Choosing a Perspective on General Anesthesia
One of my favorite things about RC is the encouragement we are given to choose perspectives that are separate and distinct from our feelings. And after several decades of RC, I’ve concluded that developing, and holding, correct perspectives is among our most important tools for re-emergence. History is full of individuals who have played good and important roles by organizing around accurate-enough perspectives about critical issues of their historical time. But in RC we are in an even better position. It is an incredible gift to regularly combine discharge with accurate perspectives about a growing range of issues.
I remember being fifteen years old and trying hard to make sense of an upsetting event. In a moment of great clarity it suddenly occurred to me that my feelings of the moment were in no way an accurate representation of the total situation. At that point in my life I didn’t have any idea about the importance of discharge (which probably wasn’t an option in my circumstances anyway), but I realized that I wanted to reach for something much bigger than how I felt: I wanted to have an accurate perspective outside my feelings that I could use to “ground” myself, to stay connected to reality.
That was an exciting and important insight. In my mind I began cycling through all the possible perspectives I could think of on the situation (probably eight to ten), intuitively dismissing each one as “not quite right” until I finally landed on one that rang true (seemed correct). I still had plenty of upset feelings about the situation but was relieved to no longer feel confused about it. That was enormously helpful in deciding what to do next—so helpful, in fact, that from that moment on I used the same approach as broadly as I could. I’m sure it was the best way I could figure out to manage a life that was mostly cut off from discharge.
Less than a decade later it was life changing to be introduced to RC and finally have the opportunity to add systematic discharge to the muscle I’d begun building in developing and holding perspective. I’ve found that discharge makes accurate perspectives easier to achieve and so much easier to hold on to when distresses make things feel confusing. But as I counsel with more and more people, I’ve grown to appreciate even more the critical importance of developing and holding accurate perspectives. Accurate perspectives allow us to more easily see our distress as distress, not reality.
APPLYING PERSPECTIVE TO GENERAL ANESTHESIA
About two years ago I had a meaningful opportunity to experiment with what is possible when undergoing general anesthesia. I was scheduled for a surgery to have my gall bladder removed (also called a “cholecystectomy”), and my doctor advised me that this surgery must be done under general anesthesia. I had experienced some very negative effects from general anesthesia three times previously—at birth, during a tonsillectomy at age four, and with minor surgery at age nineteen. After each experience I’d been left with significant distress recordings, and I was concerned about adding one more incident to the chain of hurts.
Is general anesthesia inherently a significant new hurt? As I carefully thought about it, I began to seriously question the assumption that general anesthesia would inevitably restimulate me, or worse, cause a significant new hurt that would require countless hours of discharge to recover from. Was it possible that I could develop a perspective and make decisions before the surgery so I would experience the fewest possible negative effects from it? That seemed like an interesting thing to try.
Reviewing Previous Anesthesia Experiences
I started by reviewing the counseling work I had done on previous anesthesia experiences. In particular, over the years I had discharged a significant amount on my birth. (My mother had received general anesthesia during my birth, which greatly affected me too.) I had also done a number of sessions on later anesthesia experiences and experiences with drugs in general. I’m not close to fully cleaning up these incidents, but I now have a good understanding of the major content of the hurts I got from them.
As I thought about my upcoming surgery, I asked myself, where was I now most vulnerable to restimulation? And was it possible for me to decide in advance not to be restimulated? I decided to put a lot of attention on how my brain and body had reacted in the past to drugs and anesthesia. What key distresses were attached to these experiences?
In my case (this is likely to vary somewhat, depending on the person) the two most significant effects seemed to be that (1) my mind fiercely fought the effects of drugs, to the point that painkillers sometimes didn’t have much effect on me, and (2) I had a feeling of defeat from when the drugs had overtaken my mind anyway—that is, when I had tried to fight the anesthesia but hadn’t been successful. I decided that a successful approach would require that I address these issues in particular.
Thinking About Accurate Perspectives, and Restimulation
Restimulation seems to be a decision, either aware or unaware, to use the present as a pretext for working on the past. Once restimulated, I’ve generally needed to either (a) discharge on the distresses related to the restimulation or (b) find a way to pull my attention back into the present. This isn’t always easy to do; it’s much easier to handle situations when I’m not restimulated in the first place.
