Speaking from my experience as a caregiver for my son Robert after his traumatic brain injury, and now being a TBI survivor as well, this type of injury can create intense mental states that are difficult to deal with. The injury he received in Iraq became my first exposure to the concepts and realities of TBI – unfortunately, I had no idea what he was going through or how to provide an effective support system for him.
Considering the critical back injury resulting in a spinal fusion while he was still a teenager and the PTSD that life threatening injuries and war zones commonly bring, he already had a lot going on emotionally. But as those of us who are TBI caregivers or survivors know, a TBI changes everything in the area of emotional control.
The most common areas where we experience problems are depression, anxiety, irritability, mood swings and what I can only describe as the complete loss of our emotional buffer zone. This can be fueled both by difficulties in adjusting to the impacts of our acquired disabilities, as well as physical injury to the parts of the brain that are responsible for expressing emotions.
Irritability and anger were some of the biggest initial impacts my son experienced. Don’t get me wrong, he had many things to be angry about starting with his injury from an IED, loss of his life plan of retiring from a military career and the very real possibility of being in a wheelchair for the rest of his life. But where he had his greatest struggles wasn’t with that kind of anger, instead it was the kind that’s just below the surface and goes from zero to out-of-control in seconds.
Debilitating social anxiety made itself evident even in small gatherings. PTSD from wartime experience often makes the sufferer hypervigilant, meaning they feel a driving need to keep close track of everyone in their field of awareness. TBI related anxiety occurs when too many demands are being presented and the brain is unable to keep up.
Depression started to evidence itself in many ways; it was mostly as a lack of interest in doing anything except playing video games, and even that was just a way for him to fill the time each day. The depression drove another issue that we struggled with… self-medication, which is very problematic where TBI is concerned. I’ll address that topic in another post. The strength and variability of his mood swings became a significant challenge for me to accept without judgement. Sometimes the swings are connected to an event of some sort, and other times they appeared right out of the blue.
How do we support a loved one who is going through some, or all, of these struggles? First and foremost, my approach was to always be slow to respond – to allow myself a few moments to put things in perspective and avoid an emotional response that would only escalate a situation. We always need to maintain an awareness that a TBI can render a person unable to control their emotions as they did before the injury, and to recognize that it’s really the injury talking, not our loved one. It’s easy to offer guidance like “stay calm” and “be patient”, but when we are in the moment it can be very difficult to do this.
And now I’ve seen this from both perspectives – that of a caregiver and that of a TBI survivor. As a caregiver, it was hard seeing my son struggling to adapt to the changes in who he was; at the same time it was so hard for me to accept and understand these new behaviors. As a TBI survivor, I saw my family and my girlfriend going through the same challenges to accept my behavioral changes, all while I desperately struggled to restore some sense of balance and control in my life. I’ve learned just how frustrating it can be to see the pain in the eyes of someone you love because of your unintended words or actions, and all too often being unable to find the words to soothe the hurt.
If you are a caregiver, patience is important, forgiveness is critical. If you are a TBI survivor it’s the same, you need to be patient and forgiving with yourself. Some things may never heal, and those that will, take time.
My TBI husband is pretty hard on me when he is overwhelmed, but he is also very hard on himself when he recovers. I’m better at being patient in recent years, but I can still react badly. The change in his demeanor from one moment to the next is just really hard, and it’s not going away.
From the perspective of a brain injury survivor, I can share that when I’m dysfunctional, I’m not always fully cognizant of it. Typically, in these moments I’m in a state of mind that tells me others are being unreasonable and they apparently just can’t see reason, why are they being so obtuse/demanding of me/unsympathetic/(and the list goes on). And as you describe, I can sometimes go from zero to out of touch instantly. I can tell you that these days I have much more clarity and emotional reserve than I once did – I accredit this largely to my daily meditation practice.
Meditation is a simple, non-religious practice of quieting the mind for a short time each day. What I was taught in class, and have found from personal experience, is that meditation isn’t about what you experience during the meditation so much as what you begin to experience in the rest of your day. As I discuss in my meditation post, those who are closest to me confirm that I am calmer, more patient, and my emotions are no longer just below the surface (on most days that is, unfortunately, a night of poor sleep can still change this). There is much scientific evidence that meditation increases neuroplasticity and changes our brain in many good ways. It might be worth exploring.