The hazards of mtbi micro-traumas

Another Monday, another week. The weekend was pretty good, all things considered. I got a fair amount done, and I also had some time to just relax. Not much, but some.

I did a little reading about “The Cognitive Control of Emotion” by Ochsner and Gross, who say

“Conflicts, failures, and losses at times seem to conspire to ruin us. Yet, as Marcus Aurelius observed nearly two millennia ago, we humans have an extraordinary capacity to regulate the emotions occasioned by such travails. Importantly, these regulatory efforts largely determine the impact such difficulties will have on our mental and physical well-being.”

They also include a good quote from Marcus Aurelius:

If you are distressed by anything external, the pain is not due to the thing itself, but to your estimate of it; and this you have the power to revoke at any moment.
Marcus Aurelius (Meditations)

The rest of the paper is about fMRI results and neural mechanisms, most of which went over my head because I’ve been having trouble focusing and comprehending what I’m reading. I’ll have to go back and re-read it, because I believe there’s something in there I can use. But the thing that I took away from it, is that we actually can choose how we will experience and react to and emote over our circumstances, and the better we are at that, the better off we may be.

Or course, this doesn’t speak to people being in just plain crappy living situations, but there is at least a little bit there that I can use.

Anyway, I’ve been thinking about how bent out of shape I’ve been for the past month or so. It feels like a whole lot is piling up with me, and I haven’t been able to get out from under. Certainly, not getting enough sleep is not helping. I’m working at turning that around. It’s slow going, but at least I’m making the attempt.

And I’ve been thinking about all the things that have gotten me worked up, bothered, troubled, anxious, etc. A lot of those things aren’t even that big a deal, on some people’s scale. But for me they are. And they seem to add up a whole lot faster than one would expect. It’s a little dispiriting, but that’s how it is. Everything adds up. Quickly. Even the little stuff.

Especially the little stuff. I have a name for all those little things that “shouldn’t” bother me — micro-traumas. Specifically, mtbi micro-traumas. They’re the little things that get under my skin and set me off — because I’m tired and/or stressed and/or not paying attention. They’re the little things that “shouldn’t” happen because regularly functioning people don’t have these problems — like waking up one morning and not being able to read or write as well as you could the day before… like forgetting so much stuff that if you don’t write it down, it might as well not even exist… like getting incredibly bent out of shape over developments at work that most people take in stride… like flipping out over dropping a spoon while you’re making your breakfast.

Those little experiences, those tiny explosions, may not seem like a whole lot in and of themselves. But when they happen again and again and again, tens (even hundreds) of times a day, they add up. And they wear at you. It’s like a death by a thousand cuts. It’s not even the exact events themselves that constitute the explosions — it’s the experience of those events, the biochemical bursts and blasts and ka-booms that take place out of sight of anyone else, that set you on edge and tear the living crap out of your interior.

Isolated and not considered in light of the continuous whole, these explosions, these micro-traumas probably don’t look like much to the outside observer, but internally and over time, they add up. And they add up to cumulative trauma — just like all those sub-concussive hits (from practices and full-on collision play) take down professional football players years later, the micro-traumas that bombard mtbi survivors day in and day out also take a toll. And it all adds up.

This is coming back to the ANS balancing issue I talked about yesterday. And it also ties in with PTSD and resilience. I really believe that unaddressed TBI issues — especially “mild” TBI issues — lend themselves extremely well to creating an everyday “substrate” of stress and fight-flight orientation, which erodes our personal resilience and gradually over time in countless invisible ways pulls us down into a way of life that is hallmark PTSD. For all the talk about traumatic brain injury, there is remarkably little overlap between the TBI and PTSD conceptualizations, that I can see. Everybody is trying to establish that THEY are the ones who have it all figured out, and precious few people are giving quarter. But that’s a bit dense and self-serving. It’s also not practical, nor is it accurate. The two overlap and feed into each other — obviously (to me at least) — and any approach to TBI recovery (yes, I’ll say recovery) must necessarily include an approach to trauma that is patently unlike the talk-therapy approaches that just serve to drive us half-mad with all the emotional stirring-up and provocation.

