‘An ongoing journey’: A qualitative case-study exploring growth following spinal cord injury

Abstract

This qualitative single-case study explores the lived experiences of posttraumatic growth (PTG) and posttraumatic depreciation (PTD) in an individual following spinal cord injury (SCI). A narrative analysis approach enabled the collection of multi-layered and rich insights into the lived experiences of Melanie, a doctor who has had a SCI for over 6 years. Melanie’s woven narrative showcases the complex interplay between PTG and PTD, with her adjustment to a new way of living being described as ‘an ongoing journey’. We highlight Melanie’s emergence of PTG as well as the challenges she has faced in the aftermath of her SCI. The findings represented by five themes: Adapting to a new way of living; Recognising what matters; Relationships and the two sides of its coin; The personal nature of spirituality; and Reflections: ‘we are a hard population to talk to’ demonstrate the coexistence of PTG and PTD in the aftermath of a traumatic event. Future research should explore this further, given the potential implications for the provision of holistic and person-centred SCI rehabilitation strategies.

Introduction

Globally, 250,000–500,000 people sustain a spinal cord injury (SCI) each year (World Health Organisation, 2013). An SCI involves trauma to the spinal column, damaging cells and nerves that transmit signals between the brain and body (National Institute of Neurological Disorders and Stroke, 2023). It may be complete, with no motor or sensory function below the injury level, or incomplete, with partial preservation of function (Waters et al., 1991). Beyond physical effects, SCI profoundly impacts psychological wellbeing, often causing stigma and social disconnection (Budd et al., 2022). Individuals report poorer mental health and wellbeing than the general population (Carrard et al., 2021), face higher risks of anxiety and depression regardless of injury severity (Khandelwal et al., 2022), and experience reduced quality of life (Lude et al., 2014). SCI also heightens vulnerability to traumatic stress reactions and PTSD (Cao et al., 2017), with 5.8%–11% of post-SCI deaths attributed to suicide (Kennedy and Garmon-Jones, 2017). Given the significant physical, psychological, and social changes that accompany SCI, psychological adaptation is a normal and complex process. This can encompass internal cognitive and emotional components (i.e. grief, uncertainty, alterations in thinking, one’s identity, sense of self-efficacy) as well as external ones (i.e. adapting to social spaces and environments, addressing systemic barriers when living with a disability; Barclay et al., 2019). SCI can also impact one’s sexual sense of self and intimate relationships. Among others, primary physiological effects include a reduced ability to experience orgasm, and erectile dysfunction in men (Earle et al., 2020). However, it appears that secondary (i.e. bowel/bladder issues, pain) and tertiary (i.e. changes in body-image, relationships) effects of the injury are seen as more impactful on one’s sexuality following the injury (Earle et al., 2020), with changes in self-esteem and anxiety about intimacy post-injury impacting it as well.

The mantra ‘what doesn’t kill you makes you stronger’ is concomitantly spread within our cultural narrative, suggesting traumatic events can offer a chance for individuals to emerge stronger and experience posttraumatic growth (PTG; Tedeschi and Calhoun, 1995). PTG is defined as a positive psychological change that arises following a highly challenging situation (Tedeschi and Calhoun, 1995) and involves an improvement in psychosocial functioning (Barskova and Oesterreich, 2009). This narrative is promulgated in the SCI community and has been evidenced in the academic research (e.g. Kalpakjian et al., 2014; Pollard and Kennedy, 2007). The Posttraumatic Growth Inventory (PTGI; Tedeschi and Calhoun, 1996) is a validated questionnaire that captures five domains of growth: enhanced interpersonal relationships, increased personal strength, enhanced spiritual and existential change, greater appreciation for life, and new possibilities (Tedeschi and Calhoun, 1996). As PTG is a multi-dimensional construct, it does not develop equally across all domains in individuals with SCI. Kunz et al. (2019) identified a change in priorities in their lives, a greater sense of closeness to others, and being stronger than they thought they were; however, nearly half of the sample reported no spiritual development or identification of new opportunities. However, some researchers have questioned whether reports of growth may, in some individuals, represent adherence to a cultural script and reflect cognitive distortions, acting as a self-defence mechanism to manage emotional distress in the short term, but not long term (Maercker and Zoellner, 2004). Kunz et al. (2018) argued it is possible to distinguish between individuals experiencing actual and illusory PTG through whether they also report negative consequences of trauma (i.e. posttraumatic depreciation, PTD).

