Traumatic Brain Injury - A Piece of the Puzzle Often Gets Overlooked

I came across an article in the New Yorker recently that stressed the importance of assessing for traumatic brain injury in victims of domestic violence and sexual assault.  This is also an advocacy issue.  With approximately 50 percent of victims being strangled in some point of their relationship it is imperative that we ask the questions about a possible history of strangulation and advocate for victims with the medical community to assess for possible brain injury.  We often become focused on the current issues or assume that a person's actions and behaviors are related to something else that we fail to ask simple questions that could rule out a possible brain injury or prevent further damage from failure to address an injury.  

"Such women would have been labelled 'difficult' in the recent past,  The police may dismiss them as being drunk, the state’s attorney may think they have mental illness.… Even the medical profession may dismiss them as being overdramatic. We have been able to intervene on their behalf to help other agencies understand that it is the T.B.I. that is causing some of these behaviors and symptoms.” NO VISIBLE BRUISES: DOMESTIC VIOLENCE AND TRAUMATIC BRAIN INJURY

by Rachel Louise Snyder

 , DECEMBER 30, 2015

Domestic violence and sexual assault advocates can do a simple screening to determine if further assistance may be needed. 

A brief screening tool that was designed to be used by professionals who are not TBI experts is the HELPS.²

HELPS is an acronym for the most important questions to ask:
H = Were you hit in the head?
E = Did you seek emergency room treatment?
L = Did you lose consciousness? (Not everyone who suffers a TBI loses consciousness.)
P = Are you having problems with concentration and memory?
S = Did you experience sickness or other physical problems following the injury?

If you suspect a victim has a brain injury, or she answers “yes” to any of these questions, help her get an evaluation by a medical or neuropsychological professional – especially if she has suffered repeated brain injuries, which may decrease her ability to recover and increase her risk of death. If she wishes, reach out to the TBI service provider with information about DV, what support she needs, and what services are available to her. Look for ways to work together.

The National Brain Injury Association has links to the TBI associations in each state:  http://www.biausa.org/

Insidious Traumatization – How Recent Events are a Call to Self Care

Over the past months we have been exposed to a large amount of hate speech.  We have also seen a number of reports of poor to dismal responses to sexual assault and domestic violence.  I won’t go into those in detail.  They fill our inboxes, Facebook feeds, newspapers, and news channels.  The images fill our brains or we create our own images based on the details we are given.  We become angry at the way people do not seem to take the allegations seriously and how systems and persons continue to find ways to re-victimize.  We lose hope in our ability to make and sustain change.  We are reminded of our own victimization(s) and we start to feel helpless and hopeless.

Our response to the ongoing exposure to the victimization of others is the result of insidious trauma, often called “micro-aggressions.”  According to Laura S. Brown in her book, Cultural Competence in Trauma Therapy, “in the lives of many individuals who are members of target groups, daily existence is replete with reminders of the potential for traumatization and the absence of safety.”  These micro-aggressions can often seem fairly benign such as when a group is ridiculed in a public way or when one’s group is betrayed in a stereotypical way.  However, when a person is targeted in a violent way through hate speech, threats, invalidation of or disbelief in their experience and this is made public the impact on other members of the group can be significant. 

Laura Brown goes on to quote Root (1992) as arguing that “when a person is subjected to insidious traumatization, that individual experiences a gradual and often imperceptible erosion of the psyche.  A useful metaphor is that of very small drops of acid falling on a stone.  Each drop by itself does little damage and may in fact etch the stone in such a way as to make it more beautiful.  Thus, in some ways the experience of daily micro-aggression may evoke resilient coping responses (as when we find positive strategies to address the ongoing violence against the groups of which we are members).  Yet each drop of emotional acid creates just enough damage to render the next drop more damaging.  Over time a fissure develops in the form of an emotional vulnerability that is invisible so long as certain aspects of the biopsychosocial and spiritual environment remain steady or supportive.” (italics mine)

This insidious trauma can create conditions in us similar to those to whom the significant aggressions are directly applied.  When it is combined with the effects of previous trauma that we have experienced and are now re-living it damages the psyche and makes us weary. 

Our only hope is to surround ourselves with others who understand what this type of trauma can do to a person and find ways to care and nurture each other as we continue to face the onslaught of further violence against groups to which we belong or have a strong affinity.  We may, at times, need to take a break in order to be able to come back in support of victims, but it is by filling our cup that we are able to have enough to help others.