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From post-traumatic stress disorder to absolute dependence in an intensive care unit: reflections on a clinical account
  1. Tina Sideris1,2
  1. 1Clinical Psychologist Private Practice Wits Donald Gordon Medical Centre, Johannesburg, South Africa
  2. 2Research Associate WISER, University of the Witwatersrand, Johannesburg, South Africa
  1. Correspondence to Dr Tina Sideris, Clinical Psychologist, Wits University Donald Gordon Medical Centre, Parktown 2193, South Africa; tinanded{at}icon.co.za, tinanded{at}icon.co.za

Abstract

This paper tells the story of one man’s experience of terrifying hallucinations and nightmares in an intensive care unit (ICU), drawing attention to the reality that intensive care treatment induces emotional suffering severe enough to be identified as post-traumatic stress disorder (PTSD). A body of international research, confirmed by South African studies, links life-saving critical care to symptoms which qualify for secondary psychiatric diagnosis including of post-traumatic stress. Risk factors include pre-ICU comorbid psychopathology. Early on in the clinical encounter with the patient in this paper it emerged that he bore the scars of another trauma. He had been a soldier. Recounting the terror he experienced when he was being weaned off mechanical ventilation evoked memories of his military history. Paradoxically, these shifted the focus away from the symptoms of PTSD, to make the helplessness and dependency of ICU patients more visible. This patient’s clinical account and patient experiences in other studies reveal the relational vulnerability of ICU patients. In as much as experiences of ICU treatment can be terrifying, the non-response of carers distresses patients. This interplay of wounding and care provides a starting point from which to explore how we account for the neglect of relational care that is a recurring theme in medical contexts, without blaming the carers. These questions find resonance in a South African novel to which the paper refers. A novel about war and trauma movingly portrays the internal conflict of the central character, a nurse and her quest not to care, as a defence against vulnerability. In these ways writing about the relational vulnerability of patients opened up questions about the social and institutional context of carer vulnerability.

  • critical care/intensive care
  • psychology

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Footnotes

  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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