How Classical Conditioning Explains Medical Trauma

Introduction and ending note written with Claude (Anthropic). Voiceover by Aurora at Evernote.

Introduction

For Week 5 of my General Psychology I course at CT State Community College, we studied learning theories (Chapter 5) and memory (Chapter 6). The discussion assignment offered three options, and I chose to analyze a personal fear through the lens of psychological theory.

This assignment gave me an opportunity to apply what I’ve been learning about classical conditioning and memory processes to my own experiences with medical trauma. Years ago, during a hospitalization, I went through what’s called a prescribing cascade—where adverse effects of medications were misinterpreted and treated with additional medications, creating a cycle of harm. The healthcare providers involved showed little understanding of patient-centered care or how to recognize medication side effects, and my reports about what was happening to me went largely unheard.

That experience left me with lasting fear and anxiety around medical settings. While I’ve spent years understanding this trauma from advocacy and policy perspectives, this assignment challenged me to examine it through formal psychological frameworks—specifically, how classical conditioning created the fear and how memory mechanisms maintain it.

Below is my response to the Week 5 discussion questions. It demonstrates how psychology can help us understand even our most difficult experiences. Whether you’re interested in psychology, have experienced medical trauma yourself, or are curious about how our brains create and preserve fear responses, I hope this provides some insight into the science behind lived experience.

My Response to Initial Post, Question Set Three

(1) Describe in detail about a situation or an object you fear (20 point).

I am afraid of hospitals, medical settings, and interactions with healthcare professionals. It is because of some traumatic experiences many years ago during a hospitalization in which severe adverse effects of medication were misinterpreted as being due to underlying mental health conditions, a clinical bias called diagnostic overshadowing (Nash, 2013). I went through something called a prescribing cascade, a series of events where adverse effects of a medical treatment are misinterpreted and treated with additional treatments that cause more side effects, and so on (Rochon & Gurwitz, 1997), which my doctors probably had little training about. They also probably lacked training in patient-centered care (NEJM Catalyst, 2017), as my feelings and wishes were not respected. Because of the medical trauma (Philadelphia College of Osteopathic Medicine, 2023), I often feel some anxiety when going to medical appointments. Sometimes the anxiety causes high blood pressure at appointments.

(2) Choose a learning theory discussed in Chapter 5 (modules 15 - 17), summarize the theory (10 points), and use the theory to explain in depth the causes of the fear (20 points).

Classical conditioning is a type of learning in which a neutral stimulus causes a particular response after being paired with another stimulus that naturally brings about that response (Feldman, 2024, pp. 173-180), and it partly explains the fear. The neutral stimulus is something that doesn’t naturally cause that response, but will cause the response after classical conditioning. Research on this type of learning was pioneered by Russian physiologist Ivan Pavlov, who found that after pairing the ringing of a bell with the presentation of tasty meat to dogs, the dogs would begin to salivate in response to the bell ringing, even when the meat was no longer shown to them. In that research, the meat was an unconditioned stimulus (one that naturally causes a particular response without being learned) and the dogs’ salivation was an unconditioned response (a natural response that occurs without training). The bell was a neutral stimulus that, after learning, became a conditioned stimulus, bringing about the conditioned response of salivation after pairing with the meat. As Feldman describes (2024, pp. 176-177), classical conditioning explains why some people develop a fear of going to dentists after experiencing painful dental procedures.

Classical conditioning partly explains my fear of medical settings after my experience of trauma in the hospital. Although healthcare appointments are usually benign or helpful (neutral stimuli), during my hospitalization I experienced physical and emotional pain, unconditioned responses to adverse effects of cascading medical treatments, which the nurses and doctors mostly ignored. Thus, nurses, doctors, and clinics became conditioned stimuli that still cause my conditioned responses of fear, hypervigilance, and increased blood pressure.

A learning process related to classical conditioning is stimulus generalization, in which after an original stimulus becomes conditioned to produce a response, similar stimuli produce the same response. This also explains why I feel some fear in other types of healthcare settings, even a bit for outpatient dental and vision appointments.

(3) Use memory theories in Chapter 6 (modules 18 and 19), discuss and explain the role memory plays in your fear (20 Points).

Memory, the process of storing and retrieving information in our minds (Feldman, 2024, p. 207-218), was central to the creation of my fear and allows its preservation. In my brain’s limbic system, my hippocampus consolidated and stabilized my memories of the trauma and sent them to my cerebral cortex for permanent storage as long-term memory, while my amygdala, involved with emotion, is reactivated when I’m in medical settings that have any similarity.

Theories of long-term memory (Feldman, 2024, p. 219-230) explain the persistence of my fear. Because the experience was emotionally significant, it became a flashbulb memory, one that is recalled easily and vividly (Feldman, 2024, pp. 222-223). Many years later, I still recall interactions with hospital staff with a distinct emotional impact. Levels-of-processing theory emphasizes that the amount of processing of information determines how much of it is remembered (Feldman, 2024, p. 220). Because I ruminated and journaled about my experiences while in the hospital, the memories became easy to recall. I have spent much time considering the significance of the events in the hospital, how they relate to other parts of my life, and problems with healthcare in general. Constructive processes like this, in which memories are influenced by the meaning we assign to events (Feldman, 2024, p. 224), have further affected how I recall the events in the hospital.

References

Feldman, R. S. (2024). Essentials of Understanding Psychology (2024 Release, 15th ed). McGraw Hill LLC. pp. 171-239. Print.

Nash, M. (2013). Diagnostic overshadowing: A potential barrier to physical health care for mental health service users. Mental Health Practice, 17(4), 22–26. https://doi.org/10.7748/mhp2013.12.17.4.22.e862

NEJM Catalyst. (2017). What Is Patient-Centered Care? NEJM Catalyst, 3(1). https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0559

Philadelphia College of Osteopathic Medicine. (2023, June 7). Medical Trauma: Dealing with Psychological Responses to Medical Events. PCOM. https://www.pcom.edu/academics/programs-and-degrees/mental-health-counseling/news/what-is-medical-trauma.html

Rochon, P. A., & Gurwitz, J. H. (1997). Optimising drug treatment for elderly people: The prescribing cascade. BMJ, 315(7115), 1096–1099. https://doi.org/10.1136/bmj.315.7115.1096

What are your thoughts on applying psychological theory to understand medical trauma or other personal trauma? I welcome your comments below.