What Does Recovery From Medical Trauma Look Like? With Dr. James Jackson (Part 2)

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This is Part 2 of a two part conversation. Part 1 is here.

What does recovery from medical trauma look like? It rarely looks like the absence of symptoms. It looks like the symptom no longer running your life, no longer being avoided, and no longer standing between you and the things you care about.

Most trauma has an address. It happened in a place, and the place stays behind you. You can decline the trip.

Medical trauma removes that option. When the frightening thing happened to your heart or your gut, you wake up inside the reminder.

In this episode of the Biology of Trauma® podcast, I continue my conversation with Dr. James Jackson, PsyD, neuropsychologist at Vanderbilt and author of Reclaiming Your Life from Medical Trauma. He works with people who are recovering after critical illness. What may surprise you is how much recovery is available while symptoms are still present.

Why is medical trauma different from trauma you can leave behind?

Because the source of it lives inside you, so distance is not available.

Dr. Jackson uses Vietnam as the comparison. Something happened in the jungle. It imprinted. But the jungle stays where it is.

"If you associate the trauma with Vietnam, you don't have to go back to Vietnam. You likely will never go back to Vietnam. You can avoid the jungle, you can decide not to go to Florida on a humid summer day, which many people don't who were in Vietnam. So you can avoid it."

Then he turns it around.

"But if the trauma happened in your body, you're carrying that around. You're carrying it around, and you can't avoid it. It's always there."

Take cardiac arrest. Dr. Jackson points to a study or two reporting that forty to fifty percent of survivors carry symptoms of PTSD. The pooled figure across the literature sits lower, closer to one in five, and individual studies range widely in both directions.

Either way it is a large number, and the reason is structural. The organ that frightened you is the organ keeping you alive, and it goes everywhere you go. As you age it works a little less well, and the odds of it happening again move in the wrong direction.

For someone living with a chronic condition, the arithmetic gets harder still. The trauma is behind you, and you also know it is ahead of you, because you will be back in the emergency room three or four times a year.

Medical trauma is trauma where the body itself becomes the reminder. Because the source travels with you, avoidance cannot create distance from it the way it can with an event that happened somewhere else.

Which therapies help when the trauma is in the body?

The ones that treat you as a body.

Dr. Jackson endorses EMDR directly and says the results are sometimes dramatic. He groups it with the somatic therapies, and his reasoning is structural rather than preferential.

"I like EMDR, among other somatic therapies, because I think the truth is medical trauma explicitly involves the body."

He is blunt about the alternative.

"At a minimum, I think we need to move away from the disembodied therapies that treat us as if we're not a body at all. That deal particularly narrowly with our thoughts, let's say. Well, the things that occur, occur in your body."

This matches what I have seen in my own patients and in my own recovery. The combination of somatic work and narrative work reaches the subconscious level where the sense of ongoing danger actually lives.

Can you change your relationship to a symptom you cannot change?

Yes, and Dr. Jackson considers this the more useful question.

The approach he has had the most success with, in his patients and in his own life, is acceptance and commitment therapy.

"Acceptance and Commitment Therapy is a little bit unique in that the goal of it isn't necessarily just to change your symptoms, but it is to change your relationship with your symptoms."

"We can't change our body, but we can change our relationship to what's happening in our body."

He hears a particular sentence from patients constantly, and he says it with sympathy because he used to say it himself.

"If only XYZ goes away, then I will be fine. Well, it might never go away. So the invitation is, how can you be fine right now? How can your body be fine right now?"

If you are waiting to be fine until the MS flare-ups stop, or the long COVID lifts, or the post-intensive care syndrome resolves, or the scar disappears, you may be waiting for something that does not arrive.

"It's too binary. Let's find a way to be fine with your body the way it is right now."

Acceptance and commitment therapy is an evidence-based approach focused on changing your relationship with your symptoms while moving toward what you value, rather than on symptom removal as the condition for living.

Why does it matter what your illness means to you?

Because the meaning is doing as much work as the diagnosis, and nobody finds it without asking.

I did four years of general surgery residency. I left because I could not sustain my own recovery inside that environment, and part of what I was carrying was the experience of being the one causing the trauma.

I was the one who helped with open heart surgery. I was the one they handed the saw to. I was the one who opened up that chest.

