The biochemistry of beginning

Source: nasa1fan/MSFC

I’ve been giving a lot of thought, lately, to my suboptimal tendency to procrastinate. I think “procrastinate” is actually a euphemism — I don’t just put things off. I simply don’t do them.  I know there are things I need to get done. I know I need to do them. I know I need to do them sooner, rather than later.

I just don’t.

Until much later. When it’s almost too late. Then, on the verge of calamity, I throw myself into a full-on drive to make it happen. And I do. It’s very exciting, and when I’m done, it’s very gratifying. But it’s exhausting. And it’s no way to live.

Case in point:

I have a number of things I need to do on a weekly/monthly basis:

• Bag up the trash and take it to the transfer station.
• Mow the lawn.
• Order meds for my pet when they are running low, so they don’t get violently ill.
• Pay certain bills, so the utilities stay on and I can still talk on my cell phone.
• Etc.

My life is no different from others’ in these respects. Some things just need to be done, and nobody else is going to do it for me. I know I need to do these things. I understand the importance of doing them. Yet, week after week and month after month, I consistently don’t do them. It makes no logical sense. It’s counter-productive and problematic, and I each week/month I promise myself I’m going to do things differently the next time.

But I don’t. Once again I let things slide. The phone gets turned off. The pet needs to go on half-doses till the next order comes in. The trash sits in the garage, piled up in the garbage cans waiting for me to haul it away. And the lawn gets wild and high all over again.

Etc.

Then, when all seems just about lost, I kick into high gear, I set about doing the things I’m supposed to, and I do them extremely well, extremely efficiently, and with an ease that belies my days/weeks of procrastination and makes me look like a jerk/loser/slacker for not having just done it all up front, when things were still relatively normal.

I’ve spent a ton of time feeling bad about this tendency to allow myself to drift into the danger zone, trying to “whip myself into shape” and failing all over again. Not understanding why, not fathoming why I slack so terribly, when I know full well that I need to do this stuff, and I am perfectly capable of doing it. Does this, in fact, make me a total loser? Some might say yes, and I often agree.

But I’ve been giving this a lot of thought, lately, stepping back from the self-recrimination and agitation and anger (from myself and my spouse). And I think I’ve figured out why it is that A) I don’t do things right away, and B) why I can do all those things so very well, when I finally kick into gear.

Essentially, for me, it seems to boil down to an issue of Tonic Arousal —

Tonic arousal refers to relatively slow changes of base-level arousal. For example, the daily cycle of sleep and wakefulness represent changes of tonic arousal. Stimulants (such as caffeine) or depressants (such as alcohol) also produce notable changes in tonic arousal — changes that may last several hours. The most important factor affecting tonic arousal is the diurnal cycle of wakefulness and sleep.

Tonic arousal is your general level of wakefulness. It affects attention, learning, and level of irritability. And it’s affected by sleep disruptions. Also, it’s very commonly affected by TBI. It’s related to brain stem formation and its connection to the frontal lobes, and given that the brain stem is so frequently damaged in TBI, tonic arousal issues often go hand-in-hand with head injury.

Now, there’s another aspect of arousal, called Phasic Arousal, which is defined as: “those transient states of arousal that are stimulated by significant environmental or internal events.” It’s that charge that you get out of something novel or something pressing, an alert or an alarm of some kind. If our lives are exciting (or even normal) we all go in and out of phasic arousal at least several times a day.

I (and many other people) tend to use phasic arousal to offset the dull effect of chronically low tonic arousal. We seek out excitement to perk ourselves up. We watch shows and videos that “bring us to life” with phasic arousal and get us out of our doldrums. We drink coffee and other concentrated caffeine drinks, we eat lots of “cheap” carbs and sweets, that get us going.

In addition to this, alarm coming from problems that emerge in my life can also have the same effect as a strong cup of coffee or an apple turnover. The sudden rush of stress hormones (as one of my friends once said) “is fun!” It feels good to be immediately alert and engaged. It feels good to be sharp. It also feels wonderful to have all that extraneous crap blocked out, and to be totally focused on only the main THREAT at hand. Being suddenly on alert over something I completely forgot to do, 10 minutes before the deadlines, brings me back “online” in a way that no caffeine or carbohydrate can.

