Rage, rage and more rage…

I’ve had a bunch of people finding their way to this blog, looking for info on rage. Road rage. PTSD. Anger. All that.

It’s getting late, and I need to finish my taxes, but let’s consider for a moment how the ‘rage thing’ works with TBI.

The brain gets its wires crossed.

It doesn’t quite understand why it’s getting confused.

It revvs up and goes into overdrive, trying to get things sorted, but it keeps getting stopped.

Meanwhile, the rest of the world is like, “Come on! Hurry up! What’s taking you so long?!”

And the adrenaline gets going.

And it goes and goes and goes, and the parts of the brain that can usually talk it down are impaired, so it never gets chilled out. And the ptsd kicks in. And the whole works gets churned up.

Rage, rage, and more rage…

And that’s not even talking about possible seizures.

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The physiology of anger

Speaking of temper…  Here’s a blog post that talks about the physiological impact of anger.

This is pretty important, especially for TBI survivors. Anger and temper flares are very widespread among folks who have experienced head injury — even mild traumatic brain injury — but even so, they are woefully under-researched.

Personally, I feel there’s not nearly enough good information out there for folks to use — both survivors, family members, and the doctors who help them. It’s a problem.

I’m in the process of documenting my own anger/temper issues, talking about how I experience them, and describing ways I’ve found to deal effectively defuse — or at least deflect — the temper flares I have. And believe me, I do have them. Especially after my last TBI.

Sudden, extreme, inexplicable temper flares can be emotionally, socially, and physically debilitating. From the blog post I mentioned above, here are some of the ways anger affects our bodies:

  1. Muscles that are needed to fight or flee become very tight, causing an “uptight” feeling.
  2. Chemicals known as catecholamines are released causing us to experience a burst of energy (which causes a sugar deficiency, so that an angry person may “shake from anger”).
  3. Heart rate accelerates: Because of our anger, the usual (average) heart rate of 80 climbs to 180 beats per minute.
  4. Blood pressure rises: An average blood pressure of 120 over 80 suddenly soars to 220 over 130, sometimes even higher.
  5. As the body prepares for survival, it safeguards itself against injury and bleeding. Likewise, an angry person’s body releases chemicals to coagulate (clot) the blood, creating a situation that’s potentially dangerous. Although there is no physical injury, the clot is formed, which can travel through the blood vessels to the brain or heart.
  6. Rate of breathing increases to get more oxygen into the body.
  7. Increased blood flow enters our limbs and extremities.
  8. Attention narrows.
  9. Hormones (adrenaline and noradrenaline) are released which trigger a lasting state of arousal.

Furthermore…

“If anger has a physiological preparation phase during which our resources are mobilized for a fight, it also has a wind-down phase as well. We start to relax back towards our resting state when the target of our anger is no longer accessible or an immediate threat. However, it is difficult to relax from an angry state. The adrenaline-caused arousal that occurs during anger lasts a very long time (many hours, sometimes days), and lowers our anger threshold, making it easier for us to get angry again later on. Though we do calm down, it takes a very long time for us to return to our resting state. During this slow cool-down period we are more likely to get very angry in response to minor irritations that normally would not bother us…. High levels of arousal (such as are present when we are angry) significantly decrease your ability to concentrate.”

Which means, the naturally hyperaroused, hypervigilant, brain fog state in which we already exist is only exacerbated by anger. We need to consider this. We need to see ourselves. We need to make a change.

Our bodies are already stressed, tensed and on edge any normal day. Why make it worse by not controlling our anger? It is, after all, an emotion that is within our capability to focus, modulate and contain.

Indeed.

The long-term effects of too much uncontrolled anger are in the same ballpark as the effects of long-term unaddressed PTSD, from what I can tell. In both cases, the physical system is dragged down, day after day, week after week, month after month, year after year… and what do we have to show for it? Yet more stress.

That being said, I wish I could say I just have PTSD, but my TBI makes it even more difficult for me to parse things through and manage my anger at times. I have to follow specific guidelines to keep myself in check, and I need to keep an eye on myself on a regular basis, lest my anger/temper/freak outs get way out of hand. I’ve lost jobs because of temper flares. And I’ve hurt a lot of people  I care about. Uncontrolled temper flares have done plenty of damage to my heart and the hearts of others. So, I owe it to myself to keep my anger in check.

And I owe it to myself to keep in mind the physical effects that uncontrolled anger has on me. Somehow, my brain finds it easier to wrap itself around objective, non-emotional reasons for staying chilled — like the physiological effects  listed above.

Objective data is one more tool in my toolbox for living well, despite multiple TBIs.

