A Perilous Relief – The Physical Backdrop(s) of My Risk-Taking Behavior(s)

At the risk of sounding like I’m sitting around feeling sorry for myself, let me tell you about my physical experience. I don’t want pity, I don’t want clucking of tongues, I don’t want you to feel sorry for me. This is just my experience, and I’ve acclimated to it over the years. But I’d be lying, if I told you it’s easy…

To fully appreciate just how my risk-taking and danger-seeking constitute attempts to soothe my overworked physical/mental/emotional system, you’d have to understand just how anxious, sensorily overloaded, and painfully sensitive I tend to be. And you’d have to understand the impact that repeated injuries, including head injuries, have had on my everyday life. I have, in fact, sustained numerous mild traumatic brain injuries since age 7, the experience of which is consistent with my sensory and other physical issues. (See http://www.traumaticbraininjury.com/content/symptoms/mildtbisymptoms.html for a list of mild tbi symptoms.)

All my life, I have had issues with pain and handling sensory input. As a child, I had a hard time differentiating between different sounds, but at the same time, my hearing was very sensitive. I was very attuned to fine details, and I was highly distractable. I experienced touch as pain, which caused many forms of regular human contact to be uncomfortable, even painful for me. I was not very limber, I had trouble touching my toes, and doing exercises like somersaults was difficult. Cartwheels were out of the question. I was an active child, and I loved to climb and play and join in with games, but my coordination wasn’t always the best, and I was often picked last for team games in school.

I loved to play sports, but I didn’t have a very broad range of abilities. For example, I loved to play softball. I loved it so much, that I wanted to become a professional softball player, when I grew up. Baseball didn’t appeal to me, because having a small, white object hurled at me scared the bejesus out of me. I had a hard time judging distance and speed, and the larger, softer softball wasn’t nearly as frightening to me.

There were a couple of problems with my pro ballplayer aspirations, though. The first was, I had a hard time catching fly balls. When my dad would practice with me and hit flies to me, I couldn’t judge the distance to the ball, or I shrank away from it in fear. My preference was to let the ball drop and then pick it up and throw it to another player. But that kind of choice-making in a serious ball game would have cost my team dearly.

Playing the outfield was not an option for me.

Sliding was out of the question. I was to hesitant and too gawky to do it very well. And the pain that came afterwards was inhibitive, whenever I considered sliding.

I couldn’t react quickly enough on the spot to play shortstop.

My coordination issues kept me from being a very good baseman. My reaction time wasn’t consistent, and my ability to catch and tag wasn’t very good. I wanted to play shortstop, but it made me too nervous, and I couldn’t think and react quickly enough to make a very good player at that position.

I made up for all this by throwing myself wholeheartedly into the small range of activities I could do well. I had too much trouble with fielding and reacting quickly to be an all-round good player. What I could do, was play third base, hit, and be a good team captain. Third base was a kind of in-between position that was half-baseman and half shortstop, that let me be in the infield, but in a more marginal position. I was a pretty decent batter, and I also learned I could switch hit. I’m right-handed, so I always thought that I should bat right-handed. But I actually found that I was better able to bat left-handed. It just felt so much more natural to me. Most of all, I was a good team leader — a captain who led by the example of just throwing myself into the game and doing my best at any and all times, even if I messed up, now and then. I think, if anything, my spirit helped the team more than any amount of technical skill.

But still, it wasn’t easy to come to terms with the fact that I just didn’t have what it took to become a professional softball player.

When I was young, there wasn’t really anything like a diagnosis of sensory integration dysfunction or sensory perception disorders, and attentional challenges weren’t yet on the radar. All I know/knew was, I was immersed in a seething cauldron of sensory input and there was really no escape.

I’d like to say things got better when I grew up, but I can’t say that’s so. All I can say is, I’ve gotten used to these problems, which doesn’t make me very happy, actually. But there it is.

Below is a run-down of the persistent physical issues I’ve had to deal with most of my life, and that still plague me intermittently. I’ve tried to be as thorough as possible, so you can get an idea of the scope and intensity of my “sensory landscape.” These issues can range from mild to extreme, and they manifest with varying degrees of frequency. I do not experience all of them simultaneously, but many can appear concurrent with others.

Ringing in my ears (tinnitus)

I have a constant ringing in my ears. I’ve had this as long as I can remember. It used to drive me crazy as a teenager, but eventually I got used to it. It’s a high-pitched whine, not so much ringing — a very thin, reedy, penetrating whine “over” several other deeper tones. It rarely goes away. If there’s no ringing when I wake up, it usually starts by mid-morning. It’s worse when I’m tired and/or stressed and/or have allergies. It’s better when I’m rested.

Vertigo, Dizzy-ness, Light-headedness

I have occasional feelings of being “woozy” and/or losing my balance suddenly. Sometimes it can last for a day or more. Sometimes, when it’s really bad, it lasts for days — nearly a week, in the past. I have to be very careful that I don’t fall, when it’s particularly bad. Holding onto things, keeping myself rigidly upright and intently focusing my attention on something in front of me helps. Tactile activities help me focus — holding onto things, making contact with things around me, like fabrics and curtains, arms of chair, objects held in my hand. It’s much worse when I am tired, and when I have allergies, it’s worse. It gets better when I’m rested, but it usually takes at least a day or so to clear up, even when I am rested.

Balance (Vestibular) details (when they’re at their most extreme)

When I’m experiencing “vestibular challenges,” the whole world spins wildly around me… swaying and shifting. Every time I move, no matter how small the motion, I feel like I’m going to fall over. I cannot move my head without being overwhelmed by waves of nausea that wash over me in progressive swells. When I turn my head this way or that — I never know when, or which way — there is a swooshing sound in my ears that is sometimes accompanied by pressure and pain. My ears hurt me with a dull ache that’s sharp at the center… like thick sticks that have small points being pressed into my eardrums. My stomach lurches, and my head pounds with a sick headache. A whining, whistling, high-pitched roar fills my ears, and through the intense ringing, I hear muffled sounds that annoy me with distraction. Even when I stop and hold still, the sense of imbalance continues, like a bucket of water that’s been swung to and fro, sloshing back and forth for a while, even after it’s set down on a level surface.

Going about my everyday business, I sometimes have a sudden sense of falling that eclipses and overrides all other sensory input in my system. The room spins, my legs become weak, and my head swirls in sickening waves of disequilibrium. The walls seem to move before my very eyes, the floor rolls beneath me, and my body feels like it’s swaying. For as long as the feeling lasts, I cannot think, I cannot talk, I cannot react to anything around me. I cannot hear or see much of anything around me. I’m dimly aware that there are objects or people nearby, but they don’t register. I’m faintly aware that people are talking to me, but I cannot respond immediately. All I can do, is try to right myself, try not to fall, try to fight back the waves of sickening vertigo, and hang on, till the nausea passes.

My condition does not seem to respond to “standard treatments”. I’ve tried ear drops and anti-vertigo medications, and they did nothing for me. I also wish I could just write this off as a simple balance issue and have that suffice. But there’s a whole lot more to my situation, than being off-balance. Vestibular issues are just the beginning.

Coordinated Balance (“Proprioceptive?”) Issues

I also have issues with sensing where my body is in relation to the world around me (“proprioceptive” issues). These tend to kick in most intensely when I’m off-balance. I cannot feel where my body is in relation to things around me, and I bump into objects all the time — corners of tables, sides of counters, chairs I’m passing… I also knock things off flat surfaces, if they are too close to the edge. I have a hard time gauging how quickly my body is moving in any one direction, which can cause me to misjudge distances and be uncoordinated. I fumble at picking up objects, I drop things I’m holding, and I tend to have trouble judging distances between myself and others. I also inadvertently bump or hit people when I’m just trying to reach out to them or move past them. When I’m trying to keep my balance, I tend to (for lack of a better word) “proprioceptively overreact,” which makes me either bump into things and people around me or shy away from them abruptly, neither of which is interpersonally optimal.

Hearing

My hearing is also affected by my simply not being able to pay attention to anything but staying upright and not running into things. I can be so intent on trying to stay balanced, that I don’t hear anything around me immediately. I’ll hear things, but they don’t immediately register. And when they do register, I’m often so far behind in figuring out what’s going on, I get the message turned around and am not successful in responding to what I’m hearing right away. When I’m really struggling to navigate contact with the world around me, it can take a few minutes for sounds to sink in and be processed in my brain. I hear them, but I don’t process them immediately. This can be a problem when someone is talking to me. I won’t hear them for a few seconds, and then when I do hear them, I am so busy trying to figure out what they just said to me that I miss what I am able to hear. This is less than optimal.

One of the most annoying and disorienting auditory aspects of my bad days is the whooshing sound, which comes and goes when I’m “off” — sometimes quickly, sometimes gradually. I can rarely predict when it’s going to happen (although during allergy season it is usually more pronounced). It often takes me by surprise and thoroughly distracts me from what I’m doing. I’m usually so caught up in going about my daily business, I don’t notice the dull roar or the achy pressure or even the whooshing sound until it’s unmistakable. And when I finally hear this whooshing sound, I tend to feel nauseous and dizzy. I seem to associate it with feeling lightheaded and sick on my stomach, and whenever I hear it — whether I’m nauseous and dizzy or not — I cringe. I freeze. My rest of body seems to remember what it feels like to hear that whooshing sound, and it reacts accordingly.

Sight

My vision can be affected, too. When I’m off-balance, and I’m not well in-touch with the world around me, my vision gets “re-assigned” to the task of helping me keep my balance. It’s hard to describe, but when I’m “off,” I can visually detect things around me, but I don’t readily process what that means. It’s like with my hearing — I know I’m seeing something, but my brain is too busy trying to figure out how to just keep steady and parse out all the input coming in, to interpret what that something I’m seeing is.

