Emotional Issues Associated with BI
Changing Roles in Families
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We often think of brain injury as affecting the injured person primarily or even exclusively. The focus of attention in terms of medical care, rehabilitation therapies and return to the community rests upon the person with brain injury. Although the adjustment of the family to caring for a loved one with brain injury is frequently addressed through the process of brain injury rehabilitation, it is easy to overlook role changes in that family.
Changes that occur in families are much like thinking about a closed glass tank filled with water, with two plungers that go into the tank from the top. Before brain injury, the plungers are at equal levels. After brain injury, one of the plungers is pressed in (i.e., more responsibility is taken on by that family member) whereas the other plunger is lifted (i.e., the person with brain injury is less able to fill some of the original roles). Soon, a new balance level of these plungers occurs though the configuration may look quite different than before the injury. Some roles such as the management of financial matters may change suddenly after brain injury (e.g., home budget management is now taken over by the spouse of a person with brain injury), whereas other roles may slowly change across time (e.g., the father with brain injury no longer takes the initiative to engage and support his children in after school sports; now the mother is the one to initiate and take charge of this aspect of family functioning). There is often a change in the balance of initiation, emotional care taking, and everyday management of activities in the household of a person who has brain injury.
In couples and families whose spouse or parent has sustained a brain injury, there is a significant increase in the number and breadth of responsibilities that are taken on by the other spouse or parent of the person with brain injury. This is mostly out of necessity and the need to keep the family running despite the reduced capacity of the person with brain injury. If the person with brain injury happened to be the breadwinner, that person’s spouse may need to find a job or work more hours in order to make up for the financial losses that are associated with brain injury.
Much can change in spousal roles and parental roles in the family. Spouses who take on caregiving responsibilities for their injured spouse may feel and act in ways that appear to more parental rather than in a marital role. Many spouses will attest to the fact that they feel more like a caregiver or parent rather than as a husband or wife. The same changes in roles occur for those in other couple relationships as well. What may have started out as an equal partner relationship in terms of emotional care, financial management, initiator of fun activities, or planner of social events, may be taken more fully by the non-injured partner.
Children are often placed in similar role reversal and new role taking situations when a person in the family sustains a brain injury. A sibling with brain injury may receive a significant amount of attention and care, and sometimes enlisting the help of other siblings may be necessary for household tasks to be done. These may be new roles for the uninjured sibling. Sometimes roles of supervision and being an extra helper in the house for the person with brain injury leads to what some have called the “parentified child.” Such child act in parent roles out of a need for getting things done at home.
Each of these situations has the potential to produce significant conflict and stress in the home environment. Family members who take on caregiving roles are at high risk for experiencing stress, burden, and burnout. Those who experience significant caregiver burden often suffer from physical ailments due to a vulnerable immune system. Others may feel depressed and anxious, and have associated sleep disturbance and fatigue. In the same way that it is important to take care of the person with brain injury with regard to mood and stress, it is equally important for caregivers to have times of respite and ability to recoup energy. This may require planned respite times by getting friends or other family members to temporarily assume caregiving responsibilities. Treatment of mood problems in family caregivers may need to occur. Couples therapy can be helpful finding a new balance in roles that now are creating conflict. Family therapy may be helpful for these same reasons. On the practical side, it may be helpful to problem solve ways to assume former roles or to find ways to redistribute responsibilities that reduce tension and lead to a new level of balance in family roles.
Jay Uomoto, Ph.D. is a Professor in the Department of Graduate Psychology at Seattle Pacific University and teaches neuroscience, personality and rehabilitation psychology courses in the Ph.D. Clinical Psychology Program. His research emphasizes the neuropsychology and multicultural aspects of traumatic brain injury, long-term care patterns in older Japanese Americans, as well as studies in interpersonal changes after brain injury. Dr. Uomoto is certified in Health Care Ethics. He also has a private practice in neuropsychology and rehabilitation psychology.