When medical care becomes traumatic, healing can feel complicated. In this interview, I sit down with Dr. Christen Mullane, a psychologist who specializes in medical PTSD and trauma to talk about what happens when the very care meant to help us—hospitals, procedures, diagnoses—end up leaving emotional scars.
The following is the raw transcript of our interview.
Understanding Medical Trauma and PTSD
Emma McAdam (00:00)
Christen, thank you so much for joining us. I’m really excited to talk about this. I’ve been on YouTube and looking and there’s really not very many good resources for people on medical trauma. So thank you for joining us.
Christen Mullane (00:09)
Thanks for having me and you’re right. This has been, it’s one of the struggles we face, yeah.
Emma McAdam (00:12)
Yeah! Mm-hmm. Let’s start with what is medical trauma or medical PTSD and is there a difference?
Christen Mullane (00:19)
So, medical trauma is a more broad term for things that happen that might damage our beliefs about ourselves or other people or the world. Medical PTSD is post-traumatic stress disorder that arises from medical events. And there are specific diagnostic criteria to meet if we’re thinking about that as a diagnosis.
And so in the DSM-5, which is our current version of how we diagnose people, and these things change, which is important to just remember and recognize, but currently, in order to meet criteria for medical PTSD, a medical event has to be sudden and catastrophic. And then after this sudden catastrophic event, we see people have symptoms like re-experiencing the trauma through dreams or nightmares, intrusive thoughts.
We see people use avoidance coping strategies like not going to the doctor because it’s a trigger. And then we also have hypervigilance or hyperarousal kind of symptoms. And what that means is that people might get really really anxious when thinking about or talking about medical events and what happened around them. Or they’ll get really vigilant often around the body. So they’ll start really tracking symptoms closely or any new physical symptoms can become really anxiety provoking for folks. Like they’ll really hyper attend to it.
Physical Symptoms as Triggers for Health Anxiety
Emma McAdam (01:41)
So like if their heart skips a beat, they’ll be like, oh my goodness, what is that? And then they’ll get a heart rate monitor and be constantly checking and scanning and hypervigilant in that way. it looks like maybe someone might be like, oh, you’re a hypochondriac, right? You have health anxiety. It might be more closely related to medical trauma or medical PTSD.
Christen Mullane (01:55)
Mm-hmm. Yes, and this is one of the things that I hope providers who might be listening to this take away from this is that oftentimes, we might hone in on something like a needle phobia or like hypochondriasis sort of speak when really that’s a symptom of a larger problem. So even some of our diagnoses like somatic symptom disorder, when they talk about the experience of health anxiety within those disorders. I would really recommend for providers to screen for PTSD related to medical events and just see if there’s a barrier there.
Emma McAdam (02:32)
Yeah
Complexities of Medical Trauma Diagnosis
Christen Mullane (02:33)
And I think one of the things that we don’t do a good job of yet diagnostically is talking about more complex PTSD syndromes where it’s not one discrete event. There’s an accumulation of stressors over time that result in changes to how we view ourselves and the world. And so that isn’t captured in a PTSD diagnosis, when it comes to medical trauma.
Emma McAdam (02:54)
Yeah.
Christen Mullane (02:56)
Like usually by the time we go to the doctor, we’ve kind of been in our bodies for a while, And so the way our bodies have been treated in other contexts is going to enter into the exam room with us. So that’s one piece to be aware of here is that other kinds of trauma can be reactivated when we go to the doctor.
Because going to the doctor is an intimate experience and it involves disclosing pieces of ourselves and information about our lives that we don’t just talk about. And the procedures like dental work in particular, like being in someone’s mouth, that’s a very intimate experience.
In your example, there’s the accumulation of memory around what it’s like to go to the dentist and the pain that might happen when we go there and the other kind of physical pieces of that. There’s also a person’s lived experience and both of those can start to accumulate and play off of each other in order to develop sort of exacerbating and worsening mental health outcomes for people, So a person’s whole self is going to the doctor, right?
Emma McAdam (03:41)
Yeah. Mm-hmm. Yeah.
Christen Mullane (03:58)
Yeah. Some other examples we see a lot of medical PTSD after ICU stays. Right? So what we’re working with there are intense life-threatening situations that involve a really high level of care. And during the pandemic, one of the things that we saw was that ICU stays skyrocketed and oftentimes, wrapped around the COVID experience with so much uncertainty.
Emma McAdam (04:04)
Yeah. Mm-hmm.
Christen Mullane (she/her) (04:24)
So much uncertainty around like is this treatment experimental? Like is it actually going to help me? Am I going to live through this? I mean we saw so much grief and loss. So that’s one level of it.
Social isolation due to medical or chronic health issues
Emma McAdam (04:24)
Yeah. And isolation, right? And isolation when you experience a frightening event, one of the first things people do is scan for support, scan for eye contact, scan for like, who’s going to help me here? And there’s so much isolation with COVID that left people feeling alone and vulnerable.
Christen Mullane (04:48)
Yeah. And that’s another piece with medical events in general. Like oftentimes people will isolate because they’re immunocompromised. They cannot engage in community the same way. So when it comes to like the sort of longer term impacts of this, we have Ongoing life impacts. People’s jobs get disrupted. People’s roles in their family systems shift around.
Emma McAdam (05:04)
Yeah.
Medical Debt Fuels Trauma and Stress
Christen Mullane (05:08)
Their finances. my gosh, like we could talk about medical debt that’s a huge impact for people. So we have these, yeah.
