coping with brain injury
by Jamie Dibdin, with advice from Anne Hunter *
coping with brain injury | help and info
Brain injury can affect a person's physical abilities, their speech and other cognitive functions, their behaviour, emotions and the way they interact with other people. Their hearing and tolerance of noise may also be affected.
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The head injured person may make a good physical recovery and look really well while being quite heavily disabled and injured. In fact, often people who have had a brain injury may say that they wish that they did have some physical sign that they have a disability.
It is often the more subtle changes to a person's personality that can be the hardest for the family and friends to cope with.
can I tell what effects the person will experience, by knowing where on the brain the injury has happened?
In general no, as our brains are such delicate and individual organs: for example, left-handed people's brains are different from those of right-handed people. It is not possible to say that a particular injury will result in particular difficulties. However, if someone has damage to the front of their brain it tends to affect their personality, whereas injury to other parts of the brain can affect people's spatial functioning and general thinking processes.
in what ways can someone's personality change?
Changes in personality can be very subtle and outsiders may not notice as they do not see the person on a day-to-day basis and may focus only on their physical recovery.
People with a brain injury can find it hard to understand the effect of their behaviour on other people. This can mean doing things such as saying the first thing that comes into their head and getting things in social situations wrong, for example not knowing that they are taking over the conversation or picking up on subtle signals such as other people's boredom. Their lack of insight or awareness may prevent them from understanding the impact that their injury is having on their health or on their family. All of this can be very stressful and embarrassing for the person's family.
After a brain injury people can often see the world in a more black and white way, finding experiences that are ambiguous or uncertain difficult to cope with. They will often find it difficult to get motivated, losing interest in things that they used to enjoy, and they may feel much more tired than they used to.
A person's capacity to tolerate noise is often greatly reduced after brain injury: this can have an effect on their ability to cope with children.
All these things can lead to a great deal of frustration on the part of the person with the brain injury and their family, leading to increased conflict and aggression.
in what ways will their memory change?
One of the most common changes in people who have had a brain injury is that they suffer from poor memory. People who have had a brain injury will almost always not remember the actual event that caused the injury. This is not for psychological reasons; rather it is to do with the way that memories are laid down in the brain. This can be very hard for their family as they are likely to have distinct and traumatic memories of what happened. It can help by being aware of this and talking about this experience.
An assessment by a neuro-psychologist is the best way to identify memory difficulties. You can ask your GP to refer you or contact the British Psychological Society (see help and info), who will be able to put you in touch with someone with the qualifications to carry out this assessment. This will detail the kind of difficulties the person has and offer practical ways to help manage them.
how can I help with the loss of memory?
People will always find it easier to remember things that they are interested in. If you are talking to someone with a brain injury, focus on things that they used to enjoy to engage their interest.
Keep information short. Repeat things often.
how should I talk to my children about this situation?
Firstly, ask them what they already know about the person with the brain injury; this will give you a much better idea about what to say to them.
How you explain the situation to your children will depend on how old they are: if they are younger, focus on the more concrete things that have happened. You could explain that the brain is a very fragile but clever organ that makes everything work in the rest of the body and that this has been hurt. For older children, you can explain more about how and why this has come about.
Try not to feel bad if you get upset when explaining to your children - this may help them to express what they are feeling too, rather than feel they need to 'be strong' or protect you from their own emotions.
Let your children understand that the things that have changed about the person with the brain injury are not his or her fault but they are because of the accident. Very often, children of people with brain injuries feel embarrassment about their parent, especially as they may look the same as before, but act in ways that are not very appropriate. Acknowledge that this is indeed embarrassing.
Help your child to find his or her own way of explaining what has happened. Help them to rehearse this so that it will be easier for them to explain to their friends and teachers.
what impact can I expect this to have on my family?
There is likely to be a lot of friction in the family after the brain injury as people learn to adjust and cope with the new situation.
Partners of people with brain injuries often say that the person after the injury is no longer the person they chose to have a relationship with. This is often the reason for a breakdown in relationships.
It is important to recognise the significant impact of shock of the actual event on you and your family. You might have been told that your loved one is likely to die, then had to cope with a whole rollercoaster of emotions, with the relief of their survival followed by coming to terms with the consequences of the injury.
The feelings that people go through are often like a feeling of loss. It is important to recognise this sense of loss and to talk about the sadness that you feel. You may also feel guilty about these feelings, as the person has often survived against all odds.
Very often family and friends of the head injured person will feel very angry about the person who has had the brain injury: this may be because of their behaviour but also people going through a process of loss can feel anger towards the things that they have lost.
what things can I do to help?
Encourage the injured person to access help; a brain injury support group can be very useful, as they will be able to meet other people with similar experiences (see help and info). This can help a person recognise difficulties that they may also be experiencing.
Someone with a head injury may suffer from depression as a consequence of their beginning to recognise the impact of their injury: counselling may be a useful way for them to cope with this.
Help them to develop coping strategies if they are experiencing anxiety and panic, and support them to learn ways of staying calm. Try to encourage them to talk about their fears and worries.
Beware of any organisations that claim they can achieve a complete cure. The person may never regain certain skills, but it may be possible to help them to compensate for this loss. Don't be afraid to talk to professionals, particularly your GP, who can help you access appropriate help.
* Jamie Dibdin is a consultant clinical psychologist.
Anne Hunter is a consultant clinical neuro-psychologist.
(June 2006)
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