There are a lot of different ways that people understand or try to understand or think to themselves about what may be going on with some of the behavior changes we often see with traumatic brain injuries. And it's often handy to talk particularly about the example of impulsive anger. Maybe two examples will serve. The other one, the one I've mentioned before, is the lack of initiation. And I picked these two because they're enduring problems that tend to be very disruptive to someone's return to their usual role and they're very frequent problems. And they are also very treatable. They can be made better. There are lots of other problems too, but we'll pick those. When we consider the different-- I'm going to talk from a neuropsychological perspective first and then go on to some of the other cultural things that can go on. From a neuropsychological perspective, we can think of three major components of the personality of someone who's had a significant brain injury. There's the personality they already had before the injury, and an injury can happen to anybody, so there's the full range. There are the reactions they have to that, and I put that in two parts. One is the reaction to the experience of the injury itself. So you might be really angry at the driver or the person who assaulted you or you might feel really guilty because you were responsible for the accident, or you might have post-traumatic stress disorder from the ambulances coming and from seeing the car coming at you at the last moment, all kinds of reactive things to the accident itself. Then there's also a reaction to being disabled and to what life is like now-- the embarrassment, the fears of the future, the depression and so on. And there's a third component. So we've had personality prior to the injury, reactions to the injury which we can understand from the point of view of people with intact brains, and the third is the changes in personality and emotions that result from injury to the brain itself because the brain is the organ of emotion, it's the organ of personality. And so when it's changed, emotion and personality are changed. Impulsive anger comes in large part from that third component when we see it as a change, that the person who gets angry very suddenly out of proportion to whatever the event is that's triggering the anger and when they calm down suddenly afterwards and when it's out of character, often people say, "Why am I acting like this? I never used to be this way before." "Please help me get rid of this anger." I know we're talking about the organic impulsive anger of brain injury. When it has those kinds of components and when it doesn't serve a purpose very often, it doesn't get them anything. Anger serves a purpose in our lives much of the time. It can get you something, and there are times when it's appropriate to get angry. But the impulsive anger of brain injury often doesn't get you anything. So those are some of the characteristics of that. Most people, when they first see it, will tend to assume that either the person was like that before, if they didn't know them well and haven't seen it as a change, or perhaps that this is a reaction to either the injury, "Well, they're angry because they were in an auto accident," or "They're angry about being disabled." They'll see it as reactive to that. And that's a possibility, but much more often it's something else. Likewise, people will tend to see that lack of initiation, that dead battery in the car kind of experience, as, "Well, they must be depressed or they're unmotivated "or they don't really want to get better," rather than seeing it as a brain problem. Those are common interpretations to see in any culture. In addition to those interpretations, we may also see people who put a spiritual interpretation on it, who see it as fate or who see it as a punishment from God or from the gods or the ancestral spirits or various other sources for something that either they or someone in their family did or one of their ancestors did. There are people who may see it as something that's part of a past life of their own that's responsible for it or who may not attribute it to anything in particular, just chance and life happens this way. And one of the things that sometimes we have difficulty understanding from a Western perspective, even though we do it ourselves, is that many people hold several interpretations at the same time and it's not contradictory for them. Actually, that's true of us, although we don't recognize it. What caused the accident? Well, what caused the accident was that the car ran off the road. But what caused the accident was that the road wasn't well marked. But what caused the accident was that it was rainy that night or that the driver was drunk or that the person at the bar didn't recognize they were drunk and let them go out or that we have a society such that blah, blah, blah. Causality can have many different levels, and they can all be operating. And that person themselves may say, "Well, this is a punishment for my terrible ways," and that may also be another level of explanation that likewise applies. And that's okay, and we can work with all of those, and sometimes you just pick the one that's going to serve the purpose now as best you can.
Produced by Victoria Tilney McDonough and Brian King. Dr. Tedd Judd shares his experience and advice about culture, ethnicity, and brain injury rehab. Transcript of this video.
Posted on BrainLine April 29, 2009.
Tedd Judd, PhD is adjunct clinical faculty in psychology, University of Washington and adjunct faculty in psychology, Seattle Pacific University. Much of his work has focused on traumatic brain injury rehabilitation.