12. THE UNBEARABLE HEAVINESS OF REMEMBERING
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CHAPTER 12
THE UNBEARABLE HEAVINESS OF
REMEMBERING
Our bodies are the texts that carry the memories and therefore
remembering is no less than reincarnation.
—Katie Cannon
cientific interest in trauma has fluctuated wildly during the past 150
years. Charcot’s death in 1893 and Freud’s shift in emphasis to inner
conflicts, defenses, and instincts at the root of mental suffering were just
part of mainstream medicine’s overall loss of interest in the subject.
Psychoanalysis rapidly gained in popularity. In 1911 the Boston psychiatrist
Morton Prince, who had studied with William James and Pierre Janet,
complained that those interested in the effects of trauma were like “clams
swamped by the rising tide in Boston Harbor.”
This neglect lasted for only a few years, though, because the outbreak
of World War in 1914 once again confronted medicine and psychology with
hundreds of thousands of men with bizarre psychological symptoms,
unexplained medical conditions, and memory loss. The new technology of
motion pictures made it possible to film these soldiers, and today on
YouTube we can observe their bizarre physical postures, strange verbal
utterances, terrified facial expressions, and tics—the physical, embodied
expression of trauma: “a memory that is inscribed simultaneously in the
mind, as interior images and words, and on the body.”1
Early in the war the British created the diagnosis of “shell shock,”
which entitled combat veterans to treatment and a disability pension. The
alternative, similar, diagnosis was “neurasthenia,” for which they received
neither treatment nor a pension. It was up to the orientation of the treating
physician which diagnosis a soldier received.2
More than a million British soldiers served on the Western Front at any
one time. In the first few hours of July 1, 1916 alone, in the Battle of the
Somme, the British army suffered 57,470 casualties, including 19,240 dead,
the bloodiest day in its history. The historian John Keegan says of their
commander, Field Marshal Douglas Haig, whose statue today dominates
Whitehall in London, once the center of the British Empire: “In his public
manner and private diaries no concern for human suffering was or is
discernible.” At the Somme “he had sent the flower of British youth to
death or mutilation.”3
As the war wore on, shell shock increasingly compromised the
efficiency of the fighting forces. Caught between taking the suffering of
their soldiers seriously and pursuing victory over the Germans, the British
General Staff issued General Routine Order Number 2384 in June of 1917,
which stated, “In no circumstances whatever will the expression ‘shell
shock’ be used verbally or be recorded in any regimental or other casualty
report, or any hospital or other medical document.” All soldiers with
psychiatric problems were to be given a single diagnosis of “NYDN” (Not
Yet Diagnosed, Nervous).4 In November 1917 the General Staff denied
Charles Samuel Myers, who ran four field hospitals for wounded soldiers,
permission to submit a paper on shell shock to the British Medical Journal.
The Germans were even more punitive and treated shell shock as a
character defect, which they managed with a variety of painful treatments,
including electroshock.
In 1922 the British government issued the Southborough Report, whose
goal was to prevent the diagnosis of shell shock in any future wars and to
undermine any more claims for compensation. It suggested the elimination
of shell shock from all official nomenclature and insisted that these cases
should no more be classified “as a battle casualty than sickness or disease is
so regarded.”5 The official view was that well-trained troops, properly led,
would not suffer from shell shock and that the servicemen who had
succumbed to the disorder were undisciplined and unwilling soldiers. While
the political storm about the legitimacy of shell shock continued to rage for
several more years, reports on how to best treat these cases disappeared
from the scientific literature.6
In the United States the fate of veterans was also fraught with
problems. In 1918, when they returned home from the battlefields of France
and Flanders, they had been welcomed as national heroes, just as the
soldiers returning from Iraq and Afghanistan are today. In 1924 Congress
voted to award them a bonus of $1.25 for each day they had served
overseas, but disbursement was postponed until 1945.
