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Arava (Leflunomide)

Some might say that the only rational understanding of an accidental spinal cord injury is that it is irrational! There is no logical reason why a particular car is rear-ended on a particular day with a particular person inside. Much of life is serendipitous, chaotic, or random. Yet the human proclivity for imposing sense or order sometimes helps us cope with unexpected and disruptive life events.
Psychologists have studied the impact of attribution of responsibility on psychosocial adjustment following spinal cord injury. This dimension of cognitive processing (intellectual understanding through reasoning) of the injury refers to whether the injured person believes he or she is or is not responsible for causing the injury. One study found that patients who believed they were responsible for the injury were not as well adjusted emotionally during inpatient rehabilitation as those who believed they were not responsible. The degree of adjustment was not related to the medical staff’s ratings of patients as either “risk-deniers” (responsible) or “innocent victims” (not responsible), even though medical professionals are presumably more objective than patients. This suggests that a belief that one caused the injury is more important in adjustment than are the objective facts of the situation.
The same study found that by one year after injury, many people had changed their attribution of responsibility for the injury, and the researchers no longer saw any difference in adjustment between the groups with different beliefs. This suggests that as recovery progresses and the injured person moves out of the hospital environment, other factors become more important in overall adjustment than how responsibility is attributed. However, for those in the early phase of rehabilitation, accepting random events at face value, rather than imposing personal responsibility, may be psychologically helpful. If you are able to see your injury as neither victimization nor self-induced but simply a random event, you may be better able to put your energy into living with your injury and be less preoccupied with anger and guilt.
Viewing an accidental injury as a chance or random event may help you avoid irrational self-blame, guilt, or irresolvable anger. Yet the perception that, in general, you can control events in your life may be beneficial to your recovery. If you see your own behavior as a factor contributing to your injury (as it sometimes is – driving while drunk or participating in a risky sport without proper safety equipment, for example), you may also believe that your behavior can influence your recovery.
A related concept in psychology is locus of control, which refers to the extent to which an individual believes that changes in events and in the environment (good or bad outcomes, rewards or punishments) are either internally (self) or externally (other or chance) controlled. “Internals,” believing their behavior and actions can affect their life circumstances, tend to be more active in their approach to problematic situations. “Externals,” believing that life events are not under their control but brought about by fate, luck, or powerful external forces, are more passive and less likely to spend energy on problem-solving.
Again, the critical issue is one of cognition. What matters is not the objective fact of having control but the belief or expectation that your behavior can affect the outcome of events. For example, consider a woman with quadriplegia who is an “internal.” She has a high degree of expectancy of control and can use her mental and emotional energies to make her life more satisfying. Now consider a woman with paraplegia – with far fewer physical limitations and, viewed objectively, more control over her immediate environment – who is an “external.” She is passive and emotionally helpless, assuming that any effort will have little effect on circumstances that are beyond her control.

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