When reality slips through your fingers: in search of dissociation

is a clinical psychologist and researcher specialising in dissociation and psychosis at the University of Oxford. She lives in Oxford.

What did you think was happening? Maybe you thought you were reading a description of how it feels to be drugged, or to go ‘mad’. Or perhaps it sounded like a script from a horror film involving computer simulation, telepathic control, or being trapped in a parallel universe. Unsettling, strange. Something you might watch on Netflix. But sadly, these experiences aren’t fiction at all, and no drugs are involved. Instead, they’re a part of everyday life for people who experience dissociation.

Since the 19th century, there have been arguments about what exactly dissociation is. Attempts to understand and define it have resulted in various phenomena being added to (or removed from) the concept. But, rather than clarifying the term, this has led to it being more and more contested. In 2013, the American Psychiatric Association defined it as the ‘disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behaviour’– but this is incredibly broad; it covers disruption in almost every aspect of human experience. The term ‘dissociation’ urgently needs clarifying if it is to be useful at all.

What we do know is that these feelings of disintegration, of reality shifting, can be a natural stress response and, as a result, are also common in people with mental health problems. They often happen when people are highly stressed, anxious or tired – up to 66 per cent of the general population report that they’ve experienced dissociation temporarily during a traumatic event. Symptoms of dissociation also appear at high rates across a wide range of mental health disorders including post-traumatic stress disorder, eating disorders and depression, and are associated with increased risk of self-harm.

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