Episode 393: When to Say I Love You & Numbness in Face After TBI

Hello friends!

In today’s episode, we explore the deep and complex emotions involved in expressing love within romantic relationships and the challenging path to recovery following a severe traumatic brain injury. We kick off with a question about the appropriate timing for saying “I love you” in a romantic context, especially considering cultural differences and personal challenges such as being on the autism spectrum. Our listener’s journey brings forward the importance of understanding personal feelings and the unique dynamics of each relationship.

We then shift to an inspiring yet poignant story of miraculous recovery and the persistence of hope. Another listener shares the journey of their mother’s recovery from a severe traumatic brain injury resulting from a car accident. While her recovery has been astonishing, they grapple with the lingering issue of facial numbness. This story highlights the incredible resilience of the human body and spirit, the complexities of the brain’s healing process, and the necessity of advocating for comprehensive care that addresses all facets of recovery.

As we navigate these profound topics, remember, whether it’s about expressing love or facing the aftermath of a traumatic event, the journey is deeply personal and filled with opportunities for growth and understanding.

As always, you can send your questions to duffthepsych@gmail.com and find the full show notes for this episode at http://duffthepsych.com/episode393

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Question 1:

“Greetings Dr. Duff, Long time reader + listener of your work- thank you for all you create and share with the world.

My question is: Is there an appropriate time to first say “I love you” in a romantic relationship? Some personal context: I grew up in a few different cultures, and in many languages, there exist multiple ways to say “I love you” (different “levels”/ connotations), when in English we only have this one. I am on the autism spectrum, and don’t always understand social conventions. If the relationship were platonic, I would have told this person that I loved them a while ago. Have an amazing day”


Firstly, thank you immensely for your longtime support and for reaching out with such a heartfelt question. The topic of when to express “I love you” in a romantic relationship is indeed a nuanced one, and your personal context adds layers of complexity to consider.

Navigating the timing for these three powerful words can be puzzling, especially when considering the diverse cultural and linguistic backgrounds that offer various expressions and levels of love. This richness in language allows for nuanced expressions of affection, something that English, with its single catch-all phrase, can sometimes fall short of capturing fully. Your unique experience, growing up amidst various cultures and being on the autism spectrum, understandably makes discerning social conventions around love even more challenging.

The essence of expressing love, particularly in a romantic context, is deeply personal and subjective. There isn’t a universal milestone or a one-size-fits-all timeline. For many, including myself, understanding the “appropriate” time to say “I love you” is a journey of its own, filled with uncertainties and moments of vulnerability. The fear of saying it “too early” or the anxiety over not having those feelings reciprocated is common, transcending neurotypical and neurodiverse experiences alike.

Reflecting on my own journey, I recall moments of accidental confessions and the humorous awkwardness that followed, underscoring that even without the added complexities of autism or cross-cultural nuances, the act of declaring love is fraught with uncertainty for everyone.

The experience of love is as diverse as our individual stories. For some, love might manifest as a profound intellectual connection, for others, it’s an emotional resonance or even a physical sensation—a warmth, a pull towards someone that transcends words. And sometimes, it’s a combination of all these elements, uniquely intertwined.

If you find yourself contemplating whether to express your love, it might be beneficial to explore what love means to you. How does this feeling differentiate from other forms of affection you’ve experienced? Understanding your own heart can be as revealing as understanding the person you’re with.

Regarding the timing, there’s a consensus that the initial stages of a relationship might not be the ideal time for such profound declarations. However, as weeks turn into months, if your relationship deepens and these feelings continue to grow, sharing your heart can be a beautiful, honest expression of your emotions. It’s less about a specific timeframe and more about when these feelings of love are genuine and not merely caught up in a fleeting moment of passion.

In sharing your feelings, especially given your thoughtful consideration of your unique perspectives, it’s essential to approach the conversation with openness and without expectation. If this person knows you well, they will likely understand and appreciate your honesty, regardless of whether they’re ready to reciprocate those feelings immediately.

