Rejoining Joy

Ways of living

Pockets of Joy, Caverns of Purpose, Mountains of Hope

Rehabilitating Polytrauma

Shauna's and Dave's accident was so serious that the police had wondered how they could be alive. A tractor-trailer truck had been too close behind them when they had to stop suddenly to avoid an accident that was taking place in front of them on the highway. The huge vehicle rammed into them, going over the back seat of the car. Their twins were 2 years old then, and in their child's seats buckled up. Shauna was rendered unconscious for a while, and she suffered disabling back injuries. Dave fared better, getting just whiplash, but he froze in fear seeing his wife leaning on his shoulder unconscious and in not hearing the children in the back once the truck stopped. He looked in the rearview mirror and saw the truck. He was too afraid to check if the children were alive. Then, to his relief, they started crying. He still had decapitation nightmares. His wife did recover consciousness before the ambulance arrived, and was diagnosed later with a concussion. However, she never recovered enough to return to her work in accounting, especially given her pains, headaches, sleep difficulties, depression, anxiety, PTSD, chronic pain, and cognitive difficulties. The couple's intimacy was greatly affected. The family doctor referred the couple to a psychologist.

Robin was 8 when the accident happened, Darlin 3, Billy 6, and Belinda 6. The parents died in the accident, and family helped raise them. The children suffered serious injuries and burns, and were treated for this for years. The intense heat in the accident is one more factor beyond all the physical impacts that seems to have affected their brain functioning. I worked with them throughout their childhood and teenage years, and they were quite traumatized and numbed. They tried to forget about what happened, but locked it in or denied that it still affected them. They became quite inward but, as they got into the teenage years, they acted out. They required a full rehabilitation team for all the years of the treatment. They remained quite depressed and struggled with school and career choices, although all the help that they received had given them a future as adults. However, they needed counseling throughout their early adult years, and beyond. Each new crisis in their lives required more intense psychotherapy.

Andrea lost her child in her accident. She was not hurt much, but her son was evicted from the vehicle, as the chair snapped from the impact. She suffered terrible nightmares and flashbacks, feeling as if she was reliving the accident. She set up a "shrine" about her son in his room, and withdrew from the world. She felt so guilty even though the accident was not her fault. All her past psychological difficulties re-appeared as serious problems, as well, and had contributed to the development of a prior personality disorder that had never been treated. I tried to instill some hope and have her stay focused on her remaining children. However, her long-term prognosis was poor. I could not use the standard cognitive behavioral techniques, offer her hope, and help her accept and move forward. She needed a high dose of anti-depressants. She never could return to the work force. Her other children suffered from her withdrawals, as she was a single mom. Social workers had to be called in.

When there are complex psychological injuries that touch the body, mind, and brain, psychologists use complex treatment procedures that address them all. Moreover, we examine in detail the daily life of the individual and how it has been impacted by the accident in order to help in adaptation. What are the changes in the functional activities of the person, such as in work, and homecare? How have leisure activities been affected, as well as family life? We explore quality of life, activities of daily living, sense of well being, and so on.

Also, accidents are not the only way people might need the services of psychologists for physical and psychological symptoms. Patients might be suffering from illnesses. These might have psychological consequences, such as depression, or they might worsen when depression is present.

The body and mind work together in disease. Psychologists refer to the biopsychosocial model. That is, the physical conditions of patients are influenced both by their psychology and by their social environment. For example, the more that they have good coping skills and good family support, the better should be the outcome.

Whether dealing with psychological injury due to accidents or psychological conditions that accompany illness, psychologists adopt standard psychological approaches, such as cognitive behavioral therapy and interpersonal therapy. The former helps find the triggers to maladaptive thoughts, so that they can be changed and lead to improved behavior and mood. The latter works on social skills and relationships in context. Rehabilitation psychology is special in the way we work in teams, as required, such as with physicians, occupational therapists, and physical therapists.

There are other valid psychological approaches in rehabilitation, such as narrative therapy. What are the negative stories that patients are telling about themselves and their future, and how can they be changed? Can patients write or author new chapters about their lives that are more positive in outlook? For example, how can a tragedy be a growth experience, even in a minor way?

One way of summarizing the approach that could help patients in rehabilitation is to have them realize that they have the ability to change their psychological compass to point in a better direction, given what has been learned about their strengths and the positives in their progress to date. One way that I might inspire patients is to refer to helping them find pockets of joy, caverns of purpose or even mountains of hope. The approaches of positive psychology and finding solutions are very helpful with patients in rehabilitation, and they illustrate the progress being made in the field.

Gerald Young, Ph.D., is a professor of psychology at York University.

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