BEHAVIORS: Dissociation and Dysphoria

[BPDFamily.com]

What is Dissociation and Dysphoria?

[geroldmodel]

What is Dissociation and Dysphoria?

[daughter1124]

In the glossary of the DSM it says "A disruption in the usually integrated functions of conciousness, memory, identity, or perception of the environment. The disturbance may be sudden or gradual, transient or chronic."

The DSM lists borderlines as experiencing "transient stress-related paranoid ideation or severe dissociative symptoms". The key here, I think, is transient and stress-related. I've seen this in mom, usually when she's flipping out over some perceived abandonment - like when I'm leaving on a vacation OR like now, where she's worried/stressed (and rightly so) about where she's going to be living in the near future (we are looking for some place different, and the anxiety of not knowing the final outcome is flipping her out). But it comes and goes. For example, when we visited a Personal Care Home last week and she was pretty much ok in the car on the drive there but once she got out of the car and went inside, she was so preoccupied w/her own thoughts of worry that she was a bit removed from reality - dissociated. Her focus was so narrowed on herself and her internal worries that she really didn't see the home or appropriately interact w/the people.

I can also recall many occassions, like holidays or special events, where mom has said afterwards that she doesn't really remember the details of the event. This is even when I didn't think she looked too out of it during the event.

Just now reading the definition, I see it mentions memory. I guess that explains it. At those events, she was not so dissociated as I would notice (like last week's trip to Personal Care Home) but her brain was clearly not integrating/merging her memory w/her conciousness and perceptions. Basically, the fact that she was a bit nervous, but not so wigged out that it showed, still had the effect of messing w/her memory of the event.

Another psychiatric glossary that I have calls it a kind of defense mechanism that may defer or postpone experiencing some kind of emotional impact.

[rock_scissors_paper_2]

I disassociated for about a year.

It's weird. It's actually really pleasant in a way.

Imagine an emotional crisis as being like the turbulence of a raging sea, and disassociating as sinking into the quiet oblivion below. You just give up the struggle and let yourself go.

When you start trying to resurface, though, it's like getting the bends if you come up too fast. Because all that trauma is still there, it didn't go away. And now you have to deal with it all at once.

[Numbnut]

I believe that the difference between a disassociative episode and a psychotic break is one of degree.  Disassociative episodes are "blackout" type experiences, in general, while psychotic breaks are literally where the person is manifesting psychotic behavior and disconnection from reality and not necessarily accompanied by a blackout, although often is.  When my current g/f gets home (who ironically enough is a clinical psychologist (Ph.D) who works with many borderlines albeit in an eating disorder context) and see if she can shed more light on it.

[Alana]

Hi folks, I didn't see this thread til just now, and thought I'd add my perspective. From what I've read about dissociation (& derealization) there can be chronic and short term dissociation. Neither are amnesia-like usually, but the person's perspective is altered so, memories can be different than what others remember.

I have had chronic dissociation since my childhood. I remember exactly when it became permanent, but am no longer sure how old I was. Until recently, I thought I was 11 or 12, but now I think I must have been 8 or 9. I was very scared when it wouldn't go away, and told my dad, but it was never discussed again. Soon, I just accepted it as me, and didn't think about it for years (decades?) at a time. (I'm 43.) I had no idea what it was until a few months ago.

I assume that everyone who has this is slightly different. But I'll try to describe my experience. It's like living in a 3-D movie that I can interact with. It's not my senses per se, but it is more centered on my vision than hearing or touch. If I close my eyes, and concentrate I feel closer to reality. When it first began it was episodes that I could 'pop' out of. I would have to concentrate really hard on something that I could see, and 'convince' myself that it was really there in front of me. When it worked, it was like a light switch. 'Pop'. All at once, everything became more vibrant and 'closer', if that makes any sense at all. Imagine wearing tinted glasses all day long, then taking them off.

When it became permanent, I couldn't pop out. It was late in a chaotic day, and I was very tired. And I thought that maybe it would just be gone in the morning. It wasn't, and I could never get out again.

