Good progress on the insomnia front

Something quite magical has been happening in my life, lately — I’ve been getting more than 6 hours of sleep each night. To people who have no trouble falling asleep and staying that way until they get 8 hours, this might not seem like a big deal, but it is to me.

Leading up to my last MTBI, I couldn’t sleep much more than 3-4 hours a night. I got 5 hours if I was lucky. I was regularly waking up at 3 a.m. (after getting in bed around 11-11:30)… just waking up. BAM – I’d be awake – and I couldn’t get back to sleep, no matter how I tried.  My system was fried, my mind was fried, my life was fried. I was in a crazy intensely stressful job that was tweaking my PTSD off the charts. And when I fell down the stairs at the end of 2004 and hit my head hard on the top 3 stairs, it was the coup de grace (pun intended) of a long progression of gradually worsening conditions in my life.

In a way, it was a good thing that I had to leave that job within the  year after my TBI, but I really miss the money…

Anyway, after I fell, my insomnia did not improve at all. And then more crap started happening in my life — family emergencies and tragedies, medical crises, personal crises… everything got even more intense, even more crazy, and it was impossible for me to tell what exactly was going on or why things were getting so mucked up. It was like my brain was in suspended animation — nothing seemed to be firing properly, nothing seemed to be working as it should. It would have made me nuts, if I’d understood what was going on, but I didn’t.

As you may or may not know, slowly things have clarified for me, and I’ve taken a lot of steps over the past years to set things to right. But one important aspect has eluded me — getting enough sleep. I had gotten acclimated to getting maybe 6 hours a night, and I thought I was doing well when that was happening. But plenty of people have informed me that you really need 8-9 hours each night, if you’re going to function properly.

I took a good hard look at my life, and I realized that yes, I actually was usually exhausted. I was usually overly fatigued. I had just gotten used to the feel of it, I’d acclimated to the experience, to the point where I thought it didn’t bother me. It was just how it was… I had resigned myself to being constantly tired, and I kept myself going on caffeine and projects and having a jam-packed schedule all the time. I left myself no downtime at all. If I had downtime, I just felt bad, so I didn’t bother giving myself any rest.

Like I said, on a certain level it didn’t bother me. But logically, I could see that something was amiss. Everyone was telling me I needed more sleep — from friends to family to therapists to doctors — and it occurred to me that what they were saying probably had merit. They were folks I trusted, and whose input I believed. They had no reason to deceive me, and I had no reason to disbelieve them.

So, going by a purely rational approach, I decided to try to get more sleep. And I tried to stop pretending that being tired all the time was okay.

I tried:

  • Taking naps whenever I could, especially on weekends.
  • Taking Benadryl to knock myself out, when I couldn’t even begin to relax.
  • Doing very rigorous chores that wore me out.
  • Taking hot showers to relax.
  • Listening to guided meditation (Belleruth Naparstek’s “Stress Hardiness Optimization” CD, especially)
  • Doing progressive relaxation.
  • Deep breathing and counting my breaths and alternating opening and closing my eyes at longer and longer intervals, so that my body would get the idea I was going to sleep.
  • Closing my eyes and moving them around behind closed eyelids — like I was in REM sleep.
  • Sleeping in different places – in the guest bedroom, on the living room couch, in the car.
  • Meditation
  • Exercising mor
  • Tracking the amount of sleep I was getting, so that I could tell — objectively — when I was probably over-tired (when I’m over-tired, it’s hard for me to tell subjectively that something is wrong)

All these things, to some extent have helped me. And over the past several months, I’ve been able to sleep more and more. I’ve now gotten to the point where I can literally sleep 8-9 hours, under the right conditions, which is a really “new” experience for me in light of my past 6 years or so.

I have also found it helpful to learn about the parasympathetic nervous system and the important jobs it does in maintaining health and vitality. Doing things like deep breathing and relaxation to help jump-start my parasympathetic recovery from stress, has been a big part of helping me get to sleep. The more relaxed I am, when I go to bed, the easier it is to sleep.

It might sound basic and obvious, but that fact eluded me for many years.

