From Linda M. Rio, PWN contributor and mental health professional – In recent years, it has been more and more recognized that medical illnesses, procedures, interventions, and personal encounters can sometimes be experienced as traumatic, even leading to a mental health diagnosis of posttraumatic stress disorder (PTSD) or other stress-related mental health diagnoses. It is critical to note that the word “can” is italicized intentionally. I will discuss its significance further. Medical trauma is an extremely complex issue that I can only scratch the surface of within the context of this article. Still, I will attempt to provide at least some basic understanding for those who may want to explore this further. Experiences that can, by definition, be considered traumatic are very personal and experienced uniquely. In my experience as a mental health clinician who has worked with many pituitary patients, I can absolutely confirm that trauma has truly been experienced as a result of pituitary/neuroendocrine disorders for many, but certainly not all, of those with a pituitary disorder diagnosis.
What is a medical trauma?
In general terms, this refers to a physical or psychological injury that results from a medical event that overwhelms a person’s ability to cope. A medical trauma can be the result of a singular acute event or a series of many physical and/or psychological events. Examples of medical trauma might include a painful and/or frightening experience from an ER visit, getting a serious and scary diagnosis, surgery and its aftereffects, prolonged exposure to a medical setting, repeated painful and difficult medical procedures, and even very negative experiences with medical staff. And unlike some other forms of trauma, medical trauma is often strangely interwoven with true attempts at healing. This added complexity can make unraveling traumatic components a bit trickier.
Some people may find it difficult to categorize their experience(s) as “traumatic” because they were seeking help from “experts,” so they may think, “How can I complain about such an esteemed doctor…”. Others may find themselves obsessing over their efforts to get help from doctor to doctor to doctor and finding no correct diagnosis for years, making it difficult to let go of the anger, disappointment, and sadness of seeking help and not getting it. Family and friends may not understand, because actually no one can truly feel another person’s pain, especially when it can be so hidden, like so many of the pituitary disorders. Some family members may downplay lingering fears, saying, “Don’t complain, it’s over now, get on with life…”, or “You look fine,” when inside you don’t feel fine. Many pituitary patients have lived for years with the feeling that “fine” isn’t even a memory. Or, for some, the grief of what they have lost- the time, their physical appearance- is the trauma itself. And, for some, the trauma is about losing their very identity due to the physical/bodily changes that can result from some pituitary disorders, especially acromegaly and Cushing’s. When looking in a mirror each day brings forth shock, shame, anger, intense sadness, and loss over not even recognizing that person, this can become a daily trauma as well.
Of course, medical patients do sometimes have to experience a wide range of tests and procedures, some of which are painful and frightening. Temporary or permanent injuries do result from either medical malpractice or just the reality that even the best doctors have limitations on what they can heal. Sometimes surgeries or other medical procedures end badly because of unexpected or unforeseen complications that may result in physical pain, extended recovery, or even death. Physicians, nurses, and other medical practitioners are human after all. Most provide amazing healing skills; some make mistakes; some are incompetent; and all are merely human, doing the best they can within real-world limitations.
Differentiating Medical Trauma from a Negative Medical Experience
It is extremely important to recognize that not all medical procedures or serious life events can be considered “traumatic”. And sometimes the word “trauma” is inappropriately and overly used when it needs to be applied only to certain situations according to diagnostic definitions. When a term becomes popular in the current lexicon, it can lose its intended meaning and become useless. The problem is that if everything is seen as traumatic, then nothing is. More importantly, it’s important to remember that trauma truly is a very personal experience. Clinically, it’s also vital to assess not only what a person describes as traumatic, but also their whole life experiences. One event alone may not be experienced as a trauma, but piled on top of several similarly intense events, it can then become collectively very intense psychologically. It is also important to consider a person’s early childhood experiences, some of which may not be easily recalled but still unconsciously affect how a person responds to an event later in life. The impact of such early childhood life experiences was demonstrated strongly in the ACES research study, which showed the effects of early childhood trauma on physical health later in life.
