When all you have is a hammer, everything is a nail. Learn how, early in my training, I jumped to a (very) wrong conclusion when, with "blinders on", I focused narrowly on the psychological meaning of a sudden-onset illness.

(You can also view the content of this video in 4 shorter episodes.)

What is your understanding of traumatic brain injury? Why do similar impacts to the brain have different outcomes? Learn how each person’s unique Protective Barrier - composed of biological, psychological, and social factors - influences the outcome of traumatic brain injury.

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The concept of the Protective Barrier is explained and illustrated with case examples by Dan Gardner, MD

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Transcript: As an internal medicine intern, I and other trainees evaluated a distraught artist, suffering from shortness of breath and progressive walking problems. Noting a normal physical exam and a recent emotionally traumatic breakup with his lover, I concluded that the symptoms were manifestations of an hysterical conversion reaction, rather than caused by any physical problem. What a shock I had the next day as I observed a swarm of medical personnel rushing this poor man, barely able to breathe, to the intensive care unit to be placed on a ventilator! The diagnosis: polio!

The same year I speculated that a man complaining of severe back pain and a stormy relationship with his son was symbolically expressing his disappointment, frustration, and anger with his son through the pain. That is, his son was "a pain in the back"! I changed my diagnosis, however, after seeing the bone spurs (probably pressing on nerves) in his spinal x-rays.

These two cases are examples of a common pitfall to which we all fall prey at times: the wish to find clear-cut, simple, unambiguous answers to life's complex problems. At the time I was so interested in the psychological factors in illness, that I downplayed possible physical contributors.

And so it can be in the evaluation and treatment of brain injury. Pressured by constraints of time, money, and other resources, we may eagerly narrow the focus to one particular issue to explain complicated behavior. For example, depending on the perspective of the evaluator, a brain injury survivor's irritability may be attributed only to: frontal lobe bruising, neurotransmitter imbalance, inadequate sleep, poor nutrition, excessive or inadequate medication dose, relationship disappointments, lack of recreational and vocational outlets, loss of job, etc.

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