Marriage and Relationships after Traumatic Brain Injury

Long-term relationships and marriage are marked by challenges and even threats to the partnership. After all, there is a reason that “in sickness and in health…for better or for worse” has become part of the standard marital vow exchange.

Although some challenges arise from the world around us, such as a bad economy or a major disaster, some arise within the partnership or– more challenging yet – from an individual within the relationship.

Seemingly worse still, neurologic injuries like brain injury often occur spontaneously and without fault by any partner.

Although a relationship after traumatic brain injury faces new challenges. But these challenges are not insurmountable, and if navigated properly can even bring a relationship closer.

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Facing a unique challenge

It is worth highlighting that medical events and diagnoses are different from other threats to the relationship. Although we may not realize it on a conscious level, a brain injury can put a unique strain on a relationship given its locus of origin.

A lousy economy or major disaster arises from the world around us, exerting malignant pressure on a relationship from outside.

Though admittedly stressful, such externally arising events can have the effect of bringing a partner closer together.

In such situations, for supporting your partner, you must “circle the wagons” or “dig in” to endure a shared hardship that fate has imposed on them.

Like graphite turned into a diamond by heat and pressure, partners working together to overcome a challenge can emerge victoriously and be stronger for it.

Although medical events and diagnoses exert a similar strain, the locus of origination complicates things.

The world around the relationship is not to blame; the unexpected stressor is the medical status of one partner in the relationship. Suddenly that person may become the one who is needier and less able to contribute.

Despite best efforts by everyone, that dynamic can produce feelings of resentment. It is essential at those moments to remember the partners are on the same team.

Being on the same team

Acknowledging and being aware of the unique challenges of a marriage or relationship after trauma is only half the battle. Another important to-do for the partners for supporting through sickness and health is to get and remain on the same team.

Ironically, though, our complex human brains can make this difficult.

You see, as human beings, it is our nature to categorize things. Categorization behavior is a product of natural selection, it helps us survive by speeding decision-making, and we see it emerge early in childhood.

An object may be safe or dangerous; an animal may be friendly or mean; the weather may be comfortable or uncomfortable; a person may help or obstruct our efforts at happiness.

As we age, we learn the world, and many of its features are gray rather than “black and white,” but the instinct to categorize remains.

Thus, when someone we love suffers a temporarily or permanently disabling medical event, our categorization instinct can create a cruel paradox, categorizing the loved one as “the bad guy” in the way of our happiness.

This can happen because that survival component of categorization teaches us – from a young age – to move toward the good and away from the bad.

In a relationship after traumatic brain injury, more challenges and obligations appear for the uninjured partner. But the survivor is not creating the difficulties – their brain injury is.

The problem is that our categorizing mind can only observe the survivor, not the brain injury. The survivor, now needier and less able to contribute, could be mistakenly categorized as the bad.

But the bad is the brain injury, not the survivor who sustained it. And therein lies the cruel paradox: The brain injury affected the survivor, but by altering the survivor’s behavior or personality, it can cause a partner’s brain to miscategorize the survivor.

Although one individual acquired a brain injury, it is hopefully clear now that the relationship sustained it.

Partners who can remind each other – and themselves – that the brain injury is the bad guy can overcome the “me versus you” that instinctual categorization may mistakenly create.

They can instead get on the same side of the “us versus the brain injury” battle. And sometimes it can be achieved with a simple reminder: “Hey, remember, we’re on the same team.”

Don’t add fuel to the fire

An obvious aspect of being on the same team is not working against the team’s goals.

Soccer players don’t kick the ball toward their own goalie, after all. It seems simple enough, but when emotions like frustration or resentment take over and guide our behavior, we can do things that make a situation worse.

Don’t get hooked by those emotions and add fuel to the fire.

For survivors, actively fight back against feelings of uselessness or victimhood.

One of the worst things a survivor can do – for their relationship after traumatic brain injury – is fuse with the idea that they are a victim or useless.

