Complex Trauma: Dissociation, Fragmentation, and Self-Understanding

Unfortunately, many people dealing with the after-effects of a traumatic childhood have summoned up the courage necessary to start a course of therapy, only to be forced to stop because confronting their repressed, or partially repressed, memories caused a breakdown or personal crisis that made it impossible to continue.

While it can be argued that therapy on the “it must get worse before it gets better” model nevertheless helped many people, the desirability of finding a less painful model is obvious.

Fisher describes both the new, improved model for trauma therapy and the process by which it came about, which is itself a fascinating story.

To do the book justice would be impossible within a single article, but I will attempt to describe some of its main features.

As the subtitle “Overcoming Internal Self-Alienation” indicates, a central theme of the book is the phenomenon of dissociation, which is found in so many survivors of trauma.

Dissociation doesn’t just affect those who meet the criteria for dissociative identity disorder (DID) as found in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

Fisher discusses the ways that dissociation, or alienation, manifests itself in people who have been through extended periods of trauma. She explains a biological mechanism for these symptoms, which makes sense in the light of contemporary neuroscience and the study of human and animal behavior.

The human brain is a remarkable machine, refined by millions of years of evolution for survival. Perhaps its most remarkable feature is its ability to learn and adapt to different environments. One of the most extreme, but far from rare, situations that humans have to develop coping mechanisms for is abuse at the hands of a caregiver.

Fisher explains the mechanism by which children who experienced abuse, people who have been kidnapped, and other survivors of complex trauma cope with the most horrific forms of violence and cruelty by dissociating — that is to say, separating the part of their personality that experiences the abuse from the parts that experience other aspects of life.

Dissociation is particularly essential when the abuse happens at the hands of a primary caregiver who is also responsible for providing food, shelter, and physical protection. In such a situation, the one experiencing abuse has to learn to function in a dual way, seeing the same person both as a threat and a source of essential goods.

Dissociation — the fracturing of the personality into different parts — is the easiest, and perhaps the only possible, way of doing this.

Dissociation is a different experience for different people. It may feel like:

• a disconnect from your body, or an out-of-body experience
• feeling separate from what’s around you, or the world around you feels unreal
• emotional detachment or feeling numb
• lacing a sense of identity
• forgetting personal information or events
• having a number of distinct identities, such as in DID

Dissociation can occur in many mental health conditions, particularly those that have links with trauma, such as dissociative disorders and borderline personality disorder (BPD).

Since even the healthiest and most well-adjusted person has a variegated personality — you probably act somewhat differently at a party to the way you act at work — someone who has experienced abuse can be described as drawing on a normal part of the brain’s toolkit in an extreme, and ultimately damaging, way as the only path to survival.

Understanding how trauma produces dissociative symptoms points to the way to the solutions. Dissociation isnot the result of a damaged brain, but the result of a learning process.

A learning process, it is true, that should never have had to have happened, but nevertheless something that is in itself a positive.

The way out of complex trauma is to recognize the different fractures of your personality not as a wound, but as a badge of survival — not as something that should be excised, but as parts of you that require reintegration.

The path to healing, Fisher explains, is found in genuine self-love — in the desire to care for each part of your personality.

Dissociative episodes can be painful, frightening, and disturbing, often highly so, but hating a part of yourself only prolongs the agony.

What I find most fascinating about Fisher’s book is the way she shows that people who have experienced complex trauma can progress better in therapy when they have a good understanding of their fragmented personality, what caused it, and what sustains it.

This reminds us of a fundamental difference between mental health and other areas of medicine. An operation or pill can work just as well regardless of how well you understand its mechanism.

Psychotherapy, by contrast, is often more effective when the person in therapy develops an understanding of how his or her thoughts operate. Indeed, an important part of therapy (though not the only part!) is the communication of knowledge in order to generate self-understanding.

In this respect, therapy bears a close relationship to philosophy and many religious traditions, in particular those based on meditation and self-reflection. Mindfulness, of course, is the most cited example of a psychological technique that developed from a religious (specifically a Buddhist) source, but the observation applies more widely.