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Dissociation during trauma: the ownership-agencytradeoff model

Yochai Ataria

# Springer Science+Business Media Dordrecht 2014

Abstract Dissociation during trauma (peritraumatic dissociation) lacks an ade-quate definition. Using data obtained from interviews with 36 posttraumaticindividuals conducted according to the phenomenological approach, this paperseeks to improve our understanding of this phenomenon. In particular, itsuggesting a trade off model depicting the balance between the sense of agency(the sense of control over the body) and the sense of ownership (the sense thatthis is my body): a reciprocal relationship appears to exist between these two,and in order to enable control of the body during trauma the sense of owner-ship must decrease. When the relationship between the sense of agency andsense of ownership changes disproportionately to the constraints of the trau-matic event, the dissociative mechanism becomes dysfunctional. By contrast,when the relations alter in accordance with the surrounding conditions, thedissociative mechanism functions properly.

Keywords Trauma . Terror . PTSD . Dissociation . Peritraumatic dissociation (PD) .

Sense of ownership . Sense of agency. Lack of sense of time . Interviews

Phenom Cogn SciDOI 10.1007/s11097-014-9392-9

Y. Ataria (*)The Hebrew University of Jerusalem, Jerusalem, Israele-mail: yochai.ataria@gmail.com

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1 Introduction

1.1 Dissociation during trauma and posttraumatic stress disorder (PTSD)

Dissociation is defined as the “lack of normal integration of thoughts, feelings,and experiences into the stream of consciousness and memory” (Bernstein andPutnam 1986, p. 727).1 Some scholars believe that peritraumatic dissociation (PD)is a defensive mechanism activated during trauma to reduce the impact of thetraumatic experience (see for example, Cardeña 1994; van der Kolk & Saporta1991). As Breh and Seidler (2007) put it, “The individual is thus protected fromtotal perception of the event and dissociation puts an abrupt end to acute andmassive pain and to feelings of helplessness and powerlessness” (p. 54). Yet thereis no consensus among researchers as to whether peritraumatic dissociation (PD)“serves defensive purposes or constitutes integrative failure” (van der Hart et al.2004, p. 907). Hence McNally (2003) rightly asks how we can distinguish “acutereactions to trauma arising from properly functioning mechanisms from thosearising from dysfunction in these mechanisms” (p. 779).

1.2 Aims and goals

In light of the disagreement among scholars regarding the nature of PD, themain goal of this paper is to describe this experience, in great detail. In orderto achieve this goal, the study applies a phenomenological approach, whichdiffers from the narrative approach: “Whereas a narrative study reports the lifeof a single individual, a phenomenological study describes the meaning forseveral individuals of their lived experiences of a concept or a phenomenon.Phenomenologists focus on describing what all participants have in common asthey experience a phenomenon” (Creswell 2007, pp. 57–58). In particular, sincethe phenomenological method is characterized by its ability to reveal the bodily(pre-reflective) experience (Petitmengin 2006), and because the traumatic expe-rience is encoded bodily-somatically (Rothschild 2000; van der Kolk 1994),using the phenomenological approach is extremely useful in the case of indi-viduals suffering from PTSD (Ataria 2014).

1 I have chosen to define “dissociation” in this manner because the term is extremely difficult to define withoutreference to trauma. Dissociative symptoms such as amnesia and non-dissociative phenomena such asdaydreaming, absorption, spaciness, and altered sense of time are often mixed together (Bryant 2007).Moreover, as van der Velden and Wittmann (2008) maintain, altered states of consciousness (ASC) anddissociation are in reality often not fully distinguished. van der Hart et al. (2004) argue that “there is pervasivemisunderstanding of the nature of dissociation” (2004, p. 906). Indeed, a review of scientific literature revealsthat the use of the term “dissociation” has become all-encompassing, describing a wide and unwieldy range ofphenomena that include perceptual alterations, memory impairment, emotional numbing or detachment,reduced awareness of one’s surroundings, limited encoding of events, a distorted perception of reality (forexample derealization), time distortion, seeing events as dream-like, a fragmented self, perceiving the self froma third person perspective, dissociative amnesia, and flashbacks (Bryant 2007; Foa and Hearst-Ikeda 1996). AsHolmes et al. (2005) note, we use the term “dissociation” in a highly confusing way that leaves room forscientific inaccuracy and/or problems in treatment. Clearly a definition of dissociation is elusive and since thetopic of this article is not dissociation, but rather dissociation during trauma, this partial definition seemssatisfactory for the purposes of this paper.

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In order to shed light on the dissociative experience during trauma this paper focuseson the following questions from a phenomenological perspective:

1) Can the same dissociative mechanisms2 operate both positively and negatively?2) When does the dissociative mechanism allow an individual to function during the

traumatic event and conversely when does it prevent an individual from doing so?3) What is the relationship between the sense of ownership (this is my body) and the

sense of agency (I am controlling my body) during trauma?4) How does the dissociative mechanism function when the individual is injured or in

pain?5) How does the sense of time change during a dissociative experience?