So I changed one thing. I started asking patients what their condition meant to them.

The answers were raw. They were vulnerable. I felt like I was looking into their soul in that moment, and it would almost catch them by surprise, what came out of their own mouth.

This means that this is the beginning of the end of my life.

This means that I will never be able to be the person that I really wanted to be.

Dr. Jackson recognizes the pattern and reaches for Stephen Covey.

"He had this image that he talked about of a ladder leaning against a building, and of a person climbing the ladder, and they got to the top, and they were really happy, and then they looked around, and they realized the ladder was leaning against the wrong wall."

"The ladder, meaning the questions we're asking, meaning the care that we're giving, meaning the perspective we're taking with patients, it's got to be leaning against the right wall."

His prescription for clinicians is physical and specific.

"One of the most important things we can do, I think, is to get at eye level and make eye contact and say some version of, here's how I'm understanding this, perhaps, but how are you understanding it?"

Why should you never assume what counts as a big trauma?

Because the size of the event predicts very little about the size of the response.

"Some people are doing much better than you would predict on the heels of really big trauma, and some people are doing much worse than you would predict on the heels of what you might imagine would be a really small trauma."

He learned this from the inside, in an elevator.

Fifteen or twenty years ago Dr. Jackson was stuck in an elevator at the Albuquerque VA Hospital. Three or four minutes, maybe five. He had a panic attack. A psychiatrist riding with him pried the doors open and got him out.

The following week he was at a meeting in New Orleans on the twenty-third floor. He was afraid to ride the elevator. He walked all twenty-three flights.

What followed was a claustrophobia that shaped years of his life. It reached his children, who developed anxiety disorders. It closed off international travel to crowded cities, because of the subways.

"And so many things developed from this little kernel."

"The most humane thing we can do to our patients is we can listen to them to understand what is a big thing and what is a small thing. I think we owe them that."

What does recovery from medical trauma actually look like?

It looks like the symptom losing its authority over your life.

"Often recovery, to me, is things like, it's not controlling my life. I'm not avoiding it, even though sometimes I want to. When I have a little bit of a flare-up, I recognize it for what it is, and I do something productive."

There are measurable signs alongside that, and Dr. Jackson names three while hedging each one.

"Now, clearly there are objective markers when people's PTSD is improving. They're sleeping better, typically they're less avoidant, their bodies I think are less reactive, although often they're still a little reactive, they're easy to react. But those things can get better."

He treats those markers as real and secondary. The measure he returns to is different.

"The goal of recovery is, at the bottom, how can you live a rich, meaningful life where you're pursuing the values that are important to you?"

"A lot of Acceptance and Commitment Therapy is helping people identify values. Who do you want to be, and what do you want to do?"

"Even if officially you're still carrying a diagnosis of PTSD around. It's about living a meaningful life."

Three signs that recovery is underway: sleeping better, avoiding less, and a body that reacts less intensely. Dr. Jackson holds all three loosely, and treats the ability to live by your values as the measure that matters most.

Why is overselling recovery harmful?

Because it sets a standard the body cannot meet, and then the person concludes they are the failure.

Dr. Jackson believes in recovery and refuses to promise it cheaply.

"Sometimes we, a little too casually, say to patients, this will get better, it's no problem, our PTSD therapies work really well. Well, yeah, sure. There are empirically validated treatments, I'm a fan of those, they can work well. But I'm not a triumphalist. I think we need to be careful in overselling what we are offering the patients."

"You could have anywhere from a few symptoms to quite a number of symptoms, and you can still have a really rich recovery. Because you can find a way actually to live a really meaningful life with a lot of symptoms."

Then the line I have not stopped thinking about since we recorded.

"Too often the way that I think we have primed our patients to define recovery is, you're not recovered until we take an eraser out and erase all these symptoms. Well, respectfully, good luck with that. Once the inflammation candle is turned on, it's a little hard to snuff it out. It's not so easy. You can mitigate it, you can reduce it."

What is post-traumatic growth, and should you expect it?

It is genuine positive change that some people experience after trauma. It is never something to promise.

Dr. Jackson is careful here in a way that is worth noticing.

"This is an area where I do tread a little lightly, because I never want to say to someone, oh gosh, you had a trauma, this is a gateway to something amazing. That would be so cruel and not true, unkind, all of that."

