So, I had a good session with my neuropsych yesterday. We ended up running pretty late, because there’s a lot to cover. As much as I have rebuilt my basic functionality, I still have work to do on my decision-making.
I may be at a point far beyond what I ever believed possible, in terms of human relationships and daily functioning, but I’m still really lagging, in terms of thinking things through. Prefrontal cortex and all that.
As it turns out, I’ve been making some really dangerous choices. I know I make iffy choices on a regular basis, but a lot of them I haven’t thought through well enough to realize just how dangerous they are. Driving down the road in undriveable conditions… having conversations with self-identified criminals, in relatively secluded areas… jumping on the back of a motorcycle with someone whose skill level I don’t know, and who pulls some extremely dangerous stunts along the way to where we’re going.
Thanks, mild TBI, for making my life so exciting.
Actually, it has made my life very exciting. And there are a lot of things that I’ve experienced, that most people wouldn’t, because their decision-making abilities are much better than mine.
So, yeah. I have some work to do. And when I got home last night, instead of exercising or reading or even watching television, I did a little bit of work to get oriented to a really challenging job I have on my plate. I didn’t overdo it, either. I worked for 45 minutes, while I ate my supper, and then I closed up shop and went to bed.
Smart. For once.
In the past, I would work till midnight, pushing through to make good headway — all the while producing work that was not nearly as excellent as it seemed at the time. I would waste a lot of time. I would also tire myself out more than is healthy, and I would suffer for days after that.
And so would my work.
It’s a multi-part conundrum. First, I’m not thinking things through as well as I might. Second, I get caught up in the work and feel so energized and alive, that I don’t want to stop. Third, I “get in a groove” and stop being responsible about how I use my time and energy. Another component of this, is wanting to wake myself up and feel more alive, feel more like myself, so I stress myself like crazy to get to a state that feels “normal” for me.
The only problem is, my “normal” is everyone else’s extreme.
And that doesn’t help.
So, today, instead of pushing myself to ACCOMPLISH THE IMPOSSIBLE this morning, I’m easing into the day. I worked out pretty thoroughly yesterday, with a longer bike ride than I originally planned, and some good all-around exercise, going pretty close to failure a couple of times. My body needs a break, to rebuild and recuperate, and I need a break to ease into my day. The nice thing is, I got a good night’s sleep last night — close to 8 hours — so although I am feeling foggy and a little dull this morning (and I can’t seem to spell to save my life – thank you spell-check, for helping me), I don’t have that crazy sense of being all jammed up that I often get to.
I really need to take a break. And I’m getting better at it. I’m actually able to consciously relax — which I am doing right now with my breathing and my state of mind and body — and it feels pretty awesome. This is a new skill for me — relaxation. And with practice I get better. So I’d better practice.
Taking a break is not, as I used to think, an interruption. It’s actually a chance for my whole system to catch up with myself. I’ve been juggling intermittently – not daily like I used to – and my skill level is actually improving each time. I don’t have to push myself past my limits every single day, in order to make good progress. If anything, pushing myself, then backing off for a little bit, then coming back to push myself, is working out much better.
Thinking about aggression and TBI, I got to wondering about whether the impact of aggression might make a difference, depending whether a survivor is man or a woman, a boy or a girl. I did some googling, but I ran out of steam trying to sort through all the different pieces of information.
Apparently, research points to women having worse long-term outcomes than men. Interesting. And unfortunate. There are a number of different possible explanations, which I found at http://www.dawncanada.net/ppt/Women%20and%20Brain%20Injury.ppt (Good presentation! Very informative. I’ll have to examine it more closely when I have more time…) Some of them are that perhaps the medication prescribed interacts differently with women’s chemistry than men’s. Or women report more issues, and therefore appear “sicker” than men. Or perhaps it’s because of psychosocial factors. That is to say, women tend to be more verbally “fluent” than men, so they present as being much better off than they are cognitively. They seem fine, but they may be struggling in ways that only an objective test can pick up — but nobody thinks to administer a test, because “she seems fine”.
Anyway, in thinking about TBI-related aggression, I got to thinking about different scenarios where a man exhibiting aggression would fare better than a woman exhibiting the same behavior. Aggression in men is often tolerated much better than aggression in women. With men, aggression is often expected, where with women, there’s a completely different standard that they’re expected to follow.
Say you’re standing in line at the post office during the holidays. Everyone has been standing in line for 45 minutes, holding heavy packages and wishing they were somewhere else… when in comes a guy who’s frazzled and obviously in a big hurry. He goes to the back of the line for a little bit, but after a few minutes he starts to fidget and curse under his breath. He then proceeds to jump the line and push his way into second place. The guy standing behind him gets bent out of shape and pushes him out of line, the two of them trade words, then start pounding on each other. The police are called, and the two men are hauled out of the post office and given a talking to by a couple of officers. They won’t let it go, though, and they still keep trying to punch each other in the face, so they’re separated in two separate police cruisers and driven off to jail.
