Spinal cord injury as a critical life event
The occurrence of a spinal cord injury, whether caused by an accident, illness or medical intervention, is unforeseeable and usually happens very quickly. It is like a turning point in life and nothing seems the same afterwards. Many things that used to be familiar, safe and controllable are no longer that way. The fact that your body or parts of your body feel numb or can no longer be felt and / or moved at all can mean that in addition to the physical and somatic challenges, you are also faced with psychological challenges. Often this situation is initially accompanied by a feeling of helplessness and powerlessness. The mind thinks the familiar patterns of movement, but the body suddenly no longer implements them. For this reason, a spinal cord injury is regarded as an especially critical life event.
Shock, disbelief and denial as natural defence mechanisms against the all-too-painful reality
Immediately after the occurrence of a spinal cord injury, you may experience a type of physical and mental shock. On a psychological level, this may manifest itself for example by your not being fully aware of the consequences at this stage, which is part of a natural psychological defence mechanism. This cuts in to protect us whenever we are threatened by something unbearable and inconceivable. It is understandable that when a spinal cord injury occurs, most people are at first unwilling or unable to believe what has happened. The fact that a spinal cord injury generally means a relatively definitive and drastic change of life is thus hidden and often the all-too-painful reality is denied. In research, we also talk about the “airbag effect” in this context, since this psychological defence mechanism works like an airbag in a collision to cushion the severity of the impact. Transferred to the psyche, this means that threatening thoughts and emotions are cushioned. This highly-automated defence mechanism has evolved in each of us and is essential for survival at this stage. It has a stabilising function, to enable the experience to be endured. Relatives, on the other hand, often experience the situation differently. They do not have this “airbag”. Generally, they realise the significance of this event much more quickly, and initially are often just as profoundly affected emotionally.
„It is perhaps less the paralysis itself which afflicts a person than the loss of the normal ability to move oneself – in spite of lively, correct imagination and intensive desire. „
P. Lude, J. Eisenhuth, 2015
Psychological assimilation and the ability to explore new possibilities
Over time, this psychological defence becomes weaker and will naturally diminish to allow you to begin a process of psychological assimilation. This is usually the time when you, the affected person, increasingly realise the true extent of the spinal cord injury, not only physically and mentally, but also emotionally. For many people, this is like waking up from a bad dream and falling to the floor of reality. This also means that you may come more into contact with unpleasant feelings at this stage, such as despair, depression, grief, anxiety or rage. Doubts often arise about your own worth or the meaning of life.
This increasing confrontation on the emotional level is often unpleasant and very hard to bear, yet it is a typical adjustment reaction to the new life situation, and at the same time it is an extremely important step in the natural assimilation process in order to be able to explore new possibilities. From the psychological point of view, for example, it is very important to mourn for the losses suffered and to internally assimilate that which is lost in order to make space to be able to consider new ways and goals, and to find individual coping methods in order to adapt to the new life.
Different areas of life can undergo changes due to a spinal cord injury
The consequences of a spinal cord injury are very far-reaching: they affect a person not only on a physical level, but also when it comes to the social and psychological aspects of his or her life. Nothing is as it was before, and much of what was previously considered meaningful and emotionally stabilising is suddenly called into question or destroyed. In addition to the medical aspects, there are often questions about relationships, sexuality and partnership, and also about hobbies and interests that can no longer be pursued. There are also many questions about the professional situation, planning for the future and accommodation.
Dealing with these subjects is imperative in most cases. In addition to fundamental life changes, they contain opportunities for personal growth and can play a leading role in dealing constructively with the spinal cord injury.
„In most cases, the spinal cord injury remains an inescapable fact – only the way it is dealt with can be optimised. „
D. Stirnimann, 2015
Coping strategies for dealing with a spinal cord injury differ from one person to another, and you are generally best placed to know what helps you and what does not.
Presented below is a small selection of examples of possible coping strategies which have proven helpful in dealing with spinal cord injuries.
- Strengthen relationships: A stable social network increases resilience and thus also the ability to overcome the challenges posed by a spinal cord injury. Relationships can be strengthened by consciously taking time for other people, showing appreciation, loyalty and affection, resolving conflicts and sharing your spiritual life. For example, approach other people and actively network with them, whether they are your friends or just acquaintances, and make use of the new opportunities that arise, e.g. wheelchair sports and offers from the Swiss Paraplegics Association (SPA).
- Take up exciting activities: Studies show that activities which we enjoy have a positive effect on our well-being, mood and thoughts. You will certainly have taken part in activities where time has flown by and you were so deeply immersed in what you were doing that you seemed to forget about everything around you. This experience is also known as a “flow experience”. Flow experiences which occur repeatedly lead to a more positive feeling of self-esteem, greater satisfaction and meaningfulness. Try to consciously increase the number of such activities / situations.
- Set and pursue targets: People who strive for something that means a lot to them personally (e. g. learning a foreign language, trying out a new sport, keeping a pet) are far happier than people who have no dreams and goals in their life. It is useful to select one, two or three important and personally meaningful goals, then spend time and energy to make them happen. Make sure that you set short-term goals, not just long-term ones. The goals should be realistic and achievable.
- Enjoy the finer things in life: “Enjoy” means creating, intensifying and extending pleasure. It can refer to the past, present or future. Take pleasure in beautiful events / moments and look back on them. Enjoy everyday experiences, for example, by being more aware of beauty and remarkable things, and share these experiences with others.
Psychological counselling – yes or no?
Because a spinal cord injury places huge demands on you in terms of adaptation, it is entirely “normal” to experience comparatively intense feelings and emotional reactions for your circumstances, for in many respects you have to rediscover and reorientate yourself. This does not mean that something is wrong with you – it should be seen as a natural adjustment reaction. Some patients and their families overcome this without the professional support of a psychologist, others welcome counselling and therapy. This is offered voluntarily as part of the initial rehabilitation, according to standards based on expert knowledge, which many patients and their families greatly appreciate and find very helpful.
What kind of support can psychological counselling provide?
Psychotherapy accompanying initial rehabilitation can support you in your personal process of assimilation, for example by helping you through the grieving process, working with you to develop strategies to regulate and cope better with emotions. It can help to find new norms and values for building up a new life perspective or encourage you to try out new behaviours. By learning relaxation techniques and developing strategies for psychological pain management or building up resources you can actively have a positive influence on the process of your rehabilitation. In parallel to this, it is also possible for your family to take advantage of psychological discussions, whether individually, as a couple or as a family.
Supporting therapy options
In addition to the supporting psychological discussions mentioned above, there are further therapeutic options which are helpful for dealing with a spinal cord injury. These options are not necessarily geared toward dialogue, but offer the opportunity to find a different way to relate to yourself, your body and the current situation. For example, Feldenkrais, art and music therapy can contribute in various ways to psychological stabilisation and / or support the psychological assimilation process and promote the improvement of your body awareness and performance of your movement patterns.