The East Central Florida Memory Clinic Newsletter

Understanding the Emotions of a Stroke Survivor

A cerebrovascular attack, otherwise known as a stroke, is an unfortunate situation when normal blood flow to the brain is interrupted by a blocked or burst blood vessel. It is estimated that 700,000 people per year in the United States suffer from stroke. (1)

However, because strokes can occur in any area of the brain and vary in degree of severity, each stroke survivor is affected differently. For some, the damage from a stroke is hardly noticed while for others, it can complicate their physical, emotional and psychological health. There can be a wonderfully fulfilling life after stroke, especially when stress and frustration is met with support and understanding.

One of the most difficult aspects of stroke recovery for both survivors and caregivers is understanding and managing the complicated emotional consequences of the stroke. Dealing with the losses associated with stroke such as reduced physical ability or language-related difficulties, for example, is similar to grieving in the terminally ill. The psychiatrist Elizabeth Kubler-Ross has written that people with a terminal illness typically go through a grieving process with a series of distinct emotional stages. Stroke survivors are also likely to react to the effects of their condition in a similar way.(2) These stages are as follows:

Stage 1 – Denial: This stage usually follows immediately after a stroke, when the family and especially the survivor cannot believe that such dramatic changes can occur so abruptly and unsuspectingly. Not admitting one’s difficulties to oneself or others is referred to as denial.

Stage 2 – Anger: Typically, anger sets in when the survivor can no longer deny that he has changed as a result of the stroke. The survivor may become angry with himself for not being able to perform as he once could, especially during rehabilitation.
He might also become angry with God for his condition.

Stage 3 – Bargaining: The bargaining stage may be characterized by pleas to God for a complete recovery or for the return of certain abilities. For example, the survivor might offer things such as, “If you give me the ability to walk as well as I could before, I will make the world a better place in any way I can.”

Stage 4 – Depression: The moment of recognition can be quite upsetting when the survivor realizes the possibility of never fully recovering. It is estimated that 30-50% of all stroke survivors experience depression.(3)

Stage 5 – Acceptance: When he acknowledges that things may never be the same, and when all the preceding feelings have been fully dealt with, then the survivor can come to terms with his condition.

Stage 6 –Hope: With acceptance comes the hope that although things may never be the same, life can still be fulfilling. A shift from one’s old perspective to a new one that takes into consideration one’s limitations is the healthy and adaptive response that charactizes this stage.

Not everyone goes through all of these stages after a stroke, and the order may not be the same as listed above.

Depression is common following stroke, and it may be one of the most misunderstood emotional consequences. An easy way to understand depression in a stroke survivor is to separate it into two types:

1. Depression imposed by social factors
2. Chemically-induced depression due to the trauma that the brain itself has incurred

“Social factors” are all of those things that enable a person to be a social being and include one’s thoughts of who he is. When a stroke survivor suffers a physical deficiency, this may prompt anxiety about how he is perceived by others. Additionally,
the individual may feel inadequate as a person because he cannot perform physically as he once could. Stroke survivors often struggle with the rehabilitation process following a stroke. Physical, occupational, and speech therapy is not easy. Recovering from certain types of stroke takes a lot of effort. When one is tired and frustrated that they cannot perform as they once could might prompt thoughts such as “What good am I if I can’t perform certain things anymore,” or “There is no point in trying, I’m never going to be the way I used to be.” This kind of thinking is a probable sign of socially imposed depression.

The other type of depression is related to the physical damage to the brain that the stroke has produced. Depression in this case is the result of imbalances in the brain’s chemistry, and it has nothing to do with a stroke survivor’s will to recover. However, a strong will and effort to recover can reduce the depressive feelings that certain brain damage can cause.

Thinking about depression in these two ways simplifies this very complex phenomenon, although it is likely that both types of depression will happen simultaneously. The distinction is made to make this complicated situation more understandable to both survivors and caregivers. It is understandable how a fully motivated and energetic survivor might still be depressed, and this is important for everyone to consider.

The most important part of recovery for a stroke survivor is the support received from loved ones. Better understanding of the survivor’s emotions will lead to a more healthy recovery process for both survivor and caregivers.
The following sources offer more information regarding all aspects of stroke:

Internet:

1.) American Stroke Association, http://www.strokeassociation.org

2.) Internet Stroke Center of Washington University, St. Louis http://www.strokecenter.org

Books:

1.) A Guide for Families Living with Stroke, 3rd Edition (2001). Richard Senelick, MD, and Karla Dougherty.

2.) After Stroke: Enhancing Quality of Life, Wallace Sife, Ph.D.

- Justin Koenitzer, BA

East Central Florida Memory Clinic
3661 S. Babcock Street; Melbourne, FL 32901
Phone (321) 768-9575 Fax (321) 725-1998
info@ecfmdc.org