The Self alone is not the only thing that can get lost after TBI. Along with the Loss of Self, there’s the Loss of your Sense-Of-Self1.
Your Sense-Of-Self is that level of comfort you have with yourself. It’s how comfortable you feel in your own skin. It’s the feeling you have of being “in your proper place” that gives you confidence and security. It’s a very physical sensation, a visceral experience, that sets the stage for what our mind thinks about our surroundings. Our Sense tells us if we’re safe, if we’re competent, if we are up to handling the world around us.
If your Sense-Of-Self is disrupted, nothing feels safe. Nothing feels familiar. You may recognize your surroundings, but they don’t feel the same. You don’t feel the same. And because you don’t have a consistent sense of yourself in your surroundings, it sets off all sorts of alarm bells that you are not safe. IT IS NOT SAFE. Cue the fight-flight-freeze response. Cue the adrenaline rush. You’re on edge… often for reasons you cannot detect or determine. Something just doesn’t feel right. And that “something” is you.
As I discussed earlier, the “Self” is the part of us that keeps reliably showing up. It’s the part of us that we recognize as uniquely us, which sets us apart from everyone else, and feels familiar and comfortable on a deep, fundamental level. It’s who we are — and who we can expect ourselves to be in the course of everyday life. And our Sense-Of-Self is the level of physical, mental, emotional, and spiritual comfort we feel with this familiar Self. Our Sense-Of-Self is the underlying foundation of confidence we have in living in our own skin, and our level of surety we have in what we believe we will do under different circumstances. In many ways, the Sense-Of-Self is our safety net that allows us to walk into unfamiliar situations with the confidence that we will “just know” how to handle conditions we may have not encountered before. We’re solid in who we know ourselves to be. We have faith in our Sense-Of-Self. We can depend on the person we have become over the course of our lives, to do the kinds of things we expect in even the most challenging situations.
And when that Sense-Of-Self is damaged, all hell breaks loose. Literally. Not only do we not know who we are anymore, but we also have no one to reliably depend on to make the right decisions and take the right actions in the future. We watch ourselves doing things and handling situations in ways that we never would have handled them before. We hear ourselves saying things that don’t “sound like us” and that seem to be coming out of a stranger’s mouth. We witness the internal reactions to things that never used to faze us before – we explode inside, when we drop a spoon… we get tied up in knots when we can’t understand what someone is saying to us… we get bent out of shape over little things that we rationally know should not be bothering us… we weep bitter tears for hours over things that other people take in stride. All of these experiences tell us that we’re living in a stranger’s life, and the person we once were – who we worked so hard to become – has abandoned us to the world and left an idiot it their place.
And that idiot keeps screwing everything up.
Our Sense-Of-Self becomes damaged… fragmented… shattered. Over time, one experience after another of watching yourself behave like a stranger undercuts the most basic foundations of our confidence, and erodes all the assumptions and knowledge we’ve built up about ourselves in the course of a lifetime. Your best friend and longest companion – the person you once knew yourself to be – has deserted you without a trace.
Having a fragmented Sense-Of-Self isn’t just troubling. It can be terrifying. How are you supposed to function in the world without the person you know yourself to be? How are you supposed to interact with friends, family, and strangers, if you can’t rely on the person you once were, to handle all of that? How are you supposed to function in the larger world, if all your usual reactions are gone without a trace… or just different enough that you’re never sure how you’re going to handle things? How are you going to keep a job? Pay the bills? Be the person other people need you to be?
If these issues persist over time, the cumulative results can be catastrophic. Because living your life as a stranger to yourself and having no reliable sense of who you are is more stressful than the average everyday person can imagine. It’s cumulative stress, too, each traumatic challenge producing stress reactions and hormonal overloads that never fully get cleared… one after another, the biochemical stress load builds up, the experience of stress itself produces yet more stress, and the trauma becomes entrenched. The brain becomes more wired to “kindle” (think of a pile of tinder catching fire – bursting into flame) and produces a trauma response, with each subsequent experience. And on any given day, there can be tens, if not hundreds, of these kinds of experiences. Small and large, they come and go, and they become so customary they feel like your “new normal”.
The trauma of traumatic brain injury doesn’t end with the cause of the brain injury itself, when you lose your Sense-Of-Self. It continues, non-stop, through the years in a brain-injured individual who has become a stranger to themself.
It’s no wonder that the numbers for long-term outcomes for brain injury (even so-called “mild” traumatic brain injury) tell such a dismal tale . Experts can’t seem to figure out why folks who experience a “mild” brain injury slide downhill and degenerate. It’s no mystery to me. Over time, without a clear sense of who you are and a confidence in what you can do, the very thing that makes it possible to get on with your life and engage with new situations – a solid Sense-Of-Self – is eroded like a canyon cut deep into the earth by a flowing river over millennia. The erosion doesn’t happen once. It happens over and over, each traumatic situation undercutting your confidence and adding to the mental and biochemical stress.
In my mind (and also in my experience), losing your Sense-Of-Self plays just as significant a part in traumatic brain injury’s impacts, as the Loss of Self. Losing your Self is confusing, disorienting, and sometimes disabling in those moments when you need to call up your Self’s abilities to deal with things. Losing your Sense-Of-Self, however, creates a far more pervasive sense of alienation and helplessness. It stops you from even attempting to reach down deep inside to find that part of yourSelf that will get you through any challenges you face. With a loss of Self, you’re impaired in the moment. With a lost Sense-Of-Self, you lose the will to even find out whether or not you have what it takes to rise to the occasion.
