Spinal Cord Injury

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Spinal Cord Injury

Spinal Cord Injury

Table of Contents

1.0 Introduction 2

2.0 Bereavement and grief theories 3

2.1 Freud’s Model of Bereavement 5

2.2 Kübler-ross model- five stages of grief 6

2.2. 1. Denial 8

2.2.2. Anger 8

2.2.3. Bargaining 9

2.2.4. Depression 10

2.2.5. Acceptance 11

2.3 Attachment Model of Bereavement 13

2.3.1. Numbness and shock 15

2.3.2. Yearning and searching 15

2.3.3 Despair and disorganization 16

2.3.4. Re-organization and recovery 17

2.4 Erich Lindemann’s grief work 18

2.4.1. Emancipation from bondage from the deceased 21

2.4.2. Readjusting to the new environment whereby the deceased is absent 22

2.4.3. Creation of new relationships 22

2.5 Rando’s six “R” Model 22

2.5.1. Avoidance Phase 23

2.5.2. Confrontation Phase 23

2.5.3. Accommodation Phase 26

3.0 Conclusion 27

4.0 References 29

1.0 Introduction

Spinal Cord Injury (SCI) can be a devastating and sudden event that changes an individual’s life forever. It sometimes results in permanent neurological injury coupled with other related consequences such loss of functional abilities like walking, sexual and bladder function, changes to bowel, Loss of sensation and paralysis (Harvey 2008). Additionally, SCI does affect not only the physical function of an individual but also their psychological wellbeing. Several studies have indicated that after SCI, people have reduced their quality of life, life participation, subjective wellbeing and have increased their likelihood of developing depressive or anxiety disorders (Van and Kayes 2014). This shows that employing physical interventions only may not be enough for comprehensive and successful rehabilitation outcomes. According to Van and Kayes (2014), one SCI rehabilitation aspect that is challenging is the uncertainty that surrounds recovery. Depending on the SCI level and impairment level, some patients will have a much higher chances of improving compared to others; with the patients having incomplete injuries tending to gain more (Vazquez et al 2008). However, very few SCI patients recover fully. Despite the fact that an increasing number will walk again in some ways, courtesy to the improving acute and emergency care.In most instances, patients ask the healthcare workers, and in particular the physiotherapists, about the prognosis: “will I be able to use my limbs?,” “will I ever walk again?” no one can answer these questions from the SCI patients with absolute certainty, because of the SCI variable nature during recovery. The aim of this paper will be to outlining the typical stages of bereavement after sustaining a spinal cord injury.

2.0 Bereavement and grief theories

Spinal Cord injuries are situations that are frequently encountered by healthcare workers in the course of their duties. It is significant that the healthcare professionals have a good understanding of the responses and reactions to bereavement and grief so that they are in a better position in supporting the patients, relatives and family members during the process of bereavement and grieving (Van and Kayes, 2014).

Grief is a natural response by humans to loss, bereavement or separation, in particular, the loss of the family members or the l0oved ones. The term bereavement, mourning and grief are often used interchangeably, despite the fact that they have different meanings. According to Greenstreet (2004), grief describes a person’s response to his or her loss and has spiritual, social, cognitive, behavioral, physical and emotional dimensions. On the other hand, mourning is the active and outward expression of that grief. Greenstreet (2004) stated that it is through the mourning process that grief is resolved. Similarly, Bereavement is the period after loss whereby mourning and grief occur. It is the state after experiencing loss. According to Greenstreet (2004), a bereavement is a depression form that normally resolves over time spontaneously. The bereaved person may experience the feeling of helplessness, hyperactivity, inertia, insomnia or anxiety.

Bereavement, Mourning and grief may be affected by nature of the relationship with the individual traumatized or deceased and the way he or she was traumatized or died, religion, culture and personality. On the other hand, bereavement was defined by Stroebe et al (1993) as a state of loss, that triggers reaction which manifests in different behaviors referred to as mourning.

