The following paper was written for a graduate level course: Interpersonal Neurobiology. The paper has been modified for publication here. View summary handout by clicking the thumbnail below:
Dissociative Pathology as a Neurological
Framework for Trauma Recovery via Creativity
ABSTRACT: Flow is a brain state neurological similar to dissociation. Flow is part of a creative process. Creativity is linked with psychological healing following trauma, thus I propose that dissociative pathology within the brain of a traumatized individual inherently creates a framework that can be used to heal and integrate trauma via facilitation of creative flow states. Clinical Implications: Clinicians should honor the trauma survivor’s ability to heal and integrate their sensory implicit memory via artistic and creative endeavors. In addition to traditional therapies, therapists may wish to provide psychoeducation about the benefits of creative expression and encourage clients to create routines (examples below) that foster creativity. Unlike other alternative therapies, artistic expression is free or low cost and does not necessarily require a facilitator. Neurobiological research in the areas of creativity and dissociation are not extensive enough at present to prove beyond doubt there is a link, however, the high anecdotal evidence combined with the high accessibility and low cost of artistic expression means that, in this authors opinion, therapists should encourage dissociative clients to access their innate ability to enter creative flow states as a part of the client’s recovery process.
View a PDF file summarizing and illustrating this paper: Creativity, Dissociation, and Flow by Lindsay A Braman
The artist, like the neurotic, had withdrawn from an unsatisfying reality into this world of imagination; but, unlike the neurotic, he knew how to find a way back from it… (Freud, 1989, pg 73)
The ability of the human brain to enter a dissociative state allows for survival via disintegration during times of extreme stress. Dissociation is also the underlying mechanism of a brain state referred to in modern literature as “flow”. Flow is a process neurobiologically similar to dissociation, in which the brain is able to enter a dissociative state in order to facilitate creativity. Since creativity facilitates psychological healing following traumatic events, it follows that the dissociative capacity of the brain extends past facilitating survival of initial trauma events via disintegration, but also lays a framework for creative flow within the brain that can be utilized to heal and integrate trauma.
During dissociation the brain compartmentalizes or dis-associates processes that would normally be integrated (Seigel, 2012). Dissociation can present as a wide variety of behaviors listed by the American Psychological Association to include trance like states, “spaced out” feelings, derealization, depersonalization, and amnesia (as cited by Becker-Blease, 2013). Neurobiologically, According to Lanius, dissociation in PTSD patients is characterized by “predominantly right hemispheric activation” (as cited by Shore, 2012) indicating the left hemisphere goes “offline” during dissociative episodes. According to Craig (as cited by Shore, 2012) the right anterior insula is responsible for integrating information received by the body and translating this data into self-awareness of felt affect and experience. During a dissociative episode, Lanius has shown, the right anterior insula is temporarily deactivated (as cited by Shore, 2012) indicating what Devinsky has shown to be impaired function of the right cerebral hemisphere (as cited by Shore 2012). These neurobiological processes result in a difficulty of the right brain (the felt “self”) to integrate external sensory information with internal input and create a feeling of disembodiment, emotional flatness, loss of empathy, and a sense of fragmentation of self (Shore, 2012).
Similar but notably different from the brain state of dissociation is a brain state referred to in modern literature as flow (Csikszentmihalyi, 1990). Flow is “…an almost automatic, effortless, yet highly focused state of consciousness…” and involves a person being “…fully immersed in what he or she is doing for the sake of the activity itself” (Csikszentmihalyi, 1990). When a person is experiencing flow their brain is experiencing less activity in the frontal lobes and is able to process information in a more creative and less distractible way (Richman, 2014, p. 5-6). According to Richman, during flow a person experiences an altered state of consciousness in which there is temporary deactivation of prefrontal areas of the brain (2014, p. 5-6). Though producing art, music, or another creative product engages both hemispheres of the brain during the production phase of the creation process, primarily the right hemisphere is activated during the creativity (flow) portion of the creation process (McNamee, 2004). McNamees and Richman’s research demonstrates the neurobiological similarities in flow and dissociation- in effect, flow is a sort of “creative dissociation”. In Richman’s words, “Thus, the same dissociative process that is responsible for moments of inspiration when the artist is deeply immersed in creative work is also responsible for fragmentation of the self when the individual is beset by trauma” (Richman, 2014). Though extensive research into the neurobiological processes involved in flow is lacking it is clear that these processes are very similar. Because of this similarity on a neurobiological level, flow and dissociation have significant similarities in how they present in a person’s behavior and affect- but also have small but very significant differences in presentation.
Both dissociation and flow present as a brain detached, on some level, from reality (Richman, 2014) Both flow and dissociative brain states involve changes in perception in the areas of alteration of consciousness, changes in the experience of one’s own body, self, time, or outside world (Csikszentmihalyi, 1990; Thompson and Jaque, 2011). In fact, many descriptions in literature describing one state describe accurately the other. For example Butler (as cited in Richman 2014) describes dissociation as “a telescoping of the attentional field and concentration on a narrow range of experience, with simultaneous exclusion of internal and external material from both awareness and accessibility.” This is a description nearly synonymous with descriptions of the experience of flow.
Despite these similarities, it is the neurobiological and behavioral/experiential differences between flow and dissociation that play the vital role in survival and later healing. These small differences are significant and pivotal. Flow produces, while dissociation obscures. Put succinctly, flow integrates and dissociation dis-integrates (Thompson and Jaque, 2011). Additionally, when an individual’s brain is in flow state the individual retains more agency as to the duration and intensity of the experience. As Richman (2014) states, echoing Freud’s quote cited above, “It is the ability to temporarily let go of reality and return to it when desired that ultimately distinguishes creativity from pathology.”
