TBI and PTSD – The chicken or the egg?

I’ve been giving a lot of thought, lately, to how TBI and PTSD interconnect and “feed into” each other. In my experience, the two are closely interconnected, and they can make each other pretty confusing and convoluted. Each condition changes the brain in subtle but important ways, and when the two interact in one brain/body/mind/spirit, the compounded difficulties can be exponentially more difficult to identify — and treat.

Traumatic brain injury is by its very nature traumatic, and post-traumatic stress disorder comes out of trauma. So, when you fall and hit your head, or you are in a car accident, or you are attacked and knocked out, trauma happens to the body. The body is threatened – sometimes mortally – and the brain kicks in with all sorts of great hormonal and biochemical survival mechanisms. Adrenaline gets pumping. Endorphines start flowing. Glucose gets delivered to muscles. And the less-survival-based reactions we have get pushed off to the side, so our bodies can focus on one thing: survival.

Even if we are not consciously aware that we are in danger — like when I fell down the stairs in 2004, and I didn’t fully realize the extent to which my physical safety had been threatened — our bodies are aware that they are under attack, and they respond accordingly. It’s not something we can control, it’s not something we should control. We need our brains to be able to care for our bodies without our minds knowing how to do it. The problems start, when our brains don’t realize that we’re out of danger, and/or we get caught in a constant feedback loop of detecting perceived danger, reacting to it, stressing out, and never getting a chance to settle down.

That settling down piece is very important. After our sympathetic nervous systems have risen to the challenge(s) of a perceived threat, our parasympathetic nervous systems need to kick in and help our bodies chill out. Rest. Restore. Relax. Digest… Take a break and get back to balance. But if we never take a break and get our nervous systems to relax and get back to normal, we can get stuck in a constant roller-coaster of fear/anxiety/stress/hyper-reactivity that just won’t quit. And traumatic stress eventually turns into post-traumatic stress disorder. Not fun for anyone.

One of the big ways I think TBI contributes to the development of PTSD is in the “debriefing” phase after a crisis or trauma. TBI can impair a person’s ability to self-assess — sometimes we literally don’t know that something is wrong with how we’re experiencing/reacting to life. It can be harder to detect physical experiences and decode behavioral problems, not to mention cognitive ones. And that diminished ability to self-assess makes it more difficult to self-regulate… to consciously and deliberately change your behavior and actions so that you can “power down” and let your over-taxed body restore itself.

At least in my case, when I went through traumatic experiences — let’s take one of my auto accidents as an example — I wasn’t able to think things through after the fact and assess how I was feeling. I literally didn’t know that I was having trouble understanding what people around me were saying. I thought it was them, who were suddenly refusing to speak intelligibly. I literally did not realize that my sleeping schedule was off — I just stayed up later and got up earlier and pushed myself to go-go-go… and then drank and drank and drank to get myself to relax. I wasn’t even able to determine how I was feeling physically. All I knew was, something was up with me, and it really made me feel awful.

So, I pushed myself even more to “keep up”… and it just added to my already overtaxed body being stretched beyond its means. Not good.

A few posts back, I wrote about being wired to survive and all the biochemical activities that take place as a result of some traumatic crisis. The thing to remember about that wiring system is that it is totally independent of rational thought… but rational thought is necessary to deal with its aftermath. The physical experience of all that adrenaline and endorphins and glucose is not a walk in the park. Our bodies need our brains to take over, after we have rushed to safety, to tend to our frazzled nerves and make choices that allow us to relax, regroup, recuperate, and restore the delicate balance in our central nervous systems.

But with TBI, even mild ones, the brain is impaired and it cannot process clearly. So, we can end up making choices that do not help us relax, that keep us on edge, that keep us going-going-going, so we never really get a break from the crisis and drama.

And post-traumatic stress disorders emerge, which further alter our brain chemistry and how we make choices and take action in our world. PTSD actually alters our cognitive functioning. It makes us think differently than we would, under normal, non-stressful conditions. And that different thinking is not always the smartest thinking.

But wait, there’s more…

Impairments to our thinking — our heightened hyper-reactivity, our hair-trigger response systems that are fried and frazzled — can cause us to make choices that are dangerous and risky. Choices that can cause further head injuries. Being all PTSD’ed-out can make us very quick to anger, in situations where we’re likely to get in a fist-fight, even if our opponent is twice our size. It can make us “slow on the uptake” so we miscalculate choices while we’re driving. It can cloud our judgment about whether or not to take up skydiving. And our increased appetite for stimulation can cause us to pursue activities that are custom-made for yet more traumatic brain injury.

