Mood and Neurobehavior Issues with Brain Injury

Stories of Mood and Neaurobehavior Issues after Brain Injury

The following are stories of real life survivors of brain injury.  Clicking on the titles will take you to their actual story.

Chris’s persisting Deficits

Many of Chris’s ongoing deficits are the classical cognitive issues one would expect to find after a TBI memory, language, speed of information processing. Others are classic frontal lobe problems, such as the executive functioning problems that made it so hard to get to work on time. Emotions and mood are big ongoing problems. Chris’s Mom explains the mood swings;”It’s a roller coaster. There’s times where she can be happy and then there’s times where, “Why me?” And then  there’s times where, you know, she’ll just not care about anything. It can just be how she wakes up, you know. It can be anything.”

Chris – Clearview Key For Recovery From Coma

Before the transfer to Clearview, she had been at the combative stage, aware but unable to speak. Chris’s Mom continued to visit every weekend and has nothing but good to say about her time in Clearview. It is while she is in Clearview that Chris’s memory begins to return. She remembers the transition from a wheelchair, to a walker, to a cane.

Chris – Returns Home, Not a Simple Reunion

Chris and her mother talk about the 10-month transition from a nursing home to her family home after recovering from a coma. Concerns for Chris focus on difficulties such as managing stairs and friends whose names are hard to remember. Chris’s mom discusses the behavioral challenges related to weekend visits-having to set limits with a physically strong adult who refuses to return to the nursing home after the visit ends. From her mom’s perspective, the two key ingredients to making this transition successful were involving the entire family in the process, as well as having an understanding employer.

Chris – Persisting Deficits Include Executive Functioning

Chris’s Mom talks about problems Chris continues to have: difficulty with motivation, planning, reasoning & making decisions, impulsiveness, roller coaster moods and emotions, self-centered behavior (i.e.,tendency to understand and see the world only from her perspective), difficulty inhibiting her emotions, and poor insight. These problems are typical of frontal lobe injury.

Craig – Only Vague Memories of Going Home After Severe TBI

“I’ve never been an aggressive person, so I never physically was abusive. I was kind of verbally abusive to her at that time. Kind of just things would come out, just, you know. It’s just like I would be sitting there thinking I can’t believe I just said that and they just flew out and nobody had any answers for that.”

Craig – Marital Help Fell Thru Cracks After TBI

It sounds like there was a lot of anger going on back and forth.: “Yeah, I mean. She obviously thought I’m doing this purposely insulting her. I never really insulted her in the past, but just one thing after another. You know, it would escalate. We didn’t have any systems in the place to stop (that kind of interaction.)”

Craig – Legislative Change Thru Traumatic Brain Injury Leaders

“So our movement is just so that people understand that it’s a real disability and it’s probably one of the most sinister disabilities. I’ve worked with a lot of disabilities and this one’s sinister in the fact that you can be normal one day and not so normal the next day, depending on where you are in your injury. See when I’m not normal, then actually I know to stay home. I’ve learned that, that’s the thing, I have to, because I don’t want to destroy bridges that you’ve worked really hard to do. So, I actually have a scheduled day every week that is a down day in case I need it, just in between my workweek.”

Craig – Traumatic Brain Injury Support of Relationships

Violence nobody should have to go through. I don’t believe in any violence and I know that violent people become more violent and I was never a violent person. The only person I wanted to hurt was myself because I didn’t want to be here but I know people that almost killed their spouses. You don’t want that. So, at that point they, if you’re that violent you need to go into an intensive rehabilitation until..

DJ – Mood Issues After Severe Brain Injury

Let’s talk about your mood. Is irritability one of your most significant problems?: “It was during my time in rehabilitation. It just got to be so frustrating that people kept asking me what’s different or what does that matter. I mean, come on. I just could not believe how people were acting during my rehabilitation. And I did yell at some people and I swore at some people and I never did that to strangers before I got hurt.” One of the greatest injustices that befall brain injury survivors is the disturbance in an already fragile mood because of wrongly motivated attempts to deny them benefits to which they are entitled. Insurance defense doctors love to claim that mood problems are all associated with “litigation neurosis”, that the survivor has created a fixation on his or her injuries that is magnifying the problem. The treatment plan for this neurosis? Boldly tell the injured person they are not injured and cognitive function will be restored.”

