Traumatic Brain Injury Survivors: A New Challenge for the Health Community and Public Awareness
Traumatic Brain Injury (TBI) survivors are a relatively new group within the healthcare community and society at large. Historically, individuals with severe brain died from the trauma. However, medical advancements pioneered during the Iraqi War have significantly increased the survival rate for TBI patients. As a result, TBI survivors have only been a recognized presence in society for approximately 22 years. Recovery from such injuries is lengthy, often spanning 5 to 15 years. Survivors frequently experience behavioral changes due to their brain injury.

Adding to the challenge, TBI survivors are often misclassified as individuals with mental illnesses. This mischaracterization has led to misunderstandings in critical interactions with law enforcement, mental health evaluators during Temporary Detention Orders (TDOs), psychiatrists, employers, coworkers, and the general public. The symptoms of TBI—such as behavioral changes and cognitive difficulties—often mimic those of mental health disorders, making it easy to misidentify these individuals at first impression. However, TBI survivors suffer from a neurological, cognitive disability rooted in physical brain injury, not a mental illness.

Legal precedence (no cases) has yet to address the unique needs and rights of TBI survivors comprehensively. The lack of case law or established legal frameworks contributes to systemic misunderstandings, leaving survivors vulnerable to inappropriate treatment and discrimination.

This issue is compounded by historical dominance of the mental health industry. Since the 3rd century, the mental state of the brain and behavior has been the primary focus, with psychiatry shaping much of our understanding. It was only in the 18th century, with the emergence of neurology, that the study of brain operations became a scientific pursuit. TBI survivors, however, have been thrust into the psychiatric domain of mental illness, when their condition belongs in the physical science domain of neurology.

To address these gaps, society must recognize TBI survivors as individuals with distinct neurological conditions and ensure that appropriate medical, legal, and social support systems are developed to meet their needs.

Comparing the scientific definition of Traumatic Brain Injury and Mental Illness
TBI is primarily a condition of externally induced neurocognitive dysfunction, whereas mental illnesses are defined by internally mediated disruptions in psychological and behavioral functioning. Traumatic brain injury (TBI) and mental illness represent distinct, yet occasionally overlapping conditions, each defined by specific criteria and characterized by unique etiologies and clinical presentations.

Definition of a Traumatic Brain Injury
CDC (Center for Disease Control) defines a traumatic brain injury as a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury. Even the DMS-5 of the American Psychiatric Association has a clear definition of Traumatic Brain Injury that describes the normal functions of the brain altered and social cognition impaired.

• DSM-5 Diagnostic and Statistical Manual of Mental Disorders
Traumatic brain injury (TBI) is defined as: “brain trauma with specific characteristics that include at least one of the following: loss of consciousness, posttraumatic amnesia, disorientation and confusion, or, in more severe cases, neurological signs (e.g., positive neuroimaging, a new onset of seizures or a marked worsening of a pre-existing seizure disorder, visual field cuts, anosmia, hemiparesis). To be attributable to TBI, a neurocognitive disorder must present either immediately after the injury, or immediately after the individual recovers consciousness after the injury AND persist past the acute post-injury period. The cognitive presentation is variable. Difficulties in the domains of complex attention, executive ability, learning, and memory are common as well as slowing in speed of information processing and disturbances in social cognition. “DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) May 18, 2013 by the American Psychiatric Association)

A TBI is a ripping, tearing, and shearing of brain tissue. It is a physical disability with neurological consequences in information processing, memory loss, concentration, speech, and motor control. The definition emphasizes the causal relationship between physical brain trauma and subsequent neurocognitive dysfunction. Psychiatry is not a treatment for the loss of neural network or neurons.

Traumatic Brain Injury is considered an “Intellectual Disability” NOT a “Mental Illness” under Americans with Disability Act 1990

Definition of a Mental Illness
34 U.S. Code § 10472 – Definitions
(1) the term “mental illness” means a diagnosable mental, behavioral, or emotional disorder—
(A) of sufficient duration to meet diagnostic criteria within the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association; and.
(B) that has resulted in functional impairment that substantially interferes with or limits 1 or more major life activities;

DMS-5 Definition of Mental Illness, or Mental Disorder:
DSM-5 consider these 5 factors:
1. A behavioral or psychological syndrome or pattern that occurs in an individual
2. Reflects an underlying psychobiological dysfunction
3. The consequences of which are clinically significant distress (e.g., a painful symptom), or disability (i.e., impairment in one or more important areas of functioning)
4. Must not be merely an expected response to common stressors and losses (ex. the loss of a loved one), or a culturally sanctioned response to a particular event (ex. trance states in religious rituals)
5. Primarily a result of social deviance or conflicts with society
“The DSM-5 will carry on the long tradition of diagnosing mental disorders using behavioral criteria alone. These criteria will continue to take the form of lists of behaviors. Biological indicators will not be used to diagnose mental disorders, because we simply don’t have the ability to do that at the moment. “(Saybrook University, What is the DSM-5 Definition of a Mental Disorder? June 7, 2017)

Comparing Traumatic Brain Injury with Psychotic Disorder

Traumatic Brain Injury                                               Psychotic Disorder

Delayed Information Processing, lack of                    Psychotic behavior is often categorized by its way of concentration, disruption in short term memory      causing the person affected to have a skewed idea of slowed thinking, quick to anger, mood swings,         reality

difficulty finding words.

