Here’s your memory training image for the day (sorry I have forgotten to include these in the past days)
So, I’m starting my new job tomorrow, taking it easy today, catching up on my rest, and not going too crazy with everything. I had some errands I intended to run, but I went to bed, instead.
Just as well. Those errands can wait.
I’m pretty excited about my new role, and I can’t wait to find out how it’s going to go.
I got myself some really nice, fresh food for dinner, and I’ll start cooking that up in a little bit. I need to get my things together — make sure I have clean socks, as well as a formal suit to wear. It’s my first day. I want to look my best. I’m sure it will prove to be a lot less formal than I’m dressing for, but I’ll just take off my jacket. Roll up my sleeves.
I’m trying to drink a lot of water, so I’m clear for tomorrow. The last few weeks were pretty action-packed, and I need to settle my system. Yesterday I ended up being pretty busy and active, which wasn’t my ideal. I really wanted to have yesterday off, but that’s not what happened. Oh, well. That’s what Sunday’s for, right?
I spent a lot of time, this afternoon, relaxing and stretching and breathing. I did that after my nap, while I was lying in my warm bed, feeling comfortable and easy. I am having more trouble with my upper back, shoulders, neck, and trapezius muscle. I’m really stiff and sore, and not feeling great. All that lifting and moving yesterday didn’t help. Oh, well. I stretched, rolled on a tennis ball to work out the knots, and I “breathed into it ” as my chiropractor tells me to do. In the end, I felt better than when I started, but it’s still tight and painful to move at times.
The main thing for me is to work on clearing out the stress sludge from my last job. Let by-gones be by-gones, and also help my body clear out the biochemical leftovers from all the ridiculous dramas and conflicts that people seemed to dream up to keep themselves entertained. It’s not a small thing, clearing out the sludge. We have to do it, in today’s world, because nobody else will do it for us. We live in very stressful times (especially as the new political season picks up), and our systems are deluged with all kinds of conflict and strife and perceived threats.
If we allow it to build up and stay there, it takes a toll. It puts additional stress on our systems, and it drags us down. I dunno about you, but I don’t need anything else dragging me down. Especially if I know how to clear it out.
So, I’m breathing – steady as she goes – count of 5 in… count of 5 out… nice and even, relaxing all the while. It balances my autonomic nervous system and gets me out of fight-flight mode. It backs down the stress response and makes it possible for me to clear my head, so I can think properly.
This is important. This is critical. I know how to do this, and I must do it. It’s no longer optional for me. Not just some interesting thing to try out, here and there, but a discipline I need to regularly do.
Like the image memory exercises.
Both help. In different ways. They really help.
And now, get your pencil and paper and draw the image you just looked at above. No peeking. It’s important to see where you come up short. If you succeed each and every time, you’ve learned nothing. Good luck.
This is Part 2 of a long post that I’ve split into two parts. The first part is here:
Long-term outcomes after mild traumatic brain injury — and persistent post-concussion syndrome that doesn’t resolve in the usual couple of weeks — have baffled researchers and practitioners for a long time, but to me it makes perfect sense. There is a cumulative effect of stress and strain that comes over time. There’s plenty of research about the long-term effects of chronic stress. But there doesn’t seem to be a lot of research about the levels of stress among mild TBI and concussion survivors.
Everybody seems to think things just resolve. And they don’t seem to think it matters much, that we are no longer the people we once were. They don’t seem to realize what a profound and serious threat this is to our sense of who we are, and our understanding of our place in the world. At most, it’s treated like an inconvenience that we’ll just see our way through with time.
But it’s bigger than that. Losing your long-held sense of self when you’re a full-grown adult, with a full docket of responsibilities and a whole lot invested (both by yourself and by others) in your identity being stable, is a dire threat to your very existence. It is as threatening to your survival, as surviving an explosion, a flood, an earthquake, or some other catastrophe that nearly does you in.
It’s traumatic. But because it’s not over the top and in your face and dramatic — and it doesn’t register on most imaging or diagnostic equipment — people think it just doesn’t matter.
Or that it doesn’t exist.
Frankly, the professional community should know better — especially those who work with trauma. They, of all people, should know what trauma does to a person — in the short and long term. I suppose they do know. They just underestimate the level of stress that comes from losing your sense of self and having to rebuild — sometimes from scratch. I’m not even sure they realize it exists.
