Acquired Disability: Grief and Adjustment After Losing Physical Function

What is acquired disability like emotionally? Read about the grief, the change in identity after an accident or illness, and steps that help with adjustment.

One morning you left home as usual. Perhaps there was a traffic accident, perhaps a fall at work, perhaps a stroke you never saw coming. When you opened your eyes in hospital, your body was no longer what it had been. You might not be able to feel one leg, or use one hand, or you might have lost the sight in one eye. When the doctors said "there's no danger to life", everyone breathed a sigh of relief; but for you, the real difficulty began at that moment. Acquired disability, that is, becoming disabled later in life, is a profound process experienced by a person who, at some point in their life, permanently or for a long time loses a physical, sensory or cognitive function; it involves loss, grief, a change in identity and adjustment, all together. In this article I will try to explain the psychological side of this process: the feelings involved, the point at which more support is needed, the particular difficulties of living with a disability in Turkey and the steps that can be taken on the road to adjustment.

Acquired Disability: The Grief That Follows a Physical Loss

Someone who is born with a disability comes to know the world through that body and largely builds their life on that reality. A person who becomes disabled later, by contrast, remembers a "before": the roads they walked, the vehicles they drove, the work they did, the everyday details they managed on their own. So what happens is not only the loss of a function but also the loss of a life, of a sense of self and of plans for the future.

The reaction to this loss is very similar to the grief we feel when we lose someone we love. Denial, anger, bargaining, deep sadness and, over time, acceptance... But these stages are not steps experienced in order and only once. One day you may think you have accepted it, and the next you may fall apart again looking at an old photograph. The article on the grieving process can also be a guide to understanding this wave-like nature of grief.

An important distinction: Grieving is not a weakness or a sign of "failing to accept". It is a natural sign that what was lost was valuable.

What Does Acquired Disability Affect Psychologically?

Identity

"I'm a cook", "I'm someone who runs every morning", "I'm the one who provides for my family." Much of our identity is built on what we do. When we can no longer do these things as before, the question "So who am I now?" arises. This question is one of the most shaking parts of the process, but also one of the parts that most opens the door to rebuilding.

Dependence and accepting help

For someone who has helped others for years, asking for help getting into the bath, getting dressed or going down the stairs can be a source of deep shame. The thought "I'm a burden" is one of the thoughts most often voiced by people who have become disabled later in life. This thought can lead a person to refuse help, to push themselves more than they should and to become isolated.

Anger and a sense of injustice

If the accident was caused by someone else's carelessness, the anger may be directed at a particular person. If the disability followed an illness, the anger is directed at the body, at luck or at life. Anger is a natural reaction to loss; but when it is suppressed for a long time or turned on those nearby, it can wear relationships down.

Body image

The loss of a limb, the use of a prosthesis, a change in the way one walks or a scar on the face changes how a person looks at themselves in the mirror. Some people begin to avoid going out, running into old friends or having their photograph taken.

The traumatic imprint

If the disability resulted from an accident, an earthquake or violence, the person carries the imprint not only of the loss but also of that moment. Nightmares, the moment of the accident coming alive in the mind, being unable to get into a vehicle or startling at similar sounds are common in this period. You can find detailed information on the psychological reactions experienced after a traffic accident in the article on the psychology of surviving a traffic accident.

Pain and fatigue

Many disabilities are accompanied by persistent pain, muscle fatigue or sleep problems. Pain that never ends directly affects mood, and depression and pain can feed each other. The article on the psychology of chronic pain offers further information on this.

Depression, Trauma and Adjustment: Which Signs Need Attention?

In the first months after a physical loss, sadness, anger, crying and pessimism about the future are entirely expected reactions. Adjustment often happens by going through these feelings. However, some signs may suggest that grief is turning into depression, or that traumatic stress is also present:

• Hopelessness that does not ease at all, or even deepens, as the months go by,
• Giving up physiotherapy and rehabilitation altogether,
• Neglecting one's own care, refusing to eat or to get out of bed,
• Withdrawing noticeably from loved ones, not wanting to see anyone,
• Constant intrusive images of the accident or event, nightmares and intense avoidance,
• Trying to suppress feelings with alcohol or other substances,
• Thoughts such as "There's no point living like this".

These signs do not on their own mean a diagnosis; but they show that the adjustment process needs support.

Living With a Disability in Turkey: Pitying Looks, Pavements and Family

A person who becomes disabled later in life has to face not only their own body but also the reactions of those around them and the barriers of the physical environment.

Pitying looks: Sentences such as "Oh dear, what a shame" or "May God spare everyone this", even when said with good intentions, place the person in the position of "someone to be pitied". Many disabled people say that this look is what wears them out the most. The person wants to be seen not as incomplete, but as an adult living with a different body.

Physical barriers: Buildings without ramps, apartment blocks without lifts, pavements with cars parked on them, the difficulty of getting onto public transport... Being disabled is often less about the body itself and more about the environment not being ready for it. Having to plan before going somewhere you once went without a second thought can shrink a person's world.

Bureaucracy: Medical board reports, rehabilitation applications, return-to-work or retirement processes... A person who is already tired, and their family, carry an extra load as they go from one institution to another.