Probably the best quick example I can give of this, is from a time when I was driving through a parking lot, and I literally didn’t see another driver, who nearly hit me, and I didn’t hear him honking his horn at me, until I was nearly out of the parking lot. I was at an office supplies store, and I’d just bought myself a new headset for my cell phone, so I could drive hands-free and still talk on the phone. I try to avoid talking on the cell phone while I drive, but I was hoping that a headset might let me at least be able to accept incoming calls without being a hazard to other drivers.

I sat in my parked car for a few minutes, figuring out how to put the headset together, then I placed it on my head, positioned the mic in front of my mouth, and slowly pulled out into the parking lot. As I was rolling towards the exit, I noticed that a car was pulling out of a side lane just ahead of me. The headset felt like it was slipping off my head, and the microphone wasn’t staying in front of my mouth. My attention was focused intently on the feel of the headset on my head and the mic at my mouth.

As though in slow motion, I saw the front of the other car inch out into my path. I didn’t slow down, but continued to drive towards the exit. The headset felt strange on my head, and I could hardly think of anything but keeping my head straight. The front the other car was rapidly approaching the driver’s side front fender of my own vehicle, but I continued to drive on. I didn’t veer, I didn’t slow down, I didn’t speed up. I didn’t react at all — I just drove on. Only dimly was I aware that I had barely slipped past the front of the other car and avoided a collision. It never occurred to me that I should react in some way. It never occurred to me that I should interact with the other car.

As I continued to coast towards the exit, I could hear a beeping in the distance. The headset on my head continued to bother me with its pressure on my one ear and the feel of the microphone near the side of my cheek. The mic wasn’t pressing against my skin, but I was keenly aware of its proximity. I really felt like I was losing my balance, and I held my head absolutely still to keep the apparatus properly positioned. The beeping continued, and I wondered if someone’s car alarm had gone off. But the sound wasn’t rhythmic or regular, so it must have come from somewhere else.

I looked in my rear-view mirror, and I saw driver of the car I’d narrowly missed yelling and beeping his horn at me and wildly gesticulating, pointing at his head. At first, it didn’t sink in, that he was communicating with me, but when I looked up again, I realized that his behavior was directed at me. And he was furious. The headset kept slipping off the side of my head, ever so slightly, but enough to distract me.

Realizing what was going on around me, at last, I tore it off my head and threw it on the passenger seat beside me. When the headset was off, it was as though the lights went on in a dark room, and someone suddenly turned up the volume on life all around me. I could suddenly see. I could suddenly hear. Suddenly, I wasn’t sitting in an enclosed cell with a headset on, I was driving a car in a parking lot. I got out of the parking lot as quickly as I could, merged into traffic, and went back to work, shaken but grateful that I hadn’t done any damage.

I haven’t used that headset at all, since I bought it.

My vision and hearing aren’t the only senses that get “whacked” when I’m out of sync. My taste and smell do, too. My sense of smell tends to be either all-on, or all-off. It’s very rare that I smell something “normally” and can take deep breaths of scents, like perfumes or foods. If I get too strong a whiff of something, it makes my head spin and really overloads me. And if I’m already off balance, or I’m not connecting well with the world around me, my sense of smell sometimes completely turns off. My sense of taste is even less predictable. It’s muted and vague, and I often judge the foods I like more by their texture, than by their taste.

Touch – Pain

My sense of touch is quite variable — like my sense of smell, either it’s all-on, or it’s all-off. I can literally slam into things, and never feel the impact… sometimes I don’t know I slammed into something until I see the bruises on my leg the next day. But my sense of touch in my hands is very active. When I’m feeling nervous or agitated, running my hands over objects — like the interior upholstery and surfaces of my nephew’s new BMW — is very soothing for me. I’ve always loved satiny fabrics, and when I was a kid, I couldn’t fall asleep unless I rubbed the satin edge of my blanket. I rubbed that smooth, soothing edge so long and so often, I wore a hole in it!

On the other hand, I can experience a lot of tactile discomfort. A simple human touch can feel like a blow to me, and when people put their hand on my arm, sometimes it feels like they’re smacking me. Hard. It’s very strange and difficult to describe, and it makes me very uncomfortable to talk about it, but I experience pain and discomfort from things like clothing, hugs, harmless social touches, and jewelry. I don’t wear any bracelets or extra rings or necklaces, or even a watch, because the contact tends to be very uncomfortable — and distracting — for me.

There are a number of different kinds of tactile discomfort I experience. They are not like muscular pain, but are very much on the surface and localized in my skin surface. Here are some details and descriptions:

Burning – It feels like being burned with a hot coal(s), like embers are laid on top of my skin and are burning down through to the bone. This occurs often on my upper arms and across my shoulders and back. It’s usually worse when I’m tired or have a lot of stimuli coming in on me, and its origin is internal in nature (I’ll call it “autonomic”).

Twisting – It feels like I’m having my skin twisted by two hands having a firm grip on my skin, and twisting in opposite directions (like the “Indian burns” we kids used to give each other). It is mostly on my outer forearms and wrists, and it’s worse when I’m tired or stressed. (Autonomic)

Healing burn – It feels like having second-degree burns that are healing under my skin – not on the surface, not down at the bone, but just under the surface of my skin. This occurs mostly on my outer forearms and wrists, and it’s aggravated by having long sleeves. It’s usually worse when I’m tired or have a lot going on around me. (Autonomic)

Chafing – It feels like being rubbed by by a rough surface – either a piece of rough material, or in some cases, a surface that is a little sticky or ‘grippy’ and pulls my skin a little as it rubs. Some people talk about “sandpaper” type of pain, and this might be close to it, but it’s not exactly. It sometimes feels like a moist, tacky texture being rubbed across my skin. I experience this mostly on the tops of my thighs, aggravated by my slacks. Sometimes I feel it on my arms, and it’s aggravated by the touch of light clothing. (Autonomic)

Prickling – This feels like being jabbed with little tiny pins over an extended area. It’s somewhat similar to “sandpaper” type of pain, but not exactly. It sometimes feels like coarse sandpaper against my skin — not rubbed across it, but held in place, so it irritates me with its presence, but it doesn’t rake. I usually experience this when my clothing brushes my forearms and wrists, also happens without prompting on my upper arms and across my shoulders. (Autonomic)

Blistering – It feels like my skin is blistering and cracking, like paint cracking in the sun, or my lips cracking from being chapped. It usually happens when I am just lying still and trying to relax, like when I’m in bed and trying to sleep. The more I relax and just breathe, the more my skin feels like it’s blistering and cracking and peeling. It happens when my skin is exposed to the air and doesn’t have anything over top of it. It’s much worse when I am tired, but it can happen pretty much anytime. It often takes me by surprise. (Autonomic)

Brushing/Raking – This feels like having my skin brushed/raked/ stroked with a metal-bristle hair brush – the sharp ends pulled across my skin, not pressed in really deeply, but just on the surface, where it irritates and I can’t get away from it. I usually feel this on the tops of my thighs — when my pants brush against my skin lightly. It’s not startlingly painful, but it does hurt. (Autonomic)

Smacking – This feels like being hit hard with an open hand or broad surface – and then the pain scatters out across my skin, as though it were a campfire that had something land in it, and the coals and sparks scattered all around it. It usually happens when someone touches me for a few minutes (an short but extended period of time). Like when my partner put their hand on my forearm when we were driving down to visit family for Christmas. They just laid their hand on my forearm affectionately. It really hurt, and I could feel the pain spreading out around where their hand lay on my forearm. The pain continued, even after they took their hand away. (This is an interactive type of pain, brought on by human contact.)

Banging – This feels like being struck with a blunt instrument – and then the impact reverberates throughout my body. This usually occurs when someone touches me briefly without warning, often in casual conversation, like when my brother-in-law was talking to me at a restaurant one Christmas, and he was harmlessly touching my arm (in a friendly, appropriately affectionate way). This also happens when someone tries to hug me. I have also experienced this when my partner was checking me over for ticks, and they touched the backs of my legs, near my knees. The pressure was very light, but it felt like they were poking me very hard with a blunt object. (Interactive).

Please keep in mind that (thankfully) not all of these types of pain happen simultaneously, and they tend to vary. From one minute to the next, I can go from a relatively pain-free state, to waves of strong physical discomfort. I can be 75% fine one day, and be 15% fine, the next. One type of clothing can be unbearable for me, while others are benign, even pleasurable. And a person’s sudden touch can be excruciating one day, while the next, it can be welcome and enjoyable. “Pain” can also be relative, varying from mildly uncomfortable to downright agonizing. But I differentiate it from “discomfort” in that its degree is different.

Discomfort is something I can deal with, but pain is something that every fiber of my being seeks to escape. An itch is uncomfortable for me. Fabric sensitivity, even at its slightest, feels painful to me. It’s not just discomfort, which to me to me is just annoying and transitory. It’s pain.

My autonomic pain seems to be exacerbated by the qualities of the things I contact — the chemical makeup of fabrics, the quality of light and sound around me, the intensity of the sensation I have (such as the strength of pressure on my skin from the cell phone headset). It tends to get worse, also, when I’m over-tired or I’ve got a lot of different sensory input to process. I haven’t taken the time to figure out what kinds of textiles or materials give me the most trouble. Some days, everything gives me a lot of trouble. I just kind of go with it, and see how I’m doing, where I’m at, and I adjust accordingly.

