But getting hit on the head was just part of the game

I’ve gotten to watching YouTube videos today, since I’m off work. Here’s another one I just watched:

Just part of the game

I’ve been thinking back to when I was a kid, and all the rough-housing I and my siblings did. We were a pretty rough-and-tumble gang, and we played a lot of games that involved a fair amount of hitting and falling and running into each other. We used to play full-contact soccer in the back yard, and by the end of the game, any living plant on the periphery of the “field” would be shredded, we’d be all hopped up from chasing and jumping and crashing into each other, and our heads would be spinning. It’s like we got this major contact high from going all-out, and the experience of falling down (or being taken down) and having your vision be disrupted, have your hearing get weird, and be wobbly and unsteady on your feet, wasn’t something we were particularly worried about.

If anything, it was part of the game. We just went all-out. And this was in the days before organized sports took over. These were sandlot/backyard games, and God only knows how many concussive or subconcussive hits I took over the course of my childhood and youth.

In retrospect, when I think back on those games, I can remember some element of wooziness many times. I can practically feel the wooziness when I think back. Memory is a tricky thing, of course, and there’s no guarantee that I’m 100% on, but the feeling of being out of it when you got up and went back to playing was not unfamiliar to me. If anything, it meant that you were playing right. You were going all-out. That’s all that mattered.

There’s another piece of this sports concussion discussion that I think gets lost in the shuffle — the fact that sustaining a concussion, getting hurt, having the breath knocked out of you feels… well… good. It wasn’t a bad thing. It didn’t scare me. It didn’t even hurt as much as it might have. OR if it did hurt, the pain-suppressing endorphines would flood in, and all would be right and well with the world.

Getting concussed was actually a good thing, as far as my feelings told me. It may have knocked me off my feet and pulled the rug out from under me when I got back up, leaving me wobbly and woozy, but otherwise, I felt like I could do anything. Like I was a berserker in some Norse battle, where the worse I was hurt, the more intent I was on going back in.

This is all anecdotal, of course, so it’s an unscientific observation. But it may be worthwhile considering, among athletic trainers and others who are looking out for kids’ safety on the playing field. Feeling something that is closer to good than bad, after you’ve sustained a brain injury, is all the more incentive to lie about your symptoms and dive right back into the game. And having more concussions in the course of playing isn’t necessarily detected as a bad thing. It feels right, and since we live in a society that tells us “If it feels right, it must be right,” going with your instinct to seek out more of the same kinds of hits that knocked you off balance would seem to be the “right” thing to do.

It’s exactly the opposite of right, and it’s very, very bad. But it sure doesn’t feel that way.

Great video, compliments of The Concussion Blog

Thanks Concussion Blog

It’s great to hear stories from female athletes. I’ve read that females tend to be more vocal about their issues than males — hopefully we can all learn something from the experiences they’re talking about.

A few days back, I wrote about how head injuries can affect women differently than men, but I think that straight talk about concussions cuts across gender lines, and seeing individuals being honest and detailed about their experiences can help others who may have difficulty vocalizing — male or female.

What’s gone is gone

I had an interesting conversation with a friend, yesterday. I had woken up from my nap (thank heavens for vacation) and I had this sudden revelation about how to deal with some worries that I’ve been having. I called them up and told them that I had found a solution, and proceeded to announce my discovery with great satisfaction and relief.

Imagine my surprise, when they informed me that I was saying exactly the same thing I had said about similar situations many times in the past. Here, I thought I had made this amazing new discovery that would solve all my new troubles, and I come to find that not only are my troubles not new, but I have also “solved” them many times in the past.

WTF?! I had absolutely NO recollection of having had any such conversation in the past. I wracked my brain and I could not for the life of me remember having discussed anything like this at all with them before.

At first, I laughed it off and played along and pretended like I knew that!

Then I tried to talk around it and get some clues about when we had discussed the kinds of things I was talking about.

Then I tried to change the subject.

That worked for a while, but then I came back around to wanting to know if we had really talked about the thing I had called to share.

The conversation didn’t really get very far, because my friend wasn’t really in the mood to get into an in-depth conversation about my crappy memory. There was someone else in the room with them, so there was only so much attention they could give to me. Plus, I was headed out the door to run some errands, so that was that.

What I was eventually left with was a weird uneasiness that morphed into a distinct uneasiness today. Whatever conversations I had had with this friend about solutions to my problems, once upon a time (or more times than that), were gone, baby, gone.

This can make a person crazy. More times than I can count, things that I was “supposed” to remember have flown far, far away from my memory. It happens at work, it happens at home, it happens in conversations with friends and acquaintances. I try to bring it back, try to reconstruct situations, try to connect with the foggy past and see what I can tease out of it.

All too often, it’s to no avail. No matter what I do, if the stuff isn’t near the surface of my recollection, it seems to be gone for good. And there’s no point in chasing after it. That’s a huge time-sink. Of course, I usually try to chase after it, and time flies from me as quickly as the memories did. I’ll do my damnedest to uncover the missing pieces of the puzzle, but when all is said and done, what’s gone is gone.

