Relationships after head injury
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As someone who has represented brain injury victims for many years, I am aware of the problems that can arise and have heard the statistics that two thirds of marriages end in divorce after severe brain injury.
The key note speech was given by Dr Jeffery Kreutzer, Neuropsychologist from Virginia Commonwealth University Medical Centre. He described himself as a family therapist because it is the whole family that are effected by brain injury, not simply the person who is injured and to ensure the best future for everyone; all the family have to be helped.
Families often describe feeling trapped, isolated and misunderstood. Friends help during the initial weeks and months following an accident but after time they see the physical injuries improving and think things are back to normal and go back to their own lives. This leaves the family having to deal with on going consequences of the head injury which can be catastrophic. Families often become the principle care givers with limited help and no training.
People often soon forget about the accident. This is particularly true of teachers, co workers and acquaintances. Their lives have moved on and they forget what has happened. This makes it particularly difficult for partners and children who are still living with the long term effects of brain injury and yet others do not understand why there is a problem. This adds to their feelings of isolation.
Counselling for the whole family helps them readjust their expectations of what life will be going forward. It provides practical management advice and also alerts family members to their own needs. Carers Week has recently hi-lighted the plight of carers and the fact that many neglect their own health to look after another. Whilst this can be understandable, in the long run it can be detrimental to the person they are caring for. If they become unwell, they will not be able to care for their loved one and what happens then? Carers should be allowed to feel that it's ok to think about themselves and put themselves first. Depression in those who have suffered brain injury is well known but what is not, is that Dr Kreutzer research shows that there is a higher incidence of depression amongst surviving partners than for those who are injured. This is a worrying finding because these people often do not seek help and are ignored by medical professionals. The focus is very often always on the injured person and never on those around them.
Families frequently describe personality and behavioural changes in the head injured person which can lead to them feeling that they are now living with or are married to a stranger. They are sharing their home with someone they do not know and who if given a choice pre accident would probably have not decided to share their lives with. Unfortunately, now, as a consequence of head injury, they feel trapped and alone. Brain injury often causes mood swings, memory loss, lack of motivation and fatigue. The brain injured person can be oblivious to these changes and some can become violent and aggressive. The incidence of physical assault whether it be pushing and shoving or strikes with a stick or cane are not unheard off and many go unreported.
It is therefore not surprising when the national statistic is 1 in 3 marriages ending in divorce, that when brain injury is added to the mix that a higher incidence could occur. What I did not realise however is that some of the reported studies have very small sample sizes. Panting's study, reported in 1972 only contained 10 couples and found 40% of relationships broke down. Thomsen in 1984 only contained 9 couples and found 78% breakdown at 10 years post injury.
More recent studies have contained larger sample groups. Dr Kreutzer's own study in 2006 of 120 couples, discovered that only 25% of relationships had broken down when reviewed an average of 4.1 years post injury. This also revealed that the incidence of breakdown was more prevalent in those who have been together less than 10 years and that of all the couples who had been together 30 years or more before brain injury, none had separated or divorced.
What these statistic's reveal is that no one knows what the future holds and which relationships will break down and which will survive. What is known is that families need help following injury. The family need to be seen as a whole unit and whilst initial treatment is centred around the accident victim, longer term rehabilitation needs to be a mixture of individual and family support.
I found the day incredibly useful. It reminded me that I need to think about family and care providers and not simply focus on the individual who has been injured. I often spend most of my time talking to these people and so need to give them the opportunity to be heard and tell them it's ok to put themselves first.
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