After a brain injury, people may appear completely “normal” physically, but those who know them well may be perturbed by changes in behavior. For example, it takes a great deal of focus and maturity to invest energy in relationships even when we’re healthy. Imagine the stress on family life when a loved one is behaving differently.

Let’s review the list of common consequences of a brain injury and think about each one as it can affect everyday life, especially relationships. The following are vignettes from my case files:

HEADACHE
OR CHRONIC PAIN
DIFFICULTY
WITH
CONCENTRATION
SLOWNESS IN PROCESSING INFORMTION EASILY CONFUSED OR GETS LOST LOW ENERGY/ MOTIVATION LOSS OF LIBIDO LOSS OF
INHIBITIONS
CHANGE IN SLEEP HABITS CHANGE IN APPETITE DIZZINESS/LIGHT-
HEADEDNESS
LOSS OF TASTE/SMELL EXAGGERATED
SENSE OF SMELL
TINNITUS RAPIDLY SHIFTING EMOTIONS

 

CONSTANT MILD HEADACHE OR OTHER CHRONIC PAIN

Lydia, a 36 year old housewife, had nearly constant migraines that sapped her energy. “Trying to fix dinner and help the kids with their homework was more than I could manage. Talking while I had a headache was so hard, I just avoided it. I guess I thought my husband would understand.” By the time Lydia came in for neurofeedback, her marriage was in jeopardy.

•  •  •  •  •

“Ever since Tim’s accident, he’s been in pain. He’s lost his sense of humor, his energy, his interest in me and our home. I know he hurts, but I’m doing all the work for both of us.”

•  •  •  •  •

Max was very active in sports throughout school, but during soccer season his sophomore year he had a couple of on-field accidents. After the second one, he was noticeably disoriented and his coach removed him from the game. A year and a half later he was still having headaches and neck pain. School work had become very difficult and he had trouble focusing in school. Sports were no longer an option. He went from being academically and socially engaged to withdrawn, sullen and depressed.

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DIFFICULTY WITH ATTENTION, CONCENTRATION,
MEMORY, PLANNING AND/OR DECISION MAKING

Kathie, a 43 year old former school administrator, had been happily unaware that her family and friends were frustrated with her. She chatted all day, recounting stories from her past, not realizing she was repeatedly telling the same people the same stories until one day her sister lost her patience. In addition, Kathie could no longer be counted on to plan the many family events. “Kathie was always the organized one in the family,” her sister told me. “We knew something was wrong, but nobody connected it with the car accident. She walked away from that. A few months later I was supposed to meet her at the mall near her house to shop for our mom’s birthday party, but when I called to find out what was keeping her, she said she didn’t know what I was talking about. Then there was the family picnic at the beach and Kathie showed up three hours late with a basket full of empty Tupperware. She looks the same, but she’s not Kathie.”

•  •  •  •  •

Because he had always been in charge of finances in the family, Tony insisted on continuing in that role and rebuffed his wife when she tried to intervene. He did not want to give up his role as “The Decider”. His wife was frantic because he trusted total strangers with some major investments but then he could not remember what he had agreed to.

•  •  •  •  •

I have seen this phenomenon fairly frequently and I believe it has to do with the pressure of decision making. When someone, especially a well dressed stranger, is charming and presents an idea with confidence it is easy to be swept up in the moment. On the other hand, friends and family members come with “baggage”. Our relationships with them are more complex and after a brain injury that very complexity may make us less trusting of their motivations. In addition, accepting the simple conclusion of a stranger can be less confusing than the burden of making a decision. How does one make a choice when one can not easily transition between two thoughts?

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DIFFICULTY OR SLOWNESS WITH PROCESSING INFORMATION -
SPEAKING, SEEING, HEARING OR THINKING

Terry, a young father with small children, felt he was failing his kids. He could no longer communicate with them in a way they could understand. He could no longer read them bedtime stories and his wife did not trust him to take them to the park by himself since he could not track what both children were doing.

•  •  •  •  •

Mark had to drop out of college after flying off his bike. “I felt dazed, but shook it off and rode my bike back to the dorm. Over the next few weeks, reading became difficult and I couldn’t track what the professors were saying. I tried using my friends’ notes from classes, but they didn’t make sense. Nothing makes sense. I can’t even understand stop signs. I have to think, ‘Red. I know that shape. Octagon. S. T. O. P.’ By that time, I’m through the intersection. It’s getting scary.”

•  •  •  •  •

Several months after a fender bender had left Brenda “addled”, she was struggling with her course work in college. She managed to scrape by with “good enough” grades but was worried that things would just get worse. “What really bothers me is that I study really hard but I feel like I’m not learning anything. I’m scared to death to take tests. I have no idea what the questions mean, but I try to answer and somehow I get enough right to pass. I really don’t get it. I feel like I’m just a weird kind of lucky. How am I going to manage with a job if I ever graduate?”

