Brain Injury and Lying – The Rest of the Story

Summary: Brain injury and lying can go hand-in-hand. First, there is confabulation, where the brain-injured individual genuinely thinks they are telling the truth, but they have their details confused. Second, there is the outright lying, which can come from experiencing an intensely emotional “catastrophic response” to situations which seem insurmountable. This is an account of how a good friend of mine changed from a basically honest person to a compulsive liar after experiencing several strokes.

It seems so innocent…

I’d like to write this morning about a friend of mine who had several strokes back in 2007, a couple years after I had my last TBI. In fact, I’d say that working with them after their strokes really make me aware of brain injury issues… so that I could recognize and deal with my long-standing issues, at last.

I have known this individual for more than 20 years, and we’ve worked together on a number of occasions. We have common friends and we have similar senses of humor, so it’s been pretty easy to become – and stay – friends with this person. I am friendly with a lot of people and I make a lot of effort to really be a good person, but this particular friendship is closer than most others I have. This individual knows things about me that I wouldn’t tell most other people. And I know more about them than most others do.

The one exception to this is TBI. When they had their strokes – two of them, a week apart – in 2007, I was one of the few people who didn’t back away from them and run. I have actually known a number of people who had strokes and TBIs, and even before I knew that I myself had traumatic brain injury issues, I was willing and able to hang in there with them. So, this time was no different really. Different strokes for different folks, y’know? But when I was dealing with my TBI stuff, they just couldn’t deal with hearing about it. It was like they thought that it meant I couldn’t be there for them – and since I was one of their main supports after their strokes, the idea that I had neurological issues must have been pretty frightening for them.

Anyway, despite not getting any support from them, I really went out of my way to make time for this friend, to help them get back on their feet and rehabilitate. I have always been a firm believer that the human brain and body and spirit are incredibly plastic — and they can and will recover to a much greater degree than the “experts” believe, if you give them a chance, keep working, and don’t give up.

Working with this friend, we got them on a regular eating and sleeping routine… we got their weight down about 30 pounds… we managed, changed and then regulated their meds… we restored the strength and coordination in their right side… we got their speech and organization together… and – together – we got them back to functioning again.

We had to do it ourselves, and we had to do it alone. Because even though the MRI showed even more damage to their brain than “just” the strokes — they had other evidence of brain injuries that they couldn’t remember having — the doctors never gave them any indication that they needed any neurological or neuropsychological help, and their strokes weren’t “disabling” enough to warrant official rehab.

The impact was pretty noticeable to me, though. Their processing speed had really slowed down. They got confused a lot more than before. They had extreme emotional reactions to things that are sad or frustrating but aren’t exactly the catastrophes they thought they were. They had trouble keeping a conversation going. Their ability to multi-task was pretty much out the window. They basically went from having six gears, to having two, one of which was reverse, and when pressed to do more, they blew up or broke down in tears.  But since I’m not an “official” family member, there was only so much the doctors could offer me. Unfortunately, they and their family weren’t really emotionally or logistically able to deal with all of it. They just wanted things to go back to normal.

Out of everyone, I turned out to be the only one who was A) able to deal with the fact that they’d had several strokes (and evidence of previous TBI), and B) willing to do something about it. I’ve worked with relatives who had strokes and TBIs in the past, and this time was a repeat of those past experiences.

It took several years to get them back on track, but we did it.  And it was really gratifying to see. Plus, in the process of helping them, I realized I had my own set of issues I needed to deal with — which I’ve written about plenty in the past. Again, it’s taken me years to get back on track — more years than my friend, actually — but I’ve done it.

The only thing is, this friend of mine didn’t continue to take care of themself. They didn’t have the support of their family and friends, and I couldn’t be with them 24/7. One of the reasons that I’ve “gone off” on therapists in the past, was that I was being actively undermined by their friends who were therapists, who kept telling them that their issues had to with their terrible father, their hell-on-wheels mother, or other past relationship issues. When I tried to get support from these therapist friends, to deal with the neurological issues, I got either blank stares or active opposition, because they were so sure it was an emotional thing, not a neurological thing.

So, with family pressuring them to just get back to how things were, their friends telling them that they just needed to make peace with their parents, and me not being able to be around as much as I wanted to, because I had a lot of work commitments, they just went back to how things were before.

They stopped eating the right things and they stopped eating at regular hours.They started eating the wrong things, too — lots of sugar and fats and junk food, which has put the weight back on them — and is how they got into their situation to begin with. They let their sleeping schedule go all to hell, and by now they are pretty much nocturnal and they are rarely available during daylight hours.They stopped cleaning up after themself, and they live surrounded by piles of stuff that they can’t seem to figure out how to clear away.

It’s been really weird — it’s like they just got to a point where they decided, “Oh well, I’ve had some strokes, and I’m getting old like my parents did (my friend is  now in their 60s, and their parents both died in their late 60s/early 70s)…. so I really don’t feel like doing all this work anymore. I’m going to take a break, because I’m going to die pretty soon, anyway.“

And it hasn’t had good consequences. A lot of times when I see them these days — which is more rarely than before, because I’m on a “real world” sleep-wake schedule — they look more and more like a “stroke victim” — and less and less like the person I know they are. I try to bring up their progress with them, but they always shut me down. I try to hint that they may want to take better care of themself, but they either start to yell at me, or they change the subject, or they start to cry. It’s that catastrophic response, for sure — a reaction that is just dripping with the emotion of fear and overwhelm.

Fear that there is something terribly wrong with them.

Fear that they are damaged beyond repair.

Fear that others will hate and look down on them because of the strokes.

Fear that they will never be “normal” again.

Fear that they’re going to die a horrible death and go to hell forever.

Fear that it is all TOO MUCH to handle.

So, even though I have seen changes in their behavior and their functionality, I am helpless to change any of it. I can’t even bring it up – not with them, not with their family, not with their friends. People tell me that I have no control over others, and that I should take care of myself first, but it is so painful to watch them do this to themself. Not only do they have physical and logistical issues, but there’s more.

There’s the lying.

I’ve written before about confabulation and how traumatic brain injury can mix things up in your head and make you think you’ve got it right, when you have it completely wrong. I have a had a long history, myself, of accidentally “lying” about things  — it wasn’t my intention to lie, and I didn’t actually think I was lying, but I had my facts all turned around… which looked a lot like lying. I still do it today — I miscalculate, or I get things turned around — but fortunately I have a lot of people around me who genuinely care about me and want to help, and they don’t hold it against me. So, the consequences are less, even if the problem persists.

I have seen confabulation happen with my friend, as well. They were so sure they had things exactly right… but they didn’t. Not even close. Over the past few years, however, I have seen their accounts turn into outright lies — some of them more extreme than others. They know they’re lying, but they either can’t seem to help themself or they just LIE, and then make excuses.

It’s getting really bad. On a number of levels.

First, there’s the routine lying to people about what they do with themself all day — they paint a picture that makes them look quite functional, when the opposite is true. They talk about doing things that they aren’t even close to doing — like running errands or working on important projects and going about their business like they’re “supposed to”. They’re just thinking about doing them, but they tell others that they actually have done them.

And then there’s the deeper sorts of lies — the adulterous affairs, where they aren’t only sneaking around behind their spouse’s back and flirting with people who seem intriguing, but they are actually having sex — a lot of it, and really wild stuff — with these adulterous interests, lying about it, getting hotel rooms, visiting the long-time family vacation spots with the object(s) of their adulterous affairs, and openly talking about their affairs with people who know both them and their spouse. I found out about it by accident, and I got a lot more details than I wanted to. I almost wish I’d never found out, to tell the truth.

