Psychological considerations are of supreme importance in good recovery from brain injury. True restoration of the person means not just walking, talking and returning to work (of some type) but restoration of hope, purpose, goals and self-esteem. Brain injury is psychologically shattering because it reduces the survivor’s control over his mind, body, moods and environment; and in doing so it challenges his core identity and forces him ultimately to give up or go through a healing process of denial, anger, grieving, acceptance and rebirth. The new life is one shaped around who he is, not who he was, around what he can still do, not what he used to do. The brain injured person needs help with his anger, rage, depression and apathy.
Lithium for anger and anti-depressants for suicidal thoughts are not enough. An understanding and supportive psychotherapist is essential to guide the person through all the changes post-injury and help him reach the other side. When choosing a therapist, try to find someone with experience counseling brain injured people. Consumer satisfaction tends to be much higher with therapists who work directly on the patient’s cognitive and behavioral problems rather than focusing on the “dynamics” of the therapist-patient relationship (See Harvard Mental Health Letter Feb. 2000). Getting in touch with faith, spirituality or one’s own “core” values can improve attitude and boost morale.
Research on how people handle pain shows that positive thinking and hopefulness can stimulate the hypothalamus to instruct the pituitary to secrete natural pain blockers called endorphins, and bring about pain relief. Depression and pain re-enforce each other. One way to jump start a TBI patient is to get him into a TBI support group. This can bring open, honest talk with, and emotional solidarity with, people in the same boat, and lessens the feelings of being isolated or being the only one to go through it.
How doctors, family members, friends, employers and co-employees react to a brain injured person is important. When they show impatience, frustration and disappointment, and turn away, the injured person’s tendency towards shame, avoidance and self-ostracism will be promoted. Counseling and education are not just for the injured person, but should be directed at significant others. The Law Office of HeadInjuryLaw is very sensitive to the psychological dimension of brain injury, the client’s need for psychotherapy by a qualified person (such as a clinical neuropsychologist) and anti-depressant medication and the importance of having the client’s family educated and counseled in how best to deal with their brain injured loved one at a time of maximum stress.
HeadInjuryLaw is also sensitive to the pain, humiliation and anger felt by persons with mild brain injury when they are disbelieved and branded malingerers or hysterics by defense counsel and the defense experts in neurology and psychiatry.
In litigation the insurance company attorney will almost always question the persistence of symptoms, and suggest that psychological factors (not the brain injury) is the primary factor perpetuating the plaintiff’s complaints. Older medical research suggests that most persons with “mild” TBI (equivalent to concussion with zero or minimal loss of consciousness) are symptom free in about 3 months, and only a minority of patients (around 10%) are still symptomatic from the brain injury at the end of 12 months post-injury. Newer research shows the % of patients with impairment or disability from a “mild” TBI at 12 months may be significantly higher.
Until the newer research is duplicated and validated, cases will revolve around the organic vs. psychological explanations. Defense experts frequently point to pre-existing depression or psycho-somatic illness as a reason someone would unconsciously choose to feel ill and to “play the sick role” long after the organic cause of the illness was gone. They also blame doctors, attorneys and even TBI support groups for “iatrogenic causation,” i.e. working to convince the patient he is worse off than he really is. This accusation can lead to bitter disputes. Sometimes the issue of organicity can be decided with a PET scan, which may show significant metabolic disturbances in the brain secondary to trauma in a person mistakenly labeled by the defense as a faker or hysteric.
Sometimes the issue is more clouded, and consideration may be given to alternative explanations such as Post Traumatic Stress Disorder, Chronic Pain Disorder or other “co-morbid” disorders suffered along with the mild TBI. Sometimes what would have been a short lived concussion in one person, proves to be the “straw that broke the camel’s back,” because the victim had pre-existing burdens and could not shoulder the weight of the mild TBI. These may include learning disability, depressive disorder, anxiety disorder and others.
