The Importance of Team Support on the Road to Recovery

It would be nice to think they exist

I found an interesting article today — about a Marine who did something about the isolation that veterans go through when returning with injuries – especially TBI.

“They train together. They fight together. So if wounded, why shouldn’t they go through recovery together? This was the question that Lt. Col. Tim Maxwell asked about his fellow marines being discharged from the hospital and left alone to recover from injuries of war.

“When you’re in the hospital, you are with other wounded warriors. But once you are out of the hospital, it’s tough,” explains Maxwell.

He should know. While on his sixth combat deployment, Maxwell sustained a severe traumatic brain injury (TBI) during a mortar attack in Iraq. When he awoke a month later at the Bethesda Naval Medical Center, doctors didn’t think he would survive. The
shrapnel that penetrated his skull inflicted severe damage to his brain, impairing his vision and leaving him unable to talk or walk.”

Read the full article here (it’s a PDF download). >>

This is the kind of news I love to read – the kind of forward thinking that comes from within the ranks of TBI survivors. I understand that Lt. Col. Tim Maxwell is now retired, but I believe Maxwell Hall is still going.

And I have to wonder if these things are still going on, if they are still holding up under present circumstances, or if the resources and halls and support networks are able to stand on their own, after their founders retire or just can’t do it anymore. I wonder if the “superfriends” ever get replaced when the original members bow out or fade away. Of course, in the comics, none of the Superfriends die or are destroyed. I think… But in real life, does that really happen?

Seldom.

I suppose in a way we are all on our own, and we all have to take it upon ourselves to take steps to get better, when we get hurt or injured. But what about those who just cannot find it in themselves to do that? What about those whose brains are damaged in ways that keep them from even wanting to get better… or that keep them from even realizing they need to improve?

And what about those who go back to lives after their injuries, surrounded by people who neither know – nor care to learn – about what TBI / concussion can do to a person, and who just can’t bring themselves to help.

Yesterday I spent much of the day with a friend who has been through some serious sh*t and could relate to some of the difficulties I have, now and then, with fatigue and light/sound sensitivity. All through their growing-up years, they were in and out of trouble, in and out of institutions, so when I talk about having a tough time at this or that, they seem to get it. And they don’t judge.

I don’t know how much they know about my TBI history – I’ve never brought it up, but my spouse may have mentioned it in past years when I was having a much more difficult time than I’m having now. I just don’t have the heart to bring it up in person. Whenever I try to discuss it with people who didn’t know before, they usually either make some blanket statement about how “smart” I am and how it’s just not possible that I could have any brain issues… or they back away from me, become distant, don’t bother with me the same way the did before. So, I haven’t said anything about it, specifically.

But that didn’t actually matter yesterday, because I could talk about the difficulties I have with getting tired and then having everything crash in on me… or losing my cool and freaking out… or whatever various difficulties come up in the course of my everyday thanks to TBI stuff. I could talk about these things not as TBI-related, specifically, but just generally in my life. The “why” about it didn’t matter as much as the “what” — in other words, I could just discuss the issues without getting into the root causes, and get some feedback about what to do.

And that’s the thing that I have learned will help me, when I need feedback or support — not getting specifically into the TBI-nature of my issues, but just talking about them as I experience them.  So long as I don’t go down the road of “I was brain-injured in 2004, and nothing has been the same since”, and I talk about the things that happening with me just for what they are, I can actually get some useful feedback from people.

It’s the “brain injury” thing that keeps me cut off from the rest of the world. It’s the root cause that is the problem with people, I have found. But when I don’t get into the causes, and I stick with the end result that I need to manage, people can actually hear me and help me out. Or at least not push me till I’m crazy.

And it’s funny – when I first learned about TBI and finally had an explanation for why I was so screwed up and everything was falling to pieces around me, it was like I was finally free. And I thought that telling others and educating them would help them the way it had helped me. But all it did was freak them out. They just couldn’t deal. And everything got lonely really quick. Then I got to a point where I made peace with this loneliness and just focused on my own TBI recovery, understanding how it affected me, and getting a handle on what I really wanted to change in my life. Then I got to a point where I was less focused on the brain aspects and more concerned with the end results and managing them, getting them better. And now I’m at a point where I am mainly interested in having the best life possible, without making everything that goes wrong about my brain’s problems, and making it more about getting on with my life, picking myself up after I fall… and being able to talk to people about my issues in ways that they can hear and support – instead of getting all freaked out about it.

