Spiritual component of patients who experience psychological trauma: family physician intervention.

Susan, was referred to me by her primary care physician for counseling 30 years after her husband was killed instantaneously in an auto accident. The event was frozen in her mind as if it had just occurred. Susan was experiencing anxiety while driving, which was manifested by gripping the steering wheel so tightly her hand and shoulder muscles hurt, panic attacks, visual images of auto accidents, and intense fear. It quickly became apparent that she was suffering from post-traumatic stress disorder. It also became evident that a large component of her struggle revolved around unresolved spiritual issues about the accident. She believed she was the reason for the accident; maybe God was punishing her. At the same time, she continued to feel angry with God for taking her husband. For 30 years she had kept such thoughts inside and believed she could not share them with anyone, especially anyone in her faith community. The usual paradigm of addressing primarily the physical and mental symptoms in the treatment of post-traumatic stress disorder can be usefully supplemented by considering the spiritual response to psychological trauma. The spiritual response is certainly not the only way to understand the effects of trauma, but it is an important aspect of the trauma experience for some and is often overlooked by professionals. Consideration of spiritual dynamics can not only help physicians be more sensitive to those who are experiencing emotional trauma but also help them conceptualize the experience of trauma in a way that resonates with our patients. I am referring to psychological trauma in the broader sense, which includes events and situations that make persons feel helpless, overwhelmed, and disoriented. Family physicians are often at the forefront in dealing with those who have been traumatized or who are in crisis. In primary care settings, such patients do not always have symptoms that fit neatly into the diagnosis of post-traumatic stress disorder. Their symptoms might not even fit into the diagnosis of an acute stress disorder (disturbance lasts for at least 2 days and a maximum of 4 weeks). Fortunately, most patients will never develop post-traumatic stress disorder and will adjust to the trauma in a relatively short time. They are, however, undergoing a tremendous upheaval. Life events have turned their world upside down, and the horrific traumatization can result in severe questioning or loss of faith. Recognizing the magnitude of the physical, emotional, social, and spiritual components of traumatic experiences is essential to helping these patients as well as to intervening so that additional complications do not develop.