Just happy to be here

Uh oh – I just got back from a session with my neuropsych, and it appears that some of the “adventures” I’ve been having — some of which were really fun at the time and left me feeling energized afterwards — were actually caused by very poor decisions and a lousy ability to assess risk.

So, I’m actually lucky to be alive. Many, many, many things could have gone wrong on three separate occasions over the past six months. I realize that now.

Good grief.

Well, I’m pretty bushed after that session. It took a lot out of me.

I need to have some supper and go right to bed.

Later, all…

Watching within

“You’re feeling sleepy…” No, I’m NOT!

So, this year is off to a roaring start. I’ve already had a few situations of hurting people’s feelings — that escalated from people being super-sensitive to something I said, or how I behaved.

I will admit, I have come on very strong at times, and I have had a little “scorched earth” action, where I felt like I was either being threatened or disrespected.

Yeah, I’m not much for being threatened OR disrespected, and I will react if it seems like that’s happening. I have to watch myself, though, because that can cost me — in damaging existing relationships or nipping new ones in the bud before they get a footing.

The thing is, I need to make sure I don’t over-react, which I can certainly do. Especially if I’m not paying attention to what’s going on inside my head and veins and autonomic nervous system, I can quickly switch into survival mode over some interpretation. In some cases, I need to be in survival mode, but I don’t need to completely scorch the people who I perceive as a threat, like Smaug laying waste to so many Middle Earth towns.

Yeah, gotta watch that. Particularly when I am tired and stretched.

I had a couple of tricky situations this past week, during the conference. Even before I left the airport, I had sent an email to a colleague who is also a good friend, which really hurt their feelings. I was reacting to them running their mouth and getting me in trouble because they don’t know how to be discrete about sharing information with upper management before it’s been fully analyzed. They let a few little factoids slip, and the uber-uber-boss got wind of it and proceeded to tear my boss a new one, over what was really nothing.

Geeze. And this after I’d specifically told this person to NOT share information with the uber-uber-boss. God help us.

Anyway, the email I sent was terse, abrupt, and pretty harsh. The situation called for it — something had to be done to keep them from continuing to run their mouth. But then they got all worked up over it and pitched a little hurt-feelings hissy fit, and then it blew back on me and I had to spend days patching things up. If they’d been able to keep their mouth shut, this never would have happened. But the individual who “over-shared” has impulse control problems. They always have. They get carried away and say and do things that make them extremely difficult to deal with. I don’t doubt for a minute that it’s due to them having sustained a severe brain injury when they were younger — they got thrown from a motorcycle and landed on their face and spent the next week in a coma, then had to learn to do everything — walk, talk, function — over the course of several years.

When they get tired and out of sorts, all the standard TBI stuff comes up — impulsiveness, outbursts, emotionality, aggressiveness, confusion, disorganization… and last week, when I sent that email, they were coming out of an extremely long week that was a prime recipe for TBI meltdown — for both of us.

Because I was tired, too. And under pressure. And I wasn’t minding my P’s and Q’s, and I let things get out of hand. I wasn’t the bigger person, and I took matters into my own hands, and the result was not pretty. It’s human, it’s to be expected under the circumstances, but I don’t want to do it again anytime soon.

The second experience I had was at the conference, when I met up with some old friends whom I hadn’t seen for a long time. One of them brought their new love interest with them, because they wanted to introduce them to me and my spouse. After an initial contact at the hotel that was pleasant and friendly, I had to run out and take care of some more things, then I came back, and we spent more time all hanging out together.

That’s when things got dicey. The new Love Interest started telling us about themself, and the more I heard, the less I liked. First of all, they had dredlocks, which is a huge flag for me with white people. Something about white people wearing “dreds” pushes a bunch of buttons with me, partly because every white person with dreds I’ve ever known has come from a privileged background and they live their “alternative” lives scamming off other people. This is only my own limited experience, but every white person with dreds has given me attitude about being part of the “system” and selling out for my full-time job and my house and my regular life.

It makes me insane. Partly because I work in the “system” and have a full-time job and house and regular boring life, because it’s the only way I can function under my circumstances. I need routine. I need predictability. I need a full night’s rest, or I cannot function. At All. This isn’t by choice — it’s by necessity. Certainly, I would love to be able to come and go as I please and be all alternative and what-not and “live my dreams” and “embody my passion” however and whenever I like.

But for me, that’s a recipe for disaster. My brain is such that if I don’t have regular routine and predictability and a whole lot of really boring stuff giving structure to my life, I lose it. It’s not pretty. I become extremely difficult to live with — as the Love Interest found out.

