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 I’m not sure why I unpublished it, but I like it.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…

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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.

Learning as pain/stress relief

I’ve been giving a lot of thought to the article I read the other day about how the ‘Thirst For Knowledge’ may be a kind of opioid craving… thinking about how that has held true in my own life.

I have to say, it really rings true for me. And I while I was having dinner with a friend the other night, they were telling me how they’ve always loved to learn. They’ve just eaten up new information and they’ve always gotten a charge out of taking in new information and putting it to good use in their life.

Interestingly, they also have a lot of problems with chronic pain — low back pain, especially. The pain pretty much derailed their life for many years, keeping them from getting decent sleep, and probably taking a few years off their life. They are in their 50’s, but they look like they’re 10 years older. It could be that their biological age — due to their chronic pain problems — is just that.

I never would have guessed that they’ve got this pain thing, which they only started really talking about with me recently. They’re one of those people who seeks out all sorts of new and novel information, and they seem to have a genuine thirst for living large, when it comes to heady stuff. Sure, they have other issues, and when they get pissy, they’re no walk in the park, but the way I’ve always seen them, is more as a hungry mind than an aching body.

It’s funny — I rarely discuss my own pain with other people, too. I don’t really get into it — there doesn’t seem to be much point. It’s just depressing, to go into the details about how my shoulders and elbows and hips and knees and back are all on fire, screaming with pain, keeping me up at night, waking me up early… and there’s precious little I can do about it. Even ibuprofin (which is the only anti-inflammatory, including prescription NSAIDs that I’ve used in the past) doesn’t always help. So, I just have to tough it out.

In fact, I rarely devote much time to thinking about my pain when it’s around. It’s just always there. In the background. Nudging me, every now and then, when I step out of line. Twinging or stabbing or whatever. Headaches. Neck aches. Back aches. Joint aches. It never entirely goes away, and I try not to dwell on it, when it comes up. Very little seems to fix it, other than scaling back on my activities and trying to get more rest and steering clear of foods that I know don’t sit well with me.

Now, when I do think about it, it just makes matters worse. I start to notice it. I start to get bothered by it. I start to get crazed and anxious and frustrated and beside myself. It’s a little like being stalked — it’s always there, lurking in the background. Not directly assaulting me so violently that I cannot function, but always reminding me that it just might step up at any time and do just that. And that drives me nuts. Feeling like I cannot escape this shadow, this constant reminder, this ever-present phenomenon that refuses to respond to medication or management techniques or even diagnosis… As Charlie Brown would say, Aaaaaaaauuuuuggggghhhhh!

One of the reasons I realize I haven’t been doing my self-assessments lately is because there are a bunch of places where I track my pain.  And when I do the entire sheet and include my pain(s) in the assessment — rating its severity and impact on my life from 1-10, describing it and its impact, detailing what I am doing about it, and recording whether that worked or not — well, I can see how poorly my coping mechanisms work. And I get depressed. Really down. Just despondent.

So, I don’t self-assess. Which tells me that I need to come up with a different self-assessment approach — probably break out the different areas into separate pieces, and only focus on one type of issue at a time — the cognitive OR the behavioral OR the emotional OR the physical — not lump them all together in one place, which gets overwhelming.

But when I don’t self-assess, I get into trouble with my thinking and my behavior and my attitude. So I need to do something about this. Soon. Today, in fact.

And so, I shall.

But back to my main topic, which is about learning as a pain/stress reliever… No matter how badly my pain is, no matter how much stress I’m under, I find that learning things provides an almost other-worldly relief for me. I’ve been going through some very heavy job stuff, lately — in this economy, talk about stress — and I’ve sorely needed a break from all the intensity. I don’t want to lose my house. I don’t want to be out of work. I don’t want my health to go spiraling downhill, because I’ve taken on more than my body and mind can handle, and it all gets to me and sends me over the edge. Times like this, my PTSD and TBIs rear their ugly heads, and my thinking gets foggy, my reactions get “dumb”, and my whole system starts to go haywire. Which is about the last thing I need, when my home and my family and my future are on the line.

I need some serious stress relief, but I’ve been having a lot of trouble with being outside in the open — lots of anxiety comes up, and I start to freak out with the bombardment of all the stimuli, especially sounds, as my hearing has been hypersensitive to a point that’s starting to drive me nuts. So, I have to find something to do inside that not only takes my mind off my physical discomfort, but also provides serious relief.

That relief comes from learning. Learning new things I need to know for my job. Learning new things from the world wide web. Learning new things from friends. Learning new things from books and white papers. Learning new things that may not be all that practical, but really interest me and keep me engaged. Focusing my attention on things that fascinate me and that enlarge my store of available knowledge does something amazing for me… it cuts the pain. It not only takes my attention off it, but it seems to physically ease my suffering.

And that’s huge.