In order to tackle these issues, 36 subjects, victims of terror attacks, all sufferingfrom PTSD, were interviewed. The evidence obtained from these interviews suggestthat dissociation during trauma is flexible, as reflected in the trade off model betweenthe sense of agency and the sense of ownership described herein. This model improvesour understanding of PD.

2 Method

2.1 Participants

Interviews were conducted with 36 victims of terror attacks, including suicide bomb-ings of buses and other crowded areas, stabbings, and rockets attacks launched fromGaza and Lebanon. The interviewees were aged 22–78 (mean age 50.56, SD=12.26),13 male (7 Severely injured) and 23 female (3 severely injured), all recognized by theIsraeli Office of Social Security as suffering from PTSD (with more than 20 %disability), all members of the charitable organization “OneFamily” (a non-profitorganization), and all scoring more than 44 (44<85) on the PCL questionnaire, a 17-item self-report scale for PTSD based on Diagnostic and Statistical Manual of MentalDisorders (DSM)-IV (Weathers, Litz, Herman, Huska, and Keane 1993). These 17items correspond to the key symptoms of PTSD and the form includes questionsregarding symptoms in stressful situations (Weathers, Litz, Herman, Huska, andKeane 1993).

The interviewees had experienced a traumatic event between 2 and 41 years prior tothe interview—the mean years since trauma is 10 years (2003, SD=6.58), and seven ofthe interviewees had experienced more than one traumatic event.3 All of the inter-viewees had undergone a course of therapy in the past, consisting of at least 12sessions; 22 of them are currently in therapy, and 31 are receiving medicinal therapy.Thirty two of the interviewees were born in Israel and four are immigrants from othercountries (3 originating from the former Soviet Union and one from America).

2 It is important to understand that one of the central problems regarding the term dissociation is the fact that itis used to describe both the mechanisms (dissociative mechanism) and the experience. In this article I willattempt to distinguish between the experience itself and the mechanism.3 Based on the “life events checklist”, we know that seven of the participants experienced more than onetraumatic event.

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2.2 Procedure

After receiving all the requisite ethical approvals (IRB approval), 97 members of“OneFamily” filled out a number of questionnaires, including the PTSD Check Listand civilian PCL-C. The next stage involved a second approach to 42 subjects selectedrandomly from those scoring above 44 (range of 17–85) on the PCL. There exists someagreement among experts regarding this cutoff of 44, which appears to reveals bettersensitivity (0.94), specificity (0.86), and overall diagnostic efficiency (0.90) with MotorVehicle Accidents victims (Blanchard, Jones-Alexander, Buckley, and Forneris 1996).Furthermore, the National Center for PTSD (US Department of Veterans Affairs)recommends that anyone scoring above 44 seek medical advice and/or therapy. Of these42 subjects, 36 agreed to participate in the research and were interviewed accordingly.

The interviews were conducted in Hebrew at the homes of the interviewees or atanother location where the interviewee felt comfortable enough to speak freely (ac-cording to his/her choice). Each interview lasted between 45 min and 2.5 h.

2.3 The interviews

The interviews utilized the phenomenological method, which seeks to describe thelived, bodily experience (Husserl 1964). Phenomenology focuses on the study ofexperience from the individual’s perspective: usual assumptions and manners ofperception are “bracketed out” (Husserl’s Epoché), thus forcing us to suspend judgmentabout the “natural world” and return to things themselves (Depraz, Varela, andVermersch 2003). In addition, the phenomenological method emphasizes not goalsthemselves but the processes that enable their achievement.

Essentially, since pure phenomenological research seeks to describe rather thanexplain its methods are particularly effective at drawing out the experiences andperceptions of individuals from their own perspectives (for a detailed discussion seeCreswell 2007; Moustakas 1994).

By adopting the phenomenological approach we follow the principle that one muststop asking “why” and start asking “how” (Maurel 2009). We are not looking for the“truth” but rather the authentic experience. Furthermore, in this process we seek toreveal the pre-reflective self-consciousness experience, and by doing so we may be ableto “bring a person, who may not even have been trained, to become aware of his or hersubjective experience, and describe it with great precision” (Petitmengin 2006, p. 229).Indeed, given that PTSD goes hand in hand with over-generality (Moore and Zoellner2007, p. 420), breaking through the “cooked-up/ready-made story” is crucial (Ataria inpressa).

Accordingly it was made clear to the interviewees at the outset of the interview thatthere are no “right” or “wrong” answers and that the aim is to receive the richestpossible description of the experience itself. Interviewees were also informed that theycould terminate the interview at any point. Thereafter, participants were asked todescribe the traumatic experience in detail.

Following their initial description, participants were asked to describe first andforemost the bodily experience during trauma, in order to break through the autobio-graphical story that is usually told in an interview and reach into the primary and pre-reflexive experience (Depraz, Varela, and Vermersch 2003; Vermersch 2009).

