wellness

Art by Mira Klein

I’m preparing to teach a class called Becoming Unfuckwithable: Finding Your Sacred “No” So Your Yes Is A “Hell Yeah,” and as part of creating curriculum for that class, I’ve been pondering what makes people “fuckwithable” in the first place.

Part of what I’ve observed as I’ve worked with patients and clients over the years, especially the ones with chronic illnesses who struggle with codependent, people-pleasing, boundary wounded parts that struggle to stand up for themselves, say no, and protect themselves adequately, is that Complex-PTSD and the frequent dissociation that tends to go along with it is a risk factor for getting frequently f’ed with. And it’s dose dependent. The more severe the dissociation, the greater the risk.

Why? Because when you’re checked out, you’re not self-protective, you’re not present, your critical thinking is not online, your discernment and judgment go out the window, you’re not in what IFS calls “Self,” and you’re not feeling protective emotions (like fear that helps you spot dangerous people or anger that fires up your boundary setting “Hell no!) You’re also in a very suggestible trance state when you’re dissociating, and you may even have memory loss, so you don’t remember exactly how someone might be love bombing you or grooming you or exploiting you or seducing you into doing things you would definitely not say yes to if you were not dissociating. This makes you very vulnerable, especially to narcissistic or sociopathic individuals who prey upon those who dissociate frequently and might even intentionally seek them out.

Several of my severely traumatized loved ones experience traumatic dissociation enough to qualify for a dissociative disorder, so I’ve been reading up about coercive control, narcissistic abuse, the long term impacts of child abuse, and dissociative disorders. I just finished reading psychiatrist Marlene Steinberg’s The Stranger In The Mirror and IFS therapist Joanne Twombly’s Trauma & Dissociation Informed Internal Family Systems. I was particularly impacted by the list from Dr. Steinberg’s book about common descriptions of various dissociative symptoms, on a spectrum from normal everyday dissociation (like daydreaming or spacing out) to severe dissociation (like amnesia or floating above your body.)

Do any of these sound familiar?

• When I become engrossed in a good book, I lose all track of time.”
• “I feel that somehow my body is not doing what my head wants it to be doing.”
• “My mind wanders, and I go in and out. I just go away to myself. Nowhere, really, just not there.”
• “I have trouble remembering what I said in a presentation after I’ve made it.”
• “I was at home with my mother, and the whole thing was unreal. I knew she was my mother, but I just had a feeling that she wasn’t really my mother.”
• “I’m like a filter, who I am on a particular day depends on what’s coming into me and what’s going out. I don’t feel connected internally all the time.”
• “I’ll explode at my husband, and afterward I can’t remember what I said.”
• “It’s not feeling real or feeling that I’m just doing things automatically.”
• “I feel like a girl most of the time; other times I feel more like a guy.”
• “It’s like watching a movie in my head. You know, like when you’re watching a movie and you get all absorbed in the movie. And you forget who you are, where you are, what time it is, what’s going on in your life.”
• “I can become so totally concerned about what people are thinking of me or expecting from me when I’m talking to them that I become lost. I lose me.”
• “I couldn’t remember whether it really happened or I imagined it.”
• “It’s like being shell-shocked, you know that you’re doing something, but you feel that somebody else is doing it. You’re watching yourself from a distance. Doesn’t everyone have that feeling sometimes?”
• “I don’t feel like myself; I feel like some other person inside me.”
• “I didn’t let myself feel anything about my divorce until after I was divorced. The emotional side of me just shuts down under stress.”
• “I’ve been in a shell, and I feel empty inside.”
• “A very powerful wave of emotion comes over me, and I don’t feel in control of myself. I feel that this person is going to do what she wants and I’m over in a corner, helpless, waiting to see what happens.”
• “I act differently with different people.”

What Is Dissociation?

