From post-traumatic stress disorder to absolute dependence in an intensive care unit: reflections on a clinical account

Publication Type:

Journal Article


Sideris, Tina


Medical Humanities (2018)



This paper tells the story of one man’s experience of terrifying hallucinations and nightmares in an intensive care unit (ICU), drawing attention to the reality that intensive care treatment induces emotional suffering severe enough to be identified as post-traumatic stress disorder (PTSD). A body of international research, confirmed by South African studies, links life-saving critical care to symptoms which qualify for secondary psychiatric diagnosis including of post-traumatic stress. Risk factors include pre-ICU comorbid psychopathology. Early on in the clinical encounter with the patient in this paper it emerged that he bore the scars of another trauma. He had been a soldier. Recounting the terror he experienced when he was being weaned off mechanical ventilation evoked memories of his military history. Paradoxically, these shifted the focus away from the symptoms of PTSD, to make the helplessness and dependency of ICU patients more visible. This patient’s clinical account and patient experiences in other studies reveal the relational vulnerability of ICU patients. In as much as experiences of ICU treatment can be terrifying, the non-response of carers distresses patients. This interplay of wounding and care provides a starting point from which to explore how we account for the neglect of relational care that is a recurring theme in medical contexts, without blaming the carers. These questions find resonance in a South African novel to which the paper refers. A novel about war and trauma movingly portrays the internal conflict of the central character, a nurse and her quest not to care, as a defence against vulnerability. In these ways writing about the relational vulnerability of patients opened up questions about the social and institutional context of carer vulnerability.

Medical Humanities in Africa

WISER is working to establish the field of medical humanities in South Africa with other partners at Wits and in the region. Medical Humanities took root in the interdisciplinary spaces between social history of medicine, medical sociology, medical anthropology, literary studies, art and film studies, cultural studies, politics, philosophy, legal studies, public health, psychiatry, medical economics and medical ethics. Although initially concerned with contrasting and comparing approaches from the humanities and medical science to themes of health, suffering, therapy, pain and illness, it has grown in ambition to consider the foundational question of what it is to be fully human, inviting debate around vital epistemological problems. The interface of medicine and humanities also demands a broadly interdisciplinary discussion about what constitutes evidence, and this is critical in the formulation of all contemporary political arguments, including health policies.