Dissociation and Psychosis


Dissociation represents a condition of disconnection from events and states that are usually integrated. These include many conditions of consciousness, such as memory, identity and perception. For the purposes of this article, there is a focus on depersonalization and derealization.

Depersonalization is a sense of existence in which one inhabits a consciousness that allows for the feeling that one is not in her own body. In this feeling-state, the individual’s body is perceived as disconnected from one’s sense of self. This state typically results from physical or sexual abuse or other types of trauma.

Derealization comprises a state in which the world and the environment “feel” unreal to the individual residing in this state. Both depersonalization and derealization are aspects of dissociation represented by subjective states that usually result from trauma.

Both of these aspects of dissociation, specifically, depersonalization and derealization, can be considered psychological mechanisms of defense. Nevertheless, living in a dissociative state is not ideal: it represents an emotional withdrawal from one’s healthy sense of self and the world. However, dissociation can protect the individual in that state from future trauma, such as physical abuse that results in psychological abuse.

Dissociation in the forms of depersonalization and derealization provide a thin, albeit very thin, emotional buffer against physical or psychological harm.

The science of psychiatry treats psychotic disorders through the application of medication to the problems of hallucinations and delusions. The reality or unreality of hallucinations, which may be considered a semantic onslaught, can cause one to withdraw into the self and experience dissociation, such as depersonalization and derealization. While meds might culminate in the elimination of hallucinations (which is a great achievement), psychotic states whose symptoms are represented by auditory hallucinations, are experienced by the psychotic individual as torture amounting to trauma. Delusions compound this suffering.

Trauma can result in regression through emotional withdrawal of the self from the material self and the material world. While it might seem sentimental to procure the phrase, “a return to the womb”, this may be exactly what dissociation represents.

While perhaps not understood to be a salient precursor to Eriksons’s stages of development, this “return to the womb” may be considered to be an internal state of those who have experienced trauma, including the subjective experience of psychosis.

Regressive psychotherapy based upon the Eriksonian stages, proceeding with a a focus on “trust versus mistrust” and on to psychological dichotomies at the psychotic person’s natural level of development, such as “intimacy versus isolation”, may prove to be effective. This psychotherapy might be created utilizing appropriate interventions, such as Rogerian therapy as an initial stage focusing on trust, moving toward the cultivation of feelings of autonomy using Adlerian therapy, reinforcing acts of initiative and industrious accomplishment using behaviorism, engendering identity using cognitive therapy that addresses the emergence of abstract thought.

Overall, the dissociative person is a fragile shell of a person as a result of trauma. Nurturing this budding human being through appropriate psychotherapy might ameliorate the trauma associated with the expression of depersonalization and derealization.

Image via Anna Tamila / Shutterstock.

Ann Reitan, PsyD

Ann Reitan, PsyD, is a clinical psychologist and well published essayist of fiction and creative nonfiction. She holds a Bachelor of Arts in Psychology from University of Washington, Master of Arts in Psychology from Pepperdine University, and Doctorate of Clinical Psychology from Alliant International University. Her post-doctoral research at Washington University in St. Louis, MO, involved personality theory, idiodynamics and creativity in literature. She recently published Illuminating Schizophrenia: Insights into the Uncommon Mind.
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