The long process of recovery for a head injury victim
is shared throughout by his or her family. During the early period of
medical crisis, it seems like everyone's energy is directed toward basic
survival -- getting through the crisis. But as the months draw out and
it becomes clear that the injured person is entering the recovery period,
other members of the family experience stages of recovery as well. Their
ability to deal with this difficult process will ultimately affect each
one in the family, including the victim, and the family unit as a whole.
Not everyone experiences this process the same way, so different people
in the same family will react differently and move through their adjustment
process at different rates. It's easy to see how this can be confusing,
and why it's so important to speak of the recovery process for the whole
family and not just the injured member.
Beyond the initial shock we experience in a major medical emergency,
perhaps the most obvious feeling we have to deal with is grief. Grief
is both a reaction to loss and an important part of the process of recovery.
In order to reach a stage where we can accept the loss that has occurred,
grief must be experienced. Within this grief process, four stages have
been identified. These will be present in some combination throughout
the recovery process. The first stage is shock that this has happened
in my life, and denial -- it must be a mistake; it isn't really as bad
as they think, and so on. The next stage is anxiety -- or maybe more
appropriately, panic - what do we do now? How can we possibly cope with
all this disruption in our lives?
The third aspect of grieving involves anger -- anger at the victim for
getting injured in the first place, anger at the doctors, at others
involved in the accident or at the world in general. Anger at God for
letting this happen. Perhaps the easiest person to be angry at is ourselves
-- and this can get translated into guilt. "If only I had done something
differently - if only I could do something more to help now".
Finally, as part of this grieving process, comes depression. As the
weight of all that has happened presses down and we feel overwhelmed,
the problems seem tremendous and insurmountable. We have been patient,
we have hoped and prayed, but we begin to realize there has been a loss
- life may never be returning to quite the way it was before. This hurts,
and it is natural, and a necessary part of the adjustment process.
So far, I've talked about the family as it is affected by something
as traumatic as a head injury -- the feelings of shock and grief that
everyone feels in his or her own way and own time over the terrible
thing that has happened to a family member. These feelings are part
of the recovery process. Shock gets us through the initial crisis -
in most cases making us numb to what has happened, allowing us to function
well enough to take care of the details at home, at work and at the
hospital. Grief is a longer and more complex process that we go through
to reach the stage where we can accept the consequences of the injury.
But there is more to the family's adjustment than shock followed by
grief.
Sometime soon after the initial shock of the accident, the family will
focus on prospects for total recovery. The injured person is regarded
as "sick" but getting better. In order to comfort each other as well
as the one who's hurt, they might discuss plans for when he or she "gets
well". This may be accompanied by unrealistic expectations for speed
of recovery, as well as the extent of recovery. Some families will continue
to expect total recovery for years beyond the accident, putting off
acceptance of permanent disability and preferring not to deal with that
prospect at all.
In addition to shock and expectation of recovery, a third stage in the
adjustment process is mourning. Much of the feelings of grief mentioned
earlier involve mourning, especially anger, guilt and depression. It
may seem like all is lost and there is nothing left to recover, and
the future for the injured family member is hopeless, with really nothing
to live for. These thoughts are as irrational as the expectation of
total recovery, and might be considered the other end of the same spectrum.
In fact, a family may have someone at each end of this continuum at
the same time, one despairing, the other desperately hopeful, with each
trying to console the others from very different points of view.
The fourth stage in the recovery process involves emotional defense.
This can be a very healthy reaction by the family to all that has happened,
and recognition that "it's time to get on with living, and facing this
disability is only one important aspect of our lives". Family members
may now turn their attention back to issues of individual importance,
at the same time accepting the disabled member back into a normal family
routine. This stage really involves establishing a new routine that
incorporates the needs of the head injured member.
In some cases these emotional defenses take an unhealthy turn with the
family essentially denying that there are any permanent consequences
and trying to resume life as if nothing happened. The potential for
a family to react this way is especially strong if normal or nearly
normal physical function is restored. The result may be impatience with
his/her behavior after the return home, and talk of poor motivation,
attitude problems and selfishness. When this type of emotional defense
is put up, it becomes even more difficult for a family to understand
the long term consequences of head injury. While they are devoting energy
to returning to the family life they had before, the head injured person
is unable to cooperate fully - because there are long term consequences
- and he or she becomes the disruptive member of the family. In this
situation the family has used denial as their primary defense, preventing
acceptance of "the invisible disability" - and creating added tension
in the home.
The final stage of adjustment is acceptance. This implies that the family
has a realistic understanding of the head injured person's assets and
disabilities, realistic expectations for his or her behavior in different
situations and is willing to accept him and deal with him as he is today.
Such a family can recognize the actual limits imposed by the disability
-- not more or less.
They can maintain a wide scope of values regarding life's possibilities
and can change from comparing the disabled member to others to valuing his assets and recognizing his gifts. It is important for the
family to realize how tough the disabled individual really is. It's
very natural to be protective -- to want to shield the injured person
from any more hurt. But a remarkable aspect of ours, as human beings,
is our ability to come back. Emotional adjustment to being disabled
is a major aspect of the rehabilitation process for a head injured person.
It's vital that the family remain supportive through this process, but
also that they allow the emotional recovery process to continue for
him or her. Acceptance and understanding are thus major goals for both
the family and the individual. |
