True Independence

There are many different ways to do things

I think I need to start seeing my chiropractor again. The headaches are back after quite some time of being away, and I haven’t been feeling that great, lately.

Lots of pain. I wake up in pain, and at the end of the day I’m in pain. I also haven’t been sleeping that great, either. All of these things were better when I was seeing my chiro, but I had to stop because I ran out of money and I couldn’t afford $120/month for adjustments. It’s just too expensive, even when insurance does cover it. When I’m fully covered, it’s $15 co-pay, and I have to go twice a week, so that’s $30/week — $120/month. That money needs to go to things like my electric bill, to run my air conditioners, pay off some back bills, etc.

Come to think of it, I guess I don’t need have the option to start seeing my chiropractor again. There’s just no way I can come up with that kind of money on a monthly basis. You’d think that it wouldn’t be a problem because of my job and my salary, but between car repairs, mortgage payments, food and gas, and … well, you know the drill. Something has to give, so I have to find another way to do better for myself and feel better in my daily life.

So, it’s back to the drawing board and doing basic things like stretching and moving on a regular basis… getting decent sleep by making it a priority and making sure I at least start to bed well before midnight. I also need to watch my posture and make sure I don’t stress out my body by slouching or getting stuck in off-balance sitting positions at work all day. Just basic stuff, really — but the kind of basic stuff that gets lost in the shuffle, because, well, it’s just not very sexy, it’s drab and everyday and it doesn’t always grab my attention.

But it’s the kind of stuff that matters — really matters — on a regular basis. And if I don’t pay attention on a regular basis, I just get into trouble. In a way, seeing a chiropractor was compensation for me living like a bit of an idiot. I wasn’t taking good enough care of myself, so I hired someone to fix what I’d broken and wasn’t taking care of. I get that now. So, it’s no more excuses — and back to basics.

Which is a good place to start for July 4th – Independence Day. If I think about taking care of the basics in terms of supporting my own independence from expensive experts and professionals (who may or may not be able to help me), then it becomes a lot more interesting and compelling, than thinking about it as something I “have” to do (sigh)… or else.

What a difference a slight change of perspective can make. It can mean the difference between an odious task and something I do on my own to make my life better, to make myself better, to be stronger and more free than ever, without being held back by lack of money or access to professionals.

If that’s not what Independence Day is about, I’m not sure what is.

Speaking of changes in perspective, I’ve been reading more on the Polyvagal Theory, and it’s making a lot of sense to me. The basics are pretty self-evident to me — we have a three-fold system for dealing with challenges in our lives:

  1. An ancient, primal (vagal) system which automatically shuts down our heart rate and breathing and muscle tone in response to inescapable threat. I call this “hypo-freeze” because hypo means “lower” — as in hypotension or hypothyroidism.
  2. A more recently developed sympathetic nervous system which causes fight-flight (and hyper-freeze — which is the high-muscular-tone freeze that’s completely different in nature from the hypo-freeze primal vagal impulse) to kick in to override the hypo-freeze, so you don’t get killed off by your body’s own automatic response to inescapable threat.
  3. A more developed vagal response system which can control the two earlier systems. This system is closely tied in with the muscles of the face and neck, and it can literally signal the “all clear” based on observing the expressions on others’ faces, among other things.*

Essentially, what can happen, is that you can run out of coping and response strategies when faced with inexplicable, inescapable, and seeming insurmountable challenges. When we run out of higher-level approaches (like being able to think things through), we revert to the older ways of responding. And then we can get stuck in those ways of responding, because the “neuroceptive” response (what we take in on a biological/neurological level, rather than an intellectual/conscious level) which is based on prior experiences, kicks in at levels thatprecede conscious thought.

Long story short, our bodies are wired to survive, and when they’ve become trained to respond with fight-flight, time and time again, we automatically jump to that without even thinking about it. Even if we are thinking about it, we sometimes (or often) can’t stop the process of kicking into fight-flight mode, because our bodies are so well-trained in doing that.

Which ties in with the readings I’m doing on trauma and PTSD. It puts trauma and post-traumatic stress in a whole new light. And it gets it out of the domain of the psychological mental illness… and into the domain of the physiological. It explains a whole lot, and actually excuses a whole lot, too. It doesn’t excuse the behavior, but it excuses the brain’s/mind’s role in “causing” bad behavior to happen.

And what happens, when we get our brains/minds off the hook for our “mental illness” and start to see our cognitive-behavioral issues as physical issues which were trained to be that way? For me, it tells me that I’m NOT crazy, that I’m NOT mentally ill (as well-meaning and ill-meaning people like to pronounce me). It tells me that I am dealing with a physical condition that was trained into place, and it can be trained to do something different. It doesn’t just get me off the hook in ways I never should have been ON the hook, to begin with. It shows me the way to do something about my situation — and approach my challenges in whole new ways.

