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Emotional changes following brain injury: psychological and neurological components of depression, denial and anxiety

Journal of Rehabilitation, April-June, 1991 by Carol Armstrong

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The spouse's mourning may not be legitimate in the eyes of society even though he or she has surely experienced a traumatic loss and an extended period of grieving (Lezak, 1978). Their grief is similar to the family response to bereavement described in the literature on death and loss.

The spouse also has no sharing partner nor is free to get one. The intact spouse may feel the need of a more supportive partner, but is unable to elicit this quality from the injured spouse.

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"The spouse cannot divorce with dignity nor in good conscience. Gratitude, fond memories, feelings of responsibility, guilt, and fear of social condemnation contribute to the reluctance" (Lezak, 1978, p. 593) to divorce the injured mate. Moreover, brain injury not infrequently prolongs an unhappy marriage due to bonds of guilt, feelings of helplessness, and fears of disapproval. The uninjured spouse is forced into a parental role, at times. The rules for this parenting role are not clear, however, and unpredictably interact with the need to give the patient independence. Rarely does the patient provide the leadership and nurturance which helped form the relationship. Spouses almost unanimously remain "undercover" about their feelings and personal needs. They are difficult to reach by giving them "permission" to protect themselves. A better strategy is to help a spouse focus on normalizing his/her relationship with the patient as early as possible, and then deal with the resulting problems in individual and couples' therapy.

Patients tend to be much more needy than they are able to provide love and comfort. The patient's own sexual competency may be far different from their demands for sexual attention, and he or she may make incessant sexual demands regardless of feedback from the spouse. The injured person may perform in a one-sided way, without regard for the partner. Lack of sexual relations may be easier to live with than overactivity.

Finally, mention must be made of the plight of the young children of an injured parent. The crises of the injury and possibly multiple hospitalizations often absorbs the parent's attention completely, and children are inadvertently ignored. Children will predictably develop angry feelings about their radically changed parent and decreased parental nurturance. A child's assertion of a need for attention and affection may come into direct competition with the patient's own demands, and both child and parent may compete for the uninjured parent's attention. Many children will either perceive no opportunity or lack the ability to express their feelings about their catastrophically altered world. However, they also have an uncanny ability to know that their uninjured parent needs help, and will offer their aid, mixed with their desire for personal involvement and attention.

Depression in family members may be a fixed emotional burden, and for others it may come and go with the patient's ups and downs, and the amount of freedom and satisfaction which they themselves can gain. Even family members who have good understanding of their depression may at times worry about their worth and mental integrity. Among these families, depression is natural and expected. These feelings must be faced in order to turn a reactive emotional disorder into an adaptive response which leads to change, growth, and preparation for the future.

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Emotional changes following brain injury: psychological and neurological components of depression, denial and anxiety

Journal of Rehabilitation, April-June, 1991 by Carol Armstrong

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