Duty to Warn: The Fort Hood Murders/Suicide and the Taboo Question

The Baltimore Chronicle has an interesting article by Gary G. Kohls, MD about the role of psychiatric medications in the Fort Hood incident. From the article:

Most of us have been listening to the massive, round-the-clock press coverage of the latest mass shooting incident at Fort Hood, Texas. Seemingly all the possible root causes of such a horrific act of violence have been raised and discussed. However, there is an elephant in the room, and it’s something that should be obvious in this age of the school shooter pandemic.

We should be outraged at the failure of the investigative journalists, the psychiatric professionals, the medical community and the military spokespersons who seem to be studiously avoiding the major factor that helps to explain these senseless acts. Why would someone unexpectedly, irrationally and randomly shoot up a school, a workplace or, in this case, an army post? Why would someone who used to be known as a seemingly rational person suddenly perpetrate a gruesome, irrational act of violence?

The answer to the question, as demonstrated again and again in so many of such recent acts of “senseless” violence, is brain- and behavior-altering drugs.

You can read the rest of it here.

I can see his point, and I think it is a good idea to factor in the potentially dangerous effects of psychoactive drugs. But I also believe there are many layers to this, the effect of drugs being only one of them. Something(s) else contributed to pushing the shooter to that point. And I’m not sure we can fairly lay all the blame at the feet of the pharmaceuticals industry.

Whatever the cause of the rampage, this issue of pharma-gone-bad is of particular interest to me, because as a multiple-TBI survivor with a bunch of cognitive-behavioral issues, it could be all too easy for a “qualified” doctor or neurologist or psychiatrist to load me up with a bunch of pills and send me on my way. I consider myself unbelievably fortunate and blessed to be working with a neuropsychologist who is very wary of pharmaceuticals and approaches them as a last resort, when all else fails. They are also very happy when I come up with alternative solutions to my issues that work well and do not involve drugs —  like exercising regularly as an antidote for fatigue and drowsiness and a way to wake up fully in the morning.

Interestingly, my psychotherapist tends to come down on the side of drug therapies for individuals with attentional difficulties. I may have to cut them loose, if they turn out to start pressuring me to resort to drugs. If they so much as start hinting at me using them, simply because other approaches “don’t appear to work as effectively” I may have to have to reconsider working with them and seek help elsewhere. Who knows? I may even cut out the psychotherapy completely.

Hard to say, at this point. I think it’s been helping me in some ways… no, I’m pretty sure it has.

But I have been growing a little more leery of my shrink, over the past month or so. They seem more distant than they did at the start. They also have said some things to me over the past couple of sessions that don’t sit right with me, but I haven’t actually followed up on. I should probably do that, to clear the air. It’s hard for me to spend the time and money with someone who I think doesn’t believe me, or seems to be insinuating that I’m misrepresenting my difficulties to the rest of the world. I’m not sure if they think I’m worse off than I appear to be, or if they are just having a hard time, themself.

To be fair, they did suffer a devastating personal loss, last year about this time, so I think it may be messing with their head a little bit. They have definitely not been at their best, of late. So, I’ll cut them some slack, give it some more time, slow things down, and not let them pull any punches with me. We’ll see how it goes.

Bottom line (if there is one) is… mental health care providers can have problems, too. And those problems can get to them in some pretty serious ways.  I’m just glad my shrink isn’t trained in small arms — I’m assuming they aren’t — and that they don’t work in an environment where the use of firearms is part of the job.

My solution for TBI/PTSD rage

Anger (or out-and-out rage) is one of the places where my TBIs and PTSD intersect to cause real problems. I’ve been having some rage issues, lately. Getting worked up over little things — getting angry over nothing, really. Just getting angry. Temper, temper…

In the moment, my anger — my rage — seems completely justified. I feel with every cell in my being that I am entitled to be outraged. I am entitled to be angry. I validate my emotional experience, and I end up spiraling down into a deepening pit of anger, resentment, and acting out. Yelling. Making a fuss. Putting up a stink. And getting aggressive with whomever happens to be offending me at the moment.

This is not good. I’ve done it with police officers, and I’m lucky I didn’t get cited. Or arrested. I’ve done it with family members, and it’s cost me plenty, in terms of peace of mind and my relationships. I’ve done it with co-workers, and it strained our connections to the point of breaking.

Not good.

But lately, I’ve been able to pull myself out of my downward spiral before it gets too much of a hold on me. I’ve started doing some basic things that stop the progression of rage before it picks up so much speed it’s like a runaway freight train.

First, I recognize that I’m angry, and I am convinced that I’m right about being angry. This might not seem like a big thing, but I have trouble figuring out how I’m feeling sometimes, and anger is one of those emotions that I don’t always identify well. It just feels like a rush of energy — and while everyone around me knows I’m pissed off, I usually can’t tell what’s going on with me until it’s progressed to a really problematic point. I recognize that I’m angry, and I remember that I need to not let myself get carried away.

Second, I step away. I take a time-out and just walk away. I stop myself from saying what I’m about to say, no matter how badly I want to say it. I tell myself, I’ll give it some thought and figure out how to say it exactly the way I want to say it. I tell myself… anything … just to extract myself from the situation. I step away, telling myself I’ll come back when I’m better able to express myself.

Third, I take some deep breaths.  This helps stimulate my parasympathetic nervous system, which is the part of the nervous system that chills you out. The sympathetic nervous system is what gets you worked up to respond to a crisis situation — and when I get really angry, it’s often because I think and feel like I’m in a crisis situation, and my body is getting all geared up for fight or flight (more often fight). I consciously take some deep breaths to get my parasympathetic nervous system to chill out.

Fourth, I seek out some kind of tactile stimulation. I need to get out of my head, which is spinning out of control, and just give myself a different point of focus. My head is going so madly, at this point, that I cannot even think straight, so I seek out some kind of physical sensation to get my mind off the madness. I press the side of my face against the cold side of a door that leads to the outside. I pick up something rough and rub my fingers along it. I jingle change in my pocket. Or I find something heavy and hold it. The physical sensation, along with the deep breathing, gets my mind off the crazy cycle it was in, just a minute ago, and it lets me focus on a single point — the feel of the cold door against my cheek or the feel of quarters and nickels and dimes juggling among my fingers. Tactile stimulation, like looking at a flame of a candle while meditating, helps me center and get my mind off that crazy downward cycle.

Fifth, I remind myself that my body and brain are playing tricks on me. I am probably not getting angry for the reasons I think I am — it’s my body that’s getting all worked up into a fight/flight/freeze state, and my mind is interpreting that as a real sign of DANGER. And I’m probably starting to panic a little, too. As a matter of fact, when I take an objective look at things, the rage that’s building inside of me might not even be real rage, rather a response to a hyperactive sympathetic nervous system response. It could very well be my body tricking my mind into thinking the wrong things. And I need to remember that I get to choose how I interpret my life. My mind gets to decide how I’m going to think about things, how I’m going to react. And my well-intentioned body, which thinks it needs help, is just misleading my brain into thinking that I have to do something about whatever it is that’s getting to me. When I remind myself that this is a physiological process that’s taking place, I am able to relax… and the anger subsides.

The thing I have to remember, when all this is coming down, is that It Is Not Worth It. No matter how justified my rage seems to be. No matter how entitled I am to be angry. No matter how wronged I may have  been. It is not worth it, to get so tweaked over things. When I go off on an anger “binge” I end up feeling really hungover and dumb and numb afterwards, which just makes my life more difficult, once it’s passed.

