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Ever since a van hit Jackson when he was 9, emotions, words and memories have flowed in and out of his head with little control. Like many people with brain injuries, Jackson has learned that the behavioral effects can make staying on an employer’s good side challenging.

Going back to work is part of returning to normal life after an illness or injury, said Mike Davis, a certified brain injury specialist and president of Neurological Case Management Associates. Davis arranges rehabilitation and other services for injured people.

“That’s what we do in our lives: we’re working, living or playing,” he said.

People who experienced a traumatic brain injury, or TBI, can find their personalities — and ability to function in society somewhat unmanageable.

“They’re not the same,” said Dr. Rabah Boukhemis of the Family and Community Health department at Marshall University. “They’re impulsive. They’re socially inappropriate. They can have temper tantrums. Get in trouble. It’s not unusual.”

“I’ve seen personalities flip-flop,” Davis said. “They become violent or start cursing, drinking when they didn’t before. Some people are able to have these injuries and move on with or without rehab, but that’s rare. It’s like people who wake up after being in a coma for 20 years. How often does that happen? One in a trillion.”

Jackson’s accident happened in the summer of 1979, when a ride on a friend’s 10-speed bike turned into a 1 1/2-month hospital stay. The impact of the van partially ripped off Jackson’s ear and he was in a coma for about four days, he said.

At that time, rehabilitative care focused on the basics, Davis said: using the bathroom, eating and learning to speak again.

After Jackson regained basic survival skills, he went home.

His school grades tanked. He and trouble became close friends.

Now 36, Jackson only recently learned that his childhood behavior might stem from his brain injury.

“I’ve kind of grew up with what a lot of people would call antisocial behavior,” he said. “Knowing [about TBI] gives me a little bit
of hope. I can zero in and find out exactly what’s going on and work around it.”

Unfortunately, his brain often thinks for itself faster than it does for him.

“It’s like there’s no filter,” said Jackson. “I tell people exactly what I think. I tend to blurt things out. I’ve lost quite a few girlfriends that way.”

And jobs. He’s had more than 30. He will get upset and walk out or curse managers in front of customers, he said.

“At the time I feel totally justified,” Jackson said after recounting a time he lost his temper and began ripping off his clothes and throwing shoes. “A few hours later, I’ll say, ‘You were wrong there, Dan.’

“His brakes are gone,” Davis said of Jackson, whom he has not met. “He’s a 6,000-pound car going down the road and he can’t stop.” The effects of TBI leave some people “unemployable, practically,” he said.

Jackson earned a four-year degree in biology. He finished a year of graduate study at Marshall University with a concentration in molecular biology. He eventually flunked out because his brain — so quick with the wisecracks — grows a thick coat of glue when Jackson needs it most.

Ask him about heart cells and the answer could have you begging for a dictionary. Ask him his address and you could have a good wait. In conversation, Jackson’s eyes wander and he tends to lose track of his topic, no matter how interesting he finds it.

He recently started taking medication for attention deficit disorder medicine to help his wandering mind. He said he relished the pills’ introduction of a new element to his life: organization.

Then he stopped talking.

“It just happened again,” he said, rubbing his head. “It just froze. There’s nothing there.

“I can think about the entire aspect of what I want to say but the way it comes out is something different,” Jackson said. “I have to read things 15 times and even then I only half understand them. Once I understand and get my head around it, I’m fine. Getting to that point is a problem.”

Jackson even tried to strike out as an entrepreneur, but the business plan he created — the one that seemed so clear in his head — materialized as a jumbled mess.

“Long-term planning seems foreign. I have a general picture, but as far as conceiving the details or how to go about doing that, I have no clue,” he said.

“Knowing that I can do this stuff, knowing that I can do a good job but not being able to do the job is intensely frustrating. It’s more than frustrating it’s almost discouraging. Deeply.”

Davis said people who held complicated, professional jobs before their accident may still have all their knowledge, but cannot access it, like an encyclopedia with pages stuck together.

“I’ve had Ph.D.s who have been injured and can’t go back to their jobs,” Davis said. “He might remember steps one and four, but two and three are gone. They know they can do it and they can’t. It frustrates them and they have an anger outburst. Next thing you know, they’re out of a job.”

In 20 years as a case worker, Davis has met engineers who can no longer use a washer and dryer or one-time schoolteachers unable to pick out their clothes. His own son had an IQ of 137 as a child before his brain injury. Now the 34-year-old’s score is around 50 and he needs around-the-clock care, Davis said.

The answer to why an injured brain can misfire as badly as it does skirts certainty and mystery, Boukhemis said. A hit to the head — not necessarily a hard one — makes the brain bounce around inside the skull, causing bruising, bleeding and swelling.

This movement destroys or kills cells, which interferes with the brain’s complex chemistry, Boukhemis said. Chemical pathways and nerves that produced a person’s normal behavior before become broken or impaired.

Simple thoughts and behaviors — such as not calling your boss a jerk — get lost in the jumble. Those thoughts never get processed, so the person does not act on them.

“The right connections to behavior have changed because of all the trauma,” Boukhemis said. “I wish I could say more. We don’t understand this very well, why people have all these personality changes.”

Davis said people with TBI can do small things to help themselves. Those having memory problems can keep on track with a personal organizer or tape recorder, by keeping lists or wearing a watch with an alarm on it. A person can even borrow someone else’s brain by looking into a job coach, or someone who helps keep a person on track and explains instructions.

As for emotional control, common regulation methods such as leaving a room when things get tense, could help. Behavioral therapy might be an option, Boukhemis said.

But friends, family and employers should not expect the stranger inhabiting the body of the person they knew to just disappear, Boukhemis said.

“Sometimes the family expects the person to go back to their old selves and sometimes it just doesn’t happen that way,” he said.

NOTE: Few disabilities are invisible as TBI. Head injuries happen more each year. Please be kind to our least fortunate, including me, a TBI survivor.

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