Army sees sharp rise in suicide rate

According to the Los Angeles Times, military officials have reported that this past year (2008), the suicide rate among Army soldiers reached its highest level in thirty years. The news came in a report that pointed to the inadequacy of anti-suicide efforts undertaken in recent years.

From the story:

At least 128 Army soldiers took their own lives last year — an estimated suicide rate of 20.2 per 100,000, a sharp increase from the 2007 rate of 16.8.

Note: That’s a nearly 20% increase in the suicide rate — and it also does not include additional folks below. I’m not sure about the total math/percentage increase (math has never been my strong suit, and I’m short on time), but 143 is more suicide casualties than 128.

It marked the first time the Army rate has exceeded the national suicide rate for the corresponding population group — 19.5 per 100,000 — since the Pentagon began systematically tracking suicides nearly 30 years ago.The 2008 figure does not include 15 additional deaths under investigation that officials suspect were suicides.

Also Thursday, Marine Corps officials revised their suicide numbers upward, reporting a rate of 19.0 per 100,000 in 2008, the highest for the Marines since 1995.

“Why do the numbers keep going up? We cannot tell you,” Army Secretary Pete Geren said.

Army officials believe that contributing factors include emotional and psychological stress caused by repeated combat deployments, along with the toll that the tours have taken on marriages.

Despite official reticence on this, there are a whole lot of people who can add insight into how and why suicide can go hand-in-hand with traumatic brain injury. I found this presentation on Suicide Attempts Following Traumatic Brain Injury that helps shed light on things.

I think that a wide array of issues play into this — the times we live in, when a state of war is pretty much constant (be it on battlefields abroad or at home, where the War On Terror is inescapable), so much intense pressure is placed on military personnel whose service is more needed/desired/required than ever before (and on so many more levels), and there is far less social and cultural support for our walking wounded, once they return home. The fact that soldiers are being deployed out of reserve ranks — not career military — complicates things, too, I believe. Plus, our whole society’s treatment of our soldiers is a recipe for disaster — on the one hand, those who serve are given no choice but to go, often leaving dependent families behind, but the society which requires their unquestioning service insists on preying on those left behind. Banks foreclose on soldiers’ homes. Employers refuse to allow families and loved ones any leeway in seeing these soldiers — I used to work with a woman who quit a job she needed because her employer wouldn’t give her a few days off to spend with her son who was being redeployed to Iraq. And once our service members return, they are all too often NOT given proper care by those charged with their well-being, and they are returned to an ignorant, self-absorbed society which doesn’t understand their injuries, their needs, their unique circumstances — all created in the name of protecting the very ignorant, self-obsessed society that treats them like crap.

And adding insult to injury, the wounds that many of our soldiers sustain are hidden from the rest of the world — TBI & PTSD — or are considered signs of “bad behavior” or “poor discipline”, rather than bona fide injuries with real physical and mental health consequences. So, rather than being able to find help, these folks — and their families, who may or may not know about TBI and how it can and does affect them — are marginalized even more from society, forced to fend for themselves in our “information society” with injuries that A) keep them from participating fully, B) keep them from realizing the extent of their difficulties, and C) keep them from reaching out effectively to get the help they need.

The truly frightening thing — as if all this isn’t horrifying enough — is that their problems will ultimately become all of society’s problems, sooner or later. As though it weren’t bad enough that our men and women in uniform are being severely injured in ways that prevent them from accessing help, but their injuries over the long term can morph and evolve and become far more serious and far more intractable than they might be, if they were able to get help up front. And that has ramifications for their families, their employers, their communities, law enforcement, public services… really, anyone who has anything to do with them if/when they’re having bad days on down the line. And some lobbyist-compromised politician in Washington will propose harsher, longer, more draconian laws and prison terms as a “solution” to all these “bad people” who “can’t control themselves”.

Of course (and I’m being sarcastic now), this is all very well and good for the prison industry, which can hire out inmates to corporations that need cheap labor. In the absence of illegal aliens and people willing to work under the table and cheap offshore personnel, there could eventually be an abundance of prison-based workers whose labor is available for pennies on the dollar, all within the borders of these United States.

Okay, I’ve stopped being sarcastic. For those who are concerned about the possibility of a loved one who’s sustained a TBI and PTSD during deployment, there is a lot of help available out there online that you can access for free. There are lots of websites that talk about TBI, there is a lot of information to read. There are videos on You Tube you can watch. And there are online forums for vets and their families where you can turn for support.

You do not need to suffer alone. There are many, many people — military and otherwise (I’m not military) — who have lots of life experience with TBI and dealing with it constructively. You don’t have to be at the mercy of the VA or officials who aren’t able to be forthcoming with the facts and details about TBI (and PTSD) and how they affect people’s lives. So, reach out. Speak up. Participate and contribute. We cannot change the injuries we’ve sustained, but we need not suffer in isolation. We may not be able to 100% cure our conditions, but in some way or another, we can heal.

God bless.


Blast overpressure is generated from the firing of weapons and may cause brain injury

InteBIC has a post on how Blast overpressure is generated from the firing of weapons and may cause brain injury.

Text from a press release from University of Gothenburg in Sweden, which publicized the findings is below:

The brain may be injured by the noise, which is produced when, for example, an anti-tank weapon (Bazooka, Karl Gustav) or a howitzer (Haubits) is fired. Scientists at the Sahlgrenska Academy demonstrated mild injury to brain tissue. In response to this, the Swedish Armed Forces restricted the number of rounds per day Swedish personnel can be exposed to.

A number of reports, which have appeared during the last few years, have shown that the brain is sensitive to blast. This study determines whether the occupational standards for the highest levels of blast exposure were valid enough to avoid brain injuries. Traumatic brain injury is very common among war veterans from Iraq and Afghanistan and the majority has been exposed to explosions. The soldiers have symptoms of disorders of memory, mental processes, emotion, sleep, speech, vision and hearing. The symptoms may be similar to those of post traumatic stress syndrome, which may be caused by factors other than combat experience.

The Swedish Armed Forces sponsored a study, which has been carried out by scientists at the Sahlgrenska Academy, University of Gothenburg, Sweden. They have examined the effects of noise after the firing of a Haubits, an anti tank weapon (Karl Gustav) and an automatic rifle and by the detonation of plastic explosives underwater. The study was done on anaesthetized pigs and rats.

“We examined the maximal peak level of the blast in the brain transmitted from the blast in the air, as well as, brain tissue changes that were detected with the microscope, says Annette Säljö, one of the scientists who conducted the study.

The noise produced by the firing of both the haubits and the anti-tank weapon exceeds the occupational standards for highest levels of blast exposure. The scientists found that the maximal peak levels of the blast were unexpectedly high in the brain, i.e. that skin and bone appeared to protect the brain poorly. The results suggest that the degree of transmission of a pressure wave from air or water to the brain depends on the dominating frequencies in the frequency spectrum of the noise; low frequencies are transmitted considerably better than high frequencies.

The microscopic examination of the brain showed that the blast from certain weapons produces small haemorrhages (bleeding) in the brain tissue and the meninges (lining of the brain). The examination also suggested that blast exposure leads to the development of brain edema, i.e. increased fluid content. The scientists were later able to support this finding with other measurements. The results are in agreement with findings in the brains of soldiers who had been injured or died after being exposed to explosions in wars, from WW1 to the war in Iraq.

In summary, the study shows that the maximal peak levels of blast generated by the firing of certain weapons led to a small but measurable effect on the brains of pigs and rats.

The study also showed that this effect on the brain becomes worse with increasing maximal peak blast levels. The results poses the question as to whether exposure to even lower levels of blast than previous thought injurious might be contributing to the large numbers of mild traumatic brain injuries in American military personnel.

“This is of course an occupational question for Swedish Armed Forces. In light of the results of the study, the Swedish military has instituted restrictions in the number of firing rounds a person is allowed to be exposed to in a single day”, says Annette Säljö.

Direct studies on humans are difficult to perform, since biomarkers of injury in cerebrospinal fluid or blood and imaging studies such as computed tomography (CT) and magnetic resonance imaging (MRI) do not appear to be specific or sensitive enough to detect mild brain injury.

This being the case, I’m inclined to wonder if TBI is the signature wound of only the recent Iraq and Afghanistan wars, or if it’s been a hidden wound and disability that’s never gotten proper attention in wider society, once soldiers got home.

Big guns and explosions have been hallmarks of war for a lot longer than the past 10 years, and I suspect that a number of social ills that plague us today can be traced back to brain injuries sustained in military service (and in other areas), which were never recognized or addressed, and which continued to cause problems for veterans after their return home.

I think, perhaps, the prevalence of domestic violence, crime, drug and alcohol addiction, and a whole host of other extreme cognitive and behavioral problems in the general populace may have some (tho’ not all) origin in head injuries sustained in earlier generations.

I have been personally impacted a number of times, by what I believe were head injuries sustained in wartime by earlier generations. The father of a dear friend of mine made his family’s life a living hell, with drugs and alcohol and violence and all sorts of intepersonal issues he never got help for, after having done several tours in WWII, having been injured several times, patched up and shipped back to the front. His father was a WWI veteran, too. From what I heard about them both, they exhibited a lot of the symptoms that go with TBI.

Another friend of mine had a father who was also a WWII vet, and while he wasn’t nearly as extreme as the other man, he still showed a great many signs of having sustained TBI(s) during his tour of duty.

At the risk of drastically oversimplifying a complex chain of events and trivializing the mysteries of authentic human experience, consider this scenario:

Dad marches off to war, is exposed to multiple blasts and head traumas in the line of duty, returns home to his family, starts having interpersonal trouble, gets in trouble with the law, drinks heavily, hits his wife and kids (who may also sustain brain injuries from his violence), and has a history of interpersonal and vocational problems throughout the course of his life. His children, who sustained mild traumatic brain injuries from his beatings, get into trouble, get into fights, get hit on the head more, have continued cognitive/behavioral/emotional problems, and end up either in jail or in problematic relationships or in a string of ill-fated jobs, or all of the above. For some of them, the only place they can really turn for structure and dependability is the military, which is particularly well-suited to providing a hospitable environment to wounded warriors.

