In some cases survivors of a brain
injury can appear to become very self centred and display the
egocentricity more normally associated with a young child.
They lose the ability to see the world from another person's
perspective and have little or no self awareness about how their
behaviour is impacting on others.
"Gavin used to be a thoughtful considerate husband and
father. We've made so many sacrifices since his hospital discharge
but he says we have not been supportive. No matter what I'm doing
he expects me to drop everything to do the smallest tasks and
responds with outbursts the moment he doesn't get his
"Before her stroke Belinda was a great listener. But now she
never takes an interest in my life any more, and gets frustrated
when the kids want her attention."
"I gave up my job to look after Andrew full time. This has
been so exhausting that I've arranged respite one night a fortnight
to have coffee with friends for an afternoon. Every time he sulks
and complains that I don't really care about him."
This inability to see another's point of view can be very
destructive as the family often cannot understand how a previously
caring person now lives completely for themselves and has no
insight into how they are affecting the family.
Why does it happen?
Although we take it for granted, the ability to view the world
from someone else's point of view is a very complex cognitive
skill. This is just one of many sophisticated mental skills that
occur in the frontal lobes of the brain. Unfortunately this is a
very common area to be affected in a traumatic brain injury (TBI)
and other brain disorders.
This is why self centredness frequently goes hand in hand with
lack of self awareness, anger, depression, fatigue and reduced
social skills. It is no wonder that families are often brought to
the breaking point in the months after the injury.
Impact on the family
Families are usually overjoyed when their loved one survives the
initial trauma of acquiring a brain injury. After discharge, a
relieved family will go to great lengths to help with the
continuing rehabilitation process, usually making many
sacrifices in time, money and effort on the road to recovery.
As the months and years go by, families understandably become
frustrated if none of their sacrifices are acknowledged, in fact
often they will be criticised for not being supportive enough.
Friends will be even less likely to tolerate self centredness
meaning the family is usually left as the only social network
In some cases the person may be able to portray a cheerful
caring seemingly unchanged personality around their old friends but
immediately revert to their self centred behaviour when only the
family is around. This is particularly difficult as these friends
may not believe the family when they talk about the difficulties of
the new personality they are facing.
What the family can do
Often the hardest part for a family is accepting that the self
centredness is unlikely to go away. Some say that understanding
that the traumatic brain injury has caused the self centredness
eventually brings them to a point where they can accept the changes
and enact strategies to manage the situations that arise.
Sometimes the family unwittingly contributes to the problem. In
the early days after the injury families may spoil the patient and
do everything for them. If the family member is self centred they
will obviously lap up the attention, become dependent and expect to
be the centre of everyone's world even more. Families need to be
very firm in setting boundaries, and realise that they must look
after their own needs as well as their loved one's needs.
Understand that your loved one will no longer be concerned about
your rights and needs. Instead of feeling hurt try to be assertive
about your rights and needs.
In some cases a person will not only be self centred but very
skilled at manipulating their family emotionally. If their demands
aren't met they try various strategies to get what they want such
as threats, pleading, criticising the lack of compassion or sullen
silences. Family members are often surprised that their loved one's
skills in manipulation are so effective when their overall social
skills have dropped significantly. In these cases it is vital for
the family to have agreed on boundaries for acceptable behaviour,
not be drawn into arguments and always be assertive.
If there is a support group for survivors of brain injury it may
help if they can go along. Sometimes seeing similar behaviours and
attitudes in others can bring about some level of self
Another possible way to increase a person's awareness of their
self centredness can be through therapeutic sessions with a
neuropsychologist. If an assessment indicates the person could
benefit from therapy, the neuropsychologist will gradually gain the
person's trust and begin exploring and challenging their beliefs
and behaviours. With time this can gradually increase a person's
awareness and insight into how their behaviour impacts on