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2.4 Data analysis

The interviews were analyzed according to the grounded theory approach (Glaser andStrauss 1967; Strauss and Corbin 1990, 1994), which is rooted in a pragmatistphilosophical method (Charmaz 1995) and helps researchers to increase the analyticalpower of their work. According to this method, no hypotheses or categories are fixed atthe outset. Rather, the researcher remains as close as possible to the field of research,both in the presentation of the results and in their discussion (Shkedi 2003). Categoriesarise from the field of research (data) itself (Charmaz 1995) and at each stage ofdiscussion the level of abstraction rises, as expressed in the categories themselves.

3 Result and discussion

3.1 Withdrawal from the world: deathly silence and blackness

Many of the posttraumatic individuals interviewed in the framework of this studydescribe their traumatic experience, or at least parts of it, as accompanied by a senseof total silence. A sense of deafness (not caused by any physical injury) can function asa dissociative mechanism, detaching the individual from the auditory field of percep-tion. O.B.S., for instance, describes her inability to hear anything as she sees a rocketcoming towards her. This sense of stillness indicates that the individual closes herselfoff, at least partially, from the world: “The moment that I saw the rocket falling, myhead was sealed. I didn’t hear anything anymore” (O.B.S.).

According to B.A., this sense of silence is oppressive and disturbing: “There was akind of silence for a few minutes. A disturbing silence” (B.A.). Similarly, I.H. describes itas unbearable: “It was a terrible kind of silence” (I.H.). The sense of silence is at once inthe subject’s inner world—“I remember the sights and the shock, I remember my silence,a deep, inner silence” (B.A.) — and the external world — “I didn’t hear anything thatwas going on around me” (I.H.), although the two are not identical experiences.

Y.A. associates this silence with death: “There was deathly silence, like everyonewas dead, and only I was left alive” (Y.A.). M.J. echoes this feeling: “There was suchquiet, deathly silence. I didn’t hear anything” (M.J.). Furthermore, when sinking deepinto this sense of silence, some interviewees describe a detachment on the auditorylevel which represents a withdrawal from the world: “In the middle of the madness, thenoise and the turmoil, it was actually terribly quiet. There was no noise. But Iremember that it was very quiet—even a bit calming. Like everything had stopped.There’s no noise now. There’s total silence” (R.M.). A careful reading of this testimonyseems to reveal that this sense of stillness can be experienced (to a certain extent atleast) as calming: the individual finds a quiet/calm safe zone, a kind of bubble, inparticular after injury (R.M. was seriously injured, along with six of her children). E.D.also describes the sense of silence that he experienced after being critically wounded aspositive, or at least, calming: “And I’m lying there. It became quiet, silent. Like whenyou get up in the morning on your own in a room, a calm silence…. Nothing…. Silence.I’m alone, there’s no one else. Quiet. Like a deep silence. Silent, I’m in pain. Butthrough the pain I feel the silence” (E.D.). Similarly I.H. (also critically wounded)describes this as “the silence of paradise” (I.H.).

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Therefore it appears that while the sense of silence can be unbearable (deathly silence),on another level, and even for the same individual (E.G., I.H.), it can also be a calmingexperience, a place for the individual to hide from the horror, a safe zone for the self.

In addition, it is important to note that one can become detached from the world onthe auditory level while remaining connected to one’s surroundings on other sensorylevels. For instance, B.A. feels that everything was very quiet, as if her auditoryperceptual field was detached from the world, yet her sense of sight was neverthelessactive: “I only felt my eyes. My eyes were looking and everything was very, very quiet”(B.A.). However B.A. also feels that her eyes were disconnected from herself: she doesnot say that she saw the world but rather that her eyes were looking at the world, almostas though detached from her.

While some of the interviewees describe deathly silence during peritraumaticdissociation, others depict the experience in terms of blackness: “Darkness, total andutter darkness, my eyes went dark” (S.B.S.). More accurately, the traumatized individ-ual feels as if she is sinking into this blackness or immersed in it. Unlike the sense ofsilence this is never a calming experience, but rather is accompanied by a sense ofsuffocation or dying/death: “I sensed darkness in front of my eyes, I felt like I was insome kind of black cloud. I felt like I was dead. My eyes were open but I saw onlydarkness. Everything became black. Gloom. Suffocating.” (M.J.).

Essentially, the posttraumatic individual associates the experience of seeing onlydarkness with an inability to remember what happened during that time. In moreinclusive terms, a sense of blackness is characterized by a lack of structured memory:“The whole time I just saw blackness…darkness. I don’t remember anything from it”(E.G.). In addition, it can, at times, develop into a sense of blindness: “I couldn’t seeanything” (Z.O.). Furthermore, as in cases of a sense of deafness during trauma, thissense of blindness can be reduced to closing oneself off from the world: “I didn’t see, itwas like my head was closed off” (M.S.).

