Stretching for more

April first. Surprise. I have a noontime appointment scheduled with my neuropsych today to follow up on some things we didn’t get a chance to talk about on Tuesday. I’ve got the time, so why not use it? Except that the weather is bad. And I’ve got things I’d like to do with the three hours it would take me to drive in, consult, and then drive home. Like sleep. Seems to me, sleep might actually help me more than driving through bad weather, sitting and talking, and then driving back.

It might shake me out of my funk. I have to admit, I’m not very good at vacations. I like my schedule, my routine. It has been good, getting out of the schedule-driven mainstream for a week, but I’m ready to get back into work. I’m ready go back to my job, my office, my roster of duties. I don’t quite feel like myself, when I’m off my schedule. I have more time, but I get less done.

Still and all, it’s been good to get out of the frantic go-go-go of the daily grind. Working in technology sets a grueling pace, which is promoted by people of a distinctly darwinian bent, who think that the better you are, the faster you’ll go. Hm. Not sure about that. Seems like speed is its own justification, at times. They just want to feel like they’re doing something. They just want to feel like they’re making progress.

Hm.

Anyway, the weather is letting up, but I think I’m going to cancel my appointment. I have a standing appointment on Tuesdays, and I’ll be closer to the neuropsych’s office on Tuesday than I am today. Time savings. Life savings. I just don’t want to wear myself out even more than I already am. Didn’t get my nap yesterday. Got busy running around in the evening. Also didn’t get things done that I need to get done.

At three years into my active recovery, I’m finding that I need to make some substantial changes to how I go about living my life. Discovering that mild traumatic brain injury was the cause of many of my difficulties throughout the course of my life was amazingly freeing and totally unexpected. It set me loose in the world, the way few other things have. It gave me a framework to understand myself and my own personal situation, and it gave me a route to follow to address specific issues I had in a systematic, common sense way, rather than the scatter-shot trials and errors of my life to that point.

Discovering the root cause of my issues gave me the means to address them. And address them, I have. Now that I’ve made all this progress, a different approach is called for. It’s about using the tools I have and the knowledge I’ve gained, to take things beyond the basic survival tactics I’ve employed for the past three years. The basics are pretty much in place — being, my understanding of my history and how it’s affected me — and I have the tools to address my issues, like fatigue, irritability, anger, aggression, and memory issues.

With these in place, it doesn’t make sense for me to keep subsisting at a fundamental level, “just happy to be alive”. Sure, I’m VERY happy to be alive. Don’t get me wrong. But I don’t want to fall into the rut that some acquaintances of mine are stuck in. They’re my “recovery friends” on the mend from histories of violence, abuse, addiction, and other things that strike at the core of who we are and what we think we’re all about. They literally tell me, “I’m lucky to just be functioning at a basic level,” and they mean it. But from where I’m sitting, it seems to me they’re capable of a whole lot more than that. They’re just not taking that chance. They’re not testing their own limits. They’re sitting in their stuff, feeling sorry for themselves or telling themselves they’re really badly off… when they’re really no worse positioned in the world than most of the other non-recovery-focused people I know and work with.

Don’t get me wrong. I don’t dismiss their troubles and their issues. Lord knows, I’ve got my fair share — we all do. But that’s the point — we all have our issues, and nobody goes through life without some measure of pain and suffering. Even the richest and most entitled people in the world experience excruciating pain — which must actually be worse than being in pain as a “normal” person. It must be awful to suffer, when you’re well aware that all of life is arranged around you to minimize, even prevent, any sort of pain at all.

But who can say why or how or for what we experience what we do? Lessons, I suppose. Just a lot of lessons.

Which is where I find myself now, on the last day of my official vacation. I’ve had a lot of time to think and ponder and examine my life, and while I’ve come away with a pretty good sense of being in a far better place than I was three years ago, something is missing. Something more. Maybe it’s in my nature, being the sort of person who is always looking for what’s next and what else is out there. Maybe I’m just naturally inclined to push the envelope. Bottom line is, I need more challenge. I need more living. I need more life. I need to get beyond this immediate situation of mine and look to the future, with my tools and strategies as a good foundation for moving forward.