Memory isn’t the only persistent, recurring problem with me. As I continue with this TBI recovery process, I come up against certain limitations time and time again. Memory problems are only part of the whole picture. There’s the fatigue, the irritability, the dizziness and sensory sensitivities. There’s the confusion and frustration that come up regularly that I have to fight back before they get a toehold in my emotional lability and turn my life upside-down. There’s the anger, the aggression, the mood swings, and the impulse control that has me saying things I really should not be saying. I make good progress and take many steps forward. Then I fall behind on my sleep. Or I start to eat a lot of junk food. Or I take on too much and over-commit myself. Or all of the above. And I start to see cracks in my foundation.

Again.

As I get yet another look at the things I think I have all figured out, it becomes all too obvious I need to figure them out.

Yet again.

Oh well, what can you do? Just keep working at things, I suppose. And write things down, instead of relying on my memory all the time. I like to think that if I just “exercise” my memory more, I’ll be able to strengthen it. But I end up just exhausting myself, and what good does that do? Instead of strengthening myself, I’m weakening myself.

I guess it’s all part of this trip called “TBI recovery” — finding out what works, and what doesn’t. Finding out what strategies are well-suited to my life and my personality, and finding out which ones don’t help at all. I have found myself drifting more and more from the things that I know work — getting enough rest, writing things down, sticking with a schedule, and so forth — because there’s still a part of me that doesn’t want to have to be so vigilant all the time. I need a “break” from the discipline. But the discipline is there for a reason — when I get away from it, I start to have problems.

The biggest problem, I have to say, is with my immediate surroundings — the people around me who are convinced that there is nothing at all “wrong” with me, and who don’t think I need to do anything different from what they do, in order to live my life. My spouse doesn’t think I really need to get to bed at a decent hour, and they don’t think that I need to be writing everything down. They think I should loosen up and go with the flow, and they refuse to stick to any sort of schedule. To this day, they have a ton of trouble accepting the fact that there is anything about me that is different or not like everyone else. They are fond of saying that there’s nothing “wrong” with me, and there never was, as though all the work I’ve put into my rebound has been a waste of time and utterly needless.

They love to stay up late, eat at irregular hours, and not exercise. They love to spend their time lolling about, “taking it easy” and they hate to have any kind of schedule to stick with. They live like they’re on vacation, basically, which is made a whole lot easier by me being the primary breadwinner — and them pitching a fit everytime I suggest that they should make more of an effort to bring some money in to keep the joint running. They don’t get the concept of having money in the bank – they think if you have it, you should spend it(!) so we have this ongoing “dialogue” about what is and is not appropriate to spend money on.  Usually the dialogue ends up in dissent and heated arguments. So, I do what I can to keep things cool and just stay on target as much as possible. After years and years of this same discussion of what is and is not a good way to spend money, some years ago, I started putting a certain percentage of money aside — and I mean aside — so we would at least have something to fall back on. It’s kind of a bummer to have to defend yourself and your well-being against the very person who you turn to for support, but there it is.

I could spend time anguishing over the years and dollars lost, struggling in vain to change them, but what’s done is done. Those years and dollars are gone, baby, gone. Just let it go, and keep looking to the future, I guess…

And keep myself safe, above all else. My spouse makes choices that I would never make. They seem to think they live in a protective little bubble where nothing ever goes wrong. I know different. They don’t live my life, and they don’t live inside my head, and they don’t have the same experiences I’ve had.

If they can’t see what effect lack of sleep and lack of a set schedule has on me, if they can’t see that being frugal is the way to go, then that’s on them. I need to protect myself and keep myself on track. Mind you, they have many other strengths for which I love them with all my heart and soul. But in certain significant ways, we differ. Differences like this have broken up stronger couples. But we’re not them. It’s like I’m living with a heavy drinker, when I’m trying to stay on the wagon. It doesn’t make things easy at all. But at least I’m aware of the situation, which makes all the difference.

One thing that makes it easier, is that they’ve become really busy and involved in different business activities, so I have more time to myself, to tend to myself away from their constant influence of really bad choices and bad behavior. I get to take care of myself, and that’s exactly what I do.

Yesterday was an absolutely beautiful day. I lay down for a nap, and I slept for about 4 hours. I had been really troubled by the discussion I had with the friend who told me I was forgetting things. I woke up feeling terrible and consumed by the confusion of the missing pieces of my memory, I was tempted to just sit inside and wallow. I did that for a while, in fact. But that didn’t last long. Being on vacation and having a rare gorgeous day during this unpredictable season, it just didn’t seem right for me to camp out inside. Besides, I needed some fresh air.

So I went outside and picked up fallen sticks in my yard. I walked around and looked at the effects that winter had had on everything, and I noted the new growth that’s starting to show. As I tromped around, it occurred to me that these TBI complication and memory loss issues of mine are not unlike experiencing a kind of earthquake or tsunami. It comes in and shakes and takes away the things you used to know, leveling the things that made up your past and trashing the connections you had with people and places and things. Sometimes the damage is minor, sometimes it’s irreparable, and it’s easier to take a proverbial bulldozer to the whole lot of things, than to try to put it back together again.

Two steps forward, one step back. One step forward, two steps back. Five steps forward, six and a half steps back. And three steps to the side.

