Dissociation

The meaning of dissociation is found in the word itself: dis-association.  Dissociation occurs when a person’s mind dis-associates with his or her body.  This is not the technical definition of the term, but it’s where I start when I explain it to patients.  (The Diagnostic and Statistical Manual of Mental Disorders defines dissociation thus: A disruption in the usually integrated function of consciousness, memory, identity, or perception of the environment).  When a person dissociates, his body stays in one place while his mind sort of goes somewhere else. 

Dissociation is not necessarily pathological.  In fact, everyone dissociates.  Have you ever driven an oft-travelled route - perhaps heading to work or driving home – and arrived at your destination to find that you have no recollection of the actual journey (perhaps because you were daydreaming or otherwise absorbed in your thoughts)?  That’s dissociation.  Another example of dissociation is the experience of “flow:” we become totally absorbed in some task or activity such that we are completely unaware of our surroundings, to include the passage of time.  When we look at the clock, we are surprised to find that several hours have passed in what seemed like only minutes. 

So in certain forms, dissociation is a normal and quite common experience.  In extreme forms, however, dissociation can become disruptive and therefore problematic.  Probably the most severe manifestation of dissociation is in Dissociative Identity Disorder.  (Some of you might know it as Multiple Personality Disorder).  The identity or self of any given person is made up of various parts or components.  For example, there is a part of me who is compassionate and benevolent and another part of me who is petty and vindictive.  There is a part of me who is responsible and a part of me that is reckless.  I will think, feel, and even behave differently depending on which part of my “self” is activated at any given time.  Even though my identity consists of many different parts I am still only one person.  There is an overall cohesiveness among the different parts of myself.  There is some sort of “observing ego” that stands back from it all, that intimately knows each individual “part” of my identity, and that holds all the pieces together.  A person with Dissociative Identity Disorder (DID) does not have this “observing ego.”  The various parts of a person with DID are completely separate and unaware of one another.  They do not share memories and they do not share information.  One part has no awareness of what another part does, even though they all reside in the same physical body. 

Fortunately, Dissociative Identity Order is extremely rare.  In fact, there has historically been quite a bit of debate about whether it exists at all.  I have only ever worked with one person who was diagnosed with DID and I suspect the diagnosis was incorrect.

I have, however, worked with many patients who struggle with other forms of dissociation.  I’ve had several patients who recalled experiences in which they were outside of their bodies, seeing themselves but having no control over what they were doing.  One person saw herself go into a store, buy a bottle of pills, and take the entire bottle.  She said she was screaming at herself to stop but was powerless to prevent her own suicide attempt. Another person was involved in a serious industrial accident.  He described being outside of his body, watching himself curl up on the ground and scream with pain.  He told himself to get up but to no avail. 

Other patients have no recollection of what happened during dissociative episodes.  They simply report “losing time.”  One woman regained awareness to find herself in an unfamiliar city with no idea how she’d gotten there.  She’d somehow driven 75 miles without meaning to.  Another patient became anxious while driving and decided to pull off the road to calm himself down.  He remembers looking at the clock as he pulled off.  The next thing he remembers is looking at the clock again and seeing that over an hour has passed.  He has no idea what he did during that hour.

Dissociation fascinates me.  How can someone’s mind wander away from his body?  I imagine it is a scary thing to know that your body has been doing things without your knowledge (or consent).  I’ll talk about what causes dissociation and how to treat it in future posts.

Narcolepsy

I have narcolepsy.  It's not something I talk about a lot, especially not online.  Because I don't talk much about it, it seems like the people closest to me don't really consider how it affects me.  For example, my husband frequently becomes frustrated when I say I'm too tired to do something.  Take a recent Saturday for example.  At 7:00 AM, my stepdaughter and I met my sister, parents, and some extended family for a two mile charity walk.  Afterwards, my husband, stepdaugther, and I went to the beach and took the jet ski out.  The following morning my family met up at 9 AM for a Father's Day breakfast.  We all went to church afterwards.  As church let out, my sister mentioned that she and her husband were taking my nieces to the water park.  She invited us to meet them there.  My husband and stepdaughter went but I just couldn't do it.  I went home and napped for two hours.  When I got up, I finished doing laundry and went to the grocery store.  Later in the week, my husband commented on how active my sister is.  He said he wished I could be that way instead of only doing "one activity per weekend."  A couple of weeks later he told my stepdaughter that I'm boring because I never want to do anything.  He didn't understand when I told him his comment hurt my feelings.  "You don't like to do anything," he said, as if stating a fact.

It bothers me.  It's not that I don't want to do things.  It's just that I know myself.  I have a good idea of what would've happened if, for example, I had forced myself to go to the water park that day.  I would have been extremely irritable (because I was tired) and unpleasant to be around.  I probably would have wanted to go home well before everyone else was ready.  I would not have had the energy to do laundry and go to the grocery store when we got home, even though these things had to be done and no one else was going to do them.  And I would have been exhausted at work the following day and struggled to stay awake.  It's possible I might have fallen asleep at some inopportune moment, such as when driving to work on in the middle of a session with a patient.