I’m no doctor, but I suspect that it may be connected with the mechanics of panic/anxiety… all that post-traumatic stress stewing in a pot, and my TBI brain being unable to sort it all out in a timely fashion… My processing speed is slower than I’d like, and by the time I figure out what’s going on, the damage is often done.

So, I do my best to recognize when I’m getting angry, I step away, I take some deep breaths and try to relax, and I do something that gets my body’s attention — like feeling something cold or rough or tactile in some way. And I remind myself that my brain and body are playing tricks on me again. They’ve done it before… and they’ll do it again.

The perils of pseudo-psychological problems

Something has occurred to me repeatedly, over the past month, as my sleeping habits have improved. Namely, that many of the “mental health” issues I’ve been experiencing over the past several years, have had a distinctly physiological component to them. In fact, at the risk of sounding radical, presumptuous, and heretical – though I’m seldom reluctant to be just that 😉 – I suspect that a ton of my “psychological” issues have actually been physical ones.

I’m sure I’m going to really piss off some of the psychotherapists in the room by saying this, but I have to say that catching up on my sleep and figuring out how to get a full night’s sleep more than one night in a row, has done more for my mental health than two years of therapy.

And no, I did not have a bad therapist. They were great – awesome – and they really helped me a great deal, if only by sitting there and not making fun of me when I talked about this and that.

But let me tell you – as a TBI survivor who had/has a whole raft of physical ailments (chronic pain, insomnia, sensory hypersensitivities, weight fluctuations, heart palpitations, vertigo, tinnitus, and more…), just living with all those issues can really mess with your head. And as long as only the symptoms of my physical distress were being addressed, not much moved.

I did get in touch with my feelings. That’s for sure. I figured out that I actually mattered, and that it was important for me to take care of my own health and well-being, not constantly do the martyr-hero thing and sacrifice my own safety for the sake of others. I had space to learn to look at myself and my life through a less negatively critical eye and consider that maybe, just maybe, I had a right to do more that survive in life. I had/have a right to thrive.

But one of the things I really got in touch with was the fact that my physical well-being is a huge contributor to (and predictor of) how well my mental well-being holds up. When I’m tired and in pain and weak, my ears are ringing like the dickens, and my head spins wildly and I feel like I’m going to fall over every time I move, it’s pretty damned difficult to maintain a positive mental outlook and count my blessings. When I’m not feeling well physically, the chances of me feeling well mentally and emotionally decrease exponentially.

There are some people who manage to keep a cheery, chipper outlook, despite significant physical issues. I’m usually one of those  people, and I usually manage to not let my physical problems bother me. But when I haven’t had enough sleep for weeks and months on end, chances are pretty good that I’m going to feel depressed, anxious, irritable, low — and show other signs of clinical depression.

Okay, so here’s the thing — when I was in therapy with my prior therapist, they repeatedly came back to the suspicion that I was depressed. They asked me a number of times if I thought I was depressed, and if I’d said “Yes,” I’m sure they would have followed up on that, however a therapist does that. And they probably would have plumbed the depths, looking for what it was that made me depressed — some repressed past trauma, some childhood violation, some incident that I’d blocked out to keep from being unhappy.

And lots of talk would probably have ensued. Talk, talk, and more talk.

Now, talking is all very well and good, but as Belleruth Naparstek said at a conference I once attended (and I believe she’s said in her book “Invisible Heroes”), sometimes talking does more harm than good, by dredging up old traumas and forcing you to relive them. That can be very unpleasant, as I’m sure everyone is aware. And for me it’s really problematic, because I prefer to dwell on problems with a solution in mind, and if I’m dwelling on a past incident which cannot be changed (it’s already over and done), I get even more agitated and irate over it.

Some people might say that I’m just not willing to deal with the emotional fallout of misfortune, but I say I’m a solutions-oriented individual and the main reason I think about things, is so that I can change them, so why in the hell would I spend all this time thinking about stuff that cannot be changed? The therapists in the room who would say I’m emotionally “blocked” would probably try to treat me… with more talking about shit that makes no sense for me to talk about.

Make no mistake — I’m not at all reluctant to discuss misfortunes I’ve experienced in the past. But any discussion that takes place with me, has to be about devising solutions and coping mechanisms for the problems I have as a result. I’ve had some really shitty things happen to me, but you know what? It’s over, and I’ve managed to forgive just about everybody in my past for their shortcomings… even myself. The problem is not that I’m represssed. It’s that people want to process the wrong type of stuff with me — problems, problems, and more problems — and my reluctance to discuss stuff I’ve already been through a thousand times in my head is interpreted as repression or avoidance or some other psychological/emotional impairment.

What’s more, when pressed to explore the nether regions of my soul with talk therapy, I tend to get turned around. As good as I am at writing, I’m can be kind of pathetic when it comes to spoken conversation. I have an intensely visual mind, which follows conversations and spoken communication with series’ of images that are like an associational, disjointed movie in my head. I literally see pictures of what people are talking about, and when people start talking about things for which I have no picture — or I have several of them to choose from — it takes me a while to catch up and keep up. It’s not that I’m stupid. Or that I’m slow. I’m just incredibly visual in my own mind, when it comes to spoken language, and visual processing doesn’t lend itself as well to spontaneous conversation.

So, when I’m talking to someone about what’s going on with me, and they start talking about things that aren’t immediately famliar to me — or that I’m not expecting them to talk about — it’s really easy for me to get agitated and introveted. I need time to catch up. I need time to keep up. I need time to translate their words into pictures and process the information visually, so that I can make sense of what they’re saying to me. But I don’t always have that much time, and over the course of my life, I’ve gotten into the bad-but-pragmatic habit of just pretending I know what’s going on, while making mental notes in the back of my mind about what was just said, so I can go back to it later and rethink it all and hopefully make sense of things.

The problem is, in a therapeutic situation where I’m supposed to be making some sort of progress and addressing issues, this really works against me. It tends to make me look reticent and/or like I’m deliberately withholding. I’m not — I’m just trying to process the information and make sense of it. Believe me, if I could answer immediately like other people, I would. But my brain just doesn’t work that way.

I also tend to get really frustrated with myself and get agitated, which looks like I’m uncomfortable talking about certain things. It’s not that  I don’t want to let other people in. I do — more than I can say. But I get so turned around in my head, and I get so upset with myself for not being able to follow, that I start to flail and spin and then shut down. I feel like I’m getting backed into a corner, and I get revved… and by the end of the session, I look like a totally basket case who needs to spend years sitting across the room from someone, before I can get in touch with my feelings.

This sucks on so many levels, I can’t even begin to tell you. The worst thing of all is having someone who is supposedly trained and experienced in these matters misunderstanding, miscalculating, misdiagnosing, and mis-treating conditions which don’t even exist the way they think they do. On the surface, you’re exhibiting classic signs of clinical depression and post-traumatic stress disorder, but underneath it all you’re struggling for words that will explain exactly what is going on with you, and why you’re acting the way you do. And the bitch of it is, because you’re the (sick) client and they are the (trained, experienced, licensed) therapist, you’re not in a position to be taken totally seriously when you do manage to tell them a little bit about what’s up with you. ‘Cause they think you’re seriously mentally ill and you can’t possibly know what your real problems are.

After all, you probably have no recollection of what that nasty-ass uncle did to you as a toddler when your mother’s back was turned.

