Episode 226: Burnout in Healthcare: How Depersonalization and Dissociation Manifest, and How to Overcome Them
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Article Authors: David Puder, MD
Burnout in healthcare professionals often shows up as depersonalization, an emotional detachment that allows clinicians to shield themselves from the overwhelming trauma they witness on a daily basis. Depersonalization falls into the broader category of dissociation, where a clinician becomes emotionally numb and detached from their patients. It acts as a protective mechanism to shield against overwhelming emotions, but is also something we must actively work through to regain emotional connection.
Dr. Jessi Gold, a psychiatrist and Chief Wellness Officer of the University of Tennessee System, sheds light on these experiences through her work, highlighting the toll burnout takes and offering practical solutions for how healthcare providers can reconnect with their emotional lives.
What Does Depersonalization Look Like In Healthcare Workers?
Depersonalization doesn’t happen all at once—it builds gradually as clinicians overexpose themselves to trauma without sufficient emotional processing. As a patient of Dr. Gold explains, it’s a protective mechanism: “Not feeling anything is protective in the job, for sure, and I think it’s good sometimes, but maybe it isn’t good all the time” (How Do You Feel?, p. 56).
When depersonalization occurs, healthcare professionals may feel as though they’re going through the motions, seeing patients as tasks to complete rather than individuals in need of care. This is captured in a common set of experiences that align with the depersonalization domain of the Maslach Burnout inventory, such as:
“I feel I look after certain patients/clients impersonally, as if they are objects.”
“I really don’t care about what happens to some of my patients/clients.”
“I have become more insensitive to people since I’ve been working.”
“I’m afraid that this job is making me uncaring.”
These statements reflect the emotional distancing that comes with burnout, as clinicians become detached from the empathy that once motivated them. Dr. Gold shares a story about a clinician noticing their own experience with emotional detachment: “...like once at a family dinner when someone asked me about work, I told them about one shift where a bunch of family had died in a car accident, a lot of them kids, and everyone looked so surprised. Some even teared up. And, then there’s me just telling the story like I was ordering a cheeseburger. I didn’t even stop eating dinner” (How Do You Feel?, p. 55).
This numbness isn’t necessarily deliberate—it’s often a way to cope with the relentless exposure to suffering. As one patient describes: “It feels like I’m not processing things like a human” (How Do You Feel?, p. 56). Over time, this lack of emotional processing can lead to deeper feelings of alienation, where healthcare workers feel like they are merely going through the motions, both professionally and personally.
Depersonalization And Dissociation As A Unified Experience
In Dr. Gold’s work, the concepts of depersonalization and dissociation often blend together. When clinicians begin to dissociate, the broader category that depersonalization fits into, they are emotionally disconnecting from their environment. As this emotional detachment deepens, clinicians may lose their ability to feel empathy for their patients—and sometimes, even for themselves.
“I used to be able to go into work and see the roses through all of the thorns, but now I only see the thorns. Are there still any roses?” (How Do You Feel?, p. 54). This poignant metaphor illustrates the gradual erosion of joy and meaning in work as depersonalization takes hold.
At its most severe, this process leads to clinicians feeling like they are no longer fully human—just cogs in a broken healthcare machine. As Dr. Gold describes, We healthcare workers regularly see trauma and tragedy in ways that slowly desensitize us... It’s the system that needs fixing, not just us.
The Role Of Alexithymia
One of the consequences of prolonged depersonalization and dissociation is alexithymia, the inability to recognize or describe one’s own emotions. This can be particularly dangerous for healthcare providers, who rely on their ability to empathize with patients and process their own emotional responses to trauma. Over time, clinicians may lose touch with their emotional states altogether.
Alexithymia often goes hand-in-hand with burnout. A patient of Dr. Gold’s describes how the culture of medical training sometimes discourages the display of emotions: “I remember, in medical school, receiving what were basically subjective evaluations of my personality, in which my supervisors said things like I ‘made faces,’ and I ‘didn’t take my job seriously’ when I acted like myself around patients and supervisors…” (How Do You Feel?, p. 68). Through mentors, we may learn or be encouraged to hide our emotions.
Solutions For Overcoming Depersonalization And Alexithymia
Dr. Gold offers several strategies for healthcare professionals to overcome depersonalization, dissociation, and the emotional detachment that accompanies burnout. These solutions are not just about "fixing" the clinician, but also about recognizing the systemic issues that contribute to burnout.
1. Recognizing and Addressing Burnout Early
Dr. Gold emphasizes the importance of catching burnout early, before depersonalization and dissociation become entrenched. “By the time someone shows up in my office, I’m often thinking, ‘I wish you’d come months or even years earlier.’” Recognizing the early warning signs—like feeling other burnout symptoms such as emotional exhaustion or a decreased sense of meaning and purpose at work, can help you catch burnout early.
2. Seeking Therapy to Process Emotions
Therapy is a vital tool for healthcare workers, offering a space to process difficult emotions and reconnect with oneself. Dr. Gold says in the episode, “I would always want a therapist who sees a therapist. I think it’s healthy to admit that our job affects us too”. For clinicians experiencing alexithymia, therapy can help them regain the ability to recognize and describe their emotions, which is essential for both their personal and professional lives.
3. Creating Emotional Boundaries While Staying Connected
While emotional boundaries are necessary for protecting against burnout, Dr. Gold emphasizes that healthcare workers need to find a balance between protecting themselves and staying connected to their patients. “Not feeling anything is protective in the job, for sure, and I think it’s good sometimes, but maybe it isn’t good all the time” (How Do You Feel?, p. 56). Therapy, mindfulness, and regular check-ins with colleagues can help maintain this balance.
4. Challenging Systemic Burnout Causes
Individual solutions are not enough to tackle burnout on their own. Dr. Gold advocates for addressing the systemic issues that drive clinicians to depersonalization in the first place. Sometimes the system says, “You fix you”, instead of fixing itself. That’s what the resiliency conversations have become, and it misses the point—changing the system is what really helps. Institutional change is crucial to preventing burnout, whether through reducing workloads, increasing support staff, or creating environments where healthcare workers feel valued and supported.
5. Reconnecting with the Meaning in the Work
One of the key steps in overcoming depersonalization is rediscovering the meaning in the work. Finding ways to reconnect with the reason you entered the profession—whether through peer support, mindfulness, or creative outlets—can reignite a sense of purpose.
Empathy For Healthcare Providers In Burnout
Burnout is not a personal failing—it’s a response to overwhelming systemic pressures. Dr. Gold’s work offers empathy and understanding for clinicians who find themselves emotionally disconnected from their patients and themselves. She reminds us that it’s not uncommon for healthcare workers to feel numb or disconnected after years of exposure to trauma.
For those struggling with burnout, it’s important to remember that seeking help is not a sign of weakness, but of strength. As Dr. Gold so aptly puts it: “Your story is your story. Tell it when you’re ready, but just know, if a place rejects you for being honest, you probably wouldn’t have fit there anyway.”
By addressing depersonalization, dissociation, and alexithymia head on, healthcare providers can begin to heal, as well as help create a healthier, more sustainable system for everyone.
Further reading:
Connect with Dr. Gold on social media (Instagram, Tiktok, X): @drjessigold and her website drjessigold.com.