And so, we end up with a vicious cycle of traumatic head injury feeding our post-traumatic stress, which evolves into disorders of mind, body, heart, and spirit… and leave us wondering why the hell everything around us is going to shit. Our brains have been injured, and our judgment is impaired. And each condition feeds the other.

I’m not sure how much research has been done on the interactions of TBI and PTSD. I think it’s a topic that’s ripe for harvesting, and we could probably learn a lot from taking a close look at the two pieces of the puzzle. I think that folks being treated for PTSD should also be evaluated for TBI, and vice versa. Having experts and folks in positions of authority say that “most TBI suvivors heal” sends the message that the brain will just take care of itself, and everything will be fine. But while the brain is healing — to whatever extent that may be — post-traumatic stress can emerge, which can feed a vicious downward spiralling cycle that affects not only the mind, but the spirit and the body as well.

And that needs to be addressed.

And I do more of that here…

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Hitting the 10,000 mark today

I just checked my blog stats, and lo and behold, I’ve reached the 10,000 hits mark.  Actually 10,092, but what’s a few more? More is good! 🙂

I’d just like to take this opportunity to thank everyone for stopping by. This journey is a solitary one for me, as it is for so many tbi survivors, in part because brain injury is so baffling to the person who’s been hurt, and in part because our society is still woefully ignorant about the true effects of brain injury and doesn’t have a lot of tolerance for people who got hit on the head and aren’t able to just jump up and say, “I’m okay — I’m good.

Given the kinds of comments that people leave, TBI really is a big concern with a lot of folks — especially those affected by injuries in the wars in Afghanistan and Iraq… returning soldiers and their families and friends and coworkers… and more. And given the amount of traffic over time, it seems to me that interest is really picking up and people are getting pro-active about dealing with TBI — either their own, or a loved one’s.

This really makes me happy. (Not that TBI happens, but that there’s more interest and information.) Over the years, as I’ve experienced injuries, I was unable to get the help I needed, first because 35 years ago, people didn’t know much about this brain injury stuff. And later because I wasn’t able to accurately self-assess my own situation and see that I needed help.

Now, with more and more info getting out there, more blogs, more websites, more YouTube videos, people are better able to find the help they need — either online, or through live resources they locate by online means.

Hitting the 10,000 mark is so invigorating for me! And it’s helping me focus more — on life outside my broken brain. It’s all too easy for me to slide into my “pity pot” and bemoan my fate… when (relatively speaking) I’m doing way better than a lot of folks out there. I’m not making light of my own difficulties, but I have to get some perspective at times and realize that A) I’m not the center of the universe whose pain matters more than anyone else’s, B) I am extremely fortunate in many respects, and C) that because of both my injuries and my recoveries and my unique abilities, I’m in a position to reach out to others who are in need and offer them some of what I have.

10,000 hits is a great sign that “feeds me” and lets me know that I’m doing something constructive with my time and energy. And it also reminds me of my responsibility (a “calling” if you will) to those who are reaching out for help, with all those search engine terms and queries and all those clicks on tags… looking… searching… seeking clues that will explain the mysteries of the mind and strategies for living life to the best of one’s ability.

And now it’s time for a contributory post. Enough about me… What about you?

More attention for the invisible disability – TBI

Over at New York Brain Injury Lawyers, there’s a great post, Brain Injury The Invisible Disability

I’ve copied and pasted a fair amount of the post here (their content is indented), and I’m going to add my editorial commentary to it, as well.

Brain injuries can affect people’s compulsive nature and decision-making skills. It is a very sensitive area of personal injury law and quite rightly so. Brain injury varies greatly from person to person because each person’s injury allows for differing affects due to the location of the damage.

I love it that they start out on this note. It’s interesting how, of all the people who talk about brain injury, the people who seem to be the most sensitive to the issues and complexities are attorneys. Lawyers tend to get a bad rap, but in the big wide world of brain injury blogging and generally available information, I’ve found their sites/blogs to be some of the most helpful. Indeed, some of the most reliable and insightful and encompassing (as in, approaching the complexities of the situation without succumbing to the temptation to oversimplify) pieces of truly useful information (at least, for me) have come from lawyers. So, my hats are off to them — the ones who use their powers for good instead of evil, of course 😉

A traumatic brain injury is potentially one the most devastating disabilities. It not only affects the person suffering from the injury but can turn whole families upside down.

