The Mental Side of Surgery and Recovery
Interview With Social Psychologist Dr. Warren Reich
Link to the Original Article
Getting injured, surgery, and the process of recovery, to put it mildly, is psychologically draining. It involves a loss in a multiplicity of facets of life. One form of this loss is feeling at a loss when it comes to what to do mentally when preparing for when we have become injured, are preparing for surgery, or are going through the recovery process. Recently, I spoke to social psychologist Dr. Warren Reich. He is currently a professor at Hunter College and has published work on identity and well-being, mental health, and youth-crime recidivism. He holds a Ph.D. from Rutgers University in social psychology. Dr. Reich had beneficial insights. However, it has been some time since he has looked at the literature/research that has been done on the psychological factors that go into surgery, injuries, and recovery. Here are a few important practical takeaways from the psychological literature before getting into the interview:
Recovery-Stress Balance:
Specifically for athletes, injury is often seen as the accumulation of physiological stress. This is the reason why athletes deload, take days off and prioritize sleep and nutrition. However, stress is stress. Psychological stress and physiological stress are synergistic in their effect on the body because psychological stress elicits a physiological response. Research (1,2) shows that psychological stress is not only the consequence of getting injured, but it is also part of the cause in many instances. Thus, if you are an athlete or are very physically active, take psychological recovery into account in parallel with physical recovery. It might save you from getting injured.
Find What Works For You:
Ultimately, human beings are individuals. The structure of the mind widely varies from person to person. Research (3) shows that different conceptual models of surgery preparation help different people differently. For some, understanding the surgery procedure before entering into surgery is de-stressing (4). For others, talk therapy or the company of family is helpful. Ultimately, you have to work with your needs, not the needs others believe you might have, to cope with the stress that is intrinsic to getting injured. If you prefer to be alone, be alone. If you need to be with others, make connections. Some of the options that the literature alludes to are support groups specifically for people who have gone through similar injuries, cognitive behavioral therapy, revaluing one’s values, finding new hobbies, and talk therapy.
Here is my interview with Dr. Warren Reich. His opinions on the matter are highly aligned with the literature:
Daniel: How should one face the task of mentally preparing for surgery?
Warren: It would depend on the severity of the surgery. The best thing to do is to learn as much as you can about the procedure so you could imagine yourself going through it. Get as much information as you can. It would be tough to mentally prepare for something that you do not understand the details of.
Daniel: What are some strategies or tools one can use to endure the recovery process mentally?
Warren: I’m all for accommodating individual differences. Suppose meditation helps you, great if a support group helps you, great. I think that there is a lot that can be learned by simply asking people what they prefer.
It also depends on the length of the recovery process. If it is an injury where you will back on your feet in a matter of a few days or weeks, it might just boil down to pain management. In the more severe cases, by contrast, where you might even be facing the prospect of never being the way you were before surgery, that takes a whole nother level of coping. This coping has to do with the loss or the feared loss of something you had been doing before the surgery. This can be experienced as a loss of identity. Such an experience would go beyond mere meditation or support groups when it comes to coping. A consideration would be to seek out therapy. Ultimately in these cases, the psychological work to be done is to restructure your life, how you approach things, finding new meaning, finding other outlets for doing the things, and being the kind of person, you had been previously. Not doing this will cause even more psychological pain. This is a layer of recovery that goes on top of physical recovery. What needs to be inculcated is the notion that “there is a future out there for you, it might not look the way it previously did, but you could still have this future being the same person you always were but just doing something different.” Coming to terms with a revolutionary future change, where one’s values are manifested into something different, is crucial and takes time. In graduate school, I had a roommate who ran marathons, and he got a minor injury; as a result, he became depressed. I don’t think he was prone to depression, but losing part of his identity as a marathon runner did him in. Restructuring that identity with something new, though a difficult feat, will be crucial to the psychological component of recovery.
Daniel: How should family members approach caring for their loved ones during a time that can be mentally and physically difficult for the patient?
Warren: Be attentive to the patient’s needs. Understanding that the patient has new needs that they may not have had before being injured or undergoing surgery. On the flip side, caregiving is hard work. Caregivers can get burnt out too. You want to cater to their needs but not make it so that their needs become all that you are concerned with because that will become a psychological drain for both parties. There must be a mutual understanding that, at least for the time being, life is not going to be the same and that accepting this fact is part of the process of making things work. If things get to a point where it becomes untenable, it might be advisable to seek out a competent family therapist.
Daniel: What should someone without family do to cope with an injury, the prospect of surgery, and or recovery?
Warren: Most people have at least some support network. This is one of the first things that is quantified in psycho/social evaluations. The main question really is: is there less of a support network than you need? If so, then there is an intervention that is required. What this means exactly varies from individual to individual. Some people prefer to go at it alone more than others. For some people, therapy works tremendously, and for others, it doesn’t. Social support is likewise tricky. The sort of people you might rely on the most in these sorts of situations have needs too. These people need to help, but they also cannot be taken advantage of. People who have absolutely no social support should seek a therapist. Further, in some cases, people want to help more than the patient wants to be helped, which can make things worse by infringing upon the latter’s autonomy. This can cause stress that might impede the recovery process's physical portion, let alone psychological.
In short, we should cater to the needs of the patient. Not our own. Start by talking to them, asking them how you can help, and listening. Listening is the key to communication that is crucial to helping and not hurting the patient.
Citation:
Brink, Michel, and Koen Lemmink. “Recovery-Stress Balance and Injury Risk in Team Sports.” Sport, Recovery, and Performance: Interdisciplinary Insights., edited by Michael Kellmann and Jürgen Beckmann, Routledge/Taylor & Francis Group, 2018, pp. 108–118. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2018–00552–008&site=ehost-live.
Singh, Harnoor, and David E. Conroy. “Systematic Review of Stress-Related Injury Vulnerability in Athletic and Occupational Contexts.” Psychology of Sport and Exercise, vol. 33, Nov. 2017, pp. 37–44. EBSCOhost, doi:10.1016/j.psychsport.2017.08.001
Block, Andrew R., et al. “Conceptual Models of Surgery Preparation.” The Psychology of Spine Surgery., American Psychological Association, 2003, pp. 131–148. EBSCOhost, doi:10.1037/10613–008.
Faust, Jan, et al. “Same-Day Surgery Preparation: Reduction of Pediatric Patient Arousal and Distress through Participant Modeling.” Journal of Consulting and Clinical Psychology, vol. 59, no. 3, June 1991, pp. 475–478. EBSCOhost, doi:10.1037/0022–006X.59.3.475.
