Wednesday, April 29, 2015

The looping cycle of PTSD and TBI in his battle-zone brain.

My understanding of the dance between Dean's PTSD and TBI is deepening. I've learned a few things this year about how the two injuries affect each other.

PTSD (Post Traumatic Stress Disorder) is a STRESS disorder. Dean's was caused by being in almost constant danger and under surprise attack daily, when someone is trying to kill you and all your battle buddies your body responds with all it's wonderous chemicals to aid you in saving your life! That's our "fight or flight" system. For the average civilian, who also experiences moments of fight or flight, the scenario causing the panic subsides and our brain chemicals normalize and we can find our calmness again. Since Dean's system had to be in overdrive day in and day out for many, many months, his brain chemicals don't know how to properly regulate themselves. Now, when he encounters stressors, his brain floods him with fight or flight even if the stressors aren't ones that could injure you.

Think of the stressors in our everyday lives - we can't find our shoes and we're going to be late, we bump into a corner and spill a bit of our coffee on ourselves, someone calls us while we are eating breakfast and they are upset, we get a bill that we didn't expect and now have to wonder how that will fit into the budget, our child gets hurt and abruptly breaks out in a cry from the other room, etc. These stressors occur to everyone, everyday. They are no big deal really....on the grand scheme of things. Our daily stressors aren't causing us to have to battle some attacker in order to save our life.

When our brain responds to stressors with a flood of chemicals, our body experiences symptoms like racing heartbeat, more blood gets sent to our skin making us flushed and warm and we may even sweat, our brain becomes ultra focused on the threat, we have momentary increased strength and stamina, etc. Think of if you've ever encountered a person in the throws of major stress (a parent who just lost her child in the park, someone who just had a car accident, etc), they are freaking out a bit....breathing fast, confused, very focused on the event that is causing the stress, red, racing heart beat, scrambling around but not having much logic...they are stressed!

Dean's PTSD now causes his brain to respond improperly to small, daily stressors. His body doesn't know the difference and so he gets all the physical symptoms like the ones I mentioned above.

Now let's add a layer that complicates it a bit. When Dean has one of these stressors, say he dribbles coffee onto his shirt, his body floods him with chemicals that cause him to immediately be ready to kill the wall he just bumped. He is PISSED! He tries to realize that it's just coffee, it's easy to clean, it's no big deal, watch how you act....your son is don't want to scare him....(these are all great skills Dean has that not every warfighter with PTSD has) and then the next layer kicks in. He then gets mad at himself that spilling a little coffee made him that angry. He's mad that people may have seen him freak out over coffee. He gets defensive and just wants everyone to get the fuck away from him, stop looking at him, don't help him, leave him alone and he continues this cycle of "mad at himself" until he can go be by himself to regroup his thoughts and calm his body's symptoms down.

I haven't even mentioned the complexity that the TBI adds far that's just his PTSD. His stress response is broken and blows little things out of proportion and he has no control over the flood of chemicals his brain decides to dump into his body causing him to just lose his marbles!

His TBI has it's own symptoms.

  • He can't process incoming information quickly, kind of like when you are trying to learn some really difficult math and you're in class the first day while the teacher is explaining concepts you don't know yet. 
  • He can't respond or communicate quickly, kind of like when you are learning a foreign language and your teacher asks you a question in French and wants you to respond in French back and you have to piece together a sentence with words you don't know how to access. 
  • He is often confused because he doesn't live in a whole picture with all the context there for him to understand. This would be like when you first walk up on a scene and don't have a clue what is happening, what just happened, who is involved, etc. There is a confusion taking place while you gather data to paint a whole picture for yourself. He lives without that whole picture because his memories don't stick. He can't really gather the missing data because that's another TBI challenge. He mostly just has to try and function without the whole picture or the memories that he thinks he has are incorrect and he pieces together a picture that is wrong. 
  • He can't see, feel, or experience himself accurately. He doesn't know when ate or if he's hungry or that the dizziness he's feeling is because it's been 10 hours since he last ate or that the stomach ache he's feeling is because all he's eaten for the day is sugar cereal. He doesn't realize his eyes are hurting and causing the headache he's getting because the light is too bright and he should put on the sunglasses that are hanging on his shirt. He doesn't know that he feels like he's falling down because he's in a room with stripes on the carpet. He doesn't know that he feels really sick throughout his body because a stressful day is coming up that he doesn't remember. He doesn't know why walking through a room feels like he's walking under 1000 feet of water with the sounds being muffled and him feeling heavy weight all around him and his body is pushing against a resistance he can't see. He has body sensations that he doesn't understand the cause of and just kind of trudges along not being a "complainer" about it but not knowing what is wrong either. 
With all these symptoms of TBI, when we add them to a stressful situation, they get a say too. Sometimes the TBI affects how the stressor begins or happens, sometimes it affects how he responds, sometimes it affects the results or aftermath of the stressor, and sometimes it affects some or all of them randomly.   

I'll give you some examples:

  • TBI affecting how the stressor begins: bumping a wall, spilling coffee on his shirt - His TBI is causing him to experience more vertigo this morning so he's feeling clumsy, he doesn't know it's because yesterday we went to the hardware store. Since he's off balance he bumps into a wall and spills his coffee, he gets mad that he's so damn uncoordinated and can't control his own body and that no matter how hard he tries he just can't make it happen! 
  • TBI affecting how he responds: he gets a phone call - He feels like he wants to answer the phone and says "hello". The person on the other end begins talking and Dean doesn't know who it is or what they are talking about. He can't figure out what they want or why they are calling. He picks up on a few key words and tries to run them through his memory to see if it pulls up any files to clue him in to the conversation. The person is continuing to talk while Dean is still trying to figure out who it is. Now he needs to interrupt the person and ask them to SLOW DOWN, not to speak so fast, that he has a brain injury and can't keep up with them. He asks them who they are. He realizes this is sister and so instead of getting mad he smiles as now registering her voice with his good memories, he feels love for her and is happy she called. He tries to engage in small talk so that he can keep hearing her voice. He realizes that after 5 minutes of trying to keep up he's very tired and he needs to get off the phone. He thinks of some words to say that can get him off a phone call pretty quickly, like "Well I have to get outside and feed the animals", or "Little Dean needs me so I gotta go". He ends the call happy but tired and his brain hurting. Now he needs to recover with silence for a while.
  • TBI affecting the aftermath of a situation: he's watching tv - He's watching some program on the History Channel for a couple hours. He decides that it's time to go out to the shop to get some work done. Later I go out to see how he's doing and he starts talking about some strategy in some battle that was really stupid and it's making him agitated. He doesn't know if it was 10 years ago, 1 year ago, 1 week ago, or 1 hour ago that he watched a program about this but now he's a little preoccupied with the stupidity of some guy in history and how if that one guy had done something different all of history would be changed and on and on. Now that he's agitated he's making more mistakes in the shop, having to redo tasks over and over again because he keeps losing focus. 
Any one of the above examples (or thousands more) causes him stress which then loops into the brain chemical response which loops into the TBI confusion into a cycle that because it affects every facet of his day to day life, the cycle doesn't really end. One loop pours into the next and on and on. Part of what I do is to keep track of what he's doing so I can know what is triggering something or causing something and then I offer explanations which sometimes helps him not feel "crazy". I also try to add in positive stimuli at every turn such as wearing the perfume he likes because that activates a happy, loving feeling in him which can turn a bad moment into a normal moment or cooking him a favorite food or giving him a hug or saying a loving word to him. These little positive things can help his battle-zone brain to have a tie to reality and to the love of his family which is the reason he stays in the battle rather than giving up. 

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