That’s how I get my support, these days. I’m still learning the best way of doing these things, and I still don’t have a lot of friends I can actually talk to about what I’m experiencing. But at least I’ve learned a thing or two in the past four years.

Actually, you know what…? I’m really tired and foggy. I’m really struggling to put words together, right now, and my head feels like it’s packed over-full of cotton. I have been at this computer for the past 2 hours, reading and writing, and I need a break. So, I’m going to pick myself up, change my clothes, then get out and walk in the woods for a while… and be quiet and settled and not worry about much of anything.

And that, my friends, is probably the best support I can give myself today.

Soldiers Who Suffer Mild TBI During Combat May Be More Vulnerable to PTSD

Study Links PTSD to Hidden Head Injuries Suffered in Combat.

Even when brain injury is so subtle that it can only be detected by an ultra-sensitive imaging test, the injury might predispose soldiers in combat to post-traumatic stress disorder, according to a University of Rochester Medical Center study.

The research is important for physicians who are caring for troops in the years following deployment, as they try to untangle the symptom overlap between PTSD and mild traumatic brain injury (mild TBI) and provide the appropriate treatment. Until now, the nature of the interaction between TBI and PTSD was unclear. URMC researchers believe they are the first to find an association that can be demonstrated with advanced imaging techniques.

The study is published online by the Journal of Head Trauma Rehabilitation.

“Most people believe that, to a large extent, chronic stress from intense combat experiences triggers PTSD. Our study adds more information by suggesting that a physical force such as exposure to a bomb blast also may play a role in the genesis the syndrome,” said lead author Jeffrey J. Bazarian, M.D., M.P.H., associate professor of Emergency Medicine at URMC, and a member of the 2007 Institute of Medicine committee that investigated brain injuries among war veterans. (continued…)

Read the rest here >>

PTSD/TBI Factor #7 – Societal Context

What the larger group thinks, does matter

This is a continuation of the discussion about PTSD from TBI – Exploring some possibilities.

The next factor in the development of PTSD, according to Belleruth Naparstek, is societal context — what the culture you belong to believes — and communicates to the survivor — about the source of your trauma. “The meaning and significance assigned to a  traumatic event by the larger culture makes a difference in its impact.” (Invisible Heroes, p. 52)

In an example she cites, Finnish veterans of WWII showed extremely low incidences of PTSD — the war was seen as important, the fighting spirit of the veterans was celebrated, and overall there was a relatively high sense of subjective well-being, despite disabling health issues. The sacrifices of the soldiers were celebrated by the society — in sharp contrast to American veterans of the Korean War and the Viet Nam War, whose PTSD rates were as high as 30%.

Now, when it comes to TBI, so little is actually known about it in the general populace, and there are so many misconceptions about what causes it, what it means, and where it can lead, that it’s pretty difficult sometimes to ascribe any meaning to it at all. On top of that, when you get into labeling TBI’s as “mild” or “moderate” or “slight” you not only skew the facts of the situation (every brain injury is a serious matter, not to be taken lightly) but you also diminish the significance of it.

And when the injury happens as part of a freak accident, like something falling on your head, or you falling down a flight of stairs… that makes it even worse.

So, all the upheaval you’re experiencing, all the ups and downs, the confusion, the cognitive processing issues, the light and noise sensitivities… well, it doesn’t mean all that much, really. And society doesn’t have much use for you, when you’re unable (they think unwilling) to “get your act together”. As Belleruth Naparstek puts it, “… the significance that the larger community attaches to the traumatic catalyst has the power to cushion or exacerbate PTSD symptoms.” And all too often, no significance is (or ever can be) attached to the injury, leaving TBI survivors open to post-traumatic stress, which gradually builds over time.

PTSD/TBI Factor #6 – Perpetrating Violence

Here it comes… everybody feels its wrath

This is a continuation of the discussion about PTSD from TBI – Exploring some possibilities.

So far, we’ve looked at how TBI directly contributes to PTSD through proximity, duration, extent of brutality, betrayal, and threat of dying. In all cases, the big way TBI contributes to these factors is through the skewed perception it can create, causing us to perceive “threat” where there is none, as well as amplifying our emotional and physiological reactions to events. There’s nothing like a hyper-activated amygdala pushing the brain’s automatic fight-flight response, to make everyone’s day that much more “interesting”.

And now we come to an area that has particularly strong implications for TBI survivors — perpetrating violence. As Belleruth Naparstek points out in Invisible Heroes (p. 51), we don’t normally think of folks who perpetrate violence as the ones affected by post-traumatic stress. It’s the victims after all, who bear the brunt of it. Right?

