Free Falling Into the Fire: A Psychiatrist's Encounters with the Mind in Crisis by Christine Montross Page A

were hurting themselves calmed the “mutilators” down. No such results were evoked from the “nonmutilator” subject group.
    Months after I encountered Lauren, I treated a woman who, in the context of her husband’s moving out, had cut her wrists with a razor blade. “I felt so empty, so separate from myself, I didn’t even really notice I was doing it,” she recounted to me, her thin forearms wrapped in gauze. “Or I noticed, but it was more like I was watching it happen from above, not participating in it. At some point I saw something glistening white, and that kind of snapped me out of it. I remember thinking, ‘What are those white lines interrupting the red?’ and then I realized they were my tendons, and then I saw how much blood was all around me.
That’s
the only time I got scared. Not because it hurt—it didn’t, it hadn’t—but because I suddenly realized that I was going to have to go to the hospital.” She paused. “I knew that my sister would be really upset. I guess I only freaked out because I realized what a mess I had made and how badly I had screwed up.”
    This numbness and disconnection that my patient described help elucidate the phenomenon of dissociation. The self becomes an outsider who observes the body from afar, who does not participate in its actions and does not feel its feelings, be they emotional or physical.
Foreign body.
    To a certain degree, dissociation can be a normal part of our everyday lives. I may feed the dog, brush my teeth, empty the dishwasher, yet on any given day have no recollection of the steps I took in the process of each of these mundane, everyday occurrences. I had the attention to complete these tasks but not the conscious awareness of doing so. “Highway hypnosis” is another common form of dissociation in which people may drive for long distances without clear recollections of shifting gears or maneuvering in traffic, without an awareness of having navigated turns and off-ramps on their way to their destination.
    Trauma is understood to cause a spectrum of more serious dissociative symptoms. A mild form of dissociation may occur in the midst of grief when, after the death of a loved one, we feel as if we are floating above ourselves or wading through a thick emotional fog, unable to connect with others or respond to our lives in the ways we normally do. After the September 11 attacks, hordes of New York City residents reported uncharacteristic feelings of detachment and disconnectedness. Scientific research has linked high levels of dissociative symptoms to the aftermaths of war, of earthquakes, of torture, of firestorms. Studies have demonstrated that people are far more likely to embody a dissociative state after they have witnessed an execution. The psychiatrist Glen Gabbard, a renowned psychoanalytic scholar, explains these occurrences succinctly. “Dissociation,” he writes, “allows individuals to retain an illusion of psychological control when they experience a sense of helplessness and loss of control over their bodies.”
The type of dissociation that permits self-harm, however, is obviously less benign than that which results from inattention, or even from grief.
    Not all people who endure trauma—or even all those who exhibit dissociative symptoms in its wake—engage in self-injurious behavior. In her illuminating 1998 book on self-injury,
A Bright Red Scream,
the journalist Marilee Strong turns to attachment theory to explain why this is so. Attachment theory postulates that a child’s ability to develop into a psychically healthy individual is largely dependent upon whether there has been a stable emotional bond between the child and an adult who cares for him. A secure attachment bond assures the child that he is safe and that he will survive. Strong writes, “Research has confirmed that a single secure attachment bond is the most powerful protection against traumatization. Emotional attachment makes a child feel connected and