So, I’m learning everything I can, these days, about things that interest me. And I’m also learning how to pass what I learn along to other people. I come from a family of teachers — professors, elementary school teachers, Sunday school teachers, tutors, instructors. I also worked my way through what college I could manage to complete by tutoring folks in subjects that interested me. And I did a good job. I would probably be a teacher now, if I could have finished college, but that wasn’t in the cards. But I can do it now, in my own way, without the limitations of administrative types who are looking over my shoulder, breathing down my neck, saying, “You can’t say that to those kids!”

Online, in this blog, I can share and teach and instruct. And I’m figuring out new ways of getting information across. It’s my hope that I can do a better job of communicating the stuff that’s in my head to folks who can use it. ‘Cuz I’ve spent an awful lot of time figuring out how to be highly functional and “normal” as normal can be, despite a history of head trauma, chronic debilitating pain, not to mention considerable sensory issues that — when they’re at their worst — turn me into an automaton of sorts.

The information and experience has been invaluable to me, in just living my life. And others might find it useful, too. If I can use what I’ve learned to ease others’ pain — through the process of learning, as well as the experience of using what I relate — then my own difficulties have all been worth it.

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…

The best cure for self-pity

Just when I’m starting to really succumb to the poor-me’s, I get an excellent reminder of what I really have going for me. It’s true, being a multiple MTBI survivor hasn’t made my life any easier, and I do have a lot of issues I need to overcome. But I’m also highly functional, I have full use of my body, I’m not laid up in a hospital or rehab, and I’m able to fend for myself.

My life isn’t perfect, by any stretch, but it’s a far sight better than it might have turned out, had my falls and injuries been worse. I really believe that I was divinely spared a lot of disaster over the course of my life — for what reason, I’m not sure. I’ve come close — so close — to being badly hurt, attacked, arrested, institutionalized, even abducted (when I was a kid and wasn’t very prudent about whom to talk to and how to interact with people)… not to mention sued and fired and a lot of other things people could do to me that would really mess up my life. Time after time, when I think back, I’ve narrowly escaped serious damage, literally through no effort of my own.

And I wonder, why was I spared? Why am I walking around in okay shape, after those car accidents, those falls, those attacks? Why am I able to walk through life on my own steam, when so many others are unable to do so? Why have I been given so much and allowed to keep so much of what I could (and perhaps should) have lost along the way?

What makes me any better than, say, the thousands of troops returning from Iraq and Afghanistan, who have really severe injuries — some of which cannot be detected from outside their heads?

What gives me the right to live as fully as I do, when others who experience the kinds of car accidents I was in are watching their lives fall to pieces before them, unable to think, remember, function, or even walk around a grocery store without sunglasses on?

What can possibly justify the fact that I’ve managed to keep my house, my family, my car, my job(s), even in the face of a debilitating head injury? What makes me so deserving, so special, so… worthy of all this?

I just don’t know. I look around me at the other folks who have sustained head injuries – from mild to severe – and I marvel at their resilience. I’m not sure I could hang in there the way they have. I look at the pictures and read the accounts and try to put myself in the shoes of folks who have to overcome not only the loss of their memory and their life savings, but also their most basic bodily functions.

And I am both humbled and chastised. The problems that I have — the slowed processing speed, the lousy short-term memory, the inability to concentrate on things longer than half an hour at a time, the chronic pain, the sensory sensitivities, the temper flares, etc. — as challenging as they may be, still allow me to move about the world on my own steam. They may keep me from being fully functional, but they don’t prevent me from looking and acting fully functional (which in our superficial world, is 3/4 of the battle). And as rough as looking for more work may be, the fact that I actually can look for more work, is a gift I mustn’t take for granted.

Who can say why I was spared a worse fate?

Who can say why I was knocked out for only a few minutes, rather than a few hours?

Who can say why my fall out of that tree in 1980 didn’t break my back?

Who can say why the hits I took in high school sports weren’t more serious?

Who can say why my car accidents derailed me for a shorter time than others’ do?

Who can say why I was able to hop up after my fall in 2004 and say, “I’m okay… I’m good,” and get on with my life — even if the getting was a lot less good than it was prior to my fall?

I don’t have the answers to those questions. And there’s this little voice in my head that’s warning me away from comparing myself — favorably or unfavorably — with others and their situations. We all have our challenges, and we all have our limits, and it’s not really for us to judge which is better or worse, which is easier or harder, or even if we deserve what we got.

All I know is, things haven’t been easy for me. But they haven’t been as hard as they could have been. I’ve been spared, and while I do wonder why I rate that, the bottom line is that my difficulties have made it possible for me to understand what it’s like to struggle terribly with things that others cannot see. I know, first-hand, what it’s like to be lost and alone and afraid and totally invisible to the rest of the world. I know what it’s like to live, day after day, wondering if I’m going to lose everything because of some mysterious difficulty I can’t put my finger on. I know what it’s like to be abandoned by people who were supposed to help me, and treated like shit by mean-spirited people. I know what it’s like to be preyed upon because someone senses I am at a disadvantage in life.

