Thinking about moral responsibility and agency in TBI

Tonight I will assigned my Counseling & Physiology students a response paper to the following case study. As you read this fictional case, consider how you might answer these two questions:

  1. What are the spiritual issues in this case and how do you consider Tim’s limitations in considering these spiritual issues? What is his personal accountability in light of his functional limitations and injury?
  2. How might you advise Tim’s wife and pastor as they struggle to understand and respond to Tim’s inappropriate behavior?

Tim is a 34-year-old, married man and deacon in his church. Prior to a serious car accident 2 years ago, Tim was a successful general contractor generating income over $200,000 a year. 2 years ago, Tim suffered a traumatic brain injury when a drunk driver, traveling at a very high rate of speed, slammed into his vehicle. Damage to his brain was located in the frontal and temporal lobes. Tim spent a total of six months in the hospital and in rehab. Initially, He was in a coma for 3 weeks and not expected to recover. However, he did emerge from unconsciousness and with rehab regained his capacities to walk and talk. His memory is mostly intact, missing only the week prior to the accident and the five weeks post accident. He seems to be able to form new memories but complains that he has to write everything down or he will forget tasks. He also complains that it is hard for him to find words. His friends notice that his speech is slower now. He is oriented to person, place, and time.

Tim’s wife and pastor ask you to meet with him. Tim complies. In session he is affable, talkative, but unsure why others think he needs counseling. He notes that he works hard every day, uses his daily contacts in business to talk about God’s miraculous work in his life. He admits that he smokes now and should quit but that shouldn’t be reason enough to warrant counseling. He signs a release to talk to his wife and pastor.

You learn from his wife that Tim has numerous problems that did not exist prior to the accident. Most notably: he doesn’t complete work; fails to bill clients properly; seems to over-estimate what he can complete; work done does not meet his pre-accident quality; he is easily angered and even aggressive; he curses and smokes 2-3 packs per day (none prior to accident); he drinks; he spends beyond his means; he has periods of deep depression; he engages in foul language about sex; is demanding of sexual activity with his wife (but cannot perform since the accident); he flirts with other women.

Tim refuses to return for further appointments. His wife and pastor come to you to discuss options and how to think about Tim’s behavior. The church board has removed Tim from his diaconal position this week and is likely to initiate church discipline after it was discovered that he made a sexual comment to an 18-year-old girl (he commented (spoke admiringly) about her breast size).


Filed under biblical counseling, christian counseling, Christianity, counseling skills, Psychology, Relationships, teaching counseling

4 responses to “Thinking about moral responsibility and agency in TBI

  1. Lou Buses

    Actually, you asked four interrelated questions:

    1. What are the spiritual issues in this case?
    2. How do you consider Tim’s limitations in considering these spiritual issues?
    3. What is his personal accountability in light of his functional limitations and injury?
    4. How might you advise Tim’s wife and pastor, as they struggle to understand and respond to Tim’s inappropriate behavior?

    The key question is, “How do moral responsibility and physical trauma (impairing intellectual/emotional/spiritual functioning) interrelate?” [Similar to # 3 ] Do we have Biblical examples? Principles?

  2. Andrew Pomeroy

    I know that even though his body may have been partially destroyed. The soul cannot be severed in a car accident. But the soul and the body are very closely linked. Through a traumatic event a person will behave differently…well, duh!
    So we have to be patient, not accepting, of his different behavior. He needs people to re-inforce the notion that he can still be used mightily for God and that God can and will use all things together for good for those who love Him and are called according to his purpose.
    But we have to let him.

    He needs healing, mentally and physically.
    He needs to know that his efficiencies can
    be replaced by God’s strengths. But he may
    have to alter some life styles now.

  3. Kathleen

    Well I am having a hard time with the “fictional” story……I would much rather have heard of the true stories from TBI victims.

    I am personnaly a victim of TBI. I sustained much more major and as somewould say catasrophic injuries than your made up story. I took a fall from 10 feet and broke my lower back, shoulder, shattered by neck and the right back half of my skull creating a major closed TBI…..I was in a coma for three weeks and they even waited a week for the swelling to go down in my brain so that they could perform surgery on my neck.

    I am told I am lucky that “Allah” saved my by the Irain Doctor when I awoke and I was very quick to point out that Allah had nothing to do with it, It was the all might true GOD. He just smiled and said ok. I had no knowledge of the fall but can remember up until 15 minutes prior to it. I only have a couple of vague memories in the ICU. I had to learn to walk again, because all the muscle mass was gone. I was home in 6 weeks…….. I have lost no past or present memories, my first thought was to get into my church and give thanks. Now my issues almost two years later: I am tired more easily, I have to concentrate on spelling, if I do not finish my sentence there is be chance that I will forget what I was going to say, the frontal lobes of my brain are mush and dead. I have lost all sense of smell, taste and there fore appetite. I set an alarm to remind me to eat. I am plagued by daily headaches. I have lost the sensation of hot and cold and pain on the left side of my body and my hair will not quit falling out. I was back to work part time in 6 months and am now back on my 4/10 shift. I am told I will never ride my horses again but I can fish. I am quicker to anger and I no longer tolerate ‘stupid”….I used to have the patience of Job, now I have to count to 100. I was never a smoker and am still not and according to family and friends my assertiveness is the only change that they have noticed in me and that is not all bad, since I used to let people use me for a door mat.
    This was a work related incident that my boss has tried to sweep under the mat like it never happend and since it was work related there is NO compensation per say other than medical and keeping my job if I want it. SO I do get angry, but I put it on paper. I don’t blow at people.

  4. Debbie

    I don’t know the answer but I’m interested in knowing what the answer is. TBI causes all kinds of impairment that is beyond the survivors control. How does God relate to these survivors and how can we relate to God? What does that relationship look like?

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