Still In The Dark Ages

    Our society does not revere individuals who display the psychological symptoms of traumatic brain injury. It does not accord them positions of honor as oracles, seers, wise men, visionaries or tribal medicine men. Instead, we subject them to modern forms of exorcism to rid them of their demons. We apply strange and frightening medical procedures and torturous treatment plans in vain attempts to effect a cure. We strip them of the last vestige of self-respect by offering them substandard employment, housing, and lifestyles. And, when they do not show appropriate gratitude, we lock them up in mental hospitals or prisons, allow them to hide in the dark corners of our communities. 

      Our prisons are overflowing with rehabilitation failures. We call it "recidivism" and execute the very worst of the lot. A recent panel of New York University psychiatrists studied a group of inmates awaiting execution and found that many of them were victims of sever neurological problems in addition to their psychiatric problems. All of the inmates in the group had suffered at least one "major" head injury before their crime; yet this information was not brought up at their trial even though it could have played a role in sentencing. 

      The news media, and television specials, depict our mental hospitals as crowded prisons of another sort. Under the guise of "protection" and "treatment", they subject inmates to a series of physically and psychologically brutalizing experiences which can only be designed to drive out any remaining scrap of individuality, and render the person stark raving mad. 

Stigma

    Brain injury: a mark of disgrace. The psychological climate in this country is distinguished by the words it chooses to describe brain injury. In current use are words from the dark ages which demean and debase human worth. They are born of ignorance and fear, and they have tremendous power to destroy the frail spark of individuality struggling to free itself from the debilitating effects of brain injury. The fourth edition of Roget's International Thesaurus lists pages of synonyms for brain damage. A few of them are listed below: 

      Mature, high level functioning adults who suffer debilitating emotional trauma as a result of closed head injury seldom receive counseling until they are well into denial and it has devastated their lives. In addition, the therapist frequently does not have enough specific knowledge of the brain and its functioning to properly treat such patients. Brain injury may produce symptoms such as altered states of consciousness, and other subtle impairments which closely mimic mental illness. 

  The System Might Get You

     Treatment for the effects of closed head injury is frequently influenced by the presence of an unseen, third party. When the individual referred for therapy is involved in a disability claim or civil litigation, or is an insurance or welfare recipient, the therapist may be under some pressure to make a quick diagnosis. The diagnosis will usually determine whether the client meets qualifications for personal injury, disability or other insurance benefits. In a number of circumstances, the type as well as the length of treatment is decided by individuals outside of the actual treatment situation. 

    Too frequently, the uninformed medical or psychiatric professional called upon to provide services forms an inaccurate diagnosis. This diagnosis leads to inappropriate treatment and rehabilitation plans, and in cases which involve injury claims or litigation, an inadequate financial settlement. 

  An Outdated Yardstick 

    Pre-morbid personality is a term used to describe the extent and the manner in which you fulfilled the established age-appropriate and sex-appropriate demands of society prior to your head injury. It is the yardstick used by health professionals to predict how well you will adjust to the impairments caused by brain injury. It is based on antiquated, unrealistic social standards that do not reflect the reality of modern times and is both opinionated and judgmental. 

     The most commonly used measure of pre-morbid adjustment is based on social competence. Such measurements incorporate factors such as education, intelligence, employment, social history, marital status and age at the onset of injury. Education and intelligence are presumed to reflect both intellectual ability and the special application of that ability to school demands. A person who completes high school is judged to have met social demands better than a person of equal intelligence who leaves before graduating. 

   Employment is rated in terms of salaries, prestige and type of work. In our culture, success is usually associated with white-collar, managerial positions with high salaries. Such jobs are seen as indicators of a person's work skills and ability to deal with people. Poor work skills or an inability to get along with people usually result in unemployment or underemployment. A long history of frequent jobs of short duration reflects an inability to meet either work or interpersonal demands. 

    Marital status, is another time worn measure of one’s ability to get along with others of diverse interests and needs. It is a yardstick that is old and worn and somewhat inadequate for today’s mores and habits. Medicine has been slow to adjust to the changing social climate regarding marriage.

    It is generally presumed that the older an individual is when an illness or injury occurs, except for extreme old age, the better the chance of handling it due to years of experience in successfully handling difficult situations. 

  The Old And The New

    Traditional psychotherapies focus on childhood trauma. Doctors use pre-morbid personality indicators as a basis for making diagnosis and prognosis regarding the patient's anticipated level of recovery. This practice can destroy a mortally wounded identity. It uses an arbitrary and old fashioned yardstick to measure individual worth. 

    Contemporary, eclectic therapies, focus on the here and now. They are generally more creative and more effective. Such treatments combine elements of behavior modification, massage, exercise, bio-feedback, common sense, and/or medication. In so doing, they foster skills in their patients that help them to regain control of their lives. 

  Whom Can You Trust?

     Psychotherapy is always painful. It involves dropping your mask and exposing your soul. Many times it is dangerous. Too often, therapists cling to their own masks and retreat into their own realities. Frequently, they are biased by their belief systems, and never really see you as a singular, unique human being. If you sense that your therapist is unwilling or unable to hear you and does not appear to appreciate you as a significant person, run as fast as you can. You are in very grave danger. 

  Trust Yourself

     There are many human instincts which have been finely tuned over the centuries. They revolve around man's desire to know himself and to cherish his values. They do not depend on mental acuity or sophisticated social systems for they deal with the part of our consciousness which is not exclusively interested in, or satisfied by mere survival. Instead, they are concerned with needs and desires which exist within each of us, in addition to, and in spite of the disabled condition in which we find ourselves. 

    Your instincts are still intact, perhaps buried under denial and incapacitated by fear. Ultimately you will have to rely heavily on them to guide you. The following section is designed to shed light on subjects that are either taken for granted, or never mentioned in connection with the relentless sequelae of brain injury. With knowledge, understanding and self-acceptance you can begin to trust in your basic instincts again and find the courage to build and shape a new reality.

     The Head Injury Losses Chart, below will help you identify some of your losses, examine your reactions to them, and focus on what you need to do to cope more effectively with them. 

    Remember that supports group are not substituted for professional counseling.  A professional therapist or counselor knowledgeable about brain injury can help you sort through your feelings, release pent-up emotions, and think through how brain injury has affected yourself and your family.  The danger of keeping feelings inside is that they come out sooner or later and not always in a productive way.  See our Anger Inventory.