And that’s a pretty extreme turn of affairs. Not only are they spending money that they (and their spouse) cannot afford to spend on hotels and meals and entertainment, but they are also doing it in plain view of people who know them and their spouse. But when I have confronted them about it, my friend has lied right to my face about what was going on. They have sworn – up – down – left – right – that there was nothing untoward happening, just a “close friendship”, and when I have pushed them, they claimed it was just for “emotional support”.

Right. Emotional support. Unfortunately, I know differently.

This, dear readers, is very out-of-character for my friend. For as long as I have known them, they have been stable and loving and committed to their spouse. And they’ve at least tried to be honest. Until the strokes. Since the strokes, and especially they stopped taking care of themself, their behavior has become so erratic, so chaotic, so extreme — with the cursing and laughing and crying and lying — that I frankly don’t want to be around them much. I can’t just abandon them, but it’s hard to be around it all. And when I try to bring this up and discuss with them, they just can’t hear anything about how their strokes have affected them. It’s too much. It’s just too much for them to handle. And they pitch headlong into yet another mother-of-all-catastrophic-reactions. Yelling, cursing, crying… and more lying.

Watching someone who used to be level-headed, strong, secure, and self-confident burst into tears or blow up in a rage or come up with some cockamamie fantastical version of “reality”, because you’ve drawn their attention to something that everyone else on the planet can see clearly… something that is really and truly wrecking their life (how long till their spouse finds out about the affair(s)?)… well, that’s a pretty bitter pill. Trying to reach out and help one of your best friends — only to have them freak out on you and become threatening… it’s a hard one.

And it’s complicated. There are a lot of factors in play. And I can understand why a lot of this happens. But the lying doesn’t help matters any. It’s one thing to confabulate, but outright telling a falsehood deliberately is something that doesn’t sit right with me.

It’s just wrong. And to see them do it so compulsively… that’s pretty hard to take. I am almost neurotic about telling the truth — I get myself in trouble all the time, because I’m not willing to lie to people. And when someone who matters this much to me just runs around lying through their teeth, left and right, to everyone — including their spouse — it really works on my nerves.

But when I look at this in terms of catastrophic reaction, it starts to make sense. It’s like there’s all this conflicting stuff rattling ’round in their head that they can’t make sense of, and it puts them on edge. They have a history of trauma, too, with a father AND a mother who were each a real piece of work, so that personal history has biochemically primed them to go into fight-flight over just about anything that looks like a threat. From what I’ve seen, they are geared towards a fight-flight response to life in general… and their blood sugar is out of whack, so that it’s making that fight-flight even worse, and every little uncertainty looks like an enormous THREAT!!!

So, being on edge, and having the perception that there are things that are too big for them to handle, and they’re not going to be able to handle them, and they are in DANGER because they can’t handle them… well, that sets up the perfect “petri dish” for growing lies. Because lying is the one (and only) way they can immediately cope with an imminent threat — which of course everything looks like, especially when a social situation calls for the kind of quick thinking they cannot do anymore.

When I look at this whole business through a neuropsychological “lens”, I can understand the reasons for their behavior. And bottom line, knowing what I know, I actually don’t blame them. Yes, they are an adult, and yes they are responsible for their actions, but this is a neurological condition, not a psychological or emotional one. I’m not letting them off the hook — lying is still wrong, and I am still very uncomfortable with it.

At the same time, I’m seeing the real reasons behind it. I’ve discussed this a few times with my neuropsych, and they propose that their brain might be experiencing further vascular damage, because not only do they have a history of strokes, but their blood sugar is on the diabetic side, as well, which can cause more vascular “insults”. And that’s a whole other ball of wax to deal with.

But still, the lying… I keep coming back to that. It’s really tough to watch, really hard to handle. One of my best friends is self-destructing before my very eyes, and I am helpless to do anything about it. All I can do, is learn from their actions and their mistakes, and do what I can to help them as best I can. To be honest, it motivates me to take even better care of myself and better manage my physical and neurological health, because I don’t want to end up like them. I have noticed myself lying at times, when I felt cornered and felt I couldn’t handle everything that was coming at me. That is something I DON’T want to make a habit of, and seeing my friend go through everything they’re going through, is lighting a fire under me to do better. To be better.

None of us has control over others, which is probably a good thing. But we do have control over ourselves, which is an even better thing.

Here’s to life – onward.

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.

Is post-traumatic stress contagious?

What goes around...

I’ve been thinking a lot about pts (post-traumatic stress) lately. Especially in conjunction with traumatic brain injury, which I’ve said a number of times is an ongoing traumatic experience, and not only at the time of the initial injury.

Anyway, I’ve been thinking about the effect my TBIs have had on the people around me, and I can definitely see how my own trauma led to their trauma, too. The jumpiness that people who love and/or care for someone who has experienced TBI, is a common thing — and I think it’s directly related to their own traumatic stress.

‘Cause traumatic stress is, in fact, contagious. (And so I’ve answered my question.)

From the ever-handy Wikipedia:

(PTSD) is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma.^[1][2][3] This event may involve the threat of death to oneself or to someone else, or to one’s own or someone else’s physical, sexual, or psychological integrity,^[1] overwhelming the individual’s ability to cope.

Think about it… Someone sees someone they love and care for experiencing this traumatic experience, and they themselves are traumatized. And when the person who experiences TBI is a close part of that person’s life, then their injury can in fact represent a threat to their “physical, sexual, or psychological integrity, overwhelming the individual’s ability to cope.”

When you’re in the midst of your post-injury haze, and things are starting to fall apart — whether or not you know why it is or what to possibly do about it — you can say and do things that seriously threaten the people around you. It can threaten them on physical levels — like when your temper becomes violent and unpredictable. It can threaten them sexually — like if you lose all desire to have sex, or you become more sexually assertive. It can threaten them psychologically — like when you’re not acting like the person they know, and your behavior is so bizarre and unpredictable that they start to feel like they’re losing their mind and they doubt their own sanity.

Yes, post-traumatic stress — especially with TBI — is definitely contagious.

And that seems to me to be one of the missed pieces in TBI recovery — addressing the PTS of caretakers and partners of TBI survivors. It doesn’t even need to be moderate or severe TBI. I think mild TBI makes for an even likelier candidate for PTS, because it’s so insidious and can sneak up on you in subtle ways that make you — more than anything — feel like your psychological state is threatened.

Everybody feels like they’re going crazy, and when you don’t understand the underlying causes of it, well then, you’re totally screwed.

Until you get help.

This is where I can see some trauma therapy really helping — for the caregivers and partners and family members of TBI survivors. You get a really good trauma therapist who can work with those “TBI satellite participants”, and you help them sort things out, help them come to terms with their own individual trauma, and you get them on their feet, realizing that they are safe, that they are okay, and that they can deal with everything that comes up.

It’s one way that therapists can occupy themselves — while acknowledging that talk therapy probably isn’t the best thing for someone who is neurologically compromised. Everybody gets their place, but talk therapy and TBI can be a recipe for disaster, which can create even more trauma after the fact.