Elizabeth Part Nine – Mood and Social Challenges

On the question of her mood and social problems, her husband had this to say: “She’s not the same woman I married. She gets frustrated real easy. She doesn’t understand a lot of basic everyday things that people take for granted, you know, just how to cook a meal or to follow instructions. She’ll have to look at it continuously instead of just reading and doing it, and helping her control her emotions. Basically she gets, like I said, frustrated. It’s just, she didn’t ask for this accident to happen, nobody does, but I think she tries to do the best that she can but she still needs, you know, support to, to help her through just the basic things in life.”She agrees with his assessment of her mood issues; “If somebody said something I could take it the wrong way and not understand it the right way, and so for no reason I’d snap. I guess snap’s a good word. Kind of yell, scared, afraid, so I’d kind of take everything out that way.” She continues to explain; “Most of the time it (has helped) and the only thing I’m snapping with lately – I’m hoping I’m right but I could be wrong – at least hopefully we’ll find out soon and then hopefully I can try to turn things back in the right direction again  is stress, nerves, fear.

Gina – Early Return Home Created Difficulties

The result, a severely damaged, if not destroyed personal relationship. Fortunately, the risk of violence in such setting is not as severe with women as men. Men often end up jailed or divorced from predictable neurobehavioral outbursts, especially directed against their wives. But even without violent outcomes, the radical shift in interpersonal power and responsibility can create hard feelings on both sides of any relationship, as it did with Gina and her mother.

Gina  – Mood and Emotional Problems

When asked about her emotions Gina states; “I think the biggest problem I have is I’m flat. I guess I don’t have, I don’t feel like I have emotions either way. I rarely feel completely happy about everything or feel like joy or anything at all. I’m just flat one way or another and I don’t show emotions.” When asked Are you depressed?; “I am, I have been right along. I know I have but I also have issues with my insurance company and I find that it’s, I probably don’t, I don’t like, they have tried me on several different anti-depressant drugs and it seems like when I go on that, I’m on other drugs to keep the headaches away basically. I got thyroid problems now because of that. I’ve got a lot of other things that it seems like then when the anti-depressants are added into the whole mix, it screws up other stuff so it’s kind of like I’ve played like what’s the lesser of two evils? So I deal with the depression. It’s not the depression so deep that I’m suicidal. I don’t feel any true joy or happiness or I’m flat. I just feel like emotionally I’m flat. There’s just nothing either way.” Gina’s husband sees the depression as well. He states; “She has gone through periods of depression. She struggles with it and she’s a very  independent person so it’s hard for me to intervene with that a lot but she does have a lot of struggles that she does share, she keeps bottled up. (Before) she would share her feelings and what was going on and if she was having a bad day or whatnot. Now she tries to sugar coat a lot of the problems that she is having.

Kelly – Return Home After TBI Complicated by Hormonal Problems

“I was just starting it so my, my hormones I say were off kilter just a little bit. Well of course that makes a person kind of moody. And I’m not going to say the acronym that a lot of people attribute that to so, but anyway I was accused of being that all the time. And I wasn’t.”
Mood issues after brain injury are multi-factorial and complex. Emotional changes are far more complex than just being “depressed.” While sadness related to the losses that come from a TBI are to be expected – as Kelly’s mourning of the loss of the use of her hand – the emotional picture isn’t as much about tears as it is the inability to feel in the normal way. The degree to which hormones play apart is still being researched, but energy, fatigue and organic changes to the part of the brain that feels and balances emotions no doubt play a part as well. I have long written about the role that fatigue plays in depression after brain injury and the complex interrelationship of all of these issues:

