How severe was my injury when I was 8?

My parents are coming to visit me next weekend,and I’ve been thinking a lot about my earlier injuries and how they affected my childhood. How they affected my development, how they affected my interactions with people, how they affected my future. When I was seven, I fell down a flight of stairs and was very dazed and confused and wasn’t able to talk. And when I was eight, I was hit in the head with a rock and knocked out for a while. (I tell that story here.)

In the ensuing years of my childhood and youth, I had more injuries — concussions and falls. It was not uncommon for me, while playing, to fall hard and/or hit my head and get up a little dazed and confused… but keep playing. Just keep playing.

Now, concussions alone could account for a lot of the problems I had when I was a kid — problems understanding what people were saying to me, problems with distractability, problems with temper outbursts, problems with getting really turned around and confused… lots and lots of mood and behavioral problems that my parents handled with faith and prayer and lots of structure, rather than pharmaceuticals.

In retrospect, I think it really helped, when I was young.  The structure gave me a framework to live within, the faith gave me something bigger to hang onto, and prayer offered me a way to ask for help from a Higher Power when I couldn’t find the words or the means to ask for it from human beings. It was a pretty exacting way to live, though. My family was very religious, and my parents were very strict (at that time) about what was permitted and what was not… what was sinful and “worldly” and what they considered pleasing to the Lord.

But while that faith and prayer gave me a much-needed support system when I was young, when I entered my teen years, it backfired. As I grew older, I still had a hard time, cognitively and behaviorally speaking. The problem was, I wasn’t just having troubles at home, I was having troubles out in the world. Teen years are marked by increasing social activities outside the home, and I just didn’t do a very good job of handling myself. I was alternately shy… and openly rebellious. I was alternately a high achiever and a slacking ne’er do well. I did a lot of good and helpful things in my youth, including saving an elderly lady who was trapped when the open door of her car (it was not in park) rolled and pinned her leg to a very large object (I can’t remember what it was, but she was pinned, and the metal of the door cut into her leg — I can still recall the sight of the inside of her fleshy thigh cut open — I guess my brain selectively records images). But I also sold drugs and bought liquor underage and distributed it to friends. I wasn’t a big-time criminal, but my later youth was marked by a lot of the warning-sign activities of criminals in the making.

Jekyll and Hyde… or head injury? Given the number of injuries I’ve had over the years, and the fact that a lot of my rebellious and “alternative” behavior was directly connected with an internal storm of confusion and agitation and rage that never disappeared, only subsided a little, I think the latter applies.

Okay, so all that being said, I have been wondering a lot, lately, just how severely I was injured when I was 8. I was knocked out with a rock thrown by some kids who didn’t like my looks and had been taunting and teasing me and my sibling from a distance. We didn’t respond, and they started to throw rocks. My sibling wanted to leave, but I said “NO, we’re staying right here.” I still feel awful about it; they could have been injured, instead of me. But I was hard-headed and stubborn, and I didn’t want anyone to chase me away from doing what I was doing.

Anyway, after a number of rocks landed closer and closer to us, one clocked me on the head. I recall feeling a dull-sharp impact and thinking, “What was that…?” and then I went down.

The next thing I remember, I was looking up and my sibling was hovering over me, crying, with tears streaming down their face. I was woozy and wobbly and at first I wanted to stay and keep playing, but they were so upset, I realized I couldn’t keep us there. I was also not feeling so great, and they led me home to my parents, who had me lie down on the couch while they called a friend who was a nurse, to find out what to do. I didn’t want to do what they told me to — I didn’t want to lie down, I didn’t want to hold still, I wanted to either get up and move around or go to sleep. I remember trying to sleep, but they kept me awake. I seem to recall being really tired, but also kind of punchy and agitated and restless. Eventually, as I recall, after checking my eyes with a flashlight a number of times, they let me get up and move around. And my life went on.

When I think back on that time, it seems to me that it was a pretty serious deal – but I’m not sure how aware of it my parents were.  Or anyone was, for that matter. And when I think back, I honestly can’t say how long I was knocked out for. I might have been out for a few seconds, a few minutes, even an hour or more. It’s impossible to say. My sibling can’t recall the event clearly, so I can only guess at how long it was.

And up till recently, I’ve been thinking I was out cold for a relatively short time. But it could have been longer. I can’t recall the kids who attacked us being in the field when I came to — I can’t recall how the light of the day was, and I’m not sure if my parents were concerned about my sibling and me being out longer than we should have been.

But to be accurate, there is a chance that I was knocked out for longer than a few minutes. It could have been much longer. And from what I understand, the length of unconciousness is an indicator of the severity of an injury, which can also be an indicator of long-term problems. Given the level of difficulty I had when I was a kid — particularly during and after 3rd grade… from that point on, life was one big obstacle course for me — I have to wonder if maybe I wasn’t injured worse than I thought I have been thinking I was.

I need to do some more research on this… It could be a good thing to learn. And I think it might help me talk to my parents about my childhood. Because despite learning a lot and putting a lot of things together over the past year and a half, I haven’t yet discussed my TBIs with them. I haven’t discussed them with anyone in my family. But next weekend, I think that’s going to change.

Figuring out how to talk to my parents about my childhood TBIs is actually one of the big action items on my plate, these days (in addition to working like a mad person to keep my job and keep up with my work… organizing my study in a way that helps me, not hinders me… clearing out old files and projects that were artifacts of TBI-induced agitation, rather than being something that would ever bear fruit… and tending to my marriage and home life). My folks have been saying for years that they can’t figure out what they did wrong to make me so unhappy when I was little. They can’t  figure out why I took so many wrong turns.  They can’t understand why I was so angry and rammy and difficult — what did they do wrong?

I have to tell them, it wasn’t them that caused the bulk of my many issues. It was TBIs. Getting hit on the head. Hard. And at an early enough age that it sheared and skewed the connections in my developing brain so it couldn’t develop “normally,” no matter what they tried. I have to tell them it wasn’t all their fault, and that all things considered, they actually helped more than they hurt.

For all their flaws, for all the things they might have done differently, my parents did create a home where I was able to develop habits of self-inspection and introspective reflection. They created a very structured and well-organized environment in which I could safely do things like paint and draw and write stories and express myself and learn things and be my own unique (and sometimes very weird) self. Certainly, it might have been helpful, if they had taken my shortcomings into consideration more and not overwhelmed me constantly with so much friggin’ input (my mother has always been a manic force of nature, God love her). But the fact that I’m still here, still standing, still able to keep motoring on, despite pain and agitation and confusion and generally feeling like I live my life in the dark and have to just bumble/stumble through a lot of things the first time, before I figure out how the heck to do stuff… Well, I have my parents to thank for that.

Even if my TBI at age 8 was more than mild — even if it was moderate — they raised me in a way that made it possible to keep going, keep moving, keep making my life the best that it could be.

And for that I am eternally grateful.

Now, I have to figure out a way to tell them, when they come to visit. I don’t think I could live with myself if I didn’t.

TBI Survivor Loved Ones – Don’t Put Up With Our Crap!

If you are a friend or family member or a significant other of someone who has sustained a head injury, you definitely have a unique set of challenges. Head injury is a terribly intrusive and disruptive condition to deal with — it can be extremely difficult for the survivor to deal with, and it can be utterly maddening for the people around the TBI survivor.

They got hit on the head, sure, but it wasn’t a bad injury, from what the doctor said. They weren’t even admitted to the hospital! They were foggy and groggy for a little while, but that passed. As far as anyone can tell, they should be back to normal, no problem. But all of a sudden, the person you once knew and loved — who may seem perfectly fine on the outside — is changed. Their temper is shorter. They forget things. They make stupid decisions and don’t even seem to understand how dense they’re being.

