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More PsychNotes: Physical Health

Recovering from the Physical Assault of Surgery or Intensive Care
by Monica A. Frank, PhD

doctor and patient in hospital bed
Although the vast majority of people hospitalized in an intensive care unit reported good care, at six months following treatment 14% were suffering from post-traumatic stress (PTS). In addition, a large portion of the patients reported depression (30%), anxiety (23%), and general stress symptoms (18%) with poor sleep quality associated with these conditions. The PTS symptoms did not appear to be related to previous levels of trauma (Elliott, et al., 2016).

My clinical experience with clients who have had surgery or intensive care is that they are not adequately prepared to understand and manage the aftereffects of their treatment. Although psychological symptoms are often assessed these days they are not adequately explained. People continue to associate psychological symptoms such as depression and anxiety with mood states. As a result, they often resist the label: “I'm not depressed! My life is good. I've recovered well from the surgery. I just need to shake it off.” Thinking this way often prevents them from effectively taking care of themselves post-treatment.

What people often don't realize, however, is that the psychological symptoms are not due to a mental condition but to a physical one. Think of it this way: when a person has surgery or intensive hospitalization their body has been seriously assaulted. A few months later the doctor may pronounce good physical recovery, but the body doesn't recover completely from such an assault that quickly.

When the body is assaulted, it rallies by trying to protect the areas that have been effected. Healing requires a great deal of energy. So when the body has to expend more energy for healing, it reduces the energy expenditure in other ways. As a result, a person will lack energy, be more fatigued, have sleep disturbance, lack interest in usual activities, all of which are generally signs of depression. In addition, fear and anxiety is a normal reaction when the body has been assaulted because it is the body's way to avoid and protect from further assault.

Therefore, I think of these symptoms more as a physical depression than as a mood disorder: the body is slowed down (depressed) because it has to focus energy on physically recovering from the assault of medical treatment. More intensive treatments can take a good year or more to fully recover from.

In my experience, the more people are able to understand this normal reaction to the assault on the body, the more they are able to take care of themselves and recover more completely. By understanding that their symptoms are not about mood but about the bodies need to focus energy on healing, they can focus more on getting proper rest, eating well (even if they don't feel like it), and avoiding undue stress in order to help the body with the healing process.

For more information, read Mobilizing Your Body's Resources: Healing from Illness or Injury.

Elliott, R., McKinley, S., Fien, M. and Elliott, D. (2016). Posttraumatic Stress Symptoms in Intensive Care Patients: An Exploration of Associated Factors. Rehabilitation Psychology, 61, 141–150. DOI: 10.1037/rep0000074

curved line