New York Times on: Veterans and Brain Disease

The New York Times has a great article on CTE and the returning servicemembers

Veterans and Brain Disease

He was a 27-year-old former Marine, struggling to adjust to civilian life after two tours in Iraq. Once an A student, he now found himself unable to remember conversations, dates and routine bits of daily life. He became irritable, snapped at his children and withdrew from his family. He and his wife began divorce proceedings.

This young man took to alcohol, and a drunken car crash cost him his driver’s license. The Department of Veterans Affairs diagnosed him with post-traumatic stress disorder, or P.T.S.D. When his parents hadn’t heard from him in two days, they asked the police to check on him. The officers found his body; he had hanged himself with a belt.

That story is devastatingly common, but the autopsy of this young man’s brain may have been historic. It revealed something startling that may shed light on the epidemic of suicides and other troubles experienced by veterans of wars in Iraq and Afghanistan.

His brain had been physically changed by a disease called chronic traumatic encephalopathy, or C.T.E. That’s a degenerative condition best-known for affecting boxers, football players and other athletes who endure repeated blows to the head. …

Read the rest of the article here >>

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TBI/PTSD anger management by using the breath

Breathe
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

From Drama to Trauma in a few easy steps

Drama... trauma... not too far removed

When it comes to understanding the connections between TBI and Traumatic Stress, it’s important to think in terms of the whole person and their whole experience. Neither conditions exists in a vacuum, and they both feed directly into each other in really sinister ways. What’s more, with TBI, you don’t need a particularly bad experience to produce bad results in your life. Even good stress can contribute to a downward spiral that just is NOT good.

Here’s a picture:

From drama to trauma, the TBI way - click the image to see a larger version

And here’s how it all shakes out:

All the Excitement! The drama can be good or bad, positive or “negative”. It can be invigorating, or depleting, but ultimately with TBI, when you have way too much excitement, you can get into trouble.

First you have The Rush

Then you have The Physical Toll

Then you get The Cognitive Collective THREAT to the person & their survival

Then you get Trauma (and hence, traumatic stress)

Here it is, step-by-step:

The Rush

  • Adrenaline is flowing big-time. It feels great! Or maybe it doesn’t. The adrenaline might be in response to something dangerous, something unwelcome.
  • Excitement is the elixir of life. Woo hoo! Many times, the degree of excitement we feel depends on how we interpret the experience. If we are convinced we can handle whatever comes across our path, it can be exhilarating. If we’re convinced we can’t handle anything, it can be depleting.
  • Thrills, chills, and adventure – makes you feel more alive than ever. In the case where there are unwelcome forces at play, this can dull the anxiety you feel. Or in the case where there are welcome things happening, it can make them feel even more interesting.
  • Fear plays into it a little bit — or a lot. What’s a thrilling situation without a little fear?
  • Biochemical floods douse your body with all sorts of complexity-dampening goodness that clears your mind and brings your body to life. Only the most critical things come through, which can be a relief. You also get all pumped up, which in itself can feel good.
  • Whole system ON so you can handle whatever comes your way.

With Adrenaline, you eventually get a little wired. Maybe a little, maybe a lot. Your body can get taxed from all the adrenaline, if it goes on for a while without taking a break. Like if you’re in combat, day after day. Like if you’re working on a huge, critical project that will have an impact on your career. And with TBI, if you’re not thinking very clearly and you get nervous/scared/anxious about the choices you’re making and your ability to handle the situation you’re in, you can get even more flooded with adrenaline.

All the Excitement at first makes you ALERT, but eventually you get Fatigued. It can’t go on forever without some sort of relief. It’s like driving your car at 95 mph, mile after mile. You need to stop and refuel, every now and then. But with all the excitement, you can lose sight of that and want to just stay in the “zone” where you’re charged up.

Thrills may keep you Always-on, so that you eventually Cannot Rest – you’re like a machine that’s jammed in high gear. You can end up in a self-perpetuating cycle of action/adventure that feeds itself and wants to stay ON, to keep as sharp as it thinks it is.

Fear can be healthy in small doses, but too much of it over a period of time gets you Strung out. Remember all those biochemicals flooding you? They’re not going anywhere until you can take your foot off the gas pedal. But doing that can put you into a fear state, which can plunge you into exaggerated responses to fairly minor provocations. Fear tends to feed itself.

Biochemical floods leave you Physically depleted, and that in itself can make you depressed and unwell. Physical depletion includes the brain — it needs about 20% of the energy in your body, so if your body is low on energy, so is your brain.

Having your Whole system ON over an extended period of time leaves your Whole system TAPPED OUT like nothing else.

As a result of all this excitement and depletion, you can end up having a ard time processing complex ideas. The Excitement and ALERT state leaves you Fatigued, which then can lead to Cognitive fatigue … and that leads to increased agitation/restlessness. 

The Thrills, Always-on state, and lacking rest can put you into a Hyper-alert, hyper-vigilant frame of mind, driven by Strung out Fear, Anxiety and thoughts shaded by yet more fear.

In response, Biochemical floods pick up, leaving you even more Physically depleted, and when your Body is that taxed, it can distract the mind with pains, aches, sensitivities… which makes you even less cognitively capable. It can cut down on your capability, your ability to think clearly, your processing speed, and your overall experience of life.

Ultimately, your whose System starts to slow down, you can’t continue at that pace. When you have a Hard time processing complex ideas, you can find yourself thinking, “Why can’t I think? What’s wrong with me?” Cognitive fatigue, agitation/restlessness, can leave you not feeling right — Something is wrong. And you can over-compensate for that sense by being even more Hyper-alert, hyper-vigilant — telling yourself, “I have to be careful, I have to be cautious — WATCH OUT!”

Anxiety and thoughts shaded by fear can practically shout, “Something is going to go wrong! I’m going to be screwed!” Enter paranoia and dread. All that stress leaves your body taxed and hurting, distracting the mind with pains, aches, sensitivities, insomnia, etc. You can’t focus, can’t stay on track. Can’t keep your sh*t together.

Meanwhile, your system is slowing down even more. You push yourself harder, but you just can’t continue at that pace. You can’t keep up, you feel like you’re losing your mind, you can’t seem to hold your own with others. Your life is going to hell in a handbag… and you’re not quite sure why.

And you decide “I’m useless and nobody cares.

All of these things — this cascade of experiences — contribute to trauma on multiple levels. Physical trauma. Mental trauma. When your system is threatened and you can’t get free, you feel like you’re going to be destroyed — on some level or another. And that’s traumatizing. It’s too much for our systems to take. And if we don’t understand what’s going on, why we’re acting/reacting the way we are, it can put us in a real state of existential threat.

This trauma — the daily experience of having your life, your person, your identity endangered — is very real and needs to be addressed. It needs to be specifically “treated” with proper food and rest and exercise, with information that tells you about your situation, with a positive feedback loop from trusted friends who are there for you and can help you (or some other support group). It needs to be taken seriously by healthcare professionals, and it needs to be integrated into the treatment of mild traumatic brain injury.

Based on my own life experience, and what I’ve learned and contemplated about trauma and the human system over the past three years, I have to say that the traumatizing effects of unaddressed mild traumatic brain injury, is one of the key ingredients in long-term difficulties. And it’s not just the results of the trauma that need to be addressed, but also the somewhat preventable conditions that contribute to the trauma.

Mild traumatic brain injury, in my opinion is a chronically re-traumatizing condition which can be progressive. It’s a little like addiction, in that it’s not going away just by wishing, and the main thing you need to do is not fix it completely, but manage the ongoing impact it has to your life. Many of the traumas, I believe, can be avoided. But to do so requires information and support of some kind. It’s not the sort of thing we can sort out on our own, or that we can handle all by our lonesome. We need to have resources and connections outside ourselves, and we need to have support in regularly using those resources.

