Anger, anger, and more anger

One of the things that can make TBI particularly difficult, in the ensuing weeks, months, even years, is anger issues. Rage issues. Flying off the handle and attacking others for no good reason that they can see.

There are a lot of reasons this happens. Some of them are:

• Fatigue – your system is compromised by too little sleep and/or too much activity (with me, the two go hand-in-hand), and you don’t have the energy/wherewithall to stop yourself from going off
• Fear – there’s nothing like a sharp spike of adrenaline, combined with anxiety and fear to set you off. Fear has a way of clouding your judgment, so you not only under-think situations (from fatigue) but you also overreact to the circumstances (which may or may not be true).
• Frustration – when you’re trying to get something done/said/understood, and it’s just not happening, no matter how hard you try, patience wears thin — especially with yourself. My frustration tends to be directed inwards, though it also gets directed outwards. But the inward-turning kind is actually a lot worse for me. It makes me mean and aggressive. The worse I feel about myself, the angrier I get with life in general, and the more I tend to blow up.

It certainly doesn’t help that my brain gets into an uproar and starts getting into a biochemical soup drama, so that even if I wanted to think straight, I can’t.  The constant restlessness of my brain, coupled with the toll that agitation and fatigue take, can combine for a pretty potent mix of explosives.

So, what can I do about it?

• At a very minimum, be aware that I’m angry. It often feels like something completely different — it feels like I’m just revved, and I don’t recognize the emotional piece of it. It may sound simple, but realizing that I am actually angry is a big challenge for me.
• Realize that my anger does not necessarily make sense to others. What I’m thinking and feeling may be entirely unique to me.
• Realize that my brain may be sending me wrong signals, and the surge of emotion that’s coming up may be simply a biochemical response by a physical system that is WAY overloaded and highly sensitive.
• Remember that the long-term effects of a blow-up are probably not worth the satisfaction I get from venting. No matter how justified I feel about my anger, it can do much more harm than good. I have to think about whether I want to spend the next days/weeks/months patching up the damage I do to myself and my relationships with others, thanks to uncontrolled anger.
• Keep myself in check. No matter how justified I feel, the more revved I get, the more I need to step away. I need to do whatever I can to remove myself from that situation, before it escalates and turns really nasty.

It’s not a perfect process, but it’s something. It’s an ongoing thing, and I’m far from perfect. But ultimately, life has a way of teaching me the lessons I need to learn, so if I just keep at it, eventually I do make some progress.

The downward spiral of fatigue

It’s wild – it starts with the best of intentions. It’s exciting… very exciting to life my life, to go-go-go, to do lots of things and get tons of stuff done.

But if I don’t watch myself, I can get into trouble pretty quickly. If/when I get over-tired (and at the rate I tend to to, it’s usually a question of when I’ll get over-tired, versus if that will happen), a downward spiral starts in, that just won’t quit, till I start to rattle and shake like the USS Enterprise being pushed through an asteroid field at full speed. (And I hear Scotty yelling, “Cap’n, she’s breakin’ up! I can’t give ‘er anymore!“) I question my sanity, my ability to cope, my ability to live, and I’m exhibiting symptoms that someone who doesn’t know better would interpret as mental illness.

It’s not mental illness, per se. It’s my brain acting strangely under abnormally taxing conditions.

Here’s how things steadily go downhill…

And before I know it, I’m in trouble. I’m angry, I’m emotionally volatile, I’m raging, I’m blowing up at people, I’m melting down into a pile of quivering agitation, I’m irrational, I’m over-reactive, I’m hyper-active, I’m everything I know I should not be, but I am powerless to prevent it.

Also, I am in pain. Not just the muscular/skeletal pain that comes from over-exertion, but the surface pain that comes from fatigue, that makes everything hurt, from my clothing to human touch. It’s awful, and there’s nothing to do to stop it, when it’s full-on.  Advil doesn’t help. Only sleep does — days and days of extra sleep.

The thing is (the pain aside), a lot of the behavioral problems that come up are a result of how I perceive myself in relation to the rest of the world. Yes, I’m emotionally volatile. Yes, I’m losing it when I should be keeing cool, but it’s not so much that I am in trouble over things I’m doing — the real trouble happens and I get bent out of shape, when I misinterpret what I’m doing. I assume that because I’m having problems keeping things straight in my head and I’ve gotten turned around, that I’m screwing up (yet again) and I’m a mess, I’m broken, I’m damaged, I’ll never amount to anything, yada-yada-yada-yada-yada-yada-yada-yada-yada… an unbelievable amount of agitation results, which feeds back into the insomnia/fatigue loop. And that just makes my behavioral issues worse.