It’s a problem. I hear plenty of stories about therapists who don’t know  what they’re doing… as well as those who know very well what they’re up to but have no scruples or morals. I hear plenty of tales about over-prescription of medications, as well as  misdiagnosis of mental health issues that have more to do with fundamental differences of information processing, than pathology. The mental health profession has been pathologizing the diversity of human experience for as long as it’s been around — perhaps that’s a hallmark of any helping/caring profession that’s trying to get on its feet. Applying labels like “hysterical” or “deviant” or “sick” to people who are just different from the norm is a time-honored tradition in the mental health field, so there are no surprises there. But it’s a problem that’s been shifting and changing over the past 30 years, and that’s a good thing.

Now, if I can figure out a way to explain to my new therapist the nature and degree of my physical issues, so they can see my issues in light of my insomnia, pain, and physical sensitivities… and not spend an inordinate amount of time focusing exclusively on my past emotional trauma, that will be a good thing.

MTBI and mental health

I’ve been thinking a lot about how TBI (especially MBTI) can either masquerade as mental illness… or lead to it. Not being a psychotherapist, I can’t speak to the intimate details of what makes a person mentally ill, but being a multiple MTBI survivor, I can speak to my own experiences.

In my recent post The Disordered Life and the Need for Psychotherapy, I talked a bit about how my past therapy experience was perhaps not the most effective for me — or the most appropriate. And now I’m starting to think that maybe it did me more harm than good, in some respects. That constant plumbing the depths of my soul, looking for things to explore… well, that frankly wasn’t often a very productive experience. I’d end up in tears, 24 hours later, and I’d be turned around for days, confused about things and off-balance in my life.

Here are some more thoughts regarding the mention over at Get Real Results. Their text is in bold, mine is plain.

Many people who enter traditional psychodynamic psychotherapy do so because they are dissatisfied with their lives.

I got into therapy, because I was having an incredibly difficult time dealing with being a caregiver for a family member who had developed disabling health problems. They had been going slowly but steadily downhill for a while, their health problems worsening without being really addressed. They frankly refused to see a doctor for their problems. They wouldn’t even admit that there was a problem. I had tried to soldier through with them, stick with them, no matter what, and be loyal and helpful and stabilizing. But ultimately, they ended up in the hospital, where they were properly diagnosed and put on a recovery regimen. They were unable to do much of anything for themself, so I took time off from work and helped them get back on their feet. During that time, I was the only caregiver for them, and due to circumstances that are way too complicated to go into here, I couldn’t ask friends of family for help. Only a few were available to me, and then in a very limited capacity. Basically, I was holding the fort down for the two of us, and I was getting increasingly frayed… and incapable of dealing with the situation in a productive manner. My temper got shorter and shorter and increasingly explosive, I was melting down (in private), occassionally self-injuring to relieve the internal pressure, and becoming more and more PTSD-y. It was just not good. I was getting worse by the week, and it was starting to get dicey for the person I was supposed to be caring for. I knew I was supposed to be doing better than I was, and I couldn’t figure out why I was so fragile and inept and having such a terrible time of things. A friend pushed for me to get into therapy, and they found me a seasoned therapist they thought would be a good match. I decided to give it a try.

Their dissatisfaction may be due to being unsure of themselves, goals that are not clear, inability to accomplish what they want, unsatisfying relationships, anger or fear, or they are depressed.

I really didn’t know what was going on with me. I was having a hell of a time understanding what the doctors were telling me, remembering the info I was getting, and if I hadn’t had us all on a very strict schedule each day, with extra attention paid to nutrition and exercise and the most  basic of needs, we all probably would have spun wildly out of control. Friends who knew about what was  going on would would ask me what I needed, but I had no idea. They would try to talk to me about the situation and give me some support, but I coudn’t seem to access anything useful to tell them. I could discuss high-level things like medical research. I could talk about basic stuff like eating plans. But when it came to regular human interaction and talking about what was going on with me, I was at a complete and total loss. People would ask me what I needed from them, and I couldn’t answer. I literally didn’t know. All I knew was, I was locked on target to keep everyone in the household going, and keep my care-take-ee on the road to recovery.

Hoping to find out what was going on, I went into therapy. I really didn’t know what to expect. I had tried therapy years before, and it ended badly. What I did know was that I was wearing thin, I was melting down, I was not holding up well, and I didn’t know why. I needed someone to help me figure it out — and hopefully address it.

Psychotherapy offers them a chance to explore their feelings and past, uncover and resolve the conflicts that interfere with their lives, vent their frustrations, and get on with their lives.

Oh, yes… the exploration of the past… My therapist was really into that. They wanted to know what my parents were like, what they’d done that was awful, what my childhood environment was like, etc. Granted, my early childhood was not easy — I didn’t see much of my parents in my early years, I was in childcare during most of my waking hours, and when I did see my parents in the evenings or on the weekends, they were busy working around the house or they were occupied with concerns other than me. And the times when I did interact with them, I often had troubles. We would start out pretty good, then eventually things would go south, and I’d end up melting down or being disciplined for something I’d done. I had a lot of sensory issues when I was a kid — touch felt like pain a lot of times, and I had a hard time hearing and understanding what people were saying to me — so the “easy” times were a bit more complicated than one might expect.

Anyway, my therapist apparently had a lot of interesting material to work with, ’cause my childhood as I reported it was such a tangled mess. And my teen years and early adulthood weren’t much more straightforward.  Let’s just say I’ve had an eventful life. A non-standard life. A unique experience. I often got the feeling, during our sessions, that they were trying to uncover something really awful that would explain why I was such a wreck.

I have to say, I wasn’t always comfortable with that dynamic. It seemed to me that they were making some assumptions that just didn’t “sit right” with me. Looking back honestly and truthfully — and I’m not afraid to look at bad things that have happened, to me (even though I’m not usually comfortable talking about them with others) — I just couldn’t find any evidence of the kinds of abuse that are usually associated with intense PTSD. Sure, there’s that whole “repressed memory” thing, but I’m sorry, I just wasn’t feeling it. My diagnostic neuropsychologist concurred (on their own steam) that the difficulties I face are not psychological in origin, rather TBI-related, and even before I started the neuropsych testing, I had a strong, undeniable sense that the problems I was having with keeping up with everything around me were NOT just about stress, were not just about an unhappy childhood, were NOT based in psychological problems, but had some other origin. And I had to figure out what that was.

I suspect that hard-core psychiatric/psychological “team members” are going to turn their noses up at this, but you have to understand — I have spent 30-some years specializing in exploring the innermost recesses of my psyche. I’ve got countless journals filled with self-exploration to prove it. I’ve peered into dark corners on a daily basis for decades, and I’m not afraid to confront my demons. Seriously. I’m not. And when I took a long, hard look at the chronology of my childhood and teen years and early adulthood… and up to the present time… and I compared it with the chronology of my regular-functioning siblings… and I compared how I wanted (and tried) to  behave and experience life against how things actually turned out, well it was pretty damned clear to me that there was more than psychology at work.

There had to be a logistical, systemic issue at hand that hadn’t been identified or dealt with. My difficulties stemmed — it was pretty clear to me — NOT from things that were “done to me” but rather how I interpreted and experienced the events of my life. My siblings had gone through many of the same things I had — some of them had gone through much worse — and yet they presented as (and were/are) perfectly normal. Ironically, my siblings are — in the estimation of people who know both me and them — a lot less “together” than I am. But they are/were a whole lot more functional in the most basic ways — particularly socially. They knew how to identify and communicate to others what was going on with them and what they needed in tight spots.

