Addressing emotional issues that occur after major surgery


Q. Could you please address the issue of disorientation and emotional issues that occur after major surgery? My mother had surgery and was in intensive care for several days. Few people understand what she has experienced.

A. Most serious surgeries require time in the Intensive Care Unit (ICU). While there, many patients experience “hospital psychosis.” The person may not recognize family members, suddenly begin to talk as if someone else is in the room, or have even more serious psychotic reactions.

According to the website MedicineNet.com, there are both environmental and medical reasons for ICU psychosis. Patients often experience both sensory and sleep deprivation due to medical monitoring. The normal circadian rhythms which control each individual’s 24-hour sleep/wake cycle are interrupted. Additionally, strong pain medications often have side effects, which include delusional thoughts and psychotic behaviors.

When the patient is in a room or the rehabilitation unit, other problems may occur. At that time, patients may begin to experience anxiety. If the procedure has been cardiac or cancer related, many people fear a return of the condition. They may begin to think more about the end of life, but are usually hesitant to talk about it. In fact, depression and mental fatigue are common after most major surgeries. It can present as overwhelming sadness, loss of interest in activities that were once pleasurable, or a feeling of apathy. Conversely, depressed patients can become angry, sullen, or even abusive to their caregivers.

According to an article by Dr. Randi Epstein in the New York Times, current estimates are from one-third to three-fourths of patients experience depression after major surgery. Yet little is done by most medical facilities to address these problems, and many family members have little understanding of the magnitude of the surgical experience.

The good news is that depression and fatigue usually lift after a few months. If they continue or the outcome of surgery does not alleviate the problem, one should speak to the medical provider about prescribing an antidepressant and seeing a mental health professional.

Q. I’ve been diagnosed with breast cancer. Is it true that people with a positive attitude can defeat cancer or add years to their lives?

A. According to Dan Shapiro, a psychologist and cancer survivor, “people with cancer deal with too much New Age guilt. This is the notion that if you don’t think the right way about cancer, you’ll contribute to your own demise.” The truth is that everyone with cancer has bad days, fearful days, and days that you do not want to hear “you’ll be fine”or “this isn’t going to get you.”

According to the American Cancer Society, many people still believe that if they feel sad or depressed after a cancer diagnosis or during treatment, that they are more likely to have a negative outcome. This is simply not true. You are having a normal reaction to a life-changing event.

During the course of your treatment, someone will also likely say that studies show that people with positive attitudes are more likely to beat cancer. This is also not true. The American Cancer Society reports that these studies are either based on anecdotal evidence or have been conducted using questionable research methods. No solid research has shown that a patient’s attitude has anything to do with their recovery. Some people recover from cancer completely, some beat the odds and live much longer than expected, but researchers do not know the reason.

Don’t let the positive attitude myth keep you from telling your loved ones and your medical team how you feel. Tell your “positive attitude” friends to do their research, and meanwhile watch bad television, cry, eat chocolate, and do whatever you please. Get through your disease experience in your own way.

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Nancy Ryburn holds a doctorate degree in psychology from Yeshiva University in New York City. She currently teaches psychology at Southeast Arkansas College. If you have questions, e-mail them to drnryburn@gmail.com. They will not be answered personally, but could appear in a future column. There will be no identifying information and all e-mails remain confidential.