Recording my hours of sleep each night has been really helpful, just so I can tell how I’m doing and where I need to improve. After all the last thing I want, is to undermine my health just because I can’t subjectively assess the level of my fatigue. If I can’t do it subjectively (when someone asks me how I’m feeling, even if I’m exhausted, if I’m caught up in a project or I’m “locked on target” for something I need to get done, I am honestly feeling no pain or fatigue), I can do it objectively by tracking my hours of sleep each night.

Most of all, I’ve been benefited by listening to Belleruth Naparstek’s “Stress Hardiness Optimization” CD — especially the last 2 tracks for relaxation and restful sleep. I put on my headphones and play the last 2 tracks, and I’m usually asleep by the middle of the first track. If I can’t sleep by then, I’m usually under a few minutes into the “restful sleep” track. In fact, it’s worked so well that I haven’t the faintest idea what’s at the end of the “restful sleep” track, since I’ve slept through it over and over.

I make a point of listening to the CD every day for several weeks, then I’ll take a little break, and go back to it. I’m a real believer in it, and since I’ve become  increasingly sensitive to Benadryl (it knocks me out too much over the following days – it has a very long half-life), the guided imagery has turned out to be my “prescription” of choice for insomnia.

So, now I know I have tools to help me sleep when I need it. And that takes the pressure off… which also helps me relax… and sleep.

More talk about resiliency

There seems to be something in the air… Human resiliency in the face of trauma is on my radar again.

Over at the NICABM blog, there’s a post about Trauma Recovery with Tibetan Monks that I found really interesting. The video is a short blurb/(promo?) for a teleseminar with Dr. Michael Grodin who is the co-director of the Boston Center for Refugee Health and Human Rights. While I’m not a huge fan of using YouTube as an advertising vehicle (I like to watch videos that are self-contained “units” of really useful information — like some of the TBI education videos I’ve watched), I did find it interesting to hear about different sorts of therapy being used to work with survivors of torture, imprisonment, and other trauma.

I also found it informative to hear a little about what can happen to a Tibetan monk who is thrown in jail by the Chinese authorities. “Free Tibet” comes to mind…

Anyway, I’ve been thinking a great deal about my own resiliency, lately. Not only thinking, but living it. The conversations in the back of my head about what I need to do and how and why and when have given way to a more instinctual kind of flow. Even though I’m in a lot of pain, my ears have been ringing at an unbelievable rate, my balance is off, and I haven’t been sleeping as well as I’d like, that’s not stopping me. I’m just going with what seems right to do at the moment, these days, and doing what I can to keep up with my “self-maintenance” and mindful living, and it all seems to be working out pretty well. I’ve got projects in the works I can be proud of, and that I’m quite happy with. It’s good. Very cool things are happening, that are totally unexpected and unpredictable… but still good.

See, that’s the thing — I never know when things are going to turn around for me. Maybe I’ve been hit in the head too often to have a good sense for when things are going to get good again, or maybe it’s just the human condition to be unaware of the Good that lies just around the corner. Whatever the case may be, I’m constantly surprised by good fortune, and it saves my ass time and time again, as I’m slogging away… I just have to hang in there. Eventually, if I keep trying and keep going, chances are good that I’ll happen across an opportunity that will work in my favor.

You just never know…

Yes, times have been tough. Yes, I’ve gotten knocked around a great deal. Yes, I’ve lost a lot and have had to build back my life several times over. Yes, I was homeless at one time. Yes, I worked my way back from the street to a great job and a good profession and the kind of life I can be truly proud of. Yes, I got “body slammed” again, and yes, I cluelessly burned through hundreds of thousands of dollars I’d earned back… in record time. Yes, I’m struggling on a regular basis to find my footing. Yes, I have to work pretty hard at things that others find easy.

But you know what? That’s okay. I’m learning a lot in the process, and I feel smarter as a result –  tho’ whether I am smarter, is another issue ;). If nothing else, it builds character. I know that the idea of character is somewhat nebulous in this 21st century. In fact, it’s pretty much fallen off the radar — nowadays, the ticket to success seems to be popularity and marketability, not so much what you’re made of inside. But that’s not stopping me from developing my own life and my own character… even if it doesn’t make me instantly popular or famous.

Ultimately, what matters most is not what others think of me, but what I think of myself… and the real results of my life.

