Our research with women who have sustained brain injuries from muggings, rapes, and other physical assaults illustrates neuropsychological sequelae and the difficulties in coping with ordinary life activities after injury. Psychodynamically-based interpretations of some women's inability to quickly return to a fully functioning status have interfered with comprehensive diagnosis and prevented women from receiving available rehabilitation. Many health professionals have been trained to perceive women as having emotional problems whereas men have "physical" problems. Furthermore, feminist approaches to diagnosis and treatment have been limited in areas considered to be "hard science" such as health psychology, behavioral medicine, and neuropsychology. As a result, women's physical concerns, outside of a limited set of reproductive problems, are overlooked and misdiagnosed as "hysteria" and "psychosomatic" disorders.

In most of the clinical cases we have evaluated, the women were previously told by medical and nursing personnel in emergency rooms that they had no injuries other than lacerations and broken bones, which would heal eventually. Frequent problems include symptoms of frontal lobe syndrome, such as poor judgment, flat affect, severe depression with suicidal tendencies, inability to learn new material and make generalizations, and inability to manage employment and homemaking tasks previously handled with ease. Other difficulties involve partial paralysis of limbs which limit ability to walk and manual dexterity, and increase risk of falling, which can lead to additional damage. Chronic stress, depression, and organic anxiety complicate the lifestyles of women and children as they adjust to their changed lifestyles after head injury. Often personality changes occur with consequent need for multiple caregivers to provide several aspects of ordinary living activities. Social isolation complicates family and support network dynamics. Violence and hostility, ease of anger, poor judgment, and assaults against others become frequent with brain injuries. Neuropsychological implications are illustrated with data on rape victims from the Ackerman-Banks Neuropsychological Rehabilitation Battery. In the absence of appropriate diagnosis and treatment of the brain injuries, there is a downward spiral in overall functioning.

In addition to the brain injuries caused by physical assaults, there are many diseases which compromise brain function. Such diseases, including substance abuse, cardiovascular disease, lung problems, diabetes, as well as inappropriately prescribed and/or dosed medications, have been more closely examined in men than women.

Symptoms noted above as sequelae of head injuries are found in women suffering from a variety of diseases. A current devastating disease which has been overlooked in research on women is Acquired Immunodeficiency Syndrome (AIDS). This disease is quickly becoming the fastest killer of young and middle-aged women. Research on women has tended to examine mortality issues, such as the relatively short time between diagnosis and death of women; symptomatology has been less well-defined for women with AIDS than for men. For example, the primary focus of AIDS-related dementia has been on men. When sexually promiscuous behavior occurs as a result of substance abuse altered states, sequelae from brain injury (such as poor judgment), and/or economic factors, AIDS and other sexually transmitted diseases become prominent risk factors for women and children. Although AIDS transmission to children is usually portrayed as a consequence of intravenous drug use by pregnant women, incestuous relationships still exist in many families with a patriarchal sense of ownership of women and children, especially girls. In such families, Human Immunodeficiency Virus (HIV) is directly transmitted from infected males.

Recommendations:

1. appropriately assessing brain injury in the early stages of health workups
2. referring to appropriate health consultants
3. intervening based on neuropsychological implications of brain injury
4. serving ethnic minorities, poor, older, and middle aged women
5. identifying relevant goals for workplace, community, volunteer placements, and new job areas for those with brain injury sequelae
6. identifying and supporting psychosocial adjustment strategies and behaviors

improving quality of life
7. adding social support groups and/or individuals
8. providing psychological and/or neuropsychological interventions for behavior change, e.g. using biofeedback, hypnotherapy, psychotherapy, and/or comprehensive rehabilitation programs

This paper was presented at the May 1994 convention Psychosocial and Behavioral Factors in Women's Health: Creating an Agenda for the 21st Century in Washington, DC. 

Last Updated: 12/26/00