So, there I am, hanging out with people I really love and care about, and here’s this dredlocked person making snarky comments about “white people”. As though they’re not white. And they start talking about their past, moving around here and there. Back and forth all over the world. USA – China – South America – Europe – Asia – back to the US – all over. I guess I got a bit jealous, because that’s the kind of life I would rather be living, but circumstances demanded different choices from me. It’s a little rough to move around the world all the time, when your spouse is disabled and ill, they depend on you to survive, and you can’t keep a thought in your memory for longer than 15 minutes.

According to my spouse, I got pretty aggressive with this Love Interest, firing off questions about where they lived and when. Thinking back, it was definitely an Alpha-situation, with me standing over them, like some interrogator, bombarding them with questions. At the time, I was so caught up in learning more – I actually wanted to hear more about what they did, and when. At the time, I didn’t intend to be aggressive. At least, I don’t think so. I was actually really interested in hearing what they had to say. I wanted to hear more.

But it wasn’t perceive that way, and apparently I made everyone in the room very uncomfortable. I was clueless that people were uncomfortable. I was just focused on hearing more, because my life has been so incredibly uniform and established for the past 20 years.

At the same time, though, there were some alarms that were going off in my head — so maybe I was being aggressive.

The first alarm was the dreds. The second alarm was the Love Interest trying to sell my spouse on their services doing “neurolinguistic programming” — a/k/a hypnosis — to solve some of their mobility issues. My spouse has some serious and long-standing mobility problems due to back and leg pain, and many people have told them it’s because of some emotional block or unresolved issues. Personally, I think it has more to do with them just not moving enough and not strengthening the right muscles to support their frame. They also need to lose about 30 pounds. Most healthcare professionals we talk to, feel exactly the same way. But lo and behold, here’s yet another “alternative healthcare practictioner” trying to sell my spouse on mind control techniques to solve their physical problems.

Of course, it couldn’t be done in just one session. But after an “intake interview” they could continue to work over the phone at any distance. The rate was $100/hour.  No insurance coverage available.

So, yeah, here’s this individual who’s living on the margins, pretending to be something they are not, just flitting around doing as they please, subtly slamming people like me, and they’re trying to hard-sell my spouse into signing up for hypnosis, which of course I will be paying for out-of-pocket, if it ever happens. On top of it, they’re talking to my spouse about working together to create some sort of alternative event, and I’m getting a sickly deja-vu in the pit of my stomach about all the other marginal folks my spouse has tried to work with who started out seeming so alternative and progressive, and just turned out to be nutso, flighty, opportunistic users who thought they could take advantage of the “rich” people with the salaried job, the house, and the two cars in the garage.

Come to think, of it, I’m surprised I was as polite as I was, that night. If I had really been aware of how I was feeling at that time, I probably would have 86’ed them, or called it an early night.

But like I said, I was pretty clueless about just how threatened and aggravated and antagonistic I was feeling. I was in the “zone” — or so I thought. And my memories of the evening were totally different from how my spouse describe them to me later.

Anyway, the rest of that evening went slowly downhill. I was actually feeling pretty strong, that night, and I had a good time catching up with my old friends. But the Love Interest became increasingly withdrawn as the evening went on. They wouldn’t make eye contact with me, and when we rode back to the hotel, they made sure to sit far away from me. It was weird. I mean, I tried to reach out and talk to them, but they kept their distance. Maybe because I was a representative of “THE MAN”, and/or I wasn’t playing along with their alternative role-playing game.

In the end, they barely said good night to me, and they were obviously glad to get away.

I feel badly about the situation — mostly for my friends, who were obviously fond of the Love Interest. To them, they were wonderful, from what I could tell, and it seemed like they did really care about each other. But my shields went way up – to 110% – with this person around, and I was NOT going to have my spouse snookered into yet another boondoggle that was expensive, time-consuming, far from guaranteed, and happening on the other side of the country.

Yah, not gonna happen on my watch.

Looking back, I realize now that my instincts were pretty accurate. I was “tuned in” to what was going on beneath the surfaced, and I took corrective action without going ballistic. I could have gone ballistic, under the circumstances. The warning signs were written all over the situation. But aside from some pointed questions and uneasiness-provoking directness, I didn’t go all Rambo on the Love Interest. I just made it clear that I was not buying what they were selling, I didn’t just agree with every little thing they said. And I didn’t give a shit if I did piss them off.

My friends were certainly uncomfortable, now that I think about it, and they should be. Because here is someone they ostensibly love and trust, who is probably using them for their own selfish purposes. And I hate seeing that happen to anyone I care about. My friend who is dating them has fallen in with questionable people before, and they are extremely susceptible to users like this. I’ve seen it before, and it appears to be happening again. I think it has to do with some sort of guilt from their parents having money and being community leaders, and them wanting to reach out and help the less fortunate.

