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Expert Q&A

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How can I get help for PTSD induced by an ICU stay?

Asked by Celia C, Denver, Colorado

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Following a two-month ICU stay five years ago, I was told that I had many symptoms of PTSD. The near-death experience would have been enough to shake me up alone, but when I wound up with ICU delirium ... I don't know how long it lasted, it felt like years, and the hallucinations were worse than all of the surgeries and physical therapy put together. Worse than anything I have ever experienced. They were just too vivid, and my periods of lucidity were few and far between. I couldn't sleep soundly through the night for almost a year afterward.

I never seriously pursued any form of therapy, despite the advice of my doctors. Naturally, my symptoms haven't evaporated since then, and I've felt, many times, like an emotional cripple. I know I need help, and I want it very badly, but I've spent years avoiding every kind of clinical setting possible. It's a stupid fear, I know it, I understand it's completely groundless, but that doesn't stop the fear from winning out in the end. Living this way is exhausting, and the ways I try to deal with it range from merely unsuccessful to outright self-destructive.

My question is this: How can I push past that initial panic and discomfort to start the process of finding a therapist?

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Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear Celia,

I spent years treating patients in ICUs, and what you describe is one of the most common, most distressing and least talked-about problems associated with intensive medical care. You may not realize this, but there is a whole scientific literature on what is sometimes called ICU psychosis, but that is really the delirium you describe. Some progressive hospitals are now building ICUs and changing their daily schedule of activities in an attempt to combat delirium.

We should briefly tell our readers what we mean by delirium. The essence of delirium is what doctors call -- in fancy language -- a clouded sensorium. In simpler terms, delirium is a state in which people suddenly become deeply confused and disoriented. They lose track of who they are, where they are and when they are. It is also very common for delirium to come with hallucinations, and often these hallucinations are extremely disturbing. Unlike dementia, which is a slow, progressive loss of mental ability, delirium often occurs in people who are cognitively normal, but who are very medically sick. It is really a mental symptom of sickness. When the physical cause of the delirium is resolved, the delirium itself nearly always goes away fairly quickly. Finally, delirium is not dangerous in itself, but it is an ominous sign because 30 percent of people who experience a delirium will be dead in a year, not from the delirium, but from the underlying medical illness that caused the delirium in the first place.

Delirium typically strikes older people, because their brains are more vulnerable, but also because they are more likely to get sick. But it can strike at any age. I had my tonsils out when I was 7 years old, back in the bad old days when they put an ether mask over your face and held it there until you blacked out. They called it anesthesia, but it was more like being smothered to death. Ether is famous for its hallucinatory effects, and I learned this firsthand.

Like you, the hallucinations I experienced more than 40 years ago are as real as any of my other childhood memories. I was adrift in a sea of burning red jelly beans, which culminated in a giant wooden clown's face vomiting out a massive stream of the fiery beans. And then, everything went blue, and I was up at a place in the California mountains called Sequoia Lake, and then a curtain of blackness came down. I still drive by Sequoia Lake once or twice a year and feel a powerful feeling of warmth for the place because it provided relief from the hellishly red vision of my ether-induced delirium.

It is very common for people who survive bad ICU stays to be subsequently crippled by the post-traumatic stress disorder (PTSD) that develops. The longer the PTSD continues, the harder it is to treat. Because of this, you don't have a minute to lose. It is so important that you find a way to overcome your fears and get into treatment. I know from your e-mail that you live in a large urban area that has a medical school with an excellent psychiatry department that would be an ideal place to get the help you need.

Here is one suggestion: Rather than trying to tackle the whole problem yourself, why don't you break the challenge of getting into treatment down into smaller pieces? One way you could do this would be to research therapists and/or centers that treat PTSD in your city. And then, why don't you have someone close to you (a family member, a close friend, etc.) make the actual call to set up the appointment. Then have that person drive you to the first session and wait for you in the waiting room, so that you don't have to do all the emotionally hard stuff by yourself.

Whatever way you find, please don't wait any longer to get treatment. Life is way too short to lose so much of it to a treatable condition.

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