From Brain Injury and Football — No Place to Run — on CRAIN’S COMMENTS

concussion_nutrition

The latest evidence is pretty hard to ignore. The research leader is Dr. Ann McKee, chief of neuropathology at the VA Boston Healthcare System and director of the CTE Center at Boston University. She examined the brains of 111 deceased NFL players. Of these, 110 had CTE, the degenerative disease caused by repeated blows to […]

via Brain Injury and Football — No Place to Run — CRAIN’S COMMENTS

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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.


Help for a teen-age girl who had a brain injury

I recently received this comment from someone looking to help the daughter of someone they work with.

I was wondering if you could give me some advise a woman I work with has a 13 year old daughter who was shot in the head at the age of 7. She has more or less fully “recovered” physically and mentally as according to her physicians.

Recently she has been getting in trouble at school when she gets stressed out about tests and friends and one of her problems at school is that when she gets stressed she involuntarily scratching her forearms which is alarming school officials . But when the officials approach her she becomes more stressed and scratches her self more.

So I gather you see the problem — the school has ordered my friend (who I will call Stacy) to take her daughter to a psychiatrist and to her PCP. The PCP says that there is nothing physically wrong with her so he can’t do any thing. The psychiatrist wants to medicate but is unsure what the side affects will be as seeing that she has had severe brain trauma and suggested Stacy to contact her neurologist; which she is doing but it takes awhile to get an appointment.

While they are waiting for the neurologist appointment I suggested getting her daughter involved in a support group with others who are going thru the same kind of emotional and psychological healing that she is going thru so she doesn’t feel alone and this is where I’m drawing a blank can you or can any one else get me in contact with a support group that may meet this girls needs if you can

Bless you

Thanks

I’m worried for Stacy also, I think she needs some one to talk to who is going thru what she is.

And here is my (slightly modified) response:

Hi Mel –

Thanks so much for writing and thanks for helping Stacy!

It sounds like Stacy’s daughter is using (negative) sensation as a way to calm herself down. This is not uncommon — some folks with seizure disorders will do it to stop/interrupt their meltdowns — they hit their heads or they hurt themselves in some way. Other folks who are overwhelmed will use pain to focus their thinking. They will scratch or hit themselves, bang their heads, or do something else to “get themselves back into the present”.

It could also be that she’s using it as a way to get people to back off of her — I have been known to do some kind of bizarre things — unconsciously and consciously — that caused people to back off of me. Things like twitching and behaving strangely, that made people look at me strangely, but got them to stop coming at me so hard. I didn’t WANT to act like a freak, but I found that my involuntary reflexes had the (negative) benefit of putting some distance between myself and the person who was yelling at me, so it actually helped in a way. Additional Note: I’m not saying Stacy’s daughter is intentionally doing bizarre things — I’m just saying I can relate, and the negative reactions I myself have displayed, have contributed to my own behavior and social issues, over the years.

Also, with me, my tbi’s have slowed down my reaction time, so when I have gotten into trouble with authorities in the past, and I haven’t reacted as quickly as they wanted, they acted like I was intentionally defying them, and they came at me all the harder. I wasn’t deliberately being bad, I was just “slower on the uptake” and they mis-interpreted my response as defiance. That may be happening with Stacy’s daughter, and if she’s like me, the increased attention feeds my confusion and I get even more overloaded — A Real Problem, which Stacy’s daughter may be having.

It also could be that — like me, when I was a kid — Stacy’s daughter is (mis)interpreting the school officials’ attention and concern as being in trouble and she thinks she’s being punished or disciplined, which — if she’s like me — just adds to the overwhelm. When they approach her, the school officials need to say explicitly that she is NOT in trouble. They are trying to help her. They may think she knows, but with tbi, it’s never safe to assume anything. Now, if the school officials ARE treating her like she’s in trouble, that’s another issue — a problem with the officials, themselves.