This is — again — an area where mTBI folks face challenges. Because so many of our friends and loved-ones just want this to be over with. They want to get back to the way things were. They want to get back to “normal” — whatever that may be. And they often don’t understand that we need ongoing support and resources far beyond the timeframe of our initial injury. Something fundamental about us has changed, and if we don’t incorporate that change into our lives then we’re going to find ourselves in trouble again and again, without really understanding why.

This TBI stuff won’t just go away for good. And it can rear its ugly head, time and time again. Realizing this is a good part of the battle. And using that realization to prevent further traumatization, as we go on with our lives, is yet another part.

After the war – battling off that pesky PCS

Cleanup time...

Headache today. Headache for the past few days. I suspect it’s a combination of lack of sleep last night, bone-weary fatigue that reaches far beyond the past few days, being dizzy and having to hold my head in certain positions so I don’t fall over, and a variety of other stressors that are adding to my tension and tightness.

I haven’t been to see my chiropractor in several weeks. That might have something to do with it, too.

I also haven’t been exercising as much as I normally do. Something in me is rebelling. Just doesn’t want to do it. So, this is what I get – headache.

The interesting thing about this is that I have gone for at least a year without that nagging headache that was always with me, day in and day out, to the point where I didn’t even notice it anymore.

How can you not notice a headache? Well, if it’s always there with you, it just becomes part of your life — a part of your “new normal” that you sometimes end up having to accept and adapt to. I figured the headaches were just part of my “new normal” and I had to just live with them. Then I started exercising regularly. And I started going to a chiropractor. And I started practicing consciously relaxing. Who knows exactly why, but the headaches subsided, then completely went away.

And I had to adjust to yet another “new normal” where I wasn’t in constant pain anymore.

But something in me, I think, needs to push the envelope. And something in me needs to have some level of constant stress. I need it to keep me a little sharper than I am when I’m totally relaxed. I need it to keep me engaged. I need it to keep me feeling alive. This is a problem. Because logically I know that this is why I’ve gotten hurt a bunch of times — I’ve pushed myself when I should have taken it a little easier. I exceeded the limits of my capacity, and I fell. Or I got in an accident. Or I got knocked around. I tend to push it. So, I tend to get hurt.

I also tend to fight. I mean, really battle. I used to go after people — individuals who seemed like they were in my way. People I worked with, who I felt competitive with. People in my life, who I felt were making me feel less-than. People I encountered who had something I wanted, or who were what I wanted to be. I was always going after people, literally or figuratively, setting up competitive scenarios where I could either come out on top, or I could at the very least knock the other person down a bit. I wanted a fight. I wanted to fight. And there were plenty of people who obliged me. But too often, I’ve been a bit of a wuss and have either backed down or deflected someone’s counter-attack. I’m not proud of it, but that’s what’s happened, time and again.

Okay, so it’s embarrassing, but there it is. I’m human, after all.

But back to the war… and my PCS, which is what this feels like — a resurgence of post-concussion syndrome. The Mayo Clinic website says this about PCS:

Post-concussion symptoms, which vary, include:

  • Headaches
  • Dizziness
  • Fatigue
  • Irritability
  • Anxiety
  • Insomnia
  • Loss of concentration and memory
  • Noise and light sensitivity

Headaches that occur after a concussion can vary and may feel like tension-type headaches, cluster headaches or migraines. Most, however, are tension-type headaches, which may be due to a neck injury that happened at the same time as the head injury. In some cases, people experience behavior or emotional changes after a mild traumatic brain injury. Family members may notice that the person has become more irritable, suspicious, argumentative or stubborn.

That’s pretty much where I’m at right now.

  • Headaches – a sick, migraine-y feeling behind my eyes, a thickness in the front of my head that feels like my skull is too small for my brain, and my brain is trying to get out through my eyes.
  • Dizziness – wobbly and lightheaded, I have to keep my attention focused on ONE THING AT A TIME, or I feel like I’m going to fall over. And throw up.
  • Fatigue – It’s so deep, it’s in my bones, pulling on me, dragging me down. I’m so tired, that I am having trouble sleeping.
  • Irritability – Edgy at work, edgy at home, I have been having issues keeping my irritability under wraps.
  • Anxiety – Yeah, that too. It’s a little embarrassing to admit — why does everything make me anxious — but it does. I’ve got this low-level anxiety that’s been crowding out intelligent thought for some time.
  • Insomnia – Yeah, that too. Waking up at 3:30… 4:00 a.m., and not being able to get back to sleep. And having trouble falling asleep to begin with, now and then. It’s more about having trouble staying asleep than getting to sleep, but in any case, I can’t sleep nearly as well as I have been in the past.
  • Loss of concentration and memory – Yeah, well, I’m getting by, I suppose. I’m trying to stay flexible and responsive to what the hell is going on around me, but I’m having real challenges remembering some things. I try not to let it get to me, because that makes a difficult situation even harder. But it’s a real pain in my ass, these days. I’ve done pretty well with accepting that I can’t remember some things, so I have to ask again and again and again, and ignore the strange looks that people are giving me.
  • Noise and light sensitivity – Makes staying asleep hard, if I don’t have my earplugs in. ‘Cause I’m so sensitive to sound, that if I hear something off in the distance when I’m half-asleep, it sounds like it’s right there in the room with me, and it wakes me up.

So, the war is back again. And I say that with both a humility towards the veterans and soldiers who have served in actual wars, knowing that the “war” I am fighting pales in comparison to what they have gone through overseas… and I also say it with the sense that no matter what your experience in actual combat, there is an element after TBI that is war-like.

My neuropsych hates it when I talk about battling through things. They want me to think about my experience in terms of a dance or a game. They don’t want me to get so hung up on things, and to ease up on the intensity in my life. I get that. It’s not such a great thing for me to be so god-awful tweaked about every little thing. And I understand they want me to keep the agitation levels down as much as humanly possible. They want me to manage my situation with forethought and insight and mindfulness. They want me to approach my situation like a dance. Better yet, as a game.

Certainly you can think about it in other terms, like it’s a dance or it’s a game, but in my experience, it’s more like a battle. Because this is not some game that has no consequence. This is my life. My survival is at stake. In a dance or a game, you can always walk away from the situation and get back to normal. But with my situation, I AM the situation. And I can’t just walk away from myself and find some more normal way to be.

And in a dance or a game, you don’t acquire post-traumatic stress and have horrible, terrible biochemical consequences of your “adventures”. You don’t have that constant cascade of fight-flight stress chemicals marinating you from the inside-out. You don’t have that repeated surprise(!) experience of having things turn out completely differently than you expected/planned — without having any idea why that happened. You don’t feel like you’ve lost yourself — sometimes the most important parts of yourself — and you have no idea how to get them back. You don’t feel like you’re cut off from the parts of you that once mattered so much.

Treating the challenges of life like a dance or a game may be fine for some (and some days it seems that way) , but it’s just not my experience, and my experience speaks louder than words.

It has been a battle. On and off. It has been a struggle at times. It has not been easy. Sometimes things have come together, but many times they have not and I have had to make do after the fact — scramble to sort out my snafu’s and fubar situations. Scramble I do — I sure know how to do that! And I can usually come out on the up-side. But then comes the post-traumatic stress. Even if the outcome is good, there can still be post-traumatic stress, when you’re hopped up on all the excitement, and the excitement seems to connect directly to your survival.

Excitation cascade to stress

Good stress, bad stress… it’s still a stress on your system, no matter how positive the outcome is.

