- Typically, when we think of a traumatic brain injury, we focus on the physical trauma, which is usually the most graphic and evident.
- The majority of individuals with mild traumatic brain injuries do recover but some go on to experience chronic symptoms and sometimes feel worse.
- After an injury, the brain becomes hypersensitive and, during this period, maladaptive ways of coping and processing may take hold.
- When perceiving the plight of a brain injury victim, we can often be lazy when it comes to understanding ambiguity and so we rely on extremes.
Typically, when we think of a traumatic brain injury, we focus on the physical trauma, which is usually the most graphic and evident. Whether it’s the loud bang when two football players collide or the visible scars as their broken tissue mends, the physical trauma of a brain injury understandably takes center stage.
But what happens with the unseen portion of the injury? Do we too often dismiss the corresponding emotional trauma often associated with traumatic brain injury?
Depending on the severity of a brain injury, patients may contend with symptoms ranging from transient confusion and dizziness to the inability to walk or regulate bowel movements. For many patients, independence can be lost for brief moments. For a few, it can last a lifetime. What happens to one’s identity when the person he or she sees in the mirror is unfamiliar, or to their confidence when they need assistance to perform simple daily tasks?
For many people, agency flows from utility and a sense of worth from action. Yet, in moderate to severe injuries, the hospital course may be lengthy with inpatient rehabilitation to follow. Once discharged, the road to recovery continues on an outpatient basis or at home, with family members and loved ones becoming caregivers and therapists. In mild injuries, the suffering becomes more covert, with wounds being much less visible and expectations much more demanding.
The term “walking wounded” has often been used for individuals with injuries that leave minimal to no scars, yet continue to experience significant post-trauma difficulties. While the majority of individuals with mild traumatic brain injuries do recover, some of them go on to experience chronic symptoms and sometimes report feeling worse over time.
We know from published studies that, after an injury, the brain experiences a neurochemical onslaught, with excitatory and inhibitory neurotransmitters not being where they need to be or working as they should. The brain becomes hypersensitive and, during this period, maladaptive ways of coping and processing may take hold. Similar to an acute stress reaction or post-traumatic disorder, this sensitivity can generalize and result in behaviors such as hypervigilance, isolation, and depression. Over time, these maladaptive changes are reinforced by providing avoidance and escape, thus further decreasing thresholds.
Family members of the injured often complain that their loved one is not the same person, often becoming irritable and moody while exhibiting poor frustration tolerance.
Meanwhile, for the patient, the world won’t wait. Finances, relationships, and occupational duties remain, impatiently demanding their attention. With the need to function normally seeming ever-present, individuals may attempt to transition back into their former lives long before being ready, which may further exacerbate and perpetuate their injury-related difficulties.
Still, I am a proponent of positive psychology and truly believe that trauma can lead to growth. As I often tell patients, a trauma can define you or it can motivate you.
Unfortunately, when perceiving the plight of the brain injury victim, we can often be quite lazy when it comes to understanding ambiguity so we rely on extremes. This causes us to put people in too simple of categories, seeing individuals with visible impairments as grossly disabled and those without visible scars as generally fine.
Patients and their family members must learn to integrate both good and bad moments in their lives. As tempting as it may be, avoidance does very poorly to rid us of our true problems, allowing for them to grow and generalize in a hidden manner. This is what causes trauma to thrive. Yes, the person had a traumatic brain injury, but they are much more than a traumatic brain injury. Those things that we tend to avoid about ourselves and our experiences have a nasty way of defining us in a covert manner. So, as an analog to brain injury awareness, let’s bring awareness to the trauma of traumatic brain injury.