I recently came across a video of Dr. Dan Siegel talking about how mental illness can be defined as extreme rigidity on one hand and/or chaos on the other. I wish I could find the video, but I can’t locate it right now.
I’ve been giving a lot of thought lately to the connection between traumatic brain injury and mental illness. One of the reasons is, it’s one of the most common combination of search terms people use to find this blog. Plus, I’m personally invested in it, because the last thing I want is to become mentally ill as a result of my head injuries.
Biochemically, I suppose it is quite possible to change as a result of TBI. The brain’s interconnected systems, while amazingly complex, can also be fragile, and the vital balance that keeps us even-keeled can be upset. And after TBI, with all the shocks that hit our systems in the course of experiencing one screw-up after another and/or getting screwed over by the world at large with out being able to properly defend ourselves, whether it’s PTSD or some other form of mental illness, we can certainly develop complexes of some sort.
I have a friend whose mother became a paranoid schizophrenic over the course of years of raising 4 kids after her husband left his family. Between problems of making ends meet and raising 3 sons and a daughter without their father, and never being properly supported financially, she just snapped. Perhaps there was already something going on with her, that made her husband leave… or maybe his leaving tipped the scale. In any case, the hardship had a definite impact on her mental health, and she’s been in and out of institutions, on and off meds, for about 40 years, now. She’s the nicest, kindest lady when you meet her. You’d never guess she raised her daughter with frequent announcements that “the voices” told her to strangle her child.
Anyway, I don’t want to get overly dramatic. That’s just one (extreme) example.
Back to the idea of rigidity vs. chaos. From what I gathered from Dan Siegel, he considers mental illness to arise from being overly rigid and inflexible and/or having a lot of chaos in thoughts and action on the other. This rigidity/chaos is pretty much what I experienced in the first few years after my last injury. In fact, it’s what I’ve experienced in the aftermath of just about all my injuries that I can remember. And rigidity and chaos have marked my life in many ways, intermittently, over the years.
Personally, I’m not sure that I’d call all of what I experienced mental illness. I think there was a distinct neurological/physiological “flavor” to it, which eased up over time, without the assistance of a mental health care provider. Granted, I did get help and support from folks in different ways. But I never took on what I was experiencing as definitive mental illness.
Maybe it was wrong of me to think that way, but the more I think about it, the more it seems to me that although many folks might advocate talk therapy or some other form of psychotherapy/counseling (especially my therapist friends), that wasn’t really what served me best. What served me, was learning how to just manage my life, and learning that I could manage it — from personal experience. I’m not sure that psychotherapy would have helped me, in any case, immediately after my tbi’s, because my brain wasn’t working well enough to “get” what people were saying to me.
Life, literally, was my best therapy. It was the daily practice of engaging in life to the fullest, seeing how much I could get out of my daily experiences, and committing to being the best person I could be under the circumstances, that restored me to functioning, time and time again. It still does.
And I have to remember that, because when life gets increasingly challenging (as it has been lately), I tend to withdraw and not engage as much as I should. I tend to pull back and shut down, block out the world around me, and try to soldier through, head-down. I have a tendency to block others out, to take on everything by myself, and not be open to input from others.
And that makes me mentally ill.
The more I pull back, the more rigid I get. The more rigid I get, the more everything around me seems to be chaotic and confusing. The chaos contributes to my anxiety, which makes me withdraw even more… and the cycle continues.
And on top of it, I usually get behind in my sleep, which is when the trouble really starts. Being tired… no, in my case, being overly fatigued and downright exhausted (which is where I get to very quickly, if I’m not careful) makes me even more rigid than usual. And chaos reigns — if not in my outer life, than in my head.
So, what helps? Taking care of the basics. Getting ample sleep. Eating right and on a regular schedule. Keeping life simple and not allowing myself to get sleep-deprived. Focusing on the moment for what it has to offer… rather than getting caught up in what’s wrong with it, what I’m not getting, what I’m lacking, how I’m messed up… etc.
When I take care of my body, my mind takes care of my brain. And the physical factors that contribute to rigidity and chaos — and produce the classic emotional volatility, emotional lability, irritability, anger, temper tantrums, rage, shutting down, etc. that makes my life much more difficult than need be — don’t have a chance to get a foothold. It’s good when they don’t get a foothold. I, and everyone around me, has a chance to experience me for what I am, who I am — not the person I become when I’m in bad shape.
TBI or mental illness… chicken or the egg…? It’s a discussion that could go on forever, really. Each can give rise to the other, and each feeds off the other. But where do you determine which is which? On the extreme ends of the spectrum, is there even any difference?
It’s a challenge, to be sure. And judging from the number of people who end up at this blog looking for information about tbi and mental illness, it’s not a rare one.
Broken Brain - Brilliant Mind 
BB –
This could be a long response but I am short of time……….
Mental illness is so poorly understood and misdiagnosed that it’s almost ludicrous to attempt to define it. If you give one set of diagnosticians a bunch of patients with symptoms the label they would each give them will be different. Environment – physical environment, including stress, nutrition, health, hormones, abuse, trauma, lifestyle, etc all contribute to exacerbate personality traits – both good and bad. We WAY over medicate and then medicate some more in response to people’s response to medications. We substitute drugs for community, conversation, activity, work, love, friendship. We pathologize grief, anger, pain and other loss. Half the people on Wall Street are absolutely rigid as board when it comes to political and economic visions of the world – and since that pretty much comprises their whole universe one would say they are pretty rigid. Brilliant and successful scientists and artists can be rambling and chaotic – the wonderful and delightful Stephen Jay Gould was known for his circuitous writings which were absolutely amazing in print and seemed somewhat confusing in presentation. Brain injury absolutely has a multitude of behavior responses – your brain chemistry is changed and you will react – anger and denial are consistently found in brain injury. However this is also aggravated by being in an environment where people are telling you who and what you are – and since you CAN think you resist – which may be a sign of health in the long run. The guy who is responsible for uncovering the SS Central America and not only unearthing one of the largest finds of gold in history but also changed the technology for underwater exploration and a science dropped out of school at one point and lived in his car while thinking about how these things work.
