Emotional Adjustment
Following traumatic injury, the survivor and their families experience a wide range of emotions, which can lead to crisis and dysfunction. The manner in which each individual involved copes is highly subjective, but particular themes often emerge. Similarly, these reactions develop in stages until the extent of the afflicted individual’s injuries are fully understood. The initial stage or the Impact Stage begins when the family is notified of the injury. Typical emotions include shock, helplessness, and disorganization. Family members may further be coping with whether the loved one will survive their injuries. The manner in which daily activities are conducted will vary depending on the individual; some may prefer to remain by their loved one’s side, while others may choose to immerse themselves in work and “non-related” activities.
Some individuals may experience their emotional stress in physical ways, such as disturbances in sleep, shortness of breath, restlessness, agitation, tightness in the throat, or problems with thinking and memory. Common emotions include anger and irritability, which may be atypical for the person and can further be directed at anyone. The combination of these physical and emotional reactions is extremely taxing on any person, and can ultimately lead to complete exhaustion.
Depending on the injury, “survival” may not be synonymous with “recovery,” which can be a devastating realization for the injured and their family. The joy experienced once the injured individual has survived their accident may subsequently be replaced with dismay if the road to recovery is determined to be a long one, or if full recovery is not estimated to be possible. Notably, medical doctors and staff typically equate “good recovery” with stable vital signs and no imminent threat of death. Conversely, patients and families often perceive such a prognosis to indicate a return to previous functioning.
The Medical Stability Stage is reached once the injured individual has progressed beyond critical condition, and has reached physical stability. This may include being transferred to a “step down unit” within the hospital or rehabilitation program. This stage is where the individual and their family begin to fully comprehend the long-term implications of the injuries sustained. Family members may cope by becoming extremely involved in their loved one’s care. They may wish take on a supportive role in order to guide the individual through their recovery, to act as a liaison for other family members, and/or to regain some semblance of control.
Questions regarding the injured individual’s recovery may develop including, “Why aren’t they improving more rapidly?” “Why have they stopped progressing?” “Are they receiving the best care possible?” Further inquiries may be related to experienced stress, anxiety, and confusion such as “Why can’t I be productive like I used to be?” “Why do I feel so angry?” “Why can’t I remember like I used to” “Why do I feel guilty?” This stage is marked by emotional highs and lows, which typically depend upon the individual’s progress. Further practical complications may have to be considered to address the demands of treatment, such as financial constraints and resource allocation.
The final stage is the Post Discharge Stage, which occurs when the survivor is discharged. At this point, family members may begin to observe a change in the survivor’s character and personality. As the survivor learns to cope with the realities of their injuries, they may evidence feelings of sadness, frustration, and even symptoms consistent with depression. Family members may comment on the similarities they observe in the survivor before and after their accident, but further understand that they are not the “same person.” These subtle changes may become overt when the injured individual begins to assume previous activities such as work or school, and their performance level pre- and post-injury is compared. Adjustment in this stage is typically complicated and taxing, because coping must incorporate the realities of treatment options and implications. Feelings of exhaustion, despair, anger, grief, and mourning are common, but may lead to emotional disengagement between the survivor and family members. This stage is typically re-experienced due to the cyclical nature of the recovery process.