5.1 Dissociation An Asian woman trafficked for sexual exploitation. Dissociation is the perceived detachment of the mind from the emotional state and the body. Dissociative states are a response to severe trauma and are frequently observed across the clinical spectrum of cases in which interpersonal violence has occurred. Hua had to run away from her traffickers and she had never seen her baby again. As she recounted this experience this she appeared dissociated. Her face was blank of expression and she appeared unaware of the questions she was being asked. Judith Herman in her book Trauma and Recovery states that, “People in captivity become adept professionals of the art of altered consciousness. Through the practice of dissociation, voluntary thought suppression, minimization and sometimes outright denial, they learn to alter an unbearable reality. Although dissociative alterations in consciousness may be adaptive at the moment of total helplessness, they become maladaptive once the danger is past 54.” A West African woman with a background of domestic servitude who was trafficked for sexual exploitation Abi’s presentation was one of a sad, exhausted woman. “I am so tired; sometimes I just want it to end.” As she recounted her history, her voice was slow and monotonous and she demonstrated short periods of dissociation from time to time in which she would stare straight ahead, without blinking, neither seeing nor hearing what was being said to her. Her body was motionless and she sat slumped in the chair. A person who is severely traumatized may become “absent” and “dissociated” from their physical and psychological presence in the room for example during a clinical session, discussion or interview. This may arise in particularly stressful situations such being interviewed by the authorities, or giving evidence in court. While dissociated, a person’s mind is elsewhere. They may be involuntarily “re-living” a traumatic experience (i.e. having a “flashback” and therefore re-experiencing sensory components of the trauma); or shutting their mind down defensively to protect themselves from the distress of traumatic memories. When people dissociate, they appear to lose their awareness of where they are. They may not hear questions they are being asked, lose eye contact with others or appear to be attending to sights or sounds which are not apparent to anyone else. Their emotional state may also change suddenly and lack a clear link to what is happening in that moment. This can manifest itself in extreme emotion (such as sobbing or retching) but can also appear as a form of emotional detachment, whereby descriptions they provide of their own traumatic experiences are recounted in an unemotional, almost “deadpan” way. An East African man trafficked for sexual exploitation Whenever Greg got close to talking about being raped, he would fall into an almost catatonic state (i.e. an immobile or unresponsive stupor). He stopped talking, his eyes would glaze over and he would remain silent and motionless – sometimes for 15 or 20 minutes at a time. During the fifth therapy session however, after a long period of silence and withdrawal, he began to speak more openly. Dissociation as a manifestation of emotional detachment may be particularly difficult to recognize, and the lack of “appropriate” emotional response can be misinterpreted as indicating that an account has been fabricated. It should not be assumed that descriptions of experiences of extreme trauma are only valid if their recounting is associated with what are considered to be appropriate and explicitly manifested emotional responses. Emotional numbing operates as a psychological defence to reduce the momentous pain of recollecting painful experiences. People who dissociate may have great difficulty in describing events accurately and in chronological sequence if they are continually reexperiencing them.55 Medico-Legal Journal The British Journal of Psychiatry, Trauma and Recovery: The aftermath of violence – from domestic abuse to political terror Memory, 75