Why Do I Avoid the Doctor Now? Medical Trauma and Post-Intensive Care Syndrome, with Dr. James Jackson (Part 1)

This is Part 1 of a two part conversation.

Why do I avoid the doctor now? Because a medical event can leave a trauma response in the body. Medical trauma is trauma that comes from a medical experience. It can follow an ICU stay, a difficult surgery, or an emergency C-section. The most common sign is avoidance. In this episode of the Biology of Trauma^® podcast, Dr. Aimie Apigian, a double board-certified physician in preventive and addiction medicine, speaks with Dr. James Jackson, PsyD, a neuropsychologist at Vanderbilt and author of Reclaiming Your Life from Medical Trauma.

I have watched what people carry home from a hospital.

They come back for the follow-up appointment and everything looks fine on paper. The wound closed. The numbers came back where we wanted them. Then something else shows up months later, and nobody connects it to the hospital.

For a long time medicine had one question about critical illness. Did the person live. That was the whole measure of success.

Dr. Jackson spent years driving around Tennessee, Kentucky, and Alabama asking a different question. He sat on front porches with people who had survived the ICU. He asked what their life was like afterward.

He heard the same story hundreds of times.

Medical trauma is a trauma response that comes from a medical experience. It shows up most often as avoidance, meaning you steer around hospitals, appointments, and reminders. In the Biology of Trauma^® framework, that is the pattern of Disconnection.

What is medical trauma?

Medical trauma is trauma that comes from what happened to you in a medical setting. It is not defined by how serious the event looked from the outside.

Dr. Jackson does not spend much time on precise boundaries. He is more interested in naming it for the people living it.

An ICU stay can produce it. So can a hard surgery, an emergency C-section, or a long stretch of caregiving.

He wrote a book on the topic and found that almost everyone he mentioned it to had a story.

Who is most likely to carry medical trauma?

People who went through something in a hospital that their body could not process at the time. Survivors of critical illness sit at the center of that group.

Many people still hold a narrow picture of trauma. They think of combat, abuse, or assault.

Those are traumas. Dr. Jackson is clear that he is not comparing them to anything.

His point is that the medical setting produces trauma too, and that it goes unnamed.

What is post-intensive care syndrome?

Post-intensive care syndrome, or PICS, means new or worsened problems that appear after critical illness. They can affect thinking, mental health, and physical function.

Dr. Jackson co-founded the ICU Recovery Center at Vanderbilt, one of the first clinics built for these survivors.

People started arriving from all over the country. The stories shared a shape.

Fine on a Monday. On a respirator by Wednesday. Discharged home, then a life that does not work the way it used to.

Post-intensive care syndrome is a set of new problems in thinking, mood, and physical function that appear after critical illness. It has a name, and it has a clinic.

Why has my doctor never heard of PICS?

Because awareness has grown slowly, even among clinicians. Dr. Jackson describes the pace as glacial.

Survivors tell him the same thing. They raise their hand at an appointment and name the condition.

Sometimes they get a blank look. Sometimes a kind one, followed by an admission that the clinician does not know the term.

Awareness is moving. Dozens of papers now exist, and patients hold a walk for PICS each September.

How much can a body carry before something gives?

There is a limit, and Dr. Jackson names it plainly. Load a person with enough trauma and something gives way.

His examples are stark. Fourteen deployments. Nineteen consecutive surgeries.

People in the ICU often carry a load in that range without anyone naming it as a load.

Modern critical care keeps people alive longer, which he calls a good thing. It also means bodies endure more than they once did.

How do I know if I have post-intensive care syndrome?

The signs tend to arrive slowly, because life restarts slowly after the ICU. They surface as you re-engage.

Dr. Jackson describes the thinking problems first. You run a red light and wonder why you were not paying attention.

You go back to work and the spreadsheet does not make sense the way it used to. He calls this a processing speed problem.

The emotional signs carry a clearer signature, and that signature is avoidance.

What is the number one sign of medical trauma?

Avoidance. It is the sign Dr. Jackson watches for above all others.

Classic combat PTSD avoids war films, crowds, and memorials. Medical trauma avoids something different.

People with medical trauma have no problem with a war movie. They will not watch a hospital drama.