Oct.9.2011 – And here’s one more tool I’ve discovered since I first wrote this: TBI/PTSD anger management by using the breath

Hello, Officer… A Temper Flare (Almost) Gone Wrong

What a beautiful day it was! The mid-winter sky was bright and blue, and the sun was finally showing its shining face after days of inclement weather. Driving home from work, I gazed around me at the gorgeous landscape. A thick blanket of fresh new snow covered the fields on either side of the back road home, softening the stubble-covered terrain. Intermittent stands of woods were silent with insulating white, trees sleeping silent beneath a delicate frosting that broke loose in passing breezes and showered to the forest floor in a sparkling cascade. Babbling brooks flanked the country road, here and there, cascading cheerily down rocky beds, icicles dangling from sticks and grasses which hung close enough over their splashing course to catch — and instantly freeze — splashes from the snow-melt swollen streams.

I was on my way home from my new job to my new house, and as I gazed around me at the beautiful scenery, it felt as though my life were being made new again. The stress and strain from the recent move from the suburbs to the country had tested my endurance sorely, and all but exhausted my strength. The transfer from my old job had not been without some challenge, as well. Change is never easy for me, and adjusting to not only a new home in a new place with new neighbors, but also a new job with new responsibilities and new coworkers, had turned my post-holiday season into a see-saw of elation and despair.

But after weeks of settling in, getting acclimated, developing my new routines, and finding better ways to drive to and from work than the freeway filled with aggressive drivers, I was finally starting to feel my balance returning.

That day, as I motored happily across the countryside, making it home before dark (for once), everything seemed like it was falling into place. I had the radio on — loud — and my spirits rose with the energetic dance beat. My little car — a late model hatchback with a funky heater — had finally warmed up, after running for 10 minutes. I was making good time, and I’d be home soon.

Or was I? I suddenly looked up at my rear-view mirror, and lo and behold, there was a local cop with his lights flashing… coming on fast. I instinctively took my foot off the gas and glanced down at the speedometer. The needle drifted quickly south from around 45 mph… and I looked up as I passed a sign that said I was in a 20 mph speed zone. Shit! I had been so busy listening to music, and thinking about getting home, I hadn’t even noticed the speed limit. Maybe he was after someone else, I thought for a moment… But no, as I slowed down, so did he. I braked, signalled, and pulled over to the side of the road, and he pulled in right behind me.

*&%! I thought to myself. How could I do something so stupid?! I knew that this stretch of road was where the local cops hung out. I’d passed them plenty of times before, as they lay in wait of commuters taking the back way home. A wave of angry frustration welled up in me, and my head began to spin as the officer got out of his car and approached. I could feel my pulse quickening, a roar in my ears starting, and my gut churned as I started to build up a head of steam. All I wanted to do, was get home. All I wanted to do, was get through this town. All I wanted to do, was put the tough day behind me and relax in front of my fireplace. I didn’t ask for much. And I didn’t mean to speed through this town. I just lost track of how fast I was going! What the hell was this cop pulling me over for? Didn’t he have other real criminals to catch? What the fuck?!

I could feel the indignation rising in me, with every approaching step of the cop. Strings of profanity coursed through my head, and my gut continued to constrict as my hands tightened around the steering wheel. I couldn’t believe I’d been stupid enough to speed. I couldn’t believe this cop had been that stupid to pull me over. Everybody was a fucking idiot. Jesus fucking Christ.

The cop reached the side of my car, and I rolled down the window.

“Do you have any idea how fast you were going?” he asked.

“Too fast?” I heard myself say. It sounded smart-assed, and he didn’t like that.

“License and registration please,” he said, and I pulled my license out of my wallet and handed it to him. Still seething, I reached into the glove box to find my registration. I always kept it in the same place — in a long sleeve that held my insurance papers as well. But as the crashing ocean of agitation crashed in my head, I had trouble finding my papers. I couldn’t find my registration. I couldn’t find my insurance stuff. I couldn’t find anything… and I started to lose it. The cop at my window was getting impatient, and when he prodded me to come up with my papers, I snapped at him that I was looking as fast as I could. I finally just pulled everything out of the glove compartment and spread it across the passenger seat.

“Is this your car?” the officer asked, with a wary edge in his voice.

“Yes, it’s my car!” I barked. “I’ll have the registration in just a minute. I know it’s in here somewhere…”

My vision was getting cloudy and blurred, as I sorted through the mess on the seat beside me. Finally, I found the sleeve, pulled out the registration paper, and handed it to the cop. But after taking a look at it, he handed it back to me.

“This isn’t current,” he said. He sounded like he was talking to a criminal.

