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Dissociative Events

Question:

I have chronic depression (being treated with Prozac), and have anxiety attacks, fibromyalgia, and a history of childhood abuse. In the past 5 years I have increasingly frequent "lost time" episodes. I (apparently) can drive, carry on conversations, and work, etc. I never feel myself dissociating…just "popping" back in, with no memory of what has transpired in the missing period of time, sometimes just an hour, sometimes a full day. My question is, if I am "dissociated", who is driving my car, talking to business associates, etc? Apparently, the dissociation must not be evident to those around me. How can I be "out", and still functioning?

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Answer:

When you are dissociated and driving your car or talking to business associates, it is you who are doing these things, except you aren’t paying attention to doing these things, or remembering that you have done them. That is how dissociation works. That is the essence of dissociation.

Normally, people walk around and do things and they are aware of doing those things as they do them. Further, people normally remember having done things after they’ve done them. Not so in dissociation. When people are dissociated, they still are out doing things, but they are not aware of doing those things. Further, they are not able to recall having done things either. It is as though they were going about their business on autopilot. Things get done, but no one is paying attention, so it seems.

It is possible and even common that this sort of situation occurs because of the nature of human memory. We tend to think that there is only one kind of memory – the kind that enables us to remember what we had for dinner last night. There are actually two kinds of memory (at least). This first kind of memory (that helps us remember our history) is called episodic memory. The second kind of memory is the sort of memory that enables you to remember how to walk, how to drive a standard shift car (with a stick-shift), how to play a musical instrument, or how to make small talk. It is called procedural memory, because it heavily involves muscle memory and the learning of patterns that can be repeated with increasing perfection the more we practice them.

What we call dissociation involves a disruption of episodic memory – we expect there to be a continuity of historical memories but suddenly there is a hole we can’t account for – but even while we are at a loss for what happened to our episodic memories, our procedural memories generally stay intact and continue to function. So – even though we aren’t storing the memory of talking to business associates or driving the car, we know how to do these things procedurally and we continue to perform these procedural tasks with great skill.

Procedural memories have some interesting properties. They are largely automatic and non-verbal in nature. They work out best when you don’t try to think about what you’re doing too hard. Think about driving a car or playing a musical instrument. You can explain what you’re doing in language of course, but the explanation you give will be after the fact. The act of playing the instrument or driving the car just happens. If you think about what you’re doing too hard, you’ll screw it up.

Different cases of dissociation occur differently with regard to the disposition of the missing episodic memories. In some cases, it seems that the episodic memories just never get stored away properly and they get lost forever. This is the case when you’ve had too much to drink (and have a blackout experience), for instance. In other instances, episodic memories are stored away, but in such a manner that they are no longer accessible to your normal state of mind. It’s like they get misfiled and you no longer can find out where they were placed.

Episodic memories tend to be stored in what is known as a state dependent fashion, meaning that they get filed away in reference to the mental conditions that were present during the time they were created. If you were feeling very sad at the time you created a memory, for instance, you might have difficulty recalling that memory again when you were feeling happier, but it could come rushing back to you when you felt sad again. There are other factors that can be at work as well that determine how accessible a given episodic memory will be.

Most common dissociation ends up being of this relatively passive mood state dependent learning type or of the blackout variety. People experience themselves simply spacing out – or more properly, as you point out – spacing back in and then wondering what just happened. However, there are more extreme forms of dissociation that involve more active forms of denial and repression of particular memories, and there are cases where dissociation occurred at such a young age that a unitary sense of self never had the chance to develop, and instead a set of self-fragments forms as a sort of shield against painful self-knowledge and abuse memories (e.g., the case of dissociative identity disorder otherwise known as multiple personality). This is not all that common however.

The fact that you are experiencing dissociative episodes with increasing frequency is concerning enough that I’ll recommend that you get yourself checked out by a neurologist or by a neurologically sophisticated psychiatrist. Someone who can check you for neurological problems and possibly do some neuropsychological testing. It is possible that this sort of thing has something to do with any drugs or alcohol you are using, or to some brain problem (that should be identified and treated if it exists). It could be a side effect of your medication (although that would be a rare sort of symptom), or it could be associated with your other diagnoses or your childhood history of abuse. Whatever it is, it ought to be studied and identified so that you can be offered whatever help might be available. People can function in a dissociated state, but that doesn’t make it a good idea.

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