Apart from any specific behavioral or emotional difficulties, people with head injuries or acquired brain injuries typically go through a number of emotional changes as they adapt to their new circumstances. In the immediate aftermath of their injuries, patients commonly experience a great deal of confusion, as well as an agitation with their unfamiliar internal and external environment. The struggle to deal with such a profoundly altered situation and brain injury symptoms may cause even the most mild-tempered person to lash out physically at those nearby. In most cases, this confused state will diminish or disappear entirely within anywhere from days to months.
Brain-injured people also frequently develop an attitude of denial toward their situation. Sometimes, this denial manifests in people who have undiagnosed problems in the aftermath of an accident. At other times, it manifests in people with diagnosed cases of brain damage. While denial has a strong emotional component, it can also reflect a true inability to recognize the fact that something's wrong. For instance, some forms of brain trauma limit self-awareness and the ability to notice changes in perception. In addition, undamaged portions of the brain can contribute to this problem by following automatic routines that effectively "hide" the presence of serious malfunctions.
Usually, blanket denial eventually gives way to a mixed state of anger and depression. Bursts of anger, in particular, can stem from actual physical changes inside the brain that reduce normal levels of emotional control. However, anger and depression can also stem from a recognition of changed circumstances and a feeling of helplessness about remedying those circumstances. In some cases, brain-injured people blame themselves for what's happened to them; this is especially true for those involved in risky behaviors such as drinking and driving. In other cases, people with brain injuries blame another person who caused their accident, or blame some larger, unknowable force or fate.
Behavioral problems commonly associated with acquired brain injury or more generally head injured can include violence or other forms of aggression, failure to comply with prompts or requests, diminished self-awareness, diminished self-control, inappropriate behavior, egocentric or childlike behavior and an unwillingness to take responsibility for one's actions. Common emotional problems include anger, confusion, depression, mood swings, apathy, agitation, frustration, paranoia, irritability and anxiety. In some cases, combined emotional and behavioral problems grow severe enough to warrant a diagnosis of a condition called borderline personality disorder.
People with even mild or moderate brain damage commonly experience disruptions in their normal ability to remember, think and reason. People with more severe forms of damage may have extensive problems in these areas, as well as problems expressing themselves, understanding what's being said to them and processing information from any or all of the five senses. Most people who suffer traumatic brain injuries also have significant psychiatric problems that manifest as changes in their behavior or emotional state.
Some people remain more or less permanently angry and/or depressed in the aftermath of their injuries. However, others improve through rehabilitation and start to test the limits of their returning mental and motor skills. While this testing is vital for maximizing the potential for recovery, it can also lead to its own denial or sense of frustration as patients with significant remaining problems seek to gloss over those problems and focus only on their successes. For example, a person with diminished levels of energy may decide to ignore this problem and attempt to get a lot of things done in a relatively short period of time. In turn, this overexertion can result in fatigue that lingers for days and leaves the person feeling like a "failure." Unnecessary feelings of failure can also set in if a brain-injured patient has unrealistic expectations about the pace of rehabilitation and doesn't reach a self-directed goal or milestone in a certain amount of time.
In some cases, people with brain injuries eventually come to accept their limitations, brain injury symptoms and the pace of their rehabilitation. For those with temporary problems, this can mean dealing with short-term difficulties on the way to a full recovery. However, for those with permanent impairments, it means making ongoing adjustments to a new reality and learning how to regain a sense of self that will sustain them in the future. On a physical level, this type of adjustment involves working within the known capabilities of the body. On an emotional level, it can involve forging new relationships with friends, family and acquaintances, as well as forging a new internal self-image.
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