Intimate Partner Violence & Brain Injury: Eve Valera, PhD

Q:  The World Health Organization reports that almost one-third of women worldwide have experienced physical or sexual violence by an intimate partner. Yet, a lot about the relationship between intimate partner violence and traumatic brain injury, also known as TBI, remains unknown. For over 20 years, Eve Valera, a neuroscientist at Mass General, has been researching the prevalence of TBI resulting from intimate partner violence, as well as the impact these injuries have on cognitive and psychological function. She is also devoted to training professionals to recognize TBI from partner violence in order to get proper help and interventions to women in need.

Most recently, Eve and her colleagues concluded first of their kind studies that used neuroimaging to look at the effects of TBI from intimate partner violence. From these studies, she found that the number of TBI sustained was related to the way certain networks or regions in the brain interact with one another. Many women, she says, may not even be aware that they have sustained serious brain injuries and that they are directly impacting things like their memory, learning, cognitive flexibility, mental health or response to stress. For Eve, this is more than just an area of interest. It's a public health epidemic. So welcome Eve, it’s such a pleasure to have you here today.

[00:01:19]

A:  Thank you so much for having me. It’s a genuine pleasure. I'm always eager to talk about this.

Q:  So Eve, I've heard you speak about partner violence as being a public health epidemic and I'd love to start there, if we can. Can you talk a little bit more about what your thoughts are on this?

[00:01:35]

A:  Absolutely. In short, when we look at  the epidemiological studies, what we see is that globally an average one in three women have experienced physical or sexual partner violence at some point in their lives. 

And this persists in all different ways and forms and is sanctioned. And is not necessarily considered to be a crime, even in some countries. So it's clearly a tremendous problem, does not get the attention that it really needs. And, quite frankly it’s stigmatizing.

[00:02:31]

And there's a lot of victim-blaming. And it makes no sense to me.

Q:  And is this a problem that you would say is specific to women? 

[00:02:47]

A:  Well, that's a great question. So I have not studied males so far, for a couple of reasons. One is, it would be much more difficult to engage men in this type of research. I think it's even more stigmatizing for a male to acknowledge that his partner has injured or hurt him. The other reason is that females are disproportionately more likely to be physically injured by partner violence. 

[00:03:15]

[00:03:43]

But men certainly are victims of partner violence and I think it's a problem there, as well. 

Q:  Can you talk a little bit more about just the stigma piece of it, how that plays a role in the work that you do?

[00:04:16]

A:  Yes. 

So there’s gaslighting. There's victim-blaming from everybody around.

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So even a mother, or somebody else may say, “ you have to keep your marriage together.” Just, “Why do you do this? Why do you get him so angry?” So there's many reasons why women may not want to come forward if you put yourself in that situation, do you want to admit that someone you love and chose to be with is hurting you?

[00:05:26]

And then, internally, it’s certainly conflicting as well. Because, you might love this person at the same time and they're also hurting you. I mean, in some of these cases, the love has been drained out of the relationship and women are just too afraid to leave. But there is certainly a lot of love still there. 

[00:05:56]

And so, it's not that easy for women to come forward. And it’s also hard to talk about. They know it makes other people uncomfortable. So ultimately, it ends up being very stigmatizing and it's not something that people want to share. So it may make women more likely to keep it to themselves. 

[00:06:24]

And so, they're hiding the abuse. And then, ultimately, they may be hiding injuries associated with the abuse, et cetera. So in terms of my work specifically, there's levels of complications that you don't necessarily have in in a lot of other studies. So you have to build trust.

[00:06:56]

You have to be someone who women can perceive as someone who's trustworthy and willing to share their information with.

Q:  And just coming back to that idea of this being a public health epidemic, is that something that you found is commonly regarded in the medical world and by your peers? Or is this a new term being put to the concept of intimate partner violence?

