Emotional/Behavioural Changes after Brain Injury – Part 1

lightning striking the ground under dark clouds
Sometimes the storm seems to come out of nowhere.

From The Toronto Acquired Brain Injury Network.

My comments are in bold like this.

Emotional/Behavioural Changes

Some people are left with changes in emotional reaction or behaviour after a brain injury. These are more difficult to see than physical or cognitive changes. However, they can be the most difficult for the person and their family to deal with.

BB: I had no idea that a TBI would affect me emotionally, or change the way I acted. Like so many people, I figured that a bump on the head was just an external thing. I'd feel pain on my scalp, and maybe I'd feel a little woozy, but it would clear up in a few minutes... or hours. How wrong I was - so many times. Emotional and behavioral issues have been the bane of my existence (and my family's) for years and years, starting back in my childhood when my behavior was erratic, and my emotions were volatile.

Not everybody will experience these problems and their severity will also vary.

BB: The severity can vary from person to person, as well as from situation to situation. With me, I can be fine, one day... be not-so-great (but seem fine), the next... and then completely lose it a few days later. It's often cumulative, but nobody on the outside sees it building up. That happens inside. Where nobody can see. And when it erupts... hooo boy.
fireball explosion
The problem for me, is that when I blow up, it puts people off, and then they think that's how I always am... and then they walk on eggshells about it, all the time.

And I sometimes never get a second chance, because they've made up their minds about me in a negative way.

Agitation

This frequently occurs at a very early stage after the injury. It can be a coping mechanism for the person, who may be disorientated and very confused. It is most often a stage a person passes through, rather than a permanent change. Examples include: restlessness, pacing and pulling at intravenous tubes.

BB: I've been extremely fortunate to never having had intravenous tubes to pull at, but I know the feeling of not being able to sit still, being extremely agitated - especially after a TBI. A number of times, I can recollect getting hit in the head, and then being flooded with agitation and an overpowering need to MOVE! Like when I got hurt during an informal pick-up soccer game in high school, after the hit, when I was lying there, dazed and confused, I suddenly felt like I'd been given super-powers, and I leaped up and started playing like a crazy person. I don't think I played better than I had before I got hit, but I felt like I did. And I was ON FIRE - or so I thought.

In another soccer game, when I got my bell rung, I knew I'd been hurt, but I felt this incredible urge to GET UP AND GO!!! And I started racing around the field -- in the wrong direction, no less. I nearly scored on my own team, which I think was a red flag for everybody on the sidelines. I did get taken out of that game, and I paced the sidelines in confusion and anger, because I NEEDED TO BE IN THERE! But it was wise to pull me from the game. I was not in good shape, at all.

So, while agitation may be a coping mechanism for some, as they say above, I suspect it also has to do with the mechanism of the brain - the release of all those chemicals, and the general confusion that causes. The brain is trying to figure things out - plus, it's firing on ALL cylinders, like there's no tomorrow. In addition to being a behavioral coping mechanism, it's a result of the brain's basic function.

Explosive anger and irritability

If there has been damage to the part of the brain that controls emotional behaviour and the ability to tolerate frustration, emotions can swing to extremes. The stress of coping with even minor crises, such as misplaced shoes or a noisy vacuum cleaner, can be too much and trigger an angry outburst. If these stresses can be identified, it may be possible to reduce them.

BB: Amen to this. The part of the brain that controls emotions is particularly susceptible, as it's out in front and there are so many types of injury that can affect it. Car accidents, where your brain slams up against the inside of the skull... or tackles that snap your head back and forth... falls, etc. Minor events can turn into crises -- just being blindsided by a sudden change or something unexpected happening, can set me off. Little things can turn into huge things, in an instant. One minute, I'm fine, then all of a sudden, it's off to the races with emotional overload and over-reaction.
galloping horse
Prolonged stress will also do a number on me, as will fatigue. The more tired I am, the more irritable I get - a tired brain is an agitated brain. And when I get too agitated, it's not cool.

Sudden outbursts... extreme reactions... it's all part of a day in the life for me, sometimes. Unless I can get enough sleep and take good care of myself. If I can keep on my schedule and be smart about eating and drinking enough water, that helps. So does meditation and just taking time to chill out. 

Lack of awareness and insight

The ability to recognize your own behaviours and change them when needed is a sophisticated skill that can be affected by brain injury. This can affect someone’s ability to: be self-aware; have insight into the effects of personal actions; show sensitivity; or feel empathy. It also means that a person may not fully appreciate or understand the effect that the accident is having on their life, health or family.

BB: I honestly had no idea how my TBI was affecting my household, back in 2005. I'd gotten injured at the end of 2004, and 2005 was the start of the downhill slide. I became incredibly self-centered and obsessed with myself. Small wonder - I had to recover and build myself back up, as my Sense-Of-Self had taken a huge hit. I didn't know who I was or what I was about, anymore, and it was devastating. I didn't recognize myself, and I was so caught up in figuring it out inside my head, that I never realized the extent of the changes on people closest to me (who were outside my head).

It took talking with someone on a regular basis about what was going on with me, to help me see what an ass**** I was being, and to do something about it. Until I started talking to a neuropsych on a regular basis, I had no way to understand myself and objectively examine my behavior, because nobody I talked to actually understood how TBI affects the mind, body, and spirit... so they made all kinds of flawed assumptions about who I was and how I was. It was incredibly unhelpful for me, and it did more harm than good. 

I got lucky. A lot of others don't have that opportunity. And that's a damned shame. It's criminal, really.

I’ll continue this post in Part 2. Watch this space for notifications.

Source: www.headway.org.uk

Source: Emotional/Behavioural Changes | ABI Network

Into the bleak mid-winter

winter sunset with geese flyingI have a confession to make. I love the bleak mid-winter. There’s a hymn about it, that sounds like a funeral dirge. The first verse starts off with a not-so-perky extended complaint:

In the bleak midwinter, frosty wind made moan,
earth stood hard as iron, water like a stone;
snow had fallen, snow on snow, snow on snow…

It’s actually a religious hymn about the birth of Jesus Christ, and I don’t want to get too faith-based here, but the bottom line is, the start of the song sounds pretty dire, but it ends up in a happy, light-filled place. If, that is, you’re a Christian believer. Everybody else will probably be left as cold as the first verse sounds.

Regardless of religious conviction, however, the point of the song is that despite the cold and gloom of the winter months, a light comes into the world. And that transcends it all.

Personally, I like the bleak mid-winter, because it slows everyone down. All the running around and chasing after things during the spring, summer, and fall… well, it all gets a little tiresome, after a while. Our systems aren’t really built to keep going at top speed, all year long. Or even all day long. We need our sleep. It cleans out the gunk that builds up in our brains, and it helps our systems restore their balance.

The idea that you can get up at 4 a.m. and push-push-push for 18 hours, till you collapse, and then get up and do it all over again, is a dangerous concept. Some people can do it, sure. But they’re the exception. The vast majority of us really need our sleep to function. And that includes me. A lot of us could also use a nap, each afternoon. That includes me, also. But I only get that on weekends and my days off. All the other days, I have to keep up with others.

Of course, getting enough sleep is more easily said than done for me. Lately, I’ve been pretty anxious about some work issues, and I’ve been waking up at 5 a.m. instead of 6:30 or 7:00. So, I’ve been losing sleep. I’ve also been staying up later than I should, watching the tail-end of movies that I really like. It’s irresponsible, I know, and I need to stop it. And I will. But right now, my focus is on making sure I’m functional for today… not focusing on the evening at the end of my day.

But I’ve digressed. I love the bleak mid-winter for its cold, which slows us all down, as we have to deal with more layers of clothing. I love it for its long nights, which help me rest and relax. I love it for its crazy weather that keeps me on my toes. I don’t even mind the snow so much, because it gets me active and out and about. And I love how other people slowing down makes it easier to shop and go to the gym, because people are not feeling up to working out (especially after the initial rush over their New Year’s Resolutions has passed), or going to the store at early/late hours of the day.

