Why a Successful Surgery Can Still Feel Traumatic

Source: Photo by Akram Huseyn on Unsplash

All too often, mental health and physical health are treated as distinctly separate. Mental health practitioners are often not trained on physiology, and medical providers are not always trauma informed.

One of the consequences of this split is that medical events such as surgery are treated as purely physical, with no consideration of the potential mental health implications. Surgery recovery is generally focused on physical outcomes such as mobility, temperature regulation, and infection prevention, all of which deserve attention.

Far less attention is paid to what happens psychologically after a major medical event.

Researchers have increasingly recognized that illness, injury, surgery, and recovery can be experienced as traumatic. As McBain and Cordova (2024) note, "There has been an increased focus on scholarly work related to medical trauma and medically induced posttraumatic stress disorder (PTSD)." While most people associate PTSD with events such as combat, assault, or natural disasters, medical experiences can also overwhelm a person's sense of safety and control.

This growing area of research challenges the implicit assumption that emotional recovery naturally follows physical recovery.

For some patients, it does not.

The prevalence of postoperative traumatic stress may be higher than many clinicians realize. According to El-Gabalawy and colleagues (2019), "Postoperative traumatic stress occurs in approximately 20% of patients following surgery, with additionally elevated rates in specific surgical groups." Although most patients recover emotionally after surgery, a substantial minority experience ongoing distress that extends well beyond the operating room.

Medical trauma differs from many other forms of trauma because the source of threat is often the body itself. Following a car accident, reminders may come from driving or passing the site of the crash. Following surgery, especially when general anesthesia is involved, unexplained anxiety, depression, and nightmares reminiscent of PTSD may co-occur. Physical pain, post-operative emotional flatness, fatigue, and uncertainty about recovery can all trigger fear and vigilance reminiscent of PTSD. All these symptoms make sense, considering surgery often includes immobilization, intubation, and insertion of foreign objects into the body. All of the aforementioned elements of surgery, while typical and useful in addressing the physical need, can be registered by the nervous system as assault trauma or sexual trauma.

Researchers have begun to recognize this distinction. Haerizadeh and colleagues (2020) explain, "Research has traditionally focused on PTSD that develops in response to external traumatic events such as military combat, natural disasters, and sexual assault. However, a growing body of literature supports the existence of PTSD induced by internal threats in the form of acute medical events."

This distinction matters because patients often judge themselves and feel ashamed of their reactions. They may think, "The surgery went well. Why am I still anxious?" or "My doctor says everything is healing normally. Why can't I stop worrying?"

The answer may be that the nervous system has not yet processed the trauma.

For patients and clinicians alike, three considerations may be helpful:

1. Successful surgery does not guarantee emotional recovery. A positive medical outcome can coexist with significant psychological distress.
2. Persistent fear is not always a sign that something is medically wrong. Sometimes the nervous system remains vigilant long after the immediate threat has passed.
3. Emotional responses to surgery deserve attention. Anxiety, avoidance, intrusive memories, hypervigilance, and other post-traumatic stress symptoms are not uncommon and may benefit from professional support.

As our understanding of medical trauma continues to evolve, recovery may need to be viewed more holistically. Mental health is a physical process, and for many patients, efforts to screen and address potential mental health symptoms are worthy of further consideration.

If You Are Experiencing Emotional Difficulty After Surgery, Consider These Three Strategies

1. Expect recovery to be both physical and emotional. Many patients prepare for pain, fatigue, and physical limitations. Fewer expect anxiety, irritability, sadness, hypervigilance, or a sense of vulnerability. Emotional reactions after a major medical event are common and do not necessarily indicate that something is wrong with your recovery, though you should always check with your medical providers to address concerns.

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2. Resist the urge to interpret every sensation. Paying attention to your body is an important part of healing. Constantly scanning for signs of danger, however, and assigning a catastrophic meaning to every symptom, can keep the nervous system in a state of high alert. Follow your physician's guidance, but recognize that not every ache, twinge, or unfamiliar sensation is necessarily problematic.

3. Talk about your experience, not just your outcome. When people ask how you're doing, they often want to know whether the surgery "worked." Recovery is more than a medical outcome. Sharing your fears, frustrations, uncertainty, or emotional reactions with a trusted person can help process the experience rather than carrying it alone.

Psychological recovery and physical recovery do not always occur on the same timeline. A person can be healing medically while still struggling emotionally with vulnerability, uncertainty, loss of control, or fear of future health problems.

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