Sometimes anxiety stems from the loss of control and the extreme dependence on others imposed by the disability, regardless of how the injury occurred. Spinal cord injury caused by a vascular problem or spinal tumor (rather than an accident) may not cause posttraumatic stress, but it nevertheless results in a major loss of independent function. Basic biological functions and the simplest tasks of daily living may suddenly require the assistance of another person.
When you are no longer able-bodied, you must depend on others to take you to the bathroom, get you dressed, or help you dial the phone. You are suddenly confronted with a host of uncertainties. Will the nurse answer your call-bell in time, or will you wet the bed? Will you get help to make a call home before your wife leaves for work, or will you have to wait until visiting hours to talk to her? What if the staff doesn’t like you? What if your injury is repulsive to others? Will you still get the help you need? These uncertainties produce anxiety and feelings of helplessness in the rehabilitation hospital and often afterward, when problems become even more complex. Will my office or school be wheelchair accessible? How will I reach the files? Can I use the bathroom independently at my favorite restaurant?
Just as when you were a small child, you have to depend on the care and assistance of others for many of your basic needs. At first you may expect the hospital to take care of all your needs, but you’ll inevitably be disappointed. You’ll learn that there aren’t enough nurses, or that other patients’ needs are more urgent, or that priority is given to biological over social needs, even though the latter may be just as important to your sense of well-being.
You may feel frustrated and angry about not getting help. You may also be quite anxious and afraid – that you will never get help, that others will forget about or abandon you, or that something terrible will happen to you because you are helpless and alone (you will fall, stop breathing, or lose your sanity!). This type of anxiety, if left unchecked, can lead to disabling attacks of panic, requiring medication or other treatment. But more often, this anxiety is experienced as a humiliating regression to an infantile state of fear, frustration, and irritability, a loss of control over oneself and one’s environment, which is at best unsettling and at worst an assault on one’s dignity.
Learning to manage anxiety is an important task for every person, regardless of circumstances. Most people need some predictability and some sense of control over their bodies, their behavior, and their environment in order to feel secure and confident. We all learn ways to manage anxiety about new situations: by learning about what to expect (knowledge), developing skills to meet the new demands (mastery), gradually imposing some regularity or predictability (control), and allowing for periods of rest or “down time” when we temporarily set aside the new demands (pacing). These strategies are also helpful in coping with the anxiety generated by disability and dependence.
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