That anger thing

Source: racoles' photostream @ Flickr

I’ve been thinking a lot, this morning, about that anger thing — you  know, the way it just comes up, seemingly out of nowhere, like a sudden squall on the sea. I won’t say it’s like a tornado, because the signs of an approaching tornado are generally pretty obvious. They let you take cover. Anger following brain injury, on the other hand, is a completely different story.

Even after years and years of supposedly learning how to deal with it, I still get waylaid by those sudden temper bursts. Like yesterday, when I was having a really great day — did my chores, kept a decent pace, took good care of myself. Suddenly, after I’d eaten my lunch and had my shower and was getting ready to lie down for a nap, it came up, just out of nowhere. I snapped pretty badly at my spouse and groused and was difficult and just acted like a jerk. Arrgh! And I was doing so well…

Actually, now that I think about it, it’s not entirely accurate to say that anger after TBI can come just out of nowhere. Certainly, it can take people by surprise — especially if they’ve just happened upon someone who is having a tough time, and they don’t know about their issues. And if you’re not paying close attention to yourself, you can get swept up in it for no apparent reason. But people who are present during a lead-up to a temper flare are often in positions to see the warning signs, and to spot the conditions and warning flags that often preceded those TBI temper flares. The thing is, we need to be present.

It’s not like we never have any chance to observe TBI-related anger issues. Anger is by far one of the most common and most problematic challenges with brain injured folks. And it can be frighteningly frequent. So, if we just pay attention, observe, and make a note about what worked, what didn’t, and what led up to the flashpoint, we can learn. But we have to pay attention.

That’s one thing I’ve resolved to do more of — pay attention to my anger issues, and head them off at the pass. Granted, it’s not the most pleasant pastime. Throughout my life, I have frequently dealt with my temper issues, and over the years I have learned to overcome them — often with the help of friends and family and coworkers. But at this point in my life, I need to get in the habit of looking at them myself and dealing with them myself . It’s just silly for me to act like I can’t monitor and manage my issues on my own (tho’ that’s what I’ve often done over the years). I know I can do better, so it’s high time I did.

Looking around online, I found a great paper called Anger Following Brain Injury from the Brain Injury Association of Washington.

It talks about how anger is common after brain injuries, and that can have a number of sources which can work in combination with each other:

• You may be angry about the injury and the problems that resulted, including disabilities, losing your job, being out of work, problems with your friends (those that stick around, anyway), money problems, and loss of control over your life.
• Some folks were already angry people before their injuries. That problem doesn’t necessarily go away. (Although I have heard about folks who sustained brain injuries who became nicer people after the fact — but this is not a common occurrence, from what I hear.) If anything, existing anger issues may get worse.  In that case, psychotherapy may be necessary to teach the survivor new coping skills. In some instances, medication may be prescribed.
• In many cases, impulsive anger can develop due to damage to the brain.  The parts of the brain which work to inhibit feelings of anger   and related behavior got damaged and they don’t do what they’re meant to quite as well as they used to.  This lowers the anger threshold of the survivor, and they become much angrier much more quickly and much more easily than before.

How can you tell that brain injury is the culprit, in this kind of impulsive anger? Here are some telltale signs:

1. You didn’t used to get angry so intensely or so quickly; after your brain injury things got a lot worse.
2. Your angry feelings suddenly come and go;  they’re here one minute and gone the next.
3. You may get angry over “little” things; you sweat the small stuff.
4. You are surprised and/or embarrassed or distressed by your angry episodes.
5. Fatigue, pain, low blood sugar, or other physiological stresses make things a lot worse.

Unfortunately, a lot of people jump to the conclusion that personality, not brain function, is behind poor anger management and behavior control. This doesn’t help a TBI survivor constructively manage their issues. It just complicates things and muddies the waters and lays the blame at the feet of the very facility that’s trying to keep it together – when it doesn’t have all the resources it needs to do so. Being faulted and blamed for your anger issues, when you’re trying like mad to keep it together, just plain sucks. And it really works against everyone in the situation. In some cases, it can make the anger even worse, adding more emotional causes to the physiological/neurological ones.

For myself, I can use the five points above as a pretty clear reference point for tracking my TBI-related anger, and knowing when my outbursts are neurological, rather than being related to the stresses of everyday life that everyone experiences and has to contend with.

This is an important distinction. Because sometimes you have every right to be angry, and telling yourself that your TBI is to blame and you don’t really have the right to be upset, can cause you to put up with a lot of crap you normally wouldn’t. It can also give the people around you a “free pass” to be jerks and pains, because they say you getting angry with them is a malfunction of your system, rather than a proper function in response to their inappropriate behavior.

As always, discernment is the key. But TBI doesn’t make that any easier, so you have to be pretty resourceful and deliberate in dealing constructively with that powderkeg we call anger.

