I’m reading Mindsight by Daniel Siegel, these days. I’ve been slowly making my way through it while I ride the exercise bike each morning. 15-20 minutes is about the right amount of time for me to read and ride. I’ve been wanting to learn more about mindfulness, and this mindsight variation of it, which (from what I gather so far) involves intentional focus on something specific, seems like it could be quite useful to me.
Apparently, the practice of “mindsight” helps to physically build connections in the prefrontal cortex, which is where complex processing and social “maps” are created. I’m not 100% clear on all the details of it — I’ll have to re-read the book, most likely — but it looks promising.
One thing that grabbed my attention right off, was the opening story about a family that came to therapy, because one of the kids had stopped talking. She was selectively mute, except at home. One thing that appeared to be the main factor was that her mother had sustained a traumatic brain injury in a car accident, and she was no longer the same person she was before the accident.
Needless to say, that got me to sit up and pay close attention.
The story culminated with the little girl starting to talk again, but the mother was still relatively incapacitated. The discussion of the family situation was a lot more about the little girl, than about the mother, so I didn’t get much more out of that account that could help me, specifically relating to TBI.
Later, in the second part of the book, the author talks about a young man who came to see him who was essentially a normal teenaged boy — 16 at the time — but who was having a lot of trouble with feeling low, crying in bouts that came out of nowhere, and flying into rages over relatively minor incidents. His explosions of rage were getting worse, he admitted sheepishly, and both he and his parents were increasingly concerned. He was depressed, and he sometimes had thoughts of suicide.
He hadn’t always been this way — this had started around the time he started middle school, when he was 13. He’d had some outbursts, but everyone thought he was just being a teenager. Still, things were getting worse.
The diagnosis that might have been assigned to him, according to his symptoms, was either depression or bipolar disorder. But the description of his situation sounded a whole lot like a concussion or mild traumatic brain injury to me, when I first read it. We pretty much always see what we’re trained to see, so of course I thought, “That kid’s not mentally ill! He’s dealing with the after-effects of a head injury that either nobody realized he’d had, or they didn’t take that seriously.”
Indeed, reading about this guy’s situation — the unprovoked, uncontrolled rages, the bouts of feeling down, the general blah-ness, the crying jags that came out of nowhere, and the embarrassment about it all on top of it — really hit a nerve with me. It sounded all too familiar. And I wondered if he might have had a concussion when he was about 13. Maybe he got beat up at school. Maybe he fell off his skateboard. Maybe he had a bike accident. Most TBI’s happen to boys, so the odds are not exactly against him having sustained a traumatic brain injury.
I’m no psychiatrist, of course, but I wonder… if mental health professionals first screened for TBI before they cracked open the DSM, what would that mean for mental health care in this country? How many people would be kept off medications — a TBI can really muck with your body’s sensitivities to medicine — that they either didn’t need or couldn’t tolerate? How many people would have actual answers to why their behavior has evolved as it has? How many people would be spared the stigma of a diagnosis of “biopolar disorder”?
Of course, the stigma of traumatic brain injury could be even worse — and given the low level of awareness around what TBI survivors are like in real life (especially mild TBI survivors), a TBI diagnosis could socially do more harm than good. Perhaps.
But still, what if screening for TBI were the first thing that happened, instead of some afterthought or the result of a chance inquiry? What if instead of medications and talk therapy, a regular regimen of exercise and good sleep hygiene and a battery of taught coping skills for their specific difficulties were prescribed? What if, instead of medicating kids who are having these kinds of troubles, we took away their mobile phones and cut off their texting and IM’ing at least an hour before bed, and enforced good sleep hygiene — or else? What if we had them get on a treadmill or an exercise bike for 20 minutes, before anything else happened in the day? What if people could see past their conditioning and their formal training, to see the underlying physiological/neurological underpinnings of these kinds of conditions, and clinicians were open to the idea that structural changes in the brain could be the root cause — and the best way of addressing that is NOT to numb/dull the symptoms, but build in new neural pathways to “route around” the compromised areas?
If you come to a washed-out road on your way to an important appointment, you don’t pull the car over, wring your hands, talk to someone for hours about how sad it is that you can’t go that normal route… and take a pill to take the edge off your discomfort while you contemplate your bad fortune. You turn the car around, and you go find another route. The brain’s neural pathways are much the same as the roads we travel in larger life — if one route doesn’t get us where we need to go, there are other ways to get there. Imagine what would become of us, if we all did the logistical equivalent of diagnosing a disorder, and then coming up with a pill to take the edge off the discomfort of our inactivity… Would anything ever get done?
Of course, what really drives a lot of the diagnosing is the DSM, is that fact that it offers codes to plug into insurance forms. So you can get your care paid for. And it has designations of disorders which map to certain drugs and therapies — TBI is not nearly as clear-cut or straightforward as a “standard-issue” mental illness. Not enough is known about it. And not enough people (therapists, doctors, and other sorts of clinicians) are willing to take on the seemingly daunting task of dealing with an injured brain at the neurological level.
What’s more, there aren’t any clear, easily obtained, ready-made, neatly packaged treatments for TBI, that people can prescribe and dispense. TBI recovery is an extended process, and a tricky one at that. It could lend itself well to a hybrid sort of therapy, which involves cognitive behavioral elements, nutritional and fitness education and coaching, not to mention plain old-fashioned talking things through with an impartial party who has a good head for what you’re tackling. But that sort of treatment (from what I’ve seen) doesn’t yet exist. What’s more, TBI has a nasty way of telling you you’re fine, so even if you do engage in that therapy for an extended period of time, you’re prone to quit, ’cause you think you’re all better now (and then you’re likely to end up back in therapy again, after things get mucked up all over again).
It’s worth the effort and well worth the investment of healthcare professionals to develop a system like this. But until people get more educated — and they stop being so afraid of the brain — and they develop formally recognized ways of dealing with TBI, a mental illness diagnosis is the most likely thing one can expect from a trip to a clinician for help with inexplicable mood and behavior issues.
Which, frankly, sucks.
We need a better approach. And we need something that works. ‘Cause no therapist I know of is going to start poking around looking for trouble that they don’t know how to solve — or that seems innately unsolvable.
Until we do figure out how to solve this brain injury problem, it’s going to keep getting categorized as good old-fashioned mental illness. And in that case, a lot of us are probably safer going it alone, rather than seeking out clinical assistance in the mental healthcare swamp that’s lined by the slippery slopes of DSM-driven diagnosis.
But let me ponder this a while longer. Maybe practicing mindsight will help me settle down the outrage and frustration I feel and channel it into more productive activities, than cursing the darkness that seems to surround us.