'A different person': Personality change often brain injury's hidden toll

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By Bill Briggs

When Mac Fedge, 31, talks about his old life, it’s like recalling an old friend, now gone. Back before a devastating car accident 12 years ago twisted his brain “like an Oreo cookie,” he was different person in a lot of ways, he says. 

“I used to have so much good humor and I used to be a leader. But now, after brain injury, I’m more inclined to just watch,” says Fedge, who lives with his parents in a Reston, Va., townhouse. “I used to be even-tempered but now I might flare up with anger, especially if I’m tired.”

While many people know that brain injury can cause physical problems such as headaches, dizziness, impaired memory and problems with balance and walking, what’s often unseen – except by family members, friends and even some survivors themselves – are personality changes that come when brains have been wounded. It’s something that an increasing number are grappling with, particularly among injured soldiers.

Since the war Afghanistan began in 2001, and during the eight-year Iraq War, TBIs diagnosed among U.S. troops have totaled more than 260,000 worldwide and at home, according to the Department of Defense. The rate of TBI diagnoses in the military peaked in 2011 with 32,625 new cases -- a 198 percent increase from the number of TBIs sustained across the U.S. armed forces in 2000, the most recent peacetime year. During the first quarter of 2013, another 6,248 service members had suffered brain injuries. 

The personality changes that can come with TBI are clearly shown in HBO’s new documentary “The Crash Reel,” about ex-snowboarding phenon Kevin Pearce, who was critically injured in a 2009 snowboarding accident. Promotional materials note "he's a different person."

In “The Crash Reel,” one of Pearce’s former snowboarding buddies is also shown struggling with his own behavior following multiple brain injuries – exposing to viewers how people can be reshaped by the physical trauma inside their heads.

The reason why temperaments can change is not simple because the human brain and its connective networks are so intricate, says Dr. Brent Masel, president and medical director of Transitional Learning Center in Galveston, Texas and national medical director for the Brain Injury Association of America. Doctors have learned, through new imaging tools, there is no single hub for emotion, no neurological sectors for happiness or pleasure.

But the frontal lobes, tucked behind our foreheads, are known to fuel our “executive functioning” – from planning and organizing to sequencing and multi-tasking to putting a needed filter on our impulsive behavior, Masel said.

“One of the problems for people with injuries to the frontal lobes is they frequently do or say things before they've thought them out. It’s sort of like somebody who’s had three, four beers. An injury there can cause you to lose that filter,” Masel said.

“Your overall personality remains about the same. If you were a nasty guy before the injury, you’re likely to be a nasty guy after. If you were a sweetheart before, basically you’ll be a sweetheart after,” he added.

But in studying and treating injured brain, Masel also has found previously unpleasant people be transformed into nicer, gentler folks, adding: “I really haven’t seen that many nuns – for lack of a better word – become aggressive, hostile people. It’s more the other way around, and I don’t know why.”

For some brain-injury survivors, emotional control is lost. Through intensive therapy, those patients work on new coping skills to harness their post-injury tempers.

When college professor Alan Cromer suffered a massive heart attack aboard an aircraft in 1998, starving his brain for oxygen, he emerged with parts of his personality that had “changed dramatically,” says his wife, Janet Cromer, the author of “Professor Cromer Learns to Read: A Couple’s New Life after Brain Injury.”

“Emotionally, he would go from zero to 60 – get frustrated by something he recognized he couldn’t do, like putting on his clothes in the right order. He would be humiliated and that would quickly lead to anger,” Cromer says.

While the core of his personality remained, agitation and anger were the hardest emotions for Cromer to control, recalls his wife, a psychiatric nurse. “Most people can do it to a certain degree with behavioral strategies, or medications. They have to be willing to put in the effort to learn. Alan tried very hard but because of the extent of the injury, sometimes the prevention strategies didn’t help.”

Cromer was 62 when he suffered the cardiac arrest. He died in 2005 from heart failure.

In Virginia, Mac Fedge mentions his own outbursts and the other persona differences that emerged after an oncoming Jeep, traveling in the wrong lane of a country highway, slammed head-on his Honda Civic. At the time of the accident, he was a triple major student at Virginia Tech, studying German, international studies and political science, but after the crash, brain scans showed his injured frontal lobes eventually “shrank into nothingness.”

His sense of humor, once sophisticated, now churns jokes “at the level of a pre-schooler or a young teen,” he says.

“It feels like part of me has disappeared since the accident and trying to get that aspect of me back and that’s probably one of the toughest aspects of the recovery is trying to find out how to do what I used to be so good at doing, how to do it again.”

And when he stares off silently and suddenly during a group conversation, he explains: "It's not that I’m bored, it’s just that I can’t come up with anything to contribute.”

What remains is an introspective man. And as his different identity has taken hold, Fedge has slowly come to know his new self.