Website for Veterans with TBI/PTSD at Work

America’s Heroes at Work
Supporting the Employment Success of Returning – Service Members with TBI & PTSD

This website “a U.S. Department of Labor (DOL) project that focuses on the employment challenges of returning service members living with Traumatic Brain Injury (TBI) and/or Post-Traumatic Stress Disorder (PTSD).”

Bravo! Brava!

The site has good information that’s straightforward and to the point. I would like to see more detail, but I think they’re a fairly new site, and they’re still under construction.

If I ever am in need of support in telling my employer about my TBI(s) and/or coming up with solutions for dealing with my challenges, I’ll definitely point them to this website.

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Reverse-engineering my “depression”

I’ve been thinking a lot, lately, about whether or not I’m depressed. I posted yesterday about how someone asked me if I wanted to end it all, and how I said NO, in no uncertain terms.

I’m getting ready to go see my doctor in a little bit, and the first time we met, they thought I might be depressed. They told me so, the second time I went to see them.

Here’s the thing: Going to see a doctor who thinks you’ve got a problem, and who is in a position to “do” something about that supposed problem puts me in a precarious position. I’m not a big fan of pharmacological solutions for emotional issues — some people are chemically and clinically depressed, there’s no disputing that. But if I’m not chemically or clinically depressed, but I’m medicated as someone who is, might that not complicate things even more for me – even more than they already are?

I mean, I have a hard enough time keeping up with my life without my senses being dulled and my processing being interfered with by meds. Plus, some anti-depressants have been shown to produce suicidal behavior in some folks. That’s about the last thing I want.

In my seemingly eternal search for what’s going on with me, what — if anything — I can do about it, and how to best make the most of my amazing life, I have found it quite helpful to first seek to understand the underlying facets and aspects of my situation, before coming up with a solution for what appears to be wrong. I’m an engineer by nature, so in order to move forward with courses of action, I need to understand what all is involved, what the different considerations are, and what my desired outcome is.

Here’s what I think about the “depression” that others seem to think they’ve observed with me:

The first time I went to see my doctor, I was in a pretty wary state. I have not had a lot of luck with physicians over the years, and I have a lot of trouble communicating. I am very aware of doctor-patient power dynamics, and the situation tends to make me nervous. I haven’t the faintest idea, sometimes, how to behave in a way that makes a doctor believe I’m a nice person — I get agitated, and when I do, I can get defensive, combative, argumentative, passive, aggressive, non-verbal… you name it. When I perceive myself to be in danger — and going to the doctor sometimes makes me feel that way — my worst symptoms get triggered and I resort to behavior that is not productive. If I could stop myself or alter that, I would be happy to. But when I perceive my personal safety and self-determination to be fundamentally threatened, well, all bets are off.

Anyway, when I’m in this place, it’s not good. And I’m keenly aware of it. So, when I went to see my current PCP for the first time, I was bound and determined to be on my best behavior. My relationships with my 3-4 prior doctors (I’ve had at least that many, over the past 10 years) ended on sour notes, all across the board, and I didn’t want that to happen again. I HAD to at least try to get off on the right foot with this doctor, who was recommended by someone I really trusted (a rare thing). I did not want to completely screw up my new relationship. I wanted to build a working partnership that could really work.

Needless to say, I was a bit stressed, going into the office. I was on high alert, trying like crazy to make sure I didn’t say or do something that would completely irritate, antagonize, and alienate this individual. It was almost like holding down a wild animal … trying to hold back a large, aggressive dog on a leash… All the past failures with doctors kept running through my head, and all I could think was, “Don’t screw this one up… Don’t screw this one up!”

I thought the conversation I had with the doc went really well. I liked them and they seemed really on the ball. Engaging and compassionate and highly intelligent, not to mention a little intuitive, which can be helpful when I’m at a loss for how to communicate to someone. I wasn’t rude, I didn’t say or do something that was completely inappropriate, I didn’t lash out, I didn’t make a snide comment about something that alarmed me, I didn’t make myself look like a total fool. I was poised — I thought — and polite and coherent. I was really happy.

But when I went back, the second time, the doc said they thought I was depressed.