More life. Different life. I’ve been spending more time stretching, the past few days, and I’m realizing that I probably need to shift my daily routine away from straight weight training and more to strength-building yoga. Lifting weights is great, but it also shortens the muscles (when you build bulk), and that may be contributing to my pain. Also the tightening causes me to tense up. I’ve been tense for a long, long time, and I need to find a different way of living in the world.

I have to say, I feel much better when I stretch. I steered clear of yoga for many years, because it was painful for me to do the stretches and hold the poses. But I’m at a point now where I’ve done enough stretching on my own to get past that excruciating pain. Stretching on my own, taking it easy, and being focused on my own movement (rather than a roomful of people) has been good. And I really need to do more of it — in a different way… in my own way.

{Pause to stretch}

Stretching… yes… in more ways than one. Physical stretching, as well as mental and professional stretching. I’ve had a lot of time this week to contemplate my work, why I do it, what it means to me. And I realize that the “career path” I’m on is less about climbing the ladder and more about having a quality experience… and sharing that experience with others It’s all very well and good for others to chase after the brass ring and climb over each other to reach the top, but that tends to be pretty debilitating for me. All that adrenaline pumping all the time — the constant go-go-go is all very well and good, but where does it eventually take you to? And once you get there, is that really where you want to be?

In the years before my last TBI, I was living that life. Fast and furious. Fiercely driven. I was a force to be reckoned with, and I was alternately feared and respected by my peers and highly valued by my employer. Then I fell, and it all fell apart. Then someone close to me died, and I sat and held their hand as they slowly slipped away from a life they had dearly loved and hated to leave. Then someone else close to me became seriously ill, and I was their caretaker for about a year. Three big hits in about three years. Even one of those would have been plenty to handle. But no, there had to be three.

Anyway… Coming out on the other side of it, now with three years of active rehab under my belt, I see how those experiences changed me, and how they have shaped my attitude towards life and my work. I know, having watched the young children and loving spouse of my loved-one who died all too young, that none of us has any guarantees in life. Even when the doctor gives you a clean bill of health and tells you to expect to see your kids graduate from college… they could be wrong. Even when you think you’ve got it all together, something as simple as a fall down the stairs can wipe out some of your most prized, cherished coping mechanisms. Even when you’re locked on target and think you’ve got your path figured out, serious illness can manifest and leave you feeling and acting like a six-year-old child, with all certainty erased.

And I realize — with the last week’s perspective — that no matter how hard I work, no matter how hard I push myself, it will never be enough. Not for me, anyway. And it will never be enough for the world. There will always be other things that need to be done, other endeavors to perfect. I also know for certain that the most important thing to me in my work is not the work itself, but the experiences I have in that work. That’s something that can’t be taken away. I need depth of experience. I need the kind of engagement and connection that makes memories for years to come. In the past, I have been so focused on getting things done, that I never stopped to fully experience what it is I was doing. I was so driven by results, that the process got lost along the way.

And that’s a shame. Because my memory is already iffy — why make it even worse?

Indeed.

The ironic thing is, when I take my focus off the delivery dates and bottom lines and pure results, and I focus on the core essentials — doing good work for the sake of doing it, and sharing the success with others to really create a working environment that, well, works — the results turn out even better, the bottom line is fed, and the actual results are longer-lived and more sustainable than ever. Getting the focus off the short-term, and putting it on the long-term, creates success not only in the present, but in the future as well. In the process of transcending the bottom line and delivery dates, those very things are fed. And it turns out better in the long run. For everyone. And I have real memories of live to look back on, later, not just a handful of deliveries and goals achieved.

Well, despite the weather, it is a beautiful day. I think I’ll step away from the computer now and have a good stretch.

TBI and Aggression – the comorbid mix

More thoughts on Aggression, for the series Then And Now – Managing TBI Issues Over the Long Term

As Google shows, TBI and Aggression are the subject of a whole lot of research and discussion. There are close to a million results when you search for +tib+aggresssion.