Being human and all, of course I have a lot to learn, and my understanding is still imperfect. It will probably always be imperfect. But at least now I have more to go by, than I did just six months ago.

And that’s the beauty of the right information — and access to the right information. I have found a bunch of really great papers and links on the polyvagal theory (I’ll have to dig them up and share them here), which have served to really expand my understanding and give me much hope. I can’t say that my understanding is perfect, but when I practice what I read and I think about what it all seems to be saying, it helps. It helps a great deal. It’s information that I can put into practice, by doing my daily breathing exercises first thing in the morning before I start anything else, and also recognizing the biochemical processes that are kicking off when I (or others around me) start to get revved and rammy. It helps me come up with different responses and it motivates me to take better care of myself, get better sleep, take it easy (especially last night after the fireworks, which were both beautiful and very stressful with all the noise and lights — and me being behind on my sleep). It gives me more to go by, than “I’m a nervous wreck again” — and it shows me the way to level out after those extreme spikes and jolts that used to just wreck me.

Information is power. Knowledge (the ability to put information into action) is power. It’s all power of the best kind — not power over others, but power over our own lives, our own experiences, our own futures… beyond the dictates of fate.

Well, it looks like it’s turning out to be a beautiful day. The rain of this morning has given way to sunny, clear skies. We needed the rain, and now we have a clear day for the 4th. Not bad. Not bad at all.

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* People are calling the most recently developed vagal system the “social” vagus, but to me, that’s just a related aspect of the mechanism that doesn’t describe what it actually does. It describes how — based on just some of the ways it operates. The “social” moniker seems to have sprung up as a result of people connecting malfunctions of this vagal system with autism and other social challenges, so they’ve taken a bit of a conceptual detour (probably in the interest of popularizing the concept and making it more appealing to funding sources). But my arguments about naming conventions are getting me off track, so more on that later.

Finding a good place

May you find your own good place

I’m sitting outside this morning, writing in the quiet of the day, before the lawnmowers start and the leaf blowers and the construction projects my neighbors are doing over the long weekend.The sun is hot, where there is no shade, but the air is cool where there is no sun, and I have been moving my chair around to find the best place to sit where I am not too hot, but not too cool, and I can enjoy the morning.

Some robin has found some good bugs/worms in my back yard, and it’s making repeated caterpillar-fetching trips to the high grass (I’m letting it grow, so the roots get well established before I start mowing for the summer (and yes, I am aware that summer is practically here). Other robins have also discovered this, and they have been fighting over that little space in the back yard for a little while, now. They are very aggressive with each other, and they have been flying and fighting over this territory with loud, angry cries and swooping attacks. The other birds that happen to be nearby — the blue jay, the downy woodpecker — have been also getting the brunt of their aggressive anger.

But something very educational just happened, while they were fighting with each other. They were all embroiled in a flying group brawl, when I saw a big crow fly into a nearby tree. He sat there a few minutes, seeming to hide behind the trunk of the tree, seeming to look over at the robins. Then, when all the robins were flying around attacking each other, the crow flew over to where they were… and a minute later, it flew away — with a baby robin in its beak. I could see its legs hanging down, and the crow’s flight was a little more lumbering than it had been, coming in.

All the robins flipped out and realized what was happening, and they turned from their attacks to chase the crow, which was already on the wing, headed off to some place where it could eat its little victim.

Over at the nest, a lone robin calls plaintively, chirping with distress over and over again.

Nature can be cruel. And it can be beautiful. Just now, a yellow swallowtail butterfly flew over to me and fluttered around my head for a while. A study in contrasts — in the space of a few moments, terrible “cruelty” and wonderful beauty. Coarse necessity and fragile bliss.

That crow has to eat. The butterfly has to fly. Sooner or later, each of them will in turn become food for something else. That’s just nature’s way — as surely as it’s also nature’s way for yellowjackets and mosquitoes to be visiting me, as well.

This was a good lesson this morning — watching the robins fight, and seeing how their distraction cost them one of their little ones. I doubt that if they had all been minding their nest, the crow would have come in and picked off one of their babies. It is a natural thing, but it could have turned out different, if those birds hadn’t been so fixated on fighting amongst each other.

The other thing I noticed was how quickly these aggressive enemies became allies, when they had a common foe. When they had the same threat to combat, they quickly left their differences behind and joined forces. That is also nature’s way.

Seeing this happen, I can’t help but think about all the ways that we people also fight amongst ourselves, and in the process lose things that are very important to us. We can be so intent on proving we are right, or filling some need that we are convinced we need to fill, that we trash our relationships and alienate/punish those closest to us. We can get so caught up in “taking care of ourselves” — or just looking out for NUMBER ONE — that we lose the connections that bring us life and happiness and fulfillment. We can get so caught up in chasing after the things we think will bring us happiness, that we never get there. And the more we chase, the harder we try, the farther we are from our goal of ultimate happiness.

