Duty to Warn: The Fort Hood Murders/Suicide and the Taboo Question

The Baltimore Chronicle has an interesting article by Gary G. Kohls, MD about the role of psychiatric medications in the Fort Hood incident. From the article:

Most of us have been listening to the massive, round-the-clock press coverage of the latest mass shooting incident at Fort Hood, Texas. Seemingly all the possible root causes of such a horrific act of violence have been raised and discussed. However, there is an elephant in the room, and it’s something that should be obvious in this age of the school shooter pandemic.

We should be outraged at the failure of the investigative journalists, the psychiatric professionals, the medical community and the military spokespersons who seem to be studiously avoiding the major factor that helps to explain these senseless acts. Why would someone unexpectedly, irrationally and randomly shoot up a school, a workplace or, in this case, an army post? Why would someone who used to be known as a seemingly rational person suddenly perpetrate a gruesome, irrational act of violence?

The answer to the question, as demonstrated again and again in so many of such recent acts of “senseless” violence, is brain- and behavior-altering drugs.

You can read the rest of it here.

I can see his point, and I think it is a good idea to factor in the potentially dangerous effects of psychoactive drugs. But I also believe there are many layers to this, the effect of drugs being only one of them. Something(s) else contributed to pushing the shooter to that point. And I’m not sure we can fairly lay all the blame at the feet of the pharmaceuticals industry.

Whatever the cause of the rampage, this issue of pharma-gone-bad is of particular interest to me, because as a multiple-TBI survivor with a bunch of cognitive-behavioral issues, it could be all too easy for a “qualified” doctor or neurologist or psychiatrist to load me up with a bunch of pills and send me on my way. I consider myself unbelievably fortunate and blessed to be working with a neuropsychologist who is very wary of pharmaceuticals and approaches them as a last resort, when all else fails. They are also very happy when I come up with alternative solutions to my issues that work well and do not involve drugs —  like exercising regularly as an antidote for fatigue and drowsiness and a way to wake up fully in the morning.

Interestingly, my psychotherapist tends to come down on the side of drug therapies for individuals with attentional difficulties. I may have to cut them loose, if they turn out to start pressuring me to resort to drugs. If they so much as start hinting at me using them, simply because other approaches “don’t appear to work as effectively” I may have to have to reconsider working with them and seek help elsewhere. Who knows? I may even cut out the psychotherapy completely.

Hard to say, at this point. I think it’s been helping me in some ways… no, I’m pretty sure it has.

But I have been growing a little more leery of my shrink, over the past month or so. They seem more distant than they did at the start. They also have said some things to me over the past couple of sessions that don’t sit right with me, but I haven’t actually followed up on. I should probably do that, to clear the air. It’s hard for me to spend the time and money with someone who I think doesn’t believe me, or seems to be insinuating that I’m misrepresenting my difficulties to the rest of the world. I’m not sure if they think I’m worse off than I appear to be, or if they are just having a hard time, themself.

To be fair, they did suffer a devastating personal loss, last year about this time, so I think it may be messing with their head a little bit. They have definitely not been at their best, of late. So, I’ll cut them some slack, give it some more time, slow things down, and not let them pull any punches with me. We’ll see how it goes.

Bottom line (if there is one) is… mental health care providers can have problems, too. And those problems can get to them in some pretty serious ways.  I’m just glad my shrink isn’t trained in small arms — I’m assuming they aren’t — and that they don’t work in an environment where the use of firearms is part of the job.

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Yes, I’m back…

Well, that was interesting…

I stepped away from regular posting for a little while, thinking that I was going to make a change (a number of changes, actually) in how and when I write, how and when I post, and what I write and post about. My motivation was the intent to err on the side of caution, as I was starting to feel, well, exposed by all these posts. I’ve shared a lot of personal information here, and frankly, it started to spook me out a bit. It’s always been my intention to speak fairly personally here, to share details about my life that might be considered “intimate” by some, but to just let it all hang out, because when it comes to personal health issues, especially TBI, there aren’t a lot of sources that speak directly to us as human beings, and put a real face on our experiences.

All too often (especially given the state of healthcare in the US at this time), we are assigned patient IDs, given little plastic cards with our numbers on them, added to hospital and clinic databases, issued either a prescription for pills or told to ‘get more exercise’ and more actively control our stress. That’s if we get any help at all. Lots and lots of us never get the help we need when we need it – or if we get it, it’s not till much, much later, after considerable damage has been done. And we’re left to struggle along, muddle through, and generally find our way by trial and error.

It’s been my hope that this blog would help alleviate some of that. Give people a bit of hope. Offer my own experiences as a resource for others who don’t know where to turn. It hasn’t been perfect, by any stretch. But as of today, I’ve had 35,928 different page views. Not bad, for about 18 months of work.

And when I announced that I was going to be shifting my focus (I wasn’t really specific), I did hear from some folks about how they wished I wouldn’t go away and quit keeping this blog. It gave me pause. And over coffee this morning, I decided, “Oh, what the hell — I’m come this far, why pull out now?”

