I have written about PTSD several times here at the Kos. And because I saw a story on Science Daily about Pregnancy and PTSD, well—here we are again. This story was a little better than some of the other tripe I have read about women, PTSD and pregnancy. But in these little blurbs, there is not enough room or time, to put things in these stories that needs to be communicated. Sometimes things, that the medical professionals simply do not know or cannot include for whatever reasons.
I went through pregnancy twice with PTSD. And both times I specifically sought the services of independent midwives, because my experience with conventional medicine and PTSD has been very disappointing. It was also disappointing with the cancer treatments as well.
Conventional medical personal seem to know less about PTSD than they do about breast feeding, and that is saying something. What this means to any women seeking any kind of medical treatment? The possibility of being triggered over and over by well meaning or perhaps disinterested or ignorant staff, during serious medical events that can leave us curled up in a ball for months at a time.
For me, as it is for some other people, medical situations are one of my main triggers. That means just being in a facility being in the midst of doctors and nurses is on some very deep levels absolutely terrifying in ways that I cannot always give voice to. But for years I worked on my communication skills so that I could talk. Because PTSD turns this normally articulate, intelligent woman, into a blathering idiot, studdering, sometimes shaking, heart racing, clammy hands, cold sweat—the whole 9 yards. What I learned is that any situation that makes you feel helpless can act as a proxy for your regular triggers. And serious medical events—those usually involve in large degree, feeling helpless.
But hey, I was working on my communication skills. If I just tell the people working on me that I have PTSD, they will know what to do right? WRONG! Numerous times I have dealt with medical personnel who literally didn’t know what PTSD stood for, and still required a detailed explanation after you decoded the acronym. --Okay, so now they will remember what to do yes? NOPE.
Your status in their eyes just dropped to about on par with crazy homeless bag-lady who eats checkers. When you have these special conditions, they aren’t grateful for you giving them a heads up. They are annoyed because this means that either you are a hazard in some fashion, or a hypochondriac, or just some new form of a pain in their ass. You see people are not above shooting the bearer of bad news (the messenger that is) even if they are lying in a hospital bed.
And there have been times when I perceived that this news, not only didn’t make things better, but that this information caused negative behavior in medical professionals. Remember I am a pain in their ass, I am a nutter, and I am in their way, so it sucks to be me. I have had people be extra rough with needle insertion, refuse to make eye contact with me while taking blood or giving intravenous medication (even after politely requested). And medical setting and personnel are my main triggers, so guess what they just did?
Yea, that.
So when I found out the first time, that I was pregnant, I knew better than to go into a conventional medical setting if it wasn’t absolutely, medically necessary. And it wasn’t. But for the first month of my first pregnancy, I did have daily freak-outs about what to do. I feel very lucky that someone suggested midwives.
This was many years ago. When many people didn’t believe that the terrible things that happened to women in the military were as bad as reported. And that women, because they didn’t go into combat couldn’t possibly get PTSD---because only male combat vets get that. So there was no “help” for me from any quarter. In fact, the kind of treatment I am getting now (out of pocket), EMDR had only been used in this country by a few therapists for about 3 or 4 years. Not something easily found yet on the economy.
But what about now?
You cannot treat people who have this condition with a cookie cutter mentality. This isn’t a virus or a bacterium where one can prescribe the right pill to alleviate these symptoms. This is a condition that requires the medical practitioners to be mindful of the patient in a very personal way. You see, what sets me off, may not set other people off. All our triggers are different, our symptoms are not identical, nor is our reaction to PTSD the same. That means real communication has to take place, it cannot be prefunctory. This isn’t a checklist one must mark, but a patient you need to do your best to comprehend and not re-traumatize.
Having PTSD makes you feel like you are into kink somehow. Because it feels like you are constantly informing people of your safe-words. It’s weird.
But if you go into setting and make a pregnant woman feel helpless, afraid, and without a voice, if she becomes combative, that’s not her fault. That’s yours as a medical professional who failed to take the proper steps to allow for her condition.
All pregnant women should be cared for in a way that makes them feel safe. The problem is the medical community is rife with paternalistic attitudes, so much so, that they often cannot distinguish between safety and absolute control. Controlling the patient makes the doctor feel safe, but he or she doesn’t necessarily understand that it might freak the patient right the fuck out. They are under this mistaken impression, that if they forcefully take full control of a situation that this will make a woman feel safe.
All that does for many is make her feel helpless and without a voice (hello trigger). FYI a trigger is not the Lone Ranger’s horse.
We get the “don’t worry about that right now.” which is the equivalent of telling someone with major depression to just “snap out of it!” PTSD is all about intrusive thoughts and flashbacks. Telling us not to think of our personal elephant is like taping our mind’s eye open to the pink elephant scene in Fantasia for 72 hours straight.
It’s like treating someone after a major trauma like a terrifying car accident, or a bomb blast, or a house fire, where they barely escaped with their lives. That means you—medical personnel need to be mindful of this and take the time to be extra gentle, to take extra steps to communicate what you expect or want, and actually listen to the what the patient is saying. Because forcing the issue, holding them down, yelling at them? All you do is feed the PTSD beast, and force the already planted seeds of distrust to bloom like hot house flowers in seconds. Trust that might not ever be won back. And might cause the person to avoid you and all treatment in the future.
What happens if you force a pregnant woman to let a medical team she doesn’t trust or like, treat her pregnancy? Nothing good. The added stress leads to what? More medical interventions. Now imagine that with PTSD.