I’ve been seeing this more and more, lately, as my sleeping habits have deteriorated. They truly have. It’s been very fun and exciting to do things late into the night (as in, after 10 p.m.), but it’s cost me dearly, in terms of peace of mind, not to mention being able to deal effectively with increasing demands and challenges.

Stop the madness!

Seriously.

So, I have re-prioritized rest. I’ve bumped it up to the top of the heap. And I’ve made some small but important adjustments in how I do my work, so I have a better handle on things.

Objectively speaking, I’ve actually been dealing with some of the challenges and demands quite well — but because I’m so tired, I can’t really accurately assess how well I’m doing. So, when I feel like I’m having trouble, I assume I’m not doing well at all… and my successes are nearly lost on me. Unless someone can talk me through them. Like my spouse or my neuropsych.

Speaking of my neuropsych, I had a really great meeting with them  last night (thank heavens), on the spur of the moment. I was in town, they were in town, they had an opening in their schedule, and I had a sudden cancellation on mine. So, we managed to meet for a few hours. And after checking in with them about some recent experiences that had thrown me for a loop, I realized that I had actually done extremely well under very demanding and challenging circumstances. The biggest hurdle in all of it, was me being so tired that I couldn’t think clearly about what had really happened that was good.

I was so tired, nothing seemed good. But it actually was. So, my neuropsych talked me back from the brink of despair. And then I went home and  got to bed at a decent hour — 9:30 p.m., thank you very much! — and I woke on my own after 8 solid hours.

Wonder of wonders.

And suddenly, the world looked a lot better. The “mental illness” subsided, my mood disorder cleared up, my crappy attitude and biting self-criticism subsided, and I was able to get on with my life. Like a normal person.

And I’m back on track with watching myself more closely than I had been, taking my issues one at a time through the course of each day, and addressing the real underlying problems when they come up, so I can get on with my life, despite them. I’ve refined my daily log for what I have planned and what I really do. I’ve become quite diligent about keeping notes on my daily activities, and now I’m furthering that even more with a better kind of journal that helps me a lot.  Tracking my activities and the results is one sure way to see how I’m doing, from day to day. My brain will tell me any number of things about how I’m doing — many of which may in fact be untrue. But if I’ve got my notes, I can see for myself how I’m doing.

Onward…

The MTBI Downward Spiral

I’ve written before about how ignorance and narrow-mindedness produce greater disability than injuries alone.

TBI related issues like increased distractability, lower thresholds for anger, and sleep disruptions, the cascade of behavioral and logistical effects can create subtle cracks in the foundation of your everyday life, which ultimately compromise your ability to get on with your life in a mature and responsible fashion, even your physical and mental health.

Here’s how you can get into trouble, thanks to a TBI:

• TBIs have a nasty way of slowing down your thought processing speed.
• Sleep disruptions have a nasty way of resulting in increased agitation and distractabilty.
• Increased distractability can lead to “careless mistakes”.
• These can lead to arguments with others.
• Arguments can escalate if your flashpoint threshold is low.
• A low anger flashpoint threshold can become even more explosive if you’re tired and not thinking well.

For example — say a guy with a wife and two kids and a good job is in a car accident and smacks his head against the car window. I’ll call him (Car Accident Guy.) He’s knocked out for a few minutes, and when he comes to, the EMTs take him to hospital, check him out, determine there’s no serious damage, and turn him loose. He goes  home and lies down for a while, then the next day he’s up and at ’em again, ready to get on with his life and just relieved he wasn’t hurt worse in the accident.

He seems fine to everyone at home and at work — the only problem is, all of a sudden, he can’t seem to do the simplest things — like going to the store. Or completing a job his boss assigned to him. He keeps getting distracted by the simplest things, and when his wife sends him to the store to pick up milk and bread and his prescription refill, he ends up coming home with milk and eggs and shampoo, instead. In the process, he runs out of his daily dose of blood pressure medication, and his wife is upset, impatient and pissed off at him.

His wife tries to overlook his forgetfulness at first, but after a while, she starts to get pretty fed up with this guy. They quarrel and bicker, and he becomes nastier and nastier when they fight. He takes it out on his kids, too, yelling at them when they do things like turn the t.v. up too loud or come home late for dinner.  His wife’s patience gets shorter and shorter, and she feels like she has to double-check everything he does. He used to be so reliable, but now he’s just not trying… What’s wrong with him?

At work, things are getting tougher, too. Car Accident Guy’s boss has been noticing how he’s not delivering results when he promises he will. The reports are late. The analysis is incomplete. And he’s started making stupid mistakes he doesn’t even catch till someone brings them to his attention. Even when folks do show him how he screwed up, he’s contentious and argues about it, and his relationships with his co-workers seems caught in a downward spiral. His boss tries to talk to him, but he can’t seem to sit still in their meetings, and he keeps changing the subject or talking about other stuff that has nothing to do with what they’re there to discuss.