Posttraumatic depreciation (PTD) is an inverse and independent construct of PTG referring to negative changes across the same domains (Baker et al., 2008; Barrington and Shakespeare-Finch, 2013). Illusory PTG may hinder individuals from acknowledging PTD, as it is proposed to serve an avoidant, denial-like function. PTG and PTD are positively related (Kunz et al., 2017) demonstrating that they can co-occur. High trauma exposure is associated with depreciation profiles and correlates with increased depression, anxiety, and posttraumatic stress (Rønning et al., 2025). Zięba et al.’s (2019) findings highlight the coexistence of these two processes in the aftermath of self-reported trauma in students, with participants experiencing both PTG and PTD in the domains of personal strength and interpersonal relationships. Quantitative studies in the last decade have explored both PTG and PTD in SCI across a wide range of sub-topics and using different methodologies. In a quantitative study of 122 participants (Kunz et al., 2017), individuals with SCI, who report both PTG and PTD had lower depressive symptoms, while those who experienced only PTD had lower life satisfaction and poorer physical functioning. Using a longitudinal design, Kunz et al. (2018) identified coping flexibility (the ability to use both approach- and avoidance-oriented coping strategies) with SCI individuals’ experiences of PTG, suggesting that fostering a flexible coping style could be target for intervention. They also found that retrospective self-reports of PTG/PTD made soon after injury showed weak links with changes measured later on, suggesting that some early reports may be partly illusory. Building on this research, Kunz et al. (2019) examined the metric properties of the PTG/D-SF and their findings, using cross-sectional data in a sample of SCI patients, concluded that PTG and PTD should be conceptualised as distinct concepts, rather than opposite ends of a continuum. More recently, Müller et al. (2025) explored this further and found similar findings that highlighted the value of exploring individuals’ qualitative experience of PTG and PTD in the context of SCI. Qualitative studies in this area can provide valuable insights into what factors might contribute to the found discrepancies in retrospective self-reported PTG/D versus actual longitudinal measured changes.

Despite this, almost a decade later, no other qualitative studies have explored both PTG and PTD in individuals with SCI. Given the conceptual distinction between PTG and PTD, there is a need to understand both the positive and negative changes of SCI through the lens of those who have experienced SCI. The present study aims to fill this gap by utilising a qualitative single-case study design, which seeks to collect multi-layered, rich insights into the lived experiences of the participant (Thomas, 2011). By using this approach, we aimed to capture one participant’s deeply personal and intricate journey of adjustment following SCI while accounting for her idiosyncratic personal story. This approach allows for an in-depth exploration of the interplay between the individual’s characteristics, environmental factors, and the distinctive challenges posed by SCI that quantitative research studies may not capture.

Method

Design

Experiencing an SCI involves the negotiation of multiple complex issues including the re-storying of life and the navigation of new body-self relationships (Sparkes and Smith, 2005). To access the lived experiences and changing narratives of one individual who acquired an SCI, this study was rooted in an interpretivist epistemology and a relativist ontology (Guba and Lincoln, 1994). Through a narrative analysis of interviews with a participant with a medical background, we acknowledged the existence of her reality, experienced in time, space, and subject to the medical narratives of being both a medical practitioner and a patient. In the study we have emphasised the meanings she created and attributed to her experiences.

The researchers and the participant

Ioana, the first author has an interest in SCI from an academic health perspective. Karen, the second author, is a sport psychologist with an applied and research interest in PTG and novel qualitative methodologies. Heidi, the third author is a health psychologist with a research interest in underserved populations within healthcare. The participant, Melanie (pseudonym), has a medical background and works in the NHS, she experienced an SCI in 2017. Certain details have been changed to protect her identity while ensuring none of the changes impacted on the presented narrative.

