Death and Loss

A disability is a major physical and emotional stressor. It may shorten our lives. It often increases our potential for medical crisis that may be life threatening. It forces us to deal with the issue of loss. Not just the loss of "health", but of loss of ability. As the word implies, we have a disability. We are unable to do certain things that other people are able to do or perhaps that we were able to do at one time. Managing our disability means that we have to deal with the losses that we have sustained. To deal with these losses we have to acknowledge their existence and communicate about them. If our disability was created by an accident then we may need to deal with the trauma, or that we survived and someone did not.

A young woman named Marie was referred by her attorney. She had been involved in a car accident as a passenger. A close friend of hers had been killed. She received minor injuries and although she was confused and had little memory of the accident she was released from the hospital emergency room. No one told her that her friend had died until the next morning. The physician who made the death notification was very blunt and brief in his presentation of the bad news and did not give my client an opportunity to ask questions or to express the shock and outrage that she felt.

At the time of the accident my client had been planning a large wedding. Her fiancee and friends were very much caught up in this process and encouraged her not to talk about the friend who had died and to focus her attention on preparations for the wedding. The client's fiancee who had grown up in a dysfunctional family was very good at shutting out things and encouraged the client not to talk but to simply "put it out of (her) mind". She was unable to do this and had a miserable wedding and honeymoon. When she returned home, she found herself having great difficulty riding as a passenger in a car or returning to her workplace where she and her friend had been employed. At her work her boss also discouraged her from talking about the accident with others. A new woman had been hired to replace her friend at work and the boss' attitude was "out of sight, out of mind". When the client finally came in to see me she was not sleeping, was continually irritable and unpleasant at work and at home, and was experiencing a number of flashbacks when watching violence on television or when trying to prepare meat for a meal.

My first challenge, when I saw Marie, was to convince her through my actions that I could help her deal with the accident. Initially I taught her stress management exercises that she could begin to use at work and at home to relax. Her homework assignment was to learn more about the accident by asking questions and to force other people to talk with her about the accident. A number of months had now passed and others had dismissed the accident as over. My client clearly had not. As she began to talk with others about the details of the accident, much of her memory of the accident came back. She spent many days being upset, crying and going through the grieving process that should have occurred soon after the accident, but was delayed because of her failure to attend her friend's funeral, her focus on the wedding and her friends' emphasis on her "being happy". Their well-intentioned, but misdirected advise to simply put the accident out of her head had not worked.

Within a few weeks, Marie was beginning to relax more and talk more with others. She was feeling less angry, less depressed and in many ways, was "back to her old self". She had not forgotten the accident or her good friend who died in the accident, but she had learned a way of coping with this unexpected change in her life. This crisis also changed her relationship with her husband. Marie became clear with her husband, that if the two were going to be together for the next fifty years they needed to be able to talk about the bad as well as the good in life. This forced her husband to deal with some issues related to his father's alcoholism that he had never resolved. As a celebration of their first wedding anniversary, the couple took their wedding vows a second time, and, in many ways, had the wedding and honeymoon that they had missed the first time around.

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