A lesson on trauma: a personal story

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 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 and was told something along the lines of, "This will make you 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 companions. The elevator descended a floor or two, the doors opened, and the suite of operating rooms was before my eyes.

Then, all hell broke loose.

I sprang 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 for an invasive biopsy. I have an irrational dread of the upcoming procedure. While going about my business as the day nears, 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 experience it as if I will be subjected to an execution by lethal injection. As irrational as this all is, my thoughts are resistant 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 myself in the hours before the procedure.

Later that day, I get a call. Given the era of litigious patients and hungry lawyers, I'm not surprised when I am told not to take the pills until I have signed all consent forms—just hours before the operation. Lacking the anxiety pill, I'm forced to remain on the anvil of dread. The sole upside is that, as a mental health professional, I’ll be interested to see 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 my mental suffering to good use: I have gained some insight into trauma. Here is what I have learned from the anvil of dread.

Throughout my life, I had not paid much attention to the fact that I had been traumatized as a three-year-old. PTSD is associated with a hyperactive amygdala, the brain’s center of fear. The latter has links to centers in the brain that set off hormones related to "fight or flight." There are also links to higher cognitive areas of the brain, which have the potential to calculate risk, 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 reacts to a trigger much like a healthy person experiences a reflex: if someone claps their hands unexpectedly behind a person, they jump—the rational mind is not in the neurological loop.

What I experienced—and then learned from—my psychological ordeal is that the circuits responsible for higher cognition are mute compared to the fight-or-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 whose job it was to protect me. In short, I couldn't think my way out of the dread, nor was I reassured by others.

Yet, upon arriving at the hospital, something happened to calm my nerves—a powerful, almost magical something. 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 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 in them. The social support was like a net that allowed me, in quite an unselfconscious way, to calm my nerves. There are powerful connections formed in certain types of groups.

I suspect that we will have much to learn in the future regarding the neuroscience behind social experiences that help with PTSD. On a scientific front, the psychedelic sciences are giving us hints as to 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, etc., may well tap into the brain’s natural potential 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.