There may be nearly 8 billion people in the world, but no one knows your spouse quite like you do. That's why after your loved one survives a traumatic brain injury, you'll likely be the first to notice the changes the injury has caused. Brain injuries can cause a variety of physical, emotional, and cognitive effects that can drastically alter the way a brain injury survivor thinks, feels, and behaves.
Relationship changes that accompany a traumatic brain injury are difficult. They can place a strain on a once-solid relationship, and cause pain for both parties. Grasping how to deal with brain injury in a spouse can be trying, but understanding why these changes are happening and how you can effectively communicate is the first step in healing your marriage.
How a Brain Injury Affects Your Spouse
In an accident, even without extensive trauma to the skull or broken bones, the brain can ricochet around the cranium, bruising and tearing sensitive tissue. We refer to this as a traumatic brain injury (TBI), as an outside force or trauma caused the damage. The injury is also referred to as traumatic because it can cause devastating changes within the victim.
Brain injuries are classified as mild, like a concussion; moderate, like a seizure; and severe, like a coma. While milder injuries such as concussions do not always result in long-term or significant relationship changes, after moderate or severe brain injuries, both survivors and their partner must often alter many aspects of their lives.
Survivors of a brain injury may need to relearn how to walk, talk, and even think clearly again. Physically, the impact of a TBI can cause spasticity, seizures, and bladder, bowel, and swallowing difficulties. Cognitively, brain injury survivors may have difficulty processing or understanding information. Emotionally, TBI victims can develop new personality traits, fears, challenges, and limitations. After your spouse survives a brain injury, it can feel as though you're married to a stranger.
How Is Communication Affected by TBI?
One of the first problems you may face as a partner is how to communicate with a brain injury patient. This is especially true if your spouse awakened from a coma or other severe TBI that could have drastically impacted their communication skills. In the early days following a brain injury, your partner may have difficulty finding their words, producing understandable speech, or comprehending what you're saying to them. Many communication issues stem from cognitive changes that have occurred.
Brain injury survivors will often begin a sentence that trails off into gibberish. This is because even their thoughts have become scrambled, leaving them unable to formulate proper words or sentences. Survivors might develop a stutter or slur their words when speaking. Your partner may struggle with understanding and using non-verbal communication, such as facial expressions and body language.
Day-to-day conversations may take more time and effort than they did before the accident. Take your time. Your partner may struggle with expressing romantic feelings, which can be frustrating and upsetting for you both. Likewise, impaired memory is one of the most common cognitive consequences of brain injury. For spouses this may be problematic – for instance, your partner might struggle to remember key dates and memories such as anniversaries and your wedding day. Short-term memory struggles can make carrying out longer and more meaningful conversations difficult. Remain patient, and don't be offended when your spouse asks you to repeat yourself.
Changes in Behavior and Personality
Changes in behavior are incredibly common among brain injury survivors, especially those who suffered an injury to the frontal lobe. Damage to the frontal lobe can be caused by disease or stroke but is commonly caused by a blow to the front of the skull, consistent with blunt force trauma, auto accident, motor or bicycle accidents, or a significant fall. Frontal lobe injury can impair a survivor's ability to make good choices and recognize the consequences of their actions.
In brain injury victims, behavior can become uninhibited and socially inappropriate. Survivors may make inappropriate comments or swear excessively in public, losing touch with the social cues with which they were once familiar. These effects combined with altered emotions can cause an overall switch in personality, which is often most clearly noticed by a spouse.
Sometimes a brain injury survivor may be unaware of how their personality has changed, or in what ways their injury has affected them. Psychologists refer to this as lack of insight. Survivors suffering lack of insight may not even realize how much their new behavior varies from their typical behavior, which can be incredibly frustrating for a partner.
While this can be difficult to absorb at first, it's important not to be overwhelmed – understand that while this is still the person you fell in love with, their brain has quite literally been shaken. Sternly, but kindly, let your partner know when their behavior is inappropriate. Encourage close friends and family to do the same – while this may feel awkward at first, consistent messaging on social norms will help a brain injury survivor re-learn social skills.
Intimacy after TBI - What Happens Now?
Intimacy forges an emotional, psychological, and physical bond between two people. While intimacy is often perceived as strictly sexual in nature, that could not be farther from the truth. Intimacy lays the groundwork for romance through small actions and gentle touches. For spouses, intimacy should provide both security and satisfaction for you both. It can be as simple as holding hands, moving closer to brush the hair from their eyes, or snuggling on the couch.
