Dissociation as Trans Method; or, the Depressive’s Technique
This year I've made it through some powerful PTSD, but what I learned about dissociation was unexpected.
I hope you don’t take this the wrong way
But I think your inside is your best side
—Sophie, ‘It’s Okay to Cry”
Sometimes dissociation feels like being stoned. Your eyes lose their focus, but the world doesn’t go blurry, exactly. Maybe you feel an impossibly wide openness just behind your eyes, an airiness in your head that takes up massively more space than actually exists there. Things go very quiet, like a walk through your neighborhood on Sunday morning, but it’s disturbing and eerie more than it’s relaxing. Your jaw doesn’t slacken. Your shoulders don’t slide down your back. The information stream of the world just stops resonating in the surface of your skin, though it hasn’t diminished in its relentless assault on your flesh. It’s like touching a vibrating cymbal and watching it go empty, deadened into silence only in the outcome. And you feel tired, so tired, because the energy required for this dampening field is monumental. You float through the world like a cloud, but one gliding ahead because it’s growing heavier from a thundery line on the horizon.
Very few signals can make it through the blanket of dissociation, lead like the one they put on you before an x-ray at the dentist’s office.
I floated though the world, exerting myself to keep the weight of the lead on my skin, for at least two decades. It’s the kind of situation you can only get into in childhood, where you make pacts as bold and naive as your very real vulnerability and its limited capacity to process your lifeworld. My dad, deadened on the couch one month and manic the next, was emotion incarnate to me in his bipolar condition. His body and mind rising and falling like a sea where the tide comes in and out only as tsunami. There was no ground there for identification, so none ever took root.
Little Jules, a girl who found herself in a boy’s skin last, after everyone else had already decided, screams at the top of her lungs for a few months at age four, throwing everything in her bedroom at the closed door where she has been put in time-out, until her mother eventually unscrews the door and takes it down. Then the little girl goes quiet and never yells again.
Dysphoria is too weak a concept for that girl because it doesn’t explain anything especially trans. Dissociation feels much more pregnant with possibility, something like a trans method. For a long time, I thought dissociation was something to be subtracted in order to make me whole again. But then I was prescribed dissociation and my body and mind turned inside out.
This is an essay about the depressive’s technique in the twenty-first century.
There’s an important anti-psychiatric critique of antidepressant SSRIs and Cognitive Behavioral Therapy (CBT) correlate to the neoliberal, insurance-driven understanding of depression as an illness characterized by becoming incapable of capitalism. Too tired and heavy on the couch all day, too ruled by brain fog, the depressive can no longer work formally, let alone bear the affective burden of production that runs 24/7 in the gig economy. If you’re lucky, like me, you can take medical leave and still get paid, at least for a while.
The therapy that forms in this economy is ruled by the god of adjustment, a mode in which you don’t worry so much about the cause of your depression as try to interrupt its rhythm by building a new one, a more socially resilient one. You “adjust” to the environment that depresses you by cultivating your body and brain to tolerate their condition of being in the world. The therapist points out that some things, like racism, transphobia, or fascism, can’t be adjusted to, however. They can’t be treated even though your body and soul bear the scars of their lashes that eventually flower, like the barnacles that grow across the quiet giantess of a whale cruising the open ocean.
I tried it all. Lexapro, 5mg. Then 10mg. Then 15mg. Then back down to 10mg but that felt like my brain falling off a cliff with no bottom in sight, so quickly up to 20mg. Then that still wasn’t enough to arrest the drop and the doctor added 150mg of Wellbutrin. It made me intrusively want to kill myself a few times a day, whispering in my ears. But then that feeling suddenly dissipated. I breathed a drugged sigh of relief, sleepy in my precarious stability.
In psychotherapy I was given worksheets and followed a module system, which was maybe good because I was capable of nothing else at the time. First, I wrote a “victim impact statement” about my childhood sexual abuse. Then I made a list of “stuck points,” or self-limiting beliefs, and used a worksheet to determine the flaws in their reasoning. The common point, I was learning, was to use my cognition to convince my prefrontal cortex that it didn’t have to think as if I were traumatized, or depressed—that it could overrule my amygdala, the oldest and most protective part of the brain.
I was good at this, like I’m good at anything cognitive, but it didn’t make me feel better.
Then, for a while, I tried Eye Movement Desensitization Therapy (EMDR) therapy. It’s as close to tripping while sober as anything I’ve ever experienced. In EMDR you recall a traumatic memory and the therapist guides you through re-experiencing it while a form of bilateral stimulation—moving your eyes back and forth, or in my case, tones playing alternately in my left and right ears—allows your nervous system and brain to downshift from their heightened state of arousal that usually jams your ability to do anything. In this rhythmic state, you try to recodify and remember differently, integrating the trauma into your present self.
