Why Traumatic Head Injuries Are an Urgent Feminist Issue

Given the already precarious circumstances of many domestic abuse survivors, early and accurate diagnosis is essential.

It is a familiar and harrowing story: the soldier, returning home with invisible wounds, irreversibly changed by head trauma sustained in war. The athlete with serious brain injury from repeated blows to the head. Known as Traumatic Brain Injury, or TBI, these injuries are serious and complex. They demand intensive treatment, and early diagnosis is critical.

But a recent article in the Huffington Post posits that a different group may make up the majority of those living with TBI. Melissa Jeltsen writes that survivors of domestic violence are now thought to experience these injuries in numbers that eclipse previous estimates. The Centers for Disease Control and Prevention's haveestimated that 1.7 million people experience TBI every year, and 2 percent of the population, or 5.3 million Americans, are living with a disability caused by it. But experts speculate that as many as 20 million women each year - up to 6% of the population - could have TBI caused by domestic violence.

Domestic violence survivors have largely fallen by the wayside in conversations about TBI. One such survivor is a 51-year-old woman named Kerri Walker. Thirty years ago, Walker found herself driving down the left side of the road into oncoming traffic. She said her behavior “felt totally normal.” At the time, Walker was involved in an abusive relationship, and her experience was in reality one of the first signs of an undiagnosed brain injury. She estimates now that within 2 ½ years, she was repeatedly shaken and hit in the head - once with a gun.

The brain trauma caused by these assaults manifested in major headaches and periods of dizziness and disorientation. Still, it wasn’t until a year later, after being diagnosed with TBI by a doctor at Geauga Medical Center in Ohio, that Walker was able to make the connection between these symptoms and her abuse.

Walker is now a coordinator for Sojourner Center, one of the largest domestic violence shelters in the U.S. On June first, Sojourner Center launched the BRAIN (Brain Recovery And Inter-professional Neuroscience,) Program. Together with TBI experts at local hospitals and medical institutions, BRAIN will seek to determine the percentage of domestic violence survivors suffering from TBI caused by domestic violence. They hope to develop an accurate estimate by screening the roughly 9,000 women and children who are seen at Sojourner every year.

The program will investigate the occurrence of domestic violence-related TBI, its short-term and long-term effects, and how best to provide individualized treatment plans. BRAIN also aims to develop tools that can be used by non-medical staff, such as social workers and shelter employees, to screen for head trauma.

Maria E. Garay, the CEO of Sojourner Center, is spearheading the initiative. “These women are falling through the cracks,” she said. “This is a public health epidemic. The fact that no one is tracking this is, to me, a crime.”

Robert Knechtel, interim director of the BRAIN program, said, “Most of the work has been done with athletes or the military. This is a group that, by extrapolating some numbers, would dwarf the military and the athletes combined.” Due to this gap in research, the program will start by using tools already developed for the military and athletes. Jonathan Lifshitz, a neuroscientist at Phoenix Children’s Hospital who is working with Sojourner, said “We don’t know what tests will be the most effective in this particular population. The BRAIN program is going to provide the evidence necessary to change practice in this field.”

The impacts of TBI cannot be underestimated. Symptoms of TBI include headaches, double vision, imbalance and decreased motor ability, problems with memory, planning, and learning, aggression, irritability, and depression. These symptoms range in severity, depending on the extent of damage over time and the location of the injuries.

“Most domestic violence research skims the surface of TBI and its associated problems,” said Knechtel. “Sojourner Center seeks to dig deeper, listen to our participants, and gather empirical data to inform hypotheses on how we can better assess and treat the specific and long-lasting trauma domestic violence imparts on women and children.”

TBI in abuse survivors can also have repercussions that extend beyond health. Kim Gandy, president of the National Network To End Domestic Violence, said undiagnosed TBI may play a role in some women being unable to leave an abusive relationship. “Having a brain injury makes it a lot harder for her to get a job and support herself and her kids,” Gandy said. Some symptoms of TBI, such as problems with memory and irritability, can make taking legal action against an abuser more difficult. “She may have more difficulty making her case to the judge, to a police officer, getting a restraining order.” Gandy also said that women with TBI may appear uncooperative or unreliable in court. 

Given the already precarious circumstances of many domestic abuse survivors, early and accurate diagnosis is essential. With correct treatment and rehabilitation, most TBI patients can return to a normal level of functioning.

For Kerri Walker, It’s taken enormous time and effort to adjust to life after TBI. "It’s changed me for the rest of my life," Walker said. "My short-term memory is shot. I’ll be writing and I’ll mix up letters. All of a sudden, I’ll write an E backwards. I had to find a new normal for myself.” Walker had a brain aneurysm rupture just four months after leaving her abusive partner. It’s taken her years to accept the effects of her cumulative brain injuries. 

Although these effects remain, she said her TBI diagnosis has allowed her to stop blaming herself.  “One thing that abusers tell us over and over is that we are stupid,” she said. “The relief factor for so many women is going to be unmeasurable.”

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