That gets me started. It gets me to begin what I need to begin. It gets me to begin what I needed to have begun two weeks ago, but “never got around to it.” It overrides my procrastination, my anxiety, my fears, my phobias, and sets me in motion. When it works well, it puts me on the fast-track to success. Of course, it can also send me hurtling head-first into a great cosmic face-plant in the snowy slopes of life. But at least it gets me jump-started.

After giving this a lot of thought, and examining my behavior over the course of my lifetime (especially over the past years), I’ve come to the conclusion that I use the alarm states created by procrastination to perk myself up and get going on things that need to be done. Essentially, I use procrastination and the stress hormone biochemical cascade from the relative dangers of me not doing important tasks in a timely manner, to wake myself up and raise my overall arousal level.

It’s not very healthy, overall, but it works. And it works to my detriment, as often as not.

Below is a picture of what I tend to do. The red line represents the level I’d like to be at, to really feel like “myself” and be at my peak best (which I really need to feel like a real human being).  The brown line at the bottom represents my tonic arousal, or my general level of wakefulness and arousal. The blue line in the middle represents my phasic arousal — the intermittent, transient level of wakefulness and arousal that I experience in response to specific events/stimuli.

Here’s how this works:

I start out with a task (shown in the boring gray stars). My overall tonic arousal (shown at the bottom in brown)  is low, blah, and I’m just not feeling like doing much of anything. I’m not feeling very good about myself… not feeling like I’m “me”.

But stuff needs to get done. And all of a sudden, there’s an alarm(!) (shown in the yellow bursts) when I realize that if I don’t get going, I’m screwed. Body goes on alert. Stress hormones start to pump. And I kick into gear. My phasic arousal jumps way up, to about where I’d like to be all the time. All of a sudden, extraneous distractions like hunger and thirst and irritations from the neighbor’s barking dog are blocked out, and I’m fully focused on the task at hand. I’m ON, and I feel like myself, I feel capable, I feel competent. I feel human.

And I get the job done. Sometimes in record time.

However, after the alarm has passed, my phasic arousal starts to drop again, and I end up down where my basic tonic arousal is. Bummer. Eventually, another task shows up, which I don’t respond to very well, because my tonic and phasic arousal levels are way down.  I might also be pretty tired from the burst of energy — or, worse, my sleeping schedule might be totally hosed by my burst, and my overall arousal is lower than it could be.

Ack! It’s terrible. I feel awful. I feel blah. I don’t feel like myself. I feel boring and drab and useless. Until another crisis comes along. Then I feel great – energized, and useful and needed.

But the crisis takes it out of me, and I end up down again, before very long. Plus, the people around me who depend on me to be steady and consistent and reliable are starting to get a little peeved with me. If this happens enough, even if I eventually get my work/tasks/jobs done, the drama and delays and uncertainty that others feel at my erratic behavior takes a toll on my working (and living) relationships.

And so it goes… The rollercoaster of drama-fed effectiveness. It’s not the most efficient way of doing things, though it’s effective according to some criteria. People get tired of me not being as steady as I once was. And I find myself having to make up for past infractions on a regular basis – which is in itself a source of stress and focusing biochemical “pump”. Again, it helps focus me, but not forever. It wears me — and others — out. Worse-case, I set myself up for an anxiety attack or a full-blown panic attack. My autonomic nervous system can only take so much.

Like I said, it’s not rare for people to do this. Tons of people do it, according to my neuropsych. In fact, if you look around, you can probably find thousands of examples on large scales and small, of how people use this strategy — TBI or no. (I believe that PTSD sufferers and trauma survivors may be prone to this “strategy” since prolonged effects of trauma tend to dampen down the nervous system.)

But it’s no way to live. I need to do better. I want to do better.

Now that I’ve figured this out, I need to figure out a way to work around this. It’s no good for me to be on this perpetual roller coaster of drama/doldrums. It’s way too exhausting, and I don’t want to do it anymore. I need to develop tools to spot the danger zone ahead of time, before it starts to take too much out of me. I need to train myself to develop habits that keep me healthy and off that roller-coaster.

My primary purpose, these days, is twofold:

1. Identify times and places where I am dull and low and not getting started on things, and I’m in danger of falling back on the “cheap” high of crisis to get me through life, and
2. Find ways to avoid/address those scenarios in a proactive, productive way.

