Dr. Richard Bruno is Chairperson of the International Post-Polio Task Force and Director of The Post-Polio Institute and International Centre for Post-Polio Education and Research at Englewood (NJ) Hospital and Medical Center. His new book, The Polio Paradox: Uncovering the Hidden History of Polio to Understand and Treat "Post-Polio Syndrome" and Chronic Fatigue, will be published by Warner Books in June 2002. Please e-mail questions directly to him at ppsforum@newmobility.com.

Note: This column is for information purposes only and is not intended as a substitute for professional medical advice.

Q: An article in the New York Times says people who were abused as children would be better off if they forgot what happened. I have had flashbacks of being abused in the hospital. Should I try to remember what happened or try to forget my past?

A: This is a question many polio survivors ask when abuse rears its ugly head. In our 1995 international survey, polio survivors reported 34 percent more physical abuse and 94 percent more emotional abuse than nondisabled respondents. We also found that polio survivors were on average 15 percent more sensitive to the criticism of others and prone to thinking of themselves as failures. What's more, polio survivors on average reported 30 percent more type A behavior: being hard driving, pressured, time-conscious, overachieving and perfectionistic. Said one polio survivor, "We aren't just type A, we're type 'E': We do everything for everybody every minute of every day!" Not surprisingly, the polio survivors who were abused were more sensitive to criticism and failure and more prone to both type A and type E behavior.

In May's PPS Forum we talked about "sleep inertia"--grogginess and sluggish brains after awakening from a long nap. Polio survivors' type A and type E behavior could be called "action inertia"--constant activity and doing for others to prevent criticism in the hope that they won't be abused again. We've found that action inertia can also help polio survivors repress experience of and feelings about abuse. When some Post-Polio Institute patients slow down and start taking care of themselves, they have flashbacks of past abuse or become terrified they will be abused again. This is one reason polio survivors have such trouble managing PPS by doing less.

Can action inertia be treated with hypnosis or drugs to recover and face lost memories of abuse? Unfortunately, memory is not like a videotape that can be rewound and played back--it is a creation of the brain, constructed from experiences, sensations, emotions and thoughts. Even if memories could be recovered, they would not necessarily be accurate reflections of past events. Just think about reports when 10 eyewitnesses to a crime tell 11 different stories about what happened.

We find that it isn't necessary or even desirable for polio survivors to recover lost memories. When it comes to memories of abuse, acknowledging and accepting what you think or feel happened way back then is what's important. You then need to find out how those thoughts and feelings cause action inertia and prevent you from taking care of yourself and managing PPS.

The Times article didn't actually say you should repress memories of abuse. It suggested that you shouldn't spend years in therapy trying to recover imperfect memories, relive the abuse in your mind or dwell on the pain and fear it caused. You should no more define yourself as an "abuse victim" than you should think of yourself as a "polio victim." The victim mindset creates the most pernicious and disabling polio paradox: Polio survivors cheated death, conquered disability and dealt with years of severe physical and emotional pain to become "the best and the brightest," not just surviving polio but thriving and creating extraordinary personal and professional lives. The paradox is that many polio survivors believe, in spite of all they have overcome, that they have no survival skills at all--no courage, imagination or internal resources to build a new life--to survive and even thrive with PPS. This paradox is why psychotherapy for polio survivors is so important: to help them accept the bad things that have happened, to not get stuck in the past or to expect future abuse, and to accept that they are competent adults whose emotional and physical future is in their own hands.

It is exactly because of everything you have already survived that you will survive again in spite of PPS. To do this you need to look at the broad scope of your life, at the panorama of your own personal history, including any abuse you may have experienced. You need to read these two words again and again and take in the depth and breadth of their full meaning:

POLIO SURVIVOR

If you can acknowledge the abuse you have survived (even if the memories are fuzzy), you can then cope with your past, stop action inertia and make the physical and emotional changes necessary to survive and thrive with PPS.