TBI/PTSD anger management by using the breath

Breathe in... breathe out... relax

I just found this poem, while looking through WordPress for blog posts on anger. It says so well in far fewer words, the same thing I’m about to elaborate on.

I’ve been studying a bit of breathing over at coherence.com and also thinking about things I’ve read there. I’ve also been studying sitting zazen, as it’s described by elders who have been practicing it for many decades, and I am struck by the similarities between the two.

Now, breathing can take may shapes and forms, and different people have different ideas about how it “should” be done. I’ve actually been criticized by friends who thought they’d been taught the “right” way to breathe. They said I was breathing too shallow, or too fast, or not having the right posture.

I appreciate their concern and wanting to help me, but … whatever.

And then there’s the formally trained respiratory therapist I came across, years ago, who said that there is no wrong way to breathe. And that was a real breath of fresh air for me — literally and figuratively.

Anyway, in my reading about Coherent Breathing, I’ve come across the concept of “Breathe… then relax.” Now, I don’t know about you, but I was usually told “Relax… then breathe” but it never quite did it for me. When I read up on coherent breathing, I understand why — because you need to give your body what it needs to relax. You can’t just order it — RELAX!! — and demand that it comply. But if you give your body what it needs to relax — a balancing of the sympathetic and parasympathetic nervous systems, which gives them both equal time and lets them work together, instead of at odds — you actually CAN relax.

I’ve come across more and more talk about the autonomic nervous system (ANS) — the combination of fight-flight sympathetic and rest-digest parasympathetic nervous systems — when I read the writings of elder (or deceased) lifetime zen / buddhism practitioners. While everybody else seems to be fixated on things like mental calm and personal peace and spiritual enlightenment, they focus in on the basic physical components of calm and peace and enlightenment — the balancing of the ANS.

This, they say, is the foundation for what so many seek. And yet so many are focused on things other than their bodies.

Now, I’m not going to spend a lot of time yammering about all the high-minded stuff right now. What I AM going to talk about is something very basic, very essential, very critical to TBI and PTSD recovery* — Anger Management (*and yes, for those who believe they are chronic lifelong conditions that you can never completely cure, I’m going to use the word “recovery” anyway — in the sense of recovering our composure, our presence of mind, our human dignity, our relationships, our futures).

My own Anger Management, I am finding, is made about 1000-times better, when I use steady, conscious breathing to keep my ANS in balance. See, here’s the thing — I hate to admit it, but I get anxious really easily.  I also am prone to panic attacks, which I would never admit until this past year — heck, I didn’t even realize I was having panic attacks!

Now, I used to be pretty chill, but since my TBI in 2004, all that gradually went away. I believe it’s because of a combination of physical biochemical changes that took place when I fell, the constant restlessness that feeds my brain’s agitation, and the repeated abrupt, jarring surprises I had, time and time again, when my brain wasn’t working the way I expected it to. Any way you look at it, I can be a real ticking time bomb, if the conditions are correct.

Now, this has been a HUGE problem for me and my family — I also had a lot of problems with this when I was younger (and having a concussion or two about every year or so). But I never made the connections or figured out what would help me chill out my anger, till pretty recently.

See, the thing is, everybody I’ve ever talked about has approached anger management from a psycho/spiritual standpoint. They’ve encouraged me to “get in touch with what’s bothering me”… to “learn to love myself”, to “make peace with my shadow” and learn to “dance with my demons”. All good advice. But it’s all geared to a level of experience that is a symptom of my agitation and rage, not the cause.

The REAL cause of my anger management issues? I believe it is, was, and (almost) always has been, an out of whack Autonomic Nervous System — a hair-trigger fight-flight sympathetic nervous system taking over and pushing my rest-digest parasympathetic nervous system out of the way, like a bully shoving a “sissy” down into the mud and stomping on their head.

Flying into a rage over the slightest thing? Not because I wasn’t “my own best friend” — rather, because I was tired and agitated and I flew into fight-flight mode on an instant’s notice.

