Is post-traumatic stress contagious?

What goes around...

I’ve been thinking a lot about pts (post-traumatic stress) lately. Especially in conjunction with traumatic brain injury, which I’ve said a number of times is an ongoing traumatic experience, and not only at the time of the initial injury.

Anyway, I’ve been thinking about the effect my TBIs have had on the people around me, and I can definitely see how my own trauma led to their trauma, too. The jumpiness that people who love and/or care for someone who has experienced TBI, is a common thing — and I think it’s directly related to their own traumatic stress.

‘Cause traumatic stress is, in fact, contagious. (And so I’ve answered my question.)

From the ever-handy Wikipedia:

(PTSD) is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma.[1][2][3] This event may involve the threat of death to oneself or to someone else, or to one’s own or someone else’s physical, sexual, or psychological integrity,[1] overwhelming the individual’s ability to cope.

Think about it… Someone sees someone they love and care for experiencing this traumatic experience, and they themselves are traumatized. And when the person who experiences TBI is a close part of that person’s life, then their injury can in fact represent a threat to their “physical, sexual, or psychological integrity, overwhelming the individual’s ability to cope.”

When you’re in the midst of your post-injury haze, and things are starting to fall apart — whether or not you know why it is or what to possibly do about it — you can say and do things that seriously threaten the people around you. It can threaten them on physical levels — like when your temper becomes violent and unpredictable. It can threaten them sexually — like if you lose all desire to have sex, or you become more sexually assertive. It can threaten them psychologically — like when you’re not acting like the person they know, and your behavior is so bizarre and unpredictable that they start to feel like they’re losing their mind and they doubt their own sanity.

Yes, post-traumatic stress — especially with TBI — is definitely contagious.

And that seems to me to be one of the missed pieces in TBI recovery — addressing the PTS of caretakers and partners of TBI survivors. It doesn’t even need to be moderate or severe TBI. I think mild TBI makes for an even likelier candidate for PTS, because it’s so insidious and can sneak up on you in subtle ways that make you — more than anything — feel like your psychological state is threatened.

Everybody feels like they’re going crazy, and when you don’t understand the underlying causes of it, well then, you’re totally screwed.

Until you get help.

This is where I can see some trauma therapy really helping — for the caregivers and partners and family members of TBI survivors. You get a really good trauma therapist who can work with those “TBI satellite participants”, and you help them sort things out, help them come to terms with their own individual trauma, and you get them on their feet, realizing that they are safe, that they are okay, and that they can deal with everything that comes up.

It’s one way that therapists can occupy themselves — while acknowledging that talk therapy probably isn’t the best thing for someone who is neurologically compromised. Everybody gets their place, but talk therapy and TBI can be a recipe for disaster, which can create even more trauma after the fact.

The more I think about it, the more surprised/dismayed I am that more sensible approaches to TBI and PTS haven’t been developed. There seems to be a sort of territorial overlap between the two, that doesn’t need to exist. Traumatic Brain Injury comes with a full compliment of neurological issues that can be as physiological as psychological. And those issues can — and often do — lead to traumatic stress. That traumatic stress then compromises the cognitive processes of TBI survivors, thus short-circuiting their recovery in the period after the initial injury… which then compromises their long-term prospects for restoration of their quality of life. I really believe the trauma piece is why TBI survivors — especially “mild” traumatic brain injury survivors — have poor long-term outcome prognoses.

There’s the trauma overlap that biochemically shorts out the adaptive nature of the brain, so the brain doesn’t get a chance to adapt in the ways it needs to, in order to effect actual recovery.

And countless people are suffering needlessly, because psychotherapists and neuropsychologists and neurologists are all battling over their respective territories, causing needless pain and suffering as a result.

But if people could put their own individual needs and wants aside and collaborate in a meaningful and respectful and productive way, who knows how many people could be helped?

Who knows? It’s maddening to think about all the suffering that’s taking place, because therapists are saying “You don’t have TBI/brain damage, you’re experiencing trauma,” and neurology folks are saying, “You don’t have trauma, you’ve had a TBI.” The two are inextricably interconnected, but nobody seems to have either the courage or the insight or the will to team up and come up with a common-sense approach that can mitigate both.

Simply put:

  • TBI leads to disrupted neurological function
  • Disrupted neurological function leads unanticipated changes in thought and behavior
  • Unanticipated changes in thought and behavior leads to trauma
  • Trauma biochemically prevents neurological adaptiveness.
  • Lack of adaptiveness feeds into yet more trauma.
  • And the cycle continues.

Each “arm” of the therapeutic/rehab community could easily find a complimentary place where they could constructively collaborate with each other.

But they’re so accustomed to marking off and defending their territory, that they fail to live up to their full potential. And countless people suffer as a result. AND they decide that it’s “impossible to recover” from TBI. What a terrible, inhumane thing to tell people. That they are irreparably damaged and have no hope of true recovery. Please.

The solution? Well, our “experts” could start talking to each other and start collaborating on a win-win situation for everyone.

Or those of us who have been neglected and abandoned and misguided by the therapy/rehab establishment can take matters into our own hands and address the most fundamental underlying basis for our ongoing issues — constant fight-flight sympathetic activity in our autonomic nervous system, which feeds the traumatic stress dysfunction and short-circuits our ability to recover and rehabilitate.

In a way it might just be possible for TBI survivors to take their recovery into their own hands — especially mild TBI sufferers. And the therapists and neuro people might be put out of a job. Because I suspect that countless people who have been sitting in therapy for years and years actually have underlying neurological issues that no amount of talking will fix — it only makes it worse and perpetuates the therapeutic relationship — and ongoing billing for the therapist and the insurance companies.

If we just got some exercise and learned to balance our nervous systems with slow, steady breathing, and we ate decent food at regular intervals, how much less “therapy” would we need? (There are always those who need to have someone to talk to just to check in regularly, but I’m talking critically about psychotherapists who insist on digging around and raking up all the muck inside you to “release it for healing”. All that stirring up will do a neurologically compromised individual more harm than good, trust me.)

Anyway, it’s a beautiful day and I’ve got a lot on my plate before the weekend is up. If only the weekends were three days instead of two. I feel like I’m just getting started, but I’ve got less than 12 hours till I start working again.

Oh, well. I guess the main thing is that we see where there are opportunities for positive change — stemming from seeing where things are not working as well as they could. If we can piece things together and understand the origins of post-traumatic stress and how it affects the people around us, we might be able to do something about it.

But as long as we keep separate and alienated and territorial, the suffering will continue.

And that’s a damn’ shame.

Because rust never sleeps

 

Tea catastrophe averted

 

I got a good lesson this morning. I managed to sleep in  till 8:15, with my earplugs firmly wedged in my ears and extra curtains pulled across the windows to block out the light. Even the birds that fill the trees around my house, clamoring for attention from each other and battling for position at the bird feeder first thing in the morning didn’t wake me up, as they often do, ’round about 6 a.m.

I’ve been feeling progressively more under the weather over the past few days, with my balance getting worse and worse and the headache starting up again. Work has been really good – very rewarding and satisfying. But it’s taken a toll, and when I got up this morning — without doing my usual breathing exercise (I did that at 4 a.m. when I was trying to get back to sleep) — I was feeling wobbly and out of it. I had to lean against the walls as I walked to the bathroom, and while I brushed my teeth, I had to prop myself up with one hand firmly on the sink counter.