Ethical considerations

Ethical approval for the study was obtained through the authors’ university ethics committee. Key ethical considerations included informed consent for Melanie, including explicit consent to disseminate her story, and a defined protocol that comprised immediate referral to support services if needed, to mitigate potential emotional distress in Melanie. Prior to each interview Ioana checked that Melanie was alone in a safe and secure environment. To address any potential impact on the researcher (Palmer et al., 2022), Ioana engaged in regular support meetings with the other authors.

Recruitment and procedure

The study was advertised at an SCI charity which runs peer-support groups and was promulgated via word of mouth. The eligibility criteria involved: being 18 years of age or above, being fluent in English, and not being involved in the management of any third sector organisations. The latter avoided any conflict of interests. The participant must have sustained the injury between 5 and 10 years ago. This timeframe was selected as adjustment to SCI is an evolving process, taking anywhere from 2 to 7 years (Dijkers, 1997). Woodbury and Redd (1987) found people with SCI experience psychological distress around 3–5 years post-injury, it is at this juncture patients reported feeling the complete impact of the injury on their lives. Two individuals expressed an interest in taking part, however, only Melanie met the selection criteria to participate as the other individual experienced injury less than 5 years previously.

An interview guide, informed by pre-existing research addressed key areas of interest (i.e. Melanie’s life history (interview 1), identity pre- and post-injury, the impact on relationships, physical and mental health). She was interviewed remotely on two occasions via Microsoft Teams to overcome geographical and physical mobility constraints (Janghorban et al., 2014) and to provide flexibility around her schedule. The first interview lasted 80 minutes and the second, 90 minutes with a short break just over half way through (m = 85 minutes). Although Teams recording captured both audio and video, only the audio content was used, and the video was deleted directly after the interview. The audio was transcribed verbatim. During each interview, Ioana adopted the role of an active listener (Louw et al., 2011) while using prompts (e.g. ‘Could you share more about how that has changed you?’) to access more in-depth information. She was neutral and non-judgemental, asking open-ended questions (e.g. “would you mind telling me about your experience of being in hospital after the injury?), and avoided offering advice or interrupting Melanie’s discourse (Walcott, 1994). An unstructured life-history interview enabled the provision of a first-person narrative of Melanie’s life story and unique perspective (Davies et al., 2018). The second interview was semi-structured and informed by Melanie’s life history interview.

Analytical techniques

Interviews were analysed using Narrative Analysis (NA; Lieblich et al., 1998) to interpret how Melanie made sense of her experiences (Smith and Sparkes, 2009). NA is suited to exploring perceived adjustment after SCI to construct meaning from lived experience (Busanich et al., 2014). Analysis followed descriptive and interpretative phases (Murray, 2015). The descriptive phase involved repeated reading to identify key themes (e.g. PTG, PTD) and narrative elements, which were inductively coded to capture Melanie’s posttraumatic changes. The interpretative phase linked these narratives to theoretical literature (Murray, 2015), including PTG (Tedeschi and Calhoun, 2004) and PTD (Baker et al., 2008). To enhance trustworthiness, the findings were presented in Melanie’s words, arranged to form a cohesive narrative (Waldron et al., 2011). A layered approach. Co-constructing meaning alternated between Melanie’s voice and theoretical interpretation (Ely et al., 1997). Ioana adopted dual roles of storyteller, presenting Melanie’s account, and story analyst, applying theory to explain her actions (Smith and Sparkes, 2009).

Quality

Establishing trustworthiness was central to this research and was achieved through alignment between our interpretivist epistemology, relativist ontology and methodological choices. Dialogic engagement (Smith and Sparkes, 2008), the view that knowledge is co-constructed through dialogue between researcher and participant, and between the research text and its readers, enhanced authenticity by recognising the relational nature of meaning-making in our interactions with Melanie. It also strengthened credibility by ensuring that our interpretive processes were transparent. Ongoing reflexivity was essential in shaping how questions were asked, particularly in the unstructured first interview, how Melanie’s accounts were interpreted, and how meanings were constructed in the final write-up. Ioana engaged in reflexive journalling (Finlay, 2002) after the first interview, where she also noted initial ideas for themes and potential probe questions (Sparkes and Smith, 2005). Regular meetings with the second and third authors, who acted as ‘critical friends’ (Sparkes and Smith, 2005), further challenged and refined her initial interpretations. Finally, member reflections (Smith and McGannon, 2018), coherent with our philosophical positioning, were conducted with Melanie to invite feedback on the interview and ensure her perspectives were carefully considered in the representation of the findings.