But they do exist. Dealing with the daily barrage of surprises about things not working the way they used to… it gets tiring. Trying to keep up, takes it out of you. I know in the course of my day, I have to readjust and re-approach many, many situations, because my first impulse is flat-out wrong. I have to be always on my toes, always paying close attention, always focused on what’s important. Always reminding myself what’s important. I have to perpetually check in with myself to see how I’m doing, where I’m at, what’s next, what I just did, how it fits with everything else I’m doing… Lord almighty, it takes a lot of energy.
What’s more, those stresses and strains are made even worse by being surrounded by people who don’t get how hard I’m working. I swear, they just have no clue — my spouse and my neuropsych included. They seem to think that this all comes easily to me, because I do a damned good job of smoothing things over and covering up the turmoil that’s going on inside of me. I have trained myself — through a combination of techniques — to at least appear to be calm in the midst of crisis. Even when things are falling apart around me and inside me, even when I am at my wits’ end and am about to lose it, I can (usually) maintain a calm demeanor and chill out everyone around me.
Heaven knows, I’ve had plenty of practice over the years. If I hadn’t learned to do this, I would probably be in prison right now.
No, not probably. I would be in prison. I like being free and un-incarcerated, so I’ve learned to hold my sh*t.
Which is where sleep and proper nutrition and exercise come in. Because after years of thinking that sharing my experience with the ones closest to me would enlist their help, I’ve realized that doing that will never ever achieve that goal. People just don’t get it. Even my neuropsych doesn’t get it. Everyone has this image of me as I present to them, which is totally different from what’s going on inside of me.They seem to make assumptions about how I am and what I am and what life is like for me, that have nothing to do with how things really are.
Inside, I have a ton of issues I have to manage each and every day. Today, it’s
confusion & disorganization
neck, back and joint pain
ringing in my ears that’s not only the high-pitched whine that never goes away, but is now accompanied by intermittent sounds like a tractor-trailer back-up alert beep. Nice, right?
And that’s just for starters. Who knows what will happen later today.
But I’ll stow the violins — the point is, I really can’t rely on others to figure things out for me — even the trained professionals. I can’t rely on them to understand or appreciate what my life is like from day to day. I need to rely on myself, to understand my own “state” and to manage that state on my own through nutrition, adequate exercise, rest… and to advocate for myself to get what I need.
I have to keep those needs simple — rest, nutrition, exercise — and not complicate matters. Getting more elaborate than that just works against me. It’s hard to explain to people, it gets all jumbled up in my head, and the other people try to solve problems they don’t understand, in the first place.
On the one hand, it can get pretty lonely. On the other hand, it’s incredibly freeing. Because I know best what’s going on with me, and I know I can figure out how to get that in place.
The bottom line is — after this very long post — TBI and concussion take a ton of energy to address. It’s not a simple matter of resting up till the extra potassium and glucose clear out of your brain. There are pathways to be rewired, and they don’t rewire themselves. Depending on the nature of your injury — and a diffuse axonal injury that frays a ton of different connections, even just slightly, can introduce a wide, wide array of frustrations and hurdles — you can end up spending a ton of time just retraining yourself to do the most basic things. Like getting ready for work and making yourself breakfast without missing any important steps (e.g., taking a shower or turning off the stove).
And when you’re trying to rewire your brain and retrain yourself to get back on track, at the same time you’re trying to maintain your life as it once was… well, that’s a recipe for a whole lot of hurt, if you don’t give yourself the energy stockpiles you need to move forward, and if you don’t take steps to regularly clear out the gunk that accumulates in your physical system, as a result of the stresses and strains of the rewiring process.
That being said, I wish that someone would do a study on the stress levels of concussion and other mild traumatic brain injury survivors. We need to collect this data, in order for professionals to better understand us and our situations, and to better know how to treat us.
For the time being, however, I’m not holding my breath. I know what works for me, with regard to my recovery — having someone non-judgmental to talk to about my daily experience, keeping records of my daily life so I can self-manage it, regular exercise, pacing myself, good nutrition, intermittent fasting, keeping away from junk food, adding more high-quality fats and oils to my diet, and getting ample sleep with naps thrown in for good measure.
