The psychological impacts of burn injuries, and ways of coping

This section covers:

  • Psychological impact
  • Moving forward and getting ‘back to normal’ after having a burn
  • Acceptance of the situation
  • Ways of coping

Having a burn injury can be a traumatic experience, with emotional and mental health impacts as well as physical ones. A lot of the people we spoke to told us that, over time, it was important for them to “get back to normal” – though ‘normal’ was different for each person. As well as the impacts of having a burn, we heard about the different coping mechanisms people used for adjusting to life with a burn.

There are times when Frazer feels vulnerable about his burns, but on the whole he feels he has “dealt” well with the support of his friends and family.

All of the people we spoke to had been burnt at least one year before being interviewed, though many were burnt a lot longer ago. Some of the adults we spoke to had been burnt as a child and had lived with a burn for over 40 years. Other people had been more recently burnt.

Psychological impact

People we spoke to described feeling shocked, frightened and uncertain when they were first burnt and in the following weeks or months. Some had flashbacks and nightmares about what had happened, or ongoing anxiety related to the circumstances of their burns. Charlotte explained how having a burn “is very much a mental and physical thing”. India told us that people sometimes don’t realise how traumatic having a burn injury can be, she believes this is because of a lack of awareness about burn injuries within society.

Charlotte experienced post-traumatic stress disorder (PTSD) after being burnt.

And then I got put through and then got help for the PTSD. And then they explained it to me, you know, this is post-traumatic. This is everything and then they started going through everything, and you realise how significant it was. I honestly didn't realise how significant the burns was at that stage. I mean, I knew it's a big thing, you know. I've been burned, but I still couldn't talk about it at that stage.

So, if I had that conversation with someone and they'd say, “Oh, have you been burned?” I’d try and talk about it and I’d end up, my hands would just be shaking. I couldn't talk about it, and I didn't realise then that this was not, this isn’t good. You know, this is all stuff that needed to be dealt with. So, on the other side of all that, a couple of years later, it's almost like I can just talk about it now, and I can think about it, but it's the images are flat. It's like looking at a book, and we can look at the pictures together. When I used to talk about it before, it was like going back there. And I could still smell things and feel things and it was like a-, you could, you'd go back to actually being in that thing and all that anxiety would come up, and it would be-, whereas now I’ve separated them all.

So, it's not to say I’m not going to get anxious. If, you know, I’m still anxious with fire. You know, I’m always going to be. That's like, you'll be unreasonable to think that, you know, it's not going to affect me. But I can understand it, so I can actually say oh, I’m feeling a bit anxious because of this or because of that. Whereas before it would just be overwhelming feelings of anxiety and I need to be safe and I need everyone around me to be safe, whereas now I’ve got a little bit more understanding, and can reason with myself about what's going on.

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For some, it took a while for the emotional impact to hit. Holly, whose child was burnt, explained, “it’s a funny one, how your brain sort of compartmentalises some [things], maybe dulls things down so you can deal with it at the time, and then maybe later it really comes out”.

A burn injury could add to existing stress, anxiety, depression, or grief. Raffaella’s mum died in the months after her burn injury, which added to difficult feelings of “isolation [and] being alone”. Tom’s burn happened when he had just finished his university degree and was gearing up to enjoy summer before starting work: “I was just stuck at home living with my parents, it’s supposed to be like a new chapter in my life and it was just hard to find jobs when you’re sort of recovering from a burn injury”, which left him at “quite a low point of confidence”.

Frazer experienced anxiety growing up, he said his anxiety returned after he was burnt when he was an adult. He said having a good friendship network helped him to cope.

I suffered anxiety in the past to the point I couldn't go into stores like when it was sort of growing up. I sort of learned how to cope with that, so it sort of came back a little bit. I thought I don't want to go to a bar alone, so having my majors to come up, you know, but always together just things like that. They sort of, I guess I don't ever appreciate how much it helps but yeah, just having someone to go out with who would, he doesn't care about you, your appearance anyway, you know, they like you for you, but the fact that they make me feel so comfortable that it didn't matter if I had some, you know, dressing on my wrist, it didn't matter if people asked because, he was there next to me and he'd always make me feel comfortable, you know. And if they ever got too much, we'd sort of be able to leave it.

