Stroke - A Different Approach by David Hearnden

A DIFFERENT APPROACH

In June’s PSW, BASW Cymru’s Robin Moulster talked about life following a stroke, and the patronising attitudes he has confronted. Is his experience typical? Does social work escape this criticism?

A stroke is the sudden interruption of the supply of blood and oxygen to the brain, often resulting in significant impairment or death. It can happen at any age, and to anybody. Yet, it’s generally seen as something that only happens to older people.

Every year, around 150,000 people in Britain have a stroke; a third dying as a result, a third being left moderately or severely disabled. Stroke is the single, largest cause of adult disability in this country, around a million people live with the effects of stroke, and the reason why many people end up needing social care. Yet, it is an area that has been ignored in social work. Why is this?

One reason may be the tendency to see stroke only through a medical lens (the medical model of disability), and not to recognise the impact that social and other factors can have on its cause, and the role that social work and social care can play in stroke recovery and living with stroke. This is reflected in the National Stroke Strategy (Department of Health, 2007), which understandably prioritised prevention  and acute stroke care to save lives, but paid much less attention to rehabilitation and the emotional and practical support disabled stroke survivors need to help them rebuild their lives.

Another reason could be the negative image of stroke that exists; that sees only loss and impairment, and does not recognise the strengths and resilience that survivors have, and the part that enabling social work practice can play in encouraging and helping them to get their lives back on track. Too often, the focus is on deficits not strengths, and rehabilitation and recovery, no matter how limited, is seen as hopeless.

This negative image is compounded by stroke’s association with old age. ‘It is something that only happens to old people; they are at the end of their lives and therefore there’s little that can be done to change this’. Defeatist and ageist, yes, but this tends to be the general view of stroke. It ignores the many ways that stroke survivors, whatever their age, can regain control over their lives if they are encouraged and enabled to do so.

The association of stroke with old age may also explain why social model of disability writers have similarly had little to say about stroke. Its analysis of how disability is socially constructed is as relevant for stroke as other conditions; yet, despite stroke’s prevalence and the complex impact it frequently has, it is ignored.

The image of stroke is of physical disability, but stroke can affect people in different ways. How stroke affects the person varies depending on the part of the brain damaged, its severity, their previous health and how quickly it was treated and how. The effects can be physical, sensory, cognitive, mental, psychological or a combination of some or all of these. This can make working with stroke survivors complex and challenging.

Whatever its effect, stroke is sudden and life changing. The things you took for granted, such as the ability to walk normally or at all, suddenly you are unable to do. The suddenness of stroke and the shock it causes leaves survivors struggling to understand what has happened to them, what it means and whether any recovery is possible. Often the change is so overwhelming that the person cannot see how they can get back from where they are. Depression is common. The resilience they might have had to deal with what has happened is shattered, and they cannot find the strength to rebuild their lives. Trying to help someone in this situation come to terms with what has happened, and start to rebuild their lives is not easy, and the social worker may think that nothing meaningful can be done.

There isn’t a manual for social workers working with stroke survivors, but, perhaps, Robin would agree that the basics of more enabling practice are:

  • greater knowledge and understanding of stroke
  • encouraging resilience and promoting strengths
  • adopting a recovery, enabling approach
  • relationship-based practice
  • multi-disciplinary working

Surviving a major stroke myself, which left me disabled, and having worked as a specialist stroke social worker, I know the important part social work can play in helping survivors to rebuild their lives, but also the damage that can be done by practice which is patronising and disabling. I’m not arguing for stroke survivors to have greater priority than other people we work with, rather that the complexities and challenges this area of work can throw up are recognised, and a recovery-oriented, enabling model of practice is followed.

David Hearnden