Work and livelihood: Being unable to continue in your old job is not only a loss of income, but also a loss of status and belonging. Some people start learning a new profession, some prepare for the exams for public-sector posts reserved for disabled people, and some begin thinking about work that can be done from home. This change of direction may at first feel like a "step backwards", but over time it can be an important step that brings structure to the day, self-confidence and a social circle. Looking into vocational rehabilitation options can open up new paths at this point.

Changing roles within the family: The extended family structure can be an important source of support in this process. However, the family's overprotective attitude, the "You sit down, we'll do it" approach, can get in the way of the person relearning the things they could do on their own. Being left out of household decisions also leads a person to feel worthless.

Let's say a construction foreman in his thirties starts using a wheelchair after a fall from scaffolding. His wife and his mother do everything for him, even handing him his glass of water. On the one hand he feels grateful; on the other, he feels himself shrinking a little more every day. He even stops doing the exercises the physiotherapist recommended. In a picture like this, directing the family's love in a way that supports the person's autonomy, for example by talking together about "What would you like to do yourself, and where do you need help?", can be one of the most important steps in adjustment.

How Can You Support Yourself During Adjustment?

• Record the gains alongside the losses: Write down the small progress you make in rehabilitation in a notebook. Getting dressed on your own for the first time, moving from the chair to the bed, taking a few steps with a new prosthesis... Alongside the thought "Nothing is like before", these gains also make room for the thought "I'm relearning some things".
• Keep goals realistic and concrete: Instead of "being like before", set achievable goals such as "This month, I'll go to the local shop on my own".
• Meet people who have had a similar experience: Disability associations, groups at rehabilitation centres or online communities give you the sense that "There are people who went through this before me and managed to rebuild their lives." Peer support does not replace professional support, but it powerfully complements it.
• Redefine accepting help: Everyone needs others at some point in their lives. Accepting help does not reduce your worth. Saying clearly which things you want help with and which you want to try yourself makes things easier both for you and for those close to you.
• Adapt your old interests: If you cannot play football, perhaps coaching, perhaps wheelchair sports; if you cannot use your hands, perhaps audiobooks or voice-controlled technology. Passions often do not disappear completely; they change shape.
• Have a ready answer for the looks: Preparing a short, calm answer to curious questions or pitying comments protects you from being caught off guard: "I had an accident, and now I'm getting used to my new routine."

For family and friends

Do not try to hurry the person's grief; the sentence "Be thankful, it could have been worse", however well-meant, silences feelings. Instead, acknowledge the loss they have experienced and ask what they want. Rather than doing the things they can do for them, stand beside them when needed. Do not neglect your own tiredness and sadness either; a loved one becoming disabled is a grieving process for the whole family.

When Should You Seek Professional Support?

It is important to talk to a mental health professional in the following situations:

• If hopelessness, listlessness and low mood are not easing even as the months go by,
• If you are clearly struggling to keep up with the rehabilitation process,
• If nightmares and intrusive images of the accident or event are restricting your life,
• If there is constant tension and disconnection in family relationships,
• If you notice that you are trying to cope with alcohol or other substances.

If you are having thoughts such as "I don't want to live like this" or thoughts of harming yourself, be sure to share them with someone close to you and with a professional. In emergencies, call 112 (emergency services) without delay. If symptoms of depression or trauma are severe, an assessment by a psychiatrist may also be needed.

How Is Acquired Disability Addressed in Therapy?

The aim of therapy is not to force the person to "accept" their loss, but to accompany them as they reconnect with their life while making sense of the loss they have experienced. In this process, work usually focuses on the following areas:

• Grief work: Making room to grieve lost functions, roles and dreams; allowing sadness, anger and longing to become things that can be talked about.
• Working with thoughts: Within the framework of cognitive behavioural therapy, examining together how realistic thoughts such as "I'm no use for anything any more" or "Everyone pities me" are.
• Values and meaning: Using the acceptance and commitment approach to discover ways in which the person can live in line with the values they care about, despite physical limitations.
• Processing trauma: Addressing traumatic memories of the accident or event safely, using appropriate methods.
• Family sessions: Reorganising roles and talking about the balance between overprotection and support.

Many people say that at the end of this process they did not return to their old life, but built a new one. This new life does not ignore the losses; it becomes a whole that includes them too.

When the body changes, the person changes too; but what changes is not the whole of who you are.

During periods when getting around is difficult, it is possible to take part in sessions from home; you can find information about this on the online therapy page.

Frequently Asked Questions

How long will it take me to accept my disability?

There is no set time for this. Acceptance is less a destination than a process that deepens over time. Some people experience marked adjustment within the first year, while for others it can take years. What matters is not being left alone in this process.

Does missing my old life mean I haven't accepted it?

No. Missing something you have lost shows how much you valued it. Many people, even after adjusting to their new life, continue to live with a longing for the old days from time to time. Longing and adjustment can exist side by side.

How can I cope with people's pitying looks?

These looks often come from a lack of knowledge and not knowing what to say. Preparing short, clear answers, setting boundaries when necessary and spending more time with people who see you as you are can lighten this load. Talking about these feelings in therapy also helps you protect the way you see yourself.

My partner has become disabled. How will our relationship be affected?

Changing roles, the load of care and the grief both partners are going through can strain the relationship. In this period it is important for partners to make room for each other not only as "carer" and "cared for", but as partners too. When needed, joint sessions can help in establishing a new balance.

• #disability
• #loss of physical function
• #grief
• #rehabilitation
• #adjustment

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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