[00:07:23]

A:  I think that people who know about partner violence and are aware of it, will certainly acknowledge, that it's a public health epidemic. I think that a lot of people don't necessarily recognize it as such, because it is so stigmatizing and, sometimes people think it's a private thing. So for example, if you think somebody in a bar and somebody cracks a bottle over somebody's head in a bar. whoa, that person, you should press charges, buddy. That’s not a right thing.

[00:07:58]

But now, if you're in the home and a husband cracks a bottle over a woman's head, there may not be that response at all. What did she do to deserve it? You guys have to figure this out, whatever. And there should not be a difference there and it's often hidden. So  a lot of abuse still happens behind closed doors. And so, even my own mother, for example, was really shocked when she read the statistics from some of my work.

You're walking around amidst women who have experienced partner violence left and right and you would never necessarily know it. It’s kind of, it’s not necessarily visible. And it's sort of a parallel, too, with what I specifically study, which is brain injuries. And they are often invisible as well, unlike other types of injuries that women may sustain, like a broken arm or something like that.

Q:  So it's interesting to hear about when women start hearing other people in the community come forward, they too come forward. So do you find that women recognize what's happening to them as being violent. Or has it been normalized to some extent in their life? 

[00:09:48]

A:  I think it's both. I definitely think that women don't necessarily recognize what's violence. So there's physical partner violence and there's emotional or verbal. 

[00:10:18]

But women can be tortured. Their every move is tracked. They walk in the door and they get harassed and threatened and what exactly did you do? Like, well, is it really partner violence? Because he didn't actually hit me. So that's a great example of how women don't necessarily recognize that as violence and that’s definitely partner violence. 

[00:10:42]

And then, maybe, “Well, he just hits me a little bit,” or “He just pulls on me,” or, maybe there's a little bit of, there's some hitting but there's also intense controlling behavior. And so, it's a combination. So women don't necessarily recognize it or label it as partner violence. And they may normalize it, especially if they've come from homes where they've witnessed their parents. So unfortunately, it's too normalized for too many people.

[00:11:12]

And then when it may be recognized, it's often stigmatized. 

Q:  And I'd love to shift gears, and talk a little bit about sort of your entry into this field. Can you talk about the research that you do specifically and what the state of that research was like when you first started?

[00:12:57]

A:  I started in the ‘90’s some time. My interest in graduate school was neuropsychology, so brain behavior relationships. And I was also interested in domestic violence more generally, so child abuse, partner violence, et cetera. And so, I was learning both of these things and I was volunteering at a woman's shelter for domestic violence.

[00:13:25]

And I noticed that the women who were in the shelter reported things that certainly could have resulted in brain injuries. And they had problems with attention, concentration, memory frustration, et cetera. And those were the same symptoms that one that might see if somebody had just sustained a concussion or a brain injury. And so, I said, “Well, gee, these women are probably sustained brain injuries. What’s going on here?”

[00:14:18]

So I brought it to my dissertation committee and crazily enough, started doing that. 

Q:  And so you mentioned domestic violence and intimate partner violence. It sounds like the two aren’t interchangeable. Can you just provide a little context as to what the differences are? 

[00:14:53]

A:  Domestic violence really refers to violence that occurs within the home. So it could be child abuse. It could be partner violence. It could be elder abuse. And when we get to intimate partner violence, that's clearly a subset of domestic violence, but it doesn't necessarily occur within the home. 

[00:15:19]

It's really violence between a couple. So either a boyfriend, a partner, or even an ex-partner. So it could be someone your dating, someone you don't live with, et cetera. So there is a subtle distinction. 

Q:  So this first study that you brought to your dissertation committee, how did you go about kind of putting this idea into practice?

[00:15:57]

A:  Well, I decided. What were going to be the most important measures to include? And what I wanted to measure. And so, I needed to determine whether or not there were sustaining brain injuries. And then, in a quick way, whether or not it was associated with other things that we know are typically associated with brain injuries, like depression anxiety, PTSD symptomatology. Or problems with memory or learning cognitive flexibility. 

[00:16:28]

And so we set up a protocol that included those types of measures. So measures that would test people's memory and learning. Measures of worry, anxiety, depression, et cetera. Then I basically got different people from around to be on the team.