Kelly – Natural Hormone Replacement Stabilized TBI Moods

So you are on an antidepressant?: “Yes.” What would you say is the reason that you are taking one?: “Mood, mood depression or mood enhancement.” Well, the first antidepressant they had me on, and again, I alluded that I thought it was also interacting with my hormones, and it literally had me bouncing off the walls. Not literally, but mentally, not physically, but mentally I felt like I was jumping up one side of the wall, down the other and landing on my head on the floor. And that antidepressant was just not working on the sane ends, but it just wasn’t working. So I went back to my doctor and I said, I cannot deal with these mood swings. So let’s try something.” So they put me on a different antidepressant which instead of bouncing off the walls, I was doing cartwheels up and down the walls, you know. I was fluctuating even greater. And I says,  Listen, I cannot take these fluctuations in mood. Just get me off of these things.” So, I asked my doctor about this particular antidepressant and he says, “Well, it’s a pretty good one. Let’s try it.- So, I’ve been on, I’m taking that one now.” How long has that been for?: “Three years.” And that has stabilized your mood?: “I do believe so. I still don’t like

Lethan – Neurobehavioral Extremes

Probably the scariest things for a family after severe TBI, are the wild mood swings and temper outbursts. While a teenager returning home to his parents is not nearly as dangerous a situation as when a man returns home to his wife, the nature and extent of these outburst are rarely appreciated before discharge. It is something that if you haven’t lived through, you will probably not understand. Lethan touches on those issues in the voice of his sister. Lethan first sets the stage: “And I witnessed the difficulties with the return, the inconsistency of moods. I remember getting into fights with him, being afraid that I was going to be hit, the hand would raise, pause, and I witnessed the struggle between rage and reason on his face.”

Lori – Returning To Parent’s Home After Severe Brain Injury

Do you remember anger at being treated like you were, as our lead guy Lethan (from Who I am Again?) says, “I’m not Four.”
Do you remember anger at being treated like you were 4?: “Yeah.” Tell me about that.: “I’m not so sure that I know. I let some anger out but a lot of it was inside, my thoughts. And I remember, I, I remember wanting people to talk to me like I was an adult. I remember anger. I don’t remember specific anger in that instance, but I do remember that I wanted to be, maybe, I was more angry at myself because I wanted to be that adult that I was, more than I was angry at my family and my friends.”