The more I think about it, the more surprised/dismayed I am that more sensible approaches to TBI and PTS haven’t been developed. There seems to be a sort of territorial overlap between the two, that doesn’t need to exist. Traumatic Brain Injury comes with a full compliment of neurological issues that can be as physiological as psychological. And those issues can — and often do — lead to traumatic stress. That traumatic stress then compromises the cognitive processes of TBI survivors, thus short-circuiting their recovery in the period after the initial injury… which then compromises their long-term prospects for restoration of their quality of life. I really believe the trauma piece is why TBI survivors — especially “mild” traumatic brain injury survivors — have poor long-term outcome prognoses.

There’s the trauma overlap that biochemically shorts out the adaptive nature of the brain, so the brain doesn’t get a chance to adapt in the ways it needs to, in order to effect actual recovery.

And countless people are suffering needlessly, because psychotherapists and neuropsychologists and neurologists are all battling over their respective territories, causing needless pain and suffering as a result.

But if people could put their own individual needs and wants aside and collaborate in a meaningful and respectful and productive way, who knows how many people could be helped?

Who knows? It’s maddening to think about all the suffering that’s taking place, because therapists are saying “You don’t have TBI/brain damage, you’re experiencing trauma,” and neurology folks are saying, “You don’t have trauma, you’ve had a TBI.” The two are inextricably interconnected, but nobody seems to have either the courage or the insight or the will to team up and come up with a common-sense approach that can mitigate both.

Simply put:

• TBI leads to disrupted neurological function
• Disrupted neurological function leads unanticipated changes in thought and behavior
• Unanticipated changes in thought and behavior leads to trauma
• Trauma biochemically prevents neurological adaptiveness.
• Lack of adaptiveness feeds into yet more trauma.
• And the cycle continues.

Each “arm” of the therapeutic/rehab community could easily find a complimentary place where they could constructively collaborate with each other.

But they’re so accustomed to marking off and defending their territory, that they fail to live up to their full potential. And countless people suffer as a result. AND they decide that it’s “impossible to recover” from TBI. What a terrible, inhumane thing to tell people. That they are irreparably damaged and have no hope of true recovery. Please.

The solution? Well, our “experts” could start talking to each other and start collaborating on a win-win situation for everyone.

Or those of us who have been neglected and abandoned and misguided by the therapy/rehab establishment can take matters into our own hands and address the most fundamental underlying basis for our ongoing issues — constant fight-flight sympathetic activity in our autonomic nervous system, which feeds the traumatic stress dysfunction and short-circuits our ability to recover and rehabilitate.

In a way it might just be possible for TBI survivors to take their recovery into their own hands — especially mild TBI sufferers. And the therapists and neuro people might be put out of a job. Because I suspect that countless people who have been sitting in therapy for years and years actually have underlying neurological issues that no amount of talking will fix — it only makes it worse and perpetuates the therapeutic relationship — and ongoing billing for the therapist and the insurance companies.

If we just got some exercise and learned to balance our nervous systems with slow, steady breathing, and we ate decent food at regular intervals, how much less “therapy” would we need? (There are always those who need to have someone to talk to just to check in regularly, but I’m talking critically about psychotherapists who insist on digging around and raking up all the muck inside you to “release it for healing”. All that stirring up will do a neurologically compromised individual more harm than good, trust me.)

Anyway, it’s a beautiful day and I’ve got a lot on my plate before the weekend is up. If only the weekends were three days instead of two. I feel like I’m just getting started, but I’ve got less than 12 hours till I start working again.

Oh, well. I guess the main thing is that we see where there are opportunities for positive change — stemming from seeing where things are not working as well as they could. If we can piece things together and understand the origins of post-traumatic stress and how it affects the people around us, we might be able to do something about it.

But as long as we keep separate and alienated and territorial, the suffering will continue.

And that’s a damn’ shame.

Truly encouraging. Truly amazing.

chill

So far, so good. I am still managing to get up and get into my day first with sitting and breathing, then with some exercise before breakfast.

The results have been pretty amazing. I knew it helped me before, when I would do my exercise, first thing, but I think the thing that was missing was the sitting piece — breathing regularly to balance out my autonomic nervous system, so that I’m neither exclusively in fight-flight mode nor in rest-digest mode, but I can move freely between the two.

In years past, I have found myself either all jazzed up when I got up — I’d leap out of bed and race into the day. Or I would be sluggish and cold and numb. Nowadays, even when I am tired, I am still relatively alert. And even when I am well-rested, I am still pretty calm and balanced.

That calm and balance is priceless to me. It eluded me for so many years — pretty much all my life, actually. Now, with some simple, relatively minor changes, I have a way to start out the day on that note. And that’s pretty encouraging.

In the past week or so, I have not woken up angry or pumped up. I have not started my day on sour notes. I have been able to keep steady and clear-headed, even when I was sick and was really very tired.

This is good. It’s very good.

Because the times when I have had the hardest time of all, has been when my fight-flight impulse was dialed up to a deafening level — when I was so jazzed, so charged up, that I couldn’t settle down. It was like I was stuck on ALWAYS-ON and couldn’t find a way to turn it down. I didn’t even want to turn it down, because it was familiar and I thought that was what worked for me.

Untrue.

This is better.

I’ve been reading Training the Samurai Mind: A Bushido Sourcebook, gleaning what I can from the online version. I’m short on cash, so I can’t afford to buy the book, and I can’t find it at the library, but I can read bits and pieces on Google Books, so I have been. (It’s better that way, too, because it forces me to read only portions of the book and focus on and them and digest them over time, rather than rushing through, willy-nilly, and not really digesting any of it.) I have long been an avid reader about Samurai and Bushido, and it makes sense to me — the life path of warriors who very likely sustained their share of TBIs in the course of battle… a life path which enabled them to restore their faculties and remain viable warriors… that is very useful to me, and I learn a lot from reading those kinds of books.

One thing that strikes me in Samurai-related literature is the focus on self-lessness. Getting rid of thoughts of the self. Focusing on an certain ethic, a certain way of life, to the exclusion of the self. And I have to say, I feel so much freer, when I get my mind off my SELF, than when I focus on my “own” self.

The difference I feel in myself when I read Samurai writings, compared to how I felt when I was seeing a therapist who was intent on getting me to think more and more about mySELF is remarkable. It’s amazing. And when I think back to when I was in therapy, I realized that although the therapist meant well, they were actually leading me down a path that was completely wrong for me. They wanted me to focus on mySELF more, but what I really needed to do, was focus on my “self” less.

It’s been several years since I was last in therapy, and it’s taken me this long to get back to a way that suits me much better than those SELF-absorbed conversations that used to plunge me into confusion and chaos on a weekly basis.

I have no words to describe the sense of calm I have, that comes from simply sitting and letting all the crap go… that comes from refusing to get caught up in the drama that churns inside my head… that comes from balancing my nervous system with steady focus on my in-breath and out-breath.

There is another way for me to find peace. There is a genuinely reliable way for me to chill. This is truly encouraging. It’s truly amazing.

Trauma + TBI = Trouble

I am writing this after several conversations and some reading — one conversation with a former soldier who was in Iraq during the first Gulf War, several conversations with a friend of mine who sustained a brain injury about three years ago, but has never gotten help for their injury — and is making increasingly poor choices about their life, their relationships, etc… all the while saying they need to find a therapist to help them deal with childhood trauma. They need a neuropsychologist, more like… As for the reading, check this out: Two Must Reads: The struggle for comprehensive PTSD and TBI treatment. I skimmed through it quickly, but I’ll have to go back to it. And I recommend you check it out, as well.