By 1932 the nation was in the middle of the Great Depression, and in
May of that year about fifteen thousand unemployed and penniless veterans
camped on the Mall in Washington DC to petition for immediate payment
of their bonuses. The Senate defeated the bill to move up disbursement by a
vote of sixty-two to eighteen. A month later President Hoover ordered the
army to clear out the veterans’ encampment. Army chief of staff General
Douglas MacArthur commanded the troops, supported by six tanks. Major
Dwight D. Eisenhower was the liaison with the Washington police, and
Major George Patton was in charge of the cavalry. Soldiers with fixed
bayonets charged, hurling tear gas into the crowd of veterans. The next
morning the Mall was deserted and the camp was in flames.7 The veterans
never received their pensions.
While politics and medicine turned their backs on the returning
soldiers, the horrors of the war were memorialized in literature and art. In
All Quiet on the Western Front,8 a novel about the war experiences of
frontline soldiers by the German writer Erich Maria Remarque, the book’s
protagonist, Paul Bäumer, spoke for an entire generation: “I am aware that
I, without realizing it, have lost my feelings—I don’t belong here anymore,
I live in an alien world. I prefer to be left alone, not disturbed by anybody.
They talk too much—I can’t relate to them—they are only busy with
superficial things.”9 Published in 1929, the novel instantly became an
international best seller, with translations in twenty-five languages. The
1930 Hollywood film version won the Academy Award for Best Picture.
But when Hitler came to power a few years later, All Quiet on the
Western Front was one of the first “degenerate” books the Nazis burned in
the public square in front of Humboldt University in Berlin.10 Apparently
awareness of the devastating effects of war on soldiers’ minds would have
constituted a threat to the Nazis’ plunge into another round of insanity.
Denial of the consequences of trauma can wreak havoc with the social
fabric of society. The refusal to face the damage caused by the war and the
intolerance of “weakness” played an important role in the rise of fascism
and militarism around the world in the 1930s. The extortionate war
reparations of the Treaty of Versailles further humiliated an already
disgraced Germany. German society, in turn, dealt ruthlessly with its own
traumatized war veterans, who were treated as inferior creatures. This
cascade of humiliations of the powerless set the stage for the ultimate
debasement of human rights under the Nazi regime: the moral justification
for the strong to vanquish the inferior—the rationale for the ensuing war.
THE NEW FACE OF TRAUMA
The outbreak of World War II prompted Charles Samuel Myers and the
American psychiatrist Abram Kardiner to publish the accounts of their
work with World War I soldiers and veterans. Shell Shock in France 1914–
1918 (1940)11 and The Traumatic Neuroses of War (1941)12 served as the
principal guides for psychiatrists who were treating soldiers in the new
conflict who had “war neuroses.” The U.S. war effort was prodigious, and
the advances in frontline psychiatry reflected that commitment. Again,
YouTube offers a direct window on the past: Hollywood director John
Huston’s documentary Let There Be Light (1946) shows the predominant
treatment for war neuroses at that time: hypnosis.13
In Huston’s film, made while he was serving in the Army Signal Corps,
the doctors are still patriarchal and the patients are still terrified young men.
But they manifest their trauma differently: While the World War I soldiers
flail, have facial tics, and collapse with paralyzed bodies, the following
generation talks and cringes. Their bodies still keep the score: Their
stomachs are upset, their hearts race, and they are overwhelmed by panic.
But the trauma did not just affect their bodies. The trance state induced by
hypnosis allowed them to find words for the things they had been too afraid
to remember: their terror, their survivor’s guilt, and their conflicting
loyalties. It also struck me that these soldiers seemed to keep a much tighter
lid on their anger and hostility than the younger veterans I’d worked with.
Culture shapes the expression of traumatic stress.
The feminist theorist Germaine Greer wrote about the treatment of her
father’s PTSD after World War II: “When [the medical officers] examined
men exhibiting severe disturbances they almost invariably found the root
cause in pre-war experience: the sick men were not first-grade fighting
material.… The military proposition is [that it is] not war which makes
men sick, but that sick men can not fight wars.”14 It seems unlikely the
doctors did her father any good, but Greer’s efforts to come to grips with
his suffering undoubtedly helped fuel her exploration of sexual domination
in all its ugly manifestations of rape, incest, and domestic violence.