Interestingly, a lot of the page views are for posts I wrote many months ago, so the content has value for people (apparently) beyond the immediate moment when I write it. That’s one of my goals — to have “evergreen” material here that people can find useful, even if they are stumbling across the info many months after I first wrote it. These issues of ours are, unfortunately, very tenacious, and they don’t go away.  So, as long as I’m not a complete and total narcissist about this, and do it just for ego-casting, it makes sense for me to continue.

So, given that I believe in this work, and others have told me it’s needed, I’ve decided to restore my past posts for folks who are looking for info on dealing with mild TBI or PTSD. It’s pretty important work, whether or not I’m doing it. And I realized over the past days of not doing it, how much I love it. It’s not just about me and my life — it’s about chronicling human experience and finding workable solutions to tenacious problems, to share with others.

I do love the work, so yes, I’m back.

Now, I need to tell you why I pulled away so abruptly in the first place.

There are several reasons, which are actually closely related — and everyone who does health research and posting online needs to think about this very carefully. Please pay attention to this, as it may pertain to you, as well.

First, there are basic survival issues at stake.

I’m in a position where I may need to look for a new job in another three months or so. My COBRA-supported health insurance stops being subsidized at the end of this year, which means my health insurance costs are going to more than triple.  I have been offered lower cost coverage, but it doesn’t provide ample coverage for me, and I cannot, under any circumstances, get lousy health insurance, if I’m going to continue to see my neuropsych and psychotherapist.

The job I am in now, which is just a contract, may not pay me the money I need to keep going, so that means, I need to do some hard thinking about what work I do for a living. I have been needing to branch out from what I’ve been doing, for the past 15 years, and see where else my technical skills can take me. I need to update my skillset and expand my resume and portfolio, and that takes time. It takes time to keep this blog. I have regularly spent the first hour or two of most days in the week posting here, and that is time I could be spending on developing my skills.

I have a hell of a time keeping focused and sharp. I only have so many resources, and I only have so much energy. I need to feed my family and keep a roof over our heads, and I have to take my professional performance to the next level. That means something may have to give, and until this morning, I was convinced it was this blog. I only have time for really essential things, these days — given how much longer it takes me to read and comprehend and learn and keep my act together (compared to how I was before I fell in 2004), I have to carefully pick and choose what I do, and save my best energy for my most lucrative and financially beneficial activities.

More on this later…

The second reason I decided to give up this blog, was because of privacy issues and my concerns over this information working against me in this job market.

Let’s face it, traumatic brain injury is not the sort of thing that most employers embrace wholeheartedly. It’s highly stigmatized and people just do not understand it. It’s one thing, if you’re a veteran returning from the front lines of the War On Terror, and you come back after having been head-injured in a roadside IED blast while safeguarding our freedom. That’s something that (many) people can see as worthy of respect and consideration. People support troops. They have compassion for victims of insurgent attacks — Important Note: Please don’t think I am making light of combat TBI, or assuming that every returning soldier gets the full compassion and cooperation from the normal world upon their return. I only wish it were so. — But a traumatic brain injury sustained in a car accident or a fall down some stairs or having something fall on your head is harder to explain as the serious issue it can be — especially when popular culture (including Pepsi during the Super Bowl) makes light of head injury and promotes the perception that you can just shake it off, say “I’m OK — I’m good” and everything is hunky dory.

Even if people do understand that TBI (mild, moderate, or severe) can cause tremendous difficulties at the start, plenty of folks are of the belief that things should just sort themselves out over time. Indeed, many neurologists believe just that — including one I had the misfortune to visit when I was just starting out on this serious diagnostic/rehab quest of mine.

Now, given the types of information I have posted here, and given the breadth and depth of my own issues which I have willingly and eagerly chronicled here, I am admittedly putting myself in a very vulnerable position. No joke. Every so often, news comes out of some blogger being “outed” by their hosting service, because they’ve said something that pissed off someone with a vested interest in what they were discussing. And that blogger — like Valerie Plame — is exposed and banished from their position and/or blog. Recently, a Scottish policeman who blogged very candidly about his work, was exposed and dismissed from his job, and down came the blog. Which was a loss for everyone, especially him.

I have no interest in repeating his performance. I want to speak freely and do my part to support others, but at what potential cost? I’ve got to keep the money coming in. I have a grown-up life in the grown-up world, and I have a family to support. Thinking about the possibility of being fingered and stigmatized by what folks read here spooked me pretty badly, so I decided to back off the posting.

Third, all this personal health/medical information floating around online might not be such a great idea.

I mean, seriously. This whole “Health 2.0 — community-driven health research and open-source information sharing” strikes me as possibly the worst idea to come along since, oh, the collusion of church and state. There are many health information sites and communities which give people the chance to post personal information about their health concerns as well as engage in discussions with others. Some of the conditions are serious, some of them are relatively benign. But they are all personal. And lots and lots of people are not very careful about hiding their identities when they post to them. In my visits to various Health 2.0 sites, I see a lot of people using their real names, talking about their real conditions, and I wonder if they realize their information is visible to as many people as it is — including potential employers and insurers… not to mention the government.

