What keeps people from moving on is that after a brain injury life becomes very difficult for everybody. Nobody wants to believe that what's happened is going to be permanent, so for the person with the injury very often it's memory problems, it's problems multitasking, it's problems with concentration, it's headaches, it's fatigue, it's slowness, it's reading slowly, learning slowly, talking slowly. People don't want to believe that that's what they're stuck with. That's a very painful idea and a very unpleasant idea. The other thing--and where I say this challenge is the greatest is for people who have worked really, really hard to get where they are, and some of my patients are doctors, and some of them are attorneys. Some of my patients are neurosurgeons, and some of them are cardiac surgeons, and these are people who committed to 4 years of medical school, 5 years of residency. People who work really, really, really hard. They're 1 or 2 years into their career, and all of a sudden they have this horrible injury, and it's like "I want to be what I planned on being, what I spent those 9 years doing, studying late nights, working late." "I cannot believe that all this work I did was for nothing." The people who have the most painful experiences-- there's actually at least 2 kinds of people. There are people who have worked really, really, really hard and have advanced degrees. Lawyers, accountants, physicians, dentists, veterinarians. People who have given up much of their life to get an education, who put off getting a job because they wanted to prepare themselves educationally. That's one group of people who really, really has a hard time and the other kind of person-- and sometimes these people are also lawyers or physicians-- are people who have really high personal standards, and you've heard the expression "She's never satisfied with anything she does." "He's a perfectionist." People who are perfectionists do not do well after a brain injury and I've worked with a couple of people--one case comes to mind. I've worked with a man who was an attorney and he recovered enough--he had a severe brain injury. Probably close to a moderate, actually. And 3 years after his accident I worked with him. We redid the testing. He was using a lot of compensatory strategies, and his boss said to him "I'm not sure I care really how well you do." "I just want you back at work. Let's give it a try." "And I know the kind of person you are, a hardworking person, and we have a good crew of folks here." "We believe that you can succeed," and so he went back to work, and I was seeing him in counseling every other week or so, and what happened was he would come in my office, and he would say, "You know what?" "I did this project, and I swear I could have done this project twice as fast before, and I had to ask for help with this, and I never had to ask for help before." "I'm letting my colleagues down." And I would say--part of what I try to do with people is to see the positive side, and I would say things like "It's really good that they want you back at work." "It's really good that people care about you and that you're the kind of person that they want to help." "You seem like a really nice person." "You're the kind of person that people want to be kind to." And my patient said, "I was never like that." "I never needed people's help." "I can't stand it. I'm letting people down." And he actually resigned from his position. Even though he was getting good reviews from his employer, even though the people at work were perfectly happy supporting him, doing these new things that he was doing okay at, he couldn't take it.
After a TBI, no one wants to think that they are stuck with long-term symptoms like short-term memory loss, cognitive impairment, slow processing, and so forth. Acceptance can be especially hard for perfectionists and high achievers; they have a hard time accepting the loss of who they once were.
Posted on BrainLine July 30, 2012.
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.
Produced by Victoria Tilney McDonough, Justin Rhodes, and Ashley Gilleland, BrainLine.