I managed to get downstairs in one piece, and I made my breakfast slowly, deliberately. I took my time with it, taking care to not move too quickly and put myself off balance. In the past, when I was still dealing with the early years after my last injury, being off balance would send me into a panic and it would throw me off for the whole day, even before the day began. But since I’ve been making important changes in my daily life — including regular exercise — the panic has subsided considerably, and I’ve learned how to handle the sense of teetering on the edge of collapse without having my psyche collapse, too.

And that’s important.

So, anyway, after I had my breakfast, I decided to spend my day reading and writing and checking in with myself. The weather has been pretty wet, lately, and I can’t do much outdoor work. Plus, I’m not feeling well, and I would love to just spend the day reading, studying, and writing. Taking it easy, instead of taking care of everybody else’s business. I put some water in the electric kettle and fixed myself some fruit with crackers and goat cheese and went up to my study to settle in.

After a little bit, I realized I’d forgotten my trusty writing cardigan, and I went back downstairs to get it from the kitchen. While standing in the kitchen, looking around to see if there was anything else I’d forgotten, I heard an odd hissing sound. I went over to the kitchen counter and found my tea mug with a dry tea bag in it, and beside it was the electric kettle, hissing away, nearly all the water boiled out of it.

Now, the way the kettle has always worked in the past, is that when it gets low on water or reaches a certain temperature, it shuts off. This time, it did not shut off. So, I did. And when I looked closely at the heating element, it was showing signs of rust — perhaps from the intense oxidation from the coils evaporating off the water?

I kind of went into a tailspin about this. Yes, I know my alarm was disproportionate to the situation, but I got seriously upset by this and I started to beat myself up over having put water on and then walked away. I won’t write all the things that went through my head, because they are not the kinds of things I care to archive for posterity. Suffice it to say, for a few minutes this morning, I was not my best friend.

But then I realized I was pretty off the charts with my distress — how much would a replacement kettle cost? not very much, really — and it was more about me being absentminded and not paying close enough attention … no to mention feeling ill and “off” this morning. So I was wasting a lot of precious time getting bent out of shape over this. It’s turned out to be a beautiful fall day, and I have given myself permission to take time off to take care of myself. Why should I waste my time and energy beating myself up over a simple case of absent-mindedness that really anybody could have done, too?

Okay, so I established that it wasn’t worth wrecking myself over this oversight. And I realized that this electric kettle is not going to automatically turn off whenever it’s low on water, as I assumed. I would just get in the habit of A) putting more water in the kettle and B) not leaving the kitchen till it’s done heating the water, which takes all of maybe 30-60 seconds. Simple solution, right?

Well, what came up next was the burning question (and yes, I realize this sounds a bit neurotic, but I am not feeling well this morning) about what to do with the “extra” water that I wasn’t using for my tea? See, when I pour water in, I pour exactly as much as I need, so when it’s hot, I don’t have to check the level of liquid in my mug. I just know that I have exactly as much water as I need. If I heat more than I need, what will I do with the extra?

This was the hotly burning question in my fuzzy brain this morning (in the moment it seemed extremely important). I was all up in my head about the evils of waste and getting frantic about not having the exact amount of water I needed in the kettle, and having to gauge how much I was pouring in… and so on.

Ugh.

Then it occurred to me that having the extra water would come in handy for clearing the drain. I’ve been having some problems with the kitchen sink drain getting sluggish. My fix for it is to pour boiling hot water down, and that often works. So, this “problem” is actually no problem at all — in fact, it solves some problems, namely:

  • I need to slow down more in the morning, and this will help me do it.
  • I need to heat more water in the kettle, so it doesn’t fry the coils, and this will let me do that.
  • I need to periodically clear the drain with boiling water, and this will let me clear it daily, so the buildup doesn’t accumulate and become a bigger problem down the line.

So, there’s really no problem at all. Not anymore. But this morning, for about 15 minutes, I was going into a tailspin that threatened to wreck my entire day and set me down a spiraling path of upset — at the innocent electric kettle and at myself for getting so bent out of shape.

The electric kettle is forgiven, and so am I. I know full well that I am off balance, not feeling well, and I am spending an awful lot of cognitive energy just trying to keep myself vertical and not get hurt. I can cut myself a break, and just get on with my day and my recovery from the past week+ of hectic activity.

I’d better cut myself a break. Because rust never sleeps.

Neil Young reminds me of that constantly, while I’m driving to and from work. For some reason, radio stations in my area keep playing his music, and “rust never sleeps” is often what I hear him singing about. My, my,  hey, hey… It’s better to burn out, than to fade away… And this gets me thinking. Especially in the autumn, when the effusive growth of summer is giving way to frosts and withering and deadening, and the cycle of life turns to a cycle of death, my thoughts become, well, a little maudlin. The change of the season gets me to wondering “what’s it all about?” and “is this all there is?” and all manner of existentially angst-y ruminations. And my brain starts to perseverate and lock onto misperceptions and misconceptions and any number of irregular reasons to doubt my ability to live effectively in the world.

Some days, I suspect it’s due to the way my life turned in the course of my concussion-punctuated years. Each injury left a mark on me — a “ding” or two or three in the fuselage of my vehicle that didn’t exactly ground me, but kept me from achieving the heights I might otherwise have reached. I don’t want to blame the brain injuries for my ills — certainly, they have played a part, but they’re not the only reason I’ve had difficulties.

More than the traumatic brain injuries, in fact, I believe that the aftermath, the reactions, the later reactions of others and myself (which were based largely on ignorance about what brain injury does to the personality) and the meanings I gave to those reactions, had the biggest impact. And the time when I was actually recovering from the physical effects, I was sinking into a psychological morass of confusion, dread, insecurity, and the conviction that this temporary situation was permanent, totally screwed me up. After my injuries, my neuroplastic, adaptable brain was on the mend and finding new ways of doing the things I wanted to do, but because those new ways were different from the old ways — and therefore threatening and alarming to me — I discounted them and told myself they were WRONG and I should not be doing things the way I was doing them.

I had it in my head that the roundabout way I learned was Wrong.

I had it in my head that the way I communicated with people was Wrong.

I had it in my head that the way I structured my daily life — much more downtime than most people I knew — was Wrong.

I had it in my head that the choices I made about my social life — who I would and would not interact with — were Wrong.

I had it in my head that the choices I made about my domestic life — not having children and not officially getting married until 15 years into the settled, intricately entwined relationship — were Wrong.

Now, to be fair, there was an awful lot of social pressure to adhere to certain ways of doing things, so I had plenty of reinforcement for judging myself and my choices. And the rigidity of my upbringing didn’t help. But I suspect that the rigidity of my parents and wider social circles wasn’t the only reason I was so locked in, and so quick to judge myself. Indeed, I believe that the head injuries I sustained as a young kid (when I was about 4, then again when I was 7 and 8 ) predisposed me to an intense rigidity that locked out any alternatives to routines or “standard issue” behaviors.

The Brain Injury Association of New York State has a great little tutorial on Flexibility Versus Rigidity In Thinking And Behavior that I really like. (They’ve got a bunch of great material there, especially for teachers and parents of brain-injured kids.)