Now, I am not a conspiracy theorist, and I’m not the kind of person who thinks the government is out to get us all, in some Matrix-movie-type of blue-pill-induced power grab, where everyone is walking around like zombies, feeding the machine unwittingly with their vital life force. I think real life is a lot more complicated than that. But I do believe that if unscrupulous individuals and organizations have free access to lots of personal information, they have plenty of opportunity to do unscrupulous things with that data.  It’s not a question of the right people having access to the right information (like members of a forum or online community) or the wrong people having access to the wrong information (like private investigators trying to dig up dirt on genuinely injured people who the insurance company doesn’t want to cover). It’s a question of all the information being accessible to any people who care to get at it.

And believe you me, people who really want to get to it, will. It’s not that hard — either they can do it by trickery (like in phishing emails from Big Banks that have links to them pointing to some .ru website that looks really official), or they can do it by hackery. I’m not paranoid. I’m just a highly experienced information technology veteran who has been active in a highly regulated and highly sensitive sector for quite some time. Wait — maybe I am paranoid 😉 Can you blame me?

Anyway, the thought that my own personal information is floating around out there — albeit in an anonymous fashion — sorta kinda spooked me, so I yanked it in a hurry, one frantic afternoon. I hadn’t been sleeping well, I was in a lot of pain, and I was contemplating the prospect of a potential employer finding out all about me and saying, “Why the hell would I hire some washed-up, brain-damaged has-been who runs around telling everyone how much difficulty they have doing basic stuff? Where’s the ROI on that?” In my mind, my whole way of life was seriously threatened, and I had to do somethign to take the pressure off.

So, I disappeared. And I thought it would make me feel better.

But, as you can see, it didn’t. I felt like I’d abandoned my post. I felt like I’d deserted those  who trusted me, and I felt like a total loser.

So, I turned around and came back. And here I am.

I am still a bit uncomfortable with being this vulnerable, but it’s the only way that really works for me. The truth is not a simple thing, and the full range of human experience is not a cut-and-dried, clean and tidy topic. It’s messy. It’s inconvenient. It’s exposing. It’s vulnerable. And at its very best, when it’s done properly and honestly, it turns us all into deeply fragile creatures whose lives literally hang by a thread at times.

Le’ts be honest, people. The very fact that a lot of us are alive is proof of miracles. The fact that any of us emerges from the womb with 10 fingers and 10 toes and all our organs intact, is nothing less than amazing. The very fact that countless people, over the course of human history, have been terribly, terribly injured — both within and without — and yet have survived, or even thrived, is further proof that we frankly don’t know shit about how everything is put together, and trying to come up with pat answers or reduce the deepest mysteries of the human spirit to reproducible, mechanized formulas is an exercise in futility.

Certainly, we will never stop trying to decode life’s intricacies, but deep down inside, we all have to admit that there’s way too much mystery surrounding us, for any of our arbitrary rules to apply for long.

So, that being said, I’m going to reverse my former position and venture back out into the light of day with this blog. I am still very concerned by the Health 2.0 movement to get everyone to put their health information online. Google Health, and other publicly available patient records management programs, scare the living daylights out of me. And the fact that people are embracing this innately non-secure, non-private, non-controllable new trend — which can have personally devastating consequences for individuals whose privacy is compromised — worries me deeply.

But I’m still going to keep blogging. I’m still going to keep talking.  Above all, I’m not going to stop believing that the power of the mind and the human spirit can — and do — work together to triumph over the injuries of the brain.

The Magic of “Analgesic Stress”

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

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

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

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

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

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

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

Re-experiencing the traumatic event

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

Avoidance and emotional numbing

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

Increased arousal

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

Other common symptoms

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

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

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

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

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

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

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

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

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

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

And analgesic stress lets me do just that.


A Perilous Relief – Table of Contents

Hits madness… the good kind

What a day I’m having… That little post I put together on the train while coming to work has caught people’s attention. My normally sleepy little blog has by now logged 1,646 visitors. Up from a high of 200-some, a few months back.

Suddenly, people are paying attention
Suddenly, people are paying attention

I’m pretty excited about this, and checking where the traffic is coming from, Alphainventions and Condron.us are both feeding me. Alphainventions mores0, but Condron is doing it, too.

It’s a pretty intense jump — a 10-fold increase over what I typically get. Dizzying. It’s kind of depressing, that this happened as a result of me talking about terrible things happening, but I guess in these times, everybody is paying closer attention to terrible things.

I think that perhaps we’re really trying to figure out how to handle it all. It’s not easy, living in these times, and I suppose it’s human nature for people to ponder imponderables. That’s not a bad thing. In fact, it’s a good thing. Writing about terrible things isn’t the most pleasant activity, but if we can come away with some lessons learned, then we may be able to turn negatives into positives.

One can only hope.

I talked to my friend today about their nephew. People think it was a drive-by shooting. Stupid, stupid, stupid. What’s the point?! What does it give us — anyone — to strike out against others from a safe distance?! From the safety of a passing car… What is the point?

I can think of a number of reasons someone would want to do such a thing. I can think of a whole lot. In a small way and on a very limited scale, it certainly has allure. But on a grander scale, within a community context, it has on meaning at all, and it only serves to destroy what little connection we have with our world.

