And now I feel it for the next week

I had a busy day, yesterday. A quiet day, too. I helped my spouse get ready for their event, drove them there, unpacked the van, chatted with people at the venue, hopped in the van, and drove home along back roads (because the main roads were packed).

I had some lunch when I got home. Nothing huge, just a sandwich, potato salad, chips, pickles. I had a handful of things to do, so I ordered them according to the weather. It was amazing weather, yesterday — sunny with passing clouds, a nice breeze, in the mid-60s. Couldn’t ask for better mowing weather. So, I pulled out the lawn mower from the back corner of the garage, topped off the gas, and got mowing. It took me an hour and a half, but I got the front and back yards done. I also raked up leftover leaves from last autumn, swept out the garage, replaced a down-spout that had fallen off my gutter, and trimmed back some underbrush that was blocking the view from my driveway.

I used the leaf blower to clean off my driveway, stairs, and deck, and then I ran my snowblower till it ran out of gas. It’s best not to let it sit with old gas in the engine all winter. I’ve had the snow blower nearly 15 years, and it’s held up well, but I need to be smart about storing it over the winter. At last.

After that, I had a snack, took a shower, and put up a new huge bookshelf in my study that I got from the neighbors for almost nothing. I’d been needing a new bookshelf, and the timing was perfect. It took a lot longer than expected, because I don’t have a lot of room to maneuver in my study, and I had to put it together in a very small space. I also had to partly take it apart, because the way I’d assembled it first made it impossible to turn upright. Eventually, I got it, but I was not expecting it to take me three hours to do it.

Ah well, so it goes. I now have enough shelf space in my study, so I can get rid of some of the piles. I also have a lot of books I want to get rid of. I was interested in a lot of stuff, years ago, that just doesn’t have anything to do with my life, anymore. And I need to get free of all of it.

I also need to get rid of some of the computers I have. I don’t need to hang onto them. There’s no point.

Lightening my load. Getting my life in order.

It feels like I’ve been doing that a lot, lately. Picking and choosing and prioritizing. As it should be. I can’t do everything in my life, and I don’t have unlimited energy. So, when I do find something I care about that matters, I need to make the most of it.

I’m also getting clear about where I want to go with my work in life. Future directions. Areas where I need to focus.

I’m sore as anything, today. Just aching. But it was worth it. I got a ton of stuff done that I’d been needing to finish.

Whatever I do, and however I do it, I just want to make it count.

For June: Do one positive thing a day for myself and my dreams

Just keep steady, in a good way

Let’s just face it.

I’m stalled.

I’ve been stalled for months, even years. Even longer than that, actually. No matter how I’ve tried, I haven’t been able to break free of the rut I feel like I’m in. It’s just felt like one problem after another that I’ve handled… that is to say, other people’s problems. And in the process, I solve my own.

I get paid to solve other people’s problems. I get paid pretty well, too, so that solves a lot of problems in my life. I need money to survive. I need a certain amount of status and security to stay healthy and not die. I know people who treat money like an optional thing. They don’t want to get entangled in it. They have more important things to worry about.

And I’m happy for them. I really am. If they can make it — or survive the stresses of not having enough — that’s a quality I admire. But I can’t do it. The stress throws me off too much. It disrupts my sleep, and when that happens, I can’t function. Even worse, my behavior takes a nose-dive and I lash out. Yelling. Slamming things around. It’s not good, for me or the other people around me. I’m stronger than people realize, and I can do some damage, if I let it all loose.

So, I need to keep things well managed, in a steady state of balance. That means getting enough sleep. And that means not getting so stressed out that it starts to wreck my life.

I keep myself in a pretty regular routine. And it works for me. I manage to get enough sleep, most of the time. I eat regularly, exercise regularly, take care of my responsibilities, hold down a job.

But I’m in a rut.

So, I need to get myself out of it. I need to take action on my own behalf, to at least create the impression that I’m taking care of myself. I’m so busy taking care of everyone else, I get lost in the shuffle of my own life. And that needs to change.

