9 Things NOT to Say to Someone with a Brain Injury

Marie Rowland, PhD, EmpowermentAlly
9 Things NOT to Say to Someone with a Brain Injury

Brain injury is confusing to people who don’t have one. It’s natural to want to say something, to voice an opinion or offer advice, even when we don’t understand.

And when you care for a loved one with a brain injury, it’s easy to get burnt out and say things out of frustration.

Here are a few things you might find yourself saying that are probably not helpful:

1. You seem fine to me.

The invisible signs of a brain injury — memory and concentration problems, fatigue, insomnia, chronic pain, depression, or anxiety — these are sometimes more difficult to live with than visible disabilities. Research shows that having just a scar on the head can help a person with a brain injury feel validated and better understood. Your loved one may look normal, but shrugging off the invisible signs of brain injury is belittling. Consider this: a memory problem can be much more disabling than a limp.

2. Maybe you’re just not trying hard enough (you’re lazy).

Lazy is not the same as apathy (lack of interest, motivation, or emotion). Apathy is a disorder and common after a brain injury. Apathy can often get in the way of rehabilitation and recovery, so it’s important to recognize and treat it. Certain prescription drugs have been shown to reduce apathy. Setting very specific goals might also help.

Do beware of problems that mimic apathy. Depression, fatigue, and chronic pain are common after a brain injury, and can look like (or be combined with) apathy. Side effects of some prescription drugs can also look like apathy. Try to discover the root of the problem, so that you can help advocate for proper treatment.

3. You’re such a grump!

Irritability is one of the most common signs of a brain injury. Irritability could be the direct result of the brain injury, or a side effect of depression, anxiety, chronic pain, sleep disorders, or fatigue. Think of it as a biological grumpiness — it’s not as if your loved one can get some air and come back in a better mood. It can come and go without reason.

It’s hard to live with someone who is grumpy, moody, or angry all the time. Certain prescription drugs, supplements, changes in diet, or therapy that focuses on adjustment and coping skills can all help to reduce irritability.

4. How many times do I have to tell you?

It’s frustrating to repeat yourself over and over, but almost everyone who has a brain injury will experience some memory problems. Instead of pointing out a deficit, try finding a solution. Make the task easier. Create a routine. Install a memo board in the kitchen. Also, remember that language isn’t always verbal. “I’ve already told you this” comes through loud and clear just by facial expression.

5. Do you have any idea how much I do for you?

Your loved one probably knows how much you do, and feels incredibly guilty about it. It’s also possible that your loved one has no clue, and may never understand. This can be due to problems with awareness, memory, or apathy — all of which can be a direct result of a brain injury. You do need to unload your burden on someone, just let that someone be a good friend or a counselor.

6. Your problem is all the medications you take.

Prescription drugs can cause all kinds of side effects such as sluggishness, insomnia, memory problems, mania, sexual dysfunction, or weight gain — just to name a few. Someone with a brain injury is especially sensitive to these effects. But, if you blame everything on the effects of drugs, two things could happen. One, you might be encouraging your loved one to stop taking an important drug prematurely. Two, you might be overlooking a genuine sign of brain injury.

It’s a good idea to regularly review prescription drugs with a doctor. Don’t be afraid to ask about alternatives that might reduce side effects. At some point in recovery, it might very well be the right time to taper off a drug. But, you won’t know this without regular follow-up.

7. Let me do that for you.

Independence and control are two of the most important things lost after a brain injury. Yes, it may be easier to do things for your loved one. Yes, it may be less frustrating. But, encouraging your loved one to do things on their own will help promote self-esteem, confidence, and quality of living. It can also help the brain recover faster.

Do make sure that the task isn’t one that might put your loved one at genuine risk — such as driving too soon or managing medication when there are significant memory problems.

8. Try to think positively.

That’s easier said than done for many people, and even harder for someone with a brain injury. Repetitive negative thinking is called rumination, and it can be common after a brain injury. Rumination is usually related to depression or anxiety, and so treating those problems may help break the negative thinking cycle.