And I think about how this relates to TBI. And PTSD. I can’t help but think about it. I wonder if the people involved were cognitively impaired, in some way. If they were socially impaired. If they had been injured so often and so badly by a wrecked family system and a wrecked culture, that there was no way they could get through it in one piece. If they were so brutalized by the inequities of this culture we tend to adore, that there was no hope left for anything but violence. Shooting. Cowardice from a moving car.

Certainly, whoever did this was alienated from their community, else they wouldn’t have done this. People are by their nature self-preserving. They do most things because they get something out of it. My logic is getting all tangled around, I’m sure, because I’m so pissed off about this shooting — about all the shootings that have been going on. But it seems to me that people who feel they have a place in the world, who have a future ahead of them, who can clearly see how they are interconnected with one another, and who have positive, mutually beneficial relationships with others they care about, are not going to run around shooting other people from moving cars.

But, you may say, people are responsible for their life choices. They have to make wise decisions and act on them, and if they choose the lesser, then they should be caught and punished… possibly put away for a very long time. I’m not saying that isn’t true. I agree with it. Personal choice is critical in all this, and I do believe in finding, catching, and punishing wrong-doers. I hope whoever killed my friend’s nephew is found, tried, and sent away for good.

But if someone is so f’ed up by a long, long history of abuse and neglect, and thanks to many beatings and falls and fistfights, their brains have been altered in ways they’re unaware, so that they’re doing things and making choices whose reason escapes them, and their skills and abilities are eroded by lifetimes of neglect and misunderstanding and seemingly random punishment, what chance do they have of acquiring the ability, even skill, of assessing their behavior and their situation and figuring out how to set right what’s been wrong for so long?

I do think, based on my own experience, that head injury probably plays a much larger role in our society’s ills than we care to admit. Certainly trauma and post-traumatic stress does. We should probably look closer at it as a nation. I suspect we’ll have ample opportunities to do so, as our veterans return from Iraq and Afghanistan, many of them with TBI and PTSD — and not all of them diagnosed and treated or supported in any way. I fear we are headed for social melt-down, even as our economic situation worsens waaaay past where we thought it would bottom out.

This is not to say that I think everyone who’s been hit on the head or suffers from PTSD gets a “pass” when it comes to bad — even evil — behavior. Some sh*t is precisely that — pure evil. The thing is, with brain injury, you don’t always know how evil your behavior is. It’s when you start to approach your injuries and deficits and learn to understand it and you get your broken head around the ideas of what’s right and what’s wrong and what you should and should not do, that you have the chance to examine your choices, become conscious about them, and become capable of taking responsibility for what you’ve done.

But until you can look at your injury and the after-effects, and come to terms with the person you’ve become as a result, you can’t really even start to approach the level of self-examination that’s so important, even vital, to responsible behavior.

My friend’s nephew is dead. It is a goddamned tragedy. Hearts have been broken, and some of them will never heal. This happens every day, all over this country… all over the world. And every time it happens, it is a tragedy. There’s no two ways around the awfulness of it all. But the worst thing of all is, this sh*t keeps happening, and we don’t seem to learn. We can’t seem to figure out how to stem the tide of this wretched self-destructiveness, and we can’t seem to figure out how to make our streets safe. Not just the nice streets in the nice neighborhoods, but all streets. In all neighborhoods.

I’m just one person looking on from something of a distance, but I am holding onto some hope. Maybe it’s easier for me to do it, because I’m not in the middle of my friend’s family’s pain. I’ve been in similar pain… and if nothing else, I cannot lose hold of hope.

I can only pray that maybe someday we’ll figure out ways to approach our social limitations with common sense and compassion, find the courage to reach out to ask for (and offer) much-needed help, and force ourselves to look at social ills not just as opportunities to capture and punish the anti-social dispossessed, but as gateways to greater understanding… Gateways that not only make it possible for us to understand, and sometimes forgive, but which force us to face up to the terrible things we have done… and change our ways.

Maybe I’m being overly optimistic. I’m sure on some level I am. But after all I’ve been through and survived, after having come through so much wretched difficulty in my own life, after having won so much and achieved so much despite my limitations, I’m convinced, there are such things as miracles.

Giving hope its due

Okay, now that I’ve riffed on despair, it’s time to dwell on hope. And healing. And the good things that come along with brian injury.

I can almost hear you thinking, “What good things that come along with brain injury? What are you – nuts? Head trauma sucks, and long-term after effects of even a mild brain injury can be so debilitating as to ruin lives, destroy families, trash careers… and more.”

