“A Flight of Mind: The Act of Dissociation Can Protect Children Emotionally From Trauma, but Repeated Use May Cause Lasting Harm” ~ by Pamela Oldham
Special to The Washington Post
This is an old article but this case has always intrigued me because Rachael suffered terrible stomach pains, which were psychosomatic body memories from severe child sexual abuse. Doctors even performed surgery on her abdomen, and still found nothing physiologically wrong…
“Rachel Downing, a 58-year-old therapist in Frederick, often tells her colleagues the true story of a little girl who fell into a deep well while walking alone on her family’s farm. After landing on a narrow ledge several feet below ground, she sat patiently, ignoring her scrapes and bruises, waiting to be rescued. A few minutes later, it seemed to the child, a firefighter pulled her to safety.
In reality, several hours had passed. The girl had no memory of feeling trapped, afraid or even worried. She didn’t recall hearing the sounds of rescuers working frantically overhead to save her. Instead, the girl separated emotionally from the event, Downing says, because remembering her feelings of terror or how long she had been inside the well wasn’t important. Surviving the ordeal was.
“When you think abou it, this was a very good tactic,” Downing said. “Imagine what might have happened if that young child had sat there all that time, feeling terrified for hours, wondering if she’d be rescued, wondering, ‘Am I going to die?’ “
Research tells us what children — or, for that matter, adults — generally do when exposed to physical violence or other trauma they can’t flee from or prevent: They “dissociate.”
Dissociation is an involuntary human response to high stress or trauma that causes the conscious mind to withdraw and turn inward, reducing incoming stimuli and mitigating the effects of overwhelming emotion. The feeling is one of being present but not consciously aware of oneself or one’s surroundings and is characterized by memory loss and a sense of disconnection. For victims of trauma, experts say, dissociation is often lifesaving.
But when the dissociative response is called on repeatedly, especially in early childhood, the defense can become fixed and ingrained, disrupting normal functioning and undermining emotional and physical well-being. The most common cause is chronic child maltreatment — physical, emotional or sexual abuse.
Downing knows about this firsthand.
She battled depression and unexplained physical illnesses throughout childhood and early adulthood before she was diagnosed with dissociative identity disorder at age 35 and then treated. The source of her problems, she says: Child abuse at the hands of her father, now deceased. “Within one three-month period, I was taken to the emergency room 17 times for abdominal pain,” Downing said. “They even performed surgery, and still found nothing.”
What’s more, new biological research has found that repeated triggering of the trauma response early in life visibly injures the brain.
A Complex Process
When our brains perceive danger, sensory information is diverted from the hippocampus, which is responsible for processing non-intense emotion and committing everyday events to memory. Instead, the brain zaps the information from the thalamus, the brain’s sensory input center, to a tiny almond-shaped nerve center, called the amygdala, in the midsection of the brain, for emergency processing.
At the amygdala’s command, orchestrated in milliseconds, the heart rate quickens, and respiration and blood pressure increase. Noncritical sensory information is tuned out and activity in the hippocampus is suppressed so we can concentrate on self-preservation.
When the threat persists beyond a few seconds, other neurophysiological and functional processes kick in to disengage us from the outside world and routine sensations. Heart rate and blood pressure suddenly drop, and we may feel as though we are floating. We may be unable to speak — or scream. We might “blank out,” faint or experience phenomena outside the realm of what we consider normal. Such responses may inhibit the ability to readily retrieve details later.
Automobile accident victims who dissociate, for example, are frequently unable to recall the moment of impact while others describe experiencing the crash in slow motion. Adult rape victims who dissociate during their attacks often report observing the assaults rather than experiencing them. Survivors of fires may stumble out of a burning building, not knowing how they escaped or realizing the extent of their injuries.
For much of her life, Downing says, she blocked out memories so well that she couldn’t explain some of her own behaviors. “As a child, I had thoughts that didn’t make sense — of animals being killed and people being tied up and sexual things being done,” Downing said. “My diary shows that at the age of 12, I wrote about myself in the third person. During my teenage years, I had irrational fears. I was afraid to date because I feared being raped.”
According to Marlene Steinberg, a Northampton, Mass., psychiatrist who is a leading researcher on dissociation and dissociative disorders, people who dissociate during a traumatic event will often describe their experience as if they were detached from it.
“They’ll say ‘I was numb, I didn’t feel anything,’ ‘It was like I wasn’t really there,’ or ‘It was like watching a movie,’ ” Steinberg said.
Martin Teicher, an associate professor of psychiatry at Harvard Medical School and director of the Developmental Psychopharmacology Laboratory at McLean Hospital in Belmont, Mass., has been at the forefront of biopsychiatry research on the physiological effects of child maltreatment.
Using brain scans, Teicher has documented structural changes not attributable to head trauma in the brains of young abuse victims. “The most readily discernable abnormality,” said Teicher, “is the reduced size of the corpus callosum” — a normally thick band of neurofibers that serves as the communications bridge between the left and right cerebral hemispheres, integrating motor, sensory and cognitive functions. Teicher’s finding may help explain why abuse victims often have difficulty retrieving memories of early trauma — one hemisphere of the brain stores language-based memories while the other retains sensory-based memories.
