Exploring the link between suicide and TBI

Blogging this from http://www.apa.org/monitor/2012/12/suicide-tbi.aspx from the

With funding from the Department of Defense, Lisa Brenner is developing a suicide prevention program for military personnel and veterans with traumatic brain injuries.

By Rebecca Voelker

December 2012, Vol 43, No. 11

Print version: page 38

Earlier this year, the Pentagon reported an extremely grim statistic: In the first months of the year, a soldier was more likely to die from suicide than from war injuries. From early January to early May 2012, the suicide rate averaged nearly one per day among active-duty troops — an 18 percent increase from last year. Suicide rates among veterans are equally daunting. According to an estimate from the Department of Veterans Affairs (VA), a veteran dies by suicide every 80 minutes.

In August, President Barack Obama signed an executive order that strengthened suicide prevention efforts for service members and veterans. Among the many efforts being funded and watched by the Department of Defense (DoD) are those of Lisa Brenner, PhD, who is working with colleagues to adapt a civilian suicide prevention intervention for military personnel and veterans with traumatic brain injury (TBI).

Brenner directs the VA’s Mental Illness Research, Education and Clinical Center (MIRECC) in Denver and Salt Lake City, one of 10 such VA centers designed to be incubators of innovative research and treatment. Each center has a specific mission; in Denver, Brenner and her colleagues study ways to prevent suicide among veterans. They have about 30 ongoing research projects. Funding is from the VA, DoD, and non-federal sources including the State of Colorado TBI Trust Fund.

One project explored whether a history of TBI increases suicide risk among veterans and service personnel. “We’re just beginning to figure that out,” she says.

Brenner led a study examining suicide risk in 49,626 VA patients with a history of TBI. The team’s findings show that, overall, veterans with TBI have an increased risk of dying by suicide compared with veterans without brain injuries. This is consistent with findings among members of the general population. The analysis was published in the July/August 2011 issue of the Journal of Head Trauma Rehabilitation.

Brenner is quick to note that more severe brain injury doesn’t necessarily correlate with an increased suicide risk. “The really important point is that TBI is a very heterogeneous condition,” she says. “In terms of death by suicide, research in the field is beginning to suggest that mild TBI is a very different condition than moderate to severe TBI. We’re trying to explore key factors for those with mild or moderate to severe TBIs. We hope that looking at them separately will help us create appropriate intervention.”

Evidence-based interventions for those with TBI are needed, Brenner adds. That’s where her work with Grahame Simpson, PhD, of the Liverpool Hospital/Ingham Institute of Applied Medical Research in Sydney, Australia, comes in. He developed the Window to Hope program, which focuses on relieving feelings of hopelessness among patients with TBI. Previous research has shown that hopelessness is a stronger predictor of eventual suicide than depression. Based on the principles of cognitive behavioral therapy (CBT), the intervention consists of 10 two-hour sessions aimed at building patients’ problem-solving abilities and feelings of hope and self-esteem.

In a randomized, controlled pilot study of 17 civilian patients with severe TBI, the intervention reduced feelings of hopelessness to a similar extent as CBT in earlier studies of depressed patients without TBI. The study is believed to be the first to examine an intervention that’s tailored to address elevated suicide risk among brain-injured patients (Journal of Head Trauma Rehabilitation, July/August, 2011).

With Simpson’s input, Brenner and her team have adapted Window to Hope for military personnel and veterans. The Department of Defense’s Military Suicide Research Consortium (MSRC) is now funding a randomized clinical trial of the intervention within the VA.

Brenner’s Window to Hope collaboration is an innovative research approach for the VA, says Peter Gutierrez, PhD, a clinical/research psychologist at the VA’s MIRECC in Denver and co-director of the MSRC. “This is a much faster way to do treatment development,” he says. “A big chunk of the work is already done, so that allows you to start testing things out much more rapidly.”

Recognizing opportunities for collaboration is another of Brenner’s strengths as a researcher, Gutierrez adds. “She meets someone at a conference and realizes a shared interest they have,” he says. “Before you know it, they’re putting in a grant application together.”

Her dedication to helping brain-injured veterans earned Brenner the Special Contribution Award from the Association of VA Psychologists, presented at the APA’s 2012 Annual Convention in Orlando, Fla. “So far, this has really been a rich career,” she says, “but there is still much work to be done.”

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Rebecca Voelker is a writer in Chicago.

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.

