The Rope Swing

There was a rope swing over a river when I was a teenager.   The swing flew over an embankment that dropped off over the river bank.  It was quite steep.  To me it seemed like it was 50 feet high.  In hindsight, it was probably closer to five.

The inlet of the river had a sudden drop off in depth where someone would land when they let go of the rope.  If you didn’t, you got dragged back into the shallow are and got scraped up and bruised.  Then you’d have to make the “Walk of Shame” up the hill.  I was scraped and bruised often.  Eventually I gave up. 

My sister and I returned to the rope swing the next summer.  I made the “Walk of Shame” a few times.  Finally I took the risk and let go of the rope.  I loved the sensation of flying and then landing in the cold river water.  We spent the afternoon at the rope and returned several times over that summer.

Letting go of the rope was frightening.  It was s risk.  So I was battered by the choice that seemed safer: riding the rope back to shore. Even facing the “Walk” I still opted for the “safety” that I knew.  In the end, letting go meant moving forward into an enjoyable experience.  

I’m being battered on the rope mentally, physically, emotionally, and spiritually right now.  I don’t know what’s in the water or how to let go.  Where will I end up if I do?  The rope is holding me back.  But how do I let go?  What rope is holding you back?  Is it time we all let go?

Depression, Anxiety, PTSD, and Brain Injury…

Oh, My…..

This started as a blog about recovery from Traumatic Brain Injury and morphed into one about depression, anxiety, and PTSD.  Or did it really morph at all? They all are tied together in a complex knot of emotion, brain functions, and physical responses.  

The statistics on the number of people with depression varies slightly between research studies.  I’m going with the statistics found on Brain Line.  One in ten people without brain injury will suffer from depression.  Three in ten brain injury survivors will develop depression.  Sadness and grief are normal reactions to brain injury.  Depression is more serious and lasts longer. Developing depression is more common if the survivor had a previous experience with it.  Depression can be a chronic, life long medical problem

According to Dr. Marchand, the risk of recurrence — “relapse after full remission” — for a person who’s had one episode of depression is 50 percent. For a person with two episodes, the risk is about 70 percent. For someone with three episodes or more, the risk rises to around 90 percent.

Depression Relapse

Many of the symptoms of depression and brain injury overlap: fatigue, slow cognition, problems with concentration, lack of energy, sleep changes, irritability. Anxiety is common after brain injury.  It also goes hand and hand with depression.  

Whelan-Goodinson, R, Ponsford, J, Johnston, L and Grant, F (2009). Journal of Head Trauma Rehabilitation, Vol. 24(5), pp 324-332.

This research found that more than 60 percent of people with a brain injury had psychiatric disorders up to 5.5 years post-injury. Many of these were new cases of depression and anxiety and were not present prior to injury. The authors suggest that individuals with TBI should be screened for psychiatric disorders several times post-injury regardless of pre-injury psychiatric status, so that appropriate help can be offered.
Anxiety and Depression

Depression and anxiety may develop right after the injury or years later.  The can develop in any survivor, no matter if the brain injury was mild, moderate, or severe.

I had depression prior to the injury.  I followed the pattern of  depression relapse several times over decades. It is more serious and does not respond to medication as well post injury.   I never noticed anxiety symptoms.  If anxiety existed, it wasn’t at the level it bothered me or interfered with my life at the same level as the Dreaded D.  I now live with the burdens of anxiety and depression. In addition, I have panic attacks if overwhelmed. 

PTSD can develop as a result of the cause of the brain injury.  If it was a preexisting condition,it may worsen.  It is an anxiety disorder brought upon by trauma.  There is an overlap of symptoms of brain injury, Generalized Anxiety Disorder, depression.  

Sucidal thoughts are frequent. So many times I just want to give up.  It’s overwhelming. 

I was obsessed with figuring out what symptoms were caused by what issue: Depression, anxiety, PTSD, and/or brain injury. I finally came to the conclusion that it really didn’t matter.  I had to deal with the issues.  Currently I am in Cognitive Behavioral Therapy.  I’m also working with a neuropsychiatrist to figure out medications might help.  It’s frustrating because my brain just doesn’t respond as before.  There is physical damage that cause changes in the neurons along with the development and effectiveness of neurotransmitters .  

It’s opening Pandora’s Box.  Chaos.  