Not so fast. Post-traumatic stress which manifests in “more violent outbursts and greater severity of intrusive symptoms, as well as a greater sense of alarm, alienation, survivor guilt, and a sense of disintegration” is prevalent among those who cause harm to others. It’s a subject I’ve written about before in Putting my soul back together, one act at a time, in September of last year, and it remains a serious concern of mine.

See, TBI is all too often accompanied by anger issues. Outbursts. Meltdowns. And violence. I myself have been plagued by violent temper outbursts and extreme mood swings that shook me like a terrier shakes a rat… and I couldn’t do a thing about them. For someone who has long been known as an even-keeled sort of person who can be relied on to stay calm in stressful situations, it was a terrible blow to me to watch myself (like a train wreck) blowing up at people over what I logically knew was a small thing, but which seemed like the end of the world to my frayed wiring.

It was so distressing and so shocking to me, that I rarely brought it up with my neuropsych, and then I played it down because I couldn’t stand having someone know about what was going on inside of me. It was almost too much to take. My sense of honor, my sense of dignity, my sense of propriety, and my feelings for those I loved and cared about and worked with went right out the window without me having any understanding or control over things… and then I had to deal with the aftermath.

And the more I blew up, the more things I threw, the more I melted down, the more intrusive the memories of those times became, and the more I felt like I was in the grip of it all.

It’s no friggin’ fun watching yourself dissolve before your very eyes, and that’s exactly how it felt. Which added a sense of impending destruction/death to the whole experience.

The crazy eff’ed-up thing about TBI is that it can turn even the most mild-mannered individual into a raving lunatic, and it can cause them to do things they would never, ever choose to do on their own. It can turn even the most mellow individual into a violent perpetrator. I’m not trying to scare anyone, but at the same time, this is the dark side of TBI that people don’t like to talk about. And the toll it takes is something that really needs to be looked at.

Now, I don’t want to say that everyone who does violence to others is not in control of their behavior. Some people very much are. But with TBI, the right combination of fatigue, malaise, agitation, restlessness, and anxiety-producing sense of lost control, that nastly little switch can get flipped and you can find yourself becoming a stark raving lunatic over the stupidest little sh*t.

This is not to say that it has to — or should — stay that way. If we can see (or are informed) that our behavior is unacceptable, it’s our responsibility to fix it and make sure it doesn’t happen again. But all too often — especially at the start of your recovery — a lot of incidents can happen that result in feelings or experiences of violence.

And that takes a toll.

It takes a toll because you see and hear yourself doing these things, and it takes a toll because you may not be able to do anything about it, until you gain understanding and self-awareness, which can take months, if not years.

In the meantime, you’re racking up some serious mileage in the PTSD department. And ultimately that’s got to be dealt with constructively, or it can — and will — drag you down in the long run.

PTSD/TBI Factor #5 – Threat of Dying

This is a continuation of the discussion about PTSD from TBI – Exploring some possibilities.

Obviously, the threat of dying is going to stress your system. But even more significant than the actual threat, is the perception of the threat. Belleruth Naparstek makes this point in Invisible Heroes (pp. 50-51), in particular about heart attack survivors. What makes people more likely to develop post-traumatic stress after their heart attack is not how bad it was, but how bad they perceived it to be.

This is particularly important for TBI survivors, especially mTBI (including concussion) survivors, who may have their thinking turned around — and on top of it have a hyper-active fight-flight response. Like I discussed in the last post about betrayal, you can jump to conclusions pretty quickly about situations, and your thinking can be completely wrong. But you have no idea, because your brain has been rearranged a bit.

And that just makes things worse. Because underneath it all you can have this nagging feeling that you’re missing something, and that just adds to the sense of stress and pressure. On some level, even the most minor threats can seem life-threatening. And you can become completely convinced you are in extreme danger, because you’re getting cues and clues that tell your body and your brain that you are going to die.

I believe this happens on a neurological level (or as some would say – “neuroceptively” – or the level at which your nervous system perceives things and interprets the data it gets). I also believe this amplified “death threat” interpretation happens as a result of our body-brain feedback loop, which is compromised in TBI, both in terms of our brains being less able to decipher information, and our bodies being hyper-tweaked and on hyper-alert and over-reacting to just about everything that comes along. Over thousands upon thousands of years, the human brain has learned how to interpret signals from the body that tell it that the environment is not safe, and then our brains (not our minds) kick into action and send out signals to respond. The more extreme the signals (and with a haywire autonomic nervous system, that’s what you can get), the more extreme the response we muster. And with our brains already being on alert from having to work harder to just do normal things, we’re already primed to overdo it on the reaction front. And when our over-zealous reactions send out waves in the world around us, the people we look to for support and feedback can retreat, leaving us alone to work things through — and that adds more stress, which in turn sends danger signals to our bodies and brains, which interpret them as threats to our lives.