Amen to that. TBI does turn families upside down. It sneaks into the most secret and obscure places of one’s life, and it not only causes the affected brain to do and say things it wouldn’t normally say, but it often masks its effects by blinding the TBI survivor to the true nature of their words and deeds. I cannot stress this enough. We live in a society that lusts after self-determination and stigmatizes anyone who “can’t help themself” from doing or saying bad/inappropriate/embarrassing things. Our society is founded upon the idea that everyone has the ability to make themself and their world over in exactly the fashion they please. But though this may hold largely true, sometimes other factors come into play that are beyond our control. And that includes brain injury.

The range and severity of problems arising from a brain injury will vary significantly from person to person because every person’s brain injury varies in the extent and location of the damage. Some of the affects of a brain injury are not immediately obvious and only become apparent as time progresses.

Again, good information. It is so true that the range and severity can and will vary from person to person. No two bodies are alike, and no two brains are alike. It’s just impossible for them to be identical, as they are shaped by events and circumstances and body chemistry in unique and individual ways. So, the range of our injuries will vary… and the severity of our problems will, too. After all, the severity of our issues depend on not only the scope and nature of our injury, but also upon our own personality makeup — how we respond to different circumstances — as well as environmental factors. Things like jobs that allow us little flexibility in our daily schedule, financial difficulties that add stress to our experience, living environments that are intolerant of our shortcomings, and any number of other factors like the food we eat and the amount of sleep we get, can and will affect the degree to which we are impacted.

What’s more, some affects are not immediately obvious… subtle changes in mood, shifts in attentional ability, our cognitive capacity, our processing speed… these things aren’t always immediately detectable to the outside observer. What’s more, changes can take place over the course of one’s life, due to hormonal fluctuations and body chemistry changes.  The brain changes with age, just as the body does, and events like puberty and menopause (male and female), which alter the body’s hormonal makeup, can cause brain changes, as well, which can cause issues to arise that weren’t there before. If the part of the brain that is affected by a certain hormone was injured, and a scar develops, but that hormone remains relatively stable in the body over the course of one’s adult life… then it starts to fluctuate later in life, it could trigger some unexpected activities.

The following are pointers to look out for in a persons make-up if you feel they may be suffering from a brain injury after a nasty knock or have suffered a serious injury.

Note from BB: Keep in mind that even a “mild” brain injury, such as a hard bump or sudden impact or “whiplash” from a car accident (or even head-banging at a rock concert) can cause shearing of the connectors in the brain/brainstem, which can have the following affects. One of the biggest misconceptions about traumatic brain injury, is that it would have to be an open wound or something really dramatic, like losing concsciousness for hours or going into a coma, to cause problems. Trust me, you don’t have to teeter on the brink of destruction to be severely impacted by brain injury.

Cognitive changes
A brain injury can cause cognitive changes which affect the individual’s ability to learn new things, to work and to be able to interact socially.

So true! Some examples of this, from my own experience, are:

  • I have a hard time learning new things from books, because my short-term working memory has been compromised. If I’m reading something that’s new, and I divert my attention from it for even as short as a few seconds, I can completely lose the new information — and have to go back and start from scratch again.
  • I also have difficulty with sustained attention — I just can’t study the way I used to. I used to be able to study for hours and hours, and at the end of a long weekend of non-stop reading, I would have a new treasure trove of information to work with. Now, I’m lucky if I can last an hour with my reading.
  • I have difficulties at work, because I get so tired and I tend to space out when I’m fatigued. I find myself, sometimes, just sitting in front of my computer, staring at nothing in particular, or surfing around just for the sake of relieving my over-taxed brain. It’s not productive, but it’s unconscious, and I’m usually not aware I’m doing it, till I’ve done it for a while.
  • Social interaction is a tough one for me, because I have difficulties following people’s conversations at times, and I feel really self-conscious. I also get tired, being around people, and I find I cannot go into places I used to go fairly freely before 2004 — crowds have always distressed me somewhat, but since my fall in 2004, I’m even less tolerant of the noise and hubbub. Also, I have found myself isolating a lot more, over the past few years, and I’ve had trouble managing my emotions and words in social situations, which makes me even less inclined to venture forth.