That’s what I’m focusing on.

Now, back to work…

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.

Beyond the Invisible – TBI Video for and about Military Veterans

I just learned about a 4-part series about TBI from the Brain Injury Association of NY Military Veterans Project. Check it out – it’s great!

Beyond the Invisible

Part 1 http://www.youtube.com/watch?v=G5eWersQdRw&feature=related

Part 2 http://www.youtube.com/watch?v=TwsGzRLTRqY&feature=related

Part 3 http://www.youtube.com/watch?v=ADC93aoVkP8&feature=related

Part 4 http://www.youtube.com/watch?v=7QBnACJ7eAQ&feature=related

Yet more thoughts on TBI and mental illness

This morning (6/9/9), I took a gander at the ways people have been finding their ways to this blog since I first started it over a year ago.

  • 38 people got here by looking for info about TBI/brains and anger/rage
  • 86 got here just searching on tbi
  • 156 got here by searching for info on interviewing
  • 39 people got here by searching for brain info
  • 225 people found their ways here by searching on tbi and mental illness

Apparently, it’s something people are concerned about.

And so am I.

I’m worried. Really, really worried. Because this society seems all too eager to label people “mentally ill” when they really have logistical problems — it’s not necessarily that they aren’t thinking properly, ’cause of some inner psychological conflict going on — it’s that they can’t think properly, ’cause their brains have been rattled or somehow impacted.

And our society seems all too eager to prescribe medicines for psychological conditions — meds which may actually exacerbate the issues at hand.

For instance, as I understand it, the irritability and temper flares that come with TBI are often due to a “constant inner restlessness” that takes up residence in your head after a brain injury. That constant restlessness can be directly related to something called “tonic arousal” which (as I understand it) has to do with how awake your brain is. After TBI, certain functions slow down — processing slows down, connections that were once intact are now broken, so it takes the brain longer to sort things out. And with that slowness comes a decrease in tonic arousal… which also can lead to attention difficulties… which can feed into all sorts of problems that can make you nuts and drive you to distraction.

TBI >>> less tonic arousal >>> increased irritability >>> more meltdowns, rage, blow-ups, etc.

Now, let’s say some doctor or psychiatrist gets hold of a TBI survivor and diagnoses them with some anxiety-related condition, or some other “psychological” dysfunction. Let’s say the attending caretaker prescribes one of those “downregulators” that slows down the processes that can feed into manic/anxiety type experiences. What do you get when you downregulate someone who’s already struggling to keep up? Decreased tonic arousal. Which can mean more irritability, more temper flares, more rage, more meltdowns… possibly increased violent acting out? Maybe?

Downregulating meds >>> even less tonic arousal >>> even more increased irritability >>> more and more and more meltdowns, rage, blow-ups, etc.

I’m not a doctor, but I don’t think you need to be one, to get this connection. Maybe not being a doctor helps you see it all the clearer, without the long-term effects of that sleep-deprived-traumatized-resident fog that lots of docs get hammered by when they first start practicing.

This really worries me — had I mentioned that?

And given how many people sustain TBIs each year, not to mention how many vets are returning from Iraq and Afghanistan with TBI’s and PTSD, etc., it really opens the door to a lot of crappy medicine and pain for the families and friends of the folks who have given their very brains in service to this country.

I think the only thing we can hope to do is educate people — not so much the doctors, because how many of them are listening? It’s about educating “the people” — the patients who look high and low for help (if they ever figure out that they need — and can get) help. Making sure people have access to truthful and accurate and independent information — and giving them easy and useful ways to wield that info as they defend themselves from the quacks of the world, not to mention Big Pharma.

Ultimately, it is up to each and every one of us to fend for ourselves, but a little help would be nice, now and then…

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.

I really need to feed myself

I’ve been working my ass off, lately, being busy-busy-busy, and I’ve developed a nervous twitch on the right side of my face, so I know I need to do some “radical self-care”. Switch gears. Change direction. Take a break.

I did take a nap this afternoon, which is good, but it was only an hour. I feel like I need more.

I’m getting increasingly worried about money — who isn’t? I had a dream last night about not being able to find or keep work, having to dress in “drag” as a member of the opposite sex, in order to get hired, and having to switch back and forth between being a man and a woman, in order to make a living.

