Dissociation

Dissociation is the disconnection from full awareness of self, time, and/or external circumstances. It is a complex neuropsychological process. Dissociation exists along a continuum from normal everyday experiences to disorders that interfere with everyday functioning.

Researchers and clinicians believe that dissociation is a common, naturally occurring defense against childhood trauma. Children tend to dissociate more readily than adults. Faced with overwhelming abuse, it is not surprising that children would psychologically flee (dissociate) from full awareness of their experience.

Studies have shown that most people who have dissociative disorders, were subjected to trauma before age 8. PTSD would be more likely to result in a person any older, since children dissociative more readily than older persons.

During the period of time when a person is dissociating, certain information is not associated with other information as it would be normally. Because this process can produce changes in memory, people who frequently dissociate often find their senses of personal history and identity are affected.

Dissociation may become an automatic response to anxiety even in non-abusive situation. The vestigial defensive pattern that persists into adulthood, long after the traumatic circumstances are past, can result in a full-fledged dissociative disorder.

Dissociation is the state in which, on some level or another, one becomes somewhat removed from reality, whether this be daydreaming, performing actions without being fully connected to their performance ("running on automatic"), or other, more disconnected actions. Feeling "out of it"; unable to remember what was said or done. It is the opposite of "association" and involves the lack of association, (in the case of borderline personality disorder, the lack of association with one's identity), with the rest of the world.

Dissociation is a very important chemical process. When molecules dissociate, they break up to smaller pieces, which leave or take extra electrons from the other pieces. These are called ions. The pieces can reassemble themselves back to the original molecule, because the electric charges attract the pieces to each other. The familiar properties of salty, acidic, basic and alkaline solutions are caused by the dissociation. Salts dissociate to their ions, acids dissociate to hydrogen ions, alkali dissociate to hydroxide ions and non-alkali bases make water dissociate to hydroxide ions by absorbing hydrogen ions.

Dissolution of salts is a dissociation process. Polar solvents (e.g. water) can break the crystalline structure of an ionic crystal (e.g. table salt) and dissolve the substance. The crystal is dissociated into ions. That is, there are no molecules of sodium chloride floating in the solution, but individual sodium and chloride ions. When the water is boiled away, the salt reassembles itself back to the crystals.

NaCl (s) -> Na⁺(aq) + Cl^-(aq)

The taste and the smell of a dissociating substance is not the taste of the crystal, but the taste of the ions it dissociates into. Table salt tastes of sodium ions and chloride, salmiakki tastes of ammonium and chloride, citric acid tastes of citrate and hydrogen ions, etc.

Ionic salts and strong acids dissociate completely, but some substances dissociate only partially, forming a dynamic equilibrium between the whole and dissociated states. When one breaks up, another reassembles, so that the total ratio between them is constant. This is an important type of chemical equilibrium, which includes weak acids, weak bases and acidic or basic salts.

After our mother died, my sister and I were ok....

....for a while. And then we weren't. I think she was first. My father and I flew down to help and my understanding of how to navigate the medical maze came in very handy. It protected her job and health insurance when all she wanted to do was hide.

Our mother died in May 2000. I became Chief of Medical Staff at the hospital in January of 2002. This was not so much a vote of confidence as a vote of right then all the other medical staff were fighting with each other. I was too new to be embroiled.

I felt like things were going reasonably well, though I still missed my mother....

....until February. At the end of February I hit the wall.

I had trouble dictating clinic notes. I was slow. I felt stupid. I felt like I knew nothing. Dictating was like entering a black hole.

And I knew that it was dissociative feelings. Feelings that had nothing to do with the dictating. My notes were fine when I read them over when they came back. They were not stupid. Specialists were happy with me. My colleagues were happy with me. The staff was happy with me. Patients were happy with me.

But I was not happy with me. And my first thought was, but this is the first time in years that I have felt relaxed at home and at work. It's only been two months. Can't I have a little longer? Please?

....no....

And off I go to fire up help. One helper laughed and said, "Aren't YOU on schedule." Thanks, asshat. But I knew that he was right.

Dissociative symptoms can be terrifying. For me it was a clear signal that now that life felt the faintest bit under control, I needed to empty out old feelings and really look at my life and my relationships and my grief about my mother. And make changes.

I resigned as Chief of Staff in September, holding a meeting where I said I had things going on in my personal life and was burning out. Burn out was apparently so forbidden to bring up that not one person on the Medical Staff would even talk to me about it. The only comment at the meeting was a PA who said "If you can't stand the heat, get out of the kitchen." They all avoided me afterwards. Untouchable...

Heh. Well, duh. That is why I was resigning. And in 2016 the hospital holds a dinner and program for the medical staff about burn out because it's a crisis now, and half of primary care doctors surveyed say they are burning out....Funny, but they didn't invite me.

http://www.medscape.com/viewarticle/838437
http://www.forbes.com/sites/davechase/2016/01/06/the-story-behind-epidemic-doctor-burnout-and-suicide-statistics/#bb53136570d9
https://www.advisory.com/daily-briefing/2014/07/16/physicians-have-the-highest-suicide-rate-of-any-profession-so-why-havent-you-heard-about-it
http://www.forbes.com/sites/davechase/2016/08/29/hospital-ceos-behaving-badly-the-devastating-consequences-on-the-middle-class/#2f862c0f2417

Dis*so`ci*a"tion [L. dissociatio: cf. F. dissociation.]

1.

The act of dissociating or disuniting; a state of separation; disunion.

It will add infinitely dissociation, distraction, and confusion of these confederate republics. Burke.

2. Chem.

The process by which a compound body breaks up into simpler constituents; -- said particularly of the action of heat on gaseous or volatile substances; as, the dissociation of the sulphur molecules; the dissociation of ammonium chloride into hydrochloric acid and ammonia.

 

© Webster 1913.