Why Trauma Survivors Don’t Go To The Doctor
I have not been feeling well for months. -low energy, aches and pains everywhere, chills, and chronic fatigue. I’m so exhausted that I can barely make it from my bed to the couch downstairs without feeling drained. At first I thought maybe it was depression, but as the months went on, I started to get this feeling that there is something deeper going on with me aside from depression. I have a history of thyroid issues in my family, and I’ve been told by a few doctors that I should keep an eye on my thyroid levels, as they have historically been on the lower end of the spectrum.
Thus, after months of feeling like total crap, I picked up the phone and made an appointment with an endocrinologist, hopeful that this doctor will give me the answers I am looking for. I scheduled my appointment for the end of December – and what did I do immediately after I hang up the phone?
I agonized over the appointment. Every day that it got closer to me having to go to the doctor, I felt my anxiety increasing. I loathe going to the doctor. In fact, I’m petrified. And here is a little glimpse as to why doctors appointments, for myself and many others, are often traumatic:
My recent appointment with the endocrinologist went as follows:
I arrived, checked myself in for my appointment, got my temperature taken, and was called back by one of the techs.
“Step on the scale please,” she says. I respond “Oh, no, I am in recovery from an eating disorder and I cant – ” She cuts of me off. “Ma’am, we really do need your weight if you’re going to be a patient here.” I feel myself starting to shut down. “Ok dont be a big baby, just get on the scale” I think to myself. As I step on the scale, I say to her “Okay but it’s triggering to weigh myself so can you please not tell me what my weight -” She cuts me off again to say my weight out loud in front of multiple other people in the office so that someone else can write it down.
And then the shame starts. I start sweating. “Oh my god oh my god that bitch yelled my weight out to the whole office everyone is going to know my weight oh god I cant breathe.” I walk into the room to wait for the doctor. Soon enough the doctor barges in the door and says hello without making eye contact. She sits down at her computer and asks me deeply personal questions without looking back at me one single time.
“You wrote down that you have PTSD?”
My heart sinks right into my gut. I stammer on my words as I try to give a 15 second elevator speech about my trauma to a woman who isn’t even looking at me. As I finish speaking I start to cry into my mask. “Why couldn’t I just tell her I wasn’t comfortable discussing it?” I think to myself. But I cant help it. I’m with an “authority figure”. I’m playing out my trauma – giving my all to a person who promises to help me but doesn’t actually care about me.
She types on the computer in complete silence for what feels like 15 minutes. She gets up, touches my hands, my ankles, my neck, my chest, and says “There doesn’t seem to be anything wrong.”
I finally start to get angry. “That can’t be right. I’m telling you, I don’t feel well. I know when something is wrong with my body. I am in recovery from my eating disorder and eat better now than I ever have in my life and somehow have put on an excessive amount of weight in the last few months that has me extremely concerned about my health.”
She says “Well, I’ll send you for more bloodwork but in the meantime, you should exercise, 20 minutes a day. Sound good?”
NO THIS DOES NOT SOUND GOOD, DOC. If exercise was the f&%$*@! answer, I wouldn’t be here talking to you, now would I? The problem is that I do exercise, perhaps not as much as I would like because I’m so exhausted I can barely function but I do my damn best. I’m not here because I needed you to tell me to exercise. I’m not here to talk about how to lose weight – I’m here because everything in my body is screaming “SOMETHING IS WRONG.”
But I dont say any of that to her. Instead, I nod through my tears “Yes, I’ll exercise.” and I am sent to the front desk to check out. The woman hands me a piece of paper with the summary of my appointment, in which it says that the doctor discussed BMI with me and I agreed that I was going to exercise every day for 20 minutes.
And I sobbed. The discharge summary said nothing other than that I am overweight and need to exercise. I threw it in the garbage because IT IS garbage. Why why why can we be so obsessed with someone’s weight but be completely oblivious about the trauma that is often behind the number on the scale? Why are we still even talking about BMI? There is a plethora of research negating its validity as a tool for determining health.
How differently could that appointment have gone if she had asked me what is going on in my life aside from exercising? If she had looked me in the eye when she walked in the door and made me feel seen and heard? Would I have been so horribly triggered if they had respected my right not to step on the scale? I guess I’ll never know, but I do know one thing:
This sort of stuff happens in doctors appointments over and over and over again. Folks who are struggling with eating disorders are often masking trauma. When you get to the root of the trauma, you mitigate the eating disordered symptoms. The person then learns how to listen to their bodies and eat intuitively, and their weight becomes whatever it is meant to be.
