Miscommunication in Couples After Brain Injury

Dawn Neumann, PhD, Brain Injury Journey magazine
Miscommunication in Couples After Brain Injury

The dam finally broke for Christine as she shared with the group her mounting frustrations towards her husband, Mark. “Since his car accident, every time I talk with my husband I get the impression I must sound like Charlie Brown’s teacher,” she said. “Repeatedly, I try to explain my thoughts and feelings to him, trying to make him understand what I’m going through. I feel that I must be insane. Otherwise, why would I keep doing the same thing over and over expecting to get a different response? I’ve explained a million times how I feel, so why won’t he change? I can only assume from his lack of a response, he must not love me anymore because if he cared, he would try to make me happy.”

Anyone ever feel like Charlie Brown’s teacher when talking with your spouse or partner?

No doubt you have heard before that good communication is the foundation for a good relationship. Without good communication, relationships are as vulnerable as a house of cards, struggling to withstand even the slightest breeze. Communication is often a challenge for most couples, but after a brain injury, couples are even more susceptible to problems with miscommunication. Largely, the miscommunication we often see after brain injury tends to revolve around the couple’s inability to share and understand each other’s emotions and needs.

“When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone.”
- Fred Rogers

Christine was trying to share her fears and needs with her husband, looking for him to communicate support and understanding, only to be met with a blank stare. Christine felt very alone in their relationship. Instead of soothing her emotions, they were only worsened.

“The void created by the failure to communicate is soon filled with poison, drivel and misrepresentation.”
- C Northcote Parkinson

Mark’s silence and lack of response falsely communicated to Christine that he didn’t care about her. If asked, Mark would say he loved his wife very much, that she meant the world to him and he’d be distraught without her. So why didn’t he respond to her? After Mark’s injury, his ability to experience and express certain emotions, like fear or sadness, changed. For the most part, he was a happy go lucky guy; he could no longer experience or relate to the emotional concerns expressed by his wife, and as a result, was unable to empathize. He couldn’t infer her needs or detect the urgency or seriousness of the matter.

“Assumptions are the termites of relationships”
– Henry Winkler

Because Christine did not realize Mark’s brain injury made it difficult for him to relate to her emotions, she began to make assumptions about what he was thinking and feeling. She assumed he no longer loved her because her emotions seemed to mean nothing to him. She asked, “Would he even be upset if I left? I really don’t know.”

“To effectively communicate, we must realize that we are all different in the way we perceive the world and use this understanding as a guide to our communication with others.”
- Anthony Robbins

Mark and Christine were not seeing each other’s side. Unfortunately, the ability to think of things from another person’s view point is often greatly diminished after a brain injury. We cannot assume our spouse is going to interpret or understand our feelings, anticipate our needs, or respond to a situation the way we would expect most people to. It is also difficult for a person without a brain injury to imagine how someone who has a brain injury sees the world.

“Remember not only to say the right thing in the right place, but far more difficult still, to leave unsaid the wrong thing at the tempting moment.”
- Benjamin Franklin

One of Mark and Christine’s interactions ended with him saying, “Christine, you’re overreacting like you do about every little thing.” She responded, “You are such a jerk. Maybe it’s time I found a new man to care about my needs.” For both partners after a brain injury, it can often be hard to know the right thing to say in a given situation, and it can become even more difficult in the heat of the moment to fight the impulse to say very hurtful things to our loved ones. When angry, we respond with a kneejerk reaction that really doesn’t communicate to our partner how we really feel or what we want.

But there is hope for good communication after brain injury. Here are some important communication tips:

  • Be explicit. Tell your partner when something is truly important to you.
  • Share and validate each other’s vulnerable emotions. For example: “I can see how you might feel worried and afraid, and I’m sorry you are feeling that way.”
  • If you don’t understand your partner’s emotions, or you don’t know how to respond, then ask your partner for guidance: “Please, I’m having trouble understanding what you mean. Can you try to explain it differently?” or “Tell me what I can do to help you feel better.”
  • Role-play and try to put yourself in your partner’s shoes. Think about where your partner is coming from, and what your partner could relate to. Use this understanding to explain your situation in a manner he or she could better understand.
  • Because people with brain injury may have difficulty knowing how to respond to your emotional needs, tell your partner what you would like to be done.
  • If you have trouble experiencing emotions the way you used to, think back to your emotional experiences before your injury. Act out emotions in the mirror. These exercises could help ignite your emotions.
  •  Avoid making assumptions. Realize your thoughts are not facts, so verify your thoughts with your partner.
  • Before responding harshly to your partner, try to figure out why you feel so angry. When we feel angry, there are often more vulnerable emotions at the root of that anger, such as feeling hurt, afraid, or disrespected. Try to communicate what you are really feeling. For example: “It hurts my feelings when I express my fears to you and you don’t try to comfort me.” Refrain from blaming, name calling, attacking, and “I told you so’s.”
Posted on BrainLine July 10, 2013.

