No one knows your spouse the way you do, so after a traumatic brain injury you are usually the first person to notice what has changed. 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 strain 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 that caused the damage. The injury is also referred to as traumatic because it can cause devastating changes within the victim.
Doctors grade a traumatic brain injury as mild, moderate or severe using the Glasgow Coma Scale together with how long the person lost consciousness and how long their memory of the event stayed impaired. A concussion is the most common mild TBI. A severe TBI can leave a person unresponsive or in a coma. Seizures are a symptom that can follow an injury at any grade, not a grade of their own. 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 partners 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. 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 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 can hurt. Your partner might not remember key dates such as your anniversary or 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 accidents, 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 a lack of insight. Survivors suffering from a 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.
This is hard to absorb. The person you fell in love with is still there, but their brain has been injured. Firmly and kindly, tell your partner when their behavior is out of line, and ask close friends and family to do the same. It feels awkward at first, but consistent feedback about social norms helps a brain injury survivor relearn those 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, 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 leave a survivor questioning their role in a sexual relationship and doubting their appearance, their attractiveness and their 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. Your partner may also be physically unable to work or drive after the injury. You may have to adopt a caretaker role, managing the health of the survivor full-time.
Spouses of survivors of brain injuries commonly take on new responsibilities formerly managed by the survivor, such as:
- 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. Roles inside the house may have to change, and your usual date night probably will too.
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 is also easy to want to walk away. Healing a marriage after a brain injury is possible, and the sections below set out what has worked for other couples.
Consider these tips:
- Do not baby your partner. It only puts more distance between the two of you. Be honest about your thoughts and feelings, and communicate openly with one another.
- Do not assume your spouse is coping just because they do not talk about their injury, and do not assume they know how you feel. You have to talk about it.
- Find emotional outlets that work for you, like journaling, drawing, or gardening.
- Write letters to one another. Writing gives you both time to find the right words.
- Let your partner try to finish activities on their own. Relearning skills is a large part of brain injury recovery, so do not rush to do everything for them. Let them attempt the task before you offer help.
- Balance your responsibilities as a couple. Your partner may not be able to take on what they did before, but in a reduced capacity you can take turns with tasks they are comfortable completing, like washing the dishes, getting the mail, or picking out the groceries.
- Make a conscious effort to be regularly intimate, and not only sexually. Small gestures like holding hands or stroking their cheek 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 take that path with them, so take inspiration from other families without measuring yourself against them.
- Be patient. You may need to repeat yourself ten times in one morning, or remind your partner about restaurant etiquette. You might be frustrated, heartbroken, or both. Be patient anyway. They are in this with you.
- Celebrate achievements in your spouse's recovery. Be vocal about their wins and about yours.
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 a 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 weighs on the wallet as much as on the heart. If your spouse was hurt in an accident they did not cause, or only partly caused, speak to a lawyer early. Under Florida Statute 95.11(5)(a), a negligence claim that accrued after March 24, 2023 must be filed within two years of the accident, and under Florida Statute 768.81(6) a person found more than 50 percent at fault recovers nothing. A Florida brain injury attorney can pursue the cost of medical care, lost income and long-term care at home.
Moving on after a traumatic brain injury is possible. By working with your partner, the happily ever after you've always dreamed of is still in reach.