So, I’ll do one positive thing a day for myself. Something that brings me happiness, not just maintains my steady state. And I need to prioritize it over everything else. Yes, I may need to do other things, first thing in the morning, to get myself going — exercise, eat breakfast, take care of my spouse — but then I need to just take a little time on something that contributes to me. And my future.

There’s a lot of stuff I can do for myself. I have a bunch of books I’d love to read. I’ve been wanting to read them for a while, and I will surely get around to them. And there are other undertakings — writing, designing, artwork — that I want to get back into. My legendary (in my own mind, anyway) projects take on a life of their own, and they bring me a lot of happiness. But I’m stalled between a number of choices. Each of them has benefits. Each of them has downsides. I might be able to do any of them and be happy about it. But I have to pick one. And move on. Get going with just one, so I can get out of my rut… make some progress.

So, that being said, I’m picking one project and doing something positive about it, each day in June. I may not blog about it, every single day, but I will have that focus. I’ve made the commitment to myself, and now I’ll carry through.

The main thing is to have a deliberate focus in my life. My job is… fine. But it’s not how I want to spend all my free time. My marriage is on good footing, although it seems to be getting more challenging each week. My health is pretty good (though I could stand to lose 15 pounds). Overall, my life is… fine. But I need a specific focus on something that is mine and mine only, so I don’t feel like I’m just evaporating into the mist of everyone else’s dreams and ambitions.

I can do that. I will do that. I am doing it.

Onward.

No sooner do I say I need more movement, than my day fills up with meetings

Today there is not one minute of my day that is not scheduled for a meeting. Non-stop. Eight hours. No fun.

But that’s the deal, today, so that’s that.

Fortunately, I’ll be working from home today, so I can walk around the house while I talk on the phone. I can’t do that at the office… at least, not on the scale I can do it here. I can’t walk around the halls, talking on the phone. I can reserve a conference room and then walk around it, while I’m listening. I could even project the meeting proceedings on the big screen, so I can watch what’s happening as I pace. But it’s not the same as being able to walk around my house.

So, at least there’s that.

And man, do I need that today. Yesterday I was stuck in an all-day workshop where we just sat… and sat… and sat. It started early, so I didn’t have time to exercise in the  morning before I went. But it ended earlier than my normal days typically do, so I was able to get to the pool and go for a swim. That was productive. And much needed. So, it’s all good.

I noticed that I was getting really tired towards the end of the day, and I was starting to get cranky and a little confrontational. But I managed to pull up and not blurt whatever came to mind. There was this module we were working through that just seemed like such B.S., and I wanted to say so. But I held my tongue and said nothing. Mission accomplished. I got out of it without wrecking my reputation, which is what I often do at those kinds of things, towards the end of the day when I’m tired. I blurt out crap that makes me look belligerent and confrontational, when I’m just tired.

And then all the work I put into cultivating rapport with others goes out the window. Fly away, little reputation. Fly away.

But yesterday, I held my tongue, and that was good. It was very, very good.

And today… Well, I’m looking at another day of non-stop paying attention to important stuff, and potentially being virtually motionless the whole time. I can’t let that happen. Not two days in a row. I just have to get creative and think outside the box. Find ways to keep myself moving. Heck, maybe I’ll even ride my exercise bike while I’m on a call — except that I get out of breath, and speaking up when I sound like I’m in the middle of an exercise routine is not the most professional thing to do.

So, scrap that. No riding the bike while I’m on a conference call.

I’ll just pace in my living room, walk around the downstairs. Do some movement… knee bends… stretching… anything to keep my body awake. ‘Cause if my body isn’t awake, neither is my brain.

And not-so-great things happen when my brain is foggy and asleep.

Onward.

Emotional Problems After Traumatic Brain Injury – Peer and other support

After brain injury, you need support

Peer and other support

Remember, too, that not all help comes from professionals! You may benefit from:

• A brain injury support group — some are specialized for the person with TBI, others are for family members, and others are open to everyone affected by brain injury.

