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« Reply #2 on: July 22, 2010, 12:41:27 PM » |
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Anger is a special problem in the World of Head Injury for several reasons. Those who have temporal lobe injuries can become enraged instead or irritated or angry, and they can be easily provoked by unpleasant noises as easily as by running into obstacles or having troublesome social interactions. Those with temporal or parietal injuries are prone to misunderstand what people say to them, and may read something insulting or challenging into an interaction. Those with frontal lobe injuries tend to act impulsively on their anger, saying or doing things without considering their appropriateness or their consequences. Hence anger is prone to produce overreactions which are not always well controlled. Angry behavior is also not well tolerated by the Normal World. It is easy for people to become concerned about the notion of a survivor gone berserk. Thus people who don’t make their best efforts to restrain their anger are flirting with jail time or commitment to a psychiatric hospital. Although some people won’t learn to use their best self-control until they wind up in jail or a looney bin, most can learn to prevent a crisis if the issue is addressed through Self-Therapy.
Anger is likely to be your problem, not your loved one’s, simply because it bothers you and not him/her. Hence your job is to do whatever you can to transfer the problem back to the person who committed the angry acts. You may attempt to do that by giving feedback. Always keep in mind that your loved one may be unaware of acting angry, or may underestimate how angry he/she is acting. You should begin by describing the person’s behavior and explaining how it makes you feel. This is sufficient for the most responsible survivors to produce some concern and enough motivation to get some behavior change. However, it is not sufficient for everyone. It may be necessary for you to audiotape or videotape the angry behavior. Then the survivor will have vivid evidence of the problem. This can produce a stunning revelation to many survivors, as they have no idea how far their behavior goes. However, some survivors, even knowing that their actions are beyond the bounds of reasonableness, don’t care. For them, anger control will come only when they face consequences–being beaten up due to getting angry at the wrong person, being taken to the psychiatrist for medication, being thrown out of the home, being required to pay for any property damage, or being jailed.
Once the problem is recognized, the strategy is simple. When angry feelings start, disengage and get away. Don’t wait, don’t hesitate, don’t try to make a point or get something accomplished, because that will end in lost control. Get out while the getting is good, like a passenger on the Titanic.
Some family members tend to lock horns when there are arguments, and the caregiver may be unwilling to allow the survivor to escape. This is a tragic error. By blocking escape, you prevent your loved one from restoring self-control. Under no circumstances should you allow yourself to do this. Resume the argument only when your loved one comes back calmed down.
Remember, anger is the preferred response of a person who is trapped and threatened, put in a no-win situation. Without intending to do so, you can easily create such a situation. Make extra sure that you are not doing that. Your loved one needs to have the opportunity to make his/her case when there is a dispute. Many long-term caregivers, weary of the repetitive nagging and impractical ideas, tend to ignore the survivor’s opinions completely. To quote a patient, “Just because I’m head injured doesn’t mean I’m always wrong.”
On the other hand, anger is often the result of frustration precisely because of rejection of a harebrained, impractical idea, and an unwillingness to take “no” for an answer. Angry ranting, in an attempt to get his/her way, should not be tolerated. If the ranting continues after you have issued a calm warning, it is time for somebody to leave, whether that means the survivor heading off to the bedroom or the caregiver taking a stroll.
A good guideline for you is to avoid extremes in responding to episodes of anger. Don’t get mad yourself and yell at the survivor, because that will just take away more of his/her selfcontrol and presence of mind. At the same time, don’t tolerate extended, inappropriate displays of anger, because if they are tolerated they will never come under good control.
Many head injury treatment programs have achieved good control of angry outbursts. A wellimplemented psychiatric program assigned each patient a personal therapy aide during the whole waking day, usually a college student, who could help defuse anger by suggesting self-control procedures. Many “behavioral” treatment programs teach patients self control through token economies. Patients who have outbursts have to pay a price for them, in terms of privileges for freedoms, recreational activities, desirable living quarters and other benefits. These consequences often teach patients the necessity of using self-control quickly and consistently. You may be able to try a similar approach, but if you do, be aware that these procedures work well only if they are used calmly and reasonably. The rewards and penalties are doled out by very specific rules that are put in place at a calm time, not during an outburst. If they are administered angrily, they will generate new hostility and their whole purpose will be defeated
TBI Recovery Group
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