Traumatic Stress – medically induced
After finishing a grueling year and a half bout of treatment for colon cancer, Elizabeth (not her name) began having some very bizarre symptoms (to her). She was emotionally erratic, explosive, anxious, and afraid to leave home, easily startled, had nightmares and was paranoid – afraid everything would hurt her. She didn't sleep well and she, who was/is a very social being, was not interested in seeing her many friends. Yes, she was depressed but it was more than that. Her husband, a Vietnam vet recognized her symptoms as fitting the profile of PTSD. She looked for and received trauma treatment because traditional counseling is not a good fit with PTSD. Traumatic Stress symptoms are created by a brain locked into survival -- telling the story in a prescribed way ameliorates or eliminates symptoms. And why? You will learn that in our class.
Years ago, there was an article in our local paper in St. Paul, MN by a reporter who periodically interviewed a man who had been shot and had gone through an emergency room where the reporter encountered him. Over the months, the reporter tracked him as his interviewee developed some strange symptoms that now we would now call PTS but then were a mystery to anyone but a combat veteran where PTSD had been identified. There was little awareness that PTSD existed in many of our populations. This article stuck in my mind for years. Then when I had a brain hemorrhage 21 years ago, I developed those same symptoms but because I was already working with Vietnam vets with post-traumatic stress, I recognized what was wrong with me and addressed it. I wrote and wrote and wrote about the stroke and allowed other traumatic incidents to emerge from memory and wrote and wrote and wrote about them as well until the symptoms dissipated and disappeared and my life returned to normal.
Writing using a very specific process is just one way to address PTSD – it is the process of the writing and repetitive telling of the story – this has been done, can be done and is being done. We adapted several evidence based remediation methods and created our own: the narrative Arts approach is an amalgam of “ours” and “theirs.” It is easily learned and can be seamlessly worked into a debriefing conversation when it is inappropriate to create a more formal context. The experience of my brain bleed and my own recovery from the resulting PTSD, stuck as I compared my experience with the cancer and gunshot survivors. My question became: If this has happened to me and these others, it must happen far more frequently than we currently know. Over the years I have found isolated incidents of medically induced PTSD including a recent article that states that 23% of stroke or heart attack victims will develop these symptoms within a year. This, I believe, is the tip of the iceberg and the beginning of awareness that medical events can be seriously traumatizing. In another article, sedation of ICU patients is blamed for hallucinations and PTS symptoms –, a body attacked internally by a brain hemorrhage or stroke or whatever other medical emergency, can and probably will produce in dreams, nightmares or fantasies, images of rape and assault. The body experiences the events that way and the unconscious produces images appropriate to those experiences from its storehouse of information.
I currently believe Ashlar education and teaching programs can provide the necessary assistance to the medical community in helping their patients as they anticipate the possibility for PTS and thus, eliminating that before the symptoms begin.
I also learned that staff needs help with their own Contagious Trauma (often called “burn-out”). The current method of avoiding this phenomenon is for staff to distance themselves from patients. This strategy is not the best long term: for staff and patients I experienced the dissonance of my very frightening condition with interactions of those cool emotionally uninvolved medical staff in the Hospital Culture are creating a kind of disconnect for me where I did not feel seen or safe. In my interviewing of other former patients, I run into this same experience.
I am available to present my story and the stories of others to staff and volunteers and talk about their own contagious trauma and how to avoid it. From there our services can be engaged.
Andrea Steffens, PhD Executive Director of Ashlar Center.
Associates of Ashlar Center are available to educate and demonstrate methods of working with potential PTS with hospital staff and volunteers:
- a very short course on the neuroscience of PTS
- identifying and educating patients who might develop PTS symptoms
- providing the patient and staff with educational materials about symptoms of PTS
- teach staff, volunteers, social workers, chaplain, simple remediation methods for the patient before she/he is released and strategies embodied in our Self Care program that can be continued at home
- Provide staff with methods to avoid: burn-out/ contagious traumatic stress
- helping staff to avoid PTS, formerly called Burn-out and currently called Contagious Traumatic Stress
The steps are simple and involve building the medical story into conversations between patients and staff. We believe that these directed “debriefing” conversations with patients that utilize very specific methods will accelerate healing and certainly make a hospital stay less frightening. As I said, from my own experience, I found the dissonance between what was going inside me and the approach of staff made me feel very isolated and thus, unsafe. A more helpful response to medical emergencies requires that the hospital staff and some volunteers who have contact with Emergency department patients, oncology or ICU be educated in the conditions that create PTS, how they can easily amend behavior toward patients with a simple shift in perception/ understanding what it is like and why some patients are going to experience PTS and others are not. Then, what to do about it. It helps patients when hospital culture includes understanding of the terror that can exist in their patients – sufficient enough to create the brain changes even though they may appear placid on the surface.
Our training involves about 8 hours and can be spread over several days.
We will leave you with educational materials for your staff and patients – especially useful in an Emergency Department.