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I called the first two years of my life after my brain was injured the honeymoon period. In this period, I believed absolutely in what I was told and hadn't yet fully grasped how catastrophic my injury was. Looking back on that time years later and then as I wrote my book Concussion Is Brain Injury: Treating the Neurons and Me, I thought a lot about the anger that had infused me, how I hadn't realized for six months that it wasn't my normal to be angry 24/7, and how little professionals understand the anger that emerges after a brain injury. Here's a partial excerpt from my chapter on anger and perception:
Honeymoon Learnings: Anger and Perception
Are adults likely to exhibit dramatic behavioural changes simply because they feel like it? Would you suddenly choose to go from being a friendly, hard worker to wooden and humourless with angry, scary outbursts?
I learned in February 2010, no training manual, no cohesive approach, no general knowledge exists on what brain injury anger is and how to deal with it. This is why most of us with brain injury are not taught how to effectively manage brain-injury anger, despite the fact it destroys relationships and costs jobs. And, no, regular anger-management training doesn’t work.
Brain-injury anger is like a wild animal that leaps into your brain screaming and gnashing its teeth, hurtling you into a freakishly strong fight response that shocks you as much as it does others. It can manifest from simple bellowing all the way up to yelling while hurling an offending object. Ignorance of how this anger is different can inadvertently escalate it.
There are several issues with brain-injury anger:
1. Understanding that it’s a physiological process impervious to behavioural therapies
2. Understanding its locus in the brain
3. Understanding that the affected neurons and neural networks need treatment
4. Understanding that everyone, from family to psychiatrists, not just the behavioural therapist, must learn how to de-escalate it.
Acupuncture, brain biofeedback, and audiovisual entrainment (AVE), treatments that I underwent for other reasons, had this rather nice effect of reducing my irritability from sensory overload and thus calming my anger.
Ultimately, I discovered that a combination of avoiding my severest triggers, my hypothalamus fix (Chapter Q), and gamma brainwave enhancement (Chapter R) led to my brain-injury anger becoming rare.
However, being misunderstood, disrespected, put down, acted thoughtlessly toward, being overwhelmed, being refused to be accommodated, inaccessible public transit and city systems, abandoned, and betrayed creates moral anger. A psychiatrist or psychologist familiar with brain injury, willing to keep up with the latest understandings of brain injury and how to treat it, helps with extensive talk and psychodynamic therapy. That is difficult to find.
A second hidden anger issue is response to others’ anger.
A neurotypical person would at least step back from in-your-face, sudden, top-volume yelling. After my brain injury, I don’t. Although I startle when a squirrel bounces by, I don’t even flinch when a stranger yells in my face. My brain blanks. My body freezes. In response, people either leave or begin to speak to me slowly and carefully like I’m extremely stupid. But none have analyzed why this happens or treated the involved damaged areas so that I can be safe.
In Arizona, a man shot a number of people, killing six, wounding fourteen, including Congresswoman Gabrielle Giffords. The killer’s skewed way of perceiving the world had urged him on. His colleagues and friends identified him as “obviously disturbed,” possibly due to brain damage from alcohol poisoning that had apparently interfered with the man’s ability to perceive. We had dead people and intensive use of police and healthcare resources because it had not been treated.
Not everyone who is mentally ill or has brain injury has damaged perception. But if the ability to perceive oneself is diminished, then understanding other people’s body language, verbal communication, and written language may become difficult. For example, when someone obeys police slowly or stares blankly, it’s clear the ability to understand may still be there but in slow-mo. We must give them patience. It’s the human thing to do.
People who know little about brain injury mistake the fatigue, initiation deficit, lack of motivation, cognitive deficits, anger and irritability, and/or lack of affect as behavioural or psychiatric and ascribe personality defects instead of understanding brain injury is physiological. Such a distortion results in the injured person not receiving support and having to fight for the treatment they need. In that case, privacy laws protect them.
Perception includes perceiving one’s own body. You may lie down straight but feel crooked. One side may dominate your perception, yet it feels normal. How do you correct?
As my perceptual abilities improved, each month I’d look back and go, where was my head last month? But in that month, I’d think, OK, I’m healed now. Then the next month realize nope. Still, I often had no problems assessing situations for what they were, and that would be confirmed by the professionals.
Copyright ©2017-2019 Shireen Anne Jeejeebhoy. May not be reprinted or reposted without permission.
