Does Brain Injury Change Personality?

Brain injury causes changes in personality.  

Big claim - but it seems to be generally agreed upon by much of the post-TBI rehabilitation community.  In relatively recent articles for this blog, I have alluded to changes of this sort in my own recovery - and while discussing these articles with my girlfriend, she asked me, “But what does it mean - to change personality?  What you’re talking about doesn’t sound like a change in personality as much as a…a…an intensified personality.  Is this really a change?”

Well this question surprised me - and I tried to splutter out a response about my research over the past several weeks/months and how this has led me to the belief that personality changes after TBI are accepted… but I found that none of the words that fell out of my mouth fully satisfied her — or me.  And so, for this entry I have decided to relook at what I understand such a big claim to mean.

What does it mean to “change personality” after brain injury?

To quickly review some of what we’ve discussed in the above mentioned articles - when brain injury occurs, one relatively common effect is that a survivor will have his or her “emotional control center” of the brain damaged - and as a result, the survivor has difficulty regulating which, how, and to what extent emotions are expressed.  

In the article “Can a Brain Injury Change Who You Are” - posted at www.theconversation.com - Dr. Leanne Rowlands shares three examples - two historical and one relatively contemporary - of personality changes related to brain injury - the stories of Phineas Gage in 1848, Eadweard Muybridge in 1860, and finally the more contemporary story of a school teacher (name not given) in 2000.  In all three of these of these cases, the person who received the injury is said to have developed previously unknown personality traits — Phineas Gage developed powerful aggression, Eadweard Muybridge developed emotional instability, and the school teacher developed a tendency toward sexually assertive pedophilia.  Thus, as Rowlands argues, this demonstrates the relation of the brain to personality - particularly the prefrontal cortex region of the brain — this being the area all three of these individuals received brain damage.  Please note, I cite this article because it clearly states a historical recognition of such changes, but comparable examples are discussed in much of what I read - search “personality changes after brain injury” on the internet.

It is also important to recognize that a survivor is going through a major traumatic experience, and as a part of this experience he or she must learn to apply a new set of mental and physical skills - those available post-trauma - to the life that the survivor previously understood.  Let’s be honest - this is a level of stress most people cannot realistically comprehend.  Even I - after having experienced this as a survivor of TBI - I have difficulty recalling the magnitude of this stress level.  I remember and acknowledge that it happened, that it was… painful, confounding, debilitating… but I recognize that — for the self preservation of my personal sanity — my mind has muted much of the true pain and frustration that resides within these memories.

This sort of stress, coupled with the damage to the “emotional regulation centers”, causes a survivor to react to situations in a new way.  He or she may develop a fast and/or unpredictable temper, become sexually withdrawn or hyper aggressive, find the creation of new memories difficult, lose an ability or desire to stay focused tasks…the list can continue, but I think its important to recognize that the majority of these changes tend to be viewed as negative.  Changes in personality that are viewed as positive after brain injury —while not unheard of — are rare.  

So let’s look at the claim we started with again - “Brain injury causes changes in personality.”  I suggest these are not really changes, but simply tendencies that had been perviously constrained by an adherence to societal standards that are now splorging1 out in unacceptable displays.  Furthermore, I propose that when a colleague, friend, or family member says that brain injury causes a “personality change”, the truth behind that statement is — brain injury makes it harder to enjoy interacting with the survivor and we don’t understand why.  It’s not that brain injury changes one’s personality - it’s that the unfiltered behavioral impulses of nearly anyone are not easily enjoyable or socially acceptable, and because of the psychological and physical situation — the stress of rehabilitation combined with damage to the frontal lobe region of the brain — a survivor is more likely to act upon impulses and create uncomfortable social situations.  This does not mean a survivor has a different or new personality, but that the survivor is re-learning how to regulate impulses and interact with the world.

That’s my big claim, so I’ll repeat it - a person does not get a new personality because of brain injury.

Furthermore, survivors, supports, and caregivers should not attempt to write off social follies or abrasive behavior as part of a personality change, but must accept that a brain injury survivor is in the process of reestablishing his or her self-regulation process.  Granted, this is difficult for all parties involved, and will undoubtably involve having to navigate embarrassing public social situations, but re-learning social control as part of the healing process needs to be recognized and respected - a person who has lost his or her legs should not be chided for needing to learn new ways to move by him or herself, nor should a brain injury survivor be shunned for needing to discover new methods for controlling impulses and moderating actions.

To look at why recognition of this part of the healing process is so important — the separate things of “personality” and “personhood” are — at least in English, Russian, Croatian, French, German and several other languages (still need to research Asian languages) semantically linked (linked through language) — and because of this, it is easy to equate a change in personality to a change in person-ness — especially for a survivor working on establishing his or her way of living with new skills.  Therefore, stating that there has been a “personality change” invites identity confusion for a survivor, raising questions about a consistency in one’s self-personality.  As stated by survivor Mac Fedge in an interview with NBC news, “It feels like part of me has disappeared since the accident and trying to get that aspect of me back and that’s probably one of the toughest aspects of the recovery…”.  

The linking of “personality” with “person-hood” may be a side effect of language — but regardless, questions of self-identity do exist after brain injury.  Recalling from my experience, these sort questions are damningly hard.  The title of my storytelling work is the question Who Am I, Again? — and I named it this because I found variations of this question dominating many of my thoughts during the early years of my recovery —

Am I the same person?  

Was I reborn?

Can I have any of the same hopes or dreams as before?  

Is the person I was before my injury no more?  

After brain injury, questions such as this will likely already exist within a survivor — and many of these are questions that cannot be answered — to encourage further impossible questioning of this sort by claiming one’s personality has changed is at best unproductive and — perhaps more likely — can quickly lead to dangerous thought patterns.

But for now, returning to the statement that began this entry - “Brain injury causes changes in personality” - I have examined this claim, and I cannot agree with it.  This disagreement is a conclusion I reached as part of writing this entry — I played and pondered with the research and reasoning, and now feel that to claim a personality change is - in the majority of cases - more accurately a way to explain away the social discomfort that often exists around a survivor.  The expression of one’s personality may have changed — and this may make it more difficult be socially engaged with such a survivor — but the personality is constant.

In my performance, I bookend the storytelling by stating “I am Lethan.”  After brain injury, a survivor - though learning to adapt to a new set of skills - is the same person.  You are You - and that includes all the personality that comes with You.

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Footnote - 1  Yes, this is a made-up word, but I believe it best depicts the action I want to describe.  Definition of “Splorging” — verb. — the sound and motion of a gelatin substance when it is squeezed by a person’s hand and it escapes compression by seeping through said person’s fingers.