The bleak mid-winter solves a lot of logistical issues for me, slows things down, gives me a break from the onslaught of constant go-go-go, and it gives me space to move and think instead of having to constantly negotiate the world around me.

And that’s fine. It’s just fine with me. So… onward.

More clarity – yes, more clarity

clarity-of-thoughtSo, I posted a TBI injury and recovery story from a reader, the other day, and it seems like a lot of people think her story is mine. Not at all.

Well, of course, there are some similarities, but it’s her story, not mine. I’ve just gone back and updated it with a notice at the very top and quotes around the story — it was easy to fix.

I wish all misunderstandings were that easy to fix.

I’ve also been fielding some comments in Twitter about things I’ve said, that apparently came off wrong. It is really, really easy to be misunderstood on Twitter. I’ve had people thinking I was attacking them, or their sport, or something else they held dear… and then they “fought back” with both barrels blazing, when all I was doing was raising some questions.

All around, it seems like the online world is just primed for misunderstanding — and consequently, a fight. All around us, we are trained to see opponents and aggressors. And that’s a huge problem, when you can’t even disagree with someone and/or challenge their thinking without being seen as an aggressor (or micro-aggressor). There’s a fantastic article in The Atlantic about this (click here to read it), which I came across a while back. It explains a lot — especially with regard to the younger generation who seem to have amazing potential, but also seem incredibly hung up over every little thing.

All the fighting… good heavens. There’s a reason I backed off Twitter for a while. But there’s so much good research coming out that gets posted there, I have to check it out. There’s seriously some great reading available, thanks to all the tweets flooding my feed. I think the key is to not follow a lot of people who get snarky and vicious and outraged. Especially about politics. ‘Nuff said about that.

Anyway, I’m taking more time to think things through before I say / post / tweet them — or trying to, anyway. It’s hard, when the moment to respond presents itself, and there’s something in your mind that seems 100% appropriate and on-point.

I should know by now that that feeling of 100% certainty is a tip-off to the exact opposite being true. The more convinced I am of something, the more likely I am to be very much mistaken. So, I do know that. But that doesn’t always rule how I react and interact. Impulse control issues and all that.

I guess that’s what keeps things exciting. I just have to keep revisiting things that need a little tweaking… making sure I don’t do more damage along the way. I also need to know when to let it go. Not everything needs to be fixed the way I want it to be. It’s also important that I hold my ground and not give into bullying. Just state my case, say my piece, and leave it at that. If people understand, then great. If not, there’s no guarantee I’ll convince them.

Sometimes it’s best to just move on and leave it at that. Or just stop following some people… which I have been doing regularly, when their tone gets too unremittingly intense.

Anyway, it’s a new day. It’s Saturday. I have some time to myself today, and my headache has abated somewhat. I’ve got some reading I want to do, as well as some thinking. “Tinkering and thinkering” as I’ve heard it described in something I read recently. I’ve always got to be careful when I have free time, because I can very easily get carried away in all sorts of distracting directions.

Last week, I was caught up in researching mind-control techniques of expensive large group “personal growth” programs… and a week before that, I was caught up in some fringe neuroscience that is so far beyond me, it became apparent after two days of compulsive reading that I couldn’t even scratch the surface enough to wrap my head around the name of the phenomenon. Admittedly, it is good for me to range a bit farther afield in my reading and studies, but I can get too caught up in too many fringe activities, and then I lose valuable time for the things that I really do want to work on.

Like the handful of books I’ve started to write and got 3/4 of the way through, but are all waiting for me to pay attention to them again, so I can finish them up.

Anyway, today is different. I’m not feeling great — and ironically, not feeling great is a key factor in how well I am able to focus. When I’m feeling rested and fully functional, I get pulled off base very easily — all that energy gets spread too thinly — and I get nothing done.

But when I’m not feeling great — I’m at maybe 65% today — I know I have to be more deliberate in my activities and pick and choose. So, more gets done. And oddly, I have more clarity when I’m under the weather, than when I’m feeling at the top of my game.

I wouldn’t mind feeling just a little better today. Who knows? Maybe I will by the time the game is on this afternoon. I’ll pace myself. Take naps when I need to. And pick and choose the things I want to do.

That should be good.

Onward.

Another sort of amnesia

A really interesting thing has been happening with me, lately. It’s actually been unfolding over the past six months or so, when I think about it. More and more, I’m piecing scattered parts of myself back together. Most importantly, I’m becoming increasingly aware that there are pieces of myself I need to piece back together. I’m starting to remember things I used to love to do, things that used to be part of my everyday life, that I couldn’t do without… but suddenly became “pointless” after my last fall.

In particular, mindfulness and meditation are back. And I’m really focusing again on the re-development of the abilities and the interests that keep me focused, centered, and going strong. This return is big. It’s huge for me.

Now, it might not seem like that big of a deal. After all, everybody loses motivation, now and then. Everybody goes through ups and downs, shifting in and out of specific interests. Why get so worked up?

You have to understand — my shifting away from mindfulness and meditation wasn’t just a flight of fancy. It wasn’t just me getting distracted by other things and taking a break. When I got away from it, I not only got away from it, but I pretty much removed it wholesale from my life.

To understand the full impact of this, you have to comprehend what a significant part of my life mindfulness and meditation were, for many, many years. I had always been a thoughtful kid, growing up. Philosophical, even. I spent a great deal of time contemplating life and its deeper meanings, and I didn’t let the fact that I was young stop me from pondering age-old things. I would meditate on mountain vistas and campfires, commune with nature on solitary walks… be one with the universe while sitting and watching dust particles dance in a sunbeam.

In retrospect, I believe this tendency to contemplate and meditate arose naturally from my difficulties with everyday activities that other kids engaged in. I had trouble with my coordination — real balance problems, at times — and my senses were pretty sensitive when I was tired, which was a lot of the time. I never really fit in, like a lot of kids. But unlike other kids, who went out of their way to remold themselves to they could fit in better, I withdrew to a solitary, almost monk-like life of minding the smallest details of life and extracting meaning from them.

Into my adult life, too, I spent a tremendous amount of time contemplating and meditating, communing with the cosmos whenever I could. I found tremendous comfort in that, a sense of connection that eluded me in everyday life with other people. External situations that others found easy tended to baffle me, so I focused my energies on cultivating an inner life, an inner view of the world that was consistent with my heart and mind. I spent my free time reading and journaling and meditating and exploring spiritual matters. I wasn’t heavily invested in “the things of this world” because I had other interests in mind —  namely, my connection with that still small voice within.

It served me well, too. On the surface, spending a lot of time contemplating and meditating might seem like an interesting hobby, but what good would it really do a person in the real world?

Actually, it helped me tremendously, as I developed a practice I called “modified za-zen” where you maintain your mindful composure and presence of mind in the midst of chaos. It was a real “warrior stance” I took – being impassive and composed even in the face of full-on attack or a schedule packed full of highly stressful tasks. That practice enabled me to play a significant part in many heavy-duty projects at work, and it molded me into a truly competent team player who was a rock and a cornerstone of the groups I was with. It cultivated in me a presence of mind, a peace of mind, that was the envy of my spouse, my friends, my co-workers. Very little could ruffle my feathers, when I was in the zone. I wasn’t always in the zone, to be sure — I had various issues that would come up, no doubt related to my neurology, but that practice of mindful awareness and intentional composure made all the difference in some very tough situations.

After I fell in 2004, that changed.


Broken Bokeh by WatchinDworldGoBy

Suddenly, I couldn’t be bothered with that meditation stuff. And contemplation? Well, that just seemed like a huge waste of time. As for my composure at work and at home, well, who the hell cared about that anymore? I “decided” I was sick and tired of putting forth the effort to hold myself together. I “decided” it was high time that I had a break and stopped holding myself in check. There was a part of me that suddenly felt like making the effort to sustain my calm was stupid and weak. It just didn’t want to be bothered. It told me I was “choosing” to stop controlling my behavior and stop monitoring my moods and state of mind and actively managing them, but the truth be told, I just couldn’t. The part of me that had used to do that wasn’t working the way it used to. It couldn’t.

