considered a happy and enviable woman back then, but I wouldn’t be considered unhealthy, ill or in need of any help. Sometimes I wonder if that would have been an easier time for someone like me, if the openness of today’s society somehow works against me in the sense that I know how bad things can get, I know that what happened to me was not normal was not acceptable and was in fact horrific, I know that I’m not supposed to think and feel the way I do. By telling me I do not have “good mental health” you are in fact feeding my condition, setting me apart and making my journey that bit harder. Yet to say I’m fine and normal would be denying what happened and the effect it had, invalidating my experience and making me unimportant so to be fair to you cannot win! And nor can I. All either of us can do is continue down the path our society has made, fight for changes where we need them and hope for the best.

I think dissociative disorders are some of the hardest mental health conditions to live with because we need awareness and we need help, yet by nature we need to hide and try to forget and we can’t have both.

I apologise if this has been a rather rambling post I have many thoughts and idea’s tonight and can’t quite get them in sync. Hopefully these thoughts will make sense to someone!

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Symptoms of Dissociation

I was about 14 when I was first referred to the mental health services, I was only with the children’s services for little more than 18 months before I was moved the adult services since back then the cut off point was 16, but I was 24 before anyone mentioned dissociation to me. 10 years between entering the mental health services and someone noticing and connecting the dots between my symptoms and making the relevant referral for the right course of treatment, psychotherapy. So my question today is, why 10 years? How did I go from psychiatrist to psychologist to community nurse to occupational therapist to councellor and so on and so forth, without anyone realising what the real problem was?

In the past I’ve bounced between two explanations for this – number 1. It’s the fault of the professionals who wouldn’t listen. Number 2. It’s my fault for not explaining. Now I have problems with both these explanations, maybe age really is bringing me wisdom, so before explaining my new theory I’ll rip apart the old ones. Starting with number 1; whilst my 15 years have acquainted me with many professionals who do seem to think that their patients are wasting their time and attention-seeking whenever they question the first diagnosis given, the majority have a genuine concern and desire to help however they can. I’ve had community nurses who have come out of their way to check up on me because I mentioned on the phone yesterday I was struggling, but I’ve also had one call social services with false assumptions and accusations because she thought “dissociation endangers my children” (complaints were filed and carefully overlooked, I’m still furious) so both ends of the scale definitely co-exist. The basic facts of professionals are that they studied hard to get there but they can only study the information at hand, they are trained to take notice of details in symptoms but they are not mind readers, and as with any group of people you can’t assume they’re all the same as the worst of them. In other words if I don’t tell them what the problem is how can they know? Which leads nicely onto number 2; it’s my fault for not explaining. One thing we’re always told, and rightly so, is that when you go to the doctors you have to tell them everything, explain your symptoms clearly, give them the full picture of your problem so they can accurately diagnose you. Except that if I could do that, I wouldn’t be there asking for help in the first place. One of the major parts of dissociation is a severe lack of words. Thoughts without words, feelings with no connections, reality mixed in with dream, explain that one to a doctor through a thick fog when all you can focus on is your own hand and whether or not the chair you’re sitting on is really there. It’s not going to happen. Most of my early councelling sessions were spent in silence, not usually by choice (although I didn’t like my very condescending children’s councellor) but because the words would not leave my mouth. I had issues with open questions like “how are you today” “what would you like to talk about?” ” what are your goals in therapy?” I can’t answer those questions! Ask me something specific like “do you have a headache?” or “is there something particular you’re wanting to say?” in other words yes or no questions, I can answer unless I’m completely zoned out. It took years of failing to communicate and getting more and more frustrated with the wrong questions and the wrong assumptions before I found ways around the problem – I developed an opening speech of sorts that I gave to every new practitioner stating my inability to answer open questions, my difficulty finding words and a few metaphors for what its like here in the fog. Slowly I got through to them, very slowly.

So if doctors can’t read minds and I can’t speak openly and clearly its little wonder why it took so long to get a diagnosis and a relevant referral. The real culprit here is the lack of information available. Doctors degree’s are of little use to a dissociative patient, if they don’t study dissociation and know the symptoms. The test for depression is a list of yes/no questions relating to the endless symptoms depressed people experience, even if the person suffering can’t articulate very well the doctor can diagnose them because the symptoms are well-known and therefore easier to recognise. If the symptoms are known they can be recognised, the doctors can look for them and see the problem without the need for patient articulation. So why is dissociation not studied and a list of common symptoms listed and taught to doctors and nurses etc? I don’t know. Information itself isn’t lacking and general awareness is growing but until it’s properly taught through professional training incorrect diagnosis’ and irrelevant treatments will continue because a doctor can only work with the information and training and resources s/he has.

My opinion is training should start with the GP’s, community nurses, A&E staff and school nurses because those people are our front-line troops. They are the ones who we go to for help first, and they will make that first vital judgement and referral, if they get that right they could save years of a patient’s life, if my school nurse or first psychiatrist had known the symptoms and made the correct diagnosis I could have been through therapy by my early-20’s at the latest and much further along my list of life goals in that elusive quest for “good health”.  So here’s my contribution to the cause, a list of the dissociative symptoms I’ve always experienced and if there’s any nurses doctors or health general care workers reading this do look out for these symptoms in your patients and be aware that they are a mask for a tornado of inner turmoil.

  1. Distant – if you feel the person is not quite in the room with you, lost in their own thoughts.
  2. Not listening/hearing – you’re trying to talk to them but they’re not responding, looking the other way or doing something else, try holding their hands and looking directly into their eyes to hold attention.
  3. Can’t remember personal details – name, phone number, address, family contact
  4. Lose train of thought – they might try talking to you but forget what they were saying whilst saying it
  5. Struggle to follow conversation – they are trying to listen to you but to them you are very far away, speak alittle slower and take things one step at time
  6. Staring off into the distance mid sentence – not quite forgetting what they’re say but forgetting they were speaking at all
  7. No emotion or expression – talking to you with no emotion can be unnerving, especially if they’re talking about something upsetting like a trauma, but do not be fooled, those emotions are there and will be felt at a later time, probably without the thoughts and words to explain them.
  8. Intense concentration on one object or person/animal – this one is important because they might be trying to anchor themselves, for me I focus on my children, some people may watch their pets, or the cup in their hand, the hand itself, internally they’re asking themselves if its real, if it’s theirs. You could help by asking questions about whatever they’re focusing on, make it seem more real to them by talking about it, take it at their pace.
  9. ‘High’ very excitable as if been drinking or on intense sugar rush – this may seem the opposite of everything else but it’s equally important, dissociation means shutting out reality and that can make you zone out in a fog or ‘go on the ceiling’, seeming very happy at first glance but nothings real. The confusion and difficulty with conversation will still occur in this state.

Those are my symptoms, if anyone with dissociation wants to add to the list please leave a comment, its different for every one of course. The NHS needs to include dissociation in the training of staff or people will continue to get shunted from one dept. to another and put on the wrong medication. Anti-psychotics, anti-anxiety or any medication that includes a sedative or induces sleep, causes drowsiness or confusion will make dissociation worse, much worse, it will trigger off all the symptoms and make life harder – but how will the doctors know that unless it’s included in their training?