They do not want to visit someone in a hospital. One of his patients plans a daily detour to avoid driving past the building where he was treated.

In medical trauma, the avoidance points at medicine itself. War films are fine. Hospitals, appointments, and hospital dramas are what get steered around.

Why do I cancel appointments I know I need?

Because the place that saved your life is also the place your body now reads as a threat. So you protect yourself by staying away.

This has been studied. People with medical trauma cancel more appointments than others.

They hesitate to go to the emergency room even with symptoms that warrant it. Chest pain is one Dr. Jackson names directly.

He calls this medical avoidance, and it is what worries him most about the condition.

What does Dr. Jackson tell his patients to do?

He gives one instruction, and he says it is not elegant. Move toward the thing, rather than away from it.

He is direct that this is not simple to do. His own version of avoidance was a post-it note over a check engine light.

He drove that way for six months. The engine died on the side of the road in West Nashville.

He pairs the instruction with two others. Surround yourself with supportive people, and find providers who care and will nudge you gently.

Which pattern of stored trauma is this?

Avoidance is the pattern of Disconnection. It is the first of the five patterns stored trauma creates in the body.

The five are Disconnection, Disruption, Depletion, Dysregulation, and Disease.

Disconnection means it becomes hard to be present. Staying away is easier than being here.

Stress is not what gets stored in the body. The unfinished survival response is what stays.

Disconnection is the pattern where being present becomes hard, so avoidance becomes the default. It is the first of the five patterns of stored trauma.

How long does recovery from medical trauma take?

Dr. Jackson holds an expansive view of the timeline. In his experience it can take years.

He hears people say therapy did not work for them. Then he asks how many sessions they went to.

The answer is often four or five. He thinks the number needs a couple of zeros on the end.

He speaks from inside it. He was diagnosed with OCD in 2018 and wanted it gone quickly. Many sessions later it is well managed, and it took years.

How do you live with trauma while you are working on it?

You make space for it. Dr. Jackson describes trauma as an unwanted house guest.

Nobody invited this person. He has moved in anyway, and he is not leaving on request.

You do not have to like it. You do have to stop spending all your energy pretending the room is empty.

That reframe changes what recovery asks of you. You keep working on it, and you stop waiting for it to be gone before your life can start.

What does the body need first?

Felt safety. Support comes after that, and expansion after support.

A body that reads a clinic as danger will not respond to a plan built on willingness. Willingness is not the missing ingredient.

Information alone does not move any of this. What changes a pattern is experience.

That sequence is what the Foundational Journey is built to walk you through. It is the six week entry point, and it builds the capacity the longer work asks for.

Key Takeaways

• Medical trauma is trauma that comes from a medical experience, including ICU stays, surgery, and emergency birth.

• Post-intensive care syndrome, or PICS, is new or worsened problems in thinking, mood, and physical function after critical illness.

• Avoidance is the clearest sign of medical trauma, and it points at medicine itself.

• People with medical trauma cancel more appointments and hesitate to go to the emergency room.

• Thinking problems often surface first as reduced processing speed, noticed at work or behind the wheel.

• Recovery from medical trauma can take years, and short courses of therapy are often too short.

• Avoidance is the pattern of Disconnection, the first of the five patterns of stored trauma.

• Felt safety comes before support, and support comes before expansion.

Notable Quotes

"The avoidance is the symptom we see, that's the one we worry about." — Dr. James Jackson

"If you avoid things long enough, before long you can't really avoid them anymore, because the problems will catch up to you." — Dr. James Jackson

"We need to learn to make space for it, even though we don't like it, while we're working on it." — Dr. James Jackson

"I talk about the 5D patterns of how to recognize when trauma has gotten stored into your nervous system, and disconnection is the first one." — Dr. Aimie Apigian

Episode Takeaway

I asked Jim why this became his work, and his answer was a front porch in rural Tennessee.

He sat with people who had lived and then found that living was not the same as recovering. Nobody had given them a word for what they were carrying.

That is what I keep coming back to in this conversation. Avoidance is not a character problem. It is a body protecting itself from a place it now reads as dangerous.

In our language that is Disconnection, and it is the first of the five patterns. Naming which pattern your body runs is where the work gets specific.