It’s sorta kinda freaking me out.

Not that there’s anything wrong with being a member of the opposite sex, but the pressure of having to pretend to be something I’m not really made me nuts in the dream. And, like so many other Americans these days, I worry a little more each day about being able to make my mortgage payments.

Well, I’ve been in really tight spots before, and I’ve always managed to come through. I just need to keep my head clear and steady and keep putting one foot in front of the other. Stay loose. Stay as relaxed as I can. Do relaxation exercises — deep breathing, too — to keep my parasympathetic nervous system engaged, and keep my whole system from frying. Keep doing my job at work, and keep my resume fresh and up to date.

Just tend to the basics, and don’t take anything for granted.

Double-check my assumptions — especially when I’m positive I’m 100% correct.

One way or another, things will work out.

I have to believe that. Or else.

And I have to keep my strength up. I’ve been working, working, working, yes, but sometimes a person needs to play. I’ve been focusing so intently on all the stuff I’ve got to fix, that I have at various points along the way, failed to acknowledge the things that are going right with me. And I’ve not always give myself the chance to recover and recuperate from my mad-and-intense drive to make right the things that go wrong with me.

But if the central nervous system has anything to teach me/us, it’s that you can’t keep going-going-going all the time. At some point along the way, you really need to take a break and let yourself get back the reserves you’ve depleted along the way. That means taking more naps. Eating good food. Getting to bed at a decent hour. And not getting down on myself for cutting back on my activities.

Just today, I cut short an outing that was starting to wear on me. It’s a beautiful day here, and I wanted to be out and about, active and engaged and having a grand time. But I just couldn’t. I ran out of steam. I lost my temper a few times. I got overwhelmed by all the activity around me, and I realized I was really tired and needed to sleep.

So, I had someone take me home and I took a nap. I needed a longer one, I think, but I did get about an hour’s worth of sleep, which is something.

I need to feed. Restore myself. Get back what I’ve spent. Replenish my stores.

I need to feed myself, so I can be human again.

The Magic of “Analgesic Stress”

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

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

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

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

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

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

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

Re-experiencing the traumatic event

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

Avoidance and emotional numbing

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

Increased arousal

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

Other common symptoms

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

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

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

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

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

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

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

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

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

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

And analgesic stress lets me do just that.


A Perilous Relief – Table of Contents

Cognitive skill-building doesn’t matter?

I had a good meeting with my neuropsych this past week, and they informed me that my insurance carrier may not be paying for cognitive skill-building in the future. And I’m with “the really good plan” that I chose specifically because of its coverage in this area.

Not to be glib, but it’s their loss. Ours, too. But especially theirs, because if they don’t make it possible for those of us with MTBI to cognitively rehabilitate, how can we be expected to fully re-integrate into society and hold down jobs that make insurance possible?

I would become deeply outraged over this, but I am very tired and I have a lot of work to do this weekend, before I head back into the fray on Monday. I have to pick my battles.

I guess if that happens, I’ll have to find other ways of rehabbing myself — perhaps all by myself, yet again. I would dearly love to get some help from people who are professionally trained in a rehabilitative calling, but it may not be in the cards.

I suppose if it came down to it, I could always sell a kidney…

I’m only half-way being flippant. For me, cognitive rehabilitation — which I would expect to translate into skill-building in anger management, behavioral issues, as well as communcation — is such a critical thing. Cognitive/behavioral competence is at the heart of any responsible, adult, mature, self-directing person’s capabilities, and when that goes, so much else does, too.

As someone said to me recently (I’m paraphrasing) — people with uncontrollable cognitive behavioral issues can actually have a harder time living their life than someone with paraplegia. Their personal relationships break down, their families dissolve, they cannot keep jobs… basically, everything goes to shit. And they need help dealing with it.

So, remedying those kinds of issues, it seems to me, is not exactly optional. Any money that an insurance company spends on rehabilitating people with TBI, be it mild or moderate or severe, is not an expense. It’s an investment. And it should not be one of those “optional” “extras” that they can just blithely dispense with.

The cost of not paying for it, is much, much higher.

Time to do some chores.