PCBIC 2010 Dr. Jeffrey Kreutzer: Recovering Relationships

8/7/2019 PCBIC 2010 Dr. Jeffrey Kreutzer: Recovering Relationships

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Jeffrey S. Kreutzer, Ph.D.

Virginia Commonwealth University

Medical Center


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Living with The CharacterologicallyAltered Patient

Common family problems -

when the patients characterological change isextensive, all close members of the family are

likely to suffer emotionally.

the immediate familys sense of isolation maybe exacerbated by feelings ofabandonmentby the extended family.

Lezak, 1978


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Living with The CharacterologicallyAltered Patient

Common family problems -

outside relatives who do not assumeresponsibility for the patients care are inclined

to be critical of the caretaker

Lezak, 1978


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The Spouses Special Problems

the spouse lives in social limbo, for hedoes not have a partner

the spouse cannot mourn decentlyalthough he has lost his mate as surely

and permanently as if by death

the spouse cannot divorce with dignity orin good conscience

Lezak, 1978


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from the VA statewide community based needs assessment


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from the VA statewide community based needs assessment


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The curious thing about the auto

accident that ended my life wasthat I lived through it. On January

31, 1996, Death sneaked through

a red light disguised as a minivangoing 50 miles an hour.

Kara L. Swanson

Catching the Bus


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Course, nobody told me that when

they finished pulling me out of my car,they were putting me right on the bus.

Thats what I call the process of

recovering from traumatic brain injury:getting on the bus.

Kara L. Swanson

Catching the Bus


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Its a good thing they strapped me

down and fastened my head to a

board. Had I understood even alittle of the journey that had just

begun, I would have hit theground running.

Kara L. Swanson

Catching the Bus


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and others didnt understand.How could they. They couldnt

see the hundred and one things I

was doing behind the scenes topresent myself as normal. I

looked the same (except for the

extra poundage).

Kara L. Swanson


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Postinjury Relationship Changes


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Loneliness and Other CommonFeelings after Brain Injury

lonely neglected abandoned ignored isolated rejected

disrespected disliked unworthy different unsupported misunderstood


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Understanding is Important


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Understanding is Important


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Have you found yourself saying

What happened to all the friends whocame to visit me in the hospital?

People seem to avoid me. My wife threatens to leave

me at least twice a week.


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Have you found yourself saying

Nobody has any idea what Imgoing through.

I cant relate to other people. Itseasier to be by myself.

Seems like nobodywants to talk to me.


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How Are YouTreating Other People?

Are you thinking a lot about how otherstreat you?

Have you noticed that friends, familymembers, and co-workers are treatingyou differently?


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Relationships Are

A Two-Way Street

Just as important is thinking aboutHow you treat other people

The way you act toward other peopleaffects the way they treat you.


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I got angry at nothing. One night

something irked me and I tore down

the wallpaper in my living room. I

interrupted people. They could tell

me they just found the cure for

cancer and I would cut them off and

talk about how pretty the car next to

us was.

Kara L. Swanson


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IntroductionIn 1996, Cathy Crimmins, her husband Alan,

and their daughter Kelly were on an idyllic

lakeside holiday when a boating accident left Alanin a deep coma, with severe damage to the frontal

lobes of his brain, the area that controls speech,

memory, movement, and personality. Where is theMango Princess? Is the story of what happened to

Cathy and her family after Alan woke up.


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I am beginning to understand the phrase

lack of companionship, I say to my

mother and mother-in-law as we sit eating

dinner in a nice outdoor caf on Kingstonsmain thoroughfare. Hes not here, I say

tearfully. He might never be here again.

They dont know how to answer.

from Where is the Mango Princess?


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The Ghost of Alan past. He hauntsme even more than Phineas Gage

does. The worst thing you can do is

to remind the brain-injured person ofwhat he was like before, of what he

could do back then he cant do now.

But how can you help remembering?



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How can I explain the personality

oddities of brain injury who think Alan

is the same as he was before? I ask

for Bills advice. Just tell them to

imagine the things they hate about

their spouses most and then multiply

that trait a hundred times, he

advises. How true.



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Anything annoying that Al did beforethe accident, he now does more, and

more intensely. He always had

trouble with his temper and with lossof patience. Whereas before he

might have blown up once or twice a

week, now temper tantrums are adaily occurrence.



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The Are You Pushing Other

People Away Questionnaire

focusing on whats wrong in yourlife and the world not listening when others speak,

interrupting or talking too much.

arguing or disagreeing not thinking about other peoples

needs or feelings


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talking only about yourself asking people very personal questions talking mostly about your brain injury and

how your life has changed for the worse

repeatedly rejecting others advice,suggestions, or offers of help


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touching people without asking if itsokay or standing too near them

talking without thinking or saying thingsthat hurt other peoples feelings

not using good hygiene


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One of the most important steps inrecovering from any traumatic

event is realizing that you need

help that you cant always make

it by yourself and finding the

strength to seek it out.

Kara L. Swanson


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My family and friends didntknow anything about head

injury. We didnt know howto interpret what we were

seeing.Kara L. Swanson


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Why Many Survivors Feel Lonely Even

When Around Family and Friends


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It wasnt what people said,mind you. It was what

people didnt say that

scared me. I would

sometimes catch them

trading those looks.Kara L. Swanson


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People generally make friends throughwork or being involved in social or

recreational activities.

After injury many survivors stop workingand may not be involved in sports, church

or other activities.People lose contact with co-workers and

friends.


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Fatigue and loss of energyare common after injury.

Many say they dont havethe energy to enjoy spending

time with friends and family.


