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Anger and Resentment

Anger and Resentment

Many people struggle with their feelings and emotions following a brain injury.

Sometimes this is linked to previous personality traits, sometimes to the psychological effects of trauma, and sometimes to the loss of control of emotions caused by damage to the frontal lobes. The breaking of dreams and missed opportunities to grieve and come to the point of acceptance can all add to the frustration and anger that people can feel. Some or all of these could be acting in combination along with the biological changes addressed below.

There is no one reason or absolute rule or statement about anger following brain injury that fits all. The only person who can understand the real source of your feelings of anger or resentment is you. Working this out can take time, and people often need the feedback of a specialist such as a neuropsychologist.

Sometimes people on the outside are quick to blame personality or an inability to deal with often massive life changes and the trauma; however, impulsive outbursts can directly relate to neurological damage, which inhibits the ability to control impulses.

If the anger begins soon after the brain injury event, you may notice that episodes come and go quickly and often leave people feeling embarrassed or surprised by the outburst. When someone is also struggling with a lack of self-awareness, they may be oblivious to the episode and may carry on as though nothing out of the ordinary has happened or may feel overwhelmed with confusion.

Most probable cause

If it feels like none of the above applies to you, then your ‘angry’ feelings may purely be a result of the damage inflicted on your brain environment by your injury. Did you know that the toxicity caused by a brain injury together with the biochemical reactions of the central nervous system to insult, can affect the environmental health of your whole body and your thinking? The secondary damage occurs immediately after the initial injury and turns on an inflammatory response resulting in a biochemical cascade that continues unabated until addressed.

A brain injury can also cause intolerance to some foods, especially inflammatory ones such as gluten and highly processed products. Salt, sugars and additives in food can upset the balance of gut flora and the brain injury biochemical cascade also significantly impacts the balance and health of the gut microbiome.

Scientific studies show clear links between the gut microbiome and mental health and mood. The biochemical cascade and neurological damage can exacerbate behavioural and mood responses.

Inadequate supplies of vitamins and minerals in the diet can also affect mental health. It is crucial that you look at everything and don’t jump to conclusions, especially for people with severe brain injury who may have difficulty with communicating.

Vitamin D is a critical component of neurological health and is associated with mental health issues including following a brain injury. Studies show that an estimated 50% of vitamin D reserves are used in the first 14 hours after a brain injury and those with low levels of vitamin D were shown to be more likely to have continuing problems. (1)

Whatever the cause, there are things that you can do for yourself. A neuropsychologist can help you understand the reason for anger and resentment. If you are not already under the care of a neuropsychologist, speak to your doctor and ask for a referral. Your doctor may want to try using medications to ease symptoms; however, bear in mind that these will not heal the underlying cause, but may hinder your feedback systems.

The role of personality

A pre-existing pessimistic personality may predispose people to exaggerated instances of anger and frustration following a brain injury. Life post-injury may be tougher for people who naturally see the world as a half-empty glass. A brain injury may act positively as the impetus for introspection and a desire for change.

A study by the University of British Columbia has shown that a previously known gene, ADA2b, can influence the perception of life. Previous research showed a correlation between the gene and norepinephrine, a neurotransmitter, and the formation of emotional memories. The gene has been shown to amplify negative experiences and emotional events.

A study by Professor Tim Spector indicates that our genes control around half of our personality tendencies. Other studies show that we can influence around 10% of our personality through mindfulness. The remaining 40% is influenced by environmental factors. Genes can be ‘switched’ on by traumatic events, and they are continually being ‘dialled up and down’ in a process known as epigenetics.

Current science is corroborative of transformative psychology in which there is a held belief that there are two major aspects of ourselves. One is the soul, essence, innate self, authentic spiritual nature or ‘individuality,’ and the other is the personality or persona, as Jung called it.

As we grow up, our experiences and influences condition the ‘authentic self’ and usually, by the time a child reaches five to six years old, this part of us, in the most part, is hidden or forgotten.

In the personality, which operates by habit or ‘automatic pilot,’ thoughts, emotions and behaviours arise as habit-driven impulses which work in a continuous or predictable and familiar flow prior to brain injury. Much of the anger and resentment felt by people living with a brain injury may be due to hidden alterations to this ‘auto-self’ causing profound frustration.