Let me put it simply. This is what I believe:

  • That Traumatic Brain Injury is by nature a traumatic event. It is a physiologically traumatic event. Even if the individual is not aware of their environment at the time of injury (or they forget it due to their brain trauma), their physiological experience nevertheless primes them for trauma.
  • The nature of brain trauma, as a fundamental insult to the very command center of so much of our functioning (as well as the biochemical reactions which take place as a result) puts the body into overdrive to both survive the injury and escape the imminent danger that TBI poses to the individual. The brain has to work overtime to recover and come up with compensatory techniques. And the individual can be in a perpetual state of insecurity and confusion and fight-flight, because their usual ways of approaching life are no longer available the way they once were.
  • The extreme fluctuations of emotion and ability, can fire off biochemical reactions that are disproportionate to many of the events. This is a function of an over-tweaked autonomic nervous system which is “stuck in high gear” like a Prius with its floor mat wedged to the accelerator. The injured individual can be so confused and disoriented that their ability to monitor and understand their own situation can be completely compromised, which leads to more stress — Post-Traumatic Stress.
  • To make matters worse, the general cluelessness (even hostility) of the surrounding social environment exacerbates things even further, by insisting that everything should be fine, that there should be no problems, and that the TBI survivor should be able to function as they did before. This puts the survivor into an all but permanent fight-flight mode, eventually either pushing the parasympathetic nervous system out of the picture or creating wild swings between the two ANS branches, which totally screws things up (that’s my scientific assessment ;)
  • This is especially true of mild traumatic brain injury survivors, whose brains are still rewired and who have to make more subtle changes and advances, in the face of — among other things — cognitive fluctuations, and surprisingly extreme and shocking biochemical reactions to “non-events”.
  • Unless and until a TBI survivor deals with the trauma aspects of their situation (no, not “They did this to me, and it hurt” kind of dealing, but the physiological effects of the biochemical roller coaster), they can continue to suffer and continue to struggle. Long-term prospects may actually worsen, as their post-traumatic stress is exacerbated and accentuated by ongoing issues which have not been properly balanced by exercise, rest, nutrition, and plenty of water.

It might sound over-simplistic, but may be to some extent it is that simple. And in the end, I believe that TBI survivors are not going to get proper care and assistance until the physiological aspects of trauma recovery are fully explored and matured. The vast majority of trauma research that I have encountered has to do with psychological trauma, and certainly there is plenty of that. But approaching trauma only in terms of psychology, and addressing it only in terms of talking and emoting (both of which can be extremely taxing for TBI survivors to do with great success), is just pulling us backwards.

It’s not helping.  There has to be a better way, and I think I have actually found it.

Whether anyone in a position to study this and pursue new courses of treatment is going to catch on, is anybody’s guess. I do believe that the military is the closest to making progress on this front, due to their increased focus on Total Force Fitness. They have a vested interest in coming up with what works, because their (and our) survival literally depends on it. And it is in their research that I find the most hope and the most useful material to work with, at this time.

Researchers at institutions may or may not get it. I think in fact that they usually don’t, in no small part because they are so far removed from the issues, personally speaking. Doctors and therapists may or may not get it, because of their indoctrination and their intellectual biases (plus their own trauma issues get in the way). Those of us out here walking around in the word trying like crazy to figure out WTF is going on in our lives… we’re like mobile laboratories, chock full of anectdotal tidbits.

We’ll see if things change. But for now, it’s time to go to work. Onward.

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10 thoughts on “The hazards of mtbi micro-traumas

  1. BB – A couple of quick thoughts

    Yes, absolutely there is a neural basis for emotion – and in fact in TBI the amygdala is often overstimulated. The problem however is two fold; 1) the MANAGEMENT of emotion, especially fear/anxiety/impulse comes a lot from EF (executive function) which is damaged in TBI, thus the roller coaster. What I believe (and this is only my belief) is that one has to RELEARN the mechanisms of self control. Just like we did when we were growing up – there were temper tantrums and fear of the dark and impulsive behaviors (double dare ya) etc – and as we socialized and lived we gradually underwent a process for managing our emotional states based on experience, data, etc. Your data banks are damaged and you have to rebuild them. So that is part of the process – it takes time – but look at how much you have accomplished by working on it. Because you are an adult you understand what is expected, you understand complex consequences, but your emotional response is not on par with your cognitive comprehension of the world. You are responding in a more ‘primitive’ way (that is not an insult please understand and the you is the universal you). This is why I think that how TBI is handled in the first years after the injury is so important because you are literally rebuilding the responses. I also think this is why meditation is so important – meditation is a key tool (cheap, safe, and proven effective) in relearning self-regulation. But mediation never feels like you are DOING something and so we abandon it (I am guilty as charged). Other approaches such as neurofeedback also can help, because they ‘teach’ us. And ABSOLUTELY you MUST get enough sleep, enough physical activity and a decent diet. I cannot tell you how many people I meet who’s lives would be 200% better with just a regular routine, a long brisk walk and some veggies. I am not being a pollyanna – you must start with the basics – this doesn’t solve everything but it helps a lot. However, the main issue here is that emotional management is NOT a question of will power – it is a question of practice, self-assessment and awareness.