A wave of resentment washed through me, pushing to unleash some crack or curse.

I took the paper from him and examined it more closely. Sure enough, it was from a few years back. Consternation welled up in me, and I bit back the curse that sat on the tip of my tongue. I ran through the rest of the contents of the sleeve — there were plenty of registration papers there, but none were current.

The cop pressed me for the papers, and I snapped at him again, “I’m working on it!” I couldn’t believe this shit. I rummaged once more through the pile of stuff on the seat beside me — ice scraper, breath mints, tissues, various receipts, notepads, souvenirs, tools, more papers… where was my goddamned registration!?

“Are you sure this is your car?” the officer asked.

“Yes, it’s my car!” I snapped. “Just give me a second…!” I cringed at the edge in my voice, knowing — from past experience — that police officers don’t respond well to aggressive disrespect. I’ve had several run-ins with cops over the years that escalated when I spoke out of turn or got verbally aggressive with them. A few times, I came close to being arrested, and I couldn’t afford to have something like that happen today. Not when I had this new job and a new house. I just couldn’t afford to get on the bad side of the local cops.

If only he would give me a second. Just one more moment…

But he wasn’t having it. I heard him turn and go back to his car, and when I looked up in the rear-view mirror, I saw him back in his car punching something into his onboard computer. He kept looking at my license plate and then back at his computer, and it looked like he was talking on his radio, too.

What the hell…? I couldn’t believe I’d gotten pulled over… I couldn’t believe I couldn’t find my registration papers. I distictly remembered renewing my registration just a few months before, and I distinctly remembered putting the papers in my glove compartment. Where the hell were they? Where the fuck had they gotten to?!

Suddenly, as though by magic, an envelope from the Registry of Motor Vehicles appeared before me. Inside was my current registration. It wasn‘t in the sleeve where I always put it. It wasn’t in the one place I was sure to find it. Like an idiot, I had just tossed it in the glove compartment. Stupid, stupid, stupid. I pulled out the paper and double-checked the dates to make sure I wasn’t going to make an ass out of myself — again. Then, I waited for the cop to return.

He did… with a citation in hand.

“Here’s my registration,” I said, using as neutral a tone as I could muster. I handed him the delinquent paper.

He took a long look at it and then took a longer look at me and my license.

“You should have found this sooner,” he said, handing them back to me, along with the ticket. He sounded like he wasn’t sure what to do with me — let me off the hook or cuff me and haul me into the station.

I shrugged, biting back words that I was afraid might provoke him even more.

“I had to run your plates, so now I have to have a record of this stop. I’m just giving you a warning, this time, but it’s on your record.” He sounded a little regretful, but also irritated with me. “If you had gotten your registration, I wouldn’t have had to run your plates.”

I wanted to say, “If you hadn’t been in such a godawful hurry and had given me a minute or two, I might have found it in time!” But I held my tongue and just nodded.

As he drove off, I started to shake, my stomach in knots and my torso damp with sweat. I felt like I’d just dodged a bullet… a bullet I’d stepped right in front of.

Of pain and agitation and PTSD

I am really excited to report that my pain has subsided considerably. The inflamation across my iliac crest — the top of my pelvis at my lower back — has really gone down, to the point where it’s a little painful, but it’s more discomfort than pain, now.

Also my skin is not as sensitive to every contact, like it was. I still have my moments, when I start to sting and throb and my clothes hurt me, but when that starts to happen, I press the pressure point on my hand that I talked about in this post, and I take a few deep breaths to chill myself out and stimulat my vagus nerve, and I do a quick check-in with myself to see if I’m getting agitated about things.

Agitation really seems to get to me physically. Anxiety, too. When I’m worked up, everything feels more intense. So, calming my system down really seems to help matters.

Looking around, I found a June 2001 post from Science Blog that speaks to this. It’s ‘old news’ — over 7 years old — but it makes for good reading, and it really put things in perspective for me.


From Texas A&M University

Fear, anxiety affect pain

COLLEGE STATION, June 12 – Human emotion can be a powerful force, fueling everything from improbable sports championships to tragic acts of violence. Now there’s evidence showing how powerful human emotional states can be when it comes to determining a person’s ability to feel pain.

Texas A&M University psychologist Mary W. Meagher, who has conducted pain research for 16 years, says two emotional states – fear and anxiety – have profoundly different effects on a person’s ability to feel pain.

“Fear and anxiety have divergent effects on pain reactivity in humans: fear reduces pain, whereas anxiety has a sensitizing, or enhancing effect,” says Meagher, who holds joint appointments in clinical psychology and behavioral neuroscience.