Physical aggression, verbal aggression… They’re two different things, but they still have some common origins. And how they manifest can depend on the individual, the nature of their injury, their environment and stressors, as well as a ton of other issues.

Aggression is one of the toughest aspects of TBI, for individuals, families, and society as a whole. Plenty of incarcerated violent offenders have a history of traumatic brain injury, so we ultimately all pay for those injuries, to one extent or another.

I’ve been looking through a great presentation from the Defense Centers of Excellence called Mild Traumatic Brain Injury & Co-Occurring Disorders: Scope of the Problem. It talks about the different issues that show up along with TBI among veterans seeking medical help.

From the presentation:

• Of the veterans presenting to a polytrauma network site in Lew’s study (2009), 81.5 percent had more than one diagnosis and 42.1 percent had three co-occurring diagnosis, including pain, post-traumatic stress disorder (PTSD), and post-concussion syndromes.
• In another study by Ruff and colleagues (2008), approximately 66 percent of veterans presenting with headache and TBI symptoms had cognitive deficits on examination, more severe and frequent headaches, more reports of pain, higher rates of PTSD, and impaired sleep with nightmares.
• Veterans with positive TBI screens are more likely to have a diagnosis of PTSD, depression, and substance abuse disorder.

I’m not a veteran, but I can attest to the presence of plenty of issues that would qualify as additional diagnoses. The pain, headaches, insomnia, memory issues, post-concussion stuff, not to mention tinnitus, chronic fatigue, irritability, anxiety… all of this mixed in with a bit of PTSD. I could go on. In fact, it seems odd to even break it all out into separate diagnoses.  It’s all just TBI, from where I’m sitting.

Of course, it could also be other things. Just Plain Life has had its effect. I can’t lay everything at the feet of traumatic brain injury, I suppose.

Anyway, looking at the many things that come up in combination with TBI, I can see in my own life how it all connects and can really feed into my anger and aggression issues. TBI and its host of related issues can really put you on the defensive, which can translate to some pretty aggressive behavior.

I have noticed in my own life that the times when I have been the most aggressive, were the times when I was feeling the most vulnerable, helpless, exposed. I’ve felt overwhelmed and put-upon like nobody’s business. Like an animal backed into a corner, with nowhere to run. So much was going on, and I felt like I was getting farther and farther behind, unable to follow what’s going on, because everyone was going too fast for me to keep up, or they were not letting me get clear on what’s happening, so I was losing my grip on what’s happening.  And my head would get going about all the awful things that are about to happen because I’m not following what’s happening around me. And I would freak.

See, here’s the thing — TBI can put a huge strain on your overall system. Let’s not even think about the cognitive issues, for a minute. When you’ve got intense balance issues as well as problems with light and sound, and you’re prone to fatigue (which just accentuates the sensory issues), just getting through the morning can be a challenge. And the part of our bodies which requires a whole lot of energy is our brain. Even people with fully functioning, neurologically intact brains require a ton of energy to keep functioning normally. So, when you’ve got even more demands on you — physically — it can impact your cognition as well.

Here’s a diagram of how I see it happening in my own life:

 

TBI-Aggression Flow - Click to see a larger version

It’s all connected – body, mind, spirit – and when the body is taking a bigger hit from all the extra demands of just standing up and walking across a brightly lit room filled with loudly talking people, something’s gotta give.

Problem is, with TBI, one of the results of fatigue is an increased irritability. Heck, even without fatigue, with TBI, you tend to get an increase in irritability. And that irritability, coupled with any impulse control issues you might have, can lead to outbursts.

On top of that (if you’re like me) and you’re up in your head about your interpretation of what’s going on (which usually means something really bad and threatening, like people hate you and want to get rid of you — and is usually completely wrong), your impaired thinking process can result in some behavior choices that are not only inappropriate, but completely uncalled-for.

The outbursts can take an ugly turn, because now you’re not only struggling to keep up and defend against the perceived threat of an overwhelming situation, but you’re also defending yourself against the perceived threat of someone deliberately trying to get you. And when you’re threatened on that level, anything you do and say to defend yourself from everyone who is out to get you can feel 1000% justified.