Here’s a snippet from the tutorial:

WHY IS RIGIDITY/INFLEXIBILITY IMPORTANT FOR SOME STUDENTS AFTER TBI?

Students with TBI or other neurological conditions sometimes demonstrate extreme forms of rigidity or inflexibility. Rigidity/inflexibility is often associated with damage to the frontal lobes, the most common site of injury in TBI. Therefore, some degree of inflexibility is common in students with TBI. This may manifest itself as difficulty (1) making transitions during the school day (e.g., from lunch or gym back to classroom work), (2) tolerating changes in schedules or everyday routines, (3) adjusting to changes in staff, (4) ending an intense emotional feeling, and the like. In extreme cases, a transition as apparently simple as from sitting to standing may be difficult and cause stress.

Related but not identical to inflexibility is the phenomenon of perseveration. Perseveration is a possible result of neurologic impairment and is characterized by continuation of the same behavior or thought or words or emotions after the reason for the behavior, thought, word, or emotion has passed or the thought or behavior is no longer appropriate to the situation. . For example, a student may remain focused on a given emotional behavior state long after the reason for that state has been forgotten.

This pretty much describes me when I was a kid, though today I’d have to say that emotional rigidity and perseveration is much more of an issue than cognitive. Cognitively, I can move on. But emotionally, I’m still stuck. I think that getting out in the world and holding down jobs and having gotten positive reinforcement in work environments has helped me cognitively. I’ve been able to really reap great rewards from using my head, and that’s encouraged flexibility and creativity. Emotionally, though, I get jammed up and stuck. That’s where I get rusty — stuck in place and wedged into an old pattern that doesn’t serve me or the people around me.

No, rust never sleeps. So, what do I do? Do I drive myself onward-onward-onward, in hopes of burning out before I fade away? Do I race at top speed through life and damn the torpedoes?

Um… No. Racing around and pushing myself are the very things that encourage rust. Like the super-heated coils in electric kettle caused the metal to rust, so does my super-heated life cause my system to lock up and show signs of wear. Maybe not in Neil Young’s case, but in my case, pushing for burnout is a sure route to rust. And I don’t have all the time in the world — I’m not getting any younger, and my window of non-fatigued time is significantly less than most people’s I know — so I just don’t have a lot of time to spare, cleaning up after myself when I crash and burn.

That’s no way to live.

What to do?

This is the eternal question, and it keeps coming around with me, no matter how much time I put between myself and my injuries. My first TBI probably happened when I was about 4 years old. And there were two more when I was 7 and 8 years old. More came over the years, including sports concussions and car accident mTBIs, for a total of at least nine separate instances of head injuries that involved some level of disruption of consciousness, followed by cognitive, behavioral, and physical problems.  I never got help for any of them, until about 3 years ago — just a lot of headaches (literally and figuratively) — and only in the past 3 years have I started to systematically and mindfully approach my issues with a focused desire to overcome them.

I’ve learned a lot about how to deal with the basic things — get my exercise regularly, eat right, get enough sleep, and check in with my neuropsych on a regular basis. But as the basic issues get resolved, the “higher level” questions emerge — as in, how to make the most of what life I have left, so that I can have the best life possible, whenever possible?

Ironically, the answer to this question has gone hand-in-hand with the answers to my most basic human needs. The answer is to just slow down and pay attention. For someone who is as driven as I am, it’s a tall order, and not that easy to do. But you know what? When I not only slow down but also pay very close attention to what I’m doing with myself and my life and my choices, many of my TBI related issues resolve.

When I slow down and pay attention to my physical fitness, my joint pain and headaches subside considerably.

When I slow down and pay attention to what people are saying to me, the problems I have with understanding and following clear up considerably.

When I quit going 150 miles per hour through every single day and pay attention to what I eat and how rested I am, my need to pump myself full of adrenaline and push past all sensible limits becomes far less pronounced.

Now, slowing down and paying attention is the sort of thing I’ve had to learn from scratch. A big driver behind my rushing is a constant low-level panic that simmers in my gut, day in and day out. It’s that constant restlessness, the constant agitation that comes with TBI. It’s my brain working overtime trying to find its way through the tangled networks that have developed over the years. It’s my body’s reaction to the intense energy needs of my very-active brain, and the low fatigue threshold I have.

Slowing down and paying attention has been closely connected with my exercise routine, taking the edge off my stress, finding outlets for the nervous energy, and clearing out the biochemical sludge that builds up after countless experiences of surprise/shock/dismay/confusion that come at me in the course of each day, when the things I expect to happen … just don’t… and I need to immediately adjust and move in a different direction to get where I’m going.

That surprise/shock/dismay/confusion is an ongoing situation for me, and it may never change. I may find myself spending the rest of my life realizing I was all wrong about something and needing to find another way to think/act/be. But at least I have my exercise to help me clear out the chemistry of those micro-traumas. And I have an understanding of that bio-cognitive action that lets me cut myself a break and not get all bent out of shape — for extended periods of time — over things that are either directly attributable to my brain having gotten a bit banged up over the years… or are long since over and done.

But even if I do spend the rest of my born days troubleshooting these kinds of cycles of pseudo-drama, I always have my fall-back, my comfort in the midst of the storms — the knowledge that slowing down and paying close attention to what’s going on around me, with heightened awareness and intense curiosity, can and will pull me out of my funks, can and will restore me to some sense of myself, can and will connect me to my life once more, in ways that running around at top speed never can and never will.

Rust may never sleep, but I don’t need to run from it. Ultimately, it’s not the quantity of life that staves off the debilitating freeze, the rust. It’s the quality. Cooling the hot elements, adding more water than I “need”, and just sticking with my life in all its aspects till I find some peace, some resolution, and I can make my tea… that’s what does it for me.

Now, what can I pay attention to next?

Be very, very careful

 

Warning Will Robinson!

 

Not long ago, one of my readers posted a comment about how important it is to be careful, so you don’t sustain a brain injury. Those words (at least, the gist of them, as I’ve since forgotten exactly how they said it) have stayed with me over the past day or so.

I have been working overtime a lot, having taken on a lot more responsibility that is a pretty big deal. And I have not been eating quite as well as I should be. I’ve been hitting the vending machines regularly — not insanely, chowing down on Skittles and Pop Tarts and Swedish Fish and all manner of sugar and chocolate. But I have been eating a chocolate bar a day, along with my beloved peanut M&Ms that keep me going (I need the protein).

At the time when I’ve been needing more sleep, I’ve been getting less. The Headache is back — not headaches but Headache — the long-lasting, perpetual one that doesn’t have any breaks and just keeps going to the point where I barely even notice it anymore. Except when I do. I’ve started to get the tactile sensitivity —  my clothes are hurting me — and light sensitivity and noise sensitivity. I’m kind of wired, as I’m sure you can tell. And in fact, it doesn’t take a whole lot to get me wired, so I’m feeling the burn, right about now.

On the bright side, I am functional. I’m able to do my work and get things done and interact with people at work. But that’s a downside, too. Because when I get like this, I tend to push myself and go faster than I should. And when that happens, I can get hurt. I’ve fallen down stairs a number of times in the past six months, because I was in a hurry. Nothing bad enough to injure me, but enough to rattle me.