Those are really the cornerstones of my recovery. When I do all of them on a regular basis, I get better. If I overlook any one of them, I slide back in my progress. It’s an ongoing process, for sure.
This is Part 1 of a long post that (out of consideration for your time) I’ve split into two parts. The second part is here:
I’m having my butter-fat coffee this morning, thinking about how I’m going to plan my day. I have some back taxes work I have to do — I need to refile from prior years, because I messed up a couple of times and I need to make it right. Fortunately, I erred to my own disadvantage before, so fixing those errors and refiling will bring in a little extra money, which I can really use.
I had a pretty restful sleep last night. However, I woke up at 5 again, which I did not want to do, and I was pretty stiff and sore from all my activity yesterday. That’s the thing about getting a sudden burst of energy — I want to use it, I want to experience it, I want to feel what it’s like to really move again. So, my body ends up moving more than it has in a long time, and then I get sore.
Fortunately, it’s a “good sore” which is a sign that I’m getting stronger and more active. This is one of those rare cases where “pain is weakness leaving the body”.
I considered getting up, because I would love to have an extra useful hour or two in my day. But I was still pretty tired, so I stretched a little bit, then relaxed with my guided imagery recording, and went back to sleep with earplugs and eye mask. I have light-blocking curtains in my bedroom, but sometimes the light gets in, so I use an eye mask. In the winter when it is cold, I wear a winter cap in bed to keep warm, and I pull it down over my eyes to block the light. But now that it’s warmer, I can’t use the cap. So, the eye mask it is.
Something about the eye mask helps me sleep — it’s a Pavlovian response, I think. I usually use it when I am trying to fall asleep during the day, and it works. So, I have an ingrained response to relax when I put on my eye mask. And it worked. I got another hour of sleep, and I woke up feeling much more human.
Yesterday I had written about how it’s energy shortages that make me so tired, rather than lack of sleep. Well, let me just say that it’s really both that get me. If I’m over-tired, no matter how many high-quality fats I put in my body, I’m going to run out of steam. And if I don’t have enough high-quality fats in my system to convert into energy, all the sleep in the world isn’t going to fix me up.
One of the things that I think really bites mild TBI and concussion survivors in the ass, is also probably one of the most overlooked — The Energy Crisis. I think that people (especially health care providers) really don’t get how hard we have to work to reorient ourselves and retrain our brains after a mild TBI or concussion. There are so many subtle ways that our regular routines and regular thinking patterns are disrupted, and we can totally miss those subtle disruptions until they balloon in to bigger problems.
One thing after another goes wrong. Sometimes we see it, sometimes we don’t. Sometimes we catch it in time, sometimes we don’t. But so many little tiny things can be so different from before — even just feeling different — that it’s overwhelming. And the end results can be devastating — failing work performance, failing relationships, failing finances… failing everything.
For no apparent reason.
So, we end up either being hyper-vigilant and always on guard. Or we just give up and go with the flow, because who the hell can keep up with everything that’s getting screwed up? We go into either crisis prevention mode or crisis response mode. In either case, our lives are marked by crisis. One. After. Another.
And that is tiring. It is SO tiring.
So, we run out of steam. It can happen from just being overwhelmed by the sheer volume of adjustments — large and small. It can happen from feeling like we’re under constant attack from within and without — which we often are, as our internal systems are disrupted and the “ecosystem” we have been operating in starts to rag on us because we’re not keeping up. It can happen from being on a constant adrenaline rush, just trying to keep up and respond. It can come from crashes from all the junk food we eat to make ourselves feel less pain… to have more energy… or just take our minds off our troubles. Usually, it’s all of the above.
On all levels, we’re getting hit — our mental, emotional, physical, and spiritual existence is in turmoil. And it takes a huge amount of energy to keep up.
If we don’t get enough of the right kind of sleep, and we also don’t have the right physical support to keep going, our systems short out. I believe this is why mild TBI folks can actually see worse outcomes over the long term, with problems showing up years on down the line. All the little “hits” we take in the course of each day all contribute to our biochemical overload. There’s more and more “sludge” in our system, in the form of waste from stress hormones processing, to buildup from the junk foods we eat to keep going, and that sludge adds to our overall stress levels, causing us physical stress and strain — which then contributes to our mental and emotional instability.
