Geographies of ‘out-of-it-ness’: Navigating dementia amidst cognitive normativities and bodily dissociation as mechanism of trans endurance

Abstract

In response to David Bissell's geography of being ‘out of it’, I examine two conditions that address underlying geographies involved in feeling, becoming, or being positioned as ‘out of it’. First, I examine my father's experience of Alzheimer's disease, his societal positioning as always-already ‘out of it’, and the lived consequences of this positioning. I then explore trans individuals’ experiences of bodily dissociation, a becoming ‘out of it’ often experienced as an innate or necessary mechanism of endurance that reduces bodily connection and disrupts the flow and sensation of everyday and hostile affect. I conclude with several provocations for geographers to take up, encouraging reflection on how cognitive normativities position people as ‘out of it'; on the more-than-binary nature of being ‘out of it’; and on the constant, embodied work of responding to ‘out-of-it-ness’.

Positioned and positioning as ‘out of it’

David Bissell's advance toward a geography of being ‘out of it’ will help geographers address interwoven questions of marginality, agency, cognition, and space-body encounters. As Bissell (2025, 4) notes, geographers’ focus on ‘cultivating a strong relationship with one's surrounds’ has obscured how, for some, stable mind–body–place connections are rare or illusory, especially for those societally-rendered as ‘out of it’ – whether cognitively, affectively, or in terms of (perceived) socio-spatially (dis)belonging. My work seeks to disrupt such presumptions by foregrounding processes through which marginalised people – such as trans individuals and communities – are socio-politically positioned as ‘out-of-place’ and caught in cycles of externally-imposed and internally-reproduced ‘out-of-placeness’ (Todd, 2024). These processes produce exhausting, durative, and deeply embodied impacts (Todd, 2023), often leading individuals to withdraw from spaces and even their own bodies (Todd, 2024, 2025a).

I am therefore interested in how one becomes positioned as ‘detached’, ‘cut off’, ‘tuned out’, ‘disengaged’, or ‘dispossessed’ (Bissell's terms describing what it feels like to be ‘out of it’), and the embodied consequences of this positioning. Here, I examine two conditions that address underlying geographies involved in feeling, becoming, or being positioned as ‘out of it’. First, I examine my father's experience of Alzheimer's disease and his societal positioning as always-already ‘out of it’. I read this positioning as often societally understood as a binarised state, and encourage reflection on the more-than-binary nature of ‘out-of-it-ness’ and on cognitive normativities actively and passively laid upon all individuals and bodies that reproduce such binarisation. Second, I examine trans and gender diverse people's experiences of bodily dissociation – a becoming ‘out of it’ that often arises to enable the endurance of marginalising conditions, one that reflects that being ‘out of it’ is not always-already an adverse or undesirable experience.

My undermining of an ‘in it’ vs ‘out of it’ binary constitutes this paper's core intervention. I argue that by exposing the fallacies inherent within this binary, we can further disrupt cognitive normativities that reinforce what constitutes enough, acceptable, or socially legible cognition, presence, and embodied participation with(in) society. This disruption could open space for greater compassion and understanding, and in turn aid in destigmatising and reducing the marginality or even pathologisation of those whose cognitive experiences are atypical or do not align with such expectations.

Dementia geographies, cognitive normativities: A personal story

While reading Bissell's article, I thought of my much-loved father, who lives with advanced early-onset Alzheimer's disease. I consider it crucial that social scientists take seriously the embodied experience of all forms of dementia and the lives of those affected by them, including people living with the condition, caregivers, family members, friends, and wider communities. This includes much-needed work to unspool how becoming ‘out of it’ or ‘out of place’ may not necessarily be ‘induced … as a punitive strategy by a dominant power from above or as a tactic of reverie or self-preservation from below’ (Bissell, 2025, 6). Geographical scholarship is well-placed to centre the voices, personhood, and real lived experiences of people with terminal neurodegenerative disease, as the emerging field of in-the-moment dementia geography evidences (Ward et al., 2024). Yet I often read work that universalises cognition – particularly amid trends emphasising wellness and recovery in mental health geographies – rather than investigating thought relative to ‘the onflow of worldly experience’ (Bissell, 2025, 3) and the ongoing experiences of those whose conditions can only linger and deteriorate (McGeachan and Philo, 2023). As Bissell suggests, staying with the body in such analyses could better illuminate dementia's embodied experience, aid in underscoring the selfhoods of people living with dementia, and address how they are ‘far more than a deteriorating self in an increasingly empty shell of a body’ (Bryden, 2020: 75) – a perception my father has often become subject to.