The damage is on a much smaller scale in my personal case, of course. There’s really no comparison between the devastation of Japan’s earthquake and tsunami and my memory issues or the parts of my life that have been irreversibly changed by my traumatic brain injuries. But in my own small world, the impact to my life, my sense of self, my perception of who I am, and the choices I have to make in the world, has been at times as annihilating as any 9.0 tremblor and a 100-foot wall of water. And the recovery process is every bit as long as Japan’s promises to be. Minimum five years, is what they say. With me, it’s been more than six, since my last fall, and I’m still struggling at times to get back.

Getting back… Some days I feel like I’m really there. I can go for months feeling like I’M THERE, AND I’M NOT GOING BACK. Then I get tired. Then I get overwhelmed. Then I start to feel like things are falling apart, and I feel like I’m back at Square One. I have it in my head that I’ve got things sorted, and I can fully restore myself to my former glory… then I realize that there was no such thing as my former glory, and despite the good parts, things have been a continuous struggle for me, for as long as I can remember. What makes it particularly difficult is when I feel like I’ve still got the bad stuff with me, but the good stuff has washed away or been lost somehow. And I feel like I’m starting from scratch.

All over again.

Then something happens and I see how much farther along I am, than I tend to think I am. After I picked up sticks in my yard, I went out for a proper walk, and while I was out, I got a phone call from my spouse about some friends of ours who were moving and needed help. Right away. They had to be out of their apartment that night, and they were still packing at 7 p.m.

So, I hoofed it back home, hopped in the car, and headed over to their place. They were in a state of near panic, as they still had parts of the kitchen and various pieces of furniture and odds and ends to move. It seemed endless, as that last push of moving often does. They also have a four-year-old who is a handful under normal conditions, and they were acting up even more under the strain of all the activity and change.

So, I jumped in and started wrapping dishes. Got the last of the glasses and plates packed… books… more dishes and plates… shelves… computer equipment… hauling it down the stairs and out to their truck. It really was a much bigger task than it appeared at first blush. But by 1 a.m., we had the last of the items out and they closed the door behind them.

On to a new life. From a 2-bedroom, 1 bath apartment that was maybe 800 square feet, to a two-storey house that’s probably three times the size of their old place, with 3 bedrooms and 2-1/2 baths and a full basement for their kid to play in.  Nice. The place they moved out of was the first residence they’d had together as a couple — the first place that was theirs, not one’s that the other moved into. They had a lot of great memories from that tiny little apartment, but it was time to move on.

And so they did.

The past was a good thing, but it was over. It was done and gone. They’ll always have good memories of it.

As for me and my life, who can say what kinds of memories I’ll have? In a way, losing pieces from my past is not necessarily a bad thing. Someone once said that “happiness is made up of good health and a poor memory.” I’ve pretty much got both.   So, no matter what I may think I’m missing out on, because I can’t remember the past, if I trust that there was a lot of good in it, and I don’t worry about the bad, then my spotty memory doesn’t need to a bad thing necessarily.

Of course, it’s helpful if I remember the things I’m supposed to, but I always have lists for that.

TBI and Aggression – the comorbid mix

More thoughts on Aggression, for the series Then And Now – Managing TBI Issues Over the Long Term

As Google shows, TBI and Aggression are the subject of a whole lot of research and discussion. There are close to a million results when you search for +tib+aggresssion.

Physical aggression, verbal aggression… They’re two different things, but they still have some common origins. And how they manifest can depend on the individual, the nature of their injury, their environment and stressors, as well as a ton of other issues.

Aggression is one of the toughest aspects of TBI, for individuals, families, and society as a whole. Plenty of incarcerated violent offenders have a history of traumatic brain injury, so we ultimately all pay for those injuries, to one extent or another.

I’ve been looking through a great presentation from the Defense Centers of Excellence called Mild Traumatic Brain Injury & Co-Occurring Disorders: Scope of the Problem. It talks about the different issues that show up along with TBI among veterans seeking medical help.

From the presentation:

• Of the veterans presenting to a polytrauma network site in Lew’s study (2009), 81.5 percent had more than one diagnosis and 42.1 percent had three co-occurring diagnosis, including pain, post-traumatic stress disorder (PTSD), and post-concussion syndromes.
• In another study by Ruff and colleagues (2008), approximately 66 percent of veterans presenting with headache and TBI symptoms had cognitive deficits on examination, more severe and frequent headaches, more reports of pain, higher rates of PTSD, and impaired sleep with nightmares.
• Veterans with positive TBI screens are more likely to have a diagnosis of PTSD, depression, and substance abuse disorder.

I’m not a veteran, but I can attest to the presence of plenty of issues that would qualify as additional diagnoses. The pain, headaches, insomnia, memory issues, post-concussion stuff, not to mention tinnitus, chronic fatigue, irritability, anxiety… all of this mixed in with a bit of PTSD. I could go on. In fact, it seems odd to even break it all out into separate diagnoses.  It’s all just TBI, from where I’m sitting.

Of course, it could also be other things. Just Plain Life has had its effect. I can’t lay everything at the feet of traumatic brain injury, I suppose.

Anyway, looking at the many things that come up in combination with TBI, I can see in my own life how it all connects and can really feed into my anger and aggression issues. TBI and its host of related issues can really put you on the defensive, which can translate to some pretty aggressive behavior.