One generation after another reaps what the prior generation sowed. And the cycle continues.

I’m not saying it’s always so, just that it might just be possible. War and TBI — even if you never get hit by a blast, but man a big gun — go hand in hand, as far as I’m concerned.

As if life itself isn’t rough enough on us, our repeated military conflicts and the scores of wounded warriors returning, in virtually every American generation, seems to provide a steady stream of head-injured individuals who are then expected to just fit back into society. But it doesn’t work. Not without help.

And these days, especially, we need to come up with new ways of helping. Because the old social institutions of church and lifelong jobs with the same employer and morality codes and common social standards, which used to provide a predictable set of rules for what is right and what is not — and hence helped individuals who had issues figure out where they were in the world — are pretty much gone. Or they don’t have the same validity they once did. I believe that the old institutions actually did us some good, in that they made it possible for people like me to function adequately in the world.

There’s a reason I gravitate to working for large, well-established corporations — they give me the structure and social framework within which I can work productively and know my place. Working for little companies doesn’t help me. It unsettles me and makes me very unsure of myself. And being raised with a strong religious influence and a strict moral code made it possible for me to participate in life as a person who “knew” the difference between right and wrong. Because it was drilled into my broken brain, till I didn’t need to think about it anymore.

Speaking of work, I’ve got to get going to my job, right now, but I did want to post this piece of information about the weapons impact on brains.

It’s important.

An Army of Lost Souls

Great post over here — talking about Veterans’ issues, specifically PTSD.

It’s incredibly troubling to me, that so many veterans are lost between the cracks, and that so many are returning from the wars we have going on in Iraq and Afghanistan, with serious, life-altering injuries that are not only invisible to the rest of the world (until they show up in their behavior and changed abilities), but may also be invisible to them, depending on how aware they are about their TBI(s) and how they deal with it.

The VA may intend to help our veterans, and our society may in fact have promised to provide lifelong healthcare to them, but the complexities of not only PTSD but also TBI, and the fact that they can so often co-incide, doesn’t make me very hopeful about the prospect of this happening with nearly as much effectiveness as it should.

In the absence of adequate medical care (which suffers not only from beurocratic red tape, politics and organizational inefficiencies, but also from the criminal dearth of information about these very-common conditions — I mean, come on people, folks have been getting royally screwed up by war and smashed in the head for as long as there has been armed conflict!), I think that we as a society need to come up with some better ways of dealing with this.

One way that I can think of, is the blogosphere. The internet. Say what you will about “egocentric amateur bloggers with nothing better to do than blog, and no professional reportage qualifications to speak of”, but we’re actually the ones who are making valuable, pragmatic, experience-based information we possess available to others in need of help. And we’re offering it for free, without requiring an appointment set or a referral from a primary care physician or specific insurance coverage. We have the most precious thing(s) to offer to someone in despearte need — information, experience, and proof that someone can — and does — survive terrible things. We’re laying our personal experience, strengths, hopes, fears, realities, coping mechanisms, out there in full view for all to see, and we’re doing it not only out of ego, but from a genuine desire to help others. And anyone who knows how to find us — at the local library, on their work computer, on their home laptop — can access what we have to give.

It’s Sunday, which in the world where I was raised, it’s a day of rest. And I will rest soon. But for now, I’ll perform an act of service and put links to search results for tbi and ptsd-related blog posts in the left margin of this blog.

It’s the least I can do for the folks who sacrificed their very brains for our nation — as well as anyone else who needs to find help.

More attention for the invisible disability – TBI

Over at New York Brain Injury Lawyers, there’s a great post, Brain Injury The Invisible Disability

I’ve copied and pasted a fair amount of the post here (their content is indented), and I’m going to add my editorial commentary to it, as well.

Brain injuries can affect people’s compulsive nature and decision-making skills. It is a very sensitive area of personal injury law and quite rightly so. Brain injury varies greatly from person to person because each person’s injury allows for differing affects due to the location of the damage.

I love it that they start out on this note. It’s interesting how, of all the people who talk about brain injury, the people who seem to be the most sensitive to the issues and complexities are attorneys. Lawyers tend to get a bad rap, but in the big wide world of brain injury blogging and generally available information, I’ve found their sites/blogs to be some of the most helpful. Indeed, some of the most reliable and insightful and encompassing (as in, approaching the complexities of the situation without succumbing to the temptation to oversimplify) pieces of truly useful information (at least, for me) have come from lawyers. So, my hats are off to them — the ones who use their powers for good instead of evil, of course 😉

A traumatic brain injury is potentially one the most devastating disabilities. It not only affects the person suffering from the injury but can turn whole families upside down.

Amen to that. TBI does turn families upside down. It sneaks into the most secret and obscure places of one’s life, and it not only causes the affected brain to do and say things it wouldn’t normally say, but it often masks its effects by blinding the TBI survivor to the true nature of their words and deeds. I cannot stress this enough. We live in a society that lusts after self-determination and stigmatizes anyone who “can’t help themself” from doing or saying bad/inappropriate/embarrassing things. Our society is founded upon the idea that everyone has the ability to make themself and their world over in exactly the fashion they please. But though this may hold largely true, sometimes other factors come into play that are beyond our control. And that includes brain injury.

The range and severity of problems arising from a brain injury will vary significantly from person to person because every person’s brain injury varies in the extent and location of the damage. Some of the affects of a brain injury are not immediately obvious and only become apparent as time progresses.

Again, good information. It is so true that the range and severity can and will vary from person to person. No two bodies are alike, and no two brains are alike. It’s just impossible for them to be identical, as they are shaped by events and circumstances and body chemistry in unique and individual ways. So, the range of our injuries will vary… and the severity of our problems will, too. After all, the severity of our issues depend on not only the scope and nature of our injury, but also upon our own personality makeup — how we respond to different circumstances — as well as environmental factors. Things like jobs that allow us little flexibility in our daily schedule, financial difficulties that add stress to our experience, living environments that are intolerant of our shortcomings, and any number of other factors like the food we eat and the amount of sleep we get, can and will affect the degree to which we are impacted.

What’s more, some affects are not immediately obvious… subtle changes in mood, shifts in attentional ability, our cognitive capacity, our processing speed… these things aren’t always immediately detectable to the outside observer. What’s more, changes can take place over the course of one’s life, due to hormonal fluctuations and body chemistry changes.  The brain changes with age, just as the body does, and events like puberty and menopause (male and female), which alter the body’s hormonal makeup, can cause brain changes, as well, which can cause issues to arise that weren’t there before. If the part of the brain that is affected by a certain hormone was injured, and a scar develops, but that hormone remains relatively stable in the body over the course of one’s adult life… then it starts to fluctuate later in life, it could trigger some unexpected activities.

The following are pointers to look out for in a persons make-up if you feel they may be suffering from a brain injury after a nasty knock or have suffered a serious injury.

Note from BB: Keep in mind that even a “mild” brain injury, such as a hard bump or sudden impact or “whiplash” from a car accident (or even head-banging at a rock concert) can cause shearing of the connectors in the brain/brainstem, which can have the following affects. One of the biggest misconceptions about traumatic brain injury, is that it would have to be an open wound or something really dramatic, like losing concsciousness for hours or going into a coma, to cause problems. Trust me, you don’t have to teeter on the brink of destruction to be severely impacted by brain injury.

Cognitive changes
A brain injury can cause cognitive changes which affect the individual’s ability to learn new things, to work and to be able to interact socially.

So true! Some examples of this, from my own experience, are:

  • I have a hard time learning new things from books, because my short-term working memory has been compromised. If I’m reading something that’s new, and I divert my attention from it for even as short as a few seconds, I can completely lose the new information — and have to go back and start from scratch again.
  • I also have difficulty with sustained attention — I just can’t study the way I used to. I used to be able to study for hours and hours, and at the end of a long weekend of non-stop reading, I would have a new treasure trove of information to work with. Now, I’m lucky if I can last an hour with my reading.
  • I have difficulties at work, because I get so tired and I tend to space out when I’m fatigued. I find myself, sometimes, just sitting in front of my computer, staring at nothing in particular, or surfing around just for the sake of relieving my over-taxed brain. It’s not productive, but it’s unconscious, and I’m usually not aware I’m doing it, till I’ve done it for a while.
  • Social interaction is a tough one for me, because I have difficulties following people’s conversations at times, and I feel really self-conscious. I also get tired, being around people, and I find I cannot go into places I used to go fairly freely before 2004 — crowds have always distressed me somewhat, but since my fall in 2004, I’m even less tolerant of the noise and hubbub. Also, I have found myself isolating a lot more, over the past few years, and I’ve had trouble managing my emotions and words in social situations, which makes me even less inclined to venture forth.

Lack of insight
Individuals with a brain injury can have great difficulty seeing and accepting changes to their thinking and behaviour. The individual may deny the effects of the injury and have unreasonable expectations about what they are able to do.

I’ll say. Immediately after my 2004 fall, when my job had fallen apart, and I was in the process of quickly depleting my $250,000+ nest egg, I decided I was going to become a financial planner. Talk about a lack of insight! Not only did I not see that I was having an impossible time completing the self-paced work-at-home coursework — in 18 months, I managed to complete only 1-1/2 of the 6 courses, and I got a C on the one I did complete, which is totally out of character for me! But I also was oblivious to the fact that I was mismanaging my own funds so badly that I was quickly running out of money, when I could/should have been making money on it (after I prematurely cashed out of my shares — I walked away with $143,000 instead of the $700,000 I could have had, if I’d just managed to hang in with that job another 18 months — 18 months!!! — I put the money in my checking account that earned no interest and was open-season for my spending). I was doing a piss-poor job of managing my own money and planning what to do with it. What in the world made me think I could be a financial advisor/planner for anyone else? That’s easy — classic p0st-TBI lack of insight. Sheesh!