Used with permission from Brain Injury Journey magazine, issue #2, Lash & Associates Publishing/Training, Inc.

Comments (12)

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.

If the communication problems existed prior to brain injury, it can only compound the problem.And not every caregiver has the ability to show empathy sadly.

I read this article with a great deal of interest. However, unless you have a traumatic brain injury it is extremely difficult to understand what the TBI suffer is going through. Just because someone looks fine does not mean if they are fine. A traumatic brain injury is an invisible disability. And I mean that most people that do not live with a TBI survivor on a daily basis do not see the ups and downs and the emotional lability connected with a TBI. Many people with TBI I do not speak because they can't find the right word. Also, many find the theory executive functioning is severely impaired. Let me make it very simple their hardware is intact but their software is corrupted. People with TBI are working on 386 computers while the rest of the world is working on core 7 or whatever is the highest speed now. I know these things and a great deal more because I've lived with it for 11 years. It is a horrible thing to experience and I wish it on no one. Although I am a civilian, my son will serve following his graduation from VMI. In a strange way maybe I was blessed to have a TBI. Because in this crazy world unfortunately I am fairly certain he will be sent into hell. IEDS do horrible damage. I wish I could speak with you more. I have decided to leave my current career and assist returning service members and their families to reintegrate into civilian society. I'm not a doctor, I will not nor can I provide medical advice. However, I can explain because of my own experiences why people with traumatic brain injuries behave the way they do and how best to deal with it. It's okay if one is not able to deal with it. It doesn't make you a bad person what someone who doesn't feel for the person they loved and continue to love. But it takes a hell of a long time to learn and to understand even implement your own compensatory strategies. When your family member returns home.

Since my spouse had his brain injury, that Charlie Brown's Teacher feeling occurs frequently. One thing the article misses is the tendency for the injured spouse to start to resent the need for assistance and in turn the spouse who is the acting caregiver. We are 3 years into this and he feels he no longer needs assistance and resents the assistance he is given. I as the spouse & caregiver am looking at a future and am overwhelmed with concern and worry. He does not remember things 5 minutes after they occur, will never drive or work again. I am looking at a future where I need to go back to work and will work long into my later years in order to keep up with his health costs and household expenses. Just glad we had set aside considerable funds because those savings paid for most of the needs the first 18 months. Since then, it has been robbing from Peter to pay Paul. The injured spouse does not process this stress or remember it in our case and it falls on the shoulders of the caregiver/spouse.
Thank you for giving a lot of good advise for communication with my husband since his stroke. I have many of these same feelings. Still working with speech therapy and finding improvement 10 years after AVM stroke. Each reclaimed word in his vocabulary is heartwarming. Never give up on communication and understanding. He is working with a speech therapist from the visiting nurses since having a surgical procedure, with advancement there is no limit to sessions as with insurance. Thought speech therapy was over after insurance said we reached their limit. Thank God for the visiting nurses association.
For many months after my TBI (high-speed head-on collision) I had a great deal of trouble feeling empathy even with those I love the most. I am usually an extremely empathetic person, but those circuits were damaged somehow, or over-ridden by the extreme anger I felt. In addition, when I'm mentally tired, even now I often find myself having to "replay" my friend's sentences to understand what they are saying. This could be happening with your husband.

I agreed with Neumann statement. When my husband was involved in brain injury then we consult the matter with our solicitor to get advice for compensation claim.

I think this article misses the mark. Obviously the writer is not a caregiver. If your spouse has a TBI, not only can they not relate to the caregiver's emotions, but many of them can't remember what was said five minutes later.