Many people who are living the experience of brain injury describe it as feeling as though they have no control over their impulses and as though some alien has taken over making them do things differently, or causing them to act in ways that everyone perceives as being out-of-character.

Many aspects of human nature and psychology make up the psyche of the human being. One of the most prominent thought hubs is belief and these act as innate drivers. Many of our thoughts and decisions are created by our beliefs, which act as anchors and feel absorbed and familiar. Even without a brain injury, negative beliefs can ripple out into our behaviours and actions, sometimes without our conscious awareness. Everyone has specific characteristics that all add to who we are and influence our personality.

Many people ‘learn’ to have adverse beliefs about themselves from others, and this influence can affect thinking and behaviour. Not all feedback is authentic. Sometimes other people have impaired views of the world. Learning to gauge the difference between what you think and what others have ‘planted’ can lead to a healing path. We are all made up of incredible characteristics, sometimes allowing them to surface is about choice and determining what is right for you. No one else can see into your heart and mind the way you can.

However pessimistic your view of the world may be, perhaps because of your genes or because of your upbringing, the authentic self remains untarnished, and as no life experience can erode who you truly are, it is always yours to reclaim.

Releasing the need to keep ‘inner accounts’ or tallies of the wrongs that have been done to you is one place to start rebuilding the authentic self. Negative influences such as blame and judgement are actions we carry out when we feel threatened or in fear. There are always other avenues of perception to explore. Becoming more mindful or more conscious of your behavioural patterns can help you find inner freedom and release from old patterns that no longer serve who you are or want to be. Learning to be still and watch the ‘old’ self go by before consciously choosing and action allows the authentic self to gain greater purchase and influence in your life.

Added to this, we all have an innate survival mechanism. If we pause and think about where this comes from we start to see a picture of why we keep battling on even when we feel exposed or distressed by post brain injury behaviours.

Why have you gotten to where you are today despite all the things that have happened to you? Tenacity is one of these innate drivers, and it can keep us going even when we are apathetic and unable to push past the doldrums in daily activities. Tenacity also drives us when we no longer have access to our memories, our history and experiential self. The brain is always ambitious because it is compelled to ensure survival.

People are way more informed now than they were in previous generations. We all have greater awareness about what makes us tick; however, unless we are good at introspection, we may get caught in a negative circle that is challenging to break free from and change.

Every manner of life-story can come before a brain injury. Everything from abuse to neglect and poor parenting, lack of love and guidance, to living in a loving and supportive family in a healthy environment can add to who we are. Our experiences combine into a myriad of sponsoring beliefs which can become entangled or exacerbated by a brain injury.

The brain perceives associated thoughts as facts, and so it can be challenging to recognise negativity. In other words, our brains believe whatever we tell them. The brain doesn’t make conscious choices; we do, the mind does, the thinking voice in the head, or mindful narrator, is the controller if we choose to use it rather than let it overrun us. Our brain is a tool that we use. When we have conflicting data, our biology will tell us. It is doing this when we feel confused, uncomfortable, as though we want to escape, and through irritability, frustration and anger. These responses are emotional messages directed at ourselves to let us know that something is awry.

Often we need to rely on trusted feedback from others to begin to understand how our thinking patterns affect our outlook. A neuropsychologist will guide you through understanding your feelings.

At some point or another, to have a fulfilled life, and to feel like the ‘real’ you – you have to go through a process of working out what is real and authentic, and what is not. Your willingness to address your perspectives is imperative to finding your inner balance and calm. It can help to use meditation and mindfulness techniques after a brain injury to help ‘disarm’ the dominant power of the personality.

The process of calming the auto-pilot or driving personality can be complicated when the brain is injured. However, many inspirational people have done this. If no one has ever told you that the only reality that exists is the one inside you – you may always look to the outside world – and the people in it – for your answers. Your views of the outside world may cloud your judgement and strongly influence you without you realising it.