And since I know first-hand what all this is like… AND I am still pretty high functioning, I’m in a really great position to help. My brain is broken, sure. But my brilliant mind won’t quit. And since I can write and use this blog and I know how to get the word out online about this TBI stuff, it puts me in a really great position to educate and inspire and hopefully assist others.

God, but this world can be a lonely, confusing, depressing place. But in the worst of times, it’s so very important to identify our strengths and our gifts and pitch in to help others who are in need. I haven’t the faintest idea why I have been spared the fate of so many others like me, who had the same types of experiences but have it much worse. But it’s not for me to know.

All I can know is, I’m a survivor (dammit!), and I have abilities and talents and resolve that I can put to good use for others. I have an extra hour or two in my day that I can spend blogging before I go to work. I have a job that lets me grab a few minutes, here and there, througout the course of my day to examine my life and figure out what works — and what doesn’t — with regard to my broken brain. I have been given  wonderful gifts of resiliency, determination, stubborn faith, insatiable curiosity, and the ability to overlook my own personal pain — physical and emotional — in the service of a cause greater than myself.

I know how to function in this life, in spite of a long history of brain injuries and the personal/physical/social/emotional/financial complications that arise from them. I’ve devised coping strategies (usually from sink-or-swim situations) that have really worked for me. I’ve figured out how to find jobs and stay employed, how to make money and pay for big-ticket items, how to appear functional in the world, how to interact with people well enough to get by, how to support my memory and work with my uncooperative body, and more. I’ve had to face down a lot of real challenges, but somehow I’ve managed to overcome them. And I love to write… so what better position could I be in, than to blog about it all and hopefully toss someone a little help from my own personal experience?

So, rather than sitting around and feeling unworthy and useless and undeserving because I’m able to function well, while other flounder and founder, I think I’ll just get on with my life, get on with my day, and use what I learn for the benefit of others.

God knows, we can all use a little help. And what a shame it would be, if I were the only one who benefitted from the lessons I’ve learned!

Center helps with psychological health, traumatic brain injury

A new 24-hour outreach center now provides information and referrals to military service members, veterans, their families and others with questions about psychological health and traumatic brain injury.

Operated by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, which falls under Tricare Management Activity, staff at the center are available around the clock, 365 days a year, by phone at 866-966-1020 and by e-mail at resources@dcoeoutreach.org.

“We’re providing 24/7 support to assist callers with questions regarding psychological health and traumatic brain injury,” said Brig. Gen. Loree K. Sutton, M.D., director of DCoE. “Getting the best possible information and tools, hassle-free, will empower and strengthen warriors and their families to successfully manage what can be confusing and disturbing circumstances.”

The center can deal with everything from routine requests for information about psychological health and traumatic brain injury, to questions about symptoms a caller is having, to helping a caller find appropriate health care resources.

Read more here…

More attention for the invisible disability – TBI

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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Surviving the Storms of Combined TBI and PTSD

This has been an extremly trying week for me. No, make that ten days. The storms that buried many parts of this country in ice and snow have been very challenging, yes, but my responses to them have been even more of an issue. I’ve been “going off” on people around me and being a raging terror to the people closest to me, and I feel even worse than I would if my life were just complicated.

I’ve been shut down, unable to communicate, unable to ask for help, unable to logically parse through the events around me and come up with common-sense responses to events around me. I’ve had an incredibly short temper, I find myself flying off the handle over every little thing, I haven’t been sleeping, and I haven’t been able to think past the next half hour. All this, over lots of ice and snow and the power going out.

I know that I live in an area where I am safe. I know I have a job that will pay for all these expenses. I know I have friends and family who can come to my assistance. But my body is telling me I’m in mortal danger, and I’ve been alternately freaking out with the stress, on and off, for the past week and a half. My PTSD has blown my responses way out of proportion, and it is taking a toll on my self-esteem and my ability to cope. It’s also worrying, that I should have so much trouble with such simple, basic stuff, and it makes me fear for my life, should something really bad and really serious happen. It’s worrying.

Now, I’m very grateful, that the past week or so hasn’t been a truly life-threatening situation. My mind knows it hasn’t. But to my body, it sure feels that way. And I’ve been managing a level of panic that hasn’t taken over me for quite some time. That rising, falling, ebbing, flowing sense of impending doom that sends my adrenaline pumping and slowly fries my ability to think clearly, has been a constant companion for the past 10 days, and that doesn’t make me happy. It makes me jumpy and frazzled. It makes me way beyond irritable — it makes me extremely volatile and it makes my temper outbursts frighteningly violent.

