The Forgotten Injury After TBI: The Injury to the Marriage

It is clear to the doctors who treat traumatic brain injury, as well as the attorneys that represent those same injured individuals, that the organic damage to the brain itself is a very real injury even in the mildest of traumatic brain injury cases. Sometimes though the second tier of injury is forgotten. What I am speaking of here is the injury to the relationships, including marriage, that occurs when a TBI survivor’s personality, mental state and mood are changed following an injury to the brain.

The medical literature is full of studies that show that depression is one of the most common side effects of traumatic brain injury. Brain injury survivors often become depressed as they try to come to grips with the changes that have occurred to them as a result of the injury to their brain. It permeates and affects every aspect their life. As they realize that they are having difficulty with attention, concentration, and memory they can become frustrated, short tempered, and even resentful at times of the changing “who they are”. The ripple effect that these feelings have on those friends and family members of the survivors can be profound.

Accordingly, there is no surprise that the divorce rate after a traumatic brain injury is quite high. This issue is so significant that the Brain Injury Association of America devoted its entire 2009/2010 winter magazine to the issue of “Love After Brain Injury”.

There is little doubt that brain injury can and does strain marriages. The survivor’s spouse is forced to take on many of the injured person’s responsibilities around the home and in society. Since brain injury typically affects the survivor’s ability to work and stayed employed, unemployment rates after brain injury are high. Couple this with the fact that the insurance company of the survivor is typically refusing to pay for the therapies and treatments that the person requires which causes additional financial stress and strain to the marriage.

Now, taking into the account the fact brain injury often brings on drastic personality changes including depression, irritability, short temperedness, and at times a lack of insight as to the depth of their injury, it is no surprise that the divorce rate is as high as it is. It is very common in my own practice to talk with a survivor spouse and have them say “Since the accident, he/she is just not the same person that I married”.

One of the first comprehensive investigations into marriage after brain injury was performed in 2007, by Virginia Commonwealth University’s TBI Model System Researchers. These researchers in Virginia gathered information from a 120 people who had sustained mild, moderate and severe brain injuries and were married at the time of the injury. Their results from this limited sample of 120 marriages showed that 3 out of 4 TBI survivors remained married at the time of the follow up which took place three to eight years post injury.

This data from Virginia Commonwealth University conflicted with earlier studies in Europe which suggested that the divorce rate after brain injury was much higher. If it is true on a larger scale that 3 out of 4 marriages are intact at three to eight years out from the brain injury then survivors are statistically better off than others as some media reports suggested that as many as one half of all marriages [TBI or not] in the United will end in divorce.

In 2008 those same investigators led a multi-center research team which investigated marital stability following brain injury. Information was collected at 16 centers around the country. The study in 2008 was the largest study at the time on the marital fallout following brain injury and included nearly 1,000 individuals from different cultural and ethnic backgrounds. The findings were uplifting. The research team found that nearly 85% of survivors remain married for at least two years post injury. Other important facts included:

(1) from minority group members-persons with more severe injuries were more likely to remain married;

(2) cause of injury was an important factor as persons who were injured as a result of violence were less likely to be married at follow up;

(3) male survivors were more likely to have an unstable marriage (i.e. to be separated or divorced) than female survivors;

(4) age was a very important predictor in marital stability with older persons less likely to divorce; and

(5) only 15% of subjects were separated or divorced.

What does this mean for brain injury survivors? Well, contrary to popular belief the divorce rate following brain injury seems to be less than a national average for divorce rate on the whole. This doesn’t deny the fact that for most spouses there will be more marital and financial stress post injury. Perhaps the challenges presented to the marriage following a traumatic brain injury of one of the spouses is uniting couples in a positive way as they face injury related challenges together.

To help reduce the stress on a marriage following traumatic brain injury to a spouse, the Brain Injury Association of America offers the following tips:

1. Communication.

a. Patiently listen to your partner and show a positive attitude. Are there parts of what he/she is saying that you can agree with?

b. When your partners makes a statement be cautious about disagreeing. Edit your thoughts to avoid saying only negative things that come to mind.

c. Be willing to compromise.

2. Changing responsibility.

a. To avoid misunderstandings have an honest discussion and make a list of who is in charge of what.

b. Once a list is agreed upon, expect that your partner will attend to his/her jobs perhaps in a different way or in a different time frame than you would like. Even when you think something should be done differently, avoid being critical.

c. Always express real appreciation for the things that your spouse does, even small things. People who feel appreciated are more likely to contribute their time and energy to help out each other.

3. A change in priorities.

a. Make a commitment to having a good relationship, something you did well when you first met one another.

b. Plan times when you and your partner can enjoy something fun-a movie on television, a board game, a walk-and make this an activity that can’t be pushed aside for something else.

c. Focus on the positives in your new life. Couples that are happiest make five positive statements about their relationship or their partner for every one negative statement. So, even if you are having a bad day, make sure to point out one or two good things about your spouse or relationship and say them out loud.

4. Emotional and Personality Changes

a. Look for opportunities to laugh with your spouse. Sometimes at first laughter can feel forced. The more you try to have a good time with your partner, the more natural having fun together will feel. Couples who laugh together are lots happier.

b. When your spouse says something you don’t expect, see if there is a different way to look at it. Rather than feel embarrassed, hurt, or angry, see if you can find a reason to smile.

c. It is ok to expect and demand that your partner treats you with respect. Please do not tolerate hurtful behavior, even if it seems to make things easier for a short time. If your spouse says something or does something hurtful, calmly state “I will not allow you to treat me this way” and then leave the situation.

d. Remember, brain injury or not, many couples do not agree on everything.

There is no doubt that following a traumatic brain injury remaining married and happy within that marriage is a challenge for most couples with or without brain injury. Whatever your situation is know that you can have a positive and healthy relationship by understanding the challenges that the brain injury of your spouse will present to the marriage. Lastly, if the problems seem more difficult than you can handle alone, seek the assistance of a local marriage counselor who has some understanding of traumatic brain injury.