However, brain injuries can, and unfortunately, often do, make intimacy difficult. If you and your partner are experiencing difficulties with intimacy after a TBI, it is entirely normal. A brain injury is responsible for many changes within the body, including altering hormone levels such as testosterone and estrogen. A brain injury can cause a survivor to question their roles in a sexual relationship, doubt their appearance, attraction, areas of sexual interest, and self-confidence.
Likewise, a TBI can trigger convulsions or seizures which cause aggression, disruptive behavior, anger, and even blackouts. While these incidents are traumatic on their own, a survivor is often drained of all energy after an episode. This can put a sudden stop to any plans of intimacy, for both of you. Instead of rushing headfirst into things, begin with small gestures: kisses on the cheek, hand holding, and stroking their arm are all excellent places to start.
Practical and Role Changes in the Relationship
Practical changes can flip the switch on your and your spouse’s roles. Survivors of a traumatic brain injury are often forced to give up many responsibilities, including holding a job and household chores, while they focus on getting better. Not to mention, your partner may be unable to physically work or drive following their injury. You may have to adopt a caretaker role, managing the health of the survivor full-time.
- Managing household finances
- Yard work and physically maintaining the home
- Planning and organizing activities for the family
- Becoming the primary source of income
Aside from roles within the house, these practical changes can impact your social life as a couple. Following a brain injury, there may be a change in the type or pace of activities that you can partake in together. For instance, chronic fatigue might make it harder to be social with friends. Your spouse may struggle in noisy environments. While roles may need to change within the house, you'll need to revamp your typical date night.
Tips to Heal Your Marriage after Brain Injury
Keeping a brave face after your partner has suffered a brain injury is far from easy. It's easy to daydream about the days before the accident when your spouse still acted like themselves. It's also easy to want to walk away. However, we both know that your marriage is worth far more than that. When the going gets tough, the tough get going – after a brain injury, it is possible to heal your marriage.
- Do not baby your partner. It will only put more distance between the two of you. Be honest about your thoughts and feelings, and communicate openly with one another.
- Do not assume. Don't assume that your spouse is coping just because they don't talk about their injury. Don't assume your partner understands how you feel. You must talk about it.
- Be creative with your emotional outlets. Try journaling, drawing, or gardening.
- Write letters to one another. Writing will allow you both the time you need to find the right words to express yourselves.
- Allow your partner to try to complete activities by themselves. An essential aspect of brain injury recovery is challenging themselves in order to relearn skills. Don't feel you need to rush to do everything for them, and instead allow them to attempt the task before you offer help.
- Balance your responsibilities as a couple. Yes, your partner may not be able to take on what they were previously capable of doing. But in a reduced capacity, try to take turns with tasks that your partner is comfortable completing, like washing the dishes, getting the mail, or picking out the groceries.
- Make a conscious effort to be regularly intimate. No, not sexually, but in small ways - holding hands, stroking their cheek, and so on. Gentle touches can help ease them back into normalcy.
- Do not compare yourself to other couples. Every brain injury survivor has a different journey, and you will need to take that path along with them. Your story will not be the same as another family's, so while you can take inspiration from one another, do not compare yourself.
- Be patient. You may need to repeat yourself ten times in one morning. You may need to remind your partner about proper restaurant etiquette. You might be frustrated, heartbroken, or both. But be patient with your partner. They're in this with you.
- Celebrate achievements in your spouse's recovery! Be vocal about their wins – and yours.
Recommended Reading for Partners
While being in a relationship with a brain injury survivor may be tough, trust that you are not alone. There is an entire community of women and men who are fighting the exact fight as you and your spouse.
- Brain Injury Survivor’s Guide: Welcome to Our World, by Larry Jameson and Beth Jameson
- Blog: Your Husband had a Traumatic Brain Injury – Living with a TBI
Moving on after a Traumatic Brain Injury
It's easy to feel as though life will never be the same after a traumatic brain injury rocks your marriage, and in a sense that's true. It will be hard work. However, it will be worth it. While life might develop a few more obstacles, that's not to say that it still can't be beautiful. Your marriage can remain strong after brain injury.
Working together with the help of a dedicated team of doctors, you and your spouse can remain happy and healthy. However, it may require visits with a psychologist or psychiatrist, regular brain scans, and routine monitoring. A traumatic brain injury can weigh heavily on the wallet and the heart – so if your spouse sustained a brain injury in an accident in which he or she did not or only partially caused, do not hesitate to reach out for legal help. A South Florida brain injury attorney can fight for the compensation you deserve. Compensation for your spouse's TBI can also help offset the medical bills and home expenses that can accumulate if you've lost a source of income.
Moving on after a traumatic brain injury is possible. By working together with your partner, the happily ever after you've always dreamed of is still in reach.