I agree. Brain injury is a national health crisis and it’s a tragedy and a disgrace that something so common (see the stats in the sidebar) is so little understood and its impact so under-estimated. It’s a travesty, in fact. Last night, I was reading the book Confronting Traumatic Brain Injury by William Winslade. The Amazon review says

Author William J. Winslade suffered from a traumatic brain injury (TBI) as a 2-year-old, when he fell from his second-story porch and landed straight on his head. He’s one of the lucky ones who’s recovered fully, both physically and emotionally; his only souvenirs of the fall are a three-inch scar and a dent in his skull. He warns that of the 2 million Americans who suffer from TBI each year (most of them from car and motorcycle accidents), up to 100,000 of them will die prematurely. More than 90,000 of them will face up to a decade of extensive rehabilitation, at a cost of up to $4 million each. Even a TBI as seemingly minor as a concussion can have devastating long-term physical consequences, causing seizures, memory loss, learning disabilities, and more. However sorry these problems may be, he writes, “the truly debilitating deficits” are the less-obvious emotional effects, “such as social isolation, [which] take their own insidious toll.”

Which is all very true. I can personally attest to it. And that book is ten years old. So why don’t more people know about this stuff? Why is our country — and the world — still forced to cope with so much trouble relating to brain injury. From violent crime to domestic abuse, from learning disabilities to physical limitations, to series of progressively more debilitating re-injuries over the course of lifetimes, brain injury plays a whole lot of havoc with our world.

The thing is — and I’ve read pieces by Dabrowskian therapists saying this is why they became interested in his work — the information we have (and we do have plenty of stats about TBI) isn’t always conducive to knowledge.  Perfectly intelligent people with lots and lost of information at their fingertips continue to overlook and ignore or downplay the impact of head injuries, and refuse to take steps to prevent it. What’s (perhaps) worse, is that perfectly intelligent people, who are capable of understanding the objective impact of head injury, persist in treating TBI survivors as though there’s something wrong with them, that they’re deliberately doing the things they do, that they’re intentionally screwing up, that they’re cheating the system, slacking, taking advantage, and doing any number of other things to “milk” a supposed injury.

Check the blogs of TBI survivors out there, and you’ll find more than a few accounts of difficulties with friends and loved-ones who refuse to factor in brain injury in the TBI survivor’s behavior.

Now, I could circle back around and delve into despair, but I’m choosing a different tack. Why do intelligent people neglect taking the facts about TBI into consideration? Why? I suspect it’s because brain injury isn’t just about facts. It’s about harm done to the singlemost important organ in the body. It’s important not just because nothing works without the brain, but because even if it is functioning somewhat well in a physical sense, if it’s not operating at peak performance, it deprives us of something even more vital to the human soul than motor function or control of our bodily functions — it deprives us of our humanity.

Truly, brain injury is terrifying for most people, because it hits us where we live, in the deepest, darkest part of our souls, where we are most vulnerable. Especially, I think, for intelligent, intellectual, fact-driven people, the emotional impact of brain injury — just contemplating it, to begin with — can be so unsettling that it causes higher reasoning and analytic function to slow, if not stop. Pondering the impact that head trauma can have is, well, traumatic. It kicks off our most basic survival responses. And our fight-flight-freeze response tends to make us abandon high reasoning for the sake of just getting away from the thing that threatens — or just frightens — us.

I suspect that this, more than anything, is what keeps brain injury from being adequately apprised and addressed in this country. And it appears that the only thing that will make us sit up and take notice are tens of thousands of returning veterans — trained warriors, wounded warriors — who are reintegrating into a society that is woefully unprepared for them… but will need to change that, if we’re going to get by in this new century, this dawning millenium.

And that’s where I think hope can help.

Certainly, hope is necessary in any tough situation, but especially in the case of TBI. Mild, moderate or severe, brain injuries certainly leave a mark on survivors and their family, friends, co-workers… often without them understanding why and/or to what extent. But we don’t have to let that keep us down. Yes, there are problems. Yes, there are issues. Yes, there are tremendous difficulties. But with the brain, you never know what’s going to happen next. Some recoveries last months, years, decades longer than anyone expected them to. But abilities can sometimes be restored, where the experts were sure they were gone for good. And where some abilities are lost for good, others can arise in their place — or show up where they weren’t before. Plenty of people have survived trauma that marked them “certainly” for death, and they’ve battled back from the brink. And I’ve heard stories of people who sustained significant brain trauma, only to find that suddenly they could paint like nobody’s business. Or they started writing one day for no apparent reason.

Looking at some of the most brilliant minds of the past thousand years, the brains inside their heads have not always been “standard issue”. Einstein was missing part of his brain. I’ve also heard that Thomas Edison’s brain was malformed. (Note: I’ll have to do more research that one — I’m not finding information about it right away.) Gifted artists and writers have been epileptic, as have some of our most effective leaders and gifted actors and athletes.

And I suspect, the more we learn about brain injury, the less afraid of it we’ll be. The more we realize that it is NOT a death sentence, that it is surivivable, that it can actually impart or uncover abilities and gifts that might otherwise go unnoticed and undeveloped, the less traumatic the mere consideration of it will be. I don’t mean to diminish the suffering of those who have really struggled with the after-effects. And I don’t want to downplay the seriousness of it. I’m just saying, there are two sides to this story — the tragedy and the triumph. And when we can pay as much attention to the triumph as we do the tragedy, and accept them both as possibilities… as parts of the whole of human experience, we might stand a better chance of confronting the challenges that go along with brain injury, and learn to integrate the experience into our collective storehouse of information… and for once, let facts — not fear — govern our understanding of the injured brain.