Memory problems
There may be problems in remembering people’s names, passing on messages, or recalling details read in a book or a newspaper. They may forget what they are doing from one session to the next. Memory problems may cause the individual great difficulties in learning new things.

Oh, please, don’t even get me started on this. If I don’t write down something in the moment, I might as well wave good-bye to it. I am, this very morning, trying to catch up with things I forgot to do over the past three days. If I lived alone or I was with someone who was less interactive and invested in keeping me on track, I would be lost. And quite possibly homeless and jobless, as well.

Poor concentration
A very common outcome is an inability to concentrate and to become easily distracted from what they are doing. This is usually because they are having difficulty concentrating.

Yes, yes, yes. My concentration comes in fits and starts. I found, right after my fall down the stairs in 2004, that I couldn’t concentrate to save my life. I was just flitting from one thing to the next, and I was utterly unable to learn the new skills I needed, in order to keep my job. Of course, I had no idea that I had been brain injured at the time, so I told myself — and everyone else — that I had chosen not to learn the things I needed to learn. I didn’t want to/couldn’t admit (or even see) that it wasn’t that I’d chosen to dig my heels in… I literally couldn’t. Because my concentration was totally shot.

Slowed responses
An individual with a brain injury may now be slower to answer questions or to perform tasks and may have difficulty in keeping up in conversations. Their capacity to respond quickly in an emergency may also be diminished.

Yeah, this is a problem. And it can be pretty scary, too, when you’re in an emergency situation. This has impacted me a number of times.  A couple of  times over the past ten years, in fact, I have had to help friends who were having strokes, but both times, I couldn’t seem to put two and two together. I couldn’t seem to figure out what was going on, and it’s lucky for them that there was someone else there, in both instances, who could see what was happening and come up with an appropriate response. The feeling of being turned around and not being able to respond quickly in such a life-threatening situation is scary enough at the time, but afterwards, it can really haunt you. It’s certainly haunted me. In fact, my inability to respond to a number of emergency situations — some of them life-threatening — was one of the things that “raised a red flag” with me and told me something was just not right with how my brain was working.

Responding to questions and keeping up with conversations is very important when you’re dealing with authority figures and law enforcement, I have found. One of my recurring issues with regard to my TBI is run-ins with the police that nearly went sour, just because I wasn’t following what the officer was saying to me. You have to understand, I’m a very law-abiding citizen. I believe the law is what makes our society livable, and I make every effort to obey it. So when I mess up, go faster than I should, miss a stop sign, or take a left turn too closely, and I get pulled over, I am genuinely confused, because I certainly did not intend to screw up. And my confusion makes it harder for me to focus on the situation, as well as follow the officer’s directions. I have nearly gotten into physical confrontations with cops because of my confusion and frustration and short fuse. I knew better, but my brain failed me at the time when I needed it most. This is probably one of the suckiest things about having a brain injury (or, in my case, several) — it keeps me from being the kind of person I desperately want to be, and from living the kind of life I am determined to live.

On the less dramatic side, with regard to being slower to respond to questions and finish tasks, it can take me forever to get my head around things I’m being asked. That drives my family nuts, and I have a tendency to try to cover up my cluelessness and slowness, so I don’t piss them off. But when I really want to get something, I’ll make them slow down. I also have to be ready to remind them that I am a bit slower than they expect, and they need to not get so upset with me about not following as quickly. Sometimes, they yell at me because I’m “being difficult” when I’m just a lot slower than I’d like to be.

I also often have trouble keeping up with conversations. I can’t tell you how many times people have started talking to me, and I haven’t had a clue what they were saying… for about a minute into the conversation. I tend to have to replay conversations later on, to see if I got what just happened. Socially, I’m fortunate that I have a lot of really gregarious friends who do most of the talking. I just sit back and let them do most of the “work” — and they’re fine with that. Either that, or when I’m in a conversation with someone that I’m just not following, I’ll actually just echo back what they’re saying without fully understanding what they’re talking about. I will appear to agree with them (which they like), but I’m actually just rephrasing what they’re saying. This makes me very popular (people like to be mirrored and they love it when other people agree with them!) but it doesn’t do much for my own sense of self.

Individuals with a brain injury might have difficulty solving problems and planning and organising things they have to do. They may encounter trouble with open-ended decision-making and complex tasks need to be broken down into a step-by-step fashion.

Oh yes… breaking things down. Can I tell you, my life is filled with detailed step-by-step instructions about how to do the simplest things. When I need to organize my busy day, I fill my planner with the different things I’ll need to do, in the order that they need to be done, and I walk through them in precisely that order. I cannot tolerate changes in routine — it makes me nuts and freaks me out. I desperately need predictability and routine, because backing up and re-configuring my day is a recipe for disaster.

Individuals may also have a very low tolerance for frustration and can become easily agitated and may lose their temper quickly.

Yes, yes , yes. Never forget that fatigue factor. Being tired not only makes it harder to think, but it makes it harder to manage emotions and modulate your expression. The thing with me is, too, that my TBIs have made me look more impassive and stoic on the outside than I feel on the inside. So, I may be seething with frustration on the inside, but I look perfectly fine on the outside, so people around me cannot judge my level of frustration — until I blow up.

Another thing that ‘stokes my fires’ is the pain that I’m often in. I have a lot of pain in my body that isn’t helped by drugs or much of anything other than rest. When I’m fatigued, I’m often in extreme pain, which just adds to my irritation level.

Irritation is a huge problem — for me as well as others, because I never, ever want to hurt the people I love, but my irritability gets the better of me all too often. And I have to live with myself afterwards.

Socially inappropriate behaviour
People with a brain injury may no longer know how to act or behave in in social situations. This can be incredibly difficult for families to understand and cope with, particularly as they may no longer recognise their loved ones and not understand their behaviour.

I have screwed up social situations so often, that now I just tend to keep to myself and I don’t respond unless others address me first. Some of the many things I’ve done that have landed me in hot water are:

  • Talking too loud about sensitive issues
  • Forgetting that I promised to keep a secret, and telling the world — in front of the person to whom I promised I wouldn’t tell
  • Behaving in ways that women felt were too familiar or encroaching or sexually intimidating
  • Behaving in ways that men (including security guards and police officers) considered threatening, and triggered an aggressive response from them
  • Coming across like I was making fun of or deliberately embarrassing family members

I really, really hate this aspect of TBI, especially, and it makes it easier for me to just keep to myself. It’s tough, because I want to be social — who doesn’t? But I do it so poorly, at times, that I feel it’s my responsibility to shield others from my ineptitude.

A wide range of social skills may be affected by an a traumatic brain injury including the ability to have conversations, to interpret and respond to social cues, to show interest in others, to use humour appropriately, and to regulate the volume and tone of voice.

Uh, yah. See above for how my TBI affects communication issues. I generally don’t initiate conversations, and I’m terrible at sustaining them. Good thing I live with very social people who can run interference for me. I usually don’t stray far from them, as I tend to get into trouble with people, when I try to initiate and sustain conversations. At times, I just don’t know what to say. I’m like a little lump of clay that isn’t able to create impressions on others, but can be impressed upon by others. I generally stick with just responding to people’s cues, but even then, I’m often totally lost, and I simply don’t follow. I also am often strangely devoid of interest in other people. Oh, certainly, on a grand cosmic scale, I do care a great deal about what others experience/think/feel, but personally, in my injured brain, part of me just doesn’t care. I want to care (I think), but I just don’t. I’m sorry, world. I just don’t.

I also don’t always use humor appropriately. I usually think I do, but then I find out from others that I don’t. Heaven help me — and everyone around me, who has to put up with my sense of humor when I’m tired.

Regulating my tone of voice is a constant challenge, which is another reason I keep quiet so much. I often use the exact wrong tone – I’m too loud in quiet situations, or too quiet when I’m talking about important things… I sound angry when I’m just riled up… I sound deadpan/stoic when I’m really worked up. In some cases, people I live with have been very afraid of me because my tone was a lot more intense and sounded “hateful” and aggressive, when I was just having a lot of trouble articulating, and I was scared half to death over something. I’m hoping that my family members will learn that my tone doesn’t always match my inner reality, and cut me some slack.

Depression in an individual with brain injury is a very common emotional consequence that usually comes some time after the injury. Signs of depression include lack of motivation, loss of sexual drive, sleep disturbance and tearfulness.

Okay, here’s one of my pet peeves — interpreting neurological processes with emotional ones. Lack of motivation is not necessarily depression-related, nor is loss of sexual drive, sleep disturbance, or tearfulness. There are a host of neurological reasons why all these can occur, and the fact that they’re commonly lumped together under “depression” tells me that there are probably a lot of people walking around with neurological issues that could be possibly addressed with occupational therapy or other coping mechanisms, but they’re being medicated, instead.

Unraveling neurological issues from psychological ones is in the Top Ten Things I Hope to Promote in This Blog. Calling our neurological, TBI-related issues “psychological” ones and addressing them with drugs just empowers the pharmaceutical companies, not the people who have to live their lives. Don’t get me wrong — I have nothing against a quality pharmaceutical solution. But too often pills are pushed as a solution, when they just add to a problem — like Prozac making certain people suicidal.

Mis-diagnosing neurologica/TBI-related issues as psychological ones and inappropriately medicating patients actually works against the pharma companies, as well. It makes them suspect, when the real culprits are lazy/mis-informed/biased/idiotic psychiatrists/therapists/doctors and it prevents good science and good medicine and good psychotherapy. I want good pharmaceuticals as much as the next one — but I want their power used properly and for good, instead of lazy-assed evil.

There are multiple sources of head and neck pain, both inside and outside the head. Headaches arising from a brain injury can be caused by a number of reasons.

When don’t I have a headache? Rarely. Of course, one of the neuros I’ve seen over the last year tells me they’re stress related, and if I just relax and exercise more, they’ll go away. Hasn’t worked so far… Hasn’t ever worked.

Visual problems
Vision and visual functioning is often adversely affected by brain injury. Some of the more common visual systems problems include double vision, rapid eye movement and near-sightedness.