So it was a nice team effort. And we put together a study that, ultimately, was pretty successful.

Q:  Can you talk a little bit about the findings from that inaugural study and how it's paved the way to the work that you do today?

[00:18:46]

A:  Yes. So I managed to interview 99 women. And what I showed was that, unfortunately, three-quarters of them sustained at least one partner-related brain injury. And then, what was kind of even more distressing was that about half of the women sustained repetitive strain injuries from their partners.

And the brain just didn't feel right after they were struck in the head by their partner. So that was the first part of the study and then the other thing that I did was look at how the number and recency in a variety of those brain injuries was associated with measures of cognitive and psychological functioning. 

So I found that the more brain injuries women had and the more recent they had them, the more difficulty a woman had performing a test of memory and learning. So in this test, they had to learn words that were read to them five times and then remember that list twenty minutes later.. 

Women who had more brain injuries, would also perform more poorly on a test that required what we call cognitive flexibility. And that means being able to switch rapidly from one type of thinking to the next. And also, women who had more brain injuries were more likely to have higher rates of depression, anxiety, worry and PTSD symptomatology and general distress. 

So overall, you can say, okay well, we found these brain injuries. What does it really mean? And it really means that this is having an impact on women very negatively, both cognitively and psychologically. And one of the things that I also did, that I felt was really important to do, was to look at whether or not it means that their abuse is more severe. 

But I was able to use statistical analyses to control for that. To say, “No, it's not just the abuse severity.” If we control for this, we still see this relationship between cognitive functioning and the number of brain injuries, as well as the psychological function on the number of brain injuries. And I think that was very compelling for me. 

Because, anecdotally, we've known forever that women who are in partner violence situations off problems with maybe attention concentration, learning, memory. They’re more depressed, anxious or whatever. But it was sort of like, well, of course, you're in this abusive relationship where you may have to be walking on eggshells. You may be being controlled psychologically, financially et cetera. Wouldn't you be like that? 

And want I wanted to do with this paper is say, well there is some of that. But no, we need to see here, there’s definitely this relationship between the brain injuries as well.

Q:  And what was the reaction in the medical community from your peers when the findings from this study were released? 

A:  It was definitely new information. But the problem is that people didn't necessarily know what to do with it. And/or, it's just not something that a lot of people are interested in.

And then I actually did, and I will never forget this. 

I actually got a letter from Erin Bigler, who is a very well regarded TBI person,that said, oh thank you for doing this work. It's so important. But overall, it wasn't like this started this snowball effect of, oh, we need to do this.

Although, I will say that we are gaining traction now, which is really super exciting.

Q:  Can you talk a little bit about some of the more recent research that you've been doing with the imaging and neuroimaging. Talk about those studies that you've created and why? What is new about them? 

[00:30:20]

A:  So what I did with my imaging was really, I said, okay, there are the studies out there already that have been done on athletes and the military folks, because that's where you see a lot of data. I'm looking at head injuries and more specifically, repetitive head injuries, because that's where they often occur. And so I said, “We don't have anything to build on in females or in partner violence. So I'm just going to see if what we have found over there can apply here as well.

[00:30:53]

I definitely don't think that it's necessarily going to be universal. We definitely can't apply all results there, But it’s certainly a good place to start, right? One of the things that we’ve learned in the field of neuroscience is that, functional connectivity is really important, in terms of understanding and the way people think and behave.

[00:31:25]

And what we mean by functional connectivity, is just the way the different regions in the brain that are not necessarily next to each other, are communicating with one another. And so we have ways of measuring that. And what we've realized in neuroscience is that there’s these networks within the brain, so a network just meaning several different brain regions that are working together to perform one function.

[00:31:51]

And we have a ton of networks in the brain that are required to work with other networks. And if there’s a disruption in the communication either within or between networks, you can have problems, like cognitive problems or behavioral problems, et cetera. And we know that's a large part of what we see after brain injuries, is disruptions in either functional or structural connectivity. 