This led me some years ago to an interesting question: Is it possible to decide in advance not to be restimulated? I’ve become entirely confident that it is possible, at least some of the time. I’ve had a few notable successes with it, even in challenging situations. Having regular, frequent, and effective sessions seems to be important to my ability to do it. Because I have lots of good sessions, my subconscious mind knows I will have plenty of opportunities to work on all kinds of hurts without having to use restimulation to bring them up.
Deciding not to be restimulated by something seems to be a little different from deciding to have, and holding, an accurate perspective about it. Deciding not to get restimulated probably requires that we start with an accurate perspective. (How else can we distinguish between reality and our feelings?) On the other hand, having an accurate perspective doesn’t necessarily require that we not get restimulated—it just requires that we not believe the content of our restimulated feelings. In other words, it’s easier to hold an accurate perspective about something than to decide not to get restimulated by it at all, but both are extremely important skills we can develop.
Actively Deciding Against Restimulation About General Anesthesia
In the case of my gall bladder surgery, my overall perspective was that the procedure was being done for my long-term health and well-being, even if individual components of it introduced new hurts and restimulations. There are many components to something as complex as surgery, and I hadn’t worked on every piece of my past medical experiences. I therefore wasn’t sure it was realistic to assume I could choose not to be restimulated by every one of the components at the same time. I suspected, however, that it would be extremely useful to decide to at least not be restimulated by the general anesthesia component. In other words, I could actively decide to not try to use the new surgery as a pretext for working on my earlier incidents of general anesthesia. I don’t know that this would have been possible had I not already discharged for several hundred hours on the earlier incidents. The years of work on this material1 had cleared room in my mind.
To implement the decision not to get restimulated I decided to see whether I could keep the new anesthesia experience from being recorded (stored in my brain) as a defeat, which was the most troublesome recording from my earlier experiences. In preparation, I had as many sessions as I could on adopting a clean perspective about my surgery—things I wish I had understood while I was being born.
In and out of session I “talked” to myself, telling my brain that drugs would be introduced into my system and would cause my mind not to function normally. I told it that I did not need to fight the drugs at all—that I could know in advance that their effect was temporary, the situation was benign, and my survival and well-being did not require that I fight their effects. I also told my brain that I did not even have to struggle to remember afterward what had happened. If I did remember, that was fine, but if the memories were gone, that was okay too; it didn’t mean something bad had happened.
I discharged steadily (mostly yawning) as I talked about the near certainty that the anesthesia and surgery would be hard in some ways but also completely okay and, most important, that they were intended to support my long-term well-being. “This is at its core a benign experience,” I told myself.
Gathering Detailed Information About the Upcoming Surgical Procedure
I also suspected it would be hurtful if, while under the effects of the drugs, my mind were also trying to process anesthetized and unfamiliar physical sensations. So I gathered in advance as much information as I could about the surgical procedure to increase the chances that my mind would correctly interpret these sensations. To do this, I watched (and discharged about) five different YouTube videos of actual gall bladder surgeries.
Meeting with the Surgeon and the Anesthesiologist
Just before the surgery, I had a brief meeting with my surgeon, whom I had liked very much at our first and only previous appointment. It was good to reconnect with him just before the surgery. Also, I enjoyed observing his friendly interactions with the anesthesiologist, who came into the room just after him; the two men clearly liked and respected each other, and I found that reassuring.
Next I met briefly for the first time with the anesthesiologist, who explained how the process of anesthesia and recovery would work. When he asked if I had any questions, I said, “You know, I’m not afraid of pain—it doesn’t bother me all that much. The hardest thing for me to deal with is the mental confusion caused by some drugs. Are there things you can do to leave my mind as clear as possible, even if it means I experience more physical pain?”