TBI and PTSD – The chicken or the egg?

I’ve been giving a lot of thought, lately, to how TBI and PTSD interconnect and “feed into” each other. In my experience, the two are closely interconnected, and they can make each other pretty confusing and convoluted. Each condition changes the brain in subtle but important ways, and when the two interact in one brain/body/mind/spirit, the compounded difficulties can be exponentially more difficult to identify — and treat.

Traumatic brain injury is by its very nature traumatic, and post-traumatic stress disorder comes out of trauma. So, when you fall and hit your head, or you are in a car accident, or you are attacked and knocked out, trauma happens to the body. The body is threatened – sometimes mortally – and the brain kicks in with all sorts of great hormonal and biochemical survival mechanisms. Adrenaline gets pumping. Endorphines start flowing. Glucose gets delivered to muscles. And the less-survival-based reactions we have get pushed off to the side, so our bodies can focus on one thing: survival.

Even if we are not consciously aware that we are in danger — like when I fell down the stairs in 2004, and I didn’t fully realize the extent to which my physical safety had been threatened — our bodies are aware that they are under attack, and they respond accordingly. It’s not something we can control, it’s not something we should control. We need our brains to be able to care for our bodies without our minds knowing how to do it. The problems start, when our brains don’t realize that we’re out of danger, and/or we get caught in a constant feedback loop of detecting perceived danger, reacting to it, stressing out, and never getting a chance to settle down.

That settling down piece is very important. After our sympathetic nervous systems have risen to the challenge(s) of a perceived threat, our parasympathetic nervous systems need to kick in and help our bodies chill out. Rest. Restore. Relax. Digest… Take a break and get back to balance. But if we never take a break and get our nervous systems to relax and get back to normal, we can get stuck in a constant roller-coaster of fear/anxiety/stress/hyper-reactivity that just won’t quit. And traumatic stress eventually turns into post-traumatic stress disorder. Not fun for anyone.

One of the big ways I think TBI contributes to the development of PTSD is in the “debriefing” phase after a crisis or trauma. TBI can impair a person’s ability to self-assess — sometimes we literally don’t know that something is wrong with how we’re experiencing/reacting to life. It can be harder to detect physical experiences and decode behavioral problems, not to mention cognitive ones. And that diminished ability to self-assess makes it more difficult to self-regulate… to consciously and deliberately change your behavior and actions so that you can “power down” and let your over-taxed body restore itself.

At least in my case, when I went through traumatic experiences — let’s take one of my auto accidents as an example — I wasn’t able to think things through after the fact and assess how I was feeling. I literally didn’t know that I was having trouble understanding what people around me were saying. I thought it was them, who were suddenly refusing to speak intelligibly. I literally did not realize that my sleeping schedule was off — I just stayed up later and got up earlier and pushed myself to go-go-go… and then drank and drank and drank to get myself to relax. I wasn’t even able to determine how I was feeling physically. All I knew was, something was up with me, and it really made me feel awful.

So, I pushed myself even more to “keep up”… and it just added to my already overtaxed body being stretched beyond its means. Not good.

A few posts back, I wrote about being wired to survive and all the biochemical activities that take place as a result of some traumatic crisis. The thing to remember about that wiring system is that it is totally independent of rational thought… but rational thought is necessary to deal with its aftermath. The physical experience of all that adrenaline and endorphins and glucose is not a walk in the park. Our bodies need our brains to take over, after we have rushed to safety, to tend to our frazzled nerves and make choices that allow us to relax, regroup, recuperate, and restore the delicate balance in our central nervous systems.

But with TBI, even mild ones, the brain is impaired and it cannot process clearly. So, we can end up making choices that do not help us relax, that keep us on edge, that keep us going-going-going, so we never really get a break from the crisis and drama.

And post-traumatic stress disorders emerge, which further alter our brain chemistry and how we make choices and take action in our world. PTSD actually alters our cognitive functioning. It makes us think differently than we would, under normal, non-stressful conditions. And that different thinking is not always the smartest thinking.

But wait, there’s more…

Impairments to our thinking — our heightened hyper-reactivity, our hair-trigger response systems that are fried and frazzled — can cause us to make choices that are dangerous and risky. Choices that can cause further head injuries. Being all PTSD’ed-out can make us very quick to anger, in situations where we’re likely to get in a fist-fight, even if our opponent is twice our size. It can make us “slow on the uptake” so we miscalculate choices while we’re driving. It can cloud our judgment about whether or not to take up skydiving. And our increased appetite for stimulation can cause us to pursue activities that are custom-made for yet more traumatic brain injury.

And so, we end up with a vicious cycle of traumatic head injury feeding our post-traumatic stress, which evolves into disorders of mind, body, heart, and spirit… and leave us wondering why the hell everything around us is going to shit. Our brains have been injured, and our judgment is impaired. And each condition feeds the other.