  • Speaking about what they owned Losing touch with reality (delusions).
  • Trouble finding words, slurred speech Unclear and disorganized speech
  • Inability to order tasks. Disorganized behavior

Fatigue, sudden sleeping                                Problems sleeping

TBI Symptoms include:
Physical: headaches, dizziness, sleep problems, fatigue, light sensitivity
Cognitive: difficulty concentrating, gaps in memory, slowed thinking, difficulty finding words
Emotional: Irritability, anxiety, depression, mood swings, quick to anger

The TBI Survivor is given a diagnosis of ‘Bipolar’ for sleeping long hours, and rushing to get things done when they are awake; ‘Depression’ for excessive sleeping 12-16 hours a day; ‘Manic’ for trying to get things done before they sleep; ‘Mood Swings’ for their irritability, and anger outbursts; “lack of impulse control” when they are “impulsive” or change their mind quickly, “outbursts” of anger, and thinking “off the top of their head” (stream of consciousness); “Schizophrenia” when they talk about their desire to regain their former life, scared of the future, and anxious to recover their skills; ‘Delusional’ thoughts of their prestige in their former life, and plans for recovering their life; “Anxiety” for fearing the future and never recovering their intellectual prowess.

Understanding Traumatic Brain Injury:
A Call for Awareness in Diagnosis & Treatment to Prevent Misdiagnosis and Mismanagement Observation: Mental health professionals often prioritize diagnosing and treating psychiatric conditions. They focus on BEHAVOIR without recognizing the underlying traumatic brain injury (TBI) affecting the survivor. Most commonly, they fail to realize it’s the LIMBIC system which is damaged, NOT a CHEMICAL IMBALANCE. The TBI Survivors behavior is NORMAL for the damaged brain, they cannot control their behavior, much like a child cannot monitor their behavior until their body reaches sufficient development. The emotional control mechanisms for the TBI Survivor has been damaged. It will take years for them to heal. Society must tolerate an adult with emotions of a child.

Implication: This misdiagnosis can result in inappropriate treatment plans (Medical Malpractice), including the prescription of mood-regulating mood regulation, impulse control, anti-anxiety medications, AND in some cases – facing proceedings for involuntary commitment. All stemming from a misunderstanding of the patient’s TBI-neurological impairment due to the destruction of brain tissue from the traumatic brain injury. Americans are being LOCKED UP due to a neurological disability.

No CHEMICAL INTERVENTION, DRUG, or LOSS of LIBERTY will treat or cure the loss of neurons in the brain. It has also been shown that foreign substances introduced into the brain chemistry impact NEUROPLASICITY the brain’s NATURAL HEALING mechanism that repairs the neural network in the damaged area.
Medication can cause: Tardive Dyskinesia -a movement disorder that can develop if you take anti-psychotic medication.

Involuntary movements – Facial muscles, tongue, neck, trunk muscles, limbs. (facial expressions, chewing, puffing your cheeks, rapid eye blinking)
A Call for Awareness:
These situations highlight the critical need for greater awareness and understanding of TBI among medical professionals, mental health community, law enforcement, judicial system, and the public. TBI survivors face unique challenges that require compassion, tailored interventions, and recognition of their condition’s complexities. By fostering greater education and training in this area, society can help prevent unnecessary interventions, and provide more effective support for those navigating life after a traumatic brain injury.
Key words in the paragraph (TBI survivor is given a diagnosis) with links (pop-up like WIKIPEDIA) for the following:
• Schizophrenia
• Delusional Disorder
• Bipolar
• Anxiety Disorder
• Post Traumatic Stress Disorder

Description as follows for a pop up to the disorder listed above.
Schizophrenia
At least two of the five main symptoms
You have had symptoms for at least one month
Your symptoms impact your ability to work, or your relationships.

Schizophrenia involves a disconnection from reality. It also affects your ability to recognize your symptoms.
• Delusions
• Hallucinations
• Disorganized Thinking or Incoherent speaking
• Negative Symptoms: suspicious, paranoid, scared, hygiene, depression, anxiety, suicidal thoughts, drug use.

Delusional Disorder
Delusional disorder is a type of psychotic disorder. Its main symptom is the presence of one or more delusions.
• Delusions – Grandiose, Jealous, Persecutory, Somatic, Erotomanic.

Bipolar Disorder
Bipolar disorder is a chronic mood disorder that causes intense shifts in mood, energy levels, and behavior
• Mania – abnormally elevated or irritable mood, changes in emotions, thoughts, energy, talkativeness, and activity.
• Depression – low or depressed mood, loss of interest in most activities, tiredness, changes in appetite, feelings of worthlessness and hopelessness.

Anxiety Disorder
Anxiety disorder is a group of mental health conditions that cause fear, dread, and other symptoms that are out of proportion to the situation.
• Generalized Anxiety Disorder, Panic Disorder, Phobias, Social anxiety disorder, Separation anxiety disorder.

Post Traumatic Stress Disorder
PTSD is a common mental health condition that can develop after a traumatic event. A Traumatic event is anything that severely threatens your existence, or sense of safety.
• Anxiety, Depressed mood, feelings of guilt or shame.
• Having Flashbacks or nightmares.
• Avoiding situations, places, and activities related to the traumatic event.