I, on the other hand, had my act together in many ways that they never have, and was a super achiever with a good head on my shoulders in many respects, but in others, I was just a train wreck. I had always had a hell of a time figuring out where I stood in relation to the world around me, what I was feeling, what I was thinking, and what I needed from others. And while the experiences I’d had as a kid were not unlike what others went through, I took everything incredibly hard and couldn’t deal with much of anything. Change was all but impossible for me to stomach. I took any alteration — expected or unexpected — very, very hard. Some changes I took so hard, I apparently blocked them out from my memory, and I only know about them from my parents. Social interactions were pretty much a lost cause with me. Indeed,tending to the most basic things in life were next to impossible… like following conversations, being able to follow through with the easiest of tasks, playing simple schoolyard games like kickball and four-square, interacting with others, and keeping my act together without melting down or going off on wild hyperactive sprees. I was alternately aggressive and emotionally hypersensitive, and I spent a whole lot of my childhood and youth being extremely angry and bitter, and acting out in various ways.

Now, plenty of mental health professionals could probably come up with some workable explanations for all of this, and they’d probably be right. I’m sure plenty of people would have difficulty with what I experienced. My siblings still struggle with the aftermath of similar experiences. But not to the degree that I did/do. In fact, it was the degree of my difficulties that tipped me off that there was something more going on with me. When I took an honest, truthful look at my life experiences, and I compared the outcomes with other comparable individuals, I could very plainly detect a significant difference in degree that — I’m sorry — can’t be explained as trauma or post traumatic stress or even the changing times I grew up in. There was something more going on, which complicated things then. And it was continuing to complicate things for me in the present.

Unfortunately, although many head injured persons fit the above description and thus get sent into traditional analytic or psychodynamic therapy — they often get worse, not better, to everyone’s dismay.

OMG – I wish to hell I’d read this a year ago. It explains so much. Lemme tell you, it’s no friggin’ fun sitting there, week after week, sometimes twice a week, trying “like crazy” to figure out what’s amiss, and why… to be following the standard protocol of plumbing the depths, trying to come up with examples of past distress, trying to identify what’s going on with you… doing what you think (and are told) is the right thing to do, therapeutically… only to be an emotional wreck for days afterwards. And be getting worse, not better.

That’s what happened to me. I wasn’t becoming more centered and together.  I wasn’t better able to cope with the stresses of my life. I was actually having a harder and harder time of it. And I was starting to doubt myself at every turn. I was starting to doubt my judgment, my ability to cope, my sanity. I would sit there for that 50 minutes or so, trying to come up with some examples of what I was feeling or what I had experienced, only to come up empty-handed — and feeling pretty stupid in the process.  I would try to figure out what I was feeling, how I was impacted by such-and-such an experience, what others and said or done that upset me… and try to feel my feelings in general.

Therapy was supposed to help me make sense of things, and in some ways, it did help to have someone to talk to. But it helped me most when I was just talking about my life and not processing it all in a psychotherapeutic context. When I tried to “therapize” my experience, I just ended up feeling stupid and incompetent and beset by all sorts of self-doubt. I often couldn’t follow what my therapist was saying to me, and I could react quickly enough to get them to slow down. I would rush through my sessions with them, just saying out loud what I thought should be said, rather than letting on that I wasn’t following and I wasn’t  articulating what I wanted to articulate. I was so embarrassed that I couldn’t put into words what was going on with me — and in fact, I couldn’t figure out what was going on with me — that I spent an awful lot of time spewing stuff that wasn’t necessarily accurate or reflective of where I was coming from. I had always had such a hard time interacting with people — especially in spoken conversation — I just couldn’t deal with the talk-therapy scene in a really authentic way.

I knew this on some level, though I couldn’t yet put my finger on it, and it made feel like a total fraud and a loser — both because I couldn’t seem to do better in our interactions, and because I didn’t know how to ‘fess up … and do something about it.

As a result, a lot of the problems I was having became even worse, and I started to blow up and melt down and make really stupid choices over and over and over again. I went through three or four jobs in the time I was in traditional talk-therapy, and I was stressing to the point of having spells/episodes that looked a whole lot like seizures of some sort.

Not good.

This happens because the disorder in their lives reflects not primarily underlying psychological conflicts, but the damage to their brains that has resulted in cognitive and executive dysfunctions.

Amen to that. I couldn’t for the life of me figure out why I was screwing up, left and right. I was getting in touch with my feelings, I was feeling them. I was talking about my difficulties. I was releasing old hurts. I was doing what was supposed to be done — or so I thought — but my life was still on a collision course with… well, me. I was making all sorts of bad decisions, and my therapist gave me room to “explore” them as I wished. The only thing was, the decisions put me on a really bad path to some serious professional peril — and I wish they’d spoken up and corrected some of the shitty thought processes that were in play. I wish they’d challenged my thinking on a bunch of subjects. I might not have made the choices I did, and done the stupid-ass things I thought were such good ideas at the time, if they’d just questioned me more closely … with the understanding that my brain tends to misfire at critical times. I was cognitively and executively dysfunctional in some pretty significant ways, but they approached my difficulties from an emotional point of view, rather than a logistical one. They seemed to think that if I just had a better sense of self, and if I overcame my low self-esteem, I would be able to get my life back on track.

Uh…. NOT. Self-esteem has nothing to do with any of it. Nor lacking sense of self. It’s basic system issues that plague me. If anything, my sense of self is my strongest suit, and my self-esteem is for the most part quite intact. But all of my self-regard is useless, if my brain is misfiring and giving me wrong bits of information about what I should do with all that self-esteem and identity stuff.

This has gotten me in trouble more times than I care to think about. I swear… I’ll be feeling really strong and good about how I can do anything I put my mind to… but I won’t realize that fatigue is getting the best of me, and I’m missing cues and clues about what’s going on in the world around me. And I’ll screw up the job I’ve started — like a spreadsheet of numbers I’ve collected, or a piece of programming code I’ve written. I won’t muck up because I don’t feel good about myself, but because I didn’t take the time to walk through the steps of the job I’m doing… and I’ll screw it all up, miscalculating and end up with the wrong answer entirely. Broken program. Wrong numbers. Messed-up results — not because I lack self-esteem, but because my form was crappy.

Low self-esteem wasn’t the source of so many of my problems. MTBI was. Low self-esteem was an effect of the underlying problems — not a cause.

My old therapist also seemed to think that if I looked too closely at the ways in which I was deficient, it would take a toll on my self-esteem. If I explored the details of my screw-ups, I’d get down on myself and lose ground, psychologically. Untrue, untrue, untrue. It was in NOT looking at how I was screwing up, that I got into trouble, because I could never correct my mistakes so I’d do better the next time.  They spent a whole lot of time trying to reassure me that “I could do it”, without empowering me to actually do it in the way I needed to. Actually, I couldn’t do it — at least, not without help. There’s no shame in that, but the way they went about things, they actually made me feel as though there was.

Their lives are disordered because their brains are disordered.

