“is it common for a stroke victim to lie about everything?”

house with black dots over it
This is what life after stroke may look like – you don’t realize what you don’t know… and you misrepresent it

Please Note: All brain injuries are different. They will affect people in different ways. The following are my observations from personal experience with a stroke survivor, as well as what I know about brain injury. Not everyone is going to have this. My point is, lying is a complex behavior that may be unintentional, as well as organically based — not deliberate or manipulative. Some people may be manipulators, and they may become moreso after stroke, but some people simply don’t realize what they’re doing, and they need help and compassion, not judgment and suspicion.

Somebody found their way to this blog by searching for this question: “is it common for a stroke victim to lie about everything?”

I believe it’s not uncommon.

Stroke can confuse you about what’s really going on. And they may not even realize they are lying.

Either that, or it can make a person very anxious, to the point where they’ll lie to get out of trouble, or they’ll just say whatever comes to mind, to cover their tracks.

It can be a real problem, because it can keep a stroke survivor from telling you exactly what’s going on with them.

And if you don’t know, you can’t help them the way they need to be helped.

It sucks.

But it happens.

And suddenly, it is fall

Autumn coming... time to bring back the reservoir
Autumn coming… time to bring back the reservoir

I have been so preoccupied this week with the work changes and catching up with old friends whom I haven’t seen in over a year, that I have not directed much energy towards noticing this season.

I’ve been tired — with that kind of cognitive and physical fatigue that is particular to brain injuries. My head has been looking for ways to make sense of it all… past, present, future… and that’s been taking up a lot of my time and attention.

It’s a double-whammy. On the one hand, opportunities like I’ve had in the past weeks are rare — having three days of solitude to clean out my garage and basement… having friends from overseas come to visit… being part of the beginnings of a corporate merger… These are over and above the usual speed bumps and wrinkles that populate my days and weeks. These are different, and they demand a special kind of attention — the sort of attention I actually try to avoid: drama, excitement, speculation, intense work for 12-14 hours straight, without much of a break.

Rapid-floating-in-FinlandBut because of their nature, I have to  just go with it. Get into it. Be a part of it. Allow myself to be swept along in the current – like a proverbial kayaker who gets dumped from their craft in the rapids — as you get washed along in the current, keep your head above water, keep looking forward, and keep your ass up and out of the way of rocks.

The main thing is to keep your head up. Don’t drown. Keep looking forward.

One thing you learn from TBI, is that when it comes to activities, you have to pick and choose. I suppose it’s true of anyone who expends a lot of energy in their activities… or who is very effective in what they do. You mustn’t squander your energy on things that don’t matter. But especially with TBI, you have to be extra careful.There is literally only so much you can do, and if you try to do it all, you end up wiping out your reserve of extra energy — and then you have to spend even more time building back those reserves.

Because lack of energy and fatigue just make everything worse. It siphons off your cognitive abilities, it depletes your stores of happiness and joy, and everything can feel like a slog.

Even the good stuff, the fun stuff, the stuff you know you should be grateful for and happy about.

For me, that’s probably the most depleting thing — knowing that I should be happy about things, knowing I should be pleased and excited and uplifted… but just not having the energy for it. Even energy spent on good things, is energy spent. And building it back is not a simple matter of sleeping in on the weekends. For every two days of extra energy I burn through, it takes two weeks to build it back. And if I don’t have two uninterrupted weeks (like this past month) and exciting things keep happening to me, well, then everything gets that much harder.

In what ways?

