This paper was prepared by the Encephalitis Society with advice from Dr Huw
Williams Clinical Neuropsychologist Lecturer in Clinical Psychology
(University of Exeter)
Our emotions respond very quickly to circumstances and/or events around us.
We learn as teenagers, and continually as adults, to hold down our immediate strong
emotional responses until our more logical understanding arises to determine our
behaviour. For some of us who have had encephalitis those logical thoughts
take much longer to progress through the brain to influence our actions and so our
emotions may influence our behaviour in a much stronger way than in an average person.
For others, though, emotions themselves may be slower to respond.
Emotions and the expression of emotion are not only affected directly by the brain
injury. Some of the changes in emotion that a person with encephalitis will
experience are simply be normal response to the many losses that accompany the experience
of having encephalitis. For the individual, their family, friends and professionals
working with them, it is not always easy to tease out which emotional changes are
directly caused by damage to the emotion centres in the brain and which are the
person's reaction to the situation they may find themselves in as a result of the
illness.
Encephalitis, like other types of brain injury, can also affect the ability to accurately
perceive emotions in others. For example, some people have difficulty interpreting
facial emotion in others, which can lead to person who has had encephalitis not
appearing sensitive to emotional changes in others. This may lead to others,
e.g. spouse, family or friends, feeling that the individual is not sensitive to
their emotional state.
Some common emotional reactions are outlined below.
Mood swings: Some people who have had encephalitis experience a loss
of emotional control. They may react strongly and unpredictably to events
which would not previously have troubled them. They are also often subject
to rapid and marked swings in mood - being for example happy and jokey one minute
and tearful the next.
Anxiety: Sometimes people who have had encephalitis feel considerable
anxiety and a few become obsessional in their thoughts and actions especially if
they are disturbed by their cognitive and personality changes. For some this
may be quite overwhelming. There is a fear that the person concerned feels that
they are 'going mad'. People are often afraid of repeating themselves and
often apologise for speaking.
Frustration and Anger: Many people become frustrated by their failings
and their slow rate of recovery. Some are bitter about the illness and a few
intensely angry.
Depression: Depression may not surface immediately, it can follow the
realisation that life might not ever be as before and that recovering former
physical, psychological and social skills may not be possible. This might
be particularly evident losses or changes in the person’s social roles. In
particular, a person may mourn the break up of a relationship and the inability
to pursue a former active sporting and social life and chosen career, a mother may
feel inadequate in not being able to care for children as before, whilst the father
may feel guilt and loss of self esteem in not being able to provide for the
family.
For some people who have experienced encephalitis rather than there being an increase
in emotion the brain injury can cause there to be almost an absence of emotion.
The person might 'know' that something, that they see, say, hear or do is distressing,
but they simply do not 'feel' the distress caused.
Changes in self-concept
After encephalitis people may experience marked changes in their view of themselves,
they are not quite the person they were before. Severe memory problems may result
in a disturbing lack of continuity and order to one's life, particularly for those
with loss of memory for events before as well as after their illness. Changes
in personality, especially those involving loss of control over emotions, thoughts
or actions, can be profoundly disturbing. There can be perceptual or spatial
disorders presenting a confusing and bewildering world within which it is difficult
now to play one's full part. For those with reasoning difficulties life may
appear at times an insoluble puzzle.
Whilst frustrated by their current failings, people with who have had encephalitis
tend initially to view any changes as temporary, confident of a good, if not a complete,
recovery. This may be followed by a gradual and painful process of realisation
of the full extent of their residual disabilities and an appreciation that they'II
not after all recover their former skills and lifestyle. This may result in
a period of depression, characterised by confusion, frustration and uncertainty.
Such reactions are delayed for some people who understandably find it hard to accept
their limitations and respond with renewed determination to make a full recovery.
They may set themselves unrealistic targets which may lead to repeated disappointment
and despair.
Recovering from encephalitis can be extremely frustrating for everyone concerned.
Counselling from people professionally trained in the psychological effects of encephalitis
can help people to come to terms with the overall effects of encephalitis. Such
support is highly advisable if you are experiencing emotional problems. Your
GP should be able to refer you in order to assess your needs.
Tel: 1890 609090
Last modified: February 2002