It was like the responsible, mature part of me that had good sense about keeping myself centered and sane had been shattered. And in its place I found a selfish, self-centered, self-pitying creature who had a hair-trigger temper and frankly didn’t give a damn what anybody had to say. If that part wanted to act out, it acted out, and it had the best of excuses for doing so. The part of me that had long been conscious of how vital it is to keep centered and calm and have mastery over my behavior, didn’t fully recover from that fall. It was like it got knocked out for a lot longer than my lights went dim, and while it was out, it got pushed out of the way by the other part of me that felt like any attempt at composure was cramping its style.

Whereas I had already spent many, many hours… indeed, many months of my life, if you add up all the hours together… cultivating an equanimity that was the envy of many friends and co-workers, starting at the very end of 2004 (I fell at Thanksgiving), I moved pretty rapidly away from that old practice of mine. And within a year’s time, I was in trouble. Deep doo-doo.

Of course, all this was pretty much invisible to me and my broken brain. I told myself, I had other things to do. I told myself, I had to focus on “real” things. I just let the meditation drop and walked away. And whenever some anger or frustration came up, instead of checking in with myself to see if there was any valid reason for me to act on it (there usually wasn’t), I indulged every one of my whims with a self-righteous self-justification that seemed perfectly logical to my broken brain, but logistically made no sense whatsoever.

The result? A lot of headaches at work, a lot of trouble at home, increasing money issues, relationship issues, and health issues. It just wasn’t good.

But all the while, as my struggles compounded, there was still that raging voice in me that was convinced it had every reason and right to accommodate every single negative impulse I had.  Seeing the connection between my feelings and my behavior and the consequences was next to impossible, in my diminished state. I had literally forgotten that it mattered, for me to get a grip.

Okay, enough background. The good news is, I’m coming back. Those old monitoring parts of me that I had worked so hard to cultivate, are coming back online. It’s more than just feeling better and more alert — I AM better and more alert. I’m able to wake up in the morning, I’m able to engage more fully throughout my days, I’m able to step back and take a look at my moods and my behavior and choose the sorts of responses that will work in my favor, not against me. I’m not just on this mad auto-pilot drive; I’m actually able to slow down and contemplate my life and find real meaning in it again.  I’m also able to relax — really relax. It’s pretty amazing.

And as the time passes, with each new success which I fully realize and appreciate, I build up my stores of lost self-regard, self-esteem, self-respect. I also build up my stores of self-control, and I can actually live without being right about everything, no matter what the costs to my relationships. I am better and better able to choose my responses, and even when people around me are acting up and seemingly going out of their way to provoke me, I’m able to pull back from the engagement, figure out what I want to do and say… and do it.

Yeah, it’s pretty amazing. What amazes me even more, is that I went for years without having this as a regular part of my life. It amazes me, I thought I could do without it.

So, I’m enjoying this. Thoroughly. I’m watching my life with a whole new interest, and I’m learning a lot. In a way, I feel as though I’m re-learning skills, like someone re-learns to read and write after a head injury. Like someone re-learns to walk and talk after a stroke. Like someone with amnesia who starts to remember their name, their family, their home, their work… Like someone who wasn’t even fully aware of having amnesia, who suddenly sees a world they once knew, and isn’t sure whether to be elated or dismayed. In truth, it’s a little bit of both. I’m elated that bits and pieces are coming back to me. But I’m also dismayed that I lost sight of them for so long.

It feels very odd to be writing this, and to be realizing it, but I guess I was a lot more impacted in some ways than I really realized. But now that I’ve “got” it, I can move forward. Progress is good.

What really piques my interest is thinking about what got me back on track. I think one of the big things that set it in motion, was taking care of my body — starting to exercise regularly, and waking myself up with exercise and stretching, rather than two strong cups of coffee. That, and stretching and consciously relaxing before I go to sleep at night.

I actually think that I developed a hefty dose of PTSD, in the aftermath. Not right away, not from the fall itself, but rather from the progression of small disasters — bite-size catastrophes — that have dogged me for years. The collapse of jobs, the dramas at home, the startling surprises that I didn’t see coming, the encounters that went poorly or that carried some sort of hurt with them… My sympathetic nervous system has been on high alert for quite some time, now, and it’s taken a toll.

But since I started making a point of caring for my parasympathetic nervous system — bit by bit, exercise by exercise, breath by breath — I have been able to feel a difference in my whole system. Sometimes it’s subtle. Sometimes it’s dramatic. But it’s there. Conscious breathing has played a significant role, of late.

It’s good to be getting back. I’ve been toughing it out just about all my life, but this past 5 years has kicked my butt, to the point where toughing it out is no longer the best solution I can think of. Now I have other ways of dealing with the crises and dramas — ways which involve really basic care of myself, basic care of my system, and attending to the details of my life with a much greater depth than I’ve been able to manage for a number of years.

But now I am remembering who and what I am. I am remembering what matters most to me. I am re-learning the wonder and magic of paying attention to little things, and seeking deeper meaning from my life than what the television has to offer. I am re-learning the discipline of just sitting and observing what’s going on around me, rather than diving in with the intention of “fixing” what isn’t mine to fix. I am re-learning the fine art of calm in the midst of storms, as well as making my way in the world in my own individual way.

I wish I could say it’s coming naturally to me. I used to be able to say that. I used to know it and feel it. I seem to recall that I used to not have to really work at it. But I’m not adverse to work, and if extra effort is required to get me back to a place where I can piece back my life into a state of quiet dignity and genuine happiness. then so be it.

Anger, anger, and more anger

temper strikeOne of the things that can make TBI particularly difficult, in the ensuing weeks, months, even years, is anger issues. Rage issues. Flying off the handle and attacking others for no good reason that they can see.

There are a lot of reasons this happens. Some of them are:

  • Fatigue – your system is compromised by too little sleep and/or too much activity (with me, the two go hand-in-hand), and you don’t have the energy/wherewithall to stop yourself from going off
  • Fear – there’s nothing like a sharp spike of adrenaline, combined with anxiety and fear to set you off. Fear has a way of clouding your judgment, so you not only under-think situations (from fatigue) but you also overreact to the circumstances (which may or may not be true).
  • Frustration – when you’re trying to get something done/said/understood, and it’s just not happening, no matter how hard you try, patience wears thin — especially with yourself. My frustration tends to be directed inwards, though it also gets directed outwards. But the inward-turning kind is actually a lot worse for me. It makes me mean and aggressive. The worse I feel about myself, the angrier I get with life in general, and the more I tend to blow up.

It certainly doesn’t help that my brain gets into an uproar and starts getting into a biochemical soup drama, so that even if I wanted to think straight, I can’t.  The constant restlessness of my brain, coupled with the toll that agitation and fatigue take, can combine for a pretty potent mix of explosives.

So, what can I do about it?

  • At a very minimum, be aware that I’m angry. It often feels like something completely different — it feels like I’m just revved, and I don’t recognize the emotional piece of it. It may sound simple, but realizing that I am actually angry is a big challenge for me.
  • Realize that my anger does not necessarily make sense to others. What I’m thinking and feeling may be entirely unique to me.
  • Realize that my brain may be sending me wrong signals, and the surge of emotion that’s coming up may be simply a biochemical response by a physical system that is WAY overloaded and highly sensitive.
  • Remember that the long-term effects of a blow-up are probably not worth the satisfaction I get from venting. No matter how justified I feel about my anger, it can do much more harm than good. I have to think about whether I want to spend the next days/weeks/months patching up the damage I do to myself and my relationships with others, thanks to uncontrolled anger.
  • Keep myself in check. No matter how justified I feel, the more revved I get, the more I need to step away. I need to do whatever I can to remove myself from that situation, before it escalates and turns really nasty.

