21 One Thing After Another (episode page)
Description: In this week’s main episode, Cara talks to Heather about developing post traumatic stress symptoms after the medical experiences related to their chronic illnesses. In today’s bonus episode, they talk a bit about some of the therapies that have been studied as treatments for PTSD, including Heather’s experience with EMDR. They also talk about rates of PTSD among survivors of different kinds of traumatic events, and how it is often portrayed in the media, which comes witha few Grey’s Anatomy spoilers, though nothing from this current season.

[intro]
Hey there and welcome to In Sickness + In Health, a podcast about chronic illness, disability, medical traumas, and everyday uncomfortable healthcare experiences. My name is Cara Gael; I’m not a doctor or medical professional, I’m just a person and a patient who really wants to talk about this stuff more.

Nothing said on this show should be considered medical advice. If you’re experiencing a medical issue, please seek qualified medical help. I know the system sucks, but I wish you a lot of luck. Every person is different, even within disease groups, so none of my guests should be regarded as official representatives or spokespersons for their conditions. Please respect their very personal choices, and unless they ask for it, please don’t make suggestions about treatments or lifestyle changes. Unsolicited medical advice is almost never not annoying.

Today I talk to Heather about developing post traumatic stress symptoms after the medical experiences related to our chronic illnesses. What we talk about is different than what most people think of when we talk about traumatic stress responses, or even what is officially diagnosable according to the DSM, which is the diagnostic manual for psychiatric disorders.

We’re going to be talking about some things that can be upsetting or triggering. We talk about specific medical situations, trauma therapy, and other events with the potential to lead to PTSD. If you’re feeling like you’re not up to listening to this one, by all means please turn me off and take care of yourself. But traumatic medical experiences are something that doesn’t get much attention, so I hope if this is something you experience and were feeling like it might not be valid because no one talks about it, I promise you, this is a thing. There’s not a lot out there about medical trauma, but I will link to trauma resources in the show notes.

Experiencing post traumatic stress is a normal physiological reaction to experiencing or witnessing something awful. Racing heart, shaky hands, feeling sweaty, afraid, and nervous is all a part of that built-in fight or flight response we all have. Avoiding similar situations, having nightmares, flashbacks, and feeling nervous in situations that remind you of what happened, is normal. Usually these symptoms will subside within a few days of the event, but when they go on for much longer is when you get into Post Traumatic Stress Disorder territory. The current theory is that this can develop as a result of your brain storing those memories in a different way, and to some extent, your body and brain getting stuck in a fight or flight feedback look.

PTSD occurs as a response to a major traumatic event, something that’s happened in the past, but when you’re living with chronic illness, you may develop PTSD symptoms without a major traumatic event you can put your finger on. Like Heather pointed out in that opening clip, for those of us that live inside bodies under constant assault from treatments, procedures, and even our own immune systems, it can be hard to teach our bodies and brains that we’re safe, and that fight or flight stuff is unnecessary. I think we’d both say, after lots of therapy, we’re in much better shape than we used to be, but receiving new diagnoses, going into new doctor’s appointments, tests, or dealing with medical-related stuff can still be incredibly triggering.

In The Evil Hours: A Biography of Post Traumatic Stress Disorder, David J. Morris describes the current body of research as “remarkably chaotic,” and examines his own experience, the condition’s history and various treatments that have been studied. What little we know about post traumatic stress comes from research done by the bureau of Veterans Affairs, or VA, here in the United States. PTSD is most often associated with combat veterans, because veterans are the reason it’s recognized as a condition at all.

Trauma-related psychiatric illnesses have been reported in some way throughout much of recorded history, though mostly in the realm of the arts and philosophy, not becoming medicalized until the world wars of the 20th century. Modern history of trauma usually begins with reports from the American Civil war in the 1860’s, though at the time, patients were regarded as malingerers or cowards. The condition took many different names over the years, including shell shock and soldier’s heart, which was a cluster of symptoms, retrospectively understood to encompass a group of disorders that not only included what we now know as PTSD, but autonomic dysfunction and POTS as well.

Formed in 1967, an activist group called The Vietnam Veterans Against the War began organizing the first informal support groups for combat Veterans in 1970. These rap groups provided a space to discuss what they’d experienced during the war, their disillusionment, and their negative experiences after returning home to a society that was largely hostile or indifferent to what they’d been through. They worked together with psychiatrists to lobby for the condition’s inclusion in the DSM, with it officially recognized with the DSM-III in 1980.

The diagnostic criteria has been revised over the years to reflect ongoing research, but Still not officially recognized by the DSM are things like Complex PTSD or Continuous Traumatic Stress. Complex PTSD occurs in people who have been repeatedly traumatized with experiences like childhood abuse, maltreatment by a caretaker, or domestic violence. With Continuous Traumatic Stress, people encounter traumatic circumstances regularly as a part of their occupation, like emergency first responders, funeral professionals, and even doctors and nurses.

We still don’t know why some people develop PTSD and some don’t; two people can experience the same thing with two different responses. It is violation of bodily integrity and a sense of powerlessness that are most likely to lead to a longterm post traumatic response. It is also thought that the interpersonal nature of a trauma is what makes something more or less likely to provoke PTSD in a person. For example, PTSD rates among combat veterans—who are often armed and trained for combat situations—usually hovers around 13-15%, compared with around 50% for survivors of rape. In contrast, survivors of traumatic events like accidents and natural disasters, events that that could be considered “acts of god” are among the lowest.

Medical PTSD has been studied in ICU patients, heart patients, cancer HIV patients, and even in women who have experienced traumatic childbirth. In most cases it is the singular event of receiving the diagnosis or having the heart attack that has been studied. It's much easier to track an event like that and document it's direct fallout than it is to study the effect of prolonged exposure or repeated medical events like we experience with chronic illness. And it's a shame, because an awful lot of the chronically ill people I've talked to have some experience with this.

The effect of trauma is cumulative, so having traumatic experiences in other areas of your life in combination of what’s experienced over the course of a chronic health problem can be extra complicated.

In today’s bonus episode, we talk a bit about EMDR and some of the other therapies that have been studied as treatments for PTSD. In both this episode and the bonus episode we do mention a few Grey’s Anatomy spoilers, though nothing from this current season.

Find resources and more from us at insicknesspod.com and on social media @insicknesspod, and if you can, please take a moment to subscribe, rate and review us on iTunes, which helps other people find the show. You can find Heather on Instagram @haspell and Twitter @hcorini, and follow along for her thoughts and experiences with #ChronicLife.

This was the hardest one I’ve produced so far. I am excited to put it out because I think this is something a lot of people deal with, but I am also super glad that I can take a break from thinking about this stuff for a little while. There will definitely be more to come about medical traumas, but we’re gonna talk about other stuff in the meantime to give my poor brain a break. If you’re dealing with PTSD of any kind, feel ready to talk about it, and might consider being on the show, shoot me an email at insicknesspod@gmail.com. I may not get back to you right away, but this is definitely something worth talking about. I hope you enjoy this episode…

[interview]

[outro]
Thank you for listening to In Sickness + In Health Find resources and more from us at insicknesspod.com and on social media @insicknesspod, and if you can, please take a moment to subscribe, rate and review us on iTunes, which helps other people find the show.

And don’t forget to be excellent to yourselves and each other.