Getting support before you need it but surround yourself with people that are going to help you recover because it's not just a recovery of the burns, the recovery of your, you know, your mental thinking, that whole anxiety of dealing with that, and digesting it all and coming to terms with it, and learning how to live again, you know.

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You can read more about experiences of feeling self-conscious and concerned about changes to appearance here.

Counselling, psychological therapy, and other forms of talking therapy were used by some of the people we spoke to. For some, this was beneficial and helped them to process their emotions. For others, however, talking about their burn injury was difficult and something they tended to avoid.

Gary said that attending therapy sessions was “like a release”.

Especially with psychological because it was like once I was discharged from hospital and I moved back home with my mum, we were always arguing and my mum was saying that I was very like ratty and just flying off the handle over anything and she was saying to me “You need to go and see your doctor, son. You need to go and see your doctor. Tell him, because you’re losing your temper too easy” and things like that. And the way I used to look at it was like “But it’s in my head. How is someone else going to be able to help me with something that’s in my head?” But again, it was like, so that was how I used to look at it but after I seen, because I’d say it went on for about three or four years, like my mum saying, “Please son, go and see your doctor” and I would say “No, no, they can’t, how can they help me?” But then, like, after three or four years I thought “Right, no I do need to” because it was having a big impact in my life. So, I thought “Right, I need to go and see someone.”

I kind of looked forward to going back to it, do you know what I mean. Because again, from the first session I ever had with her, I felt like a release, like I’d taken a few bricks off my shoulders, kind of thing. And so, every chance I got to go back it was like “Yes, I can take some more bricks off”. And so, it kind of like, do you know, it was a bit like, when she said. “We’re going to have to call it a day now Gary”. But again, I feel that she, like you’re saying, she gave me the toolbox, kind of thing, to help me. So, I always think back to just that last meeting we had, then when I walked out, I thought “Wow! I really want to become a psychologist” just because of how she showed me that it’s possible for someone to change another person, how they’re feeling and that. I just thought “Wow, that’s amazing that.”

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Jeff found talking to a psychologist to be a helpful way of managing his mental health.

How did you feel when you couldn’t use your hands? What was that like?

Oh, that’s when I started losing it a bit. I ended up on tablets for my head.

And were you given any support or anything for your mental health by the hospital or anything like that?

Yeah, I was actually. I used to have to go to the mental health hospital to see a psychiatrist there and I also used to go to the local hospital to the psychiatric part of the hospital and see a psychotherapist.

Did you find that helpful?

Yeah, I did actually.

What was it that you got from those appointments?

I got a lot of relief talking about it. Yeah, so I just kept going there. Felt better for it which, I don’t know if you know or not but, once you’ve had a nice long talk to a doctor like this for an hour, hour and a half, two hours, you feel a lot better, you feel like there’s a weight been lifted off your shoulders.

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The timing of support for the psychological impacts of burns was important. A few, like Sarah and Sabrina, said they thought they would have benefitted from talking to a psychologist or talking to one a bit sooner than they did. Sarah explained how “I have thought on and off like ‘Maybe I should have some help psychologically’ but as time has gone by… you get there in the end”.

Sinead, whose daughter had a burn injury, had mixed experiences of psychological support. Recent counselling had been helpful, and she highlighted that it has to be “the right time” for the person or parent of a child with a burn. Sabrina think signposting to psychological support is important; even if someone doesn’t feel they need or are ready for it in that moment, they may change their minds later on.

Moving forward and getting ‘back to normal’ after having a burn

For some people we talked to, moving forward was about learning to accept “a new normal” way of living after they were burnt. A few said that “the passage of time” was “a great healer” in helping them begin to move forwards. This was an ongoing process for many; as India said, “you can’t just deal with it one time and it’s done, it’s like a continuous process that you deal with as you grow older”.

Starting to do daily tasks and activities again, such as exercising or going to the shops, also helped people to regain a sense of normality. Marilyn shared with us that being “immersed in normality” helped her to recover from her burn, such as getting back to spending time with family.

Amy and Chris Y said that it was “a big step” when their son, William, was able to cook pasta again after he sustained a scald.