When I worked at the VA, I was puzzled that the vast majority of the
patients we saw on the psychiatry service were young, recently discharged
Vietnam veterans, while the corridors and elevators that led to the medical
departments were filled by old men. Curious about this disparity, I
conducted a survey of the World War II veterans in the medical clinics in
1983. The vast majority of them scored positive for PTSD on the rating
scales that I administered, but their treatment focused on medical rather
than psychiatric complaints. These vets communicated their distress via
stomach cramps and chest pains rather than with nightmares and rage, from
which, my research showed, they also suffered. Doctors shape how their
patients communicate their distress: When a patient complains about
terrifying nightmares and his doctor orders a chest X‑ray, the patient
realizes that he’ll get better care if he focuses on his physical problems.
Like my relatives who fought in or were captured during World War II,
most of these men were extremely reluctant to share their experiences. My
sense was that neither the doctors nor their patients wanted to revisit the
war.
However, military and civilian leaders came away from World War II
with important lessons that the previous generation had failed to grasp.
After the defeat of Nazi Germany and imperial Japan, the United States
helped rebuild Europe by means of the Marshall Plan, which formed the
economic foundation of the next fifty years of relative peace. At home, the
GI Bill provided millions of veterans with educations and home mortgages,
which promoted general economic well-being and created a broad-based,
well-educated middle class. The armed forces led the nation in racial
integration and opportunity. The Veterans Administration built facilities
nationwide to help combat veterans with their health care. Still, with all this
thoughtful attention to the returning veterans, the psychological scars of war
went unrecognized, and traumatic neuroses disappeared entirely from
official psychiatric nomenclature. The last scientific writing on combat
trauma after World War II appeared in 1947.15
TRAUMA REDISCOVERED
As I noted earlier, when I started to work with Vietnam veterans, there was
not a single book on war trauma in the library of the VA, but the Vietnam
War inspired numerous studies, the formation of scholarly organizations,
and the inclusion of a trauma diagnosis, PTSD, in the professional
literature. At the same time, interest in trauma was exploding in the general
public.
In 1974 Freedman and Kaplan’s Comprehensive Textbook of Psychiatry
stated that “incest is extremely rare, and does not occur in more than 1 out
of 1.1 million people.”16 As we have seen in chapter 2 this authoritative
textbook then went on to extol the possible benefits of incest: “Such
incestuous activity diminishes the subject’s chance of psychosis and allows
for a better adjustment to the external world.… The vast majority of them
were none the worse for the experience.”
How misguided those statements were became obvious when the
ascendant feminist movement, combined with awareness of trauma in
returning combat veterans, emboldened tens of thousands of survivors of
childhood sexual abuse, domestic abuse, and rape to come forward.
Consciousness-raising groups and survivor groups were formed, and
numerous popular books, including The Courage to Heal (1988), a best-
selling self-help book for survivors of incest, and Judith Herman’s book
Trauma and Recovery (1992), discussed the stages of treatment and
recovery in great detail.
Cautioned by history, I began to wonder if we were headed toward
another backlash like those of 1895, 1917, and 1947 against acknowledging
the reality of trauma. That proved to be the case, for by the early 1990s
articles had started to appear in many leading newspapers and magazines in
United States and in Europe about a so-called False Memory Syndrome in
which psychiatric patients supposedly manufactured elaborate false
memories of sexual abuse, which they then claimed had lain dormant for
many years before being recovered.
What was striking about these articles was the certainty with which
they stated that there was no evidence that people remember trauma any
differently than they do ordinary events. I vividly recall a phone call from a
well-known newsweekly in London, telling me that they planned to publish
an article about traumatic memory in their next issue and asking me
whether I had any comments on the subject. I was quite enthusiastic about
their question and told them that memory loss for traumatic events had first
been studied in England well over a century earlier. I mentioned John Eric
Erichsen and Frederic Myers’s work on railway accidents in the 1860s and
1870s and Charles Samuel Myers’s and W. H. R. Rivers’s extensive studies
of memory problems in combat soldiers of World War I. I also suggested
they look at an article published in The Lancet in 1944, which described the
aftermath of the rescue of the entire British army from the beaches of
Dunkirk in 1940. More than 10 percent of the soldiers who were studied
had suffered from major memory loss after the evacuation.17 The following
week, the magazine told its readers that there was no evidence whatsoever
that people sometimes lose some or all memory for traumatic events.
