Family Stress & TBI
By Mitchell Tunnell
Upon several conversations with my network of TBI friends I realize this topic needs to be unpacked. We all have family and therefore all deal with some level of family stress. Adding a TBI on top of this can make it more complicated to cope with. This led me to hypothesize why this is the case. Three main hypotheses came to mind. First, as I mentioned in my previous blog, limbic dysregulation can lead to lower levels of emotional processing power. Without this processing and filtering I believe TBI survivors can have a higher emotional sensitivity to stress thus making it more difficult on an emotional level to cope with stressors at work, financially, or with family. With a heightened sensitivity to stress, we also have to understand that stress is a signal of danger, it’s when our brain feels that it doesn’t have the resources to cope with whatever comes our way. In recent neuroscience literature, they have found that these danger circuits in our brain are also involved in the modulation of perceived pain circuits. Meaning that our danger/stress circuits are constantly firing due to the heightened sensitivity. This sensation is also known as sympathetic nervous system dominance (SNSD). SNSD can also strengthen our pain circuits, which can perpetuate a vicious cycle that can turn into chronic pain. This idea affectively can explain why people with chronic pain feel stuck. My third hypothesis is that a concussion is a tissue damage injury that inflames the brain. It is also known that chronic stress increases inflammation, therefore the inflammation sustained after a concussion is doubled for people who deal with chronic pain.
Considering these three hypotheses, I think the danger network hypothesis is particularly relevant to family stress. Looking at it from a societal or evolutionarily lens, primates and wolves think of family as a safety and protection network to external danger. A “safe space” so to speak. Consequently, turmoil within a family network, due to injury or not, could result in the weakened integrity or in some cases abolishment of this safety network. Sometimes it can even result in family members being perceived as a danger or threat. In my experience this can manifest in several different ways.
I often find relating to a family member that has never personally experienced a serious long-term concussion recovery can be difficult. As I see myself and other family members focus on how different our situations are. This can result in a sense of loneliness and alienation. Looking at this through the lens of evolutionary biology you can see how feeling alienated can contribute to a sense of conscious or subconscious danger, as animals surviving on their own are much easier to kill than ones in a group.
Another way and probably the most psychologically and emotionally taxing way I have found family stress and tension to build is when family members have expectations of how you should approach your recovery. Whether these expectations and judgments are founded on science, anecdotes, or health care practitioners these expectations really set up a frustrating and stressful experience. I would like my family members to know that everybody’s recovery is unique, I repeat everybody’s recovery is unique! So maybe the rehab they see fit might actually make you worse or the timeframe they have in their mind doesn’t align with your reality. These are examples of gas lighting. Gas lighting is a psychological term used when somebody often in a manipulative way makes you question your own reality. Most of the time I don’t think people consciously do this nor do I think they’d do this with bad intentions, but it still can be psychologically damaging. Plus, feelings of shame and/or guilt can arise when you don’t meet these expectations. This can lead you to believe the struggle to get better is your fault even though it probably isn’t. These expectations can also lead to situations where you may be given the choice to leave your family unit; which inevitably would force you into isolation and as mentioned from an evolutionarily lens this is dangerous or; to defend your stance and confront the thing that causes a lot of stress, or by accommodating to their expectations even if it’s at the expense of your health.
Furthermore, the constant pressure to be better than you are currently can cause stress. This is also problematic as it implies there is something wrong with you instead of accepting where you are at today. It looks at what you can’t do versus focusing on what you can do.
The last way I’ve seen family cause stress in recovery happens when the family unit has trouble adapting to your new reality. Please try to keep in mind the lack of resilience to change could be circumstantial for this example, there may be financial restrictions, time constraints, the need to take care of other children etc. that impact these scenarios. That is why this level of stress often requires help outside the family unit. I think just having awareness that no one is to blame and to outsource for help would be highly beneficial for the stress of the injured and their family. Just as having an injury has emotional and physical challenges caretaking does to. I also think reframing this not as the injured is a burden but rather is worthy of any help or resources available is highly important. The feeling of being a burden has actually been shown to be the number one reason for why people commit suicide post TBI or otherwise. Hence why I believe reframing it is highly important.
Knowing more about stress and some of the way’s our family can contribute to stress in recovery, the question now becomes, what can be done? To me, the first step is almost always awareness. Having the awareness of feeling isolated, awareness of gas lighting, unreasonable expectations, and lastly awareness when you need to outsource emotional or physical help. In my next blog I will give more concrete tactics to help mitigate family stress. For now practice awareness and remember that there are outlets such as HeadsupCAN where you can ask for help and feel less alienated!