Now imagine the scenario with an aggressive woman:
Say you’re standing in line at the post office during the holidays. Everyone has been standing in line for 45 minutes, holding heavy packages and wishing they were somewhere else… when in comes a woman who’s frazzled and obviously in a big hurry. She goes to the back of the line for a little bit, but after a few minutes she starts to fidget and curse under her breath. She then proceeds to jump the line and push her way into second place. The guy standing behind her gets bent out of shape and pushes her out of line, the two of them trade words, then start pounding on each other. The police are called, and the two of them are hauled out of the post office and given a talking to by a couple of officers. They won’t let it go, though, and they still keep trying to punch each other in the face, so they’re separated in two separate police cruisers and driven off to jail.
Doesn’t sound quite right, does it? How about a woman who’s just defending her own turf:
Say you’re standing in line at the post office during the holidays. Everyone has been standing in line for 45 minutes, holding heavy packages and wishing they were somewhere else… when in comes a guy who’s frazzled and obviously in a big hurry. He goes to the back of the line for a little bit, but after a few minutes he starts to fidget and curse under his breath. He then proceeds to jump the line and push his way into second place. The woman standing behind him gets bent out of shape and pushes him out of line, the two of them trade words, then start pounding on each other. The police are called, and the two of them are hauled out of the post office and given a talking to by a couple of officers. The man and woman won’t let it go, though, and they still keep trying to punch each other in the face, so they’re separated in two separate police cruisers and driven off to jail.
And then there’s the situation with two women:
Say you’re standing in line at the post office during the holidays. Everyone has been standing in line for 45 minutes, holding heavy packages and wishing they were somewhere else… when in comes a woman who’s frazzled and obviously in a big hurry. She goes to the back of the line for a little bit, but after a few minutes she starts to fidget and curse under her breath. She then proceeds to jump the line and push her way into second place. The woman standing behind her gets bent out of shape and pushes her out of line, the two of them trade words, then start pounding on each other. The police are called, and the two of them are hauled out of the post office and given a talking to by a couple of officers. They won’t let it go, though, and they still keep trying to punch each other in the face, so they’re separated in two separate police cruisers and driven off to jail.
It has a totally different feel from the scenario with two men. The situation with two men sounds like “boys being boys”, you might say. But two women behaving really badly and then coming to blows? Maybe in a toy store in LA, but in “polite society” this would stand out as an exception.
The point I’m trying to make here, is that there are different standards for acceptable behavior with men and women. And the fallout afterwards also tends to be different. With men, things can get “heated”, but with women, they get “out of hand” and the consequences are as different as the consequences for adultery in secular America versus church-centric America. In one case, it may elicit little more than a shrug, while in other cases it may result in being shunned and isolated.
Our society has a very different set of expectations for different genders, so when a woman with a TBI starts to act out, it really stands out. And it can be isolating. Unexpected, unacceptable behavior, along with social censure, can add to the cognitive load of a TBI survivor, which cuts into the available resources for just living their life, and also cuts them off from valuable social connections that can support recovery. Ultimately, if you have enough censure and isolation, without the proper feedback mechanisms for determining and modifying appropriate behavior, I would imagine things could degenerate over time and ultimately fan the flames of TBI complications, long after the initial injury has faded from memory.
If this is true in the case of women, then what about girls? I’m specifically thinking about girls who are concussed and don’t get proper care and have their concussions eventually become lasting traumatic brain injuries. What about girls who get hurt, don’t get the help they need, and end up exhibiting behaviors that alienate their friends, their families, their support groups that are necessary for healthy growth and maturation? What about them?
What makes things even more complicated, is that some of these symptoms — the aggression, the mood issues, and more — may take months to show up, so during a time when so much is in flux and changing around them, they’re all of a sudden hit with this weird new character trait of a short fuse and an explosive temper. And seemingly out of nowhere. What do they do then? If a girl is expected, pressured, trained to be a little lady, and then all of a sudden she becomes more like a wild animal, what then? If her popularity and self-image is dependent upon her behaving in a certain way, and then TBI suddenly makes it impossible for her to behave that way, what’s the impact to her development overall as a girl, then a woman?
Now I’m not saying that girls have it harder than boys, but there are differences in gender expectations, differences in behavior expectations, and if there’s one way TBI can really throw a wrench in things, it’s in the behavior area. So, if most of the studies of the impact of TBI are concerned with boys/men, what does that mean for our overall understanding of the impact — not only to the individuals, but to society as a whole?
My grandfather used to say, “Women have to be better than men. They are the ones who create our culture.” He was fine with that idea, while my mother always pursed her lips a little bit when he said that. He was an old school kind of gentleman, but there was a nugget of truth to it — although the truth was more about expectations, than actual fact.