Findings and discussion

There were so many times . . . [when] I was like: ‘I’m fine, I’m gonna get on with this, I’m gonna do all these things’ and I’m really proud of what I’ve achieved. Don’t get me wrong, but acceptance of what was going on has been, and still is, an ongoing journey.

This ongoing journey involved both positive and negative aspects of posttraumatic adaptation represented by five themes: Adapting to a new way of living; Recognising what matters; Relationships and the two sides of its coin; The personal nature of spirituality; and Reflections: ‘we are a hard population to talk to’.

Adapting to a new way of living

From an early age, Melanie wanted to become a doctor. She grew up around illness, with family members suffering from a variety of health conditions. Her mother was a healthcare professional exposing Melanie to the medical world from a young age, and equipping her with an understanding that influenced her career aspirations:

Back in those days as well, health and safety wasn’t as strict and if mum couldn’t find someone to look after me, I’d go with her to work . . . The. . . medical professions have been my entire life essentially, so I don’t think it’s surprising . . . I left school, I started working as a nursing assistant and I did the whole way through my degree.

Coming from a working-class background, Melanie acknowledged it was not easy, but she ‘went for it’. By the time of her SCI she was already qualified as a doctor. Melanie reflected on how her situation was unique due to her medical background:

[I knew a lot of what] was going on, but then at the same time I’m not a specialist, so there were things that I wasn’t sort of up to date on. And so, it did affect not just my perspective, but how I was treated in a way . . . and being taken in, in quite dramatic fashion, I think it did affect some of them.

Melanie acknowledges the shattering impact SCI had on her body-self relationship which led her to reassess and shift her perspective on life:

Spinal cord injury affects so much of your body and personality . . . Your perspective shifts on what’s important in life and I think it has to in some ways, in order for you to kind of get on with life and (sigh) adapt to what’s happened to you.

This re-evaluation of her embodied experience appears necessary to accommodate a new way of living (Linley and Joseph, 2004). It represents her development of personal strength in the face of adversity, a key component of PTG (Tedeschi and Calhoun, 2004). We interpreted her sigh as a reflective pause in which she contemplated the weight of the adjustments she has made.

Throughout Melanie’s narrative, it was evident being a doctor influenced the way she adapted and helped her cope with the injury. Her continued medical practice gave her purpose, positively linked to greater PTG (Tsai et al., 2015):

I’m still massively dedicated to my work. I’ve always been quite goal orientated and, like I’ve said, my career was a big focus and getting back to that and . . . always trying to push forward and get to the next bit. I think that really helped in terms of the [injury], in having sort of that goal orientated mindset of what I was gonna do and what I wanted to do and having that kind of drive and sense of purpose.

Melanie evidenced PTG as she was open to new possibilities (Linley and Joseph, 2004). Despite being unable to walk, she adjusted through reframing her sense of purpose and adapting to a new way of being a doctor:

There are other doctors in wheelchairs that work, and I want there to be more. I want that widening participation to happen because I think it is important. There are so many things that I can do from the chair - I can still be a doctor, I can still live a life. It’s more difficult, but I didn’t wanna give up on that just for the sake of walking, which might sound very strange, but for me the key was to get back to work, to not lose the stuff that I’d worked so hard for, and I’ve really enjoyed.

Melanie reflected on the impact her SCI had beyond her physical health. This emphasises the multilayered impact of SCI, the psychological adjustment, and potential shift in self-perception following such an injury (Kennedy et al., 2009). Her professional identity and desire to make a positive contribution through helping others served as positive motivators to help her navigate the challenges of her injury and find new ways of living. She explains this using a second person positioning, potentially distancing herself from the experience:

So many psychological and physical changes happen, and so many of those physical changes are so taxing, psychologically speaking. Being incontinent . . . is not something that’s easy to deal with. Your perception of your own body, how attractive you feel, how independent you are or aren’t really affects the way you see yourself. And it’s quite a difficult task to try and (long pause and sigh) sort of hold on to who you are and move forward. . . . After you’ve got through the initial shock and the anger and the upset - you also have this sort of altered view of what’s important and, what things you wanna do. And you have to completely reevaluate your life in some ways. I mean, for me, the key thing was to go back to work, and so it was this whole thing of trying to get through that and decide what your priorities were. And [this] may sound very cheesy (chuckles), but you know, it genuinely was why I wanted to be a doctor - I wanted to help people. I did cognitively reframe what I’d gone through as something that could improve my ability to care for others because I now had a platform to advocate for other disabled trainees too.