Emma McAdam (05:11)
What? I mean, medical bills are so stressful. I remember when I was pregnant with my third child, we were doing a cost sharing program instead of insurance. And I ended up having 30 or 40 bills that I had to file in a very specific way. And it was about $20,000. Welcome to America, right? And I just remember crying and crying about having to do my medical bills. And it was going to get covered. It wasn’t putting us into any financial hardship. It was just stressful. So for people dealing with medical debt, I’d forgotten about that aspect.
Christen Mullane (05:27)
Yeah.
Emma McAdam (05:44)
Of like the traumatic threatening aspect of medical experiences. Yeah.
Christen Mullane (05:47)
Yes, yes, secondary life crises, right? I mean, the financial ones are huge for people. And think about the person who is sick and ailing, like not privileged, right? In any kind of way, like trying to navigate the healthcare system and pay for what they need. I mean, it’s hard, it’s very difficult for people. ⁓
Emma McAdam (06:02)
Yeah. Yeah, very confusing and probably leads to feelings of like powerlessness, I would imagine. I mean, I sometimes feel that way, but for many people it could be more difficult without resources and skills.
Christen Mullane (06:11)
Mm-hmm. Exactly. And that can happen. So we talked about ICU level trauma, right? But things like this, the impacts of medical diagnosis and treatment happen at other levels of care. So there’s a really great book. I have it here. That if, you know, for clinicians who might be kind of listening, like it’s called Managing the Psychological Impact of Medical Trauma.
Emma McAdam (06:21)
Mm-hmm.
Christen Mullane (06:36)
Talks about how medical trauma can look and present at different levels of care. so let’s take somebody who’s had in their history, like maybe a really painful dental procedure, and then they’re coming in for just a routine cleaning. That routine cleaning can be a trigger for memories of the root canal that didn’t go well, right? Or a primary care office visit.
Emma McAdam (06:41)
Mm. Okay. Right.
Christen Mullane (07:01)
Can bring back memories of an ICU stay, there’s enough similarity in the environment that people can be reactive in that space. And then because the reactivity is there and they’re walking to the doctor’s visit with like maybe white coat syndrome where their blood pressure rises, like kind of a trauma symptom, right? Like they’re walking in hypervigilant already, there’s more of a risk that they’re going to be re-traumatized in that space.
Emma McAdam (07:03)
Right. Yeah.
The Impact of Medical Trauma on Beliefs
Christen Mullane (she/her) (07:27)
So I’ve definitely had patients who had birth trauma in their past but they didn’t really have PTSD symptoms had birth trauma in their past, but they didn’t really have PTSD symptoms until a nasal endoscopy, which is a routine procedure years later. That’s when the PTSD symptoms started to present because that’s when they had enough go on medically that they started to think there’s something wrong with me. I’m different. I’m bad or wrong. And so in terms of like the belief impacts, we do see things around power and control.
Emma McAdam (07:38)
And here it is. Yeah.
Christen Mullane (07:56)
Also esteem for people and safety and trust, we see a lot of different ways that a person’s whole self becomes impacted.
Emma McAdam (07:58)
Mm-hmm. It’s really interesting to me to hear you speak about trauma as a belief impact. It’s refreshing for me to hear it. A lot of times when I think about trauma, I’m going at it from a somatic approach, which is thinking about the nervous system reaction, but it’s to be reminded of those belief impacts so medical trauma can make people feel like there’s something to matter with them or like that they’re weak or there’s something broken within them because of how they’re having these emotional flashbacks to past trauma.
Christen Mullane (08:33)
Yeah, like my body, can’t trust my body. That’s a big one. I feel betrayed by my body. or medical systems are entirely unsafe, right? We might see some examples of all or nothing thinking like no provider is safe. Or I am completely powerless when it comes to my health, So part of the hope for flip in treatment is to start to notice some of those beliefs that have been changed.
Emma McAdam (08:37)
Mm-hmm. Yeah, you can’t trust any
Christen Mullane (08:55)
Like my body is broken, kind of an esteem related belief, Or my body is worthless, or I can’t trust my body. And to begin to help find the nuance, find the gray, like when can you trust your body? What are the places where that’s harder for you to do, like sort of contextualizing it a little bit? I do think somatic approaches are really important with medical trauma.
Emma McAdam (09:07)
Yeah. Cheers!
Christen Mullane (09:20)
And a piece to think about there is viewing that as a form of exposure therapy. Being in the body is really hard for folks who have had pain and distress in the body. And so often in terms of avoidance symptoms of PTSD, example, people will suppress or minimize or intellectualize, like they’ll be really thinky because it’s harder to be here. Yeah, me too.
Emma McAdam (09:43)
That’s one of my favorite distraction techniques.
Christen Mullane (09:48)
Yeah, that’s what I do to cope. Yeah, yeah, and that may feel a lot more comfortable.
Emma McAdam (09:50)
just intellectualize, read a book about it Emma. that can be form of, yeah, make you feel more comfortable, but it’s a form of distraction that prevents us from really processing ⁓ or sitting with or making space for those body sensations that are uncomfortable.
Enduring Somatic Threat Model
Christen Mullane (10:07)
Yeah, it’s a dance. there’s a, the theoretical underpinning of medical trauma is around Edmondson’s enduring somatic threat model. Yeah, so in that model, essentially, like, the body becomes unsafe. And there’s this sense with medical symptoms a lot of the time that any new thing, like any new heart palpitation is indicative of
Emma McAdam (10:16)
Yeah, let’s talk about that.
Christen Mullane (10:28)
My gosh, I’m going to have a heart attack again or whatever it happens to be. ⁓ So there’s this overlap between, ⁓ like panic symptoms, for example, and symptoms of like AFib or heart irregularities. And it’s very difficult for patients to distinguish what’s going on. So because of that, we get these attributions like panic’s a great example for this, that any new heart symptom equals heart attack means I need to go to the doctor. The doctor’s scary to me. I don’t want to go to the doctor. So people will kind of spiral in that space. Other examples would be with physical pain. Like any new pain symptom becomes like a reminder of trauma. It is a trigger in and of itself, right? Yeah.