And my diminished ability to cope with even the most basic demands (like carrying an armload of firewood in from the wood pile) without melting down, makes me feel like a wuss and a coward and a pansy-ass. It makes me feel incompetent, deficient, a loser. I feel like such a simpleton, when I end up spinning my wheels and unable to think through a logical progression of steps, during such a simple thing as the power going out. It just makes the more complex tasks (like having to relocate and keep my life on track) that much harder. It makes me feel like a total loser, to be churning and churning and not able to deal with the simplest of tasks, like shutting down the pump and furnace in the proper order… draining pipes and keeping up with my tasks at work and keeping current on paying my bills. It makes me feel like a freak, that I can’t keep my head on straight and just work my way through things.

I wish my mind were clearer — ten years ago, it would have been — even five years ago, I’m certain that I could have just dealt with all this in good form. But that fall down the stairs in 2004when I hit the back of my head, had such an effect on me. I can see it now in living color. Where I was once able to really embrace this kind of situation, roll with it, cowboy up and ride into battle with all flags flying, now I find myself cowering in a corner, struggling to sort through the different pieces of information I have, unable to prioritize, unable to think things through in an orderly manner, unable to discern the relative importance of different events… getting more and more panicked all the time.

Should I turn off the water again? Should I drain the pipes? Should I turn the heat up? Should I call my relatives? Should I worry about the health and safety of the older animals we have? Should I be this worried? Should I…? It’s maddening, but I can’t seem to make head or tail of things, at times. And that drives me nuts. All the while that my brain is trying to sort through things, my panic level is rising. I can’t seem to put my reactions in perspective, can’t seem to distance myself from what I’m feeling, can’t seem to hold back the waves of anxiety and fear that rush through me without warning.

If anything, the intense responses that I’ve had to the power outages and the disruption to my daily schedule have served to make me feel even worse than I “should” feel — I know I am not exactly in mortal danger, I intellectually know that I probably will get through this all in one piece, and I am well aware of how lucky I am to have the resources and community support that I have — but there is a part of me that gets so freaked out and starts to flail… while my mind sits back and says WTF — what is your problem? What are you, some kind of retard? What’s gotten into you? You can handle this? Why are you being such a friggin’ loser?

I have spent a whole lot of time beating myself up over this… feeling stupid, feeling ignorant, feeling incompetent. I can’t seem to care for my household. I can’t seem to keep up with the most basic elements of providing for and protecting my own family. I can’t even keep my own shit together, let alone care for the ones I love. It’s so fucking debilitating, sitting and watching myself lose it over stupid shit that didn’t used to bother me. And I wonder if I’ll ever be the person I once was… if I’ll ever be fully functional… or if this brain of mine, this spirit of mine, is so damaged beyond repair, that I’ll live out the rest of my born days as a shadow of the person I once was.

And I understand all too well, why soldiers back from Iraq or Afghanistan, who are dealing with the after-effects of TBI and PTSD end up killing themselves. I totally get it. Your brain isn’t working the way you need it to — you can’t even tell that it’s not, half the time. All you know is, things are not clicking right, and you start to panic. The adrenaline gets pumping, the cortisol gets flowing, the body kicks into high gear, trying to respond to a perceived threat that the brain can’t quite comprehend… and the biochemical onslaught slowly but surely erodes your capacity to deal… to think… to manage your own emotions…

Time after time it happens… the downward spiral, the fear, the anxiety, the feelings of hopelessness and the inability to parse out just what is happening in your life, to your life, to your body and mind and spirit. And with each successive onslaught of biochemical assault, you become a little less capable of dealing effectively with the world around you. You get a shorter fuse. You get a faster, more sensitive hair-trigger. You explode more violently. You freak out more embarrassingly. You just can’t deal… you just can’t deal… and you don’t know why.

All you know is, this downward spiral doesn’t seem to have an end.

You’re totally screwed.

The thing is, it’s not necessarily true. It feels that way. It may even seem that way. But I have to remember, in my own case, when things are at their worst, it’s often because my brain is not telling me the truth. In fact, knowing that my brain is broken, can be the best defense against doing something rash that would devastate my family and friends. Killing myself is NOT the answer. For me or for the ones I love. I frankly could never do that to the people around me — it would be too awful for them. I have a hard time, sometimes, believing that anyone could care enough about me to miss me when I’m gone, but when I think about the stigma and humiliation that my suicide would cause my family… well, from that standpoint alone, I have to stop the thoughts of ending my life.

Seriously, I have been on the brink so many times in my life, but it never seemed like it was fucking worth it, to kill myself. First, I might not succeed, and then I might end up either horribly disfigured and/or incapacitated and even more of a burden to my family and friends. Or I would find out, after killing myself, that I was stuck for eternity in purgatory. Or hell. And I’d be unable to redeem myself from the other side. Death is so final. So irreversible. At least, while I’m alive, I’m able to take action to make amends. Or I can at least have a chance STOP the behavior that’s getting me into trouble, and I can look to someone who knows better than I, what should be done. And then take order from them.