WEIGHT WILL TAKE CARE OF ITSELF. It is not necessary for doctors to be discussing BMI when 90% of the time, we don’t show up to the doctors to discuss BMI. Weight isn’t, despite what so many people think in this fat-phobic society, the root of all evil. Unprocessed emotions, underlying autoimmune diseases, irregular metabolic functioning, and suppressed trauma, are just a few of the many, many things that are more important than BMI.
I wasn’t given the time of day by this doctor, as has been the case with dozens of other doctors. Instead of leaving with answers for what is going on with me when I know something is wrong, I left full of shame and rage that no one will listen to me when I am doing everything short of screaming at the top of my lungs “SOMETHING FEELS OFF WITH MY BODY PLEASE HELP.”
I’ve been in recovery from my eating disorder for awhile now. I’m more in tune with my body than ever before, but because my BMI labels me as being overweight, everyone jumps to the conclusion that it must be my diet and exercise that are off.
We need to do better. We need to get rid of the BMI are start assessing people’s ACE scores (see https://alyssascolari.com/understanding-adverse-childhood-experiences/ for more info on ACE scores) because this is ultimately what’s going to kill people, not their BMI. You can put someone on the biggest, best diet in the whole world and they will still continue to have health issues until you get to the core of their wounds.
“Trauma-informed” is not just some training that we need to get in order to check off another box on our “to-do” list. It’s a crucial part of the work that all healthcare professionals do. When we start to shift our focus towards a truly trauma-informed practice, I can guarantee that we’ll start saving more lives than the BMI chart ever has.
Boundaries vs. Threats
Of all of the pain I have endured over the last few months as a result of a significant loss in my life, I have to say, both time and space have given me the ability to see this person for exactly who he/she/they really are. I have had some time to reflect on the recent years filled with scenarios that left me feeling full of guilt and shame. This person, who happens to be the ultimate gaslighter, loved to tell me that he/she/they were setting boundaries with me. The thing about being in toxic relationships is that when you’re in one, you inherently believe that this person is speaking the truth. You don’t question whether or not this person actually knows what he/she/they are talking about. And when you start to feel angry and offended by what this person says, instead of blaming that person, you automatically blame yourself!
Thank God I know so much better now. The fog has cleared and although this person is nowhere to be found in any aspect of my life any longer, I feel as though I can see this person for who she/he/they truly are for the first time in years.
As I am processing the depths of my relationship with this person, I have realized that if this has happened to me, it is likely happening to so many other people, so I want to provide a little bit of clarity on a rather fuzzy topic. There is a significant difference between someone setting a boundary with you and someone threatening you, but sometimes the lines can be blurred and what we think are healthy limits are actually threats.
So let’s break it down, shall we?
Boundaries are limits that we set with other people or sometimes, even ourselves. The point of setting a boundary is to protect our own physical, social, and emotional health. Setting boundaries with others can look like:
-“Thank you for the invitation, but I can’t go out this weekend.”
-“I won’t be joining you for the holidays this year due to the pandemic.”
-“I have let you know repeatedly that I do not want to speak about this topic. If you continue to bring it up, I am going to leave the party.”
-“I have told you that I am not comfortable meeting up without masks. If you are not able to wear a mask, let’s wait to meet up until it’s safer to do so.”
Again, boundaries are put in place to honor ourselves and protect all aspects of our well-being.
Threats are designed for us to get the things we want and/or need, often at the expense of someone else. Threats typically come in the form of a warning that someone or something might be harmed if we don’t get what we want. Some examples of threats might be:
– “If you are going to continue dating that guy, then I’m going to stop asking you how you’re doing since you’re only going to get hurt.”
-“If you don’t spend the holidays with us this year, then I’m not buying you those shoes you have been asking for.”
-“We aren’t having sex at night anymore since you clearly can’t even have the laundry done by the time I get home from work.”
-“I’m paying for this wedding so I think I should have some say in where you have it.”
Threats are about securing our wants and needs by taking something away from someone if things do not go our way.
THE THIN LINE
As you’ll notice in the section on boundaries, none of the examples I provided were about doing harm to the other person in any way. The only thing a boundary should do is help us to protect ourselves without doing harm to others. The line between threats and boundaries starts to blur when we start punishing other people for not getting our way. There is no punishment happening when we tell others, for example, that we aren’t comfortable meeting up with them unless they are wearing a mask. There is punishment happening, however, when we withhold sex, threaten emotional neglect, or hold money over people’s heads in order to get what we want. Sometimes it can be quite difficult to tell the difference between a threat and a boundary. Many people feel that they are one in the same, but that could not be further from the truth; and it is important to suss out the difference so that we are taking good care of both ourselves and our loved ones.