I must be very, very careful. Especially because the BIGGEST symptom I’m having, which I neglected to mention above, is the vertigo. Dizziness. Crazy spinning head and the inability to turn quickly in any one direction, without my head going haywire. I am so dizzy,  I have to keep my back absolutely ramrod straight, or I start to lose my balance. Standing at the tops of stairs is interesting, too. And I have to hold onto walls as I walk along, or I tend to wobble and stagger like I’m drunk.

This sucks.

I can’t even close my eyes without the room spinning, and I have felt like I was going to throw up for three days running. Fortunately, I’m able to keep it together reasonably well with a discretion that masks my issues. Nobody needs to know that I’m as badly off as I am. Nobody needs to know that I’m about to heave all over my office. Nice for them. Not so nice for me.

Yes, this sucks.

But you know what? It’s all in the line of duty, and it’s all for a good cause, and I get to lay low this weekend. I don’t have any pressing activities I must do. I can lay low and be ill and take care of myself at my own pace. My spouse has a bunch of commitments over the weekend, so again I’ll have the place to myself for most of the coming two days. So I can roll myself up in my blankets, pull the blinds, and just hibernate in my cave.  Drink hot tea — the nasty cold season tea I can’t drink with anyone around, it smells so awful — and read a book. I never did finish The Bourne Identity. I got it it out of the library again a week ago, so I can spend my time catching up (and seeing how much I remember from before).

All in all, I feel physically awful, but I’m still bright-eyed and bushy-tailed. I’m so tired I’m literally falling over, but it’s a good tired that comes from having spent so many, many hours doing work I love in an environment where I’m actually able to do it.

Yeah, baby.

But I have to be careful. Seriously. I need to watch myself, make sure I don’t fall, make sure I take care of myself better this weekend, and get some recovery under my belt. I can’t continue on at this pace — must take some downtime. And be very, very careful, as I’m moving about.

Times like this, I’m reminded of how head-injured folks — especially athletes — so often re-injure themselves.

We tend to have have crappy risk assessment skills after we get hurt.

We also tend to over-estimate our ability to navigate challenging situations.

And all too often we feel like we have something to prove, so we push ourselves even harder than most — even with diminished co-ordination and balance.

These things I know. These things I know about myself. As euphoric as I am about this new job and all the great potential for it, I still know that I am running a risk every time I push myself, and I am running a risk every time I don’t take it easier than I am. I know that I am in danger of being injured — as anyone is who’s overtired and tremendously off-balance and walking up and down stairs, driving in heavy traffic, and generally going about their business in environments where you can slip and fall and get hurt.

I must be very, very careful. And so I shall.

For TBI and PTSD, exercise like your life depends on it

Flood damage in Tanzania

Here is a link for Japanese readers who are seeking information on dealing with PTSD

Because it may.

See, here’s the thing – when you’ve been through a truckload of trauma (be it combat, assault, disaster, car accident, traumatic surgery, random violence, or some other life-altering/impacting event that seems like it’s going to kill you), your body responds the way any living organism would. It floods your system with biochemicals to either help you escape or make dying less painful. And if you do neither — you can’t escape, but you don’t die — there’s this huge backlog of chemicals still stuck in your bloodstream.

If you’ve ever been a flood victim, you know what it’s like — the waters rise, sometimes very quickly, and then they recede. When they go, they can take with them some of the most precious belongings you own… they can wash out roads and compromise foundations of buildings, and turn a familiar place into a hellhole. And what’s left, when all the water is gone, is this nasty goo and muck that you have to wash out, sweep out, clean out. Sometimes you can never get it out completely. And the odor stays in that place for years afterwards.

That’s sort of like what happens when you go through intense trauma, and you end up surviving (despite how things looked when you were going through it all). Your body has responded the way it’s supposed to — adrenaline, noradrenaline, epinephrine, cortisol, glucose, and more… it’s all poured into your bloodstream, your muscles, your soft tissues, to help you get through it all.

But once you’re on the other side, even though your body doesn’t need those chemicals anymore, it doesn’t know it. It’s your body. It’s on autopilot. And it’s so fried from the experience(s) it’s been through, it can’t think straight.

Literally.

And you end up extremely jumpy over every little thing. It’s not “just stress” — it’s something much bigger and much badder. It’s your body expecting and planning for more danger, being on high alert — whether it needs to be or not — because that’s what helped you before. That’s what helped you get through. And as your body continues to hyper-react to the world around you (it thinks it’s protecting you, the same way it did before), you end up marinating in this stress chemical soup that becomes a self-fulfilling prophecy and a self-perpetuating loop.

People keep telling you to “relax” — clearly, they don’t understand what’s going  on with you. They just don’t get it.

So, what to do? You can’t go on indefinitely, stewing in your own stress juices. You’ve got to do something. I should know — I’m one of those people who was on high alert for years, thanks to my body being convinced that it needed to be. Couldn’t relax. Didn’t want to relax. Relaxation meant danger. It meant death, to my wired system. Relax? Ha! But still, I just couldn’t go on like that.

Here’s what I’ve done that has actually helped me. In more ways than I can say.

I exercise. Not fanatically, not extremely, like some folks do. But I do it religiously, with a daily discipline that surprises me sometimes. I get up in the morning, do controlled breathing exercises (to counteract out my always-at-the-ready fight-flight response) and then I get on the exercise bike for 10-20 minutes. If I’m away from home, I do some other sort of exercise for 10-20 minutes. I do knee bends. Light calisthenics. Jumping jacks. Anything to get my body moving and get the blood flowing. As I do it, I imagine my veins and arteries and muscles clearing out the gunk from years of always-on alertness, and I breathe into it. I push myself, on and off, to get myself in a frame of mind to focus in and finish what I’ve started. If I’m riding the bike, I do intervals that really make me work at it — I’ll ride hard for about a minute, then pedal slowly for 15-30 seconds, then I’ll ride hard again for about a minute. If I’m not on the bike, I push myself with the jumping jacks or the arm/leg raises.

After the bike or calisthenics, I stretch and then do some light weight lifting. The lifting (I use relatively light dumbbells) is important for building strength to help with my balance and overall physical stamina. It also feels good.

Again, I don’t go overboard with this. I stay focused and keep it limited to about 30 minutes a day, because I have to get on with my day, and I can’t spend all my time working out.

The results, as I said, have been phenomenal. My mood issues — the extreme ups and downs and violent temper flares — have lessened to about 15% of what they once were. Once upon a time, I was very difficult to be around, if I was tired or agitated or anxious. I’m not like that anymore. I’m literally a different person. I look people in the eye. I listen to what they have to say. I am involved in my own life on a level that I never before thought possible. And it just keeps getting better.

So, if you’re struggling with TBI and/or PTSD, I really encourage you to start exercising first thing in the morning. First thing is important, because it gets your metabolism going better, and it also gets you woken up in ways not even a cup of coffee can. It’s good for your head and it’s good for your heart, and it helps you fight off infection and sickness as well as strengthens your whole system.