In my experience, the “less fortunate” can sometimes get that way because they would rather scam others than take responsibility for their lives. And I hate seeing good-hearted people used by those kinds of scammers. So, to stand by and do/say nothing and act like everything is hunky-dory… that’s not an option for me.

This isn’t a game, folks. This is life. I know that my friends come from money, so they will always have someone to help them, should things go sour for them. They can afford to fritter away their days and years without terrible consequence (like for me and my spouse). Their parents keep them well provided for, even well into adulthood. But can we really afford to squander our lives — our precious, precious lives — on people and experiences that constantly take, and do not give?

There is so much that needs to be done in the world, and it makes me absolutely NUTS to see the talented, gifted, intelligent people in my life frittering it all away on people who take advantage of their good hearts. They fritter it away to rebel… for entertainment’s sake… or because they don’t realize just how precious and rare their talents and gifts and intelligence really are.

What a waste.

Unfortunately, I can’t spare my friends from their poor choices in love mates. But at least, in this case, I didn’t allow the User to “attach” themself to my spouse and come home with us. Yes, people got their feelings hurt, and yes, people were really uncomfortable. But I can sleep better at night, knowing that there is no way in hell that predatory parasitic Love Interest is going to come anywhere near my family again.

They tried to work their NLP hypnosis magic on us, and it didn’t work. I saw through it and took corrective action. I wasn’t consciously aware of the details at the time, while it was happening, but I went with my gut and my instinct, and as it turns out, I was — as they say — Right On, Man… Right On!

What our denial is costing us

It’s not like we can’t see the signs

I’ve been thinking a lot about The Crash Reel, lately, especially thinking about the parents of Kevin Pearce and how they handled his accident and brain injury and recovery. One of the things that stands out in sharp relief for me is how silent his mother is, as she watches her son suffer and struggle. When he’s sitting with the doctor, telling him about how he thinks he should just go out and start snowboarding again… when he announces at a family dinner that he’s looking forward to getting back on the snow… his mother is silent. Sitting quietly in pain, having aged a great deal over the past year, and not speaking up on camera to set him straight.

I know it’s heresy to be critical of parents — especially those who have children who are struggling with a disability or recovery of some kind. It is a parent’s worst nightmare to see their beloved child injured so horribly, even killed. At the same time, parents are one of the most available lines of defense against action sports TBI, and when they don’t step in to stop dangerous behavior, I really feel for the kids who end up suffering as a result.

The kids literally do not know better. Their brains have not properly developed enough to be able to make good decisions. And parents who just leave all the decisions up to them may actually be inviting danger and disaster into their families.

On the other hand, no parent can own or control their child forever, and accidents do happen, no matter what sport you play. Even if you’re not playing a sport, accidents happen. TBI happens. No amount of good parenting will erase that chance 100%.

There are many other pieces to the TBI puzzle, especially when action sports are considered. There’s the X-Games atmosphere of daredevil stunts, the constant push to exceed your (and others’) limits, the steady pump of adrenaline that makes us feel alive — and makes some of us feel like we’re human again.

That adrenaline pump, the flow of dopamine when you accomplish something fantastic, the numbing of pain that all the fight-flight stress hormones make possible… it’s not just an addiction, which people simply dismiss. For some of us, it’s a non-negotiable part of who we are, and without it we are just shells of who we know ourselves to be.

I spent the last week deliberately resting, and man, at some times it was hell. Boring. Dull. Dampened. Blah. Booooorrrrinnnngggg.  I knew I needed to rest. I knew I needed to catch up on my sleep, and it was all good, when I finally got to a place where I actually felt rested. But that persistent sense of being so dull and dim and low-level was extremely difficult to take. And I’m not even an extreme sports athlete.

Imagine how it must feel for someone to go from the thrill and elation of successfully completing a difficult ride down the slopes… to being laid up, forced to rest and recuperate and “take it easy”. Yeah, sheer hell.

It’s the denial of this part of our lives that is the most dangerous, I think. Because we deny that we need that rush, the challenges that test our limits in real life, we don’t get the stimulation we genuinely need, and we live lives that are far less … alive … than they should be. We try to reduce danger at every turn, avoiding uncomfortable situations and everyday challenges, in hopes of having some sense of security. But in the process, we starve our systems of the important challenges and tests that make us more of who we are. We stunt our growth, and we know it harms us. But we are still so convinced that somehow, some way, we can be safe and secure.

In a way, our hunger for safety and security is the worst thing we could possibly indulge. It makes us less than who we could be, and it denies us the necessary genuine risk that fine-tunes our systems and makes us better at being who we are.

