Understanding the emotional impact of brain injury

In the wake of a brain injury, emotional changes are common. About 31% of stroke survivors, and about 50% of people recovering from a moderate to severe TBI experience episodes of depression. Rates are even higher for people with post-stroke aphasia at about 68%. These emotional changes can be a result of physical brain damage caused by the injury, or can be related to the life-changing impact that these injuries often have on the survivor and their loved ones.

It’s important to note that everyone is different, and emotional experiences after brain injury may vary in severity. The intent of this article is to normalize the emotional side effects of brain injury, and bring awareness to this aspect of the recovery journey. Hopefully, when the emotional waves present themselves, you or your loved one will feel better equipped to face them.  

How brain injury can cause emotional difficulties 

Physical damage to the brain can result from a traumatic injury like from blunt force to the head, or an acquired injury like a stroke. These kinds of injuries cause physical damage to the brain tissue, which affects a wide range of functions, namely speech, language and cognitive skills, but emotional challenges can arise as well. 

Location of physical damage

• Depending on the region of the brain that is affected, emotional functions can be impacted. For example, when there is damage to the frontal lobe (the front part of your brain), personality and emotional changes can occur. As a brain injury survivor, you may experience mood-swings, or have a difficult time regulating your emotional responses to your environment (think being pushed to tears more easily). This dysregulation and lack of emotional control can often feel alarming, and can trigger feelings of frustration, overwhelm, or even anxiety. 

Impact on daily functions

• Similarly, when an injury impacts a survivor’s daily function and activities, it can trigger a cascade of heavy emotions. For people with Broca’s aphasia, the conscious effort it takes to get the right word out can be incredibly frustrating. For brain injury survivors, sensory overload from things like lights, background noise, or lots of movement can easily occur. In both these examples, a heightened stress response is typical. A recovering brain is hypersensitive to strain or overwhelm. So be gentle. Try to relate to these emotional reactions as signals to take a break.

There can be profound feelings of fear and helplessness at the beginning of rehabilitation. These feelings are normal and fully warranted. 

Survivors can also experience “incomplete mourning” 

Survivors can often feel, especially in the beginning stages of recovery, that they are no longer themselves. The contrast of pre and post-injury life can bring up feelings of loss. In embracing a new reality post-injury, a grieving process may be necessary. A difficult aspect of recovery is the feeling of what’s called “incomplete mourning”, where some aspects of  a survivor’s life are very much the same, and some things are completely different. The change and ambiguity is difficult to process, but this emotional reckoning is a common, even foundational, part of any rehabilitation journey. 

The end goal is acceptance 

The last step in any grief process is acceptance. Acceptance means no longer resisting the reality of the situation, and no longer trying to make it different. Sadness, uncertainty, fear — all these emotions can still be present, but in a state of acceptance, feelings of loss are more manageable. Acceptance might not come immediately, but it is a great emotional goal to aim for. 

Even with these changes it’s critical to remember that as a survivor, you are still you!

Though there are a lot of changes that come in the wake of a brain injury. A critical thing to remember is that pre and post injury, you are still you. Your recovery journey is a trajectory that will offer new challenges and triumphs. And though there will be moments where emotion runs high, remember, there is agency in this process! As a survivor, you get to choose what your new goals are, the kind of  life you want to lead, what kind of care you want to receive, and who your support system includes. You are still at the helm of your life.