I’m probably sounding like a religious convert, and in a way, I am. I truly want to testify that the impact on my life has been nothing short of phenomenal. I believe it has a lot to do with me clearing out the biochemical sludge from all those floods of emotion and stress and hyper-reaction over the years of being ON. Seriously — I was so driven, so pumped up all the time, someone close to me once said was the most driven person they knew. At the time, I thought it was a compliment, but now I realize it had a price.

Now, there are experts who say you need to do moderate-to-intense exercise 30-60 minutes a day, 5 days a week. My life was changed (at first) by 15-20 minutes of light exercise every morning… and it slowly evolved into 30-45 minutes of light-to-moderate exercise. Do what you can, and work from there.  But do it.

Addressing the trauma in traumatic brain injury

Source: Scott Butner

As I’ve been exploring the landscape of my head injuries over the past few years, one aspect of my life experience has consistently come to the fore — trauma… and its long-term effects on lives of both survivors and the ones they love and live/work with on a daily basis.

It’s almost a total fluke that trauma should even have this on my radar. But over the years, I’ve befriended — and been befriended by — a number of psychotherapists and counselors, most of whom specialize in trauma. In retrospect, I suspect that many of them have assumed that my difficulties were due to past traumatic episodes — rough childhood, misspent youth, etc. In fact, one of them has flatly denied that my issues could be due to TBI, and they became more and more insistent about me getting a therapist, which was probably the worst thing I’ve ever done, in retrospect. (This friend’s denial is a topic for another post — it’s quite interesting, “clinically” speaking.)

Now, I have to say that after more than 10 years of being around these friends of mine, I get a little tired of every ill known to humanity being ascribed to after-effects of trauma. When I talk about experiences I’ve had and people I’ve encountered who have annoyed me or done some seriously sick stuff, I’ve often heard the refrain, “Oh, they’re a trauma survivor, so they’re dissociating/being triggered/experiencing kindling/re-enacting their past traumas.”

There’s not much room for just being an asshole. For some of my friends, it’s all about the trauma. And in an attempt to better understand what it is they’re talking about, I’ve attended some trauma workshops, as well as read some books. I’ve got Peter Levine on my bookshelf, along with Belleruth Naparstek. And now I’m reading Robert Scaer, M.D.’s  book The Body Bears the Burden, which explains (from a neurologist’s point of view) the effects of trauma on both the body and mind of someone who’s gone through awful experiences — and those whose experiences don’t seem that terrible, compared to, say, Pakistan’s flooding or suicide bombings in Kabul.

The DSM-IV defines a “traumatic stressor” as:

[an stressor] involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate

The part that interests me is the “direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity”. The other parts are just as significant, but I’m not going to speak to them at this time.

When it comes to mild traumatic brain injury, I think sometimes the severity of the experience tends to get downplayed. After all, the injury is mild, right? Well, interestingly, mTBI survivors apparently can show more disruptive symptoms of traumatization after the fact, than survivors of more severe injuries. And these long-term effects  can wreak havoc in the lives of survivors, as well as their immediate circle.

Problems such as fatigue, emotional volatility (emotional lability), rage, agitation, irritability, insomnia, sleep deprivation, anger, temper flares, temper tantrum, anxiety, fear, panic, risk-taking, danger-seeking, not to mention all the crisis and drama that can accompany hormonal spikes during times of stress, certainly don’t make things any easier. If anything, they complicate recovery by flooding the system with stress hormones which interfere with your ability to learn from your experiences. So, at the time when you’re having to get a new grip on your newly changed life with its “new normal,” the biochemical processes going on behind the scenes may be getting in the way.

How maddening is that? At just the time when you need your brain to be able to recover, it’s busy cranking out all sorts of interesting concoctions that specifically get in the way of your recovery.

Because (I believe) there is unresolved and un-dealt-with trauma wreaking havoc behind the scenes.

Trauma in mild traumatic brain injuries is particularly tricky. After all, the injury itself may not have been that dramatic — something gets dropped on your head, or you get in a fender-bender, or you slip and fall down and clunk your head on something. You get up again, walk away from the scene… maybe pay a visit to the emergency dept of your local hospital, get scanned, and you get a “clean” bill of health (and maybe a few pointers on what to watch out for to make sure you don’t have more serious issues later on). Then you’re expected to get on with your life.

But inside your skull, something else is happening. Some of the fragile connections in your brain have been sheared or severed or frayed, and your brain isn’t able to communicate with itself like it used to. On a fundamental, profound level, your very existence has been threatened — only nobody can see it. Even you can’t see it very well, because your brain is either still bathed in the stress hormones designed to keep you from feeling a bunch of pain (and thus preventing you from fleeing an immediate threat), or it’s just not making the connections it “should” in order to give you — the resident owner — a clear picture of what’s going on. Or it could be both things going on.

In some cases, from what I’ve read in Dr. Scaer’s book, the onset of problems can be delayed by hours, even days. So, right after the accident/event, you’re walking around looking fine, seeming to be fine… maybe you’re a little shaken up, but that’s to be expected.  But then you start to slip away… decline… feel the effects of what was supposed to be a mild event that had no serious immediate effects you. In your system, hidden from view, the process of gradual (and possibly debilitating) problems has begun.

This process is utterly maddening. Everyone around you, who was worried for your safety, just wants to be relieved that you’re okay. But all of a sudden, you’re acting strangely, you don’t seem like yourself, and you’re complaining all the time. The complaints don’t get better over time, either. They get worse. And for no apparent reason. People think you’re looking for attention, that you’re trying to “milk” your accident for all it’s worth. They just want you to get back to being your old self. But you’re doing the exact opposite.

And the pressure to return to normal builds, even as your system is being eroded by the biochemical havoc of trauma that was introduced to your system which has not been cleared — it hasn’t even been recognized. How can you clear away what you can’t see/hear/detect?

Indeed, the most insidious and problematic manifestations of trauma take root when the person having the experience is taken by surprise. Studies have shown that bracing for impact limits the impact, but being blindsided makes it worse. And it makes the experience as a whole worse. The body detects this threat to its safety and existence — all of a sudden out of nowhere — and it unleashes myriad biochemical substances for us to deal with it — including endogenous opioids designed to numb the pain of injury. Animals in the wild which are being chased by predators, when there is no way to escape, will often fall down as though dead, their bodies full of chemical substances that will both numb the pain of being devoured and turn them into “dead” prey which might discourage a predator from actually killing them.

The same biochemical process is in place with human beings. After all, once upon a time, we were hunted as prey by animals larger than us. Indeed, we still are, in some cases — the predators happen to be other people, more often than not. In times of combat and assault, when all escape routes have been blocked off and we believe (on some level) that we’re done for, our brains and bodies do their natural thing — they bathe us in substances to protect us from feeling that knife going through our lung or feeling that bullet smash through muscle and bone.

Our brains and bodies are doing their utmost to protect us as best we can. But our minds tend to interpret the experience differently.

In the case of animals who freeze and then survive the assault, they shake themselves, go through a series of shuddering/jerking motions, do heavy, deep breathing, and then pick themselves up and get on with their lives. In the case of humans who freeze and then survive the assault, we tell ourselves we were wusses for freezing the way we did, and we plunge into cycles of self-doubt and conflict, feeling like we failed — when we were simply being the biological creatures we are designed to be.

And the self-perpetuating downward spiral of the PTSD loop starts. Where it stops, is anybody’s guess.