Getting pissed off while in traffic and getting aggressive towards other drivers? Not because I projected my own insecurities onto them — rather because I was already on edge about being in traffic, I was already in fight-flight mode with my amped-up SNS, and all that adrenaline just fed on itself to make itself even more virulent and aggressive.

Melting down and flipping out over seemingly small issues? Not because I was spiritually damaged or had some character flaw — rather, because I panicked, plain and simple, and it came out as a melt-down.

Holy smokes… if I’d known this just five years ago, how much different could my life be right now? I’m telling you, seeing my anger outbursts and hair triggers as a physiological phenomenon, not some sign of psycho-spiritual disturbance, makes all the difference in the world. It instantly makes the challenges about something other than my broken self, and turns it into a physical situation that I have the tools to manage.

Again, let me say it loud and clear:

Anger issues, for me, are NOT about psychological problems, emotional damage, mental illness, or a defective character. They are about my fight-flight sympathetic nervous system being in an uproar that drowns out my system-balancing parasympathetic nervous system. Anger issues, temper outbursts, rage attacks are all reliable signs that the innermost “wiring” of my body is in need of some attention. And when I give it the attention it needs, it chills everything out in a way that doesn’t just fix it once — it lasts.

So, how do I give it the attention it needs? By breathing consciously. I breathe slow and steady into my gut, feeling my belly expand when I inhale, and filling up my whole chest cavity too. I count my breaths, focusing on them instead of all the crap that’s going on outside, and it keeps my mind from falling into the trap of someone else’s mind games, or some mistaken perception I have. When I focus on my breath, not only do I take a break from the soul-sucking drama, but I am also strengthening my whole system for future times when I need to keep balanced and sane.

I am training myself for future times when I am so bombarded, I have trouble keeping my presence of mind to breathe. The more I practice, the easier it becomes. So, it’s important for me to practice.

On the one hand, this really excites me that I have figured this out. On the other hand, it really bothers me that it’s not more widely known and used. Rehab facilities could be using this… recovery groups could be using this… hospitals could be using this… therapists and counselors could be using this… occupational therapists and physical therapists could be using this… and so could family members who want to help both their injured loved ones as well as themselves. Trauma survivors of all kinds could be using this, including traumatic brain injury survivors, particularly mild traumatic brain injury survivors, who often lose more in the long run than you’d ever guess or expect.

I think part of the problem is that when people find something that works, they instantly become very strict, rigid, and orthodox about it — they decide what the rules are, they tell people the rules (with the best of intentions), and then they enforce those rules to no end.

I’m in the position, myself, where I’m not a big fan of strict rules and regulations. I think everyone is different, and we all need to find our own ways. What works for me, might not work for you, so you have to figure out what’s most appropriate for your situation.

But I do think it’s helpful to understand the underlying “mechanics” of how this all works — to understand the physical principles behind what you want to achieve, so you can figure out the best way to do it for yourself.

Try the conscious breathing thing… counting your breaths, or just noticing how you feel when you’re taking slow, measured breaths. It’s free, it doesn’t require a trained professional to teach you to do it, you can do it anytime — no scheduling required — and you can keep practicing in many different situations, to gain your composure and strengthen your sense of self.

Conscious breathing for anger management… Try it. You might like it.

Or, as Miro says at http://warriorpoetwisdom.com

When people think of warriors
They think of blood and death
The truth is that a warrior
Is all about deep breath

The Warrior Ethos and Traumatic Brain Injury

The other day, I was surfing around and found this over at SignatureInjury:

A Warrior's Creed Matters

“I will always place the mission first.

I will never accept defeat.

I will never quit.

I will never leave a fallen comrade.”

It is this ethos that has been drilled into (soldiers) from the moment (they) step off the bus; it is this ethos that is the underpinning of (their) survival in combat.