But we can’t be deprived forever. As I said, part of us knows the constant risk avoidance is not doing us any favors. So, we seek out artificial challenges that we think we can control ourselves — like extreme sports, velocity sports, collision sports. The worst is when we ask others to vicariously seek out those challenges for us — NFL football players, extreme athletes, and all sorts of danger-seekers we reward with adulation and praise for doing things we could never do ourselves — and which might actually permanently maim or kill them, right before our voyeuristic eyes.

We need action. We need excitement. We need risk. There’s no point in denying it. Our brains and bodies are finely tuned to handle risk and excitement, and if we can’t get it in a healthy way, we will get it in an unhealthy way.

So why not exercise and develop that part of ourselves — safely?

When I say “safely”, I mean without putting our lives and limbs in direct danger — within the context of our everyday lives, taking on challenges that others so frequently flee. Countless “dangerous” situations present themselves to us each day, which we could pursue, and make our lives better in the process. Things like

  • Speaking up and telling the truth about what’s going on around us.
  • Refusing to play along when a bully shows up and demands that you join in their “game” of ridiculing or bullying others.
  • Taking a long, hard look at yourself and admitting what’s really there — and taking steps to address the things you’re not so happy about.
  • Following your dreams, once and for all, and damn the torpedoes or what anyone else has to say about it.

Those are just a few examples of the real risks in life, and those are the ones that get lost in the shuffle. I’ve been seeing a lot of trailers for the “Secret Life of Walter Mitty” movie, lately, and just from what I’ve seen, it seems like old Walter is doing just what I’ve described — replacing the challenges and dangers and risks of everyday life with extreme situations that give him that necessary pump of adrenaline and dopamine that makes him fully human. Fortunately or unfortunately, I suspect the movie concludes with him coming out safe and sound, with no TBIs or other disasters ripping his life apart. Yet more denial? {sigh}

The Walter Mitty story seems not so far removed from the story of sheltered kids taking up extreme sports to supply their brains and bodies with the biochemical pump they need to develop properly. Of course — full disclosure — I haven’t seen the movie yet, so it may turn out to be a good one. I do know the original story behind the movie, so I can speak to it a bit. I’ll have to check out the movie for sure — but on DVD later. I’m not going into a movie theater filled with people who are talking and texting and coughing all over me.

Anyway, that’s my little discourse on denial and its role in producing one TBI after another. We are all culpable, when it comes to cases like Kevin Pearce

  • those who let him take up extreme sports,
  • those who encouraged him,
  • those who rewarded him,
  • those who profited from him,
  • those who continue to urge him back on the slopes to do yet more dangerous stunts,
  • and those who sit by quietly not speaking up when the danger is so apparent, so obvious.

The crazy thing is, this keeps happening every single day, and yet we sit by silently and say and do nothing about it.

Makes no sense. I think we all need to get our heads examined.

For skiing and snowboarding, helmets are not saving lives

There is a great article over at the New York Times (http://www.nytimes.com/2014/01/01/sports/on-slopes-rise-in-helmet-use-but-no-decline-in-brain-injuries.html) about how helmet use is not lowering brain injuries or fatalities:

Ski Helmet Use Isn’t Reducing Brain Injuries

Michael Schumacher in 2005. Schumacher was wearing a helmet when he was injured recently.

By KELLEY McMILLAN

Published: December 31, 2013

BEAVER CREEK, Colo. — The fact that Michael Schumacher was wearing a helmet when he sustained a life-threatening head injury while skiing in France on Sunday probably did not come as a surprise to experts who have charted the increasing presence of helmets on slopes and halfpipes in recent years. The fact that the helmet did not prevent Schumacher’s injury probably did not surprise them, either.

Schumacher, the most successful Formula One driver in history, sustained a traumatic brain injury when he fell and hit his head on a rock while navigating an off-piste, or ungroomed, area at a resort in Méribel, France. Although he was wearing a helmet, he sustained injuries that have left him fighting for his life in a hospital in Grenoble, France.

Schumacher’s injury also focused attention on an unsettling trend. Although skiers and snowboarders in the United States are wearing helmets more than ever — 70 percent of all participants, nearly triple the number from 2003 — there has been no reduction in the number of snow-sports-related fatalities or brain injuries in the country, according to the National Ski Areas Association.

Experts ascribe that seemingly implausible correlation to the inability of helmets to prevent serious head injuries like Schumacher’s and to the fact that more skiers and snowboarders are engaging in risky behaviors: skiing faster, jumping higher and going out of bounds.

“The equipment we have now allows us to do things we really couldn’t do before, and people’s pushing limits has sort of surpassed people’s ability to control themselves,” said Chris Davenport, a professional big-mountain skier.

Read the rest of the article here

And again, we come across examples of how risk-taking behavior takes over and trumps reason. With better equipment, people take more risks — like football players who treat their protective gear like armor to protect them as they turn their bodies — including their heads — into weapons.