Therapies which have been successful in freeing people from that negative feedback loop are those which engage the body to discharge the sudden burst of biochemical self-protection, and get the autonomic nervous system back into balance. In the completion of the fight-flight-freeze cycle, the body is allowed to return to its most effective ways of working. And we can get on with our lives.

Here’s where the problem starts with mTBI. (Note, I’m not a doctor or certified health professional — this is just my belief system about how our systems interact with the world around us.) If the injury is “mild” then what’s the big deal? Why should we even need to complete the fight-flight-freeze cycle? Wasn’t the injury itself mild? We just got clunked on the head. Big deal, right?

Hardly. I think with mild traumatic brain injury, there may be another aspect of it that comes into play. With “mild” injuries (not that any brain injury is ever mild, mind you), the brain itself perceives the threat on a basic, biological level. It knows something’s wrong, and it kicks into overdrive, trying to right what’s wrong.

I suspect this is why people who have sustained concussions or mTBIs are so prone to denying that there’s anything wrong. Our brains are so busy trying to right their internal systems, that they fail to communicate with the rest of the world — that includes our conscious mind.

Based on what’s happened to me, what I’ve observed, and what I’ve read, here’s the cycle that I believe gets set up:

  1. An individual experiences a sudden, unexpected impact or injury, which injures their brain. This can be a fender-bender, a tackle or collision in a sports game, getting cold-cocked by an attacker, or having something fall on/hit their head.
  2. Fragile connections in their brain are frayed, sheared, or destroyed completely… or all three.  On the surface, they seem to be fine. The injury doesn’t look like that big of a deal. It’s just a bump on the head or a hard hit or a bit of soreness or being dazed after the fact.
  3. The body interprets the impact as a threat to the system, and it unleashes a biochemical cascade of hormones and other neurochemicals which narrow the focus, numb the system to pain, and shunt energy away from “extraneous” body functions.
  4. The injured person’s brain senses something is amiss, and it works like crazy trying to sort out what just happened. The whole body-brain connection needs to be tested to make sure everything is still online, so the system can correct itself as need be. Any outside talk or input is dismissed and rejected — “Are you alright?” isn’t a sign of concern, it’s an intrusion into the vital process of the brain checking through the bodily system for problems. And the brain is so focused on its internal process, that it “forgets” to tell the rest of the world what’s going on. There is no full communication loop with the brain — it’s in damage assessment mode, and it blocks out any input as well as refuses to provide output.
  5. The impacted individual wanders around in a bit of a daze, then they appear to recover, and they get on with the rest of their activities. They drive on in the car, they get up off the bench and go back in the game, they pick themself up off the pavement, or they go back to work.
  6. In the course of going about their business — both immediately and over the course of the coming days and weeks — their brain is having trouble figuring out how to do the things it used to do so effortlessly. The old connections have been disrupted, as though a massive storm had torn through a region, torn up trees, unleashed flash floods, and made many of the old roadways either treacherous or impassable.
  7. The brain senses something is amiss — the inability to do things it used to do before is intensely distressing, and it doesn’t understand why things aren’t working. This confusion represents a “threat to one’s physical integrity” and the body reacts as though its very existence were being threatened. The cascade of stress hormones and fight-flight-freeze substances wash through, and the sympathetic nervous system is activated.
  8. Unfortunately, the incidents of confusion and disorientation and disrupted functioning aren’t intermittent. They can be regularly occurring — as well as unexpected. Time after time, the brain is surprised by its sudden (and unexplained) inability to do what it’s always done. Surprise sharpens the experience, making it both more intense and more indelible in the body and brain.
  9. The brain/mind interprets these inabilities as a problem with the self, and a chain reaction of personal recrimination starts up, which assigns more meaning to the events, which triggers further releases of adrenaline and cortisol into the system when the amygdala is tweaked by this interpretation.
  10. When cortisol and adrenaline are released, higher reasoning is impaired, and lessons which might be learned from trial-and-error are not retained. One misstep after another occurs… one screw-up after another… confusion compounding confusion… anxiety heightening anxiety. What was originally “just a bump on the head” elaborates into a full-scale debilitating condition which becomes more and more entrenched over the ensuing months, even years.
  11. Social pressure doesn’t help at all. Impairments to speech understanding (that happened to me) aren’t interpreted as symptoms of brain injury, rather as laziness or stupidity. Sensitivity to light or sound, which foster distractability and make holding a conversation difficult are not perceived, but the results — wandering attention and apparent oblivion to what others are saying — are obvious (and not at all appreciated).  Social pressure leads to increased stress, which in turn triggers the release of more chemicals that prevent the injured person from effectively learning new patterns and building new pathways in their brain.
  12. The brain is still trying to sort out what’s going on, and it’s not very communicative, either with others or with the “resident” in this body. It gets wrapped up in the drama of flawed interpretations of what’s going on, the crisis of stories it’s invented about what’s going on around it, and the increasing struggle to make sense of anything.
  13. Time passes, and things just seem to get worse. Self-esteem plunges, and resilience declines. Self-recrimination builds, and difficulties at work and at home erode the ecosystem of the impacted individual. Jobs are lost, relationships fail, and money seems to fly away for no apparent reason.
  14. If they’re lucky, the impacted individual can find help from a competent neuropsychologist, counselor, or neurologist — or even friends who are up to the task of helping them get back from the brink. If they’re like all too many traumatic brain injury survivors, they cannot get the help they need, and they end up becoming permanently unemployed (or sporadically employed), with no savings or source of income, no social support network, and no justification for going on disability or collecting insurance payouts.
  15. Muddling through, maybe they make it, maybe they don’t. Ultimately, many end up on the streets, in jail for behavior problems, or on medication for psychological disorders that mimic brain injury after-effects and carry lasting side-effects. And unfortunately, a number eventually commit suicide, hastening the process that an oblivious, uneducated society and tough-it-out culture sets in motion.

As you can see — assuming this progression is at least somewhat accurate (and I believe it is) — the impact of a head injury need not be severe, in order to lead to severe consequences.

To fully understand the pervasive effects of mild traumatic brain injury, you need to look at multiple systems — from the brain’s inner workings, to the autonomic nervous system, to the demands of adult living or childhood development, to the expectations of one’s surrounding social milieu. With mild TBI, it’s never just one issue that sends you down the dark road — it’s a million little, subtle, interrelated issues that combine to create a recipe for disaster that, like bread dough sitting near a hot wood stove, will inevitably begin to rise and expand.

Trauma and the body’s internal responses to perceived threat and our interpretation of those threats, is like yeast added to a sugar-water-flour mix of our injury. With enough heat and time, it’s going to double, triple, even quadruple (and more) the issues that initially come with mild traumatic brain injury. Unfortunately, it appears that our systems are designed to work that way, and unless we can figure out alternative ways to address the issues, we’re in for a rough ride… till we can find help, sort things out, or end up incarcerated or dead.

What strategies and approaches we can hope to employ in this trickiest of situations — which might actually work — is a topic for another post.

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.

Stop saying PTSD (and TBI) is incurable

I came across a great post by Belleruth Naparstek over at Huffington Post about how well-intentioned professionals are running around saying that PTSD is incurable — an intractable condition.