I do not want to see geographical work mirror what has happened to my dad in care settings, where he, and the more-than-binary nature of his ‘out-of-it-ness’, has slid from view. On the surface, with his eyes usually closed, home care paraphernalia around him, and his few words often very muddled, my father appears entirely ‘out of it’, this ‘out-of-it-ness’ often perceived solely as the outcome of a bodily process – amyloid plaques and neurofibrillary tangles in the cerebral cortex, loss of synaptic connections, and irreversible neuron degeneration – rather than also a product of social, political, and economic forces: others’ assumptions of diminished personhood beyond diagnosis; the lack of state support in an austere UK health and care context; or the inability of under-resourced staff at the hospital wherein he severely declined to provide truly ‘person-centred’ care. I can, to an extent, understand this pathologised view, yet my personal experience of loving and sharing in caring for him has allowed me to bear witness to many times he is more ‘with it’, and those where it seems he has chosen to become more ‘out of it’ as a survival or self-calming tactic.

In recent instances, I have watched his squeeze and caress of a warm hand; his touch of a face in recognition of love; his shout of disgust at having his neck shaved (ever the object of his squeamishness); his reach to drink from a beer bottle while the Cup final played by Newcastle United FC, his lifetime fixation, played on TV; his foot tapping as his favourite song, ‘Town Called Malice’, is played in his bedroom; his resorting to closing his eyes as a protection mechanism in hospital to endure a loud and chaotic ward environment wherein staff did not, or could not, provide dignified care. We might configure his bodily stillness as both a medical consequence and the result of an agentive, self-therapeutic attempt to cultivate calm and embodied stability that became routine or irreversible when he endured detrimental medical care. Such displays of personhood and resistance push against the positioning of his condition as fundamental ‘out-of-it-ness’ and refute that pushing back requires ‘people to be very much “with it”’ (Bissell, 2025: 2). In other words, my father, experiencing externally imposed – and embodying agentive strategies of – becoming ‘out of it’, encapsulates the more-than-binary nature of ‘out-of-it-ness’.

I have been less able to tolerate the weaponisation of this label to deny, restrict, or avoid him and opportunities to improve his life. As his condition has deteriorated, I have watched people ignore his presence and refuse to address him. He has, at times, been treated scornfully as lacking agency and rights to autonomy. I see how some internally conceptualise him as an object to be talked about or over. His stay in intensive care has even been used by clinicians to deny certain treatments or privileges, as he has been framed as no longer capable of what Bissell (2025: 3) calls the ‘fantasy of continuous, lucid sensemaking.’ In sum, others’ positioning of him as ‘out of it’ has intensified that very condition and reinforced spatial and bodily hierarchies of cognitive normativity.

Trans experiences of dissociation

Bissell's recognition that some navigate marginality by actively becoming (more) ‘out of it’, also aligns with my work on embodied strategies that some trans people adopt to live through hostile everyday conditions (Todd, 2024, 2025a). As Bissell (2025: 5) writes, ‘feelings of being out of place can become entrenched, inducing a sense of being cut off’, yet my work demonstrates that some feel ‘cut off’ while also needing to cut themselves off for self-preservation. For example, I, as a non-binary person, and many of my trans participants, often must refocus cognition on anticipating or pre-empting hostilities, managing exhaustion, or creating space-times of cognitive and bodily ease. In countless personal and professional moments, I have consciously restricted myself – limiting visibility of my non-binaryness, enduring (and not speaking up about) misgendering, not wearing what would make me happy, and holding back on vocalising my transness to avoid violence or scorn, and to be taken seriously at work. Bissell also frames becoming ‘out of it’ as a consequence of feeling and living through hostile ideological repetition, which prompted me to consider ‘out-of-it-ness' through the current wave of authoritarian transphobia that led 533 geographers to call for the Royal Geographical Society to act to shore up trans rights (Todd, 2025b) and the Lemkin Institute for Genocide Prevention (2025) to issue a red flag alert on anti-trans and intersex hostilities in the UK.