I have noticed in my own life that the times when I have been the most aggressive, were the times when I was feeling the most vulnerable, helpless, exposed. I’ve felt overwhelmed and put-upon like nobody’s business. Like an animal backed into a corner, with nowhere to run. So much was going on, and I felt like I was getting farther and farther behind, unable to follow what’s going on, because everyone was going too fast for me to keep up, or they were not letting me get clear on what’s happening, so I was losing my grip on what’s happening.  And my head would get going about all the awful things that are about to happen because I’m not following what’s happening around me. And I would freak.

See, here’s the thing — TBI can put a huge strain on your overall system. Let’s not even think about the cognitive issues, for a minute. When you’ve got intense balance issues as well as problems with light and sound, and you’re prone to fatigue (which just accentuates the sensory issues), just getting through the morning can be a challenge. And the part of our bodies which requires a whole lot of energy is our brain. Even people with fully functioning, neurologically intact brains require a ton of energy to keep functioning normally. So, when you’ve got even more demands on you — physically — it can impact your cognition as well.

Here’s a diagram of how I see it happening in my own life:

 

TBI-Aggression Flow - Click to see a larger version

It’s all connected – body, mind, spirit – and when the body is taking a bigger hit from all the extra demands of just standing up and walking across a brightly lit room filled with loudly talking people, something’s gotta give.

Problem is, with TBI, one of the results of fatigue is an increased irritability. Heck, even without fatigue, with TBI, you tend to get an increase in irritability. And that irritability, coupled with any impulse control issues you might have, can lead to outbursts.

On top of that (if you’re like me) and you’re up in your head about your interpretation of what’s going on (which usually means something really bad and threatening, like people hate you and want to get rid of you — and is usually completely wrong), your impaired thinking process can result in some behavior choices that are not only inappropriate, but completely uncalled-for.

The outbursts can take an ugly turn, because now you’re not only struggling to keep up and defend against the perceived threat of an overwhelming situation, but you’re also defending yourself against the perceived threat of someone deliberately trying to get you. And when you’re threatened on that level, anything you do and say to defend yourself from everyone who is out to get you can feel 1000% justified.

Nobody else sees it that way, however. As far as they’re concerned, you’re just unstable and irrational and possibly dangerous.

Getting to the bottom of what’s going on and keeping the cycle from escalating can be quite a challenge. It would be great if we could say, “Okay, just stop this and this, and everything will be fine.” But it’s a complex interaction of factors that feed into the aggression mix. Comorbid factors. Stuff that happens as a result of TBI. Stuff that happened that led to the TBI. Trauma. Pain. Emotions. Everything.

Perhaps that’s the best protection, however — just the awareness of the fact that dealing with TBI-related aggression is not some easy-peasey piece-o-cake, and that it demands some pretty regular management strategies to keep on top of things. Managing comorbid symptoms and aggression are lifestyle issues — they are intimately related to how we live our lives as a whole — not just how we behave when we’re standing in line at the post office.

Aggression and TBI and gender – does the mix matter?

This is another segment about Then And Now – Managing TBI Issues Over the Long Term – in particular, about Aggression.

Thinking about aggression and TBI, I got to wondering about whether the impact of aggression might make a difference, depending whether a survivor is man or a woman, a boy or a girl. I did some googling, but I ran out of steam trying to sort through all the different pieces of information.

Apparently, research points to women having worse long-term outcomes than men. Interesting. And unfortunate. There are a number of different possible explanations, which I found  at http://www.dawncanada.net/ppt/Women%20and%20Brain%20Injury.ppt (Good presentation! Very informative. I’ll have to examine it more closely when I have more time…) Some of them are that perhaps the medication prescribed interacts differently with women’s chemistry than men’s. Or women report more issues, and therefore appear “sicker” than men. Or perhaps it’s because of psychosocial factors. That is to say, women tend to be more verbally “fluent” than men, so they present as being much better off than they are cognitively. They seem fine, but they may be struggling in ways that only an objective test can pick up — but nobody thinks to administer a test, because “she seems fine”.

Conundrum.

Anyway, in thinking about TBI-related aggression, I got to thinking about different scenarios where a man exhibiting aggression would fare better than a woman exhibiting the same behavior. Aggression in men is often tolerated much better than aggression in women. With men, aggression is often expected, where with women, there’s a completely different standard that they’re expected to follow.

Say you’re standing in line at the post office during the holidays. Everyone has been standing in line for 45 minutes, holding heavy packages and wishing they were somewhere else… when in comes a guy who’s frazzled and obviously in a big hurry. He goes to the back of the line for a little bit, but after a few minutes he starts to fidget and curse under his breath. He then proceeds to jump the line and push his way into second place. The guy standing behind him gets bent out of shape and pushes him out of line, the two of them trade words, then start pounding on each other. The police are called, and the two men are hauled out of the post office and given a talking to by a couple of officers. They won’t let it go, though, and they still keep trying to punch each other in the face, so they’re separated in two separate police cruisers and driven off to jail.