•  •  •  •  •

Robin, also a college student, had trouble in lecture halls after her skiing accident. “I know what you’re saying because you are sitting right in front of me and I can watch your lips. I can ask you to repeat yourself, but lectures are so different! You know the adults in the Charlie Brown shows on TV? That’s how lectures sound to me. ‘Mwhaa mwhaa mwhaaaa mwha mhwa.’ I have no idea what is being said. I have to read the assigned reading over and over and hope that the lectures come just from the books. If some comment is made in class that isn’t in the texts, I’m totally lost. Every time I read, I take notes on index cards. I end up with hundreds of note cards that I go through over and over. Somehow I pass, but I don’t know how.”

•  •  •  •  •

Leon’s eyes had been tested and his vision was close to perfect but his ability to process what he saw was greatly hampered after his brain injury. In fact, he eventually lost his driver’s license because it took him too long to “see” what was going on and respond appropriately. His brain simply could not efficiently register what he saw and send the message through his body to react appropriately. Unfortunately, he did not understand the implications, could not take responsibility and was irate that he could no longer drive. “I haven’t really hurt anybody. The last pedestrian made a big fuss, but I only bumped him.”

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EASILY CONFUSED OR GETS LOST OFTEN

Marvin’s wife was often frantic because Marvin insisted on doing errands by himself but couldn’t remember how to return home once he left their neighborhood.

•  •  •  •  •

Beth made three appointments with me before finally staying focused enough to find my office. When she did get to her appointment, she arrived two hours late.

•  •  •  •  •

Georgia had to pull over and call the office several times en route to her first neurofeedback appointment. Even though she had been to my office for the intake; had written instructions and a map, making turns was consistently confusing because she could not easily tell left from right.

•  •  •  •  •

With some clients, I know the neurofeedback is working simply because they start to get to my office on time.

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LOSS OF ENERGY/MOTIVATION

Berta rarely left her studio apartment after her injury. Her days and nights were spent on the couch, staring at the television. She had no interest in any of the many hobbies and sports she had participated in during her younger years and career as an educator. Her daughter, who took responsibility for getting her mother to medical appointments, eventually gave up asking her out for social activities. Instead she developed the pattern of shopping for her mother and stopping by to fix a meal for her once per week. During that visit she would clean the apartment but she could not engage her mother in conversation. “It is as though she is locked in her head. There isn’t anyone left in her eyes. My mama is gone.”

•  •  •  •  •

“Chuck hasn’t worked since the attack two years ago. The doctor says there’s nothing wrong with him physically. They put him on antidepressants but that didn’t help. Nothing helps and he just sits on the couch.”

•  •  •  •  •

“Travis was such a go-getter until his last football season. Something happened, but we never could figure out exactly what. He just changed. He’s not doing drugs. We even had him tested. He did say the coach told the team ‘If you don’t see stars, you’re not hitting hard enough.’ Could that be what caused him to lose all his steam? He just watches TV or plays video games. Nothing else interests him.”

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LOSS OF LIBIDO

Dennis told me he still loved his wife but simply could not feign an interest in sex. His wife said, “We used to have a great sex life. Now we can’t even cuddle because he gets antsy. Every time I touch him, he jumps.”

•  •  •  •  •

Jane still participated in sex with her partner but said, “There’s nothing to enjoy.” She resented having sex because she felt nothing but she believed it was her duty and she was afraid of being abandoned. Much of her body was numb due to her injuries. “Sex is boring and messy but it’s my job and I have to do it.”

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LOSS OF INHIBITIONS

Nick is a brawny former football player with multiple head injuries. Known to his family and friends as a good natured fellow with a great sense of humor before his last injury, he became what he called “…a faucet I can’t turn off. I cry all the time.” Ashamed of his lack of control, he isolated himself. “I can’t have people see me like this. When I’m sad, I cry. When I’m happy, I cry. Any emotion at all – I’m sobbing. It’s so humiliating.”

•  •  •  •  •

Tom’s head injury caused a hyper-sexuality. He struggled to control his drive to masturbate but was not successful on his own. His wife required him to move out of their home and away from their children. “I know he’s a good man and this is because of his head injury, but I can’t let the children be exposed to him while he’s like this. He doesn’t understand and is so angry at me, but I have to protect the kids.”