And indeed they may be.

So we end up in a cycle of escalating worry and isolation, and all the while there’s this ever-present threat of extreme isolation — which can feel like the equivalent of death.

I really believe that this phenomenon is particularly true of mild traumatic brain injury or concussion, which “doesn’t look that bad” to most folks, and which all too often results in isolation and increasing dysfunction over the years. Having a “mild” head injury kind of disqualifies you for any sort of compassion or accommodation. After all, you should be able to get back to normal, right? You just hit your head… you didn’t crack it open or end up in a coma or anything like that. So, what’s the problem?

The problem is, some of our most fundamental characteristics (and coping mechanisms) have changed, and we can no longer rely on them. In some ways, part of us dies — or morphs into someone or something we don’t recognize or fully understand. And we lose a sense of ourselves and our connection with life as we once knew it — which on a fundamental, basic level, is the equivalent of a death threat.

Mild TBI is anything but mild, if you feel like parts of yourself have died or are dying off, and there’s not a damned thing you can do about it. Especially if you don’t realize what’s happening.

It’s this behind-the-scenes, unarticulated, unexpected, all-but-invisible quality of the life-threat that makes it so pernicious. Our bodies and our brains are getting all these signals about being in danger, and we become increasingly paranoid and antsy and, well, driven to survive.

Meanwhile, the stress is building up with nowhere to go, because half the time we don’t even realize it’s there. Or we depend on it for our energy source.

Ironic, isn’t it, that we use a life threat as a lifeline? I know I do… and I’m sure I’m not the only one.

Bottom line is, with TBI, especially mild TBI, the important thing isn’t whether or not you’re really in danger, but whether you (your body and your mind) think you are.

PTSD/TBI Factor #4 – Betrayal

Right through the heart – courtesy of the brain

This is a continuation of the discussion about PTSD from TBI – Exploring some possibilities.

Betrayal is a big one that comes into play in PTSD — it impacts your sense of safety and that compounds your difficulties. When hurt or injury or assault or some other trauma is experienced at the hands of others, it ups the traumatic nature of the experience even more. Children who see their parent killed — often by another family member — have a 100% rate of PTSD.

The place where TBI is a contributing factor, I believe, is the place where the thinking processes of an injured brain become paranoid, suspicious, and turn even the most innocuous statement or action into a personal affront. Life can be challenging enough, as it is, but when you throw in the injured brain’s tendency to misinterpret all sorts of otherwise harmless experiences and actions as BAD, and you throw in some perseveration on top of it — spinning and spinning and turning and churning, whipping you up into a frenzy of outrage and hurt — then things get even more interesting.

The thing about betrayal, is that sometimes it’s not exactly that. Sometimes we think that we’ve been betrayed or wronged or personally attacked, when it’s just shit happening. When I got hurt in 2004, I felt intensely betrayed by a number of different experiences, and it only made things worse. I didn’t feel safe. I didn’t feel like I could trust anyone. I had very little control over my thought processes, and I didn’t realize it well enough to actually do something about it.

So I suffered. How I suffered.

The other factor with TBI and betrayal and PTSD is that (as I alluded above), you can feel everything so intensely, that a minor infraction becomes a source of immense pain and suffering. One little misspoken word can turn into a world-toppling drama, and inside the confines of your head it then amplifies until it’s deafening, and it’s all you can hear. Even the most minor of oversights can rapidly turn into a full-blown “betrayal catastrophe” with your world shifting off its axis over stuff that most people wouldn’t even notice.

But you notice. Oh yes, you notice.

 

PTSD/TBI Factor #3 – Extent of brutality

Brutality comes in all shapes and sizes

This is a continuation of the discussion about PTSD from TBI – Exploring some possibilities.