If someone in your life has been quietly steering around a hospital, share this episode with them.

FAQ

What is medical trauma?

Medical trauma is a trauma response that comes from a medical experience. It can follow an ICU stay, a difficult surgery, an emergency C-section, or a long period of caregiving. It is defined by what happened in the body, not by how serious the event appeared.

What is post-intensive care syndrome?

Post-intensive care syndrome, or PICS, describes new or worsened problems that appear after critical illness. Those problems affect thinking, mental health, and physical function. The term was established so that survivors and clinicians would have shared language for it.

Why am I not okay after the ICU?

Because critical illness can leave new problems behind that have nothing to do with the original diagnosis. This is called post-intensive care syndrome, or PICS. It affects thinking, mood, and physical function. The problems often surface weeks after discharge, as you start driving, working, and re-engaging with life.

What is the most common sign of medical trauma?

Avoidance. People steer around hospitals, cancel appointments, and skip visiting loved ones who are admitted. Unlike combat-related PTSD, the avoidance points at medicine rather than at crowds or war films.

Why do I feel anxious when I drive past a hospital?

Because your body has linked that building to an experience it could not process at the time. The reaction happens below conscious thought. It can persist even when you know the hospital saved your life.

Is it normal to be afraid of doctors after surgery?

It is common, and it has a name. Medical trauma frequently shows up as reluctance to return for care. Dr. Jackson calls this medical avoidance and considers it the symptom with the widest consequences.

How long does it take to recover from medical trauma?

Dr. Jackson describes recovery as measured in years rather than sessions. He finds that people often try therapy four or five times and conclude it did not work. He speaks about his own recovery from OCD taking years of consistent work.

Which pattern of stored trauma does avoidance belong to?

Disconnection. It is the first of the five patterns of stored trauma, which are Disconnection, Disruption, Depletion, Dysregulation, and Disease. Disconnection means being present becomes hard, so staying away becomes the default.

Can I have medical trauma if I was never in the ICU?

Yes. Dr. Jackson deliberately keeps the definition wide. A hard surgery, a frightening diagnosis, an emergency delivery, or caring for someone through a critical illness can all produce it.

In this episode

Timestamps are PROVISIONAL. Verify against the published audio before this goes live.

• 0:00 What is medical trauma?

• 2:10 Why is medical trauma so common and so rarely named?

• 5:20 Why did ICU survivors say surviving was not enough?

• 7:20 Why did Dr. Jackson start a clinic for critical illness survivors?

• 9:20 What is post-intensive care syndrome, or PICS?

• 12:25 How much trauma can a body carry before something gives?

• 14:10 How do I know if I have post-intensive care syndrome?

• 15:15 What is the number one sign of medical trauma?

• 17:45 Why do I keep canceling the appointments I need?

• 18:55 What does Dr. Jackson tell every patient to do?

• 20:35 How long does recovery from medical trauma take?

• 22:55 How do you make space for trauma while you work on it?

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. You cannot change a pattern you cannot see.

• Get The Biology of Trauma. The biology underneath these patterns, and what the body needs to come back toward safety.

• Reclaiming Your Life from Medical Trauma by Dr. James C. Jackson, PsyD.

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

1. Needham DM, Davidson J, Cohen H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Critical Care Medicine. 2012;40(2):502-509. PMID: 21946660. The Society of Critical Care Medicine conference that established post-intensive care syndrome as shared nomenclature for new or worsened problems after critical illness.

2. Jackson JC, Pandharipande PP, Girard TD, et al. Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: a longitudinal cohort study. The Lancet Respiratory Medicine. 2014;2(5):369-379. PMID: 24815803. Dr. Jackson's own multicenter cohort study following mental health and functional outcomes in ICU survivors over the year after discharge.

3. Parker AM, Sricharoenchai T, Raparla S, Schneck KW, Bienvenu OJ, Needham DM. Posttraumatic stress disorder in critical illness survivors: a metaanalysis. Critical Care Medicine. 2015;43(5):1121-1129. PMID: 25654178. A systematic review of prevalence, risk factors, and prevention strategies for post-traumatic stress symptoms after intensive care.

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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