The Impact of the Flat Affect on Families After Brain Injury

The Impact of The Flat Effect on Families after TBI

How do you love the man who can’t express emotions the way he did when you first fell in love with him? How long do you continue to gaze into eyes that don’t see your heart? How many times do you say, “I love you” to someone who doesn’t respond?

My husband, Hugh, experienced the “flat affect” after his TBI, and it lasted several months. He rarely spoke, and when he did, he spoke in a monotone voice. His face didn’t register emotion, and he didn’t respond to the emotional cues of those around him.

But I remember his dead eyes more than anything. They didn’t register, light up, or drink in the world around them. They didn’t delight in the sound of his daughters’ voices or soften at the sight of those he loved.

TBI incorporates so many symptoms into its repertoire that it’s impossible to understand the scope of havoc the injury wreaks on relationships, and flat affect, in my opinion, is one of the hardest symptoms to accept. It can lead family members to grapple with harsh self-judgments:

Why am I feeling sorrier for myself than for him?
Am I selfish for wanting more from him than he can give?
Do I love this person anymore?

These kinds of questions make family members feel shameful and blameworthy. I remember speaking to a psychologist about my disturbing inner thoughts; and no matter how much she told me that my feelings were normal and warranted, they felt reprehensible and unforgivable to me. Of course, I still love him, I told myself. But what if he never changes? What if he stays this way? Can I live like this? These questions hounded me because I feared the answers. It’s hard to accept a truth you don’t want to tell yourself.

Flat affect changes the dynamics of a person’s relationships to everyone in his or her world; but quite often, it doesn’t last longer than six months. It is not only caused by the physical trauma of TBI to the brain but can result from depression. So it’s worth having a neuropsychologist figure out this part of the equation.

These days, when I wake up each morning, I am grateful for the light that has returned to Hugh’s eyes, and for the meaningful life he now enjoys. And, yes, I was selfish. I wanted him back whole and complete and able to love me in return. His flat affect lasted nearly three months before we began to see significant improvements, but every minute felt like a year.

If your loved one suffers flat affect symptoms, I urge you to seek help from a professional. There are therapies that can help. Learning to cope with your emotional turmoil is an important first step, because while your loved one might not be experiencing or showing any emotions, yours are most likely running in overdrive.

Comments (4)

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Thank you SO MUCH for that.. I feel exactly the same way. My beautiful man "doesn't want to put me through this anymore", but I will not allow him to give up on the mind-blowing love that we share. Thank you, from the bottom of my heart.

Chemistry, yes, it's all about the chemistry ... thrown way out of kilt, it portends to the unblemished spouse as to what becomes of the relationship. Throw it out the window, no problem. Make it work, that is a monumental task that will take years, maybe decades, maybe longer ... clearly a very personal decision with nary a an upside initially, one would think. Perspective, yes, perspective ... bright, light, dark, heavy, what one chooses to put forth is the results, normally, one receives. The nature of life is present everywhere ... you have received a unique opportunity to revitalize life an experience something that few people are given the opportunity to accomplish. Reconstructing human life ... it be, it be, or, it be not, it be not ... what will it be? The degree of patience patched into the formula for reconstruction is critical to the ultimate success or failure of the project. It is not an easy endeavor one has been dispatched too if one accepts the mission. Eighty percent failure I estimate. I know what is encapsulated in such a mission. Very few people have the chemistry and the compunction to see the job through. Rare an unique is such a coupling ... my Mother an I completed the journey through the desert and I passed into the fertile land of the living, again. It be "Just Right."


FYI: My severe subdural hematoma was 20 years ago.

You’re writing is eloquent. I concur the beauty of being able to assist one with creating the experience of seeing life through a new lens. As a survivor I grieved my old self (even though I couldn’t remember who that was). I learned of the loss by people’s comments about how I was a shadow of my old self, my best friend moving on because I was too “different”, and inability to recall many memories, life skills, and my personality. There were so many stories of how awesome and funny I was. Sitting in the hospital bed was a blank yet aggressive slate.

I was literally reborn from my accident with the expectation I would fill the shoes of the asshole whose choices put me where I was- meaning myself. At first I blamed the driver of the vehicle from the accident. With time I realized it was by my own choice that I had went out that evening and would have to deal with the consequences to move on.

Riding horses helped to bring back some of myself; this was done with the persistence of my dad, who just wouldn’t give up on me. He knew the odds were stacked against me, yet he persisted and was a sort of cheerleader for me.

With time I remembered more things about my childhood and gradually I felt a bit more understanding about who I “was”- all the while struggling to exist. I was angry, would forget words that were at the top of my tongue, would lose things frequently, cried easily, felt other’s pain incredibly, wanted to fit in this world and wanted to be loved. I must have missed the memo that said “things will never be the same.”

Even with the severe injury I quickly saw beauty. I noticed the horses, the mountains, the fish, the deer, the elk, the campfires, the hikes, the smiles, the hugs, the babies, the flowers, the lakes, the oceans, the steaks, the campfires, the fireworks, the rain, the clouds, the wind, the music, love and in time, my own family.

It took years to slow myself down and development of self talk that I don’t need others to grant me permission to fit into my own skin, I could do that on my own. I would be who I was.

Without someone like my dad being relentlessly at my side and encouraging me (even in my darkest moments) I may have went to the dark side of drinking, drug use, self-harm,and other detrimental behaviors and never returned from my path of imminent destruction. My dad helped me see the beauty in life and slowly I shaped my new, slightly scarred up, self.

20 years post TBI~Ok. I’ll admit that I can have a flat affect sometimes, but that doesn’t mean that I don’t feel. At some point I remembered how I used to make silly faces as a child and I started experimenting with making faces. That’s seemed to have helped me to use more varied expressions. I still have anger issues that I have under control. I don’t fight anymore. Sometimes I still forget words and it’s embarrassing, especially if I practiced what I would say. I still cry easily because I feel so much. Still forget things, which has been significantly been boosted by using planners, reminders, and timers. Don’t have many friends, maybe I never will mad that’s ok. I like to spend time alone when I can and I work on writing, painting, cooking, reading, listening to music, working on loose ends from work, hunting, fishing, and making things. My family takes up lots of my time and that’s a good thing. My kids and husband never knew the old me and I wouldn’t go back to being my old self.

It would be difficult to have to deal with a spouse who changed from a TBI. I’m not in the position to tell anyone what to do, yet remember that brain injuries can take time to recover(?) from.

Remember a survivor of a TBI gets "reborn" after the TBI. He "gets reborn" because he has to relearn everything again. Apparently the first thing my physiotherapist did with me was to teach me how to turn independently in the bed again!

But everything improves with practice.