Defining and Handling Medical Trauma
A Guide to Understanding and Taming Your Medical Trauma
Haylee Daggett LMFT
You and so many others have felt it before. You’re in the waiting room of your physician’s office, sweaty palms and tight throat going over and over in your head your list of symptoms. It’s hard to concentrate because you’re having flashbacks to the last time you felt sick and your doctor dismissed you, only to find out months later that your symptoms had gotten much worse. Or the time when your baby niece was in and out of the hospital; she had wonderful doctors but no one knew if she was going to be ok. Or the time you had to watch your dad slowly deteriorate and you made endless decisions on surgeries he should have or not. You feel lightheaded as the nurse calls you in and you think about just turning around to leave, yet your feet carry you forward into that all too familiar corridor of exam rooms as you wonder which one will host your next medical trauma.
Oh wait, did you not know medical trauma was a term? Yes, and in fact, it’s common, which hopefully validates that recognizable experience! When I say this to my clients, they often look at me, puzzled, “I thought trauma only applied to war soldiers,” or, “Oh no! My experience wasn’t that bad!,” or the all too recognizable, “You mean I have PTSD?” I validate their confusion and go on to explain what I mean:
What is medical trauma?
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), PTSD is a growingly recognizable term that applies to anyone who has experienced trauma, has a host of specific symptoms that have lasted longer than one month’s time, and symptoms are severe enough to affect your daily functioning. Symptoms might include but are not limited to:
Nightmares about the event
Flashbacks
Physiological distress when reminded of the event
Avoiding reminders of the event
Establishing negative beliefs about yourself, such as “this was my fault”
Angry or irritable outbursts
Hypervigilance
Problems concentrating
Reckless or self-destructive behaviors
The DSM-5 goes on to also define the type of events that would lead to the development of PTSD as, “exposure to actual or threatened death, serious injury, or sexual violence,” and states that the exposure may happen first hand, as a witness, learning that the event happened to a close family member or friend, or as repeated exposure to the event of someone you don’t know, such as in jobs like police officers and paramedics.
However, in my office, we define trauma as however you describe it; if it felt that way to you, then it was trauma. Most of my clients indicate that they felt overwhelmed with emotion and like they were alone in it, whether or not they were physically alone. Or I’ll ask if they felt like they were going to die, whether or not that was a truly possible reality. There’s often a choicelessness component, and we take your age at the time into consideration to help you see that you didn’t have another option but to be exposed.
Medical trauma just means that the trauma occurred in a medical situation. Sometimes the trauma is due to a physician’s bad bedside manner, but good or bad, the bedside manner always colors the medical experience. Or maybe the bad experience came from poor hospital management—like the nurses on staff took two hours to figure out which ICU room your partner was in after a terrifying car accident.
So how do I go back to the doctor’s office now?!
Whatever your medically traumatic event was, I’m so sorry that it happened to you and I want you to know that it was not ok and was not your fault. I also want to preface any further discussion by explicitly saying that this is not a medical professional hate piece—though I understand that if you’ve experienced medical trauma you may want that from this piece. But alas, the world is very complicated and people mess up and fail, despite their best intentions. So instead of laying blame, this piece is meant to inform how you can go on to recover after such a terrible experience. But that doesn’t mean that your anger or hate is invalid, it just means that this is not the main focus at this time.
For now, let’s talk about what you can do in that waiting room scene that we started with. Because as much as you may want to run from the hospital or clinic, you and I both know that you need the help of healthcare professionals.
One of my favorite tricks is to stimulate your Vagus Nerve. Your what? Yes, your Vagus Nerve is a mile-ish long nerve that wanders throughout your body from your brain to your gut. This is the main nerve of the parasympathetic nervous system—otherwise known as your “rest and digest” system. When this system is operating, we feel calm and at ease. It’s the opposite of your sympathetic nervous system—the “fight or flight” system that gets you geared up to face or escape your enemies. When your body senses trauma, this system will ignite. When you notice this, you can manually trigger your Vagus Nerve, which will calm your body, signaling to your entire nervous system that you are not actually in a traumatic situation. A few ways that you can stimulate your Vagus Nerve are to:
Take deep belly breaths, such as an inhale for the count of four through the nose, and a slow exhale out the mouth to the count of eight. When you breathe in, send the breath all the way down into the belly; you’ll know you’ve got the hang of it when you feel your belly rise and fall with each inhale and exhale. This stimulates the Vagus Nerve at many different points from your chest through your gut.
Rubbing the inside of your ear—a place where your Vagus Nerve does a lot of wondering, making it an easy place to access it. Specifically, rub at the top inside corner or in the middle of the ear.
Humming, singing, or gargling. This stimulates your vocal cords, which the Vagus Nerve is also attached to.
There’s also a therapeutic technique called “Name it to Tame it,” which means naming your feelings as a way to help you regulate your nerves. In brain scans with emotionally or traumatically activated folks, researchers ask them to name their feelings—this can be done using feelings words (angry, sad, etc) or describing sensations (like I want to run out of here, I’m sweating, etc). When this happens, neural energy switches from the amygdala (the center of the brain that controls the fight or flight system) to the prefrontal cortex (the part of our brain that is in charge of higher thinking). What I like about this specifically in a doctor’s office or medical situation, is that it also holds the professional responsible for their treatment of you. As I said, many professionals are trying their best, but they might need you to let them know how you feel emotionally so that they can help support that. I’ll often role-play this with my clients before they go to their appointment, because it’s an understandably scary step to take. This helps them to feel prepared no matter how their physician responds to their disclosure.
