As Jasmine made her way back to her apartment, her heart began to sink just as it always did when she reached the final leg of her trip. She enjoyed going to the market and the social interactions that her errands afforded her. See, Jasmine lived alone, with no family in her hometown of Atlanta, and she rarely left her home. She walked with her cane in one hand and her groceries were precariously positioned on her left shoulder. As Jasmine reached her building, she sighed in resignation when she saw the steps that she would have to climb, just to be alone. Since her building was erected before the 1990 Americans with Disabilities Act, the landlord was not forced to install an elevator, but he had added a handrail to the dimly lit stairs as the reasonable accommodation under the act. Eight flights of steep stairs led Jasmine to her apartment.
She entered the home, and she was alone. In some respects, being alone was a comfort. She did not have to fake a smile or try to explain why she was so withdrawn. Jasmine has social anxiety, and she has been dealing with depression for a long time. Complicating these conditions, Jasmine also acquired a L-4 spinal cord injury when she was twenty-seven. After her injury, Jasmine had found it more palatable to remain at home, in relative comfort and safety. It was easier to stay home and not navigate the environment with her cane and unsteady gait.
Jasmine experienced more limitations due to her emotional and mental difficulties than she did with her spinal injury. However, the role of her physical disability was unmistakable in that her isolation had begun with the spinal cord injury, which served to exacerbate her depression, anxiety, and low sense of self-worth.
Jasmine isolated herself at her job as well. She kept her head down because to be noticed is to look pitiful or needy. Sometimes co-workers would engage Jasmine in conversation or ask her out for drinks, but she always withdrew and declined any invitations. Jasmine saw such attempts at co-worker friendship as dangerous because people may figure out how depressed Jasmine truly is. Instead of risking the vulnerability of friendship, Jasmine returned home to climb the stairs to her apartment. Back in the safety of seclusion, Jasmine began ruminating on the life she wished she had.
Jasmine believed that if she wasn’t so anxious, she could engage with her colleagues and perhaps find some supportive friends. If she was not so depressed, Jasmine would have greater ability to be social and leave the confines of her apartment. This brief imaginal symptom deprivation is very important.
Jasmine is envisioning a life without depression, anxiety, and restrictions of her injury. Jasmine has multiple strengths such as perseverance after injury, adaptability to living conditions, successfully coping with invisible diagnoses, and obtaining and maintaining employment when individuals with disabilities have a ~20% unemployment rate. Jasmine is clearly likable as evidenced by her co-workers’ attempts to include her. However, something was holding her back from full engagement.
Depression and anxiety are conditions which impair cognitive functioning. Jasmine’s depression is a by-product of her injury and subsequent isolation. After a spinal cord injury (or most other traumatic experiences), individuals tend to distance themselves, seeking safety. Furthermore, people with depression have portions of their brains that are closed, unable to see a logical solution to their isolation. Additionally, anxiety is meant to be adaptive, but it can turn into a debilitating condition when the body does not feel safe. In these cases, it makes perfect sense for a person like Jasmine to seclude herself so that her depression-based sadness/distance and anxiety-derived fear do not get overwhelmed. However, this sort of isolation, while adaptive at first, can cause serious issues including exacerbating Jasmine’s depression and anxiety. The longer that Jasmine isolates herself, the more apt she is to deepen her depression and worsen her anxiety.
Luckily, there exists a simple solution to Jasmine’s seclusion: socialization.
This is a simple, yet monumentally hard task. How is one supposed to counteract the incredibly strong pull of depression? How can one tolerate the fear and uncertainty of anxiety? The answer lies in therapy and supportive relationships. Isolating yourself may seem like the only logical solution. However, long-term, isolation in this context is damaging to the psyche and dangerous to the safety of the individual. Humans are social animals with a strong inclination to be in contact with others. When we lose that contact, our brains attempt to compensate for the lack of interpersonal closeness, but that compensation is often deficient.
Sometimes combatting isolation involves evoking the opposite action. For example: you were invited to dinner with friends and you really want to go, so instead of giving into the temptation to go home and curl up, you go with the opposite action and accept the invitation. This is so much more easily said than done. However, with incremental, step-by-step approximations at the target goal, you can overcome the isolation reflex. What would you do if you were not scared?
Jasmine has plenty of reason to prioritize safety and comfort, a prioritization for most individuals. When she is at home, Jasmine does not have to worry about being judged, scared, and forced to navigate life with both visible and invisible disabilities. However, you may also note that Jasmine is lonely, and her isolation may worsen her depression and anxiety. Through opposite action, Jasmine may decide to join her co-workers for drinks. She could also use technology (e.g., a phone call, zoom, Facetime, text) so that she does not have to traverse the eight flights of stairs to get human contact. Jasmine could also strike up a relationship with a neighbor or she could volunteer to be closer to her community.
Finally, and importantly, Jasmine could find help in the form of therapy or counseling. Which came first: he depression and anxiety or the spinal injury? What purpose are her symptoms fulfilling now? What is she getting from isolation and how can we broaden her scope of tolerable excursions? These questions and others could lead Jasmine to important self-discovery and to a resolution of her depression and anxiety. Isolation is the enemy and combating it requires strength and bravery. The alternative is distasteful, with worsening depression and anxiety.
Get out of the isolation loop and go on through your life with support and love!
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– Richard DeBord, M.S.
Mental Health Specialist | Email Richard