The statistics are staggering. The NIH tells us that in 2015, there were an estimated 43.4 million adults aged 18 or older in the United States with any mental illness (AMI) within the past year. This number represented 17.9% of all U.S. adults. To better conceptualize that idea, the next time you are in a small group of 10 people, consider the fact that two of them may be suffering from a mental illness. Like most statistics, answering the question of “why” this is happening is not as easy as collecting the data.
A very likely contributor is our use of social media. Apparently, our youth often focus on the size and quantity of their social network while the quality of that network has consistently diminished over time. Even more interesting is our apparent need for social connection to thwart off pain. EO Wilson, a socio-biologist, author, poet, and naturalist has been quoted as saying, “To be kept in solitude is to be kept in pain and put on the road to madness. A person’s membership in his group – his tribe – is a large part of his identity”. For you team athletes that have endured an injury, you can likely relate. To our Soldiers: Have you ever been on profile (a duty limitation)? How did you feel? Did you feel solitude, anger, or a decreased sense of self? All humans have a need and desire for social connectivity which seems to be directly related to our need to fulfill our role in society and, to take it a step further, our identity. Our sense of self seems to be related to our need to “fit in”.
How does this relate to rehabilitation? Before I dive in as to how this applies to improving performance and rehabilitation outcomes, let me give you a very natural and observable phenomenon from the producers of sweet nectar: the bee. Take a minute and watch this video.
Isn’t it interesting how the bee communicates to other bees where to get their food and, more interesting, how the bee, with mathematical precision, uses his natural surroundings to communicate? (I wonder, does the Pee-Pee Dance work the same way?) Are we much different than the bee? Do we not ask for referrals to health care practitioners when we are in distress or have a medical problem? Don’t we generally try to find someone who has treated a similar condition and get a sense as to if we should seek the same person? What is it that we are looking for? It’s not food, so what is it? I would suggest that trust and the innate desire to connect with others during times of trial (starvation or an identity crisis) is a necessary means to survive.
To further explore our need for social connection in rehabilitation, let’s look at a study conducted on college-aged students. Researchers sought to better understand the relationship between health locus of control and healthy decisions (physical activity and dietary behaviors). First, health locus of control is divided into an internal or external locus of control. If you have an internal locus of control, you believe you have control of your health. If you have an external locus of control, you believe that someone else has control of your health (ever felt at the mercy of a medical provider?). To examine this relationship, researchers decided to ask college-aged students several questions related to their dietary and physical activity behaviors as well as their confidence (self-efficacy) and social support to perform those behaviors. What did they find? Researchers found social support and self-efficacy mediated the relationship between internal locus of control and physical activity and intake of fruits and vegetables, and self-efficacy influenced the relationship between health locus of control and their percentage of fat intake. What does this mean? It means that college-aged students who believe they are in control of their health had higher physical activity and intake of fruits and vegetables. I know, duh! People who feel they are in control make better decisions. But, what else does this mean? It means that people are more in control of the choices they make when they are 1) confident in their ability to perform a behavior and 2) have the social support to perform the behavior.
How do we leverage this knowledge to achieve optimal health outcomes in rehabilitation?
First, we have to understand that health behaviors (the day to day choices we make) influence our ability to recover from injury. Second, we need to see how psychological variables, like self-efficacy, social support, and our mindset affect our physiological systems. As an example, here is a fascinating article about how researchers decided to measure the effect of a serious injury (greater than three months out of sport) on the immune system, stress, and mood in 9 elite European football players. The players were asked to write about their experiences for 20 minutes for the first three days after their injury. The authors measured characteristics of cellular immunity and found that emotional disclosure (journaling) had a significant effect on stress, mood, and the immune system. Additionally, stress and social support are predictive of outcomes in athletes post ACL reconstruction.
What are the practical applications?
1. Surround yourself with people who support your efforts to overcome your injury. Have open and honest discussions about how your injury may influence your mood and be willing to have an outlet available to manage it. Try writing down your emotions or calling other friends that have experienced the same injury. And seek help when needed.
2. Set realistic rehabilitation goals. The two best ways to improve self-efficacy are 1) goal-setting and 2) visual imagery. What does this mean? Write your goals down on paper and review them often. Discuss your goals and expectations with your therapist and be willing to dampen your expectations when needed.
1. Be mindful of changes in mood, anger, and signs of emotional disturbances. Know your athletes and be willing to empathize with their disposition. When athletes suffer an injury, they lose a part of their identity. Be an active participant in their rehabilitation process, providing them with motivation when required.
2. Keep them involved. They have lost their tribe. Remember EO Wilson’s quote? Solitude is the new enemy that will lead to madness. Let them review film, provide insight into strategy, etc. Keep them in their tribe.
Paul describes both the unity AND the diversity of the church body in Corinthians Chapter 12:12-31. Paul describes how our body is comprised of many parts and how each part if vital to the whole. Our role as believers is to be the social support structures for those in need. This idea is so beautifully stated in verses 21-26 below:
21 The eye cannot say to the hand, “I don’t need you!” And the head cannot say to the feet, “I don’t need you!” 22 On the contrary, those parts of the body that seem to be weaker are indispensable, 23 and the parts that we think are less honorable we treat with special honor. And the parts that are unpresentable are treated with special modesty, 24 while our presentable parts need no special treatment. But God has put the body together, giving greater honor to the parts that lacked it,25 so that there should be no division in the body, but that its parts should have equal concern for each other. 26 If one part suffers, every part suffers with it; if one part is honored, every part rejoices with it.