My interactive pain tends to be exacerbated and complicated by my vestibular and proprioceptive issues. Being unable to gauge distances from people who are reaching out to touch me (no matter how appropriately), makes it difficult to A) prepare myself for their contact, or B) react appropriately. It is difficult for me to receive hugs from friends and loved-ones when my sensory issues are kicking in, and this contributes to my social awkwardness. I tend to stiffen and get tense, which actually makes the experience worse for everyone — for me, because it heightens my agitation, and for them, because they sense a reluctance from me that is physical rather than emotional or interpersonal, and their contact tends to become a bit more clumsy. Stress and strain tend to sharpen my pain, so when my vestibular and proprioceptive issues are acting up, the startling experience of a sudden physical contact can make even a simple touch extremely painful.

The different types of pain I experience can be helped by things like sleep, immobility, keeping away from the source of irritation, movement, stretching, steering clear of people and physical contact, preparing for physical contact with others, or just distracting myself from the sensation by some sort of activity. Analgesics like Advil are not very effective, although they do sometimes take the edge off things. A hot shower can be very relaxing, and swimming in a heated pool is probably the thing that helps me the most. Depending on the type of pain, and how well I’m rested, sometimes relaxing and being immobile makes it worse. Other times, it makes it better. It all depends how I’m feeling at the time, and how well I can redirect my attention to things other than the pain. I haven’t been able to figure out exactly how best to address this. I usually just think about something else and keep myself busy to keep my mind off it, as there’s really no escaping it, when the pain is in “full swing”.

Touch – Insensitivity

One of the other tactile issues I experience is on the extreme opposite end of the spectrum — lack of sensation. When I’m off balance, and my proprioceptive sense is diminished, I tend to run into things, but I often don’t feel it right away. I sometimes notice a sharp shooting pain when I bump into things, but the sensation disappears immediately, and I won’t know how badly I’ve bruised myself till later. I have also accidentally cut myself and not felt it until some time later. At times, when I have really cut myself deeply, or I’ve bumped myself hard enough to get a deep bruise, I’ve been so intensely focused on what I was doing at the time, I hardly noticed the pain and only realized I’d hurt myself when I felt the blood or saw the bruise later.

I suspect this may have something to do with adrenaline — my adrenaline is pumping so hard, at times, as I try to keep myself together, that it seems to numb me to the pain. I’m not a doctor and I don’t know nearly enough about human physiology, but my experience when I unwittingly injure myself is very similar to when I was injured while playing sports — I’d be so intent on the game and so “adrenalized” that I would hardly notice the pain. Again, I’m no doctor, but that’s how I experience it.


A Perilous Relief – Table of Contents

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The Magic of “Analgesic Stress”

Clearly, the human body is built to survive. And the mechanisms that kick in to save our asses are as built-in as breathing heavily after a sprint or sex, as instinctual as brushing shaggy hair out of our faces when we encounter someone or something we need to see more clearly.

What’s more, the survival mechanisms we employ to escape imminent physical doom are also important parts of less extreme, yet equally vital physiological and psychological survival strategies. Physical responses to mortal danger don’t have to originate only from physical situations, like a mother grizzly discovering you standing between her and her cubs. They can just as easily — and probably, in today’s world readily — arise from psychological ones, such as a sneaking suspicion that your boss is going to fire you at the one-on-one meeting they just scheduled, or the surprise discovery of your spouse in bed with the neighbor.

In order to trigger the biochemical cascade of fight-flight-fright, our brains don’t have to be presented with cut-and-dried physical reasons to pump our systems full of glucose, adrenaline, cortisol, etc. The juices can start flooding our systems over perceived threats, as well. And those threats can be just as existentially distressing if they’re job-related or relationship-related, as threats that involve our physical being.

If something truly threatening to any aspect of your survival is registering, your brain doesn’t particularly care whether it’s a charging bear or a discharging boss. It doesn’t matter if the grizzly is coming at you with a roar, or your spouse is coming with a scream. A threat is a threat, and the part of our brains that differentiates between different sorts of threats is offline, at the time we’re reacting to something wretched happening to us. Sure, the refined, discriminatory, gray-area-friendly parts of our brains are still there, but they are waiting till after the excitement has died down, before they start to tell the difference between a purely physical fight-flight-fright scenario and one that’s all about our emotions or our self-worth or our hopes for the future. The problem is, in the interim, while the sensible part of our brains is “down,” the survival-based part of our brains is flooding our bodies with all sorts of biochemical franticness that both hops us up and dulls us down, that pumps us full of energy, while shutting down the very systems that can regulate the rest of our delicately balanced systems.

So, where does that leave us, if we’ve experienced tons of traumatic stress over the course of our lives? Where does that leave us, if we’ve been stressed and over-taxed and put-upon in very intense ways over a long term? Chances are, it dopes us up with a pretty compelling case of Post-Traumatic Stress Disorder, that modern version of “shell shock” or “combat fatigue” or “nervous exhaustion” that clouds our judgment and heightens our reactivity.

And the more it happens, well, the more it happens. If you get sucked into a cycle of intense trauma response often enough, your reactions become so sensitized that your experience doesn’t need to be extreme to trigger a heightened stress respose. I’m no neuroscientist, and I’m not a formally trained psychologist, but it’s my understanding that if you’re put through enough trauma over the course of your life, your body can get in the habit of switching on those stress hormones at a moment’s notice, just to get you through the day. You don’t even need to be in severe mortal danger, for the action to take effect. It can just look/feel/seem like severe mortal danger to the body, and the mechanisms that prevent disaster will spring into action.

That’s where PTSD really digs in and becomes more persistent, more pronounced, more likely to take over. Which cycles around to exacerbate not only its own instantaneous reactiveness, but also its after-effects. And they aren’t pretty. PTSD’s symptoms can include (in no particular order, and in a bunch of different combinations):

Re-experiencing the traumatic event

  • Intrusive, upsetting memories of the event
  • Flashbacks (acting or feeling like the event is happening again)
  • Nightmares (either of the event or of other frightening things)
  • Feelings of intense distress when reminded of the trauma
  • Intense physical reactions to reminders of the event (e.g. pounding heart, rapid breathing, nausea, muscle tension, sweating)

Avoidance and emotional numbing

  • Avoiding activities, places, thoughts, or feelings that remind you of the trauma
  • Inability to remember important aspects of the trauma
  • Loss of interest in activities and life in general
  • Feeling detached from others and emotionally numb
  • Sense of a limited future (you don’t expect to live a normal life span, get married, have a career)

Increased arousal

  • Difficulty falling or staying asleep
  • Irritability or outbursts of anger
  • Difficulty concentrating
  • Hypervigilance (on constant “red alert”)
  • Feeling jumpy and easily startled

Other common symptoms

  • Anger and irritability
  • Guilt, shame, or self-blame
  • Substance abuse
  • Depression and hopelessness
  • Suicidal thoughts and feelings
  • Feeling alienated and alone
  • Feelings of mistrust and betrayal
  • Headaches, stomach problems, chest pain

Which can all conspire to make you feel like you’re either losing your mind, or you’re not fit to live in the world, or everyone is out to get you, or you just can’t make it through the day, or all of the above. And more. I’ve had a pretty eventful life, myself, thanks at least in part to the after-effects of multiple traumatic brain injuries, so I’ve got my fair share of trauma in my past. And post-traumatic stress. And full-blown PTSD.

My brain’s biochemical reactivity has, in many cases, worked very much against me. And I freely admit that I haven’t done nearly enough tending of my parasympathetic nervous system to decompress and regain my balance on a regular basis. But where my brain has often worked against me in stressful times, it has also worked for me, thanks to stress. And the things that have worked for me are those handy endogenous opioids I talked about in my last section.

Remember, the biochemical/hormonal stress response in humans doesn’t care what the stimuli are that are freaking out the brain. All it knows is that it’s freaking out, and it needs to supply the right magic cocktail of hormonal juices, so that the taxed system can function adequately in the face of mortal danger. Even in the absence of lions and tigers and bears and horrific natural disasters, in our modern world, endogenous opioids kick in to numb us to our pain, suppress responses that would keep us from fleeing to safety, and keep us bright and alert on some level — and they can save our asses just as much as they did our Grendel-fleeing ancestors’. At least that’s my experience.

And this is not something we can necessarily stop, once it gets started. We are literally hard-wired to have these biochemicals kick into gear when we’re in danger, we’re uber-stressed, and when we’re in pain. Whether the stress is from a charging bear or an angry boss chewing us a new one in a performance review… whether we’re in danger of losing a limb or losing our job (and our house and our car and all the stuff we owe money on)… whether we’re in pain from lacerations to our legs or sleep-deprived, repetitive-stress-fried joint agony… our bodies are still sending signals via stress hormones (our messengers to/from the gods) and our instinctively hard-wired brains are going to get a shot of numbing sweetness that takes our mind off our ills and lets us live to see another day.

And so a heightened stress response becomes a self-fulfilling prophecy, a self-perpetuating loop of spontaneous over-reaction that not only jacks us up, but chills us out, as well. It’s like having an existential smoke — nicotine has the dual effect of first stimulating the system, then chilling it out (which is what makes it more addictive than heroin, I’ve been told). Getting that rush of adrenaline, feeling the mind clear, sensing the body coil and prepare to pounce or flee… and then getting that soothing rush of endorphins… It’s hard to beat that, when it comes to being fully functional.

And it does make me fully functional. In more ways than one. The net result of our inborn neuro-biochemical survival/support system is the heightened ability to respond to immediate threats, reduced pain experience, and clearer, more focused thinking. And when I am in a state of extreme agitation and sensitivity, the effect on me is like the effect of clicking the button on a morphine pump for someone who has recently come out of surgery.