Emma McAdam (11:15)
Yeah. So with Endurinsomatic Threat, the Endurinsomatic Threat model, the idea is that the PTSD trigger isn’t something outside of you. It’s your body and your body’s sensations. So now when you have these sensations, whether they’re completely normal and healthy or a little bit disordered or a lot disordered, these sensations trigger that fight, flight, freeze response, that panic response, these thoughts of catastrophe. What if this means I have cancer again? What if this means, you know, I’m having a heart attack?
And then that can fuel more avoidance or more panicking make it a little bit trickier than maybe not trickier, but a different type of difficult compared to someone who has PTSD, maybe around a car where they can escape that car. Like they don’t have to be in a car for parts of their day. But with someone’s medical trauma, you’re inside your body. You’re with your body all day. Yeah.
Christen Mullane (12:02)
Yeah, like avoidance coping gets a bad rap, but it has its place in terms of the sort of recovery cycle. We can’t do it forever. It’s sort of a short-term strategy. But if you can never escape and you feel it kind of traps you in this cycle of panic and catastrophizing and things of that nature. And so part of what people can expect in a course of therapy would be
Emma McAdam (12:08)
Yeah.
Christen Mullane (12:28)
Okay, like we need to gradually begin to approach the body in ways that you feel you have some mastery over or that you feel, you know, don’t knock you too far outside of your window of tolerance, so to speak, like they’re not going to knock you into panic or depression. We’re going to kind of try to keep you in a space where you might have some hum, you might have some feelings, a little bit of discomfort, but it feels manageable. Because it’s not like we want to, avoid the
Emma McAdam (12:32)
Right.
Therapeutic Approaches to Medical Trauma
Christen Mullane (12:53)
The threat forever because that stalls recovery. So a lot of the approaches that I’ll use in treatment and it sounds like you use too, are around mindfully coming into and noticing the body, noticing when it’s calm, noticing when it’s at rest and balancing some of these perceptions so that we’re not constantly perceiving the body as a source of grief, betrayal, threat, you know, all the light bulb stuff that’s going to keep us up here.
How to Deal with Panic Attacks and Health Anxiety
Emma McAdam (13:07)
Mm-hmm. Yeah. Okay, so let’s walk through this, ⁓ like in theory. So let’s say you’ve got ⁓ a client who has had a heart attack and that was really scary. Maybe they were in the ICU for a while. They’re out of the ICU. Their body’s overall doing better. But when their heart skips a beat or when they have another checkup or when their arm hurts, they start to think, what if this is a heart attack? What if this is a heart attack? And they’ve been to the ER 10 times and every time the doctor is like, your heart’s fine. Your heart’s fine.
So they’re having these symptoms where they’ll like just get super scared. They’ll have maybe a heart skip to beat or a little aphid or something and they start panicking and catastrophizing and feeling terrified and then beating themselves up and being like, what’s the matter with me? Like, like am I broken forever? I’m trying to think of a specific example where you could say like, here’s some things you would walk someone through in this situation. how would you walk them through this?
Christen Mullane (14:13)
Yeah, that’s a great example, you know, because this is something so many people struggle with. in the first steps of treatment, I would want to screen for PTSD related to the heart attack, related to an ICU stay, because that would inform the treatment plan. We’d talk. Yeah.
Emma McAdam (14:27)
Okay, so let’s say yes. Let’s say they still have like panic attacks when they drive by the hospital. and they have re-experiencing. like they’re playing with one of their grandkids and then they have this like flashback of like, I almost died. What if I wasn’t here? Right? So let’s say they’re having flashbacks and panic symptoms and they’re avoiding doctor visits, except for when they think they’re dying. Let’s say they do have PTSD. Okay.
Christen Mullane (14:38)
Mm-hmm. Yeah,yeah, it’s so complicated. So there are evidence-based treatments for trauma as we hopefully know. the first step would include a lot of validation we want to develop as much safety and trust in the therapy encounter as possible. Partially because even without saying a word you’re still a provider and depending on that person’s
Emma McAdam (14:53)
Mm-hmm.
Christen Mullane (15:09)
Past history with providers, just being in the room with you could be triggering. Right? So let’s kind of start there, like sort of naming medical trauma as a legitimate source of trauma reactions, really validating that they’re even here in the room. That’s a huge step for people. Then I’d want to kind of see what level of buy-in we have for a trauma-focused therapy and whether the timing for that is actually here and now, or whether things are too live
Emma McAdam (15:14)
Right? Uh-huh.
Grounding and Resourcing in Trauma Treatment
Christen Mullane (15:38)
It you know if people are actively being traumatized we don’t necessarily want to go there right away we might want to do more grounding at first and make sure and resourcing so in the same way as other traumas
Emma McAdam (15:45)
And resourcing. if someone, let’s, I love listening to you talk because this is how I think about treatment. It’s like, okay, we’ve got this decision tree, right? So this person comes in and if they’re in survival mode, right? They’re barely functioning, they’re barely sleeping, they’re maybe having outbursts or they’re just struggling to cope. You’d be focusing more on let’s do resourcing skills. Let’s learn grounding skills. Let’s do coping skills. Let’s practice like even some avoidance just to get you out of this panic zone. Is that what you’re talking about?