Chris: And he, you know, he cooks now. He makes lunches for all three of them when they’re going to school. He cooks-, we try and get all of them to cook at least once a week.

Amy: He cooks pasta. That was a big step when he managed to cook pasta again.

Chris: Big step, and he was like “Yeah, I’ll cook but I’m not cooking pasta.” Fine, well, we’ll work on that.

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It took Jessica’s daughter a long time to feel comfortable in the bath again after she was burnt.

My daughter was afraid of the bath after the incident, so it took a long time to get her back into a bath, which I don’t know if that was because we put her in the bath after the burn or due to the washings, she obviously had negative associations with the bath. But that lady that came out helped me to, helped me to sort of wash her, like just work out other ways that we could wash her and start to get her back into the water.

We had to just introduce the bath again really slowly. So she would watch her sister have a bath and be in the same room and then, we let her stand in the bath, and then we said that she could go in and come out if she wanted to, just give it a try. And just over time she allowed us to put her in and then I think she started to remember that it’s a fun, being in the bath is a fun thing. And luckily, I think having her sister there as well helped her then to just start going in. So sometimes she would go in but then she would ask to come out and I’d just take her straight out when she asked and not force her to do anything until she was ready.

She absolutely loves the bath again now, which is great, because it took a lot of months to get her into the bath again.

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Raffaella said being burnt taught her to take each day one at a time.

That’s the thing, one of the biggest lessons is that I think once something so catastrophic happens to your body, you can only take it one day at a time. I mean, it is for emotional things as well, I guess, for much, anything this traumatic in life, but for me, it was like I wanted a resolution, I wanted to hurry up, I just wanted to wish the process away. But then, looking back – and even though I’m only a year and a half – you just think that the process is what makes you. And it’s not that I enjoyed it, it’s not it was great, and I would do it again, but somehow, you know, instead of wishing it away, you’re still alive, you’re still living in the moment and if you wish them away, you’re wishing your life away, even if it’s not perfect.

I’m not saying that I’m a master now whatsoever but, you know, you try every day. Yeah. And it makes me also think it’s like I was so lucky that, you know, I don’t like my hands and I think “Oh my God, they look so ugly, and everybody looks at them” but then, I’m thinking “No, it’s not true. You’re just …” you know you feel that way and a feeling doesn’t make it real, you know? A feeling is just a feeling, the reality is something else, actually it’s not that bad. So, that’s an important reminder as well, that what I feel is temporary and it’s just how I feel, it is not necessarily a reflection of what is true. And plus, you know, we’re fragile things. Like, who is going to make it out of life completely intact?

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Some people felt that part of their independence had been “lost” when they were burnt, as they weren’t able to do some of the things they used to do. Regaining a sense of independence could be an important step towards “getting back to normal”. Rhian was unable to drive in the early stages of her recovery. She said it was “important” to her that she was able to drive again quickly as she lived in a remote area. Marilyn told us that it “helped her confidence tremendously” when she regained some of her independence.

Acceptance of the situation

Accepting what had happened was difficult for many of the people we spoke to, but some people shared with us how they had sought to make sense of what had happened and the impact on their lives. After she was burnt, Raffaella felt “incredibly angry” and was struggling to deal with what had happened. In time, she began to adopt a mindset of “what has happened has happened, you can’t change it”, and this helped her to begin to accept the situation. Rhian found that by viewing her burn as a part of herself, she was able to stop it from “taking over her life”, and that this became easier with time.

Rhian didn’t want the burn to take over her life.

I didn’t want those thoughts to go through my head every day. I didn’t want to second-guess what I was going to wear and what I was going to do, so if I just accepted it, which is hard, I understand that and just let it be part of me, then it’s ok, it’s going to carry on and we’ll be fine. You don’t want it to take your life, thought, do you really? Like, yes it was a traumatic experience but, at the end of the day, that experience has been done now, so I need to move forward and yeah, see what happens. This is me and my new scar!

At the end of the day, if I’m ok with this massive red-, because at the time it was huge wasn’t like, it was a very red thing on my arm. If I’m ok with that then everyone else is going to be. I shouldn’t be apologetic about what’s on your body. And I think lots of people have tattoos, don’t they? And some tattoos are quite offensive, so if someone finds my very red burn offensive well, that’s up to them, then, isn’t it?