It is not easy to self-reflect, to change. It is not easy to listen to what other say and consider the possible truths and integrate them into ones life, while also discarding the nonsense that is pro-forma by the book rules of thumb that make people comfortable. Is despression necessarily ‘bad’ and to be avoided – or in some cases can it be a deep form of self-regulation, a way to reduce activity and allow ‘time off’.
We live in this absurdist myth that the majority of people ‘out there’ have wonderful, whole, contented lives filled with accomplishment, love, success, etc. Yet the fact that how to achieve these things is the topic of endless magazine articles and books tells us quite clearly that in fact most folks do not feel so great about their lives – and in fact many live chaotic or rigid or troubled experiences punctuated by occasional moments of happiness or pleasure.
If you have had a multitude of brain injuries and you have experience the world in a way because of that then people will treat you in response to that – and this in turn will create a cycle of another layer of behaviors – some of which may be, by DSM IV classification, mental illness. Likewise trauma or severe stress often causes divorce and families to fall apart because ‘underlying’ mental illness expresses itself. And that’s to say nothing of the fact that 90% (or more) families have a variety of issues and interpersonal relationship problems that qualify for mental illness.
So if you are ‘mentally ill’ welcome to the club – the club of humanity.
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Yeah – what m said
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BB,
My brother was schizophrenic. As far as I can tell the experience is radically different from that of a head injury. I’m not sure rigidity had anything to do with his illness – there were many factors, including genetics – but he did become rigid after the fact. I guess that’s part of it, repeating the same thought processes over and over and over . . .
I wrote you a couple of months ago about some crime cases over the last couple of years where the accused had had (often multiple) brain injuries. Creepy Phil in California who kidnapped that girl, one of the two guys who did that horrendous home invasion in Connecticut a few years ago. Phil Spector, who people say was never the same (and became reclusive and gun-crazy) after a car accident in the early 70’s. To paraphrase one of my favorite movie lines (from Rumblefish): ‘A brain injury doesn’t mean you’re crazy – but it can DRIVE you crazy . . . ‘ Certainly, if your wires get crossed the wrong way, you can go crazy – but I think the more insidious part of it is not being diagnosed, the compounded isolation of an injury that you don’t understand, that does affect your behavior, that is met with incomprehension from everyone around you.
I mean, who wouldn’t go a little crazy from being isolated, constantly fatigued, vulnerable, irritable, not sleeping, not being able to think in a straight line etc etc, especially if you had no idea what was wrong with you?
As a side note on mental illness, part of the problem, as m pointed out, is how we in the West treat the mentally ill. In so-called poor countries they just let them go crazy and run around (I witnessed this once in Malaysia). The community makes sure they don’t hurt anyone but essentially they’re free. And, very often, after a couple of months or years they get better and go back to living normal lives. My brother, at one point, had a whole bagful of pills he had to take EVERY DAY. After a couple of years of this, one has to ask: is it the illness or the drugs?
On my one trip to a neurologist – a whole message in itself – he tried to put me on anti-depressants. A mild dose – this was considered standard treatment at the time. I took them for two days and they turned my system inside out. I mean – I did feel crazy! I wonder what would have happened if I’d listened to the guy and stayed on them.
T.
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Great food for thought
The whole issue of mental illness is a tricky one, I think. And things like schizophrenia and really hard-core stuff that makes one a danger to others… what to do? I suspect that a lot of our coping mechanisms — unlike Malaysia — come out of not having/taking the time to make space for “crazy” people. I really don’t know — I had dinner with friends the other night, and one of them was encouraging me to be a little less “sane” so I wouldn’t lose my mind. Then again, they also encouraged me to get fired from my job. Easy for them to say… they’re retired.
What a mystery this all is. It’s fun for me to pick something to think about an imagine that I can figure it out, but ultimately, the real reward for me comes from the searching for answers, not the finding.
I’m still looking…
And I canceled my dr appointment for this Friday — my PCP has indicated they want to put me on meds to help me sleep. Personally, I’d rather stretch and do conscious breathing and take Advil (just 2) to help my body chill, so it can relax and get some good rest.
It worked for me last night. I got almost 8 hours. A recent record.
Be well.
BB
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“… and *that* makes me mentally ill.”
BINGO 🙂
We heal in relation, into a new form of wholeness … and isolation, though it may feel “right” to the traumatized mind, truly is hell …
Thank you so much for your lucid, practical, and *kind-hearted* thoughts; they very much mirror my own.
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Thanks very much – have a great day
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‘A brain injury doesn’t mean you’re crazy – but it can DRIVE you crazy . . . ‘ that is so true! Human brain is the most complex organ. The more we tried to understand it, the more complex it becomes 🙂 Unlike recovery from other injuries, recovery from a brain injury is unique – the more ‘physically normal’ ta person with a brain injury seems to be, to more problems seem to occur (usually noticed by the people around them). Our brain (as well as our body) works in equilibrium. There will be stimulation and inhibition of signals and chemicals. The inhibitory signals play a major role to keep our behaviour and action ‘acceptable’. For example, alcohol can further reduce these inhibitory signals, therefore if a brain injury survivor consume alcohol, he or she runs into risk of committing serious offences.
You are right, having good quality sleep will help a brain injury survivor functions better. In fact, in severe brain injury patients, regulation of sleep wake cycle has been shown to help improve their cognitive function and reduce their agitation (not antipsychotic medications!)
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