An Iraq woman veteran friend of mine, who suffers from PTSD and MST but overcomes daily, with a delightful psychiatric service dog at her side, wrote an excellent post that I asked her permission to quote in full here. Angela was writing to this other woman, attempting to clarify, from an educated sufferer's point of view, what the differences are between dissociations, flashbacks and hallucinations, from someone who's experienced them all. At the end of the post, you can see her motivation for why she writes, and it's great. While the academic purists out there may scoff at her quoting Wikipedia for the definitions of the terms, the best part of the post is what she does with it when she compares the dictionary definition to her own experience. For someone who's not yet a college graduate, I think she did a wonderful job of expressing her understanding of the terms. It could be quite enlightening for others to read as well. Here it is, in full.
"Clearing up the differences among disassociations, flashbacks, hallucinations:
I think you are using the word "hallucination" in a broad sense of the word.
A flashback is A LOT different from a hallucination and a dissociative episode is a lot different from both also. Here are the Wikipedia definitions and then I will go into my own personal experience with the broad world of hallucinations/ illusions/ dissociation/ flashbacks. ....so you have some concrete examples. I have had all of them at one time or another. And I am a vet w/PTSD with both sexual trauma and Combat PTSD.
1. Flashbacks are the “personal experiences that pop into your awareness, without any conscious, premeditated attempt to search and retrieve this memory” These experiences occasionally have little to no relation to the situation at hand. Flashbacks to those suffering post-traumatic stress disorder can be so disruptive as to seriously affect day-to-day living.My experience with flashbacks: driving on the highway and a hospital helicopter suddenly flies over me and lands on the hospital on the side of the highway. All of a sudden the biology in my brain, retrieves old memories. All of a sudden, I feel as if I am in a convoy in baghdad, my body feels hot as if I am back in 130 degree weather, I can smell diesel fuel from the hummer engine. My adrenaline races, my breathing quickens, my whole body acts as if I am back there again. I do not "see" things, which would be a classic hallucination it is a feeling, an old body memory.
2. Dissociation is a partial or complete disruption of the normal integration of a person’s conscious or psychological functioning. Dissociation is a mental process that severs a connection to a person's thoughts, memories, feelings, actions, or sense of identity. Dissociation can be a response to trauma or drugs and perhaps allows the mind to distance itself from experiences that are too much for the psyche to process at that time. Dissociative disruptions can affect any aspect of a person’s functioning. Although some dissociative disruptions involve amnesia, the vast majority of dissociative events do not. Since dissociations are normally unanticipated, they are typically experienced as startling, autonomous intrusions into the person's usual ways of responding or functioning. Due to their unexpected and largely inexplicable nature, they tend to be quite unsettling. Different dissociative disorders have different relationships to stress and trauma. Dissociative amnesia and fugue states are often triggered by life stresses that fall far short of trauma. Depersonalization disorder is sometimes triggered by trauma, but may be preceded only by stress, psychoactive substances, or no identifiable stress at all.
My experience with dissociation episodes:
First time it happened was in the throws of a sexual assault. All of a sudden It was like I came out of my body and was across the room watching the whole thing happen in front of me. Kind of like an out-of-body experience. Since then, I can get them once in a while when I am triggered (in my therapists' office for example) I am overcome with emotions or bad memories and they hit all of a sudden and it is as if my nervous system and brain cannot handle the flood all at once. I disconnect and it's like I can't move, can't talk, nothing, just frozen in time. My SD has learned by constant positive reinforcement and picking up on my energy because of our bond. He knows my normal state so when something NOT NORMAL happens, it's obvious he would pick up on it. He will race to me, "lap up"pr nudge me with his nose in the thigh or sometimes he even slaps me with his paw. This is just enough tactile stimulation for me to realize i am "not here" and it is proven in psychology that grounding yourself with a physical object kind of snaps you out of the dissociation.
Definition of grounding. "Grounding is a particular type of coping strategy that is designed to "ground" you in or immediately connect you with the present moment. Grounding is often used as a way of coping with flashbacks or dissociation. In this way, grounding can be considered a variant of mindfulness. Grounding techniques often use the five senses (sound, touch, smell, taste, and sight) to immediately connect people with the here and now. For example, listening to loud music, holding onto a piece of ice, or biting into a lemon are all grounding techniques that produce sensations that are difficult to ignore, thereby directly and instantaneously connecting you with the present moment."
3. Hallucination: A hallucination, in the broadest sense, is a
perception in the absence of a stimulus. In a stricter sense,
hallucinations are defined as perceptions in a conscious and awake state
in the absence of external stimuli which have qualities of real
perception, in that they are vivid, substantial, and located in external
objective space. The latter definition distinguishes hallucinations
from the related phenomena of dreaming, which does not involve
wakefulness; illusion, which involves distorted or misinterpreted real
perception; imagery, which does not mimic real perception and is under
voluntary control; and pseudohallucination , which does not mimic real
perception, but is not under voluntary control. Hallucinations also
differ from "delusional perceptions" , in which a correctly sensed and
interpreted genuine perception is given some additional (and typically
bizarre) significance.
Hallucinations can occur in any sensory modality — visual, auditory,
olfactory, gustatory, tactile, proprioceptive, equilibrioceptive,
nociceptive, thermoceptive and chronoceptive.
A mild form of hallucination is known as a disturbance, and can occur in any of the senses above. These may be things like seeing movement in peripheral vision, or hearing faint noises and/or voices. Auditory hallucinations are very common in schizophrenia of the paranoid type. They may be benevolent (telling the patient good things about himself) or malicious, cursing the patient etc. Auditory hallucinations of the malicious type are frequently heard like people talking about the patient behind his back. Like auditory hallucinations, the source of their visual counterpart can also be behind the patient's back. Their visual counterpart is the feeling of being looked-stared at, usually with malicious intent. Not infrequently, auditory hallucinations and their visual counterpart are experienced by the patient together. Hypnagogic hallucinations and hypnopompic hallucinations are considered normal phenomena. Hypnagogic hallucinations can occur as one is falling asleep and hypnopompic hallucinations occur when one is waking up. Hallucinations can also be associated with drug or alcohol use (particularly deliriants), sleep deprivation, psychosis, neurological disorders, and delirium tremens.
My experience with hallucinations.:
The only time I have EVER had a hallucination is when I was coming off
many different medications all at once in a psych ward. I was seeing
faces in the wood-grained door and seeing people that were not there. I
want to stress the difference here, because seeing something or hearing
something that isn't there is not the same as recalling a memory. That
is the difference that is most important.
Sorry for the long-winded post, but I really wanted to clarify since you
are an SD trainer working with vets who often feel misunderstood by
MOST people. Saying that vets "hallucinate" is not entirely accurate and
I feel that it might add to the stigma that we are just crazy lunatics,
when PTSD is actually a stress injury to the brain, nervous system and
physiology more than it is a MENTAL ILLNESS. It is a normal reaction to
an abnormal set of circumstances."
Sincerely,
Angela Peacock and GI Joe, PSD, CGC, Iraq Veteran, US Army