Huh. How about that. Sounds to me like we’re all screwed, because a ton of people have PTSD, and it affects their families and friends and coworkers, and if it’s an intractable, incurable condition, we’re all stuck dealing with it for all time.

Which doesn’t sound right to me.

So, I’m glad Belleruth is talking about non-standard ways of dealing with it. And I have to think, also, about how I employ similar techniques to deal with the stresses of my TBI-related difficulties.

I strongly recommend the article. And the piece I’m taking away is:

[There are] consistent threads running through these approaches:
1. They first and foremost find ways to re-regulate the nervous system.
2. They destigmatize and normalize the experience by explaining PTS as the somatic and neurophysiologic condition it is.
3. They offer simple, self-administer-able tools that empower the end-user and confer a sense of mastery and control.
4. The interventions are cast as training in skill sets, not the healing of pathology.

They treat PTSD as a physical condition, first, and they teach people how to deal with that aspect of their lives.

I have found, in my own dealings with TBI-related stress, that this same kind of orientation helps a whole lot. I have to take seriously the physiological aspects of my condition, which tweak the psychological parts of me. And when I approach the situation with a physical orientation, the results really are like magic.

Except they’re not magic — they’re physiology. Which well-trained psychological professionals miss, because it all happens in realm of  a “frozen, primitive, pre-language experience – sensation, perception, emotion, images and motor reactivity – in the survival-based structures of the brain.”

I wonder… if people treated the stresses of TBI the same way that they treat the stresses of combat and other traumas, with this non-standard, non-talk-therapy approach, how much of a difference would it make? If I’m any indicator, that would be a whole lot of difference.

The warrior’s walk

Over the past year or so, I have been giving a lot of thought to head injury survival through the ages. Getting hit on the head, knocked out, attacked, and generally brain-damaged is about as regular a part of the course of human history as, say, losing your teeth or having a part of your body chopped off.

Think about it — dental care as we know it today is a relatively recent development. Used to be, a blacksmith was the one with the tools to pull a tooth — or you did it yourself with a heavy object slammed against a bad molar, or a string (tied around the offending tooth) and a slammed door. And it’s easy to forget in this convenient age, that once upon a time, people used actual tools to get their work done — lots of them sharp — and lived under conditions that were harsh and unyielding. Chopping off part of a finger — or a whole finger, for that matter — losing part of your foot to frostbite, and/or having a piece of your ear bitten off in a bar fight, happened with a lot more frequency than we 21st century folks recall.

Think about it — once upon a time, wars weren’t fought in faraway lands by trained, dedicated armies that only wanted to vanquish each other. Time was, raiders and looters and rapists and pillagers roamed the seas and the countryside, doing as they pleased to whomever was there. What’s more, in the middle ages, just about the only way am ambitious young man who wasn’t the firstborn in his family could get ahead (other than by taking up a trade or currying favor with some overlord) was to sign on as a mercenary with a local feudal lord and maraud his way to fame and fortune.

In our cozy, warm homes, with only the television and the internet to connect us with a reality outside our own, it’s easy to forget just how rough life has usually been on the human race. And it’s easy to forget that traumatic brain injury is not something that is unique to football players, boxers, and survivors of car accidents and falls. We look at statistics about brain injury — how many of them come from sports and falls and accidents and assaults — and we shake our heads, wondering what we can do to make the world safer — both before and after the accidents.

But think about it for a moment… how safe can we reasonably expect life to be? Granted, nobody wants to have their brain rearranged by unexpected trauma. Nobody actively seeks out a cognitive-behavioral condition that can be not only disturbing but downright disabling. Nobody plans to be at a perpetual disadvantage in life. But it happens.

And it’s been happening for a long time.

So, what do we do?

Certainly, we can try to prevent as many head injuries as possible, with helmets and education and training and good sense. But there’s just no way to live your life freely, if you’re on constant alert about what might happen, and what that might mean for your long-term prospects.

As an old, old relative of mine says, “Life is dangerous!” To try to limit the dangers, also means trying to limit the full range of human experience. To live fully, you need — on some level, anyway — to accept the possibility of harm, damage, danger, injury. To live fully, you need to walk — head up, shoulders back — into the face of some pretty scary stuff, and be prepared to deal with the consequences.

To live fully, to walk fully upright in the world, you have to be a warrior.

maori warrior

Maori Warrior

You have to be ready, willing, and able to look the world in the eye with a resolve that says, “I will not bend before you, I will not break beneath you, I will not yield the ground I have won. I will not falter and I will not fail, until I have reached my final destination.  The only way I am going to fall short is if I fall permanently, period.”

To do this, to think this, to live this as a recovering survivor of brain injury (or many other kinds of injuries, including PTSD), you must be a warrior.

Now, I’m not saying everyone should pick up a sword or a spear or a gun and march out into life swinging and shooting. I’m not saying that you have to be on the defensive or the offensive at all times. Far from it. According to dictionary.com, a warrior is someone who is

1. a person engaged or experienced in war(fare)

2. a person who shows or has shown great vigor, courage, or aggressiveness

Vigor, courage, aggressiveness… yes. Those are key. And they are also predicated upon the experience of war.

To be a warrior, you have to realize and accept that you are engaged in war. Not only war in the classical sense, but:

War 4. active hostility or contention; conflict; contest

For those who struggle daily with TBI (or PTSD) in a world that doesn’t give a damn about our struggles, this is not a huge cognitive stretch. We are constantly faced with active hostility or contention, conflict, and contests — whether those come from within, or without. In my case, I would have to say the source is frequently more internal than it is external, but that doesn’t make it any less challenging. If anything, it makes it moreso.

Sometimes walking through the world without acting out, without attacking, without leaping in to “defend” yourself from a mis-judged situation takes more warriorship, than striking out. Being able to stand your ground… to hold your fire… to be fully present in a moment which threatens you on every level, without flinching or fleeing… that takes true strength, courage, and vigor. And mastering the self, learning to calm and/or disregard the constant chatter that goes on in our rewired brains… well, that takes a good deal of aggressiveness.

Not against the rest of the world (tho’ sometimes that’s required), but against the inner impulses which impel us to flinch and flee and fly off the handle. It takes monumental skill to stand when you want to bolt. It takes determination to listen, when you’re just dying to shout. And it takes all you can give, to walk, when everything in you is telling you to run.

Now, don’t get me wrong.  I’m not recommending that everyone just be 100% okay with the after effects of traumatic brain injury or other tragic traumas. I’m not saying we need to just sit back and take all the crap the world has to throw at us. Far from it. What I’m saying is that we as recovering survivors need to develop the inner resources to be our own people, to stand our own ground, hold true to our values, and not be diverted by externals when they keep us from our ultimate goals.

We need to be warriors in the truest sense. To walk our own paths, wherever they may lead us. To know ourselves for what we truly are, not what the rest of the world says we are. To do what must be done to protect ourselves and our lives and all we hold dear. And whatever route we take, it must be our own, and we must be loyal to the True inner voice that compels us, while learning to discern and dismiss the internal chatter and endless distractions which strive to pull us off our path.

Only we can achieve that. But when we do, we know it is our own. We have earned it, we have won it, we have paid dearly for it. And nothing and no one can take that from us.

March on.