All the while,  Car Accident Guy has been missing his daily blood pressure dose, and his BP has been climbing — especially when he’s angry. He seems even more angry than usual, in fact, and his wife finally prevails on him to see his doctor. When he goes to the doctor, his blood pressure is way out of control, and his doc becomes very upset with him for not taking his daily dose. The doc considers him non-compliant and lectures him, and Car Accident Guy takes issue with his tone and snaps back at him. The doc, who has had a long day and isn’t in the mood for this crap, puts him on notice that he’d better clean up his act, or else. Car Accident Guy is immediately sorry for the tone he took with the doctor, and he apologizes and promises to do better. Feeling self-conscious, he tries to listen to the doctor and get what the doc is saying, but he can’t seem to focus, and he loses the piece about needing to schedule a stress test in six weeks. He takes the new BP med prescription from his doctor and puts it in his shirt pocket — but he’s distracted by what the doc is saying to him, so he isn’t actually aware of which pocket he put the script in.

Done with the appointment, he sails out of the office, forgetting to make the appointment for the stress test, trying like crazy to recall — from memory — the exact content of the his visit, so he can be sure to get himself back on track.

When he gets home, his wife asks him how the appointment was, and he has trouble remembering. He tells her it was okay, but when she asks him what the doctor said, he can’t remember exactly, so he avoids her question. She senses he’s covering something, and she’s concerned that there’s something seriously wrong with him that he’s not telling her. She becomes anxious and starts to press him for details, which he cannot recall exactly. He snaps back at her, and the conversation escalates to yet another argument.

Exhausted and frustrated, he stomps off to bed, tosses his clothes in the hamper, and sleeps the rest of the day. While he’s sleeping, his wife does a load of laundry — including the shirt with the prescription in the front pocket.

When he wakes up, Car Accident Guy remembers he needs to take his BP meds, and he also remembers he needs to get his new prescription. He can’t remember where he put the script, exactly, but it must be in the clothes he was wearing at the doc’s office. Unfortunately, his shirt and pants have gone through the laundry, and the prescription is in soggy tatters in the washer. Furious with himself and furious with his wife, Car Accident Guy flies into a rage and verbally attacks his wife, his kids, anyone who is nearby. He drives off in the car, calling his doctor on his cell phone for a new script.

The doctor is noticeably irritated, and he thinks Car Accident Guy is not committed to taking care of himself. He writes another script and faxes it to the pharmacy, so his patient can pick it up. Car Accident Guy thanks the doctor and heads to the pharmacy, but on the way there, he’s distracted by a yard sale along the road. He pulls over and spends an hour and a bunch of money buying some pieces of furniture he doesn’t really need, but that look nice and are available for a good price.

He loads the furniture in his car and heads home. When he gets there, his wife is still angry with him, and she’s packing to go to her mother’s house with the kids. In the meantime, his anger has completely dissipated, and he doesn’t understand what she’s still angry about. He also can’t understand why she isn’t pleased with the bargains he found. She asks him where his prescription is.

“Prescription?” he asks…

That’s more or less a cause-and-effect narrative of what can happen, just from a couple “simple” problems like sleep disruption, distractability, and lower anger thresholds — all of which are common in TBI. Even MTBI (supposedly “mild”) can produce life-wrecking after-effects. Believe me. I’ve lived it. I know. Car Accident Guy’s story is not terribly different from my own, though my own circumstances are different — still, the types of problems mulitiple MTBIs have brought me are not that different from these.

It’s eerily easy to end up in a downward slide — in no small part due to sleep issues, which contribute to distractability, which contributes to frustration, which contributes to lowered anger flashpoints.

But in the same vein, being aware of the issues up front, makes it eerily easy to avoid situations like this.

Getting enough sleep is a start. Being mindful of your energy level is another. Keeping notes about what you need to do is yet another. And stopping to check in with yourself and double-check your work is yet another.

TBI, even mild traumatic brain injury, can totally screw up your life. The good news is, it doesn’t have to.

Anger Notes: From mountain to molehill

I had a little difficulty this morning, getting into the day. I go through the same routine every day — wake up slowly… give myself time to wake up enough to get out of the bed without tripping or falling… get up and brush my teeth… go downstairs to put water on for coffee… do my morning workout while I am waiting for my coffee water to boil… think about what I need to accomplish today while I am working out… finish my workout and make my coffee and cereal… and then get into my morning.