In thinking about the conversation I had with the ex-Marine, what struck me is how he talked about dealing with the incredible challenge of having to do things that were against his own morality, like kill people and destroy things. I was reminded of my post a while back about how war damages the souls of soldiers when I was talking to him, and he said there were several things that he and other military members of his family have done to cope.

The first is talk to somebody who understands — veterans in the family with whom he and other soldiers in his family can talk, have been so critical. The other is to find a way to make peace with things. Find a way to make it okay, on some level, that this is happening. Through faith. Or some sort of belief system.

In thinking about the conversations with my BI friend, I am starting to take notice that all their talk about trauma and dealing with it, is set against a backdrop of the BI they sustained five years ago. We have mutual friends who are therapists who are convinced that a lot of people are walking around with suppressed memories of terrible abuse in their childhoods, and that those repressed memories are making them do the things they do. With my BI friend, I suspect that they have been getting the “party line” that they are dealing with old memories coming up, and they don’t know how to emotionally deal with them. Now, I know for a fact that this friend didn’t just sustain a BI three years ago… Back around 1999, they also slipped on some ice, fell and hit their head pretty badly. They were dizzy and disoriented after it, and I noticed them being more volatile afterwards. Then they seemed to get better (although their marriage has been a bit rocky over the years). In the past three years, they’ve made an amazing recovery, and if you didn’t know them before, you probably would never guess that they have this going on with them. But I can tell. Maybe because I’m more sensitive to it — and better educated.

Anyway, this friend of mine is in pretty bad shape, financially, yet they don’t quite seem to get it. They have serious impulse control issues with money, and their spouse doesn’t actively monitor what they are spending on, how much, and how often. So, they have ended up in a jam that might cost them their car or their house. But they keep going along just doing what they do. Whenever I suggest that they might want to take a look at their spending, they get defensive, aggressive, combative. Not pretty. They just blow up like crazy. So, I stopped talking to them about it. They think they’ve found a good therapist, but like the others they have gone to in the past, they may end up not mentioning the BIs, and they may start treating their symptoms as purely psychological or emotional ones.

I really need to say something more to them about this. I think I need to discuss it with my neuropsych. My NP is probably not going to be able to say much, but I do need to ask them if they know anyone like them who has the same orientation towards healing and recovery. I suspect that along with my friend’s childhood trauma, there are some neuropsychological issues that need to be addressed — and it could be that by simply changing a few of the ways they go about doing things, they could benefit immensely.

I just need to find a good way to bring up the subject. They know about my recovery, and they have said many times that they are amazed by how far I’ve come. And, come to think of it, they have also said they wished they could find someone who is like my NP for themself. The thing they have going for them, is they have documented medical evidence of their most recent brain injury. It’s all there, complete with MRI showing the places where they have lesions. So they could get medical coverage to help them defray the costs. That’s huge, considering they have almost no money. Maybe getting some help will help them change that.

So yes, I do need to bring up the possibility of them seeing a neuropsychologist. They can get pretty paranoid, so I need to be careful how I phrase things. But I at least need to try. They need help. And I might be able to help/support them.

One of the things I hear them say is that they’re “too old”. They’re in their 60s and they feel like they’re getting old. But I really believe that they can turn things around. With some basic logistical changes similar to what I’ve done, I suspect they can revitalize their life and not only add years to their life, but add life to their years.

I just hope they don’t end up with a therapist who stirs everything up, tries to get them to “feel their feelings” (trust me, they have no problem doing that), and disregards their TBI history, because they are convinced that all their problems are trauma related.  They might only be partly right — trauma includes traumatic brain injury, and I would hate to see that piece of their puzzle ignored.

Therapy + TBI = Disaster

"My therapist told me the way to achieve true inner peace is to finish what I start. So far today, I have finished 2 bags of M&M's and a chocolate cake. I feel better already"

I’d like to propose something controversial here that probably won’t be well-received in psychotherapeutic circles. I’ve said it before, I believe, but I’m going to say it more emphatically now. Someone recently commented on another one of my posts, right when I’ve been thinking about it a lot, so I’ll say it again:

Therapists/mental health counselors (without a strong grounding in neurological information) are about the last people who are able to effectively deal with mTBI. And in the early stages of recovery, seeing a therapist to “figure things out” can do more harm than good. Much more harm than good.

It’s unfortunate, and I hate to say it, but I believe it to be true, based on personal experience with therapists and with friends/acquaintances who are therapists. What I’m about to say comes from years and years of observation, and no matter how seriously therapists may question my point of view (after all, I might be mentally impaired), I still believe it and I stand by it.

See, here’s the thing — TBI seriously screws with the functioning of your brain. Even a “minor” concussion and shear and shred axons and synapses and all those connectors that you’ve built up over the years to learn to live your life. Plus, it releases interesting chemicals into the brain that kill cells. Don’t be alarmed – the brain is a marvelously resilient organ that ingeniously figures out how to re-route connections, recruit other parts of the brain to do the jobs of parts that can’t do it anymore, and generally adapts to changing conditions in ways we are only beginning to recognize and understand.

The thing is, in the early stages of injury (and by early, I also mean the first couple of years after the incident — TBI is a gift that keeps on giving ) your brain is still trying to figure things out and it is organizing itself around a new way of needing to live your life. Generally folks with TBI don’t have a full and complete understanding of how they’ve been impacted and how it’s affecting their life – we just thing that the world has suddenly gotten all screwed up for no apparent reason. So, our brains are floundering and confused and not quite sure how to find their way out of the messes we’ve gotten into.

And the reorganization that normally takes place as a natural part of recovering from an injury — the reorganization of our brains along certain lines, so that we can resume some level of functionality — can be a bit haywire. The “plastic” brain is a lot like modeling clay. If you press it into a certain mold and leave it there, it will assume that shape and become like its environment. If you leave a lump of it lying on a table and walk away, when you come back a week later, it will be hardened into a chunk that may shatter if you drop it. If you stretch it into lots of thin, haphazard shapes and you leave it that way, it will harden into those thin and haphazard shapes.

So, when your brain is coming back from an injury and it’s looking for different ways to reshape itself, it can get all pulled in a gazillion different directions, because in the aftermath of TBI, things can be crazy and confusing, and we can come up with all sorts of skewed perceptions of ourselves. And if those perceptions are not questioned, challenged and corrected, they can harden into “truth” — which leads us even further down an erring path — into yet more trouble.

Hm. So, the crazier things get, the crazier you feel, and you wonder if you’re just plain losing your mind. You feel depressed and confused and out of sorts, and you don’t know why. So, you do the “logical” thing and you seek professional help. Your friends and family applaud you, because you’ve been getting harder and harder to deal with, and it seems like you have “emotional problems”. (Well, duh – emotional lability and impulse control are often “bundled” with TBI, as a neat little package of insult, injury, and humiliation for everyone involved.)

The only problem is, the therapist you start to see doesn’t know jack about TBI, and they come from the camp of “repressed memory” and how an unhappy childhood marked by long-forgotten/denied/overlooked abuse and neglect is to blame for adult issues. They believe with all their professional soul that most people are walking around in life cut off from their emotions, and that the true path to happiness is to connect with your inner hurt, name your pain, confront the things you are avoiding, and learn to love your demons.