Ultimately, I think that gender and TBI should probably be studied more closely. There’s so much to it — it’s quite mind-boggling overall. But we really need to factor it in. And when we talk about managing long-term issues, I think it can be helpful to consider to social and cultural contexts. As different as each brain injury is, as individual as each recovery is, we can’t overlook factors like gender, as well as class and ethnicity and age. It’s all a huge ball of string that begs to be unraveled, but that’s a bit beyond me right now. I’m on vacation(!) and it’s a beautiful day outside.
Researcher Jordan Grafman, director of traumatic brain injury research at Kessler Foundation in New Jersey and his colleagues studied the aggression levels of 155 Vietnam War veterans who had suffered a penetrating traumatic brain injury, and divided them into aggressive and nonaggressive groups.
In the aggressive group, 79 percent were injured in their prefrontal cortex, whereas 21 percent were injured elsewhere in the brain, the study said.
But in the nonaggressive group, 47 percent were injured in the prefrontal cortex of the brain and 53 percent were injured elsewhere in the brain, according to the study.
“The locus of brain damage is important … as it will clue you in to the long-term risks to the social behavior of the patient,” Grafman said.
This is an important consideration – where you get injured can affect how you express yourself after you’re injured.
But even knowing that can’t always guarantee that you’ll be able to predict what people will do and how they will behave. The brain, as we all know, is a tremendously complex organ and people express their personalities differently, so a similar injury may result in completely different behaviors, depending on the person.
Which just makes TBI even more annoyingly complex for people looking for a silver-bullet cure. If you can’t predict accurately how people will behave, how can you control that behavior? How can you manage it effectively with pills and such?
At the same time, for those of us not looking for a pill cure, it is encouraging to think that even if you do experience a TBI that messes up your prefrontal cortex, that’s not the end of the line for you, and you always have the possibility that you’ll be able to manage yourself better than expected or predicted. This kind of stuff happens all the time with medicine — the doctors say one thing (you’re going to die in three months) and then it doesn’t happen. It happens all the time in life — I don’t think the predestination people are right — or maybe they’re 100% on, and all our human prophecies amount to nothing in the face of what fate has in store for us.
In any case, this is interesting information that bears consideration – if only for the sake of giving us something to watch out for and better understand. Aggression is definitely a problem post TBI, and the more we know about it and understand it, the better.
I’m making good progress reading Mindsight by Daniel Siegel. I’ve been reading in the mornings while I ride the exercise bike, as well as sometimes in the evening. It feels good to be reading again — I’ve realized that the main thing that makes it so hard to read, is being constantly distracted by stray thoughts.
With all due respect to my association-driven brain and the tons of (sometimes useless) knowledge I’ve crammed into all those nooks and crannies — and there are a lot of them, if you ever examine a brain closely — the main challenge with my reading is having mind seize on an idea and think, “Hey – that reminds me of _______!” and runs off in a different direction, making connections with other ideas and information I have. And I get left in the dust, the book unread and what parts I’ve read not being fully grasped.
But the Mindsight reading is going well. And I’ve gotten some really great ideas from it. The main gist of the book, that I can tell, is that intently focusing the attention on something for extended periods of time helps to build connective fibers in the prefrontal cortex — the place where planning complex cognitive behaviors, personality expression, decision making and moderating correct social behavior, originate and are managed. Mindful awareness can strengthen the physical structures that make these things possible, and add more skill to one’s practice of them. The activities of the prefrontal cortex are where I have huge issues:
It is responsible for the executive functions, which include mediating conflicting thoughts (uh-oh), making choices between right and wrong or good and bad (it’s not that I WANT to choose wrong, I just tend to have trouble distinguishing my choices), predicting future events (what will happen if I press this button?), and governing social control — such as suppressing emotional or sexual urges (sexual urges I can manage — it’s the emotional ones that get me). The prefrontal cortex is the brain center most strongly implicated in qualities like sentience, human general intelligence, and personality. (That could be why some people think I’m an idiot and treat me like one, or treat me like I’m not anyone at all. Or maybe they’re just assholes? That’s entirely possible.)
Anyway, I can really use some help with my prefrontal cortex, and I’m hoping Mindsight will do me some good.
In the book, Siegel talks about how practicing Mindsight helped that kid with the problems with outbursts — dysregulation, I believe folks call it. It helped him get a grip, handle himself better, and have an overall better view of himself in the process.
Another important piece of this kid’s treatment was exercise. He combined exercise with mindfulness work, and he used going for a run as a way to take the edge off his temper and issues. Sounds like a plan.