Can’t speak to this much, aside from rapid eye movements I sometimes get when I’m overtired.

Hearing problems
Hearing problems can occur for a number of reasons, particularly when the inner ear and/or temporal lobes have been damaged.

And let’s not forget tinnitis — that constant ringing in the ears. True, it can be more neurological than auditory, but it’s hearing-related. For the record, I have — and always have had — constant ringing in my ears. Sometimes it’s louder than others, but it’s always friggin’ there.  It used to drive me nuts when I was a teenager, but I have since acclimated to it. Now I use it as a barometer of my physical condition — louder means I’m having issues of some kind — stress or fatigue or what-not. It’s actually a useful gauge of my physical well-being. Provided I can tolerate the constant high-pitched whine.

A traumatic brain injury is often called the invisible disability. As there are frequently no outward physical signs of a disability, effects such as fatigue, lack of initiation, anger, mood swings and egocentricity may be seen simply as bad personality traits by others. It is easy to see why a traumatic brain injury can be such a devastating disability, especially when the disability is not obvious to others.

Indeed. In fact TBI is often a double-hidden disability, as it’s so often hidden from the survivor, themself. It’s a real conundrum, let me tell you. Society has so many biases against behaviors and problems that can come with TBI, it can be all but impossible to get people to consider you injured, rather than bad. The real challenge, from where I’m sitting, is learning to detect and live with my own disabilities, find my strengths, and ultimately, finding peace in myself, no matter what the rest of the world has to say.

And if I can get through the day without doing any harm, so much the better.

TBI can be a devastating experience, both during and after — in the short and long-term. But if you can get past the trauma of it and learn to deal with it substantively, it doesn’t have to ruin your life. And the pieces that have been broken, can sometimes be put back together again. Ultimately, the brain is a fascinating phenomenon. We all have one. And the challenge — for us all, at this time — seems to be learning how to use it properly.

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A Perilous Relief – Risks I Took that I Barely Escaped

I believe that smart risk-taking should be a learned skill. Danger-seeking may come naturally, early on in life, but it needs to be properly learned, in order to be survivable. History is full of examples of people who either could not or would not learn how to survive their own need for stimulation. Fighter pilots, rock climbers, base jumpers, extreme skiers, stuntmen… and more.

I’ve teetered on the edge myself, and there have been a number of times I came close to being harmed, but miraculously managed to elude disaster. Sometimes it was dumb luck that I got out in one piece, while other times it was the learning from my past experiences that I had to thank for my continued existence.

Social Danger-Seeking

I have always been an assertive, even aggressive, individual, and as a young kid, I had a tendency to engage strangers in conversation and provoke them. I relished the experience of challenging someone to a duel of wits or interacting with people who (I thought) were up to no good. I was a bit of a crusader, when I was a kid, and I had all the best of intentions. The problem was, I usually lacked the ability to successfully negotiate the entire social transaction, and there were a lot of arguments I started but couldn’t finish — or that ended in me being attacked or threatened in some way. Many of them I managed to get out of… barely.

When I was about nine years old, while walking to school, a (female) schoolmate and I were once chased by young (high-school aged) men who drove by in a car. I yelled out to them and baited them, itching for a fight (okay, I wasn’t the brightest kid at times, clearly), and when they pulled the car over and started coming after my schoolmate and me, we were barely able to elude them by hiding in the underbrush. I endangered both myself and my schoolmate, who could have been seriously injured (including raped), as a result of my brash behavior. We both escaped, but I believe the girl’s mother refused to let her walk to school with me, after that. I still feel terrible about the role I played in that scenario.

Throughout my grade school years, I had numerous run-ins with other kids who were bigger and stronger and angrier than I, running my big mouth and pushing limits of our social dynamics, till they struck out at me. On several occasions, my provocation was enough to get me physically attacked, or ganged up on and bullied for an entire year of school. The summer after 6th grade, I chose the wrong kid to take on — they were a year ahead of me in school and they had a lot of friends who were as angry and as aggressive as they — and I spent my whole 7th grade year hiding from this gang with a long and vengeful memory. I didn’t get beaten up, but part of me wishes I had, so they could have gotten their aggression out of their systems. That bullying seriously impeded my social progress for years to come. If I’d only kept my mouth shut, that hot summer day in 1977.

  • At Risk: Personal safety
  • Dangers: Interpersonal strife, Attack/assault
  • Rewards: Heightened sense of self, thrills, sense of adventure
  • Outcome(s): Quarrels and altercations, social “near misses”, Narrow escape from possible assault

A few years later, as a rebellious teenager, I was also a trouble-maker who drank and smoked and challenged authority for no better reason other than to do it. I sold drugs out of my high school locker, I bought and sold liquor out of the trunks of cars, and I brazenly tucked my pack of cigarettes in the sleeve pocket of my winter coat, not caring who saw — even my coaches and teachers. I sneaked beer into school, in my gym bag and drank it in the bathroom before first period. I drank — and drove drunk — on back roads, and I ran with a pretty rough crowd of drug dealers, thieves, and felons-to-be. I was never in trouble with the law, however, and I eluded detection for the most part. The times when I was detected by authorities, I got off with a warning. I’m frankly amazed, at times, that I didn’t end up in juvie hall, for all the crap I pulled off. I think the fact that my parents were respectable, church-going members of their segment of society got me off the hook, and a lot of adults around me weren’t looking at me very closely, because — as a “brain” — they were more concerned with my oddly substandard grades than my social/behavior problems, and they didn’t want me to have a record. But if someone had just looked a little more closely, they would have found a lot of misdemeanors and actual felonies I was committing without so much as a moment of hesitation.

  • At Risk: Social standing, reputation, relationship with authority figures, health, well-being, future prospects, academic performance, personal and interpersonal maturation
  • Dangers: Trouble with authorities, worsening reputation, legal action (arrest), physical harm from dangerous associates
  • Rewards: Thrills, sense of adventure, financial reward, social reward (from socially marginal associates and “customers”), relief from social pressure to conform, defiant independence, self-assertion
  • Outcome(s): Drinking problems, reduced academic performance, social alienation, health problems, poor relations with authority figures

When I was a junior in college, I went to Europe for a semester abroad. I purchased a one-way ticket to Switzerland and borrowed $1,000 from a family member, not having any idea how I was going to make ends meet in Europe… or even pay for my way home. While overseas in the European Union (where non-EU residents are effectively barred from ‘taking jobs from Europeans’), I managed to land a job working for an American expatriate, and although I was really struggling with getting along there, I stayed on and turned a semester into a multi-year stay. I never managed to complete my college degree, but I got an unparalleled education in living an independent life.

  • At Risk: Personal safety, future professional prospects
  • Dangers: Personal harm, financial difficulties
  • Rewards: Sense of accomplishment, self-esteem, improved professional outlook, lots of great stories, good life experience
  • Outcome(s): Several years overseas, unique take on life thanks to my time abroad

These are just a few examples of how I’ve courted danger, socially, throughout my childhood and young adulthood. There were a lot more instances than that, but the bottom line is, I have a lifelong history of taking social risks.

Physical Danger-Seeking

I also took physical risks, when I was younger. As a teenager, I was a tree climber, and I often climbed well above where it was safe to go. I well remember the sensation of climbing 50 feet up, into the uppermost branches, which sagged and swayed beneath me, creaking and threatening to break beneath me. I persisted in climbing higher, even when my heart was in my throat and my pulse was pounding and my head knew it was not safe to go any further up. I only fell once; after that, I stopped climbing trees. Lesson learned.

  • At Risk: Physical safety and well-being
  • Dangers: Falling from great heights, being injured while alone in the woods
  • Rewards: Sense of adventure, ability to remove myself from the rest of the world, sense of accomplishment, self-esteem
  • Outcome(s): Solitude and solace, minor injury

Interestingly, at the same time that I was acting out with drugs and alcohol and challenging authority as a teenager, I was also a medal-winning athlete who was a team captain on several sports, and I lettered each season in my chosen area. In my quest for excellence, I routinely pushed the limits of my physical endurance and really punished my body, driving it relentlessly beyond its capabilities. I played injured, time and again, and even when I got hit hard and was slow getting up — in retrospect, I now understand that I sustained multiple concussions throughout my high school sports activities — I was back in the game, keeping on keeping on. All that mattered, was the game.

  • At Risk: Health and safety, physical well-begin
  • Dangers: Injuries, concussions, mild TBI
  • Rewards: Social approval, team membership, medals and ribbons, heightened social status, sense of accomplishment, self-esteem
  • Outcome(s): Longstanding health concerns due to injuries, acquired tendency to ignore warning messages from my injured body and “play injured” in other aspects of life

When I was sixteen, while traveling with my family across the country, after a whole day in the car, I got out and literally sat on the edge of the Grand Canyon, with nothing other than my sense of balance keeping me from plunging hundreds of yards down to a rocky death. After being in that close space with all my siblings, rolling across the countryside with no break, no respite, no escape from the noise and din of my family, I was so out of it, so stir-crazy, so aching for a little fresh air, I actually literally sat on the edge of an abyss. I didn’t even realize what I was doing, until a little while had passed, my head had cleared, and I’d gotten enough of an adrenaline “pump” to realize where I was. It really made no sense for me to do that — I am mortally afraid of heights, including precipitous drops to a canyon floor hundreds of yards below. But I needed that little while, perched on the verge of my own destruction, to bring me back to my senses. Once I had them back, and I realized where I was,  I got up very slowly, I can tell you.

  • At Risk: Physical safety
  • Dangers: Plunging to my death in the Grand Canyon
  • Rewards: Relief from being cooped up in a loud vehicle, getting away from everyone (who didn’t dare come near the edge)
  • Outcome(s): Cleared my head… but also realized I was perched on the brink of an abyss

A Perilous Relief – Table of Contents

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Throwing nuts at the cheetah

I had a really troubling dream just before I woke up this morning.