It didn’t really work that way for me. I couldn’t remember a lot, so my working memory for therapy ended up being a strange aggregate, like a film script composed out of hundreds of nearly identical events. In the bilateral stimulation state my higher brain kept shorting out. I could barely narrate what I was seeing vividly in my mind, but I didn’t have to because my organ speech was howling at my therapist. Every time we tried to approach the location of my trauma in my memories I would throw up, or be suddenly unable to breathe. After a few sessions I was able to suppress those symptoms, but it was as if EMDR was a method for walking up to a door. Each time my hand clasped the door’s handle, it would result in a lightning strike. The space inside my head would swap out my brain for pure, soupy fog and I would go catatonic, unable to speak, move, or process what was happening.
My therapist asked that we stop EMDR because I kept dissociating so intensely that he was worried the sessions were unhealthy.
Terrified that I was out of options and still as depressed despite a thousand adjustments, I tried something different. At 6:45am on a Monday morning, I met a research assistant at a sleepy hospital. I walked into a cozy room on a mostly empty ward, got into the bed, and pulled the blankets up for comfort. An impossibly kind nurse came to put two IV lines in, one in each arm. After my pregnancy test came back negative—I was truly beaming at that—we were ready to begin the experiment.
I was to be given a small intravenous dose of ketamine as part of a psychiatric study on its efficacy in addressing treatment resistant depression. Because it was an experimental study, there was a 50/50 chance that I might receive the placebo instead. No one in the room knew what was in the small, clear bag of liquid brought up from the hospital pharmacy.
As the line was connected and the drip began, I could tell it was the ketamine because I knew what a drug entering your system feels like. A somewhat warm sensation in my chest and a buzz deep in my head bubbling up, telling my conscious mind with its endless fortress of controls to sit this one out. I had never taken ketamine, so I eagerly anticipated opening the door that I couldn’t touch in EMDR. But the next four hours were so mundane I felt there must have been a terrible mistake.
I felt a little sedate and stared at the digital clock on the wall, wondering when I might start to see the evidence I was tripping. Thirty and then 40 minutes went by and the clock started to fuzz out around the edges, but more than two seconds of concentration and it would look normal again. I figured nothing was happening, maybe I had been given the placebo after all. At about the hour mark, I had to admit that I felt heavy. It wasn’t so much that my body was growing denser as it was expanding, somehow, growing many times its size, though each time I looked down it was normal. My eyes became useless to explain the feeling. Eventually my body grew so heavy that I floated out of it and was buoyant for a long while.
But that was it. I had heard a voice in my head telling me everything was okay, that I was ready to get better. But I didn’t make much of it. I was, I knew, deeply dissociated.
I kept getting hung up, in the days and weeks that passed, on my assessments from the study clinicians. There were a series of questions about my ketamine infusion experience that included, “Did you feel like you were in the presence of something greater?” and “Did you feel like the entire universe was connected?” I kept answering no with great disappointment, certain that something hadn’t clicked for me. I had been worried that being trans might disqualify me from a study that involved no less than a half dozen long MRI scans—what if my brain didn’t register as properly sexed by their measures?—and so I had enrolled stealth, never disclosing I was trans and relishing in my first experience of being treated kindly in a medical setting. I was astonished at how friendly, compassionate, and sympathetic everyone I worked with was when they thought I was a cis woman, despite me being there because I was catastrophically depressed.
Yet despite my confusion, within 24 hours of the infusion I started to feel dramatically better. It was the most peculiar experience of my depressive life because it was devoid of content. I had been accustomed through years of therapy and pharmaceuticals to thinking that even if catharsis was just a genre sold in tv melodramas, healing came through something akin to secular revelation, where insight took on the feeling of truth in the emotional core of the self. Nothing like that had happened during my ketamine infusion, I just felt a little stoned and extremely dissociated. Yet I started, almost daily, to have unprompted moments of tectonic emotional intensity, where I would literally leap out of a chair and blurt out “what if I didn’t have to keep feeling pain about all the bad things that have ever happened to me?” and mean it, deep down to my neurons.
Within a month, decades of severe depression receded and I began to command a new plasticity and certainty about myself as a permanent feature of this world. I felt certain that if ketamine had not saved my life, it had at least secured it in a way nothing else ever had.
That its only methodology had been dissociation made no sense to me.