There’s only one problem — none of what they say actually applies to you. The issues you have didn’t start until after your traumatic brain injury, and prior to that head injury, you were a reasonably happy and functional person with their share of troubles, but no “ticking time bomb” of forgotten abuse and neglect to throw you off course. They think that like certain childhood abuse survivors, you have been in denial most of your life, until you reached a certain point in your life when you had “advanced” enough to confront the challenges of resolving a difficult childhood… and they’re going to help you do just that — get in touch with your repressed memories, love the shadow, dance with your demons, and ultimately come to accept and love yourself, no matter what.

Great.

What they don’t realize, however, is that your brain is still recovering, still changing, still modifying itself to the world as it now is (rather than as it was before your injury). It’s volatile and highly subject to suggestion, and you’ve been wrestling for so long with not knowing for sure what’s going on with you or how best to deal with it, that your system is highly tweaked and on an emotional hair trigger. They think you’re in need of emotional “tough love” — but what you really need is some good regular exercise, a daily routine to take the guesswork out of your life, and extra patience and rest.

So, they push you. They challenge you. They test your limits. They try to get you to open up to them… pushing and pushing to get you to “admit” what’s going on inside of you, when internally, you’re in storm of emotion that’s neurologically based and totally inexplicable from a purely psychological point of view. They think you’re in denial and resisting necessary change, and you’re sitting there, week after week, looking at them like they’re from another planet, wondering “What’s wrong with me?!” and getting more and more confused and depressed by the week. You take it out on your friends and family, who have really had it with you, by now, and pull even farther away from you than before, thinking you’re just not trying hard enough.

Your therapist thinks you’re making great progress, getting in touch with your feelings and emotions, letting them come up and processing them. But you’re sinking farther and farther into a morass of emotional confusion, volatility, self-doubt, even desperation. Of course, this is all helping to create repeat business for the therapist who is “helping” you, and they can add even more diagnoses to the insurance bill, so what do they care? (Okay, in fairness, I’m sure that not all therapists are interested in creating repeat business, but any time you combine “care” with making a living, you get into gray areas and tricky territory.)

You’re increasingly worried about your emotional and mental health, and that’s keeping you stressed. You’re not sleeping well, which is taking a toll on your ability to self-regulate — your ability to do, well, everything. You’ve got all of the following TBI after-effects in abundance:

emotions, moods, agitated, can’t settle down, anger, anxiety, feeling vague fear, worry, anticipation of doom, depression, feeling down, excitability, everything feels like an effort, feeling unsure of yourself, feelings of dread, feeling like you’re observing yourself from afar, feelings of well-being, feeling guilty, feeling hostile towards others, impatience, irritability, no desire to talk or  move, feeling lonely, nervousness, feelings of panic, rapid mood swings, restlessness, tearfulness, crying spells, feeling tense, feeling vague longing/yearning, etc…

And according to your therapist, it’s all due to mental health issues. Not brain issues. Emotional ones. It’s not your body that’s the problem. It’s your soul. You’re screwed.

Your brain is getting a steady stream of messages from your therapist and from yourself about “the way things are” — which is that you’re screwed up and in need of some serious intervention — and it’s causing your very plastic brain to re-form itself along the lines they’re suggesting. You feel like you’re getting worse, so your therapist dials up the intensity … and tells you all the drama is good — you’re “feeling things for the first time” (which is total, utter crap) and you’re acknowledging the difficult-to-handle aspects of your life (which really only emerged after your TBI). It throws you into even more of a tailspin, and before you know it, you’re planning on breaking up with your partner/spouse/lover, you’re riding the roller-coaster of withdrawal on one hand and aggression on the other, and you’re more and more convinced that you can’t live without your therapist, who is the one person who will sit in a room with you for more than a few minutes, as you’ve effectively chased everyone else away.

Anybody else have this happen to them? It happened to me, and looking back, all the advice from my friends and family about getting professional help from a licensed psychotherapist, was about the worst I could have gotten — and followed. It almost cost me my marriage, it turned my life into an extended experience in chaos, and the only reason I managed to escape the bogus-psychotherapy merry go round, was that I ended up seeing a truly well-meaning but neurologically clueless psychotherapist who scared the crap out of me because they had connections at a local mental hospital who could have me committed (against my will) at their say-so. A narrow escape, but an escape no less.

In fairness, I do believe that a lot of therapists are well-meaning and they are acting on the information and the training they have. But too often that training does NOT include a neurological element, and/or they decide that the awful ills of the world have psychological roots.

Another thing that makes it difficult is that a lot of therapists have mental health issues of their own. A lot of my therapist friends got into therapy because they were helped by counselors, themselves. While I applaud their eagerness to help others, it puts up a huge red flag for me. Because the nature of their mental health issues — incest or eating disorders or some other awful trauma — caused them to distance themselves from their bodies at a fairly early age, and they have grown up living outside their bodies. My therapist friends are by and large antagonistic towards their own bodies. They don’t really exercise, and if they do, it’s “gentle stretching” or yoga or something really non-challenging. They are not on friendly terms with their own physical selves, which closes their minds when I suggest that exercise and taking care of your body (as if your life depends on it, which it does) is key to mental health.

It’s all “mind over matter” for them — and I’ve witnessed the same mindset in other psychologists and therapists I’ve met. Not physically vigorous. Not physically healthy. Sitting all day in small rooms, gaining weight, losing muscle tone, planning on knee and shoulder replacements to repair the damage that their sedentary lifestyles have done to their bodies. And complaining all the while about stupid little things that a little exercise would make seem inconsequential.

Good grief.

Anyway, I’ll quit ranting, now. It’s a beautiful day, and thank heaven I remembered I need to move money into my bank account to cover a monthly autobill. Just to wrap up, when it comes to deciding whether or not you really need therapy, consider your neuropsychological state, and make sure you don’t get stuck with someone who doesn’t have a clue about how neurology can make you a little crazy… but that passes with time, and with the proper training and reinforcement for what your life can really be like.

‘Cuz if you aren’t crazy when you start seeing them, regular visits can make sure you really get there.

Caveat emptor.

The things we do to heal

I just learned about the movie Marwencol. Check out the trailer video and visit the site. Fascinating.

This kind of reminds me of my own retreat from the rest of the world, over the course of my life. Although my own withdrawal from the world where I got hurt on a regular basis was not nearly as labor intensive as Marwencol, it was in fact my own private Idaho. It was a place where I could pull back and experience my own life on my own terms without danger of being hurt or mistreated or dismissed. I have that place boxed up in tens of journals I’ve kept over the years, and stashed on bookshelves filled with subjects of  “study” that never came to anything.

My own removal from the world started when I was around seven or eight years old. And it stopped 35 years later. I can’t wait to see this movie, Marwencol — I’d like to see how someone else did it. And how it turned out for them.

It makes me wonder how many people are actually walking around with one foot in one world and one foot in the other.

Is EVERYBODY in love with their therapist?

I checked my stats, and there are all these search engine searches in my stats results for about the past year having to do with people looking for info on being in love with their therapist.

The malady seems to be going around…

Personally, I’m highly suspect of therapists. This is because I know a lot of them, and I know for a fact that none of them are any more mentally healthy than most “unhealthy” people I know.

The fact that they are dispensing mental health care to others worries me a little bit. It truly does.

One thing I’m not overly fond of, is the tendency of therapists to simulate parents or significant others, so they can establish an intimate bond with their clients.

It seems downright creepy, in fact.  I suspect it happens more with opposite-sex situations — female client, male therapist — but maybe it happens the other way around, too.