Her conclusions are based on her and graduate student Jamie L. Rhudy’s recent work focusing on the role of human emotion on pain. Previous animal studies have suggested that fear inhibits pain and anxiety enhances it, but Meagher’s results support the view that emotional states influence human pain reactivity.

“From a clinical perspective, these data suggest that a patient anticipating an unpredictable threatening event will experience enhanced pain,” she says. “In contrast, a patient that has been exposed to a threatening event will experience a fear state that inhibits pain processing.”

Meagher believes previous conflicting reports of the effects of anxiety on human pain were due to a failure to properly distinguish between the emotional states of fear and anxiety.

Fear, Meagher explains, is an immediate alarm reaction to present threat, characterized by feelings to escape and accompanied by specific physiological changes. Anxiety, on the other hand, is a future-oriented emotion characterized by anticipation of potential threats.

Fear mobilizes a person to take action – the commonly known “fight or flight” response – but anxiety leads to scanning of the environment and body, resulting in increased sensory input, she says.

With these distinctions in mind, the conclusions make sense from an evolutionary point of view, Meagher notes.

Confronted with life-threatening situations, which would elicit fear, the body reacts by shutting off the pain response because feeling pain might get in the way of survival, she says. “Alternatively, during times of low threat – those times likely to produce a state of anxiety rather than fear – the chance of survival is increased if pain is enhanced so that behavioral responses can occur to minimize tissue damage,” Meagher explains.

Meagher’s work also shows that positive emotions can lead to pain reduction as long as a minimal level of arousal is reached, but negative emotions only lead to pain reduction when they are highly arousing. In fact, she says, negative emotions can actually facilitate pain if they are only low to moderately arousing.


This is consistent with my own experience — I can definitely confirm that in my own life, if I’m presented with a situation that involves a specific, verifiable threat, all my systems kick into action and I can actually perform at a higher level, than if I’m just rolling along in a relatively event-free, stress-free life. I can see better. I can hear better. I can interact with the world around me better. Fear actually forces me to focus — that is, if the fear relates to something that is real and significant.

Anxiety, on the other hand, throws me into a panic and sends me spiraling. I can totally see many examples in my life where non-specific threats “triggered” a hyper response to everything and anything around me. It makes me more sensitive, it makes me more jumpy, it makes me more pain-filled.

And thus the vicious cycle begins… because my hypersensitivity causes me to interact with the world poorly — it makes me sensitive to pain, it heightens my hearing, my eyesight, my sense of touch… everything. It makes me avoid situations I shouldn’t, it makes me choose to wear clothing that isn’t the most socially advantageous. (Note: Wearing a sweatshirt and jeans every time I go out in the world is not sending the best message — if anything, it sets me up to not be taken seriously by other people. In fact, I believe that a number of my interactive difficulties, from dealing with doctors to dealing other professionals/consultants, have been made more difficult because I chose to wear well-worn but comfortable clothing, rather than clothes that “sent the message” that I was someone to be taken seriously.) My tactile defensiveness makes me avoid human contact, from handshakes to hugs, which impedes me socially, as well. And it makes me more sensitive to light and sound, which causes me to unconsciously avoid situations that are bright and loud — which is where an awful lot of people hang out, and where an awful lot of deals are done.

But when the offshoots of my socially and physically impactful anxiety result in poor choices or actions that endanger my social standing, my employability, my ability to function in the world at large, it sets up conditions that produce fear. Existential crisis. Serious problems that endanger my job, my house, my family, my safety, my very life. And my sensitivites shut down — they swing to the opposite end of the spectrum. I don’t pick up on clues that people send me. I don’t notice things I should. I don’t realize that I’m falling behind in my work, or that there’s a traffic cop standing in the middle of an intersection ahead of me, waving their flashlight for me to stop. I kind of “click off” in some ways, becoming numb to the world around me, as I deal with my most pressing issue at the moment: I’m late for an appointment that will get me in trouble, or I’ve fallen behind in a task I was supposed to have done by tomorrow, or my back yard is so grown up, the ticks have started to come into the house.

I’ve been in more questionable situations than I care to think about, in no small part because I was shut down while I was dealing with some other crisis that took my mind off what was right in front of me. Or because I’d just come off a crisis I couldn’t deal with and that fried my system. I’ve gone walking in areas where there was active hunting going on, following deer paths on purpose, because I was more interested in getting in touch with nature than noticing the hunters around me. I’ve hung out with underground criminals who were obviously and openly checking out my various assets and having side discussions about me, when I was in a totally new area, having just moved there on my own and not having any real way to support myself and not having a clue, frankly, where my livelihood was going to be coming from. I’ve taken chances behind the wheelof my car that almost got everyone with me killed, when I was overwhelmed with coping with some really intense, deep-seated interpersonal issues that were more than I could handle.