  1. distractionI get more distractable. I lose my focus and find it next to impossible to concentrate on the tasks in front of me. I get caught up in all sorts of side activities — which seem so important at the time, but are not actually relevant to what I’m supposed to be working on.
  2. I get more irritable. I can’t deal. I get cranky and snappy like an arthritic terrier. I get anxious and difficult to live with — with others, and with myself.
  3. I get less attentive. My attention gets fuzzy, and I stop noticing details – like the leaves turning outside, or just how beautiful everything has suddenly become. Everything around me seems wrapped in hazy gauze, and my senses are not sharp. My sense are so busy just trying to attend to the basics, that the extra special things in life slip by me very easily.
  4. Joy sorta kinda evaporates from my life. I know (intellectually) that I have a lot to be grateful for, and I know there is so much that I have to be glad about, but I just can’t find the joy. It’s nowhere to be found. And any attempt at reasoning with me to get me to find that joy… well, that just makes me feel stupid and ungrateful. My neuropsych tries to do this all the time, and the net result is that I feel stupid and short-sighted… rather than realizing that I’m simply tired, and letting it go at that.
  5. It gets hard to sleep. The more tired I am, the harder it is to relax and sleep. When I should be getting to bed early, I end up getting on Facebook for 90 minutes — and completely blowing past my normal bedtime. And you guessed right — fatigue becomes a self-fulfilling prophecy where I get more and more tired and wired, as the days wear on. All of the above continue to escalate. It’s awful, and it’s very difficult to stop it.
  6. I end up in a downward spiral. Unless I can get a bunch of good nights of sleep, I’m toast. Things get worse and worse, until I finally just  Give Up. And it turns out, giving up is the best thing for me. Some nights, I go to sleep hoping I never wake up again — I am feeling that depleted and used-up. But the very act of completely abandoning hope actually makes it possible for me to rest. And in the morning, everything looks quite different than the night before. Usually, anyway. Some mornings, I’m still not convinced I want to keep going.

So, fatigue is a thing. It’s a very real thing. And if I don’t stay alert to it, and recognize when it’s getting to me, it can get the better of me, which is never good.

For today, I know I’m tired. I have a full day of things to do, but I can pace myself and take my time… really soak up this fine fall day, and enjoy what I come across, as best I can. Seasons change. It would be a shame to completely miss this one, because I’m distracted.

Telling the difference between threat and danger

Here it comes...

One of the things that I believe makes traumatic brain injury so problematic, especially with mild traumatic brain injury, is the ongoing, long-lasting trauma aspect of it.

Post-traumatic stress complications especially emerge when someone is aware of the threat they are facing. There are plenty of documented cases of people who were drunk while driving who were in awful car accidents, who didn’t show any signs of PTSD, but people who were in far less serious collisions ended up with long-term debilitating conditions. With mild TBI, which doesn’t always involve loss of consciousness or the same level of amnesia that other forms of TBI do, post traumatic stress disorder(s) can emerge. There’s increasing research coming out about this, but I’m running short on time, so I’ll have to cite it later. (Google it, to find out for yourself.)

And that’s a whole other problem, in and of itself.

Post traumatic stress can make us hyper-vigilant, can intensify our reactions to perceived danger, and can “wire” us to respond way out of proportion to the dangers we are facing.

Granted, overcoming PTSD is a whole process in and of itself. It can be lifelong undertaking. But we can’t very well just quit living our lives until the PTSD symptoms disappear. We’ve got to come up with another way of relating to the world around us.

Personally, I’ve found that what helps me is giving myself pause to let a moment or two pass, before I do or say anything. This works very well when I am rested and have presence of mind. It works less well, if I am tired or stressed or thrown off balance about something. When I am rested and thinking clearly, I can stop, modulate my reaction, and then return to the interaction without having a ton of “charge” around things.

But when I’m feeling threatened or put-upon or not up to the task before me, I do tend to snap. And that’s not good.

The big thing for me, is telling the difference between threat and danger. It’s the difference between a perceived/sensed situation, and the real deal.

To me, a threat is something I perceive as a danger to me — my reaction is internal. It’s more related to a feeling I have — like despair over hundreds of dollars that got mysteriously spent for no apparent reason, which gives me an intense sense of lack of control… or my fear of people at work judging and resenting me for either doing too good a job, or not a good enough job, hence possibly jeopardizing my employment (and the rest of my life).

Danger, on the other hand, is something objectively dangerous to me — like a bus coming down the street towards me, when I haven’t looked both ways, or the neighbor’s dog coming at me with teeth bared and saliva dripping.  It’s an external force that is actually putting my health and safety in jeopardy.

One of the truly challenging things about TBI, is that the two often get mixed up — perceived (not always real) threats get a huge amount of reaction, while actual dangers get a minor notice — if I even notice at all. And I spend a lot of time reacting to things that SEEM like threats to me, when it’s really my internal biochemical storms that are kicking things up and crying WOLF! Objectively, there may be no real threat or danger involved, but by God, it sure as hell feels like it.