I was walking through the woods with two friends of mine. It was almost like a jungle or rain forest – the air was very humid and the trees were huge and spaced apart, and the forest floor was quite open — not a lot of underbrush, but springy underfoot. We were walking along a wide path that was well-worn, and we were talking about this and that. I believe we were discussing possible dangers from big cats that had been seen in the area.

If I remember correctly, the woods had been cleared of all dangerous wild animals a while back, but some big animals had escaped and had returned to their habitat, so hikers were warned to be very careful and not engage them.

We walked and talked for a while, and I was picking up stones and nuts and old pieces of tropical fruit that had fallen from the trees. I was tossing them around, and my friends were getting irritated with me. They wanted me to stop, but I didn’t feel like talking with them. They were just running at the mouth, and I was getting overwhelmed with all the words.

We were passing by an open clearing that was raised up above the path, when we looked up and saw a cheetah sitting in the sunlight. It was a beautiful animal, so sleek and strong. It also looked very dangerous and wild. My friends said we should walk by it slowly and not bother it. They were both terrified of it.

I was thinking that I knew how to deal with a big cat. I’ve learned (for real, not only in the dream) that with big cats, if you come across them, you have to face them down. Make yourself as big as possible and stare them in the eye. You cannot show any fear, and you cannot turn your back on them, because when they hunt, they go for the back of their prey’s neck. If you do show them fear, or you turn your back to them, they instinctively attack and go for you. This is why joggers and cyclists are often attacked by mountain lions in California — they have their back turned to the animal or their heads are down, exposing the backs of their necks, so the big cats attack.

I wasn’t afraid of the big cat, and I felt like I needed to show it who was boss. I also felt a kind of rush from the imminent danger — Here was a cheetah! A big cat this close! We were in danger for our lives! I felt that familiar rush of adrenaline that sharpens my senses and pumps me up and makes me do things that I would not do under normal circumstances. Something in me surged with daring, and I took a nut I’d been holding and threw it at the cheetah. I felt a thrill of danger course through me, and I cursed myself for having thrown it at the cat. The nut bounced near it, and the animal flinched, and it looked like it was going to back off and leave us alone. My heart was pounding and my mind was calculating what I would do in response to it. I was watching it very, very carefully, to see what it would do, and for a few moments, it looked like the big cat was going to withdraw into the woods and leave us alone.

But then my friends got very frightened that I’d thrown the nut at the cat, and they started to freak out and panic. My one friend started to shake and quiver, and my other friend, who is a bit overweight and doesn’t move very quickly in real life, took off running down the trail. In my dream, I was thinking, “What are you doing?! You’re going to catch its attention! Why are you running from a cheetah? You can’t outrun it! You have to stare it down. You have to stand your ground!

I looked up at the big cat and saw it had suddenly spotted my friend. in an instant, it recovered its composure, sprang into action, and raced after my friend. It looked so beautiful in motion, all its sinews taut, its coat shining in the sunlight that filtered through the canopy above us. But my admiration was short-lived, as it caught up with my friend, grabbed them by the back of the neck, and started to run off with their body dangling from its jaw.

Frozen with horror for a moment, I took off running after the cheetah, yelling at the top of my lungs and willing myself to run faster. I was convinced I could catch it and wrestle my friend from its grip.

The big cat was very fast, though, and it was way ahead of me, with my friend’s body hanging from its jaws. I was horrified and mortified, and my other friend was screaming at me for throwing the nut at the cheetah and making it angry. In my head, I was trying to calculate how far the cheetah could get, carrying my friend’s heavy body, if I could catch up with it because it would be slowed down by the weight, and if I could get to it in time to save my friend. I suspected that my friend had been killed instantly, or that even if I did catch up, the cheetah would be eating them, so there wasn’t much point in my running after them.

Plus, I ran out of steam after a few hundred yards, and I had to stop. I was so upset at what had happened. On the one hand, I was upset with myself for throwing that nut, but I was also upset with my friend for not having better sense, and I was upset with the whole chain of events that was probably killing my friend.

I woke up very disturbed around 5:00, and I haven’t been able to get back to sleep.

I think that this dream has something to say about a lot of aspects of my life, these days. I have a lot of people around me who are very frightened for me, as I talk to them about my TBIs and the issues that go along with them. They’re like the friends in my dream, who just want to walk along quietly along a well-worn path in the woods, chatting about this and that, not really bothered by anything… cognizant that there are things amiss in the world, but not really eager to confront them.

There’s also a part of me that’s like that. I don’t want to be bothered by dangers in the woods. I want to just go along my merry way and not have to expend a lot of energy on things like dealing with large dangers that I come across.

But there’s also a part of me that gets bored with all that safe stuff, and I need to occupy myself. So I do things like picking up rocks and nuts and old pieces of fruit and tossing them around. I get bored pretty quickly, so I start casting about for new things to learn and do.

And sometimes my casting about uncovers big dangers along the way. Like this diagnostic imaging I’m going to have done — an MRI this weekend, and an EEG in another week or so. Who knows what will be uncovered as a result of that? Sometimes I cast about a bit too freely, and I can end up stirring up things that are unexpected and potentially dangerous… but are actually authentic pieces of my human experience.  (The interesting thing is that the cheetah in my dream actually belonged in the woods — it was its home, and it had just returned to its rightful place.)

Sometimes I cast about too carelessly, too — like tossing a nut at the cheetah. Or, I take a calculated risk and push the limits. In my dream, I didn’t just toss the nut at the cheetah for fun — I did it partly to show it that I meant business, and I wasn’t intimidated by it. I also wanted to scare it away. And it almost worked. But my friend with the weak nerves had to take off running — doing exactly the wrong thing, in that situation. They didn’t have the same information as I, apparently, and they let their fear get the best of them. And then all is lost.

This is pretty significant to me, in my real life experiences with others, because as I move forward, I’m going to have to educate the people around me about my condition(s) — TBI, etc. — so that they learn how to respond appropriately to the situation I’m in. I really don’t need them to freak out and get all worked up over things that A) we don’t know for sure, or B) are big and dangerous but are totally manageable with the right information and the right team of caregivers. I don’t need them to lose it and put themselves — or me — in danger. I need them to be cool, be present, be able to help in a substantive and constructive way.

As I go through this next phase of diagnostic testing — maybe it will show something, maybe it won’t — I need to keep my head on. I need to take care of myself and take things slowly, and not only know why I’m doing what I’m doing, but be clear with others why I’m doing it. Everybody needs to be in the loop, and that includes the parts of myself, too, that are prone to freak out and make poor choices out of fear, rather than knowledge and courage.

But at the same time, I also need to be cognizant of my tendency to court danger, as some kind of reflex, some inner/neuropsychological/biochemical need to sharpen and brighten mylife experience… to wake me up and keep me engaged in life. I need to be aware of my tendency to overstep my bounds, when I’m bored or tired or in need of some stimulation. I need to remember that, when it comes to taking on new challenges, I’m not always as smart as I think I am, and I’m not always up to the task of overcoming what I’m presented with. I can’t afford to forget that I rarely know as much as I need to know — either about myself or the situation I’m presented with. In my dream, I couldn’t chase down the cheetah, once it had hold of my friend. And I can’t always overcome my cognitive and behavioral issues as well as I’d like, once they take hold of me and get a ‘running start’ ahead of my logic and innate abilities.

When (not if) I meet a proverbial big cat on the path through my own “woods,” I need everyone with me — the parts inside and the people outside — to remain calm, make informed choices, and keep their heads. I need to focus on the basics — take care of my body and my mind and my spirit, with adequate rest and activities that feed and sustain me and build up my strength (not to mention common sense). And I need to be aware of my limits and not push them carelessly just because I need a thrill. I need to be aware that I do have a tendency (perhaps thanks to my PTSD) to court danger, just to feel awake and alive. And I need to remember that I’m much more use to my friends and family alive and healthy, than injured or dead. No matter how dangerous a situation may seem, the right information and the intention/willingness to intelligently proceed in the proper way can mean the difference between keeping on my path and making progress, and disaster.

Note to self: Get plenty of rest over the coming days and weeks. You’re going to need it, to do a decent job of handling all this.

Post-TBI Job Strategies for the New Year

I’ve been thinking a lot about my job strategies for the coming year. Even though it’s been some years since my latest head injury, I still have yet to fully adjust my career approach to this reality. But since getting confirmation from my neuropsych that all is in fact not perfectly well with me, cognitively speaking, I’ve been literally forced to look at the decisions I’ve made with regard to work — and with regard to the work I’m considering doing — so that I don’t get myself into hot water that has me end up like a frog in progressively hotter water… never fully aware that the water around me is heating up, until I’m drawing my proverbial last gasps in a boiling cauldron.

I’ve always been a pretty vain person, professionally speaking. Academically, I always knew I could do better than I did. At least, I was convinced I could… I just didn’t “feel like it,” I told myself. In most things in life, where I encountered difficulties that I didn’t fully understand, I often told myself that I just wasn’t succeeding because I wasn’t fully applying myself, and I wasn’t fully applying myself because things were boring or I just didn’t feel like doing more than the bare minimum.

Looking back now, I can see that I often covered up my confusion and disabilities and difficulties at following what was going on around me, by making lame excuses that weren’t even true. And I realize that over the past four years since my most recent TBI, I’ve essentially done the same thing: told myself that I was consciously choosing to not learn the things I need to learn to stay employable, because they were “beneath” me, or they weren’t challenging enough to hold my attention, or I just had other things to do, than apply myself to mastering them.

But these days, I can see that not only is this not true — I do have trouble with learning in ways that used to come easily to me — but I need to fully own up to the fact that I have newfound limitations that have substantially changed the way I learn, the way I retain information, the way I relate to the world around me, and the way I go about starting tasks. I have to admit that my skills, sharp as they are, still move more slowly than they used to. And I take longer to grasp certain concepts that used to come quickly to me. I can no longer acquire information the way I used to: starting at the beginning of a book and reading through to the end and remembering everything I read, the whole way through. Now, I have to use other strategies to retain the information, and in fact I need to develop new strategies to even get started reading and learning the information. Forget retention. It’s the initiation that stumps me, these days.