Christen Mullane (15:53)
You. Mm-hmm. Yeah. And really actually emphasizing the importance of discernment on the front end, like discernment in terms of like what medical providers they’re working with, helping them understand that they do have power and choice from the get-go. They get to choose what kind of treatment we do. They get to choose what kind of medical providers they’re ready to work with, if any, if any. to use like IFS or parts language, we only
Emma McAdam (16:25)
Mm-hmm. Mm-hmm.
Christen Mullane (16:38)
Move as quickly as the slowest part is one way to think about it. We want to be both trauma informed and trauma focused where we can be, right? So a trauma informed lens gives people all kinds of choices in terms of how they want to do the work and lots of autonomy. and really emphasizing that the fact that they’re in the room with you is already different. They’re already doing something different.
Emma McAdam (16:57)
Yeah.
Building Trust and Autonomy in Medical Settings
Christen Mullane (16:59)
Like I had one woman who experienced a medical error and for her, she would read the handouts I gave her but wasn’t ready to do any of the things at first. So again, we see that kind of ready to engage intellectually, but the actual kind of change work of maybe trying some of the exercises was spooky. for her.
Emma McAdam (17:21)
Perhaps because her trust in the medical establishment was broken. Like she couldn’t really trust that or she was scared to try things with them or collaborate with them.
Christen Mullane (17:21)
Yeah. Totally broken. Totally broken. Yeah, yeah, and I think she learned too over the course of this thing, that she had to be in charge of all of it. And there was certain pre-existing history for her around like having to kind of be in charge and manage all the things that played into that. But when somebody made a mistake that was life-threatening for her, like a typical strategy with fear is to try to control, right? And so she needed to control and
Emma McAdam (17:36)
Mm-hmm. Yeah.
Christen Mullane (17:56)
To lean on somebody else feels really threatening when you’re in that space. Like to sort of trust that these things that are not what you’re currently doing would have any positive outcomes for you when you’ve just had a really negative outcome. That’s really hard. It was a bridge too far at first. And so it took like a year
Emma McAdam (18:13)
Yeah. Mm-hmm.
Christen Mullane (18:20)
For her to start to implement some of the things that we were talking about in therapy outside of the therapy space. At least that’s what it felt like. She might’ve been doing it in other ways, but it didn’t feel real or lived between us for a long time. She kept coming in and she would be able to like name her emotions in session little bits by little bit. But it took a long time. I think that’s another.
Emma McAdam (18:33)
Yeah? Yeah.
Christen Mullane (18:42)
Maybe take away here is that because of the nature of this trauma, people are having to interact with systems that re-traumatize them pretty regularly. with a heart condition, you’re going to be going in for followups. You’re going to have to keep interacting with the system. So treatment might take a long time. Treatment might take a long time to gradually build skills to advocate for yourself in that system, to be discerning, to build a medical team that you trust. Like these are all things we can think about with patients.
Emma McAdam (18:55)
Right. It hurts.
The Journey of Healing from Medical Trauma
Christen Mullane (19:10)
As part of the intervention, but it takes time to do those things to really find the places and spaces where you can trust what’s going to happen to you.
Emma McAdam (19:15)
Yeah. So if someone out there is experiencing medical PTSD, for them to be patient with themselves and give themselves some grace right now in this process, it important?
Christen Mullane (19:27)
Yeah. It really is. it takes time for these things to change and shift. And with medical stuff, you’re going to be taking medicines, you’re going to be dealing with changes to how you pay attention and focus. It is actually kind of harder to engage in treatment sometimes because medicines will impact attention and concentration. So will the experience itself. So to be able to kind of slow down enough.
Emma McAdam (19:47)
Good.
Christen Mullane (19:57)
To receive is hard. It’s challenging.
Emma McAdam (20:02)
That’s so true. I was in the hospital with my, she was at the time about 16 months. We were in the hospital for three days and they were trying to diagnose a GI condition, which takes a long time. And the doctor kept saying, oh, this is an eosinophilic gastrointestinal disease. And they wrote it, I was like, what? And they wrote it on the board for me. And I was sitting in the hospital room with basically nothing to do with my 16 month old. We just watched TV for three days.
And at no point did I ever process what that meant. And the normal me would be like, Oh, let’s Google this. Let’s figure out what this is. Let’s find out what the options are. Let’s explore treatment options. And I just sat there for three days, like, my brain, like the stress levels and the worry and just like, Oh, let’s make sure like, so you get enough fluids today was all that took 100 % of my mental capacity.
Christen Mullane (20:46)
Yeah… Yeah… Exactly, that’s, mean, birth trauma is such a good example of how this can unfold, right? and, you know, or birth period, even if we don’t experience it as traumatic. It’s, yeah.
Emma McAdam (21:05)
Yeah. Like birth is just a mind-blowing experience. Like you will not come out of a pregnancy, you won’t come out of a pregnancy with the same brain. You just don’t.
Christen Mullane (21:21)
It’s so true and that’s kind of medical stuff. When it’s significant, we are transformed by it. It changes our identity in some kind of way. And it can take years to put together all the pieces of how we’ve been shifted, and how we understand ourselves and the different things we have to do.
Redefining Health and Identity Post-Trauma
And so when there’s disability involved or injury involved, some of the, again, life changing. And we grieve our former understanding of ourselves as a healthy person. And I think one of the things I kind of want to note here too is that our definition of health is a little flawed. So in the world health organizations, one of the things that they’ve talked about as a definition of health is the complete absence of illness and the complete presence of wellness.
Emma McAdam (22:03)
Good. Right. Okay, yeah.
Christen Mullane (22:18)
All or nothing does not include people who are trying to operate with chronic illness or disability. And so I think other things clinicians can be doing are to reframe health as a continuum. Like that ability is a moving target and it changes over the course of like, it can change over the course of a month or a day. Like there are parts of the day when I might feel
Emma McAdam (22:19)
Huh. Interesting. Yeah.