What signatureinjury intends to do is answer the question of how this ethos obstructs many service men and women from seeking help for their traumatic brain injury. …

Mission First; Self Last

This is essential to the safety and success of any military operation. It compels the soldier to regard his unit and its mission as greater than him or herself. Many of the soldiers in the combat arms not only agree with this superficially but live it instinctively. It has become an integral part of who they are to the extent that even casual decisions are influenced by this principle. The problem with this type of mentality is that it prevents many from seeking help because the mission or unit will suffer from a potential loss in manpower. “Isn’t this subversive treatment; dangerous indoctrination?” Yes and no. On the one hand battles cannot be won with everyone looking out for their own welfare, yet on the other, it can cause those who strongly embraced the concept to unwittingly shrug off the symptoms of TBI in order to fulfill his or her mission.

How true this is.

Even beyond the combat arms, a lot of us live by this. I know I certainly do. Maybe it’s just how I was raised, but in my own world, the measure of my worth is based on how much I contribute to others — how much I give, not how much I get. That being said, the times when I have gotten hurt, I did not seek help for my injuries because I placed my own welfare secondary to the welfare of others, and I believed with all my heart that stepping away from the game or stopping what I was doing to take care of myself would have harmed others who were depending on me.

Defeat is not an Option

This tenant is not only central to the armed forces but is a trait characteristic of most men in particular. Defeat shows weakness and speaks against what men think men should be. We see this readily in sports. No one likes to win or admit defeat because it somehow means that we were inadequate in our performance. In the novel The Old Man and the Sea, Ernest Hemingway spoke of defeat this way, “But man is not made for defeat. A man can be destroyed but not defeated.” This is a common view that enables warriors to endure the hardships of combat and continue fighting; however, it is this trait that prevents many from seeking help because it can feel as if you’re accepting defeat. What compounds the issue is the fact that many with TBI have no visible marks of their injury. It is one thing to go to the medic for a gunshot wound and totally another to seek help for problems that make you look mentally unstable.

No, defeat is NOT an option

Even if it means I get bruised and battered and get the crap kicked out of me, I will keep going. I will not relent. For the record, I know both men and women who live like this. Maybe it’s because I was raised in a rural environment, where people just put the welfare of the community ahead of their own personal successes and failures. They just kept going. We just kept going. And no, defeat was not an option.

One of the things that makes seeking TBI treatment tricky, is that it can be very hard to understand and articulate what you’re experiencing after your injury, so when you do go to the doctor, all your thoughts can be jumbled up, and you can end up sounding — and feeling — crazy. Plus, with so many genuinely ignorant doctors out there, some of whom just want to give you a pill and send you away, you can end up dealing with someone who makes matters worse. This is where it’s important to seek out expertise, especially from an advocacy organization like the Brain Injury Association. They can sometimes point you towards people who can help.

I Never Quit

To quit is to lower your standards and expectations for success. This is one principle that is physically implanted in the soldier through various exercises and drills that are usually painful in nature and the option to quit even more so. Quitting becomes unacceptable. When I was in basic training it was winter and I was training in temps of around 10 degrees. I soon developed pneumonia and even though I struggled to breathe on our four-mile runs and ten-mile ruck-marches, I refused to quit. I had the choice to but it wasn’t an option. It is the same for many with TBI because to risk being pulled from your duties because of an “invisible” injury feels too much like quitting. It may also appear to your peers that you are too weak to endure and so you find an excuse to quit.

Never quitting can be rewarding

The people running the show will never punish you for doing your part. And your comrades and co-workers will always appreciate you following through. This is a hard thing to overcome – the loss of that reinforcement. And when others around you don’t understand the nature of TBI, it can be pretty rough going. You go from hero to villain in one fell swoop. Plus, many other people sustain TBIs/concussions/head injuries, don’t report them, and keep going. So, they expect you to do the same. I have a theory that a lot of people who are the hardest on TBI survivors who are taking care of their recovery have sustained head injuries, themselves, and they take it out on others, expecting them to do the same thing they did — keep going and not “quit” — and keep running the risk of getting worse. A lot worse.

