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Marriage Breakdown After Brain Injury

What do therapists need to know to help ailing marriages after brain injury?

Shireen Jeejeebhoy
Source: Shireen Jeejeebhoy

Eighty percent of marriages separate at the ten-month mark after brain injury, my diagnosing psychiatrist informed me. My husband, sitting beside me, must’ve taken that in, checked the calendar, and decided he was good to go. We would’ve been married almost thirty years if he had stayed. We’d been married twelve years when he packed up his shirts and boots, took paintings off the wall, talked me out of the Inuit sculpture our mediation had agreed was mine to keep, and left with his father helping him, a jerk of a man, to put it nicely. His father manipulated people one against another. That was one good thing that left.

In 2009, Jeffrey Kreutzer and Jenny Marwitz, of Virginia Commonwealth Model Systems of Care, wrote on “In 2008, [Virginia Commonwealth University] investigators led a multicenter research team which investigated marital stability after brain injury. Information on marital status was collected at 16 NIDRR-funded TBI Model Systems around the country. This study was the largest scale study on marriage after brain injury to date and included 977 persons from different ethnic and cultural backgrounds. The research team found that 85% of survivors remained married for at least two years post injury.”

But there seemed to be some contradictions in their results, to whit: “male and female survivors had similar marital breakdown rates the more serious the injury, the greater likelihood of divorce . . . male survivors were more likely to have an unstable marriage (i.e. to be separated or divorced) than female survivors.”

In the Jan/Feb 2011 The Journal of Head Trauma Rehabilitation, Emilie Godwin, Jeffrey Kreutzer, Juan Carlos Arango-Lasprilla, and Tara Lehan noted in a review of studies about marriage breakdown after traumatic brain injury: “Marital stability for couples after brain injury has been reported either through inclusion of divorce and marriage rates as part of larger psychosocial patient profiles or, more recently, through investigation specifically into the process of marital breakdown. A comparison of all divorce rates reported within the TBI literature reveals widely varied findings, with studies reporting breakdown percentages ranging from 15% to 78%.”

They further wrote: “The development of a body of research aimed at expressly investigating rates of marital breakdown is a beneficial step in the process of understanding marriages after brain injury. . . . Research investigating marital quality through the inclusion of relational assessments was initiated over 30 years ago in an exploration of the connection between spousal well-being and marital satisfaction following TBI. . . . Although this seminal research introduced the infusion of relational assessment into TBI study, it was still anchored in an individual model; only spousal perceptions were examined, and the relationship was investigated as a variable contributing to individual functioning, rather than as a focal point of assessment.”

What does that mean in lay speak? It means that research is lacking into how brain injury changes the relationship between husband and wife, how the pre-existing relationship may affect the long-term outcome, and, more crucially, how the ability of the uninjured spouse to relate to and support the injured one affects long-term marriage outcomes, especially if they do not have family support through their own and their injured spouse’s extended family. When research is lacking for husband-wife marriage, it's probably even more lacking for common-law, same-sex, and other kinds of spousal relationships.

Human beings are social animals. We exist in a web of relationships. As adults, our closest relationship is often the marital one. Our spouse knows us best -- knows our thoughts, our feelings, our opinions, our physical abilities, our moods, our desires and dreams, the state of our other relationships. My husband could make me laugh so hard, I’d snort water out and fall onto the floor, clutching my stomach. It was good payback when I could do that to him. Since he walked out of my life, I no longer have a stream of puns dancing challenges at my sense of humour; I no longer had someone to discuss local politics with; I no longer had breakfast brought to me when it was impossible to move; I no longer had someone protecting me from the insurance company; I no longer had someone to help me walk the dog before he crossed all four legs and his eyes looked a bit strained because I woke up in slow motion, walked in slow motion, decided whether I needed to put a coat on or not in slow motion, struggled to find my keys, put his leash on left handed, tried to remember to wrap it around my waist so that my shoulder and neck wouldn’t scream in pain when he walked ahead of me at his elderly walk. My dog stuck with me despite my descent from stable, reliable human carer to confused, slow, angry-to-zombie-to-suddenly-gone modes of caring.

But marital relationships don't exist in a vacuum; they are a key node in the outward web of our relationships -- all of them, from family to friends to therapists.

The neurorehab outpatient unit I was in told me they included families in rehab. My husband, at best, was only interested in dropping me off for my appointments. Instead of actively reaching out to him, the rehab team took my lead when I said he wouldn’t come and told me I needed to journal after he announced that he was leaving. I’d stopped writing the day of his announcement. My family and friends let him take the lead when he announced he was leaving and would not participate in marital therapy -- only in therapy to help us separate. The marital therapist knew nothing about brain injury and announced I didn’t love him; she showed her sympathy only toward what he was having to endure while he sat there tears streaming down his face and I sat with no expression as if I was simply watching some sailboats passing by on a sunny day.

The spouse is probably the first person to see the changes brain injury makes. They are quite likely to enter the grief state and may remain stuck in the denial stage. Denial can take many forms, from outright denying obvious change to attributing changes to laziness or not trying hard enough or bad temper or you’re unpleasant to be around, go out and do something already! “It isn’t all about you!”

Not only is research lacking, education of the reluctant uninjured spouse and family and appropriate clinical care are as well. Quality clinical care is lacking in how to proactively strengthen a weakened marriage; how to proactively educate a grieving spouse; how to proactively help the uninjured spouse process through their grief so that they can best support their injured spouse; how to drag family and friends in to the rehab centre, whether they like it or not, in order to educate them that it takes a community to support the uninjured spouse and help heal the injured one. Brain injury is the time to step up to the plate and act according to what you claim about yourself: that you’ll be there. Therapists should not shy away from challenging those who claim that and in the next breath announce they’re too busy to help out and, besides, the injured person isn’t trying hard enough and their spouse has needs, too, that the injured spouse is selfishly ignoring (education note: brain injury requires all focus on the injured person to heal; being able to meet another person's needs again after being injured comes after substantial healing and time).

I needed neurorehab to take the lead, not rely on me to convince family to come in. My husband needed family and friends to actively support him -- even if he said he didn’t need help -- and to persuade him to attend grief counseling and be part of my rehab.

In the end, the biggest failure was in that marriage therapist failing to recognize the hidden epidemic of brain injury and its effects. From her I learnt that every marriage and family therapist should be required to take a course in brain injury and how it impacts the individual so that when one spouse (like me!) is talking as if we’re discussing the weather, they’ll recognize that it’s brain-injury-created lack of affect and that they do love their husband. I was not the bad guy. The injury was.

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Copyright ©2018 Shireen Anne Jeejeebhoy. May not be reprinted or reposted without permission.


Godwin, Emilie E. PhD; Kreutzer, Jeffrey S. PhD; Arango-Lasprilla, Juan Carlos PhD; Lehan, Tara J. PhD. Marriage After Brain Injury: Review, Analysis, and Research Recommendations. The Journal of Head Trauma Rehabilitation: January/February 2011 - Volume 26 - Issue 1 - p 43–55

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