Subtle little differences can sneak in from out of the blue, and you sometimes can’t quite put your finger on it. They seem… different. You know they’re the same person they always were. But they’re not quite themself. And no matter how long you wait, no matter how patient you are, no matter how much you try to reason with them or walk them through things, they don’t seem to be getting any better.

Or, you can definitely see how they are different. They fly off the handle over nothing. They freak out over stupid things. They sleep all the time. Or they can’t seem to get to sleep or stay asleep more than 5 hours or so. They complain of constant headache. They complain of that blasted ringing in their ears. They suddenly grow aggressive, even violent, and they just “go off” for no good reason. They can’t seem to keep their act together and they keep getting in trouble with authorities – teachers, bosses, the police. Nothing anyone says seems to make a difference, and they don’t seem to learn from any of their mistakes.

For a loved one of a TBI survivor, standing by and watching someone seemingly self-destruct… or at least struggle terribly with things that used to be easy for them… must be terribly frustrating. And dealing with someone who used to be so sweet and loving, who’s now a pure terror when they’re tired or stressed, can be quite frightening. I, myself, have frightened lots of people I loved over the course of my life, due to my quick temper and a sometimes violent streak. I’ve never struck anyone I loved or lived with, but I have thrown and broken things and given people good reason to feel very afraid.

As a TBI survivor myself, I really feel strongly about what an important role loved ones can play in helping a head injury survivor not only recover from their physical injury, but rehabilitate behaviorally. True, the inside of our heads — our fragile, sensitive brain — has changed permanently, and some abilities we may never get back. Some of our cognitive challenges just can’t be helped. But when it comes to our behavioral issues, something can be done. I’m convinced of it. I’ve managed to overcome some really serious behavioral difficulties, and because of my relative success in this area, I’m able to find and hold down regular work. In this economy, you can’t put a pricetag on that capability. And most importantly, I haven’t done it alone.

Perhaps the number one TBI issue I have, is my temper. The inner storms that come up for no good reason really tear the crap out of me, at times. For the most part, I can keep my act together. 7 out of 10 times, nobody knows what a hard time I’m having dealing with something as simple and basic as dropping something or flubbing up. But it’s the 3 out of 10 times that get me in trouble. And it’s not good.

In my case, I am blessed to live with someone who is  pretty demanding. They are that way by nature — they have very high standards, and they expect people to live up to them. I have been constantly pushed and prodded over the years to improve myself as best I can, to not misbehave, to not be lazy, to not be lackadaisical, to not just give up. They have “ridden me” very hard, over the years, sometimes nagging and nagging and nagging until I thought my head was going to explode. But at the end of the day, when I did what I promised I was going to do, or I finished a job I’d started, or I’d done what I was supposed to do, or even when I’d tried and failed, the fact that they’d stayed on me turned out to be more good than bad.

Their encouragement has sometimes been gentle, sometimes strident, sometimes impatient, sometimes overly demanding. But even when they’ve been too hard on me and have given me all kind crap about things I couldn’t control – like my difficulties with remembering things, or hearing them when they were talking to me, or being slower on the uptake than they expecte me to be.

One of the things that’s made our life together more challenging over the years is that we didn’t factor in TBI in our interactions and my shortcomings. But when they started to learn more about TBI, they started to change the way they interacted with me, and they have been far more helpful than ever.

Once upon a time, they pushed and pushed and cajoled and nagged and cursed and hounded… with different levels of success. Now, they understand that patience and encouragement can go a long way. But they — and I — also know that sometimes I do need to be yelled at, in order to get my attention. Sometimes, I’m being so slow and dense, I can’t “get” what’s going on, unless it’s expressed at the top of someone’s lungs.

I don’t take the yelling personally, when situations are tight. I actually need to be yelled at. Or I’ll miss an important cue, I’ll run over that pothole, or I’ll do something that can get me hurt. The important distinction for me is that the yelling happens before an event, not afterwards, when it’s too late to do anything about it. If someone is yelling at me, because I am being dangerously slow and they’re trying to protect me, well then, please, by all means, yell at me.

For me, it’s important that people not handle me with kid gloves. My brain has been rattled a number of times over the course of my life, and in some ways, I’m really, really dense. I can’t be coddled and accommodated and treated like some victim by the people in my life.  And I also can’t be given carte blanche to just do and say whatever I damn well please, ’cause I’ve had bunch of brain injuries. It doesn’t help the people I love, to let me run roughshod over all of them. And it makes me feel terrible, when they let me do that.

Like it or not, there are sides of me that need to be disciplined, that need to be kept in check. And they need to be called what they are — unacceptable — by the people who are affected by them. Including myself. There are certain sides of me that need to be called out and stopped, before they do damage. My temper is hot and precipitous and often flares up with out my realizing how or why or that it’s in the process of happening. And when I’m going off over something that doesn’t warrant my level of rage, I need to be told to be quiet. I need to be told to calm down. I need to be told that my outburst is not appropriate, and I need to step away and calm myself down before I can be around other people. I need to be called on my crap, and I need the people around me to refuse to accommodate bad behavior.

There really is no excuse for bad behavior. There are plenty of reasons for it and my TBIs have not helped, but there’s no excuse for letting myself get out of hand and stay that way. Left unchecked and unstopped, temper tantrums, yelling fits, being snappy and course and crass and obnoxious is disruptive to everyone, hurtful to others, and it’s embarrassing to me. After all, I have to live with me, too. It’s not just about my loved ones. It’s about me having to look myself in the eye every morning when I get up. It’s about me being able to hold my head up, having self-confidence that comes from knowing I can manage my behavior, and having the pride of knowing I’m in charge of my own fate, even if my brain doesn’t always cooperate.

But I need help managing. I need help from my partner, who constantly amazes me with their patience and their intelligence and their willingness to stick with me — as well as their strength in keeping me from running roughshod over them. I need help not only with encouragement, but also being pushed to see what all I’m capable of, to see how far I can go in life, and to keep tabs on my inner situation as I go. And my partner has given me that regularly over the yeras.

Most of all, they’ve helped me by keeping me honest, by refusing to tolerate my bad behavior, my laziness, my eagerness to just give up. They have “kept on me” about so many, many things that I wanted to just let drop. They have prodded me to do right, when I wanted to just quit or do wrong. And they have flatly refused to put up with my crap, threatening many times to leave my ass if I didn’t get my act together and stop being such an a**hole.  They have told me in no uncertain terms that the tone I was taking was verbally abusive, or that I was frightening them, or I was getting out of line with my snarky comments. They have yelled at me, cussed me out, made me sleep in the guest room, refused to cook me dinner, given me the silent treatment, taken away my credit cards, and nagged-nagged-nagged me till I did what I was supposed to do, anyway. And I have never once doubted that they loved me, and they were doing all of that not because they were mean-spirited or wanted to hurt me, but because we both have standards to live up to, and they weren’t going to let me off the hook that easily.

Now, sure, there have been plenty of times when I’ve railed against their behavior. I’ve moaned and bitched and fussed over their demanding streak, and how hard on me they could be. I’ve wept bitterly and angrily over things they’ve said and done, and I’ve yelled back plenty of times. But in all honesty, I have to credit them and their unwillingness to tolerate my TBI-induced stupidity, aggression, and stinkin’ thinkin’ for much of my success.

