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NICU PTSD
August 25, 2009 12:05 PM   Subscribe

About three months after her son's birth, Ms. Roscoe asked to see a psychiatrist. She was given a diagnosis of post-traumatic stress disorder, or P.T.S.D. — a mental illness more often associated with surviving war, car accidents and assaults, but now being recognized in parents of premature infants in prolonged intensive care. (nyt)
posted by swift (19 comments total) 5 users marked this as a favorite

 
Having PTSD when you are constantly wondering if your child will live out the day shouldn't exactly be a surprising diagnosis, but I'd never thought about it before.
posted by BrotherCaine at 12:15 PM on August 25, 2009


George Carlin on PTSD:

I mentioned earlier several reasons we seem to employ so much euphemistic language: the need to avoid unpleasant realities; the need to make things sound more important than they really are; marketing demands; pretentiousness; boosting employee self-esteem; and, in some cases, just plain, old political correctness.

But no matter their purpose, the one thing euphemisms all have in common is that they soften the language. They portray reality as less vivid. And I've noticed Americans have a problem with reality; they prefer to avoid the truth and not look it in the eye. I think it's one of the consequences of being fat and prosperous and too comfortable. So, naturally, as time has passed, and we've grown fatter and more prosperous, the problem has gotten worse. Here's a good example:

There's a condition in combat - most people know it by now. It occurs when a soldier's nervous system has reached the breaking point. In World War I it was called shell shock. Simple, honest, direct language. Two syllables. Shell Shock. Almost sounds like the guns themselves. Shell Shock!!

That was 1917. A generation passed. Then, during the Second World War, the very same combat condition was called battle fatigue. Four syllables now. It takes a little longer to say, stretches it out. The words sont seem to hurt as much. And fatigue is a softer word than shock. Shell Shock. Battle Fatigue. The condition was being euphemized.

More time passed and we got to Korea, 1950. By that time, Madison Avenue had learned well how to manipulate the language, and the same combat condition became operational exhaustion. It had been stretched out to eight syllables. It took longer to say, so the impact was reduced, and the humanity was completely squeezed out of the term. It was now absolutely sterile: operational exhaustion. It sounded like something that might happen to your car.

And then, finally, we got to Vietnam. Given the dishonesty surrounding that war, I guess it's not surprising that, at the time, the very same condition was renamed post-traumatic stress disorder. It was still eight syllables, but a hyphen had been added, and, at last, the pain had been completely buried under psycho-jargon. Post-traumatic stress disorder.

I'd be willing to bet anything that if we'd still been calling is Shell Shock, some of those Vietnam veterans might have received the attentions they needed, at the time they needed it. But it didn't happen, and I'm convinced one of the reasons was that softer language we now prefer: The New Language. The language that takes the life out of life.

posted by Christ, what an asshole at 12:16 PM on August 25, 2009 [5 favorites]


Man, I like Carlin and all, but that bit is BS. It's not like we were tripping over ourselves to give psychiatric care to soldiers in WW1.
posted by adamdschneider at 12:20 PM on August 25, 2009 [4 favorites]


Nobody complained when they revised the thousand-yard stare to the more international 9144 meter stare.
posted by Astro Zombie at 12:24 PM on August 25, 2009


Er, 914 meter, rather.

This is why the metrick system never caugh on in the U.S. Ruins too many jokes.
posted by Astro Zombie at 12:24 PM on August 25, 2009 [2 favorites]


I recently read that babies who are born premature and thus spend a long time away from their parents are more likely to be abused. The author theorized that it was because the parents didn't bond properly with the children, but this seems like an equally valid reason.
posted by showbiz_liz at 12:27 PM on August 25, 2009


It's not like we were tripping over ourselves to give psychiatric care to soldiers in WW1.

Yeah, just ask Charles Kuhl if his treatment for battle fatigue was better or worse than a soldier being treated for PTSD.
posted by Pollomacho at 12:28 PM on August 25, 2009


Swift, thank you for posting this.

Tara Parker Pope's The Well blog (also NYT) is asking readers to share their stories in the comments.

