It’s not just women who suffer from isolation after #concussion #TBI

I knew there was a risk of leaning too heavily towards a gendered approach to concussion and TBI treatment with my last piece. It’s very tempting to narrow the focus to one specific group or case, when you’ve got a set of research looking into that. And it’s tempting to focus on subgroups who have been traditionally overlooked.

I do think there’s a lot to be learned from considering special characteristics of people, but that can leave out the needs and circumstances of those who are on the margins of the margins… or those who “don’t belong” in the subgroup, but don’t quite fit in the mainstream.

And so the pendulum swings from one side to the other… Women are marginalized… Let’s put women in the spotlight… And then comes the very human response of folks who feel left out because, well, they are left out, but they also need attention. So, the discussion may end up “pinballing” from one special case and group to another, until everyone feels simultaneously noticed and disregarded.

Funny how that goes.

The thing is — and this is especially true of brain injury — there’s no one silver bullet that’s going to fix it all. Everyone is different, everyone’s experience is different. What works for one, might not work for anyone else. But that way of exception-stymied thinking can stand in our way. I think that’s actually hindered the development of treatment innovations, because the perceived differences and variations between those millions of survivors seem to preclude a consistent, systematized approach to treatment and recovery.

But there is one thing we all have in common after TBI. Brain injury is an assault on your person, as well as your place in society and your community. So, when it happens to you, it happens to everyone. And the folks who are sequestered to heal from their mild TBIs, due to doctors’ orders, drop out of a social circle that depends on their participation to be complete. Unless you live as an island with no social contact at all, that experience is going to be shared with millions of other concussees and TBI survivors.

When a social circle loses a piece of itself, it’s traumatic by its very nature, because the integrity of the group has been compromised. Losing a connection that gave all the members a coherent and durable sense of who they are, represents a loss to all of the members — a group of friends, a clique, a team at work, a sports team, etc. The loss doesn’t just affect the injured party — the whole social circle and all its members have been impacted as well.

When a concussee is a member of a tight-knit team, the sequestration after mild TBI will absolutely contribute to their level of stress. They’ve lost the connections that tell them who they are, that remind them of their identity, which bond them with others who help them through the hard times. You can never, ever overestimate the importance of the team, when it comes to the spirits of everyone who’s a part of it. And you can never, ever underestimate the negative impact of losing that sense of belonging… that sense of self… that happens when you’re suddenly pulled from the center of the group.

So, while their tend-and-befriend impulse may predispose them to affiliating more in times of stress, women aren’t the only ones who take a hit when they lose their connections with others. (And let’s not forget that not all women are equally inclined to bond with others for reassurance and nurturance.) Anyone who relies on the support of a group, who is cut off from that connection, is going to struggle in sequestration.

What does this mean? What does it imply? I’m suggesting that we reconsider the way we respond to concussion / mild TBI in the acute phase (within the first 7-10 days when the brain is righting its impaired metabolism), perhaps exploring ways to actually increase the sense of connectedness and support, rather than limiting it.

One possibility (this occurred to me last night, as I was drifting off to sleep), is the use of therapy dogs (or cats) post-concussion. Therapy animals have been shown to reduce stress and provide companionship to folks who for whatever reason aren’t integrated into the larger community. And service dogs are becoming common with folks after TBI, especially veterans.

For those who can’t take on the care and feeding of an animal full-time — and who may not actually need a service dog — I could see how daily visits from a therapy dog could help reduce the stress and foster a sense of connectedness. I know it’s being done for folks with moderate and severe brain injury, but I think it’s just as valuable for folks with “just” a concussion of “mild” TBI. Especially in those days and weeks immediately after, when everything is so confusing and uncertain…

Animals can offer a special connection that has nothing to do with computers or devices or texting or television or any of the other modern (and medically proscribed) ways we connect with each other. You don’t have to work at a relationship with a therapy animal. But you can interact, get some lovin’, and have the contact you crave with “someone” who isn’t going to judge you or criticize you or make you work at interacting with them.

Another option might be educating members of the social circle about concussion, and fostering regular (limited) contact with real people, in real life. This is going to be more logistically difficult, because everyone is so busy, and with work / game schedules, it can be tough to carve out time. But just having some contact with your social circle is better than nothing at all. One of the big barriers to that happening, is fear and uncertainty and insecurity about brain injury in the wider population. It’s a tough nut to crack, but having some info and guidelines in place might help.

Those are two ideas for maintaining “low-impact” contact with the outside world immediately after concussion. I’m sure there are many more viable options. It’s all an evolving process, and more ideas will emerge over time. There’s lots of opportunity — it’s just a matter of what we’ll do with it.

I certainly hope we do. Because clearly, women aren’t the only ones who suffer after mild TBI and concussion. They may suffer in more specific ways, and the things we do to help may make things worse, but the same could be said for many others.

We’re literally all in this together.