On April 24, 2009, BrainLine had the opportunity to sit down with Dr. Kreutzer and Dr. Stejskal to talk about their work with people with traumatic brain injury and their families.
How Can TBI Affect Marriage?
Changes in marriages after brain injury is a very broad topic because there are lots of changes. What people tell us about a lot is that they have different roles. So the breadwinner often becomes someone who is cared for by their partner. Often their partner isn't anticipating that happening, and the spouse of the injured person becomes a caregiver as well as a friend and partner. The role changes are one of the biggest things that we see. Yeah. I think in terms of what changes most for marriages, Jeff and I often say, "What doesn't change?" Oftentimes when people have a brain injury, it can be so difficult because the things that were most valued in that relationship, whether that was being able to spend leisure time activities together like going boating or being able to go to museums or overseas travel, all of a sudden those things that people had counted on doing together aren't possible anymore, and so that really changes the quality and the tone of the relationship altogether. What happens in the long term in marriage is interesting because psychologists have developed models of adaptation and adjustment to catastrophic events, and some of those models apply to what happens to marriages after brain injury. We find that for the first three or six months after the injury there's a lot of confusion on the part of the injured person and their spouse. How has the person been injured? How are they different? How are they the same? What's life going to be like in six or twelve months? There's a lot of doubt, uncertainty, confusion. This person looks the same, but their personality is very different and their abilities and their roles are very different. So we find that it's very hard. There's a period of what I call difficult adjustment, which is recognizing the changes and recognizing that some of these changes that are unpleasant may be permanent. And so there is an adjustment process. And for some families, some families seem really good at handling that adjustment. Maybe their marriages were very strong before, maybe they have extended family that's very understanding living in the same community. Some families are great. They go to websites like Brainline and they look up and they try to find out what the most current information is and they find the best help they can find and understand the problem and get educated. Perhaps that's why some families adjust more quickly. But there is a period of adjustment, and what we tell our families when we see them is we say, "We know that your lives will get back to normal." "We hope that it's going to be a short period of time." "It may be three years, it may be five years, "it takes some people longer, but we know that if you try hard, "you get information and you focus on doing things that seem to work "and stop doing things that don't work, we know that the future can be a good one for you." We've actually done some research on marriages after brain injury. And what's interesting is that there is a myth out there that says that-- and it may be true only in the United Kingdom--is that about 56 percent of marriages end in divorce or separation within 6 years of injury. What we've found, at least in looking and doing research in Richmond, is that about 25 percent of marriages of people with brain injury end in divorce in the first 6 to 8 years. And that rate of divorce is actually lower than the U.S. rate of divorce. And one of the things is that Taryn and I are concerned in that there isn't a whole lot of research, and we have a sense of what happens, but there isn't a whole lot of research on what happens to marriages after brain injury. We think that there are a lot of people who are staying together but may be very unhappy. What we've found is that people who are married for a longer period of time-- 15 or 20 years--tend to do much better than newly married couples. Part of that, we think, is that when people are married for a long period of time, they know each other better, they appreciate each other, both the good and sometimes the bad, they appreciate each other more and they're more understanding and more flexible. And people who are married for a long period of time, because of the way life works--one person is having a hard time, then after a while the other person is having a hard time-- people tend to appreciate their own personal limitations and the fact that there is going to be good and bad perhaps better when they've been married for a longer period of time. In addition to what Jeff mentioned, which was understanding and flexibility, not expecting that things are going to be the way they were before, I would also mention empathy, having empathy for what's happened in the relationship and also for the other partner, whether your partner is the person who was injured or whether you were injured yourself. And in terms of specific examples, we've worked with a number of couples, and one thing that we've found is that couples that do best don't take things personally. They say, "You know what? He or she can't do that anymore because of the brain injury," not, "If he or she would only try harder, he or she could do that," or, "He's just not interested in going with me to the theater anymore." It's not that. The crowds jostle him or he has difficulty with attention. One couple in particular that stands out for us that we've worked with together is a couple that said to us, "One of the ways that we're dealing with this "is by taking a new picture." "And so any time we think about our future and what we imagined "and we feel sad about what we've lost and not being able to do the things "that we thought we'd do, we take a new picture "and we imagine what our new future together is going to be like now."
Posted on BrainLine May 27, 2009.
Produced by Victoria Tilney McDonough and Brian King.