I made excuses for over two years before allowing my male primary care doctor to complete a thorough physical exam. He turned down my request to be examined by a female physician. Over time I agreed to be examined by my male doctor because I was afraid of being branded as too demanding and unreasonable.
The early morning visit began with my attempts to explain that I am a trauma survivor.
Although my brain understands that you are a reputable doctor, this will still be a very stressful exam for me, and I may get overwhelmed. If you allow me to sit quietly and rest for a moment after the exam I will be okay.
I have been in recovery for a long time and have learned a lot. But when I experience overwhelming stress I can be transported from reality to full immersion in the original trauma. My vision, thoughts, sensations in my body, and view of the world are filtered through my past trauma. It is as if I am in the midst of the original trauma. This can happen seamlessly, without my knowledge and without warning.
Suddenly I may look, talk and respond to a reality to which you are not privy. Some people conclude that I am psychotic. I am not. I am reliving the past trauma.
I wanted to let you know this because when I am in this state my actions are driven by fear and terror. Other people, including providers, have misjudged my motives. I have gotten mistreated, ridiculed, and even hospitalized. Their responses only heightened my terror. I thought if you knew this, if suddenly I behave in ways that seem incomprehensible, you will understand that my behavior is because I am experiencing a flashback. Then maybe you could help me.
He remarked, “Trauma? That is outside of my territory. I don’t deal with trauma, psychology or any of that stuff!”
He seemed angry. His touch was rough. His voice was scary. My heart sank.
I guess you can imagine how this unfolded. Shortly after this experience, I was hospitalized for three weeks.
Survivors in recovery from trauma, mental illness, substance use disorders, and homelessness, may resonate with this type of experience when they seek physical care. Unfortunately for us, trauma is not a discrete psychological event. What’s more, our bodies remember and release our past experiences through physical sensations that can occur in the absence of any real memory content. So we show up at the emergency room writhing in pain, sure of some illness. Often in my case, the original pain—the original trauma— is one that occurred during and in the aftermath of giving birth to my child at home with my aunt, a nurse, and my mother. I was 13 years old and thought I had a tapeworm inside of me. Other times, it has been the savage beating I experienced after breaking a minor family rule. Occasionally it was the pain that occurred when my father simply wanted to vent and transfer his rage to me. His actions left me terrorized and suffering alone and with no hope.
In these altered states of reliving victimization from the past, I am often the last to know it is not real. I can’t always discern that I am really dealing with a memory instead of a medical crisis. Like so many survivors, I get ridiculed, blamed, and labeled as a malingerer when my level of physical pain and feelings of being severely ill are not borne out in medical exams, scans or lab results. The pain is real but the injuries are not visible because my body is remembering what has happened. As Dr. Bessel Van der Kolk so eloquently writes, “The Body Keeps the Score.”
In seeking health care I repeatedly get victimized by others who are unaware of how trauma affects the body. They use many different labels and to my dismay they all mean the same thing: liar or crazy. Now in addition to the past trauma and its impact, I am continuously victimized by people who are supposed to know better and provide help. The words and dismissals are hurtful and leave wounds to my self worth and sense of safety. My original predator wins again as I am left alone and still in pain and suffering.
In 1980, the diagnosis of posttraumatic stress disorder (PTSD) was included in the third edition of the Diagnostic and Statistical Manual of Mental Disorders. Creating a PTSD diagnosis was a critical first step in naming the often overwhelming and disabling somatic and psychological symptoms that followed exposure to war and other traumatic events. Yet, from its inception, it has been clear that the diagnosis of PTSD captures only a limited part of posttraumatic responses. Many studies suggest that complex but consistent patterns of psychological disturbances occur in traumatized children as well as in adults who have been exposed to chronic, severe interpersonal trauma at any time in their lifespan. In particular, research shows a pervasive negative impact of chronic and cumulative childhood abuse and trauma on the developing child and later on the adult.
I bear witness to the lack of trauma-informed care and beg all providers to use a universal precautions approach to providing medical care. Survivors are not trying to subvert the system or get attention. We are guilty of experiencing real symptoms of traumatic stress, becoming suddenly immersed in a terrifying prior experience, and being trapped in a traumatic memory.
Do you believe that universal trauma-informed care is an essential component of healthcare? If so, why do you think health care providers don’t understand this?
Share your thoughts with your colleagues!
Image via Yuya Tamai (CC BY 2.0)