I also need to realize that I cannot assume that just because I have my heart set on making certain “advances” in my career path, that it will work out for me. Things like managing other people and being able to navigate complex political organizational landscapes, are now not only annoying and frustrating to me — my diminished ability to deal with their complexities — can actually jeopardize my career path, even my job. Things that used to just irritate me or even roll off my back now send me halfway ’round the globe in a fit of frustration and anger. I not only have a harder time dealing with things like communication and temporary setbacks, but I also have a hard time dealing with my inability to deal with them. All too easily and quickly, I slip into a downward spiral of raised hackles, raised voice, and hot temper. Not good, if you’re in management, I’d say.

So, I need to rethink my career path and reorient myself towards the way I learn, the way I work, the way I get through my days.

Am I making sense? I hope so. But here are some examples, in case you’re as confused as I may be:

Old Way of Learning

1. Decide I want to learn something, just ’cause it sounds cool.
2. Pick up a book and read it through, using a highlighter to call out key concepts.
3. Now and then sit down at a computer and tap away at some exercises. Get the general gist of the new material.
4. Trust that I “get it” and start using what I’ve learned in the everyday.

New Way of Learning

1. Find out what skillsets are important and make me marketable. Pick one or two that I want to focus on.
2. Go online and find articles about the skill to read, to generally familiarize myself with them.
3. Install the language/program on my computer and get my development environment in place to work with it.
4. Find working, best-practice examples of the skills in action, such as code snippets and small applications, and then fiddle with them to see what happens if I make this change or that change.
5. Keep fiddling with the pieces, until I can see, feel, smell, taste, touch the way the language/application works, so that it becomes a part of me and it’s almost second nature. Start at the end, and work my way back towards the beginning, very hands-on and experimental, and involved with the inner workings.
6. Forget about trying to understand the underlying principles and the minute details of how it’s all put together from the start. Just concern myself with becoming familiar enough with the pieces, that I don’t get frustrated and confused and anxious and irate when I hit a bump with the language/application, and I can just work my way through it.

Old Way of Defining My Career Path

1. Trust my employer/headhunter to guide me in the right direction.
2. Keep an eye out for new opportunities and pursue them with all my gusto.
3. Keep moving up in the world, moving from production to management, and on up the mangerial ladder, into the corporate stratosphere.

New Way of Defining My Career Path

1. Keep a close eye on the job market. What are people paying for?
2. Focus on my skills, my technical proficiencies, rather than looking for managerial positions.
3. Keep my attention on jobs that involve working with machines and logic, rather than people. Forget about climbing the corporate ladder. That’s just not happening for me. I cannot deal with the complexities of politics and I cannot be responsible for the well-being of others. I really just want to code, alright?
4. If I start to be pressed for signs that I want to advance, assure my employer/headhunter that I’m much better off — and so are they — if I just keep my focus on dealing with machines, not people.

The last piece is tricky, because employers who have loved me in the past (and yes, in the past, before I fell and turned into a different person, they really did), have been really encouraging when it came to “advancing” through moving into management — project management, team leadership, you name it. As though the real value to their operations lay in my being able to make people obey me the way I could get machines to. Well, fortunately or unfortunately, people are not like machines, and even though I did a great job of handling people in the past, and I was able to really motivate and guide others to do their best, the fact is that now I’m a different person with different skills and different inclinations, and a whole lot less interest in running other people’s lives, than in just making the most of my own.

It saddens me, yes, to think I need to let go of that old potential I once had. I feel a distinct sense of loss and grief, that my abilities have been so sharply curtailed. But on the other hand, I’d rather be realistic and honest and accurate about where I stand, right here and now, than hold out false hope for something that not only isn’t very realistic, but could have serious negative consequences not only for me but for my direct reports, if I ever bit off more than I could chew, functionally speaking.

This is a new way of looking at things. But it’s a necessary one, as well.

Temper Guidelines Post TBI

One of the biggest problems I’ve had, related to my TBIs, has been my temper. I can’t tell you how many times it’s gotten away from me and really made life difficult for people around me, and — as a result — for me, as well. I’ve lost jobs because of my temper — which, in these tough times is a real problem. I’ve alienated friends, too — and considering how difficult it is for me to attract and keep friends, I really can’t afford to do that. I’ve hurt the feelings (and really scared) my family members many, many times, and I have to live with that for the rest of my life.

Not only is it very painful for me to lose control of my tongue and say things I know are hurtful to others, but it’s also really tough to be increasingly marginalized by people around you, because of your short fuse. On top of that, my brain doesn’t always realize it’s losing its temper, and I end up often reaping what I unconsciously sow… finding out later that my behavior was volatile and unacceptable, and I didn’t even fully realize it.

Now, interestingly, recent research has uncovered a connection between losing your cool and dementia. Google has something like 145 stories on it (See especially Staying Calm ‘Prevents Dementia’ at BBC News and Dementia Rarer in Calm, Outgoing People at WebMD.) Given this research, and also the fact that dementia runs in my family, it really raises a red flag from me, and it points out even more clearly how keeping calm and not losing my cool will not only help me stay “socially viable” but it will also help keep me from losing my mind.

Here are my personal guidelines for managing my temper:

#1: It is Never Okay to hurt another person because of my temper. I don’t care if it’s accidental or if I can “justify” it in my mind. It’s never, ever okay for me to hurt another person because I can’t keep my cool. The world has enough unavoidable pain and suffering in it, without me adding to the overall amount. No matter how upset I may be, no matter how justified I may think I am, I do not give myself permission to just run around saying and doing hurtful things because of my temper.

#2: Whatever I make wrong, I have to make right. I am only human, and I tend to slip up. But when I do slip up and do/say things that are hurtful to others, I have to make an effort to make it right. I don’t care if I choke on the crow I’m eating. I don’t care how humbling it may be. I have to make right what I’ve done wrong. Either through apologizing, or making it up to the person I’ve hurt, or both.

#3: No matter how right I think I am, chances are I’m wrong, so I may actually not have a basis for blowing up. This is probably one of the most challenging things for me to accept — the fact that my brain is broken, and it may be telling me the wrong things, so I might not actually have a good reason to get upset. But if I forget this, I can end up on one of these “righteous anger” crusades that makes me impossible to work/live with. It’s just no good. And later, when I realize what I’ve done, I feel like such an idiot. It’s just not worth it to me, to go down a road that I’ll regret for a long time, just because I lost sight of the fact that I could be (am probably) wrong.

#4: When I feel myself getting so upset that I cannot keep myself in check, I have to just remove myself from the situation. I’ve been in too many really volatile situations where I’ve lost my head and loosed my tongue and ended up on the business end of life’s cattle prod as a result. I have blown up at co-workers, only to have them turn on me and engineer my layoff… I have blown up at family members, and I spent years afterwards subjected to their passive-aggressive victim revenge. That doesn’t make what they did/do right. It just points out that I need to stop my “downward slide” if at all possible, and if I can’t, I need to just step away and not engage with them anymore. Pick up the conversation later, when I’m cooler. But while I’m still hot, just step away.

#5: When it comes to police, it’s best to keep my mouth shut. I’ve come very close to some intense confrontations with police officers, because I didn’t understand what was going on, and/or I misinterpreted their signals — and they misinterpreted mine. If ever there was a time for me to keep my friggin’ mouth shut, that would be it. There’s nothing like looking back and realizing you came this close to being busted over saying/doing something really stupid, to adjust your perspective. I’ve learned to really chill, when I see a uniform approaching. And to make an extra effort to be polite and as brief as possible. I just can’t afford to get arrested and have a record. Not when I have a family to support.

#6: Don’t get too tired. Or, if I am fatigued, slow the heck down. My thinking gets very foggy, when I’m fatigued. My judgment is off, and my temper tends to flare. I have to be very vigilant about my fatigue level. And when I’m tired — and I know it — I need to take things very slowly and be a lot more systematic about how I do things. If I’m tired, I can’t deviate from my routine. If I do, I tend to get confused and then my fuse gets shorter. And I don’t do well at determining which things matter and which don’t. It just gets messy. And if I’m tired AND hungry, well, then, all bets are off.

#7: Don’t get too hungry. Sometimes, when I’m under stress, I will not have any appetite at all. I just have no interest in food, and I’ll skip meals. That’s not good. I can become hypoglycemic, and then my temper flares. I need to keep my blood sugar pretty constant, and keep my system stable, so I don’t get overwrought over little things and make everyone around me nuts, including myself. When my blood sugar is low, my thinking gets foggy, and I get agitated. It’s not good. So, even if I’m not hungry, I make the effort to eat regularly and make sure I don’t eat a lot of junk food. If I’m still hungry, an hour or two after I’ve eaten well, I have a glass of water, which can cut that sense of being hungry. I really try to keep on a regular eating schedule, no matter how little I want to eat. I often find, also, that starting to eat makes me hungry.

#8: Talk it out — either with someone else, or just with myself. I’m the first to admit that I’m really bad at this. I’m not good at broaching sensitive subjects, and I’m not good at talking about my feelings with other people. I’m not even good at talking about them with myself. I actually spend a fair amount of time doing “self-talk” — in the car while I’m driving to/from work… in the shower, when I’m getting ready for the day… even when I’m making my breakfast or cleaning up at the end of the day. I find that even when I’m not able to really articulate things well with other people, if I’m with a good friend who knows me and my silent signals, they can often coax out of me what’s up. And when I do talk about what’s up with me, I feel better. Like I said, I’m really bad at this, but I’m working at it. Because I have to.

