Psychological impact

Royal Brompton Hospital
By Luke Blair     05/05/2023

“Some think they have been abducted by aliens and had their organs harvested. Others think they have been kidnapped and tortured.

“One patient felt he was descending a spiral staircase with computer screens every few steps where he had to log on to say goodbye to loved ones…”

They sound like strange scenes from a movie, but these are, in fact, actual dreams and hallucinations experienced by those who have been in surgery or intensive care. Caused by a combination of medication, illness and recovery, they are often more detailed and more memorable than normal dreams.

They are also more vivid. “More real than reality” a lot of patients say, and it is the clinical psychology team whose job is to help those patients make sense of what they have gone through, both in terms of this ‘internal psychological reality’ and the external reality of their physical recovery.

“These experiences are often linked to hallucinatory medication side-effects and to sedation” the head of the psychology service explains to me. “We help patients make sense of them. During sedation the brain is processing experiences and attempting to make sense of the situation. When a patient wakes up into a hazy consciousness in intensive care, with lots of beeping machines and staffed dressed in PPE, it is easy to see why they think they are on an alien spaceship.”  

The good news is that these experiences do not last long. When psychologists give patients and families a framework to understand what is happening, there is often a sense of relief.

Today, I have the privilege of sitting in on an altogether less alarming scenario: a young man who was born with a congenital heart condition is receiving help for its impact on his mental health. He has had three major heart operations, and is only too happy for me to sit in and write about his session, he says, because anything that explains the wonderful work of the psychologist has his blessing.

And I can see why he feels so strongly. His condition has affected him deeply. “I see myself sometimes as in a prison,” he says. “I feel negatively about myself. I just want to prove to everyone that I have done something with my life. That I am still useful.”

Psychologically, the patient’s heart condition has acted against the cultural pressure that says men must be successful, must be ‘breadwinners’, must be able to raise a family. “I don’t like to be seen as a weak person,” he says. “But I don’t have the confidence to go for a job.”

The psychologist says: “It is normal for human beings to compare themselves to others and feel they are doing less well.” She reassures the patient that anyone would have been challenged by his condition, that his life has been difficult by any standards, that this does not make him weak, or less of a man.

But it is clear that these words, however sympathetic and supportive, will not be enough – in fact, outside the psychologist’s room, sympathy has even had the opposite effect on this patient.

“People say they feel sorry for me but I don’t want that.” He once enjoyed a far more physical, competitive life. He feels family pressure too. “I am not negative about their success, but I feel they just want me to be like them.”

I am intrigued to know what the psychologist will do next, and the answer surprises me. It turns out she has not only written a letter to some authorities to seek practical help for the patient, but has also arranged some work experience for him.

This is not unprecedented. The psychologist says her service is there to improve physical and mental health, which includes understanding sources of stress, since living with long-term health conditions can have a major impact on work, finances, relationships and self-confidence.

“If a patient we are seeing has a leaking roof, and this is making their condition worse, it may be that writing a letter to the landlord is a higher priority than any other help we can give,” she explains. “It’s not all based in the therapy room. Many sources of stress relate to ‘real world’ problems so we use advocacy and community-based interventions as well as direct interventions based in the therapy room.”

Feedback from patients says everything there is to say about this approach and the effect of the clinical psychology service, as it takes its care of them well beyond the psychologist’s room.

Among multiple comments about finding mental recovery just as hard – if not harder – than physical recovery from surgery, one patient said: I had a degree of sceptical challenge given I have historically adopted a ’show me, don’t tell me’ approach to advice. However by the end of session ten I reflected on an outstanding experience which has been of immense help.”

Another said: “It is a crucial part of my support mechanism. At times when I am feeling low and depressed and desperate and despondent it has been a lifeline for me.”

But perhaps the most telling feedback was encapsulated in a handwritten note, addressed personally to one of the psychologists in the team: “You might not wield a scalpel, but you’re as much a life saver as those in blue and green scrubs…thank you for seeing the darkness I was in and offering a flashlight…life is life again.”

The patient I’ve been listening to has one final thing to say. “I’m so sorry, doctor – I forgot to bring those biscuits for you, a present from my trip abroad…”

It turns out this patient is grateful too.