Understanding Brain Injury: The Human Factor

My name is Dr. Bryan Weinstein. I am a board-certified psychiatrist specializing in the pharmacological and rehabilitative treatment of people with traumatic brain injuries.  I see over 100 brain-injured patients every week and am privy to the tragic details and consequences of their injuries.
 
After an injury, my patients tell me that the world looks different to them – and sees them differently too.  Allow me to employ a mental exercise to share their perspective with you:
 
Imagine that you wake up one morning to discover that you are in a foreign country.  Everyone – including your friends and family – speaks a different language.  Their language is as incomprehensible to you as yours is to them. Beyond learning the language, you now have to become culturally competent in your new home country.
 
Now imagine that you just enjoyed a dinner with friends and had one too many drinks.  You stumble into an Uber and are chauffeured home.  You wake up in the morning and realize that not only did you fail to sober up – you never will.  You will continue to be disoriented, dizzy, off-balance; impulsivity and dis-inhibition will define your behavior; your affect will alternate between inappropriately jovial and incongruously aggressive.  Absent your normal inhibitions, you say and do things with no insight into your own behavior (Let alone the ability to regulate that behavior!).
 
Take a moment to mentally fuse both scenarios. Now picture this state lasting for a minimum of two years. Or even the rest of your life.  Your loved ones may attempt to care for you, but it isn’t long before your behavior alienates both family and friends.  Maybe even your children. You can no more hold a job than you could wish yourself better. You find yourself isolated, inconsolable and without immediate access to your usual emotions, memories and coping skills.
 
This may sound like a nightmare, but the reality is that there is a very real possibility of a head injury turning into a lifelong disability.
 
Every day, we casually enter a nearly 5,000 pound vehicle and drive between 40 and 80 miles per hour while talking on the phone, texting, adjusting the radio or simply pondering the events of the day. We share the road with thousands of other drivers caught in these same moments of distraction. On some roads, oncoming traffic is separated by a single yellow line – when a vehicle strays across it, tragedy ensues.
You may think the potential for a crash is low, but how often have you heard the phrase, “I never thought it could happen to me?”  I hear it dozens of times each week. As long as you drive a motor vehicle, you and your loved ones stand a chance of becoming victims.
 
You don’t have to suffer a catastrophic accident to acquire a brain injury.  Experiencing rapid deceleration can cause your brain to slam into the front and back of your skull – this is called a contrecoup event and is one of the most common injuries resulting from an auto accident. Even minor injuries can damage billions of neurons and effect large parts of your brain. 
 
A bruise to your brain can have devastating implications.  Unlike most physical injuries, a trauma to the brain is invisible – which makes it extremely unlikely that you will be afforded any sympathy for the behaviors we discussed earlier.  Instead, you will be held responsible for your behavior.  You will become a victim of your brain’s inability to function properly. You may become a pariah, a social outcast unable to relate and unable to have other people relate to you.  Soon, you enter into a world of pervasive loneliness.
 
That’s more, the brain does not heal in a predictable fashion. Symptoms may vanish within six months or last a lifetime.  The severity of a brain injury bears no correlation to the length of recovery time. Even a minor fender bender with no visible physical injury can result in behavioral and cognitive deficits that have profound social and occupational consequences.

As a medical student, I was taught that the best moral compass for compassionate patient care was to treat patients as I would members of my own family.   It’s no easy feat for any of us to understand what a person is feeling after a traumatic brain injury.  However, it is incumbent upon all of us – whether a medical provider or loved one – to at least make the attempt. When we’re able to step into the shoes of a survivor, some things certainly do become clear.  People with brain injuries want:
 

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