Similarly to some cases of the sense of silence, this sense of blackness represents asense of death andwithdrawal from the world: “I felt a sensation of something like death…I felt total gloom. I felt like I’m not in this world” (L.J.). Yet, it should be noted that thesense of blindness is separate from the sense of silence: “I could only hear. I couldn’t seeanything” (G.O.). In fact, none of the interviewees report experiencing blindness anddeafness simultaneously; hence wemay suggest that blindness and deafness represent twodifferent independent, alternatives mechanisms for withdrawing from the world.Nevertheless, in both cases the traumatized individual feels as if she is submerged in death.

Interestingly, while the sense of blackness (blindness) is never described as calming,all those that experienced a sense of silence as calming were seriously injured. Thus itseems that this sense of calm is not only exclusive to the sense of silence (deafness) butoccurs only when the traumatized individual cannot do anything to improve her chancesof survival. Later we will see that this is supported by the trade off model (section 3.6)

3.2 Emptiness

During the traumatic experience the individual feels detached from what is happeningin the world: “My head wasn’t connected at all to what was going on” (G.O.). C.C.agrees with this: “I wasn’t there. My head was in another place” (C.C.). Additionally,during the dissociative experience the mind becomes (a) empty of any kind of thoughts:

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“I didn’t have any thoughts” (E.D.); “There’s nothing in your head. Nothing.” (Z.O.);(b) disconnected from reality: “I’m disconnected from everything” (Z.O.); (c) confused:“Confusion, confusion, you’re terribly confused” (O.S.); and (d) ceases to functionproperly: “My head isn’t functioning, nothing works” (Z.O.). As a result, the trauma-tized individual may lose her sense of inner control; this is extremely significant sinceduring a traumatic experience inner control is essential for survival (Spiegel 1997).Hence it is not surprising that when a sense of emptiness takes over, the sense of selfmay also collapse:

the head is empty, it’s a vacuum, I can’t control my thoughts, I can’t manage tocontrol my body, it’s a kind of total emptiness in which I’ve lost control, I’ve lostmyself, I’m nothing inside of it, there isn’t anything there, no thought, it takes overand you’re cancelled out and disappear. Really, you’re dead. (Y.S.)

3.3 Loss of sense of ownership

During dissociation one may experience the feeling of being detached from one’s ownbody, as in Z.O.’s testimony: “And I’m looking, like this isn’t my body, you know, I’m cutoff from reality. I’m looking, not talking, not moving, not anything. Cut off” (Z.O.).Indeed, this testimony implies that the dissociative expereince can be explained in termsof sense of ownership, which is defined by Gallagher (2000) as “the sense that I am theone who is undergoing an experience” (p. 15). To be clearer, during a dissociativeexperience it appears that the individual becomes disconnected both from her body andthe world. This could also be described as a weaking of the sense of ownership, resultingin the feeling that it is not really one that is undergoing the experience (Ataria 2013).

De Vignemont (2010) maintains that the sense of body ownership is essentially not ayes/no mechanism but rather a matter of degree. Evidence from these interviews indeedappears to support the concept that there are different levels of the loss of the sense ofownership (for more evidence see: Ataria in pressb). For example, R.M. feels that she isto some extent familiar with her body, although this is not exactly her own body, morelike a body for functional purposes only: “I recognize it, the body, but not like I know itto be normally. It’s a functional body that represents some kind of new reality, but it isnot really ‘my body” (R.M.). The same experience is formulated differently by Z.H.: “Iwas there and I wasn’t there” (Z.H.). Since the body grounds the subject in the world(Merleau-Ponty 2002), to be, even partially, detached from the body is in fact to be (atleast to some degree) detached from the world. It is clear that R.M. and Z.H. undergosimilar experiences because in both cases the sense of body ownership (SO) hasbecome weaker than usual yet nevertheless still exists to some extent. As a result, theindividual feels partly detached from her body, expressed in a being/not-being kind ofexperience which can be defined as semi (partially)-dissociative (between A and C inFig. 2). Seemingly, R.M. retains at least a weak SO toward her body during thetraumatic experience, although it appears that over the course of the event her SObecomes even weaker, leading to the feeling that her body is merely an object to whichshe is not attached, like a tool: “It’s a kind of object, flesh, flesh. Without ownership.There’s no ownership. Just another object….I wasn’t connected to the body at all”(R.M.). E.D. expresses similar feelings: “It’s not me…it’s not mine” (E.D.).

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However, it appears that the SO can become even weaker: for example, R.M.describes an out-of-body experience (OBE), a total loss of the sense of body ownership(point C in Fig. 2), “It’s not R.M. in the body now, R.M. is in another place, not insidethe body” (R.M.). M.J., A.E., and Z.H. report very similar experiences: “I felt like Idied—I’m not there at all, it’s not mine, I’m in another place” (M.J.); “It’s possible that Iwas in another place, because I wasn’t there” (A.E.); “I see everything from outside…everything that happened. I felt like I was looking at everything from above, and I’m notthere, I’m just looking” (Z.H.).