The issue of delayed recall of trauma was not particularly controversial
when Myers and Kardiner first described this phenomenon in their books on
combat neuroses in World War I; when major memory loss was observed
after the evacuation from Dunkirk; or when I wrote about Vietnam veterans
and the survivor of the Cocoanut Grove nightclub fire. However, during the
1980s and early 1990s, as similar memory problems began to be
documented in women and children in the context of domestic abuse, the
efforts of abuse victims to seek justice against their alleged perpetrators
moved the issue from science into politics and law. This, in turn, became
the context for the pedophile scandals in the Catholic Church, in which
memory experts were pitted against one another in courtrooms across the
United States and later in Europe and Australia.
Experts testifying on behalf of the Church claimed that memories of
childhood sexual abuse were unreliable at best and that the claims being
made by alleged victims more likely resulted from false memories
implanted in their minds by therapists who were oversympathetic,
credulous, or driven by their own agendas. During this period I examined
more than fifty adults who, like Julian, remembered having been abused by
priests. Their claims were denied in about half the cases.
THE SCIENCE OF REPRESSED MEMORY
There have in fact been hundreds of scientific publications spanning well
over a century documenting how the memory of trauma can be repressed,
only to resurface years or decades later.18 Memory loss has been reported in
people who have experienced natural disasters, accidents, war trauma,
kidnapping, torture, concentration camps, and physical and sexual abuse.
Total memory loss is most common in childhood sexual abuse, with
incidence ranging from 19 percent to 38 percent.19 This issue is not
particularly controversial: As early as 1980 the DSM-III recognized the
existence of memory loss for traumatic events in the diagnostic criteria for
dissociative amnesia: “an inability to recall important personal information,
usually of a traumatic or stressful nature, that is too extensive to be
explained by normal forgetfulness.” Memory loss has been part of the
criteria for PTSD since that diagnosis was first introduced.
One of the most interesting studies of repressed memory was conducted
by Dr. Linda Meyer Williams, which began when she was a graduate
student in sociology at the University of Pennsylvania in the early 1970s.
Williams interviewed 206 girls between the ages of ten and twelve who had
been admitted to a hospital emergency room following sexual abuse. Their
laboratory tests, as well as the interviews with the children and their
parents, were kept in the hospital’s medical records. Seventeen years later
Williams was able to track down 136 of the children, now adults, with
whom she conducted extensive follow-up interviews.20 More than a third of
the women (38 percent) did not recall the abuse that was documented in
their medical records, while only fifteen women (12 percent) said that they
had never been abused as children. More than two-thirds (68 percent)
reported other incidents of childhood sexual abuse. Women who were
younger at the time of the incident and those who were molested by
someone they knew were more likely to have forgotten their abuse.
This study also examined the reliability of recovered memories. One in
ten women (16 percent of those who recalled the abuse) reported that they
had forgotten it at some time in the past but later remembered that it had
happened. In comparison with the women who had always remembered
their molestation, those with a prior period of forgetting were younger at the
time of their abuse and were less likely to have received support from their
mothers. Williams also determined that the recovered memories were
approximately as accurate as those that had never been lost: All the
women’s memories were accurate for the central facts of the incident, but
none of their stories precisely matched every detail documented in their
charts.21
Williams’s findings are supported by recent neuroscience research that
shows that memories that are retrieved tend to return to the memory bank
with modifications.22 As long as a memory is inaccessible, the mind is
unable to change it. But as soon as a story starts being told, particularly if it
is told repeatedly, it changes—the act of telling itself changes the tale. The
mind cannot help but make meaning out of what it knows, and the meaning
we make of our lives changes how and what we remember.