Lack of insight
Individuals with a brain injury can have great difficulty seeing and accepting changes to their thinking and behaviour. The individual may deny the effects of the injury and have unreasonable expectations about what they are able to do.

I’ll say. Immediately after my 2004 fall, when my job had fallen apart, and I was in the process of quickly depleting my $250,000+ nest egg, I decided I was going to become a financial planner. Talk about a lack of insight! Not only did I not see that I was having an impossible time completing the self-paced work-at-home coursework — in 18 months, I managed to complete only 1-1/2 of the 6 courses, and I got a C on the one I did complete, which is totally out of character for me! But I also was oblivious to the fact that I was mismanaging my own funds so badly that I was quickly running out of money, when I could/should have been making money on it (after I prematurely cashed out of my shares — I walked away with $143,000 instead of the $700,000 I could have had, if I’d just managed to hang in with that job another 18 months — 18 months!!! — I put the money in my checking account that earned no interest and was open-season for my spending). I was doing a piss-poor job of managing my own money and planning what to do with it. What in the world made me think I could be a financial advisor/planner for anyone else? That’s easy — classic p0st-TBI lack of insight. Sheesh!

Memory problems
There may be problems in remembering people’s names, passing on messages, or recalling details read in a book or a newspaper. They may forget what they are doing from one session to the next. Memory problems may cause the individual great difficulties in learning new things.

Oh, please, don’t even get me started on this. If I don’t write down something in the moment, I might as well wave good-bye to it. I am, this very morning, trying to catch up with things I forgot to do over the past three days. If I lived alone or I was with someone who was less interactive and invested in keeping me on track, I would be lost. And quite possibly homeless and jobless, as well.

Poor concentration
A very common outcome is an inability to concentrate and to become easily distracted from what they are doing. This is usually because they are having difficulty concentrating.

Yes, yes, yes. My concentration comes in fits and starts. I found, right after my fall down the stairs in 2004, that I couldn’t concentrate to save my life. I was just flitting from one thing to the next, and I was utterly unable to learn the new skills I needed, in order to keep my job. Of course, I had no idea that I had been brain injured at the time, so I told myself — and everyone else — that I had chosen not to learn the things I needed to learn. I didn’t want to/couldn’t admit (or even see) that it wasn’t that I’d chosen to dig my heels in… I literally couldn’t. Because my concentration was totally shot.

Slowed responses
An individual with a brain injury may now be slower to answer questions or to perform tasks and may have difficulty in keeping up in conversations. Their capacity to respond quickly in an emergency may also be diminished.

Yeah, this is a problem. And it can be pretty scary, too, when you’re in an emergency situation. This has impacted me a number of times.  A couple of  times over the past ten years, in fact, I have had to help friends who were having strokes, but both times, I couldn’t seem to put two and two together. I couldn’t seem to figure out what was going on, and it’s lucky for them that there was someone else there, in both instances, who could see what was happening and come up with an appropriate response. The feeling of being turned around and not being able to respond quickly in such a life-threatening situation is scary enough at the time, but afterwards, it can really haunt you. It’s certainly haunted me. In fact, my inability to respond to a number of emergency situations — some of them life-threatening — was one of the things that “raised a red flag” with me and told me something was just not right with how my brain was working.

Responding to questions and keeping up with conversations is very important when you’re dealing with authority figures and law enforcement, I have found. One of my recurring issues with regard to my TBI is run-ins with the police that nearly went sour, just because I wasn’t following what the officer was saying to me. You have to understand, I’m a very law-abiding citizen. I believe the law is what makes our society livable, and I make every effort to obey it. So when I mess up, go faster than I should, miss a stop sign, or take a left turn too closely, and I get pulled over, I am genuinely confused, because I certainly did not intend to screw up. And my confusion makes it harder for me to focus on the situation, as well as follow the officer’s directions. I have nearly gotten into physical confrontations with cops because of my confusion and frustration and short fuse. I knew better, but my brain failed me at the time when I needed it most. This is probably one of the suckiest things about having a brain injury (or, in my case, several) — it keeps me from being the kind of person I desperately want to be, and from living the kind of life I am determined to live.