Additionally, the article says:

In fact, some studies indicate that the number of snow-sports-related head injuries has increased. A 2012 study at the Western Michigan University School of Medicine on head injuries among skiers and snowboarders in the United States found that the number of head injuries increased 60 percent in a seven-year period, from 9,308 in 2004 to 14,947 in 2010, even as helmet use increased by an almost identical percentage over the same period. A March 2013 study by the University of Washington concluded that the number of snow-sports-related head injuries among youths and adolescents increased 250 percent from 1996 to 2010.

So, dangerous sports continue to be dangerous, and may become even moreso, when the participants are “assured” that they will be protected from injury by a helmet.

But a helmet won’t protect your brain from smashing against the inside of your skull, and that’s where the real injury takes place. It’s inside – where the sharp bone impacts the soft brain… as well as deep within the brain where axons are twisted and sheared and torn, like roads being torn up by a twister or a flash flood.

The Crash Reel has a lot of people talking about TBI and snowboarding. Whether people are listening — and changing their behavior — is anyone’s guess.

Even more questionable, is whether people are actually asking the right questions about what makes this kind of risk-taking seem so attractive to people. They’re not always taking seriously the real need for a reward in life — and the rewards that dopamine and the adrenaline rush offer, can be “just what the doctor ordered” for someone who struggles with attentional issues, low dopamine levels, confusion, alienation, and a general sense of not really fitting into a larger community.

As long as risk-taking that can get you seriously injured is the only option offered to folks who need those neurotransmitters to feel whole and alive, you’re going to continue to see this sort of thing.

And helmets aren’t going to make a whole hell of a lot of difference. If anything, they can make things worse.

The secret about risk-taking

So, I searched Kevin Pearce on YouTube, and I came across this video of him in a video hangout promoting the release of The Crash Reel.

There are a bunch of folks on the video chat, including veterans, some other folks advocating for brain injured folks, and a fellow who’s been in the TBI rehab line of work for over 30 years. I only watched it for a little while, partly because I had a bunch of things to do yesterday. But the bigger reason I quit watching was  one thing in the video that kind of freaked me out:

Kevin Pearce is snowboarding again.

Now, I don’t know if he was cleared by his doctors, or how much snowboarding he’s doing — if he’s trying any of his old tricks, or if he’s just happy to be back on the snow and is taking it easy. I do know this — if I were in his shoes, I wouldn’t be able to NOT do the tricks, flips, spins, and all the acrobatic stuff for very long. Because doing those tricks has been a part of snowboarding for almost as long as it’s been around. And if you can’t do them, then what kind of snowboarder are you?

It made me a little sick, to be honest. Because I get the distinct impression that if he keeps it up, Kevin Pearce is not long for this world. He’s brain-injured. His brain has been permanently altered, and even though it is possible to build back a ton of functionality, and he’s looking worlds better than he did 3-1/2 years ago, there’s still got to be deficits in the areas of the brain that rule executive functioning and decision-making. That stuff can be rebuilt to some extent, I believe, but there will always be something different about how things used to be.

And when you get caught up in the moment, feeling great about yourself and where you’re at, not paying attention, maybe pushing the envelope a little bit, that’s when it becomes really easy to hurt yourself badly. Even a little fall — after a series of falls, including a major one that put you in a coma and forced you to learn to walk and talk again — can prove fatal.

The problem is, there’s no guarantee it will. The problem isn’t that there’s a chance it might not kill you. The problem is, you have no reason to believe with 100% certainty that it’s going to end your life. And when you’re caught up in the moment, feeling fine, feeling — let’s face it — invincible… that’s when things start to get interesting dangerous… even life-threatening. You have no reason to feel like you need to be careful. You have no reason to believe that anything bad is going to happen. You have no reason to believe that you can’t make that jump, that spin, that flip, and you have no reason to believe that you won’t land fine and be fine.

When you’re “in the zone” where you’re feeling really great, invincible, on top of your game, that’s when things can get the most dangerous with a TBI. And I feel pretty terrible for Kevin’s family, considering how elated he is to be on the snow again in the video chat, while not acknowledging that there’s any inherent danger in what he’s doing. He seems so happy just to be back… who would want to kill his buzz? Then again, who wants to see him kill himself?

Not to be a nervous nelly or anything. I just know what it’s like to be fed up with limitations, to want to push the envelope, and feel like yourself again… and end up getting set back, hurt, or worse.

I know what it’s like to crave those risks — not because I’m addicted to the high of doing it, but because it makes me feel like myself again. It makes me feel centered, whole, complete, totally in the moment, really alive. It makes all the static and the confusion and the frustration fade away into the background… none of that exists anymore, when I’m in a tight situation, and it’s such a relief to not have to THINK about anything, if even for just a few moments.

