General Mental Health
DEAR PAT:
Pat, my brother sustained a severe head injury and was treated out of state (not in his home state). After treatment, my brother returned to his home state and tried to resume a normal life. However, he has lost his job, experienced paranoia, depression and delusions. The response of health care professionals here has been to "lock him up" in the local hospital. We, his family, feel this is inappropriate. He is not at risk of harming himself or others, but he needs the right kind of help. We are wondering how to find resources in this state similar to those in the state where my brother was injured.
Almost every state has a Brain Injury Association which can refer you to brain injury rehabilitation specialists and programs, as well as other important resources for people with brain injury-related disabilities. To find out how to contact the Brain Injury Association in your state, contact the national affiliate, the Brain Injury Association, Inc., in Washington, D.C. at (202) 296-6443 or 1-800-444-6443.
DEAR PAT:
Suicide and suicidal ideation, as the professionals like to call it, are words that I read about but seldom hear verbally discussed. It is time to take the risk! I believe it would be a relief for a lot of people to know the reality and for a lot of therapists to no longer be afraid that the mere mention of suicide will trigger death. If it is done right, it will break the cycle for many.
Good point. Not talking about suicide will not make it go away. Pat encourages anyone who has suicidal thoughts to contact a counselor through the local mental health center. The phone number is in your telephone book in the city or county listings. There are people at your local mental health center who are trained to help you discuss your feelings, even suicidal thoughts. Until you have tried talking with a good counselor about your troubles, you have not given yourself a chance. Support groups can be a good source of encouragement, as well. Pat says: the world is a much better place with you in it.
DEAR PAT:
My brother had an accident in 1985 when he was run over by a camper type of pickup truck. As a result of this accident, when he was 18 years old, he has lost the use of his left eye, lost most of the use of his right hand, he has a "drop foot", and he tends to think that things happen which, in reality, do not. He seems to feel that he must always prove himself to everyone he comes in contact with, even stating that he tells the governor how to run the state and that the governor takes and uses his advise. He has also become an alcoholic and this amplifies his problems. He has been to several short and long-term programs for alcohol abuse, which seem to help for very short periods of time. He is not able to maintain a job, mostly because he has trouble dealing with people. Through the state welfare program he lives on his own, but this seems to be difficult for him at times because he does not interact with positive role models or peers. We have a large family, all of whom try to offer support and assistance, but he does not seek our help except when he "goes off the deep end". During these times he admits that he needs help, until he has had company for a while. If we offer help when he does not seek it, he becomes defensive and says that we are trying to run his life. Last night he called for help and when my sister, her ex-husband and I responded to his apartment, he was almost like a child who finally got the attention he craved. We talked and together we (he was included in the discussion) decided that he should go to the hospital to talk to a professional about his problems. However, when we got there, he refused to allow the counselor to help him. I realize that he is probably afraid to go to another program because he is not entirely sure that he wants to live the rest of his life without alcohol. He said that he would quit drinking on his own because he "knows that he has to". We finally convinced him to try one more time and he agreed to go to a four-day detox program (inpatient) which he will begin on Monday. My sister and I (along with the counselor) think that the alcohol abuse is secondary to his TBI, but we do not know of any local programs to consider. If you have any suggestions on how we can locate programs for someone with fourteen years of no help with a TBI or anything else we can do, we would be very grateful.
Well, you certainly have a complicated case! So you get an extra-long answer! Unfortunately substance abuse and traumatic brain injury often go together. This is usually because either the person was injured as a result of alcohol or drug use or because the person uses alcohol or drugs to cope with post-injury changes and stress. I believe you have chosen the correct place to start - which is the treatment of the substance abuse. Alcohol often exacerbates or masks other problems and without treatment for his alcohol use, any other mental health treatment (psychotherapy, drug therapies) will have little chance at success. The problem is that most alcohol treatment programs have very little experience working with persons with TBI. Issues related to the brain injury such as adjusting to a disability, behavior problems, memory problems or other neurologically based symptoms will probably not be adequately addressed.
Another concern that your letter brings up is the quality of your brother’s thinking. If he really believes that things happen that haven’t - like giving advice to the governor, this sounds like he may have some psychotic features such as delusional thinking. Even if he is just "telling tall tales" that he knows to be false, this will clearly be problematic in most social relationships. The problem sounds like it may go beyond just alcohol abuse.
In other words, your brother needs three major areas addressed: 1) The consequences of his TBI on his cognitive, emotional and behavioral skills 2) His alcohol abuse and 3) The possibility of a thought disorder or delusional thinking.
As I said, you have already made a good start by helping him to enroll in an alcohol treatment facility. The next step will be to find someone who can do a comprehensive evaluation of your brother and make treatment recommendations. I would suggest looking for a facility such as a university-affiliated hospital or psychiatric hospital that can provide neuropsychological testing, as well as a psychiatric evaluation. Neuropsychological testing can help to evaluate your brother’s cognitive and emotional skills. The psychiatric evaluation is to determine if your brother would benefit from medication. If you can find a facility that can do both, this would be best since both treatment providers would be in the same place and likely would be able to work together. If you can’t find such a place, try to identify a neuropsychologist and psychiatrist and obtain independent evaluations from each. I believe that it is important in complex cases to have a comprehensive evaluation that can be used to guide treatment and provide understanding and recommendations to the patient as well as family members.
Finally, dealing with a family member who has serious mental health or substance abuse problems (or both) is very hard on the family. It affects the quality of life of everyone involved. Many family members are torn between wanting to help their loved one and needing to manage their own busy lives. In addition, the person needing help may not always follow through with treatment and may seem unappreciative. It may be helpful for you to have a family meeting to discuss options for helping your brother. Because you’re dealing with a very complex set of issues, I believe you, your sister, and other family members may benefit from consultation with a psychologist or psychiatrist to develop a plan for dealing with your brother and working on how to respond to when he has a "crisis."
DEAR PAT:
My son of 16 1/2 months died of a traumatic head injury. His whole brain was swollen and the cause of death was subdural hematoma, cerebral edema, and blunt impact to the brain. I was not home with my child. My husband was home and is now in jail. I can not put my son's death to rest because I do not know how any of this happened. The prosecutors told me it was from slamming or shaking. My husband told me he fell out of the crib and later on fell off the couch. I don't know what to think. I miss my little boy and little boys of his age shouldn't have this happen to them, they are so pure. Is there any information you can give me that might ease my mind on what might have happened?
I'm sorry for your loss. Nothing is more tragic and heartbreaking than the death of a child. Unfortunately, I'm afraid I can't ease your mind very much. It is questionable that those types of injuries would occur from the minor falls your husband described. Even if he is telling the truth, one has to consider whether your son was being properly monitored by adults if he can sustain two serious falls within a short period of time. However, this may also be a case of child abuse or Shaken Baby Syndrome. The doctors that examined your child should be able to determine if his injuries are consistent with falling. Injuries from child abuse are usually quite different from those sustained "accidentally" and the medical evidence will probably hold the answer to your questions. Please see Pat Column #11 for more detail on Shaken Baby Syndrome (Click the "Archives" link at the bottom of this page).
DEAR PAT:
I was injured in an automobile accident almost 20 years ago. Way back then, little attention was paid to my head injury and the orthopedic surgeon was mostly interested in fixing my broken bones. About 10 years ago, I began noticing head-injury related symptoms as they became more annoying and painful with age. I’ve been to an ENT [Ear, Nose and Throat doctor] for tinnitus [ringing in ears] (she gave me sinus medication), a neurosurgeon for advice about tingling and crawling sensations in my left side (he said that removing cervical spine bone spurs would not solve the problem), an orthopedic surgeon for arthroscopy on my left knee (this helped a little, but my leg still hurts), a neuropsychologist (she has identified logical and reasoning issues that seem related to frontal lobe injury), and a psychologist (he thinks I have a personality disorder). In the last several months, I’ve seen a neurologist who thought I had MS [multiple sclerosis], but now that he has decided that I don’t have MS, he doesn’t know what’s wrong with me.
Taking matters into my own hands, I’ve gone back to the hospital that treated me after my accident to retrieve old records. After much back and forth, I was able to sweet-talk someone into finding the microfilm. I read through the records and discovered that I had an open wound in the frontal area and that x-rays showed a soft tissue injury in the parietal region. Could the parietal region injury be to blame for the pain in my left side, which includes inability to discriminate temperature and pressure, surface tingling and burning, zapping sensations that feel like weak electrical shocks especially in my foot and hand, maddening tinnitus and increasing weakness in my left arm and leg?
I doubt that 007 could have done much better retrieving the microfilm from your medical records! All joking aside, active participation in your medical care is vital for survivors of brain injury. Brain injuries generally result in complex problems requiring help from a number of professionals such as physiatrists (doctors of physical medicine and rehabilitation) and other “neuro” specialists (neurosurgeons, neuropsychiatrists, and neuropsychologists). As you have experienced first-hand, even medical professionals may have difficulty knowing exactly what is going wrong with an individual coming to them for help.
An important first-step is seeking out advice about symptoms and recovery from a treatment professional with expertise in helping people with brain injury. Your local chapter of the Brain Injury Association of America (Phone: 800-444-6443 or E-mail: familyhelpline@biausa.org) can provide you with a list of rehabilitation specialists in your area. Offering education, support, and referral services for individuals with brain injury and their family members are primary functions of Brain Injury Associations around the country.
People with brain injury sometimes feel strange sensations on their skin or notice other physical changes. Paresthesia is a term describing abnormal skin sensations such as burning, prickling, itching, or tingling usually felt in the hands, arms, legs, or feet with no apparent physical cause. Injury to the brain’s parietal lobe or sensory pathways may result in paresthesia. Other medical conditions such as MS, stroke, diabetes, and rheumatoid arthritis have also been known to cause paresthesia according to the National Institute of Neurological Disorders and Stroke (NINDS). For more information about neurological and medical conditions associated with paresthesia, you may contact NINDS directly (301-496-5924) or visit their web site (www.ninds.nih.gov).
The appropriate treatment for paresthesia depends on accurate diagnosis of the underlying medical cause. Doctors base their diagnosis on a number of factors like a patient’s complete medical history, physical examination, and laboratory tests. A comprehensive evaluation by a physician with experience treating persons with head injury may be beneficial. You may also benefit from speaking with other survivors of brain injury and their families about ways they have found relief from brain injury-related symptoms. The Brain Injury Association of American is an excellent source of information about support groups in your area. If you have internet access, their web site is www.biausa.org. You will also find links to local Brain Injury Association chapters through the site.