And when you perceive the action to be directly related to your survival, and it feels like your life is in danger (perhaps because you’re going to lose your house if you don’t get this right so you can keep your job), it is no dance, and it is no game. It feels bigger and badder than that. And you get traumatic stress. Plenty of it.

Which introduces a whole host of problems — which I have found can be most “tolerable” when I am adding more stress to my situation. When I don’t have enough downtime to get my balance back (literally), I can end up making things even worse, on down the line. Because I crave the soothing effects of stress hormones, adrenaline, and those complexity-dampening chemicals that make everything in my life seem more simple, more basic, less complicated and confusing.

I know I’m not the only one. And I really believe this is a big reason why people are “compelled to repeat” their choices that put them in bad situations. Because they may not have the time or the resources to sit down and take a breath and sort things through and make sense of all of them. So, they jump head-first into more stress, without even realizing what they are doing. And they put themselves back in situations that traumatized them to begin with — bad relationships, bad jobs, redeployment, crime, etc.

I think TBI ups the ante on this, because it turns up the volume on Everything. Think you’re stressed? Try being stressed on a TBI. Think you’re confused now? Get hit on the head. You don’t even need to be knocked out. Any alteration in consciousness can have an effect.

Sensitivities can go through the roof, when your brain has been injured. Welcome to the party! The one way you can take the edge off, is by going extreme — extreme sports, extreme fun, extreme danger, extreme jobs… that’ll settle you down and focus you in.

The only problem is, you eventually have to come out of those woods, and you eventually have to go about your life again.

Which is when the PCS sets in. The headaches, the dizziness, the irritability, the sensitivities. It makes me crazy, and I feel like I’m back to where I started, several years ago. And it seems like the only thing that can take the edge off, is plunging back into the types of situations that caused the trauma to begin with.

I can’t tell you how tempted I am, to dive back into another massive project at work, and just lose myself in that.

Maybe then I won’t notice the headaches…

Putting my soul back together, one act at a time

These things take time

I recently came across a really interesting and important article — Beyond PTSD: Soldiers Have Injured Souls. It says a lot of really important things, including:

The trauma of war doesn’t just harm your body and mind. It also damages the soul. When you regularly violate your own inner moral code, you harm yourself in a deep and lasting way. From the article:

The psychological toll taken by war is obvious. For the second year in a row, more active-duty troops committed suicide in 2010 (468) than werekilled in combat in Iraq and Afghanistan (462). A 2008 RAND Corporation study reported that nearly 1 in 5 troops who had returned from Iraq and Afghanistan reported symptoms of post-traumatic stress or major depression.

Since the American Psychiatric Association added post-traumatic stress disorder, or PTSD, to its diagnostic manual in 1980, the diagnosis has most often focused on trauma associated with threats to a soldier’s life. Today, however, therapists such as Jonathan Shay, a retired VA psychiatrist and recipient of a MacArthur Foundation “genius” grant; Edward Tick, director of the private group Soldier’s Heart; and Brett Litz, a VA psychologist, argue that this concept is too limited. What sometimes happens in war may more accurately be called a moral injury — a deep soul wound that pierces a person’s identity, sense of morality and relationship to society. In short, a threat in a solder’s life.

“My colleagues and I suspect that the greatest lasting harm is from moral injury,” says Litz, director of the Mental Health Core of the Massachusetts Veterans Epidemiological Research and Information Center. He and six colleagues published an article on the topic in the December 2009 Clinical Psychological Review, in which they define moral injury as a wound that can occur when troops participate in, witness or fall victim to actions that transgress their most deeply held moral beliefs.

While the severity of this kind of wound differs from person to person, moral injury can lead to deep despair.

“They have lost their sense that virtue is even possible,” Shay says. “It corrodes the soul.”

….

In Europe, post-traumatic stress disorder researcher Ulrike Schmidt even seeks evidence of the moral injury in brain tissue itself. As she told Miller-McCune.com recently, “They need to know that it’s a recognized disorder. They are not weak, they’re sick, they have a spiritual wound. … And it’s important that they aren’t treated like outsiders, which is how many soldiers were treated in Europe in the ’40s and ’50s.”

Read the whole article here >>

The article goes into more detail about specific instances of moral injuring, and then it wraps up with some descriptions of what individuals have done to heal from their moral injuries, including centuries-old ceremonies for returning soldiers, visits to religious sites, and other concrete steps soldiers have taken to overcome their trauma. I really recommend you read – and really digest it.

Now, I’m not a soldier. I’ve never been in armed combat, and I’m not part of the armed forces. Yet this article speaks to me on a deeper and wider scale.

The traumas that these soldiers experienced came from a part of their innermost selves being violated in some fundamental way that made them unrecognizable (and sometimes unforgivable) to themselves.

And that sounds eerily familiar. Because what do you often get when you experience a TBI (or head injury or concussion or ABI, etc)  that erases fundamental parts of who you are and understand yourself to be?

Precisely this: a wound that can occur when [individuals] participate in, witness or fall victim to actions that transgress their most deeply held moral beliefs.

I’m really happy to find people talking about this — even if it’s specific to soldiers and military situations. To be honest, now that it’s sinking in and I’m getting it more and more, I’m fighting back some tears. Because this is true. I really believe with all my heart that this is a critical piece of what happens in TBI / concussion / head injury — you can lose parts of yourself that you have long relied on, and which make it possible for you to live in ways that are consistent with your moral code. And when those parts are damaged or harmed or disappear completely (for short or long periods of time, maybe even permanently), you can find yourself doing and saying things that are just not you. And you can find yourself doing and saying things that go directly against who you are, what you believe is right and good – your moral sense and identity.

You can’t seem to control it. You try, but it’s just not working. Your mouth isn’t doing what you tell it to. Your actions aren’t doing what you want them to. Your behavior isn’t being like you know you are. Your reactions are way off the charts, to the point of being unrecognizable.

And that causes a deeply traumatizing wound that no amount of talk and analysis will fix. Talk therapy won’t repair it. Neurologists won’t repair it. Even loving friends and family won’t necessarily make it right again. These are wounds we need to address within ourselves, with concrete actions, rituals or ceremonies of some kind (preferably the kinds of rituals and ceremonies in groups of like-minded individuals, which have taken place with traumatized people, including soldiers, since the beginning of time) — conscious acts which help us get our souls back.

PTSD soul loss doesn’t just happen on battlefields in faraway countries. It happens in the kitchens and family rooms and cubicle farms and factory floors and bar-rooms and train stations of the world. It happens in banks and football stadiums, on little league baseball sidelines, at the grocery store, on freeway on-ramps and in shopping malls. It can happen in public and in private — whenever we seem to betray our deepest-held beliefs and moral code, with behavior we cannot control or understand. It happens when we blow up over stupid little shit that shouldn’t bother us at all.

It also doesn’t only happen in pitched battle. It can happen in quiet, seemingly “normal” moments when the disconnect between what IS and what “should be” is as deep and as wide as any Utah canyon. It happens when we lose our cool over trivial things that somehow turn into massive sources of panic. It happens when we forget to do important things we have been entrusted with doing. It happens when we fail to be adequate team members to people who are relying on us. It happens when we stop doing the things that used to define us — keeping a well-maintained car or home, taking care of our appearance, conducting ourselves in a respectable manner, and/or making a decent living at work we enjoy.

It happens when we lose our shit. It happens when we lose our keys. It happens when we lose our perspective on the most important things in life and are cut loose to wander through life, wondering why the hell everything is so f’ed up for no good reason. It happens when we attack those closest to us and betray their trust and love with behavior and actions and attitudes that don’t reflect who we know ourselves to be, yet we cannot seem to control or even understand.

