I had a rather heated conversation with my doctor the other day about — anger.
Brain injury anger, to be specific.
It had suddenly occurred to me that since the time of Phineas Gage in the 19th century, physicians and psychologists have known about how brain injury can change personality, including bringing on outbursts of anger, yet in all that time it doesn’t seem to have occurred to anyone to develop a treatment for what I call “brain injury anger.” This is mind boggling because since that time, anger and brain injury have become almost synonymous.
That’s not to say health care professionals don’t try to deal with it. They just go about it stupidly.
The first problem is identifying the anger. I think half the problem with the way the health care professionals deal with anger is that they assume that although an injury has short-circuited something — maybe the control the prefrontal cortex has over the limbic system — that it is essentially no different than someone with an anger management problem. And so they send someone to anger management. Or they figure that methods that work for people with other issues (eg, developmental delay) will work for brain injury. However, what they don’t do is treat the anger. Yet as I’ve met more and more people with brain injuries, I learn that all the strategies and management systems in the world do not work. Period.
Oh sure, we learn to avoid the triggers. But as one person told me, you can’t avoid triggers all the time. And oh sure, we learn strategies, sometimes even develop our own. But what the therapists don’t tell you (maybe because they figure once they teach, all is hunkey dorey, I don’t know), is that strategies work at best only fifty percent of the time. And in the end, the worst part of how the health care professions deal with brain injury anger is that you’re still left with it — for strategies and management don’t fix it, don’t treat it, don’t free you from it. They leave that short-circuit intact, ready and able to wreak havoc in your life whenever you let down your guard.
I tried to describe the anger to my doctor. And the more I tried, the more I realised he was still seeing it as the same as any other kind of anger. Talk about frustrating!
Rehab had taught me about different types of anger. Psychologists apparently categorize anger. Yet they do not take into account that anger that comes with brain injury arises from the injury itself; thus finding the physiological mechanism for this phenomenon and understanding how it works is the key to treating it. You gotta identify it before you can treat it.
Complicating the picture is that the consequences of having suffered a brain injury will create a perfectly natural angry response to a horrendous situation. That kind of normal angry response may be heightened by the injury or dampened, and it may be confused as being the same as brain injury anger when it isn’t. To me, in the early years, brain injury-created anger was about the only thing that gave me the energy to do things and woke up my brain enough to think. I almost saw it as the brain’s way of keeping its thinking ability working. But then the anger settled down to coming and going with a drop of a pin, startling me (and others). It is the kind of anger I feel needs treating because it’s so volatile, so unexpected, so uncontrollable. I’ve heard people throw things when under its influence, get thrown out of places, damage relationships because of it — this in spite of learning and using every strategy in the book. Although my anger did not manifest to that physical degree, it was a huge relief when as a byproduct of my hypothalamus fix, that the brain injury anger disappeared. I was no longer at its mercy; I no longer had to prepare myself for when I knew I would be exposed to triggers. Since the TTC was a huge trigger, I had had to try and avoid it as much as possible. That is no way to become independent. It is not acceptable that in order to avoid the sudden onslaught of brain injury anger, one must avoid the TTC.
I don’t know why identifying and healing the physiological injury that gives rise to brain injury anger has been so sadly neglected in the world of medical research. It’s been a century and a half after all. What have the researchers been doing all this time? Talking to themselves, not understanding how awful it is for the patients, is what. It’s time for that to change. And it’s time for people with brain injury to demand real treatment, not put up with half-assed strategies that should only be a stopgap while treatment takes effect, should never be considered a permanent solution. Because strategies aren’t.