It was the first week of January in 2014, and my men’s league hockey game was coming to its weekly late-night conclusion. I was chasing a puck into the corner while fighting off a defender with the hope of making one more good hockey play before hanging ‘em up for another week. After playing serious hockey for most of my life, my weekly men’s league game provides that sliver of competitive enjoyment that does the same thing to my brain that the Pee-wee championship game did 20 years ago. It makes me feel good. It makes me feel like a kid again.
While the need to win has begun to fade, the desire to make a quality play and not waste a chance with the puck only seems to grow. So there I was in the final seconds of the game, hoping to collect the puck and find a teammate for one more shot. Then I lost an edge that sent me feet first into the boards. I wouldn’t know it until I hopped to the orthopedic office the next day, but I had severely broken the medial malleolus in my right ankle.
I would require surgery as soon as possible to install the two new screws that will help me stand for the rest of my life.
But this isn’t a story about pain killer prescriptions, or even the mental health of hockey players after years of pain and head injuries (although those are extremely important topics). This is a story about what physical recovery can teach us about mental health and substance abuse recovery.
Pain is Painful
In the days leading up to surgery, and the months post-operation, the doctors focused me on pain management. Yes, there were medications. But also, tips about how to lay, how to move around, for how long, and how often. Then came the compression socks to help the blood pump while I was upright using my crutches. After all this and a few weeks of healing, I taught myself how to drive with my left foot and went back to work.
I was showing up to work again – but it was hard to concentrate. I wasn’t getting much done, and my foot hurt. And this is the context in which I now understand mental health and substance abuse recovery. I was there, but I wasn’t functioning. The pain in my foot was too distracting.
The Brain is a Muscle
The brain is a muscle, susceptible to injury just like the rest of our body. And just like our muscles and bones it can be hurt to varying degrees. When we have symptoms like stress, anxiety, or trauma, we are having pain. And that pain can be distracting, and prevent us from functioning at our best.
If we think of the brain as a muscle, and we think of mental health symptoms as injuries, then we can apply the same principles as orthopedic recovery. I spent the first 3 months after surgery managing pain during initial healing of the bone. Then it was time for physical therapy.
Reduce Pain and Increase Functioning
When the first day came to rehab my ankle, it hurt. It wasn’t easy and it didn’t feel good at all. In fact, it brought on more pain than I had experienced in a few weeks, and so my pain management continued. But it was necessary to increase my range of motion and start to build the strength I would need to walk again.
And this is where I really start to understand how mental health treatment works. You have to both reduce symptoms and increase functioning. In most cases, the two are happening simultaneously and are correlated, but this is where we have to be careful to understand that improved functioning does not cause decreased symptoms, and a decrease in symptoms does not produce an increase in functioning. They are components of a two-pronged approach.
If I’m walking better, that does not mean that I’m pain free. And if my pain is decreasing, that doesn’t mean that it’s easier for me to walk. To fully heal, I need to pay attention to both my functionality and my symptoms.
If we look at the chart below that represents the progress of a client in a Trauma Informed Care program we see the change over time in terms of both a functioning scale (the Daily Living Assessment, or DLA-20) and the symptomatic scale (the PHQ -9 depression scale). The client outcomes represented here show what you might expect; the client is simultaneously improving on the functioning scale as symptoms decline.
But this is where we have to be careful. Stories of suicides that spur comments like “I had no idea they were suffering,” shed light on how people can function well through pain. A person may have high functioning scores, but also have high depression scores. It’s the same as a hockey player playing through the pain. It can be done, but at the risk of long term or irreversible injury.
Long Term Recovery
I still play hockey since my surgery; however, I no longer show up to the rink once a week and call that my workout. I committed to myself that the safest way to play into my old age is to be stronger. That thought and the reminder of what it was like not to walk for three months keep me motivated. Falls will happen, but there will be fewer, with less chance of injury if I’m stronger.
At the same time, I make sure to apply the same thoughts to my mental health. Strengthening my commitment to being present, and practicing mindfulness are things that I take seriously as well. Because trauma can happen to anyone. And when it happens to me, I will be stronger and better equipped to manage my pain and increase my functioning for a speedy recovery.