True, a survivor may objectively be less able to do certain things than before, but inflexibly focusing attention on abilities lost makes it harder to see remaining capabilities.

For partners who did not sustain the brain injury, don’t emasculate or infantilize the survivor.

Surviving a brain injury and recovering from it is hard enough without being made to feel babied or emasculated by your partner. And if the team’s goal is rehabilitating the survivor, infantilization moves the ball away from that goal.

Also, don’t be afraid to show vulnerability. Uninjured partners may feel pressured to seem like they “have everything under control,” but that is often not the case, and the façade is often unconvincing anyway.

In the alternate, accepting and sharing feelings of vulnerability may reassure the survivor that they are not alone in grappling with change.

Nourish the relationship

In a relationship after traumatic brain injury, the partners must try not to work against the shared goals, but again it is not enough.

Any romantic relationship has to be nourished along the way if it is going to last. After all, even a houseplant that – protected from insects and harsh outside elements – will still wither and die if not given water, food, and the right amount of sunlight.

For survivors, find ways to be of use. Find specific actions and commit to doing them, living the relationship’s shared goal of rehabilitation.

Survivors should also support their partners in new responsibilities. Partners may take on new responsibilities that were once those of survivors (e.g., cooking, yard work).

Survivors can assist their partners by accepting this change and even feelings that come with it, offering aid and guidance (especially if in place of criticisms like “that’s not how I used to do it.”)

Lastly, survivors can ask friends and family to help their partners.

Uninjured partners might feel reluctant to seek help because they feel like they “should be able to handle things” on their own.

Although it is optimal to work through any unreasonable expectations, faster relief can be delivered if the survivor asks for help from friends, family, and other supporters.

For partners, help your partner find new ways (or adjust old ways) to be of use.

If partners give up on the idea that survivors still have much to contribute, fusing with the idea that they are burdensome or fixing attention on what they cannot do, it will be that much harder for survivors to contribute.

Pursue the relationship you wanted

One could categorize some of the above recommendations as mitigating damage to a relationship caused by brain injury. Though somewhat pessimistic, that categorization is not wholly inaccurate.

Let’s be fair and accept a painful truth: with something as life-altering as brain injury, a good deal of what follows is damage control. But damage control does not have to be the only reaction.

As mentioned in the first paragraph of this column, a brain injury presents a challenge by any standard. But with a little psychological flexibility, we can also identify it as an opportunity.

Partners in a relationship after traumatic brain injury are forced to re-evaluate where they stand and what is important to them.

If desired, through committed action and guided by shared values, it can also drive growth and evolution toward the partners’ shared goals.

With that in mind, and as roles, duties, and expectations are changing, it is worth trying to move towards the relationship you want – brain injury or not.

So, keep having a date night if you didn’t go before the brain injury.

All partners should nurture their relationships with time spent alone. That time together is equally, if not more important, than before the added stress on the relationship after traumatic brain injury.

Consider couples counseling with a talk therapist.

Couples counseling can help facilitate dialogue between partners, identify recurring sources of conflict, and offer constructive advice or provide tools and resources.

And if applicable, consider sex therapy with an occupational therapist or other professional.

Due to the varied effects of brain injury (physical and psychological), and because physical intimacy is an essential component of any romantic relationship, a professional may be able to assist couples in sustaining or recapturing sexual intimacy in their relationship.

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Michael E Keesler Psychologist

Michael Keesler, JD, PhD, is a graduate of Drexel University who completed his APA Internship at UNC Chapel Hill and his neuropsychology fellowship at the University of Pennsylvania. Since completing his training, Dr. Keesler has divided his time between neuropsychological assessment and individual... Read more psychotherapy, with many therapy patients being survivors of brain injury or living with progressive neurological illness. He also teaches for Drexel Psychology, regularly publishes on topics relevant to neuropsychology, and remains involved in various organizations and outreach efforts. Dr. Keesler owns and operates Fox and Ferns Mental Health, based in the Chestnut Hill area of Philadelphia. Read less