Furthermore, if you tell someone to stop thinking about a certain negative thought, that thought will just be pushed further towards the front of the mind (literally, to the prefrontal cortex). Instead, find a task that is especially enjoyable for your loved one. It will help to distract from negative thinking, and release chemicals that promote more positive thoughts.

9. You’re lucky to be alive.

This sounds like positive thinking, looking on the bright side of things. But be careful. A person with a brain injury is six times more likely to have suicidal thoughts than someone without a brain injury. Some may not feel very lucky to be alive. Instead of calling it “luck,” talk about how strong, persistent, or heroic the person is for getting through their ordeal. Tell them that they’re awesome.

Posted on BrainLine October 10, 2012. Reviewed July 25, 2018.

Written by Marie Rowland, PhD, EmpowermentAlly. Used with permission. www.brainhealthconsulting.com.

Comments (514)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

I was hit by a car and have a TBI. I have trouble remembering things, keeping track of the flow time (i.o.w. I can't tell how long ago or how recently something happened when more than a couple days have passed.), and organizing my thoughts in the moment. That last one has been the most difficult to cope with. When I'm trying to engage someone in conversation and they ask me a question, I get stuck and can't formulate a reply. And when I try, my statements are fractured and make little sense. When I take my time answering, people think I've become disinterested. This has led me to become anti-social.
The things people say, don't bother me. It's what they do. The one thing you should do with someone who has a TBI is be patient. I can joke about my TBI, and I don't mind if other people joke about it with me. I don't mind if people point out the obvious problems I have because of it. I'm only bothered when they give up on me.

I was TBI and it is so frustrating having to keep asking what something means.
They just look at me like I am stupid or something.
I just don't understand why people are like that.

my husband has a t.b.i tramatic brain injury,his mother keeps talking to him like a baby.i know thats not normal.she doesnt stop.i dont know what to do..she talks to him like a baby,laughs like a baby,treats him like a baby,blows him kisses through the phone.i dont know how to get her to stop.can someone please help me with this?

no matter what sweetheart, he will forever be her baby, thats just a mothers love. youd do the same if it were your child. im just saying, be patient and considerate, you also got to understand that she is going through it too. try to find ways for both of your to get along and work with your husband and in all honesty.. why are you upset? your husband is dealing with the injury and in my opinion, as his wife you should be there for him not fighting with his mom about what she does or doesnt do atleast shes showing him affection while your just complaining about the love your husband is getting. i dont knwo my friend but seems kinda selfish

Hi, my husband and I were in a severe motorcycle accident in 2011. Neither of us were wearing helmets.
I had internal bleeding 11 broken bones. My husband had brain trauma, a left lobe hemorrhage and subdural hematoma with a 2mm midline shift.
The years immediately following he seemed to be doing better, he returned to work until he retired in 2014.
The past few years, he has become self centered, zero empathy for others, argumentative, hot headed when he drives, aggressive even pushing a shopping cart. Most days he looks at me with the same angry expression I remember seeing in the hospital after our accident. I literally feel like he hates me and quite a few times I have considered divorce.
A very close friend and relatives have noticed his personality change. He gets angry about something and will not let it go. He is ALWAYS right, no matter what.
A once happy, goofy guy who barely laughs anymore. Has anyone else experienced this late onset? How do I live like this? If he can't help it I would understand it more but how do I know if it's due to the TBI? What kind of medication is known to help this?
When I mention seeing a counselor it turns into a fight, and he starts twisting things. He has agreed to see a Neurologist, due to low testosterone and early diabetes ( not because of personality changes).His last brain MRI was approximately 6 yrs ago and it was normal, so I don't know what to think.
Any input is GREATLY appreciated.
Thank you

Forgive him its not his fault my injury was when i was younger than 10 years in my frontal lobe(emotions, cognitive abilities...). I hit the front of my head really hard and a huge bump appeared back then my parents told me that the doctor said im fine. Back then I was a kid so I didnt know better, but now im 21 and after so much(hard to concentrate and learn, depression, anxiety, sudden mood changes, no motivation,losing empathy for others, hard to control emotions...) I finally knew that it was an unidentified mild traumatic injury. The problem with mtbi is most people usually dont get the right help and are sometimes even told theres nothing wrong like my case. The worst about not knowing u have mtbi is wanting to change but physically cant because of your injury so you reach this wall because u dont know u have mtbi and just think how many people ended their lives because of this. So mtbi is a mild trumatic brain injury and judging from your accident your husbands seems to be more severe so his case is even worse than mine becuase his last mri was clean and hes also being told theres nothing wrong. I know it will be hard because he may be really hard on u but believe me I know im a good hearted person but u just cant control all these bad emotions. I hope things get better stay strong honestly your probably one of the only people who can really help him.