•  •  •  •  •

Wendy lost friends because her capacity to filter her thoughts and modulate her voice disappeared after her brain injury. Not only did she offend people; she did it in a very loud, abrasive voice. She knew she was angering others but she justified her behavior by saying, “I have to be honest and tell it like it is. I can’t lie. Besides, I have a brain injury. I can’t help it.” She told me several people have told her never to come back to their homes and she’s been “kicked out” of shops, banks, restaurants and a church.

•  •  •  •  •

Andy, a night watchman, was set upon by burglars and beaten with a wrench. “He hasn’t hurt anyone yet that I know of, but he’s broken a lot of dishes and furniture,” his elderly mother explained to me. “We had to replace the telephone twice and plaster over a few holes he punched in the walls. His wife kicked him out after he broke their wedding china. She thought it meant he didn’t love her anymore but I don’t think he could help it.”

•  •  •  •  •

Jesse, a young bodybuilder whose nose was broken in a gym accident, developed a very short fuse. It was easier for him to punch people than to discuss situations. “Yeah. If I get arrested one more time, they’ll lock me up for good.”

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CHANGE IN SLEEP HABITS

“If you can help Doug, I’ll kiss your feet. He’s up at all hours, TV on full blast or banging around in the garage with the radio on full-bore. The neighbors have complained and I haven’t had a good night’s sleep in I don’t know how long. I feel raw. He couldn’t care less.”

•  •  •  •  •

Juanita described hellish nightmares since her return from three tours in the war zone the military calls “The Sand Box”. “I’d rather not sleep at all than have those dreams. The medications the doctors gave me just make the dreams hard to remember, but I wake up exhausted - like I worked all night. I’ve tried staying up all night but that makes things even worse. My partner says my screaming is freaking her out.”

•  •  •  •  •

“Myron never used to snore, but now it’s like a chain saw all night long. Ear plugs don’t work. I’ve started sleeping in the guest room. He hates it and has accused me of having an affair, but I just can’t stand the noise.”

•  •  •  •  •

Caleb, a veteran of the first Iraq war, said he could no longer sleep in a bed. “I have to sleep on a recliner. Laying out flat feels too, you know, vulnerable. I don’t remember any dreams, but I’ve kicked out a few TV screens in my sleep. I wake up and the furniture’s broken. I’ve been all bloodied up from breaking mirrors and windows. Broke my girlfriend’s nose. No. She’s not my girlfriend any more.”

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CHANGE IN APPETITE - OVER OR UNDER EATING

Caitlyn, a teen who had a complicated series of accidents and developed an antibiotic resistant bacterial infection after the last event, came to my office emaciated. Health conscious and athletic until her injuries, she wanted to eat, but felt nauseated by the sight, smell and textures of food. “Sometimes I actually get food down, but I almost always vomit right away. I hate being this way. I can’t go out with my friends. I used to love going out for pizza with them but the thought of pizza is horrible now. They think I have anorexia and are all like ‘Oh poor Caitlyn!’ but they’re scared of me – think I’m contagious or something. I don’t want to be this way!”

•  •  •  •  •

Henry was brought in by his mother. A few years before, when three years old, he had fallen into a neighbor’s pool. Emergency medical technicians resuscitated Henry but according to his mom, he hadn’t been “right” since. “Ever since then, he can’t tell me whether he’s hungry or full. If I don’t put food in front of him, he’ll go all day without eating. It just doesn’t occur to him. He’ll even wander out of the lunch room at school because he’s not interested in eating. But if I don’t watch while he is eating, he’ll gorge himself and will end up making himself sick.”

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DIZZINESS, LOS OF BALANCE AND FEELING LIGHT-HEADED

Harold came in complaining of depression. “I’ve lost all my friends. Ever since my accident, I’ve been dizzy. I used to be active in the Mazamas (a local mountaineering organization). Now I can no sooner go for a hike than swim the English Channel. All my friends are hikers. I can’t ask them to sit around and just talk. Who wants to do that?”

•  •  •  •  •

“Doris and I met at a dance; we built our relationship on dancing. Just before her brain hemorrhage, we started tango lessons. Now her balance is so bad, I have to support her walking down the hall. I love her, but I also love to dance. I know it would break her heart if I got a new dance partner.”

•  •  •  •  •

“I used to be able to make a basket from just about anywhere on the court, but now I can’t even lift my head without the room spinning. People don’t think of basketball as a contact sport, but I can’t even guess how many times I’ve hit the floor hard enough to see stars.”

•  •  •  •  •

JoAnne, a pleasant 63 year old, seemed very distracted when we did our initial interview. “Please forgive me. I have these waves that seem to sweep away my thoughts and fill my head with air. I can’t remember what someone has said or what I’m thinking or even saying. I know there is something I ought to say, that I started to say, but I can’t remember. It’s very embarrassing. I’ve stopped going to church and Bible study group because I can’t bear the looks people give me. I know they think I’m crazy. Maybe I am.”