BB: Not everyone has access to this. But if you're reading this, you have access to the Internet, and there are support groups online, like the forum Traumatic Brain Injury and Post Concussion Syndrome

• Peer mentoring, in which a person who has coped with brain injury for a long time gives support and suggestions to someone who is struggling with similar problems.

BB: Again, it can be difficult to find someone who can help you. But if you reach out online, you may find someone. Also, you never know who's had a TBI. We're everywhere.

• Check with your local Brain Injury Association chapter to find out more about these resources. Go to http://www.biausa.org/ to find brain injury resources near you.

BB: I got some great info from my local BIA chapter. I attended some support group meetings. But I wasn't "impaired enough" for some people there, so I quit going. I guess I've gotten too good at hiding my difficulties.

• Talk to a friend, family member, member of the clergy or someone else who is a good listener.

BB: They definitely need to be a good listener - and able to deal with you. Family and friends may not be able to help, because they may be too invested in you being like you always were before. It's a tricky line to walk, but it's important to reach out for help.

Read more at: Emotional Problems After Traumatic Brain Injury

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Emotional/Behavioural Changes after Brain Injury – Part 2

Continued from Part 1

From The Toronto Acquired Brain Injury Network.

My comments are in bold like this.

Emotional/Behavioural Changes

Impulsivity and disinhibition

A person may lose their ability to control their actions or their speech. This problem often goes hand in hand with lack of awareness, and the person may not be aware of breaking any social rules or etiquette. There are strategies that can help to improve the situation, and prevent a person from developing unacceptable behaviours through habit.

BB: The first thing that we need to know, as we recover, is that we're breaking social rules. We may not be aware. And while the people around us may not be comfortable "calling us out" on our behavior, it's important to do it. And it's important to persevere in convincing us that our behavior is just not good. Because we may literally not know. We may also resist accepting that fact. But brain injury and "bad manners" often go together - and if you  never realize you're behaving badly in the first place, it's impossible to fix it.

Emotional Lability

This describes a person’s tendency to laugh and cry very easily and to move from one emotional state to another very quickly. Loss of control over emotions means the person may express their feelings inappropriately or at the wrong time. This can be very tiring and embarrassing for family members to deal with, but in time a person can begin to re-learn emotional control.

BB: I am not a fan of emotional lability. Nor is anyone around me. It can be embarrassing and stressful, and it can make things worse. The best thing to do, for me, is find some humor in it. Over time, this can sort itself out and become more manageable. In the meantime, you just have to make the best of it -- and remember to not over-react to every emotional storm that comes along.

Self-centredness

Someone may become self-centred. For example, the person may not show any interest in family matters and only be concerned with their own needs. Brain injury can affect a person’s ability to judge how someone else is feeling. The person may also become used to the huge amount of attention they receive while in hospital.

BB: Recovering from brain injury requires you to become self-centered, in my opinion. You have to pay attention to yourself in new ways. You have to get familiar with yourself again. But it's easy to get too caught up in yourself, and that can distance others. Ultimately, the thing that's saved me, time and again, is getting past myself. Learning now to be less self-centered. It helps me with depression, it helps relieve my sense of being disconnected from others. Putting others first... that's been a big benefit for me.

Apathy and poor motivation

Lack of motivation, or apathy, is a direct result of injury to the part of the brain that controls emotion, motivation and forward planning. Over time, lack of motivation can lead to social isolation and lack of pleasure. For example, a person may show no interest in hobbies enjoyed previously, or they may not get out of a chair all day. To help, activities can be broken down into small steps to avoid overwhelming the person.

BB: This is a big one for me. Most of the time, I just don't care about much of anything at all. Seriously, I don't. And so many things I've started... well, they've just fallen apart and went nowhere, which made me feel like a total loser who wasted everyone's time. My motivation generally sucks. I wish it didn't, but then again... a lot of times, I just don't care, one way or the other.