Most days, if I have had enough rest, the routine goes like clockwork. But I recently started lifting heavier weights, and I also had a chiro adjustment yesterday, so I’m a little sore and stiff, and I need to get more sleep. Under normal conditions, getting the 7 hours that I had last night would make me very, very happy. I actually slept through till the sun was coming up! And I would feel like enough. But I am still recovering from staying out all night on New Year’s Eve last week, and I need to get even more rest than usual, so I can get back to my regular sleep schedule and get over being stiff and sore from the increased weight and also the adjustment I got yesterday.

Now, for most people, being behind on their sleep and having a little stiffness and soreness in the morning is no big deal. For a lot of people, it’s actually a way of life. They don’t get totally thrown off by lack of sleep. They just muddle through the day somehow. They don’t get all tweaked and freaked out over every little thing, with hair-trigger temper outbursts over every little thing. They just go through their day, like it’s no big deal. And they live their lives like everything is relatively normal, popping Advil or Aleve or having a few drinks at the end of the day to chill out and sleeping in, in the morning.

The people who don’t have issues with sleep deprivation and pain clearly are neurologically intact. They probably have not sustained traumatic brain injuries. They probably don’t have post-concussive syndrome, and they probably haven’t sustained brain trauma/head injury.

I, on the other hand, am not in that “space.” When I am behind on my sleep, it introduces a whole host of issues that make the most basic activities into challenges. When I am in physical discomfort, I tend to push myself even more, perhaps because doing that relieves the discomfort for me. But pushing myself tires me out even more. And when I get over-tired, I have a hard time relaxing and going to sleep… which makes me even more tired in the morning. And then I have all sorts of cognitive-behavioral problems. It’s a vicious cycle that’s very difficult to break.

That’s that cycle that started with me last night. I should have gone to bed around 9:30, but then I had some stuff to do, and I needed to talk to my spouse, who was out at a late meeting till 9:30. By the time they got home, I was ready to go to bed, but the sleepy part of me didn’t want to go to bed, so I stayed up and talked with them about this-and-that.

Finally, they packed me off to bed, seeing that I was pretty much wedged into the couch, and I was making myself comfortable for a long stay-up. It was 10:30, by then, and it took a focused, concentrated, concerted effort on both our parts to get me up off the couch and upstairs to bed. Then — being as tired and as contrary as I was — I stood in front of the bathroom mirror and inspected myself, studying my double chin and looking for gray hairs and trying to make my hair stand up straight by tousseling it and trying to spike it straight out from my scalp. I know, it’s strange. But this is the kind of stuff I do when I’m really, really tired and I don’t want to go to bed.

After about 15-20 minutes of this… and deciding that yes, I am still a handsome individual with good bone structure and not to much saggy skin in the wrong places… I finally got my ass in bed. Then I remembered I needed to stretch and take Advil (my bedtime routine), so I can better relax. I did that, and I then did my progressive relaxation exercises to get myself to sleep, which went really well — even better than I expected. I got to sleep around 11 p.m.

Happily, I slept through till 6 a.m., which is a wonder, because I’ve been waking up around 4-4:30 or so — which sucks — and that felt pretty good. I gave myself some time to wake up, before I got out of the bed. If I roll out of bed right away, I tend to stagger around a lot, which is loud and also a little dangerous. There are plenty of hard surfaces and sharp corners I can hit my head on. Plus, my spouse doesn’t like to be woken up by my clunking around, bumping into stuff — which happens, when I get up too quickly.

I got myself up and started getting into the day. But man, I was clumsy this morning, right from the start. I had trouble holding my toothbrush, had trouble holding onto the water spigot, and it was really really getting to me. I am definitely foggier and more out of it this morning than I’ve been in a while. It’s probably due to the adjustment I had yesterday — the chiro went pretty deep.  And when I’m foggy and clumsy and out of it, I get really, really agitated. Every little thing gets to me, and I have a harder time with those spikes of anger that come up when things go wrong for me. They seem to come out of nowhere, and when they show up, they can be intense — and the intensity makes them even more confusing and frustrating (and damaging) because my mind knows that my reaction to what is happening is wildly out of proportion to what is going on, and I feel like something is terribly wrong with me, that I feel this way. And I start in with calling myself all sorts of names, telling myself I’m a damaged idiot loser who can’t keep their shit together, etc. etc. ad nauseum.

I’ve written about this temper flare stuff before in my posts Flash in the (brain) pan and A constant restlessness (and elsewhere), and it still holds as true as ever.  And this morning, when I was just trying to brush my friggin’ teeth, already,  I could not seem to keep my act together. I had trouble holding the toothbrush, and when I put it down on its rest, something about how it was positioned bothered me intensely. Then I tried to turn off the water, and my hand slipped, and I hit the side of my hand on the edge of the spigot, which hurt.

