After the Diagnosis

Living a rich, full life with chronic illness.

by Julian Seifter, M.D., and Betsy Seifter, Ph.D.

Trauma and Illness

A trip to the dark side

Published on December 15, 2010 by Betsy Seifter, Ph.D. in After the Diagnosis

"Trauma" means injury, from the Greek "to wound or pierce"; in its root sense, it's a blow to the body, but as anyone who's watched Oprah knows, it also refers to emotional wounds. What begins in the body often spreads to the mind; in post-traumatic stress disorder (PTSD), a physical assault triggers a mental disorder involving hypervigilance, numbness, depression, anger, flashbacks, social withdrawal.

Chronic illness is traumatic on both levels--the physical, obviously, but also the mental and emotional. People who are ill very often display classic symptoms of post-traumatic stress, even if they don't have the full-blown disorder. Some who are ill develop a veil of impenetrability--you can't see in (and it's possible they can't see out). Others are in chronic combat mode--"you talkin' to me?"-- and still others spend all their time on the lookout for the next symptom or exacerbation. In After the Diagnosis, Cathy, with her undiagnosed fibromyalgia and her hypersensitivity to pain; Beverly, who was angry, obsessed, and given to far-fetched explanations involving someone-or-other's malfeasance; Bill, who claimed he was fine as he resisted any argument in favor of further treatment--all show symptoms of traumatic stress. It's no surprise that illness can end up running the show, in some sense, when the pain of being sick is so difficult to bear.

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Patients who do well with their illnesses may simply be lucky--the symptoms aren't that bad, or can be well controlled--or they may be temperamentally resilient, inclined to forget their deficits. But for some, it might be better not to shrug off problems, but rather to acknowledge the dark side. By recognizing the traumatic aspects of illness the ill person can potentially break through denial, modulate obsession, lessen rage. Group therapies for people who've been in battle or sexually assaulted have in common a "telling" of the trauma, which robs it of some of its power to haunt; support groups for the chronically ill have a similar expressive function, as patients trade stories of their symptoms, surgeries, and treatment regimens. And a consequence of this "being in touch" with the pain-with the anger, preoccupation, sadness- can sometimes, over time, be a road to putting the illness in its place. It is part of life, sometimes overwhelmingly so; but it might not have to be all of life.