Either way, the dynamics are just too weird. Therapists need to get their own lives and stop using their clients as pseudo-lovers. And clients probably need… well… less therapy. Maybe?

The whole business of transferrence and regression raises lots of red flags for me, but it seems to be quite widespread. It’s just not the right thing to do, in my opinion, especially considering that lots of therapists have their own screwed-up issues, and it’s a rare individual who can actually manage their intimacies. When you get into a position of such power and influence over another — which therapists often do — it opens the door to a whole world of hurt that is downright dangerous.

Of course, the therapists get to charge you money for it, and they can always walk away from the situation using their “professional” discretion. They’ve been taught how to ply a powerful trade, but very few clients actually know what they’re up to.

Until it’s too late. And then, well, it’s too late.

The brain needs the body to recuperate

I’m happy to report that I am getting back to balance (literally). I’m not 100%, but I’m a far sight better than I’d been for the past few days. I really had to do something — the vertigo was seriously messing with my head and making me difficult to live with.

So, I did some smart things, last night – had a decent supper of real food, and checked out early. I spent half an hour stretching and breathing before I went to bed at 9:30. I also used some decongestant/vapor rub on my neck around my eustacian tubes, which has helped me in the past. I’ve got a lot of congestion in my sinuses and e-tubes. So, I took a hot shower, relaxed and breathed and stretched and also indulged in some Advil… and breathed some more… and I got about 7 hours of sleep, which isn’t my max, but it’s a start.

This morning I’m feeling like a new person. Still a little “off” but able to deal with it. I also took the time to exercise a little — the last couple of days, I haven’t had as much time as I wanted, to work out/warm up in the a.m. I think that hasn’t helped, either. So, this morning I did something about it. Nothing really huge, but still significant. I had to stop a few times to catch my breath and get my heart rate back to normal, so that’s a good sign that I’m actually being active. Didn’t push it too terribly, but I did get my system jump-started.

And now I’m ready and rarin’ to go.

I have to tell you — and I’m going to sound like an evangelical, here, which is sorta kind what I am — exercise is saving my life. Seriously. I was making pretty good progress with my neuropsych and my studies, for the first year or so that I was seeing them. I was making pretty decent progress, piecing my life back together from the shattered, edge-of-the-abyss state it was in. My neuropsych really helped me back away from the edge where I was teetering.

Emotionally, I was a wreck. Logistically, I was in big trouble. I was making bad decisions in my work and career, and I was really on the verge of catastrophe. I can see that now. But since I started working out regularly in the morning, my life and my decisions and my sense of who I am and what I’m all about, and what I’m capable of doing, has just skyrocketed. And this from someone who was convinced for many years that they couldn’t make basic decisions on their own.

I was in the habit of avoiding potentially sticky situations — like the plague. I had all sorts of defenses in place to justify why I would avoid certain scenarios. I had all sorts of explanations for why I wasn’t doing everything possible with the abilities and interests I have. I had all sorts of justifications for living a shadow of the kind of life I could have. And it all made perfect sense to me.

Of course it did. I had it all worked out in my head, and nobody was allowed close enough to me to tell me any different. I was a rock. An unapproachable, aloof, inscrutable rock who couldn’t be criticized or told anything other than what I’d decided in my own head.

It wasn’t until I started talking to a therapist on a regular basis, that I realized something was up with my ‘confident’ thinking. It wasn’t until I heard myself talking out loud to another person, that it sank in that all was not as it seemed. Now, I’ve said before that I’m not the biggest fan of therapy, and in some ways it did set me back. But if nothing else, hearing myself saying things out loud and watching my thought process with another human being really brought certain of my issues front-and-center.

One of the biggest ones, was “denial” of things that were going on with me. In one session, I’d talk about something, but the next time, when Therapist #1 tried to follow up on it, I’d back away. And I couldn’t figure out why that was — because I was the one who’d brought it up in the first place (and quite enthusiastically, I might add).

Why was I backing away from something that clearly was of interest to me? Why would I bring something up, say “Yeah, I really want to deal with that…” and then the next time just refuse to approach or even acknowledge the topic?

It made no sense to me, especially because intellectually it was so clear what I had to do. And emotionally, it didn’t feel like that big of a deal.

But it was a big deal to me, on some level — to my body.

See, here’s the thing:

My body has stored a ton of unhappy events in its biochemical wiring. Lots of stuff I’ve been through — much of it having to do with/directly related to the traumatic brain injuries I’ve sustained — has made this sort of  ”imprint” on my system. The stress hormones, the adrenaline, the cortisol, the flood of reaction — which at one time was more extreme than it eventually became and is today — made a huge impression on my system.

And it left its mark. Deep and wide, in some cases. On a different level than my everyday waking world. On a much deeper level — a non-verbal, experiential level, that I could often ignore or sail right past. But when I got closer to that experiential “physical memory”, all my thinking, verbal systems shut down, and there was no getting close to it.

It made no sense to me. Truly. I honestly didn’t see why I was so intent on “avoiding” my issues… Why would I react that way?

I just didn’t get it.

Until I started paying attention to my body. And I realized that I had a distinct physical reaction to the topics I was “psychologically avoiding”. Psychology had next to nothing to do with it. I was having a physical reaction, and my body was doing its best to protect itself, my mind, and my spirit, from this perceived “threat”. It was my body, not my mind, that was calling the shots. And any attempts at approaching my problems from a psychological standpoint fell flat on their face.

All the while, Therapist #1 kept sitting there looking at me like I was too emotionally damaged to address this stuff. News flash — it wasn’t my emotions that were the most impacted. It was my body, and when it got wind that an old threat was reappearing, it kicked in and took over. Because clearly, my mind hadn’t protected me well from that threat in the past. So, my body “thought” it had to take over again.

I’m sure there are folks who will take issue with my assessment of what happened. After all, I’m not a trained psychologist. But that was my experience. And I’m sure there are others in the world who would echo the same kind of experience.

Truly, it wasn’t until I started being active on a daily basis… and I made a priority of taking care of my body, each and every day, in a deliberate and focused way… that I started making some real progress. I was just kind of hanging out in recovery/rehab limbo, taking two steps forward, one step back, two steps forward, three steps back… all the while struggling with stuff that seemed like it should be a lot easier for me.

I knew I shouldn’t be having the kinds of problems I was having. Everybody around me was certain I could handle things. But everything kept getting all screwed up. Now, in the past, I’ve said that the culprit is this hidden disability of mTBI. And others don’t/can’t understand it, can’t see how it holds me back, can’t see how it screws things up. And that still holds true for me. But there’s another piece of things that complicates the complications even more — the physical reactions I have to the logistical troubles I encounter, which pumps me full of biochemical distress and keeps me from thinking as clearly as I could.

As though I need any more problems thinking

Well, anyway, let’s fast-forward about 10 months, to where I am now. I have been actively addressing my physical fitness issues — warming up in the morning, working out a bit each and every day — and I’ve been dealing with my anxiety and agitation with conscious breathing. And can I say, the difference is phenomenal. It’s like I have this whole new life — a whole new “me” if I dare say so (I don’t much like the expression, actually). And I have a whole new appreciation of the parasympathetic nervous system.

Seriously. When I look back on my difficulties, I can trace so many of them to a seriously tweaked sympathetic nervous system — all that fight/flight/freeze/fun was frying my system in a very big way. It was like I was driving my car at top speeds when the gas gauge was always on Empty. If you run your car on empty too long, it gets all the crappy sludge at the bottom of the gas tank into its system, and the results are… well, less than optimal. The body’s the same way. It operates on an “alternating current” of sorts — the sympathetic nervous system gets us all charged up and ready to take on whatever shows up in front of us, and the parasympathetic nervous system helps our system back off and regain its balance, so it can return to action even stronger than before.

