Nearly four decades after my brain injury in a motor vehicle crash, I feel like the traumatic brain injury poster child. My symptoms were just what the researchers* described when they wrote that, “Many individuals with mild traumatic brain injury and virtually all individuals who survive moderate and severe TBI are left with significant long-term neurobehavioral sequelae.”
Mine was the most common of TBI injuries. I made contact with something, in my case, the windshield and the steering wheel, and my head was thrown back and forth violently. I received cuts and bruises. My brain tissue was stretched and strained: It’s called diffuse axonal injury, the axon being the part of the brain cell, or neuron that is twisted and turned.
They say every brain injury is different, and it is. However, there are common features, especially of a secondary nature, which develop stealthily over time. Swelling of the brain causes more damage if not relieved by removing part of the skull. The pulling and pushing of the neurons sets off a massive release of neurotransmitters, of brain chemicals, that excite surrounding cells. Because of the stealthy injuries, the typical brain injury evolves into behaviors that look like psychiatric illness. In fact, they are a particular type of psychiatric illnesses associated with TBI. The altered neurochemical shower means that the brain cannot keep an even keel of normalcy of thought and action. And dysfunction of the neurotransmitter systems does not ever return to normal.
About five or so years after my TBI, I was told by my doctors that everything should go back to normal soon. But that was in the closing years of the twentieth century, when we didn’t know what we know today about brain injury. I tried to get on with my plans, but something, and I didn’t know what, nobody knew what then, got in the way. It was those darned dysfunctional neurochemicals. They begin to express themselves as mood disorders, particularly depression. They lowered my brain’s ability to use blood glucose, brain food.
Between ten and fifteen years after my brain injury, I thought I was going crazy. People didn’t like me, I thought. I didn’t know what I was doing wrong, either. I thought I was a pretty nice person. Sometimes, I just got so mad at people that I had to give them a piece of my mind. Especially my husband. He was nuts.
These days, brain researchers say that persistent thinking problems or cognitive deficits are the most common complaint after TBI. With all those damaged brain cells and leaky neurochemical switches, it’s no wonder that thinking difficulties are the major hindrance to re-adaptation to the world after brain injury. Just imagine how hard it is to corral your thinking to solve problems and curb your impulses. I didn’t know what was wrong with me, but it was my processing speed. I was slow and jumpy, depressed and anxious. Fifteen and twenty years later, I was still trying to be the person I was on my way to being after my car crash. I just didn’t know what was wrong with everybody else.
What was wrong with everybody else was that they saw my changed and deteriorating personality, even though I didn’t. It was a combination of me trying really hard to be who I thought I was and some stupid alien who couldn’t find the right words and just wanted to curl up in a corner and go to sleep.
The alien said stupid things and the me who was trying too hard got spritzed with neurochemicals and told everyone to go to hell. Then the alien went to sleep and the me dried off and cried about the stupid thing I just did. Again. And again. I didn’t have enough energy, enough cognitive reserve to be nice, so I just went crazy.
The researchers say this is normal after a brain injury. In fact, I was finally told, in 2004, that I was just a normal brain injured person. No worries. But knowing that I was brain injured didn’t make it go away. I was still impulsive, exaggerated, forgetful, irritable, and angry.
I cried a lot, too, until they gave me Prozac. That helped most of the time, but it didn’t help when I tried too hard to be my old self or I got too tired and let the alien take control of the reins.
I was the TBI poster child but I didn’t find out until after I went back to school and earned a degree in Communication Sciences and Disorders (Speech Therapy) because I sensed that communication – thinking, listening, speaking, and communicating through my bad attitude – was at the root of it all. In the end, I had my “aha moment” at last. All along, I knew something was wrong, but I didn’t know it was me. It was me with a brain injury that I didn’t know how to manage.
The other day I read a post on an SLP group page. The poster wanted to know if she should accept a patient who had a TBI 8 years ago. If he wasn’t “well” by now, what could she do? Yes! I screamed at her. He, or his doctor, realizes he needs help from a communication therapist!
This event made clear to me that the mission of this brain-injured SLP is to help people with long-term consequences, even 8 years or more later, by telling my story. I am here to research the literature for new treatments, talk to persons with brain injury about their needs, and communicate my findings to communication professionals. I am here to help by being a poster child.
*McAllister, T.W. (2008). Neurobehavioral sequelae of traumatic brain injury: evaluation and management. World Psychiatry, 7(1), 3-10.