Living with chronic illness often means living in a body that hurts. The pain can be searing or dull; intermittent or constant; affecting the body as a whole or specific body parts. Experiencing pain is a profound experience that can be overwhelming. In response, our minds — in an attempt to cope with what feels unbearable — try to protect us. One way that our minds attempt to manage pain is through dissociation.
What Is Dissociation?
In simplest terms, dissociation is the mind separating itself from the body. Have you ever driven to a destination and thought, “I have no recollection of my trip over here!”? That is a benign example of dissociation. Your mind removes itself from your experience and goes elsewhere. When you are dissociating, you do not experience yourself as an embodied person.
This is not necessarily problematic. Indeed, there are times when dissociation is a healthy response to one’s surroundings, a “creative adaptation to an environmental insult that threatens survival (Haven, 2008).” When we feel acute pain, for example, the mind’s disengagement from the body is an adaptive protective mechanism.
Dissociation is meant to be a temporary solution to a temporary problem. Our mind signals: “Let’s check out of the intensity of this pain as a means of cushioning the impact.” Smart, right? Where we run into trouble is when we get STUCK in dissociation — when we don’t come back into the body after the acute pain has gone.
A Closer Look at Dissociation
The function of dissociation is separation. We use dissociation in an attempt to separate ourselves from intolerable feelings, intolerable knowledge (including memories), intolerable aspects of self, and relationships (Haven, 2008).
In the context of chronic illness, we might use dissociation to remove ourselves from physical pain, from the feelings we have about our illness, from the memories we have about episodes of illness, from the feelings we have about ourselves as “an ill person”, and from relationships that remind us of our illness. Remember, this is not typically a conscious choice. We don’t say, “This is so painful that I think I’ll dissociate now.” Rather, it’s an unconscious mechanism that our psyche uses in an attempt to protect us.
How do we know when we’re dissociating? For many people, dissociation feels like sleepwalking through life. There is a sense that life is happening at a distance. Numbness is heightened. In this state, we are shells of ourselves, anesthetized to life itself. When we are fully present, we experience life through our bodies: Our senses take in the world around us; our emotions are responses to this sensory input. When we remove ourselves from our bodies, we remove ourselves from fully living.
Returning to the Body
The first step to undoing dissociation is to recognize when we are in a dissociative state. Naming the numb, sleepwalking feeling as dissociation is key to beginning the process of “waking up.”
Remembering that dissociation is an attempt to separate our minds from our embodied experience, we want to remind ourselves to come back into our bodies. This can be accomplished by attuning both to the world around us (external reality) and also the internal sensations of our bodies and minds (internal reality) (Rothschild, 2021)..
Returning to the body may be challenging, especially if dissociation is longstanding. Attuning to external experience is usually less disregulating than attuning to internal experience, so begin there. Notice your feet on the floor and your bottom in the chair. Look around the room and take in with your eyes the objects you see. If this feels like too much, choose a favorite color and move your eyes around the room seeking out that color. Open your ears to the sounds around you. If it would feel better to start smaller, hold a small object in your hand (a shell or a stone, for example) and focus on that. Notice the colors, textures, and smell of the object.
Tuning into your inner experience can be accomplished by following the inhalations and exhalations of your breathing. You can also focus on your body, noting where you feel tension and consciously releasing that tension. Guided body scan meditations can be beneficial.
As you’re working to return to your body, notice your emotions. Are you feeling better? If so, great! Are you feeling worse? This is a possibility, as you are actively dismantling dissociation’s protective function. If you’re feeling overwhelmed, stop. Honor your body and take a step back. Small (even 10-second) returns to your body in which you feel regulated are big wins. It is counterproductive to “rip the band-aid off” and flood yourself with panic (Rothschild, 2021).
Dissociation Essential Reads
This is challenging work, especially when dissociation is longstanding. Seeing a therapist to partner with you as you return to your body is recommended.
Try This at Home: Action Steps to Undo Dissociation
Begin to notice and name your dissociation as it occurs.
Gently come back into your body using the various tools above. Evaluate how each experience makes you feel.
Small, frequent practices of returning to your body are beneficial; overwhelming yourself is not.
Seek therapy for support and guidance in this process.
To find a therapist, visit the Psychology Today Therapy Directory.
