Dealing with anger in aphasia

Susan is a nurse and partner of someone with aphasia. Dr. Lori talked with Susan about how she handles her partner, Bob’s, anger without letting it impact her negatively. She stresses the importance of taking care of yourself so that you can be in the calmer mental state.

Susan is a nurse who is also a health and wellness coach. She trains other nurses how to work as counselors with their patients and families. She also has a unique perspective as the caregiver of a person with aphasia. We wanted to ask Susan how she deals with a loved one with aphasia who has a lot of anger.

It can come frequently with aphasia that the affected person is very angry about their situation and their aphasia. They tend to take it out on other people.

What would be your advice about dealing with someone who is very angry a lot?

Susan: it has been difficult at times. As much as I try to discern between what might be occurring because of the stroke and brain involvement and how much is emotional frustration. Being the person closest to the affected person, how that’s taken out on me.

So the challenge is ‘how do I separate myself? How do I take care of myself?’ So that I can not take on all of that anger and have it wear on my own well-being and also my reaction and response to my partner. It’s not helpful and I’m only human so sometimes it’s easier than other times. But I find that if I sleep well, I eat well, I make sure I take a morning walk, these are my own personal ways of coping and that I know I’m doing something for myself. Then when I come into the situation with Bob, I’m more able to be calmer, and my belief system is that my energy affects his energy. So if I’m frazzled and stressed out. He picks up on that. Maybe with aphasia you become more sensitive. I see that the senses are very affected. So I imagine that the environment is also affecting his perception of calm.

I love what happens here at The Aphasia Center because when he’s calm, he speaks better. He has a card that says “Take a big breath. Drink some water. Swallow. And then speak”. We tried it last night, he was trying to say something, and it worked. Somehow those cues, and those are cues on cards, so I imagine that the cues are the same from a human being.

So if I can say to him “Can you repeat that again?” rather than “I don’t understand you!” because I’m frustrated by his frustration. It becomes an energetic interaction. So my first advice would be that we have to take care of ourselves. The card that he has to “breathe deeply”, I have to practice that, too.

It makes a big difference. If I feel that my nervous system is calm, it’s going to affect my interaction with him, his response to his stress and to me.

Do you feel that, being the closest person and the most convenient one, you are the target?

I might say “I understand that you’re angry and frustrated. Let’s try to find a way that I could understand you and you can try to help me. Help me figure out what you’re trying to say. Can you write it down? Can you spell it? Is there a way that I can understand better? “

Anger and depression have a relationship to each other. Anger directed internally turns into depression. Sometimes potential clients are described as ‘really depressed’. There’s a difference between sadness and clinical depression. What I find is that once clients are here and they have an outlet and hope for recovery, that sadness tends to decrease. It becomes a cycle in which the person is angry that he can’t communicate or do something, which then turns into depression so they stop working or trying, leading to more frustration and anger again.

As a caregiver, it is important to take care of yourself. At times you may get frustrated that your loved one is taking things out on you, you may think that person is ungrateful and think about all the time and effort you put into caring for someone who doesn’t appreciate it.

It’s important as caregivers that we do step and say “this isn’t about me”. He’s not really angry with me, he’s angry. He’s angry that his hopes in retirement for another life cycle of travel and financially being more stable. All of that has been cut short. And he’s angry that he can’t communicate with his grandson. And so to turn that around as opportunities and as an incentive to really work hard.

He knows and understands before his stroke about neuroplasticity and we draw on that a lot. That you can create new neuronal pathways, you can create new circuits so you can compensate for where your deficits are. No, you may never be a conference speaker, as you were before, but you can still have social interactions and be able to communicate better.

About sadness and depression, I think one of the things that happens is people move into this feeling of helplessness and hopelessness, and that’s another piece of ‘how do you turn that around?’. I’m the eternal optimist so I’m always the glass half-full. That if you feel helpless, what do you need to do to feel more hopeful and move forward in that way. What would give you hope? Is it being able to have more communication with your child? Or would it be being able to send that email independently to someone with you?

And it happened today here with you at the Center where he came out and he had just completed a lesson. It was difficult to understand at first, and I said “give me one word”. He was trying to say that he succeeded in whatever it was he was doing 100% without having to look at the words. He was able to repeat the sentence maybe write the sentence. That’s something I’m going to draw upon when he goes back to feeling helpless to say “remember when you did that? If you did it once, you can do it again”
Really help that person move from “in the moment” feeling helpless or distraught to the possibilities. If you do it once, it’s possible to repeat it.

There’s another piece to consider, which is the lifestyle component that affects and impacts progress. I’m thinking of stress affects the brain, how nutrition affects the mind and the body, how sleep is so important. For all of us, if you’re not sleeping well, it’s hard to focus. If you have aphasia and you can’t focus, it’s harder for the words to come out. When Bob has a good night’s sleep, he speaks better. When he has had a restless night, he’s not focused the next day and he’s more frustrated and he’s more angry. It’s hard to separate out all of the components and how they impact us.