Nobody else sees it that way, however. As far as they’re concerned, you’re just unstable and irrational and possibly dangerous.

Getting to the bottom of what’s going on and keeping the cycle from escalating can be quite a challenge. It would be great if we could say, “Okay, just stop this and this, and everything will be fine.” But it’s a complex interaction of factors that feed into the aggression mix. Comorbid factors. Stuff that happens as a result of TBI. Stuff that happened that led to the TBI. Trauma. Pain. Emotions. Everything.

Perhaps that’s the best protection, however — just the awareness of the fact that dealing with TBI-related aggression is not some easy-peasey piece-o-cake, and that it demands some pretty regular management strategies to keep on top of things. Managing comorbid symptoms and aggression are lifestyle issues — they are intimately related to how we live our lives as a whole — not just how we behave when we’re standing in line at the post office.

Aggression and TBI and gender – does the mix matter?

This is another segment about Then And Now – Managing TBI Issues Over the Long Term – in particular, about Aggression.

Thinking about aggression and TBI, I got to wondering about whether the impact of aggression might make a difference, depending whether a survivor is man or a woman, a boy or a girl. I did some googling, but I ran out of steam trying to sort through all the different pieces of information.

Apparently, research points to women having worse long-term outcomes than men. Interesting. And unfortunate. There are a number of different possible explanations, which I found  at http://www.dawncanada.net/ppt/Women%20and%20Brain%20Injury.ppt (Good presentation! Very informative. I’ll have to examine it more closely when I have more time…) Some of them are that perhaps the medication prescribed interacts differently with women’s chemistry than men’s. Or women report more issues, and therefore appear “sicker” than men. Or perhaps it’s because of psychosocial factors. That is to say, women tend to be more verbally “fluent” than men, so they present as being much better off than they are cognitively. They seem fine, but they may be struggling in ways that only an objective test can pick up — but nobody thinks to administer a test, because “she seems fine”.

Conundrum.

Anyway, in thinking about TBI-related aggression, I got to thinking about different scenarios where a man exhibiting aggression would fare better than a woman exhibiting the same behavior. Aggression in men is often tolerated much better than aggression in women. With men, aggression is often expected, where with women, there’s a completely different standard that they’re expected to follow.

Say you’re standing in line at the post office during the holidays. Everyone has been standing in line for 45 minutes, holding heavy packages and wishing they were somewhere else… when in comes a guy who’s frazzled and obviously in a big hurry. He goes to the back of the line for a little bit, but after a few minutes he starts to fidget and curse under his breath. He then proceeds to jump the line and push his way into second place. The guy standing behind him gets bent out of shape and pushes him out of line, the two of them trade words, then start pounding on each other. The police are called, and the two men are hauled out of the post office and given a talking to by a couple of officers. They won’t let it go, though, and they still keep trying to punch each other in the face, so they’re separated in two separate police cruisers and driven off to jail.

Now imagine the scenario with an aggressive woman:

Say you’re standing in line at the post office during the holidays. Everyone has been standing in line for 45 minutes, holding heavy packages and wishing they were somewhere else… when in comes a woman who’s frazzled and obviously in a big hurry. She goes to the back of the line for a little bit, but after a few minutes she starts to fidget and curse under her breath. She then proceeds to jump the line and push her way into second place. The guy standing behind her gets bent out of shape and pushes her out of line, the two of them trade words, then start pounding on each other. The police are called, and the two of them are hauled out of the post office and given a talking to by a couple of officers. They won’t let it go, though, and they still keep trying to punch each other in the face, so they’re separated in two separate police cruisers and driven off to jail.

Doesn’t sound quite right, does it? How about a woman who’s just defending her own turf:

Say you’re standing in line at the post office during the holidays. Everyone has been standing in line for 45 minutes, holding heavy packages and wishing they were somewhere else… when in comes a guy who’s frazzled and obviously in a big hurry. He goes to the back of the line for a little bit, but after a few minutes he starts to fidget and curse under his breath. He then proceeds to jump the line and push his way into second place. The woman standing behind him gets bent out of shape and pushes him out of line, the two of them trade words, then start pounding on each other. The police are called, and the two of them are hauled out of the post office and given a talking to by a couple of officers. The man and woman won’t let it go, though, and they still keep trying to punch each other in the face, so they’re separated in two separate police cruisers and driven off to jail.