Given the wealth of evidence that trauma can be forgotten and
resurface years later, why did nearly one hundred reputable memory
scientists from several different countries throw the weight of their
reputations behind the appeal to overturn Father Shanley’s conviction,
claiming that “repressed memories” were based on “junk science”? Because
memory loss and delayed recall of traumatic experiences had never been
documented in the laboratory, some cognitive scientists adamantly denied
that these phenomena existed23 or that retrieved traumatic memories could
be accurate.24 However, what doctors encounter in emergency rooms, on
psychiatric wards, and on the battlefield is necessarily quite different from
what scientists observe in their safe and well-organized laboratories.
Consider what is known as the “lost in the mall” experiment, for
example. Academic researchers have shown that it is relatively easy to
implant memories of events that never took place, such as having been lost
in a shopping mall as a child.25 About 25 percent of subjects in these
studies later “recall” that they were frightened and even fill in missing
details. But such recollections involve none of the visceral terror that a lost
child would actually experience.
Another line of research documented the unreliability of eyewitness
testimony. Subjects might be shown a video of a car driving down a street
and asked afterward if they saw a stop sign or a traffic light; children might
be asked to recall what a male visitor to their classroom had been wearing.
Other eyewitness experiments demonstrated that the questions witnesses
were asked could alter what they claimed to remember. These studies were
valuable in bringing many police and courtroom practices into question, but
they have little relevance to traumatic memory.
The fundamental problem is this: Events that take place in the
laboratory cannot be considered equivalent to the conditions under which
traumatic memories are created. The terror and helplessness associated with
PTSD simply can’t be induced de novo in such a setting. We can study the
effects of existing traumas in the lab, as in our script-driven imaging studies
of flashbacks, but the original imprint of trauma cannot be laid down there.
Dr. Roger Pitman conducted a study at Harvard in which he showed college
students a film called Faces of Death, which contained newsreel footage of
violent deaths and executions. This movie, now widely banned, is as
extreme as any institutional review board would allow, but it did not cause
Pitman’s normal volunteers to develop symptoms of PTSD. If you want to
study traumatic memory, you have to study the memories of people who
have actually been traumatized.
Interestingly, once the excitement and profitability of courtroom
testimony diminished, the “scientific” controversy disappeared as well, and
clinicians were left to deal with the wreckage of traumatic memory.
NORMAL VERSUS TRAUMATIC MEMORY
In 1994 I and my colleagues at Massachusetts General Hospital decided to
undertake a systematic study comparing how people recall benign
experiences and horrific ones. We placed advertisements in local
newspapers, in laundromats, and on student union bulletin boards that said:
“Has something terrible happened to you that you cannot get out of your
mind? Call 727‑5500; we will pay you $10.00 for participating in this
study.” In response to our first ad seventy-six volunteers showed up.26
After we introduced ourselves, we started off by asking each
participant: “Can you tell us about an event in your life that you think you
will always remember but that is not traumatic?” One participant lit up and
said, “The day that my daughter was born”; others mentioned their wedding
day, playing on a winning sports team, or being valedictorian at their high
school graduation. Then we asked them to focus on specific sensory details
of those events, such as: “Are you ever somewhere and suddenly have a
vivid image of what your husband looked like on your wedding day?” The
answers were always negative. “How about what your husband’s body felt
like on your wedding night?” (We got some odd looks on that one.) We
continued: “Do you ever have a vivid, precise recollection of the speech
you gave as a valedictorian?” “Do you ever have intense sensations
recalling the birth of your first child?” The replies were all in the negative.
Then we asked them about the traumas that had brought them into the
study—many of them rapes. “Do you ever suddenly remember how your
rapist smelled?” we asked, and, “Do you ever experience the same physical
sensations you had when you were raped?” Such questions precipitated
powerful emotional responses: “That is why I cannot go to parties anymore,
because the smell of alcohol on somebody’s breath makes me feel like I am
being raped all over again” or “I can no longer make love to my husband,
because when he touches me in a particular way I feel like I am being raped
again.”
