Sean Tully is an honest and hardworking man. He’s nearly forty-seven and has worked in the construction industry for the last twenty years or so and is a member of the Union Carpenters. Right now, he is sitting across from me while his body leans heavily in his seat. We are in the waiting room of Morristown Medical Center, where an uneasy tension has built up. My eyes relax on a pair of worn-out crutches that rest next to him, and I find myself pondering how he could use them as they seemed so short and he was fairly tall.
Hours earlier, the thick hide of my dad’s carpentry boot had gotten caught under the third-from-top rusting stair of a twelve-foot ladder, and the unbalanced weight of his body shook the legs of the ladder back and forth until it collapsed. He grounded his full weight on his ankle, completely shattering the bone in his heel. But we didn’t know it at the time.
I look towards my mom, who sits next to him. She is a nervous wreck. Her hair is thrown up in a messy bun and she has trouble sitting still. The two of us rushed him to the nearest hospital after he took the fall. “How are you feeling now?” she asks.
“It’s throbbing,” he says. “The pain is traveling up my calf and thigh.”
It’s late, past midnight. We have been waiting for a few hours now. My dad shifts in his seat every five minutes and his face is stuck in a grimace. “And I hate how hospitals smell,” he complains. I hadn’t noticed anything particular lingering in the waiting room until he brought it up. A mixture of latex gloves, alcohol-infused sanitizers, lemon- and lavender-scented cleaners, and whiskey — in particular, half a bottle of Jack Daniels he tossed down after the injury to subside the pain — began to sting my nostrils.
I watch as his eyes hastily flicker around the room. They land on mundane items and pause momentarily, searching for a sort of distraction to ease himself of the pain. A crumpled gum wrapper tossed under one of the chairs. A used scratch-off ticket that didn’t quite make it into the trash can. A chipped bit of paint that had been scratched off the wall and flaked onto the carpet beneath. An outlet adjacent to myself.
“Mr. Tully?” The three of us lift our heads. “Would you follow me please?”
Society tends to pity and belittle those whose physical appearance does not fit its expectations. According to Brian Ahmedani, Director of Research and Behavioral Health Services in Michigan, social stigmas exist when large numbers of people believe a certain group of people is inferior. But people don’t need to be outwardly stigmatized by society to have a negative effect on their feelings about themselves. “In self-stigma, the knowledge that stigma is present within society can have an impact on an individual even if that person has not been directly stigmatized,” writes Ahmedi in the Journal of Social Work Values and Ethics. “This impact can have a deleterious effect on a person’s self-esteem and self-efficacy.”
Because of this, people begin mentally reconstructing the ways in which they view themselves after an injury. They begin changing their routines and succumbing to the stigma that surrounds them, often becoming dependent upon the devaluing resources and advice offered even in situations where the injuries they undergo are temporary.
According to James Dudley, a professor emeritus in the School of Social Work at UNC Charlotte, distinct physical characteristics become associated with a group when those characteristics are viewed as unconventional or subordinate to the expectations of societal norms. Specifically, the inability to perform certain basic tasks and activities, such as opening the door by oneself without the help of others, aids in degrading one’s sense of self after they receive an injury. This further discredits the overall character and mindset of those who undergo a serious injury because it allows stereotypes to form and forces them to view themselves as lesser than they were before the injury. It puts a mask over their identity.
Cassie Christakis, a student at Temple University, would agree with both Ahmedani and Dudley’s theories. After experiencing multiple seizures and having to take unexpected trips to the ER during her first year of college, Christakis and her family and friends felt fearful and were unsure of what was happening. Eventually, after undergoing a few EEG’s and having various doctors study her brain activity over the course of a few weeks, Christakis was diagnosed with juvenile myoclonic epilepsy, also known as JME. JME is one of the most common forms of epilepsy, and it is usually discovered in people during late adolescence when a lack of sleep and high levels of stress trigger seizures. After her diagnosis, Christakis didn’t know what to expect and wasn’t prepared to embrace the changes JME demanded of her. “I was told I wasn’t allowed to drive for six months,” she stated, “and this created a sort of helpless feeling because I became reliant on people, and it felt like I was giving up a part of my freedom.”
The stigma surrounding physical health causes society to reduce an individual’s overall character “in our minds from a whole and usual person to a tainted, discounted one,” according to sociologist Erving Goffman’s Stigma: Notes on the Management of Spoiled Identity. He addresses the idea that injured people “must constantly strive to adjust to their precarious social identities” due to the stigma that society surrounds them with.
