When I was three I was taken to the hospital in the afternoon for a tonsillectomy the next day. This was almost 70 years ago, a time when parents didn't remain for the overnight, preoperative sedatives were limited, and anesthesia consisted of ether delivered through a mask.
I have limited memories of this experience: I was an adventurous little fellow and don't remember missing my parents. Rather, the staff were friendly and I assume I responded to their kindness.
The morning of my surgery while still on the ward I was offered a little pill being told something along the lines of it would make me sleepy. Being a competitive little fellow I determined to resist the effects of the pill and succeeded. Soon, a couple of orderlies greeted me at my bedside offering a ride on their gurney. There was an elevator and I recall a friendly and spirited conversation with my two companion. The elevator descended a floor or two, the doors opened and the suite of operating rooms was before my eyes. Next, all hell broke loose. I sprung from the gurney in a panic and ran down the hall. I was overwhelmed by bigger people and my last memory was of a nurse pinning my shoulders down with her knees, then finally a mask and the sweet smell of ether.
Decades later I am facing the prospect of general anesthesia to allow an invasive biopsy to be performed. I have in irrational dread of the upcoming procedure. While going about my business as the days to the procedure near I have intrusive thoughts and images. In anticipation, I visualize the procedure: images of the moment I get the knockout drug are accompanied by a mild sensation of suffocating as I imagine my breath being taken from me. I picture gagging as a speculum is inserted into my mouth to establish an airway. I know none of this will actually happen but my body's response to these thoughts tells me otherwise. The dread is such that I'm experiencing things as if I will be subjected to an execution by lethal injection. As irrational as this all is, my thoughts are refractory to reassurance.
During my pre-op exam a few days before the biopsy I share my dread with the examining doctor calling it a 'phobia.' My anxiety is noted in the chart and I am offered two Ativan pills to settle my self in the hours before my procedure.
Later in the day I get a call. It being an era of litigious patients and hungry lawyers, I'm not surprised when I am told not to use the pills until I have signed all consent forms for the upcoming procedure which will occur just hours before the operation. Lacking the anxiety pill I'm forced to remain on the anvil of dread, the sole upside being that as a mental health professional I'll be interested to seeing how this all plays out.
I speak now from a position of comfort and safety, the procedure is done and all went well. I'm proud that I put to good use the mental suffering I went through: I have gained some insight into trauma. Here is what I have learned off of the anvil of dread.
Throughout my life I had not payed much attention the fact that I had been traumatized as a 3 year old. PTSD is associated with a hyperactive amygdala, the brain's center of fear. The later has links to centers in the brain that set off hormones related to 'flight or fight.' There are also links to higher cognitive areas of the brain that have the potential to calculate risk, perhaps accept reassurance, and devise plans to contend with a threat. However, in PTSD the primordial circuits predominate and act almost like a reflex. A person with PTSD is reacts to a trigger much like a healthy person experiences a typical reflex: if someone claps there hands unexpectedly behind a person, they jump, the rational mind is not in the loop neurological loop.
What I experienced and then learned from my psychological ordeal is that the circuits having to do with higher cognition are mute in comparison to the fight and flight connections. It did little good to remind myself of the safety of the procedure, that I would be surrounded by well meaning and well trained professionals who job would be to protect me. In short, I couldn't think my way out of the dread, nor was I reassured by others. Nor did it help to hear the reassurance of the professionals that would be working on me.
Yet on arriving at the hospital something happened to calm my nerves, a something that was powerful, almost magical. I think it had to do with the social aspect of joining the hive of people at the hospital. All of the staff were very kind. I felt better not because I was getting reassurance, but because I was responding to their warm and relaxed demeanor, in effect I felt a part of their tribe. I had a sense of belonging. The social interactions with clerks nurses and doctors were like a two way street. They were interested in me, and I them. The social support was like a net that allowed me in quite an unselfconscious way to calm my nerves. There powerful connections are formed in certain types of groups.
I suspect that we will have much to learn as the future unfolds regarding the neuroscience behind the kinds of social experiences that are helpful with PTSD. On a scientific front, the psychedelic sciences are giving us hints of how the reflexive circuits of PTSD can be softened. Ketamine researchers for example tell us that the drug has the potential to biologically modulate fear circuits in ways that rational pathways from the frontal lobes activated via traditional counseling may not. Newer experiential therapies, yoga, somatic therapies, etcetera, may well tap into the natural potential for the brain to heal itself in ways that are ahead of our ability to explain scientifically.
It was painful experiencing the anvil of dread but I am grateful that I learned from it. It has shaped me.