If you’ve had a TBI and you’re dealing with PTSD, believe me, I can relate to what you’re going through. I may not have been on the battlefields of Afghanistan or Iraq, but I know very well what it’s like to have your body sending you messages of HIGH ALERT, driving you to do and say extreme things that frighten and alienate and harm others… when your mind is either too confused to understand what’s going on, or it thinks things are okay and can’t figure out why you’re constantly on edge. I know very well what it’s like to have no fucking excuse for being so screwed up, and be convinced that there’s something deeply wrong with you, tho’ you’d never tell anyone else you feel that way. I know what it’s like to have no excuse at all for your shitting attitude, your bad behavior, your defiance, your violence, your uncontrollable outbursts, your desperation, your depression… but still have it all piling up, minute after minute, hour after hour, day after day, week after week, month after fucking month.

I’ve been there, too. I am there, too.

And trust me, killing yourself is NOT the answer. Not for you, not for anyone. Not for your friends, your family, your buddies, your colleages, your brothers in arms, your commanders, your dependents, your employer… not for anyone. So long as you’re alive, there’s always a chance of redemption. There always is. I don’t care what anyone says. The world is a big place and there’s lots of room for improvement all across the board. And life never ceases to surprise. You may — and probably will — suprise yourself, in fact. It’s impossible for life to do anything BUT surprise us. After all, we’re not perfect, we’re not all-knowing. We’re not God. And we don’t have the right to play God… especially when it comes to our lives.

Believe it or not, you were brought into this world for a reason. A very special, important reason. Maybe that reason is actually going through everything you’ve been through and showing the world that it can’t get the best of you. Maybe it’s going through all the shit you’ve endured, so you can learn how to handle it… and help others who are in the same place as you. Maybe it’s just showing up at the right time and the right place and helping out in a way that seems small to you, but is huge for another person. I, myself, have been in that situation a number of times. And I had the opportunity to help people who could not help themselves… just because I noticed they had fallen or were nearly unconscious when I passed by them. As of this counting, I have been able to run and get help for at least four different people who were either trapped or had fallen or were unconscious. I may have saved the lives of some of them. Or, maybe they would have been fine without my help. All I know is, if I had ended my life when I wanted to in the past, I never would have had the chance to help them. And they might be dead, too. Or irreparably injured.

So, never underestimate your ability to contribute to the world. The times when I did the most good, were often times when I was just walking along and paying attention to what was going on around me. I wasn’t “at peak function” and I wasn’t “performing at top capacity”. I was just walking along and almost barely noticing the world around me. But I was able to act. And that was enough.

Of pain and agitation and PTSD

I am really excited to report that my pain has subsided considerably. The inflamation across my iliac crest — the top of my pelvis at my lower back — has really gone down, to the point where it’s a little painful, but it’s more discomfort than pain, now.

Also my skin is not as sensitive to every contact, like it was. I still have my moments, when I start to sting and throb and my clothes hurt me, but when that starts to happen, I press the pressure point on my hand that I talked about in this post, and I take a few deep breaths to chill myself out and stimulat my vagus nerve, and I do a quick check-in with myself to see if I’m getting agitated about things.

Agitation really seems to get to me physically. Anxiety, too. When I’m worked up, everything feels more intense. So, calming my system down really seems to help matters.

Looking around, I found a June 2001 post from Science Blog that speaks to this. It’s ‘old news’ — over 7 years old — but it makes for good reading, and it really put things in perspective for me.


From Texas A&M University

Fear, anxiety affect pain

COLLEGE STATION, June 12 – Human emotion can be a powerful force, fueling everything from improbable sports championships to tragic acts of violence. Now there’s evidence showing how powerful human emotional states can be when it comes to determining a person’s ability to feel pain.

Texas A&M University psychologist Mary W. Meagher, who has conducted pain research for 16 years, says two emotional states – fear and anxiety – have profoundly different effects on a person’s ability to feel pain.

“Fear and anxiety have divergent effects on pain reactivity in humans: fear reduces pain, whereas anxiety has a sensitizing, or enhancing effect,” says Meagher, who holds joint appointments in clinical psychology and behavioral neuroscience.

Her conclusions are based on her and graduate student Jamie L. Rhudy’s recent work focusing on the role of human emotion on pain. Previous animal studies have suggested that fear inhibits pain and anxiety enhances it, but Meagher’s results support the view that emotional states influence human pain reactivity.

“From a clinical perspective, these data suggest that a patient anticipating an unpredictable threatening event will experience enhanced pain,” she says. “In contrast, a patient that has been exposed to a threatening event will experience a fear state that inhibits pain processing.”

Meagher believes previous conflicting reports of the effects of anxiety on human pain were due to a failure to properly distinguish between the emotional states of fear and anxiety.

Fear, Meagher explains, is an immediate alarm reaction to present threat, characterized by feelings to escape and accompanied by specific physiological changes. Anxiety, on the other hand, is a future-oriented emotion characterized by anticipation of potential threats.

