Acquired Brain Injury (ABI) is a very common injury, almost 400,000 per annum in the UK alone. The issues in connection to ABI are not always physical, although a majority can be. ABI is deemed the ‘Hidden Disability’ due to the underlying factors connected with it. These factors have an ongoing and traumatic affect on those personally injured, and those people, in contact around them.
I will give a short explanation of some of the factors that also lead to people getting into trouble with the law.
Emotional Instability, the key to most issues of offending, can be explained by understanding that at a young age, we learn how to control our emotions, the ‘terrible twos’ is the age where a children begin to feel these strong personal emotions and in time will learn how to manage and control them; mainly through the guidance of those parents and guardians involved. After an ABI, a person can become overwhelmed by these same emotions, due to the brain being hyper sensitive. Anyone trying to deal with this emotional saturation and overwhelming lack of control needs to relearn how to deal with them.
The causation of many of these issues can be through simple behavioural changes brought on by the brain injury, a direct issue with the executive functions. If you imagine taking a toddler tantrum and putting that into a fully-grown adult, who has the same knowledge and experience of growing up but is completely over powered by the emotion! A severe conflict could appear within them; this lack of understanding and control usually leads to anger and occasionally violent outbursts. These are not the actions of someone who is malicious or deviant in any way, this is simply a biological response of the Fight or Flight system that is hard wired into our brains. An autonomous response from the autonomous nervous system in connection with the limbic systems reaction within the mammalian part of the brain.
These cognitive and emotional effects can be brought on through the direct trauma of the injury, or through frustration on dealing with physical symptoms connected directly or indirectly.
A large number of ABI sufferers, especially males, will struggle emotionally with anger and frustration, they may possibly get onto the wrong side of the law due to the form of injury they receive. It could simply be down to physical contact through a sport injury or an assault or due to the sociological expectations placed onto younger men to act certain ways, but men are 1.6 times more likely to receive and ABI.
You will also find that a need for a regimented system of coping is put into place to manage these emotional outbreaks and that can be where the issue of re-offending can come into play. Not necessarily through a need to return to the prison environment, but through the inability to cope with the sensory overload of returning to civilian life. A very similar issue with the military has been reported on the life changing effects, which is why the military offer lifestyle retraining.
The same extreme emotional issues lead to acute bouts of depression, hopelessness and worthlessness. If you add in the mix the fact someone has been charged with an offence that they feel they had no control over, these negative feelings can increase drastically.
Self-isolation is common, through fear regarding the possibilities of what may happen, a struggle against knowing that issues created within the mind can increase to paranoia and even lead to agoraphobia.
Connecting with people from the past can be difficult after brain injury because on occasion people have changed their way of communicating, without actually realising that the change has happened.
A person with a brain injury is usually one of the last to know what the full effects of their injury is, though those close by and within their social circle are likely to notice. Unfortunately issues can appear when the information isn’t passed back to the individual and people ‘protect’ the survivor. The common “oh he/she has had an injury, just let it go’ comes into play, but then that person themselves are not aware of an issue it can increase with time.
Breaking bonds with family members and old friends happens through several reasons, the difficulties in understanding that the injury is on the inside and can’t be mapped, or that is can be graded and explained. This is difficult for people to understand and the cause of many relationship break downs.
Brain injury is a very difficult injury to deal with, once the bruises are gone and there are no physical signs, people can not understand what the issue is, the injury can be life changing and becomes a psychological drain, as well as an emotional roller coaster; yet how can it be demonstrated or understood without going through it?
I personally used 2 analogies during recovery:
“It would be easier if I had ended up in a wheelchair, because at least then I would be judged fairly”
Why did I say this? When you look ok, and people can’t see massive physical issue, there is no understanding and no tolerance for any out of the ordinary behaviour. When someone sees a severe physical issue, they automatically give allowances. A person surviving an ABI still needs that level of allowance and understanding of the difficulties they struggle with daily.
“When you’re looking outside a window, you don’t know what is painted on the wall around it on the other side”
When you have had an ABI, you still think you are acting and speaking the same as you always have done, but to those that know you, you may not be. You may seem angry, mean or inconsiderate, yet you are blissfully unaware that you acting any different to how you have always done,. Leading to not understanding why people are being different around you. This is where the inured person has to look for reasons why people seem to be acting differently.
These new life mannerisms, and ways of acting don’t always go away either, you can be an intelligent, literate person that on a day to day way comes across as sensible, pro-active and empathic to others needs, but that can change as quickly as from minute to minute, or from hour to hour. Being overly tired can cause just enough confusion to create the anxiety that is normally held in check.
Overloading the mind with too many thoughts can raise the levels of stress to stimulate the fight or flight response and people just see the over reaction, the temper or explosive responses. Managing the daily routines, doing the same tasks as everyone else at the same time, is a success. The brain can struggle to maintain levels of focus, conscious thought or remember simple tasks and routines.
Richard Hammond, the TV presenter, suffered a terrible accident while filming, and wrote a book. Within this autobiography he stated he wished he could wear a t-shirt that had “Yes, I am fine” written on the front, but would have “No, I’m not” written on the back. Because outwardly the impression an ABI survivor wants to give is that they are ok, they are managing, but inside they want to know people are there, to understand that it’s not ok, there are problems and it isn’t easy to maintain the same levels of function. It can be very difficult and extremely draining.
So where does all this come into play in regards to offending?
By following a bespoke and individual process; working with those who have offended due to issues raised by an ABI, or those who have acquired an ABI whilst within the prison system, we can focus on dealing with the issues and symptoms caused by the injury that may be likely to increase the likelihood of re-offending.
Stabilising emotional and executive function, focussing on the individuals’ changes and creating coping mechanisms, as well as creating awareness and understanding within the prison service. This will offer insight and valid practices to maintain a steady and calmer approach by the system and staffing members within.
I have personally help educate family members, friends and even Managers within workplace, to be able to help and offer support, knowing that with some very simple strategies in place, a person who may come across as aggressive, violent or out of control due to their injury, can once again regain control, relearn the early life skills and move forwards within their own lives.
In the UK a card has now been introduced, produced by Headway UK where those who have suffered a brain injury can show it to allow those who are unaware, that there is a problem. These cards are supported by the Police force, which means that there can now be awareness offered, a little bit of understanding, and maybe just a few moments that a survivor needs to regain control can be given, without it being misunderstood as an aggressive response. This should be publicised and promoted, maybe then other Countries can take it on board but maybe, just maybe that small amount of understanding could also prevent ABI survivors ending up on a downward spiral of offending and reoffending through simply not being understood.