Using psychiatric language, dissociation is defined by these core dissociative symptoms:

• Amnesia: Forgetfulness, lost time, gaps in memory or memory loss, especially lost memories related to triggering experiences), blanking out, sometimes even forgetting what just happened
• Depersonalization: The sense that you’re kind of floating above your life and watching yourself from a distance, a feeling of being detached from yourself, your body, your emotions, or observing yourself from some distance (which is commonly encouraged by some meditation teachers who encourage dissociation in their students). Feeling like an alien or robot, feeling detached from your own body and thoughts, the sense that you’re observing your life as an outsider
• Derealization: A feeling of detachment from your environment or a sense that people or your environment is unreal or not as it seems, a distorted or blurred sense of reality, a sense that life is kind of dream-like and ungrounded
• Identity confusion: Continuing, ongoing struggle and inner conflict about who you are, confusion about morality, sexual or gender identity, religious identity, etc. While identity confusion is normal during adolescence, it can be related to dissociation in adulthood (and also during adolescence)
• Identity alteration: A significant personality change or shift in role or identity, accompanied by changes in behavior, voice, mannerisms, or using different names that happens without your control. This often happens when someone joins a cult or winds up under the sway of a coercively controlling narcissist.

While mild versions of all five core dissociative symptoms can happen to anyone, those with dissociative disorders experience these symptoms more frequently. (To figure out whether your symptoms are mild, moderate, or severe, you can take the quizzes in Stranger In The Mirror, which are adapted from the diagnostic SCID-D test Dr. Steinberg developed, which is used (though underused) by mainstream psychiatrists.)

The Range of Dissociative Symptoms

We’ve all heard of the extreme cases of dissociation- the Multiple Personality Disorders (now called Dissociative Identity Disorders) typified by movies like Sybil (https://en.wikipedia.org/wiki/Sybil_(1976_film) and The Three Faces of Eve (https://en.wikipedia.org/wiki/The_Three_Faces_of_Eve). Yet dissociation happens on a spectrum. Those who qualify for the DSM-V criteria of Dissociative Identify Disorder make up only a fraction of people who sometimes dissociate, but even then, Dr. Steinberg points out that because it’s so underdiagnosed, it’s probably more like 10% of the population qualify for a dissociative disorder.

At its most benign and basic, dissociation happens to all of us when our minds wander or when we drive somewhere on autopilot and arrive at our destination without really being aware how we got there. We even consciously choose to dissociate when we practice escapism and get absorbed into fiction novels, binge watch Netflix, use consciousness- altering substances like alcohol or marijuana, practice transcendent forms of meditation, or even sometimes when we wind up in flow states- when time/space awareness disappears and you’re fully absorbed in running, making art, or otherwise entering ecstatic realms that can feel really great.

Voluntary dissociation is different than involuntary dissociation, which is a trauma symptom and happens on autopilot, sometimes as a default setting. You might voluntarily dissociate by getting totally absorbed in 3D movie at the theater. But when you involuntarily dissociate, it’s like a switch flips and you disconnect and detach from your sensory experience, your thoughts, your sense of self, your body, your awareness of time, place, and identity, your sense that the world is real and you belong to it, and even your personal history and memories. Dissociation impacts your consciousness, identity, memory, emotions, self-awareness, awareness of your surroundings, and embodiment. You could say that its opposite is a kind of integrated wholeness alive with presence, awareness, sensation, embodiment, emotions, intact critical thinking, a strong sense of identity and a healthy weaving between aspects of your being, and a good strong reality check.

Anytime you’ve had an out of body experience- like a near death experience, a sense of floating above yourself (as might occur during a traumatic event), astral travel, mystical journeying to other realms, meditative experiences when you transcend or leave your body or lose time, or even a kind of waking dream state, it’s likely that you’re dissociating.

Dissociation May Have Been Your Best Helper

From a trauma-informed perspective, dissociation is a defense mechanism, or in Internal Family Systems (IFS) language, we’d call it a “protector part.” As such, it’s an intelligent strategy that may have helped you survive hard times- or even unbearable or deplorable times, such as childhood physical or sexual abuse or living through wartime or enduring torture. When your body isn’t a safe place to be or when your emotions are just too intense for your young nervous system to handle, it makes sense that your consciousness would leave your body and go someplace where it doesn’t hurt so much- or that parts of your identity would split off so you didn’t have to be present for the trauma.