Also, the article links to the March of Dimes "SHARE your story" forum. It's an amazing, wonderfully supportive section which is worth an FPP of its own. A number of my friends whose babies did (and did not) make it home from the NICU have found it quite helpful.

Preemie-L has an excellent resources page. I would caution anyone who is pregnant that some of the links may be disturbing. But when my wife was pregnant with our twins, I happened to find the linked "Outcomes for Premature Infant Gestation" page oddly comforting as we reached 27, 28, 29 and 30 weeks.

During and after a high-risk pregnancy, parents hear quite a bit of information from the OB/GYN, perinatologist or pediatricians. Some of that may conflict. Your children may not have been born yet... or they may be hours or days old, and you are entirely dependent on the doctors' and nurses' expertise for their survival. I can't overstate the value of access to objective resources as well as kind parents who have been through similar experiences, to help prioritize what should and should not be of overriding concern.

PTSD is a given. But it's rarely acknowledged or addressed. I'm glad Ms. Tarkan is shining a little light on this.
posted by zarq at 12:32 PM on August 25, 2009 [2 favorites]


unless you want to apply "shell shock" to victims of rape, childhood abuse and survivors of disasters this is one instance where ole George wa a little off base.

In no way am I minimizing the very real trauma of these folks, but PTSD seems like a slightly askew diagnosis. I mean I can understand it, but it seems not precise enough for the situation. Certainly a stress disorder but PTSD just doesn't jibe right.

not that it matters what I think.
posted by edgeways at 12:33 PM on August 25, 2009


I recently read that babies who are born premature and thus spend a long time away from their parents are more likely to be abused. The author theorized that it was because the parents didn't bond properly with the children, but this seems like an equally valid reason.

Yes, a number of studies have consistently shown that. It's hard to nail down a single factor.

Dealing with preemie children can be very stressful. They need to be fed more frequently and often have health and development problems -- such as anemia, liver problems, blood pressure issues or breathing / respiratory troubles. New parents of preemies often feel helpless and overwhelmed. I certainly did. That doesn't explain away abuse, of course. But it strikes me as one of several likely factors.
posted by zarq at 12:45 PM on August 25, 2009


zarq, I suspect that there are some factors that predispose to both premature birth and child abuse–substance abuse, for instance. Not to suggest that's the only factor at play, but could be one.
posted by Mister_A at 12:53 PM on August 25, 2009


I suspect that there are some factors that predispose to both premature birth and child abuse–substance abuse, for instance. Not to suggest that's the only factor at play, but could be one.

Definitely.
posted by zarq at 1:07 PM on August 25, 2009


While I never thought of it in these terms before, but having an unexpected premature birth followed by a long period in the NICU (10 weeks early and 40 days in the the hospital in our case) certainly had deep psychological reverberations. A sudden, unexpected medical crisis that threatened two lives turned into a grueling ordeal in the health care system stretching well over a month with plenty of drama, and we were in most respects lucky - about as uncomplicated as such an early birth could be, only a couple of really alarming medical crises after the birth, and the exceptional fortune of having medical insurance good enough to only end up on the hook for a few thousand of the tens of thousands of dollars in medical bills - not to mention living within close driving distance of a first rate NICU (actually in the same facility as our originally planned birth hospital).

And it all occurred as the nightmare mirror-world scenario of something we were planning on (the birth) and had expectations of that were undoubtedly (if typically) unrealistically optimistic and idealized to begin with. As a psychological outcome PSTD doesn't surprise me, though I wonder how the numbers would compare with any unexpected illness with prolonged hospitalization and a lot of touch and go uncertainty. I hope anyway it leads to better support for families that don't need any further obstacles in life. We were at a first rate facility but I don't really recall there being anything much done with respect to inquiring after (or suggesting support for) the mental health of Mom and Dad.
posted by nanojath at 1:30 PM on August 25, 2009 [1 favorite]


Salon recently posted an interesting interview with the author of a memoir about giving birth to preemie twins. The author seems to have dealt with the loss of the girl and the raising of a seriously disabled boy as well as anyone could (the first two years of his life was one long crisis), but I could definitely understand parents who have had to go through the same thing cracking.
posted by orange swan at 1:33 PM on August 25, 2009


Man, I like Carlin and all, but that bit is BS. It's not like we were tripping over ourselves to give psychiatric care to soldiers in WW1.

