Doctor's Office Dissociation

RussellSue

MyPTSD Pro
I looked at my Physical Therapist today and said something very much like this:

I have been dissociating while we are working on my stretches. With all the surgeries and painful medical procedures I have had, I expect to be hurt at any medical-type office. You are telling me to make sure I stop before it hurts but I am already spaced out because I'm here for some sort of treatment and I know it is going to hurt. The next thing I know, I have gone too far and it really hurts.

I don't try - I just float away. It's what I do when I see doctors. AND it was VERY helpful for a number of procedures.

But it is not very helpful at PT where I have to be aware of the difference between a stretch and pain. I used my cane for the rest of the day after doing nerve flossing last Thursday because I pushed past comfortable into excruciating enough times to leave myself really sore and limping.

I am glad I told him what was going on this morning because I can already see that he is making an extra effort to make sure I am paying attention which I dearly appreciate. Saying it out loud also makes me have to step up and try harder to pay attention.

Does anyone else do this? Do you have any advice on how to stay present during painful/potentially painful medical situations when you have spent your whole life not being present?
 

Friday

Moderator
Does anyone else do this? Do you have any advice on how to stay present during painful/potentially painful medical situations when you have spent your whole life not being present?
My PT’s usually all come to the same conclusion... my pain-psych is too good. The more pain I’m in, the more I disassociate from it. So they either have me take a painkiller before I come in, or ask that I come in 20 minutes early so that they can dose me.

It’s the opposite of what most PTs are used to dealing with, the majority of their patients are usually first-timers for whom learning to work past the pain is a big part of their physical therapy... but as they’re also expected to make a full recovery? It’s not worth sending them to a pain-psych to teach them how to dissociate... they just need to up their pain tolerance a smidge.

SportsMed PTs & Military PTs have the opposite problem. Athletes and vets are both taught to block out pain, and have done so for so many years/decades so it stopped being a conscious thing and has become an automatic thing a lifetime ago. Athletes are usually more willing to see a pain-therapist than vets are, as it’s sold as another kind of coaching. Unlike newly-chronic (weird phrase) patients (think major car accident, no need to learn dissociation prior to the accident, but they’re going to be in lifelong pain and need to be taught now)... the focus on athlete/vet pain therapy is more commonly how to deal with the emotional side of being “useless”, how to STOP dissociating in small increments so they don’t injure themselves further, aaaaand the emotional side of what happens when you DO stop dissociating from the pain (anxiety and depression out of “nowhere”).

Adding in dissociation from childhood trauma I could ask my cousin about... but I’d suspect??? that you’d find the most traction with a SportsMed PT, or PT who trained at WalterReed (it’s a premier slot, in an already fiercely competitive degree path; and as such, is usually plastered all over their “About Me” page). Because they’re already used to dealing with populations that see pain as a challenge to push past, not a warning thay something is about to go badly.
 

Still Standing

MyPTSD Pro
Yup! I never knew what I did had a name until I started therapy over 3 years ago. PT is not a problem in that mine is a hands-on guy so his touching me keeps me present. My difficulty is sitting in a Dr.s' office listening to him talk to me. I hear everything he is saying but it is "fuzzy" and my head feels like it is on the verge of panic 'cause I am trying so hard to understand what is being said. As soon as I am out of the office, I have a very difficult time remembering what he actually did say. All I know is that he talked to me but the details are gone. This has been a frustration for me for years.

The last time I saw my internist, he wrote things down and repeated what he had to say. Maybe I looked at him funny about it, I don't know, but he told me that it is common for people to dissociate when dealing with a doctor. I think with the increased awareness of people's mental health, his office is being a bit proactive in this area, now. They have even opened up a large mental health counseling center in his building.

As for dissociating during painful procedures, the best I can do is deep breathing, relaxation, and distraction exercises. If you have had children and went through natural childbirth classes, you were trained in these things. I still resort to my Lamaze training during medical procedures. I can hold one part of my body dead still if need be even though it is dealing with invasive tests and such. I wish I could fully dissociate during these times, but I can't.

I have had pain since childhood, I have learned to live with it. I have seen it as "levels". I learn to adjust to the increased pain until it is "controllable". When it increases again, I work at living above it. It is sorta like the biology example of putting a frog in water and slowly increasing the water temp. The frog is unaware of the change and eventually succumbs to the hot water. In my case, I know the water temp has increased but I live with it until it is too much, at which time I cry, "Uncle" and it is back to more surgery.
 

RussellSue

MyPTSD Pro
So they either have me take a painkiller before I come in, or ask that I come in 20 minutes early so that they can dose me.

So, not having the pain start means you won't dissociate?

I think, but am not 100% certain, that I start dissociating somewhere on the freeway before I arrive because I know where I am going or at least as soon as I see a sign for whatever practice I am going to.

they’re already used to dealing with populations that see pain as a challenge to push past, not a warning thay something is about to go badly.

Very well put. I assume that going into the operating room at one day old started this trend of go, go, go, no matter what. All of a sudden I am 40 and people are telling me to pay attention to the pain, slow down, stop being so stubborn? This is how I roll -- or it will be until my leg falls off -- or that's how it feels, anyway. I honestly am trying to pay close attention but this is not how this brain works.

I don't know how much this guy knows but we did talk at length about dissociating and chronic pain and he seems to be on board with making eye contact and making sure I am still with him on an ongoing basis.

Thank you for your thorough response. You know lots of stuff!
 

RussellSue

MyPTSD Pro
PT is not a problem in that mine is a hands-on guy so his touching me keeps me present.

I wish that helped me. I think I get worse when he touches me. On the upside, he isn't touching my face. When they do that, I might as well lose consciousness -- I become utterly useless in a hurry.

he wrote things down and repeated what he had to say

I actually wrote things down for a PCP ahead of time about a year ago because I was in too much pain to talk at length with a new doctor. I handed her the paper and she handed it back to me without even looking at it. That was my cue that I had chosen the wrong PCP.

I imagine having someone get it is very helpful.

he told me that it is common for people to dissociate when dealing with a doctor.

That's awesome. I didn't know that. No one has ever told me that. I have little doubt that this is totally accurate.


It is sorta like the biology example of putting a frog in water and slowly increasing the water temp.
I get that totally. I was doing great with occasional limping from hip dysplasia, impingement and arthritis -- that had been a steady progression. When I tore my left lip labrum, things were a whole lot different, though. That was a major pain spike with little warning and then the right one went a couple of months later. I can live my life with level 5 pain but sudden 7 and 8? It went too far, too fast.

Thanks for your response. It is good to know that I am not the only one who does these things.
 
Top