    As a corollary to this we form patterns of behavior – these patterns are very important and may serve a need in some way. It is hard for us to see them, so it is hard for us to change them. They are the messages we tell ourselves at a deep level, they are our quick responses. Part of cognitive behavioral therapy as a psychotherapeutic tool is to help us develop new patterns. This is what your NP probably is trying to do with you – make you break away from the reasoning that you use to explain your world in the cases where it may not serve you. For example, one of the catch22′s of TBI is that others don’t understand it and so they may do or say things that reflect a lack of comprehension or support – but then people with TBI become inured to the feedback and input of others because they feel misunderstood. Yet people with TBI NEED that input and need to determine how to use it to self-adjust. Most TBI folks do not trust anyone to give them honest, supportive feedback – but it is critical to find.

  2. There is a great deal of truth in what you say. When things go awry I myself have to fight my urge to overestimate the severity of the event – to paint things as black and white necessitating an immediate and drastic response. I remember that my TBI has affected my ability to adequately gauge events and keep them in their perspective. After I’ve successfully overcome the particular problem vexing me – which I always seem to do one way or another – I always find myself telling my mind, “See? It wasn’t as bad as you thought.” :)

  3. Very true. I get hung up on things all the time, and I can get completely derailed over things, especially at work. I can get deeply offended at a moment’s notice, and then decide to unleash the full fury of my indignation on the person who “hurt” me — when they never intended to hurt me at all.

    It is extraordinarily difficult for me to keep things in perspective when that happens. And then I need to work a little harder to patch things up, which can be quite humbling.

    Ah, well, we’re human after all…

  4. Your blog is a godsend. I sustained a concussion in February of this year and had a second fall in March due to the excessive vertigo I was dealing with. I dealt with short term memory issues, headache, light and noise sensitivity etc after the first fall. I hit the right side of my head after the second fall. The symptoms were a billion times worse and the amnesia now surrounds over a 20 year span. I have some memorys of childhood and growing up but my marriage, my kids….all of that is gone. I feel like a freak most of the time as the doctors I see claim this is unusual and no one has those issues. It will take me a while as I am having a lot of eye issues as well but I look forward to reading what you have written. Thank you so much

  5. Glad you found this resource!

    With regard to your eye issues, I recently learned that light sensitivity can be due to the pupils staying open because of an over-active sympathetic nervous system — the fight-flight response that gets you away from danger, like a burning house or a saber-toothed tiger. With TBI our sympathetic nervous systems (SNS) stay “on” all the time, which can throw everything off. I know that when I’m intensely fight-flight, my vertigo gets worse too.

    You may want to try some relaxation techniques to help your SNS chill out. Doing slow breathing while listening to relaxing music is one way. Also, progressive relaxation — relaxing your body, one section at a time — and yoga or meditation can help too.

    That’s pretty wild about your amnesia. You may find the memories coming back. It sounds like it might be a recall thing — memory issues can happen because they don’t get properly “logged” in our brains, but it sounds like that’s not the issue with you. You may find that your memory returns… or it may not. When I was having a lot of memory problems, I used to watch the “Bourne” movies a lot — the ones with Matt Damon. Somehow I found it very comforting.

    Good luck and keep us posted on how you’re doing.

    All the best
    BB

  6. My eye issues go beyond light sensitivity. I have a convergence issue, fourth nerve palsy and possibly a contusion on my optic nerve. My neuro-opthamologist prescribed me glasses to help with these issues and they seem to be working ok so far. I seem to keep pushing things and causing arguments at home and I don’t know why. It doesn’t seem like me, the real me, but I just keep doing it. Anyway, thank you for this blog!

  7. Hm. That does sound complicated with your eyes. Hope the glasses continue to help.

    I hear you about pushing things and causing arguments. I am going to talk to my neuropsych today about this exact thing. I seem to have a real issue with not being able to stop myself saying things that I really want to stop saying. But for some reason, once I get started, I can’t seem to stop. It doesn’t seem like “me” doing it, but still it happens.

    I’ll have to see if there is anything I can do to stop myself when I should.

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