Medical procedures and treatments are often painful, difficult, frustrating, and fear-producing. But most often these events are never experienced as “trauma” and do not have long-lasting and life-impacting emotional and psychological effects. For some, even very serious diagnoses are addressed and then mostly forgotten. An example might be someone who gets a diagnosis of cancer, undergoes radiation and chemotherapy, and recovers. This person may become anxious as their annual check-up approaches, and they may occasionally worry that the cancer could return, but most of their time is spent moving forward and feeling grateful for surviving such a major life event. Another person, long after facing the very same situation, may find themselves unable to let go of the fear of cancer returning, may have nightmares about what they had to go through, stop going out with friends due to embarrassment about having lost weight or their hair, and continue daily to experience fear in a variety of ways. The objective experiences are the same,, but the responses feel very different because these are two unique individuals with different strengths, resources, backgrounds, genetics, family histories, and more.
Healing from Medical Trauma
It is very possible to heal from a singular medical trauma or series of traumas, but trying to ignore or forget such painful experiences won’t promote the process. The first step toward true emotional healing is acknowledging the emotions felt not only in the mind but in the body as well, since the body, not just the mind, stores memories. Often,, putting a label on something experienced as negative or harmful is a first step toward mapping a path to recovery. The term “name it to tame it” is often used in recognition of the immense power a person can begin to feel when working toward overcoming the effects of trauma. An example of this for pituitary patients comes from those who have spent months to years searching for answers for their numerous symptoms yet to be dismissed or misdiagnosed. Once these patients finally receive an accurate, understandable diagnosis of a pituitary disorder, there is a strange relief, even facing something serious. They finally feel seen and heard, validated, and can finally have an identifiable path toward healing!
Another important step in the healing process is having someone – a physician, nurse, family member, friend, therapist acknowledge, truly acknowledge the intensity and power of your experience(s). But recognizing and validating someone else’s experience is not the same as agreeing with them. Empathy is not agreement. As noted above, trauma is uniquely experienced by each person. As noted above, the same event might be experienced as trauma by one person but as just a bad experience by someone else. There are, of course, some exceptions that would be universally considered as terrible and horrific, such as childhood abuse, war, torture, etc. This is why another person needs to judge someone’s experiences, since everyone experiences things uniquely based on many factors, including personal history, physical and emotional capacity for endurance, and more.
It is important to recognize that any singular trauma or series of traumas must also be assessed in the greater context of each person’s individual strengths, background, and resources. Often recovery involves assessing what resources are available to help someone move through, not past, pain. Resources can include trusted, understanding family and friends; financial help; education and intellectual capacity; cultural and community assistance; and spiritual and/or religious anchors that can support the healing process.
There are many forms of well-researched and evidence-based treatments for all forms of trauma. Which treatment modality to choose may depend on several factors, including what is covered by insurance or what is locally available. Other considerations include whether seeing a clinician in person or virtually via telehealth matters. For some people, face-to-face contact is vital, but others may prefer the distance and flexibility that virtual appointments allow. Below are some of the most current modalities offered that have been shown to be effective in treating trauma, medical, and/or other conditions. Often, psychologists, marriage and family therapists, counselors, clinical social workers, and other licensed professionals advertise their expertise and training in the following methods. They may have certifications or extensive training in trauma treatment.
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- Trauma-focused cognitive behavioral therapy (TF-CBT) was first developed to help children and adolescents heal from sexual abuse. The family therapy aspect of trauma-focused CBT attends to the problems family members may have in dealing with the trauma and tries to help the patient address unhelpful thoughts and behaviors associated with the trauma. This is a short-term intervention that typically lasts 8 to 25 sessions. Cognitive, or thinking, techniques help modify distorted or unhelpful thinking and negative reactions/behaviors. Part of this therapy is for the patient to learn to challenge negative, intrusive, unhelpful thoughts of guilt or fear. This form of treatment often uses homework assignments for the patient and family to practice at home.