Uh, yah. And acting like I was cognitively and excutively intact, was a huge mistake. For them, and for me. I guess I just didn’t grasp the extent of my difficulties, nor did they. They seemed to think that my lack of initiative stemmed from emotionally based depression, rather than a physical slowing of the brain processes… that my difficulties socially came from low self-esteem, rather than a long history of mucked-up relationships that stemmed from behavioral issues that began around the time of my first TBI and got worse with every successive one. My life, while full and whole and complete and highly functional in some ways, was in a total shambles in others.  It seems to me that that should have raised a flag of some sort — why does someone who is such a top performer and peak achiever in significant ways, also show such profound deficits in others? It’s not emotional in nature and origin. It’s neurological.

“Talking things out” does not solve the problem and may worsen it.

Which it did for me. Talking just made everything worse — it was all talk, no action, and if I talked about my difficulties, their main approach was to reassure me that I was an okay person (which I already knew!) rather than encourage me to deal with the logistics.

This is because traditional therapy removes structure and encourages the spontaneous expression of whatever thoughts and feelings seem most important.

Yet another contributing factor. OMG — can I tell you how many sessions I just rambled on and on without any particular direction? It may have seemed like giving my emotions free rein was a good idea, but they clearly didn’t know how capricious my brain can be around thoughts and feelings. Without structure and purpose, all that cognitive energy just went flying all over the place, leaving me even more confused than before, in many ways. Which did not support my mental health.

Such a process is guaranteed to lead to further disorganization and confusion in a person whose major problem is structuring and organizing the thinking processes, while trying to keep surges of emotion from washing everything away entirely.

Amen to that. Now I can see why my present therapist, who is a neuropsych by training, is constantly steering me away from the emotional exploration I became accustomed to. This new therapist (NT) takes a totally different approach from my Old Therapist (OT), and I have to admit it confused me at first and made me angry and disoriented. I was accustomed to therapy being about venting and “releasing”, but NT was focusing on logistics. And steering me away from overly emotional responses to every little thing (which had been encouraged by OT before).

When individual “therapy” is a successful adjunct to a rehabilitation program, it is a structuring, supportive, problem-solving approach.

And so it is — this new approach with NT is so much more helpful to me. And to everyone around me. My family members have commented that I’m doing a whole lot better, now that I’m seeing NT, and I can tell a huge difference. NT is very supportive, but they don’t let me get away with crappy cognitive processes, and they make me stop and think things through before I take action I’m talking about. They’ve already “talked me back from the edge” of doing something really stupid, a number of times. And this in only a few months. Plus, they’ve talked me through some wrong assumptions and bad information I was working off of, for nearly 20 years. They are talking me through thought processes that have been deeply flawed — yet rote — for decades, now. And I’m revising my perceptions in the process.

That’s just huge. And it’s something that I, as an MTBI survivor, need desperately. I need to be stopped and questioned and challenged. Even if it makes me uncomfortable and mad. I need to be forced to think things through in a careful and deliberate way, not just fly into situations thinking I can do everything on reflex. I can’t. I’m not sure I ever could. But this is the first I’m realizing it fully.

But at least I’m realizing it now. So I can actually do something about it. And make some real progress!

This does not mean that head injured persons cannot have mild or severe psychological problems that either result directly from, or exist (usually existed) separately from the results of their injury.

In my case, I would say that a fair number of my psych issues have stemmed from my long history of screwing up due to MTBI problems. There’s only so many false starts and cock-ups you can commit, until you start to be convinced you’re an idiot and don’t deserve a full and fulfilling life. There’s only so many relationships you can blow away, before you start to think you’re unfit for society. And having people make fun of you and bully you and ostrasize you and tell you you’re lazy and stupid and slow and whatnot also takes a toll.

I’m not complaining and I’m not crying boo-hoo.

I’m just saying…

They can, and often do. It does mean, however, that the traditional psychodynamic approach seldom offers the head-injured person relief from their disordered life.

Yes to this. To get relief from my disordered life, I need specific coping strategies and tools in my “toolbox”. After I’ve stopped making a mess of everything I touch, I can start to rebuild my self-esteem. But not before then.

The psychotherapist who specializes in brain injury must have an appreciation of the impact of brain damage on the patient’s capacity to benefit from the process of therapy.

Which my OT didn’t, I don’t think. At least, I don’t think they understood just how deeply I’d been impacted by a lifetime of injuries and the resulting effects.

Rehabilitation professionals should seek out such specialists if their clients require psychotherapy.

And clients should do the same.

I’m really hoping that this post has offered some food for thought to therapists and clients alike. It’s just so important, and there are so many critical considerations to go into this.

If TBI isn’t considered fully in therapy, the process itself can wreak havoc in an already disordered life… making things worse in the process. Folks may disagree with what I’ve said above, but that’s just my own experience and perception.

Therapy should be helpful. I think we can all agree on that.


All new me… all the time…

I have been contemplating my situation as an MTBI survivor pretty intensely, lately. Thinking about how it’s changed my brain — not only since 2004, when I fell down a flight of stairs and smacked the back of my head hard a number of times on the steps… but throughout my entire life. After all, I have had a wide array of injuries — I got knocked out, I’ve had several sports concussions, I’ve been in car accidents, and I’ve had other falls.

Head injury has undoubtedly affected my life, and until a few years ago, I had no idea that the problems I’d always had (but never wanted to own up to) were in fact of a common kind and traceable to common reasons — mild traumatic brain injuries.

The more I realize just how much MTBI has affected me, the more I realize that I really need to re-learn how to walk through the world. Not just because of my most recent accident, but because of a lifetime of TBI-related changes to my cognitive-behavioral version of reality. I need to seriously back it up and rethinking just about everything I assume to be true… because so much of it has been shaped by TBI and clouded by a broken brain… and now I have tools — the Give Back Orlando material as well as other info and tools I’ve come across — to repair some of the damage and renew my life.

Some of the repairs are relatively small – like just changing around some of the things I do when I get up in the a.m. Others are larger, like changing direction with my work and being more realistic about my abilities and inclinations. But the bottom line is, I really need to rethink many of the aspects of my life and not take everything for granted, all the time.

The habits of thought and action I have become accustomed to, may be working against me. I know many of them are. So, I need to fix that.

I’ve recently reached the conclusion that MTBI, as “mild” as it may be, has significantly skewed my perception and interpretation of the world around me and it has effectively caused me to live in a different version of reality than lots of other people. Many situations in my life, I now believe, may have been very different from how I perceived them, which has caused me to grow up with inaccurate understandings of others and my place in the world.

Let me explain — I have always had a heck of a time interpreting people’s social cues. I don’t always understand how to make conversation (correction — I very rarely understand how to make conversation) and I don’t always understand what people are saying to me. This has happened for as long as I can remember. It’s also a point of frustration for people, that I don’t communicate as well as they apparently expect me to (while talking, not when writing – one of the reasons I write so enthusiastically is that conversation and spoken communication is such a bear of an undertaking for me).

When I was growing up I was constantly getting things turned around, and people would lose patience with me. They would raise their voices at me — to get my attention or out of mounting frustration. And I would often startle, because I had trouble following what was going on. I’d then get that rush of adrenaline and heart-pounding and all of that uproar in my head and body that told me “You’re in trouble — they’re mad at you, and they’re yelling at you because you’re a bad person.” I thought I was in trouble — that people hated me. That they didn’t like me. That I was being bad and awful and problematic.

But actually, in some cases, they were just trying to get my attention, and they did it in ways that were less gentle than they could be.

