Post Traumatic Stress Disorder and Illness

I recently received an email from a reader of this blog. The author nursed his wife back to health from cancer. Now that she is doing better, he suffers from "shell shock." Her every cough and pain sends him reeling back into the fear he lived with when he thought she might die.

PTSD - Post Traumatic Stress Disorder is a condition that trauma sufferers can experience. It can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD are usually considered to include violent personal assaults, natural or human-caused disasters, accidents, or military combat.

People with PTSD have persistent frightening thoughts and memories of their ordeal and feel emotionally numb, especially with people they were once close to. They may experience sleep problems, feel detached or numb, or be easily startled.

Why am I writing about PTSD in association with this man whose wife is a cancer survivor?

Surviving illness, recovering from a potentially terminal disease, finding relief from pain and suffering are all joys to be celebrated. So where does PTSD fit in?

I believe that just as war and violence serve as external threats that damage the body and warp the spirit, so too can debilitating illness serve as an internal threat that harms body and soul. The result of living with this protracted internal threat, illness, can also trigger PTSD, long after the illness has abated or been controlled.

Violence contaminates the lives of its victims. During the abuse or the disaster, there is no escape from either experiencing fear and pain or anticipating fear and pain. One's world shrinks to the size of a tiny circle charged with the terrible energy of violence. Even after the violence ends, its energy continues to saturate the life of its victims.

Life threatening illness, chronic pain, and debilitating health conditions are also violent traumas -- to the body, the mind, and the spirit. Even if the illness is cured or the symptoms relieved, the reverberations of the stress the illness caused can continue for a long time.

When my pain condition was unconrollable and at its worst for months on end, there were no walks around the pond, no movies, no tasty food, no socializing -- there were only degrees of pain. Psychologically, being tortured from the outside may have different meaning than being tortured from the inside, by your own body, but the ongoing stress, exhaustion, fear, and constriction are just as powerful.

And if you share your illness experience with a committed partner, that partner suffers his or her own trauma and also lives inside the circle of fear.

For months, even years after my pain was under control, I trembled at the slightest pain ripple and re-experienced myself curled up on the couch in a fetal ball of hurt and desperation -- a position I could often be found in during the bad old days.

For months, perhaps a year after pain was not the determining factor in our lives, Richard still watched me like a hawk. Scanning. Vigilant. Looking for the tiny clues that used to signal an impending pain attack. I could hiccough, burp, groan after watching a bad movie, or rub my belly after eating too much and Richard would bark, "What's the matter?" as if he were a watchdog on alert. His morning greeting remained, "How are you doing?" for a long time. When he finally switched to "Good morning" we both smiled.

Living with serious illness, suffering the invasiveness of medical tests and surgeries and drugs, waiting for results, living in a closed circle of fear, being unable to govern your own body, enduring pain and exhaustion -- all this is a persistent traumatic ordeal that can result in "shell shock," in PTSD.

In an upcoming post, I will write about what couples can do to address the PTSD of illness.

Grands Round is Up at Emergiblog

It's a good read of this week's best posts from the health blogophere. It's up at Emergiblog

Valentine's Day Wish For You

My valentine to all you couples who are living with illness. May you find respite in each other.

from The Garden of Love
by William Blake

Love seeketh not Itself to please,
Nor for itself hath any care;
But for another gives its ease,
And builds a Heaven in Hells despair.

MBTI & Illness: Judgers and Perceivers

In my previous articles about MBTI, a widely used personality profile instrument, I wrote about the four dimensions of personality preferences MBTI measures and about one dimension in particular - Thinkers and Feelers.

In this post, I write about another dimension of personality preference- the dimension that is about one's basic orientation to the world. Within this dimension people tend to have a preference for either Judging or Perceiving.

Judging does not mean being judgmental. Rather it means that one prefers to move towards organization and closure -- to consider a defined set of options, make a clear choice, and head toward action. A Perceiving preference means that one likes to remain flexible, adaptable, and to keep options open and add choices to the mix.

Neither preference is better. And we all have both Judging and Perceiving capabilities and can be both flexible and decisive. But, we tend to have a natural affinity for one or the other.

