Life on Wheels (11 page)

Depression and suicidal feelings are common during acute rehab— although not everyone experiences them. The staff is trained to recognize behavioral signs of these feelings. Depression and suicidal feelings are treatable and generally temporary.

The overall work of rehabilitation depends on commitment—an attitude that promotes full participation and cooperation with the process. In these times of relatively short rehab stays, it is especially important that you not be unnecessarily limited by manageable emotional burdens. The psychologist helps you sort out what drives your behavior in ways that limit you, cause you unhappiness, or compromise the potential you can reach in the rehab process. Types of behavior that could interfere with your ability to gain from rehab include:

Passive-aggressive behavior, in which one is indifferent to the value of what is being offered and places responsibility on others’ shoulders

Extreme dependency, in which one fails to participate proactively and surrenders the opportunity to feel personal accomplishment

Severe antisocial behavior, in which one possibly represents a danger to self or others

Rehab doctors and therapists know they must adapt their approach to each person according to how that person is coping. Says Dr. Michael Scott:

The fact that someone is depressed or angry while in rehab does not mean he will fail to adapt to disability. Saunders Dorsey was a young attorney in Detroit when an angry client attacked the office with a rifle. Saunders jumped out of the third-story window and became spinalcord injured:

Dorsey has since returned to a thriving law practice, established a successful accessible transportation company after seeing the flaws in the services he was receiving, and is living in a comfortable home with his wife and children.

Violently acquired spinal cord injury (VASCI) has been on the rise since the 1990s. The vast majority involve firearms. The incidence, understandably, is higher in urban areas. Automobile crashes remain the number one cause of traumatic spinal cord injury. Violence has been moving into and out of the number two spot in recent years, trading places with falls. The incidence has been growing; between 1973 and 1977, violence accounted for approximately 14% of all spinal cord injuries. Data from the National Spinal Cord Injury Statistical Center (1994) indicate that during the 1973–1978 time period, violence accounted for 13% of new spinal cord cases. By 1994, this figure had increased to 30%, and ethnic minorities accounted for 72% of this group. The greater emphasis is on African American and Latino men.

Statistically, victims of VASCI tend to have fewer financial resources, so VASCI places more demands on the resources and dollars in the system in the form of emergency medical services, rehabilitation, home modification, and so on. They also tend to draw family members away from work— and preciously needed income.

A unique set of issues arise in the context of VASCI. Features unique to people with VASCI include early anger at being a victim and the impulse for revenge, a “macho” type of personality that tends to resist participation in rehabilitation (especially when small white women therapists attempt to direct them), and the challenges of returning to the very environment where they were at risk in the first place.

The Disabling Bullet Project is a program out of the University of Illinois in association with Schwab Rehabilitation Hospital in Chicago, the National Rehabilitation Hospital in Washington DC, and Oak Forest Hospital in Cook County, Illinois, where there are notable populations of patients with VASCI. The Project aids these young men in the process of reintegration into their community through a peer-mentoring strategy. They get the benefits of the experience of other young men who have made the transition back into the community—and achieved a better quality of life. Mentors go through a rigorous training process that starts by taking the young men through their own initial experience with VASCI and reviews topics, including disability awareness and etiquette, the various emotional stages one might go through as they adjust, dynamics particular to their particular minority status, and how to establish an optimal peer-mentor relationship based on trust and strong communication.

The rehabilitation period is recognized as an important time for psychological support. Psychotherapists are typically included on the rehab team. Many rehab clients have the opportunity to spend time with a therapist as part of their daily schedule, where they are free to ask questions and explore their feelings confidentially.

Many people who find themselves in rehab will never before have met with a therapist. Those persons might feel as if therapy is being forced on them and is an invasion of privacy. Psychologists expect that some people will be unwilling to participate at first and will have negative ideas about the psychotherapeutic process.

Meeting with a psychologist means revealing intimate facts and exploring deep and often troubling emotions. Although the process can seem threatening at first, the therapist’s job is to be an ally—not a friend, because this is not a personal relationship—who listens openly and explains what he or she has to offer. Psychotherapists can affirm the validity of what you are going through and help you begin adapting.

Jeri Morris, PhD, of the Department of Rehabilitation at Northwestern University Medical School in Chicago, writes:

Thinking about longterm effects can be especially hard for people with progressive conditions, such as MS or ALS. People with MS fight hard to maintain their health. One of the most difficult moments is when it is time to begin using a wheelchair, as explained by Cynthia Bishop:

Generally speaking, it’s not something that people receive warmly. We have to continue the process over several visits. We have to gently bring them to the point where they say, “Okay, I’d like to do that, I think it might be a good idea.”

Most rehab centers emphasize education, offering programs on an array of topics to enhance your sense of control and sense of self. Dr. Michael Scott describes the offerings at Rancho Los Amigos:

The confidential relationship with the psychotherapist is an opportunity to safely discuss this crucial topic. You might be hesitant to bring up questions as personal as what kind of sex life you might be able to look forward to. Dr. Michael Scott describes his approach to helping people ask about sex:

The priority of sexuality to the person depends on many factors, including the type of disability, age, and sexual experience. Dr. Ed Nieshoff of the Rehabilitation Institute of Michigan, himself a chair user with quadriplegia, talks about younger men with a spinal cord disability:

Much of the information offered in rehab is about male sexuality. Since women with disabilities are generally not prevented from having children, the emphasis often falls on male fertility. And since maintaining erection is an issue only for men, this also tends to weigh the discussion in their direction. There is a lot of information about penile implants or injections, and harvesting sperm is now possible.

Yet women also face questions regarding vaginal lubrication, positions, bladder control, and how to attract men in a culture that doesn’t encourage women to be the pursuer. Women need to hear about birth control, pregnancy, and gynecological care. Margaret Nosek of the Baylor College of Medicine Center for Women and Disabilities has been researching sexuality in women with disabilities, and says: