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It s Not Always What You Say But The Way You Say It! For 20 years after my traumatic brain injury, I wouldn't have read a magazine about survivors, much less by survivors. There was a twenty year period of time when I was convinced that I was completely recovered and had no problems resultant from my six-week coma. I was positive that I had overcome TBI (Traumatic Brain Injury) and that it was a thing of the past. Denial was the biggest obstacle to my recovery. I could not see myself as I was. I seemed to be caught in a time warp. I had lost six to ten years of my life and I was stuck back in that time. This way of thinking is probably the main reason that it took me nearly 20 years, post trauma, before I was willing to admit that I had severe problems and needed intense treatment to become aware of my deficits and to accept the changes and limitations my TBI had placed on me. The physical problems were enough for me to deal with at first. I learned to walk the same way I learned the first time; the automatic reactions were still there. My body needed only to accomplish the movements again. I learned to compensate for my lack of balance with a cane because it was obvious that, without it, I would fall. I could not deny my problems with balance so I learned to use a cane as a compensation. However, when it came to speaking again, that was something different. After my TBI, the automatic reactions involved with speech became confused. Now it s not always apparent to me when my tone of voice is out of control. The pitch, tone and intensity of my voice can be an inaccurate representation of what I am meaning to express. The compensation I use as a way to avoid misunderstandings is not as obvious as the one I use to walk and, frankly, it s much harder to use than a cane. To be quite honest, it doesn't always work. Now that I am aware that how I sound can be very different from how I feel, I need to repeatedly assure the listener of what I am feeling. I have learned that I need to make sure my meanings are clear by checking to see that I m expressing my feelings clearly. It is hard to erase words that sound angry even if the anger was not real and terms of endearment sound like sarcasm when spoken too harshly. I will never forget something that happened in family therapy when my son was fourteen years old. Dr. Rick asked him why he felt that I did not love him. In response, he shuffled his feet a for moment, wiped tears from his face and buried it in the bend of his arm as if to hide his tears. Then he said, Mama doesn't love me because she ALWAYS yells at me. I denied for 20 years that anything was wrong with me because I never knew how I came across. I seldom remember unless the event is extremely emotional or I am reminded by someone or something. Thus, I never realized that I needed to think about how I was coming across or that I might need to compensate for the way I do things. I just reacted without realizing the impact I was having on people, especially those close to me. I don't hear the tone of my voice nor do I realize the intensity of it. Often I hear sounds differently than they are meant. I seldom realize my voice is screaming until I m in the midst of an escalating confrontation; usually it s over nothing or maybe we re arguing for or against the same idea. The amount and type of cognitive (perception and memory) impairments or behavioral disturbances depend on the location and severity of the injury. However, even slight changes in the physical, chemical or the electrical state of the brain can lead to changes in the way my emotions are expressed. Even if I show no damage on the outside, I still can have neurochemical changes that are discharged in my hypothalamic area. This area of the brain controls the endocrine (gland) system and the autonomic (involuntary) nervous system; it produces the hormones and neurochemicals that cause my different body parts to spontaneously react to stress. After any type of brain injury, the control that comes from the frontal/limbic connections can be weakened. The limbic system can then fire its messages of emotion and, with the connections weakened, behavior becomes unpredictable. Emotional distress can occur out of nowhere and it can have no obvious relationship to situations in the present. Examples of this would be anxiety/panic attacks; the flip side could be a deficiency in emotional response. I never have a quiet conversation about how or what I feel. If I speak about anything that I am upset about or passionately involved with, I can lose control of my automatic reactions. Conversations tend to end in frustration when I can't express my feelings without rage, crying or screeching sounds coming from my mouth. Then, because nobody wants to upset me or see me out of control, nothing is said about it. I might not remember for months unless my memory is refreshed, so I guess that s called a catch 22. For me, this catch 22 is the loss of short-term memory combined with the loss of control over my vocal intonation. It is labeled emotional or affective lability. What I can tell you about emotional lability is ... it s a real disaster in most of my long term relationships. My children are now aware of my limitations because they were part of my rehabilitation program and I m proud to say that the program was successful repairing our relationships. I m sure the intense family therapy sessions we experienced helped us to become aware of each other s feelings as well as my limitations and, finally, enabled us to search for ways to overcome these problems. Now, my children will ask me if I mean to yell. It emphasizes my point when I reply YES .. I m mad but they don't get their feelings hurt if I m not. I have found that it s necessary for me to explain that I have experienced some personality changes as part of an organic or structural change in my brain and these changes can lead to inaccurate assumptions. Making the people with whom I have an ongoing relationship aware of my problems with the tone of my voice, my short term memory and the expression of my feelings enables me to come away from those conversations with much clearer understandings. I haven't quite decided if the reason for this is that I am now aware of my shortcomings and, thus, I try harder to be understood or if the listener is aware and tries harder. Regardless of the reason, it works. The best part of relating to people that I have communication problems is that it balances the levels of responsibility for understanding the situation. |
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