I’m not sure how much research has been done on the interactions of TBI and PTSD. I think it’s a topic that’s ripe for harvesting, and we could probably learn a lot from taking a close look at the two pieces of the puzzle. I think that folks being treated for PTSD should also be evaluated for TBI, and vice versa. Having experts and folks in positions of authority say that “most TBI suvivors heal” sends the message that the brain will just take care of itself, and everything will be fine. But while the brain is healing — to whatever extent that may be — post-traumatic stress can emerge, which can feed a vicious downward spiralling cycle that affects not only the mind, but the spirit and the body as well.

And that needs to be addressed.

And I do more of that here…

Head injuries make a big difference

I’ve been looking around a lot, lately, at all sorts of different materials — in books as well as online — about how the brain and the body interact with each other. The gray mass inside our heads is getting more and more press, as people pay closer attention to the after-effects of the Iraq and Afghanistan wars, and hear about how so many vets are affected by TBI.

I can’t believe we had to have two wars to figure out that TBI — whether it’s open head or closed head wound, whether it’s mild or severe — can have a substantial impact on people’s lives after the fact.

I can’t believe we don’t know more about this. People have been getting hit on the head since time immemorial. Why is it we’re only starting to take it seriously now? People have been recovering from blasts for generations. Why is it that we’re only starting to study it now? What is up with us, anyway?

I am also more than a little incredulous that the human race — which is defined by its brain — doesn’t know more about this thing that everybody has. I mean, come on people. What’s taken us so long to start paying attention to this common organ of ours? And why does it take war and injury and extreme circumstances to perk up our attention sufficiently to realize we don’t know nearly enough about this thing called the human brain?

What is up with that?

I mean, so many different societal ills can be traced back to head injury — domestic violence, violence in general, social dysfunction, emotional problems, even mental illness, financial woes, crime, illness… there are just so many ways head injuries can totally screw us up, and an awful lot of people experience them — check the stats on the left side of this blog, if you’re not convinced.

Head injuries do have an impact. A big one. And as our tens of thousands of troops return from Iraq over the coming 18 months, we’re probably going to be seeing even more impact — not to mention a whole lot of PTSD fallout throughout this country. I’m trying to be hopeful, but I must say I’m worried.

I just hope we can figure out that head injuries matter, and that PTSD is something worth treating, before we have to learn too many lessons the really hard way.

The best cure for self-pity

Just when I’m starting to really succumb to the poor-me’s, I get an excellent reminder of what I really have going for me. It’s true, being a multiple MTBI survivor hasn’t made my life any easier, and I do have a lot of issues I need to overcome. But I’m also highly functional, I have full use of my body, I’m not laid up in a hospital or rehab, and I’m able to fend for myself.

My life isn’t perfect, by any stretch, but it’s a far sight better than it might have turned out, had my falls and injuries been worse. I really believe that I was divinely spared a lot of disaster over the course of my life — for what reason, I’m not sure. I’ve come close — so close — to being badly hurt, attacked, arrested, institutionalized, even abducted (when I was a kid and wasn’t very prudent about whom to talk to and how to interact with people)… not to mention sued and fired and a lot of other things people could do to me that would really mess up my life. Time after time, when I think back, I’ve narrowly escaped serious damage, literally through no effort of my own.

And I wonder, why was I spared? Why am I walking around in okay shape, after those car accidents, those falls, those attacks? Why am I able to walk through life on my own steam, when so many others are unable to do so? Why have I been given so much and allowed to keep so much of what I could (and perhaps should) have lost along the way?

What makes me any better than, say, the thousands of troops returning from Iraq and Afghanistan, who have really severe injuries — some of which cannot be detected from outside their heads?

What gives me the right to live as fully as I do, when others who experience the kinds of car accidents I was in are watching their lives fall to pieces before them, unable to think, remember, function, or even walk around a grocery store without sunglasses on?

What can possibly justify the fact that I’ve managed to keep my house, my family, my car, my job(s), even in the face of a debilitating head injury? What makes me so deserving, so special, so… worthy of all this?

I just don’t know. I look around me at the other folks who have sustained head injuries – from mild to severe – and I marvel at their resilience. I’m not sure I could hang in there the way they have. I look at the pictures and read the accounts and try to put myself in the shoes of folks who have to overcome not only the loss of their memory and their life savings, but also their most basic bodily functions.

And I am both humbled and chastised. The problems that I have — the slowed processing speed, the lousy short-term memory, the inability to concentrate on things longer than half an hour at a time, the chronic pain, the sensory sensitivities, the temper flares, etc. — as challenging as they may be, still allow me to move about the world on my own steam. They may keep me from being fully functional, but they don’t prevent me from looking and acting fully functional (which in our superficial world, is 3/4 of the battle). And as rough as looking for more work may be, the fact that I actually can look for more work, is a gift I mustn’t take for granted.

Who can say why I was spared a worse fate?

Who can say why I was knocked out for only a few minutes, rather than a few hours?

Who can say why my fall out of that tree in 1980 didn’t break my back?

Who can say why the hits I took in high school sports weren’t more serious?

Who can say why my car accidents derailed me for a shorter time than others’ do?

Who can say why I was able to hop up after my fall in 2004 and say, “I’m okay… I’m good,” and get on with my life — even if the getting was a lot less good than it was prior to my fall?

