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There are so many terms that family and friends of brain injury survivors are exposed to that are simply not part of our day to day vocabulary. Learning to understand all these new terms while attempting to cope with an already trying experience can be quite dizzying. I would like to take a moment to explain one of those terms, “flat (or flattened) affect.”
A flat (or flattened) affect is when a person does not display or experience emotions with the same intensity that he or she did before an injury so that the affect (mood) of the individual in question appears to be unchanging (flat). This symptom is most common in right-sided brain injuries. A survivor with a flat affect may be told that a friend has died and blandly state, “That is too bad.” The same survivor could be told that he or she has won a huge contest and simply say, “That is nice.” Instead of being distraught and tearful in the first example or excited and elated in the second, everything ends up feeling to the survivor similarly ordinary. This is not to say that the person does not understand the importance of each situation. It is simply that the person’s brain is no longer capable of experiencing the strong emotions we generally associate with having encountered such a situation. Rather than traversing the hills and valleys of normal emotional fluctuation, the person’s emotional experience is more akin to that of an even surface or flattened plain.
As we are social beings, a flat affect can of course interfere with social relationships. Other people may find it awkward or off-putting when the survivor does not display the emotions that would be normally expected in a given situation. For instance, a friend might find it odd that a warm smile is not reciprocated with a similar smile by the survivor. It may feel to the other person like the survivor is now almost robotic in most interactions. Many survivors with a flat affect need to be retaught social skills so as to allow for improved social functioning. This may include learning to show facial expressions appropriate to the emotion associated with a given social interaction, even if the person is not feeling said emotion or perhaps not feeling the emotion very strongly. Sometimes, loved ones mistakenly assume that the flat affect implies depression or anger.
A further complication is that the lack of or decline in the experiencing of emotions can also impact motivation to engage in activities. If a person feels strongly that he or she wants to accomplish a goal, then motivation there will clearly be high. However if the person feels little emotion to begin with, it is often difficult to arouse more than minimal motivation. Many survivors with flat affect report little desire to participate in activities that they previously enjoyed or weak motivation for therapy.
Survivors with flat or flattened affect often find that as their injury heals, they experience a wider range of emotions. Unfortunately, there are also those survivors for whom this will prove a symptom that provides some level of struggle throughout the remainder of their lives.
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