And structural connectivity is really talking about, basically, the axons, which are part of the neuron in the brain that connects different brain cells. So in the first study, I looked at functional connectivity. And what I found is that two regions that I looked at that usually increase their communication with one another when people are doing a complex cognitive task, for women who had sustained more brain injuries, they had less connectivity between those two brain regions.

Just when the woman is lying there not doing anything. 

But, within those same women, I found that the less connectivity there was between those brain regions, the more difficulty women had performing the task I talked about before, of memory and learning. And so that's a real life consequence. Because if you can't learn and you can't remember, then that's going to have, obviously, negative downstream effects. So that was the first study, the first imaging study, that I got out there. 

And then, with the structural connectivity I had modeled it off of football players. So football players who had sustained repetitive injuries showed what you'd call, fractional anisotropy. All that means is the degree that water is diffusing or moving in the axon, which is a part of the brain cell. 

We found that, in several of the regions that we looked at, indeed, the number of brain injuries she had sustained was associated with that measure. So that was just another way of showing, like, these very, we’ll call them preliminary data in the field. Because it was a relatively small sample and basically one study. So we really want to have a number of different studies, coming together and finding similar effects, or larger studies looking at things in different ways. 

So but it definitely said, look this is not something that is just in women's heads. We can't ignore this any longer. And there's no reason that we shouldn't be studying women to the same degree that we're studying athletes and military folks who are mostly men, because there are thousands of studies in those areas. And imaging wise, there's only two women who have experienced partner violence, looking at the effects of brain injuries. So, obviously, that needs to change.

Q:  How affirming for these women to have, sort of this concrete evidence now, that it's not in their heads, if they were thinking that before. How do some of these findings kind of translate into patient care? How are they impacting the way doctors are approaching women who are presenting with these types of symptoms?

A:  Well, ideally, doctors will start changing. And I don't know to what degree they have. I did write an opinion piece at the start of COVID, because COVID, unfortunately, is associated with an increase in partner violence and increase in severity of that violence, which certainly is probably going to translate into many more brain injuries as well. 

The first step is for a physician to recognize that partner violence is occurring at all. And that's not necessarily an easier, obvious step. That may be something that may need to be asked. Then the next question needs to be, “After anything your partner ever did to you, did you ever lose consciousness?” 

Or, “Did you ever feel disoriented or confused, or see stars or spots or something like that?” To get at whether or not there may have been a brain injury as well. Because if somebody presents to a physician confused, not paying attention, irritable, maybe real sad. 

The physician may say, “Okay, you need to see a therapist to help you deal with your depression. But what they should be saying, if they’ve asked that question and they discover that there's a brain injury is, “You need to maybe have a neuro evaluation. And we need to determine whether or not you have certain cognitive difficulties now associated with this.” 

“And if you need occupational therapy or physical therapy for things that may be resultant from the traumatic brain injuries.” And so, as a physician, there’s sort of a two-step process, because I think the partner violence isn't necessarily always recognized. 

And then, if you go a step further, in terms of care, when women go into a shelter, it’s a chaotic environment, so that's not going to be good, because when you have a brain injury, what is ideal is something that's calm and soothing and things are all in their place, et cetera, and familiar. So if you've just fled from your partner, you're in an unfamiliar place.

And then you have a shelter worker, an advocate, telling you you're going to have to file for an order of protection. You have to start looking for a job. You have to start looking for housing. And for someone who's just sustained a brain injury, that's incredibly overwhelming. You're going to want to assess whether another brain injury has occurred. And then, alter what you have them do, based on that. 

Because they're more likely to come back with nothing done, versus if you say, “Okay, we recognize you've just sustained one brain injury. Maybe you've had others in the past. This may be more difficult for you to get all this done without extra help. And again, that's something that we need to really work on. We need to have shelters or facilities that are geared towards helping women who are basically running for their abusers. 

