Attention as the Mechanism of Dissociation

We often view dissociation as a sort of state in which we lose connection to things we are usually aware of. Dissociation could be defined as subtraction of subjective experience (or potentially also function). This may occur as a muting of components of subjective experience on a particulate level (perceptions, empathy, feelings, sense of self, etc.). This may not necessarily be some sort of induced intoxication, but instead may come down to the way we pay attention to external and internal stimuli. This essay is an exploration of dissociation as a general phenomenon of normal attention, trauma-induced dissociative responses, the mechanisms of psychedelics & dissociative drugs, and how delusions may form from altered attention to internal stimuli.

Ordinary Attention

What we pay attention to is often based on how worthy a stimuli is of being attended. This kind of worth-based propensity for stimuli to be attended could be termed incentive saliency (Zhang et al., 2009). In psychology, the term salience is used to refer to how strongly stimuli draw our attention. In contrast, dissociation may be like anti-salience. Stimuli with high salience more easily capture our attention. In this sense, incentive saliency suggests that our attention is based on our motivation to attend, which is usually based on the consequences of paying attention to stimuli. Paying attention to stimuli can lead to increased wellbeing or security. Initially, we pay attention to things based on how likely we believe our investment of attention is to lead us to more security or increased wellbeing. We pay attention to some stimuli and learn how to react to the stimuli so that we acquire a reward or avoid suffering.

After repeatedly acquiring rewards or avoiding suffering, we can automate a task and perform the actions that lead to the reward somewhat reflexively, as a habit or script. When we learn to automate a task, we often dissociate from that task and begin to daydream (Norman, 2015). Since the task is able to be performed without as much attention, we have more room to attend to other stimuli, which tend to be internal imaginations for some people. We learn to automate tasks so that we no longer have to pay attention. This gives us the ability to attend to other stimuli and essentially learn more and automate more things, allowing us to improve our navigation in the world. After a reaction to a stimuli is learned, attending to it is no longer rewarding, so other more rewarding stimuli begin to capture our attention and become more salient.

This automation is basically reinforcement conditioning. Acquiring rewards leads to positive reinforcement while avoiding suffering leads to negative reinforcement.

In some sense, we are always “dissociated” from whatever we are not paying attention to. This is important to realize because we often talk about dissociation as something that is only sometimes occurring. We say “I am dissociated right now” but really, we always are. You can dissociate right now by focusing on this very text. You might notice that you are attending much less to your surroundings or your bodily sensations, depending on how focused you are. You may focus intently on hearing conversations behind you, to the degree that you stop focusing on what you see with your eyes, effectively rendering you attentionally blind. You can also try to focus on the sensations that are occurring in your back. Notice any aches or feelings and you might observe that you loose awareness of the screen you are reading from. While you read, you may lose track of the sensations in your back. The kind of dissociation we usually refer to are sort of an automated form of this attention and attentional blindness.

Conditioned Dissociative Responses

When someone experiences dissociation from a traumatic experience, they may have essentially learned how to not pay attention to the things that bring out the suffering. The motivation to avoid suffering drives this phenomenon. Specific types of dissociation are induced by aversive stimuli that causes us to avoid paying attention to possibly fundamental stimuli that most other people are attending to and this is often what people refer to when they say they are dissociated. Consider someone who experiences trauma caused by empathizing with a victim. This might happen if you observe your mother’s face being slammed into the concrete by an abuser (this is something I’ve observed). Your reaction might be to stop paying attention to empathy because doing so hurts really badly. It is somewhat similar to those who can meditate to avoid physical pain by controlling how they attend to the painful stimuli and essentially reject (or not judge) the negative quality of the experience (Grant & Rainville, 2009). Children who have faced extreme suffering may often learn to use similar strategies that eventually become problematic in later life. In the case of dissociating from empathy, one may develop psychopathic tendencies if they are too chronically inattentive to empathic stimuli. Luckily, I am able to engage and attend to empathy now and have recovered from much of what I’ve experienced in earlier life.