I will say that I am very emotional, even though I am chronically dissociative. It's hard to for me to imagine that this blunts my emotions, though I guess it does. (Scary thought.) Now that I know what my problem is, and that it is possible that I can break free from it, I'm trying to do that. I am also now aware of 'the veil'  most of the time. You'd think I'd have known this before, but the intensity varies quite a bit. I have come close to breaking through once, and I was suddenly terrified, and pulled back. Other times I feel that it's very 'thick', to the point that it's hard to concentrate. (It's similar to how you might feel under severe sleep deprivation.) That has happened most frequently as I read books related to BPD, sometimes when reading here, and when I'm with my T.

Anyway, I hope this helps someone understand more what chronic dissociation feels like. I feel like I've 'outed' myself. This is not something I've talked about much. My dad when I was a kid, and my H and my T just recently. I didn't go into this kind of detail though. Frankly, it so weird and hard to understand and embarrassing (?), that it's not something that most people would want to know about anyway.

Alana

[turquoise]

Technically dissociation is defined as follows:  The capability or process of separating thoughts, emotions, affects, or experiences from one another either purposely or involuntarily.
 
For BPD's it is usually a defense mechanism. Allow me to copy and paste dissociation vs BPD from this French BPD site.
 
Turquoise
DSM / Dissociation in borderline disorder
 During periods of extreme stress (e.g., perceived or actual abandonment), these individuals may experience transient paranoid ideation or severe dissociative symptoms (e.g., depersonalization).
 
Dissociation is the state in which, on some level or another, one becomes somewhat removed from "reality," whether this be daydreaming, performing actions without being fully connected to their performance ("running on automatic", or other, more disconnected actions. It is the opposite of "association" and involves the lack of association, usually of one's identity, with the rest of the world.
 
Data studies (statistics, prevalence, comorbidity, co-occurency)
 "The percentage of patients with borderline personality disorder who also have dissociative identity disorder is unknown"
 
"It is estimated that one-third (33%) of patients with dissociative identity disorder also have borderline personality disorder"  (apa)
* van der Kolk BA, Hostetler A, Herron N, Fisler RE - Trauma Clinic, HRI Hospital, Brookline, Massachusetts
 
1994 Psychiatr Clin North Am - Trauma and the development of borderline personality disorder.
Dissociation have a high correlation both with the degree of borderline psychopathology and with the severity of childhood trauma
 
Dissociation is a way of coping with inescapably traumatic situations by allowing the person to detach from the reality of the situation. Often there is a loss of the memory and the relief of pain for the situation, the person can feel numb or spaced out. For some people this becomes a conditioned response to stress even if the situation is not inescapably stressful
 * Jonas JM, Pope HG.
 
1984 Psychiatr Dev- Do patients with borderline personality disorder (BPD) display psychotic symptoms as part of their syndrome?
 Broadly defined psychotic,symptoms, such as depersonalization, are much more often reported in BPD, but many of these symptoms have also been reported frequently in patients with non-psychotic disorders and in normals. Thus, the evidence for psychotic symptoms in BPD remains equivocal.
 * Zanarini MC, Ruser T, Frankenburg FR,... .- Lab Study of Adult Development, McLean Hospital, Belmont, MA
 
2000 Compr Psychiatry - The dissociative experiences of borderline patients.
 290 borderline patients. Result : 42% with a moderate level of dissociation, and 26% of BPD patient have a high level similar to that reported by patients meeting criteria for dissociative disorders

[Alana]

For anyone, dissociation is a defense (coping) mechanism.

Alana

[Clouded North]

My T is very experienced in the complex trauma (C-PTSD) disorders which can be very similar to most personality disorders.  Not the same as PTSD.  She is very familiar with dissociative symptoms and says it's very likely with people who have experienced complex trauma in their early childhood are dissociating on a high-functioning level when experiencing stress in their lives... .and can account for the feeling that we nons feel we "don't exist" at times... .b/c we really don't to them.  My T has mentioned this before to me while I was involved with my ex the other times I would just not hear from her for days... .I used to take it very personally, but learning to just be content with the fact that it had nothing to do with ME, and everything to do with her disorder(s)... .as a result of her childhood trauma (which was very disturbing).

[snowwhite]

I have pictures of my ex-husband (BP) when he is dissociating while standing next to me.  You can actually see on his face that he is just not mentally there.  I cannot imagine what the stressful part of the situation was since we were spending the 4th of July at an amusement park with my family. 

I also remember passing him in the hall of our home when I swear he did not realize I was there.