It’s not a perfect process, but it’s something. It’s an ongoing thing, and I’m far from perfect. But ultimately, life has a way of teaching me the lessons I need to learn, so if I just keep at it, eventually I do make some progress.

The downward spiral of fatigue

It’s wild – it starts with the best of intentions. It’s exciting… very exciting to life my life, to go-go-go, to do lots of things and get tons of stuff done.

But if I don’t watch myself, I can get into trouble pretty quickly. If/when I get over-tired (and at the rate I tend to to, it’s usually a question of when I’ll get over-tired, versus if that will happen), a downward spiral starts in, that just won’t quit, till I start to rattle and shake like the USS Enterprise being pushed through an asteroid field at full speed. (And I hear Scotty yelling, “Cap’n, she’s breakin’ up! I can’t give ‘er anymore!“) I question my sanity, my ability to cope, my ability to live, and I’m exhibiting symptoms that someone who doesn’t know better would interpret as mental illness.

It’s not mental illness, per se. It’s my brain acting strangely under abnormally taxing conditions.

Here’s how things steadily go downhill…

The Downward Spiral of Agitation and Fatigue

And before I know it, I’m in trouble. I’m angry, I’m emotionally volatile, I’m raging, I’m blowing up at people, I’m melting down into a pile of quivering agitation, I’m irrational, I’m over-reactive, I’m hyper-active, I’m everything I know I should not be, but I am powerless to prevent it.

Also, I am in pain. Not just the muscular/skeletal pain that comes from over-exertion, but the surface pain that comes from fatigue, that makes everything hurt, from my clothing to human touch. It’s awful, and there’s nothing to do to stop it, when it’s full-on.  Advil doesn’t help. Only sleep does — days and days of extra sleep.

The thing is (the pain aside), a lot of the behavioral problems that come up are a result of how I perceive myself in relation to the rest of the world. Yes, I’m emotionally volatile. Yes, I’m losing it when I should be keeing cool, but it’s not so much that I am in trouble over things I’m doing — the real trouble happens and I get bent out of shape, when I misinterpret what I’m doing. I assume that because I’m having problems keeping things straight in my head and I’ve gotten turned around, that I’m screwing up (yet again) and I’m a mess, I’m broken, I’m damaged, I’ll never amount to anything, yada-yada-yada-yada-yada-yada-yada-yada-yada… an unbelievable amount of agitation results, which feeds back into the insomnia/fatigue loop. And that just makes my behavioral issues worse.

I’ve been seeing this more and more, lately, as my sleeping habits have deteriorated. They truly have. It’s been very fun and exciting to do things late into the night (as in, after 10 p.m.), but it’s cost me dearly, in terms of peace of mind, not to mention being able to deal effectively with increasing demands and challenges.

Stop the madness!

Seriously.

So, I have re-prioritized rest. I’ve bumped it up to the top of the heap. And I’ve made some small but important adjustments in how I do my work, so I have a better handle on things.

Objectively speaking, I’ve actually been dealing with some of the challenges and demands quite well — but because I’m so tired, I can’t really accurately assess how well I’m doing. So, when I feel like I’m having trouble, I assume I’m not doing well at all… and my successes are nearly lost on me. Unless someone can talk me through them. Like my spouse or my neuropsych.

Speaking of my neuropsych, I had a really great meeting with them  last night (thank heavens), on the spur of the moment. I was in town, they were in town, they had an opening in their schedule, and I had a sudden cancellation on mine. So, we managed to meet for a few hours. And after checking in with them about some recent experiences that had thrown me for a loop, I realized that I had actually done extremely well under very demanding and challenging circumstances. The biggest hurdle in all of it, was me being so tired that I couldn’t think clearly about what had really happened that was good.

I was so tired, nothing seemed good. But it actually was. So, my neuropsych talked me back from the brink of despair. And then I went home and  got to bed at a decent hour — 9:30 p.m., thank you very much! — and I woke on my own after 8 solid hours.

Wonder of wonders.

And suddenly, the world looked a lot better. The “mental illness” subsided, my mood disorder cleared up, my crappy attitude and biting self-criticism subsided, and I was able to get on with my life. Like a normal person.

And I’m back on track with watching myself more closely than I had been, taking my issues one at a time through the course of each day, and addressing the real underlying problems when they come up, so I can get on with my life, despite them. I’ve refined my daily log for what I have planned and what I really do. I’ve become quite diligent about keeping notes on my daily activities, and now I’m furthering that even more with a better kind of journal that helps me a lot.  Tracking my activities and the results is one sure way to see how I’m doing, from day to day. My brain will tell me any number of things about how I’m doing — many of which may in fact be untrue. But if I’ve got my notes, I can see for myself how I’m doing.

Onward…

The MTBI Downward Spiral

I’ve written before about how ignorance and narrow-mindedness produce greater disability than injuries alone.

TBI related issues like increased distractability, lower thresholds for anger, and sleep disruptions, the cascade of behavioral and logistical effects can create subtle cracks in the foundation of your everyday life, which ultimately compromise your ability to get on with your life in a mature and responsible fashion, even your physical and mental health.

Here’s how you can get into trouble, thanks to a TBI:

  • TBIs have a nasty way of slowing down your thought processing speed.
  • Sleep disruptions have a nasty way of resulting in increased agitation and distractabilty.
  • Increased distractability can lead to “careless mistakes”.
  • These can lead to arguments with others.
  • Arguments can escalate if your flashpoint threshold is low.
  • A low anger flashpoint threshold can become even more explosive if you’re tired and not thinking well.

For example — say a guy with a wife and two kids and a good job is in a car accident and smacks his head against the car window. I’ll call him (Car Accident Guy.) He’s knocked out for a few minutes, and when he comes to, the EMTs take him to hospital, check him out, determine there’s no serious damage, and turn him loose. He goes  home and lies down for a while, then the next day he’s up and at ’em again, ready to get on with his life and just relieved he wasn’t hurt worse in the accident.

He seems fine to everyone at home and at work — the only problem is, all of a sudden, he can’t seem to do the simplest things — like going to the store. Or completing a job his boss assigned to him. He keeps getting distracted by the simplest things, and when his wife sends him to the store to pick up milk and bread and his prescription refill, he ends up coming home with milk and eggs and shampoo, instead. In the process, he runs out of his daily dose of blood pressure medication, and his wife is upset, impatient and pissed off at him.

His wife tries to overlook his forgetfulness at first, but after a while, she starts to get pretty fed up with this guy. They quarrel and bicker, and he becomes nastier and nastier when they fight. He takes it out on his kids, too, yelling at them when they do things like turn the t.v. up too loud or come home late for dinner.  His wife’s patience gets shorter and shorter, and she feels like she has to double-check everything he does. He used to be so reliable, but now he’s just not trying… What’s wrong with him?

At work, things are getting tougher, too. Car Accident Guy’s boss has been noticing how he’s not delivering results when he promises he will. The reports are late. The analysis is incomplete. And he’s started making stupid mistakes he doesn’t even catch till someone brings them to his attention. Even when folks do show him how he screwed up, he’s contentious and argues about it, and his relationships with his co-workers seems caught in a downward spiral. His boss tries to talk to him, but he can’t seem to sit still in their meetings, and he keeps changing the subject or talking about other stuff that has nothing to do with what they’re there to discuss.

All the while,  Car Accident Guy has been missing his daily blood pressure dose, and his BP has been climbing — especially when he’s angry. He seems even more angry than usual, in fact, and his wife finally prevails on him to see his doctor. When he goes to the doctor, his blood pressure is way out of control, and his doc becomes very upset with him for not taking his daily dose. The doc considers him non-compliant and lectures him, and Car Accident Guy takes issue with his tone and snaps back at him. The doc, who has had a long day and isn’t in the mood for this crap, puts him on notice that he’d better clean up his act, or else. Car Accident Guy is immediately sorry for the tone he took with the doctor, and he apologizes and promises to do better. Feeling self-conscious, he tries to listen to the doctor and get what the doc is saying, but he can’t seem to focus, and he loses the piece about needing to schedule a stress test in six weeks. He takes the new BP med prescription from his doctor and puts it in his shirt pocket — but he’s distracted by what the doc is saying to him, so he isn’t actually aware of which pocket he put the script in.