And that old temper flare jumped out again, like Old Faithful… that geyser that comes up regularly at Yellowstone. Or maybe a better analogy would be, like one of the geysers that erupts periodically without warning. Tori Amos has an album I love called “Little Earthquakes”. Maybe I’ll do an album called “Little Geysers.”

Anyway, for a few minutes, as I stood there nursing my aching hand, I was

absolutely furious!!!!

It was all I could do to keep myself from hitting something or slamming something down. I was angry with the spigot for having hard edges. I was angry with my hand for being so weak that a little bump would hurt so much. I was angry with myself for being so uncoordinated and not being able to simply turn off the water like a normal person would. But most of all, I was angry with myself for getting so bent out of shape over something so simple. “I know better,” I told myself. “Why can’t I act better?”

I was really getting whacked-out over this, and it literally threatened to derail my morning. When I get going like this, I descend down into a pit of ugliness, and the whole day can be tainted by my temper outbursts, whether they are internal or external. In fact, sometimes the worst ones are internal, that no one but me sees or hears or knows about, which makes my crabby, short-tempered behavior all the more confusing for people around me. It makes no sense to them — how could it? They don’t know what I’m experiencing, and I’m doing everything in my power to shield them from that.

I could feel that rush of anger, that temper flare, that wild spike of emotion… it tore through me like one of those microbursts I’ve seen on the Weather Channel… and I was starting to get freaked out… and go into one of those wild rages that’s like a forest fire tearing through my head.

Then I checked myself. Something in me — the something that has been observing myself with increasing knowledge of TBI over the past few years — told me to take a break and just give myself time to catch up with myself.

So, I stopped and took a breath and thought about what was happening. And when I took a break from my downward slide, I realized:

1. I am still tired. I did not get enough sleep, and I am groggy.
2. When I am groggy, my neuropsych has told me that I am more prone to agitation.
3. When I am groggy, I also can be uncoordinated. I don’t need a trained expert to tell me this. I have observed it countless times.
4. When I am uncoordinated, I tend to bump into things.
5. When I am groggy, I tend to propel myself through events on adrenalin — because I need an extra “pump” of energy — energy I  don’t have from regular sources (like getting enough rest). When I’m fatigued, I have to pump myself up just to do the basic stuff… because otherwise I can’t get going.
6. When I pump myself up, I move faster.
7. When I move faster, and I am uncoordinated, I hit things with greater force than I would, if I were rested and had full motor control.
8. When I’m fatigued, my brain’s constant restlessness and agitation is worse, it makes me snappier and more extreme in my reactions. I am also more physically sensitive, and I feel everything more intensely.
9. And finally, I remembered — from what I’ve read and what I’ve been told by my neuropsych — this type of reaction from me is actually quite typical of TBI survivors. It’s just what my brain does, when it has to operate on too little sleep/energy.

So, there it was –this drama I was experiencing, standing in front of the bathroom sink, freaking out over hitting my hand on the spigot had everything to do with my brain/body AND it had NOTHING TO DO WITH ME.  It wasn’t me being an asshole loser who’s emotionally inept and a worthless use of space. It was just my brain and body doing what they did, when I am tired and out of it and I am moving too fast.

I did NOT need to make a big deal out of it — just recognize what was happening… And I also realized that it was actually my brain sending me warning signals about what was amiss in my day, thus far. I recognized that this little snap of mine was like a gift from the gods — a hint about where I was at, that day, which I could use to inform the rest of my day to make better choices.

I also realized that if I didn’t take steps to stop this flash in my brain-pan, I was going to start the day on a really BAD note. Temper flares with TBI survivors tend to be quick-on, quick-off affairs, instantaneously coming up out of nowhere and disappearing just as instantaneously for no apparent reason. I realized I just needed to occupy my attention long enough for my system to calm down, and then I could get on with my day.

So, I took action. I kicked into gear and did something with all that agitation and energy — I channeled it into a constructive activity. I looked at the spigot that I’d hit my hand on, and I realized that it was slippery with soap on the handle. I studied the handle and felt where the slippery soap was, then I ran the water and rinsed off the handle, until it wasn’t slippery anymore. That made me feel a lot better. Then I dried my hands and went downstairs to make my breakfast.

Again, I had more trouble with uncoordinated blunders downstairs. I was off-balance and I was clumsy, getting my coffee stuff together. But I remembered what I’d noticed upstairs — I’m tired. I’m uncoordinated. This is not about me, it’s about my brain and body. When I am this tired, it’s perfectly normal — for me — to be agitated and restless and make mountains out of molehills. But it has nothing to do with me and my character… Forget about the supposed stupidity and ineptness and all those other words I use to attack myself. It’s about my slightly broken brain which has trouble when it’s tired, and I know what I can do to make it better — take it easy, take things slow, don’t push myself like crazy, and cut myself a friggin’ break, already.

