In my series on grief that occurs after acquiring a disability, I have talked about denial, anger, and bargaining. These stages all include ways to try to avoid a disability, as it is difficult to accept a new disability as permanent. The first three stages of grief give the brain time to slowly come to the reality that paralysis may be permanent. There is nothing wrong with delaying such a harsh reality. Based on my years of experience as a social worker in rehabilitation and my history, I have found that these stages give us time to acclimate to our new circumstances.

Often the next stage of grief is depression, which can last from a few weeks to years. There are several types of depression, including situational depression. You will know if your situational depression has become more permanent (also known as Major Depression) if you experience five or more of the below symptoms for longer than two weeks, according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders of the DSM 5. If you do, I recommend you go see your physician or mental health professional.

• Depressed mood: For children and adolescents, this can also be an irritable mood
• Diminished interest or loss of pleasure in almost all activities (anhedonia)
• Significant weight change or appetite disturbance
• Sleep disturbance (insomnia or hypersomnia)
• Psychomotor agitation or retardation
• Fatigue or loss of energy
• Feelings of worthlessness
• Diminished ability to think or concentrate; indecisiveness
• Recurrent thought of death, recurrent suicidal ideations without a specific plan, or a suicidal attempt or specific plan for committing suicide

Seeking professional assistance for depression is no cause for shame – we all need help at some point in our lives. Many people who become disabled will seek support through professional counseling in addition to medication.

And sometimes, it can help to learn from the stories of others and how they got through things.

My Stage of Depression

I wasn’t able to fully accept that I would never walk again. Within the first weeks or months of the shooting, I felt waves of depression from the moment I knew I couldn't feel my legs, all the way through rehab, after returning home and for years after the shooting. I relied heavily on the love and support of my friends and family after becoming paralyzed.

I was nineteen years old and not sure who I was or what my place was in the world. To become paralyzed during that already fragile time in my life was terrifying. My biggest fear was that I would end up alone, never getting married or having children. These thoughts seem ridiculous to me now, but at the time, they were real, and they led me to contemplate taking my own life.

I confided in my best friend about these real, serious thoughts I was having. Worried about my well-being, she called my parents and they promptly checked me in for in-patient psychiatric care. I spent a few weeks there coming to grips with the fact that I would likely be paralyzed for the rest of my life. During this time, I also was able to open up about my fears, of not finding a person that would accept me with paralysis. I also listened to the issues other people were struggling with and it really put my problems into perspective. I realized that not being able to walk was not the worst thing that could happen to a person. I continued to see a counselor for a few years anytime I felt the weight of living with a disability was too much.

Barb Zablotney’s Stage of Depression

Barb Zablotney is a dear friend of mine and Ms. Wheelchair Pennsylvania 2018. She was in a car accident in 2007, which left her with a T10 incomplete spinal cord injury. Before becoming paralyzed, Barb was struggling with depression and was in therapy and taking antidepressants, so this traumatic event certainly added to it.

Barb was progressing reasonably well with her outpatient therapy and learning how to care for her body when she was hit with another terrible loss – her mother passed away very unexpectedly, almost exactly one year from the day she was paralyzed. Losing her Mother increased her depression exponentially and prolonged its duration.

While Barb has an incredibly supportive family and helpful resources, she still struggled with depression and turned to an unhealthy habit. For approximately ten years, she ate her feelings and let her addiction to sugar consume her. Barb reports that she gained close to 100 pounds and was feeling trapped in her body because of her weight, which also led to other health issues, like bowel and bladder incontinence.

Bowel and bladder issues, are topics people with disabilities don't like to admit and, therefore, often don't seek help. Incontinence will keep a person with a disability from going out in public for social reasons, for fear of having a bowel or bladder accident.

Due to Barb’s constant bladder incontinence, she looked into having the Mitrofanoff procedure that would solve her issue. However, the doctor said she would have to lose weight to be eligible for the surgery. This motivated her to get a dietician, personal trainer, and after years of hard work, she lost 100 pounds. After she lost weight, she decided that the Mitrofanoff surgery was not right for her, but she started to use a Foley catheter, which solved her problems with constant urinary incontinence. The Foley gave Barb the freedom to go out with friends and family in public places. Barb no longer felt "trapped in her body." She could go out and begin to rebuild her life.  These physical changes were the beginning of the end of her severe depression.

Once she tackled her physical challenges, Barb next sought to make some changes to how she approached life and dealing with her depression. December had always been a trigger for Barb's depression because it is the month when her accident occurred and her mother passed away. Rather than dwell on it, she decided to start volunteering with her local police station, passing out gifts to children. She found that staying busy helped keep her from ruminating on her losses. Barb does this volunteer work every December, which helps to get her through a traditionally depressing month.

She also heard joined the Ms. Wheelchair America community by running for Ms. Wheelchair Pennsylvania. Meeting other women who were wheelchair users has helped Barb with her intermittent depression. Participating provided her with a community, and the advocacy work gives her a sense of purpose that is so important in keeping depression at bay.

Today Barb is on the board of multiple non-profit organizations that help people with disabilities. She is a leader in the disabled community, a mentor, and a friend.

If you would like to follow Barb on social media, you can find her on Instagram, Facebook, and YouTube. 
 
What I’ve Learned

In hearing the stories of many people who are disabled and have dealt with depression over the year, I find there are three things that help the more than others:

1. Seek professional help. If you have been having symptoms for a prolonged period, you should seek help. If you don't know where to find resources for mental health, your primary care physician is an excellent place to start.
2. Take care of yourself. Proper nutrition and exercise are essential for both your physical and mental health.
3. Be an Advocate. Find an organization that you are passionate about and give some of your time, talent, or resources. You will help someone else, and you will help yourself at the same time.

There also are online support groups, and you can always find a word of encouragement from someone going through a similar situation. The names of the groups on Facebook are Spinal Cord Peer Support USA, Spinal Cord Injury USA Group, and Wheel Mommies, to name a few.