Getting back on track

Source: Kevin Collins

One of the things I’m really looking forward to, in the coming weeks, is being able to get back on track with my life. I haven’t said much about it, but the job search and interview process really disrupted my daily schedule, including my sleeping patterns and my ability to take care of basic tasks that are part-and-parcel of my daily life.

I’ve let some things slip, since I’ve been job-hunting and position negotiating, and I’m looking forward to things settling in, so I can get back to my sleep and my studies. I’ve been meaning to delve more deeply into the different symptoms and issues that come along with TBI, but I’ve been so focused on my basic survival, I haven’t had much energy left for that.

I have also been meaning to finish my paper (which has by now become book-length), A Perilous Relief, which is about the physiological bases of risk-taking and danger-seeking behavior. I personally believe that a lot of risky and dangerous activity has a physiological foundation — in my case, anyway. It’s been my experience that when I’m participating in high-stakes pastimes or pushing the envelope with risky types of behaviors, I just feel better. I feel awake. I feel alive. I feel calm and collected and a whole lot more centered, than when I’m just moseying along, taking my time, going about my everyday life. When I’m pushing the envelope, I feel human. And I need to feel human, so I tend to push myself.

The problem is, all that pushing comes with a cost. You can’t continue to amp up your system, revving your sympathetic nervous system, day in and day out, without some physical effect. Eventually the autonomic nervous system is going to get stuck in high gear, and the continuous effects of stress, cortisol, adrenaline, epinephrine, and all those other stress hormones that — in small doses — feel divine, are going to tear the crap out of your nervous system and essentially cause your body to “forget” how to ratchet it back and slow down.

You can’t drive 95 mph forever. You’re going to have to stop and refuel, sometime or other. And you’re going to have to change your oil and get your engine tuned up. Getting jammed in sympathetic nervous system overload is like keeping the pedal to the metal with no thought of refueling, oil changes, or tune-ups. Any vehicle will start to break down after too much prolonged use without some sort of repair. Witness the irritability, the agitation, the rage, the emotional volatility, the temper tantrums, the meltdowns, the snapping out, the roller-coaster of moods, the exhaustion that’s barely staved off by yet another cup of coffee.  It just can’t go on indefinitely.

Unfortunately, I tend to think I can. A lot of folks do, actually. Especially these days when the “new busy” (i.e., never being without your mobile phone and being constantly connected to “what’s next”) is touted as a good thing and lauded as a condition that everyone should desire. We all want to participate, to be a part-of, to have a hand in the excitement that is modern life. Mobile technologies bring us into the midst of the action in an instant, and ever-expanding social networks keep us connected with people we had never thought cared about us (and vice-versa). All around us, there’s constant movement. And we like it. I like it. It feels good, to be included in life, to be popular, to be connected. It makes us feel vital and needed and useful.

But in extremes, it is utterly distracting, even exhausting. And that’s where I find myself, now. I’ve been so caught up in my job situation, so immersed in it, that I’ve let a lot of things around me slide. Things I need to do every day, to keep healthy and happy and with-it. (In fairness to myself, I have been exercising each morning, which has been a huge help.) Now the job situation is settled, I’m in my final week at my current job, tying up loose ends, and I can turn my attention back to the regular business of my everyday life.

Again, I find myself striving to find the fascination in it. I will find it, but it takes effort. And with my initiation issues — I just can’t seem to get started — it’s like trying to get a rocket off the ground, sometimes. I read somewhere that it takes 90% of the fuel to get a rocket out of the earth’s gravity pull. That’s how I’m feeling, these days. But at least I’m not alone in my inertia — many, many rockets have the same problem.

So, I’m moving forward. Bit by bit. Piece by piece. And it feels, well, oddly normal. You have to understand — since I got a handle on the concepts of A Perilous Relief, I’ve been actively working with my parasympathetic nervous system, to chill out my nerves, and the results have been pretty amazing. I’m actually able to relax, which is a new experience for me. Understand, I was a very tightly wound kid, when I was little, with a host of strange mannerisms that ran the gamut from talking a mile a minute, to rubbing the silky lining of my blanket till I wore a hole in it, to banging my head on the wall beside my bed, to rolling myself up in a blanket from head to toe so tightly that no light or sound or anything could get in, to picking at myself till I bled. I was a mass of jangled nerves, with a pronounced startle response, intense sensitivities (tactile and hearing, especially, though smell and taste have never been my strong suits), and I would blow up at the drop of a hat.