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Building LastingRelationships

Ask trusted friends for their ideas abouthow you can be helpful.

Helping, caring for, and reaching out toother people is a good way to show others

that you are the kind of person that theywant to be around.


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Can I make and keep relationships

if I dont have much money?

Weve made a list ofideas about how you can

be nice to other people.

Try out the ideas. Be creative, add and try

out some of your own ideas.

What you should

be thinking.

Being kind doesntnecessarily meanspending lots of money


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Be Kind to Others Dont be shy about complimenting others.

Think about what you like about other

people and tell them.

Pick flowers or vegetables from yourgarden and give them to others. Share a comic strip, story, joke,

magazine article or book.

Hold the door or elevator for someone. If someone drops something,

pick it up for them.


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Be Kind to Others Tell someone who helps you how

much you appreciate them.

Offer to baby sit for someone,take care of a pet, or help withtheir chores.

Buy or share with someone asnack, coffee, tea, or soda.

Bake someone cookies,brownies, or a cake.

Make a meal for someone.


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Be Kind to Others Offer to help someone organize or clean

their house, basement, or garage.

Offer to pick up your neighbors mail andnewspaper when they go away, andwater their plants.

Volunteer your time to your church, locallibrary, Red Cross, or other community

organization. Smile and say, Hello to people.


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Building Lasting

Relationships


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Building Lasting

Relationships


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The research that enabled me to identify

the phenomenon of ambiguous loss was

conducted with the families of pilotsdeclared missing in action in Vietnam and

Cambodia. It was 1974, and I was

collaborating with staff at the Center of

Prisoner of War Studies in the U.S. Naval

Health Research Institute in San Diego. Weinterviewed the wives of missing pilots in

their homes, and it was from them I first

learned about the power of ambiguity in

complicating loss. I tried to determine how

to ease their stress in spite of the ambiguity

they had to live with in many cases for alifetime.


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Ambiguous LossPauline BossA situation where a loved one is perceived

as physically present while psychologically

absent, or physically absent but kept

psychologically present because their status

as dead or alive, dying, or in remission

remains unclear.Our premise is that the most stressful

losses are those that are ambiguous.


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Ambiguous LossPauline Boss

Research has supported the idea that

ambiguity creates a powerful block tocoping and grieving, predicting symptoms

such as depression, anxiety, loss of

mastery, hopelessness, and conflictwhich erode couple and family

relationships.


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When illness cannot be cured, people

must simultaneously hold twoopposing ideas in their minds: The

person as she or he was is gone, but

that person is still in my life.


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In the second type of ambiguous loss, a

person is perceived as present butpsychologically absent. This condition is

illustrated in the extreme by people with

Alzheimers disease can also occur when

a person experiences serious head trauma,first becoming comatose and then waking up

a different person.


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Lack of clarity about prognosis, daily physicalcondition, and fluctuating capabilities createrelationship confusion, preoccupation with the

illness or avoidance of the individual.

Immobilization, depression, and relationshipcollapse may occur in response to features ofchronic illness over which there is no control.


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Ambiguous loss can cause personal and

family problems, not because of flaws in thepsyches of those experiencing loss, but

because of situations beyond their control or

outside constraints that block the coping and

grieving process.


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Learning to Like and LiveWith a Stranger

Not everything has changed. Recognizethe good qualities that are still there.

Post-injury change is a process.Recognize the injured persons ability to

change for the better. Point out what

you see and like. Encourage the personto speak in ways that are appreciated.


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Communicate and get to knowthis different person better. Ask

about their feelings, what they like

and dislike, and how you can

help. Try to share your feelings,

good and bad, with them.


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The injured persons acting different is partlyrelated to being treated differently by other

family members, friends, and co-workers.

Understand that you are probably acting and

treating the injured person differently too.

Perhaps you are treating your husband more

like a child. Maybe you are treating your

injured child like he is several years younger.


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Perhaps you arent noticing the good thingsthey do. Try to avoid a natural tendency to

focus on the things you dont like. A focus on

the positive will improve the injured persons

motivation to change for the better, their self-

esteem, and the quality of your relationship.

Appreciate your ability to have a positive

influence.


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Learning to Like and Live

With a Stranger

Recognize the possibility of changing for thebetter as many survivors do. Many develop

wisdom from their experience. Many developan appreciation for the little things in life,

that many people take for granted.

Try to do some of the things you used toenjoy together. Taking a walk, seeing amovie, or visiting mutual friends can bring

back good memories and good feelings.


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The Change Recognition

Questionnaire

1. What changes have you noticed in the waythe injured person treats you?

2. What changes in the injured person aremost upsetting?

3. What can you do to encourage the injuredperson to change for the better?

4. What familiar qualities do you still see inthe injured person?


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Questionnaire

5. Are there new qualities that you canappreciate?

6. How are you treating the injuredperson differently?

7. How are other family memberstreating the injured person differently?


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Questionnaire

8. How are friends, neighbors, andcolleagues treating the injured persondifferently?

9. What things that you used to dotogether can you still enjoy?

10. What new activities can you enjoytogether?


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Most of all, try to be patient. The injuryrelated changes that occurred were sudden,

but getting better is a long-term process.

Over time your family member will seem

more familiar, understandable, and

predictable.


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Department of Physical Medicine and Rehabilitation

VCU Box 980542, Richmond, VA 23298-0542

Ph. 804 828-9055

Virginia Commonwealth UniversityMedical Center

Jeffrey S. Kreutzer, Ph.D., ABPP

[email protected]

www.nrc.pmr.vcu.edu

PCBIC 2010 Dr. Jeffrey Kreutzer: Recovering Relationships

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