And then there’s the situation with two women:

Say you’re standing in line at the post office during the holidays. Everyone has been standing in line for 45 minutes, holding heavy packages and wishing they were somewhere else… when in comes a woman who’s frazzled and obviously in a big hurry. She goes to the back of the line for a little bit, but after a few minutes she starts to fidget and curse under her breath. She then proceeds to jump the line and push her way into second place. The woman standing behind her gets bent out of shape and pushes her out of line, the two of them trade words, then start pounding on each other. The police are called, and the two of them are hauled out of the post office and given a talking to by a couple of officers. They won’t let it go, though, and they still keep trying to punch each other in the face, so they’re separated in two separate police cruisers and driven off to jail.

It has a totally different feel from the scenario with two men. The situation with two men sounds like “boys being boys”, you might say. But two women behaving really badly and then coming to blows? Maybe in a toy store in LA, but in “polite society” this would stand out as an exception.

The point I’m trying to make here, is that there are different standards for acceptable behavior with men and women. And the fallout afterwards also tends to be different. With men, things can get “heated”, but with women, they get “out of hand” and the consequences are as different as the consequences for adultery in secular America versus church-centric America. In one case, it may elicit little more than a shrug, while in other cases it may result in being shunned and isolated.

Our society has a very different set of expectations for different genders, so when a woman with a TBI starts to act out, it really stands out. And it can be isolating. Unexpected, unacceptable behavior, along with social censure, can add to the cognitive load of a TBI survivor, which cuts into the available resources for just living their life, and also cuts them off from valuable social connections that can support recovery. Ultimately, if you have enough censure and isolation, without the proper feedback mechanisms for determining and modifying appropriate behavior, I would imagine things could degenerate over time and ultimately fan the flames of TBI complications, long after the initial injury has faded from memory.

If this is true in the case of women, then what about girls? I’m specifically thinking about girls who are concussed and don’t get proper care and have their concussions eventually become lasting traumatic brain injuries. What about girls who get hurt, don’t get the help they need, and end up exhibiting behaviors that alienate their friends, their families, their support groups that are necessary for healthy growth and maturation? What about them?

What makes things even more complicated, is that some of these symptoms — the aggression, the mood issues, and more — may take months to show up, so during a time when so much is in flux and changing around them, they’re all of a sudden hit with this weird new character trait of a short fuse and an explosive temper. And seemingly out of nowhere. What do they do then? If a girl is expected, pressured, trained to be a little lady, and then all of a sudden she becomes more like a wild animal, what then? If her popularity and self-image is dependent upon her behaving in a certain way, and then TBI suddenly makes it impossible for her to behave that way, what’s the impact to her development overall as a girl, then a woman?

Now I’m not saying that girls have it harder than boys, but there are differences in gender expectations, differences in behavior expectations, and if there’s one way TBI can really throw a wrench in things, it’s in the behavior area. So, if most of the studies of the impact of TBI are concerned with boys/men, what does that mean for our overall understanding of the impact — not only to the individuals, but to society as a whole?

My grandfather used to say, “Women have to be better than men. They are the ones who create our culture.” He was fine with that idea, while my mother always pursed her lips a little bit when he said that. He was an old school kind of gentleman, but there was a nugget of truth to it — although the truth was more about expectations, than actual fact.

Ultimately, I think that gender and TBI should probably be studied more closely. There’s so much to it — it’s quite mind-boggling overall. But we really need to factor it in. And when we talk about managing long-term issues, I think it can be helpful to consider to social and cultural contexts. As different as each brain injury is, as individual as each recovery is, we can’t overlook factors like gender, as well as class and ethnicity and age. It’s all a huge ball of string that begs to be unraveled, but that’s a bit beyond me right now. I’m on vacation(!) and it’s a beautiful day outside.

But first, I could really use a nap…