And I also have to credit myself. Because frankly, I wouldn’t be with this person — and I wouldn’t have stuck with them for 18 years — if I didn’t have standards of my own. If I didn’t agree with them about the range of acceptable behavior, and what is and is not allowed in our marriage, I wouldn’t be able to tolerate their level of demanding-ness. Rather than finding their standards annoying and aggravating, I find them good and positive reminders of things I already know, but easily lose track of.

Of all the things that make successful TBI recovery possible for me, standards of behavior — and the enforcement of those standards — are some of the most important. Understanding that some kinds of behavior are good and allowed, while others are not, is key. Having a code to live by. Having a set of internal guidelines. Agreeing upon rules about what is and is not okay. And submitting to the discipline of being policed — both from within and without — is key.

And my partner has played a huge role in all of this. If they had been inclined to hold back and not engage with me… to be the silent suffering type who just let me go off as much as I liked, and didn’t challenge me… to put up with my crap and then go talk to friends about how hard I was to live with… to not face me down and make me behave myself — or else… to do like so many people I know, who don’t understand what’s going wrong and don’t want to make waves and piss other people off, so they do nothing besides take the brunt of their loved-ones’ anger/rage/temper/sharp tongue… If my partner had been like that, I would not be as well-off as I am today.

Now, make no mistake — my life is no bed of roses. I’m really struggling, these days, with job stuff, learning difficulties, job performance issues, and extreme fatigue. I’m almost beside myself with frustration and agitation, and I am having a hell of a time sleeping. But I have no doubt that all these things would be catastrophic for me and my career and my living situation, if I didn’t abide by very strict guidelines about what is and is not acceptable, what is and is not okay to do/say/outwardly express. If I just cut myself slack, or if I lived with someone who suffered silently while I went off on tears all the time, I probably wouldn’t be here.

I’d be in jail.

Or on the streets.

And I would be alone.

I’m not kidding, and I’m not being facetious. I don’t say any of this lightly.

So, it may sound a bit overly controlling to some, and it might sound like borderline BDSM, but discipline is one of the biggest keys to my success. I’m not advocating loved ones of TBI survivors being strident harpies who give no quarter and drive their brain-injured loved ones to the brink of madness with an unending string of impossible demands. But there is something to be said for demanding that people do/be/talk/relate better than they are at the moment — and better than they think they can.

Ultimately, I think that we are all capable of far more than we think we are. And the first step towards being/doing/living better, is refusing to be/do/live worse than you have to.

TBI and PTSD – The chicken or the egg?

I’ve been giving a lot of thought, lately, to how TBI and PTSD interconnect and “feed into” each other. In my experience, the two are closely interconnected, and they can make each other pretty confusing and convoluted. Each condition changes the brain in subtle but important ways, and when the two interact in one brain/body/mind/spirit, the compounded difficulties can be exponentially more difficult to identify — and treat.

Traumatic brain injury is by its very nature traumatic, and post-traumatic stress disorder comes out of trauma. So, when you fall and hit your head, or you are in a car accident, or you are attacked and knocked out, trauma happens to the body. The body is threatened – sometimes mortally – and the brain kicks in with all sorts of great hormonal and biochemical survival mechanisms. Adrenaline gets pumping. Endorphines start flowing. Glucose gets delivered to muscles. And the less-survival-based reactions we have get pushed off to the side, so our bodies can focus on one thing: survival.

Even if we are not consciously aware that we are in danger — like when I fell down the stairs in 2004, and I didn’t fully realize the extent to which my physical safety had been threatened — our bodies are aware that they are under attack, and they respond accordingly. It’s not something we can control, it’s not something we should control. We need our brains to be able to care for our bodies without our minds knowing how to do it. The problems start, when our brains don’t realize that we’re out of danger, and/or we get caught in a constant feedback loop of detecting perceived danger, reacting to it, stressing out, and never getting a chance to settle down.

That settling down piece is very important. After our sympathetic nervous systems have risen to the challenge(s) of a perceived threat, our parasympathetic nervous systems need to kick in and help our bodies chill out. Rest. Restore. Relax. Digest… Take a break and get back to balance. But if we never take a break and get our nervous systems to relax and get back to normal, we can get stuck in a constant roller-coaster of fear/anxiety/stress/hyper-reactivity that just won’t quit. And traumatic stress eventually turns into post-traumatic stress disorder. Not fun for anyone.

One of the big ways I think TBI contributes to the development of PTSD is in the “debriefing” phase after a crisis or trauma. TBI can impair a person’s ability to self-assess — sometimes we literally don’t know that something is wrong with how we’re experiencing/reacting to life. It can be harder to detect physical experiences and decode behavioral problems, not to mention cognitive ones. And that diminished ability to self-assess makes it more difficult to self-regulate… to consciously and deliberately change your behavior and actions so that you can “power down” and let your over-taxed body restore itself.

At least in my case, when I went through traumatic experiences — let’s take one of my auto accidents as an example — I wasn’t able to think things through after the fact and assess how I was feeling. I literally didn’t know that I was having trouble understanding what people around me were saying. I thought it was them, who were suddenly refusing to speak intelligibly. I literally did not realize that my sleeping schedule was off — I just stayed up later and got up earlier and pushed myself to go-go-go… and then drank and drank and drank to get myself to relax. I wasn’t even able to determine how I was feeling physically. All I knew was, something was up with me, and it really made me feel awful.

So, I pushed myself even more to “keep up”… and it just added to my already overtaxed body being stretched beyond its means. Not good.

A few posts back, I wrote about being wired to survive and all the biochemical activities that take place as a result of some traumatic crisis. The thing to remember about that wiring system is that it is totally independent of rational thought… but rational thought is necessary to deal with its aftermath. The physical experience of all that adrenaline and endorphins and glucose is not a walk in the park. Our bodies need our brains to take over, after we have rushed to safety, to tend to our frazzled nerves and make choices that allow us to relax, regroup, recuperate, and restore the delicate balance in our central nervous systems.

But with TBI, even mild ones, the brain is impaired and it cannot process clearly. So, we can end up making choices that do not help us relax, that keep us on edge, that keep us going-going-going, so we never really get a break from the crisis and drama.

And post-traumatic stress disorders emerge, which further alter our brain chemistry and how we make choices and take action in our world. PTSD actually alters our cognitive functioning. It makes us think differently than we would, under normal, non-stressful conditions. And that different thinking is not always the smartest thinking.

But wait, there’s more…

Impairments to our thinking — our heightened hyper-reactivity, our hair-trigger response systems that are fried and frazzled — can cause us to make choices that are dangerous and risky. Choices that can cause further head injuries. Being all PTSD’ed-out can make us very quick to anger, in situations where we’re likely to get in a fist-fight, even if our opponent is twice our size. It can make us “slow on the uptake” so we miscalculate choices while we’re driving. It can cloud our judgment about whether or not to take up skydiving. And our increased appetite for stimulation can cause us to pursue activities that are custom-made for yet more traumatic brain injury.

And so, we end up with a vicious cycle of traumatic head injury feeding our post-traumatic stress, which evolves into disorders of mind, body, heart, and spirit… and leave us wondering why the hell everything around us is going to shit. Our brains have been injured, and our judgment is impaired. And each condition feeds the other.

I’m not sure how much research has been done on the interactions of TBI and PTSD. I think it’s a topic that’s ripe for harvesting, and we could probably learn a lot from taking a close look at the two pieces of the puzzle. I think that folks being treated for PTSD should also be evaluated for TBI, and vice versa. Having experts and folks in positions of authority say that “most TBI suvivors heal” sends the message that the brain will just take care of itself, and everything will be fine. But while the brain is healing — to whatever extent that may be — post-traumatic stress can emerge, which can feed a vicious downward spiralling cycle that affects not only the mind, but the spirit and the body as well.

