It’s All In Your Head – Returning To Work With A Traumatic Brain Injury (TBI)

Learning to read at 33 was a challenge. As a self-proclaimed word nerd with a minor in developmental psycholinguistics, and holder of the family Christmas Scrabble tournament trophy eight years running, (it was actually nine, since the play by my sister was illegal, and I can prove it, but who’s counting?) it was disconcerting to say the least when I found myself struggling to string together a sentence. Or forgot the word for “coffee” in a coffee shop. Or unable to recall a simple list of five grocery items. It was a humbling moment, sitting with my young son, realizing that he could follow the story of his kindergarten reader much more fluently than I could. The frustrating part was knowing what was lost, and just how much I had to regain.

Losing grip of my language, and my life, happened suddenly following a quite frankly embarrassing accident at work involving a poorly placed chair, the corner of a metal desk, and my skull. Security cameras documented the moment of impact, but not the simultaneous loss of my job, my mental health and my sense of self. All swept away quicker than you can say “oh, I’m sorry, you’re not eligible for long term disability” …

Being suddenly unable to work in a world where such a large part of your identity comprises employment is devastating. Individuals who experience accidents at work consistently report troubling symptoms of depression and anxiety concurrent with having to deal with symptoms caused by their accident. An enormous 75% of people who experience a TBI develop a psychiatric diagnosis within five years. As many as 57% of these are first-time diagnoses, unrelated to a pre-existing condition. The most common of these diagnoses is depression, with over half of those with a TBI experiencing symptoms within a year. Many individuals face loss of identity, income, and sense of self, breakdown of relationships, post-traumatic stress symptoms, and language and cognitive impairments. It’s a terrifying laundry list, made even more difficult when coupled with the dismal statistics surrounding returning to work, and recovery of function.

Becoming disabled I felt robbed of my future, and angry at the system. Having to re-engage and rebuild on some days felt insurmountable. Some days it took everything I had just to get there, to sit in front of a professional who would admonish me for being late.

At this point, If you are sat across from me trying to gauge my functioning – I am angry at you. I am angry because you represent loss. Look at you, put together and successful with a job and a future. I don’t want to engage with you because you remind me of everything that I am not, everything that I can’t and everything that I don’t. You are the embodiment of my grief, the personification of my anger, and the target of my vulnerability which is currently manifesting as ambivalence because it feels safer.

If you ask me where I see myself 5 years from now, I have no idea, because I am still bewildered at how I ended up where I am now. I am still raging at the loss. I am still grieving over how unfair it all was.

I taught kindergarten, but I can’t do that anymore because I can’t remember the children’s names, or how many I have in my care. I struggle to order at Starbucks, and don’t trust myself to engage in proper safeguarding. I have sticky notes to remind me that I have potentially sleeping toddlers in my car. I cried on the way here because my GPS dropped out and I got lost.

Ok…what else? Well, I worked as an assistant psychologist in a psychiatric hospital. But I can’t do that anymore because I can’t stand for an extended period, or I can’t hold numbers or stats in my head, and I can’t recall how to run the programs correctly.

So, what can you do? Well, right now, it feels bleak and hopeless.

The switch was flipped for me with a professional who acknowledged me. She validated my sense of loss, and utter despair. She held space for my grief, and celebrated the fact that I got there at all. She reminded me that We all find ourselves in places that we need help to come back from.

The treatments for post-concussion symptoms and TBI are many and varied. Recovery of function is not necessarily linear, but a journey of many parts, starts and setbacks. Victories can be as small as remembering where you put your cup of tea or reading and recalling an old favourite novel. They can be as huge as applying for a new job. For some, sadly, there is no coming back. For me, five years of brain and balance rehabilitation, occupational therapy, psychotherapy, medication, and the sheer dumb luck of having a huge and tightly woven safety net, culminated in the victory of being invited to interview for a job.

I enjoyed the irony of being called to interview at PATH Employment Services. Based in Hamilton, Ontario, PATH supports individuals with disabilities in reaching their employment goals. Their approach is client-centered and strength-based, focusing on the ability of the individual. “What can this person do” is embedded in the philosophy of the place. For me, re-entering the workforce looked like so much more than just a paycheck. Employment in a place that “got me” and celebrated my abilities rather than focusing on my shortcomings was the greatest boost to my mental health and healing so far in my journey. Alongside a whole cast of incredible supporting characters, I was able to rewrite my story with the best version of myself.

Things still feel precarious. It took crying at my supervisor to feel a little bit sure that I might be ok, that I was not going to get fired. When you have experienced losing everything, nothing feels sure anymore. As a professional working with this population, the best thing you can do is to be a safe place to land. Celebrate the victories, validate the struggle, and have a little compassion if your client is late. You have no idea what it took for them to get there that day.

Hannah Carey