"And yet some percentage of people that we interact with, the struggle they've had, which I wouldn't wish on anyone, for some percentage of them it's quite transformative. And they are kinder, and they possess a unique kind of gratitude they didn't have, and they see things a little differently."

"But when you see post-traumatic growth, I have to say, it's quite beautiful."

Note the phrase he uses twice. Some percentage of people. Growth is a real outcome and it is not the expected one, and telling someone it awaits them on the other side of what they survived does harm.

Post-traumatic growth is genuine positive change that follows trauma for some people. It is observed rather than prescribed, and it is never a reason to reframe someone's suffering as an opportunity.

Why can't you recover from medical trauma alone?

Because isolation reliably blocks it. This is biology rather than sentiment.

Dr. Jackson names it as the single largest take-home from his book.

"There are a lot of ways to heal, but one way not to heal, one guaranteed way not to heal, to me, is to try to go it alone."

He borrows the phrasing from a Nashville songwriter, Drew Holcomb, whose song is called Find Your People.

"I don't really care who your people are, but find your people. Because this traumatic journey is so difficult. If you join arms with people who love you, who you love, find them wherever you want them, find them, it's going to be much better. Don't go it alone, whatever else you do."

Find your people. We don't heal in isolation. Our healing is our own, and we don't do it alone.

What kind of book is Reclaiming Your Life from Medical Trauma?

A practical one, written deliberately in plain language.

Dr. Jackson describes his office as full of academic papers, dense and technical and hard to understand, and says the book was written to be the opposite of the pile on his floor.

"Let's write a practical, accessible book that is going to offer hope grounded in evidence, and that is going to offer a path forward that people can embrace."

He is specific about the kind of hope on offer.

"I'm not a big believer in hopium, meaning, it's not all rainbows and unicorns dancing across the field. But there are reasons to be hopeful."

"The day that I lose hope in the possibility of recovery is the day that I need to hang it up and go fishing, or sit in an old chair and watch Bonan

za reruns."

His image for what the book is doing is a hiker's one.

"The book is a little bit like a cairn. Sometimes you'll see a little cluster of rocks that someone has stacked up to denote that you're going the right way, you're on the trail. Really, Reclaiming Your Life is meant to be a guide for people who know something is wrong, they don't really know quite what to do."

Key Takeaways

Medical trauma differs from other trauma structurally. The source lives inside the body, so it cannot be left behind in a place or a year.
PTSD after cardiac arrest is common. A 2022 meta-analysis pooled the prevalence at roughly one in five survivors, and individual studies report considerably higher.
Somatic approaches suit medical trauma because the event registered in the body. Disembodied talk therapy addresses a narrower target.
Acceptance and commitment therapy changes your relationship with a symptom, which stays available even when changing the symptom does not.
Recovery measured only by symptom erasure sets a standard most bodies cannot meet.
Three signs recovery is underway: sleeping better, avoiding less, a body that reacts less.
Overselling recovery damages trust with the person who most needs to keep coming back.
The size of an event predicts very little. A five-minute elevator entrapment reshaped fifteen years of one clinician's life.
Post-traumatic growth happens for some people. It is never something to prescribe or promise.
Isolation blocks recovery. Connection is a biological requirement.

Notable Quotes

"If the trauma happened in your body, you're carrying that around. You're carrying it around, and you can't avoid it. It's always there. And I think in some ways that is why medical trauma is uniquely challenging, because you're carrying around the source of the trauma." — Dr. James Jackson

"We can't change our body, but we can change our relationship to what's happening in our body." — Dr. James Jackson

"If only XYZ goes away, then I will be fine. Well, it might never go away. So the invitation is, how can you be fine right now? How can your body be fine right now?" — Dr. James Jackson

"I'm not a triumphalist. I think we need to be careful in overselling what we are offering the patients." — Dr. James Jackson

"Recovery, to me, is things like, it's not controlling my life. I'm not avoiding it, even though sometimes I want to. When I have a little bit of a flare-up, I recognize it for what it is, and I do something productive." — Dr. James Jackson

"Don't assume that this thing that no one else thinks is a big thing isn't a big thing. The most humane thing we can do to our patients is we can listen to them to understand what is a big thing and what is a small thing. I think we owe them that." — Dr. James Jackson

"There are a lot of ways to heal, but one way not to heal, one guaranteed way not to heal, to me, is to try to go it alone." — Dr. James Jackson

"I started to ask my patients, this disease, this condition, this injury ... what does it mean to you? The answers that I got were so raw, so vulnerable. I felt like I was looking into their soul in that moment." — Dr. Aimie Apigian

"Find your people. We don't heal in isolation." — Dr. Aimie Apigian

Episode Takeaway

I spent four years in general surgery residency. I was the one they handed the saw to. I was the one who opened the chest.