For dealing with sensory overload… Other people with sensory integration issues will do things like rub a coarse surface, tap a rhythm, hum, or do some other action which brings a single point of focus to their attention. It’s called “stimming” or “self-stimulation” and there are many different kinds that people do in different ways. If you Google “stimming” you may find something useful.

Additional Note: Stimming is often used by folks who are autistic or have some other developmental delay — I AM NOT saying Stacy’s daughter has become autistic as a result of her head injury, only that understanding stimming behaviors (as they are used by folks on the autistic spectrum), may help Stacy understand her daughter’s need to scratch her forearms.

I have been known to hurt myself (slightly) to “get out of” a downward slide into a meltdown or when I feel like I just can’t handle all the outside stimuli coming in. Before I knew about how even a mild TBI can affect the brain, I used to bang my head when I was too overwhelmed to function. (Note: since I learned more about tbi, I’ve stopped that behavior — I’ve got all the head injury I can handle, thank you very much.) I have also hit myself, grabbed my forearms really hard and squeezed long and hard enough to bruise myself, I have punched myself, and I have done other things to get a little pain into my system to clear my head. I have never severely injured myself — like cut myself or banged my hand in a drawer or something extreme like that. I just needed a little bit of pain to chill myself out and stop the chaos in my head. I have used sports in the past to create “managed pain” in a positive way — I would push myself really, really hard in practices and competitions, to the point where I was in real physical distress. But then I was able to chill, and life went on.

I’m not an expert in this, but I believe it’s because the pain triggers endorphines (and other stress hormones/adrenaline) which can help clear the mind and help someone get a single point of focus back, when they’re being bombarded with stimuli that they cannot sort out. (Interestingly, this ties in with the research I’m presently doing about how people (unconsciously) create stress and really difficult situations to help themselves function better, when they’re totally overwhelmed.) From personal experience, I can say that there’s nothing like a little pain, sometimes, to help me focus. NOTE: I am NOT advocating self-injury as a coping mechanism, I’m just observing that — on a very limited scale — self-administered pain/stress has helped me cope throughout my life. And in fact, I still use it, now and then.

Anyway, to avoid real injury and help myself focus, I use other techniques that are less stigmatized — more like stimming than self-injury. I usually have a rolled-up paper napkin or towel in one of my pockets that I carry around with me to rub and clench in my fist, when I’m feeling overwhelmed. A rolled-up napkin really works, because it’s coarse, and it fits in my hand, so I can carry it around without people noticing it. I find it very soothing. Also, I do things like rub the seam of my jeans, tap out rhythms (working on a computer keyboard is very soothing for me), and press my thumbnail into the sides of my fingers or palm. I do these things secretly, so no one will see, because if/when they do notice, they become worried and agitated, and it makes the situation worse for me.

For Stacy’s daughter, I would strongly recommend regular exercise, like getting involved in sports. I had real sensory issues and I was a total wreck, when I was a kid. Bit when I got to high school, I started getting involved in organized sports, and that made all the difference. But I couldn’t do every sport — team sports like basketball and softball and field hockey were too chaotic for me, so I ran cross country and track. I did individual sports as part of a team. If I hadn’t been so afraid of water, I would have gone out for the swim team, but I had a lot of trouble coordinating my breathing with motion when I swam, and I was (rightfully so) afraid of drowning.

If Stacy’s daughter is not athletic, I would really encourage her to do some sort of rigorous physical activity that she can do alone or with a small group. But find something physical to do, that lets her really work out her anxiety and channel all that energy. With each successive head injury I’ve had (8+), I’ve often noticed a sudden surge in my physical energy — and I felt more blocked, like I didn’t know what to do with it. That’s been a real problem over the years. But if I can find something really physically demanding to do, I’m usually able to get myself back on track.

If Stacy’s daughter can find something to do that is safe, as well as physically challenging, and not terribly expensive (running cross country and track are about the cheapest sports you can participate in), I really think it could help. And being in organized sports in school was great for me, because it gave me structure and guidance from coaches, as well as well-defined rules to play by — very important for me, after those injuries and concussions.