So, that’s what I did. And by the time I got done with my workout, my day had re-booted nice and fresh. I’m still tired, but I’m not wiped out like I could be, because I made changes to how I was doing things. I had a good solid workout, and I lifted shorter sets with fewer reps, because I realized my body needed to catch up with the heavier weights. I also focused more on my exercise — I had been letting my mind wander more, over the past week or so — and I didn’t lose track of where I was with my workout, like I had been, in the past few days. And as I was planning my day, I made a point of scheduling just a fraction of the number of activities I’m prone to schedule for my day, which takes the pressure off, right off the bat.

AND instead of checking email from friends first thing in the morning, as I’ve been doing for the past few weeks, I am waiting till later in the day to do that, because there is a lot I need to get done, and I cannot be distracted from the work that’s waiting for me to finish it.

All in all, even though the day started out on a rough note, it was for the best.

Because I stopped and thought about what was happening. I learned about the experience as it was happening. And I used my tools. I used the info I got from my neuropsych, and I used the knowledge I had of myself. I used the opportunity to stop and think to really appreciate what was going on with me. I cut my brain and body a break.

I am also planning to lie down for a nap later today. I’m working remotely, plus the weather is not good right now. I can get a lot done, if I focus on what I’m doing. And with the appreciation of how tired I am, I can make the extra effort to take care of myself, take my time at what I’m doing, and manage my energy with intention and discipline.

All because I stopped for a moment and thought about what was really going on with me.

This is progress.

What I do, versus who I am – TBI and Behavior Issues

I have been giving a lot of thought to behavior issues that arise as a result of TBI. Discussing my “eventful” childhood with my parents, in light of the concussions I experienced, brought up a lot of old memories about the bad behavior I exhibited, time and time again.

At the same time, I’ve been meeting with my neuropsychologist, who has been trying to explain to me that relatively speaking, the neurological after-effects of my TBIs are not so terribly severe. For the most part, I have a lot going for me, and I score well in key areas. I do have a few significant areas of difficulty, but I’m really not in terrible shape, neurologically speaking.

I’m still trying to get my head around it. Maybe I’m being dense, but it’s hard for me to see how little is wrong with me.

Because I struggle. Oh, how I struggle. The fact that I’ve been up since 1:30 — wide awake from worry and pain — is evidence thereof. Now, part of it may be the fact that I’m a highly sensitive individual with a lot of life and curiosity and adventurousness in me… which tends to put me on a collision course with the less desirable parts of human experience. A lot of it may be due to that, in fact. But it certainly doesn’t help that my memory leaves a lot to be desired, my processing speed isn’t as fast as I’d like, and I tend to get overwhelmed and melt down.

I don’t want to make more of my situation than need be, and I certainly don’t want to hold myself back in life  by focusing on my limits, rather than my strengths. I just need to understand why it is that I have such a hard time with things that others seem to be fine with. What, in fact, is holding me back?

All things considered, I think most of my day-to-day issues are behavior-related, versus purely neurological. I have had a bunch of head injuries, it’s true, but my MRI and EEG both came back looking peachy, and that doesn’t seem to correlate with the difficulties I have. Indeed, the problems I’ve got with insomnia, anger management, becoming quickly fatigued, trouble getting started, trouble reading, getting turned around and overwhelmed, saying the wrong things and doing things differently than I’d like, seem more behavioral than cognitive.

Well, it’s 4:30 a.m. and I’ve been up for three hours. I’m bushed and I need to sleep. So, for now I’ll just share a number of links I’ve found interesting and useful in understanding tbi and behavior:

• Traumatic Brain Injury: TBI Inform – Managing Behavioral Problems
• Tutorial: Behavior And Behavior Problems After TBI
• Long-Term Behavior Problems Following Pediatric Traumatic Brain …
• Behavior Problems After TBI in Children and Adolescents (PDF)
• Behavior Problems Resulting from Brain Injury
• FCA: Traumatic Brain Injury

My solution for TBI/PTSD rage

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

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

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

Not good.

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

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

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

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

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

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

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

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

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

Goal One: Composure

So, I prepped very carefully for this contest I entered. I got all my information together and collected my creations, and with what I thought was a very nice submission package, I arrived at the jury room.

Late.

I was “too late” they told me.

How could that be? I had called ahead, and at the front desk, they told me I could arrive between 7 and 8 and all would be well.

Untrue. I needed to arrive by 7 in order to participate. And it was 7:40.