3.4 Loss of the sense of agency

According to Spiegel, “traumatic stress is the ultimate experience of helplessness andloss of control over one’s body” (1997, p. 227). Hence it is clear that the sense ofagency (SA), “the sense that I am the initiator or source of the action” (Gallagher 2000,p. 15), plays a fundamental role during trauma. Notably, the SA can be either strong orweak, the latter being “the pre-reflective feeling that a given movement is performed byme” (Hohwy 2007, p. 1). Gallagher (2011) provides an example that clarifies thisnotion of a weak sense of agency: “I am pre-reflectively aware that I am reaching forthe bottle and that this is part of what it means to have a sense of agency for my action”(p. 24). By contrast, a strong (reflective aspects of self-consciousness) sense of agencyworks on the “intentional level, and it is tied to the goal or purpose of your action”(Gallagher 2011, p. 16).

K.B. has completely lost her ability to function, to the extent that she is unable toprotect her own children: “When I heard the boom I couldn’t go out and I couldn’t move,I had a kind of black out and I froze on the spot. My children were outside and I couldn’tgo out and get them” (K.B.). It seems that K.B. is simply unable to function under severestress—“I kind of froze and then I fainted” (K.B.) — indicating that under suchconditions her SA collapses: “It’s happened to me many times during this period, whenI was in the car, the siren would go off, and I couldn’t get out of the car or take cover orrun anywhere. I was just frozen” (K.B.). O.S. is another mother who, according to herown testimony, lost her ability to function during a traumatic event. Indeed, 7 yearsafterwards she still cannot accept what she perceives as a failure: “I was stuck… I wasfrozen, my daughter was outside the door and I couldn’t get it open for her. My handwouldn’t move. I’m frozen. That doesn’t leave me. All day long that thought is with me”(O.S.). It appears that responses such as these are not uncommon to stressfulevents. Indeed, B.A. describes a similar experience, during which she was unableto move her body in order to take cover. She too felt frozen to the spot: “My legsdidn’t move. People shouted, I hear the shouts, get out of the way quickly! Run,run! I hear the people’s shouts. Only my eyes and my ears work. My body won’tmove. My legs won’t move. Completely paralyzed, I am not doing anything to helpmyself” (B.A.). H.C. adds:

I hear the noise of the rocket, the wooosh…passing over us. I couldn’t doanything. All of a sudden my legs froze and it’s like they were made of concrete.My legs won’t work…I can’t run. Even if I want to run, I can’t. People around meare running and taking cover but I can’t do anything. It’s not in my control. Mychild is with me and I can’t help myself to help him. (H.C.)

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Although A.R. also becomes paralyzed, his circumstances are fundamentally differ-ent to those discussed above, demonstrating the distinction between situations in whichan individual is able to act to help herself (fight or flight) and those in which no suchpossibility exists. While in the cases of H.C. and B.A. action (running for cover) wouldimprove their situation (the dissociative mechanism is dysfunctional in those cases),under heavy bombing A.R. has no alternative other than to stay still (motionless),hiding in his improvised shelter— he had already done everything in his power to helphimself: “You’re like a fossil or paralyzed under a rock…you have nowhere to run to”(A.R.). Z.O. describes the exact same experience: “I was paralyzed, I became fossilizedin the only shelter available, seeing everything but totally detached” (Z.O.). In bothcases (when the individual has the possibility of improving his situation and when hedoes not) the individual feels frozen: “It’s like being frozen” (R.M.).

Since the SA is rooted in body movements (Gallagher 2007, 2011; Legrand 2007;Sheets-Johnstone 1999), the SA collapses when an individual is frozen, causing a senseof helplessness to take over. This inability to move leads to a loss of sense of control,resulting, in turn, in dissociation: “the more immobile, helpless, and powerless a personfeels, the more likely they are to dissociate in the face of threat” (Breh and Seidler 2007,p. 62). This notion is supported by the following testimonies: “You’re frozen, it’s anexperience of helplessness and then you simply detach” (A.R.); “You can’t run awayanywhere, you are simply frozen to the spot and there’s a very strong sense ofhelplessness and then, from nowhere, you’re just not there, you’re simply detached”(C.B.).

It seems that the ability to move brings the SA back to life. Indeed, according toC.B., “The moment I started to run away my control began to return” (C.B.); S.B.S.adds that “The moment I started running I started to come back to myself, I started tocontrol what was happening…I came back to life” (S.B.S). Taking into account thesetwo testimonies, it appears that we must distinguish between a situation in which theSA is merely “on hold” and its total collapse. S.B.S is an example of the former case:

I was under the table…I’m frozen and I’m not breathing but I’m thinking andlistening. The moment that there had been a few seconds of quiet I understoodthat the terrorist was putting in a new magazine, I took hold of myself and said tomyself, “now is your chance or you’re dead”, I don’t know how I did it, andafterwards it became apparent to me that at that point I was already wounded,but I came out from under the table and I started running. (S.B.S)

A.D. represents an example of the latter situation: “The siren goes off and I just don’tknow what to do, I can’t do anything, I’m not in control of anything. Straight away, I’mhysterical and fainting. It’s like immediate. The same moment that it starts for me it’salready over” (A.D.).