 

What REALLY happened

Storms happen

Just a quick note before I head out the door to work — I had a somewhat rough weekend, feeling sick and out of it, after my meltdown on Friday. I really felt like I’d screwed up, and I didn’t know how to make it better or what to do to fix it. I knew that I’d been over-tired, that I’d been stressed, that I’d really had a hard time handling everything, and that the next time I needed to do a better job of managing my time and my energy — and come up with an alternate plan, in case the first one doesn’t work out (d’oh).

Yesterday, though, while I was doing some work around the yard, I was giving this all a lot of thought, wondering what the hell would have possessed me to say and do the things I did. It made no sense. I know better. I have better sense. I am capable of better things than that, and I know it. I tried to do better. I really did. I almost pulled it together a bunch of times, but I could not let it go. And it tore the sh*t out of both my spouse and me.

So, why didn’t I do better? Why did I end up getting hijacked by those emotions and carried away to the abyss? Seriously, the things I was “up against” were minor, compared to other more serious things I’ve faced with more agility and control. So, why was I in such terrible form on Friday?

It occurred to me that the thing that got hold of me was not psychological. It was not mental. It was not a problem with my thinking. After all, on Friday while I was having that meltdown, there were periods when I was completely calm and lucid and at peace — then BAM! — everything changed in an instant, and I was off to the races again. The only explanation that fits, is that it was an actual neurophysiological reaction — a physical thing that got sparked by something that actually precedes rational thought in my mind. Of course, I could not defend against it, because it got hold of me before my mind could get a hold on it. And that has the hallmarks of an over-activated fight-flight response written all over it.

That is, it was not a problem with my thinking, per se, it was a problem with my body. The whole drama was based on a purely physical response. It was not a psychological drama that I created, it was a physical phenomenon — a physiologically rooted set of behaviors that kick into action way before any kind of logically calm and mindful activity could take place. In fact, it was based on a system of response that is hard-wired into me (into all of us, actually) to save me from being burned up in a fire or carried away in a tsunami. When things seem dangerous (and my body is primed to be hyper-alert to danger), like they did on Friday when things weren’t working out the way I wanted them to and I was really uptight over not having enough time to rest, my fight-flight kicks in big-time. And then look out.

Like on Friday.

Oh – I’m running out of time. Gotta go.

More on this later.

One last thought for the day: 50 bucks says that before the end of the decade, people are going to have a friggin’ clue about the role the autonomic nervous system plays in not only trauma and PTSD, but problems with TBI healing and recovery, panic-anxiety, anger management, various behavioral syndromes, ADD/ADHD, self-injuring behaviors, mental illnesses of many kinds, as well as autistic spectrum disorders… and they are going to actively incorporate physiological therapies (including regular well-designed exercise) into the mix that target specific physical elements that need to be strong and balanced, in order to get your act together. Less drugs, more exercise and attention to the body. Better health overall.

And fewer meltdowns. At least for me. (And not before the end of this decade for me

‘Cause seriously folks, it’s all connected.

More on the Polyvagal Theory (pdf) later. It helps explain what really happened on Friday.

I will eventually get to the possible solutions

I’ve been focusing on understanding the trauma in traumatic brain injury, writing about the ways it intersects with PTSD. There’s a lot of territory to cover, and I’m really just scratching the surface. Beneath it all, there are massive changes that take place in the brain, the cells, the central/autonomic nervous system, which I can barely speak to.

I can, however, speak to the everyday experience, so that’s where I’ll focus.

And when I’ve gotten to the end of the laundry list of discussion items (list courtesy of Invisible Heroes by Belleruth Naparstek):

The Nature of the Traumatic Event

• proximity (follow this link to see more discussion)
• duration (follow this link to see more discussion)
• extent of brutality (follow this link to see more discussion
• betrayal
• threat of dying
• perpetrating violence
• societal context
• unpredictability
• injury
• loss
• being trapped

Survivor Traits

• gender
• age
• psychological history
• education
• ethnicity
• social support

Reactions Around the Trauma

• panic and acute stress
• dissociation
• biochemical anomalies
• drinking and intoxication
• sense of control during the event
• self-blame and negative beliefs
• subsequent health problems

… then I’ll start talking about what we can do about all this.

But for now, I’ll be focusing on laying the groundwork for the intimate connection between TBI and PTSD… in hopes that others will pick up on this, as well, and maybe run with some pieces of it, themselves. There is a ton of work to be done in this area, and in many respects, we’re just getting started.

Onward.

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.