Ask Kathy M. Archives
A Collection of Questions and Answers from TBI Advice Expert - Kathy Moeller

Topic: Social-Emotional - Adjustment Difficulties and Hostility


Dear Kathy M.,

I am a 17 year old girl and I received a tbi in a car accident recently. My boyfriend was driving, and I was in the passenger seat. I am having a very hard time dealing with emotional issues and especially adjustment after the injury. I am getting depressed and feel hostility toward some of my friends. I am very alone and I could use some guidance.

Kathy's Response:

I cannot speak to the parts of your message that deal with so-called "adjustment" issues because I am not a professional psychologist. I hope you are getting good counseling, and if you are not, it's something I would suggest you pursue. If you're feeling hateful and alone (perhaps depressed too), these are good signs that professional counseling would be a good idea. I've been in counseling, and a good therapist can help a person see light where they could see only blackness before! I strongly encourage you to get some good professional help with all this!

Broken "Gatekeeper"
The part I can address, has to do with what some people with brain injury report about how they process feelings now -- after a brain injury. I would like to share something I learned from one of my therapists about this, when I was first injured.

It has to do with something my therapist called "an emotional gatekeeper," and this example might explain some of what may be happening in terms of the intensity of the feelings you may be experiencing. If you can imagine a "gatekeeper" being someone whose job it is to let things in and out of a particular area, say, their job is to let cars into a property one at a time. Or perhaps, they are "keeping the gate" of an exclusive estate, and it is their job to only let in certain cars, and keep out others.

If you can imagine the brain having a "gatekeeper" too, the analogy my therapist gave me was that my "emotional gatekeeper" was busted after the injury. That meant that whatever it was in my brain that used to regulate the intensity or the appropriateness of certain feelings (the doctors probably have a technical term professionals use), was all out of whack, and emotions would "flood the gates" at times, when they would not have, prior to the injury. Kind of like what it would be like if the gatekeeper at the estate let all the cars on the freeway into the estate grounds. It wouldn't take long before the situation was in "overload."

The example I'm going to share with you is from my personal experience. I remember being in line at the store and noticing that the clerk was particularly slow, or was making mistakes -- something along those lines. Instead of just feeling "annoyed" (which I might have felt before my injury), I was ANNOYED with a capital "A." I would get angry -- or abusive -- or even swear. I might thrown my merchandise down and walk out, grumbling about the lousy service -- something that not only would have been out of character for me prior to the injury, but was not appropriate to the situation. It was extreme! By anybody's standards.

Over time I learned that I would feel FLOODED by anger and agitation at what would have been minor things before I was injured. And I learned strategies for dealing with all these troubling, and extreme feelings. You see, I knew I wanted to be a "responsible citizen" again. I wanted to be able to go to the store without seeing all the clerks run for the back room! And I wanted to be able to be in enough control to work again. Unless I fixed the emotional "gatekeeper" problem I knew these things would not be possible.

We can develop strategies for dealing with some of our uncomfortable feelings. You create a kind of physical gatekeeper (on paper) you can turn to before things get out of control. You can learn some of these strategies from people like me and other peers (persons with brain injury who have "walked the walk."). One way to learn how others have coped, is to join a peer group or an Internet discussion list. Your injury is "fresh" and you are also young. By networking with other young people, as well as older folks who were perhaps injured at about your age and have learned some coping strategies, you will likely find support, ideas and comfort for some of the things you are dealing with.

Some of the most common uncomfortable feelings persons with brain injury deal with include frustration, anger, feelings of overwhelm and confusion, feeling disoriented, feeling misunderstood, and others. I create what is called a "Strategy Page" for each feeling I struggle with, and then write down a list of options I want to be able to read when I'm upset. For example, some typical strategies for "feeling angry" include: - taking a break - writing in a journal - reading the "Serenity Prayer" - calling one's counselor - calling a friend - talking a walk - petting the dog - walking the dog - writing out a script for what you want to say to someone (if you're angry with a particular person).

There are others. I have found that the process of creating a list of things I can do is empowering and often helps, just by writing all the options down. Having the list visually available (somewhere I can find it quickly, and read it), makes it possible to "nip things in the bud" as they say. The feeling I'm struggling with does not get so embedded that I can't find my way out of it.

You've got your hands full! I would like encourage you to join one of the e-mail discussion and support lists I mentioned, so you can start networking with your peers (people like me who have been dealing with life and brain injury for a while now, and also people more your age). Also, and very importantly, please get some good, professional counseling! If you don't know how to do that, when you join the list, some of us might be able to help you access resources for that too!

Not only is it normal without a brain injury, but the brain injury makes your feelings feel worse, if you know what I mean. We're not just sad, we're SAD or we don't just get depressed, we get DEPRESSED. Part of that is from the brain's new difficulty doing something called moderating feelings. It takes some time to figure out how to deal with normal "feelings" feelings and exaggerated brain-injury related feelings.

Do you have a counselor? Have you tried your community support group for folks with brain injury? These might help.

How about joining a little group I've got on the Internet. It's an e-mail discussion list called TBI-WORKING (most are back to work or back in college now), and it's a great way to talk about stuff like this and even make some cyber friends. Want to give it a try? Everyone on there (most everyone, except for a couple of professionals) have had brain injury, some younger, some older, some when they were kids, and everyone has lots of good information and support about getting your life back on track.

Let me know about joining TBI-WORKING, OK? I'll need a first and last name too, though you can make that part up if you want to have a "handle" and be anonymous.

Hope this helps!

Kathy M.

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