Now imagine the scenario with an aggressive woman:

Say you’re standing in line at the post office during the holidays. Everyone has been standing in line for 45 minutes, holding heavy packages and wishing they were somewhere else… when in comes a woman who’s frazzled and obviously in a big hurry. She goes to the back of the line for a little bit, but after a few minutes she starts to fidget and curse under her breath. She then proceeds to jump the line and push her way into second place. The guy standing behind her gets bent out of shape and pushes her out of line, the two of them trade words, then start pounding on each other. The police are called, and the two of them are hauled out of the post office and given a talking to by a couple of officers. They won’t let it go, though, and they still keep trying to punch each other in the face, so they’re separated in two separate police cruisers and driven off to jail.

Doesn’t sound quite right, does it? How about a woman who’s just defending her own turf:

Say you’re standing in line at the post office during the holidays. Everyone has been standing in line for 45 minutes, holding heavy packages and wishing they were somewhere else… when in comes a guy who’s frazzled and obviously in a big hurry. He goes to the back of the line for a little bit, but after a few minutes he starts to fidget and curse under his breath. He then proceeds to jump the line and push his way into second place. The woman standing behind him gets bent out of shape and pushes him out of line, the two of them trade words, then start pounding on each other. The police are called, and the two of them are hauled out of the post office and given a talking to by a couple of officers. The man and woman won’t let it go, though, and they still keep trying to punch each other in the face, so they’re separated in two separate police cruisers and driven off to jail.

And then there’s the situation with two women:

Say you’re standing in line at the post office during the holidays. Everyone has been standing in line for 45 minutes, holding heavy packages and wishing they were somewhere else… when in comes a woman who’s frazzled and obviously in a big hurry. She goes to the back of the line for a little bit, but after a few minutes she starts to fidget and curse under her breath. She then proceeds to jump the line and push her way into second place. The woman standing behind her gets bent out of shape and pushes her out of line, the two of them trade words, then start pounding on each other. The police are called, and the two of them are hauled out of the post office and given a talking to by a couple of officers. They won’t let it go, though, and they still keep trying to punch each other in the face, so they’re separated in two separate police cruisers and driven off to jail.

It has a totally different feel from the scenario with two men. The situation with two men sounds like “boys being boys”, you might say. But two women behaving really badly and then coming to blows? Maybe in a toy store in LA, but in “polite society” this would stand out as an exception.

The point I’m trying to make here, is that there are different standards for acceptable behavior with men and women. And the fallout afterwards also tends to be different. With men, things can get “heated”, but with women, they get “out of hand” and the consequences are as different as the consequences for adultery in secular America versus church-centric America. In one case, it may elicit little more than a shrug, while in other cases it may result in being shunned and isolated.

Our society has a very different set of expectations for different genders, so when a woman with a TBI starts to act out, it really stands out. And it can be isolating. Unexpected, unacceptable behavior, along with social censure, can add to the cognitive load of a TBI survivor, which cuts into the available resources for just living their life, and also cuts them off from valuable social connections that can support recovery. Ultimately, if you have enough censure and isolation, without the proper feedback mechanisms for determining and modifying appropriate behavior, I would imagine things could degenerate over time and ultimately fan the flames of TBI complications, long after the initial injury has faded from memory.

If this is true in the case of women, then what about girls? I’m specifically thinking about girls who are concussed and don’t get proper care and have their concussions eventually become lasting traumatic brain injuries. What about girls who get hurt, don’t get the help they need, and end up exhibiting behaviors that alienate their friends, their families, their support groups that are necessary for healthy growth and maturation? What about them?

What makes things even more complicated, is that some of these symptoms — the aggression, the mood issues, and more — may take months to show up, so during a time when so much is in flux and changing around them, they’re all of a sudden hit with this weird new character trait of a short fuse and an explosive temper. And seemingly out of nowhere. What do they do then? If a girl is expected, pressured, trained to be a little lady, and then all of a sudden she becomes more like a wild animal, what then? If her popularity and self-image is dependent upon her behaving in a certain way, and then TBI suddenly makes it impossible for her to behave that way, what’s the impact to her development overall as a girl, then a woman?

Now I’m not saying that girls have it harder than boys, but there are differences in gender expectations, differences in behavior expectations, and if there’s one way TBI can really throw a wrench in things, it’s in the behavior area. So, if most of the studies of the impact of TBI are concerned with boys/men, what does that mean for our overall understanding of the impact — not only to the individuals, but to society as a whole?

My grandfather used to say, “Women have to be better than men. They are the ones who create our culture.” He was fine with that idea, while my mother always pursed her lips a little bit when he said that. He was an old school kind of gentleman, but there was a nugget of truth to it — although the truth was more about expectations, than actual fact.

Ultimately, I think that gender and TBI should probably be studied more closely. There’s so much to it — it’s quite mind-boggling overall. But we really need to factor it in. And when we talk about managing long-term issues, I think it can be helpful to consider to social and cultural contexts. As different as each brain injury is, as individual as each recovery is, we can’t overlook factors like gender, as well as class and ethnicity and age. It’s all a huge ball of string that begs to be unraveled, but that’s a bit beyond me right now. I’m on vacation(!) and it’s a beautiful day outside.

But first, I could really use a nap…

Brain Injury Location Tied to Higher Risk of Aggression

Prefrontal cortex

Found this the other day, via BIACACLC Brain Injury Ass’n on Twitter – where you get injured in your brain can determine the risk of aggression.