I need to watch out for the following things:

• Being over-tired. That screws with your tonic arousal, especially. And when I am over-tired, I am even more prone to push myself and over-do my activity levels, just to feel human.
• Dodging tasks without thinking about them, because I’m not taking the time to consider what I’m doing and why. Avoiding tasks for no apparent reason is a great way to get myself into trouble and get totally backed up — and stressed.
• Diving head-first into things without stopping to think about them first. This is a great way to mess things up, and introduce even more phasic-arousal-producing “energy” that sends me up to a high, yes, but ultimately throws me even more out of whack.

And once I’ve identified these problem areas, I can do the following:

• Get some sleep. Get to bed earlier than usual. And keep myself from staying up so late. If I’m overtired in the middle of the day on the weekends, I can stop doing what I’m doing and take a break. Or I can step away from what I’m doing, do some conscious relaxing for 15 minutes or so.
• Stop and think about what I’m not doing — and why. I find that when I take a long look at what I’m avoiding, I can get past the unconscious avoidance tendency. A lot of times, I run away from doing things just because I don’t feel like I have the energy to do them.
• Get some energy. For real. Going for a brisk walk, doing some jumping jacks, or even some stretching, often does wonders for me. A small cup of coffee can help, too, but I have to be careful I don’t drink it too late in the day (never after 3 p.m.), or it will screw up my sleep schedule.
• Steer clear of cheap and easy energy. Stay away from the vending machine at work. Stay away from the snacks and treats and cheap carbs that spike my energy, but then let me down terribly afterwards.
• Stop and think about what I’m about to do. Pause for a moment to make sure it makes sense. And be open to the idea of not doing it at all. Not everything I feel compelled to do — like go to the library and check out more books before I’ve finished reading the ones I already have — makes sense. I have to really check myself at times, and when I do, I rarely regret it.

It’s all a process of course. It’s a never-ending exploration of what works and what doesn’t. I keep learning, all the time, about my limits and capabilities, which can be as discouraging as it is encouraging. The important thing is that I don’t quit, that I don’t give up on myself, and that I keep refining my approach.

It’s also important that I understand there is a physiological/neurological basis for these kinds of behaviors, and what I’m doing is actually an ingenious short-term solution for potentially debilitating levels of low tonic arousal. It’s not a character defect or a sign that there is something desperately wrong with me. Ultimately, it’s me trying to take care of myself and feel like a real person again. But I have to understand the limitations of the overall approach, and use it judiciously so I don’t overtax my system and do more harm than good.

Obviously, nobody’s perfect. But if I keep paying attention to myself, I can teach myself to be more effective at being the person I am meant to be.

Crossing the river(s) when the bridge is washed out

I’ve been thinking a lot about how my brain developed over the course of my life, wondering if/how my early mtbi’s affected me.

I have to say, it’s a bit confounding. It’s hard to see where the differences between me and everybody else are just regular personality differences, and which ones could be related to my falls and accidents and the assault when I was eight. I’ve actually remembered more incidents, over the past few months, most notably an incident when I was in daycare as (I believe) a 4-year-old.

I don’t remember much — just climbing up some stairs when some of the older kids encouraged me to come play… then running and jumping a lot… and then lying on the ground, looking up at an older kid looking down at me… and one of the other kids running downstairs to tell the lady who watched us all that something was wrong… the lady coming at me, looming over me, checking me over… yelling at the big kids… lots and lots of yelling. I’m not sure if my parents ever found out that something happened, but I remember trying to get upstairs a few more times, but the lady who ran the place wouldn’t let me, which really made me mad! It was fun playing with the big kids. I didn’t want to be stuck downstairs with the “little peepies”. I wanted to run around and play with the big kids.

I think that I may have been kept downstairs because I was small for my age. A couple of my younger siblings were actually bigger than me, till I was about 12 years old and I started to grow. I was a little kid, so I think the lady who kept me probably told me to stay downstairs so I would be safe.

