As both a survivor of severe relational and developmental trauma and a practitioner of integrative medicine with over 20 years of experience treating trauma survivors, my first reaction to PVT was “So what?” Years of extensive study and investment in various modalities for myself led me to question its contribution to therapeutic interventions. Polyvagal Theory sheds light on the extreme states of freezing and social discomfort experienced by many trauma survivors. Yet, while it provides a physiological pathomechanism, it doesn't offer new therapeutic interventions outright. This realization prompted me to explore broader challenges faced not only by trauma survivors but also by healthcare professionals navigating their own traumas within a demanding medical system. (1)
Navigating Healthcare's Emotional Landscape:
Our current medical system, with its demanding education and work conditions, has inadvertently contributed to widespread clinical trauma among clinicians and first responders. This issue became more clear during the COVID-19 pandemic when numerous medical staff, including myself, grappled with PTSD and unresolved childhood relational trauma. In our pursuit to serve the needs of our patients, we often shield them from the depths of our struggles, leading to emotional detachment and a lack of awareness about our own mental health challenges.
Our patients, both lay friend and professional medical practitioner, deserve more than what our current healthcare system offers. They reflect deeper issues within our culture and within ourselves. Many of these individuals have heightened creativity, empathy, and intuition, leaving them vulnerable to the emotional turbulence of those around them. Consequently, their sensitivity and empathy make it challenging to disconnect from the external world as they continue to grow emotionally. Regrettably, the grueling cycle of 14-hour workdays, completing chart notes while unwinding with a bottle of wine, and collapsing are commonplace for many practitioners and support staff. Given the aftermath of COVID-19, it's logical to presume that many clinicians across the nation faces some level of PTSD, emphasizing the critical importance of addressing the systemic issues fueling this crisis and offering crucial support for our healthcare professionals.
Secondary trauma, often overlooked yet profoundly impactful, permeates the healthcare environment, affecting not only clinicians but also patients and the broader healthcare system. As healthcare providers navigate the complexities of treating trauma survivors, they inevitably absorb and internalize their patients' pain and suffering. This secondary trauma can manifest in various forms, from emotional exhaustion and burnout to compassion fatigue and decreased empathy. The relentless exposure to traumatic narratives and challenging clinical situations can erode the mental and emotional resilience of healthcare professionals, further exacerbating the challenges of providing effective and compassionate care.
It was only upon listening to a profound dharma talk by Thich Nhat Hanh that I began to connect emotionally to my own experiences. He elucidated how doctors, nurses, clergy, monks, nuns, teachers, and others strive to alleviate the suffering of others, thousands of others, while neglecting their own. The crux of his message was that we must first acknowledge, tend to, and learn to transform our own suffering, as it is only then that we can genuinely be of service to others.
The Interplay of Financial Strain and Personal Health
In addition to the emotional toll of secondary trauma, healthcare professionals face another formidable challenge—managing financial strain and personal health. The demanding nature of the profession often leads to grueling workdays, sleep deprivation, and a constant battle against exhaustion. This lifestyle, further exacerbated by the aftermath of COVID-19, has resulted in a scenario where many healthcare providers and support staff grapple with some level of PTSD and emotional burnout. These challenges underscore the urgent need for systemic changes within healthcare to better support the well-being of healthcare professionals.
“As a surgeon, I never questioned the demands of my profession. I willingly worked nights, weekends, and holidays. I accepted the burden of $400,000 in school debt and a 7-year residency. I didn't hesitate to scrub in at 4 AM instead of 9 AM if it was more convenient for our staff. My only time to really save for retirement was in my 50s and now I have stage 4 cancer.”
This insight from a respected surgeon sheds light on the sacrifices and commitments healthcare professionals make. Despite working tirelessly, often sacrificing personal time and family engagements, many of us are struggling to save for retirement until later in life, facing financial burdens that can be overwhelming. This insight underscores the delicate balance healthcare professionals must maintain between their dedication to patient care and their personal well-being.
The financial strain is particularly challenging in ancillary care fields such as Traditional Chinese Medicine (TCM), Chiropractic (DC), Naturopathy (ND), Physical Therapy (PT), and Occupational Therapy (OT). Salaries in these fields have not kept pace with the rising costs of education, especially in private, for-profit schools. In TCM schools, the lack of billing and coding education is a significant issue, as most of my own instructors advocated cash-only practices. That is no longer a sustainable business model for those with student loans or families.
Additionally, many of us in ancillary care are self-employed or contractors, lacking the social safety net of employer-sponsored healthcare and retirement support. This further complicates our financial situation. Addressing these issues is crucial to ensure the financial well-being and success of professionals in these important fields.