Never Leave a Fallen Comrade

As far as TBI goes, this state of mind is not a barrier to treatment but a consequence for those who wind up leaving their unit for lighter duty or medical discharge. Before being removed from my unit, I had a particular soldier in my squad that was good at heart but gave me grief for the decisions he made. I spent countless days working with him to make him a better more disciplined soldier. A year later, my unit deployed back to Iraq for the third time, a deployment I should have been on. I received word from a friend that Zapasnik, my soldier, died in combat along with three others from my platoon. It was at that moment that I truly felt I left a fallen comrade because I should have been there with him.

Leaving is always a loss

Anytime we step away from something, we lose a bit of ourselves. When we step away from our company of peers, we lose our part in that group, and we lose the chance to contribute. And we lose the opportunity to be of service to others. This is probably one of the most challenging aspects — the loss of community that’s based on you going above and beyond. That loss of identity, that loss of purpose. Dealing with this loss can be tremendously difficult.

Traumatic brain injury is a complex issue, one that affects multiple areas of life and is influenced by many factors. It is an injury that lies in stark contrast to the way the military is trained because the majority of cases lack substantial visible evidence of injury. Many, if not all, of the points I have made may happen on a latent level that those with TBI may not realize. Understanding these points will enable those in the related health fields to develop better programs to educate a treat those that may be apprehensive in seeking treatment.

The warrior life necessarily involves prevailing in the face of injury, defeat, potential destruction

And when we commit our lives to pursuing goals, no matter what, when we step outside of that, we go into uncharted territory that goes directly against the grain of our being.

For me, I had to realize that taking care of myself was an integral part of me being able to be a quality member of a tight-knit group who worked together. Realizing that brain injury had compromised my ability to handle things the way I once had, made it imperative for me to seek help. Only when I realized that the best way I could help my community, my team, my co-workers, my company, was by learning to recognize my challenges and get myself back on track, was I able to seek help.

It’s made an immense difference, too. Getting help was one of the best things I’ve ever done. It’s not just good for me, either — it’s good for everyone in my life, family, friends, co-workers — all of us.

The importance of a one-track mind

Staying steady – it’s about the only thing that saves me. Staying focused on what is important to me, what matters to me, what drives me in life. Truly, without knowing these things — what I’m willing to live for, what I might even be willing to die for — it may sound old-fashioned, but it’s the stuff of my life.

In today’s world, we are surrounded by constant enticements to stray off course. Media tempt us with a constant stream of engaging images which ultimately bring us nothing other than a moment’s entertainment. Advertisers and marketers interrupt us constantly to tell us about things they would like us to buy. Everywhere we look, everywhere we go, people are vying for our attention, and for those who have trouble staying on track, it can be murder.

It can literally wreck your life.

So, it’s up to us. It’s up to you. It’s up to me. To stay focused. Steady. Intent. It’s important not to take ourselves too seriously, but at the same time, don’t fall into the trap of discounting yourself and your values for the sake of some brief relief — fitting in, “taking the pressure off”, or whatever other reason you have for straying from your path.

What IS your path? What matters most to you? What do you want to devote your life to? Your family? Your country? Your job? Your home town? What? What matters enough to you, that you will get up early each day, and stay up late each night, in order to do it? What matters so much to you that you willingly forego personal comforts and convenience to do/have/achieve it?

These are important questions. Especially when it comes to TBI recovery. I am thinking particularly of the servicemen and women who have sustained TBI’s in the course of their service, who now come home to a life they may not recognize, in a country that owes them the world, but cannot/will not help them.

To these folks I say, “Find what matters to you. Find others who share those same values. Find your tribe, your home, your extended family. And put everything you have into serving your common cause.”

To all of us, I say, we should do the same. Find what matters most to us, what drives us, what feeds us, what keeps us going, no matter what. These things can — and do — save lives. Because they hold our focus and they keep us on track, when all the rest of the world is being pulled in a million different directions by a million different messages, very few of them are actually true.

Stay the course. Find your spark. And keep on keepin’ on.

Giving hope its due

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

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

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

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

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

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

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

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

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

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

And that’s where I think hope can help.

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

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

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