Other abnormalities captured by brain imaging include diminished growth in the left hemisphere, atypical amygdala size and reduced hippocampus size and volume.
The nature of the physical changes, Teicher says, offers a physiological explanation for why early maltreatment increases the risk for development of post-traumatic stress disorder, depression, substance abuse, antisocial behavior and other problems. ” This provides scientific evidence that you can’t abuse or neglect children and then expect them to simply ‘get over it’ as adults,” Teicher said.
This new research underscores the importance of early treatment for child abuse victims. Experts theorize that specialized therapy may help restore normal brain function and neurodevelopment in children because their brains — unlike those of adults — are still malleable.
Diagnosing dissociative disorders can be difficult because they often masquerade as other, more familiar conditions — depression, panic and anxiety disorder, bipolar disorder, ADHD and obsessive-compulsive disorder. The 2.5 million children whom the government estimates are maltreated, abused and neglected each year in the United States are particularly at risk for developing dissociative of disorders.
At the root of these difficulties is a collection of five conditions known as dissociative disorders — ranging from depersonalization disorder, the mildest and most common form, to Dissociative Identity Disorder (DID), formerly known as multiple-personality disorder.
With early identification and treatment, Steinberg and others say these disorders can be effectively treated and, in many cases, cured.
For children and adults, treatment generally consists of specialized psychotherapy to establish a sense of safety and connection, stabilize function, process and resolve the traumas experienced, and learn new ways of coping with everyday stress. Medication is normally prescribed only to manage symptoms of co-existing conditions, such as depression and anxiety.
Therapy often also includes treatment for post-traumatic stress disorder.
Since 1990, Baltimore psychologist Joyanna Silberg has treated about 350 children with dissociative disorders. Dissociative children, she says, may exhibit stress, appear emotionally inaccessible, dazed and sometimes unresponsive. They may forget their own behavior or events from one day to the next. Depression is common and so is “acting out.”
“When abuse takes place outside the family . . . what I see most often are reports of assaultive behavior toward parents, sometimes without the child’s memory of behaving that way,” Silberg said. “Or, I hear about kids who deny behavior — even good behavior — that others have observed.”
Keeping young victims safe from further harm and helping them to accept anger and other emotions as valid are primary treatment goals. As traumatized children learn that they need not be ashamed about past trauma and abuse, Silberg says their identities consolidate, memory improves and they become less reliant on dissociation and other coping mechanisms.
Adults with dissociative disorders may face bigger challenges; those who seek professional help typically do so for relief from depression and anxiety. On average, they spend five to seven years after first seeking treatment before an accurate diagnosis is made. They may undergo a wide variety of therapies. But until the underlying problem — trauma — is addressed, they don’t get better.
It wasn’t until after the 1976 death of her father, an Episcopal minister, that Downing sought professional help. The immediate trigger: She became physically ill and doctors were unable to find a cause. Finally, in 1979 she was diagnosed with dissociative identity disorder. Downing says she had been severely abused and maltreated in childhood and that her father had been her primary abuser.
To amass corroborating evidence, she has interviewed family members and examined school and medical records, diaries and journals, photographs, old letters exchanged between her parents and her father’s calendars, personal papers and records.
Downing’s childhood school records document difficulty in learning and poor attendance. Her first-grade report card shows she was absent 17 days during the first seven weeks of the school year, and written comments by her teacher suggest Downing had a difficult time attending to classwork “without getting emotionally upset.” Downing says she was absent from school one or two days every week throughout grades 1 through 12.
“My fifth-grade teacher wrote ’emotionally disturbed’ on my report card that year,” Downing said. “Keep in mind, this was in the 1950s, when people didn’t talk or know about such things.”
In junior high school, Downing says, her IQ measured just 90. But Downing became a serious student despite everything, graduating from college magna cum laude in 1971 and earning a master’s degree in 1973. Before her father’s death, she says, she had no conscious memories of his abuse, just sketchy recollections. Later, she says, she began to remember — and her childhood fears and thoughts began to make sense. According to Downing, her father had repeatedly abused her sexually and killed her pets to punish her. Remembering helped her heal.
“It’s like a widow who’s lost her husband in a tragic accident,” Downing said. “If she doesn’t talk about it, deal with it and set it aside, she can’t move on with life.”
After several years of specialized psychotherapy, Downing says, her dissociative identity disorder was cured, and her depression and anxiety abated. She has remained virtually symptom-free since concluding therapy in 1994. Today, Downing says her life is happy and full. In her practice, she sees clients with a range of mental health needs and says she has a high level of respect for them because she has walked the path to recovery herself. She teaches fellow clinicians about dissociative disorders and the power of the human mind to protect and preserve our young when there is no escape from terror.”
A Flight of Mind, Pamela Oldham, The Washington Post, February 18, 2003, Page HE01