To evidence ‘bottom-up experiences of cutting oneself off’, Bissell (2025: 5) cites my work on dissociation, which I theorise as a conscious and unconscious ‘phenomenological orientation’ some trans people ‘adopt to alleviate overwhelming affective dynamics and navigate everyday life scenarios’ (Todd, 2024: 14). Trans voices demonstrate that dissociation may involve bodily detachment within cisnormative spaces; dislodging from linear time; numbing/suspending bodily sensations; constraining bodily functions; or projecting to alternative selves and space-times (Ibid., 15). In my more recent work, UK trans adults have described experiences of dissociation. For example, Cillian (they/them, 30–39, non-binary, gender fluid, transmasculine person, London), a participant in my ongoing research, expresses ‘constantly feeling at odds with the world’, a burden they experience as constant ‘heavy’ or ‘anxious’ sensations. Expressing difficultly in putting ‘words to what's somatically happening’ during dissociation, they shared:

[It's] like sort of disconnect and like a blank […] it's like I’m sort of like shutting myself off a bit […] it's just kind of like I’m not there and I can’t really access my, my brain or, like, feeling. [December 2024]

Here, Cillian conceptualises dissociation as a necessity, their blank disconnect from affect and feeling both a symptom of heaviness they feel as a trans person in the UK, and a vital tool for endurance, a deliberate somatic mechanism of fogginess enabling continued existence.

Tim (he/him, trans man, 30–39, Scottish Central Belt), meanwhile, described his experience of dissociation as tied to living through socio-bodily dysphoria:

I keep reaching a point, or a kept reaching a point about a year ago, where I would hit, really, really, really low lows with dysphoria and then I would just kind of slip. I wouldn’t feel anything, no emotions, no dysphoria, really kind of blank and that felt so much better […] I don’t do well in those phases […] I’m less involved with people I’m just kind of floaty and weird and spaced out. […] Everything feels like it's flat, two-dimensional. I just don’t engage with stuff, I don’t engage with people, I kind of withdraw from people and just do the bare minimum that I need to do in my day […] [that] I’m less perceptive of other people, is the largest problem. […] it switches on when I get extremely dysphoric […] I start feeling kind of more suicidal, a little flip, and then I suddenly feel fine, which is kind of alarming. [August 2024]

Here, Tim understands dissociation as an innate mechanism that occurs relative to extreme dysphoria and suicidality, one that initiates a near-total withdrawal from sensing and feeling emotions, and from social interaction, with Tim occupying a ‘floaty and weird and spaced out’ embodiment to do so. This spontaneous, sudden slippage from intense, overwhelming feelings and sensations into an alternative, affectively ‘flat’ and ‘two-dimensional’ inhabitation of and interaction with space can be conceptualised as a protective shielding. Unlike Cillian, Tim's control over the process of dissociation appears more limited, reflecting, again, the more-than-binary nature and complex emergence of ‘out-of-it-ness’.

Further provocations

Bissell's work, and my reflections on my father's positioning as ‘out of it’ as a person living with advanced Alzheimer's disease in a societal context structured through cognitive normativities, raises several questions for geographers to take up: how do we capture and respond to the experiences of those of ‘altered cognitive experience’ and those positioned as ‘out of it’ who are unable to advocate otherwise? How do we surface the more-than-binary nature of ‘out-of-it-ness’? And how can we visibilise more ‘with it’/‘in it’ experiences of those positioned as ‘out of it’?

Meanwhile, in light of trans geographies of dissociation, while it is important to consider experiences such as brain fog as phenomena that can manifest as ‘banal everyday experiences that [come] and [go] with no apparent trigger’ (Bissell: 2025, 2), examining bodily experiences of differential cognition should also involve asking: what happens when cognition is constantly oriented toward anticipating threat or hostility, and when ‘out-of-it-ness’ or ‘out-of-placeness’ become near-constant embodied states? And how can we examine how dissociation and related cognitive states function both spontaneously and tactically in response to exhausting and hostile atmospheres? Bissell's work will doubtless aid in responding to these provocations.