He looked at me closely for a few seconds and said, “Well, I can tell2 you aren’t anxious about your surgery, and that is one of the biggest issues we typically have to address with patients. So here’s what I will do: I will reduce to a minimum the amount of sedative I give you, and that will reduce to some extent the amount of confusion you experience. But we have to block pain, because it’s important that your abdominal muscles be relaxed for this procedure. And the narcotic painkillers we use do cause some confusion. That’s just the unfortunate state of our current pharmaceutical technology, but I’ll use as little as I can. Are you okay with that?” He was respectful, and had listened well to my goals and agreed to accommodate my wishes as best he could, so I said it would be fine and sincerely thanked him.
Preparing Myself on the Operating Table
As I lay on the operating table before the anesthesia was administered, I reminded myself of my decision not to try to fight the drugs. I also reminded myself that this was a temporarily difficult but basically benign situation being undertaken by a team of good people for my long-term health and well-being.
As I watched the friendly, mutually respectful interactions among all of the operating room staff, I thought about how much I enjoy interactions with my colleagues in my own workplace. So in the last minute or two before the anesthesia was administered, I further decided that I could choose to enjoy hearing these people working around me and that no matter what they actually said, I could choose to find the friendly tone of their banter reassuring. These thoughts about being in a completely benign situation were in my mind as I “went under” (was anesthetized).
Doing Well After the Surgery
About ninety minutes later, I “woke up” with no residual confusion and no feeling of being groggy or drugged. In fact, the sensation was almost identical to waking up in the morning after sleeping through the night. I had an immediate awareness that my body had experienced a major and serious event, but it did not feel upsetting or traumatic, just serious. I was content to lie in bed while my body recovered strength. I was quite alert and found it pleasant to listen to the interactions between the recovery room staff and the other patients around me.
After an hour or two in the recovery room, I was finally ready to dress and prepare for departure. Again, I had great awareness that my body had been through a deeply significant event and, although I was relaxedly looking forward to having a session to process everything, the events did not feel particularly upsetting.
More striking, on the way home from the hospital I noticed that I had more present-time attention than the person who was driving me home. She was driving an unfamiliar car in a strange city and was clearly nervous about traffic and directions, but I was able to easily pay attention to traffic and navigate our way home.
In my sessions after the surgery, I talked about everything I remembered, everything I found interesting, and all of my physical sensations. I talked, cried, shook, and yawned in every session that afternoon and in every session in the weeks afterward. I continue to avoid the temptation to “try to remember” events of the surgery that occurred while I was “under” the anesthesia. Prior to the surgery I had given my mind permission not to try to process or store what happened during the surgery, and it seemed important not to undermine that.
The anesthesiologist had told me it would take about twenty-four hours for my system to eliminate all of the drugs, and I could definitely feel their effects throughout the first day. After my last counselor left that evening, I set to work on a simple jigsaw-puzzle game on my cell phone, and my brain instantly felt more alert and alive than when I had been trying to talk or listen to speech. I concluded that the drugs had more deeply affected the speech centers of my brain than the visual centers. That effect was gone the next day.
Even immediately after the surgery, I did not experience residual anxiety, memory loss (apart from the time I had been under general anesthesia), confusion, or my other usual signs of a big new hurt. And far from feeling like I had experienced a new defeat, for several days I felt surprisingly triumphant. I don’t know exactly what to think about that but strongly suspect it was because I had been successful in my decision not to be restimulated—even in the face of general anesthesia.
CONCLUSION
I imagine that the exact effects we experience from general anesthesia depend greatly on a number of factors, including how much previous discharging we’ve done on anesthesia and other physical hurts, the exact mix of anesthesia drugs administered, the length of time we are anesthetized, and what happens to our bodies during the surgery. I have no illusions that every surgical experience will be as easy as this one seemed to be or that everyone will (or even should) find general anesthesia easy to handle. But no matter what else is true, I suspect it always makes sense for us to deliberately try to develop accurate perspectives about every major challenge we face. And I suspect it similarly makes sense, where possible, to actively decide in advance not to be restimulated by the things we know we are going to confront. It has to be okay if we don’t always succeed in this endeavor, but I think it’s important that we keep trying—and discharging fully on our efforts along the way.
Barbara Boring
Seattle, Washington, USA
1 “Material” means distress.
2 “Tell” means see.