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Lives At Risk: We Urgently Need More Mental Health Care For People Who Experience Dissociation

18/04/2017 08:07 BST | Updated 18/04/2017 08:19 BST
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Dissociation is a complex mental health condition which can protect you, but can also carry huge risks.

I have experienced it myself - the first time was probably during the traumatic event which triggered it. Despite feeling terrified, profoundly shocked and deeply distressed during that experience, there was a part of my brain that seemed to remain entirely rational, unemotional and focused. It was as if my mind had separated into two parts. The "rational" part told me that I must focus on every aspect of the other person's face and remember every detail because this was going to be important later. I homed in on every contour. I recall seeing three deep furrows to the left of the person's mouth and thinking "You must remember this detail". The image is still imprinted upon my mind.

Six weeks later, I experienced a similar kind of separation in my mind in the week that I was planning suicide. I had woken up one sunny May morning and made a decision to end my life a week later. I had final acts which I needed to carry out which was why I delayed it for a week. As the days went by, I recall feeling surprised that I was proceeding in such a calm, clinical manner to plan my own suicide. I was under the care of the NHS crisis team at the time and told them "It seems so cold and calculated. I'm usually a more emotional person." I was commenting on my own emotions and feelings, as if I was an outsider observing them.

They called out a psychiatrist who expressed concern about the "disconnect between my thoughts and emotions". I had no idea what this meant. He explained that in his view it was dissociation. This was confirmed by other psychiatrists in the following months.

Dissociation is a way in which your brain protects you from unbearably painful, overwhelming emotions. It allows you to disconnect from the emotional pain. The type of dissociation I experienced was called "depersonalisation". In some ways I am grateful that it took me away from such inner torment - but dissociation can also bring huge risks.

I now run a Suicide Crisis Centre and see the risks that dissociation brings to some of our clients who experience it. It is most commonly triggered by an extremely traumatic experience. It can involve a disconnection between your thoughts, memories, feelings, actions or perceptions.

One of our clients, Rob, experienced it after a deeply shocking event. He came to us initially because he was planning suicide. But he also revealed that he was terrified that he was losing his sanity. He said he would suddenly find himself in situations or strange places and have no idea how he got there. He described waking up in bed one morning and finding a knife in each hand. This was deeply shocking to him as he was not a violent man. He feared where this might lead.

When it became clear to him that this was likely to be dissociation, he was extremely relieved but still very worried about the implications - as we were, too.

It's astonishing how little help there is within mental health services for people who experience dissociation. Rob ended up barricading himself into his bedroom every night so that he couldn't leave it and get into situations where he was at risk. But he couldn't spend his whole life in a room with heavy items of furniture pressed against the door to prevent his exit.

One winter's evening, he "came to" in the middle of a road, aware that a driver was shouting angrily at him for walking straight out in front of his lorry. Rob wasn't even aware that he had left home. Fortunately the driver realised very quickly that something was wrong and ensured that he was safe.

Time was what helped Rob's dissociation, fortunately. He had no specialist input from psychologists.

Another highly concerning aspect of dissociation is the feeling some people have that they are not in control of their actions. Holly, one of our clients, told us that she did not want to end her life but talked about the suicidal impulse being outside her control. She felt like she was a passenger on a train - unable to control the destination, she said. She was under mental health services but we became very concerned about the absence of specialist input in her case, and recommended seeking an urgent out of county referral to a London dissociation clinic which takes NHS referrals.

The national charity Mind confirms on its website that mental health professionals "don't usually get enough training in dissociative disorders"(1). As many of us will have to wait months before seeing a specialist psychologist or therapist who has knowledge of the condition, it's important that mental health staff receive more training in how to recognise it - and also how to help someone with it.

I was fortunate that a clinician realised that I was experiencing dissociation. But once it had been identified, I didn't receive any further help to understand or manage it. When I asked questions about the condition, I was told "You can ask the psychologist that." But that would be months away. I asked what would help in the meantime and the psychiatrist responsible for my care wrote advising me to search on the internet for "grounding techniques". He didn't provide any input, though.

In view of the risks to a person's safety and the risk to life which dissociation can create, we urgently need to ensure that mental health clinicians understand it and can provide support at an early stage. There also needs to be faster access to psychologists and therapists. We should not be left to battle with such a complex and challenging condition alone.

For information about the Suicide Crisis Centre: http://www.suicidecrisis.co.uk

Facebook: http://www.facebook.com/SuicideCrisisCentre

Reference (1): http://www.mind.org.uk/information-support/types-of-mental-health-problems/dissociative-disorders/diagnosis/#.WPSyNfnyvIV