But yet, I need to keep moving. I need to stay productive. I need to keep myself from falling into "disrepair" and ending up feeling worse than I already do. Life has always been painful for me. It hasn't been a long exercise in glee and joyfulness. It's been awkward and uncomfortable, and I've been in multiple kinds of pain for as long as I can remember. 

But something in me needs to keep moving. I find motivation where I can get it - generally not from the things that other people get motivation from. Just staying alive. Feeling like I'm doing something productive with myself. And constantly coming around again to take another shot at what I want to do.

Motivation is a tough one for me. I guess I've just developed habits around getting stuff done, and they work for me when I have no motivation to do anything, at all.

One thing that keeps me motivated, is doing things for others. Serving others. Being available to others to help, so they can have the best life possible. That motivates me, I guess. It's probably my biggest one. The rest of the things -- money, success, fame -- nah, I'd rather do something useful that benefits others, to be honest.

Depression

Depression is a very common emotional reaction experienced in the later stages of rehabilitation—often when a person realizes the full extent of the problems caused by the accident. This can be seen as a good sign: the person is aware of the reality of the situation and is coming to terms with the emotional consequences. “Healthy” depression can be worked through in time, as adjustments are made. If a person feels emotionally blocked and unable to move on, professional counseling from someone who understands head injury may be helpful.

BB: I never gave much thought to this before, probably because I've always been depressed, and it's nothing new for me. When I was in high school (I had a handful of mild TBIs in the course of three years), I went through a period that was utterly, completely black. Literally. I couldn't see anything, at some points. Everything was dark for a little bit, and my vision wasn't working.  Fortunately, it seemed to happen when I was sitting down. But the emotional darkness was the worst. I just felt like I didn't even exist, and I didn't care, one way or the other. 

I'm not sure that it had anything to do with realizing how messed up I was. I didn't realize those blows to the head had any effect on me at all. I just felt awful. Whether it was the mTBIs or just being a teenager, is anybody's guess.

Someone asked me once, if I had a history of depression. I said, "Of course," and they seemed sad. I didn't mean to make them sad -- just tell the truth.

Anxiety

It is natural for people who have had a traumatic experience to feel anxious afterwards. Individuals may experience a loss of confidence when they are faced with situations and tasks that are difficult to cope with. However, problems can occur if difficult situations are continually avoided, or if those caring for them encourage dependence rather than independence. Talking about fears and worries is very helpful. Learning ways to stay calm under stress can also reduce the effect of anxiety on everyday life.

BB: I know this one all too well. And what most people don't realize, is that anxiety isn't just about the injury itself. If anything, the injury is just a small part of the total anxiety-generating stuff. Insecurity and instability builds throughout the course of your recovery (because some recovery is invariably happening, even if it doesn't seem like it), as you walk into different situations that you feel should be OK, but then you screw things up -- many times without even realizing it -- and it happens over and over again. Everyone around you is afraid to say anything, because you might A) blow up, B) cry, C) fight them on it, D) feel terrible. Everybody's walking on eggshells, so you never get the information you need to recover sufficiently, or adjust your behavior and adapt to situations.

So, people just basically leave you to your own devices, which is a terrible idea, because it leaves you alone with the very thing that's causing you problems -- your brain. And the anxiety builds over and over and over, because you can't get the help you need to adjust and recover -- and regain your dignity.

Small wonder, that we start to avoid situations. Sometimes it's just easier to not even bother, than get dragged across the hot coals of embarrassment all over again.

Inflexibility and obsessionality

Examples of this behaviour include: unreasonable stubbornness; an obsessive pattern of behaviour such as washing or checking things; or fear of possessions being stolen. The person can lose the ability to jump from one idea to another, and becomes “stuck” on one particular thought. This type of behaviour is often made worse by anxiety or insecurity, so it is helpful to reassure the person and and redirect their attention to more constructive ideas and behaviour.

