Christina D. Howells, L.C.S.W.

The majority of patients who choose refractive surgery for vision correction have a good outcome and are happy with the results of the surgery. Their life is changed — for the better.

But what if you choose refractive surgery for vision correction and you have a less-than-ideal outcome or a very bad outcome? Your life is changed as well — but not for the better. Suddenly, you are in a life crisis.

What is a life crisis?

A life crisis is an unexpected event or occurrence that changes your life and affects you to such an extent that you experience a strong emotional reaction.

Like the death of a loved one, a divorce or a serious illness, your unexpected complications from refractive surgery may trigger emotions in you that can be intense and overwhelming. Any and all aspects of your life can be impacted, including your relationships, your health and your career.

Am I going crazy?

When you realize that your surgery has not turned out as you had hoped and your life is now in crisis, it is common to experience a series of intense and powerful emotions. The most commonly occurring are: shock, anger, fear, anxiety, panic, sadness, guilt, helplessness, depression and at times, hopelessness. The emotions are so strongly felt and so easily triggered that patients often ask, "Am I going crazy?"

Sometimes emotions during a crisis are so intense that it feels as though they are out of control — as if you are riding an emotional "roller coaster" with no end in sight and no way to get off.

The feelings can be extreme at times and your mood can change rapidly. You may feel quite fragile and often helpless.

Refractive surgery complications specifically can trigger fears of loss of vision, loss of career, and loss of the ability to experience and enjoy life as you know it. Loss, grief, sadness, shock, betrayal, mistrust, self-doubt, guilt, anger, helplessness and hopelessness can all be a part of the emotional reaction you feel.

Most post-refractive surgery patients quickly try to find medical solutions to their problems. Of course, that makes good sense and a quick medical solution can help resolve your crisis. But what if you don’t find a quick medical solution? What if your doctor can’t help, won’t help, or doesn’t know how to help you?

Learning ways to cope with your crisis can help you find relief from the intense emotions you are experiencing and also can help prevent your acute life crisis from developing into a long-term psychological problem such as clinical depression, anxiety or post-traumatic stress disorder. In understanding how to help yourself emotionally through this crisis, you may also contribute positively to your health and the healing process, as the mind and the body are intricately linked.

How can I learn to cope?

Cognitive coping skills

Cognitive coping skills are coping skills that use your mind to help you understand your feelings and your experience. In other words, your thoughts can be powerful tools to help you feel less helpless and distressed. Knowing, understanding, planning, strategizing — these are all cognitive coping skills that can help you through your crisis and make your experience less frightening, as well as ease the intensity of your emotions.

When you first realize that "something is not right" with your surgery or healing process, you may begin to feel fear, anxiety, worry and even panic. The next step typically is to ask questions of your doctor to help you understand what is happening. It is a natural reaction and an important step in coping with the crisis. If the doctor honestly answers your questions, recommends a treatment protocol and openly discusses what happened and what can be done, you will be well on your way to coping with the crisis. You have information, you have a plan and you feel supported by your doctor. You still may be anxious, worried and in shock, but because you have information you feel less alone and less prone to panic.

Unfortunately, most doctors DON’T honestly answer your questions. Most eye surgeons and eye doctors are not trained mental health professionals. They may not know how to respond to you. They may themselves be quite distressed about your complications and they can be quite uncomfortable when you are emotionally distraught. Instead of providing MORE information, doctors may provide LESS information so as not to "upset" you more that you already are. As a result, at the point that most patients are most in need of information from their doctors, they often receive very little. Most patients are frightened and anxious and place their utmost trust in their surgeon. When there are no answers, no explanations, no plans for resolution of the problem, the intense emotions become even more intense. Now, a sense of betrayal, paranoia and distrust are added to the above emotions.

Patients have reported that when they were anxious and in need of reassurance, their doctors were dismissive, irritated and even angry toward them. Patients have even reported that their doctors suggested that the intense emotions that they were experiencing were the CAUSE of some of the complications rather than a reaction to those complications.

So, if you go to your doctor for answers that will help you cognitively understand and emotionally cope with your complications, and your doctor does not give you the answers that could help, what can you do?