On the less dramatic side, with regard to being slower to respond to questions and finish tasks, it can take me forever to get my head around things I’m being asked. That drives my family nuts, and I have a tendency to try to cover up my cluelessness and slowness, so I don’t piss them off. But when I really want to get something, I’ll make them slow down. I also have to be ready to remind them that I am a bit slower than they expect, and they need to not get so upset with me about not following as quickly. Sometimes, they yell at me because I’m “being difficult” when I’m just a lot slower than I’d like to be.

I also often have trouble keeping up with conversations. I can’t tell you how many times people have started talking to me, and I haven’t had a clue what they were saying… for about a minute into the conversation. I tend to have to replay conversations later on, to see if I got what just happened. Socially, I’m fortunate that I have a lot of really gregarious friends who do most of the talking. I just sit back and let them do most of the “work” — and they’re fine with that. Either that, or when I’m in a conversation with someone that I’m just not following, I’ll actually just echo back what they’re saying without fully understanding what they’re talking about. I will appear to agree with them (which they like), but I’m actually just rephrasing what they’re saying. This makes me very popular (people like to be mirrored and they love it when other people agree with them!) but it doesn’t do much for my own sense of self.

Problem-solving
Individuals with a brain injury might have difficulty solving problems and planning and organising things they have to do. They may encounter trouble with open-ended decision-making and complex tasks need to be broken down into a step-by-step fashion.

Oh yes… breaking things down. Can I tell you, my life is filled with detailed step-by-step instructions about how to do the simplest things. When I need to organize my busy day, I fill my planner with the different things I’ll need to do, in the order that they need to be done, and I walk through them in precisely that order. I cannot tolerate changes in routine — it makes me nuts and freaks me out. I desperately need predictability and routine, because backing up and re-configuring my day is a recipe for disaster.

Irritability
Individuals may also have a very low tolerance for frustration and can become easily agitated and may lose their temper quickly.

Yes, yes , yes. Never forget that fatigue factor. Being tired not only makes it harder to think, but it makes it harder to manage emotions and modulate your expression. The thing with me is, too, that my TBIs have made me look more impassive and stoic on the outside than I feel on the inside. So, I may be seething with frustration on the inside, but I look perfectly fine on the outside, so people around me cannot judge my level of frustration — until I blow up.

Another thing that ‘stokes my fires’ is the pain that I’m often in. I have a lot of pain in my body that isn’t helped by drugs or much of anything other than rest. When I’m fatigued, I’m often in extreme pain, which just adds to my irritation level.

Irritation is a huge problem — for me as well as others, because I never, ever want to hurt the people I love, but my irritability gets the better of me all too often. And I have to live with myself afterwards.

Socially inappropriate behaviour
People with a brain injury may no longer know how to act or behave in in social situations. This can be incredibly difficult for families to understand and cope with, particularly as they may no longer recognise their loved ones and not understand their behaviour.

I have screwed up social situations so often, that now I just tend to keep to myself and I don’t respond unless others address me first. Some of the many things I’ve done that have landed me in hot water are:

  • Talking too loud about sensitive issues
  • Forgetting that I promised to keep a secret, and telling the world — in front of the person to whom I promised I wouldn’t tell
  • Behaving in ways that women felt were too familiar or encroaching or sexually intimidating
  • Behaving in ways that men (including security guards and police officers) considered threatening, and triggered an aggressive response from them
  • Coming across like I was making fun of or deliberately embarrassing family members

I really, really hate this aspect of TBI, especially, and it makes it easier for me to just keep to myself. It’s tough, because I want to be social — who doesn’t? But I do it so poorly, at times, that I feel it’s my responsibility to shield others from my ineptitude.

Communication
A wide range of social skills may be affected by an a traumatic brain injury including the ability to have conversations, to interpret and respond to social cues, to show interest in others, to use humour appropriately, and to regulate the volume and tone of voice.

Uh, yah. See above for how my TBI affects communication issues. I generally don’t initiate conversations, and I’m terrible at sustaining them. Good thing I live with very social people who can run interference for me. I usually don’t stray far from them, as I tend to get into trouble with people, when I try to initiate and sustain conversations. At times, I just don’t know what to say. I’m like a little lump of clay that isn’t able to create impressions on others, but can be impressed upon by others. I generally stick with just responding to people’s cues, but even then, I’m often totally lost, and I simply don’t follow. I also am often strangely devoid of interest in other people. Oh, certainly, on a grand cosmic scale, I do care a great deal about what others experience/think/feel, but personally, in my injured brain, part of me just doesn’t care. I want to care (I think), but I just don’t. I’m sorry, world. I just don’t.

