Uses and abuses of the concept of acceptance in rehabilitation and recovery.

Abstract

Although acceptance may be a crucial step in responding to catastrophic losses, such as those resulting from spinal cord injuries, a careful analysis of case studies and psychological literature supports the notion that acceptance is a place that one arrives at and not something one can make happen. We present five responses to loss with the goal of enabling helpers, whether professionals or family, to address the situation of patients in a nuanced, empathic, and helpful way: (a) Resisting, denying, and the value of fighting, (b) putting aside the painful awareness of loss allows forward moving action, (c) giving up and stopping the fighting while remaining distressed in an unacceptable situation, (d) resignation as a reluctant yes to a life situation that cannot be changed, and (e) reconciliating; coming to terms and finding peace with the way the world, which is what we mean by acceptance. Since acceptance is not an act of the will, it is crucial that helpers respect the difficult and lengthy process that patients move through in their individual way and at their own pace. Here we draw upon the philosopher Emmanuel Levinas's interpersonal philosophy of ethics to elaborate on what it means to treat persons with respect and emphasize the critical importance of listening deeply to patients as fellow human beings. Public Significance StatementThis article provides a careful evaluation of the emphasis on encouraging people with spinal cord injuries to accept their new circumstances. Based on literature and extensive interviews we have concluded that while acceptance may be an important step in responding to catastrophic loss, it is not an action but a place that one may arrive at. Accordingly, we recommend that helpers be responsive to the particular situation and experiences of people who struggle with tragic life changes and consider how "denial" and "resistance" may be adaptive at both a physical and a practical level. Furthermore, those who have been injured may benefit significantly from having someone accompany them on their journey.