Brenda Denzler, a North Carolina writer, recounts in the online magazine Cure the abject fear that gripped her as she prepared for surgery.
“Fear and anxieties so intense that they bordered on hysteria emerged,” writes Denzler. Luckily, the surgery went well and her fears subsided. Then in 2018, she was diagnosed with cancer.
“I was 100 percent afraid of the cancer,” she writes. “Unlike most other cancer patients, I was almost as afraid of my doctors.” Denzler traces the origins of her fears to a six-week hospitalization when she was a child. During that period, she almost died, underwent painful procedures, and experienced prolonged episodes of isolation. This experience was so terrifying that Denzler developed PTSD.
Denzler’s not alone. Data show that as many as a quarter of individuals who experience an acute, life-threatening event — such as a heart attack, stroke, or respiratory failure — suffer traumatic symptoms as a result (Edmondson, 2015). Even a diagnosis of a serious illness can result in symptoms of PTSD.
Most studies focusing on medical PTSD were conducted with cancer patients. They suggest that people with brain and gynecological cancers report the highest rate of PTSD, roughly 18 and 13 percent respectively. Research by Michelle Flaum Hall and Scott Hall suggest that cardiac events, intensive care stays and strokes also increase one’s risk.
While there is growing attention to the traumatic impact of treatment on some patients, the phenomena is largely invisible to healthcare providers. It is often misunderstood by the patients themselves, and frequently unaddressed within the field of mental health.
How is Medical PTSD Unique?
Medical PTSD looks a lot like other forms of PTSD. People may experience flashbacks (when the body and mind experience a traumatic event as though it were happening in the present moment), panic attacks, and intrusive thoughts. They might avoid people, places and activities to manage the intensity of their feelings. For example, they may not visit loved ones in the hospital, or might skip medical appointments.
There are, however, a few key differences. With many forms of PTSD, triggering events are often in the past. For example, a person who has a car accident may suffer from flashbacks, but experiences some comfort in not having to drive. A woman who has been physically and verbally abused by her husband may experience some relief in her symptoms once he is no longer an active part of her life.
For people who experience medical PTSD, however, avoidance may not be possible. A person who hyperventilates when he sees the hospital may have to endure those reactions to continue treatment for a chronic or serious condition. A woman with heart disease may have a device that shocks her heart, a jolt that both saves her life and makes her live in fear of the next jolt, which she can’t control. Extreme anxiety surrounding thoughts of death may be hard to manage when tied to a person’s medical reality.
“Medical trauma comes from within,” writes psychotherapist Katie Willard of St. Louis. “Our bodies are the source of danger, and, as such, it can seem that a safe haven is not available.”
A first step in working with medical PTSD is validation of the person’s experience and normalization of their symptoms. Because patients’ emotional responses may be downplayed or dismissed within health care, being heard and affirmed can bring healing.
Skills for managing anxiety and building self-advocacy can help people regain a sense of control. Knowing that they have the power to soothe their symptoms and ask for help can increase their sense of safety.
Activities that help people connect with their bodies as safe and strong can help counter one’s experience of the body as sick, weak and vulnerable. This may be done through trauma-informed yoga (such as that offered by Lenna Jawdat at The Viva Center), qigong, swimming, breath work or other activities that help guide exploration of the body with attention to traumatic cues.
Narrative work (a form of expressive therapy) can help people claim their own illness story, as well as illuminate previously unrecognized strengths and positive coping skills. This type of work can clarify the underlying source of the trauma, and thereby identify potential triggers. All of these approaches can help clients feel less helpless and at the mercy of their symptoms.
We have several therapists at Viva who specialize in working with medical PTSD, coping with diagnosis and treatment and caregiving for a seriously ill loved one. Please contact Elizabeth Tschoegl, Stacey Thompson or Regina Tosca if you’re interested in more information.
Thank you for allowing us to support you on your journey.
Regina Tosca, LICSW is a therapist at the Viva Center in Washington, DC. She works with people experiencing grief and loss, including from their work in animal welfare. Other blogs by Regina include “Grieving the Loss of a Pet” and “The Power of Mind-Body Approaches in Trauma Recovery.“