Indeed, I have to say that the same survival mechanisms that let me haul my ass out of mortal danger, also enable me to function at a “normal”level in my day-to-day life. This is probably going to sound crazy to some people, even mentally ill to others, but there’s a logistical reason I find my ass in a sling, time and time again — an inborn, ingrained need, even dependency, on stress hormones to function adequately in the world, and actually feel like a normal person.

Putting myself in the direct line of danger — whether by cultivating friendships with people who are innately hostile towards me, seeking out work with employers whose environment seems custom-tailored to trashing my work-life balance, or taking on too much work at a time when my body is sorely in need of rest and rejuvenation — triggers that magic biochemical cascade of endogenous opioids, and suddenly everything is better. It’s not only BETTER, it’s just better. Normal. Regular. Boring. Standard-issue. Uneventful. Drab. Blah.

This probably sounds odd, but normal, uneventful, rote life is something I really need to work at. Whether due to my head injuries or just my nature, I seem to be hard-wired for excitement. And that tends to get in the way of living my life — especially around other people and when I’m at work. Plus, I have a raft of physical/sensory issues that really get in the way and keep me from getting on with it in a productive and steady way. I don’t need my experience to be over-the-top better, just normal. Just regular. Just standard-issue, run-of-the mill… the way everyone else’s life seems to be, and the way I wish my life were.

And analgesic stress lets me do just that.


A Perilous Relief – Table of Contents

A Perilous Relief: Bliss From Within – The Glory of Endogenous Opioids

For better or for worse, I tend to have pretty high stress levels. It comes from an eventful past, as well as a busy present, and the intense drive to realize my deepest desires for my future. Certainly, it’s not much fun having to constantly “quality control” my thoughts and my actions, so I don’t get myself in trouble over post-traumatic stress that has nothing to do with what’s really going on around me. I certainly don’t want my energy and attention to get pulled down by old stuff that still makes me jump when an unidentified figure appears out of the corner of my eye. And it’s no fun “melting down”

But being highly stressed isn’t as bad as it might sound. In fact, there is a side to my typically high levels of stress that feeds me. And I love it. After years of being down on myself for being “over-stressed,” I’ve come to terms with that shadow side of myself. And I’ve learned to love my stress.

Here’s why:

In addition to these classic “fight-or-flight” responses to get you going, the little almond-shaped gland in the brain, the amygdala, triggers the brain to release endogenous opioids (opium-like chemicals that originate in your own system) which help your system function adequately in high-demand situations.

These endogenous opioids are a built-in part of our naturally functioning system and they are ever-available in varying quantities. Endogenous literally means “from inside”. And endogenous opioids are magic opium-like potions our systems create on their own (it’s been discovered that the human body actually produces morphine in small amounts). Yes, Virginia, there is a way to get high on your own steam, as the biochemicals our brains produce are of the same type as the illegal, intensely addictive stuff you can buy in a plastic baggie from some sleaze who will take sex as payment for the goods instead of money. They’re just a little different, so they match our body chemistry better. And they aren’t usually available to our bodies through our brains in the intense concentrations that leave overdosed junkies dead on the street.

In particular, these internal substances can have a hypoalgesic or analgesic (pain reducing) effect on the body, which helps you deal instinctively with whatever threat is in front of you, without having to deal with pain, as well. I’ve read that endogenous opioids serve to suppress the “lick response” in injured animals, so they can escape. (An animal, when injured, will instinctively stop to lick itself and tend to its wounds, but if it’s been injured by a predator this instinctual response makes it easy prey for its hungry attacker. By suppressing the pain – and the lick response – this natural impulse lets the animal ignore its wounds and focus on escaping to live to see another day.)

The same holds true with us humans. Imagine how short-lived we would be in crisis situations, if we were distracted by pain and other heightened sensations. We’d be too busy going “Ow! Ow! Ow!” and checking to see what bone we broke or what piece of flesh we tore, to get out of the way of the oncoming rockslide, tidal wave, or speeding bus, or haul ourselves out a burning car and run to safety before the gas tank explodes. The adrenaline rush and sudden biochemical cascade of pain-numbing opioids makes it possible for us to do important things like rescue each other, even when the rescuer is injured… to pull ourselves from danger, even if we’ve been hurt… and do things that would be utterly impossible, if we had to deal – for real — with intense pain. Endogenous opioids may well have been what let that tech guy save himself from dying on an ill-fated hike through the California wilderness by hacking his arm off below the elbow with a pocket knife.

Now, these endogenous opioids are truly wonderful things. Among them are Endorphin, Enkephalin, and Dynorphin. More research keeps trickling in about these substances — and others like them. It seems implausible that we could know so little about these important biochemicals until recently, but some of these have only been identified and studied since the mid-1990’s. And by the time I write (and you read) this, much more will probably be known about these substances, and how they interact with our sensitive systems.

It’s my understanding that the reason that artificial opiates work is because they are so much like the opioids we produce in our own bodies. Like a copy of a master key fitting into a lock, artificial/man-made opiates “open the same doors” that our own bodies normally have closed… and then open, when properly prompted by our biochemical “keys”. If you consider how strongly heroin and morphine can affect the human system, and if you consider that the only reason they work is ‘cause they mimic the qualities of opioids we already have in our own brains/brains, you can begin to understand just how powerful our own biochemical systems intrinsically are.

Yes, these endogenous opioids have the same sort of effect on us as opiates. They cut pain. They give us a euphoric feeling. They help clear our minds. They do amazing things to make life worth living. Lenny Bruce, the heroin addict, said of his addiction, “… it’s like kissing God.” If you consider that endogenous opioids can work the magic of relieving/inhibiting pain, imparting euphoria, and making us think better, it explains how human beings can sometimes perform at super-human levels irrespective of pain, danger, stress, or other normally stymieing influences (like, for example, the voice in their head urging them (in vain) to keep a low profile).

These magic potentialities we have in our brains have recently been getting more “air time” from scientists like Irving Biederman, who studies perceptual and cognitive pleasure. According to Dr. Biederman, we’re not only wired to survive — we’re wired to enjoy ourselves in the process. A lot. Things like learning new things, encountering novel situations, looking at innovative art, “tickle” the parts of our brains that release endogenous opioids into our systems.

So, under the worst and the best of circumstances, endogenous opioids are about as close to a gift from God as you can get. Not only do they buffer our bodies from the ill effects of extreme duress, but they also reward certain kinds of behavior (learning, in particular) with a pure shot of unbridled joy.

Kind of makes it all worthwhile, doesn’t it?

A Perilous Relief – Table of Contents

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Hits madness… the good kind

What a day I’m having… That little post I put together on the train while coming to work has caught people’s attention. My normally sleepy little blog has by now logged 1,646 visitors. Up from a high of 200-some, a few months back.

Suddenly, people are paying attention
Suddenly, people are paying attention

I’m pretty excited about this, and checking where the traffic is coming from, Alphainventions and Condron.us are both feeding me. Alphainventions mores0, but Condron is doing it, too.

It’s a pretty intense jump — a 10-fold increase over what I typically get. Dizzying. It’s kind of depressing, that this happened as a result of me talking about terrible things happening, but I guess in these times, everybody is paying closer attention to terrible things.

I think that perhaps we’re really trying to figure out how to handle it all. It’s not easy, living in these times, and I suppose it’s human nature for people to ponder imponderables. That’s not a bad thing. In fact, it’s a good thing. Writing about terrible things isn’t the most pleasant activity, but if we can come away with some lessons learned, then we may be able to turn negatives into positives.

One can only hope.

I talked to my friend today about their nephew. People think it was a drive-by shooting. Stupid, stupid, stupid. What’s the point?! What does it give us — anyone — to strike out against others from a safe distance?! From the safety of a passing car… What is the point?

I can think of a number of reasons someone would want to do such a thing. I can think of a whole lot. In a small way and on a very limited scale, it certainly has allure. But on a grander scale, within a community context, it has on meaning at all, and it only serves to destroy what little connection we have with our world.

And I think about how this relates to TBI. And PTSD. I can’t help but think about it. I wonder if the people involved were cognitively impaired, in some way. If they were socially impaired. If they had been injured so often and so badly by a wrecked family system and a wrecked culture, that there was no way they could get through it in one piece. If they were so brutalized by the inequities of this culture we tend to adore, that there was no hope left for anything but violence. Shooting. Cowardice from a moving car.

Certainly, whoever did this was alienated from their community, else they wouldn’t have done this. People are by their nature self-preserving. They do most things because they get something out of it. My logic is getting all tangled around, I’m sure, because I’m so pissed off about this shooting — about all the shootings that have been going on. But it seems to me that people who feel they have a place in the world, who have a future ahead of them, who can clearly see how they are interconnected with one another, and who have positive, mutually beneficial relationships with others they care about, are not going to run around shooting other people from moving cars.

But, you may say, people are responsible for their life choices. They have to make wise decisions and act on them, and if they choose the lesser, then they should be caught and punished… possibly put away for a very long time. I’m not saying that isn’t true. I agree with it. Personal choice is critical in all this, and I do believe in finding, catching, and punishing wrong-doers. I hope whoever killed my friend’s nephew is found, tried, and sent away for good.

But if someone is so f’ed up by a long, long history of abuse and neglect, and thanks to many beatings and falls and fistfights, their brains have been altered in ways they’re unaware, so that they’re doing things and making choices whose reason escapes them, and their skills and abilities are eroded by lifetimes of neglect and misunderstanding and seemingly random punishment, what chance do they have of acquiring the ability, even skill, of assessing their behavior and their situation and figuring out how to set right what’s been wrong for so long?