What to do? Well, I need to pay attention to what the hell is going on around me and not take the chatterings of my nerves so seriously. Sometimes the thing that helps the most is just stopping and taking a few long, deep breaths, stretching my shoulders and cracking my back, and things start to feel a whole lot better. Or I go for a walk. I move. I get the energy unstuck from wherever it’s jammed up. And I often find that the things that were bothering me the most are no longer a real issue. Or, I can see the real issue, and it’s very different from the one I was just concerned about.

But above all, the thing that helps me the most is realizing that not all “threats” are what they seem to be. Sometimes they are just my internal reactions to what I think is going on. It’s my autonomic nervous system out of whack, with the sympathetic fight-flight going into overdrive just ’cause it can… while my parasympathetic nervous system tries to find ways to balance out all that crazy stuff, so I can rest, digest, and integrate what I’ve learned.

I also need to realize that sometimes the “smallish” deals that I shrug off, are bigger deals than they seem to me. And not let my fight-flight keep me from addressing them.

This Autonomic Nervous System stuff is turning out to be a bigger and bigger deal to me. The beauty part is, I can actually do something about it. It’s not beyond my control, and I can have a hand in setting things to right.

Alice in Wonderland was never so upside-down. Oh, well. I guess everybody’s got their rabbit hole. Maybe I shouldn’t have taken the red pill… No, I should have. I’d rather know what’s going on.

TBI Issue #2 – Aggression

This post relates to the ongoing series Then And Now – Managing TBI Issues Over the Long Term which I’m slowly but surely building out.

I should probably call this TBI Issues #2A and 2B – Verbal and Physical Aggression, because while aggression can be a big problem post-TBI, it can take several forms. It can manifest as verbal aggression or physical aggression, but in either case it’s problematic. For everyone.

In my case, verbal aggression has often escalated into some sort of physical aggression — I haven’t struck anyone in recent memory, but I have thrown things (occasionally at someone), and I’ve broken things as well.

It happened a lot when I was a kid, too. I would just get more and more wired and wound up, and then I’d just lose it. Flip out on my siblings. Or one of the neighborhood kids. I didn’t just get time-outs, either. I was considered a menace by my neighbors — a real problem.

The net result? My family has always been a bit afraid of me, and they’re often on edge around me, when they sense my temper heating up.

My spouse is also afraid of me, on and off, and I’ve had to work pretty hard at not losing my cool, so they could start to feel comfortable around me again. The problem is, it only takes one or two episodes of me losing my cool, to trash all the progress I’ve made.

Back to square one all over again.

Or at least, that’s how it feels.

“On the inside,” it can be confusing and frustrating, as I often can’t tell that I’m getting edgy. All I know is, something doesn’t feel right when I’m having a conversation/discussion. It doesn’t feel “fluid” and I try harder to get my point across, the less effective I feel, and the more frustrated I become. And the edgier I get. And the more on-edge others around me get.

I don’t know if it’s a TBI thing or what, that I can’t tell when I’m getting edgy. I generally have difficulty figuring out what my emotions are, anyway. I usually feel like I’m happy, but sometimes I’m sad and I don’t realize it. Anger and fear both confuse me. For some reason, I just don’t “get” them, and I have to take others’ words for it, when they tell me I’m angry or sad. One of the confusing things is that I tend to tear-up over stupid little things. Frustration makes me look like I’m crying, which maybe I am, but it’s not the same kind of crying that comes from being sad.

It’s confusing. Which is frustrating. And anxiety-producing. And it just sets me off at times, especially when I feel like people are condescending to me or treating me wrong.

Verbal aggression is a bigger issue with me, I think, than physical — primarily because I’ve learned how to hold myself back with the physical expression. I’ve gotten into a lot of trouble over the course of my life for beating on people, so lessons learned. Still and all, sometimes it does come up and I walk a very fine line between “getting in touch with my feelings” and getting carried away by them.

It’s funny – my spouse used to lecture me about not being in touch with my feelings, like that was a bad thing. But you know what? Not being in touch with my feelings and being somewhat numbed out towards them makes it a whole lot easier for me to not get sucked down into the whirlpool of emotion. I’ve had shrinks lecture me about not being in touch with my feelings, too, as though experiencing all those emotions was actually going to help me. Frankly, with the emotional volatility that comes over me, everyone is better off if I’m completely out of touch with my inner world.

