The mind and body work together. Injury to one part of the body affects other parts. Often the mind and body are treated separately for the unification of the whole. Something that happens to the central nervous system, such as a brain injury or spinal cord injury from trauma or disease, affects body functions, including mental wellbeing.
Not everyone will have adaptation issues after a significant health change. There is research about the ‘hardiness’ and ‘resilience’ of individuals. Both have to do with the ability to deal with adverse situations. Hardiness is the ability to look at stressful situations as a challenge. It is a way to take control of the negativity and work toward activities that will help you cope with the new situation. Resilience is a personal coping style where people accept the reality of the situation and learn to live with it.
In rehabilitation, we see individuals who dive right into the rehabilitation process. They want to know all about how their bodies have changed, what can be done to help themselves, and how to set a plan to reach their goal of independence as their new situation evolves. Some individuals will keep up with this mindset as it is the way they cope with change. Others might see a setback in a year or two when they feel they have done everything possible that they can for themselves but do not see a return to their previous function. Still, others dissolve into despair.
Seeking to self soothe themselves, some individuals will turn to addictive behavior. This can include drugs or alcohol but also overeating, sex, spending money, taking unnecessary risks, gambling, and just about any activity that makes them feel better for a few moments, only to be let down when that buzz resolves.
Individuals naturally have a reaction to life-changing diagnoses. However, ongoing and persistent obsessions with challenges affect your mental well-being. Research demonstrates that about half of the individuals with central nervous system injury have mental well-being issues, mostly depression, anxiety, stress, or post-traumatic stress disorder (PTSD). Therefore, having a diagnosis of injury to the central nervous system from disease or trauma is an upsetting concern.
Depression is a feeling of being down mentally. It can also be alternating with extremes in a high mood. It can be from a chemical imbalance in the brain, perhaps due to decreased production of neurotransmitters, including serotonin. Causes of depression have been related to major life changes such as neurological injury, abuse, medications, aging, genetics, or any life-altering change. Chronic conditions and chronic pain are high-risk factors for depression. The grief of the loss of function or lifestyle is another major risk.
Symptoms of depression include:
- Sadness, hopelessness, worry
- Lack of enjoyment
- Irritation or frustration
- Changes in eating habits ranging from eating too much to eating too little
- Difficulty with concentration or memory
- Physical symptoms of headache, stomachache, total body pain
- Thoughts of death
Not everyone with depression has every symptom, and variations in symptom intensity are common.
Some individuals do not recognize depression in themselves as it develops slowly. They may attempt to self-medicate with drugs or alcohol, but these do not treat the underlying issue and can worsen the cycle of depression and addiction. Most depression is treated with antidepressant medication and mental health therapy. Talking with a therapist can assist you with getting to the issue and learning strategies to deal with the situation. In severe cases, brain stimulation therapy can help. Keeping your body healthy by eating a healthy diet, exercising or having your body exercised for you, and getting enough sleep can assist in your recovery and maintenance of mental health.
Anxiety is excessive and ongoing worry about particular situations. This might include symptoms of a rapid heart rate, rapid breathing, sweating, and feeling tired. With neurological conditions, you may not feel these symptoms but may have a sensation of feeling something is wrong in your body without being able to pinpoint it. You may have a feeling of impending doom. These feelings become so strong that your daily activities are interrupted. They may grow in frequency and intensity. There are many sources of anxiety that include feeling trapped or helpless, medical conditions, panic, social, phobias, and even general anxiety disorder. Substance abuse can lead to anxiety disorder.
Treatment for anxiety disorder includes therapy – especially cognitive behavioral therapy. This helps you learn to recognize triggers and symptoms of anxiety before they spiral out of control. It provides strategies for you to deal with anxiety and eventually be able to manage it. Antidepressant medications, anxiety medication and sometimes medication to control your anxiety symptoms are prescribed. You can assist in your recovery by eating healthy, exercising, and getting enough sleep. Stopping smoking, caffeine, and drug use, including alcohol, is helpful as all these substances increase anxiety. Learning relaxation techniques is helpful.
Stress is the body’s response to feeling out of control in a situation. This can be from a situation or an inability to control what is happening in life, particularly when your body functions and lifestyle have changed due to neurological issues. Stress can make you feel frustrated, angry, or nervous. It can come in periodic episodes or be a constant issue in your life.