Taking risks is not necessarily about addiction to adrenaline. It’s not necessarily about having a death wish. It’s not necessarily about wanting to tempt fate and rebel against a tyrannical order. Taking risks can be more about just wanting to feel like yourself again, needing a break from all the difficulties of thinking things through, every single moment of every single day, and being physically hungry for the experience of just BEing part of something that’s bigger than you and gets you out of yourself and your head.

In a way, risk-taking could be seen as a sign of mental health — a needed pause from the pressures of EVERYTHING that gets you back into a sense of purpose and belonging and meaning in your life. People who don’t struggle daily with cognitive challenges like attention issues, dyslexia, and other neurological issues, cannot begin to imagine just how overwhelming and exhausting it is to have to THINK . THROUGH . EVERY . LITTLE . THING . EVERY . SINGLE . MOMENT . OF . EVERY . DAY. Unless you’re in it, you just can’t imagine how much it takes out of you and what a number it does to your sense of self.

Given that Kevin Pearce has struggled with dyslexia (according to The Crash Reel) and had difficulties in school, I can totally see how he’d end up where he is. And given how rough society is on people who can’t read and write and cogitate like the “norm” and isolates people who don’t function that way… and considering what a social guy he is, and how important his friends frends are, and how much snowboarding is a part of the world where he belongs, I’m not surprised he’s out there again.

He doesn’t have to have a death wish. He doesn’t have to need to take risks. He doesn’t have to be self-destructive. On the contrary, him getting out there is just him doing the thing that he feels will help him most — which could turn out to be the thing that does him in.

I just hope he stays safe, and that he’s got people around him who can help him dial it back, when everything in him is screaming to crank it way up… I hope he can find another way to feel like Kevin Pearce again.

Because rust never sleeps

 

Tea catastrophe averted

 

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

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

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

And that’s important.

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

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

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

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

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

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

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

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

Ugh.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Here’s a snippet from the tutorial:

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

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

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

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

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

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

That’s no way to live.

What to do?

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

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

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

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

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

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

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

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

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

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

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

Now, what can I pay attention to next?

Be very, very careful

 

Warning Will Robinson!

 

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

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

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

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

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

This sucks.

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

Yes, this sucks.

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

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

Yeah, baby.

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

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

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

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

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

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

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

Addressing the trauma in traumatic brain injury

Source: Scott Butner

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Concussion stampede

Source: t3rmin4t0r

Football season is picking up, and with it comes a spate of stories about professional players suffering concussions… then we have stories about student athletes suffering concussions… head injuries on the rise… mild traumatic brain injuries increasing… trips to the ER… stories from individuals talking about either their own or their kids’ head injuries…

You’d think all the world were sustaining traumatic brain injuries.

Then again, maybe we are. I mean, look at the stats:

  • 5.3 Million Americans are currently disabled by a traumatic brain injury
  • 1.5 Million Americans suffer a traumatic brain injury each year
  • 80,000 Americans sustain long-term disability from TBI each year
  • Every 21 Seconds, someone in the U.S. suffers a traumatic brain injury

Source: Neurology Now, Sept/Oct 2006

That’s an awful lot of traumatic brain injuries (which include concussions — don’t let the semantics confuse you). And that was back in 2006 — who knows where we stand now.

That’s an awful lot of people — and only in this country, we’re not talking the rest of the world — getting “dinged”, or worse, and suffering long-term because of it. Crazy. When will this madness stop?

Or will it? I’m not sure it ever will — as far as I’m concerned, head injury is about as endemic to the human condition as promiscuous sex and violent crime. As damaging (and as interrelated) as they may be, and as much as we may try to reduce the incidence, the fact remains that they continue to happen.

It is so very hard to have a healthy perspective on this head injury situation. On the one hand, you don’t want to overreact, but on the other hand, you don’t want to under-state the significance of head injury. It’s serious business. People get badly hurt — even when they don’t look like they’re injured. And they suffer for a long, long time. Some people never rebound. They get lost in the crowd, fall between the cracks, and fade away into their own private hell.

And our culture just keeps churning them out — especially in the sports arena. Between professional football and student sports and cage matches and mixed-martial-arts fighting and extreme sports and the heavy-duty ‘roids folks are on (including student athletes) and the popular fascination with hard hits and rough pastimes… it’s just one big head injury circus waiting to entertain all the folks sitting home on the couch with a cold beer, waiting for the blood to start flowing.