Ah, here’s an interesting one… that is particularly strongly colored by TBI — Extent of Brutality — as in, how personal was it? Was it brutal? Was it intentional? Belleruth Naparstek tells us

“Atrocities and interpersonal violence have a more devastating effect on the human spirit and psyche than, say, a natural disaster, even though both can be equally terrifying, life threatening, and consequential in terms of actual injury or material damage suffered. When people are subjected to malevolence and brutality at the hands of their fellow human beings, the ravaging symptoms of PTSD go wider and deeper.” (from Invisible Heroes, p. 50)

And this is where TBI is especially troublesome. Because the pain inflicted by others can be real, or it can be imagined, but either way it hits hard and it strikes deep. In fact, it hits harder and strikes deeper than anyone would reasonably expect it to. With emotional lability, the volatile hair-trigger stuff going on, and a ton of other amped-up nervous system reactions, everything can take on a sense of personal attack. When you’re addled by TBI and your sympathetic fight-flight system is in overdrive, it’s easy to perceive every less-than-perfect interaction as some kind of attack or a personal slight or injury. ‘Cause your rewired brain has got its wires crossed and it tends to take things the wrong way.

On top of that, “regular” people are generally not very kind to people with TBI. There’s something about us that seems to prompt their laughter, even scorn… and who in the TBI ranks hasn’t been on the receiving end of ridicule or accusation because someone thought we were either lazy or faking or not trying hard enough… or just plain stupid?

It’s a nasty little mix, that — the real difficulties along with the perceived danger along with the hyper-activated fight-flight impulse that has all those stress hormones marinating your body, mind and soul, day and night… which in turn impedes your ability to think straight about much of anything important.

People don’t even need to BE brutal towards us, for us to sense a certain brutality to the interactions. Having a botched conversation with someone and having your system go haywire with all sorts of doomsday messages and klaxon alarms has a way of giving even the most harmless of misunderstandings a sharp, jagged edge that tears the living crap out of our sense of who we are and what we’re capable of in life. The brutality seems to be at the hands of others, but it’s really at the hands of our rearranged nervous systems and our rewired brains… which is about the most intimate kind of insult you can live through, day after day.

Indeed, if we are our best friends or our worst enemies, with TBI, things tend to get skewed to the latter. And god help you if you try to fight back. There’s no fighting a battered brain — because it beats back, even harder than before.

So there it is. Brutality can come in all shapes and sizes. And when it comes from within, man is it a bitch.

PTSD/TBI Factor #2 – Duration of the trauma

Like a storm hit your brain – hard

This is a continuation of the discussion about PTSD from TBI – Exploring some possibilities.

The next factor in the development of PTSD, according to Belleruth Naparstek, is “a longer duration of exposure to the trauma, or a greater number of exposures within a certain period of time — in other words, the “dose” experienced.” (Invisible Heroes, p. 49) Victims of domestic abuse that lasts for years and years, those exposed to war, and also helpers and first responders, are particularly susceptible.

As I discussed in my last post PTSD from TBI — Like being trapped in an abusive household, TBI can – and often does – result in repetitive “micro-traumatic” experiences which all add up over time to clog the system with biochemical stress sludge. What’s more, in the initial period after the injury — and even weeks, months, and years after the TBI — you’re pretty much bombarded by a constant stream of “micro-traumatic” experiences, which all adds up to a hefty dose of post-traumatic stress.

There really is no way around it. Your brain is functioning differently from how it used to — and as far as you’re concerned (and everyone else), it’s functioning wrong. Everything is starting to slide, nothing seems familiar anymore, and there doesn’t seem to be anything you can do about it.  Chances are, your wits aren’t about you, so you’re not 100% aware of how different you are from how you used to be — your behavior and your thinking are all sort of jumbled up, so nothing is really clear. But still, you’ve got this mounting sense that something is not right, and you can’t figure out what it is, or what to do about it.

Depending on your reaction, and depending how you interpret your experiences, you can be primed for some real PTSD in the weeks and months following a TBI. If you’re determined to do and be and work and live and play exactly like you were before your injury, you’re in for a lot of rude awakenings. And if nobody is around to explain to you how the brain is affected by TBI, it can be frightening – terrifying, even.

So, yeah, it’s a big dose of trauma. Over an extended period of time. And if your family and friends and surroundings aren’t understanding or helpful, it can prolong the pain and also exacerbate it. Ignorance and fear rarely help anything. And when pushing you to “just be normal again” is the chief strategy, it can open the door to even more traumatic experiences over time.

Adjustment on some level is necessary, but when you’re under intense pressure to be something you’re no longer inclined to be, it adds even more stress — and more trauma. And the longer you put off making necessary adjustments, the longer you prolong your suffering, and impact your mental health.