So much of it, I realize now, was my nerves. My family lived in a borderline part of town in a small city, where there was lots of racial violence during the late 60’s and early 70’s. And being bused across town to a massive holding pen for thousands of K-2 children, through some pretty rough neighborhoods didn’t help. I was constantly on edge, constantly alert, constantly on the lookout for who was going to come after me next. So, from an early age, my autonomic nervous system has been skewed towards the sympathetic fight-flight-freeze end of the spectrum. And with all the drama in my life over the years, there hasn’t been much opportunity for me to cultivate that other side — the parasympathetic, rest-and-relax-and-digest part.

Looking back, I see that my predisposition to fight-flight responses, and my craving for situations that challenged me on the nervous system level, has contributed a lot to my behavior and choices. If I’d been aware of what I was doing, I could have seen time and again how I was making choices that put me into an intensified, hyper-alert, jazzed-up state which actually made me feel better, with all those stress hormones. And I can see how my lack of knowledge about the other side of things — the parasympathetic repair of the jangled system — kept me from doing things that could chill me out. I can also see how not knowing that I needed my system to be ON caused me to make choices that were clumsy attempts at heightening my arousal and clarity — and their clumsiness led to a lot of mis-steps, confusion, drama, and additional brain injuries.

Nowadays, now that I know that my system is inclined to be sluggish, due to my repeated TBI’s (slower processing and less “tonic arousal” — which is the relatively slowly changing metabolic/physical readiness to act or respond to the world around us), I know that I literally need to jazz myself up in some way, in order to be fully engaged with the world around me. Traumatic brain injury has a way of mucking with your metabolism and your tonic arousal, and I’ve had a number of brain injuries, so based on that and the results of my neuropsychological testing, I have a pretty clear understanding of my need for an extra “pump” to get through my days.

And knowing this, I can make conscious, deliberate choices about how I do that. I have a bunch of choices:

  • I can seek out pharmaceuticals to wake me up (my doctor has mentioned them, but I’m very wary of a drug “solution”).
  • I can drink a bunch of coffee, which will get me all wired and fry my system.
  • I can watch what I eat and make sure I don’t consume a lot of “cheap” carbs, like muffins and cupcakes and sweetened drinks, and make sure my body has a steady supply of real energy coming from complex carbs like fruits and vegetables and whole-grain breads.
  • I can get up earlier and exercise first thing before I do anything else.
  • I can make sure I get enough sleep.
  • I can do some or all or none of the above.

It’s my choice. And therein lies the power.

Getting back on track after the excitement and pressure and stress of lining up this new job is proving to be a challenge in itself. There’s none of the fear-for-my-life adrenaline rush to keep me on my toes, there’s none of the intense anxiety over my existential uncertainty to flood my brain with pain-numbing, sense-centering hormones. There’s not the same immediacy and sense of crisis that I had before, which kept me alert and fully engaged. Now I need to center in and get down to work and have that be okay, in the absence of the biochemical always-at-the-ready cocktail that bathed my brain for the past few months.

I’ll need to find a way to replace that. I’ll need to find a way to balance out my desire to drive, with my need to rest and rejuvenate.  Exercise is one way. Also, getting fully engaged in my daily life is another. Being “on” by choice, rather than by gut reaction, takes a lot of practice. But I’ve got time. And I’ve got ample opportunity to do just that — practice.

Onward. The world is waiting.

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Chillin’…

Source: D.Reichardt's photostream

This relaxing stuff is pretty cool. Now that I’ve learned how to take the edge off my sympathetic nervous system with focused attention, conscious breath, and intentional relaxation, my life is really amazingly chilled.

Never did I ever expect this to happen. I didn’t think I needed it to happen. I just figured, “I’m wired, I like being wired, and I’m always going to be wired.” And that was that. But no — now I have discovered ways to take the edge off, and now that I’ve been practicing, I’m finding that I actually enjoy taking the edge off.

Which is life-changing.

Truly.

Lookit — I’ve spent my life in a state of heightened alertness and anxiety. For as long as I can remember, I’ve been on edge. And I thought I liked it that way. The edge pushed me to achieve and accomplish, to pile on undertakings and activities, to attempt to do things that intimidated others, to drive myself at full-speed, from the time I got up in the morning till when I lay down (exhausted) at night.

And I thought that was just my lot in life.

But now that I’ve found a new way of doing things — exercising first thing in the morning, and stretching and relaxing before I go to sleep — a remarkable transformation is taking place. Remarkable. Amazing. Nothing short of dramatic. I’m actually able to relax before I go to sleep. And when I wake up, I lie in bed for a little while before I get up. It was never that way before. When I was up, I was UP. When I was down, I was DOWN. There was no in-between. No happy medium.

