Dealing with traumatic memories and phobias

Qn: “I had a knee operation three years ago, but I keep getting spasms of pain especially around the month of June when the operation was conducted. Should this worry me?”

Yours is a truly interesting question and it raises a number of issues that we do not discuss often. The first and perhaps most obvious is that of anniversaries and what they mean.

The second is the effect of weather on general health and in particular its effects on older people, specifically in relation to chest infections but also in relation to diseases of the joints.

Another less known fact is the effect of season of birth in relation to some mental illnesses including Schizophrenia. Sounds so complicated!

Indeed, the whole conversation about environment and health is not often put on the discussion table. There is for example some evidence linking maternal stress during pregnancy and the later development of some anxiety disorders.

Some of this evidence comes from studies that looked at children born after the Second World War (the blitz) as well as some studies from the various wars in the Middle East, Israel in particular.

As you can see, yours is a fairly simple question of knee surgery and its long term effects, but it now raises many other considerations. Children born during the Mau Mau would be an interesting group of old men and women.

Let us therefore start with the simple things. June and July are some of the coldest months in the Kenyan Highlands. Without knowing why you had the surgery to the knee, and without knowing how old you are, it is possible to speculate that the cold during the month of June is the cause of additional pain to your already damaged knee. That is the simple answer, and it might be possible to relieve the pain by keeping warm and doing physiotherapy.

Again, without knowing what the surgeons did to your knee, one could speculate about the trauma you might have gone through before, during and even after surgery. Such trauma could include great pain and possible threat to life or limbs.

If at any stage in the process there was perceived or real threat to your life, then you might be going through some form of exacerbation of Post-Traumatic Stress Disorder (PTSD).

Older Kenyans will remember the events of August 7, 1998, when the American Embassy in Nairobi was bombed by terrorists. 219 people died and over 5,000 were injured. Tens of thousands suffered from PTSD.

Many described experiences similar to yours at every anniversary of the attack. Twenty-one years later, we still mark the anniversary with great emotion. In addition to experience of life threatening events, the current diagnostic systems require that the person diagnosed with PTSD be showing certain basic symptoms of the condition. An example will make the point.

A few years ago, we saw a young man who had been injured by a stray bullet during an attempted robbery at a bank where he worked as a teller. The bullet had struck him in the knee shattering the joint and leading to much bleeding and drama. He believed he would die. He did not die, but there was extensive damage to his knee. He was able to go back to work, six months after the incident. When time came for him to start work, he could not and his employer could not understand why he “refused” to work.

He was sent to us for “counselling on the subject of the merits of hard work”. On careful examination, we made a diagnosis of PTSD. First of all, he had the classical symptoms of re-experiencing the trauma. From the blue, as he put, the memory of the shooting kept coming to his mind all the time. The more he tried to push the thought away, the more the thought kept coming back. The memory kept intruding into his mind.

Then there was the clinically relevant symptom of avoidance. He was unable to go back to the branch where the shooting took place. The thought of entering the banking hall led to much terror and apprehension. The name of the bank caused him anxiety, and he would sweat and tremble at the mention of the bank.

To his utter confusion, he had “stopped feeling”. He explained that he did not love his wife and children and he felt numb and cold. His whole being was numb and devoid of any emotion.

When we saw him, he was also clinically depressed, was drinking heavily and felt a hopeless failure. It took three months of intensive care to treat the PTSD. He went back to work, loved his family again and is now well. He still feels sad and moody on the anniversary of the shooting.