Expressing love is an act of courage, a step towards vulnerability that deepens connections, whether or not the words are mirrored back at the same moment. Love, in its essence, thrives on honesty, growth, and understanding. It’s a journey you embark on together, learning and growing, irrespective of who voices their feelings first.

Remember, love is not confined to the words we say but in the myriad ways we show up for each other, in understanding, patience, and the shared moments that build your unique story together.

Question 2:

“Hello! And thank you for all that you do. Your podcast and books have helped me in so many ways. Today marks two years since my mother suffered a serious traumatic brain injury from a car accident. She was in a coma and intubated and had the worst coma score (I think that’s what it’s called) you can get. She made what could be referred to as a miraculous recovery and moved home and started working within months. She drives, works full time, and has almost returned to her former self. One more issue that we can’t seem to figure out is facial numbness. One whole side of her face and head are completely numb. She describes her nose as feeling closed and says her tongue being partially numb makes eating unenjoyable. We can’t seem to find any help for this. She’s had an mri and they don’t see anything wrong and everything appears to have healed well. Doctors haven’t really given her the time of day because they say that she should be grateful she has her life. I’m trying to find any resources on this we possibly can. If you know of any info on the topic could you please share links or contact info for specialists, etc. For reference we live in Southeastern PA. Thanks so much for reading my question and for all that you do!”


First and foremost, I want to express my gratitude for your kind words and for sharing your journey with us. Your story is one of resilience and strength, and it’s an honor to be a part of your support system through the podcast and books.

The journey you’ve described regarding your mother’s traumatic brain injury (TBI) and her subsequent recovery is nothing short of remarkable. It’s stories like these that truly highlight the incredible capacity for recovery the human body possesses, as well as the undeniable spirit of those who face such daunting challenges.

The Glasgow Coma Scale, which you mentioned, is indeed a critical tool used in assessing the severity of brain injuries. It measures eye, verbal, and motor responses to gauge the level of consciousness in a patient suffering from a TBI. The scale ranges from 3 to 15, with lower scores indicating more severe injuries. It sounds like your mother was at the lower end of this scale, facing a severe TBI, which makes her recovery all the more astounding.

However, the path to recovery from a TBI is often complex and multifaceted. While major milestones like returning to work and regaining independence are celebrated, it’s the lingering symptoms, such as the facial numbness your mother is experiencing, that can continue to pose significant challenges. These symptoms, though perhaps seemingly minor in the context of her overall recovery, can have profound impacts on quality of life, affecting daily joys like the taste and enjoyment of food.

Your frustration with the lack of attention from healthcare providers regarding this issue is entirely understandable. Recovery is not just about surviving; it’s about thriving and enjoying life to the fullest extent possible. Your mother’s desire to address this lingering symptom is a testament to her strength and her determination to reclaim as much of her former self as possible.

The MRI results you’ve mentioned, while reassuring in showing that there’s no visible structural damage, don’t necessarily provide the full picture, especially when it comes to nerve function. The numbness could indeed be related to damage to the cranial nerves, such as the trigeminal nerve or the facial nerve, which might not be readily apparent on an MRI.

Seeking out a neurologist who can perform a more detailed examination, such as a nerve conduction study, might provide further insights into the cause of this numbness. Additionally, exploring imaging techniques that offer a more functional view of the brain, like PET scans or functional MRIs, could shed light on areas that might not be functioning optimally despite the lack of visible structural damage.

There are various avenues for addressing nerve-related issues, from sensory reeducation and electrical stimulation to acupuncture and more, each with its own potential benefits. Finding a specialist who is willing to explore these options with you could be a critical step in addressing this lingering symptom.

Your dedication to your mother’s recovery and quality of life is truly inspiring. It’s clear that you’re not just content with her survival; you’re committed to ensuring she can live her life to the fullest. I commend you for your advocacy and determination in seeking out the best possible care for her.

Continuing to explore all available options, advocating for your mother’s needs, and seeking out specialists with the expertise to address this specific issue will be key. Your journey underscores the importance of not just surviving after a TBI but thriving, and I’m hopeful that with the right support and resources, your mother can continue to make strides in her recovery.

Wishing you and your mother all the best on this continued journey of healing and discovery.

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