There were two major differences between how people talked about
memories of positive versus traumatic experiences: (1) how the memories
were organized, and (2) their physical reactions to them. Weddings, births,
and graduations were recalled as events from the past, stories with a
beginning, a middle, and an end. Nobody said that there were periods when
they’d completely forgotten any of these events.
In contrast, the traumatic memories were disorganized. Our subjects
remembered some details all too clearly (the smell of the rapist, the gash in
the forehead of a dead child) but could not recall the sequence of events or
other vital details (the first person who arrived to help, whether an
ambulance or a police car took them to the hospital).
We also asked the participants how they recalled their trauma at three
points in time: right after it happened; when they were most troubled by
their symptoms; and during the week before the study. All of our
traumatized participants said that they had not been able to tell anybody
precisely what had happened immediately following the event. (This will
not surprise anyone who has worked in an emergency room or ambulance
service: People brought in after a car accident in which a child or a friend
has been killed sit in stunned silence, dumbfounded by terror.) Almost all
had repeated flashbacks: They felt overwhelmed by images, sounds,
sensations, and emotions. As time went on, even more sensory details and
feelings were activated, but most participants also started to be able to make
some sense out of them. They began to “know” what had happened and to
be able to tell the story to other people, a story that we call “the memory of
the trauma.”
Gradually the images and flashbacks decreased in frequency, but the
greatest improvement was in the participants’ ability to piece together the
details and sequence of the event. By the time of our study, 85 percent of
them were able to tell a coherent story, with a beginning, a middle, and an
end. Only a few were missing significant details. We noted that the five
who said they had been abused as children had the most fragmented
narratives—their memories still arrived as images, physical sensations, and
intense emotions.
In essence, our study confirmed the dual memory system that Janet and
his colleagues at the Salpêtrière had described more than a hundred years
earlier: Traumatic memories are fundamentally different from the stories we
tell about the past. They are dissociated: The different sensations that
entered the brain at the time of the trauma are not properly assembled into a
story, a piece of autobiography.
Perhaps the most important finding in our study was that remembering
the trauma with all its associated affects, does not, as Breuer and Freud
claimed back in 1893, necessarily resolve it. Our research did not support
the idea that language can substitute for action. Most of our study
participants could tell a coherent story and also experience the pain
associated with those stories, but they kept being haunted by unbearable
images and physical sensations. Research in contemporary exposure
treatment, a staple of cognitive behavioral therapy, has similarly
disappointing results: The majority of patients treated with that method
continue to have serious PTSD symptoms three months after the end of
treatment.27 As we will see, finding words to describe what has happened to
you can be transformative, but it does not always abolish flashbacks or
improve concentration, stimulate vital involvement in your life or reduce
hypersensitivity to disappointments and perceived injuries.
LISTENING TO SURVIVORS
Nobody wants to remember trauma. In that regard society is no different
from the victims themselves. We all want to live in a world that is safe,
manageable, and predictable, and victims remind us that this is not always
the case. In order to understand trauma, we have to overcome our natural
reluctance to confront that reality and cultivate the courage to listen to the
testimonies of survivors.
In his book Holocaust Testimonies: The Ruins of Memory (1991),
Lawrence Langer writes about his work in the Fortunoff Video Archive at
Yale University: “Listening to accounts of Holocaust experience, we
unearth a mosaic of evidence that constantly vanishes into bottomless layers
of incompletion.28 We wrestle with the beginnings of a permanently
unfinished tale, full of incomplete intervals, faced by the spectacle of a
faltering witness often reduced to a distressed silence by the overwhelming
solicitations of deep memory.” As one of his witnesses says: “If you were
not there, it’s difficult to describe and say how it was. How men function
under such stress is one thing, and then how you communicate and express
that to somebody who never knew that such a degree of brutality exists
seems like a fantasy.”