It’s hard to describe this whole process to someone who’s never experienced TBI or some other condition that puts them at odds with how they “should” be, but if you’ve been there, I’ll bet you know what I’m talking about.

PTSD from TBI — Like being trapped in an abusive household

Yeah, I used to live there

I’ve been giving a lot of thought to my discussions about how TBI can introduce chronic trauma to the lives of those who experience it, and I was searching the web looking for some ideas about how to explain or describe it.

I happened upon a site that’s devoted to the recovery of women who were essentially held captive by a spiritual abuser, and who were physically and psychologically abused and controlled for years.

Hearing the descriptions of the process of their gradual traumatization that led to raging cases of PTSD, it reminded me a bit of what it can be like living in a body that’s being run by an injured brain.

Now, I’m not going to even hint that experiences post-TBI equate with those of being kept under lock and key by a viciously controlling “spiritual leader” who beats his charges bloody each night for no apparent reason. There’s really no comparison. However, on a much smaller scale, the mechanisms are the same, eventually leading from traumatic brain injury to post-traumatic stress.

With TBI (especially early on), there can a really pronounced sense of lack of control over circumstances which lead to harm, injury, and real/perceived threat. Your brain is not firing on all pistons, and it’s mis-reading cues left and right. On top of it, TBI has a way of super-activating the amygdala, the part of the brain that sends those WARNING! messages to the rest of the brain, so not only are you mis-reading cues and doing/saying things that A) don’t match what you want to be doing, B) don’t match what others expect you to be doing, and C) don’t make much sense to anyone, actually, but you’re also experiencing an exaggerated response to the series of unfortunate events that befall you.

You’re in danger. You’re taking “hits” throughout the course of each day as you stumble through activities that used to be easy for you. The harder you try, the worse you fare, and the resulting biochemical onslaught of try-try-again — and again — and again … all to no avail… builds on each last botched attempt, like so many blows from an angry guardian. It might not be the case that someone is physically abusing you, but the experience of one failure after another, in one activity after another, with things falling apart more and more with each day, and no clear view of how to deal with and fix it all… well, that’s the sort of beating you take. And it’s not easy.

It adds up, too. Mentally and physically — but mostly physically. Here’s an excerpt from the web page I found (Under Much Grace) which talks about PTSD after spiritual abuse:

Review of the Survival Response

When confronted with a traumatic or threatening situation, as discussed at length in a recent post, the brain of a person responds by activating a survival response which is profoundly physical in nature. If a person stopped to think about and plan a response to the threat, chances are that they would not be able to respond quickly enough to survive the threat. The brain’s analytical or critical thinking faculties suspend momentarily, and lower brain structures kick in, enhancing the speed of physical response.

BB Note: In TBI, with a hyper-activated amygdala and flawed processing to boot, it’s really, really easy to think that you’re being confronted with a traumatic or threatening situation. Logic and reason have nothing to do with it, when you’re stuck in the echo-chamber of your injured brain. Unless you have someone to turn to as a sounding board, anything and everything can seem like a threat — which means that your brain spends an awful lot of time activating physiological survival responses.

Before advances in science allowed better observation regarding the brain’s response to threat, science took note of the “fight or flight” response. When faced with a serious threat, the body started into a cascade of hormones and neurotransmitters which enable the body to flee or to fight. The autonomic nervous system (the automatic system that governs unconscious physical response) shunts blood away from the gut and to skeletal muscle and brain, as the body releases hormones that raise blood pressure, heart rate, and blood sugar as they also speed the response of nervous tissue. It makes energy and oxygen available to the systems of the body that play the greatest role in either running from or resisting a threat.

BB Note: I’ve talked about this before on this blog, and this is a great summary, too!

Please take note: The mind processes psychological threat or perceived threat in the same way that it does a physical one, and the same cascade of neurotransmitters and hormones plays out, even if an individual is not in a situation where they would need to physically run or fight. The mind and body processes these threats in the same manner. Also note that these are not chosen responses but are deeply physiologic, and they actually bypass critical thinking or choice.

BB Note: All threats really are equal, when it comes to fight-flight responses. The chemistry kicks off and takes over, and even if you ARE able to give some thought to what’s happening, still, your body is working around your thinking brain, so it doesn’t even get a chance to weigh in.

Chronic Stress

Those who cope with chronic experiences of trauma are often faced with these types of responses on a regular basis. The body cannot maintain this high level of energy and stress for long periods of time, and over time, the body learns to adapt because the pressure and stress becomes to great. . . .  And as previously discussed, some of these responses that result in a psychological change result from a physiologic cause.