If I assume that my anger has to do with some “character defect” it slowly but surely bores a hole in my soul.  I’ve had anger/temper issues all my life, which have been really debilitating to my self-confidence and self-esteem, but after my most recent injury in 2004, all hell broke loose. And it wasn’t just at home, where my problems most commonly were. It was at work. It was out and about in the world. Whereas I was once cool as a cucumber at work, and I was the go-to person who stayed calm in any sort of crisis, after my fall, I started to fall apart, and each anger episode made things that much worse. It took a huge toll on me, personally and professionally, and it was freaky. All of  a sudden, as mentioned in point 1 above, I couldn’t keep it together.

And point 2 above  played into this, because the anger would literally come and go out of nowhere. I remember driving to relatives over one holiday season around 2007-2008, when I was having a lot of problems with sleeping and pain. My spouse and I were also on a long trip, and we’d been on the road for two days running. Driving down the road, I was practically overcome with flashes of rage – they would shoot up like geysers in Yellowstone, and I’d start to yell… then all of a sudden, the rage would subside, and I’d be back to normal, wondering “where that came from?” Then, a few minutes later, the rage was back, and I’d be yelling again. It wasn’t anything my spouse had done or said — out of nowhere, it was just back. And it felt awful to be taken over by that.

As for sweating the small stuff in point 3 above, well, that’s one of the toughest things for me. Because I’ve often been in the role of a first responder to crisis situations, and having a level head has always been my saving grace. I’ve found people collapsed on public byways a number of times, and I’ve gotten them help. I’ve rushed people to the hospital when they appeared to be having heart attacks and strokes. I’ve been the one to take command in some dicey situations, and I’ve always relied on that ability to block everything out except the most critical pieces of information. After each of my head injuries in adulthood, I noticed a distinct drop in my tolerance level for stressors, and it’s costs me jobs and friends along the way. My sudden, inexplicable failure to not sweat the small stuff wasn’t something my inner circle could tolerate.

And that just sucks. Because so many times (see point 4 above), my outbursts or meltdowns have taken me by surprise. I wasn’t watching for them, I wasn’t anticipating them. I didn’t understand them and I couldn’t plan for them and address them either ahead of time or in the moment. Not good. I guess my brain just got hijacked by the biochemical cascade, and the parts of it that used to monitor and modulate my responses didn’t work the way they used to. Yeah, it sucks.

But here’s the thing — since I know that I’ve got these issues, and I know that physiological stressors like fatigue and pain and low blood sugar make me more inclined to “go off” over every little thing, I’m in a position to monitor that and make sure I don’t get too far into the danger zone. Point 5 above is really critical, and it’s probably one of the most useful of the points, because it gives me a tangible thing to pay attention to — fatigue, pain, low blood sugar. I can often tell when these things are coming into play, and knowing what I know about how they make my flashpoint much lower, I can take constructive steps to address them. I’ll write more on that later.

This holds true for my friends and family, too. My spouse is well aware of what can happen when I am over-tired, so they help me get to bed at a decent hour. I need the help at times, too, since my foggy brain gets even more foggy when I’m tired, and my tendency to perseverate over every little thing can keep me up for hours. Like last night, when I headed to bed around 11, but ended up staying up till past 1 a.m. It’s a problem, but it’s one that I’m capable of monitoring myself. I just need to make the effort.

So, yeah, the anger thing is a challenge. Rage, temper tantrums, low flashpoints, acting out, lashing out. Not good. Some days, I really despair about the kind of person I’ve become, and I wonder if I’ll ever be able to get myself fully back on track. I wonder if I’ll ever be able to be fully independent, or if I’m going to have to rely on my spouse or a significant other for the rest of my born days to keep out of trouble. Because the anger is pretty bad. I’ve gone after police officers with verbal attacks over little things, and that’s a clear warning sign (Fortunately, I haven’t done it for over a year, now, so that’s a sign of progress. It’s also a sign of progress that I haven’t gotten pulled over for attention-deficit-related traffic violations, like not noticing a stop sign).

The worst part is when an intense anger flare shows up when everything is going great — like yesterday — and it messes everything up. What I wouldn’t give to have some level of confidence in my emotional stability, and know that I can, indeed, control my anger and manage the conditions that give rise to it. What my spouse wouldn’t do for that, too. And, come to think of it, my coworkers who literally fear my wrath at times.

Well, it’s a journey and an adventure, and as always, I have a lot to learn. Don’t we all? I need to explore this more and learn more… and put it into action.

More to come… Onward!

---

Source: Anger Following Brain Injury by Tedd Judd , Ph.D. Neuropsychologist (April 1992) – Brain Injury Association of Washington