I’m a bit punchy tonight, I’ll admit. But buried deep inside this thought process, there’s a rhyme and a reason. More and more awareness is coming out about brain injuries and the long-term effects of head trauma. More and more players are agreeing to donate their brains to research. More and more air time is given to concussion and who’s on the disabled list this week, thanks to post-concussive syndrome symptoms. More and more stories of chronic traumatic encephalitis are coming out, and more and more tales of soldiers getting hammered by IEDs and other blasts are making the news.

But still we parade on like it’s all good fun — or at least the kind of thing that we should take in stride. You get hit, you go down, you wobble around when you get up, and nobody thinks anything of it, should you keep yourself in play. You get dinged, you drop to the ground, you get up dimmer and slower than you were before, and the game goes on. You get blindsided on the ice, you land hard and have to be carted off on a backboard, and when you’re not back playing in two weeks, the world starts to forget about you. If you do manage to come back (before all the symptoms have really cleared), you’re lauded as a brave soul.

And we think it’s fine.

Why even bother with all the pres and all the stories? Our culture loves its hard hits and its blindside tackles. We love to watch people get the crap pummeled out of them every Monday night. We love to watch our heroes go down, and get up and continue to play, no matter what. We get all hopped up on adrenaline and drama, get high off our bodies’ stress response hormones, and we worship the ground the most risk-taking, danger-seeking players walk on. We love our heroes, and we expect everything of them — except basic human vulnerability, and simple biological susceptibility.

It’s football season, and student athletics are swinging into high gear.

Concussion anyone?

Oh, take two — they’re small.

A million little hits

Source: photolib.noaa.go

Somebody needs to do a study on the cumulative biochemical impact of constantly finding out you screwed up. I’m serious about this – especially for new mTBI survivors. And long-term survivors, as well.

See, here’s the thing – stress impacts thinking. Cortisol mucks with your thought process. Stress hormones block out complex reasoning abilities, in favor of pure fight-flight-freeze reactions. And the long-term effects of high levels of stress hormones do have a cognitive impact.

So, after you sustain a TBI, and you’re in that initial phase of cluelessness, where you are so positive that you’re fine and everyone else is screwed up… and you keep undertaking things that seem perfectly reasonable to you, but aren’t exactly good ideas… and you keep bumping up against your new limitations (I won’t say “newfound” because it takes a while to find them)… all the while, you’re getting hit with these little “micro-blasts” of stress. The plans you make don’t work out. The relationships you depend on start to erode. Your behavior becomes not only mysteriously different, but also uncontrollable and unmanageable, and every time you turn around, something else is getting screwed up. You weren’t expecting it at all. It’s a shock — to your self and to your system.

Lots of false starts, lots of botched attempts, lots of pissed off people… and all the while, the cumulative effect of your body’s stress response to these “micro-traumas” is building up. The really messed-up thing is, that when you’re freshly injured, the experiences you have can take on vast proportions, and every little thing can seem like a monumental event. Which makes your reaction to them that much more extreme — a lot more stress hormones get released into your system that might otherwise, if you had a sense of perspective that was proportional to the actual events of your life.

But no, when you’re freshly injured, EVERYTHING can seem like a

Big Deal.

Of course, you have no reason to clear out the biochemical sludge with something like exercise or mindfulness meditation or anything like that, because either your brain is telling you that it’s much more pleasant to sit around and watch television, and/or you’re so exhausted from the stresses of daily living that making additional efforts or changes is out of the question, and/or you’ve got a lot of pain, and/or you don’t have access to the equipment or a support system or good guidance for how to start with something like that.

You’re off in your own private Idaho — no, wait, your own private hell — of watching your life fall apart for no reason that you or anyone else can discern.

After all, it was just a little bump on the head, right?

People have been puzzling for some time about the connection between TBI and PTSD, as though they are two entirely different and distinct conditions. I can tell you from personal experience that traumatic brain injury, even mild head injury, can and does result in post-traumatic stress disorder. Because even though the build-up of stress hormones is gradual and incremental, it still happens. And unless and until you figure out a way to clear out the biochemical sludge of one alarming stress response (no matter how small) after another, you’re going to have a heck of a time clearing your mind to the degree you need to clear it.

Being a mild traumatic brain injury survivor (I’m actually thriving, not just surviving), and having experienced what my neuropsych has called a “phenomenal” recovery, I can personally attest to the importance of exercise and good nutrition in helping the brain recover. I can’t even begin to tell you how “gunked up” I was, when I first showed up for my neuropsych testing. I was a wreck. Just a walking series of screw-ups waiting to happen. I bounced from job to job, just dropped out of a couple, made really bad choices about my money and my career and my home and my relationship, and to those who were watching, I was indeed teetering on the brink.

Now, I’ve been extraordinarily blessed to have connected with a neuropsych who firmly believes (after 25 years of working in TBI rehabilitation and 30 years in neuroscience) that recovery is possible, even probable, and that there is hope of some kind for even the most intractable cases. But even they weren’t expecting me to do as well as I have.