Clearly, that didn’t work. If memory serves — and there’s the distinct possibility that it doesn’t. At least, in this case. I was reading a book, lately, about how the brain doesn’t always store the information it’s exposed to. It’s not like a tape recorder or digicam. It doesn’t just take in everything it’s shown. And sometimes it “records” things that never happened. So, I could be wrong about this — yet more fiction about my life…

But I’ve felt for a long, long time that something bad happened to me when I was little — in day care — and I always had this faint memory lurking in the back of my mind. It’s always just been there, I just never paid any attention to it. But then, the other week, all of a sudden, I got this big Wham! of a hit of the sequence of events. Like all of a sudden, they “clicked” with me, and I could see it all happening in front of me, like it was yesterday.

Hmmmm…

I also remember falling down the stairs more than once when I was a kid — one time in particular, I went down and slid the whole way down the carpeted stairs, banging my head on them, one at a time. Similar to my fall in 2004, which anniversary is coming up soon, but when I was little, I hit just about all the stairs on my way down. I can still remember the feeling of my head bouncing off the stairs — bang-bang-bang-bang-bang-bang-bang-bang-bang-bang — and the dull fog that enveloped me when I got to the bottom.

Man, oh, man…

Well, anyway, I know that I have a long history of head traumas — plenty of them subconcussive, as I was a very rambunctious kid with a lot of energy but not quite as much balance… I was always biting off more than I could chew, energy and coordination-wise. So, I fell down a lot, hit my head a lot, ran into things a lot. I got banged up, bounced back up, and got back in the game. I was game. Totally. Always up for more. Just try and hold me back…

Sometimes, people were able to, like the lady who watched me when I was little. But most of the time, they weren’t.

I showed them. I could do it. I’d be up and at ’em in no time. Sure! I could do it!

Now, I’m dealing with the after-effects of my (sub)concussive childhood. And I’m wondering if the impacts over the years had a lot to do with how my brain developed. I have to say, although I have some complaints (who doesn’t, tho?) I’m pretty pleased with how flexible my thinking is, and how well I can perform, by and large. I tested very high in my neuropsych evaluation – high 90’s, percentile-wise. In my moments of self-satisfaction, I imagine I’m a genius or a savant of some kind. (Ha – yeah, right – when I figure out how to keep my study clean and get stuff done when I’m supposed to and make it to the train on time, then I’ll qualify). I have to say, though, I don’t have that many of those kinds of self-satisfied, self-congratulatory moments (I should be so lucky), so I try to savor the ones I have.

But anyway, back to the washed out bridge thing. I’ve heard head injury described as a shearing of fragile connections in the brain — the fine connectors get disconnected, sheared, frayed, and generally disrupted. Kind of like the frayed strings in my sweatpants when I was a kid and I wore my sweats to shreds. And the routes that normally connect the different parts of the brain end up having to re-route to find other ways to connect. And that’s where the fatigue comes from. And the constant restlessness. And the agitation. The brain has to work all the harder to do basic, regular stuff. It can do it, it just takes more effort. The ways that are usually used, the pathways that everybody else seems to have intact, don’t quite work the same for us.

So, we mtbi survivors have to find other ways to get down the neural pathways of our lives. We have to find other routes, when the highways and byways of our brains are washed out by the storms that take us by surprise. The traffic of our brains doesn’t stop — not as long as there is life in us. It just keeps coming and coming and going and going, and when it comes to a place in the road where a bridge used to be, or a paved portion is mising from a huge-ass virtual sinkhole that opened up under it, or there’s a huge fallen tree getting in the way, we — the traffic in our brains — have to find a different way of getting where we need to go.

And I think about all the times when I was a kid, feeling like I was so far behind, just struggling to keep up with what was going on around me, hassling and hassling and hassling over every little detail… all the while seeming to be fine, because I learned pretty early on to be stoic and not let on when I was having trouble — and anyway, I was a tough little kid who didn’t take shit from anyone — and I think about my brain and how hard it was working to put two and two together…

Man, I have to hand it to myself for not going crazy. Granted, I was a strange kid who went off on horrible tantrums, beat up on my siblings, and had all sorts of weird habits, like rubbing through the satin edge of my blanket because the feel of the satin between my fingers was the only thing that would calm me down enough at night to get to sleep… I won’t go into the hiding in dark corners and talking to myself for hours on end and tearing out clumps of my hair — that’s a tale for another time. But all that disturbance aside, I actually came out okay. And nobody I know seems to have noticed there was something really amiss with me.