Lori – Relearning How To Learn After TBI

Do you feel that your emotions are changing again?: “I cry a lot easier. A lot easier. Um, basically it’s the, the tearfulness and crying.” Now, do you think there’s a, a menopausal explanation for that, or does menopause seem to be hitting you harder than other women your age?: “I really think it’s hitting me harder than other women my own age. I’ve spoken online and then I’ve talked to and, I would just love to have the time and the strength and the patience to research this because I think that’s huge. And I’m, I’m sure, yeah, that the whole menopausal thing is more huge because of the brain injury that I went through.”
Do you feel that your emotions are changing again?: “I cry a lot easier. A lot easier. Um, basically it’s the, the tearfulness and crying.” Now, do you think there’s a, a menopausal explanation for that, or does menopause seem to be hitting you harder than other women your age?: “I really think it’s hitting me harder than other women my own age. I’ve spoken online and then I’ve talked to and, I would just love to have the time and the strength and the patience to research this because I think that’s huge. And I’m, I’m sure, yeah, that the whole menopausal thing is more huge because of the brain injury that I went through.”
In this book, my memoirs of recuperation from the car accident. I am sure you will find a new compassion for the pain, confusion, anger and hatefulness I went through. When I finally learned how the normal world lived, I began to appreciate any abilities I had that even resembled normal.
Talk to me a bit more about what your parents did in terms of that first year after you got out of there, of the nursing home in terms of helping you.: “The first thing they did, and that was right away, when I would blow up they would just get away. And usually when I blew up I was, I don’t know I blew up over everything. I had a hard time with anger issues. I still have a little problem now but not as bad. Like if I was upstairs in my room, which I spent a lot of time in, and I blew up for some reason and we didn’t know what it was my parents could hear me cursing, stomping. I had a few things I’ve just, like I had a filing cabinet, now it’s not there because I beat it up so much because of my anger issues, I couldn’t deal with it.
That actually the only one that could deal with me, and he’s my best friend during it all was my dog, Little Bit.”
Do you have any specific recollections of what would make you mad and things that would upset you?: “I remember two things; one I said about the filing cabinet, I beat up and there was nothing left. The other one, I’m sad to say, my sister came home and I couldn’t, actually I was down from Oshkosh if I remember right. And I couldn’t take kidding. I didn’t know how to understand it, and I flattened my sister a few times and finally my dad came home and I just left, I went back to Oshkosh because it was my comfort zone.” Did you hurt her?: “I hit her on the back, and I don’t think so but she had a hard time with it because at the time her boyfriend was being abusive to her and I didn’t know.”
Would frustration be one of the things that would set off your temper?: “Yes. Actually it can still set my temper off.” Describe for me a frustration event that, that will set you off.: “Actually the best one is when I’m with the kids and they’re all talking to me at once. And I try to get them to, you know, try to get them to do something really simple and they won’t listen to me. I start to get frustrated. Or another big one is I have this thing about people bothering my stuff. I just tell them just to pick it up and move it out of the way. Well the kids don’t understand that and they’ll usually just knock it over or kick it out of the way; that gets me frustrated because you know I have a hard time sometimes understanding they’re still just kids.”
“Think of the worst dyslexic, and he has a Ph.D., talk about, because being dyslexic you also have anger issues to some degree.” From the frustration?: “From the frustration. He definitely had cognitive and understanding problems. He had a hard time having other people understand what he was trying to get across and so when, when it was just me and him working and him going at his regular pace and me going at my regular pace we did very well.”
So let’s focus specifically on mood. We talked about mood some before. Do you have a formal diagnosis of bipolar disorder? : “I have – TBI, bipolar, schizophrenic. I’m dyslexic, they believe I’m ADD from when I was youth to where I was an adult. I don’t know, I just, anybody who asks me it’s just TBI usually.” Now you said that you also have a schizophrenic diagnosis?: “Yes.” Is that something that’s confirmed or just something some doctor came up with who didn’t understand everything else that’s going on?: “I’m not real sure. All I know is, when I start getting frustrated, and if I feel like people are putting too much pressure. You can ask the kids, I’ve gotten to the point a few times, to where I just get so angry, I hear, I start hearing audible stuff.” So your, episodes, if they’re schizophrenic, come at a time when you’re having, neurobehavioral problems, that we normally associate with TBI.: “Yes. I’ve quit three jobs because of it.”
What problems did you have in that job?: “Well in that job, let’s see, you have to go back to that time. I was taking 19 meds a day, and those were all psychotropic meds. They were all inflicting my judgment and understanding, to where working at that group home I ended up getting a misdemeanor against me because I got in a fight with one of the clients.”
Is that the only incidence you’ve had of violence since you got hurt?: “When I first got hurt and I first got back home after I had left E Town, because that’s where I did all my rehab, I basically stayed in my room upstairs from my parents. I beat up every piece of furniture I had because I couldn’t handle the urges or everything was making me upset and I think last time we were talking about my dog, Little Bit. Well, he was the only one that would comfort me and my parents wouldn’t deal with me. They just wanted to wait and see what happened afterwards. But Little Bit would finally get me calmed down and it took about, that’s when I was on, they put me on a large dose of Tegretol and it worked.” Another significant problem I have with the psychiatric view of brain injury is that they don’t come to the defense of brain injured persons with neurobehavior problems that border on criminal conduct, as they should. While the definition of criminal intent is as flawed as the psychiatrist’s definition of Post Concussion Syndrome, prosecutors and judges are far more sympathetic, when the difficulty of controlling mood after brain injury is explained to them. The proper intervention would likely have kept Michael with his TBI violence from a criminal conviction, especially considering the behavior issues of the individual with who he had the conflict. For more on my perspective on brain injury, TBI violence and the criminal law,

Let’s specifically talk about the kind of things that triggers your temper or what we might call a neurobehavioral problem at work.: “The biggest one is I have to figure out things for myself. You can’t just give me a piece of paper and say: “Okay, here’s how you do it. It tells you specifically what you’re supposed to do.” I have to (figure out my own way to do it.)” What job was that?: “There was a big grocery, I think it’s Meijer’s in Kentucky. I was learning on the cash registers and I was always having problems because I couldn’t connect the dots of when something would come up right or a wrong price. And they were trying to show me how to do it and I just got so frustrated because they weren’t patient enough with me and then my mouth kicked off again.”