And my nerves were shot — except, of course, when I was pushing myself to keep it together. Then I felt fine. I felt better, in fact. I felt like me. But it wasn’t me. Not entirely. It was my collected reactions and my responses to the demands (real or perceived) of the world around me. It was, in many cases, pure agitation an anxiety, plain and simple. An intensely focused attempt to Not Screw Up which was more about reacting to what I thought was going on, than acting in a way that created the kind of life I wanted to create.

When I think of how many years I lost to pure reaction… but I can’t dwell on it. It’s just depressing. And counter-productive.

Now things are different, though. They’re very different. Between working with my neuropsych and taking care of my health and fitness, and learning how to manage my para/sympathetic nervous system, I’ve been reconstructing my life skills from the ground up. Maybe “reconstructing” is the wrong word — how can you reconstruct something you didn’t really have? Maybe I’m actually constructing this, for the first time ever?

Well, whatever the word I choose, I’m remaking the way I’m living my life, and it is so, so cool. I mean, amazing. Taking the edge off my constant agitation, my sympathetic overload, and figuring out how to relax… it’s like a magic elixir. Except that it’s not. It’s built-in. It’s actually the way normal people live. And I’m discovering it for the first time in my mid-40s.

How interesting…

And how encouraging. One might think that after 40-some years, I’d be pretty much stuck in that old way of doing things. And to be honest, some days I give up all hope of ever turning things around. If this stress and drama and pain and anxiety is all I’ve known, how can I reasonably expect it to change, especially at this “late date”?

Well, it can. And I can reasonably expect it to change (as it has been) by choosing to make intentional, conscious changes to the way I live my life. Simple, basic changes that are such an interwoven part of how I live my life — like how I wake up, how I get up, how I structure my day, how I go to sleep — they seem, well, kind of rudimentary. And they are. But they’re the foundations, the building blocks of my life, and the more attention I give to them, the more they reward me.

A big part of the reward is physical. My autonomic nervous system is calming itself down… learning to calm itself down under my direction. And my body is stronger and more limber than it was a year ago. I’ve lost more than 20 lbs in the course of the past 9 months, and I’m keeping the weight off, AND my energy level is higher. All of this reduces the agitation, the anxiety, the insomnia, the pain. It take my mind off those myriad distractions of sensory hypersensitivity and pain responses that have dogged me throughout my entire life and seriously cut into my attentional reserve, as well as my energy.

After more than 5 years of struggling nightly with sleep problems… waking up at 3:00 a.m. on a regular basis, being jolted out of sleep by a racing heart, being woken gradually in the wee hours by cramping, aching legs and back… by stretching before I go to sleep, consciously relaxing, and using earplugs to block out unwanted noise, I’m able to sleep not only through the night, but even past my alarm, which is amazing. Once upon a time, once I was awake, I was awake. 4 a.m. or 8 a.m., I was UP. Now I can actually roll over and go back to sleep.

That in itself is a miracle.

And after decades of having this low-grade intensity driving me onward-onward-onward, not letting me have any downtime, not letting me take time to really think through what I was doing, and why, I am emerging from this agitation-created fog of pseudo-effectiveness, into the light of my actual life. For the first time that I can remember ever, I’m able to look at my life in terms of my own wishes and desires, and envision the kind of life I would have if I weren’t at all anxious and agitated and filled with nervous energy.

It truly is amazing.

And what’s even more amazing is that it’s happening at a time in my life, when so many of my peers are starting to head downhill, starting to slow down, starting to ratchet back their activities, in expectation of the eventual disintegration of age. This change, this transformation, is happening to me at a time when the window for that kind of change is “supposed” to be closing. And the amazing part of it is, I feel like I’m only just beginning.

Indeed, I am.

How? Why? I think it’s due, in no small part, to the fact that I trust my body. I trust my nervous system and I trust my plastic brain. I trust my body to make the changes I need it to make, and I believe that it’s possible for it to change. And I’m learning about it more and more, so I can give it what it needs to sustain the changes — good sleep, good food, good exercise. All good.

Well, another good thing is that my wrists are telling me to take a break. I need to just publish this and get on with my day. It’s Sunday, and it seems like all the world is wet. It feels like nothing is going to dry out till August — if it even does it by then. But it’s good. It’s growing.

Like me.

What to do while you’re waiting in the emergency department

It occurred to me over the past few days, while walking and breathing, that doing conscious breathing would be an excellent way to spend the hour(s) you have to wait to be seen in the emergency department. ED visits consume an average of 222 minutes of waiting. That’s over three and a half hours. That’s time taken away from doing what you would rather be doing.