I have no idea if everyone with narcolepsy has the same struggles.  I don't know anyone else with narcolepsy so I have no one to compare myself to.  (Incidentally, I have had two patients with narcolepsy over the years but I didn't think it was particularly appropriate to discuss my experiences with them).  I can't say whether or not my experiences are "normal" or "typical."  I do the best I can and I try not to dwell on my limitations.  Dealing with it is frustrating but I am grateful that things aren't worse - I know they could be.  I wonder, though, if there isn't some way to help the people closest to me understand without making it seem like I'm throwing myself a pity party. 

What makes a relationship last?

My husband and I have been married three years in November.  I wish I could say that I’ve learned a lot about what it takes to make a marriage work during the past three years.  I suppose I could say it, but it wouldn’t be entirely true and I’m not a huge fan of lying.  It’s not that I haven’t learned anything in the past three years.  It’s just that I haven’t been able to successfully apply the knowledge I’ve gained in any meaningful way. 

Here’s what I do know: Marriage is hard!  I realize this isn’t very insightful.  While I am usually a fairly introspective person, I find it very difficult to reflect on and understand my thoughts, feelings, motivations, and behaviors as they apply to my relationship with my husband.  And if it’s hard for me to make sense of myself, I often find it impossible to understand my husband. 

All this makes me wonder, what does it take for a marriage to work anyway?  So of course, I decided to do some research.  I discovered that there has been a lot of research done on this topic.  This research has led to the development of many different theories about what makes a successful marriage.  While each study generated a different list of variables associated with marital success, there were some common themes. 

*Communication: I wasn’t surprised to find good communication repeatedly identified as a factor associated with successful marriages.  Healthy communication allows a couple to understand one another; this enables partners to validate and empathize with each other.  Good communication facilitates allows day to day activities to run smoothly.  (Frequent miscommunication creates unnecessary crises.  For example, miscommunication about where to be and what time to be there can lead to confusion and disappointment.  Important tasks go uncompleted.  Problems arise.  Plans have to be changed, sometimes drastically.  More time is spent trying to fix problems caused by miscommunication, leaving less time for enjoyable activities that would strengthen the relationship).  Good communication also promotes successful conflict resolution.  It prevents disagreements from inevitably turning into arguments.

*Conflict management/resolution: This one didn’t surprise me either.  Couples who can resolve conflict have less conflict.  Successful conflict resolution prevents the same problems from arising again and again.  The ability to compromise leads to the development of solutions that leave both partners feeling loved and respected.  Time isn’t wasted arguing over who is right or who is to blame.  Both partners understand that if one person wins, the other one loses.  If one person loses, the whole relationship loses.  Thus, blaming always has a negative impact on the relationship.    

*Trust: I’ve always heard that you can’t have a relationship without trust – at least not a good one.  The presence or absence of trust impacts the level of security a person experiences in a relationship.  Security – a sense of safety – is one of the most fundamental of human needs.  An individual’s basic needs must be met before higher-level development can occur.  Thus, an absence of trust prevents a relationship from growing.  Distance emerges between two partners.  The relationship becomes dominated by feelings of doubt, fear, and hurt. 

There is a final factor that I believe deserves at least an honorable mention: commitment.  Commitment is the belief – held by both partners – that a relationship is permanent.  Commitment also describes a set of behaviors devoted to maintaining a relationship, even (and especially) when things are not going well.  When people are committed to a marriage, they are willing to do whatever it takes, again and again, to make the relationship work.  If one strategy does not work, they try something else.  Commitment is also characterized by the willingness of both partners to make personal sacrifices for the good of the relationship.

Loneliness

To me there's always seemed to be a bit of irony inherent to the experience of loneliness.  One the one hand, loneliness is inextricably linked to the connections an individual has to other people.  People feel lonely when they spend too much time by themselves and not enough time with others.  On the other hand, there is a component of loneliness that seems to have no relationship at all to being alone versus being with other people.  Thus, a person can spend significant amounts of time by himself and not feel the slightest bit lonely.  A person can also be in a room overflowing with people and yet feel utterly and completely alone.  And so I've come to realize that loneliness is a phenomenon more complex than at first it seems.

Loneliness is a virtually universal experience; almost everyone experiences it at least once in a lifetime.  Almost all of us have an idea of what it means to be lonely, even if we can't exactly put it into words.  If I say to someone, "I feel lonely," he understands what I mean; I don't have to explain it.  Perhaps this is why the scientific community has only recently begun to develop a clear definition of loneliness.  For practical purposes, there is no need for a concrete definition of loneliness.  But in order to study a given phenomenon we must be clear about exactly what it is we are studying.  And so the need to define loneliness grew out of an increasing interest among social scientists in better understanding the phenomenon and its effects.

So what exactly is loneliness?  Researchers have identified three characteristics:

1. Loneliness stems from deficiencies in social relationships.

2. Loneliness is a subjective experience.  (In other words, what causes one person to feel lonely does not necessarily cause someone else to feel lonely).

3. Loneliness is both unpleasant and distressing for the person experiencing it.
'(Perlman & Peplau)

Because loneliness is a subjective problem, there are many different ways to go about trying to resolve it.  A person might simply lack good social skills and so find it difficult to make friends.  Others might fear intimacy or have "trust issues."  In such cases, loneliness is really a secondary problem that will most likely resolve itself once the primary concerns are addressed.

When's the last time you can remember feeling lonely?  What caused it?  Were you able to overcome it?  If so, how?