Following a TBI friends seem to disappear. It is very typical for survivors of a TBI to experience social isolation and loneliness. What factors are involved? It begins with a lengthy period of hospitalization and rehab when the injured person is out of the social loop, allowing the social caravan to move on without him. More dedicated friends will make an effort to call or come over for a visit, but the brain injured person is no longer the same outgoing, funny and witty person they once knew. He is often depressed. He may suffer from conversational slowness, word finding difficulty, perseveration (repetition of ideas or words), poor memory of what was already said, loss of affect or emotional blunting, or emotional lability (pathological laughing or crying). During long conversational pauses some visitors feel awkward. There is often acute emotional discomfort in the social visitor who may feel guilt that he is healthy and unimpaired, while his friend is having so much difficulty. Often friends censor what they will say and become hyper-cautious, out of an exaggerated fear of saying anything inadvertently to offend or wound their injured comrade. Some friends even withdraw because being around someone with a brain injure evokes a fear in them of their own vulnerability to injury, disability or death. When a spouse, lover or friend leaves for good, they usually say something to themselves like "I feel bad about this, but he is not the same person I chose to be with." Obviously this is not fair to the person with the TBI, because he did not chose to become brain injured and he needs love and social support to help him recover his capacity for self-acceptance, self-esteem and feeling joy again in everyday life. Very often a TBI person is left dependent on his own immediate family for a social life, which places great burdens on his family. It would be best for the TBI survivor and his immediate family if the injured person could hold onto good friends or make new good friends. What advice do people with a TBI give on this point? Most will say don't judge me, don't feel sorry for me, don't patronize me, just accept me as I am now... accept me for who I am today, forget who I used to be. When taken to heart this advice can make a big difference and pave the way for true acceptance and true friendship in the present.