Lastly, I recommend to any of my clients who have specifically experienced bad bedside manners to call the clinic ahead of time and request a physician who is sensitive to medical trauma. If the receptionist does not know what that means, that’s a good indication that that particular clinic is not for you and you can move on to calling the next one. You can also look this up by reading physician bios ahead of time. Thankfully, many physicians are becoming aware of the concept of medical trauma, and understand and care about their role in your experience of that. Anyone who mentions this in their bio is a good option.
Can therapy help?
You may also want to begin to cope in between or regardless of upcoming appointments and I think that’s a courageous idea! It’s so tempting to ignore your experience, especially if you can for the most part! Those physiological symptoms, feelings, and memories that it can trigger are no joke. This is why my biggest suggestion is to see a mental health professional who specializes in trauma treatment. We can help you to process your medical trauma in a safe, non-triggering way so that you can go on to live life with the same trust and freedom that you felt before your medical trauma.
And when I say that I do this in a safe, non-triggering way, I mean it. I will not have my clients talk about, recall, or reference their medical trauma until they (1) understand that what they experienced was trauma, (2) feel that their symptoms are significant, and (3) explicitly want to talk about it. Likely, what made this event so traumatic is that you didn’t have a true choice other than to experience it, so the worst thing that I can do is to take your choice from you yet again.
And even if you agree to participate in the trauma treatment, we can start with just the physiological experience and regulate how it affects your nervous system. This helps my clients to be able to stay regulated, grounded, and centered when or if they do choose to tell me what happened. Whether we’re just working with the nervous system or talking about the experience, we only get more in-depth once you feel safe and calm about the previou step I just took you through.
In this way, you are the least likely to re-experience your trauma, which is why you’re avoiding it in the first place! I and many other trauma specialists understand and honor that, while also believing that you can and deserve to still experience life at the fullest.
How can I cope without therapy?
So what if you don’t want to go to therapy, yet or ever? That’s totally understandable and I respect that, so here are some other ways you may begin to cope with your medical trauma on your own.
Remember when I mentioned the valid anger, hate, or rage you may feel at the medical professionals, or system in general, after your traumatic experience? Well, a great way to begin to process that is to write a “no send letter.” This is where you can pour everything and anything you’ve ever wanted to say to whomever you feel is responsible (I say “feel” because often it’s complex and hard to grasp who’s responsible, especially in a hospital with a lot of moving pieces). A lot of times these intense emotions are scary to feel and/or frowned upon by others, but with the privacy of your own journal or notebook, no one can judge you and you can’t do any real damage that might scare you or that you might regret.
Oftentimes you may feel very emotional after this, or just very emotional at random times in our healing journey. I like to recommend different types of body movement in this case. General exercise is a great way to release the charge that emotions carry, and specific types of moments like dance or yoga can be particularly releasing. This is because yoga and dance involve elongated and stretched movement, and stretching stimulates the parasympathetic, rest and digest, nervous system which can help you to ride the wave of the emotion that you’re experiencing. Yoga poses that are heart openers (like fish pose) can help you to access healthy, but repressed emotions. Also, certain songs may help you to release grief or pain. The goal is to let yourself feel your reactions to the event; they’re valid and you probably were too frozen or otherwise inhibited from getting to feel and release them at the time.
It’s also really helpful, once you feel safe and ready, to talk about what you experienced. Others will be able to validate and reassure you in ways that you might not be able to. One of the most difficult symptoms of PTSD, or general after-effects of trauma, is the cognitive distortion and negative thoughts that you may develop. Safe family members and friends can compassionately help you see these distortions as just that—a thought that is not true. Furthermore, conversation can help you begin to develop a narrative of the event that you can feel at peace with, or just one that you can understand. Not all traumas end in some life lesson; some were just horrible and the fact that you survived and are here now is enough of a story. Altogether, my biggest hope is that you no longer feel alone in your experience, and the compassion and empathy of a family member or friend is a powerful antidote to that loneliness.
On the note of compassion, one last thing that I want you to know about your coping mechanism of choice is that there is no such thing as a bad coping mechanism. What you went through, in an environment that was supposed to be healing and life-affirming, may have been anything but that. What you need to get through each day after that is not for me, or anyone, to invalidate. Your choice is valid.
Now, there are some coping mechanisms that have more or less consequences or collateral damage to them. So if you’re worried that yours may have a lot, try experimenting with the coping mechanisms listed or any other creative ones you may come up with. Just take note of how you feel after you’ve experimented and compare it to how you felt after your coping mechanism of choice. If it wasn’t more helpful, then you never have to try it again. If it was, maybe try it again. No one is asking you to have it all together, just getting through each day is enough.
I hope this article helps you begin to understand, validate, and cope with your medical trauma. Maybe now you can see yourself one day, sitting in a hospital waiting room simply playing a game on your phone until the nurse calls you back. You smile at him and make small talk about the weather as you walk to your exam room. Best of all, you feel calm as you carry on with your day afterward and you’re grateful for your health just as you are every day.