That they really need to have a neuro rehab component to them, so that women are treated as someone who sustained a brain injury, versus someone who was just like walking off the street and totally healthy with, obviously, the exception of the psychological trauma of experiencing that. So those are just some of the ways. And you could go on, like, how might you do things differently if you were a police officer or a judge? 

So from a police officer's point of view, one of the really sad things is that a brain injury behind closed doors looks a lot like intoxication. If you open the door, you see someone who's disoriented, maybe slurring their speech, maybe not knowing how they got from one room to the other. Maybe they're being a little belligerent or irritable. The first thing that somebody might think.

 “Oh, this is just another one of these incidents. He’s giving a clear story of what's going on. She can't remember. So okay, just keep it down. No more of this,” versus, “Have you sustained a brain injury? Do we need to get home right now? We’re going to have you seen by a forensic nurse, so she can determine and document that you've just reported that you sustained a brain injury. 

And then if that proceeds up to the court, now there's a note in her record that she sustained a brain injury, versus she’s this unreliable witness. 

I think there are just very many levels at which a knowledge of a brain injury versus no knowledge of a brain injury should make a difference in whatever interactions occur. 

Q:  And relation to that piece about training police officers training other non-medical professionals to recognize the signs of TBI. I know that's an area of your work. That you go out into the community and you offer some of these trainings. Can you talk a little bit about just your experience, personally, doing that?

A: Well, actually, there was a woman that I know in the community and she had connections to the Chelsea police station, which is local, right around MGH.

And so, basically, I was invited to give a half-hour lecture in their annual training. I’m sure some people were uncomfortable, as I would expect. 

But there were definitely men who came up afterwards and were asking questions, like, oh wow. And then, somebody else just said, “Yeah, I recognize this and that.” So I was definitely happy to be able to do that. And then I also said, “You know what? I’m doing this in Chelsea, but I live in Quincy and I'm not doing my own police department.” So I reached out there and they said, “Yeah, come and do this here as well.” So I did it for them as well. 

And again, you definitely see some people getting uncomfortable, which speaks to this whole issue of partner violence. No matter who you talk to, there’s going to be, in general, somebody in the crowd that's just uncomfortable with the whole idea. 

But hopefully, eventually, there will be something like projects that are designed to do that, to train folks like police officers. And then do follow-up surveys to find out how they have impacted how they proceeded for certain calls and things like that. 

Q:  It's interesting hearing so much about how stigma plays a role in all of the different pieces of your work. How have you been able to sort of stay grounded in your purpose, conducting this research? Going out into the community, while facing some of the reluctance from people to address this?

A:  I very much like putting in positive energy in this world. And I don’t necessarily like people who incite anger or get angry. 

But lately, when I've been giving talks, sometimes I say, “You know, I’m not usually like this, but I do want to make you angry for the next hour or so.” And the reason is, because I want you to be so angry that this happens and this is happening to women. And this has been so ignored for so long, that you want to do something about it. But you're angry enough to ask your neighbor if they're safe and then go second step, if you think maybe something's going on and make sure they're not sustaining brain injury.

[00:48:12]

But there's no reason this should be going on. Why is this okay? Why is that not just something where somebody should actually be put in jail for. Part of it, it’s not necessarily my anger, it is. It makes me angry that this happens to so many women. That so many lives are damaged or destroyed because of things like this. But it’s a true passion.

[00:48:47]

I just know however it came about, it’s there. And I'm sort of like, if you're uncomfortable, I don't care. Get comfortable. You shouldn't be uncomfortable. When we talk about violence on the street, is that something that is taboo? No. Why should violence within the home be taboo? Why is it okay to hit somebody inside a home, if it's not okay to hit them outside the home? It doesn't make sense to me. 

[00:49:21]

And then, if you want to go a step further, many, many of the people who are being abused are being abused in front of their children. And so, now you're setting up this potential cycle and the damage that children are sustaining by witnessing things like this. And then a woman is potentially not able to parent her children the same way that she should be able to, if she's dealing with a head injury on top of things.