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A few people found it helpful to recognise that “accidents happen”. Some people told us they felt reassured when doctors would tell them “it was just an accident” or other people would share similar stories. This was especially true for parents, who can sometimes struggle with feelings of guilt when their child was accidentally burnt. Lily said that her family reassured her by telling her that “it can happen to anyone”.

In time, Jessica was able to accept that accidents happen.

In time, I had to accept that accidents can happen. And at first, I couldn’t sort of entertain that thought. But over time, I’ve had to sort of accept that that is the case and try and view it more that way.

I think you have to learn to be a bit kinder to yourself, because that’s what people did say to me, you know, “If this happened to me, you wouldn’t be judging me, would you?”. And I’d say “No.” And then, in time, you know, like my daughter has had another accident since – minor – she tripped and broke a tooth when she was running, and I had to try and view it more as an accident rather than something that I had done.

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Ways of coping

The people we spoke to had tried lots of different coping mechanisms for adjusting to life with a burn and managing the challenges they faced as a result of their burn.

Having a range of strategies to use to suit a particular circumstance can help people with burns to cope in different situations, rather than only having a singular way of coping. The most helpful strategies could also change over time and as people grew older.

For some, humour and making jokes were ways that they dealt with what had happened. When she was younger, India would joke about how she had sustained her burns when people asked her questions, like saying she had fought a dragon. She explained how it “took a while to be able to joke about it” and how she had to “feel comfortable” with herself before she was able to make jokes.

Frazer told us that using humour as a coping mechanism came naturally to him.

So, it was sort of, it was nice to have a network of people who would just understand and care or not necessarily understand people just care without needing to understand. And maybe, you know, there'd be the occasional joke, but half of those would be led by me, there's a sort of coping mechanism. You know, making a laugh out of it, you know. Maybe not, but that’s what I thought like it would never be about my appearance, it would never be personal, it would be about what happened. The fuel line say, you know, so no, I think it was good to both have a laugh with people I could feel comfortable enough to go outside with.

So, I think always whenever something went wrong, I’d always sort of make a joke about it, and then just sort of get back to it. So, I guess it came quite natural to me, but the fact that it was so serious this time, the humour helped hugely in my-, I never realised it could. As I say it wasn't necessarily humour being personal about it, just hearing about the situation, for example, oh, you know, “The scar will be quite cool to tell stories about” or, you know, “When we're doing that again”, you know, silly things like that kept it going.

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Sinead told us that her coping mechanism was laughter.

I think we probably laughed more during those, you know, probably when she was initially very, very, very ill, we probably laughed more than we ever have probably in our lives, and it’s probably shock, fear of the unknown, your emotions are all over the place. Probably the staff, nurses, doctors, play therapists, whoever is involved, chaplaincy team, they’re all trying to kind of, I suppose, jolly you along and get you through another day. And I think mine and my husband’s coping mechanism at that time was probably to make light of an awful situation and, yeah, just to laugh and try and get through the day as best we can which, looking back, if anyone saw us probably thought we were lunatics. But that was just our coping mechanism at that time.

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Catherine found attending local baby groups, as well as humour, to be good coping mechanisms.

But I found, actually, something that I did find useful when on maternity leave is baby groups. They’re really good, that’s where I heard the stories. So, yeah, they’re really, really good. So, I would recommend anyone to go to them because, again, especially if you’ve moved somewhere and you don’t know anyone, like it’s a good support system and people go through the same things as you and they get it, you know? They’re in the same situation as you.

Did you find that you felt better after talking to people about anything that was on your mind about it?

Yeah, I’m a bit of a joker anyway, I would … I make jokes now about it, you know? Like, ‘Do you want to put the BBQ on?’ Just light-hearted jokes because that’s how I guess I deal with it, that’s my sense of humour. But, you know, everybody’s different.

So, would you say that a sense of humour and humour is a kind of coping mechanism that you have?

