Easy to Misunderstand the Behavior of a Person with Traumatic Brain Injury

Interpreting the behavior of someone with TBI can be like trying to interpret the words of someone speaking a foreign language. Learn more.

You ask about how the behavior of a person who may experience disability following a brain injury, may be misinterpreted. It can be misinterpreted many ways. We talk about problems of awareness for people who experience disability following brain injuries, and I see awareness as a person can't perceive, understand, and react to a situation like other people in that situation do. It doesn't take a brain injury to have a lack of awareness. You walk into the wrong party, you walk into the wrong situation, and you're not going to know all the factors and you're going to be sort of the odd person out. But we also have to talk about people and programs who are trying to work with that individual about their lack of awareness. And what I mean by that, they don't understand how the person of focus is understanding the situation. And much as we talk about the person who may experience disability following a brain injury not getting it because they don't understand the context of the situation or the goals and everything, those of us who are trying to help that person, we have to understand the world as that person sees it. They're not acting insane. They're not acting delusional. They're acting according to the information that they're receiving and understanding. So if a person has problems with attention, or they have problems with memory, they don't have the same information that somebody else may have, and so we need to understand that and we need to understand the capacities of the individual and to work within those capacities. For example, if you and I spoke two different languages, we couldn't have this discussion right now, so we would need a support, which would be an interpreter. So one of the things we can talk about is being able to interpret for a person, helping to provide information to the person. We call those 'Cues' or 'Setups', and things like that, that make sense to the individual. And we do that with everybody. It's not just with brain injury. When we get on an airplane we get cues and guides of what to do to have a nice, safe flight, but just in case it isn't, this is what's going to happen and this is what you have to do. That's actually called preteaching. We find out the person's strengths, and we work with those strengths. And again, that's no different than anybody else.
Posted on BrainLine November 12, 2010.

Produced by Vicky Youcha and Brian King.

Comments (4)

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Appending my previous comment. My post morbid IQ was in the highly intelligent classification. It had dropped from superior intelligent classification. Thank you.

I am post 45 years TBI. I was inured in a car accident when I was 25. My whole family has either denied I have a TBI at all or they have decided among themselves I am a person who is mentally ill and enjoys drama. Who cannot let go of the past, etc. I needed to talk to them about the past because I had amnesia after a car accident. Which they were mostly incurious about anyhow. I could not recognize myself and had lost large parts of my childhood memories. As with all my difficulties, if they were going to get better, it took many years. Sometimes decades to get clarity.

They have completely resisted going to a neurologist or neuropsych with me who can explain exactly what you have explained in this article. My neuropsych exam says I have no delusions, hallucinations or formal thought disorders. I can't carry that around with me and show to them whenever I offend them with something I say or do.

It took me a long, long time to get where I am. And many years of therapy. I did it all on my own. My family, including my own mother were unsupportive. My younger brother said I could show my medical records to them and they still would not believe me. And, as anybody who is familiar with this problem, the chance for misinterpretation from medical records is high. For instance on my neuropsych exam it says I have a relatively minor head injury. That is compared to somebody who has obvious brain injury problems, and that was explained to me.

There is nothing minor about a "minor closed head injury". I wish there was a better distinction made because people like me whose family is looking for a smoking gun of mental illness have the words "minor closed head injury" as proof it's all for attention.

One family member said it was like falling off a bike and she would not believe anything happened to me unless I was dragging a leg behind me.

I am ever realizing things that were affected by the accident. Forty years later I am realizing how I have been too trusting. I trusted the wrong people with information, trusted them to be honest, and misinterpreted their statements as confirmation I should do a particular thing. And for the most part, these were very untrustworthy people. In other words, I am easily conned by a particular type of person. One of them passed himself off as a therapist who didn't get his degree. I can't even tell you the damage he did to me just for the fun of it.

According to my neuropsych exam my premorbid IQ was in the superior intelligence classification. I lost my photographic memory. I was already in trouble with my family because I had a mother who hated that I could see past her gossipy, self centered ways. As a child I used to tell her things didn't seem happy in the family. That made me a black sheep. So her name for me was feather head. Her campaign to sell me to my siblings as somebody who was stupid. So I was pretty much doomed to make a case for who I really am with them anyhow.

My post morbid IQ is in the superior intelligent classification. One neuropsychologist explained to me it is harder for gifted individuals to deal with what they have lost. So my recovery has been very difficult with no support. Art is one of my gifts. After my accident I could only paint muddy images. I worked my ass off for ten hears to get to the point my art had artistic merit. I did not paint often. What's the point. But I painted when I was moved because a clear concept came into my mind of what I wanted. And I could eek out parts of it. Then more, then more. That's what brain injury is like. It has a separate schedule. Art is something tangible. The way I worked to manage my executive functioning was a thousand times harder. I had to wait. So much of it was waiting and then understanding comes. Then more waiting. Putting together a million piece puzzle one piece at a time, and not always being successful when you try. It's a patience game like no other.

One sister has yelled at me that I need to face facts. I don't know what the hell she is talking about and I don't want to know. I guess yelling at me feeds her sociopathy so she doesn't really need a premise. Just the fun of yelling in my face something is wrong with me.

My message is don't treat brain injured people like this. Would you kick a dog with a broken leg? Then don't add injury to an already injured person. Accept they aren't able to live up to your expectations in ways. And also accept their cognition is hit or miss. Especially in the first few years following an injury. They may be competent in some areas and fail in others so it looks like a mental illness. Don't judge unless you have PhD after your name. It punishes them. Their injury is already punishing enough.

I wish there was some place for me to consult with brain injured patients and get paid for it. I would be an excellent person to give them some sense of peace and tell their families to be patient. Not forgetting that some families have burnout and are carrying an enormous burden of taking care of their loved one.

Sounds a wee bit manipulative, understandably, considering what you've been through.
There is an article listed on the cover of AARP this month entitled FRAUD ALERT: WHY SMART PEOPLE GET SCAMMED. I recommend you read it as the injustices you have already experienced at the hands of unconscionable, sycophantic and malicious people make me very sad and I would not want to see another elderly gentleman get hurt.

OMG, I was thrown from a horse in 1958 and semi-comatose for several days. Everything I experienced after that you articulated above. I was 10 years old at the time and wondered why everyone hated me except for boys who wanted to kiss or touch me.
At age 18 I married one of them. I have been married 53 years and he still doesn't know me. He is divorcing me. I have also had a vascular (benign) brain tumor, ulcerated colitis, pancreatic cancer, cardiomyopathy and finally went to nursing school as well as law school to be able to care for myself in a world that hates me. My first publication was in a medical journal. I'm guessing you get that I too have a very high IQ. I am currently working with hospice patients which I love, it has helped immensely. It makes me feel worthy.