I do think, based on my own experience, that head injury probably plays a much larger role in our society’s ills than we care to admit. Certainly trauma and post-traumatic stress does. We should probably look closer at it as a nation. I suspect we’ll have ample opportunities to do so, as our veterans return from Iraq and Afghanistan, many of them with TBI and PTSD — and not all of them diagnosed and treated or supported in any way. I fear we are headed for social melt-down, even as our economic situation worsens waaaay past where we thought it would bottom out.

This is not to say that I think everyone who’s been hit on the head or suffers from PTSD gets a “pass” when it comes to bad — even evil — behavior. Some sh*t is precisely that — pure evil. The thing is, with brain injury, you don’t always know how evil your behavior is. It’s when you start to approach your injuries and deficits and learn to understand it and you get your broken head around the ideas of what’s right and what’s wrong and what you should and should not do, that you have the chance to examine your choices, become conscious about them, and become capable of taking responsibility for what you’ve done.

But until you can look at your injury and the after-effects, and come to terms with the person you’ve become as a result, you can’t really even start to approach the level of self-examination that’s so important, even vital, to responsible behavior.

My friend’s nephew is dead. It is a goddamned tragedy. Hearts have been broken, and some of them will never heal. This happens every day, all over this country… all over the world. And every time it happens, it is a tragedy. There’s no two ways around the awfulness of it all. But the worst thing of all is, this sh*t keeps happening, and we don’t seem to learn. We can’t seem to figure out how to stem the tide of this wretched self-destructiveness, and we can’t seem to figure out how to make our streets safe. Not just the nice streets in the nice neighborhoods, but all streets. In all neighborhoods.

I’m just one person looking on from something of a distance, but I am holding onto some hope. Maybe it’s easier for me to do it, because I’m not in the middle of my friend’s family’s pain. I’ve been in similar pain… and if nothing else, I cannot lose hold of hope.

I can only pray that maybe someday we’ll figure out ways to approach our social limitations with common sense and compassion, find the courage to reach out to ask for (and offer) much-needed help, and force ourselves to look at social ills not just as opportunities to capture and punish the anti-social dispossessed, but as gateways to greater understanding… Gateways that not only make it possible for us to understand, and sometimes forgive, but which force us to face up to the terrible things we have done… and change our ways.

Maybe I’m being overly optimistic. I’m sure on some level I am. But after all I’ve been through and survived, after having come through so much wretched difficulty in my own life, after having won so much and achieved so much despite my limitations, I’m convinced, there are such things as miracles.

More senseless gun violence

A good friend of mine lost their nephew last week. I don’t know all the details, but I do know he was shot. Apparently at a bar. I’m not sure they know who did it, but even if they did, it won’t bring him back. It all seems so random. I didn’t know the man, and I don’t know if he was in some kind of trouble, himself, but even if he was, being shot over something — anything — hardly seems like it can be justified. By anyone. For any reason. I know there are folks out there who  believe in payback and are hardened to the effects that the most extreme forms of payback have on the “debtors”…  but I’m not one of them.

For every person who “gets what they deserved” — if they “deserved” it at all, which is usually doubtful — there are family members, friends, loved-ones, who are crushed by that aspect of the world we live in. It’s not just about “paying back” the person who did wrong — it’s about devastating the lives and hearts and futures of everyone who was connected with the person who was taken out.

Gun violence seems to be on the rise, given news reports. And it’s happening worldwide. There have been several recent incidents in Germany of people taking out numerous others — a young man killed 15 people on a shooting rampage in southern Germany this past March, a man killed his wife and child around that same time, and just recently, a court shooting in Bavaria left two people dead.

In the States, we’ve seen shootings, too.  In Alabama this past March, a man went on a shooting spree that left ten people dead, many of them children. And just recently, 13 people were shot dead in New York, and a nurse and seven elderly people at a nursing home in North Carolina were gunned down. It’s everywhere. And it happens all year round. Last year during the holidays, shoppers in an L.A. toy store had to duck for cover as a fistfight between two women turned into a pitched gun battle between their men.

Everywhere I look, these days, there seems to be gun violence. Explosive destruction on a small scale that ripples out with baffling waves of shock.

The philosopher in me wants to find some deeper meaning to this. The engineer in me wants to find the root causes and figure out a solution. The mystic in me wants to lift my eyes unto the hills and focus on Eternity. The citizen in me wants to run and hide. The social reformer in me wants both stronger firearms controls, limits on what kinds of weapons are commonly available, mandatory licensing for anyone who buys ammunition, and mandatory training in gun use for all individuals, starting at age seven (or when they’re old enough to fire a gun without getting knocked over, whichever comes first). The friend in me wants to just sit with my friend in total silence for hours on end, just being quiet, just being there for them and whatever they need.

The TBI suvivor in me is glad I don’t have a gun. I have specifically chosen not to own a firearm, not to use firearms, not to go down to the firing range to blow off steam, not to go out hunting with my dad and brother and uncles. Now, I was raised in a family of hunters, and I was taught to shoot from when I was about seven or eight years old. My dad took me out to the stubble-covered cornfields with his brothers, ’round about the time when hunting season was about to start, and we all practiced our aim on tin cans. I learned to shoot shotguns, 30-aught-sixes, and 22’s.

I went out hunting with my dad a few times, too. Deer hunting, when we went out to a cabin in the woods, got up before dawn, and I sat up in a tree stand, while he circled around to drive the deer my way. We went rabbit hunting, too. But I had a hard time seeing the rabbit, and he had to kill it for me.

Now, ever since I was a little kid, I looked forward to being one of the family hunters. One of the providers for my tribe. One of the ones who went out and did what needed to be done, to make sure my kin were fed. But I had trouble seeing, I had trouble hearing, I had trouble with my coordination. And as hard as I tried, as much as I wanted it, the whole hunting thing never “took” with me.

It wasn’t for lack of trying. I learned to track, I learned to clean a gun. I learned to shoot. I learned proper handling of rifles and shotguns. I learned how to carry a gun while I was walking around other people. And I did it all enthusiatically, from a very young age. Even  before I was able to carry and fire a real gun, I was pretending to do that, dressing up in my dad’s orange hunting vest, making sure the hunting license was clearly visible on the back.

But I think my better angels have protected me from handling guns — even in legitimate sport. I have issues with motor coordination. I have trouble with my sight and hearing at times. I also have trouble with figuring out exactly what is going on, sometimes. And I have — when I’m fatigued and/or stressed — a tendency to “go off” on raging temper flares which I manage with varying degrees of success.

Quite frankly, I make a terrible candidate for gun ownership. And even if every citizen in the United States were allowed to “pack heat”, as I’ve heard it recommended (so that we can all protect ourselves in the moment from a crazy shooter on a rampage), I doubt very much that  I would do it. I would rather duck and run for cover, than take my chances with a gun. I would be far less safe with one, than without one — as would everyone around me. I know my limits. Handling firearms is strictly out of bounds for me.

As is being around other people who carry firearms on a regular basis. When I was younger, I ran with a kind of rough crowd. And some of them carried weapons of numerous types. I’m not sure if there were guns in the midst of us, but I wouldn’t be surprised. There were drug dealers and career criminals in my immediate social circle. At the time I was running around with those hell-raisers (and worse), I was often intoxicated, and when I wasn’t intoxicated, I was definitely impaired from the aftermath of some chemical ingestion. Plus, I had a lot of unresolved TBI injuries to deal with. It wasn’t good.

Frankly, I count my blessings, these days, as I look around me and I see everything going so terribly wrong in so many ways. In my youth, I easily could have ended up like my friend’s nephew — dead after an inexplicable shooting. I could very well have had my life cut short, with my family wondering what went wrong… how they might have helped… and devastated by that inexplicable loss. Any of us could end up in that situation, really. These days, with the violence being so extreme and seemingly so random, it’s hard to know exactly how long any of us is going to make it.

But for now, for today, in this moment, I am alive. I am living, breathing, going to work on the train, and counting my incredible blessings. The world is going to sh*t in so many ways, and yet I’m still here. I’m still standing. I’m still going on with my life, to the best of my  God-given ability.

In the face of all that’s wrong, all that’s unfair, all that’s tragic and terrible and just friggin’ awful, perhaps the most exciting thing I can be is normal, boring, regular, and blessed with a delightfully uneventful life.

God bless, everyone. Stay safe.

PTSD/TBI Factor #1 – Proximity to a traumatic event

This is a continuation of the discussion about PTSD from TBI – Exploring some possibilities. (Updated June 10, 2012)

When it comes to who develops post-traumatic stress disorder and who manages to recover from the trauma without post-event effects, how close you are to a traumatic event can determine the degree to which you are affected.

People who are closer to traumatic events have been shown to develop more symptoms — folks who were closer to Ground Zero after the attack on the World Trade Center in 2001 had almost three times as much PTSD symptoms (up to 20%, versus 7.5%) as folks who were in Lower Manhattan, but farther away.

Physical proximity doesn’t always play a role in the development of symptoms. Research has shown that people who watched the WTC attack on television from a great distance, many miles away, developed PTSD after the event, and in some cases, their symptoms were more extreme and persisted longer than folks who were physically closer to Ground Zero.

One of the key factors in all this is not only actual physical proximity to a threatening event — it’s the individual’s interpretation of the even as threatening… their perceived level of danger.

Now, when it comes to this aspect of PTSD, TBI can play a significant role.

