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machado: medical trauma isn't recognized as ptsd, but it should be

we typically think of traumatic stress as being reserved for those who have survived horrific events like war or violence, but a scary diagnosis, a painful procedure or being ignored when you are in pain can also have mental health consequences.

by lisa machado

oct 14 2023

6 minute read

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what are the mental health consequences of medical trauma?

so what is it that’s so powerful that it allows otherwise unassuming sounds and smells to unexpectedly bring on a dull din of anxiety and fear? getty

“excuse me, but do you know if there is another way into this building?”

i had paused on the stairs outside of toronto’s princess margaret cancer centre to put a mask on. the voice came from the thirtysomething woman in front of me. she had her hand on the handle of the front door, but wasn’t pulling it open, apologizing profusely as three people rushed around us to get to the other door.

her cheeks were red, like the scarf she wore tightly around her head.

there was another way in, but it was a bit of walk — around the hospital and through the reams of vehicle and person traffic heading to the two adjacent hospitals. since she was pulling an oxygen tank behind her, she decided to stay where she was. except she wouldn’t — or couldn’t — open the door.

“you’d think this was my first time here,” she said, laughing nervously, as she stepped out of the way, gesturing for me to go ahead. “there’s something about the way it smells right here that i just can’t get past.”

as we walked through the door together, she explained that she had been diagnosed with a rare type of lung cancer three months earlier. her mom, who lived in another province, had met her at that very door every week at first, always with tears in her eyes, she said — there for every appointment and every meeting with a specialist — in the days when they didn’t know what was wrong. she said that things were better now that she knew what she was dealing with. plus, the radiation was working, so that was good.

“if only i could get rid of the feeling of doom that comes over me every time i walk up those stairs and smell that smell,” she said, pointing to the door behind us.

i hadn’t noticed a smell, beyond the at-times very off-putting stale coffee odour that hung in the air from the tim hortons that was just inside. but i knew exactly what she meant.

the smell of the cookies handed out by volunteers can take my breath away

for me, it’s the long ultrabright lights that run along the ceilings of the examining rooms that bring on the same shivery feeling of anxiety and fear that overwhelmed me years ago as i sat in the leukemia clinic. the incessant code blues, the smacking sound of the tourniquet as it is untied to let the blood flow into a million tubes, the gentle whirring sound of air being piped through the vents in the waiting room and the startling beeping of heart machines are hard to hear too. like the woman in the red scarf, smells are also sometimes my kryptonite. the heavy odours of disinfectant, rubbing alcohol and hand sanitizer mingling with the sweet scent of the cookies that jolly volunteers hand out with little boxes of apple juice are sometimes enough to take my breath away.

so what is it that’s so powerful that it allows otherwise unassuming sounds and smells to unexpectedly bring on a dull din of anxiety and fear? how is it that the woman in the red scarf and i can be standing in the place that has offered us options and expertise and hope and ultimately, what we need to survive cancer, and yet be overwhelmed with the sense that the worst is still to come?

it turns out that just like our brains reliably connect whiffs of apple pie to memories of a beloved grandparent, or freshly cut grass to cosy feelings of childhood, when bad things happen, our bodies “store” the emotions associated with the thing, right along with the fine details of the moment the thing happened, including smells, sounds, even objects and the location. it makes sense then, that when we encounter these smells, sounds, objects or locations again, our body reacts as if it is experiencing the bad thing all over again, because it remembers what happened the last time it smelled that smell, heard that sound, saw that object or was in that place. and while we typically think of these sorts of intrusive flashbacks as being reserved for those who have lived through horrific events like war, violence or abuse, scary health-related experiences can also take root deep within us, rising to the surface when certain triggers are present. after all, our bodies are merely processing the sense of being under threat and whether it’s gunfire or a bad prognosis, it all feels like danger.