BB: You never know if the stubbornness is unreasonable or not. There may be a very good reason for it - but nobody's asking the right questions, so you end up looking "unreasonable" to people who might be able to help you, if they just took a different route or opened their minds.

Getting stuck on an idea or a frustration is a big problem for me, to this day. If I'm tired, I can get "stuck in a loop" where I'll keep arguing about the same point, over and over and over again, making everyone around me absolutely nuts with frustration. And they don't know how to get me out of it. 

It's impossible to argue with me at those points. Best thing to do, like they said, is redirect my attention in another more productive direction.

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Emotional/Behavioural Changes after Brain Injury – Part 1

Sometimes the storm seems to come out of nowhere.

From The Toronto Acquired Brain Injury Network.

My comments are in bold like this.

Emotional/Behavioural Changes

Some people are left with changes in emotional reaction or behaviour after a brain injury. These are more difficult to see than physical or cognitive changes. However, they can be the most difficult for the person and their family to deal with.

BB: I had no idea that a TBI would affect me emotionally, or change the way I acted. Like so many people, I figured that a bump on the head was just an external thing. I'd feel pain on my scalp, and maybe I'd feel a little woozy, but it would clear up in a few minutes... or hours. How wrong I was - so many times. Emotional and behavioral issues have been the bane of my existence (and my family's) for years and years, starting back in my childhood when my behavior was erratic, and my emotions were volatile.

Not everybody will experience these problems and their severity will also vary.

BB: The severity can vary from person to person, as well as from situation to situation. With me, I can be fine, one day... be not-so-great (but seem fine), the next... and then completely lose it a few days later. It's often cumulative, but nobody on the outside sees it building up. That happens inside. Where nobody can see. And when it erupts... hooo boy.

The problem for me, is that when I blow up, it puts people off, and then they think that's how I always am... and then they walk on eggshells about it, all the time.

And I sometimes never get a second chance, because they've made up their minds about me in a negative way.

Agitation

This frequently occurs at a very early stage after the injury. It can be a coping mechanism for the person, who may be disorientated and very confused. It is most often a stage a person passes through, rather than a permanent change. Examples include: restlessness, pacing and pulling at intravenous tubes.

BB: I've been extremely fortunate to never having had intravenous tubes to pull at, but I know the feeling of not being able to sit still, being extremely agitated - especially after a TBI. A number of times, I can recollect getting hit in the head, and then being flooded with agitation and an overpowering need to MOVE! Like when I got hurt during an informal pick-up soccer game in high school, after the hit, when I was lying there, dazed and confused, I suddenly felt like I'd been given super-powers, and I leaped up and started playing like a crazy person. I don't think I played better than I had before I got hit, but I felt like I did. And I was ON FIRE - or so I thought.

In another soccer game, when I got my bell rung, I knew I'd been hurt, but I felt this incredible urge to GET UP AND GO!!! And I started racing around the field -- in the wrong direction, no less. I nearly scored on my own team, which I think was a red flag for everybody on the sidelines. I did get taken out of that game, and I paced the sidelines in confusion and anger, because I NEEDED TO BE IN THERE! But it was wise to pull me from the game. I was not in good shape, at all.

So, while agitation may be a coping mechanism for some, as they say above, I suspect it also has to do with the mechanism of the brain - the release of all those chemicals, and the general confusion that causes. The brain is trying to figure things out - plus, it's firing on ALL cylinders, like there's no tomorrow. In addition to being a behavioral coping mechanism, it's a result of the brain's basic function.

Explosive anger and irritability

If there has been damage to the part of the brain that controls emotional behaviour and the ability to tolerate frustration, emotions can swing to extremes. The stress of coping with even minor crises, such as misplaced shoes or a noisy vacuum cleaner, can be too much and trigger an angry outburst. If these stresses can be identified, it may be possible to reduce them.