I think there’s a very good reason that TBI rage, anger, and temper are some of the highest ranking search terms here at BBBM — it’s eating away at the souls of many of the 1.7 million TBI survivors who enter the US population yearly. It undermining the lives, loves, and livelihoods of thousands upon thousands of individuals, many of whom have no idea that they need help — or they know they need help, but they don’t know what kind, and they don’t know where to get it. And even the people who are trying to help them, don’t fully understand the extent of their hurt.

Because it IS hurt. It is a wound of the soul. It’s a wound of the heart, yes — of the mind, yes… and of the body, most certainly — but most problematic of all, is the harm to the soul, the spirit, the very core of what makes us human, that makes us believe we are worth something.

Working through this has not been easy. The healing of my spirit, my soul… dealing with the ongoing, recurring traumas of a life that’s very different from how it used to be, has by far been the biggest challenge for me in my own recovery from TBI — and I will say recovery, because I believe that when we come back from TBI, we have to regain both specific functions and fundamental parts our very selves. And I believe we can.

This effort-ful repair also been the area where I’ve been most on my own. People just don’t get it. Not my spouse, not my neuropsychologist, not my former therapist(s), not my friends. They don’t understand what it’s like to be totally screwed in this invisible, unpredictable way — looking fine on the outside, while things inside are a tangled jumble of confusion and disorientation and rising panic. They don’t seem to get what it’s like to watch your life take on qualities that you never, ever thought they would have — and watch yourself inexplicably become something you’ve worked very hard for many years to NOT be like.

Not everyone knows what it’s like to become a raving lunatic, an unwitting “liar”, a problem… a monster… against every single one of your own wishes. And thank heaven for that.

They don’t get it, and they often don’t take it seriously. But this IS serious. It’s probably the hardest, most frustrating, most defeating experience that comes with TBI. Forget about the headaches and pain and light/sound/touch sensitivities for a moment. Forget about the panic and rage fits and anxiety for just a little bit. What’s beyond that? What’s beneath that? The self. The soul. The spirit. The very essence of who you are. When you take that away, even if there is no pain or panic or rage bubbling on the surface, what then is life all about? What foundation do you have? What hope can you have for your future?

Indeed, based on what I know about the human system and the effects that mental experience can have on the physical — and vice versa — I’d have to say that this traumatic loss of soul could very well form the basis for other physical/mental/cognitive/behavioral conditions. For when you have lost your sense of self – SOS – it can plunge you into an abyss of serious despair. And that can contribute to a “cascade effect” of all sorts of other conditions. The confusion and frustration and loss of sense of self feed into anxiety and panic, which can heighten physical issues, as well as cognitive-behavioral ones, as well.

Here, let me draw a picture of it…

The TBI Traumatic Soul Injuring Cycle (click the image to see a bigger version)

It’s all related, no matter what the specializing experts may say. And it’s a real bitch. Even the smallest things can set that cycle in motion.

For example, TBI can screw up your sleeping patterns, which in turn can screw up your ability to think. The brain needs a lot of rest to not only repair damage but also to recover from the added load of having to work harder at certain things. And fatigue is a major factor in agitation and anger issues with TBI. Being tired can make you confused and/or make it harder to think, period. So, you end up getting turned around and lashing out at others for no apparent reason, which adds to the stress of living – both for yourself and others. Which then leads to more problems… including sleeping.

Here’s another picture:

How TBI feeds sleep issues and other problems (click the image to see a bigger version)

So no, you’re not crazy, while you’re feeling your whole life falling apart, and you feel like you’re losing the very essence of who you are… you’re caught up in a whole cycle that starts with TBI and has unidentified stresses incorporated into the whole progression. And because your injury is hidden from others, and everyone wants to believe you’ll be okay (and/or they don’t want to think about the possibility you’ve got something bigger going on with you), managing it is very difficult… and you end up pulled into the cycle of losing yourself, your sense of self, your very soul, in the process of trying to get back to some semblance of normalcy.

The BIG problem is… there are all these unresolved issues behind the scenes that are slowly but surely sucking away at your understanding of who you are and what you’re about. And as you go through each day, watching yourself do and say things that don’t seem like “you” and who you understand/need yourself to be, you feel farther and farther removed from yourself. You feel like your soul is slipping through your fingers, like sand out of a broken wicker basket. And there’s nothing you can do about it. Every day, you get up an vow to try again … and the same shit happens all over again. You’re losing it. You’re losing your spirit. You’re losing your soul. You’re losing everything that ever meant anything to you.

Or so it seems.

What’s really happening, is that you’re fashioning a new understanding and version of who you are. All the while, patterns emerge in your behavior which “inform” you about who you now are. And it’s not all good news. When you keep screwing up, it can be easy to think that, “Well, this is me now — I’m a screw-up, and that’s that.” The fact of the matter is, that can change. But we TBI folks can be quite rigid and literal in our thinking, so we may never give ourselves the chance to come up with a different idea. And we re-inforce our misunderstanding of ourselves, creating a self-fulfilling prophecy in the meantime, getting farther and farther away from our core selves, wounding our already aching souls even more in the process.

Who we think we are is not always the truth. But by God, we’re sure we’ve got it figured out. And so, we cheat ourselves of a larger truth… and everyone around us pays the price, along with us.

I say this because I know what it’s like. I’ve lived it. And in many ways, I still do live it each day. I don’t know when I’m going to learn that I am not the same person I was, ten years ago… Even five years ago (anybody who says mild traumatic brain injury is not a progressive condition, is welcome to speak to me anytime). But I still keep making assumptions about my capacity, my abilities, based on what I “knew” about myself before. Those things have changed, sometimes imperceptibly. But even the slightest deviation from what I “know” to be “true” about myself, is enough to plunge me into a crisis — and send me off the deep end.

So… to finally get to the gist of this post “Putting my soul back together, one act at a time” here’s what I’ve been doing to help myself rebuild and address the loss of my soul, my sense of self, my “center” (as some of my more alternative friends call it):

First, I get clear on what my values are and what matters to me. I identify my core values, my beliefs, my commitments, my principles. I figure out what makes me “tick” and what gives meaning and purpose to my life.

I write it all down periodically, and I remind myself what my values are all about. My neuropsych has been working with me to help me get these clear in my head. I have actually always done this (perhaps as an instinctive response to my neuro challenges over the years), but after my last fall in 2004, I pretty much stopped doing that, and I have felt the ill effects. It was really then, that I started to lose myself (though the whole story is bigger than just this one aspect).

I addition to writing my values and ideals down, I try to repeat them in my head while I go about my daily business. I think about them while I am driving to and from work. I think about them after I am done with work for the day. I really meditate on them, when I get a chance. They are my lifeline.

Some of my core values are:

  • Treat all (including myself) with dignity and respect, as creations of a loving God/Spirit/Universe.
  • Devote myself to purposes that are larger than myself — the success of my co-workers and teams at work, the different projects I help others with.
  • Make the world a better place (by treating others well, and by offering them something of myself that helps them live their lives a little better).
  • Stand up for what I believe in, no matter what people may say at work or in life.
  • Hold true to my dearest beliefs and defend them from cowards and cheats and liars and others who seek to undermine me.
  • Remember my ancestors, my grandparents, all those who have gone before me, who look to me to continue the values and beliefs they held, and to continue and protect the world they helped to build before me. Stay true to their legacy, and do them proud. On some level, they are watching… waiting for us to do great things.

