Archive for August 2011

Traumatic Brain Injury in Delaware’s Legal Landscape by Tracey Landmann

August 17, 2011

The idea for this “Traumatic Brain Injury in Delaware’s Legal Landscape” article came about in an unconventional manner.  I asked local attorney Joe Bodnar if he would share his thoughts regarding the state legal system’s perception and treatment of traumatic ally brain injured criminal offenders.   He might just have been too surprised to refuse, but in any case he did agree to the request.  I later spoke to my indulgent comrade on the phone. I had sent him a few pertinent articles; tried to frame relevant questions, but the more I read, thought, and spoke to him about this issue, the more I realized I have absolutely no clue how the federal legal system – or specifically, that of this state – would regard the brain injury problem in relation to the law.  Unless I looked a lot deeper into the TBI/crime connection, any inquiry would be vague, eliciting few answers and usurping very important hours of a very busy man for no real reason.  Time is a scarce resource; I’m not willing to waste that which belongs to anyone who grants me the favor of his or her attention. Consequently I’ve been concentrating on understanding the question before I endeavor to obtain any answers to it.  Figuring this out will require a lot of education and discovery… and a lot more indulgence.  I invite you to accompany me as I go through this learning process: with wisdom and good fortune perhaps we’ll all gain some useful knowledge.

You may wonder why I, who bear the negatively perceived TBI label, am devoting an article to the harm that can come from letting us survivors loose in society.    Do I really want to encourage mistrust and fear?  Not at all.  The information presented here is applicable to an extreme – and dangerously overlooked – aspect of TBI in some situations.   We all get damaged a little bit differently and no one deals with his/her injury in exactly the same way as another.  I know everyone reading this blog is intent on fixing the problems of TBI.  I’m not targeting you, your loved ones or your patients and clients.  Instead I’m focusing on a society that might and therefore will continue to ignore the role of traumatic brain injury in criminal behavior. 

You probably know some things about TBI-related behavior commonalities that might be at odds with model citizenry; you almost certainly know that the American TBI survivor ranks are increasing dramatically as brain injured soldier’s return from the wars in the Middle East.   I suspect that behavior problem growth will accompany the population explosion into the arena of misunderstanding encircling TBI. This ring is filled with short-term economic illness symptom relief and devoid of long-range cures for serious social ailments.   Not only does this state have a responsibility to protect its many (and multiplying) brain injured residents, but it really ought to shield its other citizens from what harm any criminals might do.  The possibility of assigning a non-corrective punishment to a massive swell of easily angered individuals and calling it rehabilitation is an alarming one: bad for perpetrators and those close to them, worse for an overcrowded prison system and eventually disastrous for all.    Many studies show that the majority of inmates convicted of violent crime have experienced closed head trauma.  Although Delaware is not a hotbed of violence, I’m not about to go into downtown Wilmington at 2 am.  I might be an advocate for the brain injured – I might be one of them – but I don’t wish to be murdered by a TBI community representative – or anyone else, for that matter.

 My goals in this article series are to ascertain whether the future TBI/crime problem really exists or if it only inhabits my nervous imagination. To explore the present-day legal situation concerning brain injury in this state, and to curry response from this blog’s readership so that I can address legal concerns I have overlooked.  I intend to write about the socially negative potentialities of Traumatic Brain Injury, socially controllable amplifiers of TBI’s ill effects, substance abuse among law breaking survivors, the current attitudes prevalent in the federal legal system, changes that must be made there, the changes that have occurred involving perception in both the legal and TBI communities of this state, and many more elements worthy of consideration.  In this, article #1, the spotlighted area will be broad, covering the generalities of the TBI-legal problem connection.

We at BIAD are currently putting together a “Brainstorming” issue devoted to the caregiver.  We are concentrating on the psychological adjustments he or she (or they) must make in order to effectively transform low-stress love into a high energy, active emotion.  A caregiver for a TBI survivor has to deal with a variety of character aspects that were not present pre-TBI in the loved one who needs her/him.    These guardians must learn a lot about TBI’s common characteristics very quickly.  They discover these qualities differ according to which area of the brain has sustained damage.  If there is injury to the frontal lobe, the behavioral aspects of the survivor can be affected.  The functions of the frontal lobe’s mechanisms are the control of judgment, and some of emotion.  A person affected by this might become angry very quickly and to others, irrationally. She or he may exhibit risky behavior or act impulsively.  Damage to other areas of the brain involved in analytical ability, depression and anxiety can further cause an individual to misinterpret the many factors contributing to a complete situation, thereby distorting his/her perception of an event and actually fanning the flames of a negative emotional response.  Not being able to maintain concentration, organize thoughts into the correct sequence and not remembering recent occurrences doesn’t help.  The inability to communicate this frustration to those near doesn’t make things any better, either.  “You don’t understand you can’t understand, and why can’t you understand?” are very common phrases among frustrated TBI
 survivors. The rewired brain:  it’s a very complex world in there.  Successful TBI Survival is no easy task!  Some of us, though, have easier mazes to navigate, lower walls to climb, as well as strong wills, sufficient rehabilitative services, vigilant caregivers and community support.  Others don’t fare so well.  Caregivers know these things.  General society does not.

