La intimidad y la memoria defuncti

Both neonatal and pediatric stress responses, measured by the re-lease of catabolic stress hormones, are significant in anesthesia and surgical settings and are relatively greater in magnitude than adult re-sponses to similar medical procedures.¹⁰³The brains of young chil-dren, therefore, regulate arousal less efficiently than adults, and are more susceptible to traumatization. Not surprisingly, emotional and behavioral problems have been reported often in children subjected to anesthesia and surgery. The procedure studied the most is child-hood tonsillectomy. As always, the measures used to assess such re-sponses affect interpretation of the outcomes. In general, phobic and disruptive behaviors seem to be the most common, and appear to be time limited and reduced by presurgical emotional support.¹⁰⁴ Re-sponses indicating traumatization are by no means universal, but when present, may be quite dramatic.

Perhaps the most potent evidence lies in the stories themselves, in this case involving a number of my own medical colleagues who have undergone ether anesthesia and tonsillectomy in their first de-cade. One recalls that for many years thereafter, he could not sponta-neously yawn without feeling panic and stifling the yawn. He recalls the operating room nurse encouraging him to inhale deeply during ether induction, an act that for years he found threatening when it in-volved yawning. Another colleague who underwent five experiences of ether anesthesia before the age of eleven had a phobia of falling asleep throughout his childhood, primarily due to a fear of being un-conscious. He also had a morbid childhood phobia of the smell of ether and other volatile chemicals. His pursuit of the medical profes-sion can only be attributed to traumatic reenactment. Many of us in the medical profession recall being allowed to perform ether anesthe-sia induction on children for tonsillectomy under the supervision of an anesthetist. The event is characterized by wrapping the child in a sheet while an orderly forcibly holds the child down to the gurney. A gauze-covered metal cone is clamped over the child’s nose and

mouth, and ether is dripped from a can onto the gauze while the child screams and thrashes. During the surgery, the mask must be removed for the surgical procedure itself, as well as for suctioning, and then placed back on the face to deepen anesthesia when the child begins to gag and cough due to the secretions and blood. The scene can only be described as barbaric, and the child exposed to it no doubt experi-ences the same horror.

The practice of immobilizing children by wrapping them in a sheet and isolating them from their mother when performing simple emer-gency room suturing for routine lacerations has all of the elements of threat and helplessness required to induce traumatic stress. One pa-tient described the injection of local anesthetic for a scalp laceration as terrifying, and still recalls the certainty that the doctor was inject-ing his brain, and that he was goinject-ing to die. Another child who was separated from her mother for essentially the same procedure, dem-onstrated anger and rejection of her mother, and acting-out behavior for months thereafter.

Unfortunately, more detailed or controlled studies of the effects of our technological system of medicine on children are not available at this time. Anecdotal medicine is uniformly rejected as a means of ar-riving at meaningful scientific conclusions, and for good reason.

Using the words, “in my experience,” to justify a medical conclusion merits immediate skepticism; yet, catastrophic complications of medi-cal procedures also merit immediate attempts to correct the fallacies in those procedures. Applying the concepts of traumatic stress to many current medical practices, reviewing the data from analogous sources of trauma in our society, and recognizing the results of that trauma should compel us to reassess some of our current standards of treatment for our patients, especially our children and infants. Anec-dotal experience in medical practice does suggest that traumatization with all of the features discussed previously occurs with shocking frequency, and undoubtedly, contributes significantly to the load of life trauma that ultimately may have devastating long-term effects on the individual.

CONCLUSION

I have only touched on the numerous sources of trauma in our world and society, neglecting entirely issues of torture,

imprison-Sources of Trauma 155

ment, genocide, civilian experiences in war, and natural disasters to name but a few. I have previously addressed the role of motor vehicle accidents as a relatively unappreciated source of cultural trauma.

I have also emphasized what I perceive to be a generally neglected source of trauma, our current system of medicine, because I am familiar with it, both as a childhood patient and a practitioner. I also see its influence on patients who suffer from chronic pain, often not because of an injury but because of the tests and procedures used to diagnose and treat the pain. Trauma will always be with us. Our bod-ies are designed to deal with it as an inevitable life occurrence. It cer-tainly behooves us as the caregivers and healers who attempt to lessen the ravages of unresolved trauma not to contribute to its effects through procedures, institutions, traditions, and behaviors that un-knowingly serve to initiate or perpetuate trauma.

Chapter 10

Trauma Therapy: Future Directions

Trauma Therapy: