Let’s just explore the differences between “sickness” and “injury”, not in the strictest linguistic or philosophical way, but in the ways the words take on meanings in real life. When we hear that someone is “sick” we usually think of a cause that lies within the individual – a weakness, a deficit, a genetic problem. Whatever it is, unless it is an infectious disease, sickness is largely decontextualized and located solely in the person – although there is a social acceptance that they are largely not responsible for their illness. This was a significant humanitarian advance several centuries ago on the notion that people with mental illness were possessed by devils or were being punished for sins committed. Nowadays we hope that their illness will be stabilized and that they will “get better” but we to do so they are probably going to have to see an expert in order to “get better”. If they do see an expert, then we expect them to do as they are told, to be passive recipients of the expert’s advice. Physical illness is kept largely segregated from emotional, social, or spiritual illness and there are different experts for each area of specialization. It must be said, however that the only illnesses that have been taken “seriously” – meaning properly and fairly funded and researched - are physical illnesses.
In contrast, an injury model connects the injured person to their environment – injuries always occur within an interpersonal and social context. Injury implies recovery and rehabilitation, even with a possible long-lasting handicap. Injury requires the active participation of the injured party – they must do what they can to help themselves heal and not do anything that will make their injuries worse. They are personally and socially accountable for the healing of their injuries, although the social context within which the injuries occur may make it impossible to fairly locate “blame”. In an injury model we should pay a great deal of attention to injury prevention and universal precautions that prevent injury. Injury can be physical, psychological, social and moral and all these forms of injury are recognized as being interactive and complex. Injuries can result from too much of something or too little – as in neglect, deprivation, and developmental insult. An injury model implies a process of recovery and rehabilitation that is mutual and may require a long-term commitment to that recovery. And such a commitment requires an actively collaborative relationship between the helper(s) and the injured party. It leads interactive exploration away from that sickness/badness dichotomy expressed as “What’s wrong with you?!?” to a very different question, “What happened to you?” . Such a change in focus provides a framework for addressing problems that everyone can relate to – we have all suffered physical, emotional, social and moral injuries, and we all know that whatever injury we experience it has interactive effects on our whole body, mind and soul. Such a change in basic stance simultaneously increases compassion and increases expectations – for everyone.
Because we have all been injured, an injury model allows us to intuitively draw on our own experience when confronted with someone whose behavior we do not understand, or who frightens us or perplexes us. The first rule of treating an injury is to “do no more harm” and to treat the most dire and life-threatening aspects of someone’s injuries. When we have been hurt, we all want to be nursed awhile, have our injuries recognized as valid, experience other people’s compassion. Since we were kids, when we are injured we want some attention; we want someone else to notice and to care that we are hurt. After awhile, however, we have to start on the difficult chore of adjusting to the changes in our lives and our bodies that are secondary to the injuries. It is our individual responsibility to learn everything we can about how to promote healing from our injuries and not do anything that will make them worse.
Part of learning to manage an injury responsibly is knowing how important it is to resume functioning at the pace the injured part can tolerate and to gradually increase stress and expectations of function, often favoring the most injured part while it gradually regains strength. As anyone knows who has ever been very hurt, social support matters a great deal so that coaches, mentors, buddies who are neither overprotective nor under-protective can significantly accelerate the healing process. We also learn as we grow, that sometimes, we are going to have to provide extra protection to some kinds of injuries for a very long time, and some kinds of injuries leave us permanently vulnerable. It is very important for people close to us to strongly address any destructive coping methods we are using that will inevitably compound our injuries. And it is impossible to predict what permanently can cripple a person and therefore we want to radically expand our definition of what is “normal”. The last thing we want to do is compound someone’s injuries by shaming or blaming them. Recovery from injuries is difficult and demanding, so it is important that we remain hopeful and that people around us maintain high, but responsive, expectations. It is vital, regardless of the nature or extent of our injuries that we always promote movement – living systems must move to stay alive.
1. Bloom, S.L., The Sanctuary Model: Developing Generic Inpatient Programs for the Treatment of Psychological Trauma, in Handbook of Post-Traumatic Therapy, A Practical Guide to Intervention, Treatment, and Research, M.B. Williams and J.F. Sommer, Editors. 1994, Greenwood Publishing. p. 474-49.