This happened over and over and over again. And over the years, when I was a kid, I developed this godawful complex about  being a terrible person, an ogre, a monster… you name it. I was convinced that everyone hated me — teachers, parents, other kids. A lot of them were unkind to me, especially my peers, but my assumptions about being bad and always being in trouble may not have actually been true.

So, I ended up with a variety of complexes and a nagging suspicion that I was good for nothing and just a drain and a chore for everyone to deal with… when actually, I just had a hard time keeping up, nobody realized it, and they did a clumsy job of bringing me up to speed.

In many ways, I think that my MTBIs had a negative impact on my mental health. Depression and PTSD and low self-esteem have all hounded me my entire life, along with a bunch of other conditions that could be in the DSM-IV, but I’m not looking up for the sake of time. I also don’t want to know. Heck, I’m reasonably functional in basic ways… why belabor it with mental health diagnoses? 😉

One of the other byproducts of this cognitive skewing is that some of my greatest skills and talents have been systematically overlooked and underdeveloped by not only the world, but also myself.

That anosognosia business (not knowing what you don’t know) has complicated my life by diverting so very much of my energy into trying to smooth over and patch up my foibles in the areas where I don’t excel (but didn’t realize it), meanwhile diverting so very much of my energy away from the areas where I have the greatest strengths. 

What a waste. All my life, I’ve been trying to make up for what I lacked, which in many cases just isn’t coming back, and in the meanwhile I’ve neglected the areas where I am strongest… thinking I need to be at least 75% all across the board, instead of allowing myself to be at 30% in some areas, while being at 99% in others.

That deliberate focus on making up for deficits at the expense of raw talent is how people dealt with special needs kids when I was growing up — trying like crazy to get them moderately functional where they were weakest and most struggling… all the while neglecting the areas where they/we were highly, highly, almost eerily functional.

Missed opportunities for the sake of common denominators.  For the sake of my sanity, I just can’t contemplate what that’s cost me…

So, now I’m going to do something about it. Because I can. Because I’m entitled. I have a right to do everything in my power to make the most of the abilities I have, while letting the less-strong areas just be. I have a right to tend to myself and gather all the knowledge I can. Even if  I’m not highly educated in a traditional sense, with all the degrees and the certifications and whatnot, I can be highly educated in a personal, modern sense. There is so much great information out there, and I have a knack for reading and digesting things over time — all the while making use of them.*

*Indeed, one of the things I love about the Give Back Orlando material is that it’s geared for self-therapy, and it never tells you “You’re just a peon without a Ph.D — what do you know!”  Dr. Schutz actually tells us what books we can read, and where we can turn for answers, which is truly amazing in the highly (almost rabidly) territorial intellectual property driven world we currently inhabit.

I’ve got my notebooks, I’ve got my library card, I’ve got my file folders and my lists of issues I need to address. I’m paying attention to myself at a much deeper level than ever before, and I’m determined to work at it as best I can, so I can overcome what’s standing in my way. I’m not just going to roll over, saying, “Oh, well, I got hit on the head a lot over the course of my life, so I guess that disqualifies me from living!”

It’s not about that, with me. Hell no! It’s about taking an objective look at what in my thought processes and behavioral patterns needs fixing – and then fixing it as best I can.

Or compensating for it.

Or avoiding situations that play to the parts of me that can’t be fixed.

I have sustained multiple mild traumatic brain injuries over the course of my life. These injuries have altered my perceptions of life around me and fostered erroneous deductions that have led to poor choices and bad behavior. They have also stoked mental health issues that have their root not in what was done to me or what happened to me, but how I thought about what took place in my life. I am a grown-up individual in my mid-40s who cannot afford to harbor erroneous thinking and poorly constructed patterns any longer.

So, I’m going to do something about it. I’m changing my life, one day at a time. One minute at a time. One experience at a time.

But change it, I will.

Moment by moment – on mindfulness and TBI

About a year ago, I had a conversation with a friend who was wondering aloud how I manage to get through life with the deficits I described to them. I had just finished telling them about my memory problems, my cognitive processing problems, my physical problems, the troubles I had when I was a kid… I didn’t hold back, but just let it all hang out. And when all was said and done, it was a lot to process, even for me (who’s been living with all that for as long as I can remember).

One of their first questions, when I’d finished, was how the hell I managed to get through life? How did I do it every day? How did I manage to make it through so many “regular” situations… not only adequately, but in fact better than many? For years, I’ve worked in high-stress, high-pressure environments that have one crisis after another. For decades, I’ve experienced job changes, moves from one part of the country to another, serious health problems that felled family members, deaths of close relatives, career insecurities, near-eviction… How did I manage to keep it all together, and actually look even more functional than others, who have not had brain injuries?

It sounded a little hokey when I said, it but the first words out of my mouth were, “Mindfulness. I just pay really, really close attention to each moment as it comes.”

At the time, I wasn’t sure that was really 100% accurate. And when I thought about it, over the coming weeks and months, I came up with a whole bunch of other ideas for how I get by:

  • mimicking others who seem to have it all together
  • being silent instead of speaking up and showing my limitations
  • hanging with good people who care about me and can help me
  • learning to ask for help in ways that don’t make me look stupid
  • learning to be stoic under any given situation, and then falling apart when I’m out of sight of others

The list goes on, of course, and the more I think about it, the more coping strategies I can come up with.

But once I got tired of thinking how else I manage to get by, I came back to my original thought, which was correct:

I get by in the world, head injuries and all, by paying really, really close attention to each moment, and living the very best that I can in that moment.

Throughout the course of each day, countless situations arise which enable me to learn more about myself and be true to that moment.

People approach me for help or input. I can choose to pay attention to them, really get what they’re saying to me, and respond to the best of my ability… Or I can pretend to listen to them, brush them off, and go back to what I was doing before.

People interact with me in stores and public places and at work. I can choose to be pleasant and polite to them, or I can be rude and impatient and make them sorry they ever met me.

Opportunities arise to make choices that will change the direction of my day. Will I dress up for work, or will I dress down? Will I take back roads to work, or will I take the freeway, or will I take the train? Will I slow down when the traffic light turns yellow, or will I speed up?

Every single choice I make through the course of each day has the potential to change my course in good ways or bad. And every action I take is both informed by my neurological profile and affects my personal relationship with my brain. It’s a two-way street. I have to both factor in the issues I have with my broken brain when I decide how to act… and deal with how my perception of myself alters, based on the outcomes of what I chose to do before.   If I neglect the former — e.g., don’t bother to remember that fatigue is a huge issue for me, and it’s impacting my ability to think and coordinate my movements — then the latter can suffer — e.g., I’ll get really down on myself for being dumb or dense or uncoordinated. Even though I know I’m somewhat impaired, I still get down on myself for doing/saying/choosing things that were better left alone. And that takes a toll… like water dripping on a rock and eventually eroding a virtual Grand Canyon through my self-esteem.

Mindfulness matters with me. Perhaps moreso with me than with other folks who are neurologically normal. Because if I want to live my life to the best of my ability, I don’t have a choice, but to force myself to be mindful. When I’m racing through my days, not paying attention to my limitations, not being mindful of where I am and what I’m doing, unfortunate things tend to happen. I rub people the wrong way. I say things I shouldn’t. I get pulled over by cops. I bump into hard/sharp objects and bruise myself. I get snarky with authority figures and alienate my supporters. I tend to end up in hot water, and then I feel just awful. I start to doubt myself. And when I doubt myself and my self-confidence takes a hit, I have a harder time just living my life later on.  Even the most basic activities can become a difficult chore, when my self-confidence has taken a hit… they’re hard enough, as it is, without the added burden of screwed-up self-confidence.