Reaching out… reaching in…

Something in me wants like crazy to reach out, to make contact, to connect with another human being on a level that has absolutely nothing to do with anything we know about each other. Not our strengths, not our weaknesses, not our issues, not even our victories.

Something in me craves the kind of connection you can only get with total, utter strangers… the kinds of people I feel most comfortable around, who know nothing about me and will never learn anything more about me, than what the moments we share have to offer.

There’s something clean in that, something pure. Something unadulterated and untarnished. There’s something divine. Utterly, inexpressibly divine.

A weird beetle is flying around my room. It’s been warm, the past few days, and the bugs are coming out again. Grass is growing again, despite the late date. This bug has been in my study for the past day or so, buzzing around, climbing on my curtains, inching closer to one of the three lamps I have on to light my workspace… to light my way.

In some ways, I feel closer to that beetle than I do to many people. It’s an ugly thing, really. Not very attractive, and sort of prehistoric looking. There are lots of them around my place during the spring and late fall. They gross out my spouse, who can’t stand dealing with them, but there are so many of them around, you can’t avoid them. But every encounter I have with them is pure and clean and straightforward: You are in my home. You will not find anything interesting to eat in this place. You should not be in my study or my bathroom or my hallway. You need to go outside, and I am going to take you there. Now.

End of contract. End of story. And no one has been hurt in the process.

How unlike my human exchanges.

I had a very probing session with my psychotherapist today. I suspect they think that I am making up my issues to “game” the system and get money out of someone. I suspect they think that I’m misleading my employer and overstating my abilities, because I need the paycheck. I suspect they can’t quite believe that someone with my history of head injuries can possibly be as functional as I am. I haven’t even told them about the other two from my early childhood that I remembered recently.

My session brought up issues that I have frankly not dealt with, about how I relate to my immediate family. The holidays are upon us, so what better subject for a shrink session? And now I am feeling sick, because the impact of some Very Bad Things that have happened since my fall in 2004 never really sank in.

Until now.

This, I suppose, is the price of increased awareness — increased awareness and sensitivity to all the crap that tends to fly about. Disturbance and distress and falling ill with nervous exhaustion. There we have it.

Part of me wants to crawl back in my cave and not sweat the big stuff that goes on. Part of me wants to go back to pretending that everything is just fine, and that my options in life are unlimited. Part of me wants to go back to not being therapized on a weekly basis. Part of me wants to just get on with my life. But then, there are Very Bad Things that need to be dealt with.

So, I guess I’ll just deal with them. Like all the other crap that comes across my path.

I’ll just deal with it. All of it. And make sure I get enough sleep and take my B vitamins.

Don’t forget the B vitamins.

My solution for TBI/PTSD rage

Anger (or out-and-out rage) is one of the places where my TBIs and PTSD intersect to cause real problems. I’ve been having some rage issues, lately. Getting worked up over little things — getting angry over nothing, really. Just getting angry. Temper, temper…

In the moment, my anger — my rage — seems completely justified. I feel with every cell in my being that I am entitled to be outraged. I am entitled to be angry. I validate my emotional experience, and I end up spiraling down into a deepening pit of anger, resentment, and acting out. Yelling. Making a fuss. Putting up a stink. And getting aggressive with whomever happens to be offending me at the moment.

This is not good. I’ve done it with police officers, and I’m lucky I didn’t get cited. Or arrested. I’ve done it with family members, and it’s cost me plenty, in terms of peace of mind and my relationships. I’ve done it with co-workers, and it strained our connections to the point of breaking.

Not good.

But lately, I’ve been able to pull myself out of my downward spiral before it gets too much of a hold on me. I’ve started doing some basic things that stop the progression of rage before it picks up so much speed it’s like a runaway freight train.

First, I recognize that I’m angry, and I am convinced that I’m right about being angry. This might not seem like a big thing, but I have trouble figuring out how I’m feeling sometimes, and anger is one of those emotions that I don’t always identify well. It just feels like a rush of energy — and while everyone around me knows I’m pissed off, I usually can’t tell what’s going on with me until it’s progressed to a really problematic point. I recognize that I’m angry, and I remember that I need to not let myself get carried away.

Second, I step away. I take a time-out and just walk away. I stop myself from saying what I’m about to say, no matter how badly I want to say it. I tell myself, I’ll give it some thought and figure out how to say it exactly the way I want to say it. I tell myself… anything … just to extract myself from the situation. I step away, telling myself I’ll come back when I’m better able to express myself.

Third, I take some deep breaths.  This helps stimulate my parasympathetic nervous system, which is the part of the nervous system that chills you out. The sympathetic nervous system is what gets you worked up to respond to a crisis situation — and when I get really angry, it’s often because I think and feel like I’m in a crisis situation, and my body is getting all geared up for fight or flight (more often fight). I consciously take some deep breaths to get my parasympathetic nervous system to chill out.

Fourth, I seek out some kind of tactile stimulation. I need to get out of my head, which is spinning out of control, and just give myself a different point of focus. My head is going so madly, at this point, that I cannot even think straight, so I seek out some kind of physical sensation to get my mind off the madness. I press the side of my face against the cold side of a door that leads to the outside. I pick up something rough and rub my fingers along it. I jingle change in my pocket. Or I find something heavy and hold it. The physical sensation, along with the deep breathing, gets my mind off the crazy cycle it was in, just a minute ago, and it lets me focus on a single point — the feel of the cold door against my cheek or the feel of quarters and nickels and dimes juggling among my fingers. Tactile stimulation, like looking at a flame of a candle while meditating, helps me center and get my mind off that crazy downward cycle.

Fifth, I remind myself that my body and brain are playing tricks on me. I am probably not getting angry for the reasons I think I am — it’s my body that’s getting all worked up into a fight/flight/freeze state, and my mind is interpreting that as a real sign of DANGER. And I’m probably starting to panic a little, too. As a matter of fact, when I take an objective look at things, the rage that’s building inside of me might not even be real rage, rather a response to a hyperactive sympathetic nervous system response. It could very well be my body tricking my mind into thinking the wrong things. And I need to remember that I get to choose how I interpret my life. My mind gets to decide how I’m going to think about things, how I’m going to react. And my well-intentioned body, which thinks it needs help, is just misleading my brain into thinking that I have to do something about whatever it is that’s getting to me. When I remind myself that this is a physiological process that’s taking place, I am able to relax… and the anger subsides.

The thing I have to remember, when all this is coming down, is that It Is Not Worth It. No matter how justified my rage seems to be. No matter how entitled I am to be angry. No matter how wronged I may have  been. It is not worth it, to get so tweaked over things. When I go off on an anger “binge” I end up feeling really hungover and dumb and numb afterwards, which just makes my life more difficult, once it’s passed.

I’m no doctor, but I suspect that it may be connected with the mechanics of panic/anxiety… all that post-traumatic stress stewing in a pot, and my TBI brain being unable to sort it all out in a timely fashion… My processing speed is slower than I’d like, and by the time I figure out what’s going on, the damage is often done.

So, I do my best to recognize when I’m getting angry, I step away, I take some deep breaths and try to relax, and I do something that gets my body’s attention — like feeling something cold or rough or tactile in some way. And I remind myself that my brain and body are playing tricks on me again. They’ve done it before… and they’ll do it again.