Fear mobilizes a person to take action – the commonly known “fight or flight” response – but anxiety leads to scanning of the environment and body, resulting in increased sensory input, she says.

With these distinctions in mind, the conclusions make sense from an evolutionary point of view, Meagher notes.

Confronted with life-threatening situations, which would elicit fear, the body reacts by shutting off the pain response because feeling pain might get in the way of survival, she says. “Alternatively, during times of low threat – those times likely to produce a state of anxiety rather than fear – the chance of survival is increased if pain is enhanced so that behavioral responses can occur to minimize tissue damage,” Meagher explains.

Meagher’s work also shows that positive emotions can lead to pain reduction as long as a minimal level of arousal is reached, but negative emotions only lead to pain reduction when they are highly arousing. In fact, she says, negative emotions can actually facilitate pain if they are only low to moderately arousing.


This is consistent with my own experience — I can definitely confirm that in my own life, if I’m presented with a situation that involves a specific, verifiable threat, all my systems kick into action and I can actually perform at a higher level, than if I’m just rolling along in a relatively event-free, stress-free life. I can see better. I can hear better. I can interact with the world around me better. Fear actually forces me to focus — that is, if the fear relates to something that is real and significant.

Anxiety, on the other hand, throws me into a panic and sends me spiraling. I can totally see many examples in my life where non-specific threats “triggered” a hyper response to everything and anything around me. It makes me more sensitive, it makes me more jumpy, it makes me more pain-filled.

And thus the vicious cycle begins… because my hypersensitivity causes me to interact with the world poorly — it makes me sensitive to pain, it heightens my hearing, my eyesight, my sense of touch… everything. It makes me avoid situations I shouldn’t, it makes me choose to wear clothing that isn’t the most socially advantageous. (Note: Wearing a sweatshirt and jeans every time I go out in the world is not sending the best message — if anything, it sets me up to not be taken seriously by other people. In fact, I believe that a number of my interactive difficulties, from dealing with doctors to dealing other professionals/consultants, have been made more difficult because I chose to wear well-worn but comfortable clothing, rather than clothes that “sent the message” that I was someone to be taken seriously.) My tactile defensiveness makes me avoid human contact, from handshakes to hugs, which impedes me socially, as well. And it makes me more sensitive to light and sound, which causes me to unconsciously avoid situations that are bright and loud — which is where an awful lot of people hang out, and where an awful lot of deals are done.

But when the offshoots of my socially and physically impactful anxiety result in poor choices or actions that endanger my social standing, my employability, my ability to function in the world at large, it sets up conditions that produce fear. Existential crisis. Serious problems that endanger my job, my house, my family, my safety, my very life. And my sensitivites shut down — they swing to the opposite end of the spectrum. I don’t pick up on clues that people send me. I don’t notice things I should. I don’t realize that I’m falling behind in my work, or that there’s a traffic cop standing in the middle of an intersection ahead of me, waving their flashlight for me to stop. I kind of “click off” in some ways, becoming numb to the world around me, as I deal with my most pressing issue at the moment: I’m late for an appointment that will get me in trouble, or I’ve fallen behind in a task I was supposed to have done by tomorrow, or my back yard is so grown up, the ticks have started to come into the house.

I’ve been in more questionable situations than I care to think about, in no small part because I was shut down while I was dealing with some other crisis that took my mind off what was right in front of me. Or because I’d just come off a crisis I couldn’t deal with and that fried my system. I’ve gone walking in areas where there was active hunting going on, following deer paths on purpose, because I was more interested in getting in touch with nature than noticing the hunters around me. I’ve hung out with underground criminals who were obviously and openly checking out my various assets and having side discussions about me, when I was in a totally new area, having just moved there on my own and not having any real way to support myself and not having a clue, frankly, where my livelihood was going to be coming from. I’ve taken chances behind the wheelof my car that almost got everyone with me killed, when I was overwhelmed with coping with some really intense, deep-seated interpersonal issues that were more than I could handle.

And the aftermaths of these times resulted in more anxiety … and behaviors that made it all but impossible for me to deal effectively with the  demands of the world around me. I descended into intense pain. Or I started drinking heavily. Or I plunged head-long into a long period of over-work, in order to block out the drama, the pain, the trauma… the pain.

I think this business of psychogenic pain — that has both logistical and physical causes AND effects — is an area that should be examined more closely, especially by the mental health field. I think that the connection of emotions — fear and anxiety — and the physical results from them, can actually explain a fair amount of how TBI and PTSD can combine and worsen each other. And it could help explain additional sources of distress and trauma for people who are dealing with emotional issues… some of which won’t “budge” despite years of psychotherapy.

Therapists, in my experience, often focus so intently on the emotional root causes, the past events, the sources, of psychological issues, that they miss the physicality of the experiences they’re addressing. And in the process, they overlook both a contributing factor and a symptom of psychological distress and dysfunction. I suppose it’s to be expected, since psychotherapy is about the psychological side of life. But the more we learn about these things, the more closely connected we realize the mind, body, heart, and spirit are… and to discount any of them, in my mind, short-circuits the process of healing and recovery from the rough-and-tumble aspects of life.