I’m sure there are people who will split hairs and tell me about how being in touch with my feelings isn’t the same thing as letting them run my life, but you know what? I’m not sure that’s accurate. Frankly, I was much more functional, aggression-wise, when I wasn’t “checking in” to see what was happening in my heart and soul.

Paying a lot of attention to what goes on in my inner landscape frankly makes me nervous and agitated — it changes very quickly, from time to time, which gets confusing and frustrating and pretty tiring, actually. So, I’d just as soon not do it.

What does this have to do with aggression? Well, if I can keep some distance between my head and heart and mouth, I’m far less likely to snap at people. I’m far less likely to get aggressive and go after people. If I can literally disregard what’s going on inside me, it actually helps me keep my cool. It’s when I start “getting in touch with my needs” that all hell breaks loose.

I start to feel slighted. Or overlooked. Or dismissed. Or ignored.

I start to feel sensitive. And raw. And vulnerable. Which I hate. And I start to feel like I need to defend myself from things and people who aren’t really out to get me — they just seem like they are.

Of course, my shrink friends love to tell me how I just haven’t processed it all enough, but you know what? Traumatic brain injury has a way of really mucking with your emotions and your interpretation of them, so what am I supposed to do — process a never-ending stream of constantly changing tsunami-like emotions? Please. No matter how much I may process them, they’ll never make sense, because they come from nowhere for no good reason, and they return to nowhere just like that. What a waste of time it is for me to process all that.

The thing for me is not so much processing my aggressive impulses, as it is recognizing and managing them up front. Once I get going, things pretty much go to hell, so it’s on me to manage the situations that give rise to aggression: fatigue, frustration, and feeling defensive. If I can just stay rested and keep my frustration levels down and take time to ask what the hell is going on before I jump to conclusions and start in on people, it goes a long way towards keeping me out of trouble.

But it’s never easy. Oh, no.

Good reading

I’ve just “re-discovered” Give Back, Inc., the organization/group that helps traumatic brain injury survivors get their lives back with self-therapy.

Their mission says:

GiveBack, Inc. is a recovery group for traumatic brain injury (TBI). Its purpose is not to help survivors to accept new lives that offer them limited options, but rather to help recoverers to deal with their deficits, improve their functioning, become active, and regain self-control of their lives.

I originally encountered them as Give Back Orlando, but the website has since disappeared, and it seems they’ve moved their operations to LA, as well as online. There is a Traumatic Brain Injury Support Group online that features regular postings from Dr. Larry Schutz, the founding director of this great organization.

I’ve been reading some of the articles about TBI and recovery and the different systems available to people. What I really respect about what I see, is that it’s based on many years of experience — both good and bad — and there’s still a perspective and a commitment to rehab and recovery, despite all the roadblocks in the way.

It’s safe to say that I would not be nearly as well-off as I am today, had I not come across Give Back. There was just the right amount of information for me, about just the right subjects, and I had room to move and develop my own self-therapy program based largely on what they outlined and suggested. And the changes to their suggested approach which I made to the recovery program I’ve been on didn’t negate the good their approaches offered. Obviously, everyone is different, and some of the suggestions just sounded hair-brained to me. But overall, the advice was sound, and I was under no obligation to do things exactly the way they said I should.

I’m really glad I came back to Give Back. Going along in my everyday life, it’s easy to forget about the things I need to do, to stay functional. And with the successes I’ve had, it’s easy (and tempting) to dismiss my difficulties and downplay them, thinking, “Well, I’m glad that’s over!”

But it’s not over. Brain injury is never over. The attention issues, the short-term memory issues, the fatigue and physical issues, as well as the processing speed issues may be mitigated by my coping mechanisms and compensatory techniques, but they aren’t going away. And if I don’t stay vigilant with them, they can rear their ugly heads and make my life a lot more “interesting” than need be.

The fact of the matter is, I have developed a lot of ways to deal with my issues. But if I don’t use them, I can get into trouble real quick.