Yeah, I guess so yeah. But everybody’s different, aren’t they? You know, some people could find that quite inappropriate, you know, whereas I see it as it’s happened, there’s nothing I can do about it, everything’s ok now.

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Other people used distraction techniques, such as focussing on their work or a hobby, to distract them from thinking about the burn. Once he was well enough, Tom joined a local rowing club to distract himself from everything else which was going on.

Rhian found it useful to focus on other areas of her life to distract her from her burn.

I’d say I am, just because as I said, like I do gym and running. I can run ultra-marathons so I have to put myself at that kind of mindset, and that can get really hard, but then it’s going to get a bit better, and then it’ll be the end and I’ll be so relieved. So perhaps everything I’ve done before, and like, starting my own business from scratch, I’ve obviously had a lot of ups and downs so, well maybe if anything, maybe I’ve been too distracted to be concentrating on my burns because I’ve had all these other goals.

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Some people found that meditation, breath work, and other mindfulness practices helped them to create a more positive mindset. Mercy told us that she would write about how she was feeling in her journal if she felt anxious and this helped her to manage her emotions better.

Mercy used journaling as a way to cope with difficult feelings and situations.

I taught myself to write those journals and something like that, pardon me. And sometimes when I notice that my anxiety’s going high or I’m feeling funny, I reach out to them, and they write how I’m feeling. And then I try to ask myself “Why am I feeling this way now?” So, I also write this down, so like, I was talking about this week because I’ve noticed that my anxiety is going high and I’ve really tried to sleep and I think yes, this burn anniversary coming up is causing me to have anxiety. Like, last night, I was struggling to sleep, just last night. And I had to wake up, get myself a drink, and then, just a book and try reading and finally I fell asleep.

And would you recommend writing a journal to other people with burn injuries?

Yes, I think for me it kind of helps because sometimes I can go back and look at the period when I was having a really, really difficult time or say, for example, I’ve gone out-, because you’ve got to think, like when you are a burn survivor, sometimes your day can be spoiled by something very, very minor. You can be out, and somebody will comment on something about you and you’re like “Oh my goodness, where did that come from?”. But I’ve learnt over the years that don’t take things like that personally, because you are only hurting yourself because that person, you don’t know where they were coming from – either they were being nasty or they were being kind in a way that they only know how, so I’ve learnt like to write things like that down – say I was out, somebody said this or somebody was really staring at me and stuff, and then what did I do about it. But when I write things like that down, and then something like that happens again, I can sometimes go back to what I wrote and I’m like “Oh, what did I do about it? So, I’m going to do the same thing about this”. So, what I’m trying to say is like that writing it helps me, personally it helps me, and I would recommend it.

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Gary used mindfulness practices, such as meditation and breath work, as a coping mechanism.

Yeah, 100%, again because, like with the breath and things like that, you’re not having to rely on somebody else, someone else’s opinion or point of view or experience of it. It’s like “Try it yourself”. But again, within a minute you can, I know you will feel a change. If you were to breath in a manner which is most optimal for us and the breaths, the breaks, the pauses in between, it all matters and I just feel we’ve kind of-, because it’s unconscious and we don’t think about it, we kind of forget about it.

Just breathing, but it’s like, at the time it was like because the nurses were always saying to me just like “Just concentrate on your breathing”.

So, I understand how integral our breath is to our being and that’s all I’ve really looked to have done since coming out of hospital, well, no, I’d say like, in the last couple of years, that’s what I’ve been more focused on is trying to personalise my breathing, do you know? So, what feels best to me, regardless of what anybody else is saying because, ok, it might be best for them but what feels best for me kind of thing?

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Exercise was a coping mechanism for a few people. Mercy would go for an early morning swim as it helped her to “deal with her day”. As well as finding enjoyment again when listening to music, Helen Y said that playing tennis released endorphins (‘feel-good’ hormones) which helped her to cope with her emotions. Some people with burns exercise in order to feel good about their body and what it can achieve.

Many of the people we spoke to described situations with other people that they tried to manage in various ways. This included having stock answers ready about their burns, wearing clothes or accessories to hide their burns and acting more confidently than they felt in some social situations. You can read more about these experiences in the sections on dealing with other peoples reactions and managing the impact on appearance and self-image.

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