Christen Mullane (22:38)
Like I’ve got no spoons. I don’t know if you’ve heard that language. Yeah, spoon theory. So having that language I think also helps to join with people, but to kind of help us see ourselves on an ability spectrum can be helpful and to help create rituals for grieving the parts of ourselves or our experience that we think that we’ve lost so that it doesn’t become disenfranchised grief.
Emma McAdam (22:41)
Yeah, yeah, the NeuroSpoon theory.
Christen Mullane (23:01)
You know, we might need a ritual to honor our hair loss after cancer treatment, but that doesn’t exist at the community level necessarily. So helping people find those avenues can be part of what we do as well.
Emma McAdam (23:16)
It’s interesting, it’s making me think about this process of grief and also of coming to terms with our bodies as like these mortal bodies that break. And even when I talked about pregnancy, like you don’t come out of pregnancy with the same brain, I didn’t necessarily mean that that was negative. It’s like we are constantly transforming and changing and birth or pregnancy changes you in ways that you kind of have to grieve and adapt to. I guess what I’m
Christen Mullane (23:34)
Mm-hmm.
Emma McAdam (23:46)
What I’m thinking about as you’re talking is this idea of like, can we adapt to change? Can we accept ourselves in ways that are like, I’ve got like these parts of my body that aren’t great and these parts of my body that are great and it is what it is. And can I make space for this process and can I be open to things not always being optimal, like zero illness or something like that, right? Like this is an interesting.
Christen Mullane (24:08)
Yeah.
Emma McAdam (24:09)
Interesting process to try and think about sitting with and adapting to changes.
Christen Mullane (24:14)
Yeah, we attach so much meaning to our bodies, but they’re not always in the foreground of our painting. Like when when we’re firing on all cylinders, so to speak, then the body is sort of in the background and other parts of our experience come up here in the foreground. But with illness or disability or, or childbirth or things of that nature, suddenly the body is in the foreground. And that can be really scary for people because it is attached to mortality. It is.
Emma McAdam (24:25)
Yeah.
Christen Mullane (24:42)
And so even when things are going really well in terms of how medical treatment is done and received, just having the body as like a center focus, It lights stuff up for us. And that can be powerfully transformational. And so often the flip, you know, is to help people see the body can be tied to ideas about strength.
Emma McAdam (24:56)
Yeah. Yeah.
Christen Mullane (25:09)
And power in the world and safety. Like if I’m able-bodied, I can run away from a threat more easily than if I’m not. So when people start to have that stuff turned up, then we have to kind of take them through this dark patch sometimes to come out on the other side to be able to redefine what those concepts really mean. Like can I see my inner strength?
Can I see my love for other people as a source of power and healthy empowerment? Or like kind of helping access those values that have stuck with people from before and after. With any kind of trauma, there’s usually a clear before and after. So we want to help people. It’s like a bomb goes off in the middle of your life. And so we’re trying to help people salvage things from the wreckage so that they’re recognizable again on the other side. Like we can feel unrecognizable to ourselves. And when we’re looking in the mirror and we’re also having trouble recognizing that person because they’ve lost a breast, they’ve lost hair, our muscles have atrophied, like whatever it is, it just makes it that much more striking, that before and after. So starting to come back to some pieces of who we are and who we have been so that we feel integrated and whole, that’s part of the work.
Emma McAdam (26:05)
Yeah. Interesting. this makes me think of something I read from The Moth. So The Moth is, I don’t know, have you ever heard of The Moth radio hour? they coach people through telling their own stories and people tell the most incredible stories on there. And I don’t want to invalidate people who are right in the middle.
Christen Mullane (26:38)
Yeah.
Emma McAdam (26:46)
This process. I don’t want to say like, you should just be happy and get over it. But for some people, clearly medical trauma can be something that changes their whole perspective on themselves. And they say everyone can tell a story as a contamination story, as in this is the story of how I was broken and ruined. This is the story of how I became defeated, or they can tell this story as a redemption story or a transformation story. This is the story of how I gained new experiences, how I came to see my ability to love others as my greatest source of strength. And we can rewrite our stories through this process. And I think it’s a process. How long does it take? Months, years? Who knows? It’s part of our growth process.
Christen Mullane (27:29)
Right, And I just love that whole framing We have choice in terms of the kind of story we’re ready to tell or that we want to tell. where we place our attention matters, right? So as people are going through medical experiences, like if we’re looking for the parts where they can
Emma McAdam (27:38)
We’re looking for.
Christen Mullane (27:47)
Teach us something about ourselves, how we handle difficulty, where we are resilient. That’s a very different frame, mental mindset to be bringing to the experience than how is this breaking me? How is this ruining my life, right? And I think that’s where it can take a little coaching to kind of flip into that mindset. Some, you know, from someone who cares about you, it doesn’t have to be a mental health provider, but someone who just sort of
Emma McAdam (28:02)
Yeah, Yeah. Right.
Christen Mullane (28:15)
Helps you see yourself as a whole person, helps you see your strength when you might feel like you don’t have it. I love that you say too, I don’t want to invalidate people going through it by saying just do X, Y, or Z thing. Because I think that there are narratives around illness that can be sort of moral or where people see them as heroes, people who are coping with this stuff when people are just humans, just humans being human. And so I think, taking each person kind of one at a time is also really important here and kind of gauging what language fits for them and what they’re ready to hear. if I’m sitting here saying, I see you as so strong, but that person doesn’t feel like I actually know them or what they’ve gone through, that’s going to land really differently than if we’ve been coming together for an hour a week.
