This is a continuation of the discussion about PTSD from TBI – Exploring some possibilities.
So far, we’ve looked at how TBI directly contributes to PTSD through proximity, duration, extent of brutality, betrayal, and threat of dying. In all cases, the big way TBI contributes to these factors is through the skewed perception it can create, causing us to perceive “threat” where there is none, as well as amplifying our emotional and physiological reactions to events. There’s nothing like a hyper-activated amygdala pushing the brain’s automatic fight-flight response, to make everyone’s day that much more “interesting”.
And now we come to an area that has particularly strong implications for TBI survivors — perpetrating violence. As Belleruth Naparstek points out in Invisible Heroes (p. 51), we don’t normally think of folks who perpetrate violence as the ones affected by post-traumatic stress. It’s the victims after all, who bear the brunt of it. Right?
Not so fast. Post-traumatic stress which manifests in “more violent outbursts and greater severity of intrusive symptoms, as well as a greater sense of alarm, alienation, survivor guilt, and a sense of disintegration” is prevalent among those who cause harm to others. It’s a subject I’ve written about before in Putting my soul back together, one act at a time, in September of last year, and it remains a serious concern of mine.
See, TBI is all too often accompanied by anger issues. Outbursts. Meltdowns. And violence. I myself have been plagued by violent temper outbursts and extreme mood swings that shook me like a terrier shakes a rat… and I couldn’t do a thing about them. For someone who has long been known as an even-keeled sort of person who can be relied on to stay calm in stressful situations, it was a terrible blow to me to watch myself (like a train wreck) blowing up at people over what I logically knew was a small thing, but which seemed like the end of the world to my frayed wiring.
It was so distressing and so shocking to me, that I rarely brought it up with my neuropsych, and then I played it down because I couldn’t stand having someone know about what was going on inside of me. It was almost too much to take. My sense of honor, my sense of dignity, my sense of propriety, and my feelings for those I loved and cared about and worked with went right out the window without me having any understanding or control over things… and then I had to deal with the aftermath.
And the more I blew up, the more things I threw, the more I melted down, the more intrusive the memories of those times became, and the more I felt like I was in the grip of it all.
It’s no friggin’ fun watching yourself dissolve before your very eyes, and that’s exactly how it felt. Which added a sense of impending destruction/death to the whole experience.
The crazy eff’ed-up thing about TBI is that it can turn even the most mild-mannered individual into a raving lunatic, and it can cause them to do things they would never, ever choose to do on their own. It can turn even the most mellow individual into a violent perpetrator. I’m not trying to scare anyone, but at the same time, this is the dark side of TBI that people don’t like to talk about. And the toll it takes is something that really needs to be looked at.
Now, I don’t want to say that everyone who does violence to others is not in control of their behavior. Some people very much are. But with TBI, the right combination of fatigue, malaise, agitation, restlessness, and anxiety-producing sense of lost control, that nastly little switch can get flipped and you can find yourself becoming a stark raving lunatic over the stupidest little sh*t.
This is not to say that it has to — or should — stay that way. If we can see (or are informed) that our behavior is unacceptable, it’s our responsibility to fix it and make sure it doesn’t happen again. But all too often — especially at the start of your recovery — a lot of incidents can happen that result in feelings or experiences of violence.
And that takes a toll.
It takes a toll because you see and hear yourself doing these things, and it takes a toll because you may not be able to do anything about it, until you gain understanding and self-awareness, which can take months, if not years.
In the meantime, you’re racking up some serious mileage in the PTSD department. And ultimately that’s got to be dealt with constructively, or it can — and will — drag you down in the long run.