Can Dissociation Lead to Depression?

“I haven’t been sleeping well,” Marjorie* said. “I have no idea why, though. Everything in my life is going fine. I’m not upset; nothing’s worrying me. It doesn’t make any sense.”

I was fascinated by what Marjorie was saying because I knew that she had just been to the doctor and that she’d gotten a pretty disturbing diagnosis. She had some difficult decisions ahead of her, not only about whether or not to start an experimental treatment, which had some potentially unpleasant side effects, but also about making some difficult changes in her living situation. If I had been in her shoes, I would have been having trouble sleeping as well.

A couple of days later, Marjorie’s daughter called to tell me that she was having trouble getting out of bed. Marjorie told her she just didn’t feel like life was worth living anymore. I asked if Marjorie knew that she had called me. “Yes,” her daughter said. “She said she didn’t care if I did or not. That’s so not like her.” It was true. Marjorie was usually a powerhouse, with opinions about everything.

I told her daughter to put Marjorie on the phone. “Hi Diane,” she said in a voice so quiet I could barely hear her. “I’m sorry my daughter bothered you.”

I asked her what she thought was going on. “I don’t know,” she said. “I just don’t have my usual energy. I can’t get out of bed. I don’t care if I live or not. I think maybe I’m depressed, but I can’t figure out why.”

Marjorie seemed to have no memory of what was causing her to feel so depressed, which could have been what psychotherapists call “denial,” which is when we close off or shut down information that we don’t want to acknowledge. But I had known her for a long time, and I suspected that it was more likely that she was suffering from something that is like a first cousin of denial, related, connected, but not quite the same. I was pretty sure that Marjorie knew about the diagnosis, that the part of her brain that knew was active and awake, but that it wasn’t talking to the other parts of her brain. In other words, I suspected that Marjorie was dissociating.

What is dissociation, and when does it become a problem?

The American Psychiatric Association (APA) defines dissociation as “a disconnection between a person’s thoughts, memories, feelings, actions or sense of who he or she is.” You might have heard of dissociation in relation to Dissociative Identity Disorder or Multiple Personality Disorder, which is the dramatic far end of these symptoms and the one that catches the public eye (think thriller movies like Split, which have been criticized for demonizing people who suffer from these disorders).

In reality, numerous experts agree with the APA’s statement that “dissociation “is a normal process that everyone has experienced. Examples of mild, common dissociation include daydreaming, highway hypnosis or ‘getting lost’ in a book or movie, all of which involve ‘losing touch’ with awareness of one’s immediate surroundings.”

Unfortunately, it is not uncommon for dissociative symptoms to be accompanied by anxiety and depression, and sometimes even with suicidal thinking.

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Dissociative Identity Disorder (DID) is a serious disorder and requires complex treatment and intervention, but it is rare and not what we're talking about here. It is normal, and part of all of our lives, to engage in healthy dissociation (like daydreaming during a boring business meeting or a phone call with your mom) or a momentary disconnect from an unhappy circumstance. Normal dissociation, when it causes problems in your life, can respond well to talk psychotherapy, often in tandem with medication and other forms of therapy.

I told Marjorie that I could hear that she didn’t feel like getting up, but I asked that she get dressed and come in for a session, even though she didn’t feel like it. She agreed. When she came in, I asked her if we could go over everything that had happened in the past couple of weeks, whether or not she thought it might have anything to do with her depression.

Because Marjorie’s dissociation was a normal, even a healthy one, it didn’t take long for her to realize that she was refusing to acknowledge to herself or anyone else how upset she was about her diagnosis. “It comes to my mind, and then I put it away and don’t let myself think about it,” she said.

I told her that it was a normal and even, in some ways, healthy response to bad news. “Putting things out of your mind for a little while can give your psyche a chance to get used to the information. But unfortunately, it can also interfere with your brain’s ability to think out the options, plan for the future, and prepare for whatever comes next.”

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Healthy moments of dissociation allow space for our psyches to rest and even to play with possibilities that our more rational brain might not consider. But keeping important information, even when it’s painful to contemplate, outside of our awareness can lead to feelings of helplessness.

What to do about dissociation

Techniques from mindfulness meditation can be useful in these circumstances. One technique that helped Marjorie move out of her state of depression was that she allowed herself to focus on gently, and without criticism, on her different and often conflicting thoughts. “I don’t want to be sick,” she said. “I don’t want to change my lifestyle. But I also don’t want to die. And I also feel so lucky to have wonderful children and friends who are there to support me through this process—whatever it’s going to be,” she said to me. “These are some of the thoughts that I have. But there are other ones, not happy ones. And then there are other ones that are happier. And even hopeful. I don’t hang onto any of them. I let them all have a space. And that seems to be helping.”

Bad news and unpleasant feelings don’t go away when you allow yourself to be aware of all of your thoughts and emotions. But they can be a little easier to process if you don’t have to work so hard at pushing them out of your awareness.

Making space for all of your complicated, complex, and even contradictory feelings and thoughts can be very hard. But talking about them and allow yourself to hold a space for these contradictions and opposing feelings—even beliefs—can be an important tool in combatting depression.

*names and identifying info changed to protect privacy

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