Oftentimes patients that have had a traumatic brain injury and some psychological injuries actually too, they feel in some ways that they're not who they used to be, that somehow their sense of self is lost. And also family members, especially those closest to them, will make comments, "Well, he's not who I married." or, "He's different now." It's important, on one hand, to acknowledge that this is the same person; however, the way of relating to him or her is different. There is a loss in that, and so validating that sense of loss and helping them really work through some of the grief that comes with that, but recognizing the essence of the person or the love that you have with them, it doesn't get broken because there has been an injury. It may be harder or different to access or connect with, and that we can help families and couples deal with, about how to connect now, given-- so, for example, I can think of a patient whose affect-- which is basically our emotional expression--not our feelings, but how someone outside of you can tell what you're feeling. One consequence of brain injury can be what we call flat affect, which there's basically--it's hard to tell what someone is feeling, so it kind of looks like they're not feeling anything. And so we rely on all of those clues from each other, especially the ones of people who are intimate and close with us. We know their glances. We know kind of if it's a look, if something is on their mind or something is not quite right. With someone who has had a brain injury, sometimes those cues are different now. And so just because in this example the patient may not look like he or she is feeling anything, it doesn't mean he isn't. I was working with a couple where the patient's wife would say, "You know--he doesn't seem to love me, doesn't seem to-- but if you were to ask him if he loved his wife, he loved her as much or as more as ever. But because it doesn't look the same, the wife wasn't sure in the same way. That caused her own sense of, of course, worry and loss, until we were able to talk about it. They could find some new ways of trying to relate and connect and develop perhaps some of those new intimacies, if you will, about that closeness that doesn't have to be gone. It may be different, but it's not gone. Love doesn't necessarily exist in the brain. Now, I'm sure there could be others who will argue that point, that everything sort of exists in the brain. However, I have observed time and time again that that love, that connection, that sort of biological connection, especially--I'd have to say, I've witnessed it even stronger in parents and children than even with a spouse-- that that doesn't get broken because there has been an injury.
Not everyone deals with his or her emotions the same way.
Posted on BrainLine March 4, 2009.
Dr. Mouratidis is a licensed neuropsychologist and currently the command consultant and subject matter expert for Traumatic Brain Injury and Psychological Health at the National Naval Medical Center.