Fighting Chronic Misunderstanding about Traumatic Brain Injury

By Lori Weisman, MA, LMHC

I want to share with you my reaction to the recent news story reporting President Trump’s remarks about the concussions that American service members received from the blast in Iraq. The original number was 34, but as of January 29, the Pentagon reported over 50 troops sustained brain injuries. This tragedy and the news that followed went straight to my heart since what we heard about brain injury is so far from the truth. I specialize in helping clients with traumatic brain injury, and I have seen the very real and very debilitating fallout of such injuries.

Here is some of what was said:

….I DO NOT CONSIDER potential traumatic brain injuries to be as serious as physical combat wounds.”

Troop members “had headaches, and a couple of other things, but I would say, and I can report, it's not very serious.”

I was shocked to hear the severity of brain injury so minimized.

These injuries are very serious. I have spent my entire career helping clients and couples deal with the fallout that occurs after a traumatic brain injury (TBI).  As healing happens on the outside, there’s so much more healing that is occurring on the inside. This is the slow, painstaking process that others can’t see – and the source of struggles that can damage a person’s life, as well have profound effects on even the most loving relationships.

Yes, people who have suffered head injuries have headaches. But they are not just headaches. They are persistent headaches that often result in debilitating migraines.

And headaches are just one of the symptoms that plague people with TBIs. The most common changes are:

  • memory loss
  • difficulty with attention and concentration
  • disorganized thinking
  • problems with initiation and follow-through
  • emotional lability
  • noise and light sensitivity
  • tinnitus
  • loss of balance
  • fatigue
  • PTSD
  • depression
  • anxiety
  • sleep disturbances

Let yourself imagine – if you were struggling with any of these issues, how would your life be impacted? How would you work?  How would your ability to have intimate relationships be affected? And most importantly, if you were tired all the time because your brain was working harder to do every single task, how would you get through each day?

People with TBIs often feel like they are living with someone else’s brain, and they never quite adjust to the changes in their personality and how they do things. How can you really ever adjust to that?

TBI is considered a silent epidemic. I often hear the heartbreaking comment, “I feel like I’m living in an invisible wheelchair.” Many people feel the victims are making up their problems because there are not enough professionals who are able to identify this population and offer treatment. Many are unable to work due to the changes in the function they experience following the injury.

People with TBIs often feel sad, confused, and in a rush to get back to their old selves. They report, “I feel like I should be okay because I LOOK okay.” The discrepancy between what’s happening outside and what’s happening inside makes it hard for friends and family to understand the severity of what’s going on.

These are serious and life-changing issues, not only for the injured person but for their spouse and family.

Life changes in a moment. No one is prepared for this lightning bolt that strikes. Many say they feel it would have been easier if they died or their spouse died – that it would be easier to deal with that kind of loss rather than dealing with the person who is still there looking “normal” when their personality and thinking are so different.

Every spouse and family member of a partner with a TBI is affected. Roles and responsibilities change. The spouse becomes a caretaker. Partners can’t find their way to emotional reconnection. Their lives are filled with medical appointments. They feel like their spouse is a stranger to them. There are communication challenges; friends and family don’t understand; they lose support around them; sexual intimacy becomes non-existent.

Neither partner can forget who they were before the TBI occurred. The relationship becomes a process of grieving and reshaping their life around the new reality as they come to terms with the loss of the hopes and dreams they had for their lives.

So, I’m here to challenge and correct anyone, even President Trump, who says brain injury only results in “some headaches” and “a couple of other things.” That couldn’t be further from the truth.

If you see people with TBIs in your clinical practice, please don’t treat TBIs as minor injuries. This population needs our understanding and professional guidance.

Here are two valuable resources you can use right away to help you screen for TBI and support clients in your practice who may already have a TBI diagnosis.

  1. Brainlash: Maximize Your Recovery From Mild Brain Injury, by Gail Denton
  2. Assessing Traumatic Brain Injury, a checklist by Lori Weisman available to download

For therapist training and information please visit my website.

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Thanks very informative

elaine dolan
elaine dolan

Lori Weisman, MA, LMHC. I’d like to shed light on and give credence to what you wrote here,especially that others do not comprehend that what you SEE is NOT what you GET in the case of TBI.

For much of my life, I wanted to scream about the tragedy and injustice that was done to me AT BIRTH. Doctor – hospital malpractice, parental and familial entities attempted infanticide and got away with years of molestation, which put me in *half-mast consciousness*. I’d start to improve but never fully improve, when there was a new injury (either a threat or any actual physical slam).. My body LOOKED fine, and I pulled off going through the motions at school, but I NEVER recovered or fully would thrive. To this day I lose my words and cannot excavate them, and it takes me five hours to write what a normal person would write in a half hour…. after even a whisper of cruelty or bullying. And again what hurts the MOST is the shaming–*There’s nothing wrong with you, you LOOK are just fine!*

My husband has a traumáticos brain injury. I’ve been his full-time caregiver. People really don’t know how it changes both the injured’s & spouse’s lives, however. One of my most aggravating problems is trying to convince local & state resources to understand that just because my husband is mobile and talks, that he needs the level of care that he does. They underplay the challenges he and I have everyday. Yes he can bath himself physically putting on the sopa & shampooing his hair, but he’s puts on the same city clothes again without supervisión & cuing. Yes he can feed himself but his stomache and brain don’t communicate so he doesn’t know when he’s hungry or full. He doesn’t know where he is and is not orientated to session, month, day or year. He cannot drive….and a lot more! But according to their functional analyses he’s mostly indepedendent and neither of us needs much assistance. Their decisions directly affect the quality of our lives, and they’re not properly trained to realize so. His memory is = or less than 1 minute, but that doesn’t need help 24/7. Very unfair, ignorante and unrealistic!

Meg Luce, LMFT
Meg Luce, LMFT

Thank you for your excellent guidance on this issue and for setting the record straight, Lori.

R. Argo, MD
R. Argo, MD

TBI is so undervalued and its severity so minimized that many are denied appropriate care, funding and understanding. (Retired psychiatrist.)

Diane Pisano, LCSW-C
Diane Pisano, LCSW-C

Ellen , thank you very much for this concise listing by Lori Weisman. It is spot on. My daughter-in-law has experienced several mild TBIs. She was retired from the Navy due to multiple injuries and was also a victim of domestic violence prior to meeting my son. They have been together for over 14 years. My daughter-in-law is still recovering from her last mild TBI which was about 18 months ago. Her doctors told her that the aftereffects of multiple TBIs become cumulative, each one taking longer to recover, and permanent damage can result.

I would like to recommend to those inquiring about a client’s possibly suffering from TBI that asking the client to complete this questionnaire quickly and/or at one sitting would not be possible for someone w/ TBI. Therefore the practitioner might have to question the client verbally, during multiple settings. Prolonged concentration would be difficult or even painful for someone w/ TBI.

Lori Weisman

Lori Weisman, MA, LMHC is a psychotherapist and consultant in private practice in Seattle, Washington. Early training in Speech Pathology gave her a thorough understanding of the intricacies of brain functioning. Later, as Clinical Director of brain injury centers in California and Utah, she witnessed the devastating effects on clients who have had a TBI. This unique skill set makes her an expert and explains why so many people seek her out for guidance and support. She has presented at conferences nationwide, consulted and trained therapists, and served as an expert witness.

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