So, I need to keep it green. I need to remember how close to the edge I was, when I first embarked on my recovery. I also need to remember that there ARE areas where I still have issues, and while my coping mechanisms may be great in most cases, they are not always second-nature, and I really have to work at them. I have to remember to do them.

And I have to keep in mind that when it comes to TBI, I may be a whole lot more functional now than I was three years ago, but I can easily go back to being non-functional with almost no effort at all. All I need to do is stop interacting with people when they talk to me, tell myself that I understand everything I think I do and not double-check, never write anything down, expect to keep everything in my head, and eat crappy food, drink too much coffee and soda, and stay up till all hours snacking and surfing the channels. I could also quit exercising each morning and stop paying attention to what’s going on around me. That’s a great way to go back to the way things were.

But if I keep my wits about me, stay mindful and pay attention to what’s going on, eat right and exercise each day, and I interact with the world and ask plenty of questions so I’m sure that I’m clear (even if I do feel like it makes me look stupid), I can stay on track. I just need to remember to do it.

And that’s where Give Back helps. Not only because of the forums they have there and the self-therapy materials they offer, but also because of the articles by Larry Schutz (I’ve been a fan of his work for some time, and that hasn’t changed). It’s so important for me to remind myself of where I come from, what I’m dealing with, and where I can end up, if I’m not careful.

I may move past the basic problems, and I may have my coping mechanisms in place, but if I don’t stay vigilant and keep up the level of effort required, I could end up like so many other TBI survivors — doing well initially, then slipping into long-term disability that I can never seem to shake loose.

How to help the “hopelessly” impulsive

For the last day or so, I’ve been thinking about how family members and caregivers can help TBI survivors overcome their difficulties. One of the things I rarely mention here, is that I’m not just a TBI survivor, I’m also an ABI caregiver. Someone close to me had several strokes a few years back, and since there as pretty much no one else they had — family is several states away, and their friends all pretty much disappeared after the strokes — I have ended up being their main source of support as well as rehabilitation.

I probably should have talked more about this, but my focus has been mainly on myself and traumatic brain injury, rather than stroke/acquired brain injury, and the times when I’ve sat down to write, I’ve often found it difficult to discuss what goes on with this situation (it’s been pretty intense at times). So, I tried to keep things simple and so I stuck with myself.

Now, however, I think I’m ready to start talking about what it’s been like to be in close contact with someone who has experienced a stroke (or two or three), and what it’s like to work with them to get back. It’s been a pretty amazing process, when I think about it.  A TBI survivor with plenty of their own issues helping a stroke survivor get back on their feet…  you don’t see that every day.

But I have to say, learning how to deal with my own issues has really helped a lot, with my work with this close friend. In fact, working with them and helping them regularly really got me thinking about my own issues.  I took several months off work when they got sick, since I had some savings I could fall back on, and I couldn’t just abandon them like everyone else had. And it wasn’t until almost a year into their recovery, that it suddenly dawned on me that I was having cognitive issues, as well. It really took until after the initial crisis and trauma had faded, for my thinking to clear up well enough to see how poorly I was coping. I was coping, sure, but I felt like I could have been doing a whole lot better… and no matter how hard I tried to do better, I couldn’t seem to get my actions to match my intentions.

So, I took it upon myself to track down my TBI issues… all the while in the background, there was this underlying theme in my life about helping someone else cognitively rehabilitate and get back on their feet. I’m not sure why, but it was like there was this really pronounced divide in my life — on one half, there was my work as a caregiver and rehabber for someone else… on the other half, there was my quest for information about my own cognitive issues. And for some reason, never the twain did meet, that often. This seems to be related to the tendency I have always had, to strictly divide the different sections of my life — school/work vs. home, friends vs. family, business vs. pleasure. I know a lot of people, but most of them don’t know each other. There seems to be a part of me that needs to keep different parts of my life separate and distinct, as though I’m afraid the the blurring lines will complicate everyting and plunge me in to chaos.

Well, whatever the reason, I’ve spent about the last four years dealing with brain injury issues on a daily basis, and a fair amount of my time has been spent dealing with someone else’s issues, not just my own.

