Dissociative Disorders: Freud’s Fainting Couch to Netflix-Induced Numbness

6 min readDec 3, 2024

Let’s set the stage: It’s the late 19th century, and Sigmund Freud is the toast of Vienna. He’s surrounded by patients — mostly women — suffering from symptoms so bizarre and dramatic they’d put any modern-day reality TV star to shame. Paralysis with no physical cause, mysterious amnesia, inexplicable fugue states, and a penchant for fainting at the slightest whiff of scandal. He called it “hysteria,” the medical community called it “interesting,” and everyone else quietly thought, “What the hell is going on?”

Fast forward to today. Freud is long gone, his theories have been dissected and dismissed more times than a bad medical drama, and the term “hysteria” has been buried under a mountain of DSM revisions. But here’s the curious thing: despite decades of Freud’s meticulous (and occasionally creepy) observations, the dramatic dissociative disorders of his day have seemingly vanished. No more fugue states, no more mysterious paralysis. I haven’t had a single patient come to me with a dissociative fugue in over 15 years. Not one. Sodium Amytal interviews? Ancient history. And yet, we know dissociation hasn’t disappeared — it’s just wearing a new outfit.

So, what happened to dissociative disorders? Did they quietly slip out the back door of psychiatry, or have we simply forgotten how to recognize them? And what does this tell us about the human psyche and where we’re headed? Let’s dig in, with a little Freud, a little sarcasm, and a lot of open-ended questions.

The Golden Era of Dissociation: When Hysteria Was Hip

Let’s give credit where it’s due: Freud was onto something. His patients were the product of their time — women stuck in the moral and social straitjacket of Victorian society, where even thinking about their own desires was enough to induce a fainting spell. If you couldn’t express your frustrations, resentments, or rebellious urges outwardly (and let’s be honest, you couldn’t), they found another way out — usually through the body. Freud called it “hysteria,” which sounds a lot better than “my life sucks, and I have no way to say it without getting disowned.”

Take Anna O., one of Freud’s most famous cases. She had paralysis, hallucinations, and episodes of dissociative states — all because she was stuck taking care of her father in a world where women weren’t allowed to have their own ambitions. Freud helped her by, well, talking about it. This was the birth of psychoanalysis, which Freud built entirely on the backs of dissociative disorders.

But Freud wasn’t just helping people “talk it out.” He was peeling back the layers of the human mind, uncovering repression, trauma, and the unconscious. Dissociation, in Freud’s world, was a way to escape from conflicts you couldn’t consciously face. It was dramatic, fascinating, and, let’s be real, a little performative. But hey, Victorian life was boring. You’d act out too if your biggest thrill was embroidery.

The Decline of Drama: Where Did All the Fainting Go?

Fast forward to the mid-20th century, and dissociation isn’t the star of the psychiatric show anymore. Freud’s theories were losing their luster (turns out not everything is about your mother), and psychiatry was moving on to shinier toys. Lobotomies had their brief (and horrifying) moment, followed by the rise of psychopharmacology. By the time we got to the DSM-III in 1980, dissociative disorders had been rebranded. No more “hysteria.” Instead, we had dissociative identity disorder (DID), conversion disorder, and PTSD.

But something else was happening, too. The dramatic presentations that Freud saw — the fainting, the paralysis, the fugues — were becoming rare. Why? Let’s look at a few possibilities.

Possibility 1: Society Got (A Little) Less Repressed

Victorian society was a pressure cooker. If you couldn’t conform to its rigid moral code, your psyche found a way to escape — through your body. But today? Society has loosened up. We can talk about sex, trauma, and mental health without (usually) being shamed for it. People have more outlets for their emotions, whether it’s therapy, social media, or screaming into a pillow. The result? Less need for dramatic dissociation. (Though I’d argue we’ve traded it for equally dramatic Facebook rants.)

Possibility 2: Psychiatry Changed Its Mind

Freud’s “hysteria” didn’t disappear — it just got new names. The symptoms he described are now classified under different umbrellas: PTSD, functional neurological disorder, or anxiety. The focus has shifted from the mind to the brain, from the unconscious to neurotransmitters. Dissociation is still there, but it’s less theatrical and more subtle. Think zoning out during a meeting, not wandering the countryside with amnesia.

Possibility 3: The Magic of Modern Medicine

Let’s not underestimate the power of medication. Antidepressants, anxiolytics, and antipsychotics have made it possible to manage symptoms before they escalate into full-blown dissociative states. That’s great news for patients, but it also means fewer opportunities to study dissociation in its raw, dramatic form. Sodium Amytal interviews? Who needs them when you’ve got SSRIs?

Possibility 4: The Internet Ate Our Trauma

Here’s a theory: modern technology has given us new ways to dissociate. Instead of escaping into a fugue state, we escape into our screens. Social media, binge-watching, and endless scrolling are all forms of dissociation, just dressed up as leisure activities. Freud had Anna O.; we have TikTok. Progress?

Where Do We Go From Here?

Freud may have been wrong about a lot (okay, a lot), but he was right about one thing: dissociation is a window into the human psyche. It’s not just a symptom — it’s a strategy, a survival mechanism, a way to cope with the unbearable. And if we want to understand it fully, we need to take a holistic approach that combines the best of Freud’s insights with the latest in neuroscience. Here’s how:

Bring Back the Mind
Psychiatry’s focus on the brain is great, but we can’t forget the mind. Dissociation isn’t just about brainwaves — it’s about meaning, trauma, and the stories we tell ourselves. Let’s use tools like QEEG and fMRI, but let’s also listen to patients’ narratives.
Stop Pathologizing Everything
Dissociation isn’t always a disorder. Sometimes it’s a healthy, adaptive response to stress. Instead of labeling it as pathological, let’s ask what it’s trying to tell us.
Revisit Freud (With Caution)
No, we don’t need to bring back the Oedipus complex. But Freud’s ideas about repression and the unconscious are still valuable. Combine them with modern trauma theories, and you’ve got a powerful framework for understanding dissociation.
Prepare for the Future
In 25 years, dissociation will still be with us, but it might look different. Climate change, AI, and societal upheaval will bring new stressors, and we’ll need new ways to help people cope. Let’s stay curious and open-minded.

The Final Scene: From Freud to the Future

So, what happened to dissociative disorders? They didn’t disappear — they evolved. The fainting, paralysis, and fugues of Freud’s time have been replaced by subtler forms of dissociation, shaped by our modern world. But the core issue remains the same: the human psyche’s struggle to reconcile the unbearable. Freud’s patients found their escape through hysteria; we find ours through distraction.

If we want to honor Freud’s legacy (minus the cigars), we need to keep asking questions, keep exploring, and keep finding new ways to understand the beautiful, messy complexity of being human. And maybe, just maybe, we’ll finally figure out how to balance the mind, the brain, and the world around us. Until then, keep the fainting couch handy — you never know when you might need it.