Ataria and Neria (2013) argue that in order to survive in captivity and maintainsanity, a prisoner of war (POW) must find a way to control his inner world, histhoughts; to retain, at least in a limited fashion, his SA. Notably, in this particular casethe sense of agency refers to thoughts, not the body—evidently in this case the SA hasdifferent qualities. In fact, S.B.S. used this same strategy: maintaining control over hisinner world allows his SA to keep functioning on the internal level. By contrast, it isvery clear that A.D.’s SA collapsed immediately and totally.

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Interestingly (as is the case for S.B.S.), the majority of posttraumatic individuals whomanaged to function appropriately during the trauma insist that they simply cannotexplain how they managed to do it: “I don’t know how I functioned, but I functionedexcellently during the event itself. I can’t explain it. I also can’t explain to you what exactlyI did” (S.E.). Many feel that they were acting on automatic pilot (for detailed account seeAtaria and Somer 2013), as if they were simply robots, indicating an emotional numbness:“I functioned like a robot” (Z.B.); “I functioned like a robot, like a machine” (S.E.); “I wason automatic pilot” (S.A.). It appears that a clarification of this matter requires improvedunderstanding of the reciprocal relationship between the SO and SA.

3.5 Loss of sense of ownership (SO) versus loss of sense of agency (SA)

As was demonstrated in the previous sections, many of the interviewees report thefeeling of losing control over their own bodies during the traumatic event; that theirbodies no longer obeyed their commands, causing them to become frozen or paralyzed.Yet E.G.’s testimony suggests that even in this situation one nevertheless still feels anSO toward one’s body:

I remember myself shouting out “help, help”. But I can’t move. In front of me, 5–10 m away, there’s a shelter and I can’t run. People in the shelter are shouting tome “Come!” and I’m saying to them “I can’t!”. I feel like my feet are rooted tothe spot. My legs aren’t listening to me. I see the rocket coming towards me. Likethat. And I’m…shouting to them…“Rocket!”. I’m trying to pick up my legs withmy hands but it’s like they’re made of concrete. I want to move and I just can’t. Ihave no control over my body…. I’m not detached, I’m totally present, it’s anightmare, I’m completely there (E.G.).

It is important to note that although E.G.’s body does not obey her commands,E.G. does not lose her sense of body ownership (I’m trying to pick up my legswith my hands…I’m not detached, I’m totally present). Rather she loses the SAover her body (she is located at point D in Fig. 2). Indeed, it appears that the SO ismuch more primitive than the SA and therefore “it is possible to say that I ammoving, and therefore that it is my movement, and thus have a sense ofownership for it, in cases where there is no sense of agency for the movement”(Gallagher 2007, p. 1). Hence a reduced SA does not necessarily indicate that theSO has also been damaged. Since it appears that in order to retain control intraumatic situations one must become emotionally detached, at least to someextent, dissociation seems to act as a mechanism of defense: through dissociationone retains control over the body. Yet nevertheless, it should be noted that Z.B.,S.E., or S.A. did not present a strong SA during the traumatic event —all wereacting automatically with no willing control over their movements. Apparently,this is also true of Z.H.4: “I was functioning, I checked the children, I calmed themdown. I was so stressed but I functioned like I wasn’t connected to there…like

4 Interestingly, all of these examples of the ability to function during trauma were provided by individualsupon whom the lives of others were dependent during the event. It seems that responsibility for others canshield the individual from losing the sense of agency.

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everything was fine and calm. You’re detached and you function. Like automat-ically” (Z.H.).

In all of these cases (Z.B., S.E., S.A., and Z.H.) the individual experienceddissociation yet continued to function automatically. One possible explanationfor this phenomenon is that those individuals who managed to function did notlose their SA completely—a weak SA was still functioning. Thus while areaction such as that of E.G. (I want to move but I just can’t. I have nocontrol over my body) during the traumatic event represents a total loss of SA,the fact that Z.B. is able to function suggests a decrease in the strength of theSA but not a total loss of SA. Interestingly, while Z.B. experienced an OBE, aphenomenon accompanied by a lack of sense of ownership, E.G. did notdemonstrate any signs of lacking a sense of ownership, but rather of lackingan SA. In fact, she says “I have no control over my body” (E.G.). Therefore itseems that an SO can be activated without an SA — E.G., who lost her abilityto function, testifies that she lost control over her body but did not lose her SO(point D in Fig. 2).

This being said, I would like to argue that a sense of ownership that is (too)strong (SO) during severe trauma may result in a total lack of sense of agency(SA). In other words, in order to retain some degree of control during trauma itappears that one must become dissociated, at least to some degree. Thissuggests that a tradeoff takes place between the SO and SA, as is supportedby Spiegel’s comment that, “There is growing clinical and some empiricalevidence that dissociation may occur especially as a defense during trauma,an attempt to maintain mental control just as physical control is lost” (1997, p.227) (Fig. 1).