As a child in an abusive situation, you might even become so masterful at dissociating that you prefer it or do it automatically and involuntarily- once you’re an adult. After all, when you’re dissociated, you don’t tend to feel your painful emotions, you can numb or leave your body so you feel less pain, you may not remember bad things that happened to you, and you may even gain access to ecstatic mystical realms that fill you with hormones like oxytocin, endorphins, dopamine, and serotonin, giving you a kind of blissed out (but spaced out) high.

In the entirety of my career as a trauma-informed physician, I’ve never in my life seen as many people actively dissociating as I’ve seen since Covid. This all makes sense when life is as hard as it is for so many folks right now. If this sounds familiar, you’re not alone. I’m in no way intending to pathologize or stigmatize anyone who dissociates often. But it might help you to understand that riding shotgun with dissociation are some behavioral and physical side effects which may impact your life. Some of these behaviors may be more readily noticed by other people than by the one dissociating, so pay attention to whether people have said such things about you or you’re noticing these behaviors in loved ones.

Dissociation is often a side effect of the dorsal vagal “freeze” response of the autonomic nervous system, when the body feigns death and lets you check out because something is hurting emotionally, physically, or spiritually. If you’re a gazelle on the run and about to get eaten by a cheetah, dropping the body in death-like state and dissociating the gazelle’s consciousness out of the body makes being eaten less painful and easier to exit, so it makes sense biologically. But when involuntary dissociation becomes chronic, as is common with people who, as children, did not get their needs for connection with the primary caregiver met in the first year of life, a certain predictable set of behaviors may be side effects of dissociation. (Learn more about what happens when an infant’s need for connection with the mother goes unmet here.

Signs That You Or A Loved One May Be Dissociating

• Emotional or physical numbness, feeling blocked when you know you should be feeling something, like grieving a pet or lost loved one
• Brain fog, feeling like you’re in a tunnel with the world fading out around you or finding it hard to concentrate
• Not knowing what you really want, difficulty making decisions or expressing preferences
• Not settling and enforcing clear boundaries because you’re not fully present, feeling your boundary-protecting feelings, or inhabiting your body)
• People pleasing, accommodating, conflict avoidant behavior (inability to say no)- because bullies, pushy people, narcissistic entitlement, or confrontation make you dissociate
• Tendency to behave in ways others might interpret as two-faced (because conflict avoidance makes you appease one person in one moment – and appease someone else in ways that feel like a betrayal moments later
• Being chronically late (because you’re dissociated from awareness of time or you have amnesia around making an appointment)
• Being perceived by others as lacking empathy or being emotionally out of touch (not co-regulating with others, lacking attunement to the emotions and needs of others, which Deb Dana calls “biological rudeness”)
• Chronic illness, weakness, or chronic fatigue (because the dorsal vagal freeze state wears down the body’s self-healing mechanisms and is hard on the body, the tendency to move at a very slow pace, take frequent naps, sleep more than 8 hours/day, or even collapse into narcolepsy)
• Getting lightheaded or even fainting when triggered
• Sexual dysfunction (because you’re not connected to your body when you’re dissociating) or hypersexualization (because you’re not in your body and trying to feel it erotically)
• Not being present or tuned in to what’s happening around you (because parts of you are checked out)
• Aloofness and/or frequent daydreaming/ active fantasy life
• Being spacey, floaty, or ungrounded (which may make people seem unreliable, immature or have difficulty “adulting”)
• Tendency to “spiritually bypass” through frequent or lengthy meditations or yoga classes or seeking out blissful spiritual experiences that promote dissociation, such as hallucinogenic medicine journeying, meditation retreats, etc.)
• Attracted to extreme sports (because you’re not in your body and trying to feel it by pushing it to the extreme)
• Unusually high tolerance to physical pain
• Short term memory loss or losing time in certain circumstances, such as not being able to remember certain things people said 5 minutes later, especially if there was conflict or someone was protesting a behavior they didn’t like or being critical
• Long term memory loss of whole swaths of time, especially during trauma
• Forgetfulness, which might be misunderstood as not caring or being insensitive, but is related to amnesia during dissociative episodes
• Paranoid feelings and distrust of others, even when they’re generally trustworthy, often related to episodes of dissociative amnesia and paranoia about what happened during that lost time
• Procrastination and difficulty with tedious tasks or things that require precise attention, like filling out forms (dissociation may be misdiagnosed as ADHD)
• A tendency to lie or cover up deceptively (usually to save face, protect from humiliation, or cover up some hurtful behavior that may have happened while in a dissociated state)