And that needs to be addressed.

And I do more of that here…

The physiology of anger

Speaking of temper…  Here’s a blog post that talks about the physiological impact of anger.

This is pretty important, especially for TBI survivors. Anger and temper flares are very widespread among folks who have experienced head injury — even mild traumatic brain injury — but even so, they are woefully under-researched.

Personally, I feel there’s not nearly enough good information out there for folks to use — both survivors, family members, and the doctors who help them. It’s a problem.

I’m in the process of documenting my own anger/temper issues, talking about how I experience them, and describing ways I’ve found to deal effectively defuse — or at least deflect — the temper flares I have. And believe me, I do have them. Especially after my last TBI.

Sudden, extreme, inexplicable temper flares can be emotionally, socially, and physically debilitating. From the blog post I mentioned above, here are some of the ways anger affects our bodies:

1. Muscles that are needed to fight or flee become very tight, causing an “uptight” feeling.
2. Chemicals known as catecholamines are released causing us to experience a burst of energy (which causes a sugar deficiency, so that an angry person may “shake from anger”).
3. Heart rate accelerates: Because of our anger, the usual (average) heart rate of 80 climbs to 180 beats per minute.
4. Blood pressure rises: An average blood pressure of 120 over 80 suddenly soars to 220 over 130, sometimes even higher.
5. As the body prepares for survival, it safeguards itself against injury and bleeding. Likewise, an angry person’s body releases chemicals to coagulate (clot) the blood, creating a situation that’s potentially dangerous. Although there is no physical injury, the clot is formed, which can travel through the blood vessels to the brain or heart.
6. Rate of breathing increases to get more oxygen into the body.
7. Increased blood flow enters our limbs and extremities.
8. Attention narrows.
9. Hormones (adrenaline and noradrenaline) are released which trigger a lasting state of arousal.

Furthermore…

“If anger has a physiological preparation phase during which our resources are mobilized for a fight, it also has a wind-down phase as well. We start to relax back towards our resting state when the target of our anger is no longer accessible or an immediate threat. However, it is difficult to relax from an angry state. The adrenaline-caused arousal that occurs during anger lasts a very long time (many hours, sometimes days), and lowers our anger threshold, making it easier for us to get angry again later on. Though we do calm down, it takes a very long time for us to return to our resting state. During this slow cool-down period we are more likely to get very angry in response to minor irritations that normally would not bother us…. High levels of arousal (such as are present when we are angry) significantly decrease your ability to concentrate.”

Which means, the naturally hyperaroused, hypervigilant, brain fog state in which we already exist is only exacerbated by anger. We need to consider this. We need to see ourselves. We need to make a change.

Our bodies are already stressed, tensed and on edge any normal day. Why make it worse by not controlling our anger? It is, after all, an emotion that is within our capability to focus, modulate and contain.

Indeed.

The long-term effects of too much uncontrolled anger are in the same ballpark as the effects of long-term unaddressed PTSD, from what I can tell. In both cases, the physical system is dragged down, day after day, week after week, month after month, year after year… and what do we have to show for it? Yet more stress.

That being said, I wish I could say I just have PTSD, but my TBI makes it even more difficult for me to parse things through and manage my anger at times. I have to follow specific guidelines to keep myself in check, and I need to keep an eye on myself on a regular basis, lest my anger/temper/freak outs get way out of hand. I’ve lost jobs because of temper flares. And I’ve hurt a lot of people  I care about. Uncontrolled temper flares have done plenty of damage to my heart and the hearts of others. So, I owe it to myself to keep my anger in check.

And I owe it to myself to keep in mind the physical effects that uncontrolled anger has on me. Somehow, my brain finds it easier to wrap itself around objective, non-emotional reasons for staying chilled — like the physiological effects  listed above.

Objective data is one more tool in my toolbox for living well, despite multiple TBIs.

PR: wait… I: wait… L: wait… LD: wait… I: wait… wait… Rank: wait… Traffic: wait… Price: wait… C: wait…

Hello, Officer… A Temper Flare (Almost) Gone Wrong

What a beautiful day it was! The mid-winter sky was bright and blue, and the sun was finally showing its shining face after days of inclement weather. Driving home from work, I gazed around me at the gorgeous landscape. A thick blanket of fresh new snow covered the fields on either side of the back road home, softening the stubble-covered terrain. Intermittent stands of woods were silent with insulating white, trees sleeping silent beneath a delicate frosting that broke loose in passing breezes and showered to the forest floor in a sparkling cascade. Babbling brooks flanked the country road, here and there, cascading cheerily down rocky beds, icicles dangling from sticks and grasses which hung close enough over their splashing course to catch — and instantly freeze — splashes from the snow-melt swollen streams.

I was on my way home from my new job to my new house, and as I gazed around me at the beautiful scenery, it felt as though my life were being made new again. The stress and strain from the recent move from the suburbs to the country had tested my endurance sorely, and all but exhausted my strength. The transfer from my old job had not been without some challenge, as well. Change is never easy for me, and adjusting to not only a new home in a new place with new neighbors, but also a new job with new responsibilities and new coworkers, had turned my post-holiday season into a see-saw of elation and despair.

But after weeks of settling in, getting acclimated, developing my new routines, and finding better ways to drive to and from work than the freeway filled with aggressive drivers, I was finally starting to feel my balance returning.

That day, as I motored happily across the countryside, making it home before dark (for once), everything seemed like it was falling into place. I had the radio on — loud — and my spirits rose with the energetic dance beat. My little car — a late model hatchback with a funky heater — had finally warmed up, after running for 10 minutes. I was making good time, and I’d be home soon.

Or was I? I suddenly looked up at my rear-view mirror, and lo and behold, there was a local cop with his lights flashing… coming on fast. I instinctively took my foot off the gas and glanced down at the speedometer. The needle drifted quickly south from around 45 mph… and I looked up as I passed a sign that said I was in a 20 mph speed zone. Shit! I had been so busy listening to music, and thinking about getting home, I hadn’t even noticed the speed limit. Maybe he was after someone else, I thought for a moment… But no, as I slowed down, so did he. I braked, signalled, and pulled over to the side of the road, and he pulled in right behind me.

*&%! I thought to myself. How could I do something so stupid?! I knew that this stretch of road was where the local cops hung out. I’d passed them plenty of times before, as they lay in wait of commuters taking the back way home. A wave of angry frustration welled up in me, and my head began to spin as the officer got out of his car and approached. I could feel my pulse quickening, a roar in my ears starting, and my gut churned as I started to build up a head of steam. All I wanted to do, was get home. All I wanted to do, was get through this town. All I wanted to do, was put the tough day behind me and relax in front of my fireplace. I didn’t ask for much. And I didn’t mean to speed through this town. I just lost track of how fast I was going! What the hell was this cop pulling me over for? Didn’t he have other real criminals to catch? What the fuck?!

I could feel the indignation rising in me, with every approaching step of the cop. Strings of profanity coursed through my head, and my gut continued to constrict as my hands tightened around the steering wheel. I couldn’t believe I’d been stupid enough to speed. I couldn’t believe this cop had been that stupid to pull me over. Everybody was a fucking idiot. Jesus fucking Christ.

The cop reached the side of my car, and I rolled down the window.

“Do you have any idea how fast you were going?” he asked.

