When I was a family doctor 20 years ago, I thought the only effects of trauma were psychological and that the main symptom was post traumatic stress disorder (PTSD). Since I was not a psychiatrist, it didn’t seem relevant to my work.
It wasn’t until I left medicine in hopes of better understanding root causes of chronic illness that I learned what trauma really was and that chronic illness can be traumatizing.
Two experiences made all the difference.
First, when I retrained as a somatic trauma therapist I was introduced to research I’d never heard of in my medical training.
Second – I developed a chronic illness myself and it gave me the painful motivation to search for answers in an even more dedicated way.
*This article is also published on the chronic illness blog called The Mighty.*
I’ve had debilitating chronic fatigue syndrome (ME/CFS) for 20 years. At my worst, I was almost entirely bed-ridden for 9 months. There’s nothing like living with a disease to truly understand what it’s like – the death-like exhaustion that doesn’t improve with rest, the vulnerability, the fear that a symptom might be life-threatening, the sense that you might keep worsening until you actually die and no one will be able to help you, the side effects, the frustration and desperation when nothing works, as well as the loss of social connections and work and income and so much more.
I’ve learned a lot from being sick and looking into the research. One of the most helpful things has been the realization that having a chronic illness can be traumatizing. This understanding has also been a powerful tool in helping me begin to heal.
Here’s How Chronic Illness Can Be Traumatizing
And in #7 and #8, tips on what you can do about it:
1. Trauma is Caused by Experiences of Relative Helplessness
Trauma can be defined as any event that triggers relative helplessness. Experiences associated with helplessness – often without our consciously realizing it – include car accidents, a scary medical procedure, the sudden death of a loved one, being given a diagnosis of an incurable disease, and more. Such events trigger the same pathways in the brain as do abuse, rape or war.
2. Anxiety and Depression are Common Effects of Trauma
You don’t have to develop PTSD to know you’ve experienced trauma. Two of the most common symptoms of trauma are anxiety and depression (1)McFarlane AC, De Girolamo G. Chapter 7: The Nature of Traumatic Stressors and the Epidemiology of Posttraumatic Reactions. In: van der Kolk BA, McFarlane AC, Weisaeth L, eds. Traumatic stress: the effects of overwhelming experience on mind, body, and society. New York: Guilford 1996. p. 160. These are also very frequent in people living with chronic illness. A lack of trauma awareness means that many health care professionals treat anxiety or depression as their primary approach to our diseases, thinking these are the cause. They still-too-often believe our illnesses are “all in our heads.” Trauma science, however, explains how these symptoms can be caused by chronic diseases themselves, and from painful, frightening, unpredictable, debilitating symptoms for which there are few or no treatments.
3. Past Trauma Can Cause Chronic Illness, Anxiety & Depression
Anxiety, depression and chronic illnesses of all kinds can be caused by adverse childhood experiences (ACEs), invisible ACEs, multigenerational trauma, and institutional trauma such as discrimination due to race, religion, sexual orientation. The research explains how trauma is a risk factor for all of these symptoms. It also explains how the effects of trauma are not because we’re weak or broken or have a personality flaw, but because adverse life experiences interact with our bodies, brains and physiologies to shape long-term health (2)Shonkoff JP, Garner AS, Committee on Psychosocial Aspects of C, et al. The lifelong effects of early childhood adversity and toxic stress. Pediatrics 2012;129(1):e232-46. doi: 10.1542/peds.2011-2663, (3)Yehuda R, Hoge CW, McFarlane AC, et al. Post-traumatic stress disorder. Nature Reviews Disease Primers 2015;October:150-57. doi: 10.1038/nrdp.2015.57, shared causation p. 19-2.
4. The View that Disease is “All in Your Head” is Traumatizing & False
5. Medical Care is Often Traumatizing
Being disbelieved, judged, shamed or told that a complaint isn’t real, is a form of abuse. When the social worker snickers behind the hospital curtain or a nurse whispers outside the office door that someone’s inability to eat or get to the bathroom is due to laziness or faking it, this is also a form of trauma. Medical procedures that pose a threat to our bodies or our lives – or that are simply scary – are also potential sources of trauma (5)Alonzo AA. The experience of chronic illness and post-traumatic stress disorder: the consequences of cumulative adversity. Soc Sci Med 2000;50(10):1475-84. These are routine experiences for people living with chronic illness. The fact that these events are common, however, does not make them benign. It’s one reason that chronic illness can be traumatizing.
6. Triggers are Indicators of Past Trauma
The act of scheduling a medical appointment, going to a hospital, or having a procedure often triggers flare-ups or set backs for people with chronic illness. We may develop brain fuzz, feel shaky or have trouble sleeping before or after such events. Sometimes we avoid doctor visits altogether, despite the possibility our symptoms may get worse. We can also have flares even if we’ve gone to help a family member rather than for ourselves. These kinds of behaviors and bodily responses are evidence of more than simple stress. They are normal indications of unresolved trauma. It’s common to become more sensitive to medical environments over time. Exposures to difficult experiences and procedures accumulate when you have a chronic disease. This is an often-overlooked reason why events that seem ordinary and that we feel we should be able to easily cope with, can act as trauma triggers (6)Lawrence-Wood E, Van Hooff M, Baur J, et al. Re-experiencing phenomena following a disaster: The long-term predictive role of intrusion symptoms in the development of post-trauma depression and anxiety. J Affect Disord 2015;190:278-81. doi: 10.1016/j.jad.2015.10.029.
