Bernadette, a 40-year-old woman, was referred following some unusual episodes at her office. She’d become involved in some conflictual situations at work and when people had tried to talk to her about them, she’d suddenly become unresponsive. She’d sit still in her chair, her eyes would roll upwards and she’d make a soft, droning sound. Some co-workers feared she was going to “go postal.”

The first time this happened an ambulance was called, but the paramedics found that she was fine. She had subsequent episodes at stressful times, and her colleagues learned that she would eventually “come out of it.” Bernadette said she could hear her co-workers in this state, but they sounded far away and faint. She said that she felt calm and “safe” in this state, and associated it with a comforting closeness to God.

Bernadette’s background helped us to understand her: she’d been born and raised in the Caribbean and had been introduced as a child to a Pentecostal tradition in which prayer, chanting, altered states of consciousness and even “speaking in tongues” was encouraged and accepted. Being in a trance-like, or dissociated state, was considered normal where she grew up.

What is dissociation?

Dissociation involves the disruption of the integrated organization of identity, memory, perception or even consciousness (see Spiegel in APA Textbook of Psychiatry 2005). In Bernadette‘s case, it was perception. She came close to a hypnotic trance. Hypnosis, whether self- or other-induced, involves the intensification of focal awareness at the expense of peripheral awareness. Spiegel notes 3 factors in hypnotic trance states:

• intense absorption
• dissociation, such that routine experiences are out of awareness
• heightened suggestibility.

Bernadette appeared to be inducing a hypnotic-type trance to block out upsetting elements of the world.

Spontaneous self-hypnosis has been found to be the underlying mechanism in states of analgesia and altered states of consciousness induced in some people in situations of stress. Responding to a traumatic incident with symptoms of dissociation appears to be a risk factor for developing a posttraumatic stress disorder later.

Indeed, in the West we tend to link such symptoms with pathology and there’s growing evidence that dissociation may occur as a defence against trauma. It’s understood that people may seek chemically-induced dissociation with alcohol or cannabis to deal with stress, but we have no cultural tradition of self-hypnosis or non-pathological dissociation as a stress reducing mechanism.

Bernadette was encouraged and supported to talk about the workplace problems directly, in an environment where she felt safe enough that she didn’t have to slip into a self-hypnotic state.