I’m working with very limited time, here, so I don’t have all the hours in my day to devote to this study, but I hope someone else out there is looking at this. Or maybe they have, and I just don’t know about it.

One person who is looking at this, I believe, is Belleruth Naparstek, a psychotherapist who works with guided imagery to address effects of trauma and PTSD and other psychological dysfunctions. She’s got a website at http://www.healthjourneys.com/ where she not only has CDs and tapes and MP3s for sale, but she also includes research and articles about the use of guided imagery in healing.

I have friends who swear by her work, and I  myself have used her PTSD and Stress Hardiness Optimization and Panic/Anxiety guided imagery with some surprising results. I’ve never been much “into” guided meditations — people who try to “guide” me tend to irritate the sh*t out of me, and it often feels like this namby-pamby coddling pansy-ass touchy-feely crap that is one of the aspects of “new age healing” that just drives me nuts. Okay, so maybe I’m being harsh and it just goes to show I have plenty of healing to do, but I just hate feeling talked down to an patronized by people who are “more enlightened” than me. I usually feel condescended to ann treated like an infant.

Belleruth’s style, however, is not like that. She seems very down-to-earth to me — at least, in her CDs — and she’s very accessible and no-nonesense. She also strikes me as being very competent and intelligent, which helps. I hate it when dense people condescend to me. It makes me crazy and is a terrible distraction. Anyway, I’ve been very surprised by the effect her CDs have had on me — after being unable to shed a tear for many, many years, I’m actually able to cry. Okay, so I’m not very good at doing it around other people, and it stresses me out when they see me cry, but every now and then, I can really use a good breakdown in the privacy of my own home. And when I’ve listened to the imagery, I can sleep. This is big. I often fall asleep in the middle of the imagery, and then I wake up when it’s done. I suppose I may be getting some benefit while I’m sleeping, but the real boon is that I can sleep, at all. I went for years, after my last TBI in 2004, not being able to sleep through the night, waking up at 3 a.m. regularly, not being able to sleep on the weekends, not being able to really rest… which fried me even more after the fall and probably impeded my recovery terribly.

Anyway, to get back to the point of this post — in tracking the sources of my pain and finding out ways to deal with it, I have to look at the emotional aspects — the agitation and anxiety and fear pieces of the puzzle — and address them. When I address them, through deep breathing, monitoring and controlling my stress, and keeping myself relatively chilled out — or as chilled out as I can be — it helps me cut back on the pain. I also do things like cuss out people who make me angry, when I’m far from polite society — in the woods, or in my car (tho’ I have to be careful when I’m venting in my car)… write letters to the people who I feel have done me wrong, and then rip up the letters (never send them)… try to get more sleep, so I can deal with the physical issues that lead to the emotional ones that lead to the physical ones… and so on.

And I use the pain points on my hands to at least give myself a little immediate relief.

If you’re dealing with pain and you’re looking for ways to deal with it, I wish you the best of luck! Everyone is different, of course, but life is all about cause and effect. Even if what I use to cut my pain doesn’t work for you, if you engage in your own process and just keep trying, you may be able to find ways that you can use to address your own situation, and get more out of life, with each passing day.

Life can be wonderful, if we figure out how to let it be just that.

Medical Humanities has some interesting things to say

I came across this blog yesterday, and was encouraged to see someone talking about the latest reports out from the Institute of Medicine — one report about the length of residents hours at hospitals, and the other about the long-term effects of TBI in (Gulf War) veterans.

I’m glad there are other folks out there who are as interested as I am about these subjects. I know I’m not alone, but it often feels that way, give my limited range of motion.

What’s really exciting about the report about residents’ hours is that it puts out there in a very public way the shortcomings of an existing system. I have a relative who’s going through their residency right now, and I hear stories from them that sound like horrors — just the sleep deprivation alone makes me cringe. And expecting new doctors, who don’t have the wealth of experience behind them in their decision-making, to perform at peak on such little sleep… well, it troubles me. And it makes me want to avoid teaching hospitals with every fiber of my being.

It seems to me that one’s residency should be a time of over-rest, rather than under-rest. The brain needs rest and sustenance, when it’s dealing with a lot of input, stress, and new stimuli (even I know that)… so, why wouldn’t we do everything in our power to make sure our future doctors — whom we are entrusting with our lives and our futures — have ample access to hours off… and are not overloaded and/or receive extra help dealing with the additional stressors.

It strikes me that this might be a throwback to the practice of medicine during wartime — the Napoleonic Wars… the Civil War… when “modern” medicine (as I understand it) really got a foothold as an organized practice. It might be a relic of the times when a doctor had to be “on” at all hours because battle conditions required it. And there may be some elements of needing to prove oneself and one’s professional worth (again on the battlefield)… part of a primal sink-of-swim coming-of-age hazing process that cements the members of the profession in a special, unique, and exclusive club.