[00:49:49]

It doesn't make her unfit, necessarily, by any means. So for me, I’ve just taken this stance that I think that this is intrinsically and absolutely and utterly wrong and unacceptable. 

 I don't ever think that anyone should be abused by anybody else, no matter who you are. And so, I'm really driven by the passion and the belief that this really needs to change.

Q:  And just from a research perspective, what do you curious about next? For you, what questions have come up from your latest studies that you're hoping to answer?

But one of the things that we’re doing, for example, is we’re looking at magnetic resonance spectroscopy, which is just a different type of imaging. But to look at normal metabolites in the brain. And I’m also collecting blood, so that we can look at things like a beta and tau, which are also potential markers for neurodegeneration.

[00:53:12]

A:  So if you’re in the football world, one of the things that they're looking at is the rates of chronic traumatic encephalopathy that occurs after people have been repetitively hit in the head for being a football player. And so they are showing that a lot of football players do have something like this later on. And it results in like eight to ten years down the line. So you think oh, I'm not getting hit in the head anymore, I may be fine. But then, many years later, instead of just growing old.

Things start going badly for them. Sometimes they get really depressed. They feel like they're dementing. They have cognitive problems. They have behavioral problems. They have bad judgment. Some of them may commit suicide. And this has been linked to tau in the brain. 

[00:54:59]

And if you have certain behavioral manifestations and this certain level of tau in the brain that you can only see once they die and you cut open the brain. Then you will say, “Yeah, that person has CTE, chronic traumatic encephalopathy.” And so that's a long-term effect, what we’re believing, is a long-term effect of repetitive concussive or sub-concussive hits that that person sustained while they were playing the game, until many years later. 

[00:55:29]

In the women that I’m studying, one of the things that I'm doing now is collecting some blood so that I will be able to get some markers that don't necessarily determine that. But get it a little closer level of, oh, something related to brain injuries. And eventually, hopefully, we'll be able to build pictures of how this may relate to ongoing or later neurodegeneration and things like that.

A:  I’m very excited to see what we come up with. And we're continuing to do just as much as we can, looking at women now. And then, I'm really hoping to look at women as they age, specifically, to see what we can find there.

Q:  And you've talked a little bit about how COVID-19 has impacted your work.  But in the context of intimate partner violence, what has changed throughout the past year because of COVID.

A:  Well, it’s been really sad. Basically, once COVID sort of started spreading through the globe, we’ve seen so many more stories in papers about partner violence and spikes in partner violence, et cetera. And then, it’s not just that it's partner violence increasing, but the severity of the partner violence is also increasing. 

Part of the problem with COVID, is that it’s not just there’s things building on top of another. So everyone’s kind of stressed out. 

And then there’s lockdowns, to contain the virus. So women have to stay in close quarters with their partners. So even if they wanted to leave or were thinking about leaving, now they’re kind of trapped. 

[00:58:32]

Or they think they can't, because they think there's not a shelter. So they stay and they stay. And what we think is going on is that, because A, the increase in stress, et cetera. And B, women can't necessarily leave as freely as they might be able to, that they end up leaving once the violence has really escalated to a point where they just have to get out, or they really require medical attention. So it’s been, basically, the clash of two pandemics for women who are experiencing partner violence once COVID hit. 

Liquor stores all stayed open, so there was never a shortage of liquor. And we know that alcohol, is associated with high rates of domestic violence overall.

[00:59:53]

It’s been very unfortunate that this has happened. And I think we’re going to see the effects of this for a while to come. And when schools really open up, we may see more kids who are suffering from either child abuse or witnessing their parents being abused. We'll see. 

[01:00:25]

Historically, we know that when there are crises, like national crises or pandemics, that rates of partner violence do go up, without the extra specificity of COVID and lockdown.  And the effects of those types of crises have tended to last at least a year longer. So I think this is a real time to be especially aware of the possibility of partner violence occurring. And of the possibility that traumatic brain injuries may be occurring as a result.