Finding information you need from other sources is the strategy you may need to pursue next if your doctor is not forthcoming or (as is sometimes the case) doesn’t actually KNOW what the problem is. Seek other qualified medical opinions (again and again, if needed); ask other patients about similar experiences; research medical journals; search the Internet. You need to know, you need to understand, you need to THINK so you can feel less helpless.

Emotional support

Friends and family can provide emotional support and comfort. Feeling comforted and cared for helps relieve the intensity of emotions because you feel less alone in your distress. With friends and family, you can feel safe to express all the emotions you feel. Don’t keep what is happening to you a secret. Tell someone who cares about you what you are experiencing and all the emotions you are feeling. It helps to share the burden with someone who cares about your feelings.

Talk to someone who has had similar experiences, via e-mail, on the phone or in person. Read the posts in the Internet forums describing other people’s experiences and feelings. It can be very comforting to know that other people have felt what you feel, that your feelings are real and are valid. It will help you feel less frightened, less alone, less vulnerable and less helpless.

Realize that you will rarely find someone who has had the VERY SAME experience with the VERY SAME feelings, but you will feel better if you read that people have had similar experiences and feelings. Search out the people with whom you can identify, and communicate with them.

Don’t let people tell you HOW to feel. Sometimes people do not know how to respond to you and may try to tell you how you should or shouldn’t feel. There are no right or wrong feelings when you are on the roller coaster of emotions that are triggered by a life crisis. One moment you may be scared, the next full of anger, the next sad and despondent. Find people who will listen and care.

Emotional support and validation from others can ease the intensity of your emotions and help you cope with your crisis.

Taking action

When your feelings are overwhelming and you feel helpless and hopeless, your natural tendency is to withdraw. It seems like withdrawing, avoiding or blocking out your feelings will help you feel better. In fact, it does not. Moving against the natural tendency to withdraw and instead becoming active will help you to cope.

As you learn and think about the information you are discovering (cognitive coping), the next step is to start acting on the information. Make appointments with your doctor, get your records, make appointments with second opinion doctors, search out new research, make new plans, get new medications and keep active in finding solutions to your complications.

Push yourself to get active in the rest of your life, as well. Get out and see friends, take part in activities. Don’t let yourself sink into inactivity. Even if you have very little energy or motivation, try to get active. It will help you to cope.

There are theories that becoming active instead of sinking into inactivity releases a chemical in the brain that helps relieve depression. Activity of any kind will help. Exercise, fun activities, housework, yard work, errands, walking the dog, even mundane tasks that get your body moving will help improve your mood and help you feel less helpless and distressed.

Do I need professional help?

You can seek professional help (counselor, psychotherapist, psychologist, psychiatrist, minister/pastor/priest) at any stage of your crisis. All of these professionals are trained to help you understand the crisis you are in, support your feelings and help you develop a positive coping strategy to move you through the healing process.

You don’t have to have an "official" diagnosis of depression or other psychological disorder to see a mental health professional. They are all trained to help you through your crisis and they are also trained to evaluate whether your life crisis has developed into a more serious psychological problem.

How do I know when a life crisis becomes a more serious problem?

Generally, the severity of the symptoms, the duration of the symptoms and how profoundly these symptoms affect your daily functioning are the key factors that differentiate a life crisis from a more serious psychological problem. Everyone is unique and for many different reasons, everyone reacts differently to a crisis. Most crises will gradually improve and resolve over time. But for some people, the emotions are quite debilitating in intensity and linger so long that normal day-to-day functioning becomes difficult.

How do you know if this is happening to you? Some things to ask yourself:

• Am I unable to sleep at night?
• Am I sleeping too much in the day?
• Am I eating too much?
• Have I lost my appetite?
• Am I too tired and listless to perform my daily tasks?
• Am I unable to feel any pleasure?
• Am I having trouble concentrating?
• Am I having panic attacks?
• Am I having constant worried thoughts running through my head?
• Does my chest hurt because of the anxiety I am feeling?
• Have I gained or lost weight suddenly?
• Am I having frequent crying spells?
• Am I unusually irritable or angry?
• Am I drinking to excess?
• Am I doing any other activity to excess (compulsively)?
• Do I feel like a failure?
• Do I think about hurting myself?
• Do I dread waking up in the morning?
• Do I feel like giving up?