Emma McAdam (28:40)
Yeah. Yeah.
Christen Mullane (29:05)
And they’ve told me the hard parts. And then I say, I really see how strong you are and how your perseverance is really showing up through this. They feel joined first in that experience. when people are moving through life-threatening experiences, not everybody’s ready to receive or hear about what that’s like. It’s too scary for them. They don’t feel like they have the words to respond. That loneliness or isolation piece you were highlighting, it can make that flare, like feeling like you’re really alone with it. The other, yeah.
Emma McAdam (29:34)
Mm-hmm. So some people might, like your friends or relatives might be really uncomfortable with the process you’re going through. They might kind of avoid talking about it or they might not know if you want to talk about it. So they might be quiet or they might like give you platitudes, but you’re doing so great. You’re so brave. You’re so proud. And you’re you have no idea. You never even asked like how I’m doing. Yeah.
Christen Mullane (29:53)
Yeah, it can land differently. So there’s that piece of it. The other piece is that these events are really common. part of the reason we have trouble seeing medical trauma as trauma is that it’s everywhere. Like if we really think about, coming back to the family system and how they may not know how to join with people around it, they’re also going through it with the person a lot of the time.
And maybe dealing with vicarious traumatization because they’ve witnessed this life-threatening event. They’ve had to make decisions when another person could not. That might be life altering for that person. So there might be reasons why that avoidance happens, where we can’t talk about the thing because it’s too threatening to talk about the thing. And then everybody’s feeling really lonely. I do see that, like there’s such a hunger for witnessing from
Christen Mullane (30:44)
Patients and caregivers and medical providers. That’s the other piece of this system that I just want to acknowledge that all three of these corners of the care experience can feel so invisible. And part of it is because I think we avoid talking about the hard thing because it’s scary to talk about.
Emma McAdam (30:48)
Yeah. Yeah.
Christen Mullane (31:03)
A really simple question is what has this been like for you? What has this been like for you?
Emma McAdam (31:09)
a great example. What has this been like for you? ⁓ That’s such an open-ended way to let people share their own experience.
Christen Mullane (31:12)
Yeah, just leave it really open.
Emma McAdam (31:16)
Okay, so going back to my hypothetical client with a heart attack. So let’s say they’re transitioning out of crisis mode into like, let’s work on this. let’s work through trauma. Could you suggest an exercise, let’s say when their heart like skips a beat or feels a little funny. They’ve been to their doctor recently. There’s nothing the matter. Can you suggest an exercise for them?
Christen Mullane (31:20)
Mm-hmm.
Emma McAdam (31:42)
Or walk us through something that might help them move towards making space for that? Is there an exercise you’d recommend or you’d walk someone through in the moment?
Christen Mullane(31:50)
Yeah. So there’s a couple of things you can think about. Like if we’re framing this under the exposure therapy kind of lens, one option would be to get them to do something that increases their heart rate, something like physical activity. So it might just be like, if they’re in a virtual session, like kind of waving your arms around or whatever it happens to be.
It might be going on a treadmill for a little while. I think that you’d want to think about with their medical team, like what that person can physically do if you’re going to do any kind of exercise intervention. But that would be an example, like to do it for a limited amount of time at first and then bring them in and out of it with some relaxation techniques just to help them know that they do have some control over this symptom and how they work with it.
So you’d want to make sure that they have relaxation techniques in place first, and then you try this exposure. You can start well before that. You can start with like, with medical trauma when it comes to exposure techniques, you can have them go sit in the waiting room at a hospital for a little while, right? And just notice what happens for them knowing that they can leave. They’re not there for an appointment. They can leave anytime. So things that, that are time limited and that emphasize choice.
would be good to do.
Emma McAdam (33:08)
Got a hypothetical heart attack client and they’re like, oh my gosh, I’m so scared. I’m having this reaction to my heart beating funny. You would say, all right, are you willing to allow your heart to beat louder and different? And they say yes. You say, okay, we’re going to start by like just getting grounded here in the present moment. We’re going to start by being here in the room or maybe do like slow breathing for a minute. And then you’re going to let yourself for about two minutes.
Christen Mullane (33:21)
Mm-hmm.
Emma McAdam (33:35)
Do some jumping jacks. We’re going to feel your heart go big and we’re going to see if that brings up some emotions for you. Like maybe your heart’s going to beat faster. Maybe you’ll feel a little panicky. Maybe you’ll, you’ll feel scared that something bad will happen. We’re going to just sit with that fear. So they do it. They do two minutes of jumping jacks or whatever they can do. Wave their arms around. Like, what do you notice? You sit with those somatic sensations. Like what’s going on in your body? What’s going on emotionally? What thoughts are you having? And they’re like, okay, I thought I was going to die, but then I didn’t die. I thought my heart beating fast was unbearable, but by letting it beat fast, realized like, huh, I can let my heart beat fast for two minutes and it’s not unbearable. so they’re learning through experience that they can sit with anxiety around their heartbeat, these thoughts, like, what if I die? These physical sensations around their heartbeat. And you’re practicing through experience instead of just thinking about it or talking about it. And then maybe follow up with
Christen Mullane (34:15)
Mm-hmm. Yes.
Emma McAdam (34:32)
Okay, that’s great. You did that for two minutes. Maybe sometimes when you do exposure therapy, people are like, I did it. I feel great. I feel very relieved. And they don’t necessarily need grounding afterwards because they’re very like calm and happy and proud of themselves. Sometimes that feeling is still there and you would do another grounding, soothing exercise. Okay, we’re done with jumping jacks. You did it. You’re okay. Let’s get let’s get re-centered here. Let’s remember your…
Christen Mullane (she/her) (34:43)
Mm-hmm. Mm-hmm.