But the role that TBI plays can be quite different from the role that other injury situations (like war or motor vehicle accidents) can play. In the case of those other two examples, the danger is immediate, extreme, and it can lead to deer-in-headlights freezing, which “locks” the experience in place, to be played out time and time again. In the cases of “classical” trauma, the single injuring event itself is the culprit. In TBI, while the injury itself can be a source of trauma, very often the injured party has either dim or missing recollections of the event, so like someone who’s drunk behind the wheel of a car who gets into an accident but comes out the other side without any PTSD whatsoever, in traumatic brain injury, the brunt of the trauma is felt after the injury, when cognitive functioning and decision making and perceptions are all out of whack. Not only can you end up making decisions and taking action which puts you in harm’s way over and over again, but your reactions to those situations can be heightened to make matters far more traumatic than they “should” be.

Let’s get into this a little more…

First, brain injury can impact a person’s ability to assess risk. They can end up underestimating the danger of a given situation and rush in “where angels fear to tread.” They’re not necessarily fools. They’re brain-injured.

I myself have been a walking, talking example of this. I can’t even count the number of times I’ve done really dense things that I didn’t realize were dense, till much later. One time stands out, in particular:

One day, a couple of years after my most recent head injury (but before I realized that I had been injured as much as I was) I went hiking bright and early one morning on the first day of deer hunting season. I was wearing natural earth-tone colored clothing and wandering off the beaten path, deliberately following deer tracks because I wanted to “get in touch with nature”. Seriously poor judgment. In the course of my ill-conceived hike, I happened to cross paths with a deer hunter who was watching the very area where I was hiking, gun in hand, ready to shoot.  I was in very real danger of being shot.

Now, I know better. I’m from a family filled with avid deer hunter – my dad and all my uncles and my brother go hunting regularly with almost religious fervor. I know that the first day of buck season is NOT the day to go hiking in the woods, and if you have to, you wear bright colors and you stick to the trail(s). But that morning my brain totally failed me. I literally could have been killed in one of those hunting accidents I grew up hearing about.

Believe me, I’m not proud of this genuinely impaired choice, but it’s a great example of how TBI-limited thought processing can put a person in mortal danger, without them even knowing it.

The second way TBI can contribute to the proximity of danger is by heightening the intensity of one’s response to situations.

For example, a head-injured person can quickly lose their temper in a confrontation with someone bigger and badder and meaner than them. That has happened to me many times, and I’ve been injured in the process. I know from personal experience that an impaired brain can make you think you can take on that opponent — and win — only to have your body find out that’s not the case. And if you piss someone off who carries a grudge, you can find yourself looking over your shoulder at every turn… becoming increasingly paranoid and jumpy… which eventually can add up to a hefty dose of PTSD.

Now, one of the things that Belleruth Naparstek mentions in her book Invisible Heroes (this discussion is based on info from Chapter 4 therein), is that another factor is internal perception of danger/trauma. If someone doesn’t know they’re in danger, they may not be impacted by even a serious event. People who are involved in accidents when they’re drunk have been shown to develop less PTSD than might be expected. That’s not to say everyone should run around intoxicated, only that having your perceptions impaired or dulled or distracted somehow can keep PTSD at bay.

But if you believe you’re in danger — even in the case of a near miss — you can really find yourself on the PTSD ride of your life. It’s your perception of danger that sets off the reaction… which can build and recur, build and recur, build and recur, till you don’t know whether you’re coming or going and you feel like you’re losing your mind. Even if you escape a traumatic situation relatively unscathed, you can end up with some nasty symptoms.

The third way TBI can contribute to PTSD is by slowing information processing and reaction times, so it can be hard to get out of a worsening situation before it turns really ugly.

Remember, slowed processing time is one of the most common hallmarks of mild traumatic brain injury. And fatigue is not only a common after-effect of TBI, but it’s also a factor in diminshed attentional abilities and cognitive functioning. When you’re in a potentially dangerous situation, the last thing you need is to be thinking and reacting more slowly than you could/should/otherwise would. But with TBI and its after-effects, that’s precisely what can happen.

As an example, say you’re driving down a deserted country road after dark one winter evening. It’s late and you’re worn out from a long day, and you just want to get home and fall into bed. Out of the corner of your eye you see a shape standing on the grassy shoulder beside the road. A huge six-point buck comes into view in your headlights. Something tells you to slow down, but tou’re not thinking clearly, you’re tired and foggy and slower than usual, and it takes you a few seconds longer to hit the brake than you normally would.

Suddenly, the buck turns and starts across the road right in front of you. Before you can react, you hit the deer head-on, crumpling the front of your car and inflating the airbags in your vehicle. Your head bounces off the airbags, breaking your glasses, and slams against the headrest. Dazed and confused, you sit stunned for a few moments. Then you climb out of the car and go see what just happened.  As you approach the deer, you feel something sticky and warm on your face. Your broken glasses cut into your scalp, and the cut — like many scalp wounds — is bleeding profusely. Clamping one hand to your head, you you try to drag the deer off the side of the road so you can drive on, but it’s too heavy — the carcass won’t budge.

You head back to the car to find your cell phone, but you’re so confused you can’t find it anywhere. It’s dark, and it’s cold, and your car looks like it’s totaled. Your scalp is bleeding, you’re disoriented and confused, and it’s been over an hour since you passed an inhabited area. It’s too cold to get out and walk anywhere. You’re cut off. Alone. You spend the night keeping your car running, so you can stay warm, afraid you’re going to bleed to death, uncertain if and when you’re going to get help, having countless scenarios of impending doom running through your mind.

In the morning, a local deliveryman finds you and your car and the dead deer and radios for help. A tow truck comes and delivers you to the nearest town, which is just a quarter of a mile away, up the road, ’round the bend you couldn’t see in the dark the night before. You find your cell phone in your car’s glove compartment and you call a family member to come pick you up. Then you get on with the business of dealing with your totaled car, getting back to work, getting on with your life. You seem okay physically, with just the cut (that stopped bleeding) and a nasty headache. But you can’t get that vision of the deer out of your head, and you keep waking up in a cold sweat, your heart pounding, feeling like there’s something sticky on the side of your face.

Now, this is not to say that someone without a TBI wouldn’t have the same experience. But having thought processing slowed can contribute to slower reaction times, poor judgment calls, and impaired coping techniques… which can contribute to and complicate bad conditions, making them worse than need be — and making them seem worse, too. And that can happen not only with someone who has a TBI going into a tight spot, but someone who experiences a TBI and then has to deal with challenging situations with an injured brain. A double whammy.

The forth way TBI can contribute to PTSD is by making everything seem a whole lot worse than it is.

With TBI, impaired risk assessment can go both ways, I believe. It can not only be impaired, but it can be hyperactivated. TBI can make you think things are lot more hazardous than they are, that you’re in more dire peril than you are, and that you need to respond more intensely than you necessarily need to. PTSD alone can do this, but when your brain isn’t firing with all pistons, your impaired judgment just feeds the PTSD fire.

So, even if you don’t end up in that car accident, or you really aren’t in danger of getting your ass kicked by that Very Large And Angry Person, or you walk away unharmed from a fall that was broken by soft snow, your (impaired) perception of “immediate danger” can trigger a bunch of biochemical reactivity that puts you very much on edge and eventually adds up to full-blown PTSD.

Warning, Will Robinson!

Danger! Danger!

You may not be in danger at all. But your injured brain tells you that you are/were. And your impaired judgment, thinking it’s protecting you from a perceived threat, gets the gears going and sets off a potent chain reaction that — while bothersome at first — can lead to serious trouble, on down the line.

So, there are several distinct aspects to how TBI affects the proximity factor of PTSD (including, but not limited to):

  • It can create conditions of actual physical proximity to danger by impairing someone’s ability to detect (and avoid) risk/danger.
  • It can make a person’s responses more intense and/or more precipitous, so they overreact to situations and put themself (unintentionally) in danger.
  • It can keep someone from getting themself out of trouble in a timely manner and keep them from adequately dealing with an existing tricky situation.
  • It can heighten the perception of physical proximity to danger.

All of these (and I could think of a bunch of other examples, but I won’t take up the time here), not only do a number on your head, but also on your body. PTSD is very much about physical reactions… and they tie in with mental processes. So, if your brain is impaired by an injury, and you’re backed into a corner (or think you are), you can end up with a more potent mix of trauma experience that heightens the post-traumatic stress impact.

And that’s no friggin’ fun.

What keeps me going

coffee and notepad and pen on a table

11/10/18 – Ha! I just discovered this old post from 2009. I’m not sure why I unpublished it, but I like it.  So, I’ll republish it. Here you go.

Ever since I read about how the ‘Thirst For Knowledge’ may be a kind of opioid craving, my thinking about how my mind manages my physical pain has really changed. Actually, it jumped ahead in a big way, when I read about Mary Meagher’s work on how fear and anxiety have different affects on physical pain. But having the kind of associational brain I do… a brain which isn’t very good at sticking with linear, sequential tasks, but eagerly hops around from one related topic to another… I did end up here, thinking about how the human brain craves novelty, and why that might be.

I’ve come to realize, in the past months, that many of my patterns of risk-taking and danger-seeking behavior, not to mention my constant stream of distractions that keep me all jazzed up, have a lot to do with relieving my constant levels of discomfort, distress, and pain. Not only that, but they seem to be linked to a sort of depressed state in my thinking — not necessarily emotionally depressed, but functionally slowed. My history of TBIs has not helped my cognitive processing speed, and there are parts of my brain (as evidenced on my EEG) that physically work more slowly than would be expected.

Actually, come to think of it, emotional depression sometimes follows on my cognitive depression/slowing, so I can’t discount that part of my experience.