The behavioral difficulties some TBI survivors endure, potentially heightened by awareness of intellectual deficits, or even more by lack of specific awareness, are extremely frustrating for caregivers and survivors themselves.  To live with the anguish, helplessness and fury an absence (or diminution) of life control brings (or conversely, that supplied by an unrealistic assumption of responsibility) is hard.  To display them to an uncertain society, with its far-less-flexible rule structure is, in varying degrees, not easily forgiven, especially when those behaviors present themselves at random times.  Take the example of Zack.  Zack was a great guy who sustained a brain injury by crashing his motorcycle.  He went through extensive rehabilitation and then proceeded to lead a “normal” life (by superficial standards).  His behavior changed dramatically in certain situations.  He was quick to react to perceived emotional distress, he acted impulsively, and he took more chances.  This may have led to TBI #2, in which Zack fell several stories at a construction site.  Miraculously he survived, but his antics grew more alarming.  Still, everyone around him asserted he was a great guy.  Unfortunately, those who did not know him, those who only observed him as his anger manifested itself in law breaking ways, were not up to the task of doing so.

Another example is one that is prominent in the media these days: concussions incurred in football games.  Perhaps the most colorful character in this scenario is Steelers’ quarterback Ben Roethlisberger, whose actions off the field caused much distaste and distress recently.  When approached with the possibility Roethlisberger’s questionable behavior had been influenced by multiple concussive incidents (for instance, riding around a high traffic area without a motorcycle helmet, and following a young woman into the restroom to ‘have his way’ with her) many football fans reacted with ridicule and rage.  “That’s a bs excuse if I ever heard one!!!” was the overwhelming reaction.  Well, it’s not an excuse – it’s a reason, and one that is much more productively addressed in a rehabilitative manner than as a subject for the usual criminal punishment, or disgust and derision.  That said, I once again would bring up how confounding this issue really is. 

The law itself is made up of firmly set rules.  There are acceptable behaviors, and then there are unacceptable ones.  The police are there to apprehend those who may have committed acts not in keeping with society’s regulations, the attorneys help determine just how the alleged offenders are to be punished (or not chastised) and the judges and juries make the final decisions as to what result will arise.  In between these three forces are so many gray areas that this “article series” just might turn into a multi-volume set.   But wait – those gray areas exist for everyone. When it comes to Traumatic Brain Injury, we’re introducing a whole new subset of gray.  The rules determining what is right and what is not are applicable to everyone; that should not change.  They are there to maintain a balance in organized society.  “Let the punishment fit the crime” is not apropos here, though.  Instead, the punishment must reform the offender or at least protect the citizens of the US – and of Delaware – against further incidents of it.

 

List of Sources:

Ventura, John, JD. Law for Dummies, 2nd edition Hoboken, NJ, Wiley Publishing, 2005

M. Virkkunen, A. Nuutila, S. Huusko, “Effect Of Brain Injury On Social Adaptability: Longitudinal Study on Frequency of Criminality” Acta Psychiatrica Scandinavica Volume 53, Issue 3 (1976) Pages 161–240.  DOI: 10.1111/j.1600-0447.1976.tb00072.x

Johnson, Gordon, Esq. “More on Roethlisberger, TBI and the Criminal LawJustice and American Politics Apr 30, 2010

M Brower and B Price. “Neuropsychiatry of frontal lobe dysfunction in violent and criminal behaviour: a critical review” Journal of Neurology, Neurosurgery and Psychiatry. 2001 December; 71(6): 720–726. PMCID: PMC1737651

doi: 10.1136/jnnp.71.6.720.

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Brain Injury: A Drama by Esther Curtis

August 1, 2011

I had an interesting dream the other night in which I was writing a play called “Brain Injury: A Drama.” The dream was brief, if only a few seconds (if time could be measured in dreams), but the concept floored me. I woke up thinking, “Who could play the part of the person with the brain injury?” Truth be told, I could, you could, anybody could. Brain injury survivors look like us, because they are us.

If I had a nickel for every time I hear someone say, “But she looks and acts normal,” I’d be ridiculously rich. The truth is, we are all alike in our uniqueness. Brain injury just throws an extra meat cleaver into the mix to chop up the uniqueness that’s already there. People with brain injury don’t have labels on their foreheads. Sometimes their scars are visible, sometimes they’re not. In any case, many people might be surprised to find out how many people they know that have sustained head injuries. I myself am still shocked that two of my family’s closest friends sustained different types of brain injuries – Traumatic (Uncle Wayne) and Acquired (Aunt Jane). In fact, their idiosyncrasies were less obvious than those of my parents’ other [weirder] friends.

Brain injury survivors are taught, through their rehabilitation, to create new neuro-pathways to do the job the old ones – the lost ones – once did. Brain injury survivors can become – in many cases – masters of disguise. They can “act normal” or “behave themselves” well enough that their brain injury doesn’t show. (These terms are ones that have been used by brain injury survivors when talking to me.) While I challenge myself to be different, they challenge themselves to blend in.

“Brain Injury: A Drama” may not be opening on Broadway anytime soon, but I have a list of actors who could play the main part… ANYONE.