I have a strong preference for Judging. Richard has a strong preference for Perceiving.

If I am hungry, I like to decide what food I want, pick a restaurant, and get in the car. Richard likes to play what he calls "the restaurant game." He likes to keep throwing out cuisine and restaurant choices up until the moment we arrive at the door of the restaurant we had originally agreed we would go to. For him, this is creative. For me, this is madness.

How does this Judging-Perceiving difference play out in terms of illness?

My pain condition was (and is) a diagnostic mystery. This meant that I saw dozens of specialists in different disciplines and had dozens and dozens of tests. The ongoingness of this experience and the increasing number of options for diagnosis and treatment pushed me so far out of my comfort zone that I fell off the edge of reason and landed into a stinky puddle of blithering anxiety. I wanted the answer!

In the face of the unknown, Richard was reassured by the plenitude of options. His mantra became, "There's always someting more to try." Each successive doorway was a portal that could lead to something that might work to quiet my pain. Another thing to be tried was another reason for hope.

Understanding MBTI gave us tools and a language for harmonizing our differences. He wasn't a foolish dreamer; and I wasn't a narrow-minded dogmatist. We were just different. I'm a "J" and he's a "P."

Richard learned to temper his plasticity with some empathy for my frustrated drive for certainty. And I learned, when the known doors closed, to find some solace in his faith that something else, some healer or medication waiting just around the next corner, might work.

Couples and Money Management

From Publishers Weekly - a book review about financial management. While not specifically about couples who are dealing with illness, it sounds like a useful resource.

Financially Ever After: The Couples' Guide to Managing Money Jeff D. Opdyke. Collins Business, $16.99 paper (240p) ISBN 978-0-06-135818-0

Opdyke, Wall Street Journal columnist, offers a sensitive and sensible manual for peaceably handling marital finances. Many newlyweds have difficulty handling the transition from being an independent agent, who can overspend like mad or pinch every penny till it screams, to a partner working to manage joint finances—the communication issues that crop up are myriad. When inevitable issues of power, independence, self-esteem, security and control come into play, the resulting arguments or silent avoidance can lead to terrible financial mistakes. Opdyke gives clear advice on managing both the real dollars and the real emotions of personal finance that course through every relationship, including scripts for questions partners should ask about each other's financial history, and gives cogent, easy-to-follow plans for the division of financial duties, budgets, prenuptial agreements and home-buying, particularly in light of the credit crunch. With its compassionate and pragmatic tone, this book is invaluable for newlyweds with stars still in their eyes—and longtime couples struggling to balance the emotional with the financial and ensure a healthy, thriving life together. (Apr.)

Grand Rounds is Up

at Not Totally Rad. It's a good read.

Patrick and Lisa Swayze Face His Cancer Together

From an article in Examiner.com about Patrick and Lisa Swayze's plans for writing a memoir together as they face his pancreatic cancer. This is their way of reconsecrating their relationship and love as they are dealing with the pain and turmoil of cancer.


"Swayze and wife Lisa, gave a touching and powerful interview about their 36 year relationship with Barbara Walters, which aired on January 8th. The couple told Walters about their belief that they were soul mates and had known each other before. Swayze credited his wife's support with his ability to endure and face his illness "with gracefulness."

Lisa revealed that when she first heard the news about his cancer and prognosis she said, " How dare you, you have to stay here." They both agreed that had this situation been reversed, he would have had an angrier reaction than Lisa.Understanding how they each react, can help them better support each other.

The Swayzes are doing many things that are helpful for couples facing a life threatening illness. They are discussing not only the impact of the illness on the everyday functioning of their lives, but also reflecting on how grateful they are for the life they have shared together.

They also recently renewed their wedding vows which can help couples ritualize their commitment to one another. The memoir may also serve as an important way of memorializing and understanding the life they share. The words on the printed page can make their experiences more concrete and provides an enduring legacy in a way that verbalization of their memories can not."

The courage to review their lives together,at this sensitive time, can provide inspiration to other couples who may be fearful that this would mean they were saying goodbye or giving up hope. Although it may be emotionally painful, this shared intimacy can actually be helpful to better cope with the challenges ahead."