Dealing with illness, disease or injury is both physically and psychologically demanding. The psychological impact of illness or injury is profound, and for many, more difficult to manage than the physical components. Yet, so often these psychological experiences go unrecognized or untreated. No where do I see more of a psychological impact than with those who are living active, busy lives or who identify as being athletes (regardless of ability level), whether recreational, elite or professional.
Brad Stulberg, along with advice from mental skills coach Carrie Cheadle, recently published an article in Outside Magazine titled How to Mentally Recover from an Injury. This is a fantastic beginning framework for understanding the psychological toll that injuries have (same principles apply for those dealing with chronic illness or managing disease), and provides some useful recommendations for mental skills in managing injury recovery. As I was reading their article I couldn’t help but ponder the framework I use when meeting with client’s struggling with illness, disease or injury.
The overall impact of a major health disruption is so significant that it can lead to quick and sudden psychological changes. I frame that impact in terms of Additions and Losses.
Additions in this context do not mean a positive thing added to someone’s life. Far from it. Rather, significant health change leads to additional factors placed on someone’s life, demands for their time, or requirements for managing appropriate levels of treatment and/or recovery. These demands are typically unwanted and at times feel quite uncertain – conditions that can quickly stir up feelings of frustration and anger. Whenever uncertainty is involved (no more so than when it involves or health, safety or well-being) anxiety is commonly experienced. Major health change involves a significant amount of uncertainty – whether that is connected to an uncertain diagnosis or prognosis, an uncertain time line for treatment or recovery, or an uncertain treatment plan. In general, additional factors often fall into the following categories:
- Damage: this includes physical damage to the body
- Pain: newfound pain experiences that may be consistent or intermittent that require attention, monitoring and treatment (both physically and mentally)
- Medical Appointments: additional time in scheduling and attending appointments
- Physical Therapy/Rehab: the requirement for rehabilitation exercises for strength or mobility
- Psychological Experiences: most often connected to feelings of anger, frustration or anxiety – especially when it’s unclear how long the injury will persist or when you will get back to normal training or daily activities. An added layer of confusion surrounding what to do or how to approach the next steps is also common.
Loss is perhaps the single greatest generator of sadness, grief, and depression that we experience as humans. We feel this most with the loss of a loved one. But we fail to recognize that the loss of functioning, the loss of identity, the loss of meaning and loss of purpose are processed in the same way that we experience the physical loss of another. We are prone to experiencing magnitudes of loss associated with illness and injury that fuel sadness and depression. We are averse to this type of identity loss, which often sets us up to continue training even though our bodies are screaming for us to stop. And as illness or injury lingers, hopelessness can follow. Loss occurs in the following ways:
- Identity: athletes especially are prone to identity loss when illness or injury sweeps them out of training or competition and pushes them away from their goals. For many, identity loss is the single greatest impact on overall well-being when confronting an injury, illness or other major health change. Identity loss also fuels the tendency to ignore taking time off and continue training.
- Purpose/Meaning: not being able to engage in activities that we find deep value creates a chasm in purpose and meaning, often leading to people wondering what else they might find as purposeful. This can lead to a felt sense of a void and tendencies towards hopelessness.
- Time: especially when impacting daily life events, we are often left with huge swaths of time in which we are unsure how to occupy.
- Connection: reduced time with community or feeling as though the role you previously occupied in social situations has changed.
- Sense of Well-Being: a general sense of no longer being well or being able to perform in a desired manner.
It’s imperative to realize that these experiences are normal, common and to be expected when confronting an injury. The reminder that uncertainty fuels anxiety and loss fuels depression is an appropriate first step. Managing your psychological framework by developing a mindset of accpetance about these experiences goes a long way in the overall process of recovery.