If you answered yes to at least 3 of these questions and these problems are lasting longer than a few weeks, you may need to see a mental health professional or your doctor to help evaluate and treat your condition. If you are diagnosed with a more serious psychological problem, a combination of medications and psychotherapy can be effective in helping you feel better.

Most people feel periods of depression, but when the depression lasts longer than a few weeks and affects all aspects of your daily life, relationships, job, family and health, you may be suffering from a more severe form of depression that requires medication for treatment. Please see a mental health professional or your family doctor.

Why do some people “get over” a crisis right away and others stay emotionally distraught, anxious or depressed?

There are many reasons why some people “bounce back” from a life crisis and others continue to sink deeper into feelings of helplessness, depression or anxiety.

A family history of depression or anxiety, or previous episodes of depression or anxiety in your own life can be a contributing factor. The presence of a supportive network of friends and family can be a factor. Previous life crises and personal losses, especially unresolved ones, can be a contributing factor. And specific to refractive surgery, the extent that the complications affect your vision, your daily life, your family and your job can be a factor.

How can I help someone who is experiencing a life crisis?

Complications from refractive surgery and the resultant life crisis may happen to someone you know. How can you help them through this crisis? There are a few things to consider.

Give your emotional support: listen, and allow them to share their feelings with you. Don’t judge or evaluate their feelings. Don’t judge or evaluate their decision to have refractive surgery. Just be there and let them know you care about them. Let them know they are not alone.

This can be more difficult than it sounds. We often want to DO something — give advice, or make things better for people we care about when they are in emotional pain. People are unique and react to crises in different ways, but unfortunately we tend to expect other people to think and feel the same as we would in similar situations. Support involves listening, not judging. For instance, one person could be furious and another could be sad, one person could be hopeful and another cynical in response to the same event. Don’t judge, just listen and let the person know you care. If you don’t agree with their thoughts or can’t identify with how they are feeling or reacting, keep it to yourself. Just let them know you care about them.

Encourage them to seek help. Help them find a second opinion doctor or find information about refractive surgery complications in journals or on the Internet. Encourage them to find a mental health professional for counseling or psychotherapy.

Help out with daily functioning. Lend a hand with taking care of the kids, housework, yard work, grocery shopping, drive them to their appointments, run errands for them. Be there to relieve some of the daily burdens.

How can I prevent an emotional crisis from happening to me?

If you are now in the process of deciding whether to have refractive surgery for vision correction, you are probably asking yourself what you can do to prevent a life crisis from happening to you. The statistics are in your favor that you will NOT experience complications from your refractive surgery. But what if you do? Can you emotionally prepare yourself for that possibility?

The old saying, “forewarned is forearmed” is applicable in any kind of elective surgical procedure. If you have a cognitive understanding of all the possible complications that could conceivably happen to you, you are already well on your way to developing an effective coping strategy. The shock and helplessness that many patients feel when the outcome of their surgery is completely unexpected contributes to the intensity of their emotional reaction.

If you consider what could possibly go wrong, have discussed it with your doctor, discussed it with your family and friends and still choose refractive surgery, and all goes well, you will be quite happy. If you consider all the information of what could possibly go wrong and something does go wrong, you will have already THOUGHT about it, already had friends and family who will provide emotional SUPPORT and you will have already taken some ACTION because you and your doctor will have had a prior discussion regarding possible complications and treatment recommendations.

When will I start feeling better?

A life crisis usually does resolve over time and the emotional intensity does gradually lessen. Developing a coping strategy that works for you will help lessen the intensity of your emotions and move you more quickly through the process toward resolution. Everyone is different and each person has his/her own time frame for recovery.

But it does get better.

I wish you the best.

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Christina Howells is a licensed psychotherapist in the U.S. with over 25 years of experience. She had LASIK vision correction surgery in 1999 and has had many complications over the years since then.