medical trauma is also known as disenfranchised trauma

it’s not a common term in the language of healthcare professionals, according to the american counselling association , but when we “ experience of traumatic stress as a result of interactions with the medical system, which may include procedures (i.e., surgeries), new diagnoses (i.e., cancer), and professionals in healthcare settings,” it is defined as medical trauma. and c ertainly, it’s easy to imagine a health event like a sudden heart attack, a life-threatening diagnosis, or a frightening procedure contributing to medical trauma. but sometimes it’s not so obvious, says courtney telloian, a writer for psychcentral. being ignored when you are in pain, not being taken seriously by a healthcare provider, or being separated from a primary caregiver during a procedure can also cause medical trauma.

makes sense, and yet, it’s complex, says telloian, partly because healthcare professionals don’t often acknowledge the existence of medical trauma. in fact, it’s sometimes referred to as “ d isenfranchised trauma.” people also experience it differently, with different emotions and triggers for those emotions, which makes it hard to identify.

there are some common signs, though, says nic schmoyer, a doctoral student in counsellor education and supervision at virginia’s old dominion university, including i ntrusive thoughts or memories of the traumatic event; avoiding medical procedures or settings; and anxiety, depression, anger, and feelings of helplessness or hopelessness.

“it is important to recognize that there are no set symptoms for individuals who are experiencing medical trauma,” he told the philadelphia college of osteopathic medicine (pcom). “if you are experiencing a significant deviation in your behavioural health that greatly affects various domains in your life after a major medical event, procedure, or interaction, you may be experiencing symptoms related to medical trauma.”

moving through medical trauma takes work

for some, this may mean a diagnosis of medical post-traumatic stress disorder, or medical ptsd. but symptoms must meet the criteria for ptsd, including distressing memories of the event, the avoidance of memories, thoughts or emotions related to the event or not remembering important aspects of the event. and while the diagnostic and statistical manual of mental disorders (dsm-5-tr) does not specify that ptsd can be diagnosed as a result of medical trauma, he says that other diagnoses would be appropriate, such as anxiety and mood disorders.

like any mental health issue, learning how to manage and move through medical trauma takes work and sometimes the help of a professional. both telloian and schmoyer recommend a focus on treatments such as cognitive behaviour therapy (cbt) to help process traumatic thoughts and memories. but perhaps more importantly, they discuss strategies to prevent trauma from happening in the first place, including having someone who can advocate for you when you are getting medical care, or seeking the help of a hospital social worker or the internal ombudsman.

before the woman in the red scarf and i parted ways — she was heading to the radiology department and i was getting into a long line at the pharmacy — we joked about what it would take to make getting through the front door easier next time. she said she’d imagine she could see a giant glass of her favourite rosé held by a tall muscle-y man standing inside. i thought five fluffy dogs that i could take home and a bag of the best dark chocolate would do it for me.

if only it were that simple.

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thanks for reading! drop me a line at info@postmedia.com .

lisa machado is the executive producer of advocacy & better health.

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lisa machado

lisa machado began her journalism career as a financial reporter with investor's digest and then rogers media. after a few years editing and writing for a financial magazine, she tried her hand at custom publishing and then left to launch a canadian women's magazine with a colleague. after being diagnosed with a rare blood cancer, lisa founded the canadian cml network and shifted her focus to healthcare advocacy and education.

machado: medical trauma isn't recognized as ptsd, but it should be

we typically think of traumatic stress as being reserved for those who have survived horrific events like war or violence, but a scary diagnosis, a painful procedure or being ignored when you are in pain can also have mental health consequences.

machado: what if living in the moment isn't that good for you after all?

machado: hey quiet quitters, you have one life. why spend it doing the bare minimum?

the smell of the cookies handed out by volunteers can take my breath away

medical trauma is also known as disenfranchised trauma

moving through medical trauma takes work

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machado: medical trauma isn't recognized as ptsd, but it should be

we typically think of traumatic stress as being reserved for those who have survived horrific events like war or violence, but a scary diagnosis, a painful procedure or being ignored when you are in pain can also have mental health consequences.

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the smell of the cookies handed out by volunteers can take my breath away

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medical trauma is also known as disenfranchised trauma

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moving through medical trauma takes work

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