Stages of grief

Stages of grief

Posted by AskNurseLinda on Jan 8, 2018 6:32 pm

When someone has a significant change in their life, grief can occur. This is the recognition of loss. Grief is a peculiar emotion as it is usually associated with the loss of something significant, but it can also be associated with any change in your life. Sometimes getting married or having a child can significantly change your life for the better but you can still have grief for the loss of your old life before the change.

People who have paralysis can have grief for the loss of their life before the injury or disease. Paralysis is a huge change in someone’s daily life. Grieving for the loss of function and all of the freedoms that come with it can be quite overwhelming. Stages of grief were defined by Elizabeth Kübler-Ross. Understanding the stages of grief can help you and your family members understand the changes that you and they are undergoing. This is not a ticket to be rude or abusive to anyone but it will help to deal with the situation.

Frequently, I first meet people with trauma in the emergency room or people with paralysis from disease in the intensive care unit. I have yet to meet anyone in either of these situations that are able to deal with the gravity of the situation. In many ways this is a good thing. It is a protective mechanism where the brain is saying that the situation is very serious and even too much to handle at the time. Therefore, people put up protective barriers from information. Everyone who has just learned of a paralysis diagnosis will say they will beat it, it is not them, this is not correct. And they mean it.

These words and feelings are classic for the first stage of grief which is denial. This disbelief of information, changes in body function, refusal to accept reality is an effective protective mechanism for such huge, life changing news. It is a basic coping mechanism that helps control the flow of unwanted information. People need to be able to control any devastating news so they can break it down into bits that can be processed.

Often times, families will want the person to recall the accident or medical event that lead to this point. I will see and hear them challenging the patient, do you remember hitting the tree, do you remember the huge seizure? This is exactly what is not needed at this time. Actually, there is no reason to recall events at all. That is over. Why force someone to recall, in detail, the worst moments of their life?

Let the person with paralysis deal with the situation in their own time. If they want to talk about what happened, listen. As a family member, you do not need to prompt them into remembering or recalling. They will think about what has happened either in trauma or medically on their own terms in their own time. If they never want to think about the events, that is ok. Let the individual take the lead on their recall and remembering if they wish to do so.

I remember one lovely lady who told me that when she heard accounts of her injury, it was like listening to a story. She was unconscious during the event so she had no recall of what happened to her. It was just like someone talking about a book or television story that they saw or read but she did not. When you are unconscious, you will have no recall of events.

Anger is the next step in the grieving process. A person may become angry with another person who caused their paralysis or may become angry with themselves for letting some medical event happen. Anger is really tough when focused on loved ones for not protecting them or even worse with self-blame. You cannot make someone become angry for what happened.

Anger might be seen in the rehabilitation process but it seems like it is more seen after people get home. In the rehab setting, people are learning to cope with new ways of doing activities of daily living. This is information that is deemed critical by the patient so they are attentive. After they get home and reality sets in, anger comes out.

You cannot rush the grief process. Anger will pop up at different times. It may appear as a huge explosion of emotion one day or it may be little isolated events that occur with frustrations throughout life. Attending therapy when it seems that a goal will never be reached can produce anger. When families come to visit and act cheerful when the person with paralysis is not, can really make a person angry. It may seem that they do not understand the gravity of your situation when in reality, they think they are trying to help you. It can be the same with the ‘woe is you’ visitor.

Anger is an emotion that can seep in slowly or be displayed in a huge outburst. It comes at any time, when you are first ill or even years later. Just as there is chronic sorrow for your loss, there can also be chronic anger. Anger might be directed toward loved ones, people who are there to assist you through your medical experience, people who are able to walk down the street or even toward God or a higher power. You want to avoid making those who are providing care to be the recipient of your anger. It can happen but talk with the person to discuss your frustrations before an outburst occurs. This is often easier said than done.

Dealing with anger is a difficult situation. Learning to recognize triggers so you do not hurt the ones you love is important. If you acted inappropriately, apologize and attempt not to behave poorly. If you are not sure how to handle your anger or just cannot get on top of it, ask for professional help. You are going through a difficult process. People can help you both professionally as well as through peer support groups. Individuals with paralysis often have wonderful insights as they are dealing with the same situations.

Bargaining is another stage of grief. It usually involves promises to God for some sort of deal. This can be things such as I will never drink again if you let me walk, or I will not swear if you let me have some hand function. Bargaining is creating some sort of if-then deal. Trying to go back in time to do something differently is a part of bargaining, if I went to the doctor sooner, the tumor would have been found in time.

Everyone in grim situations attempts bargaining. It typically produces feelings in inadequacy in ourselves. I often think of a young man who I met in my first year as a registered nurse. He wanted to just live one second of his life over again so he could decide not to dive into that lake. His bargaining is haunting. Everyone wishes they could do somethings in their life over again. It is a process that we do but we should try not to dwell in the bargaining stage as the results are always the same.

Once bargaining is deemed not to be working, people move on to the present. This is what I am. This is what I can do. The assessment after paralysis is not what was hoped or dreamed about for ourselves. I have yet to meet an individual that hoped to have paralysis in their future. It is not something people even thing about.  A lot of plans are changed. Here I would like to note that plans are changed but not destroyed. Everyone with or without paralysis has plans. How many work out as you thought? Not many. Plans change and evolve, often improving along the way.

Depression can make you not able to see a bright and valuable future. Depression focuses on what is not as opposed to what could be. Depression eats up people from the inside as you cannot think about or see anything positive for yourself. Depression may or may not appear as sadness. It can be expressed in anger or excessive sleeping and/or eating. It might not be seen until sometime after the onset of paralysis when the individual has been actively participating in the rehabilitation process but not progressing as they have thought.

There is treatment for depression. If you or your family member think you might have depression, seek treatment. Recovery from depression might be through talking with a supportive and knowledgeable person such as a therapist or clergy or through talking and medication. Trained professionals will be able to direct you to appropriate treatment.

Do not forget your peers when dealing with depression and recovery. Talking about situations with people who have gone through or are going through the same issues as you can be very helpful. Be cautious as sometimes, peers can draw you into their own world of depression. Stick to reliable resources. A good place to start is through the peer mentoring program through the Christopher and Dana Reeve Paralysis Foundation. You might find someone in your area and make a new friend who has experiences similar to yours.

The last stage of grief is acceptance. This does not mean you are celebrating your paralysis or that you are full of joy about your situation. This means you are able to deal and cope with your life. It does not mean you love your chair but it does mean that you recognize it as a resource to getting around. When you have acceptance, you are able to lead a constructive life. Not every day will be easy. Many days you will be faced with anger, bargaining and depression but you will have the resources to deal with these situations.

Dealing with grief is a revolving door. Somedays, you will sail right through and other days, you will have struggles. You might think you have conquered your new lifestyle only to be dragged right back in the next. Each individual goes through the stages at their own pace and in their own order. You can even be in more than one stage at a time. The idea is to be able to cope and deal with the challenges.

Nurse LindaI'm online in this community every Wednesday from 8-9 PM ET to answer your SCI and paralysis related questions.

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