In terms of the personal toll TBI takes on lives, it’s hard to overstate the extent to which a brain injury can screw everything up. Your brain is the “central control” of your life, and an injury to it can seriously mess with every aspect of your life. Of course, since every brain is different and every brain injury is different, the effects on your physical, mental, emotional, spiritual, social, behavioral, professional, and every logistical aspects of your life are going to differ from others’. But without fail, a TBI does have some sort of impact or another.
The weird thing is, sometimes you can’t see it right away. Sometimes it takes days for physical symptoms like headaches or balance problems to appear. Sometimes it takes weeks or months. Some people see problems crop up, years on down the line. In a very real way, the brain is a “black box” that seems to have a life of its own, and science is quite a ways away from truly understanding it.
However long it takes, disruptions to your brain’s function can mess with your performance at work and your ability to maintain healthy relationships. Impulsivity and lack of a “filter” around what you say, can put people off and spark arguments – or worse. Getting bent out of shape about every little thing can make you difficult to be around, eventually making it easier for people to be away from you, than with you – and vice versa. Sleep disturbances may not seem like that big of a deal in the first weeks, but trust me – not being able to sleep past 3 a.m. for months at a time, does have an impact on your attention, your moods, your relationships, your ability to function, and your overall quality of life.
The disruption, I believe, is the most extreme in the cases where it’s not supposed to happen – with mild traumatic brain injury or concussion. After all, you just got dinged, so what’s the big deal? It was a bump on the head… or just a fender-bender. If you weren’t taken to the hospital – or you did go to the ER and were told to go home and rest and you’ll be fine – there’s no cause for concern, right? After a few days, you’ll feel better. A few weeks, at the most.
Most of the time, that’s the case. Around 85% of folks who sustain a concussion or mild TBI do feel better after a couple of weeks. But that means around 15% of us don’t. And then all hell gradually breaks loose. When you’re not aware of your issues, you can’t very well manage them, and TBI has a tricky way of hiding itself away. The brain thinks its fine. It’s totally justified in throwing fits, getting bent out of shape, losing its train of thought, and getting agitated and antsy when it’s tired. The brain doesn’t know there’s something amiss, and if you’re not aware that you need to take special care and give special consideration to the 3.5 pounds of gelatinous tissue inside your skull, problems can develop and evolve and ultimately spiral out of control.
For no apparent reason.
Professionally, you can find yourself marginalized and demoted. If you’ve started becoming emotionally unstable over minor details, and you suddenly can’t complete tasks you’ve been given, it wouldn’t be a surprise if that happened on down the line. You may find it impossible to operate at your former level because of headaches and sleep deprivation. You may find your temper flaring uncontrollably, your attention wandering, and your ability to focus gone-baby-gone. It happens with mild TBI and concussion. And the bitch of it is, very few people expect that. Because heck, you just got bumped on the head.
Relationship-wise, you can find that the people you once considered friends are pulling away from you, getting impatient with you, and not wanting to spend much time around you. At home, you may find yourself at odds with your spouse and kids more than usual. Out in the world, you may find yourself pulling away from others. It’s hard to engage with others when you’re not understanding everything they’re saying, thanks to fatigue and distractions and the additional work your brain needs to do to keep up with everything. You may also find others pulling away from you, as you aren’t the same fun-loving, easy-going person they once knew and loved.
Quality of life in general has a way of going south after mild TBI, if the symptoms don’t abate in the short term. A study of mild TBI survivors in Sweden, which looked at their lives 3 and 11 years after their injuries, showed significantly lower quality of life scores than the average population. Another study of post-concussive symptoms of adults in western Sweden, 3 months and 1 year after injury, showed more symptoms and difficulty functioning at 3 months than at 3 weeks. And their quality of life was significantly impaired.
Data collection and analysis of the toll that mTBI / concussion takes on lives is still in its infancy. After all, the scientific community at large has only recently realized that post-concussive symptoms are a “thing” which deserves study and responses from the healthcare community. Maybe it’s the development of adequate imaging technologies that show the actual activity of the brain around emotions, motivation, and a host of other aspects of life. Maybe it’s the dawning realization that the brain can indeed be studied, even understood – albeit slowly and with a hefty dose of humility. But scientific limitations aside, anyone who has struggled with ongoing difficulties after “just” a bump on the head, knows well enough what a personal toll it takes – both on them, and on the people around them.