It’s interesting, where I see overlap between my issues and my friend’s. They have many of the same problems that I do, but they are a very different person than I — much more emotional, much more given to anxiety attacks and paranoia. They had several left-brain strokes that we knew about, and other portions of their lower brain area showed lesions on the MRI from events that nobody knew about. Many of their issues seem exactly opposite from mine — where I am often oblivious to danger or risk, they are acutely aware of it.  Where I am often open to doing things that make no sense in light of my limitations — taking on three extra jobs, when I already know I’m overly tired, or going on expensive vacations when I can barely pay the bills I’ve got — they are closed to many, many things that I wouldn’t consider that daunting — like interacting with strangers, getting out of the house, finding a job, etc.

In fact, many of the arguments we’ve had over the past four years have been about them thinking I’m pushing them too hard or I’m too risky or daring, or I’m not being careful enough… and all the while, I’ve thought they were being over-the-top paranoid about simple everyday things.

Now, you could say that this is just personality differences, but I really believe that many of our differences have been exacerbated by our brain injuries.

For example, not long after my fall in 2004, I went for a walk in the woods with no bright colors on, during the early morning hours on one of the first days of deer hunting season (when there were clearly audible gunshots very close to where I was staying), and when people got scared about my risky behavior, I just laughed them off. I couldn’t see how much danger I was in, even though I encountered a deer hunter who had his rifle trained on me, till he realized I was not a deer. That’s the sort of thing never happened before my fall in 2004, and it doesn’t happen anymore, thankfully.

In my friend’s case, in the year or so after their strokes, they became severely agoraphobic, and extremely limited in what they would do and where they would go. They were terrified of doing anything that might exacerbate their condition, and they became compulsively fixated on what they ate and what was going on with their body. Now, I know that people who experience a severe health crisis are prone to do this, but they went about it in a way that was so slow and deliberate and careful, there was no way it was a sign of a neurologically intact person. They were very, very different from how they’d been, before the stroke.

My one regret is that I didn’t spend more time with them in the initial year or so, helping them get back on track. After a few months, I went back to work and I had less time to spend with them, so my involvement was limited to times before or after work, as my schedule allowed.

Looking back now, I realize there’s a lot I could have done. But at the same time, I was still reeling from my own TBI just two years before, and I was still pretty derailed in many ways. So I guess I did the best I could under the circumstances.

Looking at my friend now, there is a real difference between how they were in 2007 and how they are today. They are still way more deliberate and plodding in getting things done (just try getting out the door to an appointment on time), but they have regained a tremendous amount of cognitive flexibility and resources.

One of the areas where we’ve had to do a fair amount of work — and we’re still working on it — is in the area of impulsiveness. I’ve written about my own impulsiveness, but there’s their lack of impulse control, as well. It has been utterly maddening, to walk into their house and find the evidence of them starting many, many things, then obviously getting distracted and walking off to do something else. Food left out on the counters… clothing left in the washer for so long that it’s soured and has to be thrown out… wrappers and packaging lying around instead of being thrown away… the oven turned on and then forgotten about…because they got distracted checking their email.

I worry about it at times. What if they leave the stove on, and something catches fire? They’re a deep sleeper, and who knows if they’d wake up if there were a fire? They also have the smoke alarms in their house disabled, because they forget that they have something cooking and it burns, and then they have this ear-splitting shriek to contend with. Their “solution” is to remove the battery from the smoke alarm and continue to burn the toast.

I’ve discussed this with them at times — very carefully, because they get defensive and then yell and verbally attack me, and then nothing gets accomplished. I’ve called their attention to the fact that they’re forgetting things and wandering away on impulse. They sort of know it’s an issue, but I have to tread lightly because they’re so defensive and self-conscious about it.

What to do?

Well, I have been taking clues from my own neuropsych and I’ve been taking a more cognitive approach. That is, I’ve been trying to engage them in thinking things through ahead of time, getting clear on what it is they set out to do when they walked into the kitchen or sat down at the computer. I’ve been discussing what kind of life they want to live, what goals they have, what they want to do do with their time. I’ve been trying to phrase it in positive ways, finding the good in what they’re doing and looking for the rewards or payoffs in doing things a certain way.