And years on down the line, when we “should be fine”, things really unravel, and we end up in terrible shape, without any clue how or why — and nobody there to support us, because they don’t know why either, and they probably wouldn’t believe us if we told them.
It’s the day before the long weekend. I have three full days ahead of me to do whatever I so choose, and I plan to choose well. Have plenty of down-time. Take plenty of naps. Not stress out about everything, the way I have been for the past several months.
Most people I work with are working from home today, because they’re closing the office early – a little after noon – and nobody wants to spend the time driving back and forth. I’m going to go in, because it’s going to be quiet, very few people will be there, and the traffic promises to be light. Plus, the internet connection is so much better there — I can get more done in less time, which is the plan.
And then I’ll have my weekend free and clear to use as I please. Last weekend, I spent half my time on work-work stuff, which really wore me out. Even if I am working on my projects on the weekend, it’s nowhere near as taxing as doing other people’s work. There’s something about being able to set the agenda myself, being able to pick and choose what needs to be done, and knowing that I’m going to directly benefit from my work, that really picks me up and puts a spring in my step.
Speaking of having a spring in my step, I just got done with my morning warm-up. It feels good to move. I worked on my knees today — leg lifts are in order, because my knees have been giving me some problems. When I do my leg lefts — front, back, sideways, up, down — for a few days running, it actually helps my knees. Something about getting all the muscles around them engaged and working again… I’ve been working long hours, sitting and sitting and sitting… and it’s definitely taking its toll.
So, it’s up-and-at-em for me, first thing in the morning. I wash my face and hands in cold-cold water, brush my teeth, and head downstairs for some exercise. It takes me a little while to warm up, but once I get going, I’m good. I pretty much do whatever I feel will be good for me. Some mornings I do a lot of squats. Other mornings I do a bit of yoga-style stuff, with stretching and holding poses. Other mornings I just move in exaggerated ways, stretching and pushing myself a little bit — especially for my balance. After about 15 minutes of that, I’m done. I’m warmed up, I’m ready to go. I stress myself just a little bit, physically, then I drink my big glass of water and make my breakfast.
And it feels good. Physically, mentally, emotionally, and spiritually. Good.
The thing that feels the best, probably, is pushing myself… just a little… and then taking a break to catch up with myself. Stressing myself just enough to feel it, testing my limits, pushing my limits back — and out — and up/down/wherever — so that I know what it feels like to push the envelope. And after I recuperate and rest and rebuild, I usually find I’m stronger than I was before. Maybe just a little, but still, it’s something.
And days and weeks and months of “just a little better” all add up to being a whole lot better, years on down the line.
All of this would not be possible, if I didn’t push myself. If I didn’t test and stress my system just a little bit, and then recover, I would never get farther down the road I’m on. People tell me I have too much stress on myself, but I disagree. The problem is not the stress. Problems start when I don’t manage my stress properly.
I’ve believed this for years — that stress is actually good for you, it’s formative, it’s educational, it’s a key part of growth and positive change. And I’ve been finding some good reading, lately, that really concurs with what I believe. The first blog I’ve found is Getting Stronger, which talks a lot about “hormesis” — or dosing yourself with little bits of stress, so you can become more resilient and capable. I’ve picked up some great tips from that blog, as well as others the author links to. If nothing else, it’s incredibly satisfying to hear the author (and many of the other writers and thinkers he references) repeat out loud what’s in my head — and have the science to back it up.
The science is where I come up short. I just know what works for me, what keeps me on track. Having those references collected in such a comprehensive manner is hugely helpful.
I’ve also come across James E. Loehr’s book Stress for Success, which I’m working my way through right now. He shares the same belief as me, that it’s not the stress that gets you, it’s the way you handle it. And if you’re not up to the task — physically, mentally, emotionally, and spiritually — of handling stress, and if you don’t allow yourself ample time to recover, you’re going to get whacked around a lot, and ultimately lose out on what you’re trying to win.
Again, he’s got the science and the experience as a world-class sports psychologist/trainer, to back him up. Me? I’ve just got my own life experience. But that’s nothing to sneeze at. Looking at how I was just five years ago, versus today — night and day. Total transformation. Not bad, if I say so myself — and thanks to everyone (including a lot of readers here) for helping me make that happen.