Emma McAdam (34:57)
Sources of safety and things like that, right? Is that kind how you’d walk through that?
Christen Mullane (35:01)
Yep, like you want to ground before and after in some kind of way as a frame, so leave yourself enough time to do that, but you’re right. Like people might just be like, exhilarated on the other side of this, saying, I saw myself do something I didn’t think was available to me anymore. And I think, before that session happens, like we’ve been highlighting, we want to, do a lot of those safety building behaviors. So, since I work virtually with people a lot of the time, because we might be working with people who are immunocompromised and things like that. ⁓ So you definitely want to have like an emergency plan in place, and kind of talk the patient through that, say, if something is to happen, who do you want close by, so you can do a lot of these anchoring things before you try the big hard thing. And then also when you work towards the big hard thing, whatever it is.
Chunking Medical Procedures for Anxiety Management
Chunk it into little bits and pieces at first so that it doesn’t activate a person over much.
Emma McAdam (35:54)
Okay, so let’s say if we’re breaking something down really small, let’s give an example of like needles, like you have to get a shot or you have to get an IV. can you give some examples of how would you chunk that or break that down into much smaller tasks instead of like, let’s just go get IVs until you’re over it, you know?
Christen Mullane (35:59)
Yes. Yeah, well some of it is around helping a person understand the medical system a little better and what their options are for advocacy. ⁓ So with needles as a particular example, there might be alternative routes of administration for medicine and that’s important for a person to know. So whether it’s you know an oral route and that’s something that they can handle and that gets them the care that they need, okay. Like in some cases we can mitigate the harm. We don’t have to do the needle.
Emma McAdam (36:22)
Mm-hmm. Yeah, okay. I like that empowerment, right? Yeah.
Christen Mullane (36:36)
But if, yeah, like, I’ve actually popped into sessions with a person and their physician before virtually. Like I just kind of come with the patient, like therapists in a box. And we’ve sort of had a conversation around like, okay, what are the options here?
And that can be really helpful too if you have a person who’s just scared to go to the doctor without support. Like maybe there’s a way that we can work with them to identify someone to go with them or look at pictures first of medical environments, have them sit with these emotions that might come up, know that they can handle the emotional piece without breaking down in a way that might embarrass them or confirm fears. so with needle phobia, I mean, there might be ways to break that down. And I also, I think it’s important to elicit from the patient what their ladder might look like to try to get there too. But it can include looking at pictures of needles for gradually increasing amounts of time. Going and holding one without having anything have to happen with it. Right? Like just kind of getting to know it. Yeah.
Emma McAdam (37:29)
Mm-hmm. Right. Yeah, just being around it. Yeah, handling it.
Christen Mullane (37:40)
Being in the same room. And so you can work really closely with a person’s medical team to organize some of this too. Because part of the rub might be, do I trust this person to stop when I ask them to stop? Is that the best course of action for me? creating a little bit of plan with the healthcare team ahead of time would be great too.
Emma McAdam (38:01)
Yeah. Yeah. So when I was at primary children’s with my daughter, I went down to the lab one day and at the lab where they have to draw blood from kids all the time and do all sorts of, you know, procedures, they have a little, a little chart and it’s like a picture chart for kids. And it says like, when this happens and it gives them all these options, like, do you want to be told everything? Do you want to be told nothing? Do you want to see it while it’s happening? Do you want to look away?
Christen Mullane (38:06)
Mm-hmm.
Emma McAdam (38:27)
Do you want a band-aid? Do you want a treat? Do you want a distraction? Do you want someone with you? Do you want a warm blanket? Do you want numbing cream before you get an injection? And it just gives them this whole menu that they can be like, this is how I like to get, because some of these kids, they’ve done this 100 times. And it’s like, this is how I like to get my IV or my shot or my blood drawn or whatever it is. I think…
Christen Mullane (38:34)
Yes. I think we can take a lot from the world of pediatrics into the world of adults ⁓ because that’s actually where we are. are. I mean, I just, there’s so much more research too around medical trauma and how to kids handle it than what we’ve got for adults right now. And there is actually, a book called Afraid of the Doctor that’s really good for parents who might be helping a kid through this that talks about like some of the things you’re describing.
Emma McAdam (38:50)
Yeah, right. We’re all little kids when it’s at the doctor. Yeah. Yeah.
Christen Mullane (39:11)
Like how to communicate with kids around medical stuff, how to help them have choice and agency and options too. So some of the same things that we’re talking about absolutely apply in PEDs. I’m gonna shamelessly self promote, but in my book, one of the exercises in there is a safety and coping plan for stressful medical situations. So that could be a needle phobia.
Emma McAdam (39:11)
Yeah.
Christen Mullane (39:34)
or something along those lines as one manifestation of this. But it kind of walks people through, what items do I want to bring with me to the doctor so I can soothe myself? What are some different places I can go to distract as an immediate kind of coping strategy? Like, can I go to the nurse’s station or the coffee bar down in the lobby? You know, different ways that you can kind of bring yourself through the experience of a hospitalization or a distressing procedure.
Emma McAdam (39:34)
Okay.
I
Christen Mullane (40:04)
I think things like that are really important to know what your options are and to develop that menu.
Emma McAdam (40:08)
Mm-hmm. Yeah, I love it. Can you tell people about your book? Tell people the name of it at least.
Christen Mullane (40:13)
So my book is back here. It’s called Medical Stress and Trauma, a mindfulness-based approach to reclaiming safety and empowerment. And so in terms of these kind of impacts on beliefs that we’ve been talking about, the book takes this structure to first articulate like what medical trauma is. It also talks about trauma-informed mindfulness and what that looks like when medical stress is present.
