01 Sep Why Are We Not Talking About the Emotional Side Effects of Surgery?
Surgery can be a life changing experience. Whether you have had a planned surgery or an unexpected surgery, big or small, the experience can bring some significant side effects. And I am not just talking about the physical ones. In my personal and professional experience, surgeons talk with their patients regarding the physical side effects of the pre-operative and post-operative procedures but rarely, if at all, provide education on the emotional side effects of surgery. Some surgeons normalize the nervousness within the pre-operative phase, but where is the conversation regarding our emotions during the post-operative phase?
Harvard Magazine published an article two decades ago about Post-Op Depression entitled, “An Understandable Complication,” yet the conversations still do not seem to be happening. According to Dr. Oryhon of Illinois Bone and Joint Institute, “There isn’t enough data” on the emotional impact of surgery. With a lack of research in the area of post-operative depression, individuals are not always provided with the information of what the emotional side effects can be following a surgery.
What is Post-Operative Depression?
Post-operative depression is not the same as depression. It is a situational form of depression that can last up to one year from the day of surgery. It can be difficult to tell the difference between post-operative depression and normal feelings of sadness that come with recovery. Shabnaj Chowdhury identified that “some symptoms overlap, such as fatigue and irritability, but post-operative depression is persistent, lasting longer than two weeks. If left untreated, it can actually go on for months. Surprisingly, feelings of hopelessness can persist even when a patient had a successful surgery and is on their way to a full recovery.”
While working with patients who are in the post-operative phase, I often observe them verbalizing feelings of isolation or hopelessness, feeling like a burden, engaging in negative self-talk and focusing on how different they physically feel. I hear patients make statements such as, “I should be able to do this.” Or “It is pathetic that I need help to do the most basic thing.” What is not acknowledged at times is that the person has undergone surgery and their body is trying to heal; however, their focus is wanting to act/move how they did before the surgery. I had even found myself focusing on what I no longer had or what I could no longer do after a recent surgery, and it brought on uncomfortable thoughts and feelings that I had felt stuck in.
Oftentimes, behavior does not make sense when it is taken out of context, so one must be willing to put it back into context to make sense of it. By doing so, placing behavior back into context will allow the dialectic for one’s post-operative experience and one’s recovery to exist together, which will allow space for self-compassion, or will provide the opportunity for holding space for healing past ailments and holding space for new functioning.
Why Are We Not Talking About the Emotional Side Effects of Surgery?
As we now know, there is not much data regarding post-operative depression. Surgeons are wired to focus on the tangible aspects of their job. They are able to fully describe the details of a surgery and provide you with what the physical post-operative phase may look like. They will provide you with post-operative appointments, send you to physical therapy, and manage pain to their ethical ability, amongst other things. Surgeon Dr. Paul Kalanithi had acknowledged in his book, When Breath Becomes Air by stating, “When there is no place for the scalpel, words are the surgeon’s only tool.” Surgeons and other healthcare providers would benefit from increasing their perspective on how surgery affects the whole body and mind in order to increase the conversation regarding the emotional side effects of surgery.
Asking your surgeon questions regarding emotional side effects can be a good start in opening that conversation. The surgeon may not be the one to initiate the conversation regarding the emotional side of recovery, so utilizing your voice and any concerns you may have can either help them address your concerns or they can provide you with other resources to help you manage those areas. It is also helpful to connect with friends or family who you know have had surgical procedures. Hearing stories of others’ post-operative experiences can help normalize any feelings that may arise and allow an individual to plan ahead by setting up a support system, identifying new ways to do regular daily activities of living, and allowing for increased self-compassion.
Helping Yourself or Someone Else Overcome the Emotional Side Effects of Surgery
Prior to your surgery, ask your doctor if they are familiar with post-operative depression and if they have any educational resources available. Staying informed is one of the biggest steps towards taking action. Here are some ideas of questions that you can ask your surgeon.
- What will recovery look like physically?
- What will recovery look like emotionally?
- How long will recovery last?
- What type of pain is normal pain to experience?
- When can I shower/swim?