My face fell. My face flushed. I became flustered and could not figure out what to say. I stammered and stuttered and probably looked like the crushed child I felt like inside. I could feel the confusion wash over me — flood of frustrated emotions… so much hope at this, so much anticipation, so much…

I cast my eyes to the floor and stammered a weak protest. I felt the eyes of the jurors on me, apprising me, critiqueing me even before they saw my work. The sting of disappointment flushed me bright red. Indignation. Outrage. Childish tantrum kicking and screaming, trying to get out.

Not the best face to put forward. Not the best impression to make. Not for a contest of this stature. And it is of a considerable stature.

I managed to hold back the outburst I felt coiled in me. And I managed to blurt out that I had called ahead, and they had given me wrong information. In a moment of compassion — pity? — the jurors allowed me to open my submission packet and show them what I had. They didn’t send me packing. I may have a chance, yet.

I will know better, next time. Be there by 7, in order to participate.

I will do better, next time. When disappointment rears its unexpected head, I can — and shall — hold myself together.

And not cry. Or look like I’m about to.

I swear I’ll manage at least that.

I’m about to go upstairs and find out if I’m in or if I’m out.

I’m ready. I think.

Protecting the ones I love… from me

I’ve been thinking a lot, lately, about how well people respond to me, when I am bold and brave and daring and don’t let anything get in my way. I seem to have a sort of mystique about me, that causes people to have innate trust in my capabilities and “powers”… even if they have only just gotten to know me.

And likewise, when I am less than my best, when I am faltering, when I am struggling with my life, and I am in full contact with my failings, people around me tend to get miffed. As though I am intentionally being that way to piss them off. Or I’m being a lazy-ass and slacking off. Or I’ve decided to intentionally not live up to my potential.

What’s more, the people closest to me have an extremely bad reaction when I don’t take the high road — they get a bit anxious and agitated, as though I’m about to eat them, or something. It’s an either-or, all-on-all-off thing with me, this adoration of my “secret powers”, and frankly, it kind of irritates me, that I’ve always got to be superhuman, or I can’t be anything at all.

Over the past week, I’ve been deliberately sticking with my mystique thing – being the bold old soul I used to be, before I had my fall in 2004, and my life went to shit. I guess I just gave up on trying to be sensitive to my own needs, and I jumped off the bandwagon that a lot of my therapist friends are on — getting into the victim mentality and concentrating on my needs… my wants… my hurts… my… my… my…

Okay, so I was a bit into that frame of mind for a while. My previous therapist was really into “helping” me get in touch with my own needs and all that, for fear that I was being trampled by the all-too-needy world. My current therapist is on the opposite end of the spectrum — they’re really into me not going off on my sore spots and getting all mired in them. I’ve been re-adjusting, over the past six months or so, and I think it’s been really good for me. Sometimes, I do wish I could get a more sympathetic ear in my current shrink, but I’d rather deal with a hard-ass than someone who coddles me and turns me into an infant, ‘cuz my inner child needs attention.

Actually, I have to say, I’m a whole lot happier now, and I’m a whole lot more functional — and leaning towards increased functionality — than I was for about a year. That whole victim orientation makes me a little nervous, and I also have to say that getting in touch with my needs is vastly overrated. To tell the truth, I’m so self-obsessed at times (I credit my right-hemisphere brain injury) that the whole rest of the world takes a back seat to my needs. The weird thing is, half the time, I don’t even realize it, ‘cuz I’m so deep in my own crap, I can’t see the fact that I’m being pathologically ego-centric. Truly, I have so many needs, there is literally no end to them… and the more I “get in touch” with them, the more I find I need, and it rapidly becomes an endless cycle of identifying my newest and most novel needs, and trying to figure out how to get them met. Which is a never-ending cycle of self-perpetuating ego-centricity of the highest order.

Sigh…

Anyway, what I’m realizing more and more all the time, is that sometimes it’s not such a great idea to focus on myself. And in fact, if I want to do my friends and family a favor, I’ll take the focus off me for a little bit. Or a lot. When I’m given free rein, I can be petulant and childish, foolish and self-serving, needy beyond words, spiteful, bitchy, cranky, and aggressive. It’s not pretty.

So, this trip I’m doing now, with being the strong silent type and holding my shit, even when I feel like I’m about to come apart inside… (which, by the way, is a trip I was on for many, many years, until some well-meaning but head-injury-oblivious person encouraged me to start thinking more about myself and consider what I wanted in life. Then, my literal head jumped on that bandwagon and we were off to the races)…  well, that old stoicism, that warrior composure, that ability to just remain calm in the midst of everything… it’s actually a very good trip, which has really good consequences, and it gets me back on the good foot, even when everything around me feels like it’s going to pot.