External realities are always subject to conjecture. We all see the world around us in unique ways, and from this, we form opinions that we believe to be ‘right.’ When we make something ‘right,’ we automatically make everyone else ‘wrong.’ It is better to notice the differences and to utilise conscious choice to determine preferences for happiness and congeniality rather than to prioritise superiority. When there is disagreement, there are usually accompanying frustrations, and a refusal to release opinions long enough to listen can be damaging to the self and relationships. It is better to accept that others have a different view and to let go and release any need to be affirmed by others. Everyone has an inner authenticity gauge.

Two things tend to keep us ‘stuck’ in our opinions. One is when we have unconscious needs, such as feeling we are not being treated properly or are not appreciated or recognised. The other is an inner unconscious or conscious need to ‘keep score’ of how we have been harmed by others, which often leads people to feel that they are owed an atonement to rebalance things.

We see we world out of personal windows and the frame of these ‘windows,’ are constructed by our beliefs. With help, we can leave behind thoughts that no longer serve us.

Tenacity

You may have been taught or came to believe at some point that certain aspects of personality are far from being a part of who you are. For example, have you been taught that you are less than other people and are not intelligent, honest, reliable or determined enough? The only thing that sustains these beliefs within you is the choices you make about them. You have the freedom to choose, and you have all of these qualities within you. We all do.

Life events may have corrupted, watered-down, or dismissed your sense of self. You may often feel anxious or as though you aren’t worthy, but, the truth is the thing that makes you think this way are your emotions. We almost always misunderstand our emotive responses.

Inside you know your negative thoughts are without any base of truth. You know that you are as ‘worthy’ as the next person and that you have just as much to give as everyone else. You keep telling yourself this but when you do ‘life’ seems to find a way of putting you back down.

This see-saw effect is what unsettles your thinking and even upsets the feelings you get in your tummy. You put these down to being anxious – but the reality is that they are an indication of something being amiss in your belief system. Emotions are messages from the brain, telling us that our beliefs are not balanced.

The only way that the brain has of talking to us is through our emotions. Few people understand their purpose, and few understand how to deal with them.

The brain is a logical thing. It wants everything to ‘match-up,’ and, when it doesn’t, we end up in inner conflict. The brain ‘matches’ our current thinking – the data concerned with our ‘living’ beliefs – to our ‘innate’ and learned beliefs, and it does this continuously. Where there are infractions, the brain lets us know by creating a biological response. When we listen to this ‘inner feedback’ and treat it is a tool we can use, we can begin to understand and work out where there are mismatches in our internal data.

Whether we understand or believe it, the brain is inordinately remarkable. Even when it is ‘broken’ as the result of an injury – those innate aspects, such as tenacity, keep firing.

The brain has one primary objective – to sustain life.

For it to do this, we are all tenacious by design. Our design is to survive, and tenacity means that we keep searching and never give up.

Managing anger

How we manage ‘anger, rage and resentment’ post brain injury very much depends on the cause. The prevalence of pessimistic thought can be more significant, as can be the ‘power’ of the personality.

When the personality has a higher position of power than the authentic self, there is more likelihood of a judgemental character and less prospect of introspection. The ability to self-observe can be lost, and self-pity can take hold.

It is crucial to address responses to trauma, ambiguous loss, and negative emotions as soon as possible so that they do not fester and harm relationships and self-esteem. Try to remember that it is okay to feel anger, you have been through a lot, but learning to manage negative emotions in the early stages will help you avoid explosive behaviour. Understanding and getting anger and resentment under better control will also help you to notice executive impairments because your emotions will not get in the way clouding your view.

Try to recognise triggers such as when plans are changed, bright lights, noise and unexpected or persistent loud noise, or when people don’t respond to you in a way you feel is understanding or appropriate. If you have also been diagnosed with PTSD expert help is critical. Your neuropsychologist will refer you or manage this.

There are also many hidden triggers such as anxiety, fear, worry, embarrassment, shame and guilt. Being told that you are doing something wrong can also spark anger because of preceding frustration.

Feeling defensive or argumentative can be a precursor to feeling angry. If you can learn to notice the early signs, you can learn techniques that help you manage situations before you explode. Managing better may be taking time out, deep breathing or finding solitude to do something relaxing or to vent in a journal.