“Too fast?” I heard myself say. It sounded smart-assed, and he didn’t like that.

“License and registration please,” he said, and I pulled my license out of my wallet and handed it to him. Still seething, I reached into the glove box to find my registration. I always kept it in the same place — in a long sleeve that held my insurance papers as well. But as the crashing ocean of agitation crashed in my head, I had trouble finding my papers. I couldn’t find my registration. I couldn’t find my insurance stuff. I couldn’t find anything… and I started to lose it. The cop at my window was getting impatient, and when he prodded me to come up with my papers, I snapped at him that I was looking as fast as I could. I finally just pulled everything out of the glove compartment and spread it across the passenger seat.

“Is this your car?” the officer asked, with a wary edge in his voice.

“Yes, it’s my car!” I barked. “I’ll have the registration in just a minute. I know it’s in here somewhere…”

My vision was getting cloudy and blurred, as I sorted through the mess on the seat beside me. Finally, I found the sleeve, pulled out the registration paper, and handed it to the cop. But after taking a look at it, he handed it back to me.

“This isn’t current,” he said. He sounded like he was talking to a criminal.

A wave of resentment washed through me, pushing to unleash some crack or curse.

I took the paper from him and examined it more closely. Sure enough, it was from a few years back. Consternation welled up in me, and I bit back the curse that sat on the tip of my tongue. I ran through the rest of the contents of the sleeve — there were plenty of registration papers there, but none were current.

The cop pressed me for the papers, and I snapped at him again, “I’m working on it!” I couldn’t believe this shit. I rummaged once more through the pile of stuff on the seat beside me — ice scraper, breath mints, tissues, various receipts, notepads, souvenirs, tools, more papers… where was my goddamned registration!?

“Are you sure this is your car?” the officer asked.

“Yes, it’s my car!” I snapped. “Just give me a second…!” I cringed at the edge in my voice, knowing — from past experience — that police officers don’t respond well to aggressive disrespect. I’ve had several run-ins with cops over the years that escalated when I spoke out of turn or got verbally aggressive with them. A few times, I came close to being arrested, and I couldn’t afford to have something like that happen today. Not when I had this new job and a new house. I just couldn’t afford to get on the bad side of the local cops.

If only he would give me a second. Just one more moment…

But he wasn’t having it. I heard him turn and go back to his car, and when I looked up in the rear-view mirror, I saw him back in his car punching something into his onboard computer. He kept looking at my license plate and then back at his computer, and it looked like he was talking on his radio, too.

What the hell…? I couldn’t believe I’d gotten pulled over… I couldn’t believe I couldn’t find my registration papers. I distictly remembered renewing my registration just a few months before, and I distinctly remembered putting the papers in my glove compartment. Where the hell were they? Where the fuck had they gotten to?!

Suddenly, as though by magic, an envelope from the Registry of Motor Vehicles appeared before me. Inside was my current registration. It wasn‘t in the sleeve where I always put it. It wasn’t in the one place I was sure to find it. Like an idiot, I had just tossed it in the glove compartment. Stupid, stupid, stupid. I pulled out the paper and double-checked the dates to make sure I wasn’t going to make an ass out of myself — again. Then, I waited for the cop to return.

He did… with a citation in hand.

“Here’s my registration,” I said, using as neutral a tone as I could muster. I handed him the delinquent paper.

He took a long look at it and then took a longer look at me and my license.

“You should have found this sooner,” he said, handing them back to me, along with the ticket. He sounded like he wasn’t sure what to do with me — let me off the hook or cuff me and haul me into the station.

I shrugged, biting back words that I was afraid might provoke him even more.

“I had to run your plates, so now I have to have a record of this stop. I’m just giving you a warning, this time, but it’s on your record.” He sounded a little regretful, but also irritated with me. “If you had gotten your registration, I wouldn’t have had to run your plates.”

I wanted to say, “If you hadn’t been in such a godawful hurry and had given me a minute or two, I might have found it in time!” But I held my tongue and just nodded.

As he drove off, I started to shake, my stomach in knots and my torso damp with sweat. I felt like I’d just dodged a bullet… a bullet I’d stepped right in front of.

Tired of being tired

I don’t like being as tired as I’ve been for the past week. I started losing sleep last weekend in anticipation of my testing results. And then when I had my neuro visit, that threw me off, too. So either way, I can’t seem to catch a break. Even though I got good news, I had been keyed up to possibly getting bad news — I like to be prepared. But when things came back inconclusive, well, my system was still on high alert, I wasn’t sure what to do with all that energy. I think it might have been easier, had I gotten something definitive, even if it were less than positive news. At least then I’d have something to focus on, to aim towards, to measure myself against. Even if it’s problematic, it’s at least something.

But this “we couldn’t get anything definitive” trip has been quite demanding. I’ve got all this energy, all this readiness, all this alertness… and nowhere to go with it. My body has been in a state of high alertness, on and off, for many years, and now it’s starting to really take a toll. I should probably exercise to work it off, and I have been trying to get myself to do just that for months — no, years. But one of the things that my TBI in 2004 did was making me really nervous about being around other people, so going to the gym has not been an option for me. That’s bad. I’m not in as good condition as I should be, and I have a hard time getting motivated to GET in better condition.

It’s a problem. It really is. But at this point, I’m more concerned about my sleeping — ‘cuz if I can’t sleep, then everything goes haywire, and I end up in this downward spiral all over again.

You wouldn’t think that sleep would be such a big deal, especially considering how exhausted I usually am. But I’ve had to really work at figuring out how to sleep, as well as get naps in. It’s wild, how napping feels like my new “hobby”. I do it whenever I can… and I’m actually enjoying it. I’ve been “off” my sleeping patterns since my fall down the stairs in 2004, getting anywhere from 3-6 hours on a regular basis, and rarely getting more than 7 at a stretch. It was such a departure for me — for most of my life I craved 8-9 hours each night, without exception. It was what I used to aim for, even when I was a kid. But I didn’t even fully realize just how bad it was, until the past year or so.

The other crazy thing about my sleeping change, was that for some reason I thought it was an okay thing to do without sleep. I guess I would just get so jazzed up and so charged and so whacked out with agitation and nerves, I would think I needed to work off my nervous energy and “get things done”. Well, news flash — I wasn’t really getting much of anything done. Just spinning my wheels. How crazy is that — I would just start all these writing projects, work like mad on them, write and edit, write and edit, write and edit, but then I would get distracted and go do something else, and completely forget about what I had been so determined to do.

Madness. I was just running like a blind fool, spinning my wheels, just being busy for the sake of being busy. Geez! I wasted so much time imagining myself pursuing success, but I was just churning. And exhausting myself in the process.

I have to say, post-traumatic stress may be a significant factor in all this. I’ve been reading so much about traumatic stress, thinking about it, talking about it with psychotherapist friends, pondering it, looking at it, I’m pretty sick and tired of it always being on my mind. But PTSD must be playing a role in my sleep conundrum. After having gone through so much over the past year, tracking down my tbi and other neurological issues, going through all the testing, changing jobs, dealing with family stuff, having various neurological complications, and trying to put two and two together and make sense of it all… not to mention the hard, hard winter we’ve had… I’ve probably got my fair share of PTSD to deal with. I’ve just been so tapped, week after week, month after month, and it’s taken a big toll on me and my already sensitive system. No, I haven’t been at war, and the past year hasn’t been as hellish as it could have been, but stress is stress, and I have been “on and off” about how well I’ve dealt with it all.