I also don’t always use humor appropriately. I usually think I do, but then I find out from others that I don’t. Heaven help me — and everyone around me, who has to put up with my sense of humor when I’m tired.

Regulating my tone of voice is a constant challenge, which is another reason I keep quiet so much. I often use the exact wrong tone – I’m too loud in quiet situations, or too quiet when I’m talking about important things… I sound angry when I’m just riled up… I sound deadpan/stoic when I’m really worked up. In some cases, people I live with have been very afraid of me because my tone was a lot more intense and sounded “hateful” and aggressive, when I was just having a lot of trouble articulating, and I was scared half to death over something. I’m hoping that my family members will learn that my tone doesn’t always match my inner reality, and cut me some slack.

Depression
Depression in an individual with brain injury is a very common emotional consequence that usually comes some time after the injury. Signs of depression include lack of motivation, loss of sexual drive, sleep disturbance and tearfulness.

Okay, here’s one of my pet peeves — interpreting neurological processes with emotional ones. Lack of motivation is not necessarily depression-related, nor is loss of sexual drive, sleep disturbance, or tearfulness. There are a host of neurological reasons why all these can occur, and the fact that they’re commonly lumped together under “depression” tells me that there are probably a lot of people walking around with neurological issues that could be possibly addressed with occupational therapy or other coping mechanisms, but they’re being medicated, instead.

Unraveling neurological issues from psychological ones is in the Top Ten Things I Hope to Promote in This Blog. Calling our neurological, TBI-related issues “psychological” ones and addressing them with drugs just empowers the pharmaceutical companies, not the people who have to live their lives. Don’t get me wrong — I have nothing against a quality pharmaceutical solution. But too often pills are pushed as a solution, when they just add to a problem — like Prozac making certain people suicidal.

Mis-diagnosing neurologica/TBI-related issues as psychological ones and inappropriately medicating patients actually works against the pharma companies, as well. It makes them suspect, when the real culprits are lazy/mis-informed/biased/idiotic psychiatrists/therapists/doctors and it prevents good science and good medicine and good psychotherapy. I want good pharmaceuticals as much as the next one — but I want their power used properly and for good, instead of lazy-assed evil.

Headaches
There are multiple sources of head and neck pain, both inside and outside the head. Headaches arising from a brain injury can be caused by a number of reasons.

When don’t I have a headache? Rarely. Of course, one of the neuros I’ve seen over the last year tells me they’re stress related, and if I just relax and exercise more, they’ll go away. Hasn’t worked so far… Hasn’t ever worked.

Visual problems
Vision and visual functioning is often adversely affected by brain injury. Some of the more common visual systems problems include double vision, rapid eye movement and near-sightedness.

Can’t speak to this much, aside from rapid eye movements I sometimes get when I’m overtired.

Hearing problems
Hearing problems can occur for a number of reasons, particularly when the inner ear and/or temporal lobes have been damaged.

And let’s not forget tinnitis — that constant ringing in the ears. True, it can be more neurological than auditory, but it’s hearing-related. For the record, I have — and always have had — constant ringing in my ears. Sometimes it’s louder than others, but it’s always friggin’ there.  It used to drive me nuts when I was a teenager, but I have since acclimated to it. Now I use it as a barometer of my physical condition — louder means I’m having issues of some kind — stress or fatigue or what-not. It’s actually a useful gauge of my physical well-being. Provided I can tolerate the constant high-pitched whine.

A traumatic brain injury is often called the invisible disability. As there are frequently no outward physical signs of a disability, effects such as fatigue, lack of initiation, anger, mood swings and egocentricity may be seen simply as bad personality traits by others. It is easy to see why a traumatic brain injury can be such a devastating disability, especially when the disability is not obvious to others.

Indeed. In fact TBI is often a double-hidden disability, as it’s so often hidden from the survivor, themself. It’s a real conundrum, let me tell you. Society has so many biases against behaviors and problems that can come with TBI, it can be all but impossible to get people to consider you injured, rather than bad. The real challenge, from where I’m sitting, is learning to detect and live with my own disabilities, find my strengths, and ultimately, finding peace in myself, no matter what the rest of the world has to say.

And if I can get through the day without doing any harm, so much the better.

