Malingering in Perspective
Even for a healthy brain, the task of knitting facts to knowledge isn’t a straightforward affair.
The critical component in gaining insight is experience. However, it becomes very challenging to connect the dots if this is lacking. It isn’t easy to connect to awareness if you don’t understand the links.
As a result, gaps exist between perception and understanding. The typical outcome of poor perception is usually poor judgement. Judgement without full consideration of all the details always creates a lack of empathy – we are creating opinions without knowing all the facts.
Subsequently, our perceptions can easily fall short of wisdom.
Let’s consider an example. Great uncle Tom has been smoking all his life and has been diagnosed with emphysema. He makes the conscious choice to continue smoking, and as such, he creates a situation that stops others from being able to help.
Tom is fully aware of the facts; he has digested them, and based on all the criteria he wants to include, he makes his decision for himself. Tom has the cognitive and memory function to make this independent choice.
Tom’s family members could react in different ways. For example, some will accept that Tom must make his own choice, while others may be upset or angry that he isn’t thinking of them.
Assuming everyone has a healthy brain, the most likely reason for the differences in reactions is personal experience.
Experience allows us to empathise, and those who have made the many personal choices for themselves, will have a greater appreciation for the reasoning behind Toms’ decision.
Sometimes people will feel they are unable to support a particular decision or reaction made by someone else, and therefore, may lack the flexibility to see how they can help in other ways.
Now, let’s consider what happens if someone living with a brain injury responds in a way that looks like they made a conscious choice or decision.
Tom had the cognitive and memory function he needed to process all the details that were priorities in his conclusions.
On the other hand, it is doubtful that someone living with the effects of a brain injury can:
- Understand priorities
- Include memories in their understanding
- Link their experiences to what they are trying to work out
- Understand the importance of a decision they are making
- See likely outcomes or consequences
- Include the opinions or incoming information from others
- Understand the effects of their actions on others
- Process multiple facts
- Maintain the attention they need to think things through fully
- Stay focused on what they are trying to think about
- Summon the energy to care
None of the above impairments reflects the person that family and friends would have known before. However, many judgements about a survivor are habitual so, sometimes family and friends act without full consideration.
It is very often the case that the survivor does not understand the depth and range of their functional deficits. They cannot understand or explain what has changed because of the deficits they are experiencing.
So, while healthy people can struggle to knit facts to knowledge, this skill is usually impossible following brain injury.
Huge gaps exist, and it can take the survivor many years and decades to rewire the brain and regain familiar or more normal levels of functionality.
What people judge as malingering, is more accurately, the very best a survivor can manage.
People living with brain injury outcomes are often caught in a perpetual struggle to hang on to the periphery of the everyday world by their fingertips. This battle needs acknowledgement and acceptance of the impossible divide created by a lack of shared experience.
Tips for transforming family understanding:-
Take a break, take a breath, and pause or stop. Allow time for the survivor to process perspective and understand their emotions and inner environment.
What may seem appropriate or fair to you as a response, might feel like undue pressure and trigger an inflamed emotional response in a survivor.
Give the survivor time, and reconsider your expectations.
Before the brain injury event, certain norms in relationships will have existed. Expectations will need adjusting; it helps to be conscious of adapting to change.
You may find other relationships strengthen as people rally to support you. Reliance on people outside of the home is about courage – not dependence or an inability to cope.
Survivors rely on routine and predictability to feel safer and calmer: daily living structure is crucial to well-being. They rely on others to provide this.
You can use phrases such as ‘okay,’ to avoid saying what you think and feel. Responses which include ‘over-reacting,’ ‘over-sensitive,’ or ‘over-emotional,’ can act as triggers producing more of what is better to avoid.
Recalibrating how you communicate is conducive to rewiring and encouraging rehabilitation and healing. People do better in safer and calmer environments where they feel their needs are understood and supported.
These needs don’t result from conscious desire, but come from a much deeper and hidden psychological condition of the wounded brain.
Assignment of Reason
Attributing blame, for example, to behaviour, reactions or even someone’s upbringing, is no longer valid. The reason behind every change you are dealing with is the trauma, damage to brain structures, and physical changes.
Inflammation follows the brain injury event and leads to a disease-like state producing multiple chronic symptoms.
It is human to need to be understood. Our survival relies on our social inclusion, and acceptance plays a huge role in the well-being of everyone.
In the fast and furious world we share, we can struggle with feeling our own needs are met, let alone trying to meet other people’s. Families may need to turn to others to feel listened to and empathised with instead of relying on the survivor. However, families still need to fulfil the need for empathy and understanding in survivors without the expectation of reciprocation.
Dynamics will change, and the more is understood, the better families can deal practically with changes to habits and behaviour.
People generally struggle to make sound decisions following a brain injury; however, this does not exclude them from wanting to run their own lives.
It is imperative to include them in everything that affects them, as denying control and choice can trigger a range of possibly long-lasting issues. Involvement helps people feel recognised, and the time it takes to confer over decisions is much more efficient, avoids unnecessary wounds, and is conducive to everyone’s well-being.
Rearrange your schedule to allow ‘you time.’ If you become frazzled, your ability to manage, and your health, will suffer. Don’t be proud! Accept offers of help from as early on as possible.
In closure, let’s return to malingering for a moment.
Your reserves will be fuller by learning and understanding the underlying causes of change: the clearer your perspective, the better your lives.
If you see the results of injury; you will no longer see malingering.