Medical PTSD

Sometimes it's not the illness itself that we fear most, but what comes immediately after the diagnosis. The memories, the feeling of loss of control, the nights when we replay over and over the same test, the same operating theatre, the same doctor's face, who may have meant well but didn't do it right. Yet it was humiliating. Yet something is forever broken.

This is medical PTSD -a little known but very real phenomenon. It is a type of post-traumatic stress reaction that is not the result of war or abuse, but of medical care.

A growing body of research shows that certain health events - especially intensive care unit treatments, surgeries, emergency procedures - can trigger the same deep neurological responses as other classic traumas. Common symptoms include hypervigilance, i.e. excessive alertness, flashbacks, sleep disturbance, physical dysregulation and, most importantly, loss of confidence.

A landmark study in 2007 (Weinert & Meller) found that patients treated in intensive care units were four times more likely to show signs of PTSD six months to a year after treatment than those who were not treated in the ICU, regardless of the severity of their illness.

What happens in the brain?

Research shows that medical PTSD leaves not only a psychological but also a biological imprint. Elevated cortisol levels in stressful situations, sleep deprivation, delirium and fear reactions affect the amygdala, hippocampus and prefrontal cortex, the brain areas responsible for regulating fear, memories and coping. In addition, during this type of trauma, the patient is often semi-conscious, unconscious or under anaesthesia, which distorts the memory and makes processing even more difficult.

Medical PTSD does not only develop in intensive care units. Another study showed that 25% of patients with PTSD had positive PTSD scores before the intervention, meaning that previous medical experiences, chronic illnesses and serial vulnerability may contribute to its development.

It is no coincidence that they are among the most vulnerable groups:

• people with chronic pain (e.g. endometriosis),

• paediatric patients,

• women who have experienced birth trauma,

• and those who experience medical gaslighting more often as members of marginalised communities.

Medical PTSD has no visible purple patches. Just a person who is afraid to go back for a check-up. A woman who would rather not have children because she can't bear another similar gynaecological experience. A patient who turns away when she sees a doctor because her body remembers that she was once left with fear.

And science says: it's not weakness, it's not hysteria, it's neurobiology. Our brain: the hippocampus, the amygdala, the prefrontal cortex, reactivates the trauma over and over again when triggered. That's why your heart pounds in your throat when you see a hospital from the bus or watch your favourite medical show.

Why are we not talking about this?

Because health care is geared towards survival, not trauma processing. If you survive, that's a medical success, period. There's such a level of strain on the system that there's no time for smiles, no time for kindness, no time for compassion, because if you can ask one more question, someone in the other room might die and there won't be two doctors on the ward. In fact, there's one for every two wards. In such circumstances, success is measured in whether you live, not in your mood and mental health. And obviously being alive is really important, but you can still say you're not well. Because even doctors don't always know what a poorly communicated diagnosis, an unexplained test, an overly strong sedative, a seemingly innocent but hurtful question can leave a mark when a patient is lying helplessly on a hospital bed or operating table. And because patients often don't know themselves that what they are experiencing, the recurring nightmares, the avoidance, the paralysing anxiety, is not a "hysteria" but a real neurological reaction. Medical PTSD is still on the fringes of research, I found 2 articles on Pubmed specifically about it, although 20% of the chronic patients who come to me, who have a patient career behind them, are certainly concerned about the subject.

What can help?

• Trauma-informed care, where not only the body is healed, but also the experience. I achieve very good results with my medical PTSD patients using Somatic Experiencing.

• Therapy, especially trauma-oriented methods

• Crisis intervention, as soon as possible after the traumatic event

• And perhaps most importantly: talking about it - with each other, with professionals, in the community

• Finding peer support (in the form of a patient group led by a psychologist, NOT an online forum!)

That's why I write about them on Endoblog. Because we know that the body doesn't forget, but we also know that we can remember and heal with the body. Here at EndoBlog, you've gotten used to the fact that we don't keep silent over the last 16 years. Here you can say yes, it happened to me. Yes, I am healing, but I am broken in the process. Yes, I have the right to rebuild trust with my body.

Medical care can be traumatic, even well-intentioned medical care. A more impatient, hissing geriatric search on an already stabbed hand, a Caesarean while a problem arose, but no one looked at the mother terrified for her child, just bounced incomprehensible Latin words over her head, then ran off with the baby she didn't even know she had, if she was still alive, or the first night after the operation, when you don't know if the blood is still normal, but you press the nurse's call button and no one comes, or if they do, they just roll their eyes, or a victim-blaming remark after a miscarriage, and I could go on and on. So yes, there's plenty of room for trauma. And no, that doesn't make us "bad patients". Just people with body memories. People who can rewrite their own history.

If you need help, you can make an appointment for an online health psychology consultation here HERE

 

One of the most telling, and perhaps most powerful, symptoms of medical PTSD is avoidance behaviour. In other words, the patient consciously or unconsciously avoids anything related to the trauma. Not going back to the hospital. Does not make an appointment. Does not respond to the report. Does not look at his own body.

And this is not hysteria, not negligence, not irresponsibility. It's a defence mechanism, a desperate attempt by the nervous system to avoid reliving what has already broken it.

But the problem is that the body cannot wait. And if someone avoids tests for years, they often only come back into care when they're in big trouble.

And then the problem happens again: he comes late, he is put down, stigmatised, and another trauma is registered, another confirmation: 'well, it would have been better not to come'.

It is this vicious circle that makes medical PTSD dangerous not only psychologically, but also medically. According to a US study, PTSD sufferers with avoidance behaviours see a doctor with severe symptoms on average 2-3 years later than those who have not been traumatised by the health system.

And many of them are no longer coming to preventive care - they are coming to the emergency room.So you can no longer say "it's just psychological". Medical PTSD is literally life threatening.

This is why the rules need to be rewritten. So that it's not just what you find on the CT scan that counts, but how you got there. How many times you had to overcome your own fear. How many times you pretended to be strong. And how many bad experiences you had to get up from over and over again.

Because if the health service really wants to heal, it must first admit that it may have caused the wounds itself.

If you need help, you can make an appointment for an online health psychology consultation here HERE