Done with the appointment, he sails out of the office, forgetting to make the appointment for the stress test, trying like crazy to recall — from memory — the exact content of the his visit, so he can be sure to get himself back on track.

When he gets home, his wife asks him how the appointment was, and he has trouble remembering. He tells her it was okay, but when she asks him what the doctor said, he can’t remember exactly, so he avoids her question. She senses he’s covering something, and she’s concerned that there’s something seriously wrong with him that he’s not telling her. She becomes anxious and starts to press him for details, which he cannot recall exactly. He snaps back at her, and the conversation escalates to yet another argument.

Exhausted and frustrated, he stomps off to bed, tosses his clothes in the hamper, and sleeps the rest of the day. While he’s sleeping, his wife does a load of laundry — including the shirt with the prescription in the front pocket.

When he wakes up, Car Accident Guy remembers he needs to take his BP meds, and he also remembers he needs to get his new prescription. He can’t remember where he put the script, exactly, but it must be in the clothes he was wearing at the doc’s office. Unfortunately, his shirt and pants have gone through the laundry, and the prescription is in soggy tatters in the washer. Furious with himself and furious with his wife, Car Accident Guy flies into a rage and verbally attacks his wife, his kids, anyone who is nearby. He drives off in the car, calling his doctor on his cell phone for a new script.

The doctor is noticeably irritated, and he thinks Car Accident Guy is not committed to taking care of himself. He writes another script and faxes it to the pharmacy, so his patient can pick it up. Car Accident Guy thanks the doctor and heads to the pharmacy, but on the way there, he’s distracted by a yard sale along the road. He pulls over and spends an hour and a bunch of money buying some pieces of furniture he doesn’t really need, but that look nice and are available for a good price.

He loads the furniture in his car and heads home. When he gets there, his wife is still angry with him, and she’s packing to go to her mother’s house with the kids. In the meantime, his anger has completely dissipated, and he doesn’t understand what she’s still angry about. He also can’t understand why she isn’t pleased with the bargains he found. She asks him where his prescription is.

“Prescription?” he asks…

That’s more or less a cause-and-effect narrative of what can happen, just from a couple “simple” problems like sleep disruption, distractability, and lower anger thresholds — all of which are common in TBI. Even MTBI (supposedly “mild”) can produce life-wrecking after-effects. Believe me. I’ve lived it. I know. Car Accident Guy’s story is not terribly different from my own, though my own circumstances are different — still, the types of problems mulitiple MTBIs have brought me are not that different from these.

It’s eerily easy to end up in a downward slide — in no small part due to sleep issues, which contribute to distractability, which contributes to frustration, which contributes to lowered anger flashpoints.

But in the same vein, being aware of the issues up front, makes it eerily easy to avoid situations like this.

Getting enough sleep is a start. Being mindful of your energy level is another. Keeping notes about what you need to do is yet another. And stopping to check in with yourself and double-check your work is yet another.

TBI, even mild traumatic brain injury, can totally screw up your life. The good news is, it doesn’t have to.

Sequelae and Intervention Following Head Injury

A great section from Neuropsychology and the Assessment of Mild to Moderate Head Injury by Dennis P. Swiercinsky, Ph.D. Note:  “Sequelae” means

  1. A pathological condition resulting from a disease.
  2. A secondary consequence or result.

The American Heritage® Dictionary of the English Language, Fourth Edition

I usually call them “after-effects”. My comments are in italics below.

Sequelae and Intervention Following Head Injury

A mild head injury, such as from a fall, an automobile accident, or a work mishap, often brings the person to the attention of a physician or a hospital emergency room.

But sometimes this doesn’t happen. Sometimes we can’t get help, whether we refuse it, or people don’t realize something significant took place.

If there are no complications or other injuries apparent, the person is checked over and sent home, perhaps with a prescription for pain relievers and a checklist to watch for any complications that might develop.

I wonder if the checklist shows what to do, if the complications arise. Seems like that would be helpful.

Without timely, appropriate, and comprehensive follow-up diagnosis, education, and treatment, the lingering problems from uncomplicated head injury can mushroom into seemingly relentless frustration.

True – and that’s what often happens with MBTI survivors. Even moderate TBI survivors, who get no (or inadequate) medical treatment, can end up without adequate follow-up diagnosis, education, and treatment. And how those lingering problems add up…

Underdiagnosis or misdiagnosis of the multiple cognitive, behavioral, and somatic complaints following head injury is common. Ultimate recovery and maintenance of a positive attitude toward recovery, as well as adjustment to the emotional trauma of the event that caused the injury, depend on early, appropriately intensive, and comprehensive intervention.

It’s a nice thought, that early, appropriately intensive, and comprehensive intervention is a possibility for people, but TBI happens so frequently, and so few people are adequately aware of it and its “wrinkles” that it seems like hanging your hat on early intensive and comprehensive intervention is a set-up for failure — or perceived failure.

Too often, symptoms are acknowledged by health care providers but are understated or minimized.

Amen to that! My doctor thinks it’s okay for me to not get a full 8 hours of sleep a night. And I can’t tell you how many doctors and healthcare folks have shrugged off my issues — pain, fatigue, etc. It’s maddening.

The urge to get persons back to work too soon and without comprehensive understanding of the injury often creates emotional and cognitive obstacles and usually worsens the symptoms and outcome due to creation of stress, greater discomfort, chronic re-injury, and feelings of distrust and resentment.

Yeah, we’re all supposed to get back to work immediately. What makes this particularly dangerous, is that a person who has recently experienced a TBI is depending on the assistance and guidance of those around them, to help them deal with everything. We’re friggin’ brain-injured, for heavensake! The fact that education and treatment so often fall into our own hands — the very people who need help — strikes me as the ultimate irony. And yet, so many of us are put in that position. We cannot even get help, lots of times, unless we push for it. Of course, it’s difficult to push for it, when your reasoning faculties and your cognitive abilities have taken a hit.

Educating the patient, family, employer, case manager, and others involved in the lifestyle changes caused by brain injury is of extreme importance.

Yes, because like I said above, the survivor is the one in need of help — and should not be the one holding the reins of the team of horses. Making a recent TBI survivor resposible for their own diagnosis and care and survival is like asking someone who is legally blind to drive a team of  Budweiser Clydesdales down a busy boulevard. They may be able to do it, but it’s a crapshoot. Someone who isn’t brain-injured needs to be at the helm, and they need to be properly educated. Preferably, everyone in the survivor’s immediate circle of influence.

Everyone needs to understand that even though no bones may be broken, no cuts sustained, and that the injured person may look and talk just fine, there is real injury.

And people need to be a lot less afraid of brain injuries. Probably the biggest hurdle to me getting help and support from anyone in my life around my TBI’s is their mortal fear of the prospect of brain injury. It’s mighty difficult to discuss your needs and your situation with people who are frozen like deer in headlights at the sound of the words “traumatic brain injury”.

The complex injury involving cerebral contusion and diffuse axonal injury within the brain, trauma and stretching of cervical muscles and supportive tissue, abrasion within the cervical vertebrae, soft tissue injury to muscle and circulatory structures of the head, chronic muscle strain due to guarded behavior in response to pain, changes in cerebral circulation and perfusion, and potential neurochemical and neurotiming changes in brain function provides the foundation for a host of behavioral, emotional, and cognitive changes.

So, how do we educate people about this? How?! It’s a lot to consider and take in — how can we get the right information to people who need to know, in ways they can actually understand it?