Now with all of this being said, I’d like to shift gears and speak directly to YOU – the one who is the epitome of the thin line. I know you lurk in the shadows of my life, reading every blog post, listening to every podcast episode, watching me rise from the ashes like the goddamn phoenix that I am. You are the thin line between threats and boundaries, the one who has been threatening me for years under the guise of being “great at setting boundaries”. I know your eyes will scan every word of this page, hoping to find evidence that you broke me but knowing deep down that you never had that kind of power. Let me take a moment to thank you for teaching me the difference between a healthy boundary and an insidious threat. You have allowed me to be able to share this critical information with others so that they can recognize a threat from a mile away and learn how to set appropriate limits with others. Allow me to express my gratitude for the blinding pain you caused me. While I would have preferred to live without your subtle threats, manipulations, and abrupt abandonment, I am proud to say that I am taking what you put me through and will use it to help others for the rest of my days.
The Pain Will Come Again
As somebody who is rarely ever short on words, I find myself struggling to speak lately. I am quiet these days, possibly because I’m not too sure how to put words to the things that I have experienced over the last couple of months that have culminated in me being re-traumatized on multiple levels.
I will never tire of the way in which I feel so alive when I sit with my patients. It feels so natural for me to enter their worlds and help them to make connections, process pain, and heal what hurts. But sometimes I don’t do so well when the roles are reversed. When I become the patient, looking back at my therapist, I am speechless. Perhaps this is because words simply do not feel like enough to describe what has recently transpired in my life.
I suppose I am doing as well as any one person could be doing after being re-traumatized. There have been moments, especially this past week, when I have wanted to crawl right back into the cold, icy arms of my eating disorder -anything to take the edge off and make me feel like I have some sort of control. I’ve had to fight like hell to maintain my connections with safe, supportive people instead of isolating. And once or twice this week, I even had to take the risk of reaching out to my treatment team to help get myself grounded.
The flashbacks have become more frequent and I am finding that the way in which I talk to myself or about myself has become increasingly negative. I’m having to focus nearly all of my efforts into the self-care department. It would be so much easier for me to constantly work so that I don’t allow time or space to process all that has happened, but I’m trying to be intentional about slowing down. My boundaries in both my professional and personal lives have gotten tighter (i.e., avoiding contact with potentially triggering people, setting limits on how many hours I am working a day, etc.). While this process has required an exhausting amount of introspection, I have become much more aware of the things that I can and cannot hold space for right now.
So what does this all mean? Does it mean I’m too sick to do my job? Does it mean I am unraveling and cannot function? Does my pain make me any less competent in my profession?
No. Not at all. If anything, being fully in touch with my emotions and having awareness of my limits right now makes me more competent in my profession than I’ve ever been. I am completely aware of how much I am hurting right now, and I am fully aware that I have more on my plate than I bargained for.
Therapists are humans too, and as a human, being in recovery from PTSD does not mean that I will never have bad days again. It does not mean that I am immune to being traumatized in the future, nor does it mean that I am immune to a relapse in my eating disorder. Relapse is not only possible, but is also probably given my circumstances right now. Healing is not linear. None of us will ever wake up one day and be 1000% cured. The simple act of being alive means we will most likely experience pain multiple times throughout our lives.
But the exciting news is that with every breath I take, I have become more aware and more empowered to take my healing into my own hands instead of self-destructing, which is what I would have done in the past. As distraught as I have been, I have turned away from self-destruction and instead, I have made every effort to take better care of myself than ever before. This is what healing looks like. Healing doesn’t mean that we never hurt again! Healing means that, when the pain creeps back in, we feel more equipped to cope and to persevere. I am healing because although I will never be okay with what has happened to me, I am choosing to love myself through it in every way that I can.
I truly don’t know what the days will bring given my current circumstances, but I do know that with every decision to love myself instead of hate myself, I heal a tiny bit more. I have the tools, the love, and the support I need right now. And when all else fails and I simply cannot turn down the intensity of the pain, the anger, or the worry, I turn back to one of my favorite fictional characters who, I believe, said it best:
“No good sittin’ worryin’ abou’ it. What’s comin’ will come, and we’ll meet it when it does.” – Rubeus Hagrid, Harry Potter and the Goblet of Fire