Next, I take concrete action. I do things that I know are consistent with my beliefs and values. These things are not always easy to do, and I have to keep that in mind. Part of me thinks, if something is difficult, that must mean there’s something wrong with me. I’m not good enough, or I’m not capable enough. But I believe that all important things are difficult to do, so the fact that I’m challenged actually means I’m living up to my potential — and beyond. All important, complex things take time to learn, and I am learning and practicing each day.

Some of the concrete things I do are:

  • Exercise regularly.
  • Eat good food.
  • Keep to a daily schedule as much as possible — get up, exercise, have breakfast, then get on with my day.
  • Go out of my way to be especially patient and courteous with my spouse.
  • Try to treat everyone I encounter with respect and dignity.
  • Stand up for what I believe is right at work – and don’t give in to peer pressure to cut corners and make excuses.
  • Connect with others who share my beliefs and communicate with them regularly.
  • Take time to plan my activities, so that I can make the most of them.
  • Do my best to follow through on my promises and what others expect of me.
  • Be easy with myself, give myself the benefit of the doubt.
  • Don’t get caught up in making up stories about what things mean or what people are all about. Don’t get paranoid and defensive just ’cause of what I think might be going on.

All these things are important to me. And all of these things help me take steps each day to getting back to where I’m comfortable in my own skin. I don’t do them perfectly each day, but they’re a priority with me, so I keep trying.

Most of all, I try to be patient with myself and give myself the benefit of the doubt. Rebuilding a life that you feel like you’ve lost is not easy going, but I try to keep focused on taking things a day at a time (sometimes an hour at a time). Sometimes I get in over my head, and I have to shovel out from under all the “compost” I’ve acquired, but I’ve gotten in the habit of telling myself that means I’m doing better. If I weren’t doing better, I wouldn’t be taking on the challenges that get me turned around, confused, and frustrated.

That’s how I do it – a little bit at a time. And with concrete steps. When I slip and fall and feel like I’m back to Square One, I check myself and make a list of all the things I have to be grateful for. And I focus objectively and realistically on the progress I have made.

The fact of the matter is, my anger isn’t constantly out of control anymore. My spouse is not afraid to be in the same room with me, anymore. I am not bouncing from job to job, leaving positions quicker than people can figure out that I’m faking my way through and I really don’t know what I’m doing. I am not spending money hand over fist without regard to my future. I am not waking up at 3 a.m. every night, unable to get back to sleep. I am not staggering around like an adrenaline-hopped-up zombie, fueled on pure agitation and nerves. I am not picking fights with police officers. I am not going for walks in the woods down deer trails during the early morning hours of deer hunting season.

I am absolutely positively getting better. Through concrete, definite steps that run contrary to the out-of-control live I once lived on a daily basis.

When it comes to getting my spirit back and healing my injured moral soul, that counts for something.

Onward.

The Warrior Ethos and Traumatic Brain Injury

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

Soldier
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.

Everything changes – let’s get past the guilt

Just look around… Seasons change, the world changes, political movements rise like tides – or tsunamis – and people change.

That includes people with traumatic brain injury. When you injure your brain, whether you know it or not, something has changed. Sometimes the change is extreme and immediately noticeable, and sometimes it’s hidden and the changes emerge only after weeks or months, even years. And if that change has been gradual and practically invisible (either because the physical changes evolved over time, or the TBI survivor is not well able to detect those changes on their own), it can be incredibly daunting to understand just what those changes have been, and what you can do about it.

At times, it may seem like nothing  can be done about it. Especially if the changes are gradual and fundamental — personality changes taking place over time in ways that you can’t exactly pinpoint when/where/how it all started. Going from being an even-keeled, easygoing individual… to an anxious, agitated person with a hot temper that will come out over nothing at all just when you least expect it. Going from mellow and easygoing to uptight and raging is a pretty extreme change, and it can look like it’s impossible to ever make it back to mellow.

But things change. People change. I’ve changed an incredible amount, just in the past three years. In the past six years, actually — the first wave of change was a result of my TBI in late 2004. And the second was as a result of my rehab. The first wave of change was unexpected and constantly traumatic in large and small ways. The second wave of change was planned and hoped-for, but to be honest, I’m not sure anyone but me really expected it to happen.

Those closest to me who saw the initial extreme changes in my behavior after my fall in 2004 were deeply skeptical about my recovery. They had to live with me on a daily basis as I became increasingly erratic, agitated, and withdrawn (and a little bit dangerous, to be honest). They were the ones who had to deal with this new person I’d become for reasons they could not understand. They were the ones who bore the brunt of my erratic behavior, my temper outbursts, my hurt and rage and fear and anger and lack of impulse control. They were the ones who had to deal with me flying into a rage, throwing things, attacking them verbally, and doing things that hurt them on a much larger scale — losing my good job and not being able to hold down steady work for longer than a year or so, not managing money, not taking care of the house, not being a present and responsible family member.

All the while they couldn’t protect themselves from that, because if they said anything, I would fly into a rage with them and become even more unpredictable.

The ones who were affected like this have had the hardest time seeing the potential of my recovery. They have hoped for precious little, to be quite honest, having seen how bad I could get. They got into the habit of handling me with kid gloves, treating me like a mentally impaired loser who needed to be coddled and kept cool at all costs. They had gotten used to the routine of carefully checking me out to see how I was, and then walking around on eggshells to keep me calm and non-agitated.

The human brain is an amazing thing. It watches for patterns, it identifies recurring dangers and situations, and it reorganizes your behavior in order to minimize risk and maximize safety. And the brains of those closest to me had become reorganized around the idea that I was pretty much a lost cause who would generally give things a good effort, but would never really amount to anything, and who would — as likely as not — end up in a temper flare-out that ended badly for everyone.

You know, it’s interesting how nobody really seems to talk about mood problems and anger/temper outbursts with traumatic brain injury. At least, not while the person is alive. One of the remarkable things about reports about CTE (chronic traumatic encephalopathy – the brain disease similar to Alzheimer’s that has been found in the brains of former pro football and hockey players — as well as a student football player), is that just about everyone talks about crazy-ass mood and behavior changes taking place after the person is dead and gone. But while the person is alive, there’s nary a hint that something is amiss.

Take for example  Shane Dronett, Bob Probert, Dave Duerson, and many other players who have posthumously been diagnosed with CTE. During their downward spirals, their situations didn’t make the news. Part of that, I’m sure, is because their falls from grace — erratic, violent behavior, business failures, unemployment, ending up living in their cars, in and out of jail — are not the sort of thing that people want to think about. Especially if it’s apparent (as it often is) that their situations arose from their former jobs of keeping us entertained by sacrificing their bodies — and brains — without any regard for their own safety. There’s a guilt that is never quite articulated by society at large, not to mention the families and friends of those in trouble.

Society has a hell of a time accepting these sorts of dissolutions. And friends and family too often feel responsible, as though they’ve somehow brought the violence and outbursts and erratic behavior upon themselves.

And then there’s the guilt of those who ARE in trouble — the confusion, the frustration, the anxiety, the depression. The constant trying to make it better, followed by recurring failures. Guilt and shame. Resolutions to try again… and then abject failures that can’t be explained.

One of the worst things about TBI is how it can strip you of your dignity. And when the people around you see — and are horrified by — your descent into behavior that is so “unlike you” that shame and guilt can be well nigh impossible for anyone to get past. People look away from what makes them uncomfortable. They distance themselves from aberrations. Want to become invisible? Present as someone with a disability of some kind, and watch people avert their eyes. Like Kevin Spacey’s character in The Usual Suspects, if you exhibit some sort of behavior that makes others uncomfortable and you don’t seem to be able (or willing to) change it, you can find yourself marginalized pretty quickly.