#9: Don’t be stupid by moving too fast. Okay, so I’m head-injured. So what? I still have the basic ability to tell the difference between a smart thing to say and stupid thing. Well, most of the time, anyway. The problem arises, when I move too quickly and don’t look before I leap, or consider what I’m about to say before it gets out into the world. Given time, I can often determine if something is a wise thing to say, or not. But if I’m moving too fast and just “firing at will,” I can get into trouble really quick. This is a particular hazard when I’m actually feeling well… feeling energized… feeling cocky and spunky. I can get turned around, even when I’m feeling good, and suddenly lose it. Because I’ve been moving too fast. And I haven’t been thinking things through before I say/do them. Ironically, the times when I think I’m feeling best are sometimes the times when I’m quite fatigued, but I don’t realize it. It’s that stress-induced analgesia factor again — I’m so pumped up, just trying to move through life when I’m dog-tired, that I don’t even realize how tired I am, and my fatigue can catch up to me. I find that paying close attention to what I’m doing, and slowing down, and not saying/doing things when I’m MOST convinced they are great things to say/do, helps keep me out of a lot of hot water.

#10: Don’t overestimate my ability to deal with stressful situations. Dude, I’m like totally brain-injured. My life, as successful as it appears on the surface, has hallmarks of multiple mild tbi’s all through it. I can never forget that. My brain is broken. I have found ways to compensate and live with my difficulties, but I’m still diminished, compared to where I was 5… 10… 15… 20 years ago… and especially compared to where I could be, if I hadn’t gotten hit on the head so often. As much as I hate and resent the fact, it still is true that I have deficits, and they are often even better-hidden from me than they are from others. Adventures in anosognosia… So, I have to stay humble, stay realistic, stay honest. And not overestimate my capacity for stress. Stress is a killer. It kicks the crap out of me. It wears me down and turns me into someone I do not particularly like. I can never forget that my brain is different, since those injuries, and I can’t take anything for granted. On the one hand, this sucks royally, but on the other hand, it makes me intensely grateful for the times when I am okay, and things are going well.

So, there are my Top 10 Guidelines for surviving my temper-related deficits. I don’t always adhere to them as well as I should, and some of them are constant struggles. But if I can be moderately consistent with them, I find my temper is more easily controlled, and I’m a much better person. I’m also easier to live with, work with, play with, be around.

It’s not much fun, having to constantly play by these rules, but it sure beats the alternative — constant roller coasters of temper flares and jags and violent confrontations.

I’d rather live by the rules and stay out of trouble, than run wild and free and end up persona non grata — or worse, behind bars.

At last, an MRI…

Good news on the neurologist front… finally! I had an initial visit with a new neuro who will actually listen to me. I guess three’s the charm. The first two I went to, seemed to have a lot invested in just dismissing my issues or making them out to be just stress-related, but this doc actually sat and listened to me list out my issues.

Or maybe I was just better prepared this time. I know I was a lot less nervous, this time around, and that probably helped. And I’ve gotten more accustomed to talking to doctors, since that first visit nearly a year ago. But this doc was actually interested in what I had to say, which was pretty amazing. And they let me use my notes.

We actually managed to cover a lot of territory in the hour we spent together, and by the time the visit was up, I had an appointment for an MRI this weekend, a call in to the EEG lab for another appointment in a couple of weeks, and I had a third follow-up appointment scheduled for late next month.

Getting the right help makes all the difference, I say.

And having the right insurance does, too.

If I’d known, a year or two ago, what I know now, I would have done the following differently:

Two years ago, I would have checked around with friends about different kinds of insurance, and I would have changed my carrier when I had the chance. I would have NOT gone with the company I’ve been with for over 10 years, which is fine if you’re healthy, but notorious for declining to cover out-of-the-ordinary things, like neuropsychological evaluations and neurological testing. I would have gone with another plan that is not nearly as stingy with adequate coverage and doesn’t treat you like a moocher for just wanting to stay alive.

A year ago, I would have been more aggressive about finding out which doctors really are in my hospital’s network, and I would have insisted on seeing them, no matter what my PCP’s receptionist told me about them not being in “the network”. God, but this has been a huge problem with me, and I still come across it — being told that I can’t see so-and-so, because they’re “not in the network” that’s covered by my health plan, when they really are.  See, since healthcare has become all consolidated, lots of hospitals have teamed up to form networks of healthcare providers. And if I need to find a specialist but there’s not one at my hospital, I need to find one who is in the wider network. The thing is, my hospital is really territorial about keeping patients within their own “walls” and keeping us from seeing people outside this hospital, even if they don’t have the kinds of specialists I need. So, whenever I have said to my PCP, “I need a referral to —–,” they have typically responded, “We have doctors like that here!”

The thing is, they don’t. For head injury, it can be very tricky, finding the right neuro. Some neuros are in bed with insurance companies and they focus on proving that people really aren’t injured all that badly, so the insurance company won’t have to cover their treatment. And others just don’t get the whole head injury thing. It’s very puzzling that professionally trained medically “qualified” doctors — especially neurologists — can’t get their heads around the idea that brain injuries (even mild ones) can carry serious cognitive-behavioral consequences that can wreck the life of even a “recovered” brain injury survivor… and that these injuries need to be constructively addressed for the sake of human dignity and basic functionality. Clearly, there’s a realy need for some substantive education, there. Either that, or the people saying, “Oh, those brain injured people will be just fine,” have sustained brain injuries, themselves, and that’s what they tell themselves to avoid the pain and tribulations of confronting their own limitations. Who can say?

Anyway, getting back to the referral thing, when I would tell my doc, “No, I need to see a TBI specialist, and this is the person I need to see,” (having done my homework and asked around), and they pushed back and told me that I had to stay inside “their network” I didn’t realize that their network actually includes a bunch of different hospitals in the greater metro area, and some of the hospitals are associated with excellent medical schools. It took me about five false starts, before I stumbled upon the information about how wide their network really is. And in the process, I canceled — or just didn’t make — a couple of appointments with neuros who came very highly recommended, but weren’t “in the network” — the immediate one, that is — but really were in the wider associated network.

Yes, it is confusing.

And over the past year, I would have spent a lot more time not taking NO for an answer, when it came to securing proper care for my unique condition. I can’t tell you how many times administrative staffers gave me the runaround, put me off, treated me like there was something wrong with me for wanting to get help for my hidden difficulties. I was just so flabbergasted that anyone would question my right to take care of myself and keep myself from being jobless, homeless, destitute, and dying before I absolutely had to. They couldn’t see my difficulties, because I hid them so very well, and it took a monumental effort to bypass my instinctual tendency to downplay my difficulties and actually say out loud that I needed some help. I hate being treated badly, when I’m in a vulnerable spot, and that’s what happened, time and time again. And it took me about a year to get the hang of talking back to the administrative staffers who were totally snowing me on the “covered network” details and actively denying me access to the help that was most appropriate to me, before I finally acquired the skill to say, “Actually, this specialist IS in your network, so don’t deny me the help I need with a specialist who knows what they’re talking about.”

I also would have challenged those other neuros on their decisions to not order testing for me. The times when the docs said, “I don’t think you need an MRI or an EEG,” I would have said, “Is that you talking, or the insurance company? How much do they pay you to say that?” I would have really given them hell about just brushing me off, and I would have challenged them on their decisions and I would have called them on it.

Apparently, as a friend of mine who used to be in medicine told me the other day, it’s common knowledge that doctors are compensated by insurance companies for not ordering testing like MRIs and EEGs. Yes, docs get a kickback from insurers for not doing their jobs — or a least doing less of their jobs than they ‘have’ to.

This just floors me. I guess I’d have to show up close to dead and hooked up to a machine cranking out objective metrics for clinical analysis, in order to be taken seriously, but you know what, I’m just not going there. I’m a lively, vibrant, awake, engaged human being, and I actually like to live. So why would I subject myself to that sort of experience, just to make some doctor/insurance company happy? It never occurred to me that I was here to do their bidding. Funny, I thought it was the other way around. But then, I have sustained multiple brain injuries, so that probably has impacted my capacity for cynical cognitive shortcuts.

Anyway, now I know these few simple but critical things, and I can now act on that knowledge. Speaking of acting on knowledge, I think I’ll pay a visit to the hospital administration and discuss this disturbing tendency with them. I understand that they are trying to stay solvent, and they have to do what they have to do, to keep their books balanced, but actively discouraging people from seeking out proper care is just unconscionable. And someone needs to be made aware of this. I’m not asking them to send everyone out to other providers for help — just don’t actively prevent those of us with specific, unique, highly specialized conditions from getting the help we really, truly need.

That being said, I’m going to read up on MRI’s now, and prepare myself mentally for my appointment this weekend. I’m actually very excited to be going — I love machines, and the whole magnetic resonance imaging thing gives me a thrill. I don’t care if it’s loud, I don’t care if it takes all day. I’m looking forward to A) getting a close-up look at this machine, and B) actually getting some answers about what’s going on in my head — answers that are NOT based on speculation and extrapolation and deduction, but honest-to-God pictures.

I can’t wait!

Help for a teen-age girl who had a brain injury

I recently received this comment from someone looking to help the daughter of someone they work with.

I was wondering if you could give me some advise a woman I work with has a 13 year old daughter who was shot in the head at the age of 7. She has more or less fully “recovered” physically and mentally as according to her physicians.

Recently she has been getting in trouble at school when she gets stressed out about tests and friends and one of her problems at school is that when she gets stressed she involuntarily scratching her forearms which is alarming school officials . But when the officials approach her she becomes more stressed and scratches her self more.

So I gather you see the problem — the school has ordered my friend (who I will call Stacy) to take her daughter to a psychiatrist and to her PCP. The PCP says that there is nothing physically wrong with her so he can’t do any thing. The psychiatrist wants to medicate but is unsure what the side affects will be as seeing that she has had severe brain trauma and suggested Stacy to contact her neurologist; which she is doing but it takes awhile to get an appointment.

While they are waiting for the neurologist appointment I suggested getting her daughter involved in a support group with others who are going thru the same kind of emotional and psychological healing that she is going thru so she doesn’t feel alone and this is where I’m drawing a blank can you or can any one else get me in contact with a support group that may meet this girls needs if you can

Bless you


I’m worried for Stacy also, I think she needs some one to talk to who is going thru what she is.

