Has a provider ever told you that you need to get used to your "New Normal"? I always know when a provider is getting ready to "break up" with me when they give me the "new normal" speech. I don't know about you, but I have always felt the "new normal" speech is a practitioner's way of saying, "It's not me, it's you! Good luck with all those symptoms, but I give up!". 

We have all encountered providers who feel that treating our injuries is futile and that we will not improve or heal any further after a certain point (usually one year from injury). In fact, after a year of treatment, I have noticed that getting approved for different rehabilitation therapies is tough, and some practitioners have even refused to take me on as a patient. Throughout my research and discussions with other Traumatic Brain Injury (TBI) (including Concussion) survivors, I have noticed that this dismissive treatment is becoming an alarming trend. This trend is so pervasive that it has been given an actual name, "Therapeutic Nihilism."

Therapeutic nihilism is when a practitioner refuses to continue aggressive treatment due to an unreasonably pessimistic prognosis. Providers give us a prognosis based on what THEY think our chances of a reasonable outcome are. This prognosis is calculated from a probability model that utilizes data from previous patients. In other words, our prognosis is based on a statistic, not our specific case. Another complexity of a prognosis is the definition of a reasonable outcome. Reasonable outcome is a term that is very personal and very individualized. Ultimately, a prognosis is simply a prediction based on a statistic, not a fact. 

One of the most dangerous consequences of therapeutic nihilism is the risk of a self-fulfilling prophecy. Nothing is more defeating than listening to your doctor tell you that you are doomed to experience your symptoms forever, there is nothing you or anyone can do, and you should get used to your new normal. I have had practitioners tell me that I should give up on goals such as completing my master's degree and settle for a career or job choice that doesn't interest or fulfill me. What if I had listened to them? What if I had just given up on my hopes and dreams in life? What if I had bought into the idea that my future was hopeless and I should give up and settle for less? I would have been self-fulfilling a prophecy from someone that had no idea how capable I am! I would have been selling myself short because one doctor looked at some data and decided they knew more about my potential than I did! 

Questioning our prognosis is one of the most critical things we can do throughout our healing journey. Be aware that therapeutic nihilism exists and that any prognosis you receive is based on statistics. YOU ARE NOT A STATISTIC! You are a complex human being far more capable of overcoming obstacles and challenges than you will ever know. Please don't let anyone convince you to give up on yourself, your hopes, and your dreams! We will encounter practitioners who give up on us throughout our journey, but we must never give up on ourselves! Be on the lookout for therapeutic nihilism along your journey, and don't be afraid to find a new medical team if you don't feel supported. Always remember, never give up!

References:

Hirschi, Ryan; Rommel, Casey; Hawryluk, Gregory W. J. M.D., Ph.D., FRCSC,*. Should we have a guard against therapeutic nihilism for patients with severe traumatic brain injury?. Neural Regeneration Research 12(11):p 1801-1803, November 2017. | DOI: 10.4103/1673-5374.219037 

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