Diminished self-confidence, negative self-reference, inflexibility, desire for withdrawal, slower thinking, emotional unpredictability, and frustration intolerance stem from the complexity of injury.

Yes, they do. And it’s a vicious, self-perpetuating cycle that we get sucked into. The more it’s allowed to escalate and continue, the worse things get… Sometimes until it can’t possibly get any worse…

If the patient, family, employer and others do not understand the injury and its consequent dynamics, unreasonable expectations, charges of malingering, and inappropriate treatment will typically follow. Failure to understand and appropriately treat mild to moderate brain injury can result in prolonged and less than desirable ultimate outcome.

Yes, yes, and yes. All true.

The good news is, it’s possible to recover from late-effect TBI’s, even if you never received adequate medical care or diagnosis or assistance. And it’s a difficult thing, and a pain in the butt to have to do it yourself, but with focus and intention and the right information, it IS  possible to get back on track and reclaim your life after TBI.

Like the folks at Give Back Orlando, Dr. Swiercinsky actually takes seriously the cognitive-behavioral impact that even a mild TBI can cause. And the mention of the long-term effects that are less than desirable gives me hope, as well.

The main issue I have with what Dr. S says, is the feeling that all is lost, if you don’t act quicly. People have been having head injuries since the beginning of time. Millions of us have them every year. And yet, we’re still here. Granted, there’s a lot we can do to improve our lot — and we have a long way to go, to fully understand how best to treat and support TBI survivors. But all hope is not lost, if you didn’t get immediate, intensive, extensive help.

I’m living proof that survival is possible, even with precious little help from the rest of the world. I’m not recommending it to anyone — it’s much harder than it should be — but it is  possible.

Anger Notes: From mountain to molehill

I had a little difficulty this morning, getting into the day. I go through the same routine every day — wake up slowly… give myself time to wake up enough to get out of the bed without tripping or falling… get up and brush my teeth… go downstairs to put water on for coffee… do my morning workout while I am waiting for my coffee water to boil… think about what I need to accomplish today while I am working out… finish my workout and make my coffee and cereal… and then get into my morning.

Most days, if I have had enough rest, the routine goes like clockwork. But I recently started lifting heavier weights, and I also had a chiro adjustment yesterday, so I’m a little sore and stiff, and I need to get more sleep. Under normal conditions, getting the 7 hours that I had last night would make me very, very happy. I actually slept through till the sun was coming up! And I would feel like enough. But I am still recovering from staying out all night on New Year’s Eve last week, and I need to get even more rest than usual, so I can get back to my regular sleep schedule and get over being stiff and sore from the increased weight and also the adjustment I got yesterday.

Now, for most people, being behind on their sleep and having a little stiffness and soreness in the morning is no big deal. For a lot of people, it’s actually a way of life. They don’t get totally thrown off by lack of sleep. They just muddle through the day somehow. They don’t get all tweaked and freaked out over every little thing, with hair-trigger temper outbursts over every little thing. They just go through their day, like it’s no big deal. And they live their lives like everything is relatively normal, popping Advil or Aleve or having a few drinks at the end of the day to chill out and sleeping in, in the morning.

The people who don’t have issues with sleep deprivation and pain clearly are neurologically intact. They probably have not sustained traumatic brain injuries. They probably don’t have post-concussive syndrome, and they probably haven’t sustained brain trauma/head injury.

I, on the other hand, am not in that “space.” When I am behind on my sleep, it introduces a whole host of issues that make the most basic activities into challenges. When I am in physical discomfort, I tend to push myself even more, perhaps because doing that relieves the discomfort for me. But pushing myself tires me out even more. And when I get over-tired, I have a hard time relaxing and going to sleep… which makes me even more tired in the morning. And then I have all sorts of cognitive-behavioral problems. It’s a vicious cycle that’s very difficult to break.

That’s that cycle that started with me last night. I should have gone to bed around 9:30, but then I had some stuff to do, and I needed to talk to my spouse, who was out at a late meeting till 9:30. By the time they got home, I was ready to go to bed, but the sleepy part of me didn’t want to go to bed, so I stayed up and talked with them about this-and-that.

Finally, they packed me off to bed, seeing that I was pretty much wedged into the couch, and I was making myself comfortable for a long stay-up. It was 10:30, by then, and it took a focused, concentrated, concerted effort on both our parts to get me up off the couch and upstairs to bed. Then — being as tired and as contrary as I was — I stood in front of the bathroom mirror and inspected myself, studying my double chin and looking for gray hairs and trying to make my hair stand up straight by tousseling it and trying to spike it straight out from my scalp. I know, it’s strange. But this is the kind of stuff I do when I’m really, really tired and I don’t want to go to bed.

After about 15-20 minutes of this… and deciding that yes, I am still a handsome individual with good bone structure and not to much saggy skin in the wrong places… I finally got my ass in bed. Then I remembered I needed to stretch and take Advil (my bedtime routine), so I can better relax. I did that, and I then did my progressive relaxation exercises to get myself to sleep, which went really well — even better than I expected. I got to sleep around 11 p.m.

Happily, I slept through till 6 a.m., which is a wonder, because I’ve been waking up around 4-4:30 or so — which sucks — and that felt pretty good. I gave myself some time to wake up, before I got out of the bed. If I roll out of bed right away, I tend to stagger around a lot, which is loud and also a little dangerous. There are plenty of hard surfaces and sharp corners I can hit my head on. Plus, my spouse doesn’t like to be woken up by my clunking around, bumping into stuff — which happens, when I get up too quickly.

I got myself up and started getting into the day. But man, I was clumsy this morning, right from the start. I had trouble holding my toothbrush, had trouble holding onto the water spigot, and it was really really getting to me. I am definitely foggier and more out of it this morning than I’ve been in a while. It’s probably due to the adjustment I had yesterday — the chiro went pretty deep.  And when I’m foggy and clumsy and out of it, I get really, really agitated. Every little thing gets to me, and I have a harder time with those spikes of anger that come up when things go wrong for me. They seem to come out of nowhere, and when they show up, they can be intense — and the intensity makes them even more confusing and frustrating (and damaging) because my mind knows that my reaction to what is happening is wildly out of proportion to what is going on, and I feel like something is terribly wrong with me, that I feel this way. And I start in with calling myself all sorts of names, telling myself I’m a damaged idiot loser who can’t keep their shit together, etc. etc. ad nauseum.

I’ve written about this temper flare stuff before in my posts Flash in the (brain) pan and A constant restlessness (and elsewhere), and it still holds as true as ever.  And this morning, when I was just trying to brush my friggin’ teeth, already,  I could not seem to keep my act together. I had trouble holding the toothbrush, and when I put it down on its rest, something about how it was positioned bothered me intensely. Then I tried to turn off the water, and my hand slipped, and I hit the side of my hand on the edge of the spigot, which hurt.

And that old temper flare jumped out again, like Old Faithful… that geyser that comes up regularly at Yellowstone. Or maybe a better analogy would be, like one of the geysers that erupts periodically without warning. Tori Amos has an album I love called “Little Earthquakes”. Maybe I’ll do an album called “Little Geysers.”

Anyway, for a few minutes, as I stood there nursing my aching hand, I was

absolutely furious!!!!

It was all I could do to keep myself from hitting something or slamming something down. I was angry with the spigot for having hard edges. I was angry with my hand for being so weak that a little bump would hurt so much. I was angry with myself for being so uncoordinated and not being able to simply turn off the water like a normal person would. But most of all, I was angry with myself for getting so bent out of shape over something so simple. “I know better,” I told myself. “Why can’t I act better?

I was really getting whacked-out over this, and it literally threatened to derail my morning. When I get going like this, I descend down into a pit of ugliness, and the whole day can be tainted by my temper outbursts, whether they are internal or external. In fact, sometimes the worst ones are internal, that no one but me sees or hears or knows about, which makes my crabby, short-tempered behavior all the more confusing for people around me. It makes no sense to them — how could it? They don’t know what I’m experiencing, and I’m doing everything in my power to shield them from that.