Quote of the Day

One of the hardest lessons of life is letting go.  Whether it is guilt, anger, love, loss, or betrayal.  Change is never easy. We fight to hold on and we fight to let go. ~~ Unknown 

This quote is a path to develop a happier life.  We hold on to so much pain and sadness because we can’t let go.

 Depression and PTSD are both rooted in worldview, self beliefs, and experiences we have in life.  My struggle with PTSD and depression started with a betrayal of trust.  After the event, I never quite trusted people again.  I like people, I have friends, I love my family.  But, I still keep a sense of distance between myself and them.  For example, I never had a romantic relationship.  I’m fairly happy single but I sometimes wonder how life would be different if I allowed myself to trust, and maybe love, again.  I just can’t get there.  

My world view changed.  So did my self-image and beliefs.  I always pushed hard against these and for years it more or less worked.  Often PTSD issues from a traumatic event in the past are made worse, maybe triggered, by another trauma.  The more trauma, the more thoughts and beliefs are reinforced .  They become so strong they are reality for that individual. This is what happened to make my PTSD worse.  The car accident.  I don’t have any PTSD issues regarding the accident.  Yet, it triggered the unresolved crap in the past.  The coping and management skills I used are gone.  This is in part due to the actual physical damage to my brain and in part because of yet another trauma leading to an increased sense of danger, weakness, and helplessness. 

Depression often appears with PTSD.  Preexisting depression is worsened or new depression is developed.  Depression is also about distorted views of self and/or the world.  As my PTSD worsened, so did my depression.  

Eveyone needs to learn the lesson of letting go.   

“It’s not that we can’t let go of the past.  The past can’t let go of us.”  PTSD is a trap.  It’s an attempt to stay safe.  We don’t let go because for us it’s a matter of survival and safety.  Those “protective” beliefs and the physical responses become wired into the brain.  We hold on.  But we hunger to let go. 

It’s not as easy

People say happiness is a choice.  Let go of the past.  Stop thinking.  It’s not as easy as it seems.  Everyone struggles to choose to be happy.  Life is stressful, there are disappointments, there are challenges and strife.  Sometimes there is trauma.  The choice of happiness is harder for people facing mental health issues.

PTSD, anxiety, depression.  They’re in your mind and in your head.  The negative thoughts, the fear, the distorted views of life all combine to shroud life in hopelessness, darkness, loneliness.  The burden is heavy and yet it’s nearly impossible to put down.  My soul shrinks or whithers on the vine.

One cornerstone of Cognitive Behavioral Therapy is to recognize the distorted thoughts that feed the symptoms and challenge them.  It seems easy when it is said.  It’s not so easy to apply.  Depression and PTSD lie.  But the lies appear as the truth because the worldview is twisted. There’s just enough accuracy to the protective, skewed world view to make it even tougher to challenge successfully. The skewed thought creeps in when it’s least expected.  

Being happy isn’t a simple choice. It’s work.  It’s choosing what I need to do to heal every day, especially when the “fuck its” set in.  

It’s oversimplified to say happiness is a choice. Some people are struggling with depression, anxiety, PTSD, and other conditions that make it challenging to find peace and joy.  But challenging doesn’t mean impossible. It’s more accurate to say, “Happiness takes a lot of choices, some of which are hard to make.” Like the choice to accept ourselves and our struggles, the choice to accept responsibility for getting help, and the choice to do things that are good for us even when- especially when- we feel like giving up.  

Lori  Deschene

Peace and joy seem like an impossible dream right now; one disconnected from the reality of a world of chaos, fear, hate- both externally and internally.  The choice now is to keep going, do the things that are good for me, get over my bullshit about actually accepting help instead of trying to deal with it myself.  

Maybe joy and peace are daily choices for everyone.  No emotion or situation is permanent. I’ll try to choose something different.  Maybe I’ll eventually build some peace and joy again.  Or at least get things better than “fuck it.”

In the Mud

I won’t be going to the creative writing group at the VA any more.  I can’t afford the vulnerability in an open group.  It’s not designed to be a process or a therapeutic group.  The focus is on being creative, sharing, and having fun. 

Yesterday’s topic hit too close to something that consumes my life: finding meaning.  The question was “What do you want to be when you grow up?” including present dreams as well as those from childhood.  We never quit growing, so in a sense, we still are “children.”