The problem with all this is that with TBI, one of the most important elements to recovery is social interaction. Connection with others. The ability to have community and connection with others. We are social creatures. We crave connection. Our brains are social organs that grow and change and adapt, based on social interactions. And when we are pushed to the side, marginalized because of our perceived differences, it just makes matters worse. It doesn’t give us a chance to come back to a place where we can be the persons we want to be, instead of the persons the TBI ushered in. It doesn’t give us a chance to practice our “social chops” and grow and improve and change for the better. Without feedback of some kind that tells us when we’ve succeeded or fallen short, recovery stays elusive. The traits and qualities that head trauma ushered in have a way of cementing themselves in place, essentially becoming the “us” that others decide we are.

That’s probably one of the most unfair phenomena of TBI — having others make up their minds about us as being a certain way after TBI, and deciding we’re not going to change, and they need to just get used to us being a certain way. When others do this, and they decide that we’re not going to change, we can get locked inside a prison of human making. It may feel safer for the people around us, if they develop these defense and coping mechanisms, but in the long run, it just makes matters worse, because it allows no room for recovery, and it locks everyone in a pattern of behavior that is far less than it could be.

It’s true — we will probably never get back to the person we were before. But that doesn’t mean we can’t become a different person of our own choosing and our own making. When we decide things aren’t going to change, and we resign ourselves to “accept the new normal” of limited options and curtailed activities, and we stop looking for what else is possible in our lives, we are neither fair nor honest with ourselves. And when we decide that injured others are permanently disabled and need to be handled with extreme care, we are giving up and consigning them to a prison of our making.

Change happens. Change is constant. And people change as much as politics and economics and fashion. We change in relation to events, but most of all in relation to others.  We mirror others. We connect with others. We evolve with others. And even in the aftermath of events that harm and hurt and kill, we can continue to change. Grow. Improve. Worsen. Deepen. Become more complex. Become more simple. We change.

But we need to be connected somehow, in order to do that.

Brianline has a great slideshow about a young woman named Freda who sustained a traumatic brain injury in a freak accident – click here to watch it. Perhaps the most remarkable thing about it, is how Freda’s friends rallied to keep her integrated into their social life, even though she was far removed from the flow of everyday life. Her family stayed with her. Her friends didn’t ditch her. Her teachers and healthcare providers worked to educate her peers about TBI. The community came together around her. And she came back.

For me, the connections that have kept me going  have been largely virtual. Connecting with people online — just about the only place I could find others who understood what I was going through — as well as one single neuropsychologist who didn’t treat me like a drug-seeking insurance fraudster who was just trying to get over on the system. I couldn’t really connect with my friends and family, because they were — and still are — really put off by the very concept of brain injury, and a lot of them had made up their minds about me a long time ago and still remain quite dependent on that interpretation of who and what I am.

The other way I’ve managed to connect is through work — the people at work, as well as the work itself. In that controlled environment, where I actively interact with others for 8 hours a day, five days a week, doing work that refines and educates me, I find a connection and a purpose that often eludes me beyond the workplace. When I haven’t been able to stay on for very long (because my anxiety level was getting so high, I couldn’t think straight anymore), I’ve been fortunate to be able to find new work, different work, to help me along. In the workplace, where I am required to interact with others, I find connections that often don’t present themselves in the rest of my life.

One of the important differences between work and my outside social life, is that there’s no room for guilt. There’s no room for sitting around feeling self-conscious. If I’m going to do my job and be fully effective, I have to engage with others on a regular basis. I have to get over my personal crap. I have to be a part of things. Or else. There’s not a lot of room for self-pity and drama. I know plenty of people who do indulge in those things at work, but for my own purposes, I can’t afford it. I have too much to do. I have too many things on my plate, to get caught up in personal dramas. It keeps me busy and it keeps me honest, and I have to constantly improve, or I sink like a rock.

The nice thing is, others at work can see I’m actively working at this. TBI doesn’t factor in at all in our interactions, because I have never discussed my situation with anyone at work, and I never will. It’s not something that needs to be part of that equation, and the last thing I need is to have to field all sorts of ignorant biases about what brain injury does to a person. It’s enough that I do my job and I do it well. The rest of it stays to the side.

And it’s tremendously freeing. Because I’m not locked away in a box made from other people’s assumptions about me and my prospects for change and growth. I’m not living under the shadow of my wary spouse who detects agitation in me and automatically begins to act like I’m a menace. I’m not constantly trying to prove to my loved-ones that I am capable of change, and that they don’t have to give up on me.

I can be who I want to be. I can be the person I choose to be, not the person others decided I was, 5… 10… 20 years ago.

People change. TBI changes people, but we can continue to change for the rest of our lives, regardless of initial setbacks. We may never go back to being the person we were, but that’s what happens with everyone, traumatic brain injury or no. Ask anyone about the kind of person they were when they were 20 years younger, and they’ll likely tell you they’ve changed a lot since then. If they haven’t, they were either uniquely evolved in their youth, or something has stunted their growth.

It’s in our nature to change. It’s in our nature to grow. It’s in our nature to improve, should we set our minds to it. With TBI comes a host of problems and issues — many of them emerging and sticking around, weeks, months, years after the injury itself. The guilt and shame and embarrassment can be pretty intense — for everyone. When you’re “not supposed” to do/say the things you are doing/saying, it can be pretty distressing for everyone. But you can’t let the distress get in your way. You just have to keep steady, keep an open mind, and keep following through to learn and grow and change for the better.

TBI does bring change. But it needn’t be a death sentence. Mild TBI needn’t derail your life, for no apparent reason. Blast injury has its own set of unique issues, but doesn’t need to destroy your future. And concussion can be profoundly disruptive, but it needn’t isolate you from the world for good.

Stay steady, stay open to change. And find out what else is possible for you and the ones you care most about.

Broken body, broken mind

Source: freefoto.com

More than ever before, I’m convinced (and riding the bandwagon around the square, beating on my drum) that the body and mind are so closely intertwined, that you cannot possibly separate out the two.

You take care of the body, and the brain will benefit. The mind will benefit, too. I differentiate between the mind and the brain because I believe (like others) that the biological, physiological organ of the brain is just one part of what makes up the mind. When you take care of the body, the brain benefits. And when the brain benefits, the mind has something to work with.

Body-brain-mind connections matter. They have such a profound impact on our health — and our illness. That goes for mental health. It goes for TBI recovery. It goes for effective and lasting healing for PTSD. If you leave you body out of the equation, while trying to fix your brain, your mind may have a hell of a time getting back on track and up to speed.

Now, don’t get me wrong. I don’t advocate that everyone who’s struggling with mental health issues, TBI, and/or PTSD run out and join a gym and get ultra-ripped. I’m not saying that you have to become a competitive athlete or reduce your body mass to 5% (which might be physically unsafe, in any case – our bodies need fat). And I’m not saying that if you’re in poor physical condition, you’re going to be a vegetable.

I am saying that exercise, when done carefully and regularly, can and will benefit not only your body but also your brain and your mind. It’s not blind faith I’m falling back on — it’s scientific fact, documented research, and personal experience. It doesn’t have to be torture, it doesn’t have to involve pain. It can be as pleasant as a walk on the beach with a loved one and your dogs, or perhaps a swim in a beautiful lake. It can be as everyday as taking the stairs three flights up, instead of taking the elevator. And it can be as invigorating as a game of touch football with your friends on Thanksgiving Day.

But if it’s not at all a part of your life, and you’re dealing with the challenges of TBI and/or PTSD, I’d hazard to say that your row is going to be a bit harder to hoe.

By now there is so much documented evidence that exercise and aerobic movement aids the brain, that it’s impossible to ignore. And it would be negligent of me to not beat on my exercise! drum, if I genuinely want to help people overcome the challenges of TBI (which I do).

