PTSD from TBI — Like being trapped in an abusive household

Yeah, I used to live there

I’ve been giving a lot of thought to my discussions about how TBI can introduce chronic trauma to the lives of those who experience it, and I was searching the web looking for some ideas about how to explain or describe it.

I happened upon a site that’s devoted to the recovery of women who were essentially held captive by a spiritual abuser, and who were physically and psychologically abused and controlled for years.

Hearing the descriptions of the process of their gradual traumatization that led to raging cases of PTSD, it reminded me a bit of what it can be like living in a body that’s being run by an injured brain.

Now, I’m not going to even hint that experiences post-TBI equate with those of being kept under lock and key by a viciously controlling “spiritual leader” who beats his charges bloody each night for no apparent reason. There’s really no comparison. However, on a much smaller scale, the mechanisms are the same, eventually leading from traumatic brain injury to post-traumatic stress.

With TBI (especially early on), there can a really pronounced sense of lack of control over circumstances which lead to harm, injury, and real/perceived threat. Your brain is not firing on all pistons, and it’s mis-reading cues left and right. On top of it, TBI has a way of super-activating the amygdala, the part of the brain that sends those WARNING! messages to the rest of the brain, so not only are you mis-reading cues and doing/saying things that A) don’t match what you want to be doing, B) don’t match what others expect you to be doing, and C) don’t make much sense to anyone, actually, but you’re also experiencing an exaggerated response to the series of unfortunate events that befall you.

You’re in danger. You’re taking “hits” throughout the course of each day as you stumble through activities that used to be easy for you. The harder you try, the worse you fare, and the resulting biochemical onslaught of try-try-again — and again — and again … all to no avail… builds on each last botched attempt, like so many blows from an angry guardian. It might not be the case that someone is physically abusing you, but the experience of one failure after another, in one activity after another, with things falling apart more and more with each day, and no clear view of how to deal with and fix it all… well, that’s the sort of beating you take. And it’s not easy.

It adds up, too. Mentally and physically — but mostly physically. Here’s an excerpt from the web page I found (Under Much Grace) which talks about PTSD after spiritual abuse:

Review of the Survival Response

When confronted with a traumatic or threatening situation, as discussed at length in a recent post, the brain of a person responds by activating a survival response which is profoundly physical in nature. If a person stopped to think about and plan a response to the threat, chances are that they would not be able to respond quickly enough to survive the threat. The brain’s analytical or critical thinking faculties suspend momentarily, and lower brain structures kick in, enhancing the speed of physical response.

BB Note: In TBI, with a hyper-activated amygdala and flawed processing to boot, it’s really, really easy to think that you’re being confronted with a traumatic or threatening situation. Logic and reason have nothing to do with it, when you’re stuck in the echo-chamber of your injured brain. Unless you have someone to turn to as a sounding board, anything and everything can seem like a threat — which means that your brain spends an awful lot of time activating physiological survival responses.

Before advances in science allowed better observation regarding the brain’s response to threat, science took note of the “fight or flight” response. When faced with a serious threat, the body started into a cascade of hormones and neurotransmitters which enable the body to flee or to fight. The autonomic nervous system (the automatic system that governs unconscious physical response) shunts blood away from the gut and to skeletal muscle and brain, as the body releases hormones that raise blood pressure, heart rate, and blood sugar as they also speed the response of nervous tissue. It makes energy and oxygen available to the systems of the body that play the greatest role in either running from or resisting a threat.

BB Note: I’ve talked about this before on this blog, and this is a great summary, too!

Please take note: The mind processes psychological threat or perceived threat in the same way that it does a physical one, and the same cascade of neurotransmitters and hormones plays out, even if an individual is not in a situation where they would need to physically run or fight. The mind and body processes these threats in the same manner. Also note that these are not chosen responses but are deeply physiologic, and they actually bypass critical thinking or choice.

BB Note: All threats really are equal, when it comes to fight-flight responses. The chemistry kicks off and takes over, and even if you ARE able to give some thought to what’s happening, still, your body is working around your thinking brain, so it doesn’t even get a chance to weigh in.