I’ve been living with a TBI since I was 16. I’m now 47. This article is on point. There’s not a day that goes by that I don’t think about being “normal”.

people, family mostly, have said it was the medication. which is bad but the worst thing is when they say it's all in your head. it kinda makes me laugh because i think to myself that it is technically correct. but it just highlights the extreme gulf that lies between them actually understanding and being able to help or at least not aggravate the symptoms, and where their apprehension of whats going on actually is.
both statements make me feel like i am stuck dealing with this all on my own. but the second takes away even hope of finding help. the first is more like blaming the victim, usually from bosses, priveledged folks, trump supporters and the like.... people who think they are better than you even before you were injured.

My brother suffered a severe TBI after being assaulted. He is middle aged and my aging parents support him. He has been in a downward spiral for the last 6 months. The smallest things set him off and he goes ballistic. He says the most awful things to them and then turns to drugs and alcohol which makes the behavior even worse. They cannot talk to him about anything important because it's just a cycle that keeps repeating itself. He won't take any medication. When he's been to the doctor he's not honest about his behavior. I don't know how to help my parents. My brother's behavior is putting a big financial burden on them amongst the emotional burden they carry. They really need to find help but I'm beginning to loose hope that there's any help out there for him and my parents. It is really hard to not be angry at him even though I know his injury is affecting his thinking. His behavior was similar before the TBI but now it's so much worse. Any advice or help is appreciated.

I would say get him checked into a place more qualified to watch over him and the behaviors he is doing, like a mental health facility. It might seem bad but realistically that's the best place for him to recover and learn different coping mechanisms. I would also suggest therapy.

My son , has a TBI , he doesn’t want to talk anyone that has experienced what his dealing with, he does take his medication, however it gets in a mode and said she doesn’t feel right, he’s messed up in the head and it’s leave me alone and he will leave and go walking, I’m always worry , I don’t know what to do if he won’t talk to anyone

He might be overwhelmed with your questions or comments causing him to be frustrated. Tell him that you love him unconditionally and to enjoy his walk. That you understand and will give him his space. Sometimes people with tbi are loners because they are struggling with navigating the new brain they have. He will come back, he just needs to figure it out on his own. Have infinite patience and unconditional love for him.

Funny, I have been dain bramaged (sic) since 1974 and no one that I can remember has ever said any of those things to me. That might be because most people I have ever known, except those most intimate to me, have no idea I am that way. Have been quite successful almost my entire life, have not bought into the "worldly" idea of having to have so much stuff, although, I do have a lot of stuff, but, it is almost all stuff that I can use to make my and anyone else's life better, who needs to have things made, fixed, improved, altered or just changed to satisfy some perceived need. Almost all of my stuff is tools and material to use to make life improvements.
Unless I told you, or you already knew, you would not have any idea that I have a TBI.

I had a TBI 20 years ago. AVM, brain hemorrhage, neuro surgery and gamma knife.

I was still school age then. After treatment I struggled with socialising and have had a relatively isolated life since. You could say I missed a lot of normal life moments. My support was deliberately removed more than 15 years ago and I live and work independently now.

Some of those problems linked to a limited exposure to social activities continues to dominate in my life today.

I worry I'll never date, I might never find love. Might never have children. And I will need to go through the next 40 years in similar isolation to the last 20. I'm not sure I could face that.

My illness or disability is visible to everyone but I've worked hard make it as invisible as possible. When it's noticed I'm often shunned and treated like an addict. My resting tremor is often taken for something else. Or I'm treated like I'm incompetent. I'm also overlooked at work.

Most normal people's opportunity to find a mate depends on how they look and interact. I'm at a disadvantage on both counts.