Now, if she cannot under any circumstances participate in sports, she may benefit from developing other (hidden) stimming techniques — like carrying a “worry stone” with her — a rough stone or some other texture that will keep her attention focused on something other than her confrontation and/or overwhelm. Or like me, carrying a rolled-up napkin to squeeze and rub, when things get a little ‘tight’. If she can be shown other ways she can dissipate the stress that don’t attract a lot of attention, that could help.

Above all, I would recommend that someone work with her in a non-judgmental way so she can develop other coping techniques. Like an occupational therapist. Since she was obviously head-injured by a gunshot wound, she must have medical records which show she is a tbi survivor, so she may be able to get help that insurance will pay for. Rather than sending her to a shrink or medicating her or treating her like she’s mentally ill, if someone can just explain to her that her brain is not processing information the same way that other people’s do, and it’s getting turned around (no fault of hers — it’s a result of the injury), and then work with her to constructively and positively deal with her unique situation, I think that could really help. Again, I’m not a trained professional in this, but as a multiple tbi survivor with sensory issues, I know it would have really helped me, when I was a kid.

As for Stacy, I would recommend that she spend some time reading about tbi online — check some of the links on my blog and learn about it. Even though her daughter has appeared to recover physically and mentally, she will likely have a bunch of issues that she needs to work through — many of which may look like “bad behavior” but are really neurological. Also, the young lady’s age tells me that because she’s going though puberty, her hormones are changing, and that can alter your neurological experience. Women with seizure disorders are known to experience changes in seizure activity which are directly related to their hormonal condition. Stacy may wish to keep a log about her daughter’s monthly cycles so she can track any kinds of behavior changes around the time of her ovulation/menstruation. That way, she can discuss it with a neurologist, and/or help her daughter prepare for times that may be tougher, due to hormonal fluctuations, and use that information to really be pro-active and common-sense about these seeming inexplicable behaviors.

I would recommend, also, that you give Stacy a copy of the self-assessment form(s) I have available on my blog, so she can see what kinds of symptoms can come with TBI. It could be that her daughter is having more problems than anyone realizes – but because of cultural bias, people think that her daughter is just being badly behaved. Or that Stacy is being a “bad mom”. I can’t tell you how many people were really hard on my parents — especially my mom — because they thought their bad parenting was responsible for my behavior. It wasn’t my parents — it was my tbi’s that caused me do do the things I did!

The more Stacy knows about tbi, the better. And her daughter’s school officials should be educated on it, as well. If nothing else, Stacy should make sure they know about her daughter’s brain injury, so they can respond appropriately and work constructively to develop positive approaches that don’t stress out the young lady. Stacy should NOT be afraid to tell them her daughter was brain injured. If she educates herself, she can advocate more effectively for her daughter.

Oh, AND — THIS IS REALLY IMPORTANT!!! if Stacy goes to a neurologist, she should make sure they know about traumatic brain injury. Not all neurologists do. I went to one who specialized in carpal tunnel and multiple sclerosis — not really helpful with tbi, I can tell you! Her local Brain Injury Association should be able to point her in the direction of a neuro with tbi experience.

Stacy may also find support through her local Brain Injury Association. Please tell her not to be afraid of the “brain injury” stigma — there are plenty of people who have had one. The association will probably have support groups she can attend, for survivors’ family members. Her daughter may be able to find support, also. On the surface, it may look like her daughter is all better, but the brain is mysterious thing. And especially since she’s going into full-blown puberty, she may find her “neurological landscape” changing, because her body and her hormones are changing, too. So, she’s going to need new and different help for her tbi, which will affect her in new ways as she matures.

Anyway, I hope that Stacy’s daughter can find other ways to relieve her stress, other than publicly injuring herself. I hope that Stacy can learn more about her daughter’s condition in a constructive and positive way. I hope that her daughter’s school can find ways to deal effectively with this young lady. And I hope you find more ways to help Stacy. It’s wonderful that you’re reaching out like this, and Stacy is lucky to have you as a friend!

Peace
BB