Many models or theories of grief have common stages or themes (Worden, 1991; Bowlby, 1980; Parkes, 1975; Kübler-Ross, 1969; Lindemann, 1944,). Diagrammatic presentations like the grief wheel are usually used in describing the process and the involved stages in grief, to suggest that it is rarely a process that is static. However, other theories or models, for instance, the dual process model of how to cope with bereavement, offer approaches to the grief interpretation and management that are more flexible (Stroebe and Schut 1999). The dual process model describes how a person who is bereaved copes with the loss in his or her daily life, along with other changes in lifestyle that develop due to that loss. Buglass (2010) stated that the dual process model is founded on the principle that when an individual is grieving, the way of coping is a two-way process. That is the individual moves between grieving and attempting to come to terms with his or her loss.

2.1 Freud’s Model of Bereavement

The study of grief and bereavement began with Freud, who for many decades has been credited with establishing the psychology of grief in the 20th century? Freud developed the grief work concept in 1917 based on the premise that the precise task of mourning is to function in detaching the survivor’s hopes and memories from the dead (Freud, 1961, pp. 253).

On the other hand, Freud (1961) regarded grief as a solitary process, in which the mourners withdrew from the world so that their letting go from their loss of the deceased could be in a process that is gradual. The griefs psychological function was believed to release the person from his or her bond with the loss of the deceased. This was realized by reflecting back at the past and forgetting the memories of the person deceased. Getting detached from the deceased person entailed working through the loss for the grief to be overcome. The process was referred to as “grief work.” According to Payne et al (1999), the focus of detaching from or letting go of the deceased accommodate grief is still a matter being debated among many theorists. Freud’s theory of grief came up as a result of clinical experience with the depressed people. Therefore, the understanding of Freud on loss and grief may be limited to his specific clinical group and may not be generalized to the population at large. However, Buglass (2010) indicated that the ideas of Freud about loss and grief, and most significantly, the need for confronting grief to let detachment have remained a characteristic of subsequent practice and theory.

Based on this model, the emphasis on the ideas of Freud about grief is on personal attachment. This theory emphasizes that the individuals who are grieving are searching for a lost attachment. Freud described mourning as the detachment from the people who are loved. According to Freud, Mourning is the melancholia state that suggests that when mourning goes wrong, the state of melancholia rises. The state of melancholia is viewed as a profound depression presentation that involves a complete loss of pleasure in almost or everything (Freud, 1961).

The mourning process is viewed as the task of rebuilding individuals inner world by experiencing the pain of loss that is intense that reawakens the effect of loving of what has been lost, which to the spinal cord injury patients are the lost functionalities due to the spinal cord injury. It is suggested that during the process of grieving, the bereaved is letting go of the several involved attachments in the relationship formation. When the individual have accepted the loss, the ego then accommodates the loss, and this enables the individual bereaving to look for new attachments (APS, 2016).

2.2 Kübler-ross model- five stages of grief

Elisabeth Kübler-Ross proposed pioneer methods for supporting and counselling grief and grieving, personal trauma, associated with dying and death. Moreover, she improved the practices and understanding with hospice care and bereavement. Her ideas and most importantly, the five stages of grief are transferable in different ways and to varying degrees, to emotional upset and personal change resulting from factors other than dying and death (KüBler-Ross & Kessler, 2005).

In most instances, alike reactions to the ones described by the grief theory are often witnessed in people who are facing less severe traumas than bereavement and death, such as enforced relocation, work redundancy, disability and injury like spinal cord injury, crime and punishment, bankruptcy, financial despair, and relationship break-up among others. This makes the Kübler-Ross’s grief model worthy of reference and study far outside bereavement and death. Actually, the grief model is a model of change for helping in understanding and dealing or counselling personal reaction to trauma like the spinal cord injury trauma, and not just for dying and death (Williams, 2007). This is because emotional shock and trauma are relative regarding effect on individuals. Whereas dying and death are the ultimate trauma to many people, people can experience emotional upsets that are similar when dealing with several challenges to life, especially if for the first time one is confronting something difficult, or if the challenge being confronted happened to threaten psychological weakness area, which every person possess in different ways.