I left because I could not sustain my own recovery in that environment. Part of what made it unsustainable was knowing I was sometimes the one causing the trauma, and having no way to mitigate what I knew was happening.

Before I left, I changed one thing. I started asking people what their condition meant to them.

I was not trained to ask that. Nothing in surgical residency suggested it was my job. But the answers came back so fast and so raw that it was obvious the question had been sitting there unasked for a long time.

This is the beginning of the end of my life.

Nobody writes that in a chart. It is what a person carries underneath the diagnosis, and it shapes their physiology every day whether or not anyone in a white coat ever hears it.

What Jim gave me in this conversation is the other half of that. I had been listening for what the illness meant. He is describing what happens when the medical system tells a person what recovery has to mean.

If recovery is defined as the eraser, then every person whose symptoms persist has failed. That is a lot of people, and it is a cruel arithmetic, and none of it is true.

What he puts in its place asks for more rather than less. Can you sleep. Are you avoiding less. Is your body reacting less. And underneath all three, are you living by what you value.

For the body, that shift goes deeper than mindset. It changes what the nervous system is being asked to do. A body organized around waiting to be fine stays braced. A body allowed to be fine now can begin to settle, and settling is what makes the rest of the work possible.

Which is where the sequence comes in. Recognition first. Recognize, Reasons, Repair, in that order.

If you want to understand the avoidance we talked about, it is on page 117 of The Biology of Trauma, chapter nine, Patterns of Pain. Page 117 covers disconnection, and creating distance through avoidance.

The Foundational Journey is where that sequence stops being an idea and becomes something your body has already done once. It is the five-week prerequisite that builds the capacity for the deeper year-long work.

Your pace is the right pace.

FAQ

Do the symptoms of medical trauma have to go away before I am recovered?

No. Dr. Jackson describes recovery as the symptom no longer controlling your life, no longer being avoided, and no longer preventing you from living by your values. He is direct that a definition built on erasing every symptom is one most bodies cannot meet, and that holding people to it damages them.

How do I know if I am recovering from medical trauma?

Dr. Jackson names three signs that recovery is underway: you are sleeping better, you are avoiding less, and your body is reacting less intensely. He holds all three loosely and notes that reactivity often remains to some degree. Alongside them he watches whether a person is re-engaging with family, friends and work.

Can I recover while still having symptoms?

Yes. In his words, you could have anywhere from a few symptoms to quite a number of symptoms and still have a rich recovery. The goal he works toward with patients is a meaningful life pursued alongside symptoms rather than after them.

Is medical trauma the same as PTSD?

They overlap without being identical. Medical trauma describes trauma arising from a medical experience. Many people who carry it meet criteria for PTSD. A 2022 meta-analysis of cardiac arrest survivors pooled PTSD prevalence at around one in five, with individual studies reporting higher. What makes medical trauma distinct is that the body holds the source, so the reminder cannot be left behind the way a place or a year can.

What therapy works best for medical trauma?

Dr. Jackson endorses EMDR and the somatic therapies, because medical trauma explicitly involves the body. The approach he has had the most success with is acceptance and commitment therapy, which focuses on changing your relationship with a symptom and on identifying what you value.

Why is connection part of medical trauma recovery?

Because isolation blocks it. Dr. Jackson calls going it alone the one guaranteed way not to heal, and names finding your people as the largest single take-home from his book.

What is post-traumatic growth?

Genuine positive change that some people experience after trauma. Dr. Jackson describes greater kindness, a distinct kind of gratitude, and a changed way of seeing. He is explicit that it happens for some percentage of people, and that telling someone their trauma is a gateway to something amazing would be cruel and untrue.