Why do you think they didn’t bring you on full time?: “I don’t think it was because of other candidates. I was selling the
stuff but I have, I call it the bipolar issue to where I can be very helpful with customers or I could be very aloof to them.
And I think that’s what they kind of focused more on was my aloofness.”

One of the things that is obvious from what you told us already that you did have trouble with is the ability to work closely
with other people, controlling your emotions, control your behavior when you’re around other people.: “Yes. It’s a huge issue.” Give me some examples.: “I can give you some examples right here. When me and my wife would get into an argument, there are times when I will, I should know just to stop, walk away, think about the issue, then come back. But I will start accelerating it to where she will start crying and I will start yelling. And then finally I’ll think, oh, I better back away. I come back and apologize to her. But she’s starting to, like I said earlier, starting to understand that you can just say Mike, go take a break.”

Do have trouble with the touchscreen?: “I get aggravated with it.” Your fingers are too big?: “No, it is just like pushing a button and I get aggravated using it.” Frustration sets off your mood, your anger?: ‘Oh yes.” Is that the biggest cause of your anger?: “I would say so because when I get upset with the kids, it’s not me getting upset with them, it’s me getting upset with them not thinking about what’s going to happen when they do things.”

Is that a stimulant?: “If you are TBI, Effexor is great for depression because when you are TBI, you have both forms of depression. The one you see on television, the mental depression ” I also have the physical depression and that helps it because I never know when the physical is going to come or go. And then for my manic stages, that inter-working with my Lamictal is supposed to help. It depends. And then I take, Seroquel at night to help me sleep and to help with my schizophrenic problems.”Do you always take the Seroquel?: “Oh, I have to Becky has had problems if I don’t and she makes sure I take it. “When you get in one of those periods where you are up for three days, do you find that you are getting some psychosis and you are really starting to come apart at the seams?: “No. I guess the best way to explain that is it’s like when I explained it to the last psychiatrist I had. It’s like I can feel the blood pumping through my veins and it just gets worse. I don’t get any psychosis like I’m hearing things or seeing things. It’s just I become, like sensory overload.”

