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The effects of injury and disease and their consequences affect different people in different ways. Many people with paralysis are affected from childhood, while others acquire their loss of movement later in life. The manner in which these two groups adapt to their circumstances is likely to differ, although the challenges faced may be similar.

For those who become paralysed as adults, how they deal with the impact of the probable major life change it will bring will vary from person to person. Everyone has their own individual experience of life and personal beliefs that contribute to their personality. Personality has a bearing on how stressful the paralysis is for a person and how well they cope with it. Many other factors also come into play, such as how old they are when the paralysis occurs and whether it happened suddenly against a background of previous good health or slowly as part of a progressive disease. In some situations the paralysis is expected to be temporary, while in others the weakness is likely to be permanent or may get gradually worse. The person’s response will also depend on the nature of the underlying condition or cause of the paralysis and any associated symptoms or disabilities.

Social and environmental factors are a further major influence on how people adjust to disability. The reactions of family, friends, health and welfare professionals, employers, workmates and others can clearly prove helpful or counter-productive. Similarly the physical setting of home, work and leisure activities may help or hinder.

Coming to terms with paralysis
While doctors and psychologists recognise that many people’s response to  becoming disabled often follows one of a number of common patterns, and while they can talk about good and bad ways to cope, no one can predict precisely how a given individual will cope or tell them how to do so. Most people do come to terms with their paralysis and get on with life.

When paralysis occurs suddenly, as after a serious injury, many people experience different stages of emotional response or psychological adjustment. The response may be similar to the grief reaction when someone close to us dies -the initial shock of realising what has happened may be followed by confusion, disbelief or even occasionally denial that paralysis exists. These emotions may be accompanied by disturbed sleep, loss of appetite, indigestion, lightheadedness and the inability to concentrate or show interest in other events. There may be sudden outbursts of intense sadness or weeping, or a more prolonged depression and yearning for how things were, which is akin to mourning. Not infrequently there is a phase of anger. This is often directed at those people closest to the person, such as the spouse or parents. It may appear as hostility to professionals. In those who hold strong religious convictions it may even extend to God. Some people also experience feelings of guilt or shame.

It is important to recognise that these types of behaviour may be completely out of character for the individual. They can affect even the toughest and most stoical of people. Usually they are relatively short-lived and many people show few or none of these reactions. It is neither a good nor a bad thing that someone goes through these stages, but if they are excessive or long lasting, professional advice from a psychiatrist or psychologist may help. Persistent mood change and loss of interest in self, family and friends, for instance, may indicate a depressive illness that may respond to specific treatment.

Even when someone appears to cope with the initial realisation of the nature of their loss of movement, they may experience emotional reactions to using a wheelchair, their first days at home after being in hospital or their first exposure to the public when out shopping.

Faced with major stress some people will resort to excessive use of alcohol, tobacco, or drugs; contemplate or attempt suicide or become melodramatic or aggressive. These negative ways of dealing with the situation are called maladaptive coping mechanisms.

By contrast, adaptive coping mechanisms describe the way some people are able to take stock of their situation, accept or come to terms with their disability and find a way forward to work things through. While it may appear rather glib or obvious to say so, those people who take this approach tend to get more fulfilment out of life. Their emphasis is on what they can do rather than what they can’t.

It is not clear whether coping skills can be taught, but guidance from health and welfare professionals and from non-professionals may help. It is increasingly recognised that the person with a disability who is able to control their own future by setting their own targets and getting on with achieving them is most successful in terms of adjusting to their disability and achieving personal happiness. It is important that the person with paralysis is empowered to take an active role in solving problems and controlling their own future rather than becoming merely a passive recipient of assistance.

Counselling provides valuable support that relies on the full co-operation of the paralysed person. The person can tell the counsellor about the problems and frustrations they have encountered and the counsellor can then help them to formulate a plan to deal with the problems. Counsellors are able to do this by drawing on their training and their knowledge and experience of how other people have coped. They are also in a position to make an independent assessment of progress. Training in self-assertiveness can also help the person get what they need in many areas of life.