The purpose of a personal blog like this is to write about what’s on your mind. What’s been on my mind lately is the rest of my life. From the moment I became paralyzed via transverse myelitis fifteen years ago this December, I asked the question: does this mean that my life will be automatically – or statistically -- shorter than the ambulatory bloke next door? Is this a clear signal that I need to re-calibrate how long I’ll be around and what I should be doing in the interim?

To some, this may sound like a morbid and disturbing topic, but I don’t think it should be. We just happen to live in a culture where death is never discussed, not even at funerals, let alone the dinner table. Ever since the late Jessica Mitford’s scathing indictment of the funeral business, “The American Way of Death,” came out in the 1980’s, we know we Americans like to keep death clean, prettified, and unreal. We see a lot of death on TV and in the movies – the more gruesome by the minute – but that’s “out there,” not “in here.”

So I searched the web to find the life expectancy of an American male paralyzed at 51 and the answer, at least in 1997, came up 69.5 years. I thought about this for a minute, then decided to dismiss it. It was, you might say, too bad to be true. Their sample population, I figured, must have included people paralyzed in the 40’s and 50’s before new drugs and new health practices changed everything. In my own relatively healthy, active state for most of my paralytic years, dying at 69 seemed silly. “I’m gonna live forever!”

Recently the matter came up again in conversation with Adam Kaplin, MD, PhD, a Johns Hopkins psychiatrist and neurological researcher who is probably the leading expert out there on the subject of depression and related psychological issues among those with MS and transverse myelitis (TM). It was Dr. Kaplan who informed me sometime back that the leading cause of death among people with TM – like, you know, me – was suicide. Whoa. Not contemplating that route, I asked him, how’s the future look for me?

Since I’m in a chair with a permanent spinal injury, I’m lumped with the SCI stats. The fact is, as Kaplan and other experts have confirmed, people with SCI have, to quote the literature, “elevated risk of premature mortality.” I asked Dr. Kaplan to quantify that, please. He snooped around recent studies and wrote back with these findings: a 55-year-old person with a cervical level injury (quadraparesis) had a 25% chance of living to 70. A paraplegic at 55 had a 50% chance of making it to 70. Someone with one SCI had an 80% chance.

If I went to Vegas and laid down a bet on my own demise, they’d probably give me 1-1 odds. I bet a dollar, I get back a dollar, either way.

Kaplan then sent me “some light reading,” a series of research abstracts about the risk of mortality after SCI. These things are in English, but the arcane English a la “(the model) had a negligible decrease in both pseudo-R2 (R2 = 0.129) and concordance (c= 0.747) compared to the full model.” I skipped that part.

One study I studied in depth – see reference below -- dealt exclusively with psychological factors and mortality, i.e., factors that might lead to a mental cause of death, like suicide, or perhaps to a physical cause of death like infection triggered by the behavior and mind-set of the person with SCI. Beyond the very exact statistical modeling, the authors concluded that three factors correlated most closely to premature mortality.

1. Sensation Seeking

2. Neuroticism-anxiety

3. Purpose In Life (PIL)

Sensation seeking is, in a word, risky behavior, both large and small. That could range from drinking a bottle of Wild Turkey every night to being sloppy with your catheter routine or hurrying too fast, taking a spill, and creating a problem wound. Neuroticism-anxiety involves tension, worry, fearfulness, and depression. You don’t leave the house, say, because the world freaks you out, and you develop problems from immobility. Stress kills. Stress and a SCI kill a little faster.

Finally there is the vague but potent Purpose In Life. To quote the authors, people high on this scale “feel their lives are purposeful, they are more likely to have goals, and they find their lives interesting on a daily basis.” PIL is also associated with a diminished likelihood of risky behavior, like excess drinking or pill-popping.

As doctor/researchers are prone to do, these authors hedge their findings in the end by saying a) some psychological factors are seriously resistant to change, and b) more study is needed to strengthen the association of these factors and premature death. While they continue to study, I plan to think a lot more about “the most logical candidates” listed above. You could get cancer tomorrow and none of this means anytime. But the way it reads to me is, if you take your state of mind seriously – moods, impulses, and outlook -- you may have as much control over your longevity as do purely physical causes like respiratory failure.

Especially Purpose In Life. Without this, it appears, your days may be numbered.

Reference: ""Psychologic Factors and Risk of Mortality After Spinal Cord Injury," James S. Krause, PhD, Rickey Carter, PhD, Yusheng Zhai, MSPH, Karla Reed, MA, Arch Phys Med Rehabil, Vol 90, April, 2009

© 2011 Allen Rucker |