Another survivor, Charlotte Delbo, describes her dual existence after
Auschwitz: “[T]he ‘self’ who was in the camp isn’t me, isn’t the person
who is here, opposite you. No, it’s too unbelievable. And everything that
happened to this other ‘self,’ the one from Auschwitz, doesn’t touch me
now, me, doesn’t concern me, so distinct are deep memory and common
memory.… Without this split, I wouldn’t have been able to come back to
life.”29 She comments that even words have a dual meaning: “Otherwise,
someone [in the camps] who has been tormented by thirst for weeks would
never again be able to say: ‘I’m thirsty. Let’s make a cup of tea.’ Thirst
[after the war] has once more become a currently used term. On the other
hand, if I dream of the thirst I felt in Birkenau [the extermination facilities
in Auschwitz], I see myself as I was then, haggard, bereft of reason,
tottering.”30
Langer hauntingly concludes, “Who can find a proper grave for such
damaged mosaics of the mind, where they may rest in pieces? Life goes on,
but in two temporal directions at once, the future unable to escape the grip
of a memory laden with grief.”31
The essence of trauma is that it is overwhelming, unbelievable, and
unbearable. Each patient demands that we suspend our sense of what is
normal and accept that we are dealing with a dual reality: the reality of a
relatively secure and predictable present that lives side by side with a
ruinous, ever-present past.
NANCY’S STORY
Few patients have put that duality into words as vividly as Nancy, the
director of nursing in a Midwestern hospital who came to Boston several
times to consult with me. Shortly after the birth of her third child, Nancy
underwent what is usually routine outpatient surgery, a laparoscopic tubal
ligation in which the fallopian tubes are cauterized to prevent future
pregnancies. However, because she was given insufficient anesthesia, she
awakened after the operation began and remained aware nearly to the end,
at times falling into what she called “a light sleep” or “dream,” at times
experiencing the full horror of her situation. She was unable to alert the OR
team by moving or crying out because she had been given a standard
muscle relaxant to prevent muscle contractions during surgery.
Some degree of “anesthesia awareness” is now estimated to occur in
approximately thirty thousand surgical patients in the United States every
year,32 and I had previously testified on behalf of several people who were
traumatized by the experience. Nancy, however, did not want to sue her
surgeon or anesthetist. Her entire focus was on bringing the reality of her
trauma to consciousness so that she could free herself from its intrusions
into her everyday life. I’d like to end this chapter by sharing several
passages from a remarkable series of e‑mails in which she described her
grueling journey to recovery.
Initially Nancy did not know what had happened to her. “When we
went home I was still in a daze, doing the typical things of running a
household, yet not really feeling that I was alive or that I was real. I had
trouble sleeping that night. For days, I remained in my own little
disconnected world. I could not use a hair dryer, toaster, stove or anything
that warmed up. I could not concentrate on what people were doing or
telling me. I just didn’t care. I was increasingly anxious. I slept less and
less. I knew I was behaving strangely and kept trying to understand what
was frightening me so.
“On the fourth night after the surgery, around 3 AM, I started to realize
that the dream I had been living all this time related to conversations I had
heard in the operating room. I was suddenly transported back into the OR
and could feel my paralyzed body being burned. I was engulfed in a world
of terror and horror.” From then on, Nancy says, memories and flashbacks
erupted into her life.
“It was as if the door was pushed open slightly, allowing the intrusion.
There was a mixture of curiosity and avoidance. I continued to have
irrational fears. I was deathly afraid of sleep; I experienced a sense of terror
when seeing the color blue. My husband, unfortunately, was bearing the
brunt of my illness. I would lash out at him when I truly did not intend to. I
was sleeping at most 2 to 3 hours, and my daytime was filled with hours of
flashbacks. I remained chronically hyperalert, feeling threatened by my own
thoughts and wanting to escape them. I lost 23 pounds in 3 weeks. People
kept commenting on how great I looked.
“I began to think about dying. I developed a very distorted view of my
life in which all my successes diminished and old failures were amplified. I
was hurting my husband and found that I could not protect my children
from my rage.
“Three weeks after the surgery I went back to work at the hospital. The
first time I saw somebody in a surgical scrubsuit was in the elevator. I
wanted to get out immediately, but of course I could not. I then had this
irrational urge to clobber him, which I contained with considerable effort.