Ironic, no?

But it seems to me that that’s how we are built. All the chasing, all the fight-flight we are caught up in… that’s the very thing that keeps us from being truly happy. When that is all we do, day after day, week after week, year after year, our ability to just let in the happiness and joy tends to shrivel and shrink. It’s like a muscle, this ability to enjoy ourselves — if we don’t use it, it atrophies, shrivels, shrinks, and becomes so weak that it actually hurts to try to use it.

But like our muscles, our ability to enjoy life can be restored. It doesn’t have to go away for good, and although at times it may feel like we will never ever get back to a place of peace (like I felt this morning at 1 a.m.), the fact of the matter is that with practice and time and patience, we can get back that sense of pleasure, that sense of enjoyment, that resting, digesting part of our lives that is as real and as vital to our survival and ability to thrive, as our beloved fight-flight reflex.

We can get back to that good place again. Because it’s always there. We just need to find it again.

We can, you know. We all come into this world with an autonomic nervous system that gives us as much access to enjoyment and relaxation, as it does to drama and stress. Over time, we may get trained to focus more on the fight-flight, and we may actually feel more alive when we are in fight-flight. But the fact that we digest our food and breathe and even have a regular heartbeat is testament to the fact that we always have a side of us that can — and does — love to just chill. Getting back to that place takes practice. God knows, I can testify to that. For some of us, it comes easy. For others (like me) it takes A LOT of practice. But it gives you something to work towards — and the rewards are pretty awesome.

So, on this beautiful day, I wish you rest and relaxation — remember those who have given their all so that we can enjoy our freedom and our opportunities. Remember those who have also returned, still bearing the burdens of their missions and their service. I like to also remember all those who have served in another capacity, tho’ they weren’t in the military — all the individuals who have given their all to make this country, and this world, a better place for those to come in the future.

May you find peace, may you find rest, and may you find your own good place.

Traumatic Brain Injury Linked to Post-Traumatic Stress Disorder, Study Suggests

Find the connections to get some relief

I continue to think a lot about the connections between mild TBI and PTSD. After going off the rails last month over some stressful stuff at work… and continuing to struggle with stress and how it affects me, I cannot help but see a lot of connections between the stress I’m under, the way I respond to it, and the way my brain has been working lately.

This article came out back in February, 2012, and I may have blogged about it before — it’s worth mentioning again:

Traumatic Brain Injury Linked to Post-Traumatic Stress Disorder, Study Suggests

ScienceDaily (Feb. 15, 2012) — UCLA life scientists and their colleagues have provided the first evidence of a causal link between traumatic brain injury and an increased susceptibility to post-traumatic stress disorder.

Their new study, published Feb. 15 in the in the journal Biological Psychiatry, also suggests that people who suffer even a mild traumatic brain injury are more likely to develop an anxiety disorder and should take precautions to avoid stressful situations for at least some period of time.

The motivation behind the study, which was conducted in rats, was the observed correlation of traumatic brain injury, or TBI, and PTSD, particularly in military veterans returning from service overseas, said Michael Fanselow, a UCLA professor of psychology and the senior author of the study.

The reasons for this correlation are unknown. It could be simply that the events that cause brain injury are also very frightening and that the link between TBI and PTSD could be merely incidental. Fanselow and his colleagues, however, hypothesized that the two “could be linked in a more mechanistic way.”

Using procedures to separate the physical and emotional traumas, the scientists trained the rats using “fear conditioning” techniques two days after they experienced a concussive brain trauma — ensuring the brain injury and the experience of fear occurred on different days.

“We found that the rats with the earlier TBI acquired more fear than control rats (without TBI),” said Fanselow, a member of UCLA’s Brain Research Institute. “Something about the brain injury rendered them more susceptible to acquiring an inappropriately strong fear. It was as if the injury primed the brain for learning to be afraid.”

To learn why this occurred, the researchers analyzed a small piece of brain tissue, the amygdala, which is the brain’s critical hub for fear learning.

“We found that there are significantly more receptors for excitatory neurotransmitters that promote learning,” said Maxine Reger, a UCLA graduate student of psychology in Fanselow’s laboratory and the lead author of the study.

“This finding suggests that brain injury leaves the amygdala in a more excitable state that readies it for acquiring potent fear,” Fanselow said.

The research was funded by the National Institutes of Health, the U.S. Department of Defense and the UCLA Brain Injury Research Center.

Co-authors of the study were David Hovda, a professor of neurosurgery and of molecular and medical pharmacology at the David Geffen School of Medicine at UCLA and director of the UCLA Brain Injury Research Center; Andrew Poulos, a postdoctoral fellow in Fanselow’s laboratory; Floyd Buen, a former graduate student in Hovda’s laboratory; and Christopher Giza, an associate professor of neurosurgery at the Geffen School of Medicine.