Researcher Jordan Grafman, director of traumatic brain injury research at Kessler Foundation in New Jersey and his colleagues studied the aggression levels of 155 Vietnam War veterans who had suffered a penetrating traumatic brain injury, and divided them into aggressive and nonaggressive groups.

In the aggressive group, 79 percent were injured in their prefrontal cortex, whereas 21 percent were injured elsewhere in the brain, the study said.

But in the nonaggressive group, 47 percent were injured in the prefrontal cortex of the brain and 53 percent were injured elsewhere in the brain, according to the study.

“The locus of brain damage is important … as it will clue you in to the long-term risks to the social behavior of the patient,” Grafman said.

Read the whole piece here…

This is an important consideration – where you get injured can affect how you express yourself after you’re injured.

But even knowing that can’t always guarantee that you’ll be able to predict what people will do and how they will behave. The brain, as we all know, is a tremendously complex organ and people express their personalities differently, so a similar injury may result in completely different behaviors, depending on the person.

Which just makes TBI even more annoyingly complex for people looking for a silver-bullet cure. If you can’t predict accurately how people will behave, how can you control that behavior? How can you manage it effectively with pills and such?

At the same time, for those of us not looking for a pill cure, it is encouraging to think that even if you do experience a TBI that messes up your prefrontal cortex, that’s not the end of the line for you, and you always have the possibility that you’ll be able to manage yourself better than expected or predicted. This kind of stuff happens all the time with medicine — the doctors say one thing (you’re going to die in three months) and then it doesn’t happen. It happens all the time in life — I don’t think the predestination people are right — or maybe they’re 100% on, and all our human prophecies amount to nothing in the face of what fate has in store for us.

In any case, this is interesting information that bears consideration – if only for the sake of giving us something to watch out for and better understand. Aggression is definitely a problem post TBI, and the more we know about it and understand it, the better.

Time to catch up

I’ve got this coming week off work. What a relief. I’ve been pushing pretty hard for months on end, now, and I really do need a break. Showing signs of wear. Getting incoherent in meetings and starting to say things that other people think are “weird” — they’ve told me so, actually.

I’m in a tricky situation, actually. My boss and my boss’es boss both seem to be a little intimidated by me. I have more years of experience than they do, and I’ve got some great insights into things. I have a very different perspective on many, many things, and that insight gives me an edge they just don’t have.

Other people notice it. Including their boss(es). And it puts me in an awkward position, because the top boss has a pretty intimidating manner and making threats about replacing people with other people is not beyond them. I get the distinct impression I’m being used as a bit of a wedge.

Or maybe that’s just my broken brain telling me stories again.

Anyway, I get to step away for a week and take some time off. Do some other kinds of things that are what I want to do, not what others require me to do. Things like yardwork. Things like driving around on back roads just to explore places I normally have no time to explore. Things like sleeping for hours in the middle of the day. The naps are probably what I’m most looking forward to, because they’re what I get least when I’m in week-work mode.

I get to slow down — or at least move at my own pace. I’ll probably do some work during this week, just to catch up. And check my email, just so I’m not blind-sided when I get back next Monday. I’ve got some medical testing coming up next Monday, and I need to rest up for that. Ultrasound. Internal pain exploration. What might that occasional (but becoming more frequent) pain and tightening in my gut be?

I don’t have a lot of cancer in my family history. Well, no, that’s not true. Brain cancer. Breast cancer. Prostate issues. Heart disease. The two big killers on both gender sides (breast cancer didn’t kill my grandmother, but brain cancer killed my grandfather), plus the extra brain thing.

In a way, I’d like to be fully employed this week, so I can get my mind off the possibilities. But on the other hand, it’s good to get some rest so I’m less anxious and paranoid when I go in for the testing.

It’s probably nothing. Indigestion. Or my gall bladder acting up. I’ve got gall bladder issues, and I can always tell when I’ve had too much fatty/fried food. Maybe it’s that. I don’t think there’s any colon cancer in my family. And I’ve always had issues with constipation and digestion, ever since I was a kid. The doctor “palpates” my gut and tells me there’s “bloating”. OK. How would I know? It always feels like that. I’ve always wondered, during those commercials for female products, how you could tell that you’re experiencing bloating? Doesn’t the gut always feel a bit spongey?

Well, this is all speculation. Who the hell knows what it is? But I’m sure not going to spend the week consumed with worry. I’ll find out in a week (hopefully) what the hell is going on with me. Or they won’t find out, and they’ll order more tests. But at least something will be happening.

Action.

That’s what matters most to me. Not words. Not promises. Not pretty pictures painted about what’s possible – but action. Where the rubber hits the road and things actually get done. All the conjecture in the world is not going to help me live my life at this point. I just don’t know enough, and I need to focus on the things I do know about — how to get on with my life, regardless of what’s going on the background. There’s an awful lot of life just waiting to be lived, and if I spend my time sitting around thinking about it, where’s the good in that? I know people who are so caught up in their anxiety and fear that they can’t even get it together to go shopping for food. They just stay inside their house, like Gray Gardens, and they think that they’re being clever by “outsmarting” the dangerous world.