[colonel]

Hi, I want to know about developing alters while disassociating. I understand the spacing out and detaching thing from stressful situations. I saw and was told about that numerous times with my bp friend. That seems to be a common bp thing. Recently though she was given a diagnosis of Disassociative identity disorder as well as bp and now suddenly after that diagnosis she has alters. Separate identities inside her each with different names and slightly different personalities. It's weird. she doesn't even call herself by her own name now but has made up a new identity. Says the original person, who she actually is before all this crap developed and still is,  couldn't cope went to sleep inside her and never woke up. So now this new identity and others look after her. I'd really love some info on this or comments from anyone that has experienced something similar because at the moment I can't really find much that explains it. I don't even know if it's a real thing or something she's made up, on one level part of me thinks it's made up but I don't know enough info about this form of disassociation to know anything for sure about it.

[Serenity.]

I don't even know if it's a real thing or something she's made up, on one level part of me thinks it's made up but I don't know enough info about this form of disassociation to know anything for sure about it.

No, they're in a lot of pain. It's real to them. They're confused and hurt inside. I think when they disocciate they can't deal with the hurt (perceived usually) in front of them. BPD is a serious and very real, painful illness. My heart breaks for my ex but he showed me too much hell to stick around.


Geroldmodel,

Thanks for the info on dissociation. I saw this time and time again, also my ex explained this to me. He said he went to his warehouse to drink as much as he could to deal with his pain when he would bolt out on me to stop his pain.

[Ruby_Slippers]

Peaceful; With Therapy, better coping skills and routines, some BPD's can learn to control their dissociative episodes. My husbands events were all stress induced (perceived or real). He would sort of glaze over, start to sway and slow sink to the floor. It was very frightening to witness. Before he was finally diagnosed with BPD we went through several years of medical tests, numerous medications even wearing a heart monitor... .no one could find a medical explanation.

At it's worst he was hospitalized with what they diagnosed as transient amnesia. He did not know where he was, who he was or who I was for 4 days. Slowly things came back but not the memory of what happened to him.

I hope this is helpful to you. I will keep you both in my prayers.

Ruby

[Up From Here]

Thank you for this workshop.

This is helping me understand much more about the things that went on and as more time goes by, and as I read these things, the hurt diminishes with more understanding and compassion takes its place.

As I read through the definitions and mechanics of these dynamics, I can get a better picture of my ex-wife, with her cutting, burning, eating/purging, distorting, etc.  I used to watch her energy shift while processing her thoughts, sometimes mid-sentence, and given that I was going to be the recipient of whatever was coming next I'd go on a kind of alert as I'd never know what "it" would be, until it came and it was pretty unnerving to observe.

This explains these things clearly for me as well as a time when she actually had a different surname for the volatile side of herself that she said, got her through traumatic events earlier in her life.  The surname wasn't tongue-in-cheek at all and was (may still be) a very literal part of her identity and perceptions and she would occasionally ask me to interact with that "other person," by taking with her.  I did lovingly talk with her "other" a couple of times but was pretty uncomfortable doing it as my instincts told me there was more to this than I was aware of nor did I want to be aware of it.  That was my shortcoming and I told her so.  I'm not qualified for this but my heart is going out for the experience and in a new and better understanding not only of my own experience, but of hers as well.

My compassion is growing and I can't thank this place enough for this. 

Again, thank you for this workshop.

UFH

[an0ught]

Dysphoria as I experienced it: for about two years my uBPDw was not able to laugh at all - no smile - nothing. Of course she was able to laugh when with others but when alone or with me - none. It was energy draining and emptiness - void. We stopped having sex as she would just cry afterward. It slowly built up over two years from sadness then to emptiness to despair to suicidal thoughts to suicidal gestures. I'm not sure what really caused it.

Then a psychotic phase of 2 months started aided by hormones - stay away from levonorgestrel. It belongs to the class of synthetic progesterone. Progesterone itself can make depressions worse (and is naturally produced in the second half of the cycle). Levonorgestrel also binds to the androgen receptor. This can turn a normal BPD into a BPD on steroids - literally. She was hours away from a padded cell. 48 hours after removing the IUD she was back to her dysphoria normal.

The dysphoria  slowly vanished over the next year and I'm not sure what really caused that either.

Myself I'm still a bit depressed and exhausted from all these years of BPD around me and I experience joy a little bittersweet and damped. But this dysphoria of her was different and scary - somehow looking into total blackness. All light absorbed without any effect.