. . .

Consider also what takes place in the brain and body when it must operate under constant high stress. The body resets itself and changes the way that it responds to certain hormones and neurotransmitters. Think of an unfamiliar noise that you hear in an new environment that is a part of it. If you grew up in the country away from traffic and then moved to a city where you could hear the sound of the traffic in your bedroom at night, for some time after relocating, that sound acts as a disturbance – until your brain learns to adapt.

A similar adaptation takes place in the body’s production of neurotransmitters/ hormones, its responses to those chemicals and how it responds to impulses related to stress. (An adaptation of the body we associate with high stress that is affected by these hormonal changes can be hypertension.) When under constant high levels of stress, the body readjusts its baseline to maintain function, but that function has been altered and is not ideal. The brain no longer responds to stress in the normal way. Some neurochemical production drops, some increases, and the degree of physical response can change also. There is so much cortisol all the time, it essentially becomes meaningless to the normal systems, so the body adapts to maintain the ability to respond immediately to serious threat, preserving that survival response as much as possible. But consider that chronic stress alters that system and how well it responds.

BB Note: Indeed. The more you’re steeped in the experience, the more it affects you and shapes you. Over time, with enough traumatic experiences that have you jammed in high gear, your whole system can turn out to be so wired, that easing up is not an option. But then we get into the problems of not sleeping enough, eating the wrong foods, being jacked up all the time on something or other… it’s just not good.

Previous Threat and Learned Helplessness

We have also already discussed that PTSD more frequently develops when a person’s efforts to protect themselves becomes thwarted in some way. The intricate and marvelous system which involves generating a great deal of emotional energy as well as physical energy on a purely physical level sometimes fails to result in a beneficial outcome. That energy must go somewhere, and releasing that kind of energy is sometimes referred to as “blowing off steam.” When the release of energy doesn’t result in protection in response to a trauma, if the affected person cannot find a safe way and an outlet for expressing that raw, hormonally driven energy, they can tend to turn it inward through negative emotion that they direct toward their sense of self. It contributes to the sense of pessimism that accompanies PTSD. When chronic, a person learns helpless behavior and believes that they are helpless, whether or not they are truly helpless. Perception becomes everything.

Learned helplessness, indeed. When you’re struggling with a brain injury and you can’t figure out what’s going on, and you can’t seem to protect yourself from, well, yourself… all that energy does indeed turn in and you can end up being incredibly rough on yourself over any and every little thing.

And with TBI, since perception is notoriously skewed, sometimes you can never really know if you’re right or wrong about things, which is even more cause for uncertainty and doubt. After weeks and months and years of things getting screwed up for some weird-ass reason, you’ve had to take hit after hit after hit on a biochemical level, that can really cut into your sense of self, ability to believe anything positive about yourself, and worst of all your cognitive ability — as though you could afford to lose any more than you already lost.  Physiologically, it takes a toll.

The bitch of it is, that’s the house you live in. The brain in the body you inhabit has gone haywire and it’s sending all the wrong signals AND unleashing the hounds of hell inside your head and your spirit, day after day. Forget about having a bad attitude about yourself – the physiological experience of trying to understand and fix up one botched activity after another is stress enough — it’s brutal. It doesn’t even need to have a mental/psychological basis. It’s the simple fact of how our bodies work in response to perceived threat and the overtime activity of always playing catch-up, that does the job on us. We don’t even need to give it any thought — just the regularly occurring, chronic need for more work, more attention, more compensation does a job on us.

It’s like living in a household with a vicious abusers. But the abuser cannot be escaped. Because they live inside your head. They are your head.

On the brighter side, there is a way out of that mess. It takes time and discipline and continuous work, but I can tell you from personal experience — yes, there is a way out of that abusive house. Stay tuned…

Traumatic Brain Injury Linked to Post-Traumatic Stress Disorder, Study Suggests

Find the connections to get some relief

I continue to think a lot about the connections between mild TBI and PTSD. After going off the rails last month over some stressful stuff at work… and continuing to struggle with stress and how it affects me, I cannot help but see a lot of connections between the stress I’m under, the way I respond to it, and the way my brain has been working lately.

This article came out back in February, 2012, and I may have blogged about it before — it’s worth mentioning again:

ScienceDaily (Feb. 15, 2012) — UCLA life scientists and their colleagues have provided the first evidence of a causal link between traumatic brain injury and an increased susceptibility to post-traumatic stress disorder.