Of course they didn’t. I learned a long time ago, to hide what goes in with me. In fact, it wasn’t until I realized I was several hundred thousand dollars poorer than I’d been three years before, and I couldn’t explain to myself exactly why or how or when that had happened, that I noticed there was something amiss with me.

Crazy.

Anyway, something must have worked, because here I am, relatively normal, as far as anyone else can tell, testing well, for the most part, in my evaluations, and able to hold down a job and advance my career. Maybe I’m just fooling myself and I’m in for a rude awakening, when I find out that I’m not nearly as competent as everyone else seems to think I am. Maybe I’ll crash and burn. Maybe I’ll self-destruct. I don’t plan to, and I don’t think I will, but you never know.

All I know is, all these years, whether because I’ve kept busy or just kept moving, I’ve been able to re-route my brain around lots of obstacles, and find other ways of getting where I need to go. I may have had all those falls and all those injuries, but if anyone is a testament to neuroplasticity, I am. I’m serious. All the crap that’s gone down in my life, and miraculously my brain has managed to adapt, grow, change, and not show up horribly deformed on my MRI or register more than slight abnormalities on my EEG. For all I’ve been through, for all the crap that’s been done to me, and the wrecks I’ve survived, I’m doing okay.

Even if the bridge is washed out in places, there’s plenty of territory to discover while I’m bushwhacking my way through the underbrush. And if I’ve learned anything from this life, it’s that if you just keep going and use your good sense and you don’t go out of your way to do genuinely stupid stuff, you can find your way back to a beaten path of some kind. It might not be the road you left, and it might not be the road you were looking for. But sometimes a detour is the best thing for us.

Just keep going.

Playing Past PTSD – Using Tetris to Relieve Trauma

A little while back, I came across mention that playing the game Tetris can help relieve — or even prevent — post-traumatic stress disorder (esp. flashbacks), if it’s played immediately after a traumatic event.

Can Playing the Computer Game “Tetris” Reduce the Build-Up of Flashbacks for Trauma? A Proposal from Cognitive Science by Emily A. Holmes*, Ella L. James, Thomas Coode-Bate, Catherine Deeprose from the Department of Psychiatry, University of Oxford, Oxford, United Kingdom published a paper you can read here. The abstract is below.

Abstract
Background

Flashbacks are the hallmark symptom of Posttraumatic Stress Disorder (PTSD). Although we have successful treatments for full-blown PTSD, early interventions are lacking. We propose the utility of developing a ‘cognitive vaccine’ to prevent PTSD flashback development following exposure to trauma. Our theory is based on two key findings: 1) Cognitive science suggests that the brain has selective resources with limited capacity; 2) The neurobiology of memory suggests a 6-hr window to disrupt memory consolidation. The rationale for a ‘cognitive vaccine’ approach is as follows: Trauma flashbacks are sensory-perceptual, visuospatial mental images. Visuospatial cognitive tasks selectively compete for resources required to generate mental images. Thus, a visuospatial computer game (e.g. “Tetris”) will interfere with flashbacks. Visuospatial tasks post-trauma, performed within the time window for memory consolidation, will reduce subsequent flashbacks. We predicted that playing “Tetris” half an hour after viewing trauma would reduce flashback frequency over 1-week.

Now, it’s been a while since I had a really traumatic experience — tho’ the winter storms we had last December did leave their mark. But I thought I’d just see if I could find Tetris online, and I did — JS Tetris 1.17

It will run in your regular browser using javascript, and you don’t need to download anything different or special to run it.

I like this game because it has vertical lines that help me line up the pieces that are “falling”. The pieces are brightly colored. And the controls are on the arrows on my keyboard, not the numbers, which tends to get me turned around. Also, I can restart the game anytime without it complaining at me. Some games make me feel pretty inadequate when I stop them before I finish. Or they try to upsell me and get me to purchase a “full” version. No thanks. I just want to start from scratch.

I don’t know if Tetris does any good in the long-term, but I know after spending a little time playing this a.m., I’m feeling a little more focused.  And after mucking up about seven different tries at filling up the bottom row, I’m ready to do something useful and productive with my time. So, playing Tetris poorly — in its own way — helps me get past my issues, t0o 😉

Something for everyone.