The public perception of head injury should be changed. I don't want to live and die alone.

don't approach someone with a TBI with negativity about others people don't or are may be unable to proses comunactioning can be a major issue, face to face communication in a comfortable setting i.e. stress-free

Number 10 is:
Oh, I forget things all the time too.

I am a care giver for my friend of 20 yrs . Some times I feel like I made a mistake, but then I see such a good improvement from when he was in facility. It seems every time a doctor says they want to test him for different things he gets mad. I am only trying to help, is there anything I can do to help him take his medicine ? Stop being mad at me ? I do everything I can for him is it to much ? Please is there anyone with some advice I am willing to try anything if I dont care for him there is know one else. I feel I gave him my word I would be here to the end, like to keep it not give up on him. I am getting to the point I want to throw the towel in, but I want to try my best before i give up. If you have any advice for me please good or bad I take anything at this point. Thank you for reading this and your time.

Hi, I dont feel like I have a lot of good answers for you. But I want to encourage you I have lived this every day for 3 years day and day out since my husband was badly injured. It is hard. You feel unseen and unheard and attacked and definitely underappreciated.
One counselor encouraged me to quietly say, "You are hurting my feelings." And then walk away. Leave them to think for awhile alone about their behavior. People with TBI are often unaware how they come across because they can no longer process empathy. Leaving them with that thought can help them learn appropriate treatment of others and at least spare you going through useless verbal abuse.
Also support group for caregivers is so encouraging. They often have providers that give helpful insight and talk about treatments. I would highly recommend looking for one near you or online even. Keep up the good work. You are invaluable.

Find an OT or therapist who specializes in TBI and work with them together with your friend. You need someone like that who understands what he needs help with and doesn’t need help with to communicate that to you and also to help him understand what boundaries you need to ser

Renee, Don't give up on your friend. Don't take the anger at you as personal, I know it's hard. I had brain surgery a year ago, I get angry at the people I love the most, I push them away and then get upset that they leave. All I want is someone to be gentle and positive regardless of how I react, because I can't control it. I want to, I see how my uncontrolled actions make my loved ones feel, and that makes it spiral even more. Physical touch, gentle validating words...can defuse the anger sometimes. sometimes it just needs to come out. If you can redirect the anger to something good or just pushing against something, it will dissipate. Like simply just pushing against a wall is so grounding and I can feel my edges and contain my emotions when I can do that. Help guide your friend to those things he can do when he feels the rage of emotions like that. He won't remember, he will need help at first to just know what to do when the emotions hit. 2 other things I want to share that may help. There are apps for meditation. My favorite is "Insight Timer", "Calm" is another one. "Smiling Mind" is another completely free one. I know, you may think, no way, this isn't going to help.... someone talking in a gentle voice about inner conflict and inner peace and dark and light places or taking to visualize a peaceful place isn't going to help.... but it really does!! Preview some of the meditations. You know your friend over 20 years, you know him... pick one that may speak to what he is in need of.... preview it, then play it for him... with him... stay close and listen and meditate with him... make it be your thing, you will find it helpful too. I'm so serious about this, I was so skeptical, but it opens a person up to eventually... and calms the inner self that is at war within. Also, the biggest thing that has helped me is a DBT group therapy, or one-on-one DBT therapist. Look up Dialectic Behavioral Therapy.... It is really helping me get my life back. I am in a year-long program now. There is hope!! Don't lose hope, help your friend re-train his brain and I pray for you, thank you for being there for him.... he probably lost his gratitude with the injury...give him some grace and time to find it again, and he'll express his thankfulness for you, until then, I thank you. Thanks for being an amazing friend!!

I had a TBI in 2017. I am fortunate to have a great support network. However, it was very difficult for everyone until my aphasia improved. Being able to communicate made a huge difference

I needed this today! There are days I feel surrounded by voices that just don't know when to shut up! These and other sentiments are only a part of the reason my brain damage went undiagnosed for so long.

ADEM survivor here waiting to die again. Everyone blamed my "emotional issues" on my medication. I can tell you right now 99% of my emotional outbursts were just. I am dehumunised, emasculated, patronize and gaslight daily. The, uninjured forget, we can have valid issues. The injured can have wants, hopes and dreams. It is the uninjured that forget there was a past and that still carries with us. Sadly I would rather have death. Life is not worth the hell I was born into and now have to relive.

