06/10/2026
Clinical PSA: Okay, y'all. Can I get on my soapbox a bit? This systemic blindspot bothers me deeply and causes immense suffering. (Cross-posted.)
After 13 years in the field of brain injury rehabilitation, I can't begin to tell you how many had suffered for months or years undiagnosed, misdiagnosed, or put on medication that was totally unnecessary or even harmful.
An extraordinary number of people with closed head injuries go unrecognized (even by themselves). Often, they are the medical "mystery cases" whose lives are falling apart.
Tragically, when these individuals suddenly present with inexplicable avoidances (some quite intense), they can appear as though they are developing a psychiatric condition, when they're actually exhibiting profound neurologic symptoms of a brain injury which can mimic:
Specific Phobias: Agoraphobia, amaxophobia, vehophobia, gephyrophobia, acrophobia, escalaphobia, naviphobia, or severe social anxiety.
Somatic/Factitious Disorders: Illness anxiety, somatic symptom disorder, or the devastating assumption that they are "faking it" because of how uninformed the majority of professionals and the public are about the current research and the many faces of brain injury.
Why Non-Specialists Miss the Root Cause:
The 3-Month Fuse: Brain injury is cumulative over a lifespan, and symptoms frequently don't appear until up to 3 months after the most recent insult that tipped the individual over the threshold into persistent symptoms, severing the psychological link to the event.
The Tip of the Iceberg: Researchers at Boston University’s leading CTE center are now more concerned with sub-concussive insults than full concussions. Why? Because they happen vastly more often, are typically asymptomatic, can cause equal or greater force, and equal or greater injury to the brain.
The "Clean" Scan Myth: "If you have a 'clean' MRI/CT you don't have an injury to your brain." Reality: Standard MRIs and CT scans only detect gross structural damage or major bleeding. They are not yet sophisticated enough to see diffuse axonal injury (microscopic stretching, tearing or shearing of neurons).
Myth: You have to lose consciousness to have a concussion.
Myth: Helmets prevent concussions.
The Tragedy of the "High-Functioning" Client
The clients who are most often missed or dismissed are those who are highly intelligent and accomplished individuals. Because they were high drivers, they have a strong ability to mask their symptoms and temporarily "push through" at work or an hour assessment. And, because they are typically articulate and their baseline intelligence, prior energy, achievements and overall functioning was so high, their post-injury drop looks "normal" on standard cognitive tests.
What most people don't see is when they crash in the privacy of their car or home.
I put together this informational card, highlighting some of the hallmark symptoms. Brain injury occurs on a broad spectrum—from completely asymptomatic, to death. The most missed people are those who look like you and I.
When a client's presentation crosses the line from purely psychological trauma into complex neuro-fatigue and brain physiology, let's stop guessing. I specialize in holding this exact, nuanced space for individuals and couples.
If you know what to look for and ask, and if they have the courage to tell you, they have a litany of symptoms that can make them sound positively crazy—but they absolutely are not.
Some are your clients who are suddenly afraid of driving, or driving over bridges or open spaces; they may have turned off all the lights in their homes, closed their curtains and seemingly turned into recluses. Some even wear hats and sunglasses indoors.
Others are highly anxious about going to social events or being required to return to the office after working from home. Their work performance may have tanked, or they're working more hours to do what they did before.
Suddenly, they don't like going to restaurants, concerts, or shopping at the mall or for groceries. They may have stopped reading their emails, snail mail or listening to their voicemails. They may dread summer, or weather changes. Their school grades may be dropping or they've withdrawn altogether.
They are writers, executives, artists, high end designers, longshoreman, nurses, bus drivers, accountants, bank VPs, ocean biologists…They've gone to 15 different doctors and have no answers. Or, they've been misdiagnosed and put on medications they never should have been on. Some are at risk of losing their house, their marriage, their job, and their friends.
Some slur their words but aren't drunk. Others have started to forget things, like their appointment with you. When you ask, they may already have an elaborate system of reminders set up. Or, it's so complicated they say they'll get a migraine just trying to figure it out.
Sadly, I could write a whole book about this. And, maybe one day I will. But for now, I shall end this here.