I don’t have the answers to those questions. And there’s this little voice in my head that’s warning me away from comparing myself — favorably or unfavorably — with others and their situations. We all have our challenges, and we all have our limits, and it’s not really for us to judge which is better or worse, which is easier or harder, or even if we deserve what we got.

All I know is, things haven’t been easy for me. But they haven’t been as hard as they could have been. I’ve been spared, and while I do wonder why I rate that, the bottom line is that my difficulties have made it possible for me to understand what it’s like to struggle terribly with things that others cannot see. I know, first-hand, what it’s like to be lost and alone and afraid and totally invisible to the rest of the world. I know what it’s like to live, day after day, wondering if I’m going to lose everything because of some mysterious difficulty I can’t put my finger on. I know what it’s like to be abandoned by people who were supposed to help me, and treated like shit by mean-spirited people. I know what it’s like to be preyed upon because someone senses I am at a disadvantage in life.

And since I know first-hand what all this is like… AND I am still pretty high functioning, I’m in a really great position to help. My brain is broken, sure. But my brilliant mind won’t quit. And since I can write and use this blog and I know how to get the word out online about this TBI stuff, it puts me in a really great position to educate and inspire and hopefully assist others.

God, but this world can be a lonely, confusing, depressing place. But in the worst of times, it’s so very important to identify our strengths and our gifts and pitch in to help others who are in need. I haven’t the faintest idea why I have been spared the fate of so many others like me, who had the same types of experiences but have it much worse. But it’s not for me to know.

All I can know is, I’m a survivor (dammit!), and I have abilities and talents and resolve that I can put to good use for others. I have an extra hour or two in my day that I can spend blogging before I go to work. I have a job that lets me grab a few minutes, here and there, througout the course of my day to examine my life and figure out what works — and what doesn’t — with regard to my broken brain. I have been given  wonderful gifts of resiliency, determination, stubborn faith, insatiable curiosity, and the ability to overlook my own personal pain — physical and emotional — in the service of a cause greater than myself.

I know how to function in this life, in spite of a long history of brain injuries and the personal/physical/social/emotional/financial complications that arise from them. I’ve devised coping strategies (usually from sink-or-swim situations) that have really worked for me. I’ve figured out how to find jobs and stay employed, how to make money and pay for big-ticket items, how to appear functional in the world, how to interact with people well enough to get by, how to support my memory and work with my uncooperative body, and more. I’ve had to face down a lot of real challenges, but somehow I’ve managed to overcome them. And I love to write… so what better position could I be in, than to blog about it all and hopefully toss someone a little help from my own personal experience?

So, rather than sitting around and feeling unworthy and useless and undeserving because I’m able to function well, while other flounder and founder, I think I’ll just get on with my life, get on with my day, and use what I learn for the benefit of others.

God knows, we can all use a little help. And what a shame it would be, if I were the only one who benefitted from the lessons I’ve learned!

Add Your Name to the Open Letter to the President

I just found this over at the Sgt. Sam Nichols TBI recovery blog:

Over the past year and a half, my daughter Erin has spent 8 to 14 hours a day in various military hospitals at the bedside of her husband Sam, a US Marine severely injured in Iraq by a roadside bomb.  It has become Erin’s dream to go back to school to become a speech therapist so that she can help Sam and other wounded veterans of the Iraq and Afghanistan wars learn to speak again.  She hopes to one day work in a veterans hospital.  One of the provisions of the new GI Bill is the option to allow servicemembers to transfer their GI Bill education funding to a spouse or dependent.  But—the military has been dragging its feet on getting the regulations in place, so servicemembers are still waiting for that benefit.  The Obama Administration can and must get the bureaucracy moving and make this benefit a reality.

In the coming months, President Obama has a unique opportunity to make a series of critical decisions impacting Iraq and Afghanistan veterans. Sign the open letter urging him to enact these four critical policies in his first 100 days:

    · Ensure that veterans don’t have to fight for funding for hospitals and clinics.

    · Prioritize veterans in the economic stimulus package. (Note: It may be a little late for this, but it’s still a good idea.)

    · Implement GI Bill transferability.

    · Aggressively address troops’ mental health injuries.

Add your name to the open letter here.

I just did

Center helps with psychological health, traumatic brain injury

A new 24-hour outreach center now provides information and referrals to military service members, veterans, their families and others with questions about psychological health and traumatic brain injury.

Operated by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, which falls under Tricare Management Activity, staff at the center are available around the clock, 365 days a year, by phone at 866-966-1020 and by e-mail at resources@dcoeoutreach.org.

“We’re providing 24/7 support to assist callers with questions regarding psychological health and traumatic brain injury,” said Brig. Gen. Loree K. Sutton, M.D., director of DCoE. “Getting the best possible information and tools, hassle-free, will empower and strengthen warriors and their families to successfully manage what can be confusing and disturbing circumstances.”

The center can deal with everything from routine requests for information about psychological health and traumatic brain injury, to questions about symptoms a caller is having, to helping a caller find appropriate health care resources.

Read more here…