Elizabeth Kubler-Ross’s model of the five stages of grief, written in her book On Death and Dying—denial, anger, bargaining, depression, and acceptance—is often applied to various types of loss, including the loss of health due to brain injury.
For someone with a brain injury, the experience of these stages can vary widely. Some individuals might experience depression while others may not. The presence or absence of depression can be achieved by various factors, including the degree of the injury, individual coping, and pre-existing mental conditions.
It’s also worth acknowledging that brain injuries can affect cognitive and emotional functioning, which might impact how a person processes their experience of loss and grief.
For example, a person with a brain injury might have difficulty recognizing or articulating feelings of depression, or they might express their emotions in ways that don’t align with the traditional stages described by Kubler-Ross.
More recently, Megan Devine, the author of “Everything is Not Okay,” and a contributor to the Huffington Post, wrote “The 5 Stages of Grief and Other Lies That Don’t Help Anyone” in December 2013.
In her article, Devine goes on to say, “Elisabeth Kubler-Ross wrote that she regretted writing the stages the way that she did, that people mistook them as being both linear and universal. Based on what she observed while working with patients given terminal diagnoses, Ross identified five common experiences, not five required experiences.”
Let me get to the point: Does brain injury always mean the stage of depression? Can we skip over that one?
We are constantly evolving, from one day to the next. Grief has its own timeline. The stages don’t go in order either. I still, fifteen years later after the stroke, have not accepted my condition for any significant length of time. The shortest stage for me was bargaining because I already had the stroke. The longest stages for me were anger and depression.
While it may not be entirely possible to “skip” depression after a brain injury, there are many ways to reduce the risk and manage early symptoms. A combination of early intervention, therapy, social support, and healthy lifestyle practices can significantly lower the chances of depression or mitigate its impact, leading to a more positive recovery process.
In brain-injured individuals, depression can be both a direct a cause of worsened outcomes if left untreated and/or a consequence of the brain injury—due to biological and emotional factors—and recognizing and treating depression early in the recovery process is crucial to improving both mental and physical outcomes.
The law of cause and effect states that:
Every consequence has a specific and predictable cause.
Every cause or action has a specific and predictable consequence.
So depression can be a cause of worsened recovery and outcomes after a brain injury, creating a vicious cycle where depression negatively impacts the healing process.
Recovery almost or entirely stops:
- Depression can lower motivation and energy levels, making it difficult to engage in rehabilitation and therapy. This can slow down recovery or make it less effective.
- Depression can impair cognitive functions such as concentration, memory, and problem-solving, making it harder to recover cognitive skills lost after the injury.
- Individuals with depression may struggle with basic self-care tasks, such as eating properly, exercising, or even brushing their teeth.
Chronic Conditions:
- Depression can increase the likelihood of long-term disability by reducing participation in physical therapy, occupational therapy, and other recovery activities. When left untreated, depression may lead to a prolonged disability and lower qualities of life.
Depression as a consequence of brain injury is also there. After a brain injury, depression often develops as a direct consequence of the injury itself, due to a combination of biological, psychological, and environmental factors.
Biological:
- Brain injuries can affect regions responsible for mood regulation, such as the frontal lobe, limbic system, or neurotransmitter pathways (serotonin, dopamine). This disruption can directly lead to mood disturbances and depression.
- Brain injuries can disrupt the balance of chemicals in the brain, such as serotonin and dopamine, which play a critical role in regulating mood.
Psychological:
- Brain injury survivors often struggle with cognitive impairments (memory, attention, problem-solving), which can lead to frustration, stress, and a sense of loss. The difficulty in performing everyday tasks can lead to feelings of inadequacy and contribute to depression.
- Many individuals face significant changes in their ability to function independently after a brain injury. This loss of independence or role reversal (e.g., needing to be cared for) can lead to feelings of helplessness, grief, and depression.
- Brain injuries can result in social and communication difficulties, causing people to withdraw from relationships, activities, and social interactions. This isolation increases the risk of depression.
- Individuals may struggle with changes in self-identity due to cognitive and physical changes. The inability to perform tasks or hobbies they once enjoyed can lead to sadness, anger, or hopelessness.
Environmental:
- The sudden, life-altering nature of a brain injury can lead to major adjustments in work, relationships, and daily activities, all of which can contribute to depression.
