Dissociation, forced normalization and dynamic multi-stability of the brain

Dissociated states represent pathological conditions where psychological trauma may emerge in a variety of forms such as psychic dissociative symptoms (hallucinations, derealization etc.) or on the other hand as somatoform symptoms (paroxysms, loss of motor control, involuntary movements etc.). Recent findings suggest that neurophysiological level of dissociative phenomena may be linked to the same neurophysiological principles that emerge in multi-stable perception of ambiguous stimuli likely caused by competing interpretations with mutual exclusivity. At this time there is evidence that temporal lobe seizure activity can produce dissociative syndrome and from these findings may be inferred that temporal lobe epileptic activity existing independently of neurological focal may share common neurobiological mechanism with dissociative symptoms. This conceptualization of dissociative phenomena is also in accordance with findings that originate from the study of the relationship between epilepsy and mental illness. The relationship was for the first time described in Meduna's concept of antagonism between epilepsy and psychosis and from the study of forced normalization introduced by Landolt in 1950s. The findings reported similar pathological conditions as in dissociative states when psychopathological symptoms and paroxysms may represent two different forms of the pathological process. Following the concept of forced normalization Tellenbach in 1965 introduced the term alternative psychosis implicating that stopping seizures does not mean vanishing or inactivity of the pathological state and that the epilepsy is still active subcortically and supplies energy for psychopathological symptoms. In the present review chaos in brain neural networks as a possible explanation of the relationship between dissociation and epileptic activity has been suggested that represents testable hypothesis for future research.