Emotional Reactions to Spinal Cord Injuries
Many people feel a sense of shock and denial around their injury. This common reaction comes as a result of the enormity of the patient’s illness begins to sink in. The victim may feel a sense of numbness, reacting little outwardly to the circumstances. They may become so numb that they cannot make informed decisions around their condition. They need family members who are more cognitively aware of what is going on to help the victim understand the choices they make, especially in the early days following a spinal cord injury.
Denial often follows the shock created by the event. The person may not be able to accept their limitations and their denial often gets in the way of active participation in their cares. While it helps the victim cope with the situation, it ultimately is not helpful because they are not thinking rationally and can make poor decisions. Denial doesn’t always have to be bad. Some patients with denial actually work harder in physical therapy and rehabilitation because they refuse to accept that they have been defeated by the injury. Denial can lead to optimism and can create a more motivated person when it comes to learning and practicing new skills.
Some patients are so overwhelmed by the situation that they cannot even recall what the healthcare providers tell them about their injury. They believe that all of this is temporary and that they will fully recover. Denial can be a constant phenomenon or it can come and go in the patient’s mind. As people are ready to grieve the loss of their abilities and move on, the denial gets better for both family and the patient.
In some situations, denial can interfere with rehab. For example, patients may refuse to learn transfer skills or wheelchair use because they insist they will soon walk again. While this is a normal response for some, others need to realize that they going to have to need to learn the skills that most reflect what is needed in the present moment. In such cases, a psychologist or neuropsychologist can be helpful so that the patient can make practical steps forward.
Denial can keep patients away from social situations out of embarrassment. They may avoid attending support groups, believing they are not really disabled. Self-neglect is a common sequela to this form of denial. These people are at a greater risk of bedsores because they won’t participate in the regular turning of the body necessary to avoid putting undue pressure on one area of the body. It can get so bad that, even when the situation is life threatening, they won’t seek medical attention.
Some patients (and family members) may need to undergo some kind of psychotherapy so as to begin to come to grips with what has happened and what needs to be done. Cognitive-behavioral therapy is especially good in these situations. Others will refuse therapy but will benefit from “peer counseling” in which others who have suffered a spinal cord injury will help the patient see that people can succeed in physical therapy and can carry on happy and relatively healthy lives.
People do not let go of denial easily because they believe that it means they are giving up on their dreams to “walk again” or to maximally benefit from therapy. They need to know that denial isn’t the same as giving up hope of a full recovery. They just need to learn that there are specific things they need to do in the present moment that will give them the resources they need to move on.
Some people go back and forth between believing they will walk again and complete despair over their situation. This is normal as long as they continue to participate in physical and occupational therapy to the fullest extent possible.
Fear and Anxiety
Stress levels are high after a spinal cord injury. This is especially true in situations where the person was healthy one minute and paralyzed the next, such as in a motor vehicle accident, fall or diving accident. Patients have high anxiety around their bowel and bladder function, which is lost in nearly all spinal cord injuries.
Some patients develop PTSD because of the violence and suddenness of the injury. Nightmares, intrusive memories, and mood changes are indicative of a person who may have post-traumatic stress disorder (PTSD).
Anxiety can also occur because the patients worry about finances and about their newly-found dependence on others for all their cares. Relaxation exercises and psychotherapy can help the patient learn to cope with their fears. Rehabilitation therapists can be especially helpful in situations where the patient’s anxiety is getting in the way of a healthy recovery. The more the patient is educated around their illness, the better able is the patient to fully participate in their recovery process.
Those people who were fiercely independent before their injury are likely to become angry after the shock of the trauma wears off and anger settles in. If the patient is paralyzed because of the actions of others (such as in an auto accident), they are more likely to suffer from profound anger and blame to the person or person(s) responsible for their injury.
Things like having to insert a suppository for bowel evacuation and learning self-catheterization can make the person even angrier. When a person holds onto this anger for too long, it can interfere with moving on and participating in their injury recovery. The anger can extend to staff members caring for the individual because the victim of a spinal injury may need someone to lash out at during the early days after the injury. Family members can be targets for the anger.
In other situations, some patients refuse to express their anger. They may be unable to express their feelings in a healthy, constructive way. This leads to frustration, depression and a profound sense of loss. Expressing anger in socially acceptable ways can encourage the patient to participate more fully in the process of rehabilitation.
Grief and Depression
Grief and sadness are common consequences after spinal cord injuries. Regret and guilt can go along with the feelings of grief. The expression of tears and emotions tend to be heightened after a spinal cord injury. Some patients too engulfed in grief will lose their appetite and will have a dwindling interest in pleasurable activities of daily living.
The individual who chooses to go through psychotherapy as part of their rehabilitation tends to do much better than those who stay too close to their grief and depression. They need validation of their feelings and experiences, along with the knowledge that what they are going through is a normal part of the recovery process. By processing their grief, they can avoid long term depression as a consequence of their injury.
When grieving is successful, the patient and family can be more realistic about their injuries and recovery. They can become better participants in their care and can even learn creative ways to help their recovery go faster and more efficiently. Those with simple grieving who continue to participate in their cares (even when they don’t feel like it) will be more successful in the rehabilitation progress.
Those who cannot process their grief properly are at a high risk of developing clinical depression. They wallow in self-pity and don’t see how rehabilitation can help them improve their seemingly hopeless situation. They may even develop physical consequences, such as an increase in pneumonia and pressure sores because they are too depressed to participate in their own cares.
These people need the help of a psychiatrist or psychologist. Besides talk therapy, some patients will respond to anti-depressant medications that help the brain begin to heal and move on from their depressed point of view.
All of the above feelings, emotions, and thoughts are completely normal and are part of the grieving and coping processes. Both family and the patient need to go through these stages in order to come out of it better adapted to the life that is to come.