Discovering impairments for the first time can also lead to emotional response. For example, noticing confabulation where you misremember things but believe them to be true. Confabulation is commonplace and is the replacement or filling of a gap in memory with incorrect information you believe to be true.

Other factors can also be involved. For example, alcohol and drugs, caffeine, sensitivity to chemicals, reactions to medications, pain and fatigue can all add to or cause angry outcomes.

Don’t forget; there can be legitimate reasons for anger. These issues must be approached, preferably with the help of a friend, family member or through talking therapies. If in doubt, seek the guidance of a neuropsychologist.

Managing anger for families

It is important to remember not to take anger responses personally when they are due to the injury.

There are several strategies you can use to prevent emotional explosions and whenever possible, talk to and explain these so that people don’t feel controlled or chastised. Memory problems can make management more complicated, and in these cases, it can help to have a whiteboard in a prominent position which notes points to remember.

These points often work best if they have been written by the person with the injury as even if they have forgotten what was discussed or agreed they will recognise their writing and are more likely to accept their agreement was reached. If you think you need professional help, speak to the case manager or presiding neuropsychologist who will point you in the right direction.

It may be necessary to change some things around in the home to make the environment safe. For example, you may need to lock power tools or car keys away. It is always best to remove any alcohol, drugs, medications or dangerous/harmful chemicals/weapons. Take a look around and try to prevent dangerous situations arising.

Each person will have different needs, and these will change throughout their recovery. You may need to be aware of providing reorientation or of phasing strategies in and out as they are required. For example, some people may need stimulation and to be kept busy while others may be frustrated if they are asked to do too much because of aggravating symptoms such as headache or fatigue.

While people need to be kept safe, it is also vital to provide the least restrictive environment possible. Finding a balance with activities or introducing new interests or pursuits can help people pass the time while healing. Talk to other people or join a support group for ideas.

Misperceiving or misunderstanding a situation can raise levels of confusion, frustration and disorientation so it can help to frequently remind the person about the strategies you are using together and to talk about what is happening and why.

When someone does become angry, it is time for you to withdraw. Make sure the person is safe and let them know you are giving everyone time to calm down and to think things through. Ask them if they would like to write down their thoughts or any points they would like to make so that you can read these through later.

Even though it can seem unfair, you must remain calm. There may be many instances when you feel unappreciated or as though there is no recognition of your needs. At these times, it can help to remember that your loved one is doing the best they can. They no longer have the thinking capacity or knowledge they once did, and it can take time for these aspects to return.

Pre-existing relationship problems can continue after the traumatic event and can sometimes be exacerbated by it. As the uninjured person, you may need some time to address your priorities and to think about what matters the most now.

If you can, catch a potential fuse before it is lit so much the better. Try using distraction techniques such as changing the subject/activity or location you are in currently. If you can clear up misunderstandings, then do. If your loved one is aware that you are distracting them let them know that you would like time to think and that during the time out they can do likewise.

People may need help verbalising how they feel. A neuropsychologist or neuro occupational therapist will be able to help. People may also need much more time to be able to work things out or get to the first stages of understanding.

Where appropriate remind the person of what was happening before they became upset, perhaps they were about to start an activity that they can now go back to doing. Reorientation can help people find their place in time and can also help to avoid frustration later on when they remember what they were trying to do on their own. If it is needed, offer reassurance or help people to fill in their memory gaps so that they feel calmer.

Looking for solutions

Consideration of the effects of the biochemical cascade on vitamin and mineral reserves and also the effects on the gut-brain axis are important components to be considered in managing anger and other mood disorders following brain injury.

Please speak to your doctor and ask for:

  • full blood counts so that you are aware of any micronutrient deficiencies
  • advice about prebiotics and probiotics as changes in the gut can inhibit the manufacture of important neurotransmitters
  • medications – some can have adverse side effects
  • pituitary function – changes in hormones can also inhibit the manufacture of important neurotransmitters

Things to try at home:

Resources:

It’s Not Easy Being Angry — Acupuncture Works With Anger Management Issues

Psychological Science – Genes for Emotion-Enhanced Remembering are Linked to Enhanced Perceiving

BBC News Magazine – Can science explain why I’m a pessimist?

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