July 5, 2024

Medical Trauma, part 4: Narratives (putting the pieces together)

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Now that we’ve seen how a child might experience a medical intervention, we can appreciate how she might develop some misconceptions about her body, the people who help, and what to expect in the future. To summarize, here are a few, common misperceptions a child could have:

And after the procedure:

These misperceptions can easily turn into long-term narratives. (Below, note that there is a range of possible narratives for each misperception, depending on how much the child generalizes the narrative.)

*Possible Misperceptions*	*Possible Resulting Narratives*
I think I caused this problem.	I did something bad or had bad thoughts which made a part of my body turn bad. I should try not to have any more bad thoughts or do any bad things. ^A Or: I am bad. ^B
I’m afraid a part of my body is broken. This part might stay broken. This part broke once and can break again.	I must always be very careful with this part of my body. Other things in my body might also break. I shouldn’t take risks with my body. My body is fragile.
Doctors hurt me when they’re supposed to help me.	I shouldn’t trust doctors or other important people who say they want to help me. ^C
My parents are siding with the doctors and not protecting me like they should.	I need to protect myself because my parents aren’t doing so. Can I trust the people who are supposed to keep me safe?

A) This reaction needs more explanation because it’s a complicated, emotional response. You are probably noticing a common theme in the young child’s thinking: she imagines she is at the center of all things, and therefore responsible for a lot that happens, both good and bad. In this way, she might explain her unexplainably broken body part as her fault. Because she can’t identify what precisely she did, she will believe she did some general, bad thing. Sometimes the bad thing amounts to having bad thoughts. So as not to repeat the past and break more body parts, she’ll tell herself not to do or think bad things. What this amounts to is dependent on the child. For instance, she may believe that she can’t behave badly, as is often defined by parents and other adults. She’ll be scared to break rules or do anything which might make others disappointed or angry. She will likely carry a lot of anxiety, always fearing that her behavior might be perceived as bad. If she tells herself she can’t have bad thoughts, this often amounts to having feelings which are commonly considered “bad,” such as anger, sadness, jealousy, aggression, neediness, etc. In this case, she will push away and deny herself those natural feelings. She may try to protect herself from having these feelings by avoiding situations that would generate them; for example, she may avoid conflict or closeness with others.

I know, in the paragraph above, there’s a lot of mays and mights and possiblys. It all sounds vague and uncertain. How are you supposed to know whether or not your kid might be pushing away her feelings, or might be afraid to break rules? This is where parenting becomes tough and nuanced, but the answers are in the details. As we discussed in Part Two: Deciphering Feelings and Narratives, you can decipher both your child’s feelings and her developing narratives by interpreting the specifics of her behavior.

B) Sometimes a child feels responsible for a bad event because she is bad. This is the most worrisome reaction a child can have, and it’s the most common issue I see in my clients, whether I’m working with a child, adolescent, or adult. To believe that you are inherently and intrinsically bad is a horrible thing to carry, and if this belief takes hold at a young age, it’s challenging to undo.
C) It’s common for a narrative to become generalized. This is true for children as well as adults when we form narratives, especially around traumatic events. Here, it’s not just the particular body part that is fragile but the whole body. Likewise, the child doesn’t just distrust doctors but all people in a helping position, such as teachers, babysitters, therapists, first responders (i.e. police), etc. In making the narrative of distrust apply more broadly, the child can believe she is further protecting herself.

Similarly, a child’s emotional reactions to a medical intervention can create narratives.

Possible Feelings

Possible Resulting Narratives

I can’t control what is happening to my body

I have to be in control of my body at all times. I’m afraid of losing control, physically or emotionally. ^D

My body felt invaded.

I must not let anyone get inside me, physically or emotionally. ^E

My feelings overwhelmed me.

Feelings are bad. I don’t want to have feelings. I need to push away all my feelings.

I feel helpless.

I am helpless. I have no control over what happens to me. There’s nothing I or anyone can do to protect me.

Or: I have to always be prepared for an attack. I must be big and strong and powerful so I never feel helpless again.

D) The need to be in control of one’s body is a common feeling. It can also lead to problems such as eating issues.
E) It may seem strange that a child who feels physically invaded might keep others away emotionally. This reaction, like many others, is an overgeneralization. Yet I frequently see this in my clients who have medical trauma. For example, when I asked an adolescent how he felt about the pressures of school, he turned on me with disgust and suspicion. “Seriously?” he said, “Why do you need to know that? You’re always asking these questions. Just question after question after question.” For him, I think my emotional probing triggered his memories of being physically probed and hurt.

Similarly, clients with medical trauma regularly take offense when I describe how it seems they’re feeling. Another client once described how a friend didn’t text her back for days which made my client quite angry. “I get it,” I said. “Seems like you felt rejected.” This was no major insight. Her sense of rejection seemed obvious enough, but she stared at the floor for a minute, silent, her lips pinched. Then she glanced at the clock on my wall, picked up her backpack and put in on her lap, and said, “So when exactly does this session end?” She couldn’t wait to get out of there. I think my observation felt more like an invasion.