It’s the same principle as over-training for a sport. If you’re training hard, you have to rest to give your body chance to rebuild the muscle you’ve torn down. It will do that naturally. The body is built to do that. But it needs time and nutrition and rest to do it properly. If you don’t give it that, you eventually get into a diminishing returns situation, where you’re just… well… broken down.

That’s where I had gotten to. It’s where I had been for quite some time. In the midst of my severe difficulties with work and money and relationships, I “overtrained” and broke myself down. I kept running into walls, having little crises, and I was constantly on alert, thinking that if I just pushed harder, tried harder, worked harder, I would eventually come out on top.

All I accomplished, was sending myself down a rathole and digging myself deeper and deeper with every push. My “solution”? To push harder. To prove to myself that I could do it. To work and work and work and never give myself a moment to back off… and breathe. That “breathing stuff” was for wussies, I thought. How wrong I was.

Yes, I was over-taxed and over-extended, but I never gave myself a chance to replenish my resources. I thought that trying harder and working harder would get me there. I thought that coffee and cheap carbs and sugar highs were enough to see me through. But the roller-coaster of the blood sugar ups-and-downs wreaked havoc with my system even more.

Indeed, the physical aspect of recovery from TBI was one of the big pieces I’d been missing — and it was right under my nose for so long. I was walking around in the midst of the problem — and the solution. And here, I’d been telling myself all along that the way to prevail was to focus on my brain… when it was my body — indeed, my mind, which encompasses the whole of my body-brain intelligence and directs it — that I needed to tend to.

In a (fairly long) nutshell, here’s the deal:

1. Traumatic brain injury (especially the “mild” kind) throws off your life in significant, fundamental ways. It disrupts your personality and causes your brain and your experience to be very different from how you expect them to be.
2. Also, (m)TBI can be quite well-hidden from others, so they’re not necessarily going to adjust their interactions/actions/behavior towards you.
3. So, you end up doing things, expecting certain results. And others expect those results, too. And when the actual results turn out different from what was expected, that sets off little Warning! alarms in the system — in yours, and others’ as well.
4. The alarms are, well, alarming, and they trigger biochemical cascades of stress hormones to respond to the perceived imminent danger. Also interactions with other pissed-off people set off alarms that release the biochemical cascades.
5. One or two of these little alarm situations every couple of days, is one thing. But when you’re impacted by TBI, these little alarms can go off tens, if not hundreds of times each day. And with each subsequent alarm, your cognition is a little more impacted, a little more impaired.
6. Of course, the alarms are “small” and invisible to most folks (including the survivor) and they take place in a non-verbal, experiential sphere, so they are often not properly identified as being the alarm situations they are, and they continue — sometimes escalate… to the point where you’ve got a substantial buildup of this biochemical Warning! concoction.
7. Under normal, obvious threat circumstances, this biochemical alarm stuff comes in handy and you can recognize it and deal with it later by talking it through with someone you trust, or taking some other steps to rest and relax. But when you’re just dealing with “everyday life” and there is no apparent reason for you to be so tweaked over “little things”, there doesn’t seem to be much point in recognizing or addressing these little incidents and their resulting biochemical pump.
8. Over time, the cumulative effects just build up. There’s plenty of literature about the cognitive impact of too much cortisol in your system for too long… the negative effect it has on cognitive processing, behavior, etc.  Biochemically, you end up a walking “pharmacy” of stress-response hormones.
9. What’s more, this hormonal overload (yes, guys, not only women get all hormonal over stuff — everybody does) can eventually translate into a nasty case of Post Traumatic Stress — and it can lead to a disorder which tacks the “D” onto the end of PTS. Fun, huh? Not.
10. Long story short, all those “little things” add up to a big honkin’ problem — and what makes it even more maddening and damaging, is that nobody thinks you should have this problem. Including yourself.

“How can I possibly have PTSD, after my brain injury?” You might ask. “The injury was some time ago, and I seem to have gotten through it just fine.”

Well, from where I’m sitting, the real source of TBI post-traumatic stress is not necessarily the injury itself, but the long-term effects of one TBI-inspired fiasco after another. One failure after another. One unhappy surprise after another. One problem after another after another… all of them unexpected, and many of them serious.

It’s not this “bullet hole” of a single traumatic incident you have to deal with:

It’s the “shotgun blast” of a hundred… no, a thousand, little post-tbi “hits” that pop up out of nowhere to put you seriously on edge and make you question your sanity (which in itself can be traumatizing):

And ultimately it adds up to a large blast area.

Just ask a city cop which kind of gun you should get if you want to do the most damage and be sure to hit something — a shotgun is an urban dweller’s choice, as it hits a larger area and can do some serious damage.

Same thing with post-tbi “micro-traumas” — they don’t look that big, but they add up. Especially when you’re not actively managing the biochemical results in a conscious and deliberate way.

And this is where the body comes in

As complicated as your life may be, thanks to TBI, one of the ways to address your issues is very, very simple: Taking care of the body, and in particular the breath.

Because PTSD is directly linked to a hyper-activated sympathetic nervous system, we actually have the means by which to counteract the hyperactivity — with our parasympathetic nervous system.

We’re built for this, people. We are physically constructed to regain our biochemical balance. It’s not rocket science and it’s not magic. Each and every one of us has another aspect to our autonomic nervous system that can and will replenish the resources we drain in the process of dealing with all the crap that flies our way throughout each day.

Controlled breathing at 12+ seconds per total breath — 6+ seconds to inhale… 6+ seconds to exhale — will activate the parasympathetic nervous system. The slower you breathe, the more it’s activated. (Just remember to keep breathing!) Also, deeeeeeeeep breathing will stimulate the vagus nerve, which helps the PNS to kick in. It works so well, that a vagus nerve stimulator was created to implant in people with intractable epileptic seizures. The vagus nerve calms down a hyperactivated system. Everyone has one. It’s also the biggest nerve in our body. So, let’s use it!

What’s more, exercise has been shown to stimulate the parts of the brain that control executive function — the frontal cortex. And conscious focus on breathing has also been shown to stimulate the pre-frontal cortex. Exercise and conscious breathing can both stimulate the higher-reasoning parts of the brain. And that’s exactly what you want to do, to get yourself back on track after a TBI.

Of course, it takes time to get in the habit of using the body to correct the brain. Most important things do. But the beauty is, you can start experiencing benefits from controlled breathing immediately. No waiting there. The PNS is always at the ready, waiting for its cue. So, cue it. Do deep breathing and count your breaths. Block out everything for 3 minutes, no more, and breathe… and see where it takes you. I did it this morning, and it really improved how I was feeling about my day.

Now, of course, everyone is different. But without exception, we all have an SNS and a PNS.  And we can use them both to make or way through life — and deal with the fallout from TBI. This is true not only for survivors, but for caregivers as well. Caregiver fatigue is a very real problem. But addressing it can be as basic and as simple as focusing on the breath and relaxing for a short period of time.

I’m not making light of serious issues. They are real and they really need to be dealt with. What I am saying is that our own nervous systems are extremely powerful, and they are always at the ready, waiting for their cue to do their work.

