Thoughts on getting help for TBI

When I checked my email last night, I was pretty shocked to see that a public figure I really admired had died unexpectedly from a head injury. Out of respect for the deceased, I’m not going to use their name. Yes, it would probably drive a lot of traffic to my blog, but I don’t feel like taking advantage of their situation for the sake of my stats. You probably know who they are, anyway.

Having been in numerous situations, myself, where I had hurt my head but I had no idea how badly, I have to say that it really is very difficult to tell how bad an injury is — especially when the injury affects the reasoning part of the injured party.

Everyone around you might be saying, “Are you okay? Are you alright?” and they’re genuinely concerned, but you just want to get away from all the commotion, lie down, and settle down. You don’t want to be bothered by all the hullabaloo, which — to your injured brain — can be very confusing, very aggravating, very anxiety-producing. It can just be too much to process. And if emergency medical teams are involved, the drama can be so disorienting, so confusing, so annoying, that it’s a relief to just get them to go away.

With me, when I fell in 2004, about the last thing I wanted, was for people to fuss over me. And I declined both help and attention for a number of reasons:

  1. I didn’t want to be bothered by all the drama of an emergency room, when I was just a little wobbly. I figured I just needed to collect myself and shake it off, and I’d be fine.
  2. I didn’t want to make a big deal out of things, when all I had done was fall down the stairs and bump my head. I had fallen plenty of times throughout my life, and I had never rushed off to the hospital before (tho’ it turns out I probably should have).
  3. I wasn’t sure that I could get the proper help in the town where I was visiting. This was because I wasn’t sure about the quality of medical care available in that relatively rural location and because I wasn’t sure, myself, how to describe my symptoms.
  4. I didn’t want to interrupt my schedule — I was packing to go home after a very demanding holiday celebration — over something as dumb as a fall. I really just wanted to go home.
  5. Nobody knew how badly I’d hurt myself. I was too out of it to tell just how I was, and the folks who were with me didn’t know enough about concussion or head injury to judge my condition.

Things might have been different for me, if we had all had more information about head injury, if we had known the signs, if we had had access to high quality medical care, and if there hadn’t been all sorts of other competing activities going on. As it was, in the case of my fall in 2004, everything added up to me not getting help for my problems, and proceeding to lose an awful lot of important elements of my life.

I’ve had other similar experiences, as well — particularly with car accidents. The three different car accidents I was in, that had noticeable after-effects, were never enough to slow me down or stop me for long.

The first one I had in 1987 had the immediate result of confusion, inability to understand what people were saying to me, and loss of ability to work for a number of weeks. I just couldn’t keep it together. Eventually, I was able to get back into the swing of things with work, and I was able to get back to normal functioning. But that was only after a couple of months of screw-ups on job interviews, missing cues, drinking a lot, and generally being a wreck at home.

The second accident I had in 1989 left me spacy and confused and having a hard time finding my way to the train station I was going to, after the accident. I also had a very sore neck — more sore than usual — and I didn’t feel quite right. But I still pushed through and went about my business.

The third one in 1996 also came at holiday time, in heavy Thanksgiving traffic, and immediately after it, I had a really hard time focusing, and I couldn’t for the life of me read the forms I had to fill out to send to the car rental agency. I just checked some boxes and signed the form and sent it in, hoping that I’d gotten it right, but not knowing for sure. I also started to lag at work, and I dropped a lot of projects I had started, without really understanding why… or properly assessing how important the fact was, that I was dropping them.

Every time I’ve fallen or been hit or had an accident, I’ve never actually received proper care afterwards. When I was a kid, people didn’t know about concussions. They didn’t know what to look for, and they didn’t properly estimate my need for help. Also, when I was a kid, I didn’t want to draw attention to myself and look like a “sissy” just ’cause I had gotten hit on the head. And as an adult — perhaps because of the series of re-injuries — I’ve never aggressively followed up on my symptoms and gotten medical help after my accidents.

Thinking about it within the context of our North American culture, I have to say that our world is not particularly well-suited to treating head-injured people. Our movies are chock-full of images of head trauma that has no consequence whatsoever — people are always getting punched, slammed, hit over the head, tackled, and generally taking a lot of punishment above the shoulders — all without apparent side-effects. Our sports are violent and often include plenty of blows to the head as a matter of course. Football and soccer and ice hockey are tailor made for getting hit on the head, whether through tackles, moving the ball up the field with a header, or assaulting an opponent to gain possession of a puck. Falls and bumps have entertainment value, whether it’s in a commercial for a carbonated beverage or it’s slapstick comedy or it’s in kids’ cartoons. When I think about how many images of violent assault and “fun” head trauma I saw just on Saturday morning cartoons — Elmer Fudd really took a beating over the years, and I’m surprised he survived — it’s no wonder that when I fell, myself, all those times… or got hit on the head… or experienced some tackle or hit or accident that “rang my bell”, I instinctively shook it off and declined help.

Now, I wish I could say, after all these experiences  (and knowing what I know now about traumatic brain injury) that if it ever happens to me again, I’m going to do the right thing and seek medical help. But I’m not sure I will. I’m not sure I’ll be able to. When you’ve been hit on the head, your thinking can get so foggy, your judgment can be so muddy, and you can be so irritable and, well, non-compliant… that your better angels don’t have a chance to step in. Those angels may be your instincts or people around you who care about your welfare, but in either case, when you’re head-traumatized, you can be ornery and contrary and refuse any kind of help and get very agitated if those “angels” press you to assist.

It’s a conundrum. One with consequences, as too many people find out regularly. Whether they’re the head-injured person or their family or friends or co-workers, they are impacted to some extent.

Perhaps the only hope we have is education. Information… Well-informed judgment. And the willingness to endure the wrath of head-traumatized individuals (who have no idea how much help they really need) and not quit insisting they get help… until they do.

Of course, even if they do get help, the quality of it is dependent on the medical team assisting. And if you’re stuck with a doctor who’s clueless about head trauma and thinks, “Oh, everything will be just fine, so long as you didn’t get knocked out for more than 2 minutes,” and gives you some aspirin and sends you home to rest, all the perseverance in the world only goes so far.

Dealing effectively with head trauma needs to be a team effort. A prioritized team effort undertaken by people who know what the hell is really going on. It’s a goal worth working towards.

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…