What happens to someone’s sense of self when an injury upends their life and constructs the idea that they are no longer fit to participate or associate themselves with societal norms? Many people I have spoken with who received an injury or diagnosis agree with the truth behind these statements. Injured people tend to be unwilling to embrace the immediate changes their injuries demand and after an injury the way in which they view themselves changes. They are forced to temporarily reconstruct their lives around their new physical limitations and mental challenges. With this comes the notion that they are unable to participate or associate themselves with societal norms, further losing a part of their identity due to the stigma and degradation society develops towards them after their injury.
“During a high school football game my senior year,” said Drew Sokolowski ‘23, a lacrosse player at Muhlenberg College, “while reaching out and trying to tackle a kid, my arm got pulled back too far and I tore the labrum in my right shoulder.” The labrum is a piece of tissue attached to the rim of the shoulder socket. It aids in keeping the ball of the joint in place when someone stimulates the use of their arms or shoulders.
After the initial contact, Sokolowski felt a strong burning sensation flare up throughout his entire arm and tried to relax on the turf of the field for the next couple of seconds. He continued to play through the injury for the remainder of the game, the two games left in the football season, and the entire lacrosse season that followed in the spring without consulting with a specialist. “The shoulder is not really a weight-bearing muscle or joint,” he said, “I was kinda able to continue my daily routine and stuff without aggravating the injury too much.”
After consulting with a few doctors about eight months after Sokolowski received the tear in his shoulder, he was told about different scenarios concerning the state of his injury. Some doctors told him he would be able to play football in the coming fall without the possibility of further damage and he could wait until the summer to get surgery. Other doctors warned him that he needed to undergo surgery as soon as possible because of the seriousness of the injury. About a week after the consultations, he ended up getting surgery.
“For the first three or so weeks of recovery,” Sokolowski continued, “I was living at home and I had a lot of support from my family and friends.” He went on to explain that he left for boarding school a few months post-surgery and he was essentially the only one supporting himself other than a physical therapist. He stated that it felt like he was stuck in a cycle of going to class and going back home to his dorm every day. “At the moment, I felt fine and felt like my normal self,” he reflected, “but in hindsight, I forgot how much I depended on being social and using physical activity to sustain my normal image of myself and my mental health.”
Sarah Duffy ‘23, one of my teammates on the lacrosse team at Muhlenberg College felt troubled after she suffered a sports-related knee injury during her senior year of high school which would impact the way she played her sport for the remainder of her collegiate level career. “I got three different diagnoses within a month of one another, and the people treating me didn’t necessarily agree on what was wrong,” she stated, “it was frustrating.”
Duffy’s knee injury occurred after she tripped while running towards the ball during a game in the middle of her senior year lacrosse season. She drove her knee directly into the ground but continued to play through the discomfort for the remainder of the game. “At the time, I noticed it hurt but I didn’t think much of it,” she said.
The diagnosis of her injury was never fully determined and has resulted in multiple inconclusive and overlapping results from different experts and specialists. After consulting with a family friend who is a physical therapist, an orthopedic surgeon, and both her high school trainer and sport-medicine doctor, the possibilities of Duffy’s injury diagnosis seemed never-ending and constantly changing.
“My main focus was staying off my knee,” she said.
With the constant examinations that were getting her and her family nowhere closer to understanding the extent of her injury, she felt the best thing to do was begin the healing process with or without a definite diagnosis. “It was definitely frustrating,” she continued, “I knew I was hurt, but not hurt to the point where I couldn’t walk, so all I could think about was being able to play in the few games we had left in our lacrosse season.” An injury can jumpstart someone’s journey of re-imagining themselves as someone who has changed both physically and mentally, but for people like Duffy, the lack of a diagnosis can delay that process and further prolong their identity crisis amidst an injury.
“My junior year of high school,” said Austin Schmitz, a football player at Springfield College, “I got a three-inch-long spiral fracture in my fibula.” Often referred to as the calf-bone, the fibula is a narrow bone that runs vertically from the top of the ankle to the joint of the knee. The injury occurred during the first quarter of his second-to-last football game, and it ended the short remainder of his season that year.
During one of the first offensive plays in the game, Schmitz found himself running the ball down the field. A moment later he was tackled, becoming trapped under a ‘dog-pile’. In football terms, a dog-pile is a large cluster of tackled football players thrown on top of one another on the ground. “As I went down, I heard and felt a crack throughout my entire ankle,” he explained. After the fall, he attempted to stand up and an immense pain shot over his entire body and he fell and yelled out in pain. The full weight of the dog-pile had crushed his ankle completely and he was unable to walk.
A few weeks after the injury, Schmitz underwent surgery. He had seven metal screws and a metal plate implanted in his ankle. For the first few days post-surgery, he was visited by friends and family who helped in distracting him from the pain that arose during recovery. After about two weeks post-surgery, he returned to school but was unable to walk. For the next few months of recovery, he had to use both crutches and a handicapped ‘scooter’ to comfortably move around. “For the most part, I just tried to make the best out of the situation,” Schmitz explained.
