Anger and Depression

Traumatic head injury can not only change your thoughts and memories but can also change your emotions. Two of the more common changes in emotion are anger and depression. If you got angry about certain things before your accident, following the head injury your anger may be multiplied 2 or 3 times. For example, before the injury if someone or something annoyed you this might be a "normal" angering situation for you and for most people. It would irritate you but that is as far as it would go. But following a head injury, your anger may be so extreme that it goes beyond irritation. You may lose your temper and want to rant or shout out or cause damage or harm. Anger after a head injury is quite different from "normal" anger.

Following a head injury anger tends to come and go fairly quickly. You can be in a good mood until some small thing irritates you when you suddenly get very angry. This anger doesn’t seem to last however.

You’re angry for a few minutes but then someone changes the topic of conversation, and you quickly stop being angry. However, in another variation of the anger problem, some minor thing may set you off and then the whole day is ruined because of the bad mood (as opposed to mad mood) it has put you in.

Another scenario, following a head injury, is the emotional overload it may create. Before the injury you may not have cried for a long time or may not have cried easily. Following the injury you may cry at the slightest thing. Life after a head injury may therefore be an emotional roller coaster. Because of this many people begin to feel that they are "losing it".

Why is this happening? We know that the middle sections of the brain are fairly primitive. Rage, fear, and sexual feelings all come from these primitive emotional areas of the brain that says YES "or" DO IT. If you’re mad it tells you to hit something. If you get hungry it tells you to eat. If you are attracted to something or someone it tells you to go for it, to have it, right now!! In contrast, the front part of the brain helps plan and control behavior. The front part of our brain is involved in moderating our primitive impulses i.e. saying "NO". For example, your boss may say something to you that gets you get really angry. Your first impulse is to hit him. The "NO" part of your brain says "Don’t do that -you’ll get arrested or fired or both." So, the frontal lobes and the primitive parts of the brain complement each other. If the "NO" part of the brain isn’t working effectively, the primitive functions tend to control your emotional behavior. This change in emotion may cause your family members and friends to start avoiding you. With family members, they’re going to learn to walk around you as if on "eggshells". They may be afraid of the changes that they see in you. Friends may drop off because they may not recognize the "new" persona.

What can you do to deal with the problem?

From what I have picked up over the years my understanding is that one very useful tip is the "Time- Out" procedure. Before reaching the point where you are going to explode (throw something, break something, or punch a hole in the wall), you MUST walk away. You have to immediately get away from the thing that’s really irritating you, for a minimum of 15 minutes. Get out of the house. Go for a walk.

Don’t stay in the situation that’s making you angry. Why 15 minutes? You may say, "I’m pretty calm after 5 minutes." 5 minutes isn’t sufficient. You will go right back into the situation and you will be instantly angry again. It takes quite a while for your emotional system to calm down. Time-Out must be at least 15 minutes. The more you do Time-Out, the more you learn to control your feelings, or hold back the flood of emotion. It’s basically practice, practice, and more practice. The more you try, the more likely you are to get better at it the next time.

One of the problems with Time-Out is that you may not realise you are angry until it’s too late. For example, you may be waiting in a check-out lane in a store and there is a little child misbehaving; picking things up, throwing them on the ground, yelling and screaming. Your anger starts to build. Your jaw is tightening; fists clenching; feet tapping. You don’t recognize the anger. You finally "explode" at the child’s parent saying "Shut your child up!"

There are cues that anger is building in us all and we’ve got to learn to pick them up. It may be tightening in the jaw; it may be clenching in the hands; it may be sweating more or breathing heavily. It depends on the person. You are capable of recognizing and working on the signs. Practice, practice, practice. You can be assisted in this by your nearest and dearest.

It is important that family members help with recognizing when Time-Out is necessary (In fact, family members are most often the target of the anger).

In order to make Time-Out work for you properly it is important to set rules and to stick to them. No matter who calls time-out (whether you feel it’s fair or not), you’ve got to do it. If you’re the head- injured person and someone calls time-out on you, you have to do the 15 minute Time-Out, even if you don’t think you need to. You may even get angry because someone’s called a Time-Out procedure. You still need to do it. Family members, however, have to "play fair". It is important they don’t pursue you with an ongoing argument. If you’re trying to get out of the situation, your nearest and dearest must take the Time-Out too.

It probably helps if you have a signal for time-out. For example someone make a "T" with their hands. The more you practice this technique, the more it works. The first few weeks, it may not seem like its working. But keep at it because it will work over time.