Now, when it comes to getting on with my everyday life, risky decision-making and flawed judgment are just part of my problem. Chasing conceptual chimeras — such as my all-consuming obsession with my MRI, as well as new and emerging neuroscience research, which I may never fully understand but which fascinate me to no end — and commencing projects that I will never actually finish — like that 500-page documentation set for one of my favorite software programs of the day — are actually more disruptive and pose more of a risk to my adequate functioning than outright risk-taking behavior.

And yet, I chase after these new ideas and take up new projects, left and right, neglecting the real parts of my life that suffer from my lack of attention. I’m so busy researching and reading and exploring my MRI in 3D, that I forget to pay bills. Or do paperwork. Or make calls I need to be making.

I don’t think I fully understood the impact that my intense need for mental stimulation had on my life, until a little over a year ago, when I came across one of my old notebooks that had plans and details and milestones for all these projects I had once been utterly consumed by. There were no less than seven different highly involved, complex projects that filled different parts of that three-ring notebook. And then I found more in another notebook. I uncovered a whole bunch of different projects that I’d started… then got distracted from and completely forgot about.

Discovering those notebooks opened my eyes in several ways.

First, I realized that I had so completely forgotten about those projects, that they might as well have never existed. And that happened, after I had invested literally hundreds of hours scoping and planning in great detail for each of them. It seemed impossible that I would forget even one of these projects. But I had lost track of more than ten.

Second, I realized just how irrationally compulsive I was about my projects, and it occurred to me that someting might be very wrong in my thought processes. The majority of people I know don’t do this sort of thing… why was I?

Third, I realized that even if I had all the time in the world, I never could have finished all of these Very Important Undertakings. But that didn’t matter to me. What mattered to me, was the doing. The “journey”. The process of pursuing these things. It went against every fiber in my pragmatic being and seemed like a total waste of time. Yet, part of me didn’t care. It would create with abandon and not give a crap about what might actually come of it all. And that troubled me. Because it didn’t seem like me.

Or maybe it did. All my life, I’ve been fascinated by fringe interests and I’ve pursued them with gusto.  When I was a kid, I had a lot of projects going on all the time, and my parents and teachers used to just writhe with frustration at how I could never take any of my projects to a higher level, where they would develop fully and be shareable with others. I would read all about certain subjects and discourse on them at great length, but I could never seem to develop my interests in other directions. I had a “chemistry set” in the basement, where I did extensive studies on the interactions of vinegar and baking soda, and I mixed leftovers from my father’s aftershave with my mother’s talcum powder. But my interests never went much farther than that, for all I learned about fizzy cooking ingredients and the crackle patterns of dried personal care products.

In my adulthood, the intensity of my interests increased substantially, as has their esoteric “quotient”. Over the past 20 years, I have frequently found myself deeply engulfed in studies that interested maybe 5 other people in the world, but my devotion ran to the very core of my being. I’ve also found myself utterly consumed with a topic that was probably well beyond my ability to understand — quantum physics, biophysics, medieval history, and more — all sorts of information-intensive subjects that require years of training (which I didn’t have) to understand completely. My interest has intensified and evolved over the years, but the shareability of my learnings actually decreased. I would read and take in and then recount what I had taken in, but my writing was dense and obfuscated by way too much detail.

Then I fell in 2004 and hit my head and found myself unable to focus and sustain the same level of attention to my old areas of study. My office is filled with books I’d bought, intending to read them in my line of study, but it could be that will never happen.

Still, I do crave my distractions. And between 2004 and 2008, the number and kinds of projects I was consumed by increased exponentially. I just careened from project to project, spending long hours scoping and planning and thinking and noodling. I got so swamped in the details, I couldn’t see my way clear to completion on any of them. But I didn’t care. I just wanted the high of that novelty. The newness, the freshness, the rush that came from a bright new idea.

While I was in the thick of my planning and dreaming and scheming, all was well. But when I stepped back and took a closer look at how much energy I was expending, and how it was getting me nowhere, it just didn’t sit right with me. And I’ve been trying to figure out what the underlying mechanism of that is, ever since.

I think I’m closer now to figuring it out, than I’ve been in quite some time. I can’t speak for anyone else, but what I’ve found makes sense in my own personal context. It’s neurological. It’s biochemical. It’s ingrained. And it’s essential for my mental health and general well-being. I need my distractions, my rushes, my “pump” in order to feel normal. In order to feel human. And the thing that delivers a better rush and pump than just about anything else, is novelty. A new idea. A fresh concept. It’s a tonic to me… and an essential one at that.

Dr. Irving Biederman has some really interesting things to say about this stuff. It’s my understanding that he specializes in things like the neurology of face recognition (which, it occurs to me, could be really useful to folks who study autism/Asperger’s Syndrome and are trying to understand why ASD folks have a hard time decoding facial expressions). This “info junkie” track he occasionally writes about seems like a lesser area of interest for him, from what I’ve read. But it’s much more practically useful to me, than shape and face recognition.

So, that’s what I dwell on, vis-a-vis his reasearch.

Here’s an article about the sensual lure of mental novelty, which I swiped in its entirety from the LA Times:
From the Los Angeles Times

The 411 to avoid boredom

As ‘infovores,’ information is the fuel that keeps our brains all fired up.

By Irving Biederman

July 19, 2008

Crackberry. Only a metaphor for our addiction-like urge to check e-mail? Or does the term shed light on a deep biological truth about our hunger for information?

Human-motivation studies traditionally stress well-established needs: food, water, sex, avoidance of pain. In a culture like ours, most of these needs can be satisfied easily. Just open the refrigerator door, or blow on that spoonful of hot soup. (Satisfying the need for sex may require a bit more doing.)

What’s been missing from this scientific research is humans’ nonstop need for more information.

We are “infovores.” The human eye makes three fixations a second on the world around it, and not at random. Our gaze is drawn to items we suspect have something new to tell us — posters, signs, windows, vistas, busy streets. Confined to a featureless physician’s examination room, we desperately seek a magazine, lest we be reduced to counting the holes in the ceiling tiles. Cornered at a party in a banal conversation, we seek to freshen our drink.

Without new information to assimilate, we experience a highly unpleasant state. Boredom. Conversely, at one time or another, each of us has felt the joy of information-absorption — the conversation that lasts late into the night, the awe at a magnificent vista.

Cognitive neuroscience — the science that seeks to explain how mind emerges from brain — is beginning to unravel how this all works. At USC, my students and I use brain scanning to specifically investigate the neuroscience behind the infovore phenomenon.

The explanation involves opioids, one of many neurotransmitters — which are molecules that the neurons in our brain release to activate or inhibit other neighboring neurons. The effect of opioids is pleasurable. In fact, the same neural receptors are involved in the high we get from opiate drugs, such as heroin or morphine.

In the past, these opioids were believed to exist primarily in the spinal cord and lower brain centers, where they reduced the sensation of pain. But more recently, a gradient of opioid receptors was discovered in a region of the cerebral cortex, humans’ enormous outer brain layer that is largely responsible for perception and cognition.

In the areas of the cortex that initially receive visual or auditory information, opioids are sparse. But in “association areas,” where the sensory information triggers memory and taps into previous knowledge, there is a high density of opioid receptors. So the more a new piece of information tickles that part of your brain where you interpret the scene or conversation, the bigger the opioid hit.

Staring at a blank wall will produce few, if any, mental associations, and thus standing in a corner is punishment. Looking at a random mass of objects will produce strong activation only in the initial stages, where there is little opioid activity to be had.

Gaze at something that leads to a novel interpretation, however, and that will spur higher levels of associative activity in opioid-dense areas. We are thus thrilled when new insights tap into what we have previously learned. We seek ways to feed our opioid desires; we are willing to endure the line at the movie theater in anticipation of the pleasure within. We pay more for a room with a view or a cup of coffee at a Parisian sidewalk cafe.

But if we get more opioids from making connections to our memories and knowledge, why do we then prefer the new? The first time our brains take in a new perception — a scene, a movie, a literary passage — there’s a high level of activity in which a few neurons are strongly activated but the vast majority are only moderately or weakly activated. The strongly activated neurons inhibit the weak — so there’s a net reduction of activity and less opioid pleasure when our brain is exposed to the same information again. (Don’t feel sorry for the inhibited neurons, the losers in this instance of neural Darwinism. They are now freed up to code other experiences.)

No wonder we can’t resist carrying a BlackBerry 24/7. Who knows what goodies it will deliver? A breaking news item. A piece of gossip. An e-mail from a long-ago girlfriend. Another wirelessly and instantaneously delivered opioid hit.

I hope you got a few opioid hits, too, in learning about your inner infovore.

As for me, I’m starting to feel separation anxiety. Where’s my BlackBerry?

Irving Biederman directs the Image Understanding Laboratory at USC, where he is a professor in the departments of psychology and computer science and the neuroscience program.

I did indeed get more than a few opioid hits while I was reading this. As Dr. Biederman says, in “association areas,” where the sensory information triggers memory and taps into previous knowledge, there is a high density of opioid receptors. So the more a new piece of information tickles that part of your brain where you interpret the scene or conversation, the bigger the opioid hit. And because I’ve devoted so much of my life to acquiring and taking in information… data… knowledge and what memories I am able to create and maintain are quite intact (my info absorption during memory creation is about around 60%, but my retention is close to 100%, so I have very detailed recollections of a little more than half of what I am exposed to), that my association areas are well-disposed to getting high off this information.

I suspect that’s what makes the internet so addictive for me — and others. It’s not about the movies and games and pictures. It’s about the novel information that I can read and take in and assimilate and use to feed my inner needs, which are more than just an information addiction.