And this self-sacrificing trip also lets me keep my friends and family from living with a madperson, a crazy-ass nut-case who jumps at every sound and attacks their own shadow. When left to my own devices and allowed to act like a child, there’s a part of me that will jump at the chance. But when someone — like my current shrink — pushes me to buck up and grow up… well, even if that costs me my warm-fuzzy in-touch-ness with all my feelings, it does make me a better person.

And that’s a good thing.

Strategies for avoiding TBI overwhelm

I’ve been getting more and more overwhelmed, lately. Things are piling up, and I’m falling behind. Then I melt down, blow up, can’t manage… Not good.

Thing is, I know what to do…

When it comes to avoiding TBI overwhelm, there are a number of things I find quite helpful:

1. Don’t overestimate my energy. I may want to have energy, but I may not. I need to track my energy, to make sure that it’s not just stress and anxiety and nervousness that’s driving me. I often mistake nervous energy for healthy energy, but nervous energy can cause me to make poor choices that get me in trouble. If I look at my schedule and see — plain as day — I am behind on my sleep, then I need to seriously consider that my “energy” might not be that healthy, and I need to take a break.
2. Keep track of what I need to do, what I’ ve done, and what I need to do later. I just make lists of what I’ve got going on that MUST be done, and I try to keep the things that I am considering doing to a bare minimum. I carry over the things that I did not get done from day to day, and I track them to see where I’m at. I check in with myself at the beginning of each day, and again at the end of each day, and it helps me keep on track.
3. Take frequent breaks. Even if I don’t want to. I am getting better at scheduling breaks for myself, so I don’t even have to think about it. I realize now, after years of messing up, that the time when I don’t think I need a break, is usually the time when I do. So, I make myself stop what I’m doing, go do something else — like get a drink of water or a snack or take a walk — and then come back to what I’m doing later on.
4. Monitor my time usage. See if I’m frittering away time on stuff I’m stuck on. If I’m stuck, I try to ask for help.
5. Plan for downtime. Seriously. Schedule naps on the weekend. Give myself permission to not do anything at all, sometimes.
6. Don’t overestimate the patience of others. I have to deliberately cut to the chase much more than other folks do, as my detail-rich brain gets going and I waste a lot of time sifting through info that doesn’t really matter that much, and that others don’t have patience for. In my mind, it’s important, but others get impatient, so I need to laser what I say and talk about — which helps everyone, actually.
7. Never forget, I’m a TBI survivor, and that has altered my brain in unpredictable ways. Sometimes, the best that I can do, is keep this in mind, so I’m not thrown off by the unpredictabilities of my brain. It’s bad enough that my brain behaves oddly at times — but the worst part is being thrown by it. When I expect the unexpected, I can deal with it objectively, which is critical.

It’s not a perfect system, but it works for me — when I work it, of course.

I just need to do that — and so I shall.

Flash in the (brain) pan

Perhaps one of the biggest and most persistent issues I’ve had with MTBI over the years — and I mean all the years, starting when I was a kid (I had my first TBI when I was 7) — is uninvited and unexplained anger.

Like a storm it comes, barrelling across the plains inside my head… like a tornado dropping suddenly from a swirling dark-cloudy sky. Touching down unpredictably and tearing across my inner landscape, ripping up trees and houses as it goes… sending cars and cows and tractors flying through the air… snaking and twisting and turning and doubling back across its own path, a demon in flight…

Like a wildfire, it flares up. A late summer California brush fire that needs only a shift in the winds to send it screaming voraciously across the proverbial fields inside my head. When I am tired, when I am frustrated, when I am out of resources, the inside of my head — and heart — is like a dry grassy field that’s seen no rain for months. The tall grasses are parched and just waiting for a spark to burst into flame. The sappy pines are ready and waiting for heat to make them explode. And the wide steppes inside my head roar and rush with the winds that kick up at a moment’s notice.

When that spark comes — something as small as a dropped potato peeler, or something as significant as being pulled over by a police officer — it touches to the kindling in my head, and flames shoot out in every direction. And when the winds of my thoughts kick up, the fire can flare up with maddening speed and race up-down-left-right, flames finding their way into the nooks and crannies of my psyche. And there is nowhere I can feel genuinely safe. There is nowhere that I can know others are safe from my sudden sharp tongue.

“Anger” is too simple a word for it. “Temper” hardly does it justice. It’s a force of nature. And when it’s at its worst, it’s a natural disaster.

It’s insane. The smallest thing can set me off, given the right conditions. I might be tired. Or I might be confused. Or I might be feeling vulnerable and stupid and slow. I might feel threatened. I might feel nothing in particular. But suddenly, without warning, there is something else in the room with me that I know I need to control. Manage. Keep on top of. Not let get out of hand. Yes, control.

So, I dig in trench lines. I set bounding fires. I do what I can… and pray for the winds to die down and this sudden fire to pass.