All Trauma Deserves Our Compassion

Suffice it to say that the psyche and body are amazingly brilliant at helping us survive the unbearable and intolerable, but the nervous system can get stuck on a default setting that makes it very hard to function at maximal capacity. If you or someone you love dissociates frequently, be gentle. These folks are our canaries in the coal mines and their nervous systems are very sensitive to any little trigger. This can be hard, because dissociation also means these folks don’t always behave well, so they tend to trigger others with what seems like insensitive, careless, or disrespectful behavior.

It’s very hard for someone who dissociates frequently to engage in healthy relationships, function optimally at a job, or keep their body healthy at full capacity. And…it’s not their fault. It’s a trauma symptom, and all trauma deserves our compassion. This doesn’t mean we shouldn’t hold people accountable for abusive or hurtful behavior, but keep in mind that scolding someone who is dissociating is only likely to make them dissociate more.

While there’s no magic bullet or quick fix pill or treatment, and while it’s not easy to become unfuckwithable if you’re chronically dissociating, the good news is that dissociation is treatable with cutting edge trauma treatments and nervous system regulation. If you or your loved ones are suffering from dissociative symptoms, I’m sorry it’s so hard. I know this past few years have been particularly hard for our most sensitive souled trauma survivors. My heart goes out to you all.

We certainly won’t be able to heal all the parts that underlie dissociative tendencies in an online program, and it’s absolutely not a replacement for one on on therapy. But for those with milder symptoms who have a tendency to get taken advantage of, we will be offering at least the psychoeducation and boundary-setting toolkit to support people who need help standing up for themselves in Becoming Unfuckwithable. You can register here.

Last month’s Conspirituality podcast shared stories of “spiritual heartbreak.” Listening to those stories left me in tears, not just tears of empathy for the spiritually heartbroken who were exploited when they dared to trust, but for my own parts that have been systemically and ritually heartbroken, first by the church of my family of origin, then by conventional medicine, then by the New Age/ wellness world. I wanted to take a moment just to ponder this idea of being spiritually heartbroken- and invite you to consider whether you’ve been spiritually heartbroken- or perhaps heartbroken by some other system you believed in, which then let you down or traumatized you.

I was raised in a family of three Methodist ministers. The Methodists are pretty tame as religions go, and two of my uncles were real social justice warriors doing pretty great ministry, as ministers go. Yet my memory of the church is that I was raised very fundamentalist. It wasn’t until my mother was dying that my mother’s sister, the wife of one of those social justice conscious Methodist ministers, responded to my anger over the church’s racist and oppressive anti-Semitism and homophobia as “That wasn’t the church. That was your mother. 

Oh.

So I’ll play it safe and say I was first spiritually heartbroken by my mother’s oppressive fundamentalist interpretation of the Methodist church and all the church sex camp nonsense that went along with it. But it didn’t take me long to realize there was nothing good for me in her religion. I left the church the minute I left home at 18 and never went back to church. Ever. 

But that’s when I took on the religion of science. First in my undergraduate studies at Duke University and then later in medical school and residency, science seemed so much saner, more rational, and more just than religion. By the time I graduated from my OB/GYN residency at Northwestern, I was fully indoctrinated into not just evidence-based medicine, but “The Northwestern Way.” Our way was better than Harvard. Our way was the most pure interpretation of only the purest science. I was so sure our way was THE WAY that I had the audacity to call a meeting of senior physicians at my first job after residence. Here I was, only 30 years old, challenging the medical practices of doctors twice my age, armed with articles from the medical literature proving that they were practicing bad medicine and I was here to save innocent women and children from their old fashioned, not cutting edge practices.

I was actually right, and they did finally change their practices about a decade later, but not until after I had made myself pretty insufferable with my certainty and arrogance.

Perhaps because I chose it myself rather than having it forced down my throat, it took much longer for medicine to break my heart. I had bought in- hook, line, sinker, fish. And the dogma started to come apart at its seams, revealing a lot of corruption and moral injury. I had not realized how much we as doctors were actually traumatizing the very people we were trying to cure, and when I did, I became suicidal with despair.