Further bolstering the argument that creative flow and dissociative experiences are linked is a well studied relationship between trauma and creativity. Flow is correlative to highly creative people (Csikszentmihalyi, 1990). Dissociation is correlative to persons who have experienced trauma (Shore, 2012). If dissociation and flow were in no way related we could expect to see no link between these two groups of people. However, Richman (2014) explores at length expansive evidence indicating a significant overlap between creative people and people who have experienced trauma. Simonton’s research has shown that highly creative individuals more frequently report experiences of psychological trauma than the average population (as cited by Forgeard, Mecklenburg, Lacasse, & Jayawickreme, 2014). One study by Pérez-Fabello and Campos (2011) found that fine art students obtained “significantly higher” scores than psychology students on the Dissociative Experiences Scale on nearly every questionnaire item. Since it can be assumed that most fine arts students chose studies in fine arts based on previous creative experience being highly rewarding, and since flow is consistently and distinctively noted as a rewarding and pleasurable experience, (Csikszentmihalyi, 1990) it follows that these students are likely to experience not just dissociation more prominently than the average individual, as Pérez-Fabello and Campos (2011) found, but also are likely experience creative flow more frequently than the average individual.
In 1889, Van Gogh stated in a letter from a psychiatric hospital “The work distracts me infinitely better than anything else and if I could once throw myself really into it with all my energy that might possibly be the best remedy.” In other words, Van Gogh’s subjective experience was that focused and fully engaged creative expression (i.e. flow) would be the best route to recovery he could imagine. He is not alone. Forgeard et al. (2014) determined creativity promotes healing through “catharsis, distraction, positive emotion, and meaning making”. The rapid expansion in research and practice of art therapy in the previous decades speaks to the powerful healing possible through creative expression.
Entering this research, I was not sure what conclusion I would reach, nor what the neurobiological research would show about the process of flow and dissociation. What I have learned has led me to believe that when the brain experiences dissociation repeatedly over a course of time, it begins to create and pattern dissociative pathology that perpetuates the disintegration of sensory data as experienced during the initial trauma(s). This dissociative pathology creates unique difficulties for processing and integrating implicit trauma based sensory memories. I believe in the pathologically dissociative individual this same pattern of pathology may create neural patterns in the brain that activate the regions of that brain that facilitate flow experiences. Essentially, this means that the brain is primed for creative integration, which may be why creative therapies and independent creative work on the part of the survivor are shown to be powerful tools for psychological healing.
Clinical implications of this argument would be to honor the trauma survivor’s ability to heal and integrate their sensory implicit memory via artistic and creative endeavors. In addition to traditional therapies, therapists may wish to provide psychoeducation about the benefits of creative expression and work with clients to encourage them to create routines that create an optimal environments for flow to occur. These routines might include setting aside uninterrupted time in a distraction-free environment with supplies needed for their preferred creative expression, a pattern of non-judgemental self talk, and freedom to create in a free-association style.
In conclusion, since flow is a brain state using similar neurological structure and processes as dissociation to facilitate a period of intense creativity, and creativity is a powerful tool for psychological healing following trauma, it seems a cautiously valid assumption, pending further research, to propose that dissociative pathology within the brain of a traumatized individual inherently creates a framework that can be used to heal and integrate trauma via facilitation of creative flow states.
View a PDF file summarizing and illustrating this paper: Creativity, Dissociation, and Flow by Lindsay A Braman
Baumann, N., Autotelic Personality. in Engeser, S. (2012). Advances in flow research. New York, NY: Springer.
Becker-Blease, K., (2013) Imagination and Dissociation Across the Life Span. In Taylor, M. (ed). The Oxford handbook of the development of imagination. Oxford: Oxford University Press.
Forgeard, M. J., Mecklenburg, A. C., Lacasse, J. J., & Jayawickreme, E. (2014). Bringing the whole universe to order: creativity, healing, and posttraumatic growth. in J. Kaufman (Ed.), Creativity and mental illness. Cambridge: Cambridge University Press.
Freud, S., Strachey, J., & Gay, P. (1989). An autobiographical study. New York: Norton.
McNamee, C. (2005). Bilateral art: integrating art therapy, family therapy, and neuroscience. Contemporary Family Therapy: An International Journal, 27(4), 545-557. doi:10.1007/s10591-005-8241-y
Pérez-Fabello, M. J., & Campos, A. (2011). The dissociative experiences of fine arts students. Nordic Psychology, 63(1), 72-81. doi:10.1027/1901-2276/a000028
Richman, S. (2014). Mended by the muse: Creative transformations of trauma. New York, NY : Routledge, 2014.
Schore, A. N. (2012). The Science of The Art of Psychotherapy.
Siegel, D. J. (2012). Pocket guide to interpersonal neurobiology: An integrative handbook of the mind. New York: W.W. Norton.
Thomson, P., & Jaque, S. V. (2012). Dancing with the muses: Dissociation and flow. Journal Of Trauma & Dissociation,13(4), 478-489. doi:10.1080/15299732.2011.652345
Van Gogh, V. (1889). Letter to Theo. http://vangoghletters.org/vg/letters/let798/letter.html, accessed March 12, 2016