The research was a collaboration between Fanselow’s laboratory, which studies neural mechanisms of anxiety disorders, and Hovda’s laboratory, which investigates brain injury.

“One of UCLA’s great strengths is the spirit of collaboration that allows scientists from very different departments to combine their very different expertises to answer important but difficult questions,” Fanselow said.

This is very encouraging (if I haven’t said it before). The fact that clinical researchers are looking at the biomechanical actions of mild TBI and PTSD opens up new routes for better understanding more pieces of this puzzle. I’ve said a number of times that TBI and PTSD are intricately intertwined in some really fundamental ways, many/most of which are experientially biochemical in nature. And the fact that researchers are now paying attention to this and publishing papers about this, really gives me hope for the future of handling this “co-morbid” condition.

I have also long believed (and I think also said) that mild TBI is especially vulnerable to PTSD development, because by its very nature it is confusing at the most fundamental level — which leads to continual activation of the fight-flight reflex, which ultimately builds up a biochemical load that’s heavy on the stress hormone side — and light on the rest-digest impulse. Mild TBI and its successive “micro-traumas” of continuously baffling and inexplicable experiences, many of which are either negative/threatening or perceived to be negative/threatening, is the experiential equivalent of all those subconcussive hits sustained in football, and the biochemical overload of stress hormones that builds up, day after interminable day, serves to further fry the system and the brain and the circuits which would normally serve to chill us out and manage to find a way around (or through) the troubles in one piece.

Unfortunately, I’m not a clinical researcher with an internationally recognized facility, so there’s only so much that I can do to advance this understanding in the circles where people make the diagnoses and treatment decisions. But I can at least do my part here, in hopes that the people who are actually affected by mTBI and PTSD will find some answers — and relief. And those who treat people with PTSD and/or TBI would be well-served to explore the connections between the two. It is such an obvious connection, when you stop dismissing life experience as “anecdotal” that it surprises me that no one is confronting it head-on. Or that anyone is still being territorial about their explanations for why some of us do and experience the things we do. If the professions would cross-pollinate and cross-promote, they would uncover a vast opportunity to not only expand their service, but come up with a whole new slew of approaches that actually work with those suffering from stress-hormone-overload-induced dysfunction/disorders in the aftermath of TBI.

I can’t control the fields/industries, but I can always hope. And keep working…

Resisting the temptation to overdo it

Sometimes you just gotta chill

My left knee is bothering me this morning. My arms and shoulders are also sore. I pushed myself harder than usual over the past few days, and I’m feeling it. So, rather than doing a full workout, I’m letting myself recover. I have plans to do a bunch of stuff later today, so for now I’m taking it easy and just starting my day at an easy pace.

I’ve been reading up on Mind Body Skills for Regulating the Autonomic Nervous System, and I”m really liking what I see. Unlike the ONF guidelines for persistent mTBI symptoms which rely on the DSM-IV far too much (in my opinion) and hit on a lot of points at a very high level from what seems like a more academic point of view, the DCoE material reads like it’s based in actual empirical results — tested and proven (or not proven) with real-live people in real-life situations (e.g., combat and post-deployment life). And where things haven’t been tested and haven’t been proven, they say so. Which is good. The emphasis in the DCoE paper is clearly on actual concrete implementation of the techniques, which is refreshing, in the midst of so much information that backs away from application with the standard-issue “__________________ can often be difficult as there is a paucity of research in the area and there are no evidence-based treatment guidelines available” disclaimer that not only absolves the writer of responsibility for inaccuracies or incompleteness, but also relieves readers of any sort of obligation to try something in good faith.

Personally, I believe that long-standing post-concussion complications and mTBI issues warrant at least a good-faith try, using the best information we have available to us at the time. The condition can be so debilitating, why sit by when there are possible alternatives? Even if they aren’t perfect, at least they’re something.

And the “something” that the DCoE is doing, is providing really excellent information on the autonomic nervous system AND ways you can possibly work with it to improve sleep, mood, energy, and the other aspects of life that the ANS contributes to.

Here’s some info from pages 7-8 of the report (bold emphasis is mine)

EMOTIONS, AROUSAL AND THE ANS

The autonomic nervous system (ANS) is the branch of the nervous system that functions independent of conscious awareness. It involves the unconscious regulation of organs and system functions that maintain basic operations within the body – for example, heart rate, digestion, respiration rate, salivation, blood pressure, perspiration and diameter of the pupils. The ANS is a functional system within the central and peripheral nervous system that manages all of the body’s internal functions. It is the automatic nature of the ANS that enables the regulation of many systems without interfering with everything else the brain is responsible for on a daily basis involving conscious thoughts and emotions.

