Dissociation is a natural way that our brains respond to trauma and stress, in fact it is often an essential way for us to recover. If a person has been in a crash, for example, it is not necessary for them to remember every single detail of the event. But what happens when stress, trauma or even the state of the world prevents someone from coming back from that dissociation? Or makes it worse?
The pandemic has resulted in a world that few of us recognise.
With countries in total lockdowns for long stretches of time, cities and towns once busy turned empty and quiet, kids not going into school, shops and restaurants closed, vulnerable and elderly people made to isolate for months at a time, people either made to work from home or simply stop working entirely and go on furlough or, in worst case scenarios, lose their jobs.
This past year has been extremely stressful. Isolation, exposure to grief or intense fear and worry of contracting the virus personally or fear for loved ones has meant many people are experiencing new mental health struggles all together, or for those who already had pre-existing disorders or illnesses, it has only made them worse.
All of this stress and trauma can have adverse effects on the mind.
For those working on the front lines, exposure to extremely ill people, overrun wards and strained workforces – whether this be in hospitals, on psychiatric units, prisons, care homes or in social work – many have developed symptoms that fit the DSM-5 criteria for Post-Traumatic Stress Disorder (PTSD).
The same goes for those who have spent long periods in hospital due to becoming severely ill with COVID-19. Psychiatric times note that there have only been a few studies on mental health problems among those hospitalized with COVID-19 and that more needs to be researched on the effects of this.
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There has been a lot said about those experiencing anxiety as things “go back to normal” and open back up again. But what about those who experience a lesser spoken about symptom of the trauma caused by the pandemic?
What is dissociation and how has it been exacerbated by the pandemic?
As mentioned above, dissociation is a natural response to stressful and traumatic experiences. Not everyone who experiences trauma will experience dissociation, but it is frequently tied to those suffering from PTSD and Complex Post-Traumatic Stress Disorder (C-PTSD).
When experiencing a dissociative episode, Mind says you may “feel as though the world around you is unreal” or “see the world as ‘lifeless’ or ‘foggy’” and on the more severe end of these symptoms you may “feel as if other people are robots (even though you know they are not)”.
All the above symptoms fall into a category of dissociation that a psychiatrist may call ‘derealisation’.
Another common type of dissociation is ‘depersonalisation’.
Mind breaks depersonalisation down as feeling as though “you are watching yourself in a film or looking at yourself from the outside”, “disconnected from parts of your body or your emotions”, “you are floating away” and “unsure of the boundaries between yourself and other people”.
All of these symptoms are intensely scary to experience and one of the few things that lessens their intensity or prevents them from turning into a full dissociative episode are things such as ‘grounding’.
Grounding can include: engaging in the five senses, talking to someone outside of yourself, adding some routine to your day that involves getting up and engaging in the world, specifically if this means you can get outside.
During the past year of the pandemic, many who struggle with dissociation or who have experienced it for the first time due to the new stressors and traumas they are faced with, have been unable to engage in these techniques that alleviate dissociative symptoms.
Dissociation often goes in hand with anxiety, PTSD, psychosis, OCD and depression. All disorders that increase feelings of worry and fear.
The fear instilled in so many of us from the very literal threat of the virus has made some solutions that were previously successful in managing dissociation, impossible.
For example, spending time outside and engaging in your senses might not feel safe or possible when we are being told spending time outside of your home can put you and others at risk.
Talking to other people, especially for those who lived alone during the lockdowns, was suddenly more difficult and surreal than it had ever been. Even for those who were able to access therapy during lockdowns, the remote nature of it (Zoom, Teams etc.) provided another barrier for those experiencing dissociation to feel connected to the real world.
Speaking for Teen Vogue, Louise Ramsay, compares the experience of dissociation to being in a dream, knowing something is wrong. The grounding techniques mentioned above can be used to “wake yourself up” but, as Ramsay says “In the pandemic, when many have lost their jobs, their loved ones…they might be experiencing trauma for the first time, the dream doesn’t stop.”
Louise Ramsay describes how being in lockdown made her symptoms worse, listing disturbed sleep, tense muscles, bad tempers, “if I become so stressed, even walking outside can cause anxiety. In episodes I become acutely aware of my surroundings – of how glassy and bright things look, like through a filter.”
Ramsay mentions some words from therapist Sally Baker, “people are often being triggered by feelings of overwhelm from previous trauma. It could be events from their past that they have not considered for a long time.”
Prolonged periods of government mandated time inside, where variation and a feeling of connectedness slips away, can result in dissociative episodes becoming so severe that people can lose hours, even days and weeks.
Re-engaging with the world after so much time spent disengaging as a means to cope, will mean many who experience dissociative symptoms may struggle with this period of “returning to normal”.
Suddenly, streets are full again and people are expected to start eating out, socialising, going to pubs and bars (if they have outdoor seating).
This can be an overwhelming experience for someone who has been feeling outside of themselves, their life or as if the world isn’t entirely real. This kind of overstimulation for those experiencing the numbing and dulling effect of dissociation can result in panic attacks or anxiety attacks.
It is really important that those experiencing dissociation, derealisation or depersonalisation are patient with themselves and firstly find safe, non-overstimulating ways to re-engage.
This could simply be short trips outside to quieter spaces, such as Louise Ramsay “touching the sand on the beach, dipping my toes in the sea”, simple sensory experiences such as these can help bring a person who has experienced prolonged dissociative episodes back into the world.
If you are someone who knows a person living with dissociative symptoms, it is also really important to be patient with them, don’t force them to ‘push themselves’, be there to support them in those first outings and help to suggest some peaceful, nature filled spaces you can visit.
“Returning to normal” looks different for everyone, especially for those who are still working through the adverse effects the pandemic has had on their mental health: compassion and patience is key.
If you or someone you know are experiencing dissociation and want to know more, you can read Mind's full page on it here.
You can access Mind's helpline for information and signposting on 0300 123 3393, 9am to 6pm Monday to Friday.