Then it’ll, walks through like the impacts on safety, beliefs about safety, ways to reclaim a sense of safety in medical environments, impacts on power and control, ways to feel more empowered. And then there are some sample scripts. for meditations, presume an able body. Like if we’re really thinking about five senses grounding,
It’s kind of assuming that people have access to all of their senses and that may or may not be true after an injury. People might have hearing loss or vision loss. Same thing with body scans. Like we want to use some caution with those because different parts of the body might be either like people might be actually missing limbs or things of that nature or there might be parts of the body that are huge trigger sources. anyway ahead of doing some of those exercises we want
Emma McAdam (41:06)
That’s a good point. Yeah. Interesting.
Christen Mullane (41:31)
To ask permission or kind of know the person we’re working with, right? Yeah. Yeah.
Emma McAdam (41:38)
Really helpful. Thank you. We’re gonna link that book in the show notes. So everyone check those out if you want to more.
Factors Contributing to Medical Trauma
Emma McAdam
Okay. Another question I wanted to address is, um, what are the factors that make medical experiences, more likely or prone to contributing to PTSD symptoms? Like, what is it about medical experiences that’s kind of unique compared to, for example, like war as a PTSD trigger.
Christen Mullane (42:04)
So with medical, one of the pieces that I think is pretty huge is betrayal. We are often socialized to go into medical systems with full trust. When you think about how we teach kids to kind of navigate the world, there’s this sense like, if something bad happens, you can talk to the doctor, you can talk to the police, and then it’s later on in life that these people who might be on pedestals kind of fall off.
Emma McAdam (42:15)
Right?
Christen Mullane (she/her) (42:29)
That’s because they’re human, like these systems are human, whatever system we happen to be navigating. But I think that’s one big piece is like the piece of trust and betrayal, which I think just to name it, I think that medical providers struggle with too. It’s really hard to be in that role.
Emma McAdam (42:32)
Yeah. Thank you. Yeah, sometimes they have limited resources, sometimes they have limited information, like they don’t know your whole case, sometimes they make mistakes, Like harm happens in medical situations, emergencies, it’s hard to make decisions, and you know…
Sometimes they just have to make their best guess at what’s the right treatment. yeah, yeah. So betrayal of trust, big factor.
Christen Mullane (43:01)
Mm-hmm. Yeah. Yeah, we’ve come so far in medicine that there’s, there can be this sort of expectation gap between what patients expect will happen in medicine and what actually happens. I was talking with an ENT the other day, she works with like throat cancer and things like that, even when things go a hundred percent well and the cancer remits,
There are still changes to a person’s quality of life and functioning on the other side of successful treatment that are just kind of awful, kind of awful. So a person might survive these events, but still have these long-term impacts. And I think that’s another shift or difference. Like with war, that can happen too. Like where people might be injured in a war context and there are these ongoing life impacts. But certainly with medical events, we see that.
Emma McAdam (43:29)
Sorry. Right.
Christen Mullane (43:51)
So that’s another, I think, shift as opposed to other kinds of trauma. So those are some off the cuff kind of thoughts. But I think that medical trauma itself, is in the body and we can’t escape our bodies, like that’s another piece that is really hard about it.
Emma McAdam (44:06)
Yeah. Mm-hmm. The shock, like being in physical shock makes it hard to process what’s going on. Physical pain makes it more likely we’ll have an emotional reaction as well.
Christen Mullane (44:19)
Yeah, and when we see things like post ICU PTSD, there can be really acute mental status changes in an ICU stay that are really confusing. So our own memories are a question, right? And often after traumatic events, we question our judgment, we question our ability to trust ourselves, but then there’s this extra layer of like medication reactions being put under anesthesia that can create almost
Emma McAdam (44:30)
Okay. There’s no Mm-hmm.
Christen Mullane (44:45)
Like nightmarish scenarios, like after with post ICU syndrome, sometimes people will feel like they’ve been, abducted by aliens, right? Like there was, we see people in different kind of garb who are giving you treatment. It’s really disorienting. The physical pain, the medicines we’re taking, like all of those things can be powerfully disorienting. ⁓ So that’s another layer to think about too, is just the surrealness of it as an experience.
Emma McAdam (44:53)
Yeah. Yeah. Mm-hmm. Interesting.
Yeah, okay. Yeah, lot of factors that can make medical experiences lead to highly emotional experiences that can lead to lasting effects like PTSD.
Advocacy for Healthcare Workers and Patients
Emma McAdam
Love it. Well, cool. Thank you so much. Really appreciate your time coming on here and helping people who are trying to learn more about medical trauma. Really appreciate it.
Christen Mullane (45:32)
Thank you for having me. This was awesome.
Emma McAdam (45:34)
Yeah, do you have a website or anything you want to send people to or just tell them about your book? Yeah.
Christen Mullane (45:37)
Sure.
But my website is ginkgoleafhealth.com. That’s G-I-N-K-G-O, leaf like a tree and health like what we’ve been talking about this whole time. ⁓ And on the website, we have free webinar videos that help with coping. Certainly there are some guided meditations there on the site too. If people work with our practice we do things like pro bono financial counseling for people who are struggling with medical debts. So there’s a lot that we’re doing to try to address things and we just got done with our very first healing health care.
Emma McAdam (46:08)
That’s awesome.
Christen Mullane (46:12)
Conference event.
Emma McAdam (46:13)
Fascinating very cool. Well, thank you so much. I’ll make sure and link that below and yeah Thank you again for your time. Really appreciate it
Christen Mullane (46:20)
Awesome Emma, thank you so much.