Oh, God, I am so tired. It’s crazy. I can’t even figure out how far behind I am on my daily quota. All I can do, is try to catch up when I can. I had a 2-hour nap Saturday afternoon, and I slept for 3 hours on Sunday. I was still really groggy after both naps, and I didn’t feel like I had caught up as much as I needed, but at least I did manage to lie down for a while, and it feels so good to relax.

This is relatively new for me, in the past years. I have gotten worse and worse at relaxing, especially after each TBI I went through. With each accident, I became a little more wound-up, a little less inclined to sleep. I think it’s become a lot more noticeable in the past years, as the cumulative effects of my injuries is catching up with me, and I’m getting older, too.

When I was a kid, I remember having a lot of trouble relaxing and falling asleep. It was very on-again, off-again. I tended to get tired and go to bed earlier than other kids, but I often had to sleep in a specific position, holding something close to me, like my blankets or a pillow (not so much stuffed animals). I also couldn’t sleep if there wasn’t a blanket over me. I was kind of high maintenance when it came to falling asleep, but at the same time I really craved a good long nap, a good rest, something that would recharge my waning batteries.

I still have trouble falling asleep, if I’m not in a certain position or if I don’t have blankets on me. And I’m still exhausted… by myself and my crazy brain. Some people call me a Type A personality. I am driven. I do push myself. I do tend to get aggressive. And I generally go full-force after whatever I want, not letting anyone come between me and my intended goal. But it’s not all psychological/ego drive that moves me. There’s more to it than that — and sleep plays an important role. In fact, the more closely I examine my life and pay attention to what’s going on with me, the more clues arise about what makes me do the things I do — including not relaxing. And in some ways, it has as much to do with physiology as psychology. In some ways, I’d say it has even more to do with the state of my body than the state of my mind. (I’ll write more on this in a bit — it’s actually a pretty important realization/development for me, and it might help others to understand and accept themselves better, too.)

But I’m operating more and more from a deficit, and it’s just not good. Nowadays, I’m trying to learn how to relax. I used to know how, but I seem to have forgotten in the past years. It helps me to listen to some guided imagery for “training” on how to do this. I’ve lost a lot of my former ability at it, so I have to have someone else walk me through the steps of relaxing… progressive body relaxation, deep breathing, letting myself “go” to an imaginary place where I’m safe (which, for me, is a made-up, imagined place I’ve never physically been to — very few of the places I’ve been in real life are places I can relax in)… At first, I felt kind of inept. I mean, who doesn’t know how to relax? What a strange concept. But when I think about it and am totally honest about it, no, I actually don’t know how to relax. Not anymore. And I need help.

I also need help falling asleep. I have noticed, over the past year or so, that when I have the worst insomnia or am waking up way before my alotted 8 hours, I am often very tense, like I’m spring-loaded. Instantly ready for action. Always on alert, because something might come up that I need to react to. My broken-brain reaction time tends to be slow to begin with, so I compensate by always being on-guard, on-point, on-alert. It’s fine when I’m going through my days, but when I lie down to sleep at night, it makes it mighty difficult to relax, let alone fall asleep. But once I let go of the tension in me… once I relax, I can start moving towards sleep.

One thing that’s really helped me, is starting to go to bed before I “have” to. If I wait until 11:00 to go to bed, and I have to get up by 7:00, I feel like I’m under tremendous pressure to perform — to get to sleep promptly and stay asleep for eight hours. I actually put pressure on myself to relax and sleep. But if I head to bed around 9:30 or so, putter and futz around and take my time getting to bed… and if I can get in bed by 10:30 or so, I have a lot less pressure on me, because I am pretty sure I’ll be able to get my hours in.

I’ve been using some guided imagery to get me “down” too. Fortunately, I get so relaxed by the initial cut on the CD, that I usually get to sleep before the “restful sleep” part starts. So, while I’m sure that it helps me, I’m not entirely sure how. Supposedly, it helps even when I’m asleep and am not actively listening. I’ll just trust that, I guess.

Head injuries make a big difference

I’ve been looking around a lot, lately, at all sorts of different materials — in books as well as online — about how the brain and the body interact with each other. The gray mass inside our heads is getting more and more press, as people pay closer attention to the after-effects of the Iraq and Afghanistan wars, and hear about how so many vets are affected by TBI.

I can’t believe we had to have two wars to figure out that TBI — whether it’s open head or closed head wound, whether it’s mild or severe — can have a substantial impact on people’s lives after the fact.

I can’t believe we don’t know more about this. People have been getting hit on the head since time immemorial. Why is it we’re only starting to take it seriously now? People have been recovering from blasts for generations. Why is it that we’re only starting to study it now? What is up with us, anyway?

I am also more than a little incredulous that the human race — which is defined by its brain — doesn’t know more about this thing that everybody has. I mean, come on people. What’s taken us so long to start paying attention to this common organ of ours? And why does it take war and injury and extreme circumstances to perk up our attention sufficiently to realize we don’t know nearly enough about this thing called the human brain?

What is up with that?

I mean, so many different societal ills can be traced back to head injury — domestic violence, violence in general, social dysfunction, emotional problems, even mental illness, financial woes, crime, illness… there are just so many ways head injuries can totally screw us up, and an awful lot of people experience them — check the stats on the left side of this blog, if you’re not convinced.

Head injuries do have an impact. A big one. And as our tens of thousands of troops return from Iraq over the coming 18 months, we’re probably going to be seeing even more impact — not to mention a whole lot of PTSD fallout throughout this country. I’m trying to be hopeful, but I must say I’m worried.

I just hope we can figure out that head injuries matter, and that PTSD is something worth treating, before we have to learn too many lessons the really hard way.

One Potato, Two Potato… A Tale of a Temper Flare

It was such a small thing. It was no big deal. So, I dropped the potato on the floor. So it slipped out of my hand and got away from me. I didn’t really need to flip out and slam the potato peelings into the trash can and curse a blue streak. I didn’t need to startle my partner and frighten them with the intensity of my reaction.

But from the way I lashed out after I dropped the potato, you’d think it was a huge deal. My temper flare was totally out of proportion to what happened, and I was totally unable to stop it. And that’s what drives me crazy.

Once again, I have overreacted extremely to a seemingly minor annoyance, turning a proverbial molehill into a mountain — no, a volcano. My partner is steering clear of me for a while, till I simmer down. My blood is pounding in my ears, I’m sweating like I’ve just run a hundred yard dash, and my head is spinning with the sudden crash of waves of unexpected emotion on my once-staid interior. Dinner might turn out okay, but the evening is pretty much ruined.

And I am humiliated.

It started out so simply. I had a long day at work, and I was looking forward to just chilling out, making my signature dish for supper — meatloaf with mashed potatoes and green peas. I don’t have the biggest cooking repertoire, and my partner usually does the cooking, but for some reason I make a killer meatloaf. After the long day I’ve had — no, a long week — tonight I need some serious comfort food.

I had intended to take off early and get home at a decent hour, but I got tied up at work with some last-minute things I needed to take care of. Running later than expected, I called my partner to say I was running behind, then did some shopping on my way. I picked up the 93% lean ground beef, egs and milk, and some extra celery, then waded through late-rush-hour traffic, and finally got home. Not bothering to change out of my work clothes, I rolled up my sleeves, chopped and mixed and patted together a pink loaf of beefy joy that would soon enough brown to perfection. I was running behind where I had hoped I’d be, but in another hour and a half, all would be well.