But when I slow down and focus on the present moment… When I’m totally involved — to the best of my ability — in what I’m doing, what someone is saying to me, what is happening around me… When I manage to block out everything else around me and focus wholly on what’s right there in front of me, magic happens. I become involved in my own life. I am able to see, feel, hear, and experience all-round the situation that has presented itself to me. When I can manage to stop the rest of the world from intruding, and I can slow down the action enough to devote my full attention to what’s going on in that moment, at that specific place in time, I can turn the full force of my abilities towards it, and be true to it.

Now, looking around at websites about mindfulness, I’m finding a lot of mystical stuff. Enlightenment stuff. Claims that mindfulness is the path to Buddha-hood. A cure for psychological ills. A cure for the soul. I don’t know about all that. I think that mindfulness is certainly a key part of becoming a fully conscious individual. But in my case, mindfulness isn’t something optional that I add to a personal spiritual practice for the sake of additional help. It’s a central and esential part of my day-to-day coping strategies, without which I’d be totally sunk. If enlightenment comes along with it, then great. But I’ll settle for basic functionality.

And that’s exactly what it offers me. Because when I’m not paying attention, when I’m not cognizant of the fact that I’m overly tired, when I’m ignoring the fact that I’m getting more and more agitated, bad things happen. I lose my cool. And when I lose my cool, I blow up. When I blow up, I say things I don’t want to be saying. I say things I don’t really mean. I break things. I throw things.  I flip. Trust me, it’s not pretty. And people close to me are occasionally afraid of me, which does not feel good. Ultimately, I start to close down, shut people out, stop communicating with them, start to get down on myself… and I slide down in that sinking spiral… sometimes into total and utter despair. The cost to myself and those around me is very high, when I’m not being mindful and paying attention to what’s going on with me.

But when I am paying attention and I’m aware of where I am and what’s going on with me, I can manage my limitations. I can see that I’m tired, and take a nap. I can see that I’m not following what someone is saying to me and either ask them to clarify or make a note (a real note on paper, ’cause I’ll forget mental notes). I can tell that my attention is wandering and bring myself back to the moment. I can see that I’m starting to lose my cool for no good reason and physically remove myself from the situation – walk away or even run, do something different, or just stop talking. I can prevent myself from going off the deep end and overreacting to what others are doing and saying. Just reminding myself that I’m  being “very TBI” at the moment chills me out. I can remind myself that my brain is misbehaving and I’m probably getting overwrought for no good reason. And I can stop the downward slide before it starts.

I cannot even begin to say how important this is. For myself, and for everyone around me. It means the difference between being a good partner and being a vexation (and sometimes a threat) to the ones I love. It means the difference between having a conversation and having a fight. It means the difference between finishing a thought and taking a definitive action, and getting mired in bogus details that keep me from going anywhere. It means the difference between being a TBI victim and a TBI survivor.

Mindfulness is not just an optional practice for me. It’s not something I can do now and then, when the spirit moves me or I’m in a meditation session. It’s something I absolutely positively must do all the time, in order to meet the most basic requirements in my life.

The beauty part is, because mindfulness is such a powerful practice outside of basic coping, it enables me to do the most basic things with tremendous focus and energy. Taking one small thing at a time, focusing fully on one moment at a time, allows me to use the full range of my abilities on that thing, in that moment.

And in so doing, my life becomes more than just a series of limitations to be dealt with. It becomes more than just a sequence of chores and tasks and obligations. It becomes more than work, work, and more work. My life — through mindfulness — becomes a form of worship. It becomes art.

“So, have they tried to label you bipolar?”

Thus asked my neuropsychologist, the other day.

I was telling them about my psychotherapist friends who are well-meaning, but ascribe all kinds of cognitive and behavior issues to psychological ones.

I’ve been labelled all sorts of things by psychologist types — obsessive-compulsive, depressed, manic, repressed childhood sexual abuse survivor (which to my knowledge, information and belief is not the case), etc. — and I told my neuropsych as much.

“Or, maybe you just got hit on the head a lot,” they said, shaking their head in frustration. And disbelief.

They also told me, that visit, about another patient of theirs who had been diagnosed with “rapid cycling bipolar disorder” because they were slow and sluggish getting up in the morning, their mood picked up in mid-day, and then they wound down at night.

Turns out, they just had a wicked case of ADD and their brain worked more slowly at the beginning and end of the day. But they had to get saddled with an “extremely rare version of bipolar disorder” diagnosis… and perhaps have to take god-knows-only-what-kind of meds, on top of it.

Sometimes the mental health profession just makes me crazy nuts. Do they do it for job security? I have to wonder… 😉

Light-sensitivity solutions

I have a friend who has an associate who has needed help for a long time, but apparently hasn’t gotten what they needed. This friend-of-a-friend (I’ll call them “Foaf”) is a very unhappy person who is just a drag, even to be anywhere near. I’ve encountered them in passing – literally – when we crossed paths in the past, and they had this really miserable vibe that totally turned me off.

My friend, who has a kind streak that’s almost super-human, has been trying to help them, with varying degrees of success.

A while back, Foaf informed my friend that they think they found out one of the things that has been making their life so hard to handle — when they were little, they got hit on the head with a baseball bat. And they think that their lifetime of problems could trace back to that experience.

My friend has been doing research about head injury, and I’ve been feeding them info as I go along. It turns out that my realizations around my own TBIs happened roughly the same time as this other person’s — was there something in the air/water? They’ve been able to pass along what I’ve given them to Foaf, and I think it’s been helping.

Now, over the course of the past months, my friend has mentioned a bunch of times that Foaf has trouble with light sensitivity. Their choices in life are actually pretty limited because of it, too. They cannot go some places because the lights are too bright. They have a hard time dealing with stuff in general, because of their light sensitivity. My friend asked, a few weeks ago, “Do you think this could have anything to do with their head injury?”

“Yes,” I responded emphatically. It hadn’t occurred to me that they might think it didn’t.

Light sensitivity is a common after-effect of head injury.

At the South Florida Psychology website, they list the following symptoms of post-concussive syndrome:

Symptoms of Postconcussion Syndrome

Symptom Percent of Patients
Poor concentration 71%
Irritability 66%
Tired a lot more 64%
Depression 63%
Memory problems 59%
Headaches 59%
Anxiety 58%
Trouble thinking 57%
Dizziness 52%
Blurry or double vision 45%
Sensitivity to bright light 40%

Even sensitivity to regular light could be a problem. And there are other issues as well, which are too many to go into at this point.

So, what can a person do about this?

Well, first of all

Understand that your vision problem may be neurological, instead of psychological. Nothing makes me crazier than thinking my head injury issues are because of some psychological problem(s) I have. I thought for years that my problems were “character defects” or evidence of mental illness that could be cured with therapy or support groups. While these things have helped me a great deal, understanding my issues as physiological ones lets me think about them differently and take steps to address them concretely, instead of trying to change my thinking or feeling about them.

Next,

See if corrective lenses help. There are a number of options you have.

Irlen Lenses can help. They “filter out the offending wave lengths of light which create [neurologically-based] stress” and givey our brain a break from dealing with crazy light frequencies that you can’t handle.