Of course. And so, as standards of care rose, they softened the name of the condition. If it were still being called Shell Shock we might take more notice. But with post-traumatic stress disorder, it doesn't sound as immediate, and despite our higher standards of care today, we aren't as worried. It makes total sense, actually.
posted by splice at 1:54 PM on August 25, 2009 [1 favorite]


Salon recently posted an interesting interview with the author of a memoir about giving birth to preemie twins. The author seems to have dealt with the loss of the girl and the raising of a seriously disabled boy as well as anyone could (the first two years of his life was one long crisis), but I could definitely understand parents who have had to go through the same thing cracking.

Vicki (the author in the Salon interview) is my sister-in-law. (Well, she's actually my brother-in-law's sister, but it seems unwieldy to call her my sister-in-law-in-law.) I remember the day the twins were born -- so early, so terrifyingly early. She had just had me over for dinner a week or two before, to welcome me to L.A. (I had just moved here). Over lemonade in the backyard, we watched her older daughter play hopscotch, and talked about how we'd take all the kids to Disneyland the following year. But it wasn't to be.

If Vicki and her husband Cliff didn't have PTSD after the twins were born (and after Ellie died four days later, and with coping with those first years of Evan's disabilities), then I don't know that there's an appopriate medical term for what they went through. The shell-shock, the grief, the exhaustion, the anger, the helplessness... every day, for years. And in the midst of it all, fierce love: the engine that seems to have driven them forward day by day, month by month, year by year, to hang on to their sanity. To be the best parents they could be to their children, and the best partners they could be to each other, and the best children/siblings they could to the rest of their families, who were themselves devastated by Ellie's death and Evan's disabilities, to create a place of love and joy and stability in the midst of pain and fragility that I never really understood was part of the bargain of being alive... well, honestly, having watched them go through it -- and having watched them say goodbye to Evan just a week shy of his eighth birthday last year -- I can only say that I have seen a couple of heroes in action.
posted by scody at 3:01 PM on August 25, 2009 [17 favorites]


in re Carlin's comments, you can go further back than WWII and consider some problems in the treatment of shell shock. Dr. Lewis Yealland reports applying electrical current and lighted cigarette ends to tongues of soldiers too traumatized to speak (from his Hysterical Disorders of Warfare, 1918). I learned about Yealland from Pat Barker's Regeneration. Also, the current standards of care leave something to be desired.
posted by girandole at 3:50 PM on August 25, 2009


Scody, that was a jaw-dropping comment. It is wonderful to have it confirmed that Vicki really is the terrific person and mother she seemed to be in her interview.

And I don't think there's any corner of the world or of human experience that the hive mind doesn't reach.

If it were still being called Shell Shock we might take more notice. But with post-traumatic stress disorder, it doesn't sound as immediate

I don't know that I agree with that. I prefer "PTSD" to "shell shock" because it's a much more precise term. For one thing it addresses the fact that PTSD affects people who have been through traumatic experiences rather than just those who have seen military action. I've never heard anyone make fun of PTSD, while I have heard the term "shell shock" used casually and flippantly.
posted by orange swan at 5:45 PM on August 25, 2009 [1 favorite]


Our twins were born at 34 weeks and spent the first three weeks in the NICU. All of my dreams from that time period involved a nightmare of beeping a whirring, which made working in a large datacenter... interesting.

I think for my wife and I it was an even more surreal experience as we'd lost our daughter to SIDS, so baby+hospital is this awful experience. Since we'd very unexpectedly lost a child earlier I feel like it wasn't quite as traumatic as it was for others who we saw day after day, but I don't know, maybe it just hasn't hit me yet (they're four months old today).

I do know that the nurses and doctors who work in the NICU are amazing people. Every one of them.
posted by togdon at 9:48 AM on August 26, 2009


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