Hearing about this kid’s problems made me think there was more to his situation than just being a teenager. I latched onto the idea that this kid may have sustained some sort of head trauma when he was around 13. I know it’s all conjecture, but if there was some brain injury involved, then the fact that he could overcome his crying jags and his raging outbursts with this mindful awareness practice and exercise (and nutrition – let’s not forget that), then it really give me hope for myself. What’s more, it is also consistent with my own experience in the past few weeks.
I’ve been practicing Mindsight, myself, in hopes of strengthening the parts of myself that seem to be particularly challenged. In addition to doing my morning workouts, I have started doing breathing mindfulness practices each day. While I’m still in bed, I breathe deeply 45 times (the number of years I’ve been alive), really concentrating on the breath. It’s interesting how I tend to wander and “get lost” in the course of this practice. I also tend to get tense and hyperventilate, if I’m not careful. But I’m working on it, and it’s getting easier over time. And after doing this for the past 2 weeks, I’m starting to get the hang of it.
Perhaps most significant, it’s helping me get out of bed in the morning, since I do it before I get up. I had been having a terrible time just getting out of bed — I’d lie there for30… 45… 60 minutes (sometimes longer), before I actually got up. Doing this breathing work helps me wake up more quickly, and for some reason, I actually want to get up. Magic.
Anyway, over the course of the past week or so, I have been noticing how I don’t get as upset over “triggers” like I used to. It’s really wild. Things that used to just set me off into a freakish rage, sometimes now just happen. I notice them, but I don’t react to them immediately. They just occur. I don’t jump into judging them, or making them into bad things, or deciding that they demonstrate beyond a shadow of a doubt that I’m a total friggin’ loser. They just happen. And I have an extra few minutes to decide what I’m going to do in response.
Case in point:
This morning I woke up at 4:00 a.m. I had gotten to bed at 11:30 p.m. last night. Now, 4-1/2 hours is not my idea of a good night’s sleep, especially when I’m at a real deficit lately, and I was pretty upset about being awake. I lay in bed for half an hour, trying to get myself, to relax, getting more and more agitated and upset. And I started to worry about money. I start a new job on Monday that’s going to pay me less each paycheck (though the benefits and total value of the position is far greater than the job I just left), so I’m concerned about my money situation.
My head got hold of that, and it started to churn. I started to make up all these mental spreadsheets and calculations of how much money I was going to have each month, and how to stretch what I had. I tried to put a better light on things, telling myself this was something I needed to figure out, but I was getting really agitated and tweaked over it.
Then, all of a sudden, I realized what was happening — I was awake before I wanted to be, I was anxious about having left my last job, and I was not on the same schedule today that I normally am on Fridays. I was off-kilter, and that was making me anxious, and my energy was trying to find an outlet.
The moment I realized that, my agitation started to subside, and I felt myself looking at my behavior like I was at a distance from it. I could see that it was just my body getting wired and getting my brain in on the action. And I could see that I had choices about what I did with the energy.
I decided to make a different choice — to direct that wave of energy towards doing some deep breathing and progressive relaxation. I also realized that the windows were open in my bedroom, and the birds singing outside were really loud. So, I closed the windows, put in my earplugs, lay back down, and did my progressive relaxation, starting at my toes and working my way up to the top of my head. I hadn’t even gotten past mid-thigh when I was back to sleep.
And I slept through — up to 5 minutes before I was supposed to run out to my chiro appointment. I didn’t get a chance to work out and stretch and get myself woken up before I left for the chiro, but I was also able to navigate that, instead of getting all tweaked about it and flipping out with myself. I just got up, washed off, threw on some clothes, and went to my appointment. Then I came home did my workout, read my book, had my breakfast, and got on with the morning.
Simple enough, right? It sounds like it, but up until a few months ago, it was a real challenge for me. Up until a few weeks ago, even. This mindful awareness practice, this “mindsight” stuff actually seems to be working for me — and this after only a few weeks of doing it every day. I do make a point of doing it every day, just like my workouts/warmups. It’s become part of my daily routine, and it helps me get on with my life, not postpone it. That’s a good thing. It’s a really good thing.
So, even if that kid in the Mindsight book was just dealing with being a teenager (rather than having sustained a mild TBI), for me the practice is working. I feel a lot more chilled out, a lot more present, and a lot less driven by events that happen to me. I know it probably sounds implausible, for it to have an effect so soon, but I hear others have had the same experience.
The great thing is, I don’t have to go to an ashram or a retreat center or sign up for some special class to do this. I can read a book, watch/study videos of Dan Siegel talking about this on YouTube, and practice it myself. I know about the vagus nerve and how it helps with relaxation. I know about the parasympathetic nervous system and how it helps tone my overall nervous system, so I’m not so tweaked and fried and hair-trigger-happy over every little thing. I know some background neurology and psychology stuff, so that helps me get my head around this.
But the proof is really in the pudding. I can “know” all I like about this mindful awareness practice, but does it really work?
So far, for me, it does. I recommend others try it, too.