Amber sunglasses can also help — they are better at blocking certain kinds of light than the green or gray ones. I have amber sunglasses that I put on just about anytime I’m driving durin gthe day. Even when it’s cloudy, I wear them. There’s something about the wavelengths they block that is very helpful to me. In fact, when I’ve gone out on bright sunny days without them, I’ve had a tremendous amount of stress, and oneday when I was driving to work, I had a bit of a meltdown over next to nothing.

It puzzled me at the time, but when I think back, it was a bright, sunny day and I wasn’t wearing my sunglasses.

I’m not exactly sure how a person goes about getting Irlen lenses. I guess you’d talk to your doctor about it. For me, my amber-tinted sunglasses– and understanding that I have trouble with bright light — helps enough to get me through the day safely.

I told my friend about Irlen lenses and amber-tinted sunglasses. They’re going to pass the info along to Foaf. I hope it helps ease their discomfort and makes them a happier person. They deserve it.

The gateway of despair

I’ve been in a really up-and-down place, lately. I’m dealing with the residue of various traumas, I’m dealing with the day-to-day crap from various head injuries, and I’m winding down one job to move on to another. In the midst of my cognitive and emotional floundering, I’m hanging in there and falling back on my old coping mechanisms of smiling stoicism and shutting down those parts of me that are prone to freak out over every little thing.

I would rather not use repression as a coping mechanism, but I really need to make this job transition, so I’m just clamping down on the heartache and emotional upheaval… until I’m settled into my new job.

It’s a bit of a gamble, really. I have to remind myself that in another few weeks, I’m going to need to decompress and do some serious “autotherapy” — using guided imagery, time alone to break down, and lots of long walks down country roads… and city streets as well.

I wish I were less nervous about this, but my pattern in the past, when I was moving on from one situation to another, has been to burn bridges behind me, so I had to move forward. Poor person’s motivation. As a result, I have a lot of bad blood in my past that I’m not proud of. I just don’t want to go there, this time. I don’t want to alienate the people I’m leaving behind, so I don’t feel so badly about leaving them.

Fact of the matter is, I do feel badly about it. I have to leave to take this new job. But I don’t want to leave the old one. It’s a wonderful problem to have, in this economy, but I’m still struggling with it on some level.

One of the things that’s helped me a great deal, over the past week has been reading about “Positive Disintegration” — or positive mal-adjustment and separation from “norms” that no longer work for you. The concept was developed by Polish psychiatrist Kazimierz Dabrowski, who (as I understand it) rejected the widespread practice of labelling “maladjustments” as forms of mental illness. His premise, as I understand it, is that as people develop and mature, they inevitably encounter things about the world that don’t sit right with them and that cause them considerable distress.

In fact, the more capable of maturing you are, the more distress you’re going to be in, because no culture is perfect, and there are a lot of things that could — and should — be done differently. When you positively dis-integrate (that is, you un-integrate from the norms of society based on your own evolving and advancing understanding of your own values and concept of right and wrong), you basically differentiate yourself from the status quo and break out to form your own identiy, with your own moral compass.

Unfortunately, standard-issue cultural norms can consider such separation and differentiation as a form of mental illness or psychosis, and plenty of psychology and counseling is geared towards “helping” people adjust to life and be “well-adjusted”. But that’s not always good. Because (for the sake of “peace of mind”) you could become well-adjusted to widespread cultural acceptance of genocidal atrocities… domestic violence…  the gutting of the Constitution… accepting (and promoting) inaccurate military intelligence that warns of WMD… and buying more house than you can afford.

All cultures are a work in progress, and according to Dabrowski (who passed away in 1980 and whose name is — I think — pronounced da-BROV-ski), it’s the mal-adjusted, individually guided, conscience-driven individuals who move the culture forward to a more advanced state.

He treated “dis-ease” and “disorders” as potentials for growth and change, encouraging his patients (and others) to examine their difficulties to see what potential for growth they revealed. If you think about it, this is a pretty revolutionary approach to mental health. And it’s inclusive in ways that excite and intrigue me… and which I’ve long agreed with, though I could never articulate it as well as he does/did.

Where I am now is really in a state of positive dis-integration. I’m un-integrating from the workplace I’ve been in, for nearly a year… de-coupling from people I’ve learned to really like and work with (tho’ with varying degrees of success)… dis-connecting from the “security” of  a permanent job offer that wouldn’t pay me enough to actually live on or give me the skills that will keep me fully employable over the coming years, in exchange for a really great-paying gig that’s a contract with no guarantees but will make me more employable than ever in my chosen field.

I’m dis-integrating in favor of something better, something bigger, something with great potential. And while it’s very exciting on some levels, it’s also terrifying on others. I’m fearful that my brain will fail me, that I’ll become over-tired, that I’ll lose my ability to cope, that I’ll end up where I was way back when, when I was in high-pressure situations and melted down. I’m very concerned about my resilience, if I’ll bring too much stress home from work, if I’ll be able to maintain my effectiveness and productivity. And in moments when I’m especially tired and lonely and afraid, I despair.

That despair, however, can be a good thing. Fortunately, I know myself well enough to realize that in the morning things will quite literally be better. After I get a full night’s sleep, I write a little bit, I read a little bit, and I get on with my life, I’ll not feel so desperate, so alone and afraid. I know myself well enough to realize that the despair is there because something is missing… and once I figure out what that something is, and take steps to address it,  I’ll be able to get on with my life.

Despair is also a good reminder to me that I’m not perfect — and I know it. Someone who had no clue about their impairments and had no clue about how much better off they could be, wouldn’t bother being this down. But I know about my deficits, and I have a very keen hunger for the ideal. So, of course I’m going to feel this way, now and then.

For me, the degree of my despair is the measure of distance between my perceived real and my imagined ideal. It tells me where I’m at and it reminds me that I can’t afford to get cocky. Fortunately, my personality is sufficiently fickle — and bores easily — so I don’t stay stuck for long in that desperate state. But when I’m there, as frightening as it can be, as dark as it can be, as agonizing as it can be, there are lessons to learn. And my life would be far less bright and light-filled, if I paid no attention to them.

When it comes to head injury, chronic illness, PTSD, or any other intractable physical or mental condition that won’t respond immediately to therapy, but takes seemingly forever to get better — if it does at all — despair can be a recurring theme. I can’t speak for anyone else, and not being a trained psychotherapist, I certainly shouldn’t dispense mental health advice (if you feel you’re in mortal danger, please seek qualified psychological help!). But in my case, when despair comes to visit — as it so often does — I find I can use it as a classroom of sorts. It has plenty of things to teach me, in the moments or hours or even days it spends with me. And I ignore/suppress it at my own peril.

Despair doesn’t have to be a bad thing — unless it’s a permanent state that requires medication or other intervention to avoid suicide. It can actually be a valuable part of maturation and personal growth.

After all, it’s easier to find a little glimmer of light, when you’re in a pitch-black room.

When in doubt… sleep

Last night I officially wore too thin.

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

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

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

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

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

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

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

So, what are my warning signs?

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

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

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

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

Not bothering to sleep.

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

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

Going too fast.

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

Not self-assessing.

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

So, what do I do about all this?

First, start self-assessing again.

Pay attention to what’s going on with me.

Second, get some sleep.

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

Take looooong naps on the weekend.

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

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

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

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

Third, stick to my plan.

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

Fourth, write… write… and write some more.

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

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

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

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

Yes, yes, yes… When in doubt… Sleep.