I suppose on the surface it might look that way — apparently low energy,flattened emotional effect, slow responses… Over at The National Institute of Mental Health, they say:

Symptoms include:

* Persistent sad, anxious or “empty” feelings
* Feelings of hopelessness and/or pessimism
* Feelings of guilt, worthlessness and/or helplessness
* Irritability, restlessness
* Loss of interest in activities or hobbies once pleasurable, including sex
* Fatigue and decreased energy
* Difficulty concentrating, remembering details and making decisions
* Insomnia, early–morning wakefulness, or excessive sleeping
* Overeating, or appetite loss
* Thoughts of suicide, suicide attempts
* Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment

And on the surface, it looks like a lot of them could have applied to me.

But check it out — I didn’t have low energy. I had extremely HIGH energy. And I was just trying to keep it reasonably bottled, reasonably civil, reasonably managed. I was irritable and restless, yes, but hell, I was trying to establish a new relationship with a person who ultimately has a fair amount of sway over my life — and in ways I’m not always comfortable with. Plus, the difficulties concentrating, remembering details, and feelings… hello, can we say TBI symptoms? I mean, come on… not every mental challenge is psychological. Sometimes there are logistical and physiological reasons for what goes on with me.

Now, the thought occurs to me that the fact that I’m a long-term multiple tbi survivor could make my anaylsis suspect in the eyes of the experts. After all, I supposedly am brain-damaged or something like that… (to which I reply, “Who isn’t?”)

But if there’s one thing I know, it’s my experience, and as much as the established experts may disagree with my habit of self-assessment and analysis, and they may say I have no standing to diagnose my own condition, the fact remains that there’s a whole lot in my experience that I cannot now — and perhaps never will be able to — express verbally. There is a lot inside me that may never get out. And the people who have the power to medicate me, commit me, lock me up, or tie me down, can never know the full spectrum of feelings and thoughts and experiences inside this singular head of mine.

Anyway, I’m getting all agitated, and I want to chill out before I go see my doc again.

So, I’ll quickly talk about my therapist, who the other day asked if I wanted to end it all.

NO, I didn’t want to end it all. I was tired, I was taxed, I was coming off a neuropsychological testing session that brought me nose-to-nose with some of my most persistent issues and made me feel like crap. Plus, I was having major sensory issues — with my hearing and my vision being so sensitive, they were driving me nuts. And my familiy situation has been tense, off and on, with money being something of an issue, and my job situation being under the gun. I was trying to sort things out in my head, trying to keep my balance, trying to just get clear on some things, and I was feeling physically low. I was also concerned about my safety, since I was driving home later at night, and I’ve been having some problems dealing with the headlights of oncoming cars.

My mind, quite frankly, was really over-taxed with trying to figure so many things out and trying to come to terms with a lot of stuff in my experience that hasn’t been pleasant, but has been… there. If anything, I wasn’t depressed — I was over-stimulated, and I was trying to sort things out. I was trying to just stay chilled and not freak out over all the unknowns in my life. I wasn’t depressed — I was busy thinking things through and trying to keep my balance. Trying to keep civil. Trying to be productive and pro-active. And I was tired.

I think the big reason I get freaked out over the idea of anti-depressant medications, is because the last thing I want/need when I’m in a place like that, is to have my brain slowed down and interfered with. I need ALL my faculties to figure out my life, sometimes, and if I introduce medication that mucks with my mind — even if it makes me feel a little better — then my most important coping tool is compromised. The very thought of slowing down my thinking or interrupting the natural flow of my brain — even if that natural flow is uncomfortable or “depressing” at times — really concerns me, and I feel like my very survival is being threatened.

I can’t just jump on the pharmacological bandwagon, in hopes of patching up little bumps in the road. I need all my faculties, even if they are impaired in some ways at some times, to get by in the world. And if I spend my energy — or divert it — to smooth over the little issues, then the bigger core issues may be overlooked and never constructively addressed.

For those who are in need of anti-depressant medication to get through life… who are otherwise incapacitated by depression and are in danger without intervention, I say “Mazal tov and good fortune to you.”

But when I just seem a little “down”, I’m not necessarily depressed. Could be, I’m just working really hard to keep my head clear and function in a productive, polite, pro-active manner that doesn’t pose a risk to myself and others, because my brain sometimes misfires when it’s under pressure.