The fact that exercise is such a simple thing for everyone to get — even in moderate amounts — makes it one of the best-kept secrets of TBI recovery. It’s so secret, even the top experts make passing reference to it, but aren’t nearly as passionate about it as, say, the folks at the Concussion Clinic at University at Buffalo. Watch the “Sportsnet Connected” – UB’s Post Concussion Syndrome Treatment Program for some very exciting developments.

For all the talk about TBI and PTSD among veterans, nowhere do I hear anyone talking about how soldiers returning from Iraq and Afgahnistan can help themselves with exercise. The VA may not have the proper pieces in place for highly effective diagnosis and treatment, and they may be discharging soldiers with inaccurate “personality disorder” diagnoses, but the one thing I see time and time again, when I look at YouTube videos of soldiers training, is gym and exercise equipment. Even gyms built in shacks on the sides of mountains in a godforsaken country far, far from home.

This puzzles me. Why would a treatment so effective and so familiar and so self-directed not be promoted and plugged (especially for soldiers), till everyone is sick of talking about it? Maybe it’s “too easy” and people think that it’s something that’s “extra” in addition to meds and/or directed therapies. Maybe it requires “too much” consistency and people don’t know how to work up the motivation to do it regularly enough to make a difference. Maybe the VA didn’t get the memo about U@B’s success stories. Maybe veterans are waiting for someone else to initiate treatment and get them on the right path.

It’s complicated, of course. I suspect it may also have to do with the professional interests and personal makeup of the top experts. After all, if earning your bread and butter (not to mention your reputation) comes from the control of information and the dispensing of advice and assistance under strictly controlled and controllable circumstances (like your office or a rehab facility), and you feel your professional position is threatened (or you may lose clients to outside forces), you don’t necessarily have a deep-seated incentive to encourage people to do simple, common-sense activities on their own (which provide tremendous benefits without requiring insurance billing codes).

Plus, if you’re a person who’s made your mark in the world sitting at a desk or standing at a podium, and you don’t have a real focus on physical fitness in your own life, why would you even think to recommend exercise to your clients/patients? The personal element to this — i.e., non-athletic individuals (who may have gotten into science and medicine because they sucked at sports) who have an aversion to exercise — should be factored in.

Plus, the focus on the brain and psychology and “mind over matter” that pervades Western science probably hasn’t helped us appreciate the role of the body in the functioning of our brains and minds.

Personally, I don’t have those sorts of conflicts of interest or an individual bias against exercise. Quite the contrary. I love to move in coordinated and sport-like ways, and I’ve got nothing to lose by telling everyone I encounter (or who reads this blog) that exercise can help heal what’s been hurt. And the more I think about it, and the more I use regular exercise in my own recovery, the more passionate (even zealous) I become. Each and every day, this flame burns a little brighter in my belly.

To say that exercising regularly changed my life for the better would be an understatement.  Once I started working out (very lightly and low-impact) each morning before I got started with my day, my anxiety level almost immediately began to decrease. Less anxiety meant less agitation, less temper flares, less acting out, less losing it over stupid shit. It has meant that my spouse can now be in the same room with me for extended periods of time. A year ago, that wasn’t the case. It has meant that I can start out my day without two or three private melt-downs that used to deplete me daily and leave me feeling broken and wrecked even before I left the house to go to work. It has meant that my constant headaches have subsided and my aches and pains which followed me everywhere and never totally went away, did in fact calm down. They’re not gone completely 100% of the time, but they are generally much less intense, and they don’t stop me from living my life, like they used to.

To say that my life between my fall in 2004 and my starting regular exercise in 2009 was getting progressively worse would also be an understatement. All that agitation, that anxiety, and the unstoppable extremes of panic and fight-flight-freeze gushing through my system were tearing the hell out of me. It was more than “just” TBI. It was (I believe) also a sharply spiking case of PTSD that arose from the constant “micro-traumas” of my TBI-addled experience, and it was destroying my life.

My brain was broken, and my mind was, too. In no small part because my body was broken in ways that no one could see.

How frustrating it was. I was trying like crazy to figure things out… totally fogged from my messed-up wiring, all disconnected and confabulated, and cognitively impaired by the daze of biochemical gunk that built up in my system.

It was like driving down a dark, unfamiliar road that’s full of potholes that I kept hitting, with the inside of my windshield fogged up.

Source: stoutandbitter

But then I started exercising. And you know what? Everything started to get clearer. Getting regular exercise each day was like taking a paper towel and wiping away the fog inside the glass. The road was still dark, and there were still potholes, but as long as I kept the inside of my windshield clear, I had a fighting chance. And slowly but surely, the sun started to come up.

Source: Kate Joseph

The road wasn’t particularly well-paved, and there were still potholes, but I could see them, at last, and I could adjust to my circumstances. As long as I was all jacked up on cortisol and adrenaline, I was S.O.L. and hurting from it. But when I started to clear that crap out of my system, I at last had a fighting chance to get on with my life.

My feeling about exercise are similar to feelings among my relatives about being born-again religious converts. There’s something so invigorating, so life-giving about this “new” discovery, that we feel ourselves transformed. And in a way, exercise has become a kind of spiritual practice for me. It gives me new life each and every morning, and even on those days when I’m not feeling as moved as other times, I still recognize the worth and value of this practice.

I would go so far as to say that exercise comes about as close to a “magic bullet” for TBI/concussion recovery, as anything I’ve come across. More and more experience and research is bearing that out, and plenty of TBI/PTSD survivors will agree. And the best part is, it not only strengthens the body and the brain, but it also gets you off the couch and/or out of the house and can get you into the company of other people where you’re less isolated, and you can interact with them in a structured context. TBI and PTSD can be terribly isolating. Having structured physical activity to get you up and out, and also provide a way to control your own social interactions is helpful in so many ways.

Out for a walk? You’re not only giving your veins and arteries and lungs and lymphatic system a much-needed boost, but you can also encounter people along the way with whom you can chat. Having trouble understanding what people are saying to you and following the conversation? You can excuse yourself and walk on, and no one will think anything of it. Feeling bad because you had trouble with the interaction? You can walk it off.

It’s what I do.

And the results have been amazing. (Obviously, not everyone has the same experience, and you’ll certainly have your own, but this is mine.) After hiding myself away for years, I’m back in the swing of things, taking care of what’s in front of me. Granted, I have my down days, and motivation is still a problem with me, but feeling as good as I do (aches and pains notwithstanding), I feel up to dealing with it all.

These results (and more) came after a relatively short time of doing them. Seriously. I started seeing real results after only a few weeks. Just in terms of feeling better, more centered, less foggy, more awake in the morning.

And this, after a prolonged period of sedentary isolating.

Oh, sure, I was active as a kid (and clumsy and prone to falling and hitting my head, unfortunately), and I went through periods of working out regularly and getting regular exercise as an adult, but after my last fall in 2004, the whole exercise thing went right out the window. It was bad. I went from being a regular at the gym to not even being able to set foot in the building, because I was having so much trouble understanding what people were saying to me — it totally freaked me out.

That freaking out was a problem. It was a problem at work and at home. It was a problem when I was with people or alone. My sympathetic nervous system was whacked and everything I encountered that was new or unfamiliar felt like a life-and-death threat, which had me pumped up on adrenaline all the time. I was a mess to live with. I had fallen, and I couldn’t seem to get back up.

