01 May 2009

Anniversary Reactions: Caution. This Post Is Not For The Squeamish

In my previous post, I mentioned "anniversary reactions". I'd like to talk a bit more about this phenomenon, because I think it is fairly common and not widely recognized.

The American Psychological Association has a good short description of anniversary reactions tucked away here. Scroll down to the subhead, "The Anniversary Effect" to read their description...

... and here is mine.

But first, a serious disclaimer. Please do not read this post if you, yourself, have recently been through any type of harrowing experience. In order to explain how I developed this reaction, I have to recount a traumatic experience which literally almost killed me. There's no way I can soften the impact, even if some of the details could be changed. Be kind to yourself, and wait for the next post, if you've been too close to such horrors recently yourself.

In the fourth decade of my life, after years of dealing with chronic abuse, overt and covert, in both family and occupational settings, I went through a traumatic experience which had all the features necessary for producing PTSD. Following a surgical procedure that was absolutely necessary to save my life, I developed post-operative internal hemorrhaging, which was ignored, disputed, and denied by the nursing staff for a period of eleven straight hours. I was essentially left to bleed to death, internally, overnight, in order to punish me for having the nerve to be both attentive and knowledgeable about what was happening to me [and for committing the additional offense of expecting the staff to listen to me and do something about it].

I refused to play, but even so, they almost won.

I spent the entire night sitting up in the tightest 'tuck' I could accomplish, in order to minimize my internal volume, hoping that would bring the bleeding to an end, and demanding fresh i.v. fluids again and again throughout the night.

Fortunately, I got them, and obviously, I survived - but it was a very close call.

I was lucky enough to have two surgeons, one of whom was a true physician. He saw to it that those responsible for neglecting me [viciously - did I mention the namecalling? Yes, they taunted a woman who was helpless and at risk of bleeding to death, mocked her concern and called her names] were fired on the spot. I received a transfusion of my own blood [banked in advance despite my being advised that I would, of course, not need it] and ultimately escaped from that place ...

The hospital went bankrupt almost immediately after this ordeal.

I was already an excellent candidate for PTSD, having been, as I mentioned, in various abusive settings for various lengths of time. My stress reactions had been 'primed', and this experience completed the recipe. I was:
-trapped
-defenseless
-helpless
-in very real danger of dying
-terrified
-sleep-deprived [if I fell asleep before I could get help, I knew I would probably never awaken]
-for hours, without any possible escape,
-and taunted by so-called 'professionals' who were supposed to be helping me.
Fortunately again, I wasn't entirely helpless or defenseless. I had my education, my intelligence, and a damn good pair of lungs, and I stayed in that tuck for the entire night, screaming for i.v. fluids every time the bag emptied. They didn't dare sedate me; I suppose it would have spoiled the fun [not to mention being detectable on autopsy]. So I kept vigil over myself, and demanded and received enough to keep me alive.

Because I knew that I had managed to survive by using my wits and guts [and being stubborn as hell], I expected to put the experience behind me - I had triumphed against truly horrifying odds, after all, and received some 'rough justice' when the people who neglected me were fired. I'm not a litigious type, and the bankruptcy seemed less like an impediment to a lawsuit, and more like karma, once I was on my feet again. And by the time I had healed physically, it seemed to me that I had also healed emotionally.

I had no nightmares. I did have considerable residual anger, but it was articulate, specific to the situation, focused where it belonged, and to my mind entirely justified.

Imagine my surprise, the following autumn, when I was suddenly and absolutely unable to lie down to sleep.

No matter how tired I was. No matter how relaxed I was. No matter how badly I needed the rest. The minute I lay flat, whether prone, supine, or on either side, I entered a state of instant, primitive, panic terror. For more than a week, I could only sleep with my upper body propped up by a mound of pillows, and I woke in terror repeatedly through the nights.

And then I thought to look at the calendar.

My night horrors had started the very week of my surgery, one year later.

I had not even thought about the surgery, but my body had remembered. My subconscious had remembered. There was an 'alarm clock' - literally - tucked away somewhere deep in my emotional wiring. The trauma of hemorrhage and near death had left something eerily like a post-hypnotic suggestion, with a one-year timer running.

"Do not lie down to sleep now. If you do, you will die."

This is an anniversary reaction. And I am one of the lucky ones. Mine was of relatively short duration, and occurred only on the first anniversary of the event, never again thereafter. And it was purely an emotional response. A massive, almost disabling emotional response, to be sure; but limited to the inside of my own head.

There are reports, going back all the way to Freud, of similar reactions that recur for years. Manifested as accident-proneness [a child loses a parent, and every year near the anniversary of the bereavement, they have an accident of some kind]; or as acting out [people quit jobs, move away, even end marriages on or near the anniversary of devastating losses].

Frustratingly, this area does not seem to have been very deeply explored. Most resources I have found don't provide much more than an assurance that anniversary reactions eventually end - and of course, the standard advice to see a professional if the reaction is particularly troubling or disruptive.

I have experienced yet another anniversary reaction this year, arising from a 'fresh' event that took place last spring. This time, I knew it might happen, and I was reasonably prepared for it, in terms of knowing what to watch for. All the same, it devastated me.

This is not garden variety anxiety, or even garden variety panic. This is something primeval - and I am very glad to be rid of it, again.

But I can't help wondering: how many others suffer this? I think of the 9/11 familes, the survivors of the Christmas Tsunami, of earthquakes, of Columbine... and of every other person who has held on for dear life, post-operatively, and lived to tell the tale.

Surely something more, something better, can be done than simply telling all of us to hold on tight and ride it out. If this response is indeed "PTSD on a timer", perhaps it can be prevented or at least diminished, by early intervention. Our culture, as a rule, doesn't seem to be much invested in prevention; but I can promise you, after two rounds of this, I certainly am.

I'll let you know what I discover.

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