The body truly is a wonder. And the brain needs its help, to get better. Knowing this can make all the difference.

I was going to write about mental illness

I have a bunch of theories about mental illness, and I was going to talk about Theory #87:

Many cases of “mental illness” are artificially created, and they’re self-fulfilling prophecies.

I was going to go on about how we live in a fragmented, disjointed world, that’s increasingly driven by professionals who need to recoup their investment of dollars and years in their chosen line of work. Those professionals create frameworks of understanding, based on their research and industry standards, and then they peddle them to the unsuspecting, fairly trusting general population, which is comprised of people who have  been disenfranchised from most of what brings meaning and purpose to our lives — family, friends, community, and a connection with the natural world.

I was going to write about how, in order to feel some connection, some meaning and purpose, we turn to mental health professionals for help, and in order to help us, they have to 1) slot us into one of the many categories they use to understand their world, and2) establish for the authorities that we indeed need help, so they can get a billing code for the insurance company.

Then I was going to write about how in order to develop the connection with this new significant other person in our lives, we (patients) need to behave in a way that justifies our being there. And we have to skew the relationship with the professional in a way that makes us look genuinely ill — which eventually we may become, if we continue to behave as such. If we succeed, we develop a kind of bond that is a substitute for the bonds we can have with family, friends, community, and nature. But the bond is important to us — especially if we are very vulnerable and have done the whole regression/transference thing. Our “helper” becomes an essential part of our lives.

Then I was going to go into how, in order to continue our interactions with this essential part of our lives, we have to continue to behave in such-and-such a way, deepen the patterns we once hinted at, and before you know it, we’ve got a full-blown set of complexes, each with its own billing code, and each with a recommended “treatment” that sucks us even further into the cycles of artificial and (dare I say) contrived relating to this essential part.

We just can’t let go.

But when I thought about this whole subject, it just depressed me, and I decided not to invest more than 10 minutes today thinking about it. There, I’ve put in my 10 minutes. Now for something completely different.

While I was working out this morning, it occurred to me — yet again — that the best remedy I have for my issues is living my life to the fullest.  Taking on the things that arise in my path, and confronting squarely the challenges that come up. I have had a truckload of unfortunate things happen to me. But you know what? I’m still here. And with the right attitude and a good sense of perspective, all those things amount to a whole lot of life experience, which is what interests me far more than any measurable “success” or “failure”.

Truly, it dawned on me the other day, that in the past 5 years since my last fall, I have been devoting an awful lot of my time and energy to avoiding experience. I guess it was because the experiences I was having were really not working out as planned, and I didn’t have the wherewithal to understand how I could work them out better. My distractability and agitation had gone through the roof, I had a truly nasty case of PTSD from all the sh*tstorms of my life, and I was in severe existential angst a good deal of the time. Even though on the surface people couldn’t see that I was struggling, the fact is, I was. Internally, on a fundamental level so deep that it was extremely well-hidden, even from me.

Especially from me.

And I realize how accustomed I had become to holding my breath. Not breathing. Not giving my parasympathetic nervous system a chance to kick in. Not giving my sympathetic nervous system a chance to take a break. Not letting my system unwind and rejuvenate and restore. I was running on fumes. Constantly. Without fail… till I failed. I wasn’t exercising, I wasn’t stretching — physically, mentally, or emotionally. I wasn’t taking care of myself, and I wasn’t taking care of my life. I was getting hung up in all sorts of sidelines and getting snagged in all sorts of distractions that truly served no one. Not me, not anyone else.

And it hasn’t just been this past 5 years, when this has been my regular practice. On and off, over the years, when I’ve had accidents or falls or other head injuries, I’ve done that same kind of thing — never stopped to catch my breath and see where I was at, give myself a chance to rest and rebuilt, but race back in, guns blazing, till I was cut down by the steady onslaught of problems, issues, conundrums, failures, confusions, distractions… until I was forced to withdraw completely from the playing field of life.

In retrospect, I have to say that if there’s anything that has made my TBI experiences worse, it’s that buildup of post traumatic stress, the post traumatic stress disorder (if I may go against my non-mental-illness focus of this post and use a mental health buzzword), which caused my body to wig out and get so wired, my brain couldn’t begin to recover properly.

In fact, if I had to pick one major contributing factor that’s made traumatic brain injury such a problem for me, it’s really been the body, rather than the brain, that’s complicated things. An overly wired, strung-out sympathetic nervous system, an underutilized parasympathetic nervous system, the knee-jerk reactivity and distractability and agitation that go hand-in-hand not only with TBI, but with PTSD, as well.

I hate to oversimplify things, and I hate to boil things down to the one thing that creates the tipping point, but the more I think about it, the more experience I have with my own recovery, and the more I learn, the more I’m convinced that the physiology of TBI and PTSD — the reactions of our bodies to the world around us — is what makes TBI such a bear to deal with.

The good news is, taking care of the body can go a long, long way to helping mellow out these issues, and restore the functionality I/we crave. TBI folks are often inveterate Type A personalities, and we love to GO-GO-GO and DO-DO-DO. There’s nothing wrong with that, within reason. But after TBI, if you want to get back to being yourself again, you have to do things differently and take special steps to support the systems that once worked on autopilot.

Autopilot is done. Finis. Kaputt. Time to get a new gig.

And so I have. Part of me would love to train for elite athletic competitions. Part of me would love to train for serious activities, like those 100-mile races an acquaintance of mine used to run, or even a triathlon — the Iron Man in Hawai’i, if course, not some mid-summer mini-triathlon in a seaside town. There’s a part of me that wants to prove how well I can do, how far I can push myself, and I thrive on the challenge. However, that’s not realistic, and I have too much at stake, to go mucking things up by overdoing it… which is exactly what I would do. Again, that’s my old autopilot self — my old overachiever, do-everything-and-then-some self — talking and trying to drive things.

My new gig is one of balance — careful balance — that preserves my resources for the long haul. My new gig is not the flameout routine I used to be on — work hard, play hard, and rest when I’m dead. My new gig is much more about staying fully present and aware of my surroundings, seeing the nuances, the fine details in things, and really, truly, fully experiencing everything that comes across my path for what it is — experience. Not a conspiracy to make my life difficult. Not a gift from a beneficent deity.  Not an emotionally weighted good-or-bad vote of confidence or slam against my very core identity… just experience.

When I let things be, when I let life be what it is, and I devote some time to really delving into what is there for me to use to my benefit — even in the mist of the sh*tstorm, I can find some peace in the midst of chaos. When I embrace the chaos and let it be what it is, without judging it and getting all tied up in knots over it, and thinking that’s the last and final word on what my life is like and what I’m capable of doing… when I give myself some room to breathe and step back and reconsider my life along different lines… tell myself a different story about what’s happening around me… well, life takes on a whole new meaning, a whole new purpose. And it becomes my life, not some series of tasks I need to perform to satisfy the requirements of others.

Of course, it’s an imperfect process… I’m still working out the details on how to keep myself consciously breathing on a regular basis. And I’m still working with my daily routine to ensure I don’t end up exhausting myself with all my productivity. You may laugh, but that’s exactly what I do.

But at least I’m aware of what’s going on with me, and at least I can have a sense of humor about it. I’m not perfect. Why would I want to be? And I’m not mentally ill (and you probably aren’t either). Why should I burden myself with that crap? I’m alive, I’m human, and I am either an amalgamation of all the DSM-based billing codes on the planet, or I’m none of them at all.