- Long-term medical care, rehabilitation, and job loss due to brain injury can add financial stress, further compounding the emotional toll and increasing the likelihood of depression.
Brain injury and depression often interact in a cyclical manner, where depression not only arises as a consequence of brain injury but also worsens the effects of the injury.
- The cognitive and physical limitations caused by the brain injury can lead to emotional stress, triggering depression.
- Once depression develops, it can hinder the individual’s ability to cope with the injury, further reducing their ability to function and recover.
Avoiding or managing depression after a brain injury requires a positive approach that addresses both physical and emotional well-being. While it may not always be possible to prevent depression completely, there are strategies that can help reduce the risk and manage depressive symptoms if they come about.
Mental Well-Being:
- It’s critical to work with medical professionals (neurologists, psychiatrists, therapists) to assess your mental health after a brain injury. Early detection and treatment of mood changes can prevent depression from worsening.
- Antidepressants may be prescribed to help regulate mood. If depression develops, medications should be carefully managed by a doctor, especially considering potential interactions with treatments for the brain injury.
- Cognitive-Behavioral Therapy (CBT) can be very effective in helping brain injury survivors manage depression. This therapy helps challenge negative thought patterns and develop healthy coping mechanisms.
- Regular sessions with a mental health professional can help process emotions, fears, and frustrations that arise from the injury and its consequences.
Strong Support Network:
- Maintaining close relationships with family, friends, and support groups is crucial. Isolation can exacerbate feelings of sadness or hopelessness.
- Joining brain injury support groups can provide a sense of community and shared experience. Talking to others who understand what you’re going through can be very comforting and reduce feelings of loneliness.
- Be open with loved ones about your emotions. Let them know if you’re struggling with depression or mood changes so they can support you.
Carry on with Physical Activity:
- Regular physical activity is known to improve mood, reduce stress, and combat symptoms of depression. Depending on the severity of the injury, even gentle exercises like walking, swimming, or yoga can help release endorphins, the brain’s “feel-good” chemicals.
- Engage in physical therapy to improve mobility and strength, which can increase independence and boost self-esteem, reducing the likelihood of depression.
Participating in Rehabilitation:
- Occupational therapy can help you relearn daily tasks, regain independence, and improve cognitive function, all of which are important for mental well-being.
- Setting small, achievable goals in rehabilitation and celebrating progress can give you a sense of purpose and accomplishment, which can improve your outlook.
Healthy Lifestyle Choices:
- Eating a balanced diet can improve your energy levels and overall mood. A diet rich in omega-3 fatty acids (found in fish and nuts), whole grains, fruits, and vegetables supports brain health.
- Ensure you get enough sleep, as poor sleep can worsen both cognitive recovery and mood. If sleep problems persist, seek help from a sleep specialist.
- Practices such as mindfulness, meditation, or deep breathing exercises can reduce stress, improve emotional regulation, and help manage depressive symptoms.
Cognitive Training:
- Engaging in activities that stimulate the brain—such as puzzles, reading, or memory games—can help maintain cognitive health and improve mood by fostering a sense of progress.
- Occupational and Cognitive therapies can improve cognitive function and help you regain skills, which can reduce frustration and feelings of helplessness that contribute to depression.
Manage Expectations:
- It’s important to understand that recovery from a brain injury takes time, and there may be permanent changes. Accepting these changes rather than resisting them can help reduce frustration and prevent feelings of depression.
- Recovery can be slow and unpredictable, which can lead to feelings of frustration or hopelessness. Stay patient and remember that progress—however small—is still progress.
- Recognizing and celebrating each milestone, no matter how small, can create positive feelings and keep you motivated.
Address Underlying Conditions:
- Uncontrolled pain can increase the risk of depression. Make sure to address any physical pain resulting from the brain injury with your healthcare team.
- Avoid alcohol and drug use, as they can interfere with brain recovery, worsen depression, and increase the risk of other complications.
- Continue engaging in activities or hobbies you enjoy, even if they need to be adapted to your current abilities. Doing things that give you pleasure can provide a sense of normalcy and improve mood.
I have a favor to ask. Since depression is an ugly, monstrous, negative quality of life, could you re-read this article? Maybe it will help to highlight some points that will stick with you. Thanks to all who did so!