[Oldsoldier2411]

I have been studying this condition for a while now and been perplexed by what I have read. My daughter has idicated to a therapist that she "zones out". Some , I have read suffer increasing periods with this part of their lives. I have read that this is a common occurrance with BPD. I have also rear that there are ways to ground yourself when it occurs. Some use ice cubes. Are there other ways when for instance you may be out shopping and you don't have access to ice cubes? Are there any signs to watch for? I know with the rages that sometimes follow that they can be almost instant. I know from past experiences with her mother that can be horrifying, as though you are looking into the face of someone completely different to who you have got to know. I still bare the physical scars of my ex-wifes rage. Do they really suffer from amnesia or are they trying to distance themselves from what they are capable of during these episodes? I have been brought up by parents to look for reasons not excuses. Do we sometimes distance ourselves from the sufferer to guard ourselves and in doing so validate the sufferers abandonment? I am still looking for answers, maybe there are some of you out there that can help. Thanks

Ian

[JulySky]

I, too, look for reasons, Soldier, and have been reading and researching our daughter's sickness for quite some time.

A therapist at the first facility our daughter was placed at in her terrible teens called me up and asked if there was anything I should mention that would help her understand our daughter. (By this time I knew what our daughter had said about us after bolting to another state: beatings, letting our youngest play with fire, sitting around all day and doing drugs, etc., etc. One of my sisters told me how believable our daughter's lies would be to people who don't know us.)

But then I thought back and recalled her 1st grade teacher calling us because our daughter didn't respond to the teacher's lunch-bell voice, again and again.  Our daughter was lost in thought while working on an art project.   

Our daughter day dreamed a lot.  But she was so creative, a straight-A student (genius IQ), and a sweet and lovely person until adolescence.  Her art work is amazing, and she can write.

The first BPD sites should disappear.  Our daughter was never abused.  She, and her three siblings, have always been adored.  I was actually grilling another child to determine whether any of our relatives or friends or daughter's fleeting boyfriends had done something wrong. But then anyone witnessing my brother's or cousin's antics, before he died, would think that they were raised by monsters.  They weren't.  Something is clearly very wrong in their wiring.

I'm wondering if the "zoning out" is some sort of epilectic seizure.  My girlfriend years ago suffered a grand mal at my house.  Upon awakening, she was exhausted.  The first thing she asked was how much time had elapsed.  BPD, as far as I'm concerned, like schizophrenia, bipolar disorder, autism, major depression and ADHD, is genetic, with a constant, but low-grade storm in the brain. The rage is the seizure, the "zoning out" are the petite mals.

[sad but wiser]

Just a question - are we sure that all of the people being diagnosed with BPD really have BPD?  Just as autism was an umbrella until we started seeing that it wasn't always autism, etc.  Is it possible that there are onsets of BPD that are actually something else that looks similar?  A viral infection and allergic reactions can look pretty similar at times.  There are only so many ways that the human body reacts physically, only so many symptoms.  Is that true for the emotional/mental state as well?  If you look at Obsessive Compulsive Personality Disorder, you find black and white thinking and ambiguity, both of which show up in BPD as well.  How about Dependent Personality Disorder?  It looks really similar to BPD in many ways.  It does seem strange to have a good chunk of diagnosed people who had no known significant early childhood trauma.

[Oldsoldier2411]

Just a question - are we sure that all of the people being diagnosed with BPD really have BPD?  Just as autism was an umbrella until we started seeing that it wasn't always autism, etc.  Is it possible that there are onsets of BPD that are actually something else that looks similar?  A viral infection and allergic reactions can look pretty similar at times.  There are only so many ways that the human body reacts physically, only so many symptoms.  Is that true for the emotional/mental state as well?  If you look at Obsessive Compulsive Personality Disorder, you find black and white thinking and ambiguity, both of which show up in BPD as well.  How about Dependent Personality Disorder?  It looks really similar to BPD in many ways.  It does seem strange to have a good chunk of diagnosed people who had no known significant early childhood trauma.

I would agree with you and that is why I have been doing a lot of research. I would also say that sometimes that the "experts" can be to quick to dismiss the input from families and friends. The reason being that they do not always seem the problems during their assessments. This canbe due to only seeing the sufferer for a short period of time but families see them for much longer.

