Part 1, Part 2
As I indicated in the previous article, it really helps to have good information about the nature of minor brain injury and post concussive syndrome. It goes some way to helping you to understand the after-effects of brain injury. It can really dispel some of the uncertainty about the condition.
You may both find this fact sheet about how the brain works helpful. It will give you a little bit more of an understanding how the injury can have such a wide-ranging physical and psychological effect.
As a partner/spouse you may be able to understand and tolerate better the more physical symptoms of post concussive syndrome such as fatigue. However, the cognitive problems (thinking skills, memory and concentration) and changes in personality can be much more difficult to cope with.
You will be aware of and often at the receiving end of irritability, angry outbursts and impulsivity. That can be really difficult to cope with.
We could say that we are our brain. In that context the changes in cognitive skills and behaviour perhaps become less surprising. However, it can be really frustrating to deal with on a day to day basis - for you as well as your partner.
This is particularly so when perhaps the brain injury has affected your partner's ability to fully appreciate the impact of their altered behaviour on you.
Many of us struggle with seeing our behaviour the same way our partners do even without a brain injury! So imagine how much more difficult it is if the very areas of the brain that govern your ability to appreciate how you are behaving has been affected.
The question your partner may need to ask of his/herself is:
“if this lack of insight thing is part of brain injury, then do I need to listen a bit more carefully to what my partner is saying when he or she says my behaviour is affecting them negatively?”
Of course as a partner of someone with post-concussive syndrome following a minor brain injury, you can get hugely frustrated too.
Your attempts to communicate with your partner can falter easily. Your partner does not always appreciate or understand your point of view about what it is about his/her behaviour that you find unacceptable.
It really does not help to criticise your partner in this way:
It is better to just point out the behaviour and the consequences of it:
Direct confrontation and criticism is hard enough to handle when you don't have a head injury. Now your partner has cognitive problems and difficulties with insight, attacks are even more likely to cause aggravation.
For more information, see: Dealing with Criticism.
In the first instance it would help to allow your partner to make their own discoveries about what might be causing them to become agitated or aggressive.
For instance, multiple sources of stimulation in a room such as the TV being on loud, people talking, children crying and the telephone ringing can be very confusing and agitating following a brain injury.
The both of you might normally have taken all that noise in your stride. However, following a brain injury it can be a source of irritation and outbursts in post-concussive syndrome.
You could get your partner to rate their levels of distress when exposed to these situations - as they are actually happening. A simple 1 to 10 scale could be used or a Green-Amber-Red scale might also work.
So finding out about things together is far more helpful than telling your partner what they are being triggered by. It may give you both a chance to work together to create a calmer, less stimulating environment. This will go a long way to reduce trigger points that have the potential to result in angry outbursts.
A lack of insight makes it more difficult for your partner to appreciate the need to learn the trigger points of their anger ourburst following a minor brain injury. However, hopefully you and your partner will get to a point where you both know when he/she starts to ‘lose it’.
A great tip is to agree signs between you. You can then discreetly signal your partner/spouse, when you become aware of behaviours that might precede a full-blown melt down. Signs might be your tapping the end of your nose or a meaningful hand gesture that symbolises the need to calm down.
Your partner will at some point start to recover his or her insight into their trigger points. He/she can then also learn to become aware of changes in his/her body at the early stages of anger, such as tense muscles.
Here are some helpful strategies, as part of the treatment, to try and avert an outburst. Allow him/her to find what works for them:
Your partner also may become better at recognising the part that their thoughts play in causing them to become agitated. As part or their brain injury rehabilitation, he/she can learn evaluate either the reality of them. Then they can decide on whether they need to act on them or to become upset about them. Actually ... this counts for you too!
What needs to be relearned is that anger is just an emotion. It tells us we need to do something about what is angering us. You can help your partner (and yourself if need be) to learn that he/she has some choices in their responses to that emotion.
Here is a great video about the impact of a brain injury on a relationship/marriage.
Headway (The Brain Injury Association): managing anger for families and carers
Part 1, Part 2