Care Guides for Survivors

Mentally and Emotionally Adjusting to Stroke

Post on 03/07/16

Adapting mentally and emotionally to a stroke is not easy. You and your family members may have reacted to the situation in different ways.

Shock, fear, and depression are not uncommon. But together, these hurdles can be overcome.

Initial shock

Patients who were once independent, are now disabled. They were once well, but are now ill. As stroke usually occurs suddenly, the unexpected experience of numbness, weakness, immobility or inability to move and inability to speak comes as a shock to the patients as well as family members. Questions like “Why me?” and “What is happening?” will commonly be asked. This should be seen as a normal reaction to a major illness.

Fear of the unknown

The future may seem uncertain after a stroke; recovery is not immediate and may not be complete. Patient and family members are often fearful of the short-term and long-term outlook and the effects on their lifestyles.

They need help and understanding, and learn how to plan realistically for the future. This will help them overcome the various hurdles along the way.

Denial

The reality of stroke is harsh. It may be difficult to absorb the full impact of the diagnosis. The patient may deny what has happened. He thus needs time to come to terms with his illness, and to reconnect with reality.

He should be encouraged to get in touch with the many mixed feelings involved. He should not be seen as trying to escape from reality.

Anger

Anger is a natural and predictable reaction to loss and an attempt to overcome it. It is a result of partially accepting the fact about the onset of a severe illness, the loss of functional ability, and the loss of significant roles. It may be displayed and randomly projected into the environment, e.g. the patient may project his anger at family members, doctors, nurses, and related health care workers by refusing to eat, becoming non-compliant with treatment, complaining about the services provided, defaecating and urinating inappropriately. It is also not uncommon for stroke patients to exhibit violent behaviour as a result of neurological deficits.

Therefore, it is important that we deal with anger consciously and try to understand the emotive reaction and cause of it. If it is not properly addressed and handled, it may result in chronic anger. When the patient is unable to express anger at anyone, it might be turned inward towards himself.

Stress and anxiety

Fear and anger about the stroke condition increase the patient’s emotional stress and raise his level of anxiety. This can cause a wide range of physical symptoms e.g. faster heart rate, increased blood pressure, headaches, muscle pains, loss of appetite, etc.

Depression

It is not uncommon for the patient to feel depressed and unhappy after a stroke. He mourns and grieves over what he has lost. He becomes rather reserved, withdrawn, moody, teary, quick tempered or may even appear unreasonable. There are some stroke patients who cry easily due to emotional instability. This is a normal psychological reaction to a sudden severe illness. These are calls for help, and he would need support through this difficult phase. Fortunately, emotional control usually returns.

Bargaining phase

Walking, dressing, feeding, toileting, turning are simple activities we all take for granted; but these become major challenges for a stroke patient.

In order to regain what has been lost, he may bargain with healthcare providers and family members over his treatment and rehabilitation plans, hoping that he has not lost too much.

Acceptance

Hand Plant (small)Finally, after the patient has worked through the various feelings involved, he will come to terms with the illness, and begin to cope. The intensity of the reaction depends on the personality of the patient.

While many stroke patients are troubled by the feeling that they have lost control of their lives and that their future suddenly becomes uncertain, there are others who improve their sense of control by learning as much as they can about stroke and its treatment. This is what self-management is all about. The more you know about what to expect, the less uncertain and helpless you will feel. You feel better able to make decisions about your treatment plans and feel more comfortable discussing your condition with health care providers. Doctors, nurses and other health care providers can give a lot of valuable information on stroke and how to manage it.

Returning to Work

Many stroke patients are anxious to get back to work. In addition to income, jobs provide a sense of returning to normal life and are important for building up self-esteem. It is not impossible for a patient with mild stroke to return to work. Adjustment of job duties may be necessary. Or, he may want to undergo rehabilitation and skills re-training to prepare himself for another occupation that is more suitable for you.

Setting Goals

Goal (small)

Setting goals gives you something to strive for. Goals give you a sense of control and make you focus on what you want to achieve. Make plans for the future, for tomorrow, for next week, for next year. Look beyond your treatment to what you want to do when you are well again.

The best way to recover from stroke is through the support and care by the people closest to the stroke patient, working together to improve every ability that remains. Remember, you don’t have to face your problems all by yourself. Self-management does not mean going it alone. Attending formal or informal support meetings can also be helpful.

How to Help as a Family Member

As a family member, you can work together with the patient through the following ways:

Give emotional support

During the crucial period of recovery, the family will need to give as much support as possible to the patient. Assure him that the concern and love, which the family has always had for him, will continue. This should be communicated both in words and actions.

Be a good listener

As the stroke patient could have lost the ability to speak or may not be used to expressing his feelings clearly, the family will need to lend an active listening ear and to grieve together with him in order to help him find new meaning in life.

Be firm at times

In an effort to show love and care, the family may accidentally slow down the patient’s recovery. Doing everything for the patient may slow down his adjustment and learning of new skills. The patient will need to learn to be as independent as possible. The family may thus need to be gentle but firm.

Be a link

Restriction of social activities and changes in lifestyle could be frustrating for the stroke patient. Accompany a stroke patient on outings and to the shops; he will find that he can learn and finally manage these activities and reorganise himself after all.

Participating with the stroke patient in relevant activities will help him regain confidence in meeting other people, even strangers. It is important now that he returns to as many of his social and leisure activities as possible. If he stopped work after the stroke, he may need to learn new skills and new hobbies.

With determination and help from family members and other important people in their lives, stroke patients should find a range of social activities that will make it worth getting up each morning. Consult an Occupational Therapist who can give advice on how to help the stroke patient engage in meaningful activities to promote his well-being and maximise his quality of life.

Summary

  • Adjusting to a stroke is not easy
  • You and your family member may have reacted with shock, fear, denial, anger, stress, anxiety, depression, bargaining and finally acceptance •
  • Learning as much as you can about stroke and its treatment will help you regain control and manage your illness well
  • As a family member, you can help the patient by giving emotional support, being a good listener, being gentle yet firm and being the patient’s link to the outside world

 

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