What a waste, right? Well, if you take the time there, to focus in on your breathing, to slow down your system, and chill out your sympathetic nervous system with mindful breathing that brings the focus away from all the terrible things that could happen and focuses it on your breath — the one thing you can be certain of — it can do you a whole lot of good.

How? By directing your state of mind away from you panic and into the areas of your brain that are more logical and more centered and better able to communicate with the doctors and nurses, and get them the information they need, to help treat you.

Time spent in the emergency department doesn’t have to be wasted. Nor does have to be consumed by fear and anxiety and dread. You have other options for how to direct your attention.

And if you direct it to your breathing, that can be 222 minutes well-spent.

A Perilous Relief – When Survival Backfires

The only problem with being able to survive terribly traumatic things is that our bodies have a way of hanging onto the stress of the situation, long past the event. Healthy processing of traumatic stress is a two-part process. Yes, traumatic stress is perfectly normal — one would expect that traumatic events carry a good deal of stress… if it doesn’t, something is wrong. The problems arise, when the stress becomes post-traumatic — when we continue to react to situations long after they’ve passed, and history hijacks our present (and future) by forcing us to react to situations and essentially live a life that has no basis in present reality.

While we’re in a state of crisis, our sympathetic nervous system (SNS) is aroused, delivering all the hormones and glucose and various biochemicals to our system. But after all is said and done, we need to get back to a resting state, so our bodies can recover. This means getting the parasympathetic part of our nervous system in gear.

The parasympathetic nervous system (PSNS) is the opposite of “fight-or-flight”. It’s about “rest and digest”. Some literature describes it as acting “in opposition to” the sympathetic nervous system, but it’s not antagonistic — it’s complimentary. The function of the PSNS is to offset the effects of the SNS, so our whole system functions properly. The PSNS calms down the racing heart, the panting lungs, the high blood pressure, and restores the blood supply to our digestive and reproductive organs. Everything that the SNS has demanded our bodies give up in order to save our ass from imminent destruction — attention to non-essential details, blood flow to digestive organs, the ability to sleep and have sex and pick up on subtle social cues — is restored by the PSNS in a far more gradual process than the hair-raising roller coaster ride that the SNS took us on. If we survive the ride, our parasympathetic nervous system lets us lift the proverbial safety bar, climb out of the car, and collect our spinning wits.

Now, if our SNS were allowed to constantly run unmodulated and unfettered, it would eventually wear us down to a nub. Like easy credit that makes it possible to buy sexy big-ticket items, purchase more house than we need, vacation at swanky exclusive resorts, and run up a massive tab buying rounds of Long Island ice teas for coach-loads of beautiful tourists who lavish you with attention, a constantly active sympathetic nervous system can really tax the physical system over time. As exciting as it may be, the drain on our physical resources is the equivalent of spending a whole lot more than you make with total intoxicated abandon. And we’ve all learned where that can take us, given enough time and intemperance.

Physically speaking, long-term one-sided excess takes a toll. Cortisol builds up… Blood sugar spikes throw off the body’s ability to effectively manage its own glucose and insulin… Adrenaline rushes keep muscles tense and stressed and unable to recuperate so they can recover their full strength… And more. Our internal organs, especially our heart, feel the burn. We put on weight. We can lose our hair and our ability to have sex. The list of issues that arise from persistent stress is lengthy, and it’s a little different for each person. But the fundamental rule of sustaining healthy living systems still applies:

You can’t keep taking away without putting back in, and expect to last for long.

Now, in a perfect world, for every shock and crisis and emergency (real or perceived) that comes up, we’ll have ample time to step back and relax, have a good meal, sleep long and deeply, and regain our strength. But that doesn’t always happen (and I would hazard to say, it happens relatively rarely in our modern American world). Our sympathetic nervous systems get all worked up, but our parasympathetic nervous systems don’t always get a chance to kick in to chill us out. After all, we’re very busy people with a lot of (real or perceived) important things to do, and our current culture has a way of socially rewarding people who are “on the go” constantly.

And so our systems can’t operate full-spectrum — what goes up must come down, but we won’t let it. We have only half of our God-given pistons cranking — at double speed — and we get into a state of physical distress that actually feeds back into itself. Our high-alert condition, which saves our asses in tight spots, can persist… and keep firing off warnings about every little thing, regardless of whether it’s truly dangerous or not.

