As a mental health professional in a hospital setting, I frequently bear witness to the lasting effects of medical trauma. I have worked with people who had to be intubated due to COVID-19, people who were prescribed opioids only to later be informed of their potential for harm, and people who refused needed treatment due to past harm at the hands of medical professionals. Medical trauma — experiencing a threat to life or bodily integrity while receiving health care — is extremely common and has only increased in the wake of the COVID-19 pandemic. Even in the absence of a specific trauma, the stressors of navigating a confusing system, facing surprise medical bills, or having concerns dismissed by providers can have similar negative effects on our health, well-being, and relationships.
The good news is that our minds and communities are incredibly resilient in the face of trauma and stress. In addition, our healthcare system is becoming more aware of the need for trauma-informed care. Below, I have provided some general advice for maintaining resilience, seeking help, and rebuilding trust if you or someone you know has experienced medical trauma. However, this advice may not apply to your specific circumstances, and should not take the place of advice from healthcare professionals involved in your or your loved ones’ care.
Traumatized does not mean broken
Even well-meaning people who want to reduce stigma around post-traumatic stress disorder (PTSD) can end up perpetuating the idea that trauma necessarily leads to severe long-term problems. The fact of the matter is that most people will experience only temporary, although no less real or painful, distress after a medical trauma. Suggesting that these emotions are signs of mental illness can be dangerous — early psychological efforts to debrief immediately after a trauma were actually found to increase the risk of PTSD. This unfortunate outcome may have been due to fostering an expectation that those affected by trauma would experience specific PTSD symptoms afterward. Everyone processes trauma in their own way. Allow yourself to feel all of the unpleasant emotions, without worrying that they will certainly turn into unhealthy patterns.
Traumatized still does not mean broken even if medical trauma does lead you to think, feel, and behave in ways that cause you or others long-term distress, or get in the way of your goals for life. You can learn how to cope with these patterns and change them for the better. The key is recognizing when these patterns are getting in our way and knowing how to seek help.
Resilient does not mean okay
Just because you do not suffer long-term mental distress does not mean that the trauma didn’t affect you. Experiencing fear, anger, sadness, or other unpleasant emotions in the wake of a traumatic event is normal and healthy. Our emotions are signals about our environment, and we want them to be responsive when our life or well-being have been threatened. They prompt us to engage in protective behaviors to minimize the threat.
At the same time, these emotions can be very difficult to face on our own. They may also provoke unhelpful responses from others, who might dismiss these emotions due to their own discomfort with fear, anger, and sadness. This minimization can lead to a vicious cycle — where someone who has experienced trauma feels like they need to “prove” how badly their trauma has affected them to make others confront and acknowledge their pain. It’s important to remember that it is okay to not be okay. You deserve to have people in your life who are able to empathize with your feelings, without catastrophizing over healthy negative emotions.
Learn when to seek professional help
One of the key signs of PTSD is unhelpful forms of avoidance. For example, you might find it so difficult to spend time in a doctor’s office or hospital that you avoid needed care altogether. On the other hand, you might be so afraid your doctors will not find something wrong until it’s too late that you seek out unnecessary, expensive tests to make certain nothing is wrong. Both of the best-researched psychological treatments for PTSD, prolonged exposure and cognitive processing therapy, attempt to overcome this avoidance in different ways. They involve exercises that help you directly confront the thoughts, feelings, and experiences your anxiety is telling you to avoid. In doing so, you can retrain your brain to recognize these triggers are not as inherently dangerous as your anxiety would lead you to believe. Furthermore, your therapist will help you to develop coping strategies to handle your feared outcomes if they do come to pass.
PTSD is not the only mental health condition that can be caused or worsened by medical trauma. Depression and anxiety are also common. These conditions can also be exacerbated by experiences that might not qualify someone for a PTSD diagnosis, but nevertheless cause tremendous amounts of stress. Treatment should be trauma-informed, but may not need to address the trauma directly in order to be effective. It can be easy to get stuck on the thought that “I am this way because of my trauma.” However, there are tools and strategies that are helpful to deal with mental health disorders regardless of their cause.
Healthcare professionals are people too
Unlike most other traumatic experiences, seeking treatment for PTSD due to medical trauma requires engaging with the source of the trauma. This aspect of medical trauma can actually facilitate healing, since PTSD treatment often involves entering into situations that remind you of the trauma and fostering corrective experiences. Reacting strongly to a medical situation is understandable in the context of PTSD. However, not every healthcare professional you interact with will know what happened to you or how it informs your behavior. This lack of understanding can lead to unhelpful responses that can appear to confirm negative beliefs stemming from your traumatic experience. For example, a doctor who tries to reassure you that “everything will be fine” out of a well-intentioned desire to decrease your anxiety may only exacerbate your fear that they are going to miss an important warning sign that something is wrong.
Another unfortunately all-too common reaction from healthcare professionals is to become defensive, especially if someone who has experienced medical trauma is vocal about the harms they suffered and distrust of the medical system. It seems like a simple ask to hear a healthcare professional say, “I am part of the system that failed you, and I am sorry.” Even those of us who are trained to monitor our own reactions can struggle with this. We can feel powerless to change a system of which we are only a small part. It is also hard to admit that we may make a mistake that leads to someone experiencing harm. Recognizing these difficulties does not excuse healthcare professionals’ defensiveness, but it may help you understand where this defensiveness is coming from and effectively advocate for your needs.
Trust is a process
In a similar vein, one of the most devastating aspects of healthcare trauma can be the sense of betrayal. Whether your experience involved a known medical error or not, the fact that those whose job it was to keep you safe and healthy failed can feel like a breach of trust. You might not be quick to put your life back into someone else’s hands, and that is valid. When rebuilding trust, it can help to start small. Ask yourself “who can I trust for what purpose?” Even if you’re not ready to trust a healthcare provider with your life, can you trust them to be upfront with you? Can you trust that they are doing their best with the knowledge and resources they have? Figure out the limits of your trust and build from there. Ideally, all medical decisions should be made in the context of a collaborative decision-making process where the risks and benefits are clearly communicated and discussed. Let your provider know when you need more information, and where you need more support and time before trusting their judgment.
The final principle to keep in mind when healing from medical trauma is that your healthcare should be centered around your values. Our culture often holds up health as a value in itself, to be prioritized above all else. Medical trauma threatens that belief. It can feel like a failure to live up to our societal obsession with health. Keep in mind that you can value your health only insofar as it enables you to live the life you want to live. If your reactions to medical trauma are getting in the way, know that help is available and there is hope. You’ve already survived so much and have incredible strengths to draw from and build upon. You may not always look or feel “healthy” in the ways promoted on social media, but you can find meaning in your journey through medical trauma. There are folks waiting to help, if you open yourself up to trust.