The days turned into weeks and weeks turned into months of having to wear a boot and using the crutches to help him walk from classroom to classroom. “Eventually, it felt like I was sort of helpless,” Schmitz explained, “because everyone was doing everything for me.” He stated that while he greatly appreciated when people would hold the doors for him, carry around his books and backpack, and drive him to and from school, it made him feel dependent on others and took away his sense of self-reliance. “I didn’t want people to feel like they had to help me,” he said. “I wanted to be able to do things for myself.”
“After an injury, your behavior changes,” said Jeff Rudski, a professor in the Department of Psychology at Muhlenberg. He explained that some of the main aspects of our identities are defined by our behavior and our actions. Injury-related restrictions make it difficult to perform actions the way a person normally did before an injury, which demands a change in things like their everyday routine. “When people are forced into changing,” he says, “they begin to feel foreign from themselves.” Rudski clarifies that this can compromise their ability to define themselves, causing identity drawbacks to begin to appear.
According to researchers Linda Sorkin and Tony Yaksha from the University of California, San Diego writing in the journal Neurotherapeutics, “behavioral reports are believed to reflect the underlying changes in nerve function after an injury.” Because immediate changes in our behavior can be linked to a loss in bodily function due to post-injury nerve damage, parallels can be drawn between behavioral changes “observed in the human after nerve injury” and the question of their identity.
When thinking about the stigma that follows an injury, it’s easy to blame it on societal expectations. But Ruski says that a lot of the time, injured people uphold expectations of themselves rather than worry about the pressure of society’s expectations. “You see yourself failing to accomplish those expectations and not living up to your potential,” he states. Because an injured person is unable to perform tasks or activities to their once able-bodied potential, an identity crisis is bound to develop. “It’s like you’re looking at yourself from an outsider’s perspective and you don’t recognize them,” Rudski explains.
“A lot of the time, it even goes beyond identity. It promotes ableism,” he continues. According to Ashely Eisenmenger, a writer with AccessLiving — an online organization that challenges stereotypes, protects civil rights, and champions social reforms — ableism is the notion that people are defined only by their disabilities and injuries. Similar to stigma, Eisenmenger states that ableism is rooted in “harmful stereotypes, misconceptions, and generalizations” and helps promote discrimination and social prejudice against injured people with disabilities, proposing the idea that that ‘typical’ abilities are superior. When someone questions their ability to maintain their sense of self-worth after an injury, the constant advertising of stigma and ableism directed towards them aids in identity loss.
Professor Rudski also highlights the role pity plays in terms of society and injured people. “There’s a big difference between doing things for people and doing things with people,” he says, “and what you see in society, through the pity-lens, is a whole lot of doing for people.” He remarks on how important it is to include those who are disabled and injured rather than simply doing things for them out of pity, which can aid in the loss of their identity.
“A typical belief associated with pity is that many creatures in the world suffer,” writes Israeli philosopher and President of the University of Haifa, Israel Aaron Ben-Zeév in an article published through PsychologyToday. “But a single person cannot do much to improve their situation.” This notion suggests that a disabled person is unable to be helped or guided by others without being pitied by society first. It promotes the idea that they are helpless and unable to improve themselves neither physically nor mentally.
Belittling them because of their situation further promotes the questioning of the current state of their injured physical self and their identity because of how degrading it feels to be pitied. For injured people like Christakis, Duffy, Schmitz, and Sokolowski recovering from their injuries is as much a mental journey as a physical one.
For my dad, that journey began while he was putting away a table and chair set in the upper level of our garage. The twelve-foot ladder he was using collapsed and brought him down with it, causing him to shatter his heel after he landed. It was devastating to my mom and the rest of my family, but even more so to himself, and with time we would come to learn that he would be unable to work or live his life regularly for the next six and a half months. Not only was he house-bound, but he was quite literally couch-bound because he couldn’t walk without the aid of crutches for the next couple of months of recovery.
“I felt like I was trapped in the living room,” he began. It was a quiet night in the Tully household. The TV was flickering in front of us and the volume was pressed low because my dad’s voice is usually quiet. He repositioned himself in the reclining chair so that he was sitting up and facing me. I glanced at his now healed ankle and the skinny meat of his calf muscle that had shrunk down during recovery. “I mean, you know. I sat on the couch-”
“Sulked,” I corrected him jokingly, and he let out a slight chuckle.
“I sulked on the couch for the first month of recovery. Not knowing when I would be able to return to work,” he paused, “and depending on you guys for pretty much everything I needed, well, that was the worst part of it.”