The autonomic nervous system has two components: sympathetic (SNS) and parasympathetic (PNS). The SNS prepares the body to fight, flee, or freeze in stressful situations (depending on the circumstances), while the PNS prepares the body to rest and digest in relaxing situations. These sub-branches both supply nerves to various central and peripheral nervous system regions, the endocrine system, and visceral organs. The SNS becomes dominant in states of stress and fear. Signs of SNS activation include increased heart rate and respiration, cold and pale skin, dilated pupils and raised blood pressure. In contrast, the PNS becomes dominant in states of rest and relaxation. Signs of PNS dominance include decreased heart rate and respiration, warm and flushed skin, normally reactive pupils and lowered blood pressure. Because PNS and SNS states are associated with distinct body activities, a variety of biofeedback instruments, such as those that measure heart rate, body temperature, blood flow, pupil dilation and breathing are often used to indicate the body’s ANS arousal state.

Stress and stress vulnerability can be broadly defined as either the absence of adequate balance between the ANS and the PNS during resting states or the improper predominance of one over the other in particular situations. For example, it would be dysfunctional to have PNS predominance during times requiring high energy and arousal, such as when under threat or attack. Equally, it would be dysfunctional to have SNS predominance during times of relaxation, such as when readying for sleep.

Research in affective neuroscience (the study of correlates between the brain and emotion) has identified central nervous system (CNS) regions involved in emotion. This research suggests that emotions involve a mix of cortical (e.g., frontal, temporal and parietal) and subcortical/limbic (e.g., basal ganglia, thalamus, amygdala and hippocampus) regions of the brain. Evolving alongside this research, emerging neurophysiological research has sought to identify the ANS correlates in emotion.

Mounting research over the past three decades suggests a relationship between emotions and changes in the ANS.  There is some evidence that different emotions may be distinguished based on a complex pattern of sympathetic and parasympathetic activation. However, this literature is evolving and there are relatively few studies that have simultaneously examined brain activity and ANS responses while experiencing emotions, making it difficult to determine specific pathways and conclusions about ways in which the brain, the ANS and emotional experiences relate to one another. Nonetheless, research exploring connections between the ANS and emotions via associated networks in the CNS continues to expand, and researchers continue to look for some of the specific ways that mood and emotions may be connected simultaneously to the brain (i.e., the mind) and to the ANS (i.e., the body), in addition to how interventions designed to directly manipulate the ANS and body may impact moods and cognitive abilities.

This to me is a key point — the ANS is directly connected to moods and emotions (in ways that we still don’t fully understand scientifically, but we can see in our everyday lives). Additionally, stress and stress vulnerability are directly related to imbalances in the ANS. It’s all tied together, closely connected, and we’re still learning how it all fits together.

But no matter how it’s all put together, the bottom line is that our autonomic nervous system (ANS) is hugely important in our lives. It’s central to it. We can’t live without it. AND Iooking to the work of the UB folks about how “concussion produces a temporary alteration of the central regulatory systems that control, for example, the autonomic nervous system and circadian rhythms, as well as the autoregulatory protection of the brain, which under normal conditions maintains a constant state of cerebral blood flow. [and] . . .  that PCS represents a condition whereby the regulatory and autoregulatory mechanisms of the brain do not naturally return to normal”  it just makes sense that if we have access to techniques and approaches we can use to actually regulate our mis-behaving ANS ourselves, then let’s do it.

Let’s not waste a lot of time trying to cover our collective asses with disclaimers and suppositions that “in TBI there is no recovery” and “every brain is different” and “we don’t have conclusive evidence to do/say/try such-and-such”. Sure, I’m all for being responsible and prudent and using best judgment and not wading in over your head at the drop of a hat.

But lives are at stake. Your life. My life. The lives of thousands and millions of individuals who sustain TBIs each year. And if there’s information out there that can help us and which might do some good, then I say, go for it. Some of it may seem to me like a bunch of hooey that’s not based at all in science or experience. But that may work for others. Still, I don’t want to see anyone taken advantage of, obviously, by hacks and people who write their own rules and come up with their own versions of “science” and “medicine”.  So that’s where my enthusiasm for the DCoE material comes from. It’s based on science,  and it admits that there may be issues with some of the techniques surveyed. But it doesn’t shy away from talking about them and encouraging further research.

So, all this being said, I am pretty encouraged by this offering from the DCoE. And I’m really encouraged by the materials coming out of University at Buffalo. These two taken together are giving me actual concrete information to work with, that is both intellectually motivating and emotionally encouraging. Probably the biggest plus of all of this, is that I feel like someone is actually paying attention to what is harming so many people, and they’re actually doing something about it. They’re putting themselves out there, setting examples, and blazing a trail that can actually be followed.

