On Twitter today, I noticed the question below:
At first glance, this might be a confusing question. Why would a therapist assume someone couldn't recognise their own dissociation? If it is happening to them, surely they would know about it?
The answer lies - once again - in the history of dissociation research...
The uni-dimensional definition of dissociation emphasises memory loss
Traditionally, dissociation has been thought of as a 'uni-dimensional' phenomenon. What I mean is, it has been considered to be one, singular problem. The problem itself might involve a number of different symptoms, but it is still one (1) entity. Just like, for example, depression is usually considered one 'thing', even if it might show up via multiple symptoms, like low energy, over/under-eating etc.
In the uni-dimensional view of dissociation, if a person's difficulty is dissociation, one of the 'cardinal' (VIP) symptoms that might show up is 'dissociative amnesia'. Dissociative amnesia means having memory loss or awareness gaps from when you were the most dissociated (or had switched to another 'personality', in the case of Dissociative Identity Disorder).
So, whilst there (sadly) isn't a lot of training about dissociation in standard clinical training, many professionals who have heard of it are likely to have been trained with this view of dissociation. If you see memory gaps - or lack of awareness of dissociated moments - as a very clear sign of dissociation taking place, then your client says that they are aware of them taking place... *confusion*.
What is my answer to the question?
I don't see dissociation this way, however. So my answer was a bit different:
The way I personally view dissociation is from a 'multi-dimensional' perspective. This means I see dissociation more like a chocolate selection box: we have been calling the box 'dissociation', but actually, inside, there are different types of chocolates. They are different from each other, made with different recipes, and can be separated out. This is how the multi-dimensional view sees dissociation: a big collection of smaller, individual 'subtypes'. Just like the individual chocolates, each 'subtype' of dissociation is also different from the others, (potentially) made to different recipes (more research needed here!), and can be separated out (some argue). They are all 'dissociative', but that doesn't mean someone experiencing 'dissociation' experiences every single type. I, for one, hate the coconut-centre chocolates. But back to psychology...
In this multi-dimensional view of dissociation, there is a 'subtype' we refer to as depersonalisation - where people feel disconnected from themselves. There is also the subtype I have written about in my research papers ('felt sense of anomaly' / FSA-dissociation), that makes you feel very strange, even when you know everything is actually fine. Both of these - or even some other subtype of dissociation we haven't named yet - could lead to someone dissociating and being aware of it, as the tweeter describes. So, my answer reflects my opinion that the writer of this tweet could be experiencing (a) subtype(s) of dissociation that doesn't involve coconut-dissociative-amnesia flavour. I would still call that 'dissociative', because we're in the right chocolate box. In this view, yes - it is possible to know about your own dissociation.
TL;DR / Conclusion
Assuming "dissociation = memory gaps" (a caricature of the uni-dimensional view of dissociation) might lead clinicians to rule out dissociation completely when memory gaps are absent. But the multi-dimensional view suggests dissociation might be made up of multiple separable experiences and doesn't necessarily have to include dissociative amnesia. My reading of this tweet is that the tweeter's therapist may have been taking the former view, but it seems that the multi-dimensional view might better fit what the tweeter is describing*.
*Caveat: no-one can get a full understanding of a situation from one tweet. I'm using this as a way to illustrate a theoretical point, please be assured that I know I do not have full knowledge and am not making any judgements about the situation or anyone involved in it.
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