And the aftermaths of these times resulted in more anxiety … and behaviors that made it all but impossible for me to deal effectively with the  demands of the world around me. I descended into intense pain. Or I started drinking heavily. Or I plunged head-long into a long period of over-work, in order to block out the drama, the pain, the trauma… the pain.

I think this business of psychogenic pain — that has both logistical and physical causes AND effects — is an area that should be examined more closely, especially by the mental health field. I think that the connection of emotions — fear and anxiety — and the physical results from them, can actually explain a fair amount of how TBI and PTSD can combine and worsen each other. And it could help explain additional sources of distress and trauma for people who are dealing with emotional issues… some of which won’t “budge” despite years of psychotherapy.

Therapists, in my experience, often focus so intently on the emotional root causes, the past events, the sources, of psychological issues, that they miss the physicality of the experiences they’re addressing. And in the process, they overlook both a contributing factor and a symptom of psychological distress and dysfunction. I suppose it’s to be expected, since psychotherapy is about the psychological side of life. But the more we learn about these things, the more closely connected we realize the mind, body, heart, and spirit are… and to discount any of them, in my mind, short-circuits the process of healing and recovery from the rough-and-tumble aspects of life.

I’m working with very limited time, here, so I don’t have all the hours in my day to devote to this study, but I hope someone else out there is looking at this. Or maybe they have, and I just don’t know about it.

One person who is looking at this, I believe, is Belleruth Naparstek, a psychotherapist who works with guided imagery to address effects of trauma and PTSD and other psychological dysfunctions. She’s got a website at http://www.healthjourneys.com/ where she not only has CDs and tapes and MP3s for sale, but she also includes research and articles about the use of guided imagery in healing.

I have friends who swear by her work, and I  myself have used her PTSD and Stress Hardiness Optimization and Panic/Anxiety guided imagery with some surprising results. I’ve never been much “into” guided meditations — people who try to “guide” me tend to irritate the sh*t out of me, and it often feels like this namby-pamby coddling pansy-ass touchy-feely crap that is one of the aspects of “new age healing” that just drives me nuts. Okay, so maybe I’m being harsh and it just goes to show I have plenty of healing to do, but I just hate feeling talked down to an patronized by people who are “more enlightened” than me. I usually feel condescended to ann treated like an infant.

Belleruth’s style, however, is not like that. She seems very down-to-earth to me — at least, in her CDs — and she’s very accessible and no-nonesense. She also strikes me as being very competent and intelligent, which helps. I hate it when dense people condescend to me. It makes me crazy and is a terrible distraction. Anyway, I’ve been very surprised by the effect her CDs have had on me — after being unable to shed a tear for many, many years, I’m actually able to cry. Okay, so I’m not very good at doing it around other people, and it stresses me out when they see me cry, but every now and then, I can really use a good breakdown in the privacy of my own home. And when I’ve listened to the imagery, I can sleep. This is big. I often fall asleep in the middle of the imagery, and then I wake up when it’s done. I suppose I may be getting some benefit while I’m sleeping, but the real boon is that I can sleep, at all. I went for years, after my last TBI in 2004, not being able to sleep through the night, waking up at 3 a.m. regularly, not being able to sleep on the weekends, not being able to really rest… which fried me even more after the fall and probably impeded my recovery terribly.

Anyway, to get back to the point of this post — in tracking the sources of my pain and finding out ways to deal with it, I have to look at the emotional aspects — the agitation and anxiety and fear pieces of the puzzle — and address them. When I address them, through deep breathing, monitoring and controlling my stress, and keeping myself relatively chilled out — or as chilled out as I can be — it helps me cut back on the pain. I also do things like cuss out people who make me angry, when I’m far from polite society — in the woods, or in my car (tho’ I have to be careful when I’m venting in my car)… write letters to the people who I feel have done me wrong, and then rip up the letters (never send them)… try to get more sleep, so I can deal with the physical issues that lead to the emotional ones that lead to the physical ones… and so on.

And I use the pain points on my hands to at least give myself a little immediate relief.

If you’re dealing with pain and you’re looking for ways to deal with it, I wish you the best of luck! Everyone is different, of course, but life is all about cause and effect. Even if what I use to cut my pain doesn’t work for you, if you engage in your own process and just keep trying, you may be able to find ways that you can use to address your own situation, and get more out of life, with each passing day.

Life can be wonderful, if we figure out how to let it be just that.