While the meatloaf was cooking, I turned my attention to the potatoes, and I suddenly remembered I’d intended to pick up some fresh spuds at the grocery store. A sudden flare of irritation rose in me, but as I picked through the potatoes we did have on hand, I found enough that were still in good enough shape to eat. As I rinsed them under cold water and shaved off their skins, I was having trouble hanging onto them. I could tell I was pretty tired from the day. The oblong shapes were slippery in my hands and I had to really concentrate at keeping hold of them, when I didn’t have rough potato skin to grip for traction. The peeling knife was slippery in my hands, too, and I struggled a bit with carving out the eyes and removing skin from tight crevices and wrinkles in the flesh.

As I turned away from the sink with one of the skinless tubers in my hand, suddenly it jumped from my grip. I tried to catch it as I felt it slide from between my fingers, but it escaped and landed with a thud on the linoleum and skittered away from me, as though it had a will of its own.

In an instant, my whole system was flooded with a sudden cascade of intense emotion. I could feel the blood rise in me, an adrenaline cocktail of volatile biochemicals boiling up at a moment’s notice, and I saw red for a split second. I felt something vicious in me coil and uncork like a thunderclap, and all I wanted to do was stab that fucking potato with the peeler I was wielding. In my mind’s eye, I saw myself stab it viciously, without hesitation or remorse, till it lay in shredded fragments before me.

“FUCK!” I fumed. “GODDAMN IT TO FUCKING HELL. MOTHERFUCKING PIECE OF SHIT! FUCK YOU! FUCK YOU!” I cursed the tuber. The unnamed thing that had coiled and unsprung inside me started to thrash, like a wild animal caged and prodded with an electrical probe. My gut churned with fierce lust for vengeance, and my head suddenly cleared of everything but a cold, cold drive to annihilate. Reaching for the nearest thing, I snatched up a handful of potato peelings from the sink and slammed them into the nearby trash can. Some of the peels slipped from between my fingers, and I pounced on them like a ravenous predator. I dropped to my knees — work clothes and all — and with tightly closed fist, I pounded them on the floor, as the inside of my head roared with rage. “STAY THERE, YOU GODDAMNED COCKSUCKING PIECE OF SHIT,” I hissed at the inert piece of vegetable peel. “DON’T FUCKING MOVE.“

The potato peel obliged me and lay still on the floor in front of me. The inside of my head howled with frustration and rage, and I snatched up the offending object and threw it violently in the trash atop the rest of the peelings. My breath was heavy and ragged, and my torso was tracked with rivulets of sweat that descended from my chest and armpits to my belt. The whole kitchen seemed to shift and sway before me, and the overhead light became unbearably bright.

Behind me, I heard a sound, and my partner appeared in the doorway.

“Are you alright?” they asked, as I picked myself up off the floor and crossed the room to pick up the potato that had slipped from my grasp.

“I’m fine,” I muttered, as I snatched up the maverick spud and turned back to the sink to rinse it off. The rage that had torn through me just moments before suddenly receded with the presence of another person in the room. The part of me that knew that losing my grip on this slippery vegetable didn’t warrant the firestorm I’d unleashed perked up and pulled me back from the brimstone brink of my outrage.

I felt my partner’s eyes on me, but I couldn’t make eye contact. Their gaze followed me back to the sink, with an all-too-familiar sense of apprehension and defensiveness. This was not the first time I’d blown up after a long day at work, and I was pretty sure it wasn’t going to be the last. I could feel the recrimination in their eyes — What are you getting so upset about? Why did you freak out over just dropping the potato? What’s wrong with you? Why are you so … violent? I knew all the questions, but I didn’t know the answer. All I knew was, I had been overcome by a wave of emotional overreaction that — once again — had blindsided me and reduced me to a big baby — pitching a fit over some stupid little thing and making me look like a raving maniac. For nothing.

As I ran water over the potato and I nearly lost my grip again, another smaller wave of anger welled up in me, but I held it back. I could feel my partner’s eyes still on me, watching to make sure I wasn’t going to get out of hand and break something. I’ve broken things in the past, slammed things, thrown things – the cracked dustpan that we keep in plain view in the kitchen is a constant reminder of how intensely my temper can flare, and how violently I can become as a result.They needed to make sure I wasn’t going to wreck anything in the kitchen.

Again.

I willed myself to act as though I were once more calm, and as I systematically went through the motions of cutting the last remaining potato into quarters, my partner’s wary curiosity was satisfied, and they disappeared again into the living room. Quiet… they were quiet in that way they get when they’re afraid of me and unsure about how the rest of the evening is going to go. I was quiet, too, willing my system to chill and not radiate the white heat of unprovoked rage that my partner can instinctively sense.

But though I seemed fine on the outside, inside part of me was still writhing. Still smarting. The crash of the rage felt like it had cracked something in me… as though a heavy anvil had fallen onto my foot, cracking and breaking bones… bones I needed so I could walk the rest of the way through my day. Something in me felt bruised and battered, but the hurt had come from inside my system, not outside me. And I had been defenseless against it. If the attack had come from someone or something beyond my own skin, I might have been able to defend myself. But this attack came from the inside, and it hurt as much as if I’d been jumped in an alley and beaten by thugs.

Yes, this attack had come from inside. From the depths of my being, the core of my character. At least that’s how it felt. I felt damaged and inept. Useless and beyond help. My insides felt sick and worried. All this drama over a little potato… All this rage over some stupid couple of minutes of me losing my grip… in more ways than one. “What’s wrong with me?” I wondered “Why can’t I deal with something that simple? My partner doesn’t seem to have this problem. Why do I?“

Keeping quiet, keeping to myself, I adjusted the setting of the burner beneath the boiling potatoes and headed upstairs to change my clothes. The best I could hope for, was that my meatloaf would redeem me, and that the food I was preparing would be more comfort for the one I loved, than my own self was, that night.

Snap! Anatomy of a TBI temper flare

If you’re a TBI survivor, you may be very familiar with the flares of temper that can sneak up on us unawares. It is very disconcerting, if you’re a pretty even-keel sort of person, or if you really don’t want to pitch a fit, but find yourself flying off the handle against your own will.

This has happened to me as long as I can remember — temper flares that come out of nowhere and decimate not only my relationships with people around me, but my self-esteem and self-confidence, as well.

I recently wrote a post called One Potato, Two Potato… that talks in greater detail about my experience of an intense temper flare that builds up over time.

I actually have identified a number of different kinds of flares I experience:

1. Flares that originate inside me – and come up suddenly without any warning
2. Flares that originate inside me, but percolate and develop over time, till I boil over. (That’s what One Potato, Two Potato… is about)
3. Flares whose source originates very suddenly outside me – they’re knee-jerk reactions to external conditions that actively provoke me.
4. Flares whose source comes from outside me that percolate slowly until I boil over.

There are other ones, as well, and I’m devoting a fair amount of my time, these days, to thinking about them. Of all the cognitive-behavioral issues I have, my temper flares are some of the most challenging. And since so many people reach this blog by searching for info on TBI and temper, I know I’m not the only one.