FYI PTSD isn’t about phobias or paranoia. We get that a lot too. Phobias and paranoia are about unreasonable fears that are improbable or even impossible. They are malfunctions of the brain. PTSD is about reliving something that however improbable or unlikely, actually DID happen (sometimes more than once), it’s about actual memories of surviving something horrific. So pretending that she or he is having an unreasonable response to an imaginary fear is truly insulting and you just showed your patient that you got your head up your ass. So much for your professional credentials!
If she is a woman with PTSD, especially in the long term, then she might not have a very good support system. It is the nature of the PTSD beast to self isolate. Your friends and family cannot help you, and often do not know what is wrong with you, and because your behavior can be angry, fearful and erratic, then over time, you wear away and isolate yourself from meaningful, long term relationships. You simply cannot help it. That means the medical system has to be that support system in some cases, but if they are as ignorant of this condition and disinterested or hostile to her as everyone else has been, then well, she just gets thrown under another bus and another level of trust is eroded.
The sad part is, PTSD has treatment options. Good ones that don’t have to involve drugs, like the EMDR. But women with this condition are often undiagnosed for their lifetime, because they are not combat veterans and they are women. Maybe they never served in the military at all. They might have it because they survived child abuse, or violent crime, sexual assault or rape, stalking, or intimate partner violence. They might have it due to medical trauma or a car accident etc., And they go through life, knowing something isn’t right but never knowing what that element is, that needs to be addressed. This will be true of poorer women who might not be highly educated or have access to anything that passes as mental health care.
What these women need is mental health services, not because they are weak, but because in spite of this condition, many have held themselves together, and even entire families together, while they limped along without recognition or assistance. Most likely they don’t need institutionalization, or to be drugged to the gills, they need good talk therapy and cognitive behavior modification or EMDR. They need a society that takes their jobs as woman seriously, and their pain too, instead of relegating all that they do as mothers, and parents, to the kiddy table, the not-adult table, that doesn’t need resources or treatment or even recognition.
As long as doctors hold onto two treatment extremes—it’s either all in a woman’s head, or she needs to be stripped of her ability to choose for herself—then that is the great neon sign that lets everyone know, that women are still considered intellectual inferiors to men and need to be managed like livestock or pets or recalcitrant children.
But then so many in that situation go without even basic prenatal care, without access to meaningful family planning services and medical screening too. How many lives could we mend, how many future dysfunctional families could we mend before hand, if we had accessible, meaningful, mindful mental health services for all?
Because when you help someone about to become a parent, you are helping the generations that follow. How many people could we save from falling through some of the cruelest cracks in the world? To help them avoid self medication, self isolation, and give them the most basic mental stability that leads to things like a steady job and maybe some day the ability to buy a home?
Each person we throw away is a future resource and each parent we throw away is a positive asset turned into a negative. Ripples in a pond. Will we make the needed paradigm shift or let things fester as they are? Choose wisely.
Thursday, Feb 11, 2016 · 7:42:59 PM +00:00
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GreenMother
In the interests of offering some solutions in addition to the criticisms, here is a list of suggestions for medical personnel regarding patients with PTSD:
1. Don't treat individuals with PTSD like a number. Often the trauma that lead to their condition was dehumanizing. They felt depersonalized and expendable and threatened. Recreating that feeling for them is a first class method of setting them off.
2. Make eye contact in a friendly, professional manner—introduce yourself. You don’t have to be their best friend, but you might need to take a little more time with them, to reassure them. Remember they have survived something horrific, so the last thing you want to do is make them feel like they might have to survive something horrific again.
3. Slower deliberate moves are a good choice. Sudden moves coming at someone causes many to respond with a panic attack and then much more. So be gentle and mindful. That way they don’t have to fight their own condition just to cooperate with you. Because even if they make it through the exam or the procedure, you are sending them home in a bad state of mind that can delay healing, suppress their immune system or even exacerbate their condition, esp if it has to do with heart problems, anxiety, depression, or blood pressure.
4. Don’t get nasty. Yes, we can be more difficult to deal with. But a shitty attitude will cause a shitty response in anyone. Even people without PTSD. Most people with this condition already judge themselves pretty harshly. They don’t need your help in that department.
5. Explain. You should calmly and hopefully in a friendly professional manner, explain the procedures or exams you wish to do before hand and as you walk the patient through it. Your kindness and your voice can be a powerful distraction from the fear and anxiety. That can be the difference between being mildly triggered and setting someone off like a Roman candle.
6. Do some training on how to help people in these episodes. Helping a person get more focused on the now instead of losing themselves in these flashbacks is possible. There are some simple techniques to learn that could make a big difference for you and your patient.
7. Network with qualified mental health professionals who can perform the kinds of services needed to help these patients alleviate their condition, because those techniques and those professionals DO EXIST! Make sure your resident mental health person has some of this training and connections.
8. Don’t fall for the stereotypes. --don’t fall for Deranged Vet Syndrome for starters. Understand that PTSD can strike anyone, male or female, military or not, adult or child at any stage of life. Replace those stereotypes with compassion and proactive steps to mitigate harm.
9. Don’t underestimate your personal power to affect a person’s life with your help or with your derision or abuse or neglect. Whether you are a Doctor or a Nurse, you hold tremendous power in your hands over the lives and well being of others. Use it wisely. Practice benevolence.