Dangerous world. Huh. Yeah, well, it is. The whole friggin’ place is dangerous, from the bedroom to Benghazi, and even with your friends, there’s an element of risk.

If only I had more energy and less fatigue, I’d be out there a whole lot more than I am. As it is, though, I have to watch my energy levels and be smart, so I do have energy for the things that mean the most to me. Picking and choosing is a pain in my ass, but it’s got to be a way of life. For the most part, it’s become that. But it’s still a pain in the ass.

Anyway, today I start my official vacation. I’ll probably be plenty busy, and I hope to update a lot of info on this blog with things I’ve been thinking about. Less snarky, more informative. That’s my intention, anyway. We’ll see how that goes.

TBI Issue #2 – Aggression

This post relates to the ongoing series Then And Now – Managing TBI Issues Over the Long Term which I’m slowly but surely building out.

I should probably call this TBI Issues #2A and 2B – Verbal and Physical Aggression, because while aggression can be a big problem post-TBI, it can take several forms. It can manifest as verbal aggression or physical aggression, but in either case it’s problematic. For everyone.

In my case, verbal aggression has often escalated into some sort of physical aggression — I haven’t struck anyone in recent memory, but I have thrown things (occasionally at someone), and I’ve broken things as well.

It happened a lot when I was a kid, too. I would just get more and more wired and wound up, and then I’d just lose it. Flip out on my siblings. Or one of the neighborhood kids. I didn’t just get time-outs, either. I was considered a menace by my neighbors — a real problem.

The net result? My family has always been a bit afraid of me, and they’re often on edge around me, when they sense my temper heating up.

My spouse is also afraid of me, on and off, and I’ve had to work pretty hard at not losing my cool, so they could start to feel comfortable around me again. The problem is, it only takes one or two episodes of me losing my cool, to trash all the progress I’ve made.

Back to square one all over again.

Or at least, that’s how it feels.

“On the inside,” it can be confusing and frustrating, as I often can’t tell that I’m getting edgy. All I know is, something doesn’t feel right when I’m having a conversation/discussion. It doesn’t feel “fluid” and I try harder to get my point across, the less effective I feel, and the more frustrated I become. And the edgier I get. And the more on-edge others around me get.

I don’t know if it’s a TBI thing or what, that I can’t tell when I’m getting edgy. I generally have difficulty figuring out what my emotions are, anyway. I usually feel like I’m happy, but sometimes I’m sad and I don’t realize it. Anger and fear both confuse me. For some reason, I just don’t “get” them, and I have to take others’ words for it, when they tell me I’m angry or sad. One of the confusing things is that I tend to tear-up over stupid little things. Frustration makes me look like I’m crying, which maybe I am, but it’s not the same kind of crying that comes from being sad.

It’s confusing. Which is frustrating. And anxiety-producing. And it just sets me off at times, especially when I feel like people are condescending to me or treating me wrong.

Verbal aggression is a bigger issue with me, I think, than physical — primarily because I’ve learned how to hold myself back with the physical expression. I’ve gotten into a lot of trouble over the course of my life for beating on people, so lessons learned. Still and all, sometimes it does come up and I walk a very fine line between “getting in touch with my feelings” and getting carried away by them.

It’s funny – my spouse used to lecture me about not being in touch with my feelings, like that was a bad thing. But you know what? Not being in touch with my feelings and being somewhat numbed out towards them makes it a whole lot easier for me to not get sucked down into the whirlpool of emotion. I’ve had shrinks lecture me about not being in touch with my feelings, too, as though experiencing all those emotions was actually going to help me. Frankly, with the emotional volatility that comes over me, everyone is better off if I’m completely out of touch with my inner world.

I’m sure there are people who will split hairs and tell me about how being in touch with my feelings isn’t the same thing as letting them run my life, but you know what? I’m not sure that’s accurate. Frankly, I was much more functional, aggression-wise, when I wasn’t “checking in” to see what was happening in my heart and soul.

Paying a lot of attention to what goes on in my inner landscape frankly makes me nervous and agitated — it changes very quickly, from time to time, which gets confusing and frustrating and pretty tiring, actually. So, I’d just as soon not do it.

What does this have to do with aggression? Well, if I can keep some distance between my head and heart and mouth, I’m far less likely to snap at people. I’m far less likely to get aggressive and go after people. If I can literally disregard what’s going on inside me, it actually helps me keep my cool. It’s when I start “getting in touch with my needs” that all hell breaks loose.

I start to feel slighted. Or overlooked. Or dismissed. Or ignored.

I start to feel sensitive. And raw. And vulnerable. Which I hate. And I start to feel like I need to defend myself from things and people who aren’t really out to get me — they just seem like they are.

Of course, my shrink friends love to tell me how I just haven’t processed it all enough, but you know what? Traumatic brain injury has a way of really mucking with your emotions and your interpretation of them, so what am I supposed to do — process a never-ending stream of constantly changing tsunami-like emotions? Please. No matter how much I may process them, they’ll never make sense, because they come from nowhere for no good reason, and they return to nowhere just like that. What a waste of time it is for me to process all that.

