Violence and Acquired Brain Injury - Fact Sheet
Violence can arise as a major issue in a family after a brain injury has been acquired.
Personality changes, particularly those tending towards anger and aggressiveness, place the greatest pressure on relationships. Another significant strain on relationships is where the brain-injured partner under-estimates or has no insight into the extent of their disability.
So, what is it like for a woman who has experienced a brain injury and is in a relationship with a man? There can be no one answer to this question. Some women report a loss of self-esteem, confidence and self-identity. They may question their value as a mother and wife. As time goes on, frustration can build and psychological abuse may be inflicted on the wife and mother by family members. And, of course, some women experience tremendous ongoing support from their partners.
On the other hand, a woman who has sustained a brain injury may begin to manifest impulsive outbursts of anger and aggression towards family members. Because of the brain injury, she may also be unable to perceive the effect this has on her partner and children. Responses to this behaviour may evoke similar aggression in them towards her.
Women with acquired brain injury with transient lifestyles, and who habitually use alcohol and other drugs, are perhaps particularly vulnerable to abuse by their male partners. Workers in homeless services tell me that they have found some of these women to be confused and frightened. Their memory is shot to the extent that they cannot remember where they are and where they should be going next. For some, being raped is common. They may not even remember the event, but if they do, they may be unable to judge that rape and sexual assault are unacceptable.
OK - as we are looking at violence in the lives of women and girls across the lifespan, I want to now focus on the important area of child abuse and acquired brain injury.
ACQUIRED BRAIN INJURIES FROM CHILD ABUSE
Unfortunately, for many of the children who survive, their brain injuries will not have been diagnosed. Two of the reasons for this are that there is usually little to no external evidence of trauma and parents do not voluntarily report a history of abusing their child.
Up to the age of 5, the incidence of head injury between girls and boys from this type of family violence is equal.
The problem with non-detection and non-disclosure of such incidents is that children grow up never knowing that they have a brain injury, and, of course, never receive the support, understanding and treatment they need.
So, for a proportion of girls in our society, this early introduction to violence will be part of their life story, and many of them will permanently carry its effects. Of course, this also holds for boys.
THE CONNECTION BETWEEN ACQUIRED BRAIN INJURY AND DOMESTIC VIOLENCE
Research has established a substantial link between frontal lobe damage and aggression in males. What the specific link is, is still unclear as frontal lobe impairment does not always lead to violence or aggression. However, how old a person is at the time of the injury has been identified as a significant factor.
Young males with chronic brain injury are more likely to continue to be violent as they grow up and to be more susceptible to alcohol and other drugs, adding to the likelihood of involvement with the criminal justice system.
A factor that can be quite disturbing is that many of these young males do not know that they have an acquired brain injury as they have never been diagnosed. It is not too far a leap to suggest that some of these young males received their initial brain injuries from violence in the home that was never revealed or identified. Indeed, research has shown that violent adult male offenders tend to have neuropsychological indicators of brain damage and have had histories of severe head trauma.
There is a correlation between acquired brain injury and men who batter their partners. However, it is unclear whether a brain injury has a unique role in domestic violence or whether it is one of several factors, including an anti-social personality. Research has suggested though, that men with acquired brain injury “are at risk of subsequently becoming aggressive in their relationships with women”.
Head trauma in women is a serious outcome of physical abuse by male partners. Unfortunately, the scope and residual effects of this type of injury have not been studied. Women who enter women’s shelters or refuges frequently report that they have received blows to the head and have been unconscious. This suggests there is cause for concern that workers in these shelters may not be experienced in identifying an acquired brain injury, or know how to support these women. It is vital that women who have been battered by blows to the head and who seek help afterwards, either from medicos or women’s refuges, are either identified or are encouraged to determine whether they have incurred a brain injury. This may mean workers in shelters sometimes taking a proactive role.
General practitioners, emergency hospital departments, social workers, refuge workers must be trained in how to recognise and to assess the possibility of a brain injury. And refuge workers need to know how to support these women. Why?
- Because a woman who has suffered a brain injury may not have the ability to make an informed, consistent choice of whether to leave or return to her abusive partner
- She may have a lessened ability to plan for her and her children’s safety
- She may be unable to abide by the refuge’s rules
- Her ability to take steps to obtain training or employment may be compromised
- She may also receive inappropriate referrals from well-meaning refuge workers which may actually compound her problems.
It is important to realise that subtle brain injury can be harder to assess immediately after a violent incident because the symptoms may appear weeks or months later. A particular difficulty for women who habitually use alcohol and other drugs is that their brain injuries may remain undiagnosed as certain behaviours are often assumed to be related to substance use.
This is all the more reason to ensure that workers in relevant areas receive sufficient training in acquired brain injury. To date it would seem that any major discussion about women with disability and their access to women’s refuges has been about ensuring physical access. Now, for obvious reasons, this needs to extend to women with acquired brain injury.
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