Checking my stats from the past few days…

One of the things I really like about WP vs. Blogger is — I get better ideas about how people are finding me here.

I’ve been looking at how people find this blog, and I’ve found the following searches recorded by WordPress:

  • polytrauma
  • i’m a tbi survivor
  • interview doesnt go well
  • caffeine and mild traumatic brain injury
  • “losing track of conversations”
  • anxiousness lack of appetite trouble fal(ling asleep?)
  • losing one’s mind in injury to the brain
  • tbi ptsd
  • how do you know that interview did not g(o well?)
  • mtbi blog

Apparently folks are looking for information about jobs and brain injury and ptsd, which is right up my alley, since all three of these are very interesting, important and pertinent to me.

About PTSD, I have to say that just living each day as a TBI survivor (even a mild one) can be traumatic in and of itself. We live in a culture that doesn’t understand the issues, even though it’s impacted daily (and in very violent and extreme and negative ways) by TBI’s of all kinds. Tons of people have car accidents, experience whiplash, get knocked in the head. Lots of kids hit their heads during sports matches and are never treated. Battering and domestic abuse causes brain injury, as well, not to mention fights and brawls and drug/alcohol related incidents. And then we have the falls… don’t get me started.

That being said, dealing with a world that is impacted by TBI can introduce all sorts of trauma — from dealing with folks who have had injuries themselves, but don’t realize it, to dealing with people who have been victimized by TBI survivors and are “triggered” by your demeanor and/or actions. Also, when you’re living with a hidden disability, there’s the danger of over-extending yourself without realizing it. We live in a very go-go-go culture that’s not big on getting enough rest and eating right, so when we’re fatigued, we TBI folks can make poor decisions and do things we really shouldn’t – like driving too fast or too slow… like taking risks we normally wouldn’t. And that can lead to yet mor injury, in my experience.

TBI is much more common that most people realize, but because it has to do with the brain, most folks are just plain afraid to approach the subject. But knowledge is power, people. And what we know can really help.

It can also really help therapists or folks who are treating ptsd — there’s not nearly enough experience and education with regard to tbi in therapeutic circles, in my opinion. I think there may be a reluctance to factor in neurological issues, when doing psychotherapy, which is understandable, as neurology is a somewhat esoteric field — especially for LICSW’s and MSW’s and other sorts of counselors who don’t have medical backgrounds. But it’s really, really important to realize that tbi can — and often does — play a part in certain issues. So that the real problems can be addressed, instead of trying to track down the emotional root of some issue that’s actually neurological/physiological in nature. I cannot stress this enough. I could write a whole book on this important issue… and maybe someday I will.

With regard to coffee and tbi — I was being evaluated by a neuropsychologist a while back, and when he found out I’d had some coffee, he cut the session short and told me the results wouldn’t be accurate. So, measuring the performance of the brain on caffeine is not accurate, apparently, which tells me that caffeine may cause the brain to function artificially well. Or it can skew the performance in some way. That tells me that while coffee may be useful to me as a short-term solution to fatigue, ultimately, it may cause me to have “false” confidence… and possibly lead to more poor decision-making.

losing one’s mind in injury to the brain… Yes, sometimes it feels like it can happen. But learning about tbi and recognizing what’s “just your brain playing tricks on you” can go a long way towards easing the stress. I have found that the first step towards dealing well with my strengths is recognizing my weaknesses and learning not to step into those holes. It’s like walking down a dark, rocky, washed-out path over and over again… until you realize where the rocks and holes and roots and gulleys are, you’re going to keep stepping in them. Best to find out where they are, so you can walk around them and stop injuring yourself. You don’t have to be down on yourself about it, you don’t have to beat yourself up about it. Just learn where you’re less than perfect, and work with that.

You can’t fix something, if you don’t know it’s broken. And there are ways to fix — or at least address — some of the issues that come along with tbi.

As for interview stuff… Well, time generally tells if the interview didn’t go well.

Stay strong, everyone.

BB

When they think your TBI is PTSD

I just checked my blog stats, and somebody came over to this site while Googling for info on soldiers and PTSD.

I want to quickly put in a word for military folks who are seeking help for post-combat/deployment issues, who may be headed down the PTSD treatment road, but may miss TBI treatment in the process.