For the uninitiated, here’s a general description what happens in one of my TBI temper flares, how I deal with it, and how I pull out of it:

1. I have a goal in mind — it can be as simple as picking up a pencil, or as complicated as making a three-course dinner.
2. I turn my attention to the thing I want to do… think about doing it… think about not doing it… and then I decide to do it.
3. I shift into gear — I reach for the pencil… or I start peeling vegetables for cooking.
4. Suddenly, something stops me — I drop the pencil, or a potato slips out of my hand and skitters across the floor.
5. A sudden wave of violent emotion sweeps through me, like a wildfire through dry California underbrush. My eyesight dims briefly, as my heart pounds and adrenaline floods through my veins. I want to strike out, lash out, hurt whatever is getting in my way. I curse the pencil… or I feel a sharp stab of rage directed at the potato. If I were able to kinesthetically direct energy at will — and if my temper had its way — the pencil or the potato would be a smoking little pile of ashes.
6. In the back of my head, the calm, collected voice reminds me that it’s just a pencil or a potato, and that no one was harmed by this thing slipping out of my hand. I don’t need to strike out and harm anyone, just because I lost my grip.
7. The part of me that doesn’t care for these temper flares is mortified at my intense reaction. It’s deeply ashamed that I would get so worked up over such a little thing. So what, if the pencil or the potato got away from me? What’s the big deal? The wild animal part of me that flared intensely is cowed and tries to defend its reaction, but when the logical, sensible, even-keeled part of me prevails in its reason, that little animal part of me slinks away to a corner to lick its wounds and chastise itself for being bad… again.
8. In an attempt to de-escalate my just-add-water instantaneous rage, I pause and take a measured breath. I turn my focus back to the basics — the simple act of picking up the pencil… retrieving the potato from the other side of the kitchen. I focus on the most basic aspects of the moment, waiting till the rage subsides and I can get back to doing what I started out doing.
9. If all goes well, I can continue with my task and not suffer too much at the hands of my self-recrimination. If things aren’t going well, like if I’m stressed or fatigued or scattered, I may throw something or curse or hit something or lash out… with the consequence of not achieving what I intended to achieve, and descending into a downward spiral of shame and blame and guilt and embarrassment. If I’m lucky, no one is around to see this. If I’m out of luck, someone I love and care for is nearby and is strongly impacted — and quite negatively so — by my sudden rage.

Now, I’ve noticed that if I have built up a lot of momentum around Step 2, my rage response is much more intense, than if I proceed with measured pace, taking things one at a time. I also need to be careful not to indulge every reaction that comes to mind.

It’s helpful if I can sit back and just observe myself, not participate 100% in the whole unfolding drama. But observation doesn’t always work. Especially if I’m tired.

Over the coming weeks (early 2009), I’ll be writing more on this. It may be helpful to others who are dealing with the challenges of TBI temper flares… with greater or lesser success. In fact, some folks have said that what I’ve written so far, is very helpful to them, so it’s my hope that I can help more.

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Too smart for my own good?

I had another follow-up session with my neuropsychologist yesterday, and I had some really good news, and some really bad news.

The good news is, according to my neurpsych, I have some pretty “phenomenal” abilities. On one of my tests, I scored in nearly the 100th percentile — a couple of standard deviations above the norm, whatever that means. Apparently, it means good things.

But on the other hand, my “singlemost biggest issue” that is keeping me from living my life to the fullest is my tendency to get “mired in detail” — and I mean mired.

On this one test, where I was asked to describe a scene, I filled two sheets of paper with details about what I saw… but the optimal response would have been a fraction of that. The thing is, I didn’t even write down everything I wanted to — I could have filled ten times as many sheets with information that all seemed important to me. But it occurred to me at some point that I didn’t have all day, so I just stopped abruptly, without an actual plan of how and when to stop.

In another test, I was asked to draw what kind of approach I would take to solve a problem, and I did — at first — draw the Number One Optimal Approach to the problem… and then commenced to totally wreck my response by not stopping there, but adding a bunch of other different versions of the same optimal approach, until the result was hopelessly muddied. So much for what I usually think of as thoroughness…

This apparently has to do with my diminished ability to plan, as well as communication issues. I have a hard time thinking through my steps to complete a task, so I just dive in and start thrashing around. Then I get so overwhelmed with detail, that I cannot think straight, even if I try. As though I need more trouble thinking! Ack! I get so fixed on different details that may or may not matter, and my head gets cranking so intensely that I end up running down all these different tracks, trying to figure out the “right” one… totally confused and turned around, but determined — by God! – to figure it out, one way or another. But I can’t. Because I’m lost. But I don’t realize it.

So, there it is. It seems so obvious now. I got really upset, at first, when the doc was telling me about how this is a problem. I felt like I’d been tricked into giving wrong information — the phrasing of the questions confused me, and I honestly have to say that if they had asked the questions differently or given me more background information, I would have given different answers that were closer to the optimal ones. I can see so many different possibilities, in any given situation… that’s a strength, I think. No, I know it is. And part of me is angry with myself that I didn’t get more background information about the different aspects of the scenario I was supposed to solve with my picture. (I know I’m being cryptic about this — I would love to give more details, but I don’t want to tip off other people who may be taking this same test about how to “do it right” and then skew their results — I easily could, and part of me wants to, to avenge my injured pride, but I won’t.)

I guess part of me doesn’t want to think that my devotion to detail is a disorder, but honestly — looking at the picture I drew and all the words I wrote to describe a scene that could have been summed up in a handful of sentences — it sure as heck looks that way! I tend to get so excited about details, so engaged, so interested in different aspects of a situation, so caught up in exploring all of the aspects, that it’s like I’m “drinking from a firehose” of detail.

The problem is — as was amply described to me yesterday — there’s this underlying logistical issue with my head — it doesn’t know how to parse through all the data I’m accumulating in a way that’s situation-appropriate. So my sensitivity and perceptiveness, much as I love it, tends to get in the damned way. It makes me go on and on about things, adding tons of incidental detail that matters to me, but doesn’t matter to others… it makes me run at the mouth and bore the crap out of people who have to listen to me… it drives people crazy when they ask a simple question and I can’t give a simple answer… and it really keeps me from interacting well with others.

I talked with my neuropsych about other examples of how I over-do things all the time. I’ll start out with a goal, like packing clothes for a trip, and I’ll know I should think through my time away and figure out what I should wear. But I’ll get turned around and can’t think, and instead of picking and choosing my clothing, I’ll just throw everything I can get my hands on into my bags, and end up packing three times as much as I need. I didn’t used to be like this. I used to pack really well and travel lightly. But since my fall in 2004, I’ve gotten in the habit of just tossing everything in my bags, so I don’t have to plan ahead of time, and I don’t have to worry about being without an item I need, later on.

Yes, despite my initial negative reaction to this result, I have to admit that it is an issue. And it’s an issue with other areas of my life, as well. I do this when I talk to people — they ask me a simple question, and I end up going on and on with all sorts of background information and circumstantial detail. I do this when I write letters/emails — I’ll just go on and on, being “verbally incontinent” and wearing myself out in the process and never knowing if I’ve said exactly what I wanted to say. (This is probably the main reason why I haven’t done a good job of writing letters over the years — I just get turned around and end up saying too much and then I feel like an idiot.) I just ramble. It doesn’t seem like I’m rambling to me — all the detail matters(!) in my mind. But most of the time, I’m splitting hairs that nobody cares about or wants to hear about.

So, there it is…  I’m feeling a bit tender today, having to admit this. And I feel badly because I really argued with my neuropsych about their assessment — took issue with it, got upset about it, felt like I was being criticized/scolded, and I got a little bit aggressive with them. I feel awful about that. All they’ve done is tried to help me, and what do I do, but take vehement issue with their findings… Bad form. Oh, no… now I’ll have to make amends next week when we meet again. But I shall. I’ll get my head back on, calm myself, make a point of getting more sleep the night before we meet, and get a grip.

It’s great to have test results that put me way up in the high 90+ percentile, but without the proper regulatory abilities, without some remedial therapy to get my act together, my abilities — strong as they may be — can be a real liability, at times.

So, now it’s time to figure out how to manage all this…