While reflecting on her ability to reframe her purpose and identity, Melanie acknowledged both her progress and the challenges she faced. Her struggle with physical realities, such as incontinence, and the impact it had on her body image and self-esteem illustrates the psychological burden associated with physical disabilities (Taleporos and McCabe, 2002) that can lead to a re-evaluation of personal identity. Melanie’s shift in perspective on what is important underpin a cognitive reframing of her experience and the integration of her traumatic experience (Salick and Auerbach, 2006). This enabled her to move forward and pursue her aspiration of caring for others:

Everybody thinks one who has been paralysed the only thing they’re ever gonna think about again is walk, how they could walk again. But that wasn’t the biggest thing to me, you know? Yeah, of course, it would be great to be able to walk again, but mobility is not by any means the most important thing. I’ve still got a life expectancy, this hasn’t killed me. . . . I don’t wanna spend the rest of my life miserable just because I can’t walk. I didn’t want it to be, because being in the health industry before I’ve seen people with chronic illnesses that become so kind of bitter and closed off and don’t wanna go out, don’t wanna socialise because it is so difficult. And so, they kind of hide themselves away and they’re embarrassed about the things they can’t do or how they look or whatever. And I just didn’t want to be that.

Melanie’s insights reflect the intricately intertwined dual nature of facing difficulties (PTD) while concurrently experiencing positive changes (PTG). However, Melanie’s expressed desire to remain visible to others and to concentrate on the positive aspects of her situation, acknowledging that, although she is unable to walk, she still possesses a meaningful life, may be indicative of illusory growth (Maercker and Zoellner, 2004). Illusory growth functions as a protective mechanism while simultaneously reflecting elements of denial. Melanie’s assertions may therefore be interpreted as reflecting adherence to the broader cultural narrative that ‘what doesn’t kill you makes you stronger’.

Recognising what matters

The SCI not only impacted Melanie’s identity and an adaption of her approach to caring for others, but also brought the challenge of accepting specific limitations on activities she could no longer engage in:

I love being out in nature. When I was in rehab, I think one of the most helpful things for me [was to] go out and sit in the garden every day because I just needed to see some green and blue (laughs). Since my [injury], not being able to go out and enjoy nature it’s been really difficult. . . . my partner’s recently bought me a track wheel and some off-road wheels. . . . I love being out in the forest or on the beach and things like that. There are days where you think ‘I just wanna get out the car and walk up that hill’. And that is really kind of bittersweet, because . . . there’s always this kind of undercurrent of ‘I wish I did more of this before’. It really is wonderful just to be able to go off walking. Well, I say walking, but you know what I mean.

Her insights highlight the shift in appreciating life’s ‘simple pleasures’. Using equipment represents a physical and practical adaptation and profound psychological adjustment, allowing Melanie to reconnect with nature, and a part of herself she feared lost. This adaptation impacts on identity, resulting in a deeper appreciation for life experiences previously taken for granted (Tedeschi and Calhoun, 2004).

While Melanie has adapted to a new way of life and finds joy in the outdoors, she acknowledges this co-exists with a part of her that mourns the loss of potential life experiences:

I was never a particularly sporty person. I’m still not . . . but you realize how important it is to look after your body. This great sense of loss about things that I didn’t do enough of before my [injury].

Melanie expresses regret over not having had engaged more in outdoor activities pre-injury, illustrating the bittersweet nature of posttraumatic appreciation for life. While the sense of loss and regret is indicative of PTD, it can serve as a stimulus for a renewed perspective in which one acknowledges the importance of not taking the small joys in life for granted.

