Physical Versus Emotional Needs: What's More "important"?

[ButterflyBean]

Hi everyone!

First, let me acknowledge what a difficult time the holidays can be for many of us even though the busyness may have passed! Whatever you celebrate, I hope for moment that you can cherish the memories and time you have with the people in your life! May you find peace among all the emotions you may be experiencing!

I'm not one to reach out very much, although asking for support is something I am always working on with my therapist. My first therapeutic dilemma had to do with my psychiatrist going on maternity leave and insurance dictating the length of my therapy sessions. I am happy to report that despite the circumstance, I have been able to work within the constraints and keep myself from getting "stuck" so far, which is progress in itself. However, here in lies my newest dilemma: how do you decide between two aspects/issues that are equally important: physical versus emotional needs?

I have decided to have major surgery on my stomach after countless conversations, with a variety of healthcare professionals, that have been two years in the making. The question now is when. The operation is currently scheduled for the end of January because my physical symptoms have gotten worse over the past few months, and now that I have come to terms with my decision (completely elective), I don't want to delay the process any longer; however, the fact that my main trauma behind the PTSD is medical in nature complicates things a little further. My psychiatrist does not return from maternity leave until mid-February, and I'm wondering if I should postpone the surgery until she returns, which was my original plan (mid-March during spring break from an online graduate class). Upon review of the course syllabus, and conversations with advisers, having the operation at the beginning of the semester, as planned, is most feasible from an academic perspective. I have made a list of the pros and cons regarding both options, which includes taking a semester off of school; however, there are negative implications to doing that, although I am prepared to withdraw if absolutely necessary. In being honest with myself, I'm not sure I took appropriate consideration of my psychological safety. I'm not even sure what that looks like at the moment, except that there should be some component of stability, which is missing due to a variety of factors that I don't want to go into right now. Keep in mind that the operation in question, and the most difficult medical decision to date, has everything to do with my quality-of-life. Of course, the goal is to achieve a great level of improvement, but I am well aware that things could go the opposite way, hence the extremely difficult decision. I am also carefully considering the grieving process associated with the trade off that is loss of independence and functional improvement.

I realize that I'm being quite vague about the medical details of the situation, but I want to reiterate that my dilemma lies in meeting my physical and psychological needs simultaneously, which doesn't seem possible. As I lay in bed writing this, I know that I'm not psychologically ready for such an involved undertaking. However, on bad days, which are more often then not, the physical symptoms are extremely difficult to deal with. I feel like I'm in an impossible situation, which is taking even more psychological energy given the associated anxiety over the hospital stay and recovery. I am quite spiritual, Christian, so I'm relying on my faith in God to help me with the timing, but I'm paralyzed by fear. That's all I've been bringing to my therapist, which is fine with her of course, although not entirely functional for the next four weeks.

Let's not forget the nature of my therapeutic relationship. Obviously, we've been focusing on safety and stabilization in the context of inner child work as it relates to the first turmeric hospitalization, which was approximately four years ago. I've been in therapy with the same therapist for many years, but trauma work has been relatively recent after my psychiatrist definitively diagnosed the PTSD. At the beginning of our relationship, the main focus was on the emotional impact of my academics during undergrad. I'm currently pursuing a masters in counseling, so I'm quite accustomed to the ebb and flow of a healthy, working therapeutic process. Stabilization and coping is essential right now, but I am not a fan of CBT or DBT at all. I am doing EMDR and spiritual exploration once a month with additional providers, so any insight or support is greatly welcomed and appreciated!

 

[Justmehere]

What other kinds of support do you have in place to get through surgery outside of therapy with this one therapist and what support do you have outside of professional supports? Maybe it doesn't have to be either one or the other.

Perhaps it doesn't need to be either I do the surgery sooner without adeaute psych support from this one therapist vs wait to do it until after she gets back. It could be that other supports could step up in a greater way. This may be important anyhow because it may take a little time for you and the therapist to settle in again with each other.

I'm considering orthopedic surgery on my leg on the next two months and my therapist and I are actually planning on taking a break from trauma work. We might meet again after a couple weeks off to get through the surgery, but she would be availed for phone calls - just taking a break from full sessions. Prior to the surgery we are working on getting through a few trauma processing related things first and building up a robust trigger management plan (doctors are a huge trigger for me) and also building up solid supports (friends to help with getting groceries and laundry) to help me get through the weeks after surgery.

 

[Friday]

Honestly, I think that if -worst case scenario- the surgery sends you into a PTSD-Tailspin = you'd have to take the quarter off (or fail your coursework) in the middle of an acute crisis ... That it makes a lot more sense to take a planned quarter off, or not take the quarter off but wait for your therapist to return to see if she can help keep the crisis from happening in the first place.

 

[Seasounds]

....how to decide..between two issues that are equally important

?

Between having a good friend who has mild to severe abdominal pains, and who deals with PTSD, I can begin to understand your situation. And I, myself, understand trying to decide to take or not take a break from school.

Some thoughts I can offer are (what I would do):

• With the emotional and physical being inextricably linked, I weigh the whole self picture.
• From what you have said, since the causes of your PTSD are medically related, it makes sense to wait for your psychiatrist to come back from medical leave.
• An advocate is a great thing to have, when involved in the medical world.

Good luck!

 

[ButterflyBean]

Thank you for all of your insights! The more I think about the situation, the more I realize that keeping everything as planned is the best option, however unsettling that may be. Postponing things also means that my recovery will be pushed much further out.

@Friday - I do understand your logic here, but continuing with the academic semester despite my surgery will give me something else to focus on and keep me busy when I am stuck in my house, so the workload is not much of a concern. The main question is whether or not the extra support my psychiatrist can provide is essential to my recovery? True, her presence is likely to help me feel safer even if she does little during recovery because I am not able to get to the clinic, which brings me to my next point:

@Justmehere - your question made me realize that I did not discuss my support system, or lack there of, in my original post. It is not very strong outside of mental health professionals when it comes to my emotional stability. My psychiatrist manages my meds, which I discontinued for a variety of reasons before she left because I did not feel comfortable with the covering doctor making significant adjustments given the fact that I don't respond well to medication due to metabolic issues. That being said, my regular doc has a great understanding of how childhood medical trauma can carryover into adulthood and lead to late onset PTSD. On the other hand, my therapist and I are discussing her ability to provide support during my recovery. We are considering sessions in my home every other week but haven't discussed the details/logistics yet because a lot depends on when I am released. Upon further reflection, I think part of my hesitation comes from having a few lingering concerns that have not been adequately addressed yet, along with the actual hospital stay and management of acute psych medications. Since my regular psychiatrist understands the complexity of my medical situation as it relates to my disability, I feel she is an integral part of med management, even though postponing the surgery is not the best option. I also have hesitation surrounding whether or not I am making the right decision regarding the surgery itself, which is something I am thoroughly exploring in therapy, although I doubt I will be able to reach a sense of peace in the next four weeks.

@Vandya - thank you for your suggestions! I am actually quite good at advocating for myself. My goal is to help teach others how to achieve the same level of advocacy in situations like my own. I'm not sure what you are referring to when you say, the "whole self picture", but the two equally important issues are my physical needs and emotional needs. Both are obviously different while being incredibly interrelated. Hence the reason I feel as if I am in an impossible situation...

If there's one thing I've learned over the years, it's that life doesn't stop just because circumstances are difficult. The world keeps going, needs and goals keep changing, which necessitates adaption within a never-ending cycle.