Sunday, April 3, 2011

Traumatic Brain Injury May Lead to Mental Health Problems

Railroad worker Phineas Gage earned a lasting place in the history of traumatic brain injury in 1848 when a 3 foot, 7 inch steel rod was driven through the side of his face, passing behind his left eye, and completely exiting through the top of his head.

Gage had been using the rod to tamp blasting powder into a hole in the rock which had to be removed to make way for new track. The powder accidentally exploded as Gage was tamping it into place, with such force, that after passing through his head the metal rod landed some 80 feet away.

Blood and brain tissue were found on the rod.  Phineas Gage is seen in the picture below, holding the tamping rod. As a result of the accident he lost vision in his left eye.

Amazingly, Gage not only survived, but was talking within a few minutes of the accident occurring, and needed little or no assistance walking. By mid-November Gage seemed to have made a good physical recovery.

But the accident had forever changed him. He had been known to the men in his charge as congenial, capable, and efficient. According to Dr. John Martyn Harlow, who treated him, after the accident Gage was:
irreverent, indulging at times in the grossest profanity (which was not previously his custom), manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires, at times pertinaciously obstinate, yet capricious and vacillating, devising many plans of future operations, which are no sooner arranged than they are abandoned in turn for others appearing more feasible.... In this regard his mind was radically changed, so decidedly that his friends and acquaintances said he was "no longer Gage."
To this day it is not uncommon for friends and family of some brain injured people to say they are no longer themselves.

And, often, people with brain injury, recognizing the changes in their behavior and personality, will say, "I just want to be myself again."

Gage's personality changes were a major factor in his being unable to continue working for the railroad.

Not everyone with TBI experiences shifts in behavior and personality, yet such changes are far from rare. When changes occur they can be relatively minor, almost unnoticeable. The more serious the changes, however, the more likely they are to result in mental health problems for the person with brain injury.

Psychiatrists and therapists working with TBI must be able to recognize the mental health impact, also known as the "psychiatric sequellae," of brain injury so as to provide appropriate care.

Psychiatric sequellae certainly include the kinds of changes Gage experienced in the ways he thought, behaved, and generally related to others.

Today a number of psychiatric and other sequellae of TBI are recognized, and include:
  • Issues with anger and emotional self-control
  • Onset of mood disorders such as anxiety and depression
  • Changes in sleep patterns
  • Problems with attention, concentration, and memory
  • Denial that there has been any injury or change
  • Confabulation, or making up "stories" with no conscious realization that they are not the truth
  • Alcohol and drug abuse
  • Difficulty maintaining or finding employment
  • Loss of interest in things which used to be of great interest, and/or major shifts in what is considered interesting
  • Hostility toward others, including physical confrontation and assault
Not everyone with psychiatric sequellae of brain injury will have all, or even most, of the problems listed above. Each individual and her or his injury is unique, and so is their response to it.

The good news is that with appropriate use of occupational and psychotherapy, peer group support, and sometimes medication,  whatever issues are present may be overcome or, at the least, brought under greater control.

As a therapist, I'm all too aware that in many case where brain injury has been diagnosed and initial treatment provided, there is lack of ongoing follow-up - in other words, once the physical issues have been dealt with, care often ends. Yet, it takes time for the psychiatric or mental health changes to present themselves.

When problems begin to appear is precisely the time patients need to be followed by an individual who understands the various ways brain injury leads to changes in a person's ability to think, work, behave, relate to others and, perhaps most important, to live with himself in a balanced and peaceful manner.

At a time when we're becoming increasingly aware of the dangers of concussion and other brain injuries, especially among children and teenagers, it's imperative that parents, coaches and team managers, and health care providers all have greater awareness of how brain injuries are caused, and what may happen as a result.

Most provinces and states have brain injury associations which can be a great sources of information and support for both patients, families, and friends. This site provides links to brain injury associations in the American states.

The Brain Injury Association of Canada provides links to provincial associations, as well as a great deal of worthwhile information.

 The Brain Injury Association of Canada site also provides valuable information on concussions, which should be of special interest to parents who have children or teenagers involved in sports. Concussions are not rare - they occur all too often in sports, and it is not uncommon for some kids to have had two, three or more concussions. Each concussion needs to be taken seriously. Many people are unaware that it often take children and teenagers longer to recover from a concussion than it does adults. Please check out this valuable information on concussions.


  1. I was wondering if being deprived of oxygen can cause similar mental issues. If so would you elaborate? TIA

  2. The human mind is incredibly powerful. Destruction of the brain can also cause powerful, equally disturbing effects, that's why the brain must be always taken care of.

  3. During accidents, one of the most common injury is head injury. If not treated properly it could turn into a traumatic brain injury. During cases like this, it's very important to have a personal injury attorney help you with a case.