I told the whole story of why I left medicine in my book The Anatomy Of A Calling, so I won’t repeat myself here. But suffice it to say that after having left first the church and then conventional medicine, I was in a very vulnerable, suggestible state when I got swept up in my healing process in 2007 and got my first introduction to the New Age at Esalen Institute, where I took a writing workshop with Nancy Aronie that fundamentally changed my life.

Not until the pandemic did I get my heart spiritually broken again. While I never bought into the New Age wellness world with quite the fervor of my Northwestern fundamentalism, it did embrace me wholeheartedly when my book Mind Over Medicine came out in 2013. I was lonely and scared as a young mother and recent divorcee, and I found a sense of belonging in that world, even though I now realize it was a belonging rooted in unearned privilege, soiled with oppressive teachings and spiritual bypassing practices.

I can write about those three big heartbreaks quite rationally, but if I dive into the emotions, let me see if I can describe what happens in my system.

Initially, I feel ecstatic. I am love bombed into the dogma and it makes me feel special. I was the special good girl child of my mother’s fundamentalism with the solos in the church musicals and my mother’s beaming face when the whole congregation gave me standing ovations. I was the special Northwestern star practicing the best medicine on the planet because I had earned my way to the top with my discipline and brains. I was the New York Times bestselling author embraced by alternative medicine practitioners and those who frequent them as the doctor who was bringing science to what they intuitively knew all along.

I felt worthy, good enough, magical, chosen, inflated, superior, the cream of the crop. In other words, I got a narcissistic hit off the high that came in the honeymoon periods of these love affairs. But then the inevitable crash came when I the crash came and I realized I had been indoctrinated into a rigid, dogmatic belief system that was unkind, unhelpful, and fundamentally untrue. Then the emotions evoked were just the opposite. I felt ashamed, morally injured, deflated, unspecial, unchosen, unworthy. I felt hurt, betrayed, duped, tricked, and ultimately ashamed of myself for every evangelizing the dogma in ways that actually hurt myself and other people. Each time, those exile feelings brought up memories of childhood exploitation by a narcissistic mother and left me in the swamp of realizing that I was not unconditionally loved; I was very conditionally approved of- until I turned on the dogma and left the fold- and then my mother (and then the church, and then academia, and then New Agers) turned vicious. You then realize it was all a ruse. All these people who pretended to love you turn on a dime the minute you take a stand against the dogma that binds you and gives you that sense of ecstatic belonging.

And then you grieve, because you realize you’ve been betrayed.  Those people never did love you in the first place. They only love bombed you because you were playing along with their agenda and not challenging the dogma. And then you do your IFS inner child work to comfort those lonely, sad, betrayed exiles and welcome back into the wholeness of your own love, compassion, and tenderness, letting them cry if they need to because their sadness is legit.

Then finally, I feel angry. I try not to blame myself and instead, I let that anger fuel my activism so I can do what’s within my power to stop others from experiencing the same kind of spiritual heartbreak (or medical heartbreak.) I feel less helpless when I actually find ways I can help others who have been systemically heartbroken or heartbroken by parents who approved of us for being good, compliant little girls and boys, rather than really loving us unconditionally and allowing us to individuate and become our own people.

I wrote about my latest spiritual heartbreak, calling out the oppression in the New Age and wellness world dogma in an unpublished manuscript I’ll be releasing on my Substack. The book is called Love Bigger: An Exploration Of Spirituality Without Spiritual Bypassing. You can subscribe to the Substack here. (But please don’t unsubscribe from this list if you subscribe there, or our system won’t ever let you register for any free or paid classes with us in the future.)

I’ll also be teaching a weekend workshop Spirituality Without Bypassing with IFS founder Dick Schwartz, PhD June 10-11. You can register here.

But I really want to hear about your own stories of spiritual heartbreak. I think it can help us heal to tell our stories and write them down, the way we do in our Memoir As Medicine class. We’re doing the third round of Memoir As Medicine starting June 28. Nancy Aronie and I will be delivering all new writing lessons for those who have taken the class before, but the gushing breakouts will stay gushy.

You can save your spot for Spirituality Without Bypassing here.