I’ve been giving a lot of thought, lately, to the subject of acceptance and denial of TBI-related issues. Denial is a big issue with lots of head injury survivors, and the inability to accurately self-assess can make lasting recovery difficult. It can make us reluctant to do the work required to achieve true recovery, because we simply don’t realize that we need to do the work. It’s not that we’re “in denial” because we’re emotionally ill-equipped to deal with the loss of certain traits we once had. We simply cannot conceive that there actually is something amiss with us. After all, our brains are telling us we’re just fine.
The second, and most important, obstacle is the inability to directly perceive the effects of the injury. In traumatic brain injury (TBI), the brain does not feel injured. It rarely hurts or feels strange, and relatively few symptoms are obvious to survivors. Most survivors overlook the errors they make because of the lasting effects of their injuries. When an error gets noticed, most survivors don’t realize that it was caused by their own, defective thinking and self-control. Even when a survivor recognizes the mistake, the injured brain usually serves up excuses that prevent learning about the injury. Serious physical disability is unusual after TBI, but if there are physical symptoms they almost always get recognized. In many cases, survivors also learn that they are forgetful. But most survivors feel sure that their thinking, behavior, personality, and abilities to get things done are unchanged or changed very little, by the injury. Common head injury symptoms like unreliable judgment, undependable follow-through on assignments and tasks, inappropriate behavior toward others, reduced frustration tolerance and self-control, and increased emotionality are usually denied no matter how serious they might be. By failing to recognize that these are permanent problems, survivors learn nothing from the mistakes they make on this basis, repeating the same errors again and again.
A lot of people tend to believe that denial of illness is purely a psychological defense mechanism, and in order to get better, you just have to emotionally come to grips with the stark reality of your life. Certainly, the psycho-emotional aspects do play into the equation. But lacking awareness of deficits has pronounced neurological aspects, which make life interesting enough, even without the psychological aspects. Things like goal-setting and basic day-to-day logistics get that much more interesting, when your brain is telling you, “Don’t worry – you’re fine!” while it’s off doing its own thing.
And that’s kind of where I’ve been, on and off, for the past month or so. It’s where I have been for about as long as I can remember, in fact. But telling myself that I’ve messed up because I refuse to accept my limitations falls short of the whole truth. I’m more than happy to adapt to things I need to change in my life — but my broken brain keeps telling me it’s fine… just fine.
Well, I’ve had an incredibly long week, and I’m completely bushed. But for what it’s worth, there’s my thought for the day.