But these time-honored practices strike me as being closer akin to mind-control techniques used to break interrogants… using sleep deprivation to break down resistance to authority figures and make them more compliant (with the powers that govern the profession)… using trauma and compassion fatigue to reduce residents to walking profiles in PTSD, who are always on and are on constant alert, their limbic systems gradually frying and fusing, their amygdalas so overworked and overtaxed, that they cease to recognize anything that’s not AN EMERGENCY. I have had dealings with doctors who seemed like they were sleepwalking… only half present, when things were going okay… but who snapped into action and came alive when it was a life-and-death situation. One of them is one of the finest practitioners of their specialty, nationwide, and I would definitely want them in the ER, if I were ever there, teetering on the brink of oblivion. But when things are fine, and there isn’t an emergency, they practically fall asleep in front of you. That’s a little distressing, given that my life consists largely of non-emergencies… and I want to keep it that way.

Personally, I think the wartime medicine model leaves a lot to be desired. If doctors are conditioned to respond and function at peak only when there is an emergency, then what hope do we have of being able to live in a world of “boring” health and happiness? If our caregivers can respond effectively only when there is something horribly wrong, then it stands to reason that they can/will/must neglect the well-being of their charges, when things are going well… ultimately creating conditions that produce the circumstances that make them jump into action and charge forward… to aver the disaster that their inattention may have contributed to, in the first place.

Yes, it’s important to have doctors who can deal well with trauma. There are a lot of conditions in this world — even in relative safety — that resemble aspects of war, on some level. Serious car accidents… gang warfare… widespread domestic abuse and violent conflict. But what about practicing medicine in peacetime? What about dealing with patients who are NOT coming in from the battlefield and don’t need to be patched up quickly and sent back out? What about tending to the health of patients, instead of just managing their eventual deaths?

This is what excites me so much about the two reports from the IoM. They don’t only stand around wringing their hands — they make objective, well-researched observations and make substantive suggestions about what to do about it. They mirror my concerns about residents’ hours – and they do it with data and authority I either do not have or cannot convey. And they are pro-active. They don’t just talk about averting disaster. They talk about optimizing physician training and improving patient safety pro-actively. They don’t just say “Oh, how terrible that our vets get injured by blasts.” They don’t just dismiss “mild” TBI because there’s no penetrating wound. They really call out the long-term consequences of TBI in ways that make the data relevant not only to vets, but to others as well.

One example in particular, on pages 304-305 of the report on TBI talks about how job retention among soldiers who sustained TBI was worse among the older population, perhaps because the nature of their work involved more management and leadership — which can be more difficult to do, when your brain isn’t working quite like it used to. This is key for me, because I am in the over-34 age group, and my own job responsibilities tend to nudge me towards management and leadership positions, which I have instinctively avoided for years… without knowing quite why (until recently, when I started to realize the impact that my TBIs have had on me).

This is the kind of data that I can use personally, and I can refer others to, when they start to argue with me about what my instincts are telling me. See, I’m not wrong to be concerned about the potential impact that my impaired cognitive capacity may have on my job performance. I have difficulties communicating my experience verbally to others, and much that I do and experience is actually hidden behind a wall of socially acceptable practiced behavior (and if I do it right, nobody has any clue about my difficulties — that double-edged sword of high functionality). So, I get a lot of crap from people who try to “encourage” me to “get out of my comfort zone” without having any clue how disastrous that can truly be for me, given my limitations. But this report gives me peace of mind, that I’m not just shirking and slacking and avoiding being an adult. It recognizes that people like me, in my age group, have genuine issues taking on (and holding onto) jobs that require increased leadership/management responsibility.

Believe me, I don’t want to be underperforming. I want to push the envelope of my abilities as much as the next person — and as much as the people who love and care for me want to see me succeed and excel. But the impact of my TBIs cannot be understated. They may be mitigated, they may be compensated for. But they are still factors, and as a responsible adult, I need to be cognizant of the limits they may set on me and my abilities, so I don’t endanger the safety and well-being of others because of my cluelessness or my wanton drive to climb to the top.

I detest having these limits on me. But have them, I do. I hate struggling with things that others find easy, like engaging in conversation and maintaining my daily life. But I cannot escape the fact that I have to work a little (sometimes a lot) harder than I would like to. I cannot stand the thought that I am not fully aware of everything that’s wrong with me — especially in the moments that what’s wrong is keeping me from getting on with my life. But I can’t ignore the fact that I have holes in my memory and gaps in my knowledge that impair me in ways I don’t even know.

I just have to keep a level head, try to stay humble, and remember that no matter how irregularly my brain may be functioning, I still have a heart and a spirit and faith and love to guide me.

And I have access to reports from the Institute of Medicine that give me hope.