Publicly speaking, TBI takes a toll as well. Studies have found that in the U.S. prison population, a history of TBI is 7 times greater than in the non-incarcerated population. According to a 2012 article in Scientific American:
In prisons . . . approximately 60 percent of adults have had at least one TBI—and even higher prevalence has been reported in some systems. These injuries, which can alter behavior, emotion and impulse control, can keep prisoners behind bars longer and increases the odds they will end up there again. Although the majority of people who suffer a TBI will not end up in the criminal justice system, each one who does costs states an average of $29,000 a year.
Crime rates and prison costs aren’t the only public costs of TBI. Domestic violence has been linked with TBI and concussion – both as an effect and a cause. Athletes with a history of concussion, according to a 2013 Toronto Sun article discussing Boston University study results, are more likely to become violently angry. That violence isn’t isolated to their own experience – it bleeds out into society and impacts us all, personally and collectively. Witness the very public domestic violence incidents involving NFL players, happening concurrently with the debate about the impacts of repeat concussions on players. Knocking out girlfriends, beating children, alleged murder. In a very public way, the violence on the playing field is carrying over to wider society, and those in the spotlight have jobs that have exposed them to frequent and repeated head impacts for years on end.
Suicide is another TBI connection that affects more than the person who takes their life. Former NFL players struggling with CTE have taken their lives – Junior Seau and Dave Duerson shot themselves in the chest,making it possible for their brains be studied for signs of CTE – and it was found. Scientists caution against jumping to conclusions that concussion and CTE fuel the urge to kill yourself, yet the correlation is hard to discount.
The connection between TBI and suicide among U.S. veterans has been studied in recent years, and a study of active-duty soldiers in Iraq in 2009 showed “that military members with multiple traumatic brain injuries are more likely to be at risk for suicide, not only in the short term, but throughout their lifetime.” Soldiers aren’t the only ones with suicidal thoughts after TBI, although the prevalence of suicide among veterans is frighteningly high. According to the American Psychological Association, in 2012, “the Pentagon reported an extremely grim statistic: In the first months of the year, a soldier was more likely to die from suicide than from war injuries. From early January to early May 2012, the suicide rate averaged nearly one per day among active-duty troops — an 18 percent increase from last year. Suicide rates among veterans are equally daunting. According to an estimate from the Department of Veterans Affairs (VA), a veteran dies by suicide every 80 minutes.” Suicide never hurts only one person. Friends and family and extended social circle are all harmed, as well. Again, numbers are fairly preliminary by some standards; the connections between TBI and suicide only started to be studied in earnest in the aftermath of the Iraq and Afghanistan wars, so there’s a lot we don’t know. What we do know, is that traumatic brain injury and post-concussion symptoms can be connected to changes in impulse control and suicidal thoughts. And that hurts us all.
The impact of brain injury on your ability to live your life to the fullest – or simply stay alive to see another day – is really just starting to be taken seriously. And it’s taken extreme situations to get people’s attention. The NFL and veteran warfighters are the obvious tip of the iceberg, with their almost universal appeal and importance to American society. But beyond the clear impacts of a life of tackling and being tackled and repeat tours of duty with multiple blast injuries, things get muddy and murky. And the impact of TBI / post-concussion symptoms to every functioning in the civilian and non-athlete population doesn’t always make sense.
It’s complicated, to say the least. Repeat blast injuries in the line of duty and countless concussions sustained in football practices and games, are one thing. But taking a tumble off a stepladder… getting hit on the head by a falling hatchback… or getting rear-ended during rush hour? How could they possibly make a difference to your overall functioning? Why wouldn’t those injuries simply heal up? I mean, seriously – how bad can it be? You just got hit on the head.
Not exactly. Even the best numbers can’t predict a correlation between severity of the injury and the outcomes. Some of us, regardless of the relative severity of our injury, struggle for years with our issues, unable to move forward except in small steps – which are often reversed by factors we can’t seem to predict or control. We see our primary relationships fray and fail. We watch our careers go into a tailspin and self-destruct for myriad “stupid” little reasons. We see our live savings dwindle in the face of ongoing medical issues and poor decisions. We embark on one attempt after another to make it all better, only to find ourselves floundering and exposed in the mist of a shit-storm we didn’t see coming. Slowly but surely, everything goes to hell. And a lot of folks who “should be fine” end up on the margins of society, disabled, homeless, slipping through the cracks or ending up in “state-sponsored care” in an institution of one kind or another – penal or mental.
It makes no sense. The severity of the initial injury doesn’t always match with the outcomes. Why does this happen? Why don’t people heal right away?
