On a recent episode of Mind Matters: Navigating Head Injuries and Concussions, host and legal nurse consultant Kiley Como with Shane Smith Law sat down once again with Paula Walters—paramedic, advocate, and founder of The Courageous Survivor—to shed light on an issue that remains largely hidden in both the medical and legal worlds: the intersection of domestic violence, trauma, and brain injury.
While concussions and traumatic brain injuries (TBIs) are often associated with athletes or car crash victims, Paula’s powerful insights reveal a much broader, more pervasive problem—one that affects millions of domestic violence survivors.
“You don’t need a helmet or a steering wheel to suffer a brain injury,” Paula explains. “You just need someone’s hand.”
The Silent Impact of Strangulation
One of the most shocking statistics discussed: up to 86% of domestic violence survivors have experienced strangulation—a form of assault that frequently leaves no visible signs. In fact, 50% of victims show no external symptoms, despite suffering potentially fatal or brain-altering internal damage.
“Strangulation can cause an anoxic brain injury, which mirrors the symptoms of a stroke,” Paula says. “But if there’s no bruise, no redness, people don’t seek medical help—and abusers aren’t held accountable.”
Trauma on Top of Trauma
These “invisible injuries” compound the emotional and psychological trauma that survivors already carry. Repeated hits to the head, slams against walls, and suffocation incidents don’t just leave emotional scars—they can leave lasting neurological damage.
Paula recounts her own experience: “My brain never had time to heal before it took another hit. It’s like stacking injuries on top of injuries, and no one saw them because I looked fine.”
The Struggle for Diagnosis and Support
Survivors face monumental challenges when seeking help. Many don’t realize they’ve suffered a brain injury, while others are forced to advocate for themselves within systems—medical, legal, or both—that don’t understand or recognize their needs.
Kiley, herself a former bedside nurse, reflects on these shortcomings. “Even in hospitals today, abusers often stay in the room during intake,” she says. “That makes it nearly impossible for a victim to speak freely.”
Paula offers practical advice for survivors:
- Document everything—in hidden apps, journals, or even voice memos.
- Bring support people to appointments, or ask to record the conversation.
- Request a brain injury evaluation if you’ve experienced strangulation or repeated head trauma.
- Understand your brain’s rhythms—schedule important appointments when you’re most alert.
“You have to advocate for yourself,” Paula emphasizes. “It’s exhausting, but it’s necessary.”
Misconceptions Around Brain Injury in Survivors
Another key takeaway from the episode is the persistent mislabeling of brain injury symptoms as emotional instability or mental illness. Survivors who show signs of impulsivity, forgetfulness, or emotional reactivity are often dismissed as “overly emotional” or “chaotic.”
“People used to say I was dramatic,” Paula shares. “But that was my brain injury showing up. We need to move from asking ‘What’s wrong with her?’ to asking, ‘What happened to her?’”
What Professionals Can Do
For healthcare providers, attorneys, and advocates, the message is clear: get trained in trauma-informed care and recognize the signs of brain injury beyond the obvious.
Simple but powerful questions can make all the difference:
- “Has anyone ever hit you in the head?”
- “Has anyone ever put something around your neck?”
Use the right language. “Strangulation” carries more clinical and legal weight than “choking.” And always remember: missed appointments may not be defiance—they may be symptoms.
A Call for Collective Change
As Kiley and Paula conclude, the path forward requires collective compassion, awareness, and advocacy. Survivors need more than sympathy. They need access to functional medicine, neuro rehab, legal support, and most importantly, validation that their suffering is real—even if you can’t see it.
“We’re just scratching the surface,” Paula says. “But the more we talk about it, the more lives we can change.”
If you or someone you know is suffering in silence, know that help is out there. And if you‘re in pain—call Shane. 980–999–9999.
For more stories like Paula’s and in-depth discussions on brain injury recovery, subscribe to the Mind Matters podcast on YouTube and your favorite streaming platforms.