Not only do we condition our actions through learning, but I suspect we also condition how we direct our attention. In the case of being triggered into dissociative episodes, it may be that we react to a stimuli automatically and change what we attend to. In the example I gave about empathy dissociation, one may have a threshold of observing other people suffer that triggers empathy dissociation and leaves one stuck, unable to feel other people’s emotions. For those with trauma, this can feel helpless. Since this dissociation can protect us from attending to things that would hurt us, it is essentially negative reinforcement. Negative reinforcement is when you are in some sense “rewarded” from the relief of removing aversive stimuli. After the traumatic experience, we may dissociate again whenever there are hints that trauma is incoming, in other words, we may dissociate when exposed to triggers. This occurs out of habit/conditioned response rather than intentional.

In a sense, conditioned dissociative responses to triggers may be like addiction. It is as if a person is addicted to the relief provided by dissociation. The compulsion to dissociate might be even less conscious than addiction, which often may still have some level of decision-making involved. Though, I do wonder if meditation could grant some level of control over conditioned dissociative responses. Meditation is about non-automatic control of attention, so it seems possible.

Attentional Mechanisms of Psychedelics

In recent posts, I’ve posited that (serotonergic) psychedelics may work by deconditioning our attention, freeing us so that we can attend to things in abnormal ways, including memories, perceptions, and the way we filter our reality based on prior experiences. The way we perceive reality may depend heavily on conditioned use of attention to memories, external stimuli, and beliefs about reality. The psychedelic drugs might disrupt recall of conditioned responses which allows these radically different ways of perceiving the world.

This can be very useful to show people the ways that they have been dissociated and also show us that we can perceive reality in numerous alternative ways just by paying attention to the details of reality differently. Our ordinary perception of the world is like a connect-the-dots game in which we learned which dots to pay attention to and specific ways of connecting the dots. Psychedelics essentially allow us to pay attention to dots without our usual priority, allowing new ways of building a reality perception to emerge.

Imagine the case of dissociation from pain. This type of dissociation might lead someone to believing that they live in a world that is not painful. On some level, I think this is an almost universal form of dissociation, though each person having various degrees of tolerance to suffering. This might keep us from experiencing the endless torture of realizing the ubiquitousness of suffering around the world. It may also help us become tolerant of the frequent struggles we face. Some people might explore novel ways of attending stimuli under psychedelics and realize that this neglected suffering exists. Not only neglected suffering but a great list of neglected stimuli exists all around us. Personally, I’ve felt that psychedelics allowed me to notice such realities, which might underlie some terrible experiences that people have.

For those with trauma, psychedelics might help by allowing them to realize that they’ve been neglecting aspects of perceivable reality that they have long forgotten. These drugs may even facilitate the restoration of the ability to attend such lost stimuli and allow for a more integrated perception of reality that accounts for previously neglected stimuli. Some lost stimuli may not only be the result of dissociation from trauma, but also the kind of dissociation that comes from automating tasks. I suspect that there is a lot of feelings and ways of perceiving that were lost after childhood and are restored while under the influence of psychedelics. In past projects, I’ve written about the hypothesis that psychedelics induce perceptual and mental effects that mimic the state that infants are in.

On the contrary, it might be possible that psychedelics also show people new ways of dissociating, presumably during bad trips that induce a level of suffering that prompts new forms of dissociation. Perhaps traumatic realizations about the self tend to lead to depersonalization, while traumatic realizations about external reality lead to derealization and neglect of one’s awareness about fundamental elements of one’s external reality. As I mentioned, we are always dissociated in some way, so psychedelics may differently calibrate the ways we are usually dissociated, bringing back attention to certain stimuli or leading to the neglect of previously attended stimuli. This could change how we usually attend reality and sort of reprogram the way that we connect our dots.