And it’s been my experience that restoring a stable and coherent Sense-Of-Self is in many ways as important as redefining the Self alone – if not moreso.
Because our Sense-Of-Self involves not only the brain and the mind, but the whole body. That fact is something that seems to get lost in brain injury recovery discussions. Everybody is narrowly focused on the mind and brain and what goes on inside your skull, as though that’s all that really matters.
But the body is more closely connected with the brain – and the mind – than folks like Descartes could ever imagine. To this day, there are still people who treat the contents of our skulls as separate from the rest of us. But in the past decades, we’ve learned how untrue and unfair this separation is. We know know that the body “keeps a record” of the traumas it experiences, and it creates biochemical reactions that respond to situations even before the conscious mind is aware. The body’s constant “dialogue” with the outside world – its split-second interpretation of a shadow approaching quickly from the left side of our peripheral vision as “friend” or “foe”, and the chemical messages it sends to our brains about how we should react to this approaching shadow, set the stage for our whole experience. We don’t even have to think, to figure out if the shadow is a lover or an adversary. Our bodies’ subconscious processes and directions to our brains take care of much of that processing up front.
When the whole body is involved in your lived experience (as it will always be), it affects your brain in significant ways that can precede conscious thought and hijack your best intentions even before you realize it’s happening. In fact, that’s how we’re built. The problem arises, when we have one bad experience after another – threat, confusion, helplessness, frustration – and our bodies get in the habit of kicking off a fight-flight response to every situation, no matter what the true nature of it. When your system is trained to go on the offensive as a defensive tactic against situations that seem threatening, you can find yourself blowing up over nothing. You can find yourself throwing, hitting, breaking things… getting into fistfights over a poorly chosen (or misunderstood) word… flying into a rage over what another driver did, and chasing them down the road in a fit of righteous anger… and eventually shutting down from overwhelm. It’s stressful. And because of the nature of it – involving a perceived threat to your existence, as well as elements of helplessness – it’s traumatic.
It’s also cumulative. If it never gets cleared out of our systems, it builds up and puts even more stress on our systems, which increases our sense of danger and threat and helplessness. The stress itself becomes traumatizing. And since cumulative stress has been shown to negatively impact the ability to learn and reason clearly, our thinking gets muddled and we rely more on our habits and training to interpret the world around us. Our training tells us the world is a dangerous place, and we are helpless to do anything but fight for our lives.
You see where the cycle is going? It doesn’t take much to see where it leads.
A compromised Sense-Of-Self, in my experience, produces exactly this kind of stress – traumatic stress. Not recognizing your Self, not trusting your Self to handle things, not knowing what to expect from your Self… all that puts you on edge in ways that don’t make logical sense. And unless you’re trained in mind-body techniques that attune your mind’s awareness with your physiological state and manage what you do with your physical sense of the world, that edginess gets entrenched and can be extremely difficult to dislodge. It “takes up space” in your experience… far outside the reach of conscious awareness. It’s there, but it’s just out of range of conscious detection. And all the while, it puts considerable pressure on the inner wiring / chemistry of the body, as well as the parts of the brain which are devoted to learning and overall functioning in your private and public life.
So, while brain injury is usually thought of in terms of what happens inside the skull, we don’t dare forget the injury that happens both inside and outside the skull. The injury doesn’t just happen when you get clunked in the head. It continues to happen, for as long as you don’t recognize your Self, and as long as you become less and less familiar with the person you now are… compared to the person you used to be.
So, just as the Self is the person we recognize as “who we are”, our Sense-Of-Self is a “felt sense” we have of the Self that is comfortable, confident, and put at ease by the predictability of how we express our Self. That familiar feeling reinforces our understanding of who we are, when we experience our Self behaving predictably in various situations.
And that Sense-Of-Self plays a critical role in allowing us to fully express who and what we understand ourselves to be. Our Sense-Of-Self makes it possible for us to step forward into life with confidence and self-awareness. In fact, unless we have a solid Sense-Of-Self, we cannot rely on our self-awareness. Or self-confidence. Or any other sort of self-possession. We have to believe in our unconscious minds, in our pre-conscious processing, that we will be able to have or produce a certain kind of outcome or result, when we take a certain action. We have to feel confident about what we believe we’ll be able to effect, and even if things turn out differently than expected or planned, we need to have a deeper understanding of who and what we are, in order to learn and adjust.
When you’re dealing with life through the eyes of someone with a fragmented Sense-Of-Self, you can never know – for sure – what will come of your attempts. You have been trained, through one failure after another, that you cannot trust the Self you think you once had. You cannot even trust the memory of the Self you believe you once were. You have no way of knowing, for certain, if anything will actually work for you, if you try. You’ve had too many experiences with failure, too many confidence-shaking and unwelcome surprises, too many expressions of shock or dismay from others who expect you to be one way, then turn out to be another.
So, why even bother?
Yes, Sense-Of-Self matters when you’re recovering from TBI. It matters very much.
1The hyphens are mine, because I am treating the sense as a distinct thing in itself