Now, I know TBI and concussion are complicated issues. And there are a lot of people who are trying to make a difference, for a number of different reasons. So in everything, I’ve got to take grains of salt here and there. Nobody’s perfect, obviously, and we’re all learning as we go. For me, in my own life and my own recovery, balancing out my ANS with breathing and practice and good living hygiene, is really key. Making sure I don’t overdo it to either one side or the other — either getting stuck in fight-flight or being bogged down in rest-digest. Both sides are important for life, and it’s vital that I be able to switch off between the two. That’s just common sense. And it’s good practice.

Speaking of practice, I just downloaded the Breathe2Relax app for my iPhone. I’ve set it up and may use it sometime. Not sure if/when I will, but I heard about it in the DCoE paper, and it’s not only free but also looks like it might be useful. I’m not a huge fan of depending on a smartphone for living my everyday life, but in a pinch at work, when I’m so wired I can’t think straight, it might come in handy. For the times when I don’t want to be hooked up to my iPhone, there’s always the simple and effective (and free) technique of counting my breaths… and imagining expanding the different parts of my body to “crack apart” the hard shell of stress that’s coating me. That helps a lot, too. It gets me to sleep, and it helps me relax in general.

Anyway, speaking of not overdoing it, it’s time I got on with my day. The weather is beautiful, and it looks like I can get to the beach. It’s a drive, but I’ve got time.

Onward.

The hazards of mtbi micro-traumas

Another Monday, another week. The weekend was pretty good, all things considered. I got a fair amount done, and I also had some time to just relax. Not much, but some.

I did a little reading about “The Cognitive Control of Emotion” by Ochsner and Gross, who say

“Conflicts, failures, and losses at times seem to conspire to ruin us. Yet, as Marcus Aurelius observed nearly two millennia ago, we humans have an extraordinary capacity to regulate the emotions occasioned by such travails. Importantly, these regulatory efforts largely determine the impact such difficulties will have on our mental and physical well-being.”

They also include a good quote from Marcus Aurelius:

If you are distressed by anything external, the pain is not due to the thing itself, but to your estimate of it; and this you have the power to revoke at any moment.
Marcus Aurelius (Meditations)

The rest of the paper is about fMRI results and neural mechanisms, most of which went over my head because I’ve been having trouble focusing and comprehending what I’m reading. I’ll have to go back and re-read it, because I believe there’s something in there I can use. But the thing that I took away from it, is that we actually can choose how we will experience and react to and emote over our circumstances, and the better we are at that, the better off we may be.

Or course, this doesn’t speak to people being in just plain crappy living situations, but there is at least a little bit there that I can use.

Anyway, I’ve been thinking about how bent out of shape I’ve been for the past month or so. It feels like a whole lot is piling up with me, and I haven’t been able to get out from under. Certainly, not getting enough sleep is not helping. I’m working at turning that around. It’s slow going, but at least I’m making the attempt.

And I’ve been thinking about all the things that have gotten me worked up, bothered, troubled, anxious, etc. A lot of those things aren’t even that big a deal, on some people’s scale. But for me they are. And they seem to add up a whole lot faster than one would expect. It’s a little dispiriting, but that’s how it is. Everything adds up. Quickly. Even the little stuff.

Especially the little stuff. I have a name for all those little things that “shouldn’t” bother me — micro-traumas. Specifically, mtbi micro-traumas. They’re the little things that get under my skin and set me off — because I’m tired and/or stressed and/or not paying attention. They’re the little things that “shouldn’t” happen because regularly functioning people don’t have these problems — like waking up one morning and not being able to read or write as well as you could the day before… like forgetting so much stuff that if you don’t write it down, it might as well not even exist… like getting incredibly bent out of shape over developments at work that most people take in stride… like flipping out over dropping a spoon while you’re making your breakfast.

Those little experiences, those tiny explosions, may not seem like a whole lot in and of themselves. But when they happen again and again and again, tens (even hundreds) of times a day, they add up. And they wear at you. It’s like a death by a thousand cuts. It’s not even the exact events themselves that constitute the explosions — it’s the experience of those events, the biochemical bursts and blasts and ka-booms that take place out of sight of anyone else, that set you on edge and tear the living crap out of your interior.

Isolated and not considered in light of the continuous whole, these explosions, these micro-traumas probably don’t look like much to the outside observer, but internally and over time, they add up. And they add up to cumulative trauma — just like all those sub-concussive hits (from practices and full-on collision play) take down professional football players years later, the micro-traumas that bombard mtbi survivors day in and day out also take a toll. And it all adds up.

This is coming back to the ANS balancing issue I talked about yesterday. And it also ties in with PTSD and resilience. I really believe that unaddressed TBI issues — especially “mild” TBI issues — lend themselves extremely well to creating an everyday “substrate” of stress and fight-flight orientation, which erodes our personal resilience and gradually over time in countless invisible ways pulls us down into a way of life that is hallmark PTSD. For all the talk about traumatic brain injury, there is remarkably little overlap between the TBI and PTSD conceptualizations, that I can see. Everybody is trying to establish that THEY are the ones who have it all figured out, and precious few people are giving quarter. But that’s a bit dense and self-serving. It’s also not practical, nor is it accurate. The two overlap and feed into each other — obviously (to me at least) — and any approach to TBI recovery (yes, I’ll say recovery) must necessarily include an approach to trauma that is patently unlike the talk-therapy approaches that just serve to drive us half-mad with all the emotional stirring-up and provocation.

