The Trauma of Awakening
Awareness under anesthesia ranks second only to death as a dreaded complication of surgery. It is reported to affect 40,00-140,000 patients per year in the US but there is reason to believe that many more have awakened during surgery. Because modern anesthesia consists of three agents – a light dose of painkiller, a paralyzing drug, and an amnesic agent that blocks memory of the experience – most patients do not remember awakening and so do not report it to their doctors. The paralyzing drug prevents any struggle or gesture as sign of distress so the surgeon, the anesthesiologist, and nurse cannot see that the patient is awake. Some experimental studies estimate the rate of awareness may be as high as 44%.
Not remembering does not diminish the pain, fear, and utter helplessness of awakening under the knife and being unable to let anyone know. Nor does it diminish the traumatic effect of that experience. Survivors who finally recall the awakening usually describe an experience in which their center of awareness coalesces outside their helpless body and they watch the scene from above. Their frozen state and accompanying depersonalization seems to go on and on without a clear point of resolution. The return to the body may happen in the recovery room or even later in the hospital room and, rarely, only after days, weeks, or years.
The experience of awakening in a panic during surgery and finding oneself unable to move or cry out creates a dramatic crescendo of survival instincts. The drug-induced paralysis thwarts any impulse to escape and deepens the instinctual freeze response. Awareness during surgery carries the exact conditions known to induce post-traumatic symptoms. The horrors of the experience become embedded in the nonverbal mind with a potential to intrude into consciousness whenever triggered. The suffering individual will not relate the emerging panic to unremembered and wordless experiences during a past surgical operation.
Over half of the patients that remember coming light under anesthesia develop the full syndrome of posttraumatic stress disorder (PTSD). Survivors with or without memory often become phobic about surgery and their avoidance of triggers may generalize to a fear of hospitals or doctors or of white coats. They may suffer attacks of frozen panic or depersonalization, sometimes with clouded states of altered consciousness. They may repeatedly hear the voices of operating room staff. Their conditions are often misdiagnosed as panic disorder, major depression, schizophrenia, or epilepsy.
Treatment of Surgical PTSD
Once the true cause is suspected the condition can be readily treated and cured with trauma therapy. Successful treatment does require processing of the entire traumatic experience so the therapy must be able to access that seemingly forgotten memory. The memory is there even though conscious verbal probes fail to reach it. It was not verbally coded when the person was under the dual effect of the anesthetics and the instinctual trauma response. Even though it was stored in fragments of nonverbal perception it can be processed into a narrative form that will be available to conscious thought.
Hypnosis is very effective in providing access to the traumatic memory fragments. Other approaches that use nonverbal communication can also be effective. These are the creative arts therapies such as art therapy, movement therapy, music therapy and psychodrama. In most applications the person constructs a verbal narrative of the trauma and comes to own it as a finished historical event.