BB: Amen to this. The part of the brain that controls emotions is particularly susceptible, as it's out in front and there are so many types of injury that can affect it. Car accidents, where your brain slams up against the inside of the skull... or tackles that snap your head back and forth... falls, etc. Minor events can turn into crises -- just being blindsided by a sudden change or something unexpected happening, can set me off. Little things can turn into huge things, in an instant. One minute, I'm fine, then all of a sudden, it's off to the races with emotional overload and over-reaction.

Prolonged stress will also do a number on me, as will fatigue. The more tired I am, the more irritable I get - a tired brain is an agitated brain. And when I get too agitated, it's not cool.

Sudden outbursts... extreme reactions... it's all part of a day in the life for me, sometimes. Unless I can get enough sleep and take good care of myself. If I can keep on my schedule and be smart about eating and drinking enough water, that helps. So does meditation and just taking time to chill out. 

Lack of awareness and insight

The ability to recognize your own behaviours and change them when needed is a sophisticated skill that can be affected by brain injury. This can affect someone’s ability to: be self-aware; have insight into the effects of personal actions; show sensitivity; or feel empathy. It also means that a person may not fully appreciate or understand the effect that the accident is having on their life, health or family.

BB: I honestly had no idea how my TBI was affecting my household, back in 2005. I'd gotten injured at the end of 2004, and 2005 was the start of the downhill slide. I became incredibly self-centered and obsessed with myself. Small wonder - I had to recover and build myself back up, as my Sense-Of-Self had taken a huge hit. I didn't know who I was or what I was about, anymore, and it was devastating. I didn't recognize myself, and I was so caught up in figuring it out inside my head, that I never realized the extent of the changes on people closest to me (who were outside my head).

It took talking with someone on a regular basis about what was going on with me, to help me see what an ass**** I was being, and to do something about it. Until I started talking to a neuropsych on a regular basis, I had no way to understand myself and objectively examine my behavior, because nobody I talked to actually understood how TBI affects the mind, body, and spirit... so they made all kinds of flawed assumptions about who I was and how I was. It was incredibly unhelpful for me, and it did more harm than good. 

I got lucky. A lot of others don't have that opportunity. And that's a damned shame. It's criminal, really.

I’ll continue this post in Part 2. Watch this space for notifications.

Source: www.headway.org.uk

Source: Emotional/Behavioural Changes | ABI Network

Emotional Problems After Traumatic Brain Injury – Temper outbursts and irritability

From MSKTC

Temper outbursts and irritability

Family members of individuals with TBI often describe the injured person as having a “short fuse,” “flying off the handle” easily, being irritable or having a quick temper. Studies show that up to 71% of people with TBI are frequently irritable. The injured person may yell, use bad language, throw objects, slam fists into things, slam doors, or threaten or hurt family members or others.

What causes this problem?

Temper outbursts after TBI are likely caused by several factors, including:

• Injury to the parts of the brain that control emotional expression.
• Frustration and dissatisfaction with the changes in life brought on by the injury, such as loss of one’s job and independence.
• Feeling isolated, depressed or misunderstood.
• Difficulty concentrating, remembering, expressing oneself or following conversations, all of which can lead to frustration.
• Tiring easily
• Pain

What can be done about temper problems?

• Reducing stress and decreasing irritating situations can remove some of the triggers for temper outbursts and irritability.
• People with brain injury can learn some basic anger management skills such as self-calming strategies, relaxation and better communication methods. A psychologist or other mental health professional familiar with TBI can help.
• Certain medications can be prescribed to help control temper outbursts.

Family members can help by changing the way they react to the temper outbursts:

• Understand that being irritable and getting angry easily is due to the brain injury. Try not to take it personally.
• Do not try to argue with the injured person during an outburst. Instead, let him or her cool down for a few minutes first.
• Do not try to calm the person down by giving in to his or her demands.
• Set some rules for communication. Let the injured person know that it is not acceptable to yell at, threaten or hurt others. Refuse to talk to the injured person when he or she is yelling or throwing a temper tantrum.
• After the outburst is over, talk about what might have led to the outburst. Encourage the injured person to discuss the problem in a calm way. Suggest other outlets, such as leaving the room and taking a walk (after letting others know when he/she will return) when the person feels anger coming on.