Let me put it simply. This is what I believe:

  • That Traumatic Brain Injury is by nature a traumatic event. It is a physiologically traumatic event. Even if the individual is not aware of their environment at the time of injury (or they forget it due to their brain trauma), their physiological experience nevertheless primes them for trauma.
  • The nature of brain trauma, as a fundamental insult to the very command center of so much of our functioning (as well as the biochemical reactions which take place as a result) puts the body into overdrive to both survive the injury and escape the imminent danger that TBI poses to the individual. The brain has to work overtime to recover and come up with compensatory techniques. And the individual can be in a perpetual state of insecurity and confusion and fight-flight, because their usual ways of approaching life are no longer available the way they once were.
  • The extreme fluctuations of emotion and ability, can fire off biochemical reactions that are disproportionate to many of the events. This is a function of an over-tweaked autonomic nervous system which is “stuck in high gear” like a Prius with its floor mat wedged to the accelerator. The injured individual can be so confused and disoriented that their ability to monitor and understand their own situation can be completely compromised, which leads to more stress — Post-Traumatic Stress.
  • To make matters worse, the general cluelessness (even hostility) of the surrounding social environment exacerbates things even further, by insisting that everything should be fine, that there should be no problems, and that the TBI survivor should be able to function as they did before. This puts the survivor into an all but permanent fight-flight mode, eventually either pushing the parasympathetic nervous system out of the picture or creating wild swings between the two ANS branches, which totally screws things up (that’s my scientific assessment 😉
  • This is especially true of mild traumatic brain injury survivors, whose brains are still rewired and who have to make more subtle changes and advances, in the face of — among other things — cognitive fluctuations, and surprisingly extreme and shocking biochemical reactions to “non-events”.
  • Unless and until a TBI survivor deals with the trauma aspects of their situation (no, not “They did this to me, and it hurt” kind of dealing, but the physiological effects of the biochemical roller coaster), they can continue to suffer and continue to struggle. Long-term prospects may actually worsen, as their post-traumatic stress is exacerbated and accentuated by ongoing issues which have not been properly balanced by exercise, rest, nutrition, and plenty of water.

It might sound over-simplistic, but may be to some extent it is that simple. And in the end, I believe that TBI survivors are not going to get proper care and assistance until the physiological aspects of trauma recovery are fully explored and matured. The vast majority of trauma research that I have encountered has to do with psychological trauma, and certainly there is plenty of that. But approaching trauma only in terms of psychology, and addressing it only in terms of talking and emoting (both of which can be extremely taxing for TBI survivors to do with great success), is just pulling us backwards.

It’s not helping.  There has to be a better way, and I think I have actually found it.

Whether anyone in a position to study this and pursue new courses of treatment is going to catch on, is anybody’s guess. I do believe that the military is the closest to making progress on this front, due to their increased focus on Total Force Fitness. They have a vested interest in coming up with what works, because their (and our) survival literally depends on it. And it is in their research that I find the most hope and the most useful material to work with, at this time.

Researchers at institutions may or may not get it. I think in fact that they usually don’t, in no small part because they are so far removed from the issues, personally speaking. Doctors and therapists may or may not get it, because of their indoctrination and their intellectual biases (plus their own trauma issues get in the way). Those of us out here walking around in the word trying like crazy to figure out WTF is going on in our lives… we’re like mobile laboratories, chock full of anectdotal tidbits.

We’ll see if things change. But for now, it’s time to go to work. Onward.

From the DCoE – Mind Body Skills for Regulating the Autonomic Nervous System

Warrior Resilience Conference – Thank you for your service – at home and abroad

Last June, the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury released a report (pdf) called Mind Body Skills for Regulating the Autonomic Nervous System, which surveys a number of techniques for regulating the fight-flight and rest-digest functions of the ANS.

I may have seen this before, but I honestly don’t remember. In any case, I’m recording it now here on this blog, so I can remember and find it later. I also saved a copy to my hard drive, and I am reading through it.

The ANS has been hugely important to me over the past years of my recovery. When I am able to step back and objectively view my progress and my capacity to live well, I can generally judge from the degree of ANS balance, how happy, productive, and involved I am in my life. More ANS balance = more sense of well-being. Less ANS balance = struggle and difficulty and feeling useless. And that holds true, whether I am more unbalanced towards rest-digest or towards more fight-flight. Either way, it’s a recipe for struggle and difficulty.