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LOSS OF SENSE OF TASTE OR SMELL

Jian, a 45 year old chef, came in after a blow to the head caused him to lose his ability to both smell and taste. “Can you imagine what it is like for a chef to not be able to taste or smell food? They’ve put me in charge of organizing banquets because I can’t be trusted in the kitchen. I don’t blame them, but this is my life! My partner is fed up with me because I am too full of self pity. Maybe I am, but I don’t know what to do.”

•  •  •  •  •

Before he was injured in a motor vehicle accident, Bill worked in a plant where chlorine is regularly used “Can’t smell chlorine any more. There was a leak - passed out. Hit my head on some pipes. Had to be rescued. Can’t work in that department any more. Too dangerous. Gave me a dumb*** job. People tease me.”

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EXAGGERATED SENSE OF SMELL

Alice explained to me that she and her husband are avid sports fishermen and they had built their 37 year marriage around their mutual interest in all things nautical. “Every vacation we’ve taken has been on our boat. I love the ocean and I love seafood. At least I did until now. The smell of seaweed and fish make me sick. And the weird part is, I smell it almost everywhere now even when we’re nowhere near the beach. I can’t stand it.”

•  •  •  •  •

Luke described coming to consciousness in the hospital and smelling something noxious. “To tell the truth, I thought it was a Port-A-Potty. That chemical smell? It was overwhelming. I don’t smell that as strong now, but there are other smells. Just out of the blue, and never anything nice. Sometimes rotting flesh; sometimes sour milk. I’d give anything if I could just go out and enjoy an evening with my buddies, without something stinking. My friends tease me about me sniffing and the faces I make. I try to control it, but it’s really hard.”

•  •  •  •  •

“I used to love my husband’s aftershave,” explained Lena. “It sort of turned me on. He’s had to quit wearing it because just a whiff of it gives me a splitting headache. I can’t get in an elevator for fear someone will have on perfume. Last summer, we flew across country to visit our daughter and her family, but the whole trip – airport, plane, rental cars and hotel rooms - was a disaster for me because I kept smelling things that gave me knock-out headaches. Now I’m afraid of going out.”

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TINNITUS
(Ringing in the ears - pronounced TIN-it-us)

“Ever since Iraq, I’ve had whistles in my head that drive me crazy. They are so loud I sometimes can’t hear what is going on around me. My husband thinks I’m ignoring him, but sometimes I just can’t hear him. I can look straight at him, see his lips moving but all I hear are the whistles.”

•  •  •  •  •

When Clinton’s wife called me to ask about neurofeedback for her husband, she mentioned his tinnitus, complaining that he tries to drown it out. “Our whole house is filled with noise, all day and all night. The television, radio, fans – sometimes they’re all on at once. He says it helps drown out the noise in his ears. I can’t hear myself think! I wish I could get away from it.”

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RAPIDLY SHIFTING EMOTIONS -
EXCESSIVE EMOTIONAL REACTIVITY AND/OR FREQUENT CHANGES IN MOOD

“I never know what to expect any more. Anything can flip the switch and make Howie’s mood change. Traffic seems to be a big trigger. Anything can freak him out, especially drivers passing him, but we don’t have to be in the car. Sometimes he just doesn’t like what I fixed for dinner and he loses it.”

•  •  •  •  •

Karen seemed bewildered by her moods. “For example, I was driving with my sister just yesterday. The radio was on an oldies station and I just started bawling. My sister couldn’t believe I was crying over the Rolling Stones. I never even liked the Rolling Stones! Why would I cry? And as quickly as it started, it stopped. I still can’t tell you what made me so upset. My moods are so wild these days, I’m afraid to go out at all.”

•  •  •  •  •

“I can’t let my husband be alone with our younger kids for even a few minutes. His moods change so dramatically, it totally confuses and scares them. It scares me too. He seems to have no control.”

•  •  •  •  •

Jonah had received reprimands from his supervisor for being short with customers. “I was employee of the year before my injury. I’ve been in retail for years and used to love my work. Now I’m afraid I’ll lose my job, but honestly? Sometimes I just want to bite a customer’s head off!”

•  •  •  •  •

According to her parents, Amy had been a model student. “We never had to worry about her. She had always been incredibly level headed, but after her injury her junior year in high school, she turned into Dr. Jekyll and Miss Hyde. Just as she was becoming an adult, we had to completely change how we deal with her. She doesn’t understand. She wants her freedom, but she simply can’t be trusted because whatever mood she’s in at the moment determines what she decides to do.”

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