7. Understanding Trauma Empowers
When you begin to understand trauma, you start to recognize that your sweaty palms and increased heart rate during medical appointments may be a trauma response. You start to look for – and gradually identify – events that trigger your flare-ups. As a result, you regain power and control in your life, even if you have a debilitating chronic disease. You learn that anything that increases your sense of safety, ease, joy or connection can decrease your threat response. You learn to ask yourself, “Am I in danger?” and that the act of consciously clarifying when you’re safe can decrease or alleviate your symptoms. What you discover is that you can sometimes lessen your flares and even prevent them.
8. Trauma Perspectives Introduce Options
Once you understand how your body reacts to your own particular stressors and triggers, you have more options. You may find that you are less stressed when you can schedule appointments at the beginning of your doctor’s day so that you spend less time waiting or in the waiting room. Conversely, you may realize you do better with the last appointment of the morning when your doctor seems less rushed. You may retain more information when you bring a friend to appointments or procedures. You may change doctors when they patronize you or don’t hear your concerns. Just as each one of us becomes an expert about our own disease – understanding trauma can help us become experts in self-care and in managing our illness.
References
I really appreciate you clarifying trauma as being a factor because you totally covered absolutely everything I was feeling when I went through several procedures, tests and appointments and how I was treated by my family doctor. I didn’t know if I was going to be here to attend my Son’s Graduation from High School. It was a very traumatizing year for me and my family.
Hi Lea, I’m so sorry you had to go through so much. And to know you’re here! Thanks for writing, warmly, Veronique
Having experienced ongoing and serious trauma post-cancer treatment, with attendant physical problems and psychological distress, I appreciate the clear, cogent and coherent observations I am reading here. It is very difficult to make loved ones and close friends understand all this (“get it”) and to read these wise and compassionate words is an antidote to the loneliness and sadness that comes with trauma that others cannot see. And to spare them, we do not share.
As a researcher myself I appreciate the two-tiered approach of this blog which relates and considers cutting edge research findings in multiple fields, as well as the personal experiences, insights and observations of Dr. Veronique.
Best wishes for a continuing conversation and enlightenment on all the issues that this blog surfaces and explores. It is most validating.
Dear Marjorie – You speak to an under-recognized and all-too-common experience so many of us have with chronic illness and cancer and other difficult life experiences – which is that we do not share.
This aspect of loneliness and isolation is not often discussed and too often we do not or cannot share the full experience – or even parts of our experience – whether it relates to the traumas, difficulties with food and other sensitivities that are hard to understand if you’ve never been through it yourself, to what happened during a procedure or as a result of one, and so much more.
And this part is so true too – which is that it’s also because we want to spare others the darkness we can feel in trying to cope with our symptoms and experiences.
May our continued and growing understanding of the science of trauma help us find the light and find our way so that we really know just how “NOT ALONE” we are. Thanks so much for writing and for sharing here.
This is one reason facebook has been amazing for those with rare chronic illness, and even non-rare. I have Ehlers Danlos Syndrome, hypermobility type, and many comorbidities. When I first got to facebook, I was tickled to find like three different groups full of folks who also have EDS. I learned more from them than I had in my previous 20 years post-diagnosis. Even my doctors didn’t know the significance of EDS. (my operating dx was fibromyalgia).
Having friends to share the pains, joys, and iniquities of this ridiculous condition has helped more than I can put into words. People who understand why you don’t want to go to the emergency room, people who can laugh with you when bedridden – their value is beyond measure.
I found this article from a local friend (whose condition actually eludes a definitive diagnosis). It’s encouraging everytime I see another doctor ‘getting’ it. Thank you.
Oh Elaine what a potent way to describe the power of finding our tribes!! People to laugh with, who get the down, dark and dirty; those we can be real with – it’s so much about connection, which is the ultimate resource for so much healing. Thanks for writing!! I’m hoping to help other doctors “get it” too :-)
I wanted to ask you about pelvic pain. Have you made any specific study on that? Or written any article? My last year has been very bad because of that pain, but I am learning a lot on myself and on how to take care of me.
Point 6 of your article is very interesting!
Thanx so much for your work!
Paola
Hi Paola,
In response to point 6 about how events in the present that trigger flares can relate to trauma from the past, it is known that a history of trauma of many different kinds can affect risk for chronic pain just as it affects risk for chronic disease.
Pain can arise weeks or years or decades later and, like chronic illness, can represent a physiological survival response of a part of the body that feels under threat. Pelvic pain may therefore be linked to events from the past such as physical or sexual abuse, but it could also be from surgery or other threatening medical intervention or a lack of safety from some other experiences.
As with chronic illness, it’s not necessarily clear what each individual person’s trauma history may be and it’s not always sexual or physical abuse. The common theme is that it is something unresolved.
I did a google search and came across this article that may be helpful, and a study showing there is often a link (note that you don’t have to have been sexually abused or to have PTSD for there to be a connection to something from the past). Also note this isn’t “psychological” or “attention seeking,” but a real survival response from the body.
I hope that’s helpful!