The one place where I come up short, time and again, is with recovery. I get so tired, I can’t sleep. I can’t relax. I’m on edge — and part of me loves it. If I’m not in the right “fatigue range”, I am not getting to sleep, no way. The image at the top of the page shows a bit what I’m trying to communicate. Lots of energy with lots of fatigue, means I keep going, no matter what. So, I have to change it up and alter one factor — in my case, the energy/activity piece.
This is all part of appropriately managing TBI — knowing what sets you off, knowing what unhinges you, and then doing something about that. Finding out what works best for you, so you can have the kind of life you want, and then sticking with it. There is so much conflicting information out there — all of it supported by some sort of science or belief or faith, much of it advocated and defended by people who either have an agenda or who mean well but can’t see past their own experience. You have to decide what is best for YOU, what works for YOU, and most importantly what DOESN’T work for YOU.
A great example of this is Tim Ferriss, who I have known about for a number of years now, and whose book “The Four Hour Body” I looked into about a month ago. He’s got a lot of great information, mixed in with a lot of not-so-great information. He’s pretty controversial in certain circles, and I consider much of what he does to be suspect. He calls what he does “hacking” the system, but in a lot of cases, it seems like he’s just cheating and redefining the rules to suit his needs. That being said, I have gotten some incredible tips from him that have literally changed my life for the better, so that alone is good. Reading Tim Ferriss is a lot like having a meal at Golden Corral, the monster smorgasbord buffet type places that is laden with all sorts of foods — some that will enhance your life, some that can kill you at the right amounts. You have to be careful about what you choose to put into your system, and you definitely have to pace yourself. You can get overwhelmed quickly — and develop a nasty case of indigestion — if you don’t use your own judgment and take your time picking and choosing what you’ll put into your system. And you have to take time to digest afterwards.
It’s like that with pretty much my entire life, actually. I have to really take care to not overwhelm myself, because I am prone to fixate on things, get stuck in a groove, and keep going — at top speed — even past the point of there being a point. I feel like I’m making great progress, and I’m really making things happen, but I’m not. Even if I am, if I wear myself out in the process, like I did last week, I pay for it. Big-time. The price tag is high with me. I could NOT afford to lose last weekend, but I did. And now I have to find a better way to get things done.
So, stress itself is not the enemy. It’s the lack of recovery that gets me. I’ve been “overtraining” for years — decades, really. And I haven’t allowed myself ample time to catch up with myself. I’m usually working on something. Always working. Always thinking. Always doing something. And it takes a toll on me, to the point where I don’t even know what I’m doing — or why. It’s clear to me that I need ample recovery time to integrate everything that I take in and learn over the course of my days and weeks and months. My life is pretty much about pushing the envelope, and now that I’ve gotten to a certain point in my life where I’ve pushed about as much as I feel like pushing, it’s time to change gears and invest in serious recovery time, so I can continue to make good progress and not strip my gears.
With that in mind, in another couple of weeks, I’m going to be on vacation — leaving town for a whole week to decompress and unwind. For real. The deadline(s) will be past, the insanity of several projects will be behind me, and I get my life back. To do as I please, to work on what I choose.
Not just yet, though. For the next two weeks, it’s work like a crazy person, and then let it all go.
Now, speaking of getting things done, it’s time for me to get going to work.
I work with a handful of people who are constantly going-going-going. Their jobs are very involved and very demanding, and they also have a very close-knit team. They deal with a lot of different types of people on a daily basis, and they have a lot of agitation from the people they work with. One of the people who causes them agitation is me. I work with them on certain projects that are always time-sensitive and mission-critical, and which they are very much invested in.
I do like them, and I think they’ve got a great team. The one thing I don’t care for, is their need to be constantly ON, constantly up in arms about something, constantly stressed. Come to think of it, a lot of people I work with are like that — mainly because they have come up with some fixed idea in their minds about what should be done, and how it should be done, and they are practically welded to that fixed idea… and damn all evidence that it might not be as mission-critical as they believe it is.
Okay, so in fairness to everyone, their compensation is directly tied to what they deliver, when they deliver it, and how many victories they can declare in a set amount of time. Everybody wants to make a decent living, and everybody needs to pay their bills.
