In the July 2023 edition of the monthly magazine for The Law Society Gazette, Daniel Lewis provided insight on how rehabilitation and depression can be linked and spoke about his own experience. View the article on page 23 here.

All rehabilitation services are both admirable and much needed in today’s world. As we know, there are some amazing companies and organisations out there that specialise in treating stroke victims, other brain and spinal injuries, and that make a remarkable difference to people’s quality of life.

Ten years ago, I had major surgery. I remember all too well after the surgery and during the period of recuperation, the physiotherapist coming round daily for a session to teach me to walk again and to get in and out of bed. At the time I resented and challenged this – all I wanted was to stay in the bed and sleep. I did not try, I just resisted. I was only in my early 50’s so deep down I knew I needed to get better in order to be allowed home, but I just did not have the will to let that happen.

Looking back on that period, I now know it wasn’t resistance as such – I was quite simply clinically depressed. It was never suggested by any of the nurses or doctors that this might be the case. Even though I would burst into tears if someone even said hello, depression was never diagnosed in order to get me better again. I did not even register it myself.

After a few months of being back home and not being able to straighten myself out, I went reluctantly to my GP who diagnosed Post-Traumatic Stress Disorder and clinical depression as a result of everything that had happened to me. He put me on anti-depressants and within a week or two I finally woke up from my dark place.

So, how can we link rehabilitation with depression? It should be easy you might think, but what I find interesting in retrospect is that when you need rehabilitation the most, is often the time when you most resist it. Perhaps, like me, you had given up and just do not want to wake up the next morning.

I find it amazing that the physio was clearly not trained to spot depression and with all her skills as a physiotherapist had not put two and two together. Treating depression is part of rehabilitation and I know that there are some rehabilitation organisations (such as The Rehab Physio) that actively see the mindset as part of the process. None of my friends spotted the depression either, so someone who has the ability to diagnose mental state is an important necessity for any rehab service.

Depression is as important as any other form of rehabilitation. When we think of the process of rehabilitation, we think about sophisticated machines helping patients to walk again, trained physiotherapists encouraging exercises, speech therapists and so on.

Then we come to mental rehabilitation.

A case that immediately springs to mind is that of the solicitor Sally Clark whose conviction for killing two of her children was quashed by the court of appeal. She served three years of a life sentence. In 2007, she died, a coroner ruling that she accidentally died from drinking too much alcohol. I do not know the ins and outs of the case, but I have to wonder whether there was enough mental rehabilitation given for her to come to grips with life after the case.

We do know there was tremendous family support, but often that is not enough.

Any form is healing, whether it be physical or spiritual, is totally dependant on whether you want to be healed in the first place. And what you want to achieve – you must want to get better. But if you have lost the will to live and it has not been spotted, any form of physical rehabilitation will be impossible. I would urge rehab practitioners to look at the individual they are treating for any form of depression that might hinder their future results. Alarm bells will often ring when resistance is shown.

In my experience, once the diagnosis of depression has been identified, and appropriate medication issued, it should not be too long before a change in the patient is noticed. Small signs such as wanting to eat, being pleased to see visitors and more crucially not battling against the whole rehabilitation process. Physical rehabilitation is of course essential, and with the physicality improving it goes without saying that the mental state will also improve. Think about achievement satisfaction when you can do something that a few weeks ago was unreachable. Hopefully, in the future depression can be treated as one of the main parts of rehabilitation and ,as in my case, ignored or not spotted.

I just hope that you, as the reader, will never have to go through what I did. And remember it is depression that can be the killer – not the injury.

Daniel Lewis is a Business Manager at Clayton Legal and a speaker on importance of noticing stress in employees.