This episode triggered increasing flashbacks, terror and dissociation. I cried
all the way home from work. After that, I became adept at avoidance. I
never set foot in an elevator, I never went to the cafeteria, I avoided the
surgical floors.”
Gradually Nancy was able to piece together her flashbacks and create
an understandable, if horrifying, memory of her surgery. She recalled the
reassurances of the OR nurses and a brief period of sleep after the
anesthesia was started. Then she remembered how she began to awaken.
“The entire team was laughing about an affair one of the nurses was
having. This coincided with the first surgical incision. I felt the stab of the
scalpel, then the cutting, then the warm blood flowing over my skin. I tried
desperately to move, to speak, but my body didn’t work. I couldn’t
understand this. I felt a deeper pain as the layers of muscle pulled apart
under their own tension. I knew I wasn’t supposed to feel this.”
Nancy next recalls someone “rummaging around” in her belly and
identified this as the laparoscopic instruments being placed. She felt her left
tube being clamped. “Then suddenly there was an intense searing, burning
pain. I tried to escape, but the cautery tip pursued me, relentlessly burning
through. There simply are no words to describe the terror of this experience.
This pain was not in the same realm as other pain I had known and
conquered, like a broken bone or natural childbirth. It begins as extreme
pain, then continues relentlessly as it slowly burns through the tube. The
pain of being cut with the scalpel pales beside this giant.”
“Then, abruptly, the right tube felt the initial impact of the burning tip.
When I heard them laugh, I briefly lost track of where I was. I believed I
was in a torture chamber, and I could not understand why they were
torturing me without even asking for information.… My world narrowed
to a small sphere around the operating table. There was no sense of time, no
past, and no future. There was only pain, terror, and horror. I felt isolated
from all humanity, profoundly alone in spite of the people surrounding me.
The sphere was closing in on me.
“In my agony, I must have made some movement. I heard the nurse
anesthetist tell the anesthesiologist that I was ‘light.’ He ordered more meds
and then quietly said, ‘There is no need to put any of this in the chart.’ That
is the last memory I recalled.”
In her later e‑mails to me, Nancy struggled to capture the existential
reality of trauma.
“I want to tell you what a flashback is like. It is as if time is folded or
warped, so that the past and present merge, as if I were physically
transported into the past. Symbols related to the original trauma, however
benign in reality, are thoroughly contaminated and so become objects to be
hated, feared, destroyed if possible, avoided if not. For example, an iron in
any form—a toy, a clothes iron, a curling iron, came to be seen as an
instrument of torture. Each encounter with a scrub suit left me
disassociated, confused, physically ill and at times consciously angry.
“My marriage is slowly falling apart—my husband came to represent
the heartless laughing people [the surgical team] who hurt me. I exist in a
dual state. A pervasive numbness covers me with a blanket; and yet the
touch of a small child pulls me back to the world. For a moment, I am
present and a part of life, not just an observer.
“Interestingly, I function very well at work, and I am constantly given
positive feedback. Life proceeds with its own sense of falsity.
“There is a strangeness, bizarreness to this dual existence. I tire of it.
Yet I cannot give up on life, and I cannot delude myself into believing that
if I ignore the beast it will go away. I’ve thought many times that I had
recalled all the events around the surgery, only to find a new one.
“There are so many pieces of that 45 minutes of my life that remain
unknown. My memories are still incomplete and fragmented, but I no
longer think that I need to know everything in order to understand what
happened.
“When the fear subsides I realize I can handle it, but a part of me
doubts that I can. The pull to the past is strong; it is the dark side of my life;
and I must dwell there from time to time. The struggle may also be a way to
know that I survive—a re-playing of the fight to survive—which apparently
I won, but cannot own.”
An early sign of recovery came when Nancy needed another, more
extensive operation. She chose a Boston hospital for the surgery, asked for a
preoperative meeting with the surgeons and the anesthesiologist specifically
to discuss her prior experience, and requested that I be allowed to join them
in the operating room. For the first time in many years I put on a surgical
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