“Nobody realizes that some people expend tremendous energy merely to be normal.“

[Referencing Albert Camus, goalkeeper and absurdist king of the existential French philosophers, and author of The Myth of Sisyphus, might be a bit adolescent for a 38-year old stroke survivor, but then, Camus wrote La Chute when he was 42.  And  one could suggest that his philosophy of the absurd was inspired by a youthful bout of TB which curtailed his nascent soccer career and cut his university studies back to part-time.  How much more profound might his work have been if he’d had a massive stroke, too?]

[As previously noted when discussing post-stroke depression, I’m no medical professional, just an interested observer.  So, again, if you think you or your family/carer may be affected by this issue, please help your recovery by going to your doctor.  And, once again, the National Stroke Association has published an excellent fact sheet on coping with emotions after stroke, which I’d also suggest you look at if this is an issue for you.]

I think I’ve mentioned previously that we received a number of warnings regarding the risks of post-stroke depression around the time of my discharge from hospital.  I could be wrong, though.  I had a stroke, you know!  As might be expected, PSD is posited to have a  adverse effect on cognitive function, recovery and survival.  And it’s horribly common.  Per my earlier post on the subject, Post-stroke depression (PSD) has been reported in not less than 30% and up to 50% of all stroke survivors (Robinson, 1998; DH, 2007a). The prevalence of PSD peaks at six months after stroke.)  This is of particular interest to me, since I have previously, some years ago now, visited a psychologist complaining of situational depression.  I suppose that there are a couple of reasons depression could set in after a stroke….

• Physical Effects on the Brain:  studies have shown that stroke patients show a higher rate of depression compared to orthopedic patients with similar disabilities, and also that lesions in particular areas of the brain, including the basal ganglia (Hi, mom!) are more likely to be associated with PSD, so, there seems to be a physical component to PSD.
• Functional: it has been suggested that PSD may be linked to a high level of stroke-related limitations and disability in functioning, especially in performing “activities of daily living“.

Drilling down on the functional issue a little, this would seem to be less of a risk for me, since I’m already fairly independent.  However, Beth and I still observe some degree of risk here: after the leaps and bounds of the progress I made in the early days of rehab, post-discharge advances will necessarily be more incremental.  In order to stay encouraged, it becomes important to firstly, recognize smaller advances, and not to take new achievements for granted, and secondly, not be discouraged by expected set-backs.  For example, last Friday, I had to head out to deposit a check.  During my trip, I noted that I could (1) independently take a multiple-step journey (including a subway ride) to a previously-unvisited location, even if it was only a couple of stops to a familiar neighborhood, and then transact my business upon my arrival, (2) step up onto the curb without giving a second thought to the positioning of my left foot, and (3) get up the subway stairs without grasping onto the bannister for dear life.  These three little things gave me a sense of achievement and encouragement for the day.

“[Sisyphus’s] scorn of the gods, his hatred of death,
and his passion for life won him that unspeakable penalty in which the whole being is exerted
toward accomplishing nothing.“

On the other hand, on Tuesday, I headed off to my first Young Stroke Survivors Support Group meeting at the Rusk Ambulatory Care Center in Midtown.  Beth came, too, and kept me right on my instructions for getting there and back, so this was less of an independent activity.  Nevertheless, I still managed to misjudge how long is should take me to get to her office, leaving us late for the meeting, and then lose my phone during the course of the expedition.  These events left me, frankly, disconsolate, notwithstanding that they were exactly the sort of things I would have screwed up pre-stroke.  Nevertheless, the problem remains that once one is far enough along the road to recovery, one wants to immediately make the jump to fully-functional and anything less is a disappointment.  That’s unreasonable, and in any event, ignores the fact that the vast majority of us, even the able-boded, are dysfunctional.  Thankfully, Beth was able to pull me out of my funk with that observation and other kind remarks.

Also, I have to note that the Young Stroke Survivors Support Group was a great help in giving me a boost.  I’d encourage any young stroke survivor to attend such meetings, because there are two types of stroke survivor, and, to turn Alexei Sayle’s remark about there being two types of jazz, “and they’re both crap” on its head, they’re both great.  There are the folks who are doing better than you, and they’re inspirational, and those who aren’t quite so well off, but doing their best, and they’re pretty inspirational (if not more so), too.  After all…

“The struggle itself toward the heights is enough to fill a man’s heart. One must imagine Sisyphus happy.“

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