Their new study, published Feb. 15 in the in the journal Biological Psychiatry, also suggests that people who suffer even a mild traumatic brain injury are more likely to develop an anxiety disorder and should take precautions to avoid stressful situations for at least some period of time.

The motivation behind the study, which was conducted in rats, was the observed correlation of traumatic brain injury, or TBI, and PTSD, particularly in military veterans returning from service overseas, said Michael Fanselow, a UCLA professor of psychology and the senior author of the study.

The reasons for this correlation are unknown. It could be simply that the events that cause brain injury are also very frightening and that the link between TBI and PTSD could be merely incidental. Fanselow and his colleagues, however, hypothesized that the two “could be linked in a more mechanistic way.”

Using procedures to separate the physical and emotional traumas, the scientists trained the rats using “fear conditioning” techniques two days after they experienced a concussive brain trauma — ensuring the brain injury and the experience of fear occurred on different days.

“We found that the rats with the earlier TBI acquired more fear than control rats (without TBI),” said Fanselow, a member of UCLA’s Brain Research Institute. “Something about the brain injury rendered them more susceptible to acquiring an inappropriately strong fear. It was as if the injury primed the brain for learning to be afraid.”

To learn why this occurred, the researchers analyzed a small piece of brain tissue, the amygdala, which is the brain’s critical hub for fear learning.

“We found that there are significantly more receptors for excitatory neurotransmitters that promote learning,” said Maxine Reger, a UCLA graduate student of psychology in Fanselow’s laboratory and the lead author of the study.

“This finding suggests that brain injury leaves the amygdala in a more excitable state that readies it for acquiring potent fear,” Fanselow said.

The research was funded by the National Institutes of Health, the U.S. Department of Defense and the UCLA Brain Injury Research Center.

Co-authors of the study were David Hovda, a professor of neurosurgery and of molecular and medical pharmacology at the David Geffen School of Medicine at UCLA and director of the UCLA Brain Injury Research Center; Andrew Poulos, a postdoctoral fellow in Fanselow’s laboratory; Floyd Buen, a former graduate student in Hovda’s laboratory; and Christopher Giza, an associate professor of neurosurgery at the Geffen School of Medicine.

The research was a collaboration between Fanselow’s laboratory, which studies neural mechanisms of anxiety disorders, and Hovda’s laboratory, which investigates brain injury.

“One of UCLA’s great strengths is the spirit of collaboration that allows scientists from very different departments to combine their very different expertises to answer important but difficult questions,” Fanselow said.

This is very encouraging (if I haven’t said it before). The fact that clinical researchers are looking at the biomechanical actions of mild TBI and PTSD opens up new routes for better understanding more pieces of this puzzle. I’ve said a number of times that TBI and PTSD are intricately intertwined in some really fundamental ways, many/most of which are experientially biochemical in nature. And the fact that researchers are now paying attention to this and publishing papers about this, really gives me hope for the future of handling this “co-morbid” condition.

I have also long believed (and I think also said) that mild TBI is especially vulnerable to PTSD development, because by its very nature it is confusing at the most fundamental level — which leads to continual activation of the fight-flight reflex, which ultimately builds up a biochemical load that’s heavy on the stress hormone side — and light on the rest-digest impulse. Mild TBI and its successive “micro-traumas” of continuously baffling and inexplicable experiences, many of which are either negative/threatening or perceived to be negative/threatening, is the experiential equivalent of all those subconcussive hits sustained in football, and the biochemical overload of stress hormones that builds up, day after interminable day, serves to further fry the system and the brain and the circuits which would normally serve to chill us out and manage to find a way around (or through) the troubles in one piece.

Unfortunately, I’m not a clinical researcher with an internationally recognized facility, so there’s only so much that I can do to advance this understanding in the circles where people make the diagnoses and treatment decisions. But I can at least do my part here, in hopes that the people who are actually affected by mTBI and PTSD will find some answers — and relief. And those who treat people with PTSD and/or TBI would be well-served to explore the connections between the two. It is such an obvious connection, when you stop dismissing life experience as “anecdotal” that it surprises me that no one is confronting it head-on. Or that anyone is still being territorial about their explanations for why some of us do and experience the things we do. If the professions would cross-pollinate and cross-promote, they would uncover a vast opportunity to not only expand their service, but come up with a whole new slew of approaches that actually work with those suffering from stress-hormone-overload-induced dysfunction/disorders in the aftermath of TBI.

I can’t control the fields/industries, but I can always hope. And keep working…