Obviously, it’s complicated, and there’s no one easy answer. Factors vary from situation to situation, from person to person. There are many experts who have theories and opinions and evidence-based explanations which range from neurology to biochemistry to psychology. And as many of them are probably as dead-wrong, as others are right.
From my own perspective of someone who should have been all better a long, long time ago – but just got worse – I have my own ideas. Personally, I believe that for some of us, TBI can start out as a complex logistical challenge and then become a chronic condition that’s fueled by a fractured Sense-Of-Self.
What starts out as a series of distinct problems can blur into a massive clusterfuck, thanks to the confusion and frustration that emerges when we don’t recognize ourselves anymore. Traumatic brain injury introduces changes to the brain that produce alterations in behavior and functioning, which literally turn us into a different person – temporarily or personally. Our traumatic experience of those changes feeds a biochemical bonfire that further morphs our changing neurology and biochemistry into someone and something new and different – and that difference can pose a very real and enduring threat to our self-concept and way of life.
TBI can screw with our Sense-Of-Self like nothing else. And when we find our identity compromised, it poses an existential threat on par with being chased by a saber-toothed tiger. The resulting chain reaction of fight-flight responses short-circuits our ability to learn and integrate new information into our world view and choices, which slows down the TBI recovery process. When connections in our brains are sheared and shorn, twisted and destroyed, our brains can recover and build new pathways. Neuroplasticity has been a known fact for decades (if not longer), and science has finally gotten around to admitting it exists, over the past years. The brain can reconnect in new and different ways, and it can re-learn how to do things it can no longer do with the old lost ways of connecting and communicating.
But you have to be able to learn, to do it. And you have to be able to integrate new information into the “mix”. You also have to be able to relax and get some rest, to refuel. The existential stress of living your life as a stranger to yourself, doesn’t help that process at all. And if you keep getting concussed (as so many of us do) but don’t get any help (as so many of us don’t), the additional cognitive and logistical load of adjusting to yet another change to your personality and Sense-Of-Self just makes matters worse.
Ultimately, the toll of an untreated mild TBI / concussion can really add up. There’s that inexplicable downhill slide that doesn’t make any sense to anyone. There’s the worsening moods, the nagging fatigue, the ongoing difficulties with things that others find so easy. Relationships fade away, career opportunities slip through your fingers, other opportunities come up that you don’t even see, because you’re so focused on just putting one foot in front of the other, or you’re too tired to notice it. Your health can suffer, with weight gain and additional conditions like clinical depression, panic-anxiety disorders, high blood pressure and diabetes. And you can see no easy way out… not even a hard way out.
And all the time, you’re wondering where the hell “you” went to? It seems like someone else has stepped into your shoes and is going through the motions of a life you don’t recognize.
- Behavioral/Emotional Issues – http://braininjuryeducation.org/TBI-Basics/Behaviorial-and-Emotional-Impacts-of-TBI/
- Long-term follow-up of patients with mild traumatic brain injury: A mixed-method study. – http://www.researchgate.net/publication/256424611_Long-term_follow-up_of_patients_with_mild_traumatic_brain_injury_A_mixed-method_study
- Quality of life and post-concussion symptoms in adults after mild traumatic brain injury: a population-based study in western Sweden. – http://www.ncbi.nlm.nih.gov/pubmed/14616303
- Brain Injury Rate 7 Times Greater among U.S. Prisoners – http://www.scientificamerican.com/article/traumatic-brain-injury-prison/
- Will NFL & NFLPA Admit Concussion Link to Domestic Violence? – http://kansascity.legalexaminer.com/head-brain-injuries/will-nfl-and-nflpa-admit-concussion-link-to-domestic-violence/
- Head Injuries Linked to Violent Behavior – http://psychcentral.com/news/2011/06/03/head-injuries-linked-to-violent-behavior/26656.html
- Repeated concussions can lead to violence, memory loss – http://www.torontosun.com/2013/08/22/repeated-concussions-can-lead-to-violence-memory-loss
- A New Link Between Traumatic Brain Injury and Suicide – http://www.pbs.org/wgbh/pages/frontline/foreign-affairs-defense/a-new-link-between-traumatic-brain-injury-and-suicide/
- Exploring the link between suicide and TBI – http://www.apa.org/monitor/2012/12/suicide-tbi.aspx
- Neuroimaging correlates of traumatic brain injury and suicidal behavior. – http://www.ncbi.nlm.nih.gov/pubmed/21734511