The Traumatized Brain: A Family Guide to Understanding Mood, Memory, and Behavior after Brain Injury

While members of the US military may be the most visible of those with Traumatic Brain Injury (TBI)—with over 235,000 service members diagnosed with a TBI from 2000–2011—they are but one group impacted. The Centers for Disease Control and Prevention (CDC) estimates that in 2010 there were 2.5 million emergency department (ED) visits, hospitalizations, and deaths in this country, from a discrete brain injury or in combination with other injuries.

For every individual with TBI there are family and friends who are also profoundly impacted. The Traumatized Brain is written especially for those with a loved one who has suffered a TBI and develops mental symptoms. That focus makes this book a unique and needed guide for those who are the most enduring and essential supports for people with a traumatized brain. The authors’ mission to “give voice to this silent epidemic . . . [and] help readers recognize and understand the psychiatric symptoms that develop after TBI” is admirably achieved.

This guide builds up the reader’s knowledge and understanding with a careful logic. First, we learn about the structures and functions of different parts of the brain. With clear and concise writing that eschews excessive technical terms and jargon and is nicely supplemented by drawings, we learn how the brain is organized and works. We are also taught about the types, severity, and signs of TBI.

On this foundation, which is very helpful but not essential to what follows, the authors proceed to explain the psychiatric problems that derive from a traumatized brain. These include depression, anxiety (which includes PTSD), apathy, and mania. As devastating as the injury may be, Drs. Rao and Vaishnavi take pains to emphasize that these mental problems are illnesses, not simply a “normal” response to a very bad event. They offer information on specific treatments and thoughtful ways for patients and families to adapt.

Behavioral problems then are addressed. These include aggression, impulsivity, psychosis (including paranoia and hallucinations), and disordered sleep (which occurs in about half of those with TBI). These are problems that make extraordinary demands upon families and community living. Appreciating their nature, the limitations they produce, and ways to better function is another notable contribution of this text.

Cognitive problems are the focus of the next section. We are taught the important differences between attention (and its variants of selected, sustained and divided attention); memory (explicit and implicit); motivation; language; and the brain’s executive functions (our abilities to plan, organize, sequence, monitor and modify). Impairments can and do occur across all these cognitive domains, so treatments need to be customized to each person’s individual deficits (and strengths).

The book’s education about TBI concludes with a section that considers other common problems such as headaches, seizures, and visual disturbances. Here, too, we are offered important and practical information about treatments and ways in which individuals and families can best manage the consequences of a traumatized brain.

There is a useful glossary and a resources appendix. But what I found missing was a discussion and examples of monitoring tests that can be completed on an ongoing basis by patients and family members. The authors offer one example, namely the Apathy Evaluation Scale, where a person’s functioning can be assessed over time. Families need to be able to monitor, in a reliable and quantitative way, their loved one’s condition. We do that for diabetes, hypertension, depression, OCD, hyperlidemia, PTSD, and many other conditions with self-report, paper and pencil tests, not just blood tests and cuffs. This is termed measurement based care and enables everyone involved to keep their bearings on outcomes, and can be very useful in advocating for needed changes when treatment is not working.  

Throughout this smart and accessible book is the message that the brain has the capacity to recover. The term often used is “plasticity”—the ability of our brains to “find new ways of doing old things.” For families and those with TBI this is a message of hope. And hope is critical to bear the emotional trauma of TBI and to maintain the hard work of recovery.

The book closes with a section that describes what helps recovery. The messages here summarize the practical and effective measures offered throughout the book.

We can thank Drs. Rao and Vaishnavi ‎for this remarkable contribution to patients, families, and clinicians. Few professionals, doctors included, know how to deliver their highly informed knowledge and experience in ways that lay readers can comprehend and use. I hope the authors build a video library to complement this text. So many more people will be reached by a set of visual and auditory communications that complement their text.