Returning to McNally’s (2003) important question regarding how we can “tell thedifference between acute reactions to trauma arising from properly functioning mech-anisms from those arising from dysfunction in these mechanisms?” (p. 779), I wouldlike to suggest that the most significant factor in doing so is the ratio between the senseof agency (SA) and the sense of ownership (SO), which can be called the “trade offmodel” (Fig. 2).

Fig. 1 Trade off between the sense of agency and the sense of body ownership during trauma. In order to gaincontrol over the body, the sense of ownership must grow weaker: partial dissociation is necessary in order tocontinue functioning

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Point A (SA/SO = 1) This point represents an equilibrium indicating that the SA-SOmechanisms were functioning properly during the trauma. The SO becomes weakerand the SA becomes stronger proportionally to the severity of the traumatic event. Thisequilibrium represents maximum utility (ability to function) under the constraints of thesituation. Furthermore, it should be noted that this equilibrium is flexible, dependentupon and suited to the character of the traumatic event.

Point B In order to gain control over the body and the inner world dissociationincreases (SA/SO > 1).

There is no clear answer to the question of whether the dissociative mechanismfunctioned properly or not, because at times, in order to remain sane during severetraumatic experiences, one must find a way to control one’s inner world. To this end,the sense of body ownership must weaken, and therefore a position to the right of pointA (SA/SO > 1) does not necessarily imply that the SA-SO mechanism is dysfunctional.

However, in some cases the SO drops too rapidly (relatively to the character of thetraumatic event itself—for example in the case of a misjudgment of the danger level)and in these cases the SA-SO mechanism may be at least partially dysfunctional,becoming too powerful. Clearly, this point requires additional empirical investigation.

Point C This point indicates an out of body experience (OBE). One becomes complete-ly dissociated from one’s own body; the (sense of) self becomes separated from thebody and the world. In turn, an alternative world is created by the traumatizedindividual, a disembodied kind of reality in which an SA can be generated by thetraumatized individual. It is important to note that in this case the SA operates inrelation the internal, mental world, not the body and, as was noted before, this sense ofagency has different qualities. Indeed, this is what Herman (1992) as the victim’s needto shift into an altered state of consciousness in order to gain control over her internalworld. It is possible to suggest that this is in fact the cause of the sense of calm thatsometimes accompanies the sense of deafness (“In the middle of the madness, the noiseand the turmoil, it was actually terribly quiet. There was no noise. But I remember thatit was very quiet—even a bit calming. Like everything had stopped. There’s no noisenow. There’s total silence” [R.M.]).

D C (OBE)

Total loss of sense of agency (helplessness) Sense of ownership

Sense of agency

AB

Fig. 2 The trade off model between sense of agency and sense of ownership (SA/SO). It should be noted thatthis sketch is merely schematic. For simplicity, at point A the ratio SA/SO would defined as equal to 1 (SA/SO= 1), to the left of A as smaller than 1 (SA/SO < 1), and to the right of A as bigger than 1 (SA/SO > 1)

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It seems that during severe traumatic experiences such as captivity, incest, life-threatening injury etc., an OBE, a combination of a strong SA and a lack of SO, is theonly option that can enable the organism to survive.

Point D A strong (which is in fact normal) sense of body ownership without an SA(SA/SO < 1). This combination results in paralysis (freezing up) and a sense ofhelplessness. In addition, an essential feature of this point is a sense of emptiness ora vacuum; the feeling that the head\mind is empty and out of control (see section 3.2.).It is also possible to argue that this sense is at times accompanied by a sense ofblindness. In this case one loses the ability to control one’s body and one’s innerworld: the SA-SO mechanism is not functioning.

3.6 Pain

During dissociation an individual may develop immunity to pain: “I was shot…but Ididn’t feel anything” (C.B.). R.M. gives the following description: “All the flesh of myhand was outside, outside, the flesh was outside…it didn’t hurt. I was like…just totallydetached. I didn’t know that it was my hand, it was strange to see the flesh, but it wasn’tme or mine” (R.M.). Even when the traumatized individual realizes that s/he wasinjured s/he nevertheless does not feel any kind of pain: “I understood that I was lyingin a pool of blood. And it was my blood. But it didn’t hurt” (M.S.). Z.B. adds: “Thesituation was very severe. Blood was flowing out of me but I didn’t feel any pain. Itdidn’t hurt, but I felt like kind of surprised, shocked. Bits of glass were stuck in myhands and in my feet. But it didn’t hurt” (Z.B.).

An interesting and important question is when exactly one begins to feel pain.Clearly this does not happen at the moment one realizes that one has been injured: “Ididn’t know that I had been injured and then I put my hand on my face and I see that itwas covered in blood, blood, blood was flowing. But I didn’t feel the pain” (Y.A.).Indeed, Y.A. began to feel pain only when he felt safe: “Only when I got to a safe havendid I start to feel the pain” (Y.A.); until that point he was detached. O.B.S. provides avery similar description:

We get out of the car, got down to the ditch, waited for the security forces andonly then do I discover that my leg is bleeding, that I’ve been wounded…I didn’tfeel that I had been hurt…it didn’t hurt, only when I got out and everything wasalready over did I understand that I was injured and I started to feel severe painthat kept getting worse. (O.B.S.)

