By Richard C. Senelick, MD
Carolyn had always been the strength of her family. Her husband and children considered her invulnerable and counted on her to keep the family running – working, cooking, cleaning, helping with homework and coordinating the family’s social life. She pulled it all off: running a successful consulting business, caring for her four children and serving on the local school board.
One rainy night, she was running late for a board meeting. She lost control of her car and hit a utility pole, fracturing her pelvis and both legs. What followed was a long period of hospitalization and rehabilitation. Carolyn wasn’t used to inactivity or depending on others. Her house and business were chaotic, and she felt out of control for the first time in her life. She was irritable, short-tempered and depressed. Little things which never bothered her before now caused anxiety and distress. Fortunately, she recognized that she needed help and sought counseling from a psychologist. It didn’t take long to get back on track, coping and running her business from a laptop computer in her study.
How would you deal with the sudden onset of a physical disability? How would you adapt to a new and unexpected way of living? Why do some people cope so well under enormous burdens while others are derailed by minor injuries?
It is normal to go through a period of mourning or depression after the loss of a loved one. The same holds true when we lose a physical ability or when we age and find that what was once easy to do is now more difficult.
Following a physical loss or trauma, you may experience symptoms that are a result of a loss of physical abilities. The changes may cause you to feel overwhelmed and as if you lost your previous identity. Typical reactions include:
Sadness: This is a normal reaction that may manifest itself in a variety of behaviors. You may be angry or irritable for no particular reason. Sleep disturbance, loss of appetite and apathy are all signs of loss and depression. You may fail to gain pleasure from those things that once provided a great source of satisfaction.
Fear: With the loss of physical abilities comes a loss of control over your environment and personal needs. You may question if you will ever regain your prior abilities. “Will I be able to dress myself and attend to my personal care? Will I be able to provide financial support for my family? Will I get better? Who will care for me if I stay like this? I don’t think I can deal with this.” This thinking results in a sense of impending doom. Physical symptoms of anxiety may follow, with palpitations, sweating, tremor, shortness of breath and a sense of panic.
Denial: It is normal for all of us to respond with the belief that everything will resolve and return to the way that it was before the injury. In a way, we refuse to believe that the changes have really happened. Many patients and families don’t want to hear what the future truly holds; not accepting the consequences of the illness, but accepting appropriate treatment may be an effective response initially. Who of us can accept up-front that we will never walk or speak again? However, if the person continues to deny the degree of their disability, this represents a significant emotional problem that requires psychological intervention.
The good news is that, with proper treatment, the majority of people adjust and go on to lead satisfying lives. It can be a stormy, difficult course, but help is available. Experts in rehabilitation psychology understand the issues that people are going through and help make the passage through this process less painful. Treatment should start early. Don’t wait to become depressed. One last word of caution: be certain that the psychologist or counselor understands the nature of your disability and has both the experience and skills to deal with your issues. Just like choosing the correct antibiotic for an infection, choosing the right rehabilitation psychologist or counselor can be the difference between success and failure. When in doubt contact your local rehabilitation hospital for a list of names in your community.
Richard C. Senelick, MD is a physician specializing in both neurology and the subspecialty of neurorehabilitation. He is the Medical Director of HealthSouth RIOSA, The Rehabilitation Institute of San Antonio, and an associate clinical professor in the Department of Neurology at the University of Texas Health Science Center in San Antonio. He has authored several books on stroke, spinal cord injuries, and brain injuries. Dr. Senelick is an expert in the WebMD Stroke Community.