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Many traumas involve the experience of terror. At the physical level, terror paralyses the body. The muscles stiffen so the person cannot move. The body may appear to have lost life or shudder back and forth to the deter the perpetrator from escalating the violence. When triggered later in life, these episodes of uncontrolled shaking have been termed dissociative seizures. 

At the psychological level, the person enters a state of emotional numbness known as dissociation. Dissociation is a state of detachment from the body, other people and the world. A dissociated person may grow up to be diagnosed with a dissociative disorder, or more commonly, walk around undiagnosed, unable to connect with people and relentlessly hollowed out by a growing sense of internal emptiness. One day the individual may come across the ideas of the highly sensitive person or borderline personality disorder, but rarely the dissociative disorders – their default state.

To make some attempt at recovery, the person makes a slow, overwhelming approach to the emotions that may have been numbed for decades because of their intensity - shock, shame, anger, fear and grief. Through a process called mentalisation, the dissociated person attempts to make sense of these emotions, which are being experienced for the first time in increasing intensity (as if the trauma is taking place now). There are risks to this process. Emotion floods the body. The person hears a 'committee' of persuasive, taunting voices without sufficient relief to provide hope of a way out. Being with people is claustrophobic, yet being alone becomes unbearable. The voices ramp up. 

During this attempt at recovery, the dissociated person experiences affective instability. After social interaction, the person may experience a shock-induced shame that feels like a sudden drop into the abyss or a black hole. The 'colour' is pulled from the world, which now appears massive, towering above a tiny self. Later this experience may be followed by downloads of fear alone, often at night, when the person is compelled by thoughts that seem convincing yet paranoid. These thoughts have the quality of feeling unspeakable in the real world. 

Many therapeutic approaches imply the need to treat affective instability by developing a healthy sense of self. This approach makes sense in cultures where human connection is based on a healthy narcissism. However, it is unclear how this approach impacts the dissociated person. Perhaps for the dissociated person, therapeutic approaches designed to develop a healthy sense of self could in fact trigger feelings of abandonment (alternating between shame and fear). Therefore, for the dissociated person, it may be worth considering alternative routes to treatment based on acceptance and subsequent grieving of the dissociated parts. Some refer to this process as self-integration. 

Self-integration demands time, space and self-care to allow the frameworks of mentalisation to 'catch up' with the re-experiencing of traumatic emotions. A slow return to the body is necessary, together with a cautious trust of bodily sensations as cues to the psychological safety of the environment. Progress is made when we move between ideas to help understand experiences. Therapeutic frameworks help structure the mess and go by lots of different names, including: Mentalisation-Based Treatment (MBT), Transference-Focused Psychotherapy (TFP), Eye Movement Desensitisation and Reprocessing (EMDR), Acceptance and Commitment Therapy (ACT), Compassion-Focused Therapy (CFT) and Dialectal Behavioural Therapy (DBT).


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