Challenging Misconceptions and Stigma
One of the barriers to addressing trauma effectively is the persistence of misconceptions and stigma surrounding mental health. Many individuals, including healthcare providers, veterans and first responders may avoid confronting their own emotional complexities, opting instead for surface-level diagnoses, medication and treatments. This reluctance hinders our ability to provide compassionate and informed care to those in need.
Lissa Rankin, MD, in her book "The Anatomy of a Calling," illustrates the trauma experienced by nearly every medical provider during their residencies beautifully. She recounts a harrowing night when, as the only resident scheduled, she had to deliver seven babies, several with complications. That night left her in a state near catatonia; after the final difficult birth, she collapsed onto the floor of the women's lounge where she was comforted by a group of nurses and midwives, while a senior attending screamed at her through a locked door. In contrast, Rankin shared another scenario involving the tragic loss of a mother and her baby during childbirth. Despite the team's relentless efforts to save them, the mother bled out, leaving the operating room resembling a war zone. Even the seasoned surgeon was in shock following the mother's death. Almost at once, another team of clinicians was at the OR door, inquiring about when it would be free.
In response to such challenges, the senior attending walked quietly to the door and locked it. She mentioned that they all took a few moments to collectively grieve, providing comfort, solace, and support to one another while gradually attending to the necessary tasks in the OR. She equates this simple act of connecting emotionally to the loss, overwhelm, and sorrow they all felt as being the single most important act to heal the collective trauma they experienced. While the situation was a devastating loss, there was comfort, soothing, and resolution, ensuring it did not remain lodged in her nervous system.
She also made the decision to leave conventional medical practice a few months later.
These powerful anecdotes serve as an indictment of the immense pressures and emotional burdens medical professionals bear, highlighting the need for compassion and improved working conditions within the healthcare system.
As a long-time provider, I must admit that I wept during this section of her book. While my experiences may not have been as intense as that of an understaffed OB GYN, the years of 70–80-hour weeks spent navigating the challenges of C-PTSD and neurological issues were equally trying. In striving to be a successful clinic director, I shielded my patients from the depths of my own pain and the severity of the medical conditions I was managing. In all honesty, I was so emotionally detached that even I was unaware of the full extent of my struggles.
Unfortunately, the failure to understand the true nature of these 'illnesses' and recognize the necessary therapeutic interventions is often deliberate and primarily driven by financial considerations. Our for-profit medical system is driven by denial and the practice of outsourcing payment responsibilities to others, with each insurance company often deflecting accountability by saying 'not my job.' Ignoring new perspectives on illness allows us to evade confronting our own shadows, a confrontation often avoided out of fear. It is frequently more cost-effective to diagnose a patient and prescribe medication than to address the underlying emotional complexities directly.
I experienced this most poignantly in serving combat veterans for many years through the VA, where I had the opportunity to witness firsthand the challenges they face in accessing comprehensive mental health care. This became evident during a recent flight home from my mother's funeral, where I was seated next to a VA doctor. He tapped me on the shoulder as the plane took off and mentioned that he happened to notice the word 'trauma' on my tablet. Could we discuss further? This opened the door for a three-hour conversation not only about his own work with pain and PTSD patients but also, albeit unknowingly until I described it, about his own. One of the colossal failures within the VA is the shortage of mental health practitioners with high-security clearance to provide counseling services for our service men and women in special forces. As was the case in my own family, our combat veterans are often asked to do assignments that not only go against their value systems as human beings but also leave them without anywhere to turn for support and comfort. We created the PTSD, and then told them they cannot ever discuss these issues due to national security.
My own Zen community has tried to fill this need by hosting private meditation retreats for former combat servicemen and women, including several for Vietnam-era vets who were thrown under the bus by the social and political issues of the time. The stories from these retreats are staggering, as many veterans had the opportunity to open up about unspeakable horrors that they had never told another living soul. The collective healing experience by these individuals in sharing their stories is profound, with terror and shame giving way to support, understanding, and compassion.
My favorite quote by Maya Angelou is, "When we know better, we do better." Our servicemen and women deserve better than a life of terror, substance abuse to help them cope, and then neurogenic decline from PTSD.
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[1] Regarding the emotional-psyche aspect of my own trauma work, I found Lawrence Heller's NARM (Neuro Attunement Relational Model) to be a more effective therapy style for my condition. Heller's approach uses both "top-down" and "bottom-up" methods, facilitating an intellectual understanding of maladaptive strategies while concurrently restructuring the personality by exploring and developing new strategies. Essentially, this model focuses on comprehending the damage caused by abuse or trauma at a specific age, and then re-parenting aspects of the self to encourage new behavior. While NARM was beneficial in addressing certain aspects of my history, it did not offer treatment for my condition, which involved autonomic dysreflexia and damage to the brachial and cervical plexuses.
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