Flat Mood After Severe Brain Injury Uncharacteristic

Flat Mood After Severe Brain Injury: Kelly Part Fourteen

In part Thirteen, Kelly attributed her flat mood after severe brain injury issues to age related hormonal changes.  Yet, her mood issues such as her flat mood after TBI is shared much with what many survivors of brain injury experience.

Brain injury comes with significant disruptions in mood, um, you don’t attribute the mood problems such as your flat mood after severe brain injury ?

No sir.

Strictly to the hormonal changes?

Yes.

Why do you attribute your flat mood after severe brain injury to hormonal changes? 

Because 1) I have never been one to do drugs, like drugs or any, anything that has to do with a body or mind change.  As soon as I came back to Nashville, the very first person I met of the medical field besides the nurse and the intake people, was the neurologist that, that my primary care physician had referred us to, to be my neurologist on site.  And the first thing he did was he prescribed me with a antidepressant.

I asked him and I remember asking him point blank, why do I need an antidepressant?  He said you’ve undergone a very traumatic incident and it’s very likely to be depressing when you realize that you will not be able to do some of the things that you did before.  Well this antidepressant he put me on I think affected those already changing hormones within by physiological system.  They just fluctuated.  Of course the brain injury to me enhanced everything.  It didn’t cut it back.  It enhanced it.  So if I was one way before the injury, now take, make it twofold and that’s the way I am now.

Describe yourself emotionally before the injury. 

Excitable, independent, hard charger, on the go always, basically I’m a semi Type A personality.

Describe yourself emotionally after the injury. 

Immediately after the injury I was calm, collected.  I had reverted back to a, I’d say a B-C personality.

You had more of a flat mood after severe brain injury? 

Yes, in the early stages after injury it was very monotone.  My speech was monotone.  I had a flat effect (flat mood after severe brain injury).

Did your flat mood after severe brain injury begin to change? 

Yes it did.

Tell me about going the flat mood after severe brain injury to back to where you are today. 

Well some of that was introduced to me in the speech therapy portion of the  therapy.  She would give me words and to inflect and different situations where I would role model or we would role play.  And I would have to be either the good guy, the bad guy, the good cop, bad cop, something like that, whatever role we were playing.  But it was usually in the field that I had experience in sales.  I was a salesperson.  She was a buyer.  And I of course I would try to close the deal.

And as a sales person before you got hurt you would have to be outgoing. 

Yes.

What does it take in terms of personality to be successful in sales? 

You have to be persistent.  You have be an outgoing persistent person.

What does that mean to you? 

Well outgoing is “you don’t meet a stranger.”  So you got to be, you shake your hand, you introduce yourself and you find out, or you ask them questions that pertain them and/or their business.  Do you see yourself as promoting your business other, any other way besides direct communication?  And they just kind of take it back.  You can’t ask close-ended questions in a, salesperson, you have to ask open-ended questions so that they can give you some feedback so that you’ll know to address that, where you want to lead that sale.

How long have you been doing sales before you, at the radio station in Austin before you got hurt, or in Texas? 

Since August of ’96.

So is that about a year? 

Yes.

After you’ve got hurt, because of you your flat mood after severe brain injury where were you in terms of being able to be outgoing? 

I don’t really think that changed because even coming back and meeting that neurologist and my questioning him, to me that took some outgoing personality to question his choice of give, giving me an antidepressant.

Mood issues such as flat mood after severe 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: See http://subtlebraininjury.com/emotional.php and the pages linked therefrom. In our next part, we will discuss with Kelly the impact that attentional problems had on her recovery.

Next in Part Fifteen – Attentional Over Load Brings Out Behavioral Challenges

By Attorney Gordon Johnson

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