I became intensely inactive. I stopped mowing the lawn and taking care of the plantings around the house. I stopped clearing leaves when they fell. I stopped sweeping the driveway. I stopped fixing things around the house when they were broken. I stopped going for the walks that I’d loved to go on for as long as I could remember. I stopped talking to people. I stopped talking to my spouse. I just stopped. Everything I encountered felt like a monstrous threat — one to be fought to the death or fled from in terror.

God, how miserable that was! The wild thing is, I didn’t even realize how whacked I was. All my alarm felt 100% justified. I felt absolutely positively certain that every novel situation I encountered was indeed a threat to my safety and sanity. I was going rapidly downhill, and I wasn’t going down alone. I hate to say it, but my spouse’s health declined rapidly as my own TBI issues escalated.

So, what got me out of that? Realizing, for one, that I was in danger of being put on meds for my attentional issues. My PCP had mentioned the possibility of putting me on something for my distractability, and my neuropsych had started mentioning the different medication options available. Talk about freaking me out. I had been on some heavy-duty meds for pain, back about 20 years ago, and they totally screwed me up. To the point of partly disabling me. What’s more, the thought of having someone else control my biochemistry — whether a pharma company or my neuropsych or my doctor (none of whom have to live in my body and brain, and none of whom are instantly available to me, should I get into trouble) — freaked me out enough to get me to sit up and pay attention and try to find some other way to wake myself up in the morning.

I had been trying for some time to figure out how to get exercise into my life, as I watched my weight increase and my strength decrease. I just didn’t have the intensity of focus required to figure out how.

When the docs started talking meds, I found my focus real quick.

The rest, as they say, is history. My life has done a 180-degree turn, and my mind and body and brain are doing better than ever. My neuropsych kind of looks at me oddly when I rave about how awesome exercise is, but theyr’e not living in my body and dealing with my brain, so how would they know what a qualitative difference it’s made? My PCP, thank heavens, is no longer talking about meds, and my level of functioning is on a whole new plane.

All this, I believe, because I have a solid physiological foundation. I’m exercising all my brains — in my skull, my heart, and my gut — and exercise helps them all communicate better with one another. My anxiety experience is now such that I can delay the knee-jerk reactions that plagued me for so many years. And I can stop to ask myself what’s going on, before I get carried away by my impulse to flip out.

It’s that effective and that powerful. And it’s so simple to do. Exercise. Take the stairs. Walk briskly instead of ambling along. Park at the other end of the parking lot and hot-foot it to the front door of the store — even in the rain. Get out for a walk on the weekends. And make a point of doing some light calisthenics before you get into your day. It can make a difference. It will make difference. The attention you pay to this will give back to you, over and over and over again.

As Nike says, “Just do it.” Your mind will thank your body for helping your brain.

What’s your mission?

Source: Aaron Escobar (the spaniard)

Disclaimer: This may turn out to be a clumsy post. I don’t want to insult anyone with any inappropriate references or seeming to make light of or diminish anyone’s career or calling or history of service. If I get clumsy with my terminology and come across sounding like an idiot, please accept my apologies. But I think what I’m about to say is important, so I’m going to take a shot.

I’ve been thinking a lot about what I’ve read about the movie Restrepo, a feature-length documentary that chronicles the deployment of a platoon of US soldiers in Afghanistans Korengal Valley. I’ve been thinking about one brief scene that someone described — a soldier being asked what he was going to do when he gets home and doesn’t have the constant adrenaline rush of war anymore.

He said, “I don’t know.”

See, this is the thing — with soldiers returning from the front, as well as TBI survivors who once lived fast-paced, action-packed lives. Logistically and qualitatively, there’s really no comparison between the constant life-and-death struggles of active-duty soldiers and, say, an acqusitions and mergers attorney. But biochemically, they’re much more similar to each other than to folk who aren’t bathed in a daily biochemical wash of super-amped-up stress hormones.

When you get bumped out of the front, thanks to TBI (or PTSD), what do you do?

We don’t know.

When it comes to addressing the issues of TBI/PTSD survivors who come from prolonged exposure to biochemical fight-flight extremes — especially when that exposure was in service to a larger-than-life, well-defined structure (in the case of m&a attorneys, the firm(s) handling the transactions and the rules of the game played… in the case of soldiers, the military culture and the rules of engagement). You have a very well-defined structure around you, you’re bound by that structure to follow certain rules, and the structure also defines for you what it is you’re supposed to do within very well-established parameters. And within those parameters, you participate in some of the most taxing and harrowing experiences the human system can endure. The structure, the order, the machine… it all makes it possible for you to do more than you ever dreamed you could — both for good and for ill.

It’s the highest of the highs. It’s the lowest of the lows. And over time, if your system is exposed to enough of those fluctuations without a chance to balance it out — the parasympathetic (rest and digest) nervous system gets out of practice, since it’s constantly pushed out of the way by the sympathetic (fight-flight-fake-it) nervous system — you get stuck in gear. Like the cable of your clutch goes on you when you’re in the fast lane hauling ass out of Los Angeles.

And then you get hurt. Or you get sent home. Or your tour ends.

And then what?

You get out of the hospital/rehab. You try to settle in at home. You look for something to fill the void left by the absence of your colleagues or comrades in arms. Everyone is telling you, “Relax… Take it easy… Calm down…” But the very things that kept you going all those months/years, the very things that made you who and what you ARE… well, they’re gone.

And how does a ghost relax? How does a shadow take it easy? How does a shell calm down?

Getting injured, getting hurt, getting fired/discharged… There’s more to it than just losing your place in the rank and file. You actually lose yourself. Who are you, if you aren’t doing the things you’ve strived to do, month after month, year after year? Who are you, if you don’t have that structure to work in, the rules to define you, the culture to tell you you’re needed?

This, to me, is the most debilitating aspect of TBI — and probably PTSD, too. It’s not just some hurt that needs to be healed or some biochemical imbalance that needs to be righted. It’s a crushing, diminishing, awful loss of the very essence of who you’ve become. And the rest of the “civilian” world — unless they’ve been in that life — cannot possibly understand how insulting it is when they tell you to relax, calm down, take it easy.

Who you are and what you are is about doing and being the exact opposite. Because that’s what you do. You don’t relax. You don’t calm down and mellow out. You don’t take it easy. Because you have a job to do. You have a mission to accomplish. And because you are who you are, you cannot and will not rest, till you finish the job.

So there.

Some of us need missions. We need a structure, a higher purpose, a job to do. We need someone to tell us This Is The Priority, so we can pitch in and do our part. We need to be part of something bigger (and badder) than ourselves, and lose ourselves in service. Some of us are not part of the cult of personality, but part of the brother-/sister-hood of service, whose very essence is refined and shaped by our selfless dedication to the Higher Good. We dedicate our lives and our whole selves to duty and to making a difference in the world — not for the sake of our own glory, but because that’s who we are.

And we need a mission.

Coming home — whether from the front or the hospital — or getting up after a fall, climbing out of a wrecked car, or waking up after being knocked out, we are not the same people as we were before the events that re-shaped our lives. But we still need direction and purpose. In the absence of the larger structures (which no longer have need of our broken selves), it’s up to us to find in ourselves where we want to serve, how we wish to contribute. I firmly believe that each and every one of us, no matter how damaged, has a role to play and a place to fill. If we haven’t got the coordination or the cognitive ability we had before, there are other ways we can pitch in and help out. If we haven’t got the old skills we once had, we have the ability to develop new ones, perhaps ones we never thought we’d have/need.

Once injured, once hurt, once damaged by the world we once participated so fully in, it can be all too easy to get lost in the shuffle.

But if we step up, we can make a fresh start, with a new mission, with a new way, a new dedication. We may not have the old structures around us, but we can find and/or create new ones. This is something we can do.

For some of  us, it’s something we have to do.

What’s your mission?