I’m just saying that the level of intensity and drama gets to be a little much, after a while, and despite their apparent belief that staying stressed and anxious and pumped, 60 hours a week, is the way to go, I know differently. At least, if you’re interested in having a long and healthy life. Stress and lack of sleep does terrible things to the body and the mind. The research is finally showing it, and people are finally paying attention. The thing of it is, our culture, our society (American, that is) has such an investment in high stress situations — work hard, play hard, with nothing in between — that to suggest something different might be in order is seen as, well, un-American. And we can’t have that.
You know, it’s kind of bizarre, actually… this fascination with stress. Then again, it isn’t. I know full well what it’s like to really feed on that sensation, to be constantly pushed forward — on-on-on, go-go-go — and never take your eye off the prize, no matter what’s going on around you. I know what it’s like to use stress as a potent pain-killer, to rely on it for my energy and my sense of purpose, to really soak it up and feel the power of a sustained, intense adrenaline rush. And I know why it’s so important to people who are continually rewarded — by themselves and their sense of self — for that kind of living.
Yeah, I know what that’s like, and I know what it’s like to crave that, to live for it, and to think that anyone who isn’t all about that is just plain lazy. Or stupid. Or unmotivated. Or whatever else you can think of that implies they’re not quite all there. And I know how hard it can be to disengage from that way of life, to either wean yourself off it, or go cold-turkey. I know how painful it can be, how frustrating, how alienating it can be.
But I also know what that kind of living does to you, internally and externally. I know what it can lead to, and I know what it can cost you. I know why people end up in mid-life crises, when they’ve been running at top speed for a couple of decades, then suddenly look around and realize — hey, this isn’t exactly what I was hoping for, when I started out down this road…
Most of all, I know that I would probably still be on that hamster wheel, grinding away day after day, if I hadn’t fallen, 8 years ago, and had everything start to disintegrate around me. I know that I would probably be looking around and wondering WTF?! when all my best-laid plans failed to come through, despite my herculean efforts, and I know that I’d probably be queueing up with my peers to buy some shiny, sexy object to boost my self-image, if I hadn’t fallen and been rendered incapable of keeping up that pace.
Right now, my attention is focused on staying calm in the midst of the storm. Because things are crazy, right now, and everyone around me is melting down in the adjustments to the New Way Things Are. Some are handling things better than others. Most people are alternately bitching and complaining and venting, and putting their heads down and driving through. They’re finding relief in drinking or some pharmaceutical solution, or they’re prepping their resumes to move on. In any case, there aren’t that many people who are truly chilling through it all.
But that’s my goal — to chill, through it all. To treat it like a movie I’m watching and not get too invested in the day-to-day drama and whatnot. There’s no resisting these changes, no matter how hard they are for us… and in the meantime, life goes on, we go about our business, live our lives, and if we’re lucky, we get a few things done. And then try to explain why the other things didn’t get done.
Anyway, speaking of getting things done, it’s time for me to get ready for work and head into the fray again. I know how important it is to stay chilled, to stay steady, to not get too tweaked over everything, and I’m stepping up my breathing and relaxation activities to offset the drama. Truly, it is helping me… and keeping track of how I’m doing physically — if I’m tense, if I’m not really breathing much, if I’m getting agitated and worked up — is helping me to manage my physical state, which also helps me manage the changes around me.
Keeping my heart rate steady… keeping my stress response chilled… keeping my head about me, and working at being resilient… these are my intentions and my focus, these days.
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.
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.
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.
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.
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.
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.
See, here’s the thing – when you’ve been through a truckload of trauma (be it combat, assault, disaster, car accident, traumatic surgery, random violence, or some other life-altering/impacting event that seems like it’s going to kill you), your body responds the way any living organism would. It floods your system with biochemicals to either help you escape or make dying less painful. And if you do neither — you can’t escape, but you don’t die — there’s this huge backlog of chemicals still stuck in your bloodstream.
If you’ve ever been a flood victim, you know what it’s like — the waters rise, sometimes very quickly, and then they recede. When they go, they can take with them some of the most precious belongings you own… they can wash out roads and compromise foundations of buildings, and turn a familiar place into a hellhole. And what’s left, when all the water is gone, is this nasty goo and muck that you have to wash out, sweep out, clean out. Sometimes you can never get it out completely. And the odor stays in that place for years afterwards.