Especially in the last year, I’ve made some pretty great progress, and it coincides with my starting to exercise each morning. I don’t do a lot, most days — just get my heart rate up for 15-20 minutes, then stretch, then do some light strengthening exercises. The main thing is that I get my heart and respiration rates up, and that I jump-start my system. This is something that anyone can do — and you don’t need special equipment to do it. We all have bodies, and most of us are able to exercise them enough to get our heart rate and breathing up.

This is key. I can’t say it enough — to help clear out the buildup of stress hormones in the body which can impair thinking and make the aftermath of an mTBI even more challenging than it is already, exercise helps like nothing else.

What’s more, it oxygenates the brain and it stimulates the parts of the brain that learn and heal. How amazing is that? Very, very cool. Even after a long period of difficulty, as the folks at the Concussion  Clinic at the University at Buffalo have found, regular exercise can clear away “stuck” difficulties of post-concussive syndrome. One of their study participants even got back to a way of being that was better than he was before his six concussions or so — according to his mother.

Why does this work? How does it work? There are lots of possible explanations, but at the core — for me — it’s about giving your body the ability to deal with the constant onslaught of surprise and alarm and reaction to situations which emerge (often blindsiding you) in situations where you thought you were fine. For me, it’s very much about giving your body the ability to return to balance, to homeostasis, so it can just get on with living life. It’s about clearing out the cortisol, the adrenaline, the noradrenaline, and the handful of other biochemical substances that our brains normally secrete in order to help us deal with emergencies. Humans don’t have the same ability as animals, to clear this stuff out. Rabbits and antelope will shiver violently and shake and run around to clear out their biochemical “load”, but humans just end up hanging onto it, for better or for worse.

But, you may say, having things turn out differently than you expected isn’t such a big deal. Why would that be so stressful?

Trust me, when you’ve sunk a whole lot of time and effort into something and your self-image and survival (i.e., job) depend on things going the way you planned… and then things turn out to be screwed up in a way you hadn’t anticipated, and everyone is all worked up and pissed off and gunning for you ’cause you wrecked things (again), it does produce an extreme reaction. Especially in someone who has to contend with the extreme emotions and volatility, uncontrollable anger, rage, inexplicable confusion, and all that crazy anxiety and agitation that go hand-in-hand with traumatic brain injury. Even folks with “mild” injuries have these kinds of issues, and it can exacerbate and compound matters to no end.

Ultimately, if it builds up enough (and let’s not forget the embarrassment and shame and confusion that can be socially isolating), it can all become utterly debilitating. Disabling. And all because our  bodies haven’t had a chance to recover adequately from all these little incremental alarms, shocks, and other reasons to get pumped full of adrenaline and cortisol.

So, it’s important to not gloss over the effect of those million little hits. Inside our bodies and inside our minds, they do add up. And as our bodies accumulate the sludge of fight-flight-freeze, our minds are affected. Fortunately, there is a way to deal with it — exercise. Vigorous to a degree that gets your heart and respiration rate up.

Don’t have access to a gym? So what? Take the stairs instead of the elevator. Don’t have a set of weights? Big deal. Carry around some heavy stuff in your home. Don’t have an exercise bike? Do some knee bends, jumping jacks, and run in place. Swing your arms around. Stretch and move. Just get going — enough to get your heart rate up and create a noticeable difference in your body.

Now, I’m not saying it can fix things overnight. It’s taken me a year of consistent effort and commitment to get to this point, and when I started out, it was about the last thing I wanted to “have” to do each morning. But I wasn’t making the kind of headway I wanted to in my recovery, and the doctors were starting to talk about putting me on meds for my attention and mood issues. Given the choice between pharmacopia and 15 minutes of exercise each morning, I went with the latter. I’ve done the drug thing before, and it just made my life that much worse. I can’t go back there again. I just can’t.

So, I started getting my butt out of bed, and am I ever glad I did. I’ve read about biochemical stresses and PTSD in the past, and I’ve read about how animals can clear out the “soup” but humans can’t. But until I started exercising and got clearer as a result, the full impact of what I’d read didn’t sink in.

Now it’s sunk in, and it makes total sense. TBI can very much lead to PTSD — by right of the constant barrage of surprise and alarm and shock (not to mention our tendency to over-react to the unexpected or unfortunate events in our lives) which bombards us with stress hormones that don’t automatically clear themselves out of our sensitive systems. Given that TBI survivors’ systems tend to be even more sensitive after our injuries, it’s all the more reason to get up and get moving.

If you’re still sitting down while reading this, please get up off your butt and move. Your brain — and your life — will thank you for it.