TBI can be a devastating experience, both during and after — in the short and long-term. But if you can get past the trauma of it and learn to deal with it substantively, it doesn’t have to ruin your life. And the pieces that have been broken, can sometimes be put back together again. Ultimately, the brain is a fascinating phenomenon. We all have one. And the challenge — for us all, at this time — seems to be learning how to use it properly.


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Throwing nuts at the cheetah

I had a really troubling dream just before I woke up this morning.

I was walking through the woods with two friends of mine. It was almost like a jungle or rain forest – the air was very humid and the trees were huge and spaced apart, and the forest floor was quite open — not a lot of underbrush, but springy underfoot. We were walking along a wide path that was well-worn, and we were talking about this and that. I believe we were discussing possible dangers from big cats that had been seen in the area.

If I remember correctly, the woods had been cleared of all dangerous wild animals a while back, but some big animals had escaped and had returned to their habitat, so hikers were warned to be very careful and not engage them.

We walked and talked for a while, and I was picking up stones and nuts and old pieces of tropical fruit that had fallen from the trees. I was tossing them around, and my friends were getting irritated with me. They wanted me to stop, but I didn’t feel like talking with them. They were just running at the mouth, and I was getting overwhelmed with all the words.

We were passing by an open clearing that was raised up above the path, when we looked up and saw a cheetah sitting in the sunlight. It was a beautiful animal, so sleek and strong. It also looked very dangerous and wild. My friends said we should walk by it slowly and not bother it. They were both terrified of it.

I was thinking that I knew how to deal with a big cat. I’ve learned (for real, not only in the dream) that with big cats, if you come across them, you have to face them down. Make yourself as big as possible and stare them in the eye. You cannot show any fear, and you cannot turn your back on them, because when they hunt, they go for the back of their prey’s neck. If you do show them fear, or you turn your back to them, they instinctively attack and go for you. This is why joggers and cyclists are often attacked by mountain lions in California — they have their back turned to the animal or their heads are down, exposing the backs of their necks, so the big cats attack.

I wasn’t afraid of the big cat, and I felt like I needed to show it who was boss. I also felt a kind of rush from the imminent danger — Here was a cheetah! A big cat this close! We were in danger for our lives! I felt that familiar rush of adrenaline that sharpens my senses and pumps me up and makes me do things that I would not do under normal circumstances. Something in me surged with daring, and I took a nut I’d been holding and threw it at the cheetah. I felt a thrill of danger course through me, and I cursed myself for having thrown it at the cat. The nut bounced near it, and the animal flinched, and it looked like it was going to back off and leave us alone. My heart was pounding and my mind was calculating what I would do in response to it. I was watching it very, very carefully, to see what it would do, and for a few moments, it looked like the big cat was going to withdraw into the woods and leave us alone.

But then my friends got very frightened that I’d thrown the nut at the cat, and they started to freak out and panic. My one friend started to shake and quiver, and my other friend, who is a bit overweight and doesn’t move very quickly in real life, took off running down the trail. In my dream, I was thinking, “What are you doing?! You’re going to catch its attention! Why are you running from a cheetah? You can’t outrun it! You have to stare it down. You have to stand your ground!

I looked up at the big cat and saw it had suddenly spotted my friend. in an instant, it recovered its composure, sprang into action, and raced after my friend. It looked so beautiful in motion, all its sinews taut, its coat shining in the sunlight that filtered through the canopy above us. But my admiration was short-lived, as it caught up with my friend, grabbed them by the back of the neck, and started to run off with their body dangling from its jaw.

Frozen with horror for a moment, I took off running after the cheetah, yelling at the top of my lungs and willing myself to run faster. I was convinced I could catch it and wrestle my friend from its grip.

The big cat was very fast, though, and it was way ahead of me, with my friend’s body hanging from its jaws. I was horrified and mortified, and my other friend was screaming at me for throwing the nut at the cheetah and making it angry. In my head, I was trying to calculate how far the cheetah could get, carrying my friend’s heavy body, if I could catch up with it because it would be slowed down by the weight, and if I could get to it in time to save my friend. I suspected that my friend had been killed instantly, or that even if I did catch up, the cheetah would be eating them, so there wasn’t much point in my running after them.

Plus, I ran out of steam after a few hundred yards, and I had to stop. I was so upset at what had happened. On the one hand, I was upset with myself for throwing that nut, but I was also upset with my friend for not having better sense, and I was upset with the whole chain of events that was probably killing my friend.