an you give me a feel for her temper issues?: “She’s never, she’s never violent, uh, like acting out towards someone. But,in situations where, uh, she is, uh, mad, she just gets angry so quick. It’s, it’s not a, an, a graceful escalation of anger. It’s up there. So, , whether it’s me or my husband, but if it’s anybody else, or the son, it’s anybody outside the family she’s different. School she acts totally different but when she gets home she just lets everything fly. She used to have, , I’m sorry I’m kind of digressing here, but, she has stressors during her, the day that happen. People that annoy her, things that happen, things that bother her, and then all of the sudden when it’s just about bedtime or there’s a situation at home that causes a flare, then all the stuff comes out about the day at school. And it’s already built up in her but she just didn’t know how to release it earlier, or maybe discuss it with an individual on a level. And then she just blows up. To hear us, maybe quarrel or raise our voices or she gets, like I say her emotions are over the top. They are always like that far above what everybody else’s would be. And so, just understanding that other people around her don’t necessarily understand what she’s going through including even her own brother.
So what was, what was wrong?: “He had a fractured skull. He had numerous contusions on the brain, numerous areas of bleeding in the brain. He was in and out of consciousness. Again, when he was awake, he was combative . “
You speak now with great appreciation, as you should, but what hurdles has your relationship had to overcome, those first months of coming home challenges and frustrations that you went through, and describe the ones like where you were sitting at the computer and she was trying to help you and you were upset, what was that like? I mean what, what difficulties did you have?: “I’ve had a few violent outbursts. I’ve never hurt her, I’ve never hurt myself, but where I just want to destroy anything in front of me; the computer, the chair through the, I just get so frustrated, and I think I’m medicated now well enough that, you know, I haven’t had those issues lately, but I’ve had that roller coaster ride of okay, I haven’t had violent or, violent feelings or violent outbursts that, I’ve been okay, I haven’t scared her, I haven’t scared anyone around me for several months, so.”
Quinn’s wife talks about the struggles with his moods: “It was stressful. His moods were very off. He had mood swings; anger issues, depression, anxiety issues. Obviously, the regular cognitive issues. The physical issues were a bit less, other than, he had headaches and dizziness, but he did go immediately start outpatient physical therapy, which helped tremendously. He was able to at least walk around the house. At first he would bump into, or hold onto the walls. Within a month or so, he was able to walk around pretty freely.” What is it like then, what’s changed?: “They had finally felt it was safe to put him on an antidepressant, anti-anxiety medication, which made a big difference. He had been on a similar-type of medicine previously, before the accident, and he had had to be off of something like that, because it can increase the likelihood of seizures. So, we were able to put him back on that, after he hadn’t had any seizures in about three months. And that, I think, gave him a much better sense of, of peace; less anxiety, less depression; a lot more stable mood. So, we were able to deal with the issues, communicate and work together much more.”
How would you describe the change in his behavior, now versus what it was two years ago?: “He’s much more emotional about
things. It’s, it’s significantly improved, when he’s on the right mixes of medications, which have been changing all the time. But, he definitely, he’s more emotional, as far as general moods go.” What are the small things that set him off?: “I, unfortunately, haven’t figured out what are those things that set him off. I will say something to him, ask him has he done X, Y and Z today, and he’ll say he did X. He didn’t do Y and Z. And I’ll say, why not? I had asked you to do X, Y and Z yesterday, and reminded you this morning? Why haven’t you done it? And sometimes he’ll answer, because of this or that; and other times he’ll yell at me, why am I nagging him? Why am I giving him a hard time, just because he didn’t do it, even though all I was trying to find out was why it hadn’t been done.”
What types of outbursts of anger occur?: “Well, starting in the hospital, when his head was hurting, he would yell at anybody that came in to, you know, be quiet; keep the lights off. He needed quiet and dark the whole time. He yelled at me one time, when I tried to open the shade to get a little bit of natural light into the room. And then once we came home, it was lots of different things. Anger was a definite issue, at the beginning; especially before he was on any medication. And he, the only time I really remember, well there were a few times that he had a physical outburst, as far as in throwing things around. He was never a violent person, before. He would never throw things around, and as much as anybody gets an urge to do so, he was always able to control those urges, previous to the accident. Now, if he has the urge, he threw a chair around the room, and he threw a phone that he ended up breaking. At one point, threw pillows onto a glass table and tipped over the glass table, which luckily didn’t break; but he later realized that that was not a good idea.” Brain injury is thought about too much as simply a cognitive or frontal lobe challenge, yet the two most common denominators across all levels of TBI
Does she have any movement on her left side?: “She has a little bit, a little bit. We see it coming back, little by little. I mean this arm is like when she gets, I’ve said she didn’t have too much emotional but she does get mad, okay. And, uh, this arm will start moving when she gets really mad. That just started happening like maybe a month ago.”