The thing for me is not so much processing my aggressive impulses, as it is recognizing and managing them up front. Once I get going, things pretty much go to hell, so it’s on me to manage the situations that give rise to aggression: fatigue, frustration, and feeling defensive. If I can just stay rested and keep my frustration levels down and take time to ask what the hell is going on before I jump to conclusions and start in on people, it goes a long way towards keeping me out of trouble.

But it’s never easy. Oh, no.

Is EVERYBODY selling something?

Once upon a time, you could surf the web and find plenty of things to read without a ton of advertising. That was one of the big benefits – you didn’t have to be constantly interrupted by some ad or some promotional thing, and you didn’t have to wonder if the person writing was doing so for the purpose of promoting their product, or a product they would earn affiliate ca$h from.

Times have changed. I get that people think the internet is going to make them rich. Tons of sites and products abound which promise just that — six figure earnings from only an hour of work each day. Hm. Really? In most cases, not. Consider that a lot of the people who are selling this dream are disciples of the “hypnotic copywriting” school, which has no qualms about openly tricking people into believing some unsubstantiated claim, and has even fewer qualms about convincing everyone else that they can, too.

It’s a problem. Because now it seems like everyone is using their blog to enhance their professional image, score social media points, and “support their brand” with some mixture of down-homey folksy everyman-sort of worldly wisdom, and brazen opportunism. Woody Guthrie meets Gordon Gekko meets one of the Kardashians.

Writers have blogs. Software companies have blogs. Marketers have blogs. Everybody’s “doing social” and everybody’s selling something. I don’t blame them. I just think there’s more to life than using every opportunity and occasion to make a buck.

And then there’s people like me. People who have jobs they like, who are earning a living the old-fashioned way — serving the gods of commerce under someone else’s watch — more or less content to let someone else sweat over the business regulations and quarterly taxes and workman’s comp issues, so we can just have someplace to contribute each day… so we are free to create other things on our own that aren’t tied in to some commercial venture… that don’t have an angle… that aren’t hooked into our professional reputations or our future earnings potential. So we are free to create something that’s as real as we can make it, and as free as we can experience it.

Something that truly IS. Just because. Because it needs to be said, because it needs to exist, because it wants to be experienced, just as it is, without an ulterior motive.

Let everyone else sell something.

I’ve got other plans.

It helps if you talk to people

Well, I’ve had a very eventful 24 hours or so. Last night I stayed up later than I should have, and I decided to take a long, hot shower before I went to bed. Odd thing was, the water wouldn’t get very warm, and needless to say, the shower was neither long, nor hot. At the same time, I heard my spouse calling that the heat wouldn’t turn on. Last night was a chilly one, and just when we thought we were in the clear, sure enough, we needed to turn the heat on a little.

Not to be. Turns out, we ran out of oil. Bummer. The tank was empty. M-T. And when I called the heating oil folks (they have a 24-hour line), they kinda bitched me out for not paying in full on time. They said they’d send someone over, but not till morning.

It’s true. I have done a piss-poor job of keeping on top of paying the people who help me heat my house. Mostly because I’ve been very low on funds all winter, and I haven’t had enough money on hand at any one time make a decent payment. Until recently. My employer paid out our bonuses a month late, so we were waiting around for that…

Anyway, the real issue was not just the late payments. The real issue was that I hadn’t communicated with them about my situation. I had a little talk with the service guy this morning about it – he said that plenty of folks are in my same situation, and that the oil company can work with me, if need be. But I do need to communicate with them.

This is an area where I am really working hard, these days, and I’ve come an amazingly long way, in the past three years. Time was, I really didn’t discuss anything with anyone. Not my friends, not my family, not my co-workers. I just kept my head down and worked. Or pretended I knew what people were talking about and faked my way through everything. And when in doubt, I did nothing. I never asked anyone for clarification, I never engaged anyone in back-and-forth communication. I either just acted like I knew what was going on, or I pretended nothing was going on at all.

Why? Because I felt stupid. Because  I felt dense and inept and I had a hard time following conversations. It’s tough to keep a conversation going, when your short-term working memory is for shit, and you never stop in mid-dialogue to make sure you know what the hell is going on.

But I never stopped to ask for clarification, and I never let on that I was confused or had gotten turned around. It was just too much for my pride to take. And all the while that I was acting like I had it together, I was struggling and beating myself up for not knowing what was going on.

This is changing. Big-time. I can even remember the first time I asked anyone to clarify what they were saying to me. It was my neuropsych — about 2 years ago. And the first time I ever stopped someone to ask them to clarify what they were saying, it was terrifying for me. A milestone. Because my neuropsych didn’t call me an idiot or treat me like I was stupid. They just clarified, and the conversation moved on.

It’s pretty amazing how that works. And it’s pretty amazing that I even took that first step. Admit that I didn’t know what was going on? Not me! Ask for help in understanding what someone was saying to me? Never! But that day, things changed.

Now they have to change again. I need to start talking to people and ask them for help when I’m in a jam. I realize that I just didn’t trust myself to discuss my situation. I kept waiting for it to change, hoping it would change. But time got away from me. And I realize that what I really need to do is trust others to be willing to work with me — and not expect that they’re going to rip me a new one, if I fall short.

I wrote a check for the oil and gave it to the service guy. Then, later, I called the oil company and told them I’d done it. They were so nice to me…

Funny, that.