Relationships and the two sides of its coin

Melanie reflected on how the physical ramifications of SCI impacted her relationship. She felt isolated with others not fully grasping her situation:

At the beginning it can make you very grouchy and irritable and you can lash out at your loved ones because you’re so frustrated at this kind of new body that you’re in. Everybody’s pain is their own and suffering is not something that is comparable, but there are times when if I’m having a particularly bad pain day. . . and friends or relatives . . . are complaining about [having] a bad shoulder or a bad back and all the rest of it. And there is a tendency . . . to be like, ‘yeah, I’m in pain all the time, like what do you want?’ (chuckles) . . . And to be honest, even some of my closest friends have no idea what I go through every day.

Melanie highlights the complexity of interpersonal dynamics when dealing with the frustrations stemming from physical limitations and chronic pain. Initial feelings of irritability and a tendency to lash out underscore a common challenge, the strains on personal relationships leading to experiencing depreciation in relationships (Jeyathevan et al., 2019). Melanie reflects on how SCI impacted her relationships by making her less likely to disclose her experiences:

There’s real complexity here and I get a lot of emotional support from a small circle of people that have shown up and been there for me, and that is something that I can’t deny, and I can’t be more grateful for. At the same time, when you are chronically unwell - and there’s always something; not wrong, but there’s always something going on - you can feel you can’t talk about it. And I do talk about it, but there’s this sense [that] people are going to get fed up with this, [that] people don’t wanna hear all this all the time. And so, there is this sense of closing yourself off from people in that way because you don’t wanna be honest about what’s going on because it’s a downer.

This speaks to Melanie’s internal conflict of seeking emotional support versus not wanting to overburden others whilst maintaining a sense of normalcy and independence and represents her adherence to what Yoshida (1993) refers to as the ‘middle self’, a dominant identity outcome that fluctuates between both the disabled and nondisabled aspects of self.

Melanie reflected on how the physical intricacies of her injury affected her romantic relationship at the time. She understood someone able-bodied might struggle to comprehend their partner’s new way of being (Kreuter, 2000), with the trauma of the event putting a strain on the non-injured partner (Kreuter et al., 1998). Melanie reflected on the effect her injury had on her intimate sense of self, an aspect that impacts the quality of life of many people with SCI (Anderson et al., 2007). Perhaps surprisingly, given her medical background, Melanie used colloquial expressions (e.g. ‘down there’) when discussing issues of intimacy, opting for language aligned with everyday cultural and linguistic norms rather than clinical terminology. This choice may reflect an attempt to distance herself from the medicalisation of her own experience, to manage vulnerability, or to speak as a person rather than a professional.

I was actually [in a long-term relationship] . . . and he decided to stay with me . . . [but] . . . he just couldn’t cope with the reality of it. Then as a woman – well, as anyone – you think about sex and things like that, but that’s so different now. At first, I couldn’t feel anything down there. And people don’t talk about it, but that’s a big part of life, [it] is a big part of relationships, and you have to navigate that, which isn’t easy. But I mean, he left, and he moved out, and then it took me a year to get carers in to help me. I was absolutely at breaking point, and I just couldn’t find any help. . . . But then at the same time I can completely understand how difficult it is for somebody who is able-bodied to be with someone who is disabled if they haven’t had experience of that world.

She reflected on the difficulty navigating non-romantic relationships:

One of the things that got me through . . . was this overwhelming sense of support from people that knew me. . . . And it’s so situational, and then sometimes it is difficult to start new relationships and new friendships because it’s bringing somebody into a world that they don’t understand and that rough things that you don’t want to show and particularly in sort of romantic relationship, that journey is really difficult. Because at first you can kind of hide some of those things, not even intentionally, just in a way you wouldn’t invite a boyfriend into the bathroom with you when you’re just getting together. But there comes a point where you then get to this thing of like ‘Oh, God, are they gonna think I’ve been hiding this all this time?’ and it’s just - you going through it together, this kind of process of being able to reveal more of yourself.

The outpouring of support strengthened her relationships and emphasised the value of social support in promoting PTG following a traumatic event (Prati and Pietrantoni, 2009). Her narrative challenged societal perceptions of disability, arguing physical limitations do not diminish one’s value as a partner (Flanagan et al., 2015). Nonetheless, Melanie’s insightful exploration of the dual nature of relationships in the aftermath of her SCI highlights the deepening of existing relationships and the struggle in forging new ones representing both PTG and PTD.