Right on the money! This is the problem with most educated doctors and Healthcare professionals their information is all paper-based knowledge and not experiential. This kind of drivel only seeks to demonize the caregiver further. They aren't doing enough to accommodate the injured spouse in a way that makes everything right again. Will you know what? The only thing that makes everything right again is a time machine to go back before the injury and then avoid the situation that caused that injury. That, or the death of one spouse so that the other spouse is no longer involved.
At this point I am 6 years in with my very damaged spouse from a medical condition that we could not have predicted. This was not a car accident, this is not the result of falling off a ladder, this is a medical incident that was out of our control. My spouse has good intentions but memory issues, cognitive problems and executive function issues that cannot be overcome. The stress of knowing that I don't have somebody to confide in anymore is devastating and something that I'm faced with and re-remember multiple times through the day. Everyday. For 6 years. I am faced with the facts that I am a lifetime caregiver until one of us dies, I will never have my kind sympathetic attentive loving spouse again, and there is no one else who can step up and provide those functions for me unless I get divorced or have an affair. Neither one of those things is a good option.
The base situation mentioned in this article of communication being the problem is literally the tip of the iceberg when you add in memory issues, cognitive issues, initiation problems, physical defects and in abilities, and everything else that goes along with brain-injured patients.
It irritates me the these Ivory Tower educated professionals write articles like this which then our family members read and think that this is a 30-minute Brady Bunch solution to a problem that is so much deeper and so much a core issue just existing. This is the kind of garbage that my mother-in-law reads and then wants to chastise me for not being a better spouse to her little darling. This is the same woman who although we have mentioned it countless times that her little darling has a 30-year lapse of memory called amnesia constantly wants to bring up past events that bothered her about our behavior that are squarely in this 30-year time lapse and agitates and stirs the pot about things that her child will never have the capacity to remember again.

This is an old comment now, but I couldn't agree more! I am now 7 years into being a carer for my severe TBI affected partner, and it is driving me into the ground. I have no support form anyone, and his family live overseas and don't have much to do with him. I am constantly the wrong one, constantly being barked at. Constant angry eyerolls over innocent questions, arguments over simple requests, no empathy, no assistance, no care or concern. He spends money all the time, and provides nothing. I earn all the money, do all the thinking, but he stands in the way of me doing anything with our property, angrily insisting he will do it but never doing it. He is like a child, and an oppositional, poorly behaved one at that. I live daily with the experience of being a deer in the headlights. Whatever I say next could make or break the entire day/week/month. Constantly taken out of context, constantly seen as 'the enemy'. Sure, it is NOT HIS FAULT - but that doesn't change exactly what you said: "I am faced with the facts that I am a lifetime caregiver until one of us dies, I will never have my kind sympathetic attentive loving spouse again, and there is no one else who can step up and provide those functions for me unless I get divorced or have an affair. Neither one of those things is a good option." Well meaning friends just say 'well good on you, I wouldn't do it'... and all suggest that I just go have an affair to fill the void. What good is that?

Like you said, well meaning, Ivory tower professionals... don't do a thing for us. I am maddened by the prospect of the rest of my life in this prison, or 'doing the dirty'... what would others do? I don't know what to do next except to maybe get sick and die.

I have felt like a widow for 4 years. My husband had a brain tumor and when they took it out I feel like they cut me out of his memory too. Cognitively they say he is fine, but emotionally? He’s an unempathetic stranger. I feel so much like what you two have said. He wants a divorce and I want the guy I married. Life can be so cruel.

Knowingly it is a post from 2013.... all said is true. People who does not live with TBI spouse will never understand your situation. Blaming is normal in my household. Not a good mother, wife, daughter in law, person.... belittling is normal in my household..... and your constant anxiety whatever you do, feeling your spouse will pick flaws and start the argument again. 14 years down the line and things has changed a little like less P abuse. He is a very smart guy, loves to help other just that when I try to speak he never understands me... I am failing and I know die or leave is the only option for me... first one I can't have 2 beautiful children who had to put up with this... if I knew it would have been like this I would have never given birth.... there is no one who understands you for sure

I got married 6 months after my injury and this past June we celebrated our 24th year of marriage. I agree with much of what Dr. Neumann says. My only concern is that while I realize what all the "right and proper" ways are to handle the various situations are, it is very clinical to believe that real relationships work like that. The answers are very rational and cerebral, the places where the problems come from are from deeper pre-cocognitive levels, which means by the time they surface they are immune to filters of reasoning. Where this advice is most valuable is not in preventing these conflicts, but in talking about and resolving the issue later. In writing this I have given by severely damaged brain time to process this information more fully, and I see that this is Dr. Neumann's intention also. Bravo doctor, you are so right!