Chronic Stress

Those who cope with chronic experiences of trauma are often faced with these types of responses on a regular basis. The body cannot maintain this high level of energy and stress for long periods of time, and over time, the body learns to adapt because the pressure and stress becomes to great. . . .  And as previously discussed, some of these responses that result in a psychological change result from a physiologic cause.

. . .

Consider also what takes place in the brain and body when it must operate under constant high stress. The body resets itself and changes the way that it responds to certain hormones and neurotransmitters. Think of an unfamiliar noise that you hear in an new environment that is a part of it. If you grew up in the country away from traffic and then moved to a city where you could hear the sound of the traffic in your bedroom at night, for some time after relocating, that sound acts as a disturbance – until your brain learns to adapt.

A similar adaptation takes place in the body’s production of neurotransmitters/ hormones, its responses to those chemicals and how it responds to impulses related to stress. (An adaptation of the body we associate with high stress that is affected by these hormonal changes can be hypertension.) When under constant high levels of stress, the body readjusts its baseline to maintain function, but that function has been altered and is not ideal. The brain no longer responds to stress in the normal way. Some neurochemical production drops, some increases, and the degree of physical response can change also. There is so much cortisol all the time, it essentially becomes meaningless to the normal systems, so the body adapts to maintain the ability to respond immediately to serious threat, preserving that survival response as much as possible. But consider that chronic stress alters that system and how well it responds.

BB Note: Indeed. The more you’re steeped in the experience, the more it affects you and shapes you. Over time, with enough traumatic experiences that have you jammed in high gear, your whole system can turn out to be so wired, that easing up is not an option. But then we get into the problems of not sleeping enough, eating the wrong foods, being jacked up all the time on something or other… it’s just not good.

Previous Threat and Learned Helplessness

We have also already discussed that PTSD more frequently develops when a person’s efforts to protect themselves becomes thwarted in some way. The intricate and marvelous system which involves generating a great deal of emotional energy as well as physical energy on a purely physical level sometimes fails to result in a beneficial outcome. That energy must go somewhere, and releasing that kind of energy is sometimes referred to as “blowing off steam.” When the release of energy doesn’t result in protection in response to a trauma, if the affected person cannot find a safe way and an outlet for expressing that raw, hormonally driven energy, they can tend to turn it inward through negative emotion that they direct toward their sense of self. It contributes to the sense of pessimism that accompanies PTSD. When chronic, a person learns helpless behavior and believes that they are helpless, whether or not they are truly helpless. Perception becomes everything.

Learned helplessness, indeed. When you’re struggling with a brain injury and you can’t figure out what’s going on, and you can’t seem to protect yourself from, well, yourself… all that energy does indeed turn in and you can end up being incredibly rough on yourself over any and every little thing.

And with TBI, since perception is notoriously skewed, sometimes you can never really know if you’re right or wrong about things, which is even more cause for uncertainty and doubt. After weeks and months and years of things getting screwed up for some weird-ass reason, you’ve had to take hit after hit after hit on a biochemical level, that can really cut into your sense of self, ability to believe anything positive about yourself, and worst of all your cognitive ability — as though you could afford to lose any more than you already lost.  Physiologically, it takes a toll.

The bitch of it is, that’s the house you live in. The brain in the body you inhabit has gone haywire and it’s sending all the wrong signals AND unleashing the hounds of hell inside your head and your spirit, day after day. Forget about having a bad attitude about yourself – the physiological experience of trying to understand and fix up one botched activity after another is stress enough — it’s brutal. It doesn’t even need to have a mental/psychological basis. It’s the simple fact of how our bodies work in response to perceived threat and the overtime activity of always playing catch-up, that does the job on us. We don’t even need to give it any thought — just the regularly occurring, chronic need for more work, more attention, more compensation does a job on us.

It’s like living in a household with a vicious abusers. But the abuser cannot be escaped. Because they live inside your head. They are your head.

On the brighter side, there is a way out of that mess. It takes time and discipline and continuous work, but I can tell you from personal experience — yes, there is a way out of that abusive house. Stay tuned…