By Alberto M. Goldwaser, MD
Many recognize the physical pain after an accident or injury, yet few realize that what goes on in the mind can be just as-if not more-devastating.
A car crash. A mishap at work. A fall. The physical wounds are often clear: a bad back, a sore neck… But there is more. There is a mental component. If this is addressed effectively, people tend to heal both mentally and physically.
I liken this to Humpty Dumpty. He sat on a wall, had a great fall and no one could put him together again.
This often sudden, unexpected assault of one's sense of integrity and continuity can interrupt the sense of well being. Posttraumatic Stress Disorder is seldom recognized, but is almost always concurrent with personal injury. Patients often undergo test after test and take medications that do not improve their condition. These people sometimes have surgery that does not heal their pain. Eventually, many with Posttraumatic Stress Disorder, or PTSD, start feeling neglected because doctors, even attorneys-do not know what to do with them.
By understanding the full dimension of a client's trauma, psychological as well as physical, an attorney can address the legal factor well armed. PTSD broadens the range of vision of what is damaged.
Depressive and anxiety symptoms are part of PTSD. The accident triggers a cycle and often people's minds become totally immersed in their mishaps and pain. There is no more order to life. People become moody, grouchy, dependent, scared, disoriented.
Not all people who experience trauma need treatment. With the help of family and friends, many find they can move on and get better. Others, however, need professional help to recover and move in a positive direction. It is not the severity of the accident that determines whether one develops PTSD; rather, it is the meaning the person attaches to the experience. It is impossible to determine who will absorb the psychological effects of trauma and move on with their lives.
Many PTSD patients have difficulty talking about their trauma, which makes it hard to detect. Sufferers also have repeated episodes in which they re-experience the traumatic event. They might have trouble concentrating because of this. They lose interest in activities and become socially withdrawn. Often, people with PTSD avoid daily situations that remind them of the accident. Irritability, sleep disturbances and restlessness are also part of the disorder.
Attorneys refer their clients to neurologists and orthopedists. Rarely do we see the referral for a psychiatric consultation and treatment, if indicated. Despite the severity of this condition, it is treatable. The results are better if these symptoms are approached early on by the psychiatric experts.
The goal is to help the patient recover to a premorbid level of functioning, by working through the trauma and pain, to resolve the resulting grief.
Psychotherapy focuses on helping patients to examine their particular style of dealing with stressful situations and how the present traumatic event violated it. We also work to build self-esteem and self-control, to develop accountability, integrity and pride. As well, medication may be needed to help control and alleviate symptoms. The treatment aims at assisting the patient to find new and adaptive solutions to the affliction.
There is a colossal challenge to these patients' physicians, relatives and coworkers to understand the chronic-neuropathic-pain, for example in the wake of a spinal cord injury. It should be relieved to help the patient go through the healing process.
The huge difference between the intensity of the pain felt, a symptom — and, for example a disfigurement or visible bleeding, a sign-often widens the distance between the pain sufferer and the observer. If the pain is intense, it elicits fear; if prolonged, depression; if both, the patient may lose the will to live.
