Self-centredness

Some people with brain injury can appear to become very self-centred and display egocentricity more normally associated with a young child.

That is because 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 and 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 way.”

“Before her stroke, Belinda was a great listener. But now she never takes an interest in my life anymore 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.

Although we take it for granted, the ability to view the world from someone else’s point of view is a complex cognitive skill. This is just one of many sophisticated mental skills that occur in the frontal lobes of the brain which are frequently damaged with brain injury. This is why self-centredness frequently goes hand-in-hand with lack of self-awareness, anger, depression, fatigue and reduced social skills.

Families are usually overjoyed when a loved one survives the initial trauma of 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.

Family members can grow resentful over time if a person with a brain injury has trouble feeling or expressing gratitude for the sacrifices they have made. Friends can be even less likely to tolerate self-centredness and move away from the friendship, leaving family as the person’s only social connections.

In some cases, the person may be able to portray a cheerful, caring unchanged personality around their old friends, but this is a very difficult task for the person, which uses a lot of cognitive and emotional energy, and it can’t be maintained for very long. As a result, they 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 challenges they are facing in this regard.

Often the hardest part for a family is accepting that self-centredness is unlikely to go away. Some say that understanding that the brain injury has caused the self- centredness brings them to a point where they can accept the changes and find ways to manage the situations that arise.

Sometimes the family contributes to the problem without intending to. In the early days after the injury, it’s common for families to try to do everything for their loved one. The person with a brain injury may be re-learning how they relate to others and how others relate to them. So they may learn that it is normal for the dependence, the attention, and being the priority in the household. If this happens, families need to re-establish boundaries and ensure that they are taking care of themselves as well.

It is important to understand that a person with brain injury is often not capable of being concerned about the rights and needs of their family; they are not intentionally being inconsiderate.

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 may try various strategies to get what they want. This can include 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 this case, it is vital for the family to have agreed-on boundaries for acceptable behaviour, refuse to be drawn into arguments and always be assertive.

Brain injury support groups can bring about some level of self-awareness as a result of seeing similar behaviours in others.

Another way to increase a person’s awareness in this regard 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 others.