What can I say about ketamine without summarizing my obsessive reading of medical journals, or trying to translate what a handful of generous neuroscientists have shared with me when I’ve picked their brains for far too long? P.E. Moskowitz has written the referential piece on the dissociative as far as I’m concerned—and not just its newly FDA-approved use for depression, but the way that its mode of dissociation is key to its utility and limitations. Ketamine, writes Moskowitz, is not about escaping reality—as in, hallucinating—so much as rebuilding reality through dissociation.
“The problem (if it can be called that) with ketamine,” observes Moskowitz,
“is that you can keep expanding your brain to understand the traumas and complexities of your environment, but that doesn’t change anything but yourself. When your alternate reality ends, the real reality—the one where everyone’s dying all the time and our politicians don‘t seem to care about us—is still right there, waiting for you. You can stay in the air, examining the earth and all its oceans and mountains and forest, for only so long before you come crashing down.”
This is, at its heart, the depressive technique’s dilemma in the twenty-first century: even if you move from a CBT paradigm to an expansive neurological model that sees the embodied brain and its environment as porous and relational, rather than sovereign and executive, the stubborn truth remains, or is even magnified, that the environment is not really changed by ketamine. Only the depressive’s tolerance for parts of it.
In many ways, the most trenchant lesson I have learned from my depression is that redistributive economic programs for collective stability work. Having grown up in Canada, my bipolar dad wouldn’t be alive and the poverty I grew up in would have been unbearable if not for state benefits that paid for all of his treatments and the tens of thousands of dollars a year of medication that he needed. In my case, an existentially brutal, PTSD-driven depression might have ended in a much more grim manner had I not been able to take fully-paid medical leave for four months, with Cadillac private insurance that I billed into the tens of thousands for every manner of treatment, plus the care and love of my queer and trans kin who never tired of reminding me that my survival was theirs—and vice versa. Spending money on taking care of us is better than nearly any other use of the immense riches of this world, but especially better than paying for interminable war, mass incarceration, and lining the pockets of the rich.
Even if I thought I was writing an essay about how the depressive’s method is changing in the twenty-first century, shifting from a cognitive mode to an embodied neurological mode—shifting, in other words, from talk therapy and SSRIs to psychedelics—it turns out that these are still in some way reinventions of a larger wheel in which the central contradiction between the self and a world cannot be resolved inside your psyche.
But I wonder if dissociation doesn’t emerge here all the better, if ketamine didn’t teach me something about the power of dissociation as a trans tool. In a recent conversation with a friend of mine who works as a neuroscientist, he explained that although he doesn’t have any studies running on trans people (too ethically fraught, given their history), his trans understanding of the relationship between self and environment informs his research into the ecology of mood and patterns of perceptual processing in people with depression. He offered that the kind of hypervigilant circuit, in which you are always devoting a considerable amount of your body and brain’s attention to surveying your environment for threats, is a hallmark of trans life that could tell us much about how the embodied brain tries to negotiate a viable way through the world.
In this context, dissociation is adaptive in a way that can’t really be rivalled. You have the capacity to not be yourself to the extent that it will ensure your survival. I can’t think of a greater power, heavy though its cost may prove to be, especially over time.
But dissociation is not a metaphor as a trans method. It’s not metaphorical to say that I wrote my first book, Histories of the Transgender Child, through dissociation. It was my final attempt to avoid transitioning by trying to prove to myself that I could master the concept of transness and trans history, thereby absolving myself of any need to internalize trans as a word that described me. In other words, I would pour everything trans in my life into the book and thus separate the word from my body.
That dissociation paid off as a scholarly methodology. As Rebekah Sheldon explains:
“Histories of the Transgender Child…offers the voices of trans children but no reading of them, at least insofar as a reading would mobilize their instrumentalization, retooling them once again as the raw material for another round of learned discussions among adults. For Jules Gill-Peterson, trans children aren’t symptoms of something from our murky cultural depths; they aren’t articulations of a social field; and they aren’t forged from the sediments of habit. They are not the shaped products of a discursive milieu, a notion that repeats the underlying metaphor of plasticity. They are already formed. In fact it is Gill-Peterson’s persistent unknowing and insistent longing that most resists any theorization and leads to the closing argument (in “How to Bring Your Kids Up Trans”) that we should stop making trans children represent something. Instead, we should just love them, for the world is infinitely richer and more delectable because of the queer and trans people in it.”
In other words, by dissociating myself from the trans children I wrote about, I was able to make a point that I stand by: trans kids are not the means to any foolish end of knowledge. They are people who deserve love and care.
I wonder how ketamine’s lesson in dissociation might teach us about that kind of love, for ourselves and for each other. I like to think that such love is the kind that doesn’t possess or idealize but demands building the kind of world that you don’t have to adjust to. The kind of world that is close to matching the soft expansiveness of the ketamine subject.