I could feel that rush of anger, that temper flare, that wild spike of emotion… it tore through me like one of those microbursts I’ve seen on the Weather Channel… and I was starting to get freaked out… and go into one of those wild rages that’s like a forest fire tearing through my head.

Then I checked myself. Something in me — the something that has been observing myself with increasing knowledge of TBI over the past few years — told me to take a break and just give myself time to catch up with myself.

So, I stopped and took a breath and thought about what was happening. And when I took a break from my downward slide, I realized:

  1. I am still tired. I did not get enough sleep, and I am groggy.
  2. When I am groggy, my neuropsych has told me that I am more prone to agitation.
  3. When I am groggy, I also can be uncoordinated. I don’t need a trained expert to tell me this. I have observed it countless times.
  4. When I am uncoordinated, I tend to bump into things.
  5. When I am groggy, I tend to propel myself through events on adrenalin — because I need an extra “pump” of energy — energy I  don’t have from regular sources (like getting enough rest). When I’m fatigued, I have to pump myself up just to do the basic stuff… because otherwise I can’t get going.
  6. When I pump myself up, I move faster.
  7. When I move faster, and I am uncoordinated, I hit things with greater force than I would, if I were rested and had full motor control.
  8. When I’m fatigued, my brain’s constant restlessness and agitation is worse, it makes me snappier and more extreme in my reactions. I am also more physically sensitive, and I feel everything more intensely.
  9. And finally, I remembered — from what I’ve read and what I’ve been told by my neuropsych — this type of reaction from me is actually quite typical of TBI survivors. It’s just what my brain does, when it has to operate on too little sleep/energy.

So, there it was –this drama I was experiencing, standing in front of the bathroom sink, freaking out over hitting my hand on the spigot had everything to do with my brain/body AND it had NOTHING TO DO WITH ME.  It wasn’t me being an asshole loser who’s emotionally inept and a worthless use of space. It was just my brain and body doing what they did, when I am tired and out of it and I am moving too fast.

I did NOT need to make a big deal out of it — just recognize what was happening… And I also realized that it was actually my brain sending me warning signals about what was amiss in my day, thus far. I recognized that this little snap of mine was like a gift from the gods — a hint about where I was at, that day, which I could use to inform the rest of my day to make better choices.

I also realized that if I didn’t take steps to stop this flash in my brain-pan, I was going to start the day on a really BAD note. Temper flares with TBI survivors tend to be quick-on, quick-off affairs, instantaneously coming up out of nowhere and disappearing just as instantaneously for no apparent reason. I realized I just needed to occupy my attention long enough for my system to calm down, and then I could get on with my day.

So, I took action. I kicked into gear and did something with all that agitation and energy — I channeled it into a constructive activity. I looked at the spigot that I’d hit my hand on, and I realized that it was slippery with soap on the handle. I studied the handle and felt where the slippery soap was, then I ran the water and rinsed off the handle, until it wasn’t slippery anymore. That made me feel a lot better. Then I dried my hands and went downstairs to make my breakfast.

Again, I had more trouble with uncoordinated blunders downstairs. I was off-balance and I was clumsy, getting my coffee stuff together. But I remembered what I’d noticed upstairs — I’m tired. I’m uncoordinated. This is not about me, it’s about my brain and body. When I am this tired, it’s perfectly normal — for me — to be agitated and restless and make mountains out of molehills. But it has nothing to do with me and my character… Forget about the supposed stupidity and ineptness and all those other words I use to attack myself. It’s about my slightly broken brain which has trouble when it’s tired, and I know what I can do to make it better — take it easy, take things slow, don’t push myself like crazy, and cut myself a friggin’ break, already.

So, that’s what I did. And by the time I got done with my workout, my day had re-booted nice and fresh. I’m still tired, but I’m not wiped out like I could be, because I made changes to how I was doing things. I had a good solid workout, and I lifted shorter sets with fewer reps, because I realized my body needed to catch up with the heavier weights. I also focused more on my exercise — I had been letting my mind wander more, over the past week or so — and I didn’t lose track of where I was with my workout, like I had been, in the past few days. And as I was planning my day, I made a point of scheduling just a fraction of the number of activities I’m prone to schedule for my day, which takes the pressure off, right off the bat.

AND instead of checking email from friends first thing in the morning, as I’ve been doing for the past few weeks, I am waiting till later in the day to do that, because there is a lot I need to get done, and I cannot be distracted from the work that’s waiting for me to finish it.

All in all, even though the day started out on a rough note, it was for the best.

Because I stopped and thought about what was happening. I learned about the experience as it was happening. And I used my tools. I used the info I got from my neuropsych, and I used the knowledge I had of myself. I used the opportunity to stop and think to really appreciate what was going on with me. I cut my brain and body a break.

I am also planning to lie down for a nap later today. I’m working remotely, plus the weather is not good right now. I can get a lot done, if I focus on what I’m doing. And with the appreciation of how tired I am, I can make the extra effort to take care of myself, take my time at what I’m doing, and manage my energy with intention and discipline.

All because I stopped for a moment and thought about what was really going on with me.

This is progress.

Doing it differently this holiday season

I did something quite unusual last night — I went Christmas shopping by myself at a much slower pace than usual. I didn’t manage to buy everything I set out to, but I got everything I could, and I got through the experience in one coherent piece — and I was able to get my nap after I got back.

Normally, this time of year is marked by team-shopping with my spouse. They contact everyone in the family and find out what people want… or we talk about what we think people want, and then they make up the list. We take the list, hop in the car, and head out to stores that look like good candidates, then we slog through the process of elimination, muddling our way through… with me getting so fried I either completely shut down and become non-communicative, or I melt down and fly off the handle over every little thing.

We usually spend several evenings like this, ’round about this time of year, and we’ve both come to dread it a little. My meltdowns had become more extreme over the past few years, and this year we were both really dreading the whole Christmas shopping business — to the point where we are going to be late(!) with presents for family members in other states. That’s never happened before. We were always good about it. But my meltdowns screwed everything up.

We both recognize that doing a lot of social things, this time of year (when work is actually getting more crazy, what with year-end and all), takes a huge toll on me. Even if it’s with friends (especially with friends), all the activity, all the interaction, all the excitement, really cuts into my available energy reserves. And then I get turned around and anxious… and I either regress to a cranky 9-year-old state, whining and bitching and slamming things around… or I melt down, start yelling, freak out over every little thing, and start picking at my spouse over things they say and do, to the point where neither of us can move without me losing it.

What a pain in the ass it is. Of all things, the uncontrollable weeping bothers me the most. The yelling bothers my spouse. It’s embarrassing for me and frightening for them, and neither of us has a very Merry Christmas, when all is said and done.

So, this year we did things differently.

We split up for the day and took care of our respective activities.

My spouse went to a holiday party that was thrown by a colleague of theirs who’s married to an attorney who deals with financial matters. I was invited, too, but we both realized that it would be pretty dumb for me to try to wade into the midst of 50+ actuaries and tax attorneys and their spouses who were invited to the shindig… and try to hold my own. Certainly, I can keep up with the best of them, but marinating in such a heady soup, especially with everyone hopped up on holiday cheer (eggnog, red wine, punch, etc.) and all animated and such, would have been a recipe for disaster.

So, I didn’t go. Instead, I took our shopping list and headed to the mall to stock up on what our families had requested. We had written down in advance all the names and the specific gifts we were going to get, and we had also written down where we were going to get them. That list was my lifeline. Especially in the rush and press of the mall, which sprawls out in all directions, with satellite stores on either end.

