The Traumatic Brain Injury Survivor and Temper
When a person’s brain hits the steering wheel or dashboard of a car, the brain is thrown into the front portion of the skull, often causing serious sheering and tearing of the gelatinous gray matter. As the brain slams up against the protrusions on the inside of the skull, it begins to bleed. As the brain bleeds and swells, the it is forced gradually toward the opposite side of the head, which can then cause significant, even more noticeable brain damage.
Open head injuries are ones which have the structure of the skull and the fluid surrounding the brain compromised. A gunshot wound to the head would be considered an “open” head injury, since something—in this case a bullet—penetrated the skull and invaded the brain’s precious space. A closed head injury is one in which the skull remains intact, and the closed-system of fluid and blood is still isolated from the environment.
For years the medical field presumed that just because a head injury was closed rather than open it meant that the impending brain damage would be less severe or substantial. However, over the past decade or so, it has come to like the problems that internal swelling can bring about. While an open head injury has a greater chance for tearing of brain tissue and the patient ultimately “bleeding-out,” the closed head injury brings along with it its own set of problems—namely, swelling.
The human skull is not flexible. It has nowhere for the fluid and blood to go as opposed to the knee—which will swell if hit with moderate force. That forces the brain to be shoved to the opposite side of the skull after a closed head-injury. Therefore, after a motor vehicle accident in which the car hits a tree or other immovable object on the driver’s side, the driver may experience left-side paralysis. Since the left side of the brain controls the right side of the body, we would expect that the right side would be paralyzed. But it is the swelling of a closed head injury that often paralyzes a person on the side which came to a sudden stop first.
So if someone’s head hits the dashboard in a motor vehicle accident (MVA), the brain—which is travelling at a fairly high rate of speed—stops instantaneously. The frontal lobes are forced onto the inside of the skull, which, as we already stated, is full of sharp protrusions. Think of a water balloon. If you drop it onto the floor or ground, it will deform or squish before it bounces. The brain is the same way. That’s why a person may lose the ability to move his arms and legs fully or smoothly. The cerebellum—Latin for “little brain”—has been affected.
The frontal lobes control much of our higher-executive functions, including planning, sorting, speech, being able to follow multi-step directions, impulse control and much more.
After a TBI, when a patient comes out of a coma, he is unsure about his surroundings and how he got there. He often cannot perform the same functions that he could only days, weeks or months—depending on how long the coma was—ago. Often the only way for the TBI survivor to respond is to become angry.
The frontal lobes act like the front brakes on a bicycle: if the front brakes are damaged or gone, you can stop going down a hill, but it will take much longer to do so. When the frontal lobes are damaged, the head-injury survivor will lose the ability to stop undesirable actions when they choose. That is the reason so many TBI survivors have problems with alcohol and cigarettes. They just don’t seem to know when to quit.
The same goes for temper-fits. When a TBI survivor first begins to lose his temper and act-out, it feels good and he likes the response he gets from those around him. Often the problem is that he fails to know when to stop his acting-out. He winds up hurting himself and others, in addition to losing almost all friends.
Without the frontal lobes to keep the survivor’s actions in check, often TBI survivors find themselves acting in irrational ways, including throwing temper-tantrums to get what they want.