As much as our survival wiring may protect and preserve us, if left to its own devices, it can also rake us over the coals. If we don’t discharge the stress of base survival and return to a restorative resting state after all our agitation has passed, we can end up experiencing even more physiological stress after the fact. We get tired. Our judgment gets clouded. We make poor decisions and do ill-conceived things, and then we spend a whole lot of time playing catch-up, in a state of heightened stress and crisis. The stressors we experience don’t even have to be real. They just have to seem real. Our bodies don’t know the difference, and they respond to what our minds tell them with a response that seems reasonable to them. One problem feeds another… and another… and another… and eventually, we find ourselves in a deep hole we can’t stop digging.

Which brings me back to my own situation. The hole I have found myself in, after many years of “digging,” is a pretty deep one. It’s been dug by a challenging childhood, lots of troubles as a teenager, drinking, drugs, petty crime, and plenty of poor decisions that were spawned, not only by past social and emotional traumas, but by mild traumatic brain injuries, as well. I’ll spare you the gory details of my tale. I’m sure you have enough excitement in your own life. The bottom line is, after over four decades of knocking around on this planet, one of my pieces of “baggage” contains a lot of post-traumatic stress, which I need to actively manage and factor into my decisions and actions, even when I’m feeling 100% sane and competent.

Make no mistake, I am a survivor. But that survival has come at a price. And some days, what I wouldn’t give to not have to pay that price, just for an hour or so.

A Perilous Relief – Table of Contents

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PTSD from TBI – Exploring some possibilities

I’ve been giving a lot of thought to how PTSD and TBI interrelate with one another. With so many soldiers coming back from Iraq and Afghanistan with serious issues related to TBI and PTSD… and considering how ill-informed and ill-equipped our society is in dealing with these very serious issues, I do want to try to explore some of the aspects of each.

I do this as someone with a history of TBI and PTSD. My injuries started when I was a kid, and children (and women) are more susceptible to developing PTSD, so that old habit I have of saying, “Oh, that was so long ago… I must be over it by now!” doesn’t hold water anymore. The fact of the matter is, I lived in very violent conditions as a kid, and it affected me. A lot. It was traumatic. It was distressful. I had a very disordered childhood. And the other fact of the matter is, I sustained several mild traumatic brain injuries as a kid, which did not help.

I’m going to be using Belleruth Naparstek’s book Invisible Heroes: Survivors of Trauma and How they Heal as a guideline. I’m not recommending that everyone run out and buy it — tho’ I won’t stop you if you want to. Be forewarned: I personally found a lot of the stories of trauma it recounted to be, well, traumatizing. If you’re squeamish about stories of violence and sexual abuse and terrorist attacks, you may not want to read it. I’ve read it — and struggled through it — so the damage is done with me. But you won’t necessarily have to go there, as I walk through the PTSD stuff I’ll be covering here and in later posts. I’ll also be drawing from other online sources about PTSD, and I’ll add links to other things you can read. I’ll try to avoid posting links to really awful stories. I don’t want to discount anyone’s experience, but some things I have a terrible time dealing with, and I’m guessing I’m not alone in that.

Note: This nasty habit of revealing horrible accounts to make a point about trauma is a common problem I find in current PTSD literature — it’s often written by psychotherapists who are accustomed to hearing people recount horrific events, so they can work through it. But I’m not a trained and objective psychotherapist, and I can’t stand hearing about awful crap other people went through. It makes me feel awful and wretched; there’s nothing I can do for them, which is deeply frustrating. It’s also sometimes vicariously traumatizing, which is no fun. If some therapists or researchers can find a way to recount trauma without needing to go into all the disturbing personal details, they’d be doing us all a big favor. I try to do it, here, but I’m not sure I do such a great job of it.

Anyway, back to my discussion…

Let’s start with the factors in and contributors to the development of PTSD from trauma (from Chapter 4 – “Who Suffers: How, When, Where, and Why”). They are (follow the links to see what I’ve written about each one – I’ll be updating these over time):

The Nature of the Traumatic Event

Survivor Traits

  • gender
  • age
  • psychological history
  • education
  • ethnicity
  • social support

Reactions Around the Trauma

  • panic and acute stress
  • dissociation
  • biochemical anomalies
  • drinking and intoxication
  • sense of control during the event
  • self-blame and negative beliefs
  • subsequent health problems

Many of these elements of PTSD tie in with experience of traumatic brain injury — even if it’s “mild” — in what I consider significant ways. TBI has a way of exacerbating a lot of problems, to begin with, but when it heightens the impact of something like PTSD, things can get really interesting.

In the past, I’ve talked about how PTSD can lead to TBI. In the future, I’m going to talk about how TBI can contribute to the development of PTSD.

But for now, it’s a beautiful day and I need to go outside.

Till later