Ian

[Monarch Butterfly]

I just read this article about dissociation. Very eye-opening.  I never really understood what went on after or during or arguments, because in my mind the scenario was way off. I guess I understand it now - it makes half the pain go away.

Usually in any conversation, as if, who would wash the dishes type thing -I was trying to work something out that was ok for both of us. But he wouldn´t/couldn´t listen.  After a bit he would fuss, rage and get verbally abusive. Then he´d say good night and go to sleep! And he sleep so soundly he´d snore - and I´d be there right awake and smoke would be coming out of my brain! How could he sleep? Honestly! Then in the morning it would be as if nothing had ever happened. Absolutely nothing! He would sit at the breakfast table, kiss me before he goes to work, and life would keep going on - normally - ARG!  

But then to life as it is now: how the h*** do i get anything discussed? I can´t even get to an agreement over dishes, what about our relationship that is falling apart? I can´t ever get into his mind!  The last few weeks I have said that I can´t stand this relationship anymore and we need counseling. I used the "we" not to suggest that he has BPD. I have suggested that before and oddly he agreed, but no to the point of treatment. He did pick up up phone to mark a psych evaluation for me because he said I was depressed. But not for "us".  I figure the counselor will figure that out that he has BPD and he´ll get help that way.

He knows I´m dead serious about leaving- and then he lives on as if things are fine... .And he isn´t calling a T or C or any type of help. When does it actually sink in: when I leave?

[Purged]

Due to an over-usage of overgeneral memory, an innocent comment you make could have her link one of the words/situations you mentioned in your sentence back to a past time in her head. This memory could connect with some core wound, could trigger her and make her attack you. But because her behavior and emotions do not logically match the situation she will distort things to the point that (most) of the time she will remember things differently, that is she will be able to justify attacking you in retrospect by distorting the facts. Also she will attack you at times because she is splitting the negative side of herself off that she can't handle, by projecting it onto you.

That sound right?

Cheers.

[PrettyPlease]

Hi Purged,

Seems like it can be completely true to me. Nice summary.     

But for others reading this thread later, I'd like to throw in that I don't think it describes all the incidents (even though some will be just like this).

For instance, you say:

Due to an over-usage of overgeneral memory, an innocent comment you make... .

But even if your comment wasn't completely innocent (like, you were trying to make a constructive criticism), then another way it could happen is that the BPD person, who has a different threshold for criticism (very low), then dysregulates, the emotion kicks in over-strong, the over-general search of the memory begins, and everything else is the same.

And heaven help you if it's actually a snide remark you've made... .but let's not go there... .   

PP

[sad but wiser]

How about this?  I disassociated in order to deal with my ex's abuse.  I could literally hear every word he was saying (he tends to stress-talk, hours of monologue without a break insisting on my presence) repeat several lines back, but let it go in one ear and out the other so that his shame and blame and so forth didn't hurt as much.  Very much an adaptive device.  The problems of the past year have included dealing with all of the things he said and did that actually registered somewhere in my brain while I ignored them.  Amazing. 

[Want2know]

Dissociation comes in varying forms.  The most basic comment about being in a dissociative state is that those experiencing it feel as if they are in a fog, a dream-like state, and they feel detached from the world.

I observed this with my ex a few times... . it can seem like they are depressed and when you talk to them there is no connection.  Kind of a blank stare.  I'm not a psychologist, so this was just my impression.

In it's mildest form, it's a defense mechanism or coping skill to separate the person from stress.  I'd venture to say that many of us have felt this, at times.  In it's extreme form, it's the basis for multiple personalities.

Are you trying to understand this because you think it can be applied to a situation with your ex? 

[Waifed]

Think about the times when you drive somewhere in your car and when you arrive you don't remember anything about how you got there because you were daydreaming.

I remember times where I would speak to her and she would not respond. I would look at her and she would have this blank (almost distant) look on her face.

Towards the end of the relationship and even still today I find myself "disappearing" from the present reality of whatever I am doing. It usually starts with thoughts about her and evolves into whatever. It happens a lot to me at lunch with the guys. I will come to and realize I am staring off into space and am lost in the conversation going on. I don't know if anyone notices but I do.

I believe it is a coping mechanism. Example:  when a child is being sexually abused they think of fantasy or "happy" thoughts to leave their current situation.

