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Catching John Cumming*

 News from the Johns Hopkins Department of Psychiatry and Behavioral Sciences

Newly married and in his 30s, John Cumming* was a cheerful and industrious subcontractor, a man who saw his job as a calling: “Building houses was what I wanted to do. I was good at it.” In November 1997, however, Cumming slipped from a 40-foot scaffold.

He fell for seven years.

Cumming went into a two-week coma from the impact that fractured his right eye socket and injured the right frontal lobe and, by rebound, part of the left temporal brain. Still, after corrective surgery and a half-year of rehabilitation, Cumming felt ready to return to work. Work, however, wasn’t ready for him. Inklings that he’d changed had come in the rehab facility: He’d made sexual overtures to his wife beyond the appropriate. And over the next few years, outbursts of anger toward coworkers and others, along with uncharacteristic sexually impulsive behavior, cost him his job and got him arrested and even jailed for several months. “My injury let the warning light go off,” Cumming explains. “It wiped out my self-control.”

Made to leave his church, separated from his wife, estranged from most of his family—including his two young children—he endured short but potent thunderstorms of sadness and persistent feelings of worthlessness. It was alonely and anxious man who came to Hopkins some six years after the accident.

“As a traumatic brain injury patient, Mr. Cumming is the rule rather than the exception,” Vani Rao, M.D., told colleagues at arecent psychiatry Grand Rounds. Now the extent of his therapy is also becoming standard. During a short inpatient stay in a Meyer 5 neuropsychiatric unit, Cumming received extensive diagnostic testing. At his release, Rao, who directs Hopkins’ outpatient Brain Injury Program, devised a highly individualized treatment plan, one meant to “rescript” his life. To give a biological hand up, he was prescribed sertraline for depression and amantadine for “frontal lobe symptoms” such as impulsivity, a low tolerance for frustration and tissue-thin inhibition. Depot lupron effectively quieted libido.

One-on-one cognitive behavioral therapy has helped Cumming, as have group therapies—weekly sexual behaviors meetings and daily psychosocial rehabilitation that includes role-playing. “We’ve been coaching him to think before he speaks, to learn to accept and cope with his injury,” says therapist Shari Keach, who’s expert in accentuating Cumming’s genuine strengths.

Gains are clear. Recently, he and relatives took his children to the zoo. He’s begun computer training. Sexual aggression has stopped. And Cumming says he likes himself: “It’s been like watching a baby grow. I’m more empathetic, more patient.” With a directness that’s the bright side of losing inhibition, he adds, “My entire heart was in pain. Now it doesn’t hurt.”

See also The Real Trauma of TBI.
For more information go to the Brain Injury Clinic.

*not his real name

Winter 2007 Index | Hopkins Newsletter Archive

 
 
 
 
 
 

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