The personal nature of spirituality

Following SCI, Melanie reached a better understanding of spiritual matters. While previously ambivalent about religion, Melanie shifted towards mindfulness and spirituality following injury (Tedeschi and Calhoun, 2004):

I was brought up Christian. I ended up . . . agnostic during medical school and then in the two years after I just was more sort of atheist about things and was quite sort of science focused. And when my [injury] happened, I had to look at what made me feel better . . . . So quiet reflection and contemplation, empathy, being out in nature and feeling a connection with sort of living things and our planet, you know, that kind of thing. And that’s how really, I recognized what I was doing as mindfulness practice, really. And when I had an episode where my PTSD got really bad that’s how I started looking into posttraumatic growth and I’ve found that in the literature there’s a lot about having a belief and having something bigger than yourself and feeling a purpose, but also that sense of connection to something bigger than ourselves. Now, whether that is a belief in God - I don’t necessarily believe in a God. However, I do believe that there are things within our existence that we cannot always explain, and if that is a sense of spirituality, so be it.

Using mindfulness to cope with PTSD, suggests a move towards finding meaning and adaptive coping strategies to foster a connexion to something greater than oneself. However, Melanie’s familiarity with the concept of posttraumatic growth, informed by her own research, may reflect adherence to a broader cultural script that frames trauma as a catalyst for existential or spiritual transformation (Tedeschi et al., 2018).

Delving deeper into the complex interweaving between spirituality and relationships in her life, Melanie discussed the impact her injury had on her parents:

My mum completely lost her faith. My dad is a complex character. He was a complete atheist. And then when my dad’s [parent] passed away, he had sort of a spiritual experience . . . and [has] had a very strong faith since. He’s really struggled with my [injury] and faith. It’s kind of gone the opposite way for me and my parents. I’ve not come back to my faith because I don’t consider myself to have one. But I have come back to the principles that I relied on in childhood and growing up with illness and grief. And I’ve come back to those coping mechanisms to deal with my [injury], which I do feel are spiritual; whereas my parents have kind of lost faith because of what’s happened to me. And I found that very sad, and I blamed myself for a long time for that.

Melanie’s account explores faith, family dynamics, and coping mechanisms. The contrasting shifts in her parents’ beliefs illustrate how trauma affects not only the individual but also relatives who experience vicarious trauma, the emotional and psychological impact on those close to a trauma survivor (Pearlman and Mac Ian, 1995). This underscores how trauma reverberates through families, with parents often experiencing vicarious trauma following a child’s injury (Barnes et al., 2002).

Reflections: ‘We are a hard population to talk to’

Melanie’s reflections highlighted the challenges of engaging specific SCI sub-populations in research. The difficulty in communication about these topics and the resulting isolation of some with SCI highlight a broader issue whereby the lack of investigation of the experiences of hard-to-reach participants may introduce a positivity bias into research findings. Melanie’s openness about her personal experiences contrasts with the reticence others may experience, particularly due to stigma associated with SCI (Monden et al., 2021):

We are a hard population to talk to - the ones of us that are sort of doing alright are busy, and the ones of us that are not doing so great I think you come up against that problem of people withdrawing and isolating and not wanting to admit [it] because some of these things are really difficult to talk about. I know I’m very open about all of it, but I also appreciate other people may not be. That also might be because of my healthcare background. You know, I find it easier to talk about bowels and bladders because they’re just natural body functions, but I do appreciate the embarrassment some people feel, and the shame. I think I can appreciate that probably it has been a struggle for you to get that side of things where people are really struggling.