The five stages of grief also referred to as the grief cycle, was intended by Kübler-Ross to be uniformly timed steps or a rigid series of the sequence. It is a framework or a model and not a process as such. A process means something that is quite consistent and fixed, while the model is less specific, that is more of a guide or shape. For instance, people do not always experience all of the five stages of the grief cycle. Some stages might not be experienced while other stages might be revisited. Moreover, the transition from one stage to the other can be more of a flow and ebb, instead of a progression. The five grief stages are not linear and are not also equal in their experience. The grief of people and other reactions to emotional trauma are personal to every individual just like a fingerprint (Van & Nel, 2011).

From the description, one might wonder what the models purpose is if it varies from person to person. The answer to that is that the grief cycle model acknowledges the existence of an individual pattern of emotional responses that are reactive that people feel when facing bereavement, death, trauma or great loss among others. The grief cycle model recognizes that individuals have to pass through their individual ways when coming to terms with bereavement and death among others, after which, they accept reality, which makes the person cope (Sánchez, 2007).

Moreover, whereas the focus of Kübler-Ross’s grief model was on death and bereavement, it is a useful perspective for understanding other peoples and own emotional reaction to change and personal trauma, irrespective of its cause.

The five stages of Kübler-Ross’s grief model include the following:

2.2. 1. Denial

This is a refusal to admit reality, information, facts among others that relate to the concerned situation either unconsciously or consciously. It is a mechanism for defence and is naturally percept. Some individuals can lock themselves in this stage when facing a traumatic change that can be ignored. Of course, death is not easy to evade or to avoid indefinitely. According to Sánchez (2007), the denial stage helps people in surviving the loss. At this phase, the world of the person who has spinal cord injury becomes overwhelming and meaningless. Life does not make sense, and the person is in the state of denial and shock. The person goes number and wonders how they can go on, and if he or she can go on, why they should continue going on. The traumatised individual try finding a way of going through every day. Shock and denial help the person in coping and making survival possible. Denial helps the traumatised people in pacing their feelings of grief. Cleiren & Clairen (1993) stated that in denial there is grace and it’s a way of nature of letting in only what an individual can handle. As an individual accept the reality of his or her loss and asking themselves questions, they are beginning the process of healing unknowingly. They become stronger, and the denial begins to fade. However, as they proceed, all the feelings an individual denied begin o surface.

2.2.2. Anger

This can manifest in various ways. Individuals that deals with emotional upsets sometimes can be angry with others and themselves, especially the people who are close to them. Understanding this helps in keeping non-judgemental and detached when experiencing someone’s anger which is very upset. Anger is an essential stage in the process of healing. A traumatised person or an individual who have had a spinal cord injury should be willing to feel their anger, despite the fact that the anger feeling may seem endless. The more they truly feel the anger, the more it will start dissipating and the more they will heal. According to KüBler-Ross & Kessler (2005), there exist other emotions during this stage, and the individual will get to them in time. However, most people are used to managing anger emotion. Moreover, there are no limits to anger, and it can extend to the doctors, friends, individually, the family, to God and to the loved ones who passed away. A person may as whether God exists and why He let everything happen. However, underneath anger is a person’s pain. Moreover, it is natural for a person at this stage to feel abandoned and deserted. However, people live in societies that fear anger. Williams (2007) asserted that anger is strength and can also act as an anchor, providing temporary structure to the loss.

According to Van & Nel (2011), grief, at first, feels like being at a sea and lost with no connection to anything. Then an individual get angry to some people, may be a person who is not around, maybe a person who has not visited him in the hospital, or may be a person who has started acting differently given that the individual is traumatised, immobile or is bedridden. Suddenly, the individual develops a structure that is channelling his or her anger to them. Having anger becomes the bridge that creates the connection from the open sea where the patient with the spinal cord injury is to the other people. It is something that they can hold onto, and the connection created from the strength of anger to them is better than nothing. Human beings understand better how to suppress their anger rather than feeling it. After all, anger feeling is just another indication of a person’s intensity of their lo.............


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