That’s sort of like what happens when you go through intense trauma, and you end up surviving (despite how things looked when you were going through it all). Your body has responded the way it’s supposed to — adrenaline, noradrenaline, epinephrine, cortisol, glucose, and more… it’s all poured into your bloodstream, your muscles, your soft tissues, to help you get through it all.
But once you’re on the other side, even though your body doesn’t need those chemicals anymore, it doesn’t know it. It’s your body. It’s on autopilot. And it’s so fried from the experience(s) it’s been through, it can’t think straight.
And you end up extremely jumpy over every little thing. It’s not “just stress” — it’s something much bigger and much badder. It’s your body expecting and planning for more danger, being on high alert — whether it needs to be or not — because that’s what helped you before. That’s what helped you get through. And as your body continues to hyper-react to the world around you (it thinks it’s protecting you, the same way it did before), you end up marinating in this stress chemical soup that becomes a self-fulfilling prophecy and a self-perpetuating loop.
People keep telling you to “relax” — clearly, they don’t understand what’s going on with you. They just don’t get it.
So, what to do? You can’t go on indefinitely, stewing in your own stress juices. You’ve got to do something. I should know — I’m one of those people who was on high alert for years, thanks to my body being convinced that it needed to be. Couldn’t relax. Didn’t want to relax. Relaxation meant danger. It meant death, to my wired system. Relax? Ha! But still, I just couldn’t go on like that.
Here’s what I’ve done that has actually helped me. In more ways than I can say.
I exercise. Not fanatically, not extremely, like some folks do. But I do it religiously, with a daily discipline that surprises me sometimes. I get up in the morning, do controlled breathing exercises (to counteract out my always-at-the-ready fight-flight response) and then I get on the exercise bike for 10-20 minutes. If I’m away from home, I do some other sort of exercise for 10-20 minutes. I do knee bends. Light calisthenics. Jumping jacks. Anything to get my body moving and get the blood flowing. As I do it, I imagine my veins and arteries and muscles clearing out the gunk from years of always-on alertness, and I breathe into it. I push myself, on and off, to get myself in a frame of mind to focus in and finish what I’ve started. If I’m riding the bike, I do intervals that really make me work at it — I’ll ride hard for about a minute, then pedal slowly for 15-30 seconds, then I’ll ride hard again for about a minute. If I’m not on the bike, I push myself with the jumping jacks or the arm/leg raises.
After the bike or calisthenics, I stretch and then do some light weight lifting. The lifting (I use relatively light dumbbells) is important for building strength to help with my balance and overall physical stamina. It also feels good.
Again, I don’t go overboard with this. I stay focused and keep it limited to about 30 minutes a day, because I have to get on with my day, and I can’t spend all my time working out.
The results, as I said, have been phenomenal. My mood issues — the extreme ups and downs and violent temper flares — have lessened to about 15% of what they once were. Once upon a time, I was very difficult to be around, if I was tired or agitated or anxious. I’m not like that anymore. I’m literally a different person. I look people in the eye. I listen to what they have to say. I am involved in my own life on a level that I never before thought possible. And it just keeps getting better.
So, if you’re struggling with TBI and/or PTSD, I really encourage you to start exercising first thing in the morning. First thing is important, because it gets your metabolism going better, and it also gets you woken up in ways not even a cup of coffee can. It’s good for your head and it’s good for your heart, and it helps you fight off infection and sickness as well as strengthens your whole system.
I’m probably sounding like a religious convert, and in a way, I am. I truly want to testify that the impact on my life has been nothing short of phenomenal. I believe it has a lot to do with me clearing out the biochemical sludge from all those floods of emotion and stress and hyper-reaction over the years of being ON. Seriously — I was so driven, so pumped up all the time, someone close to me once said was the most driven person they knew. At the time, I thought it was a compliment, but now I realize it had a price.
Now, there are experts who say you need to do moderate-to-intense exercise 30-60 minutes a day, 5 days a week. My life was changed (at first) by 15-20 minutes of light exercise every morning… and it slowly evolved into 30-45 minutes of light-to-moderate exercise. Do what you can, and work from there. But do it.
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:
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.