Over the summer months I have been working with a patient who suffered significant visual loss in a short period of time. Their behaviour over these few months has reminded me of a long-running theory about the pattern of behaviour people adopt when they suffer sudden deprivation.
In 1969, an American psychoanalyst (stay with me here), Elizabeth Kubler-Ross, suggested people going through a bereavement seemed to follow a similar pattern of emotions linked with their adapting to the loss, namely an initial denial often resulting in isolation, anger, a period of bargaining or argument and eventual acceptance. The Parkes model of loss, developed a couple of years later, has been cited by many as applicable to the way some people behave subsequent to a significant physical or sensory loss – denial, followed by anger, followed by depression, followed by a variable degree of adaptation and motivation.
While a sweeping generalisation of individual responses to a major loss might be a dangerous thing, my recent experience has reminded me of how this is still a useful pattern of behaviour to be aware of. I first saw my patient just days after his vision loss (unilateral profound vision loss due to an anterior ischaemic optic neuropathy with a concomitant homonymous field loss due to a minor stroke).
It was quite clear during the first meeting that the patient was very distressed and any mention of his visual concerns merely added to his distress. Some weeks and a short vacation later, he was keen to discuss possible management options. Being aware of someone’s state of mind may be the difference between a sensible and useful intervention or simply exacerbating someone’s distress.
Look out for our forthcoming series on the links between depression and sight loss in the coming weeks.