General discussion

This study explored Melanie’s lived experiences of the physical, psychological, and social dimension changes post-SCI. Her narrative highlights the dual nature of traumatic SCI recovery, whereby a significant sense of loss coexists with personal transformation, emphasising the dynamic interplay between PTD and PTG. Melanie’s deep-rooted determination to continue her medical career despite facing new physical limitations showcases the domains of personal strength and of new possibilities within PTG, whereby individuals discover new avenues and reshape their goals following a traumatic event (Linley and Joseph, 2004). Throughout her narrative she demonstrated growth in the spiritual domain of PTG (Tedeschi and Calhoun, 2004), by shifting towards a humanistic view of spirituality and mindfulness practice. Melanie highlights how facing a traumatic injury can both deepen existing relationships and create challenges in new and existing ones. On one hand, her story resonates with findings on the crucial role of social support in promoting PTG (Prati and Pietrantoni, 2009). On the other, it highlights difficulties in communicating one’s needs and consequent social withdrawal representing PTD, whereby negative changes in relational dynamics emerge (Baker et al., 2008). Melanie also expressed feelings of loss for her life pre-SCI, the mourning of potential experiences not accessible to her anymore as well as questioning her sense of self.

Theoretical implications

The findings contribute to our theoretical understanding by highlighting the dynamic interplay between PTG and PTD. This is important given qualitative research exploring PTG in SCI has often neglected to look at ‘the other side of the coin’ (i.e. depreciation). By presenting a woven narrative of PTG and PTD, we highlight the need for nuanced conceptualisation and exploration of adaptation following trauma. This multifaceted approach can be explained by the biopsychosocial model (Engel, 1977), which theorises health is the outcome of the complex interplay between biological, psychological, and social factors. Considering Melanie’s journey of adaptation following SCI, we explored the complex relationship between physical, psychological, and social challenges. This stresses the importance of addressing interconnected dimensions in the management and rehabilitation of SCI, specifically by implementing a holistic, person-centred approach to address not only the physical aspects, but also individual idiosyncratic psychological and relational concerns.

Strengths and limitations

The qualitative single case-study approach allowed for an in-depth and rich exploration of Melanie’s adaptation. Combined with reflexivity, it enabled presentation of the multi-faceted lived experiences of one person with SCI, acknowledging the long-term and pervasive impact of the injury. While an online interview helped facilitate data collection by overcoming physical and geographical constraints (Janghorban et al., 2014), there are challenges for privacy compared to traditional face-to-face interviews (Taquette and Borges da Matta Souza, 2022). The adoption of a single case study design intensifies ethical and interpretive challenges, as maintaining participant anonymity becomes particularly complex when personal circumstances are highly distinctive, as in Melanie’s case. Even when pseudonyms are employed, the richness of contextual description necessary for interpretive depth may inadvertently render the participant identifiable. In response, we modified distinctive characteristics while preserving the integrity and authenticity of Melanie’s voice through use of extended quotations. Furthermore, single case study research remains susceptible to over-interpretation, with a temptation to derive broader theoretical or conceptual claims from a singular, compelling account. Melanie recognised this and reflected, individuals with SCI can be hard to engage in research, those that take part may not be representative of the full array of lived experiences of SCI. This aligns with Smith and Sparkes (2002) assertion that disability stories come in contrasting forms, and are not necessarily determined by a common experience. While future research should incorporate and develop new ways of including diverse experiences of SCI, achieving this might be difficult until a holistic approach to SCI care is established. This is essential for providing appropriate care and support, particularly to sub-group populations at higher risk of adverse psychosocial and physical outcomes post-SCI.

Conclusion

Melanie’s lived experience following SCI reveals a complex recovery process that extends beyond physical rehabilitation; her account illustrates significant psychological adaptation and difficulties managing social and relational shifts following injury. Melanie’s narrative emphasises the need for a holistic and person-centred approach to SCI rehabilitation, which addresses the interconnected changes that occur across physical, psychological and social life domains. Future research could aim to explore PTG/PTD across the five domains using a mixed methods approach to gain a more granular insight into the complexity of the physical, psychological, social adaptations that people go through following SCI. This could yield significant insights into the needs of individuals going through the rehabilitation process.

Supplemental Material

sj-docx-1-hpq-10.1177_13591053261437580 – Supplemental material for ‘An ongoing journey’: A qualitative case-study exploring growth following spinal cord injury

Supplemental material, sj-docx-1-hpq-10.1177_13591053261437580 for ‘An ongoing journey’: A qualitative case-study exploring growth following spinal cord injury by Ioana Filipas, Karen Howells and Catherine Heidi Seage in Journal of Health Psychology