According to a November 2007 report by USA Today: based on military and veterans records, “at least 20,000 U.S. Troops who were not classified as wounded during combat in Iraq and Afghanistan have been found with signs of brain injury.” Shocking as this figure sounds, it pales in comparison to the fact that every 21 seconds, someone in the U.S. sustains a traumatic brain injury. That’s 5.3 million Americans, plus another 1.5-2 million per year! Traumatic Brain Injury (TBI) rarely changes someone’s outward appearance, making it difficult for family, friends and employers to recognize the injury’s severity. On the international TBI-Survivor email group, postings often discuss “the invisible disability.” Invisible, indeed. In fact, many people suffer from long-term effects of “minor” bumps on the head-never realizing the true cause of their struggles.

Have you ever counted how many times someone gets bonked in the head during a half hour of America’s Funniest Home Videos? What about the movies? How often do we laugh or cheer when someone “gets his bell rung”? In slapstick fight scenes, we anticipate hilarious knockouts. So many actors and cartoon characters reawaken without lasting side effects that we’ve come to expect immediate and complete recovery. Despite occasional articles on the dangers of contact sports for children-or the hockey player forced to retire after his fifth concussion-as a society, we marginalize brain injury into the realm of major accidents. Clearly defined “moments.” A cracked skull. Coma. At the very least, a trip to the emergency room!

A brain injury diagnosis brings plenty of its own challenges and offers no guarantee of understanding from spouses, friends or family members. When a loved one receives a brain injury diagnosis, doctors usually warn caregivers that things may change. They caution, “Every brain injury is unique, so we cannot predict the outcome with any certainty”–leaving families and spouses to navigate their own confusing roads through the recovery process. We tend to consider personality, emotions, preferences and intelligence as factors independent of the physical body. When someone breaks his arm, we don’t expect him suddenly to stop liking pizza. When our Mensa card-carrying aunt tears her ACL, we don’t expect her to forget how balance her checkbook. We think of our “Self” as invulnerable to physical change. But concussions, head injuries, TBI, and whiplash can and often do turn a familiar person into “someone else.”

If people who know their loved one suffered a brain injury have trouble dealing with the shifts, what happens in relationships where no one knows about the brain damage? What happens when seemingly overnight a laidback spouse becomes unable to tolerate any external stimulation? When the multi-tasking breadwinner suddenly cannot hold down a job? When the funny one’s sense of humor morphs into rage? What happens when the person you married starts acting like a stranger with different expectations, abilities, and a totally different personality-especially if s/he doesn’t recognize or acknowledge the changes?

Well, it’s not pretty. People on both sides feel betrayed and misunderstood. Tempers flare. Tears and insults fly. A couple might try marriage counseling, but without knowledge of the root cause, they make little progress. Many times the original love remains, but the lack of understanding leads to intense stress, sometimes even divorce. Although the injured person cannot articulate what s/he feels or exactly “how” or “when” things changed, his or her demands remain non-negotiable, or s/he simply “forgets” about carefully orchestrated compromises. So, what does help?

Education, compassion, and-sometimes-proper treatment.

I’ve listed below four ways to support your loved one without losing your own way:

1. Realize that no one makes a 180 for no reason. Personality and expectations radically shift in response to some kind of trigger, which may or may not be obvious. Emotional trauma-like the death of someone close, job loss, or betrayal-sometimes acts as that trigger. Often, multiple triggers occur all at once, and in retrospect, these factors might have pushed your loved one beyond the former status quo. Sometimes, though, the reaction seems disproportionate to any known trigger. Someone could feel overwhelmed by the stress of a funeral, but a month later, s/he normally could still make travel arrangements or follow a recipe. A person might react negatively to a cross-country move, but normally this doesn’t cause the sudden inability to retain conversations. If a spontaneous shift hangs around a long time, consider the possibility of a hidden physical trigger.
2. Temporarily remove yourself from the equation so that you can investigate the bigger picture. When we start reacting to our loved ones, it becomes difficult to see beyond daily arguments and resentments. Stepping back invites neutrality and enhanced clarity. Create a timeline of events and symptoms. Pay attention to patterns. Then ask for your loved one’s input, since his or her memory of events likely differs from your own. Remember, you’re not reacting here; you’re investigating. Put on your Sherlock Holmes cap and allow curiosity free reign. Does either of you recall a bump on the head, whiplash, fall, or fainting spell? A fleeting moment when one side of the body seemed unusually weak? Consider also illnesses whose symptoms mimic brain injury: stroke, Lyme Disease, Fibromyalgia, Chronic Fatigue Syndrome, Multiple Chemical Sensitivities, or MS. Do you remember a tick or spider bite? Overexposure to chemicals? Difficulty forming words? Recording your observations of seemingly unrelated details just might reveal an underlying cause.
3. Learn to recognize common symptoms of brain injury and other “Medical Mysteries.” According to the Neuro-Optometric Rehabilitation Association (NORA), Post Trauma Vision Syndrome affects most people who suffer neurological events or illnesses like TBI, stroke, cerebral palsy, and MS.COMMON SYMPTOMS INCLUDE: Concentration problems, Double vision, Headaches, Difficulty reading, Balance disorders, Clumsiness, Eyestrain, Intolerance of flickering lights. Intolerance to varied backgrounds, Panic attacks, Easily becoming overwhelmed. Vertigo, A neuro- or behavioral optometrist might offer relief for seemingly non-visual symptoms by prescribing visual therapy or prism lenses.OTHER COMMON SIGNS OF NEUROLOGICAL DAMAGE INCLUDE: sensory overload (smells, sounds, touch become “too intense”); inappropriate laughter, rage or crying; difficulty processing more than one thing at a time; refusal to consider alternate ways of doing things (seeming “stubborn” or “obsessive compulsive”); over-reaction to change of plans; “forgetting” about agreements; sudden resentment of prior chores or duties; leaving tasks only partially completed; defensiveness about memory or mental processing ability; erratic driving; loss of interest in hobbies requiring concentration or special skills; low tolerance for frustration; inability to grasp punch lines or clichés. If your loved one exhibits any or all of these symptoms, sometimes just considering the possibility of a physical cause allows you to relax and forgive. It also offers hope for healing on all levels.
4. Find resources to support you and your loved one. Brain injuries and other “Medical Mysteries” often take a long time to diagnose and even longer to treat. Finding an understanding and knowledgeable treatment provider can make a huge difference in the speed and level of recovery. If you suspect TBI or another physical cause has contributed to your relationship challenges, arm yourself with knowledge and support. Contact your local hospital to learn what resources they offer. Call state or national organizations and ask for referrals. Read books and blogs by other survivors and/or caregivers. Know that you are not alone.

Undiagnosed brain injury or neurological disease might not explain all your relationship issues, but it factors in a lot more often than people think. Before you discard the love of your life, consider all your options. Like relationships, our neurological systems can be both fragile and incredibly resilient!