[01:01:04]

Because I think it's not only increased violence, been increased in severity. One of the things that I do like is that it gives a window for asking. So one of the things that I've been trying to tell people and I try to share when I talk about this is to say-- so somebody will, like, “Well, I don’t want to ask her if her partner’s beating her up. I mean, like, that's like, how rude, you know?”

[01:01:32]

And it’s like, “Well, you could save her,” but if you don’t want to, a way around it would be to say, “Hey, you what? I hear that COVID is really making family life super stressful for a lot of people and a lot of people are having troubles in their relationships. And I know that couples are fighting more and things like that. Is that happening with you? Are you okay?”

[01:01:58]

“If you don’t want to tell me, that’s fine. But I’m here for you, if you need me,” in whatever way you can be there. And so I think it opens up an opportunity to non-judgmentally just say, “Hey, this is what's happening. I know partner violence is on the rise. COVID’s been really stressful. So I just wanted to check in with you. I'm checking in with everybody I know. 

[01:02:22]

So that's one thing that I think would be great if people would do. And not only is it great for just literally, potentially saving a woman who may be stuck in a very dangerous situation but increasing the awareness and opening the dialogue. Because I think one of the things we really need to do more generally, is just open the dialogue about partner violence and not have it be so stigmatizing.

[01:02:48]

It should be okay to talk about this. It should be okay to admit that. 

Q:  And outside of COVID, do you have any suggestions for how people listening, if they suspect someone they love is, or someone they know, an acquaintance, is suffering from partner violence might approach that?

A: Similarly, I might just say, you just check in, just say, “Hey, how are you? I'm always here for you if you need anything.” It depends. I mean you have to be willing to do it, too. You could just say, partner violence. You could even just say, “This happens a lot. And I'm learning about this. I just listened to this podcast and I realized that one in three people experience partner violence. 

[01:04:08]

So I have ten women that I'm calling, because I figure at least three of them have experienced partner violence. And I want to make sure that it’s not now and if it is, that they’re okay.” And it may not be easy. It's uncomfortable for people. And I think that the more we believe we could be helping somebody, or saving somebody in doing this, the more likely we’ll be able to put ourselves out there.

But when you put on top of that the fact that someone may be sustaining brain injuries, then that makes it more challenging. And the other thing is that sometimes you may feel like, well I was trying to work with this person. And I think she's just not really trying hard enough. And then \she'll do this and then she'll do that and then she’s irritable.

Well that might be a result of brain injuries. It may not be, but that's the other thing to consider. Because if it is, that may make you feel like, oh, okay, let me not be so harsh on this person. 

I'm going to try to understand this a little bit better. And then see if she can get proper resources, et cetera, to help the person deal with what she needs to deal with to get better.

Q:  This has been great. I really appreciate it. Thank you so much. Next, I just have my final five questions for you. What's the best advice you've ever gotten?

A:  Well, it's interesting. I think it came out of a Chinese cookie. And it said, do what you feel passionate about and the resources will follow. And it’s actually been surprisingly true. Because if I said, I couldn't do this because I don't have the money, or I don't have the infrastructure or something, I would have stopped a long time ago. But I kind of just did it and hoped. And it's worked out so far.

Q: What rituals help you have a successful day?

A: I have to spend at least a little time with my little boy. And I have a puppy and a bunny and a ferret, who I adore and just, it's amazing how it could just wash away the stress if snuggle with one of those little guys. 

Q:  It sounds like a full house. What advice would you give your younger self?

A:  I would say, do what you want to do, but be open. Don’t  think that you only have one idea about what you want to do. 

Q:  Do you have any guilty pleasures?

A:  Guilty pleasures. I love to dance. I don't know if it should be guilty, but I put on my six-inch heels and go dancing.

Q:  My last question, what do you consider your superpower to be?

A:  It’s in my enthusiasm and energy for what I like to do. I like being considered like the Energizer Bunny. 

Q:  That's great. Eve, thank you again so much for joining me on the podcast. It's been so great talking to you today. 

A:  Thank you so much for having me. It's been an absolute pleasure chatting with you.

END OF INTERVIEW