I've been to this site so many times, can't recall.

It disgusts me the way I've (and others like me) are treated.

It should be an embarrassment for others to act as they do, yet it still occurs daily.

Getting help is a joke. Getting everything and anything you earned prior. Is stolen, house, money, life, hopes, and what the government says they provide is not true. I'm stuck.

Most days I want to die. Actually, every day I want to die.

Regrets, many. Being nice and kind. Volunteering, so very much...

I'm so sorry for your pain.

I fond find myself apologizing just because. Just because, people treat me like sh*t. As if I've done something really bad.

I really hope you feel better. You are not alone.

The people we rely on to help us can make a huge difference in how well recovery goes and whether or not we maintain the will to live. It can be very hard if the people around you don’t get it. And are unwilling to try to learn.

I have a brain injury on the right side. It's tough, but keep going. I'll make it with you.

Hey there. I’m just curious my child’s father just had a brain injury to his right side. And he woke up from the coma but he’s not talking do you by chance know ‘ what the outcome would be ?

Hey in 2006 I had a motorcycle accident and got a brain injury from most of my left temporal lobe and a little on my right. Was in a coma for 9 days. Had to be in physical therapy for 2 months, occupational for 4months, and speech for 1 year. All I can say is my parents and friends keep me going for showing their love and support. I am almost the same person I was, but still sometimes there'll be a word I'm trying to say and mostly am able to get it said. Hopefully he'll be able to get through it well!

Regarding talking again after a right brain injury, sometimes there is a need for speech therapy to be able to communicate again.

I have has 2x brain surgeries to try to remove a tumor but I don't shout it from the roof tops. I find this really frustrating esp when I forget something and people respond with "try having my memory"! I'm sure I'll learn to ignore it in time, but i get spoken to like I'm thick, which I never have been.

I've had two as well going on 3.
For me I had to get smarter just to function and one important lesson I learned. Most people don't need to learn how to live with a TBI. Do you know sign language? How's your brail?
So I believe it's give and take.

Hi ~ I sustained a traumatic brain injury due being rear ended at a red light on 3/09/2019 by an 18yo because he was texting. The force was unbelievable - they think the car was going 50mph. My car was totalled. I am very thankful to be alive! I did not hit my head but I was jarred so hard that it felt like my brain shifted. I quickly had neck pain,back pain, and headaches. After lots of testing (MRI, CT, EMG) I have 2 herniated discs in my neck, 3 budged discs in my lumbar, nerve damage in my left arm. I have bruising and damage to my frontal lobes. The vision in my left eye is blurry, I have memory loss, lack of concentration, I am clumsy and extremely fatigued. I lost my job as a spine surgery coordinator because I was starting to make mistakes. I am 53 and this is not how I wanted to retire! I am in so much pain! I had 1 epidural and I experienced a severe reaction (red man syndrome). I'm being changed from cymbalta to lexapro due to weight gain and it makes me perspire profusely. I sleep till 12noon and I have no energy to shower or walk my dogs. I used to decorate for every holiday and enjoyed it so much. I barely have the energy to think about it. I am going to physical therapy for vestibular disorders (vestibular ocular hypofunction) if I remember. I hope by this time next year I regain some of me back. If anyone has suggestions I would love to hear them❤
Thank you,

Hi Evie,
Are you still looking at this site? If so, I would like to reply to your post. Heidi (I may come up as my alta-ego, "Ida" :-)

were accomodations or fmla options from your employer?

Hello Evie I can't say I know all that you're feeling, but I can sympathize with some. I have problems with my lower back and my knees that cause me to be in pain day and night. But the only thing I can say to you just keep praying and trusting in God. When I'm by myself I pray and talk to Him and I can't feel no pain , nothing but peace. Try it , it will help you also.

Two plants i am researching for tbi are vinca and huperzine . Sounds amazing from what ive learned so far .