And here is my (slightly modified) response:

Hi Mel –

Thanks so much for writing and thanks for helping Stacy!

It sounds like Stacy’s daughter is using (negative) sensation as a way to calm herself down. This is not uncommon — some folks with seizure disorders will do it to stop/interrupt their meltdowns — they hit their heads or they hurt themselves in some way. Other folks who are overwhelmed will use pain to focus their thinking. They will scratch or hit themselves, bang their heads, or do something else to “get themselves back into the present”.

It could also be that she’s using it as a way to get people to back off of her — I have been known to do some kind of bizarre things — unconsciously and consciously — that caused people to back off of me. Things like twitching and behaving strangely, that made people look at me strangely, but got them to stop coming at me so hard. I didn’t WANT to act like a freak, but I found that my involuntary reflexes had the (negative) benefit of putting some distance between myself and the person who was yelling at me, so it actually helped in a way. Additional Note: I’m not saying Stacy’s daughter is intentionally doing bizarre things — I’m just saying I can relate, and the negative reactions I myself have displayed, have contributed to my own behavior and social issues, over the years.

Also, with me, my tbi’s have slowed down my reaction time, so when I have gotten into trouble with authorities in the past, and I haven’t reacted as quickly as they wanted, they acted like I was intentionally defying them, and they came at me all the harder. I wasn’t deliberately being bad, I was just “slower on the uptake” and they mis-interpreted my response as defiance. That may be happening with Stacy’s daughter, and if she’s like me, the increased attention feeds my confusion and I get even more overloaded — A Real Problem, which Stacy’s daughter may be having.

It also could be that — like me, when I was a kid — Stacy’s daughter is (mis)interpreting the school officials’ attention and concern as being in trouble and she thinks she’s being punished or disciplined, which — if she’s like me — just adds to the overwhelm. When they approach her, the school officials need to say explicitly that she is NOT in trouble. They are trying to help her. They may think she knows, but with tbi, it’s never safe to assume anything. Now, if the school officials ARE treating her like she’s in trouble, that’s another issue — a problem with the officials, themselves.

For dealing with sensory overload… Other people with sensory integration issues will do things like rub a coarse surface, tap a rhythm, hum, or do some other action which brings a single point of focus to their attention. It’s called “stimming” or “self-stimulation” and there are many different kinds that people do in different ways. If you Google “stimming” you may find something useful.

Additional Note: Stimming is often used by folks who are autistic or have some other developmental delay — I AM NOT saying Stacy’s daughter has become autistic as a result of her head injury, only that understanding stimming behaviors (as they are used by folks on the autistic spectrum), may help Stacy understand her daughter’s need to scratch her forearms.

I have been known to hurt myself (slightly) to “get out of” a downward slide into a meltdown or when I feel like I just can’t handle all the outside stimuli coming in. Before I knew about how even a mild TBI can affect the brain, I used to bang my head when I was too overwhelmed to function. (Note: since I learned more about tbi, I’ve stopped that behavior — I’ve got all the head injury I can handle, thank you very much.) I have also hit myself, grabbed my forearms really hard and squeezed long and hard enough to bruise myself, I have punched myself, and I have done other things to get a little pain into my system to clear my head. I have never severely injured myself — like cut myself or banged my hand in a drawer or something extreme like that. I just needed a little bit of pain to chill myself out and stop the chaos in my head. I have used sports in the past to create “managed pain” in a positive way — I would push myself really, really hard in practices and competitions, to the point where I was in real physical distress. But then I was able to chill, and life went on.

I’m not an expert in this, but I believe it’s because the pain triggers endorphines (and other stress hormones/adrenaline) which can help clear the mind and help someone get a single point of focus back, when they’re being bombarded with stimuli that they cannot sort out. (Interestingly, this ties in with the research I’m presently doing about how people (unconsciously) create stress and really difficult situations to help themselves function better, when they’re totally overwhelmed.) From personal experience, I can say that there’s nothing like a little pain, sometimes, to help me focus. NOTE: I am NOT advocating self-injury as a coping mechanism, I’m just observing that — on a very limited scale — self-administered pain/stress has helped me cope throughout my life. And in fact, I still use it, now and then.

Anyway, to avoid real injury and help myself focus, I use other techniques that are less stigmatized — more like stimming than self-injury. I usually have a rolled-up paper napkin or towel in one of my pockets that I carry around with me to rub and clench in my fist, when I’m feeling overwhelmed. A rolled-up napkin really works, because it’s coarse, and it fits in my hand, so I can carry it around without people noticing it. I find it very soothing. Also, I do things like rub the seam of my jeans, tap out rhythms (working on a computer keyboard is very soothing for me), and press my thumbnail into the sides of my fingers or palm. I do these things secretly, so no one will see, because if/when they do notice, they become worried and agitated, and it makes the situation worse for me.

For Stacy’s daughter, I would strongly recommend regular exercise, like getting involved in sports. I had real sensory issues and I was a total wreck, when I was a kid. Bit when I got to high school, I started getting involved in organized sports, and that made all the difference. But I couldn’t do every sport — team sports like basketball and softball and field hockey were too chaotic for me, so I ran cross country and track. I did individual sports as part of a team. If I hadn’t been so afraid of water, I would have gone out for the swim team, but I had a lot of trouble coordinating my breathing with motion when I swam, and I was (rightfully so) afraid of drowning.

If Stacy’s daughter is not athletic, I would really encourage her to do some sort of rigorous physical activity that she can do alone or with a small group. But find something physical to do, that lets her really work out her anxiety and channel all that energy. With each successive head injury I’ve had (8+), I’ve often noticed a sudden surge in my physical energy — and I felt more blocked, like I didn’t know what to do with it. That’s been a real problem over the years. But if I can find something really physically demanding to do, I’m usually able to get myself back on track.

If Stacy’s daughter can find something to do that is safe, as well as physically challenging, and not terribly expensive (running cross country and track are about the cheapest sports you can participate in), I really think it could help. And being in organized sports in school was great for me, because it gave me structure and guidance from coaches, as well as well-defined rules to play by — very important for me, after those injuries and concussions.

Now, if she cannot under any circumstances participate in sports, she may benefit from developing other (hidden) stimming techniques — like carrying a “worry stone” with her — a rough stone or some other texture that will keep her attention focused on something other than her confrontation and/or overwhelm. Or like me, carrying a rolled-up napkin to squeeze and rub, when things get a little ‘tight’. If she can be shown other ways she can dissipate the stress that don’t attract a lot of attention, that could help.

Above all, I would recommend that someone work with her in a non-judgmental way so she can develop other coping techniques. Like an occupational therapist. Since she was obviously head-injured by a gunshot wound, she must have medical records which show she is a tbi survivor, so she may be able to get help that insurance will pay for. Rather than sending her to a shrink or medicating her or treating her like she’s mentally ill, if someone can just explain to her that her brain is not processing information the same way that other people’s do, and it’s getting turned around (no fault of hers — it’s a result of the injury), and then work with her to constructively and positively deal with her unique situation, I think that could really help. Again, I’m not a trained professional in this, but as a multiple tbi survivor with sensory issues, I know it would have really helped me, when I was a kid.

As for Stacy, I would recommend that she spend some time reading about tbi online — check some of the links on my blog and learn about it. Even though her daughter has appeared to recover physically and mentally, she will likely have a bunch of issues that she needs to work through — many of which may look like “bad behavior” but are really neurological. Also, the young lady’s age tells me that because she’s going though puberty, her hormones are changing, and that can alter your neurological experience. Women with seizure disorders are known to experience changes in seizure activity which are directly related to their hormonal condition. Stacy may wish to keep a log about her daughter’s monthly cycles so she can track any kinds of behavior changes around the time of her ovulation/menstruation. That way, she can discuss it with a neurologist, and/or help her daughter prepare for times that may be tougher, due to hormonal fluctuations, and use that information to really be pro-active and common-sense about these seeming inexplicable behaviors.

I would recommend, also, that you give Stacy a copy of the self-assessment form(s) I have available on my blog, so she can see what kinds of symptoms can come with TBI. It could be that her daughter is having more problems than anyone realizes – but because of cultural bias, people think that her daughter is just being badly behaved. Or that Stacy is being a “bad mom”. I can’t tell you how many people were really hard on my parents — especially my mom — because they thought their bad parenting was responsible for my behavior. It wasn’t my parents — it was my tbi’s that caused me do do the things I did!

The more Stacy knows about tbi, the better. And her daughter’s school officials should be educated on it, as well. If nothing else, Stacy should make sure they know about her daughter’s brain injury, so they can respond appropriately and work constructively to develop positive approaches that don’t stress out the young lady. Stacy should NOT be afraid to tell them her daughter was brain injured. If she educates herself, she can advocate more effectively for her daughter.

Oh, AND — THIS IS REALLY IMPORTANT!!! if Stacy goes to a neurologist, she should make sure they know about traumatic brain injury. Not all neurologists do. I went to one who specialized in carpal tunnel and multiple sclerosis — not really helpful with tbi, I can tell you! Her local Brain Injury Association should be able to point her in the direction of a neuro with tbi experience.

Stacy may also find support through her local Brain Injury Association. Please tell her not to be afraid of the “brain injury” stigma — there are plenty of people who have had one. The association will probably have support groups she can attend, for survivors’ family members. Her daughter may be able to find support, also. On the surface, it may look like her daughter is all better, but the brain is mysterious thing. And especially since she’s going into full-blown puberty, she may find her “neurological landscape” changing, because her body and her hormones are changing, too. So, she’s going to need new and different help for her tbi, which will affect her in new ways as she matures.

Anyway, I hope that Stacy’s daughter can find other ways to relieve her stress, other than publicly injuring herself. I hope that Stacy can learn more about her daughter’s condition in a constructive and positive way. I hope that her daughter’s school can find ways to deal effectively with this young lady. And I hope you find more ways to help Stacy. It’s wonderful that you’re reaching out like this, and Stacy is lucky to have you as a friend!