Based on these examples it seems reasonable to suggest that as long as thetraumatized individual does not feel safe, she remains disconnected from her own pain,feeling that this is not her body (lack of sense of ownership). In other words, as long asthe individual needs to be in control in order to survive, she remains dissociated, fittingwith the above suggestion that there is a tradeoff between the SO and the SA: When theindividual once again feels secure, the SA then weakens and, as a trade off, the SObecomes stronger, allowing her to begin to feel the pain. This explains why G.O. canfeel her own pain only after she locates her children: “All the time that they weren’t with

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me, when I couldn’t find them, I didn’t feel any pain yet, the pain only started themoment that both of them were with me” (G.O.). O.S.’s testimony tells the exact samestory:

I was completely covered in blood, I didn’t even feel it, I lifted up my daughterwith both arms and one arm was completely disconnected and I didn’t feel it, Ididn’t even understand it, only when the doctor arrived and held my child did Isuddenly notice that my arm was hanging from only a little bit of skin, and then itstarted to hurt (O.H.)

In addition, although S.B.S. was already injured when hiding under the table, onlywhen he escaped from the danger zone did he start to feel any pain: “I didn’t feel theinjury…. I didn’t know that I’d been hurt. In the middle of running I looked at myself,because I felt pain and I didn’t understand why it hurt” (S.B.S.).

Only two interviewees reported feeling severe pain during the trauma, both of whomsuffered life-threatening injuries: “Indescribable pain” (I.H.); “I was in terrible pain”(E.D.). Interestingly, however, both I.H. and E.D. were so badly injured that they coulddo nothing to help themselves. Neither of them could gain anything by trying to controlthe situation and, as a result, in both cases the SA decreased to non-existent. In addition,as was noted earlier, in both these cases calming silence, another dissociative mecha-nism, was activated during the experience—enabling both I.H. and E.D. to cope withthe situation. Thus it seems that neither I.H. nor E.D. became dissociated from theirbodies: their sense of ownership did not disappear.

3.7 Loss of sense of time

According to Terr (1984; 1990; 1994), trauma causes time disturbances; indeed, PD ischaracterized by a loss of the sense of time. Almost all the subjects report very similarexperiences of a sense of eternity: “An eternity” (C.B.); “It seemed to me like forever”;“Eternity…without any time constraints” (S.E.); “It’s never-ending” (E.G.). Yet the gapbetween the subjective experience of how much time passed on the one hand and theobjective measurement on the other is huge, as Y.A. and G.O. indicate:

“It felt to me like an eternity until we got to the barrier, but really it was no morethan three minutes” (Y.A.); “It was all a matter of a few minutes, a couple ofminutes, but you know, it seemed to me like an eternity” (G.O.); “That journey of100 m for me was never-ending, it felt like an eternity” (T.T.).

Terr (1984) argues that the slowing of the sense of time during trauma mayimprove an individual’s ability to function. However, most of the intervieweesdid not feel that the sense of time slowed down (the experience of a distortedsense of time, as described by Terr), but rather that the duration of the eventwas like an eternity suggesting that they were outside the domain of time(Shanon 2001) during the trauma. This may also serve as a defensive mecha-nism on the level of the autobiographical self.

Furthermore, I have argued elsewhere (2014) that there is a link between the lack ofa sense of time during trauma and a decrease in the SO. In fact, it can be suggested that

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the collapse of the sense of time is, at the very least, a by-product of the change in ratiobetween the SO and SA. This is supported by empirical evidence (Ataria in pressb;Ataria and Neria 2013). Thus it appears that this element (the lack of a sense of time) isalso one of the central characteristics of the dissociative experience during trauma andthe trade off model.

4 Concluding remarks

This study has several limitations: (1) only terrorized individuals suffering from PTSDwere interviewed; (2) it is retrospective and a retrospective assessment of peritraumaticdissociation, months or even years after the traumatic event, is problematic since it isrecognized that memories of peritraumatic dissociation are substantially affected bycurrent symptomatology; (3) it is introspective, and the traumatic experiences areinitially organized without semantic representations, hence any verbal descriptionsare limited in some way.

However, I am convinced that this study constitutes a first step towards understandingthe experience of peritraumatic dissociation. Indeed, it appears that adopting the phenom-enological approach allows us to delve into the pre-reflexive experience during trauma.Future research should focus on cases in which subjects have no sense of agency but therestill exists a sense of ownership (point D in Fig. 2). I believe that in so doingwewill be ableto reach a better understanding of the relationship between the cognitive mechanisms atwork during trauma and the later development of posttraumatic symptoms.

Acknowledgments I would like to thank OneFamily for the foundation’s cooperation with this study and allthe interviewees for agreeing to participate. I would like also to thank the two anonymous reviewers for theirsuggestions and comments.

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