Given the ongoing global pandemic, I believe it is crucial for health care providers, mental health counselors, and the general population to be aware of medical trauma. Unlike other trauma, medical trauma is one that we can easily predict by evaluating each individual’s risk factors. Unfortunately, medical trauma has been under-researched -- until recently.
In their 2013 research paper When Treatment Becomes Trauma: Defining, Preventing, and Transforming Medical Trauma, researchers Michelle Falum Hall and Scott E. Hall state that, “Medical trauma is indeed different from other traumas; in many cases we understand where, how, and why it occurs. Simply put, if we can anticipate the trauma we can plan for its prevention and intervention.”
“People with a history of trauma -- medical or otherwise -- are at greater risk of experiencing medical care as traumatic,” explains Falum Hall in Managing the Psychological Impact of Medical Trauma: A Guide for Mental Health and Health Care Professionals, the 2016 book co-authored by the same researchers.
When the topic of trauma comes up, many first think of military combat, sexual assault, physical abuse, and natural disasters. These are experiences that fall into the category of what is known as Big T or Large T trauma. According to Psychology Today “A large-T trauma is distinguished as an extraordinary and significant event that leaves the individual feeling powerless and possessing little control in their environment.” Unfortunately, medical events like surgeries and procedures, chronic illnesses, and acute illnesses such as COVID, cancer, etc., are no longer recognized as events that can lead to trauma.
According to the Diagnostic and Statistical Manual of Mental Disorders, or “DSM-5,” a “life-threatening illness or debilitating medical condition is not necessarily considered a traumatic event. Medical incidents that qualify as traumatic events involve sudden, catastrophic events” [(5), p. 274]. This line of thinking excludes millions of individuals in need of healthcare, leaving them isolated and without proper treatment. What leaves an individual as powerless and without control as the loss of their health?
While medical trauma is under-researched, studies have shown that individuals experience psychological distress and possible PTSD symptoms after surgery, during and after cancer treatment, and throughout the processes of dialysis and cardiac care. Multiple studies document the occurrence of PTSD symptoms among new mothers who had C-Sections, or who experienced a difficult vaginal birth due to a medical emergency.
Individuals with chronic illness and chronic pain report symptoms of irritability, hypervigilance, nightmares, and panic attacks at higher rates than those without chronic pain or illness. Approximately 15% to 35% of patients with chronic pain also have PTSD, but of those without chronic illness or pain, only 2% have PTSD (Lorie T. DeCarvalho, Ph.D.). Chronic pain may be a result of a traumatic event that may also contribute to the development of PTSD.
Knowing and understanding an individual’s medical history can reduce the risk of reactivating past trauma and potentially prevent new trauma altogether.
Factors contributing to the risk of medical trauma include:
- the level a patient trusts their medical staff
- the level of sensitivity shown by the medical staff toward the patient
- whether the patient has a pre-existing condition
- other aspects related to treatment, like treatment type, duration of hospital stay, and medication management.
The symptoms and signs of medical trauma may be overlooked when social conditioning dictates patients should endure medical treatment and adjust accordingly. Conversations around medical treatment primarily focus on pain and the effects of treatment on the body and do not include how treatment affects the psyche. Questions about a patient’s pain level, increased symptoms, and medication side effects are important and necessary, but they exclude an important discussion of how this event impacts the patient on a deeper level.
Medical crises may include a life or death event for individuals or a lifelong battle of pain. Acknowledging the impacts of treatment on a patient’s body prioritizes their physical health. Still, secondary crises impacting the patient’s mental health due to medical trauma must also be acknowledged. It is also important to remember a second crisis may occur as a result of the primary crisis -- the crisis of illness, injury, and treatment.
Secondary Crises may include:
- Developmental Crises: If any illness or injury occurs during a pivotal developmental stage, this can set the individual up to be delayed or excluded.
- Physical Crises: Surgery, illnesses, and acute injuries can impact the patient physically, making the completion of daily tasks difficult.
- Existential Crises: Illnesses may lead individuals to question the purpose in life and how they have been living up to that moment in time.
- Relational Crises: Medical crises can have a significant impact on relationships, often leading to either the strengthening or weakening of the relationship. Individuals with chronic illness or chronic pain may feel isolated from others and find it difficult to make relationships.
- Occupational Crises: The need for medical care can lead to the end of employment completely or the loss of employment that is fulfilling for the individual.
- Spiritual Crises: Individuals may find it difficult to maintain a healthy spiritual practice if they feel that their higher power left them.
- Self-Identity & Definition Crises: Trauma may occur for individuals whose health or body has changed due to a medical crisis.
When assessing for medical trauma, Hall recommends using the Experience of Medical Trauma Scale (EMTS), a guide for health care providers and mental health counselors. The EMTS provides guidance on the assessment of medical trauma in health care settings and how to decrease a patient’s likelihood of developing PTSD. Treatments like mindfulness-based Cognitive Behavioral Therapy (CBT) and trauma-informed CBT are recommended as approaches if medical trauma is detected.
Health care providers and mental health counselors must keep the importance of balancing physical health and mental health in mind. This is accomplished by both increasing the awareness of this relationship and avoiding the dismissal of interrelated health concerns; a body that is fighting itself and in physical pain can result in mental health concerns, and vice-versa.
Dismissing a person’s physical medical concerns can lead to feelings of depression, anxiety, and an increase in PTSD symptoms. The reverse can also happen: to focus solely on mental health concerns may neglect emotions stored in the body, which can manifest as physical symptoms.
By providing an integrated approach that recognizes the interrelation between physical health and mental health, health care professionals can best serve those who suffer from chronic pain or need major medical treatment.