The study explored the experiences of living and coping with disability in people with spinal cord disability due to road traffic injuries. The findings revealed that, besides physical limitations, the people with spinal cord injury experienced various negative psychological and social consequences in their daily life and had adopted some coping strategies in accepting the process and adjusting to the hardships.
In this study, "victim of destiny" was identified as the main theme that provides a picture of forced destiny in the participants’ life and a fate outside of their will. They considered themselves as victims of fate and believed this situation was a destiny predetermined in their life caused by divine will and wisdom, so they had no options but to surrender.
Belief in destiny is a common phenomenon in the Iranian cultural context. According to Islam teachings, nothing happens outside of the divine will, so one tends to attribute all the life events, especially negative ones, to divine destiny. This belief leads to peace and hope in difficult circumstances (19).
Previous studies have also pointed to the belief in divine will among patients. Accepting what comes from God and destiny helped the patients in finding and keeping hope. The study of Baba Mohammadi et al. (2013) showed people with spinal cord injury attributed their disability to the divine destiny, which helped the patients to be able to adjust to the situation (20). Also, in a study on coping strategies for breast cancer in Iranian women, belief in divine will and the occurrence of God-given disease was a strategy that helped patients cope with the illness (21). The belief that all these come from God is vital in accepting the process and adjusting to the situations.
Besides, physical limitations of disability and loss of ability to do the job made participants feel ineffective and worthless. The dependence on others for performing personal duties had also led to the feeling of being a burden among the participants. It seems the feeling of being a burden to others is a common experience among people with physical-motor disabilities.
In other studies, inefficiency due to job loss and economic dependence has been described as an unpleasant experience after spinal cord injury. In the study of Sharifi et al., the sense of inferiority caused by being a burden to others and uselessness in the community was an experience that individuals with physical-motor disabilities also mentioned in their experiences (1).
Another problem commonly experienced by the participants was pathetic social interactions. The findings suggested pitiful look, and people's pathetic behavior led to negative and unpleasant emotions such as humility in participants. The unnecessary compassion and unwanted assistance or support provided to them were meant as commiseration by participants. It was unpleasant to the participants and; made them sad and upset because they expected people to interact with them like other citizens in social interactions.
Sense of pity and misplaced compassion of the community members toward people with spinal cord disability has also been emphasized in other studies. For instance, in a qualitative study from Ghana that explored lived experiences of people with spinal cord injury, participants expressed frustration that the society saw them as disabled people and treated them with sympathy (1).
In a study by Khanjani et al. (2019), sympathy was identified as one of the socio-cultural misconceptions and a deterrent to adjustment to the illness. It was also considered an annoying behavior for patients with spinal cord injury (22).
In the Iranian cultural context, compassion for the underprivileged and disabled people is considered a noble behavior. Based on religious beliefs, people feel that they have some kind of spiritual insurance by helping disabled people and providing a sense of compassion. In fact, they believe paying attention to people with disabilities and providing them with voluntary assistance will reward them in the future. That is why they help these people regardless of the feelings of the disabled persons.
Besides, fear of the future was commonly experienced by the participants in various ways in their daily life. The fear of losing caregivers due to their dependence on others to perform daily duties made participants anxious and fearful. Moreover, the frustration with the recovery and the fear of being permanently dependent on others was an unpleasant feeling that participants had to deal with in their daily lives.
In line with the participants’ experiences, people with spinal cord disabilities pointed to their dependence on others to meet their personal needs. They believed that they had to rely on others even for their daily care. Their most significant concern was the fear of their dependence on others (23).
Participants after the injury also experienced a sense of loneliness. Lack of support from the family, a sense of being rejected by friends and being ignored by others made the participants feel isolated and alone. According to the participants, lack of family support played an important role in the development of this unpleasant feeling. In contrast, in Iranian culture, the family is considered the most critical source of support for the patient in the face of the disease and its challenging situations (24).
Receiving support from family, particularly the significant persons, has been identified as a facilitator in reducing symptoms of depression among people with spinal cord injury and their return to life (25).
Lack of government support, the inefficiency of supportive organizations to provide appropriate services for disabled people, and lack of urban furniture tailored to the disabled people’s conditions were other problems that participants noted in their experiences. Challenges related to social services delivery and neglecting the disability-friendly cities have also been reported in other studies as the shared experiences among disabled people (26).
The results obtained from this research regarding coping strategies against the disability have been raised to focus on the theme of religious/spiritual coping. In line with related research in other cultures, spirituality and religion were stated as essential elements of support in coping with stressful life events (27, 28). Hence, find religiously oriented mechanisms like satisfaction to God's practicality and accept what comes from act as a source of hopefulness and comfort.