Steven’s advocate tells of his mood issues while in school: “And then there were just the issues of school. Steven was suffering with anger issues, sometimes with other students, sometimes getting abrasive with his instructor, you know, smarting off, talking back when he shouldn’t have. Ah, Steven’s a smart guy and this thing about him being turned down because he’s too smart, I actually heard a voc rehab counselor say: “You’re not a stupid person so they don’t feel like they need to help you.
You’ve given us a number of, of examples of things that will increase your anxiety. Can you talk to us about the anxiety you feel, what triggers it and how you adapt to it and what you can’t do because of it?: “That’s something I still work on right now is trying to figure out how to get past it. I really don’t know. There’s a traumatic brain injury support group I became a part of on Facebook of all things. There’s this lady in Canada that I’ve gotten real close with that I think it’s like four years removed from hers they get a little bit better medical care. She’s got me taking MB12 stuff, it’s like Methylcobalamin I think.” Over the counter?: “Yes sir. And you get it like any health food store. It’s like something about when I get overwhelmed or like the triggers there’s a glutamate over, that like flood in your brain or something and that helps slow it down to where it’s not as bad. It doesn’t completely get rid of your triggers or how you react to them. They
won’t be as intense maybe and I’ll take usually that on the onset of something and then there. A lot of times the best thing I can do is just completely pull myself away from whatever situation is.”
What about accommodating the mood issues, the anger issues, the frustration?: “They generally came, the mood issues, you could pretty much tell when he came into school in the morning. Some of the anger issues they were usually triggered. He would just have disagreements with other students. Sometimes Steven would say things he shouldn’t so I’d take exception.”
Michelle, TJ’s stepmother, explains that they did not understand what they were going to have to deal with: “When they kept saying it’s going to be a long road. What do you mean a long road? I remember months later when we were at Spaulding and they said Michelle, you know, you’re going to outbursts. That’s probably going to be an issue that you’re going to have to (deal with.) I had no idea what that meant and he was beyond loving Tony and I, my husband and myself. We would walk in and hugs and kisses and I mean, he couldn’t wait. He’d be standing at the door waiting for us to come to Spaulding and what a nightmare we had that followed. TJ has very bad outbursts, so.”
What behavior problems was having he then?: “Then? Oh, he was chasing the nurses with like, what, what we consider chasing which is a joke, but he was trying to hit them with the washcloth and screaming at them. He did have a cane which they took away. That’s why he had no walker. TJ went from a wheelchair to just walking because every time they gave him an instrument to assist him, he would go after somebody with it.” And you had said they gave a little bit of warning what it was going to be like when you got home? What did they tell you?: “What did they tell me; just they kept saying over and over be, beware of the outbursts and I kept looking, I had no idea what they were talking about, and I found out – very quickly.” What did you find out?: “I found that with just by saying good morning to TJ he could all of a sudden snap where he’s screaming in your face and you’re scared for your life, and he’s never actually hit me, but he’s been right there, you know, a breath away and it, it’s scary.”
Michelle, TJ’s step-mom, explained that screaming fits can be set off by something as innocuous as a good morning.  Michelle explains some of the things that set TJ off: “Yeah, oh he would have had a fit if you weren’t. He cannot, you don’t change. If you say you’re going to (do something, you better do it.) Just for instance: Red Lobster for
dinner and all of a sudden you decide, well, I’m really in the mood for Chili’s. That, you cannot do that in this household.”
One of the issues that can occur, particularly with survivors who have neurobehavioral outbursts, is getting in trouble with the police, even if such conduct does not involve any direct violation of criminal law. I asked Michelle:Has he had any brushes with the law?: “No. Well, I shouldn’t say no. What happened was, there was a, some break-ins in our community so they beefed up the law enforcement to come in. So here’s TJ on a bike and, and he has a license plate that says “I’d rather be yelling bingo” – but anyway, the police officer stopped him and they asked him some questions, you know, his name and where he lives. And TJ’s response back was, why do you want to know? Are you writing a book? And the police officer was like no, I have to be writing down, you know, TJ response back was, and he told them, look, you can’t even be talking to me without my parents. And then the next response was well, if you’re writing a book leave that chapter out. That was his response back. So do we shelter him? Yeah.”
Michelle talks a little about his moods: “Well, he’s, yeah, he’s very motivated in going to the gym. The problem with TJ is – one of the issues that I find – How am I going to explain this? Okay, we have moods, we have highs and lows, which he has dramatic high and low, okay? But he basically keeps on an even keel, so if you said to TJ, we’re going to Disneyworld tomorrow, any other person or, I mean, I’ll just use Disneyworld because we know we all get excited about going to Disneyworld. So he would get, somebody would get excited. TJ doesn’t get excited. It’s the same as if you just said we’re going to sit by the pool for an hour.” Michelle explains how she handles his outbursts: “The only thing I’ve done with TJ is what I call the vertical blind theory: When he starts outbursts, as much as I want to, I want to scream, I want to strangle him, I want to pull my hair out. It’s just, I mean, it’s like stop, stop, stop, and you want to yell that. I shut the blinds, he’s there, he’s still screaming, he’s still outbursting right in front of me, he’s safe, he’s there, I’m not going to let anything bad happen to him, but I cannot react back. And that is difficult.” TJ’s father offered: “It depends