Dissociatives and Silence

Dissociative drugs are popularly known to induce dissociative effects. One stranger effect that isn’t often talked about is immersion. Initially, immersion would seem like something that opposes dissociation, though consider that immersion in this cases might be about dropping attention for other stimuli. In the same way that dissociatives allow us to stop feeling our body or sometimes lose touch with external reality, more partial effects may occur at lower doses, such as a detachment from normally distracting stimuli. This sort of effect may actually underlie the sort of dream states described in “k-hole’ experiences.

Consider how very surprising loud noises suddenly draw our attention and force us to immerse into the stimuli while dissociating from whatever we were doing. Surprising and relatively loud stimuli are highly salient (Zarcone et al., 2016; Liao et al., 2015). Surprising and relatively quiet noises do not usually have such an effect (at least this seems to be the case). Dissociative drugs may reduce the intensity of stimuli and make it so that loud stimuli are “quieter”. These drugs are known to induce numbness of the body at higher doses and are even used on people during surgery because of these body-numbing qualities. This numbing could be generalized to both internal and external stimuli so that everything is “quieter” to such a degree that immersing into a television show or your imagination becomes easier. This may result in being so immersed into television shows that you forget that you are even watching a screen and begin to believe that your observations are ones of reality. The k-hole dream states are somewhat like how closing our eyes can allow us to immerse into our imagination, potentially because we are no longer distracted by such loud external perceptions.

Attentional immersion into a set of stimuli and the dissociation from other stimuli may underlie other commonly reported effects of drugs like cannabis, dissociatives, and psychedelics, such as HD vision. On these drugs, sometimes there is a subjective effect of enhanced visual perception. This may be a result of focusing attention so highly on visual processing that visual perception is actually enhanced. Normally, we may have a conditioned level of attention to visual processing, only as much as it rewards us to attend to. On these drugs, we may surpass our normal limit of attention to visual processing, which may produce the HD vision effect.

Those with varying degrees of sensory numbness may be more prone to hallucinations. One paper has shown that quietness of a room can provoke auditory hallucinations (Knobel & Sanchez, 2009). This may result from the sudden loudness of internal stimuli in comparison to external silence. Dissociative drugs are also known to produce hallucinations, possibly because they act to silence incoming stimuli and subsequently reduce their salience.

Delusions

Delusional thinking may occur when we selectively dissociate from memories or learned ideas that are typically important in guiding our conclusions about reality. I’ve explored this in Is Delusion Ordinary?. Our motivation to believe something could bias which memories we attend to and which that we neglect, so that we pay attention to the memories that support our conclusion, essentially a confirmation bias.

Many delusions likely involve the potential suffering that could occur if the delusion were not believed. Again, this is like negative reinforcement. This might sound strange, but consider the case of debating someone in public. You’ve likely observed cases where an individual was stubbornly defending their position on a topic to the point of being delusional. This may stem from the high cost of admitting defeat. These sort of delusions likely occur when the cost of admitting defeat is horribly painful, particularly when admitting defeat is to admit you are stupid or insane. Abusing people for having bad ideas might actually facilitate the development of delusions as a dissociative coping mechanism. If your delusional belief is right, your opponent can be disregarded as crazy which invalidates their conclusion that you are stupid. It is probably the case that early life experiences involving being shamed for being wrong can lead to such delusion proneness. This may even be a major driving factor in the political polarization we see today, since both sides intellectually threaten each other.

Some researchers believe that hypersalience of evidence for beliefs drives delusional processes (Balzan et al., 2013). In essence, hypersalience of stimuli means that the stimuli are louder. Different forms of altered states may arise from stimuli being abnormally loud or quiet, producing hallucinations or delusions. Perhaps psychosis isn’t about stimuli being abnormally salient, but actually the salience of everything is reduced to a degree that allows more “choice” to what we attend to, which might be more strongly driven by motivations rather than overt loudness or importance of stimuli. To make sense of this, consider how surprising and loud events might distract your attention and force you to observe. Those with generally reduced loudness-of-stimuli might be driven more by their thoughts or imaginations and ignore stimuli that others do not, causing aberration in perception and thoughts.