ANS balance is hugely important to me. And the mind-body approach is the often-missing piece of TBI recovery that I’ve been filling in myself, along with weekly visits to my neuropsych, to help balance things out. When I have kept my fight-flight/rest-digest nervous system activities in balance, things have usually been going well. When I have not had them in balance, things have gone rapidly south, and it’s taken me weeks to get back to where I am functioning to my satisfaction again.

I’m smack-dab in the middle of one of those recovery periods right now.  It’s taking me longer than I expected, to “right my ship” so to speak, and it’s frustrating and feels defeating, but I do feel like I’m getting there… gradually. I do need to be easy on myself – pushing harder has a way of setting me back, ironically. It doesn’t feel “right” but backing off and paying attention to the small things, while letting events take their course and work themselves out, seems to be what works best for me.

The main thing is to not get all caught up in myself and get down on who I seem to be at the moment. I keep seeing this slogan, “Life isn’t about finding yourself – it’s about creating yourself.” I agree. And I really believe it’s also about creating things that benefit other people — about literally making the world a better place through our words and thoughts and deeds.

When I don’t take care of my ANS, and I allow myself to wallow in that awful feeling of sympathetic overdrive, things tend to not go so well. I also tend to get down on myself AND not be able to see the future prospects ahead of me. The more I strive, sometimes, the more depressed I get — someone once said to me that depression is the result of driving too hard for too long, and having your system get fried, without allowing it to catch up and rest. I can see that in my own life – in the way I get so down, after I have been so up.

My neuropsych once told me about an individual with TBI who had been diagnosed as “bi-polar” by their doctor, and they’d been put on meds for it. The doctor believed that they had a “short cycling bi-polar disorder” where it took them less than a day to run the gamut between manic episodes and a depressive crash. My neuropsych worked with them to work out their daily routines and activities, and when they had gotten some balance, back — poof, the “fast-cycling bi-polar disorder” was gone.

Now, I’m not a doctor, and I’m not board-certified to make diagnoses and prescribe treatments, but in my own life, I can see a direct correlation between episodes of intense activity (even if it is activity for the greater good and/or activity that is beneficial to me), and sinking into a pit of despair. I can see patterns of lots and lots of activity being followed by an extended crash.

So, regulating my ANS — when I remember it — is really a big key to me keeping stable and sane. (If you have any doubts, check out the posts when I have not been at my best – 9 times out of 10, they came at times when I was stressed and in full fight-flight mode without respite.)

Seeing the Defense Centers of Excellence releasing a report on Mind Body Skills for Regulating the Autonomic Nervous System is really encouraging to me. I have been very troubled by the lack of support and assistance that’s been offered to our returning vets (thank you to all of you for your service, by the way). It sort of seems to me that a report like this is a way for the DCoE to provide extended assistance in the way of ideas that people can learn and use to help take care of themselves. I think it would be absolutely impossible for the VA to provide personal assistance to each and every vet who returns — especially because there are so, so many who are returning with brain injury issues, and so little is actually known about brain injury AND each injury is a little different, so short of providing a full comprehensively trained team to assist each vet who returns, the level of care is just not going to be enough, coming only from the VA. There aren’t enough people and there isn’t enough money to do it all from one central source. We literally need to pull together as a country and provide support in a variety of ways.

But a report like this from the DCoE is a step in the right direction.

The cover these topics:

  • Introduction and Background
  • Practices for Regulating the Autonomic Nervous System (ANS)
    • Emotions, Arousal and the ANS
    • Breath Techniques for Regulating the ANS
    • Posture and Tension-Modulation Techniques for ANS Regulation
    • Mindfulness, Meditation and Guided Imagery
    • Mind-Body Programs
    • Biofeedback

There are other approaches, and I’m sure time will show changes to how each of these is perceived. But it’s a start. I’m having a little trouble focusing today and keeping my attention on what’s in front of me, so I can’t speak in depth about what’s there. I haven’t been able to read more than a page at a time, honestly. But in the coming days and weeks, I hope to see that change. And I’m taking steps to get that to happen.

I encourage you to follow the link and read up on it yourself. There may be something good in it. In any case, the report was created in the interest of strengthening troops in the face of new kinds of war, and since dealing with TBI can be a series of battles, in and of itself, I can see how this same orientation might benefit me and many, many others.

These techniques are not just for soldiers — although they were explored with soldiers in mind. They can help the rest of us, too.

Now obviously, there can be no true comparison between coping with the daily micro-traumas of TBI, and being deployed three times to several different desert battlefields. The scale and quality is completely different. But in principle, if not in practice, there are ideas and habits that can cross-pollinate and assist on many levels. In TBI, especially, where we are so often in uncharted territory, it makes no sense to write off a potentially beneficial approach because of perceived differences between cases. We have to pull out all the stops and do everything we can to achieve what progress we can.

Now I need to pull out all the stops and run some errands. Life goes on.

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