It seems to be working somewhat. Originally, I was taking a more “behaviorist” approach, where I was focusing on rewards/punishments, doing a lot of criticizing and brow-beating. Clearly, that got nowhere and it was largely due to my concern for their safety. Once I got real about how it was my own worry that was turning me into a royal pain in the ass, I backed off and started focusing on the positives — what did they want to do with their life? How had the good things they’d done for themself helped them live their life better? How had they taken good care? And where they’d fallen short, how could they do things differently next time, so that they had a better result?

Their impulsiveness seems to have subsided somewhat. I think that just the lower levels of anxiety (probably thanks to me not showing up after work in the evening ready to take them to task for everything they did wrong during the day), and the focus on solutions rather than problems… as well as getting in the habit of thinking and talking things through in advance, has helped. Their impulsiveness seems directly related to their anxiety level — as it is with me — so the more we reduce the anxiety through positive reinforcement, good food and adequate rest, and just quality human contact, the better they do. And the better I feel.

It also helps to laugh. I found out about this video a while back, and I showed it to them one night after work.

We both had a good laugh, and now whenever we see unchecked impulsiveness rearing its ugly head, we say “I need to wash my car!” in a really bad British accent.

Humor really helps, actually. Having a good laugh takes the pressure off, and it also reduces the anxiety that feeds the impulsiveness — which is basically an unchecked need to relieve the pressure of daily life. The more relaxed and easy-going I am, in fact, the better they do, and the better I do. Sometimes it’s a real struggle to keep cool in the face of their impulsiveness. They have always been prone to “embellish” the truth when they talk with other people — saying they’ve got 20 things to do, instead of 10, saying that they participated in some activity, when they were really just standing on the sidelines — but since their strokes, they’ve been even more loose in their interpretations of what’s real and what’s not. It’s awkward, when they’re going on about something, and everyone knows they’re lying — everyone except them, that is.

I try to be understanding and not over-react. It seems hopeless, at times, looking at their finances and trying to help them think about how they spend their money. I, myself, got into a huge jam, and I don’t want them to do the same. But I also can’t let my anxiety get in the way of the message “Well, don’t beat yourself up – just try again,”

I also try to relate to my own experiences, for clues about what might be going on with them. The more I think about it, the more I believe that confabulation may come into it — that tendency to get mixed up and say things that aren’t true, without realizing they aren’t accurate. We’ve had discussions about the “stories” they tell, and they’ve told me at the time that they don’t realize they’re not telling the truth. It seems true to them, they’ve said. So, maybe there’s something to that — confabulation. Or at the very least some impulse control issues, where they just blurt out what comes to mind.

Anyway, whether it’s impulse spending or blurting out half-truths, impulse control has not been a strong point for my friend. They were impulsive to begin with, but after the strokes… trouble. Now, we have discussed different ways to adapt – they’ve started paying for impulse buys with cash instead of their debit card, so they can see how much money they’re spending. One month, they spent over $75 on coffee and donuts and another hundred dollars or so on fast food, when they were having trouble paying their phone bill. They didn’t realize the impact, however, until I sat down and went through their monthly bank statement and tallied everything up and showed them. Then they got it — and they started using cash more often.

They still have improvements to make, but don’t we all?

The main things that help in dealing with their impulsiveness are:

  • Staying calm and not escalating and making them nervous – anxiety just exacerbates the impulsiveness.
  • Talking things through ahead of time, so you can get clear on what you are hoping to achieve, and why.
  • Following up afterwards — in a very non-judgmental, easy-going way — to see where things went right and how things might be done differently later on.
  • Sharing stories from my own life about impulsivness and how I’m dealing with it — both successfully and unsuccessfully. Sometimes the unsuccessful stories are the best, because then they get to help me solve my own issues, and they can think through their own situation in light of my experience.
  • Keeping that line of communication open, and being honest about my concerns so I don’t end up enabling them at staying stuck where they are. I really believe that thinking things through and talking them through can help change how we do things — all of us, not just the brain-injured.

The bottom line really is, I need to keep in mind that this friend of mine has suffered a terrible blow in the past, and they are working their way back. I sometimes forget, considering how well they are doing now, that they were ever as impaired as they were. But they were. There are still underlying issues that need to be addressed, so it’s really an ongoing process of coming back.

The important thing is, they are coming back. And it’s hugely gratifying for me to know I played an important role in that recovery. That, alone, keeps me coming back to keep our friendship — and their health — going.