- Eye Movement Desensitization and Reprocessing (EMDR). Unlike some other psychotherapeutic modalities, EMDR was originally designed for the treatment of trauma. This form of trauma treatment has been widely researched and found often to be effective in much less time than traditional talk psychotherapy. Trained and certified clinicians use detailed protocols and procedures to help clients/patients activate their natural healing processes.
- Brainspotting, developed in 2003, uses eye positions, or “brain spots”, to access, process, and release often intense emotional and body-based stress stored in subcortical brain regions. This method largely bypasses the techniques used in traditional talk therapy.
- Somatic Experiencing focuses on traumatic memories that are stored in the body and operates on the principle that psychological trauma, stress, and difficult emotions can become trapped or “stored” in the nervous system and physical body. Somatic treatment involves traditional talk therapy along with physical awareness exercises to help release tension and interrupted fight-or-flight responses that accompany the experience of trauma.
- Group therapy and support groups are available live and online. These may be led by professional therapists, paraprofessionals, or peers. Patients often find it helpful to talk with someone who has actually experienced the same illness or had similar experiences. The challenge with pituitary disorders is that since these are often considered “rare,” it may be difficult to find enough people in a single geographic area to fill a group. Some pituitary centers do conduct support groups. Online social media groups should be evaluated on a case-by-case basis, as some have strict guidelines and others do not and could potentially be more harmful than helpful.
- Medication to help address symptoms of anxiety, depression, and other mental health concerns is always an important treatment consideration. It may be important for pituitary patients to ask that their psychiatrist consult with their endocrinologist before starting any psychotropic medication, as this may interact or interfere with endocrine treatments.
- Psychedelic-assisted Therapy is listed here since, in recent years, such treatments have been highly researched with general trauma populations and have become more accepted in the treatment of trauma. Compounds like MDMA, psilocybin, and ketamine combine with professional talk therapy under strictly controlled circumstances. When used under the guidance of specially trained clinicians, these products have shown promise in treating trauma. Since these compounds interact directly with the hypothalamic-pituitary-adrenal (HPA) axis and neuroendocrine pathways, combining psychedelics introduces complex physiological risks. Use of this form of treatment is not generally accepted for those with pituitary disorders and should be carefully discussed with a pituitary endocrine specialist before considering this an option.
- Self-guided/Self-help treatment options are available. These can include books, podcasts, workbooks, apps, social media, and more. Some can be used alongside professional treatment options. Anything that brings insight, joy, soothing, or comfort can also be considered an aid to healing. Journaling, music, spirituality and/or religion, walks in nature, art, body movement and exercise, hobbies and much more can help in the healing process.
Conclusion
Healing from medical or other trauma is possible. Medical trauma involves the body as much as the mind and emotions, so treatment needs to address it all. As with all medical or other treatments,, it is often recommended that a trusted family member or friend attend at least an initial appointment and be willing to help decide the best treatment method for you, as this can sometimes be confusing. Those suffering from trauma often do not feel a sense of personal agency or the ability even to trust their own thoughts or decisions. Those suffering the effects of medical or other trauma may also be vulnerable to whatever others may suggest or what is popular at the current time. Medical trauma can also cause a mistrust in any helping professional. So, it is important to be aware of these vulnerabilities and seek another opinion or guidance whenever possible. An ethical, well-trained trauma-informed clinician will respect and understand these needs and even encourage you to take steps toward feeling as safe as possible by explicitly outlining boundaries and treatment expectations.
Whether using self-guided tools and/or professional guidance, it is important to find ways to become more self-assured and confident. As with any treatment, it is vital to feel physically and emotionally safe and always ask questions about any treatment that may be recommended. Getting second or more opinions about treatment recommendations is always important too.
“Linda is in private practice in Westlake Village, California, and can be reached atLinda M. Rio, M.A., LMFT (805) 619-0950
The book The Hormone Factor in Mental Health is available through Amazon.com and other major booksellers.Order your copy here.
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