On salvia, the “becoming an object” effect may be related to attentional immersion. In this case, one may immerse so strongly into certain aspects of experience like visual perception, while dropping away from other aspects of experience that are important for forming conclusions such as self-awareness, that we essentially create an experience in which our conclusions about reality lack the missing important aspects of experience. As one loses touch with their sense of existing as a person, they may forget this critical information and conclude that they are a couch. Under sober states, we may be heavily conditioned to attend to the sense of self because of its’ social importance and the way that we would be punished if we forgot such important information.

ADHD

In ADHD, it may be that salience for stimuli is different. These individuals may chase novel stimuli since they are highly salient. This may lead to issues of being dissociated, often times during important situations like while in class. Novel stimuli may also have a potentiated saliency and dissociate these individuals away from other stimuli that is relatively low saliency. There is evidence of this from an fMRI study on ADHD patients. The ADHD individuals had a potentiated response to novel stimuli that was behaviorally irrelevant (Tegelbeckers et al., 2015). This could result from decreased ability to use incentive saliency. Those with ADHD have been observed to need stronger incentives to modify behaviors compared to controls, suggesting that incentives work less well to alter attention in ADHD individuals (Volkow et al., 2010). Normally, we may use incentives to pay attention to boring tasks, but in ADHD, it may be that the ability to use incentives or rewards is less effective, causing a person to be increasingly at the whim of non-incentive based saliency, thus not paying attention to important goal-oriented stimuli.

Control

Besides using psychedelics, I think it is possible to intentionally focus on attending to normally neglected stimuli. This is hard because we don’t actually know what to attend to. People may often hold the belief that they cannot attend to the stimuli of reality in any other way. Barriers like this make it difficult, but with guidance from someone who can see one’s blind spots, sober alteration to attention may be possible. One could even utilize a combination of low dose psychedelics and guidance from an aware individual to observe reality differently without the risks associated with using psychedelic drugs. Zen meditation may also be a strategy for the control of attention and the subjective experiences that arise from attending stimuli (Grant & Rainville, 2009).

Hopefully this helps you rethink dissociation as a concept about attention and reality formation.

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References

Balzan, R., Delfabbro, P., Galletly, C., & Woodward, T. (2013). Confirmation biases across the psychosis continuum: The contribution of hypersalient evidence‐hypothesis matchesBritish Journal of Clinical Psychology52(1), 53-69.

Grant, J. A., & Rainville, P. (2009). Pain sensitivity and analgesic effects of mindful states in Zen meditators: a cross-sectional studyPsychosomatic medicine71(1), 106-114.

Knobel, K. A. B., & Sanchez, T. G. (2009). Selective auditory attention and silence elicit auditory hallucination in a nonclinical sampleCognitive neuropsychiatry14(1), 1-10.

Liao, H. I., Kidani, S., Yoneya, M., Kashino, M., & Furukawa, S. (2016). Correspondences among pupillary dilation response, subjective salience of sounds, and loudnessPsychonomic bulletin & review23(2), 412-425.

Norman, D. A. (2015). The human side of automation. In Road vehicle automation 2 (pp. 73-79). Springer, Cham.

Tegelbeckers, J., Bunzeck, N., Duzel, E., Bonath, B., Flechtner, H. H., & Krauel, K. (2015). Altered salience processing in attention deficit hyperactivity disorderHuman brain mapping36(6), 2049-2060.

Volkow, N. D., Wang, G. J., Newcorn, J. H., Kollins, S. H., Wigal, T. L., Telang, F., … & Swanson, J. M. (2011). Motivation deficit in ADHD is associated with dysfunction of the dopamine reward pathwayMolecular psychiatry16(11), 1147-1154.

Zarcone, A., Van Schijndel, M., Vogels, J., & Demberg, V. (2016). Salience and attention in surprisal-based accounts of language processingFrontiers in psychology7, 844.

Zhang, J., Berridge, K. C., Tindell, A. J., Smith, K. S., & Aldridge, J. W. (2009). A neural computational model of incentive saliencePLoS computational biology5(7), e1000437.

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