Addition to the self-help posting.

I realize that we need more specifics about the graphic narrative of infant surgery. I hope to be able to add that in the next day or so.

Our guide for trauma therapy is now available on amazon.com. It is titled The Instinctual Trauma Response and Dual Brain Dynamics: A Guide for Trauma Therapy by Louis Tinnin and Linda Gantt. It is a paperback and sells for $20.00. It offers a full understanding of infant surgery as trauma and a description of its treatment. Please read it and give me your thoughts.

The Silent Scream, The Life of Quiet Desperation, and Treatment

My continuing search for telltale characteristics of adult victims of infant surgery without anesthesia suggests two that are expressed in literature and art. These adults seem to live “a life of quiet desperation” as quoted from Thoreau’s Walden (1854) and descriptive of the person’s unconscious (nonverbal) dire expectancy of doom. The second relates to the painting “The Scream” by Edvard Munch. That was one victim’s description of her invariable reaction to stress; a silent scream. Others have endorsed this description as applying to their inner echo of perennial pain. I understand these two experiences as arising from the dissociated infant self, frozen in the trauma of surgical pain.

How Can You Treat The Trauma Of Infant Surgery ?
The processing of any trauma requires the processing of two memories, the verbal memory and the nonverbal. The verbal memory of infant surgery is a reconstruction of what-must-have-been, elicited by known facts, imagination, and guided imagery to form a narrative with beginning, middle, and end. The nonverbal memory is the body’s experience of survival instincts (startle, flight/fight, freeze, submission, and repair). The verbal memory must convey narrative truth but not necessarily historical truth. The nonverbal memory is known to the therapist as the instinctual trauma response, which is the same for all traumas at all ages. The narrative construction is assisted by guided imagery that develops a believable story of the traumatic event. The verbal story and nonverbal sensations are merged into a graphic narrative, which the patient draws. The therapist pins up the pictures and “re-presents” the story to the patient as audience. This makes it possible for the person to experience closure and to finally regard the trauma as past tense and finished.

Infant Surgery Without Anesthesia

Anyone now 23 years or older who had major surgery as a baby is at risk for chronic posttraumatic illness because the surgery was probably done without anesthesia, which was the custom in most hospitals prior to 1987. Abdominal surgery for pyloric stenosis and chest surgery for congenital heart problems were the most common forms of infant surgery. Together these surgeries were required for about 8 cases per 1000 births. A rough estimate of the number of survivors during the single year of 1987 (3,829,000 live births) is 30,600. We do not know what proportion of these survivors is now suffering with posttraumatic symptoms but considering the severity of the pain and the helplessness of the infant we would expect that the majority of these infants were traumatized.

Paralyzed, Wide Awake, No Pain Control

Those major surgeries required that the infant have artificial respiration during the surgery. The baby was given a curare drug for total paralysis while the respirator tube was inserted into the windpipe and the paralysis was maintained throughout the surgery. The paralyzed baby was wide awake with no pain control. Imagine what it must have been like for the infant: unable to lift a finger; unable to move away from the searing pain of the scalpel; the sensation of being turned inside-out as the heart or intestines are grasped; and the overwhelming pain. People that have survived these early traumatic experiences usually cannot recall them verbally while they cannot forget them nonverbally.

Life-Long Symptoms

The symptom picture of the survivors is broader than the usual picture for posttraumatic stress disorder. Adult survivors report life-long symptoms of anxiety (constant nervousness and spells of terror or panic), hostility (temper outbursts and urges to smash or break things), depression, self-consciousness, distrust of others, and a high vulnerability to stress. The life-long aspect of these symptoms leads to the faulty clinical perception that they are personality disorders instead of recognizing them as persisting reactions first elicited by the brutal surgery. That recognition opens the way to curative treatment of the adult survivor.

Infants Feel Pain, Remember Pain

We know today that infants feel pain and they remember the pain. That memory is not verbally coded and therefore is not conscious. It has not been mitigated by time or by life experience. It festers in the nonverbal mind and threatens to overwhelm the person. The unfortunate individual is blind to the origin of the symptoms and usually attributes them to present causes such as some physical or mental illness. Those survivors of infant surgery without anesthesia that do seek treatment might do so because of baffling symptoms of pain and fear or dissociative symptoms, or maybe at the urging of a parent who had seen the original damage but only later learned that there was no pain control for the baby during surgery.

Cure Is Possible

The posttraumatic syndrome of infant surgical trauma is not generally recognized. There are individual therapists using medical hypnosis that understand preverbal trauma and use hypnotic age regression to bring the original experience to consciousness. There is one specialized trauma therapy program, Intensive Trauma Therapy, Inc., (ITT) in Morgantown, West Virginia that has treated this particular type of trauma for 4 years. ITT developed a unique approach, which is not the traditional talk therapy but uses other methods to access parts of the brain that store the imprint of the trauma. It is an outpatient treatment delivered in a marathon format, which allows individuals from distant places to be treated at the center in one or two weeks.

Are My Symptoms Due To Surgical Trauma?

How can one determine if present symptoms are due to surgery during infancy? Of course there is no blood test for this. The usual clinical diagnosis of PTSD is not enough because the present symptoms might be described by other diagnoses such as panic disorder or major depression. However, in the presence of chronic symptoms and a history of surgery during infancy, a trial of treatment may be wise. Answers to the following questions and discussion with a knowledgeable therapist can help one decide.

1)    Did you have an infant operation before 1987? If so, what was it?
2) How old were you then and how old are you now?
3) Do you feel it has affected you over the course of your life constantly, only at times, or not at all?
4) How would you describe your symptoms or if no evident symptoms then your quality of life in general?
5) Had you connected the operation with your symptoms and if so how did you make that determination?
6) How long have you been aware of this connection? If not aware have you suspected there was something deeper at work in your life that you did not understand?
7) Have you sought treatment and if so what kind? How did you feel about its effectiveness?
8) Was the operation ever discussed with you, as a child, as an adult? What importance did your parents or caregivers place on its possible long-term effects if any?
9) Have you ever considered suicide?
10) Do you believe your life can improve with proper treatment?

Comments on the effects of infant surgery might bring up issues about the effects of other traumatic experiences during the preverbal period of life, from conception to age three.

Louis Tinnin, MD