I have had brain surgery twice. I too suffer from what most call memory loss, fatigue, what ever..
I call it my gift.
It made me look at everything in a positive way.
Try it, at first it's not so easy, in time it becomes habit, in fact I'm replying during covid 19 because I want to make my time count.

After consulting a doctor honestly try cannabis

Very True sometimes have gotten so Frustrated about All that's happened a Drunk went thru a Red light an caused me to be put into Hospitals for 18 months The Best thing I have found is Marijuana helps Me Deal with All the problems as well as Helps control me having .. Aura's - what You have usually before a seizure

Thank you, Evie, for sharing your story. I don't have any suggestions at this time, though I've had 9 concussions. I have gained support from Facebook groups and from interactions with others in those groups. Recovery is gradual, so celebrating small victories has been great for me. Actually, meditation has helped me a lot too; in reduces my anxiety by the end of the session, which helps me sleep. I will be thinking about you...

I do not know how to start, I had many accidents that fit under fate. one of them gave me a traumatic brain injury but the good part the unconciousness was 9 hours. I was 11 years old when i made this accident that made me make two operations. one to remove the blood plot before reaching the brain and the other one to put a medical bone in my head, that was in 1987 while i was walking in the pavement in saudi arabia I found a car in my face then i woke up in hospital. in 1992 I got part of a bullet hitting my skull so my health started to be very bad with a need to many medications. now in 2020 I keep feeling that life is not worthy when you look normal and you have to achieve everything like normal people and no body will care about what you are suffering from.

You have every right to be happy. I have suffered 2 brain surgeries and at first how I was treated bothered me. So I got a mohawk dyed my hair purple and made everyone interested comment on my scar or hair witch led to the scar.
Now everyone interested knows and can form their own opinion

Well now at least for me I know why certain things set me off now. I never understood why they did but it makes more sense now. For kindergarten to well now I have lived with brain damage due to a car accident. I have always had bad thoughts and known I shouldn't because I use to talk lots of my friends and some strangers out of suicide and well all of them have said what I have said helped. As for me i have tried telling myself the same things but I never believe them at least when I tell them to myself where I do when I tell them to others. Learning basic easy things is really hard I remember having to be told things multiple times. I'm slightly embarrassed to tell people about the damage. And well everyone in school knew and some pitted me other bugged me about it. To be honest I dont know what bothered me more. I do remember I started to surpass my some of my peers in math and some other subjects. Teachers were saying I was doing it with ease but I dont know if I was or not. I remember docters telling me I'd never walk but the nurses and parents never stopped pushing me to keep trying I use to run when I wanted to walk. I've never given up. But I almost always feel guilty I don't know why. I stand up for others I feel great but if I stand up for myself I repulse it. But hopefully with this I'll understand myself better.

From where I stand your lucky.
I'm now 53 when I was 49 I was in the FL keys and got mugged by 2 to 6 people depending on which police report you read.
What I have learned to do.

Remember, understanding a disability is easy if you have it.
You can only educate them and be educated possibly?

For 9 a lot feel the wish that luck was not on their side

I really don't know how to start but will like to know how to go about it, my wife currently undergoing brain tumor but hasn't had any surgery yet, the brain tumor was discovered when she was first pregnant and we were able to pull through with the LORD 's help, also buy applying a medication (Dostinex) advised by her doctor, reading few of your comments, on my opinion and which I stand to be corrected please, it seems to me that surgery isn't the best or first option here, because with the medication which she has been taking for over 4 years now, we had two loving kids and I can tell you that they are very healthy and blessed to the glory of the LORD, I am with your guys in prayers, I would like to know if there is any medications expert of Dostinex that could be of help or if anyone has ever tried it as well. Thanks

I have a 6 inch scar across my face after a car accident and I have to get plastic surgery and a boy I know is bullying me because of it and I choke and can’t defend myself

You don't have to defend yourself. I know the feeling very very well. Your scar is on the outside but his scar much bigger on his inside. You are so much more than a scar. Remember that people like that are weak inside and luagh it off when he tries to bully you. You are stronger inside than he will ever be. But with great strength comes great responsibility so don't be mean back and play his game. You are better than that. The joy in that secret is huge

How profoundly RIGHT ON!!! I assume you have a PHD.