Symptoms of stress include:
- Depression and/or anxiety
- Aches and pains, muscle tension, jaw clenching, headaches, dizziness, shaking
- Irritability, restlessness, anger
- Feeling unmotivated or overwhelmed
- Sleeping too little or too much
- Racing thoughts, worry, poor memory or concentration
- Making bad decisions
Not everyone will have every symptom, and there are variations in intensity.
Consequences of stress include increasing your risk of high blood pressure, heart attack, stroke, suppression of your immune system and changes in digestion and reproduction. It increases aging. Stress can affect your brain, leading to depression, anxiety and other mental health threats such as panic attacks.
Some individuals will attempt to manage their stress through maladaptive behaviors such as using alcohol or drugs, gambling, overeating, compulsive behavior of shopping, internet usage, sex, or smoking. These activities may give you a moment of stress relief, but they are followed by an increase in stress from these behaviors. A more appropriate way to deal with stress is to discuss your issues with a therapist who can provide strategies for the identification of triggers and coping skills.
You can help yourself by eating healthy, exercising, and getting enough sleep. Attempt to stay positive, learn your capacity for handling activities, say no when things become overwhelming, and keep relationships intact.
Post-traumatic stress syndrome (PTSD) is often thought of as a military issue, which it is. However, if you have had a significant medical issue from injury or disease, PTSD can be a very real issue. Symptoms include nightmares, flashbacks, or unwanted thoughts and memories about the time of crisis, heightened reactions to similar situations or possible situations (such as a visit to a healthcare professional), easily startled, being ‘on guard,’ concentration difficulty, irritability, negative thoughts, anxiety and depression. Self-destructive behavior such as overuse of alcohol, drugs, or irresponsible driving is also an indicator.
PTSD is treated with medications that treat the issue and the symptoms. Combinations of medications may be needed. A mental health therapist may use exposure therapy to gradually expose the individual to the trauma with strategies for learning to control their fear and anxiety. Cognitive restructuring helps individuals make sense of the situation. They may not have a grasp of what happened completely, so understanding the situation can make it less sensitive.
If you do not have a healthcare provider or access to mental health experts, the National Suicide Prevention Lifeline at 800-273-8255 is always an option. They provide assistance in finding a helpful resource in your area. The important point is to get the treatment you need to help heal your mental health as you heal your body.
Mental wellness issues do not appear suddenly, such as a sore throat or flu. The symptoms of mental issues appear very slowly over time, even months. Mental health issues are generally diagnosed after two years of symptoms. Therefore, identification of issues and proper treatment is critical. Early interventions are best. Self-treatment, commonly with drugs and alcohol, delay treatment and even make the situation worse. Talk with your healthcare professional and ask for a mental health screening at each healthcare appointment. These screenings can be completed within your office visit. Tracking your mental health status can lead to early intervention.
Depression, anxiety, stress, and post-traumatic stress disorder occur in children and adolescents. The symptoms are similar to adults, but children may not have the verbal or cognitive awareness to express their thoughts and emotions, not because of their neurological issues but because of the normal developmental processes. Teens might be embarrassed to admit some feelings. Being able to identify your emotions is a higher-level skill.
Children may express thoughts about being alone, hopeless, helpless, or worthless without saying those particular words. Through interruptions in daily activities, play, schoolwork, or relationships, they may express their issues. Sometimes, bedwetting after toilet training can be a symptom. Other issues may include forgetting how to talk, acting out the event during play, or clinging to adults. You may notice changes in your teen, such as becoming more isolated, changes in school accomplishments or changes in personal care habits. As a parent, you know your child’s behavior and behavior change best.
Be sure to include your child’s healthcare professional as well as check your own well-being as a reaction to your child’s health concerns. Family therapy is a good place to start to be able to work as a family unit for everyone’s mental wellbeing.
Linda Schultz is a leader, teacher, and provider of rehabilitation nursing for over 30 years. In fact, Nurse Linda worked closely with Christopher Reeve on his recovery and has been advocating for the Reeve Foundation ever since.
In our community, Nurse Linda is a blogger where she focuses on contributing functional advice, providing the “how-to” on integrating various healthcare improvements into daily life, and answering your specific questions. Read her blogs here.
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