I’m happy to report that I actually did really well. I made a few tactical errors — like not parking in the first lot I came to and walking in. But that turned out okay, because if I had parked in the first lot, it would have been all but impossible to get down to the other end of the mall. I studied the list carefully ahead of time and used a highlighter to mark the stores where I’d be going. I also kept my focus trained on the task at hand — even if it was just sitting in traffic. I also walked a lot more this year than other years. I found one parking space and used it for two different stores. And I didn’t hassle with finding a space that was as close as I could get to the building. I took the first decent spot I could find, and then I walked to the store.

Imagine that — in past years, I was possessed with finding parking as close as possible, and I would move the car between stores, even if they were only 500 yards apart.  This year, I just walked the distance. Even though it was cold, for some reason the cold didn’t bother me, and it actually felt good to be out and moving.

I think that my 5 months  of daily exercise has paid off, in this respect. I think part of the reason I was always consumed with driving everywhere was that I just wasn’t physically hardy. I was kind of a wimpy weakling, in fact — though more in thought than in body, but a wimply weakling, all the same. But having a good physical foundation — even just from doing an hour (total) of cycling, stretching, and light lifting each morning — has made a significant difference in my willingness and ability to walk between stores.

It might not seem like much, but the walking (instead of driving) between stores part of the trip actually made a huge difference in my overall experience. Walking between stores — stopping at the car on the way to stash my presents — helped me break up the activity and clear my head. It got me out of that in-store madness, the crush and the rush, and it got me moving, so I felt less backed-up and agitated. And that let me start fresh at the next store.

That was good, because the first store was a friggin’ nightmare. It was one of those big-box electronics places, that supposedly has “everything” but really didn’t. It was exhausting, combing through the stacks of movies and music, only to find everything except what I needed. The lighting was awful — extremely bright and fluorescent and glaring. People kept bumping into me, or walking so close I thought they would run me down. But the worst thing was the acoustics. Everything surface was hard and echo-y and the place was overwhelmingly loud, and every single sound was at least partially distinguishable, which drove me nuts. I’ve noticed that acoustics have a lot more impact on me than light, when I’m out shopping. The store was one big cauldron of loud, indiscriminate noise, and my brain kept trying to follow every sound to see if it mattered. I couldn’t function there. Not with the place full of people — and very agitated, anxious, aggressive people, at that.

I eventually went with a gift card and got the hell out of there. I doubt I’ll ever go back when it’s that full. When the place is low-key and all but empty, I can handle it much better. But at this time of year? Not so much.

Walking back to my car chilled me out. Sweet relief.

At the second store — a bookstore — I started to feel pretty overwhelmed. They had long lines, and the place was packed — which is good for the retailer, but not so great for me. I spent the longest amount of time there, in part because I could feel I was getting overloaded, and I stopped a number of times to catch up with myself and remind myself what I was there to buy. My list was getting a little ragged, at that point, what with me writing notes in the margins and taking it out/putting it back in my pocket. So, eventually I just pulled it out and held onto it for dear life. I must have looked a little simple-minded, but I don’t care. Everyone else was so caught up in their own stuff, anyway. My main challenge there, was not getting trampled by Women On A Mission — many of them carrying large bags and shopping baskets that doubled as ramrods to get through the crowds.

One cool thing happened, though, when I was taking a break — I had a little exchange I had with two teenage boys who were talking about some book they’d heard about. I was just standing there, pretending to look at a shelf of books, just trying to get my bearings, when I hear this one young guy tell his buddy, “I heard about this book I should get — I think it’s called the ‘Kama Sutra’ and it’s, like, about sex, and it’s got these pictures… and it’s really old… like, from India or something.”

Well, I perked up at that, and suddenly very alert, I looked over at them and said, “Oh, yeah — the Kama Sutra, man… You should definitely check it out.”

They kind of looked at me like deer in headlights, and they got flushed and flustered and stammered something about not knowing how to find it. It was about sex, and they didn’t know how to ask someone to help them. I so felt their pain…

I confidently (and confidentially) pointed them to the book-finder computer kiosk, where they could type in the title and it would tell them where to find it in the store.

“Dude, you should totally look into it. It’s got lots of information — and pictures — and it’s been highly recommended… for hundreds of years.”

They got really excited and headed for the book-finder kiosk. Here’s hoping they — and their girlfriends — have a very Merry Christmas.

That little exchange got me back in the game, so I took another look at my list and managed to find the handful of books and music and calendars I wanted to get. I headed for the line and just chilled/zoned out. I didn’t get all tweaked about how long it was taking; I listened in on a conversation for a while, till I realized it was mostly about death and health problems people were having.

Oh – and another thing that helped me keep my act together, was the 4:15 p.m. alarm that I have set on my mobile phone. 4:15 is usually when I need to start wrapping up my day at work. I need to do a checkpoint on the work I’m doing, start to wind down, and begin keeping an eye on the clock, so I don’t get stuck in town past 6:00, which is what happens to me when I don’t watch my time after 3:30 or so. I have this alarm set to go off each day, and it went off while I was in the store, which was a blessing. I had completely lost track of time and I was starting to drift, the way I do, when I’m fatigued and overloaded and disoriented.

It startled me out of my fog, and I knew I still had a bunch of things on my list to get, so I refocused and started thinking about what I would get at the next store, so I could just march in and do my shopping without too much confusion and disorientation. After I paid for my books and music and calendar, I debated whether to have my presents wrapped for free, which might have saved me time in the long run. But I couldn’t bear the thought of having to interact with the folks who were doing the wrapping. They looked really friendly and gregarious — Danger Will Robinson! Warning! Warning! Even a friendly conversation was beyond me at that point.

I realized I just wasn’t up to that, and I must have looked like an idiot, standing there in the middle of the foyer, staring at the gift-wrappers for about 10 minutes, but who cares? Everyone was so caught up in their own stuff, they probably didn’t notice me. And if the gift-wrappers were uncomfortable with my staring, they didn’t show it… too much 😉

Anyway, after I managed to extricate myself from that store, I headed for my last destination. Again, I didn’t sweat the traffic getting out of the lot, and when I got to the final store, I parked at a distance from the front doors and walked in through the icy cold, which was good — it cleared my head.

Inside, I consulted my list again and headed directly for the section that had what I needed. Halfway there, I remembered that I’d meant to buy a very important present at the first store, but I’d totally blanked on it. I started to freak out and got caught up in trying to figure out how to get back to that first store and not lose my mind in the process.  Then, I slowed down and stopped catastrophizing, and in my calming mind, it occurred to me that — Oh, yeah — they probably carried that item at this store, so I went and checked, and sure enough, there it was – score! I didn’t have to back to big-box hell. At least, not that day.

I found some more of the presents on my list, and although I didn’t get everything I needed, I made a decent dent. My partner can come with me and help me sort out the other items either today or tomorrow. Or possibly when we get to our family — they usually have some last-minute shopping to do, and they can cart us around with them. And I won’t have to drive.

By the time I got home, I was bushed. My spouse wasn’t home yet, so I called them — they were on their way home and were stopping to pickup some supper. I said I was lying down for a nap, and they didn’t have to wake me when they got home. Then I took a hot shower to get the public germs off me, laid down, and listened to Belleruth Naparstek’s Stress Hardiness Optimization CD. I had a bit of trouble relaxing and getting down, but I did manage to get half an hour’s sleep in, before I woke up in time for dinner.

My partner had a pretty good time at the party, but they said it probably would have been a disaster for me — so many people, so much energy, so many strangers, and unfamiliar surroundings. I concurred, and I showed them what I’d bought that afternoon.

We’d both done well. We both missed each other terribly, but we did get through the afternoon without one of those terrible holiday incidents that has dogged us for many, many years. Like Thanksgiving, which went so well, this Christmas shopping trip actually felt normal. It didn’t have that old edginess that I always associate with holiday shopping. It didn’t have the constant adrenaline rush. In some respects, it feels strange and unfamiliar, but you know what? If strange and unfamiliar means level-headed and low-key and plain old sane, and it means I can keep my energy up and pace myself with proper planning… well, I can get used to that.

Yes, I’ve done things differently this year. And it’s good.