What is the process that people go through when adjusting to life after they sustain a brain injury?
There is a process that I believe people go through in adjusting to their injury. And let me talk about it from the point of view of the person with the injury. My perception is based on seeing hundreds, if not thousands, of people over the years and seeing people for counseling. When people first get injured, they really don’t know what’s happened to them and they get feedback from their family. Their family might say, "You’re losing your patience, you can’t remember the way you used to. It takes you a lot longer to say what, you used to talk so fast, now you can’t even say what’s on your mind."
The person with the injury at first doesn’t really understand what’s happened to them. Then they get feedback from family members who say, "They’re different, their memory’s not working, they’re slower." And they begin to think that maybe they are different and maybe they go back to work and they fail at work and the person begins to understand over time. It may take three months, it may take six months. I had a patient who I believe it took seven years to really understand that they were a different and less effective in terms of cognitive skills and abilities than before.
And then when people realize what they can’t do, and some of this comes through failure, and some of it comes through other people giving them really negative feedback, they begin to get really upset and they lose their confidence, and they get distraught and they feel hopeless and overcome and worried about the entire future. And this is often the place where myself or my colleagues, Dr. Godwin, Dr. Nancy Sue at VCU Medical Center, where we’ll step in, because people are often most receptive to help when they feel like their life is going to fall apart. They want to find someone who can lead them to a better place.
And so part of what we do in therapy is we normalize their feelings, we help them understand that the fear and anxiety they feel is a natural part of the process of grieving. We also tell them that grieving is a process and while we can’t give them a checklist to get through it, by talking to others who understand the process they can feel a little bit better. And I try to reassure my clients because I find inevitably people do understand what happened and they do find more positives in their life and they do begin to feel that their life is worthwhile. It may take some two years, three years, but ultimately I have found that pretty much every person gets to that point.
And when I talk to my patients, I say, "You will get there, you may not believe that you will get there right now, but just for the moment I would like you to trust me. We’re going to find a way to help you find the positives in your life, the parts to feel more hopeful and to feel optimistic. You will get there and I promise you that you will feel that your life will feel a lot more like a life worth living in the future."
Jeffrey Kreutzer, PhD a Professor of Physical Medicine and Rehabilitation, Neurosurgery, and Psychiatry at VCU. He serves as Director of Virginia's TBI Model System, a position he has held since 1987. He also coordinates VCU Health System outpatient services for families and persons with brain injury.