In this episode

01:27 — Which therapies actually help with medical trauma?
03:46 — Why can't you leave medical trauma behind the way you leave a place?
04:14 — What happens when you carry the source of the trauma with you?
05:35 — What is acceptance and commitment therapy?
06:11 — Can you change your relationship to a symptom you cannot change?
08:17 — Why does it matter what your illness means to you?
09:30 — What is the ladder against the wrong wall?
11:40 — Why should you never assume what counts as a big trauma?
13:33 — What does recovery from medical trauma actually look like?
14:13 — Why is overselling recovery harmful?
15:32 — What are the objective markers that recovery is working?
17:02 — What is post-traumatic growth, and should you expect it?
17:56 — What kind of book is Reclaiming Your Life from Medical Trauma?
20:22 — Why can't you recover alone?
21:46 — Dr. Aimie's closing reflection

Resources and guides

Take the free 2-Minute Assessment for Stored Trauma. Find your primary pattern of responding when life becomes too much, then see how the other four show up.
The Biology of Trauma by Dr. Aimie Apigian. Avoidance and the pattern of disconnection are on page 117, chapter nine, Patterns of Pain.
Reclaiming Your Life from Medical Trauma by Dr. James C. Jackson, PsyD.
Steps to Identify and Heal Trauma, free guide.

Related Podcast Episodes

EP 189: Why Do I Avoid the Doctor Now? Medical Trauma and Post-Intensive Care Syndrome, with Dr. James Jackson (Part 1). Part 1 of this conversation. What medical trauma is, why avoidance is the clearest sign, and what post-intensive care syndrome means.
EP 138: Why Your Body Holds On When Your Mind Has Healed, with Steven Wright. For anyone who recognized themselves in this episode. You have done the work, you understand what happened, and your body still has not gotten the message.
EP 67: Gabor Maté on Healing Trauma and Chronic Illness Through Connection (Part 2). Dr. Jackson's answer to recovery is finding your people. This is the biology underneath that, and why disconnection drives disease.

About the guest

Dr. James "Jim" Jackson, PsyD is a licensed psychologist and neuropsychologist, and a Research Professor of Medicine and Psychiatry at Vanderbilt. He is co-founder and Director of Behavioral Health at the ICU Recovery Center at Vanderbilt, one of the first comprehensive clinics for survivors of critical illness. He also directs Long-Term Outcomes at the Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center. He is a pioneer in the study of post-intensive care syndrome, and the author of Reclaiming Your Life from Medical Trauma: Recognize the Symptoms, Find Treatment That Works, and Heal Your Brain and Body and Clearing the Fog: From Surviving to Thriving with Long Covid.

jamescjackson.com · CIBS Center

Your host: Dr. Aimie Apigian is a double board-certified physician in Preventive and Addiction Medicine, author of the national bestselling book The Biology of Trauma (foreword by Gabor Maté) and the founder of the Biology of Trauma^® framework that reshapes how we understand the way the body experiences and holds trauma. She holds master's degrees in biochemistry and public health. Foster-adopting a child during medical school set her on this path, and her search for answers deepened as she developed her own chronic health issues. Through Trauma Healing Accelerated^® — her practitioner training, podcast, YouTube channel, and international speaking — Dr. Aimie bridges functional medicine, attachment science, and trauma therapy, with a focus on facilitating accelerated repair of trauma's impact on the mind, body, and biology.

Research

Yaow CYL, Teoh SE, Lim WS, Wang RSQ, Han MX, Pek PP, et al. Prevalence of anxiety, depression, and post-traumatic stress disorder after cardiac arrest: a systematic review and meta-analysis. Resuscitation. 2022;170:82-91. DOI 10.1016/j.resuscitation.2021.11.023.
Thirteen studies covering 186,160 patients. Pooled prevalence at the earliest follow-up point was 20 percent for post-traumatic stress, 26 percent for anxiety, and 19 percent for depression. The confidence interval on the PTSD figure is wide, which is what allows individual studies to land far above and below it.

Disclaimer

By listening to this podcast, you agree not to use this podcast as medical, psychological, or mental health advice to treat any medical or psychological condition in yourself or others. This podcast is for informational and educational purposes only and does not constitute professional advice, diagnosis, or treatment. Always consult your own physician, therapist, psychiatrist, or other qualified health provider regarding any physical or mental health issues you may be experiencing.

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