- When can I exercise/increase movement?
- Will the current COVID-19 pandemic impact my recovery in any way?
- When can I expect to return to normal activity?
- Will this surgery allow me to return to how I used to move/work/exercise?
Getting Out of Bed
Some operations will require you to be in bed during your recovery; however, if you are able to get up, do it!
- Create a post-operative schedule
- Create daily intentions for focusing on what is and stay away from “what if” or “what was” thinking
- Bathing, once able, and changing clothing will help increase a sense of self
- Identify realistic goals and tasks to complete
- Have a backpack or a regular bag packed with essentials to bring with you around your house. This increases a sense of independence and confidence.
- Ideas of things to pack: electronics, chargers, medication, extra medical supplies or bandages, books, lotion, lip balm, a water bottle, journal, gum or mints, snacks, etc.
Having a Support System
Identifying what will look like and who it will include is important. Letting people know that you need help is a vulnerable yet rewarding thing to do. Talking with family or friends can mitigate isolation and make us not feel so alone at times. It is important to engage in transparency when talking about our emotions and experiences in order for people to show up for you. It is also helpful to speak with a therapist to help in areas that friends and family may not be aware of.
Eating Well and Movement
There are some activities that make healing more difficult, like smoking. It is important to talk with your doctor about the post-operative phase because, just like smoking, sometimes certain activities can prevent a person from healing or prolong the healing process. Some helpful things to do are:
- Mindful eating, which can help an individual feel better physically and mentally
- Eating healthful foods will allow the body to absorb the nutrients that will help aid in healing
- Engaging in movement, which will help strengthen the body and improve energy levels and mood
- Being outside or changing interior scenery
- Setting achievable goals, which can increase self-esteem
Acknowledging your emotions and allowing space for them, without allowing them to take over, is one of the most important things to remember when in the post-operative phase. If you suppress or ignore emotions, they will come back with more intensity and frequency. They can also lead to feelings of shame or increase feelings of depression. Follow these steps to acknowledge your emotions:
- Name the emotion that you are experiencing and be specific. Stay away from broad terms like “bad,” “off,” “upset,” or “weird.”
- Take deep breaths and acknowledge your body’s physical reaction to what you are feeling emotionally.
- Do not judge your emotions or your experiences; they come from a valid place, even if it’s hard to make sense of them. Do not add to the emotion or experience with positive or negative things because that only makes your experience grow in a direction that isn’t always helpful.
- Identify what you need. Instead of utilizing maladaptive coping, or negative coping, identify what your true need is, for example: connection, validation, support, laughter, a hug, to be seen or heard. Whatever the need is, be aware of it.
- Identify what the tiniest step is that you can take to meet that need and take it.
Patience and Acceptance
Accepting the things that have physically changed is one of the biggest steps people can take for themselves and having compassion through the process will aid in their patience and growth. Setting realistic goals towards healing is important; if you are expecting to run a half marathon three weeks after having knee surgery, you may feel defeated, hopeless, or depressed when your doctor informs you that you cannot run the marathon.
- Create and set SMART goals
- Practice acceptance – “what am I now capable of instead of ____?” instead of “why can’t I do this anymore?”
- Acknowledge your growth
- Utilize patience
- Remember: You are more resilient than you know
- Move at a pace that will set you up for success
Surgery – whether major or minor – is tough on the body, and most people can return to their lives, even if it requires some changes to how they live. Emotions are a part of all of us and there is not a big conversation about how emotions are affected by surgery. Post-operative depression is treatable and manageable. Hopefully, the information provided in this blog can help a person plan for any emotional side effects in the postoperative phase. Please remember to speak with your doctor if you are feeling depressed and/or seek help from a mental health professional.
Courtney specializes in working with children, adolescents, young adults, and families. She also has extensive experience working with clients who struggle with depression, anxiety, self-harm, self-esteem, mood disorders, eating disorders, gender issues, grief, and complex and relational trauma. Courtney utilizes DBT techniques for clients who require extra attention on regulating their mood, strengthening relationships, and utilizing relaxation and mindfulness techniques during moments of distress.