In my work as a child and adolescent therapist, I encounter many people who feel that neuroscience is too hard to understand. So when a family is dealing with a brain injury, the subject becomes especially intimidating to discuss: the severity of symptoms, poor recovery rate, and uncertainty of overall recovery. I often cite the story of Phineas Gage to help explain how physical injury to the brain can affect behavior, memory, and personality.
Indeed, the story of Gage has managed to shock generation after generation of psychology students. Gage was a young railroad worker who was known to be quiet, independent, and hardworking. In 1948, he was working with a tamping rod and explosive powder when the tamping rod exploded, leaving him with a forty-three-inch-long iron through his left cheek, eye, skull, and brain.
Gage sustained severe frontal lobe damage, seizures, and noticeable personality changes. Because the frontal lobes (an area behind the forehead) include the “seat of our personality,” impulse control, planning, decision making, and other important functions, any damage to that area can result in personality changes and poor ability to control emotions and impulsivity. This is exactly what happened to Gage.
The man now made famous by psychology textbooks eventually died of multiple and uncontrollable seizures at the age of thirty-six. And his traumatic brain injury (TBI) opened the minds and eyes of researchers on how TBI affects personality and other important functions of the brain.
According to the Centers for Disease Control and Prevention, about 138 people die from TBI every day. Short of death, such injuries can cause confusion, impaired thinking, memory problems, dizziness and vomiting, personality changes, vision or hearing loss, and difficulties with movement and sensation.
Of course, all of these things are difficult to discuss when a family is dealing with TBI. To help, doctors Vani Rao and Sandeep Vaishnavi have written The Traumatized Brain: A Family Guide to Understanding Mood, Memory, and Behavior after Brain Injury.
A variety of things can cause traumatic brain injury: a fall (which often occurs among seniors, but is the leading cause of TBI for all ages), a concussion (an issue that commonly affects youngsters who engage in sports), severe whiplash, a car crash, and other incidents in which the head is jolted or hit. Children and adolescents who suffer from TBI also often exhibit changes in their behavior over time such as becoming physically and verbally aggressive or being inattentive or impulsive. But parents don’t always realize what’s causing the issue. They often fail to recognize that the behavioral and emotional changes in their loved one are not necessarily psychological, but sometimes neurological.
Rao and Vaishnavi strive to break down the complicated nature of TBI and the many ways it can manifest in a person. They describe the basics of neuroscience, such as brain structure, function, and recovery. They cover emotional problems, behavioral problems, and cognitive problems — perhaps the most important for readers.
Cognitive problems include issues with attention, memory, language, and other executive functions. For instance, some individuals walk away from a long hospital admission suffering from amnesia or stroke-like symptoms, which can include language delay and trouble with expressive language. Others may struggle with putting complex ideas together or expressing thoughts appropriately. I often tell parents of children and adolescents who have suffered multiple concussions to see their child’s injury as similar to a stroke. While a stroke may be more severe than a concussion, they share some neurological effects. Even more, recovery times can be similar.
Rao and Vaishnavi also highlight that some TBI symptoms are very noticeable while other are not. For example, language and memory delays or challenges, labile moods, and personality changes may be quite apparent to family and friends. However, extreme fatigue, poor sleep hygiene, or frequent migraine headaches may not be perceptible to the outside world. Thus it is important for families to learn about these more under-the-radar symptoms and identify them.
The authors also do a great job explaining how TBI can lead to severe mental illness. Research into the neurological effects of traumatic brain injury suggests that a blow to the head can lead to psychosis, including delusions and hallucinations; verbal and physical aggression; ADHD-like symptoms such as inattention, impulsivity, and hyperactivity; and mood disorders such as depression.
Again, there is a lot to take in when facing TBI. Rao and Vaishnavi offer a wonderful resource for families as well as clinicians. Unfortunately, the book does not provide a great deal of information on how to locate services for those with TBI, or much about recovery rates. But those subtopics aside, Rao and Vaishnavi give a clear overview of the many complex symptoms of brain injury, as well as proven treatments — and without intimidating the reader.
The Traumatized Brain: A Family Guide to Understanding Mood, Memory, and Behavior after Brain Injury
Johns Hopkins University Press, October 2015
Paperback, 224 pages