Wonderful.  The problem: I have no dreams anymore.  I was fulfilled and happy with my life before the brain injury.  It’s something I’ll never have again.  It’s harsh but true.  What I wanted as a child morphed as my life unfolded.  I didn’t “lose” the dreams, they redirected into hobbies or avocations while my draw towards social work became stronger as I understood myself better.  That door is now welded shut and I can’t find a fucking window either. 

I’m pondering these things and trying to put them down on paper.  I fight back the tears.  An open group is not the place to go into meltdown.  I shift topics into something more lighthearted: trying to write a poem about a workout I ran that morning.  Still, there’s a growing sense of nausea, fear, an aching sadness.  I get up and leave. 

The tears fell.  I swallowed a lump of despair.  And threw up on the grass.  At this point, I ran.  I’m in my car, huddled under a blanket, in complete meltdown and panic attack.  Of course, I’m hiding under a blanket.  I hardly wanted some well-meaning vet, or staff member,  going up to mental health reporting that someone’s flipping out in a car.  So, I hide.  That’s no time to be vulnerable.  Nope.

The social worker running the group called later to see if I was ok.  “I wasn’t feeling too not.  Think I’m down with a stomach virus,.”  It was just a little stretch of the truth. I wasn’t feeling well and I did throw up.  It is a “virus” of a sort.  It’s one of hopelessness and anxiety.  I don’t tell her. I’m not going to try to express something like this  verbally over the phone or in person.  Aphasia sucks.  It’s difficult to find words verbally.    I noped out on that conversation.  

So, I’m noping out on creative writing.  Being vulnerable in that setting is not safe.  There’s a “no shit” comment.  Being vulnerable at all isn’t safe.  I can write in the safety of my own home.  It doesn’t matter if I meltdown.  I’m here.  Brighid is here.  It’s safe.  It’s comfortable.  I don’t have to worry about getting home.  I didn’t go to the VA today.  I was supposed to go to Tai Chi.  I didn’t want to leave the house so I stayed home. I get a gold star in avoidance. 

Today, I wrote about the topic of dreams for the future.

in the mud my feet sticking to the slop

i’m covered in filth 

and the rain keeps falling.

i remember a time of hope and dreams

sunshine and  clouds 

yet a future filled with promise.

now i stand in the mud

dreams shattered in glass and twisted metal 

broken in a second’s time.

there is no future in the mud

I wish that I could get out of the mud and get a shower.  I wish I knew what I want for the future.  I wish there is a future.

No.  I’m not suicidal.  I’m stuck in the fucking mud.

Grief and Bargaining 

Initially I thought bargaining was a stage that I either hadn’t experienced and probably wouldn’t.  Grief is different for everyone.  It is possible to skip a stage.  One can also cycle back to earlier stages.

I considered bargaining as quid pro quo from a spiritual standpoint, “Give me this and I’ll do that.”  While researching the Stages of Grief (Kubler-Ross), I found the Changing Minds website.  They summed up bargaining as seeking a way out of the situation.

It continues with  an in depth definition:

After the fires of anger have been blow out, the next stage is a desperate round of bargaining, seeking ways to avoid having the bad thing happen. Bargaining is thus a vain expression of hope that the bad news is reversible.

Bargaining in illness includes seeking alternative therapies and experimental drugs. In organizations, it includes offering to work for less money (or even none!), offering to do alternative work or be demoted down the hierarchy. One’s loyalties, debts and dependants may be paraded as evidence of the essentiality of being saved.

I actually experienced bargaining and denial at the same time; the behaviors and thoughts overlapped.  I kept working at reduced duties and kept trying to move to harder work before I was ready.  (denial/ bargaining) I was convinced if I just worked hard enough I would heal fully in time to deploy with my unit. I’d be an outstanding Social Worker and therapist, making a huge positive impact (bargaining). When it became clear that I wouldn’t meet that timeline, the goal  became deploying with another unit later.  I sought after every damn therapy under the face of the earth for years. I kept pushing. When all this failed, I fell into anger and depression.

While proofreading this entry, I realized that I did bargain with the Deity in a slightly different form. There was a lot of pleading for healing so I could return to my career.   I still ask for this.  I can use what happened to me to help others with a greater level of understanding and skill. Grieving can be subtle.

Expanded Stages of Grief

  1. Stability
  2. Immobilization
  3. Shock
  4. Denial
  5. Anger
  6. Bargaining
  7.  Depression
  8. Testing
  9. Acceptance

I’ll explore the rest of the expanded grief cycle during future posts.
Grief hurts but it’s the only way to find the “new normal” (acceptance).