Read the rest of this article at: Emotional Problems After Traumatic Brain Injury

Emotional Problems After Traumatic Brain Injury

From the Model Systems Knowledge Translation Center (MSKTC) comes this great information – which especially pertains to me, today.

My comments are in Bold like this.

Brain injury and emotions

A brain injury can change the way people feel or express emotions. An individual with TBI can have several types of emotional problems.

BB: Fantastic (sarcasm). There's not just one, but several emotional problems I can have.

Difficulty controlling emotions or “mood swings”

Some people may experience emotions very quickly and intensely but with very little lasting effect. For example, they may get angry easily but get over it quickly. Or they may seem to be “on an emotional roller coaster” in which they are happy one moment, sad the next and then angry. This is called emotional lability.

BB: This just happened to me this morning. I'm still fatigued from my trip, and while I was making my breakfast, my thoughts were interrupted, and I blew up. My spouse really wanted to talk to me, go over what we were going to be doing today, plans for how to organize the house, etc. And that's completely understandable, because I've been away for four days, and they had a lot of time to think. Plus, they missed me. 

I got overloaded and blew up, slammed around in the kitchen, broke down and cried for a few minutes, then regrouped and managed to eat my breakfast in peace, then joined them in the living room to talk about the day and our plans. 

Roller coaster, for sure.

What causes this problem?

• Mood swings and emotional lability are often caused by damage to the part of the brain that controls emotions and behavior.

BB: Brainline says:  The frontal lobe ... helps govern personality and impulsivity. If damaged, there might be no “braking mechanism” for self-control. A person may find [they] cannot control [their] anger or aggression. 

That's what happened to me this morning. I got irritated, and my irritation picked up speed like a freight train until I was pretty upset... then really furious. And then I got furious at myself. And then I got furious at my spouse for not cutting me a break. And then I felt generally broken and useless, which spiralled into a bit of a freak-out meltdown. A small one, but still a scary one, because I was slamming stuff around, and that makes my spouse feel unsafe in our home.

• Often there is no specific event that triggers a sudden emotional response. This may be confusing for family members who may think they accidently did something that upset the injured person.

BB: It can be hard to know when I'm going to "go off", because I'll be working hard to keep it together, and I'll seem to be fine, then all of a sudden, I'm blowing up, apparently "over nothing". There is a sequence of events that sets me off and triggers that sudden emotional response, but it's all internal, so nobody can see it building up.

• In some cases the brain injury can cause sudden episodes of crying or laughing. These emotional expressions or outbursts may not have any relationship to the way the persons feels (in other words, they may cry without feeling sad or laugh without feeling happy). In some cases the emotional expression may not match the situation (such as laughing at a sad story). Usually the person cannot control these expressions of emotion.

BB: I hate the episodes of crying. That's what happens to me most. I don't cry or laugh unless I'm feeling sad or happy, but it can come up very quickly, and it's not always clear to others just how or why I'm reacting the way I am.

Come to think of it, there have been an number of times when I've laughed for no apparent reason -- usually under the worst of circumstances... usually when an authority figure is either nearby or the "target" of my laughter. I've laughed at people telling me how their child was diagnosed with a terrible, life-threatening disease (and my boss was standing nearby and got so pissed off at me that they had to walk away). I've laughed at things bosses have said, seeming to ridicule them. I may have misunderstood their meaning, to begin with, but it could also be due to my brain mis-firing. The really noticeable times when that happened, were within a few weeks of having had mild TBIs from car accidents. I could read and write normally again, but my inexplicably jocular emotional lability was a real problem. For me and everyone arounnd me.

What can be done about it?

• Fortunately, this situation often improves in the first few months after injury, and people often return to a more normal emotional balance and expression.

