Discussion about the experience of reactivation of torture PTSD because of catastrophic illness.
How the patient feels, this he says very clearly here: “the memories started kicking in when the doctor told me that my kidney failed.” “That’s when it hit me really hard.” “I had a hard time sleeping….I had a lot of nightmares.….I felt hopeless…..I’m not going to go on living because there is no way that I have any hope I can survive.”
For these reason he felt the dialysis and kidney failure and the Khmer Rouge were the same experience. “When these things come up, it’s very hard, the emotion, the tears, and the pain, it’s like stirring up.” The patient may not bring these experiences to the clinician’s attention, for many of my patients I have had to pry this out of them and only then can I medicate them or address it. This is their private hell and they do not want to burden their family or their physician with memories that are unrelated to the challenge and the work at hand.
The focus of enormous effort is on the organ failure and it’s treatment, the details of the past can seem irrelevant. The parallels are obvious once identified. The clinician has to identify these because at times the hopelessness is unwarranted, as in this case. He is now doing well, and the physician can make it clear that the past is spilling into present events and carrying in a degree of pain and hopelessness that does not belong to the current issue, but nevertheless is active and must be addressed.
The emotional weight and hopelessness borrowed form the past can at times immobilize patients, interfere with work-ups, result in missed appointments, and loss to follow-up as patients are sidelines by grief and PTSD.