And I suspect this is what makes my world of projects so fascinating and compelling for me. It’s not about commercializing or publicizing my work. It’s not about profiting from it or getting famous from it. It’s not about taking the projects public, or even actually finishing them. It’s just about doing them. Creating. Being. Doing. Having at it and seeing what happens. Learning. Driving. Getting energized. And cutting the pain I’m usually fighting, in the process.

It’s not about the projects. It’s not even about my progress. It’s about the pain. Getting rid of it. Doing away with it. Keeping my mind off it. Not being debilitated by it. It’s about relieving the distress that comes from the daily difficulties I have with the most basic shit on earth — getting out of bed, taking a shower and using soap and shampoo, making sure I don’t lose my balance and fall in the tub, getting dressed in clean clothes that I didn’t wear yesterday, making a breakfast that will get me through the morning, feeding the cat and gathering my work stuff, making sure I have my wallet and car keys and my daily minder, and getting in the car without bumping against it and getting my work clothes covered with salt and dust that’s leftover from the winter and I haven’t gotten around to cleaning off my car, just yet.

There is so much that others can take for granted, when it comes to everyday life. How hard can it be? Well, if you don’t know… trust me, you don’t want to know. All I can say is, when I look at my distractions, my intellectual compulsions, my wide array of Beloved Projects That Will Probably Go Nowhere, I see a pattern of analgesic activity that may not serve a higher purpose and come to much, in terms of published papers or fame and glory and prizes, but which is utterly essential to my daily functioning as a “regular” person. Without my all-consuming interests, my fascinations, my cognitive compulsions, my life would be a lot more painful, my mind would be a lot less clear, and I’d be a lot less useful — not only in advanced ways, but in the most fundamental ways one can imagine.

Now, where are those printouts I’d gotten on the long-term biochemical effects of post-traumatic stress? I’ve got work to do…

More evidence of analgesic stress in my life

A quick note before I head off for my day…

One of the big, unmentioned pieces of the past few weeks has been the pain I’ve been in. My body has been really aching a lot — and I did a bunch of yard work last weekend, which threw me out of whack. My shoulders are giving me trouble, and my knees were acting up, too, which kind of sets me off.

Back in the late 1980’s and early 1990’s, I had real problems with chronic, debilitating pain. It just seemed to come out of nowhere. I didn’t connect it with the car accident I’d had in late 1987, but now it seems like the two were more than co-incidental.

I was never able to get help for that condition, and I spent years trying (in vain) to find a treatment that worked. Ultimately, the only thing that has helped me has been getting plenty of rest, taking hot baths, and keeping my stress level down.

But when I’m flaring up, as I have been for the past few weeks, it starts to drive me. I start to get increasingly anxious about it and I don’t do well with managing myself and my situations. I feel absolutely driven – propelled – through life, with sudden flashes of interest in things that don’t normally catch my attention. I feel compelled to pack each day full of as much interesting stuff as I can find. And I push myself beyond my means.

When I push myself hard, I feel better. I really do. Physically, I feel better… mentally, I feel clearer… and my self-esteem isn’t in the crapper. I feel like I can function, for once. The pain is gone. The anxiety subsides. I have an outlet for all my energy, and the stress I put myself under has a strongly analgesic effect on me.

I’m writing about this in greater detail in A Perilous Relief, and the past few weeks have been a great illustration of my underlying premise — namely, that risk-taking and danger-seeking behavior isn’t just a psychological compulsion. There are actually physical reasons for why people test their limits in extreme and sometimes dangerous ways, and those physical reasons are just as valid and vital as the psychological ones.

They’re also intimately connected — the psychological and physiological reasons for risk-taking/danger-seeking behavior. And in my own personal, daily experience, they feed each other… and soothe each other, too.

The stress I’ve been under has been taking a toll on me. But I’ve been compelled to push even harder. Why?

Because it cuts the pain.

When in doubt… sleep

Last night I officially wore too thin.

It was not a good night. After what felt like an impossibly long day, I just fell apart and broke down around the time I should have been going to bed. I got into a fight with my partner and shouted and slammed doors and stormed off and wept bitterly for about an hour.

This morning I feel hungover and groggy and stupid for having let everything get to me.

Note to self: When it’s all getting to be too much, stop trying to think things through and just get some rest.

Looking back, I can see how everything just piled up on top of me. The session with my therapist, that left me feeling like an idiot. The challenge of keeping functional at a job I’m only going to be at for another week. The pressure of learning specific skills I need to have, when I start my new job(!) in a little over a week. The insecurity I feel at stepping up my career path at this dream job of mine, which is a continuation of what I had been doing back before I had my fall in 2004. I’m terribly concerned that I’m not going to be able to hang in there and do the work. And I’m worried that my TBI stuff is going to get in the way.

But instead of paying attention to all that and slowing down and taking care of myself, I’ve been pushing myself harder and harder. My “Perilous Relief” has now swung around to bite me in the ass, and I melted down. It wasn’t awful, but it wasn’t pretty. And now I feel like crap.

This is something I really need to pay attention to. I haven’t been getting the kind of sleep I need, lately. I’ve been too busy, too wrapped up in all kinds of important stuff, too worried, too everything. I’ve been driven by my anxiety, my insecurity, my bubbling borderline panic.

Letting that get hold of me is no good. And it just makes my headache more intense. I need to pay attention to my warning signs… and do something about them.

So, what are my warning signs?

Being 150% convinced that a new project is something I must do.

I find myself starting to come up with new projects to work on that suddenly infuse me with all sorts of energy and fascination. I come up with things like creating 6-week courses in online job-seeking skills, or writing a full documentation set for a favorite software program that needs more detail, or launching a new career as a technical translator. In actuality, those projects are ill-conceived and not practical. They appeal to me on a high level, but I do not have the stamina — or the sustainable interest — that is necessary to make them “fly”. And I don’t usually think them through well enough at the outset to realize that there’s a whole lot more detail and involvement in them than I’m ready or willing to devote myself to.

So, I end up canning the ideas in the early implementation stage… and I get down on myself for having gone down that track.

In reality, what I am really doing is infusing my tired brain with energy. It has nothing to do with my life’s work or my chosen path. These new projects are just ways to invigorate a brain that’s pulsing a little more slowly than I’d like.

Not bothering to sleep.

The more tired I get, the harder it is for me to sleep. Funny how that works… I have been so caught up in running here, there, everywhere, tending to stuff, tending to what needs to happen, that I haven’t slowed down long enough to get some rest.

That’s bad. Fatigue is a huge stressor for me and it turns my triggers into hair-triggers.

Going too fast.

I have been kind of going a mile a minute, lately. I’ve been cramming in all kinds of extra activities into my days — running errands, writing emails, doing chores, picking up extra projects. Some of it has been really important, of course — like getting my new job situation lined up. But some of the other stuff has been non-essential — like trips to the library to get books I don’t need to be reading. I’ve been careening from one activity to the other, instead of taking my time. And that’s caused me to make little mistakes along the way, like forgetting to do certain chores and forgetting to send the emails that I do need to send. Little mistakes throw me off and turn into larger issues.

Not self-assessing.

It doesn’t really take much for me to self-assess each week. Or even each week. But I’ve been avoiding it like crazy, and it’s not helping. I’m not keeping tabs on my different issues, so they get out of hand, and I literally forget that I’ve got problems in certain areas. It’s just not good. Ironically, knowing what problems I’m having alleviates them. But ignoring them and pretending they don’t matter just makes them worse. Some people (who I say belong to the “think happy thoughts” school) say that you shouldn’t “give any energy” to troubling conditions, as though paying attention to them makes them worse. But in actuality, not paying attention to them makes them so much more problematic, than if I blithely disregard them.

So, what do I do about all this?

First, start self-assessing again.

Pay attention to what’s going on with me.

Second, get some sleep.

Real sleep. In the pitch-black guest bedroom at the back of the house.

Take looooong naps on the weekend.

Make sure I start going to bed no later than 10:00 p.m. each night.

Enlist the help of my partner to make sure I do this religiously, until I’m caught up.

Listen to my guided imagery to help me with restful sleep.

Deprioritize everything that is not essential, until I am caught up and am feeling better.

Third, stick to my plan.

I actually do have a plan for my life and work. I have specific steps I am going to follow to set things in order and keep myself on track. And I need to abide by it. Stick with the program. Don’t deviate. Just follow it through, one step at a time. Having a specific, expressed plan of action takes the pressure off the part of me that gets anxious about unknowns. And sticking with the plan makes my life a whole lot simpler — and less stressful.

Fourth, write… write… and write some more.

Writing really soothes me a great deal. It helps me focus, it helps me get in touch with what’s going on with me, it helps me keep my act together. I just need to write in ways that are structured and on-p0int. For many years, I kept journals that were rambling, stream-of-consciousness explorations of my inner world. They seemed to make me feel better, while I was writing in them, but in actuality, they were a kind of drug that numbed me to my troubles. They didn’t help me overcome them; they actually got me mired in them even more — I filled them with perpetual, rambling detail that was meaningless to everyone except me in that moment.

The kind of writing I need to do now is very pointed, very lasered, very specific to the real world I experience around me. It’s not all meant for public consumption — I have a number of writing projects behind the scenes that will probably never see the light of day in my lifetime, if at all. But the discipline of writing in a deliberate, structured way is good practice for my life.

In a way, I think that writing is my spiritual practice. I’ll have to write more on that later. But for now, it’s time for me to get on with my day. Take care of some errands I need to do, and prepare for a day of work at a job I’m phasing out.

I actually have a lot of really wonderful things happening in my life. But if I’m not rested and fully functional, all the wonderful things become a terrible burden for my little brain, and the sweet nectar of life gets gooey and a little rancid.

Yes, yes, yes… When in doubt… Sleep.

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…