[Mutt]

Dissociation comes in varying forms.  The most basic comment about being in a dissociative state is that those experiencing it feel as if they are in a fog, a dream-like state, and they feel detached from the world.

I observed this with my ex a few times... . it can seem like they are depressed and when you talk to them there is no connection.  Kind of a blank stare.  I'm not a psychologist, so this was just my impression.

I'm not a professional either Arn, this is how I interpreted it. I've witnessed this often, always after particularly bad fights. For example we would have a fight that would escalate in the home, I would find her on the couch sitting with a completely blank stare on her face. This would last for several minutes. I would be concerned, and approach her to ask what was wrong. She would usually shake her head no. It's as if she was disconnected from the environment, or situation. Like her senses were overloaded.

This was not always the case from what I recall. This was much later in the r/s, when our r/s was getting worse. I don't remember seeing this first hand before we got married, but that's irregardless.

[HappyNihilist]

I actually have episodes of depersonalization/dissociation myself. I don't have a PD or PTSD; mine typically come after a migraine or a panic attack, or when I'm sleep deprived (I have a sleep disorder that f###s with me constantly). My very scientific theory is that it happens when my higher levels of brain functioning need a nap. The length of these episodes varies from 15-20 minutes to days, and the intensity varies, too. Mine are usually fairly mild (by which I mean I'm aware that I'm having an episode, and mostly remember what happened during it), but occasionally I have severe episodes that result in personality changes and amnesia. The one that lasted for 2 weeks (following a TBI) made me want to kill myself.

Usually, though I think it feels neat -- but then, mine isn't trauma or self related, so that probably plays a part in why I don't find these episodes inherently disturbing. I guess I do sort of "check out" when I have one. I've also been known to spend time just slowly waving my hand back and forth in front of my face, because it feels/looks SO WEIRD to me.

But when I'm having a "bad" episode, I am absolutely worthless as a functioning human being. It's hard to explain if you've never been there -- but think of a time when you had bad jet lag, were sleep deprived, had a high fever, had a concussion, anything like that. You probably don't remember any details, but I'm sure you remember how it felt. It suuuuuuucks. And I can only imagine that it sucks far worse when it's a defense mechanism related to trauma and/or a shattered sense of self.

Regardless of the cause, there's really nothing that can bring anyone out of a depersonalized state. Unless it's a mild episode, you're not going to get through or even be remembered afterwards.

My exBPDbf couldn't believe that I had regular episodes of depersonalization without having some sort of trauma in my past (he was convinced I'd been raped or sexually abused as a child and was just not telling him). It really blew his mind that I would candidly talk about them. He said that he had them, too, but he never told me when. I suspected a few times, but I learned very quickly not to talk about anything of that nature because then I was "analyzing him" or finding fault in some way.

[corraline]

Dissociation is a phenomenon most people have the capacity to experience.  It is a coping mechanism used to manage stressors .

As a way of coping, dissociation occurs when the brain compartmentalizes traumatic experiences to keep people from feeling too much pain, be it physical, emotional, or both.  When dissociation occurs, you experience a detachment from reality, like ‘spacing out.’  Part of you just isn’t ‘there in the moment.’

I would imagine if a person with BPD is feeling shame or triggered by something they may disassociate in that circumstance.

I found this explanation from a mental health site.  Hope it helps.

[lemon flower]

hi people,

when I am stressed or feeling bad I tend to automutilate but in a "light" version, I do not badly hurt myself, but it's kind of embarrassing anyway.

it has aspects of compulsive behaviour combined with some kind of auto-hypnosis: I put myself in some kind of trance in which I do not feel the pain and I can go on for hours if I do not actively call myself back  

I wonder if there's a link between this "auto-hypnosis" and dissociation ?

[heartandwhole]

I wonder if there's a link between this "auto-hypnosis" and dissociation ?

Yes, there is.  Freud studied it, and declared auto-hypnosis as a kind of dissociative state.  More recent studies describe it as a possible coping mechanism for trauma, and/or high stress levels.  

That said, we all dissociate from time to time, in different degrees.  Even runner's high can be a kind of dissociation.  

[lemon flower]

aha, then maybe we could say that auto-hypnosis is more like an "active" way to dissociate whilst with a pwBPD, it "overcomes" them... .

I wonder if they are aware of being in such a state and if they can call themselves back to reality at a certain point ?