The scene of a traffic accident on Road 31 near Arad.
(photo credit: MAGEN DAVID ADOM)
23,133 people were injured and 355 lost their lives in 12,661 car accidents in Israel over the past year. This is our life here. Not a single day passes without an accident in the news. It’s almost hard to imagine a person living here who is not exposed to this reality. These statistics are dreadful and alarming, and they have only one meaning: the likelihood of witnessing or being involved in a traffic accident is very high.
Such thoughts can be very troubling. For some of us they are reason enough to avoid driving, or even stay at home. Still the great majority manage to function: we drive, we cross streets, we buy cars, we ride motorcycles.
How do we do it? Through emotional defense mechanisms that help us remove fear and anxiety from our consciousness, placing knowledge of car accidents under a psychological configuration easily classified as “it won’t happen to me.” This mechanism is so essential for normal functioning that it becomes an integral part of who we are.
Behind the dry figures of car accident casualties, there are thousands of injured individuals faced with physical, conceptual and emotional experiences for which they are totally unprepared. The accident and its ramifications present us with loss processes that threaten our self-identity. The accident is that point in time at which the “it won’t happen to me” approach gets a knockout punch from reality, completely shaking the sense of continuity essential to our functioning.
The emotional blow is huge, regardless of the injury’s severity. What is the meaning of a so-called “light” injury? Take for example the “lightly injured” woman in her thirties who came to me for help. While standing in a traffic holdup, her car was hit from behind at almost zero speed. Her only injury was whiplash. At home she began to feel sick: dizziness, vomiting, balance loss and speech difficulties. CT imaging in the hospital found no damage, and her problem was diagnosed as a post-concussion syndrome. Supposedly, nothing too alarming. But this patient was unable to go back to work. For many months she couldn’t read, or get up from a chair without feeling extremely dizzy. It took a very long time before she could express herself fluently, without words just “disappearing” from her mouth.
The emotional meaning of loss is not limited to the death of a loved one. We may experience loss when faced with change – any kind of change to the way we are used to living our lives. An experience of loss resulting from a traffic accident involves physical, cognitive, emotional and behavioral elements. The injured person cannot identify himself in the hurting, damaged body – undergoing surgery, wrapped in bandages and plaster. He cannot recognize his thoughts, wandering back to the accident over and over again, to its smells, sounds and sights. He is unable to feel hope, calm his anxieties, or understand his own emotions.
The personal experience is so overwhelming that the patient finds himself feeling he is no longer himself – and now he must find the motivation for physiotherapy sessions, for exercising fine motor skills in occupational therapy, for relearning how to pronounce nouns and vowels (in case of a brain injury) in speech therapy. And he simply does not know where to find this motivation.
Often patients find it hard to adapt to the idea that one brief moment has so drastically deflected their life from its normal path, and now, just to get back on track, they must work hard for many months, and even then nothing is guaranteed.
Many patients who have suffered physical injury and must undergo rehabilitation find themselves contending with weighty questions: “Who am I now? What is the meaning of my injury? Will I ever be the same person again? Will I be able to do the things I used to do? And if not, what is the meaning of my life now?” One of my patients was a young man whose legs had been broken in a hit-and-run collision with an electric bicycle. Theoretically, he should have been able to regain his normal functions in a few months, but he also had an eating disorder: he kept reducing the quantities of food he consumed. In other words, he was anorexic. This patient was intelligent, articulate, introverted and shy. His eating habits slowed down the healing of his bones, holding back the rehabilitation process. A year-and-a-half after the accident he was still walking with the aid of crutches. He tried to cope with the growing awareness that he might never walk like he had before, and that the consequences of his eating disorder had exceeded anything he had foreseen. He also developed severe anxiety and a fear of bicycles, and found it difficult to leave his home.
Alongside these stories, about patients with “light” injuries, I see many others who were severely injured.
For them, the process of physical and psychological rehabilitation is even more complex.
This is where the importance of emotional therapy, as an integral part of the rehabilitation process, becomes clearer than ever. Rehabilitation psychology deals with providing emotional support to patients also coping with orthopedic and neurological rehabilitation processes following car accidents, via a range of therapeutic methods and techniques.
Some patients need a protected, professional, neutral space, in which they can unburden their stress and convey their fear of an uncertain future, mourn the past and express frustration about the present. Others need systematic intervention, relating to their relationship with staff and family, in order to harness all emotional resources required for the rehabilitation process. Still others need focused support in dealing with the anxieties aroused by the accident – anxieties that had been repressed before the event, but now attack their consciousness, disturb their sleep and disrupt their functioning. These patients may benefit from various cognitive behavioral therapies, focusing on the connections between thoughts, emotions, feelings and behaviors, and helping the patient gain control of his self-conduct and self-management.
The author is head of Rehabilitation Psychology at Reuth Medical and Rehabilitation Center, Tel Aviv. He is a rehabilitation neuropsychologist, expert in head injuries, orthopedic injuries, pain disorders and eating disorders, with a master’s in neuropsychology from the Tel Aviv-Yaffo Academic College.