“Courage is not the absence of fear, but rather the assessment that something else is more important than fear.”
― Franklin D. Roosevelt
The northern hemisphere is in its shadowy time, when we celebrate Halloween, Samhain, and Dia de los Muertos. While these holidays originally evolved in order to honor our ancestors, they now also inhabit a space that can be very triggering for individuals who have experienced traumatic medical events.
Halloween can trigger medical trauma
Costumes may involve blood or scars; horror films may involve injury or play on medical phobias. I hope that you have been able to celebrate these holidays in ways that feel safe, centered, and joyful. However, if you notice that this time of year elicits other emotions such as anxiety or dread, please know that you are not alone, and offer yourself a bit of grace. In this post, we'll define medical trauma, discuss potential reactions to traumatic medical events, and explore the nature of trauma triggers.
What events cause trauma reactions?
The International Society for Traumatic Stress Studies (ISTSS) defines reactions to medical trauma as “mental, emotional, and physical responses to frightening or life-threatening medical events.” These events could include, but are not limited to: injury, serious illness, medical procedures, or medical emergencies. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), traumatic events include exposure to actual or threatened death, serious injury, or sexual violence through direct experience, witnessed experience, or close relationship with someone who has experienced the trauma (i.e. friends or family members).
Even if a traumatic event is not directly experienced or witnessed, repeated or extreme exposure to the aftermath of traumatic events can also be classified as trauma. What this means is that when it comes to medical trauma, those who are at risk for development of a trauma-related disorder include not only those who have directly experienced adverse medical events, but also caregivers and healthcare workers. Caregivers for rare/genetic illnesses are particularly at risk for development of a trauma-related disorder. Individuals who have been exposed to war or armed conflict, as well as medical professionals and first responders, also carry greater risk for witnessing traumatic medical events and subsequently developing trauma-related symptoms.
Some caveats: those who have experienced medical trauma and stressers may be reluctant to define their experience as traumatic. This can be due to multiple factors, such as an individual’s cultural or religious background, or stigma/concern regarding receiving a mental health diagnosis. It’s also important to note that exposure to a traumatic event does not always lead to the development of a trauma or stressor-related disorder.
Medical experiences most associated with development of a trauma-related diagnosis include:
· ICU and NICU stays
· Major surgeries, serious accidents or injuries
· Life-threatening illnesses
· Childbirth complications
· Medical procedures on children
· Organ transplants
· Witnessing medical emergencies
· Medical errors/malpractice
One common reaction to traumatic events is to avoid reminders of the event. Medical trauma is uniquely challenging in this regard. In other life-threatening traumatic situations, the traumatic event ends, and it is possible to escape or avoid reminders of the traumatic experience. For example, a car accident or deployment to a combat zone are events that are time-bound, that have a quantifiable ending. The accident happened on this date. I returned from deployment at this time. It is possible to avoid behaviors or locations associated with these types of traumatic events. For those who have experienced medical trauma, however, the life-threatening event is often ongoing and internal, rather than time-limited and external. When it comes to medical events, the effects may be long-term, or even permanent. Cancer diagnosis, for example, requires ongoing monitoring and treatment to prevent recurrence; the threat of illness remains. Physical injury carries the risk of permanent disability. Chronic illness can last a lifetime. In addition, medical trauma happens to or within the body. As much as we might try, it is ultimately not possible to escape or avoid our bodies. We carry the reminders of medical trauma with and within us.
Dealing with medical trauma while care is ongoing
An additional challenge to avoidance coping is the need for ongoing medical care. While a hospital may be a distressing reminder of a stressful medical event such as a diagnosis, it is often not possible for an individual who has experienced medical trauma to avoid return visits to the hospital. Sometimes an inability to avoid trauma reminders helps with healing by allowing individuals to habituate, or adjust, to a new reality. However, avoidance takes many forms. Given that it is not possible to avoid the body or to go without care, individuals and their caregivers may attempt to avoid trauma reminders in other ways - for example, by dissociating, compartmentalizing, minimizing, or suppressing memories or reactions.
Common trauma reactions include:
· Avoidance of trauma reminders, such as situations or environments that are
similar to those experienced in connection with the traumatic event
· Avoidance of internal experiences such as thoughts, memories, or emotions that
act as trauma reminders
· Re-experiencing the traumatic event, for example through distressing dreams or
nightmares, flashbacks, or intrusive thoughts or memories
· Heightened vigilance, edginess, or wariness
· Elevated irritability and anxiety
· Low mood or depression
· Changes to sleep or appetite
Traumatic medical events are more common than you might realize. In the United States alone in 2020, serious but nonfatal injuries were associated with over 20 million emergency room visits, and the Society of Critical Care Medicine reports that over 5 million patients are admitted to critical care annually.
When it comes to risk for multiple traumatic experiences, our medical experiences and overlapping identities (gender, race, and class, for example) matter. As David Treleaven, Ph.D., writes in his book, Trauma-Sensitive Mindfulness: if you’re born with a disability, the odds are 80% that you will also experience sexual violence at least once in your life. In fact, 40% of people with disabilities experience more than 10 incidents of sexual abuse in their lifetime. People from poorer economic backgrounds have higher rates of death from injury and non-fatal injuries than wealthier people. Lower income individuals are more likely to be forced into taking unsafe work, have less access to emergency trauma care, and are less able to afford the costs of rehabilitative treatment and lost wages. He continues, “trauma is both prevalent and political. We live inside of social and economic structures that are designed to respect and create safety and opportunity for some groups, while systematically disregarding others (p.18-19).”
Trauma reactions occur in response to trauma triggers. A trigger (such as Halloween) is a stimulus that causes a painful memory to resurface. Triggers include situations, times, places, or sensory experiences that remind you of a traumatic event.
Sample triggers for patients/caregivers with medical trauma include:
· Going to the hospital or to medical appointments
· The time of year when an individual was first diagnosed or became ill
· The location where an injury or loss of a loved one occurred
· The activity that caused an injury or accident (e.g. driving or playing a sport)
· Smells that recall past medical symptoms or treatment (e.g. antiseptic wipes)
· Physical sensations that recall past medical symptoms or treatment (e.g. nausea
or difficulty breathing)
· Sounds that recall the moment of stress or injury (e.g. sirens or particular songs)
· Visual reminders of body changes or past illness or injury (e.g. scars, hair loss for
self/other)
· Tastes that carry reminders of past illness or treatment (e.g. ingesting something
that tastes like a certain medication, or foods that remind an individual of their
hospital stay)
· Listening to the stories of other survivors
· Situations which recall invalidation, violation, or healthcare disparity (e.g. feeling
unheard by a medical provider, feeling coerced into pursuing a particular
medical treatment, lack of access to or ability to pay for a needed medical
service).
Coping with medical trauma and trauma reactions
Not every trigger on this list will resonate with you, and you may have others not listed here. You also may not know what your triggers are until you find yourself reacting strongly to them. Part of what a supportive medical care team and therapist can do is to help you determine what your triggers are, how you react to them, and how to change the habit of avoiding them - because often, avoidance has a cost. As we avoid, our lives become smaller; we are less able to be fully present in our relationships or for experiences that once gave us joy. Slowly, as you learn ways to regulate your central nervous system, it may be possible to become curious about times when you feel emotional distress. In small, well-regulated doses and with caring guidance, you can learn to gently turn towards distress rather than avoiding or minimizing it. You can find ways to cope.
For more information regarding PTSD and treatment options, check out these links:
For more information about ways to cope, check out this post, and keep coming back here for more tools and articles. May you be kind to yourself this shadowy season, and give yourself the support and care that you need.
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