Post-traumatic stress disorder (PTSD) is on our minds lately, often as it relates to veterans. However, people with medical illnesses develop PTSD too, and this happens more often than you might imagine. As you may know, the DSM IV-TR (4th ed., American Psychiatric Association, text revision, 2000) requires the following criteria for PTSD: (a) a traumatic event that involves actual or threatened death, or the threat of physical integrity to self or others and the person’s response to that event was intense fear, helplessness, or horror; (b) at least one symptom of re-experiencing of the event, such as intrusive memories, nightmares, a sense of reliving the event, and/or psychological distress when reminded of the event; (c) three or more symptoms of avoidance, such as avoidance of thoughts, feelings, or reminders of the event, inability to recall aspects of the event, withdrawal from others, emotional numbing, sense of a foreshortened future; and (d) two or more symptoms of increased arousal, such as insomnia, irritability, concentration difficulties, hypervigilance, and exaggerated startle response. Those of you who have been seriously ill or know someone who has may recognize some or all of these symptoms. Roughly one-forth of medical patients with heart disease and cancer meet criteria for PTSD. Some studies suggest that rates of this anxiety disorder are even higher. As common as PTSD is, it is striking that medical clinicians don’t talk about this more with patients. Then again, maybe it is not so surprising. Talking about trauma requires a great deal of sensitivity, time and vulnerability on the part of physicians. Medical professionals often experience trauma as well, as least the vicarious kind. Having to watch patients suffer over and over again can be overwhelming.
There has been a lot of press lately regarding boomers who refuse to acknowledge aging. For example, The Detroit Free Press offers one of many recent articles on how baby boomers view aging. Among the highlights, a majority of those polled say old age begins at age 70 and a quarter of respondent’s say it begins at 80! A third of boomers polled feel confident about growing older, and a shockingly low percentage worry about dying. On the one hand, I can understand these statistics as demonstrating the remarkable resilience this generation has always been capable of. Boomers have a great deal of external and internal resources. They have always been, and remain, a model of strength and mobility. Even people older than boomers have shown that they can take down stereotypes. Consider one of the many You Tube videos showing seniors demonstrating their dancing abilities.
You may have been hearing about rising rates of divorce among married, heterosexual baby boomers. While I am an advocate for any adult couple choosing not to stay together for any reason, the current rates of divorce in this cohort are striking. The Star Tribune reports that a quarter of all divorces occur in persons married more than 20 years and overall, rates of divorce are rising among straight boomer couples. Although certain high profile divorces have recently brought this issue to our attention, many of us know couples that have been together for decades that have decided to throw in the towel. We are also aware of stereotypes that might impact current divorce trends: middle-aged men seeking younger wives and women who feel that they have put up with enough. In thinking about these statistics, however, it is helpful to look beyond stereotypes.
Throughout history, populations have looked for people to take away mental, physical, and spiritual troubles. Shamans, priests, folk healers, and even psychics provided hope. In the 5th Century B.C., Western Medicine offered additional help, although the majority of cures and symptomatic relief that physicians could provide were not really developed until the late 19th century. For a long time physicians had little more than their personalities and bedside manner at their disposal. Now, with unprecedented advances in medical technology, the relationships we have with our doctors are less valued. It can seem as if whether or not we like our physician does not matter. Nonhuman entities, which include labs, procedures, and diagnostic tests increasingly drive doctor’s decisions and have replaced the centrality of medical relationships. However, trusting physicians is more important than ever. There is a large body of research to support this. For example, patients who trust their doctors are more likely to follow medical advice.
Although many people assume that anxiety is negative, this emotion is a normal part of human existence. Our bodies are equipped with the sympathetic nervous system, in which physiological arousal lets us know when we are upset or may be in danger. This is an important part of the fight/flight response, which we developed in order to survive as a species. Anxiety as a reaction to serious illness is normal. Since anxiety is a part of life, most people have well-honed coping strategies to deal with it. These strategies can be adaptive or maladaptive and usually intensify in the case of severe stress.
As a new blogger to Psych Central, I am still getting acquainted with the wealth of resources and great writing on this site. I recently came across a number of fascinating articles by Dr. Junig. His most recent posts address proposed changes to the Schedule Class of hydrocodone/acetaminophen and Vicodin, which would make these medications classified as Schedule II drugs, and make them slightly harder to obtain. This change sounds reasonable, though I am unsure of the impact. The real pull to this story, in my mind, is the meaning of increased attention to pain medication abuse and dependence. It all feels so familiar… During graduate school in the early 1990’s my second training site (or practicum) was in an inpatient chronic pain program. Inpatient programs for the treatment of chronic pain are rare these days; for example, there is only one in all of Northern California. Back then, opioid use for chronic pain was frowned upon.
Noncompliance, sometimes referred to as nonadherence, is when patients either do not do what a doctor has prescribed or continues to engage in behaviors that cause or exacerbate illness. Although many of us would like to believe that we take good care of our bodies, in fact, a number of us do not. Estimates of noncompliance vary depending on the study, but range from 25%-50%. Though there a lot of reasons we do not take care of ourselves, a belief that we will not “get caught” (meaning become ill) through poor self-care is often a part of the psychological equation.
Though hardly a surprise to caretakers, a recent story in The Wall Street Journal reports that more baby boomers are taking care of elderly parents. Kelly Greene reports that since 1994 the number of adults in caregiving roles has tripled. Boomers, who are most often in this position, are literally paying the price. Greene reports, “The financial toll on care providers who are 50 or older averages $303,880 per person in lost wages, pensions and Social Security benefits over their lifetime, due to leaving the work force early to care for a parent, according to the study” The emotional costs of caregiving are also high, with caretakers suffering more chronic health problems and substance abuse. Indeed, research in this area has been growing and many of us are reminded that a long life can be a pyrrhic victory. Caring for an elderly parent is one of the hardest challenges the boomer generation faces. Yet, it seems like there are no easy answers for how to cope.
Coming from a psychology background, I found myself quite shocked almost two decades ago when I began working in hospitals and outpatient medical clinics. Not only was it jarring that everyone around me literally moved so much faster than I did, but it was equally unsettling that when talking with a physician, I found that I had about 20 seconds to say what was on my mind before being interrupted! Indeed, some research has found that patients have an average of 18 seconds to speak before a physician interrupts with a closed ended question. Interruptions are just part of the problem in medicine, however. Some physicians have trouble dealing with emotions when talking with patients. A study in Canada found that doctors failed an empathy test in 90% of cases. Though this is only one example and many physicians are indeed empathic toward patients, the author of the study points out that physicians have difficulty acknowledging emotions. Patients have reported to me over the years that once they became tearful their physician changed the subject or ended the meeting abruptly! Many modern medicine clinicians are cut off from emotions. This may not be a bad thing.
Among all of the discussions taking place regarding Medicare financing these days, my mind has been wandering back to 2009, when there was an escalating and embarrassing incident regarding the idea of Death Panels. It turns out that Death Panels were in the news again earlier this year with author Wendell Potter of The Huffington Post pointing out that insurance companies do, in fact, already make decisions about who can receive certain advanced medical interventions. Remember that the original issue in 2009 had to do with a provision from last year’s health care reform bill that would have allowed Medicare to pay doctors to counsel patients regarding end-of-life medical decisions. Some got anxious and/or tried to use this provision for political gain, and well, you know the rest. Like a lot of things that happen in human group behavior, an important issue that could have led to productive discussion got lost in a torrent of political drama, anxiety and anger. A critical conversation about what we all can do to take care of ourselves when we are really ill has yet to take place.