I started professional counseling about six months ago for “coping issues” that I couldn’t get my head around. Everything in life had just gotten so difficult, and I couldn’t understand why I kept running into dead ends with jobs and relationships and why I couldn’t seem to advance in life. All my peers have “moved on” and “grown up” — many of them now with grandkids and advanced careers, long-term homeownership, and all the accoutrements of adult life… while I languished in a no-man’s-land of false starts, scattered ideas, and a long line of failed or aborted attempts at living a normal life.

Now, don’t get me wrong — on the surface, my life looks like it’s highly advanced. I’ve got a great home, a wonderful marriage, and two cars in the garage. My resume looks fabulous, and I’ve got a lot of respect from folks. But my external circumstances don’t match my internal state… and they haven’t for a long time. Nobody really knows just how deep the self-doubt, anxiety, self-criticism, abysmally low self-esteem, and constant invisible struggle really goes.

Except me. And I don’t breathe a word of it to anyone. Not if I can help it.

So, when my health and career and personal life all started to tank in a very big way, this past year, I sought professional help. The counselor I found is highly experienced, compassionate, insightful, kind, caring, and very adept at what they do. But I found myself over time feeling as though they were looking for some sort of horrific trauma in my past that would cause me to lose big chunks of my memory, be uncertain around people, and erode my emotional and behavioral (and cognitive) foundation.

I got the distinct impression they were looking for emotional trauma. Abuse. Neglect. Some sort of terrible thing(s) others did/do to me that cause me to have PTSD. Or some life-threatening event that brought on PTSD.

We had talked about post-traumatic stress a good deal, and both of us accepted that it could have a part in my difficulties. But no matter how closely I looked at my life, I couldn’t for the life of me find THE Event(s) that had wrecked me for “normal” life.

It just didn’t make any sense to me. And when I dug deep and did my own research and realized that sustaining a traumatic brain injury at the age of 8 (and possibly other times), as well as another TBI three years ago, did actually fill in a huge, gaping missing piece of the puzzle.

It’s not that my counselor was incapable or incompetent. They were just looking for the wrong thing in the wrong place. They’re a wonderful resource for me, and I really value their input, but in the case of TBI, I had to come up with my own diagnosis.

This article was very helpful:

Concerns grow about war veterans’ misdiagnoses – Brain injuries can defy easy detection” – I passed it along to my counselor, and they found it very helpful… as well as a bit disconcerting.

And the blog “A Soldier’s Mind” has some more info.

If you’re in the same boat I am/was, you may need to do your own research & preliminary diagnosis, too. After all, TBI tends to make it very difficult for people to tell what’s going on inside our heads — and it can make it tough for us to figure that out, too. Doing research online is a great way to make a start.

I’m finding that TBI is not particularly well-known in the psychotherapeutic community — I have a bunch of friends and associates who are therapists, and when I’ve talked about TBI, I’ve gotten blank stares. That’s not entirely their fault. They aren’t always trained to look for physical ailments, which are the domain of medical doctors. If anything, they’re taught to look away, in terms of medical issues — liability issues, I suppose. Unfortunately, there seem to be a lot of highly trained individuals who simply don’t have the kind of physiological orientation that treats cognitive-behavioral symptoms as possible neuro-physiological phenomena. They are accustomed to looking at emotionally traumatic life experiences as the root of PTSD problems. They’re looking for the right thing… but they’re looking in the wrong place.

I really want to devote a fair amount of time and energy on this site to explaining to psychotherapeutic professionals the personal realities of living with TBI, as it relates to trauma. There are different aspects of the condition that both mask post-traumatic stress and exacerbate it. TBI adds another wrinkle to the whole scene that complicates matters and requires greater sensitivity to our situation.

When I informed my counselor about my TBI, they seemed a bit concerned that I wouldn’t need their help anymore… or that I’d terminate my sessions with them. They seemed to think that TBI work would replace the cognitive-behavioral work I was doing with them. But in fact, the TBI aspect makes it even more important to do cognitive-behavioral counseling. It doesn’t make counselors superfluous. If anything, it makes them all the more essential.

Other posts about PTSD:

Better today… of pain and ptsd

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