BB: I found this to be true. I did start to act and react more normally over time. However, if I don't get enough sleep, I'm back to where I was before -- sometimes worse. Sleep is the key for me. If I don't get enough of it over an extended period of time, I suffer, along with everyone around me. 

• If you are having problems controlling your emotions, it is important to talk to a physician or psychologist to find out the cause and get help with treatment.

BB: For me, talking to a neuropsych on a regular basis really made all the difference. It was bad enough that it happened, but not understanding why it was happening, and not having a clue about how to help it made things worse. But when I learned that I need to get more sleep and cut myself a break, it really put me on the right path.

• Counseling for the family can be reassuring and allow them to cope better on a daily basis.

BB: My spouse has a therapist they talk to, and that therapist has dealt with brain-injured people in their own practice, so it's really helpful for my spouse to have access to that information. It's rare, to find a therapist who really understands TBI, and we're both lucky that this person came into our lives. My spouse has become so much more tolerant and understanding of me, as well as appreciative of the progress I've made over the years. And that appreciation has made a lot of things easier for both of us.

• Several medications may help improve or stabilize mood. You should consult a physician familiar with the emotional problems caused by brain injury.

BB: The problem is, brain injury can affect how you react to medications. It can make you more sensitive, or less, and some of the medications (Benzos) actually make things worse. Some mood stabilizers can make the brain more tired -- and that's a recipe for more emotional outbursts, and the pain and suffering that follows. So, your doctor needs to know about TBI and its effects on how the brain handles meds, before he/she prescribes them to you. And if you're not feeling right or you're having more trouble due to meds, let your doctor know. Be smart. Protect yourself.

What family members and others can do:

• Remain calm if an emotional outburst occurs, and avoid reacting emotionally yourself.

BB: This is one of the biggest challenges for me. I always prided myself on how even-keeled I am, and how I kept my head on straight during a crisis. Watching myself get all emotional and overwrought over things that I don't believe warrant all that emotion can be very upsetting for me. And I know I'm not alone. We may have injured brains, but we still have our pride.

• Take the person to a quiet area to help him or her calm down and regain control.

BB: I have to take myself to a quiet area and let myself calm down. I need to remove myself from the situation and get my system leveled out. Then I can rejoin civilized society. But not before. If I go back too soon, I can freak out even more, the next time.

• Acknowledge feelings and give the person a chance to talk about feelings.

BB: I need to talk about my feelings in terms of "I". As in "I feel upset because I feel like everything is spinning out of control, and my brain can't keep up, and then I feel stupid and helpless."
It does no good to lay blame -- to say "You made me feel bad because ____________" Especially because the other person usually has NO idea what they did to provoke me. The fact is, they may not have provoked me - my brain provoked itself, and I need to talk about how I feel in a way that doesn't blame the other person who already feels defensive and vulnerable to my emotional over-reaction.

• Provide feedback gently and supportively after the person gains control.

BB: It often helps, if I can come up with a clear explanation of why I freaked out (I'm tired, I'm frustrated, I'm overworked, I'm hungry), and then I come up with clear steps to fixing that. I tell whoever I freaked out at, what I'm going to do, to stop my behavior ASAP. And I make sure they know I'm going to take more steps to fix it over the long term. Sometimes it helps if I tell someone how they can help me in the future. Like my spouse helping me to get to bed at a decent time. And take naps during the day, when I can.

• Gently redirect attention to a different topic or activity.

BB: I just shift my attention to other things. I do something I've been wanting to do for a while, and that makes me feel better, because I'm using my overabundance of energy for something productive. It always helps, when I channel my energy into other things that have productive uses, like cleaning and organizing. And when I'm done, I have something to show for it. 

I just need to make that shift, which isn't always easy.

Read the rest of this great article at: Emotional Problems After Traumatic Brain Injury

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Emotional Changes after Brain Injury

The Model Systems Knowledge Translation Center has great info on TBI. Here’s one of their great infocomics on emotional changes after TBI (click to download):

Emotional Changes After TBI Infocomic

Amygdala hijacking – Don’t let it happen to you.