Changes After Brain Injury-Part 2-Caregivers by Donna O’Donnell Figurski
Changes After Brain Injury: Behaviors and Emotions (Part 2) — The Caregivers Role
Anyone who has been a caregiver for a survivor of a brain injury understands that many such caregivers need and want support. An article written by Janet Cromer in “Psychology Today” clearly demonstrated that point, especially for caregivers of the brain injured, who often struggle with emotional and/or behavioral changes in the survivor.
In the “Dark Side of Personality Change,” she tells of how her husband’s personality changed after his brain injury. Before his brain injury, Janet recalls her husband as being kind and loving with a keen sense of curiosity and humor. After his injury, he experienced intense anger and confusion. His bizarre behavior and sudden change from “calm to fiery” led Janet to believe her post-injury husband had two personalities. She likened her husband’s behavior to that of Dr. Jekyll and Mr. Hyde, which she found very frightening. (I’m sure Janet is not alone in her fears. I have heard comments such as these in my brain-injury support-groups too many times to count.)
Injuries to the frontal lobe, especially to the prefrontal cortex, often result in emotional and behavioral changes in survivors. Survivors of any brain injury may find themselves in states of agitation and in unstable emotional chaos. These states can cause outbursts of unintended verbal aggression and raging attacks on family or friends, which can be very hurtful. Though family and friends may try to understand and to be empathetic and helpful, dealing with an unexpected outburst can be an overwhelming task because it is so hard to comprehend.
Violent outbursts and aggression by the survivor can result in the lack of trust and possibly fear of personal injury by the caregiver, family, or friends. But I think it’s the lack of trust – knowing that the survivor can become volatile at any time – that is the scariest and most hurtful. That loss of the sense of security is likely to be the most devastating.
How can caregivers, family, and friends help?
I guess understanding would be at the top of the list. I know that’s not easy, especially if one feels that he or she has been unjustly attacked. Even if one knows that the survivor is not responsible, would not act this way pre brain injury, and will probably feel really bad after the incident, it will still be difficult to accept the aberrant behavior. It’s human nature.
The caregiver, family, and friends need to understand that the survivor’s outburst may occur because of his or her frustration with the reality of the new life – lacking the ability to do the things he or she once did easily and/or experiencing loss of independence and/or the realization of a futile situation. Also, an outburst might be triggered by uncontrolled pain, depression, or any number of ailments. So, showing compassion or empathy, providing comfort, support, and encouragement will go a long way to helping your survivor.
What can one do when faced with irrational behavior by the survivor?
It often helps to leave the area when an outburst begins. Don’t try to reason with the survivor – your efforts will probably not be fruitful. Remember, the survivor’s brain is injured, and he or she can’t help the aberrant behavior. It might help to talk about the behavior in a calm manner after the incident has subsided, or … maybe let it go.
Try to determine if there is a specific trigger for the outburst. If one is identified, avoid those situations that provide it. At the very least, knowing the trigger can help the caregiver, family member, or friend understand a little more. As time goes by, the caregiver and the survivor may each recognize the triggers and be able to eliminate them or lessen their impact.
Identify the survivor’s actions immediately prior to an outburst.
Does the survivor show signs of agitation, tense his or her muscles, or become distracted? If so, take note and maybe remove the survivor from the area. Large groups of people (as in malls, family gatherings, or parties) can often cause agitation in a survivor, which in turn may cause an outburst.
Any overwhelming situation can bring about an outburst. Having to be ready to leave the house at a certain time can cause stress. So, allow more time. Don’t rush.
Give plenty of notice for planned events. Make sure there are no surprises. If a survivor knows in advance that there is a family gathering to go to on Sunday afternoon, then he or she can plan for it. Surprises and unexpected events often cause anxiety and confusion, which can easily bring on an outburst. So, plan ahead.
Counseling for both the survivor and the caregiver (or family member) can be helpful. Visiting a neuropsychologist or a behavioral therapist can help. They are able to teach compensatory tactics to avoid or lessen the effects of an angry outburst. The survivor may employ deep breathing, alter thoughts to a more pleasant topic, leave the area to regroup in a quiet place, let friends know the trigger points, and ask for help. Periodic reminders can help those who struggle with memory. These are all simple and effective ways to compensate.
The life of a survivor with a brain injury is not an easy one. Neither is it easy for the caregiver. But, if both the survivor and the caregiver work together, life can be much improved. It most likely won’t be easy, but it will be worth the effort. There are many little tricks that can be incorporated into the lives of survivors and their caregivers to make life better for everyone. The keys are patience and persistence – peppered with empathy, encouragement, and understanding. It’s worth a try.
After Brain Injury: The Dark Side of Personality Change Part I by Janet M. Cromer RN, LMHC