Dealing with Unpredictability and Uncertainty After a Brain Injury

"Will my son be able to finish high school?" "Will my husband be able to keep his job?" "How will we pay the mortgage now that my wife has lost her job?" "Why do I lose my temper at the drop of a hat now when I never did before?" Unpredictability and uncertainty after a TBI are scary, but life will get easier as problems are solved and families develop a new normal.

There is uncertainty. Most people, or many people, before they have an injury, they know what they are going to do the next day and the next day and the next day. They know they're going to wake up when the alarm rings at 7:00. They know they're going to get dressed. They know they're going to feed their children breakfast. They know they're going to drop their kids off at school. They know they're going to go to work. They know they're going to work for 8 hours, and then they're going to do what they did in the morning in reverse. And people—there may be some exceptions—but most people like routines. I think we all get into a routine. It makes our lives predictable. And people like predictability. It makes us feel secure. And what happens after a brain injury, especially early on is people can look in the mirror and they say "I look the same, but my memory is not the same." "I'm inpatient. I'm irritable. I'm frustrated." "I'm afraid to be around my children because I keep losing my patience with them." "Im a very impatient person." And people—most people know themselves pretty well. But what happens after a brain injury, is people who have a brain injury are totally confused. They look the same in the mirror. Maybe they feel like they are the same, but the boss says, "You know what, you can't multitask anymore." "You used to be able to speak at our meetings, and now I'd rather not have you speak." "I'd rather have you listen." Or the wife says "You know what, I don't think you are a safe driver anymore." "You used to drive us around all the time." "Whenever we'd go anywhere—when we'd go shopping, when we'd drop the kids off at little league—I don't want you driving anymore because you're losing your temper, and you almost got into a fight with another driver yesterday when you said he cut you off." "You would never do that." And people begin to question what they know about themselves. And they experience a lot of doubt. But the uncertainty is—"Can my 17-year-old child finish high school?" "Can my 19-year-old child start college again in the fall?" "Can my son go to medical school?" "Can my husband play the piano at church anymore?" There is so much uncertainty. "Will we have enough money to make our home payment?" With the recession, I've had several clients who after their injury, they could not support their famiy anymore. Fortunately, some of them, their wives are working so they had some source of income. And what happened was I followed these people— they didn't know if they had enough money to pay the mortgage, and they didn't. And so what happened over time was—and this was part of the therapy discussion— "Well, how are things going with the bank?" And I've had some people who eventually the bank foreclosed on their home. They had to move into a much smaller place that they rented. And their credit rating, which they had worked— people will say "You know I worked for 20 years to get a good credit rating." "I never had a problem paying bills, and now I can't afford to pay the mortgage, and my family has been forced out of our home." There is a tremendous guilt and sense of failure that comes with that. And the person's accident is no fault of their own. But they feel horribly guilty. And the famliy feels like their life has been upended as well. And I've had—it's very sad—I've had a number of survivors say to me "I don't want to do this to my famliy." "I' was going to pay for my kids to go through college." "My family should not have to go through this humiliation, to give up their home and it's all because of me and my accident." And over time, people try things. And sometimes they fail. And over time—and sometimes psychological evaluations can provide really invaluable input about what a person can and can't do. But people figure it out. The process of figuring it out often involves failure with— there's often some success—but, there is often a lot of failure. There is a lot of pain, and it's very important for the uncertainty about the future— work, school, keeping house—it's important for it to resolve so people can cope with whatever their life is going to be like.
Posted on BrainLine July 30, 2012.

Produced by Victoria Tilney McDonough, Justin Rhodes, and Ashley Gilleland, BrainLine.

About the author: Jeffrey Kreutzer, PhD

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.

Dr. Jeffrey Kreutzer