I woke up very disturbed around 5:00, and I haven’t been able to get back to sleep.

I think that this dream has something to say about a lot of aspects of my life, these days. I have a lot of people around me who are very frightened for me, as I talk to them about my TBIs and the issues that go along with them. They’re like the friends in my dream, who just want to walk along quietly along a well-worn path in the woods, chatting about this and that, not really bothered by anything… cognizant that there are things amiss in the world, but not really eager to confront them.

There’s also a part of me that’s like that. I don’t want to be bothered by dangers in the woods. I want to just go along my merry way and not have to expend a lot of energy on things like dealing with large dangers that I come across.

But there’s also a part of me that gets bored with all that safe stuff, and I need to occupy myself. So I do things like picking up rocks and nuts and old pieces of fruit and tossing them around. I get bored pretty quickly, so I start casting about for new things to learn and do.

And sometimes my casting about uncovers big dangers along the way. Like this diagnostic imaging I’m going to have done — an MRI this weekend, and an EEG in another week or so. Who knows what will be uncovered as a result of that? Sometimes I cast about a bit too freely, and I can end up stirring up things that are unexpected and potentially dangerous… but are actually authentic pieces of my human experience.  (The interesting thing is that the cheetah in my dream actually belonged in the woods — it was its home, and it had just returned to its rightful place.)

Sometimes I cast about too carelessly, too — like tossing a nut at the cheetah. Or, I take a calculated risk and push the limits. In my dream, I didn’t just toss the nut at the cheetah for fun — I did it partly to show it that I meant business, and I wasn’t intimidated by it. I also wanted to scare it away. And it almost worked. But my friend with the weak nerves had to take off running — doing exactly the wrong thing, in that situation. They didn’t have the same information as I, apparently, and they let their fear get the best of them. And then all is lost.

This is pretty significant to me, in my real life experiences with others, because as I move forward, I’m going to have to educate the people around me about my condition(s) — TBI, etc. — so that they learn how to respond appropriately to the situation I’m in. I really don’t need them to freak out and get all worked up over things that A) we don’t know for sure, or B) are big and dangerous but are totally manageable with the right information and the right team of caregivers. I don’t need them to lose it and put themselves — or me — in danger. I need them to be cool, be present, be able to help in a substantive and constructive way.

As I go through this next phase of diagnostic testing — maybe it will show something, maybe it won’t — I need to keep my head on. I need to take care of myself and take things slowly, and not only know why I’m doing what I’m doing, but be clear with others why I’m doing it. Everybody needs to be in the loop, and that includes the parts of myself, too, that are prone to freak out and make poor choices out of fear, rather than knowledge and courage.

But at the same time, I also need to be cognizant of my tendency to court danger, as some kind of reflex, some inner/neuropsychological/biochemical need to sharpen and brighten mylife experience… to wake me up and keep me engaged in life. I need to be aware of my tendency to overstep my bounds, when I’m bored or tired or in need of some stimulation. I need to remember that, when it comes to taking on new challenges, I’m not always as smart as I think I am, and I’m not always up to the task of overcoming what I’m presented with. I can’t afford to forget that I rarely know as much as I need to know — either about myself or the situation I’m presented with. In my dream, I couldn’t chase down the cheetah, once it had hold of my friend. And I can’t always overcome my cognitive and behavioral issues as well as I’d like, once they take hold of me and get a ‘running start’ ahead of my logic and innate abilities.

When (not if) I meet a proverbial big cat on the path through my own “woods,” I need everyone with me — the parts inside and the people outside — to remain calm, make informed choices, and keep their heads. I need to focus on the basics — take care of my body and my mind and my spirit, with adequate rest and activities that feed and sustain me and build up my strength (not to mention common sense). And I need to be aware of my limits and not push them carelessly just because I need a thrill. I need to be aware that I do have a tendency (perhaps thanks to my PTSD) to court danger, just to feel awake and alive. And I need to remember that I’m much more use to my friends and family alive and healthy, than injured or dead. No matter how dangerous a situation may seem, the right information and the intention/willingness to intelligently proceed in the proper way can mean the difference between keeping on my path and making progress, and disaster.

Note to self: Get plenty of rest over the coming days and weeks. You’re going to need it, to do a decent job of handling all this.