We also were blessed to talk with six separate brain injury survivors and to encourage them. One area of brain injury that we discussed was how anger can be uncontrollable at times. The unaffected brain has the ability to “gate” life’s experiences. We can be approached by a situation and feel the tension rising. We can decide to stop the discussion when we reach a seven on the anger scale so it doesn’t escalate to a full-blown rage. However, the brain injury survivor doesn’t have that “gating” ability. He can experience calm in his life, and then when he feels threatened, frustrated, or frightened, he can go from a one to a ten in an instant and explode uncontrollably. When the gating mechanism doesn’t kick in, he feels an eruption of emotion before he can recognize what is happening—and it’s too late.
Anger after a head injury is quite different than “normal” anger. This type of anger tends to have a quick “on” and a quick “off.” The person can be in a good mood until something small irritates him, and he suddenly gets very angry. This anger doesn’t seem to last very long. The person can be angry for a few minutes, and then quickly stop being angry when someone changes the topic of conversation.
The caregiver can be caught off guard with this type of anger. The difficult part is to keep in mind that this is a brain injury reaction and that the caregiver can't be caught up in the argument. Instead, the best thing to do is keep quiet, don't feed the survivor's anger, and walk away for a few minutes, if possible. Distancing yourself until calm is reestablished gives the loved one a chance to return to calm on their own. It's a crazy balance of being a caregiver, nurse, therapist, and psychologist all at the same time!