Brain Injury and PTSD: Adventures in Brain

sunset guanacaste
A soothing picture of a sunset in Costa Rica

Continuing with things I needed to understand about my brain:

For previous BI and PTSD posts look under the category to the right.

  • BI: Diffuse Brain Injuries – these aren’t often talked about, but they seem to be fairly common, if less straightforward than focal brain injuries.
  • BI:Everything is Information – Everything we sense (see, hear, taste and feel to put it simply) is information that must be interpreted in the brain, and this can go wrong at a number of stages. The going wrong can be caused by both mental illness and brain damage.
  • PTSD: Wired for Survival – there are plenty of non-survival things going on in the brain (feeling confused, making puns, happy memories) but taking precedence is a need to survive.

 

Diffuse Brain Injury

A focal brain injury is localized to one area, a diffuse BI is spread over lots of areas, although the damage may be smaller and less intense in those areas. (Wikipedia page: https://en.wikipedia.org/wiki/Brain_injury )

I had a diffuse BI, which is why I had trouble with so many different aspects of functioning: memory, processing, movement, balance, sense of smell and so on. Because the damage did not wipe out any of those areas completely (as it might in a focal BI) I could be fine some of the time, but the more I did, the more my ability would disappear.

This made it confusing for other people (and me!) to understand what was actually wrong.

Everything is Information

I mentioned this briefly in a previous blog, but in order to understand BI, I think it needs more attention.

Images we see, sounds we hear, even physical sensations and smells, are all types of information that must be processed. This takes both energy and a number of different cognitive tools.

The process: Information enters the brain through an organ (eg eyes, ears)  and then bounces around the brain at great speed using existing information stored in the brain to interpret the new data. New connections are made and memories are formed on the basis that the brain thinks they might come in useful, a lot of information is discarded. The decisions for how the information is interpreted and what new memories are made, is made by routines (like computer programs) usually written in childhood and kept throughout adult life.

For example when we watch TV (I’m going to use Community as an example), our brains are very busy. These are some (but not all) of the processes that are happening. We are utterly unaware that most of them are happening:

  • Reading facial expressions – using memory to to decide what the expressions mean, based on experience from childhood of what those expressions meant in the past.
  • Remembering who characters are – using recent memory and facial recognition to know who they are  (eg that’s Jeff, he’s a lawyer), but also older memories of how we feel about people like that (he’s vain, I find this silly).
  • Understanding language – using memory to know what words and expressions mean.
  • Understanding the emotional intent behind speech – the tone, pitch and even speed of speech, indicates this.
  • Interpreting jokes – using all sorts of memory, some linked to the programs itself, some to lifelong memories.
  • Forming new memories –  about characters and situations that will be useful when watching the next episode.
  • Forming new opinions about life – making associations between people and behaviour, between actions and consequences.
  • Predicting – what might be about to happen based on previous experience (there’s Chang, he’s about to cause trouble).

With a BI, some or all of the processes can be damaged – either they don’t happen at all, they happen slowly or they happen wrongly. With a diffuse BI these abilities can change by the minute.

Sometimes I could watch a TV program for an hour and more or less understand and enjoy all of it. Sometimes I didn’t really get plot or even speech, but would enjoy watching the facial expressions (Jeeves and Wooster were perfect for this, they would keep me entertained for hours). Sometimes I couldn’t open my eyes, because trying to process what I saw hurt too much – this pain is difficult to explain. The sensation was a little like trying to do complicated arithmetic in your head, in a noisy room. It was a pain of extreme struggle and frustration which would quickly intensify into migraines, muscle pain etc.

As can be seen in the process above, memory is the way all this information holds together. There are many different types of memory that are stored in different parts of the brain (this website has a nice neat diagram showing the different types). It is possible to completely lose one type of memory, or to partially lose lots of them. Access to these memories can also be slowed down to varying degrees.

The way PTSD affects our processing of information is slightly different. Whereas BI slows down, stops or corrupts certain processes, PTSD tends to distort them through a filter of extreme emotion. Because PTSD involves emotions all turned up to 11, information that should be fairly straightforward (eg there is a dog) becomes a warning or a tragedy (that dog is about to attack me! or that dog is sad, it’s been abandoned, oh my God I have to save it!).

When PTSD and BI come together it can get truly ridiculous, because the faulty information caused by the BI then gets further distorted by the PTSD.

For example, once I was walking down a street and getting tired doing so, therefore my ability to process images started to fail. I saw a crisp packet move at the side of the road, couldn’t process what it was, so the PTSD filter came up with It’s an alien! It’s about to attack! And I was genuinely scared. It was a few moments before my memory kicked in with the information that I didn’t believe in aliens and that it was clearly a crisp packet.

Wired for Survival

PTSD is what happens when the brain believes we are in constant mortal danger. The symptoms are its way of dealing with that as it puts us in a to a physical state where we are ready for fight or flight. Due to a genuinely dangerous event, the brain seems to get locked in that state of extreme panic.

There doesn’t seem to be any logic as to why that particular experience affects the brain that way – like most people, I’ve had plenty of near-death experiences in my life, but this is the one that changed how my brain functioned.

These are some signs that the brain is locked:

(Note: All of these can be experienced when a person is stressed, but then when the stress passes, so do the symptoms. With PTSD, the symptoms are at full pelt and they don’t stop. A frustrating mismatch between our brains and modern life is that most modern stresses require clear thinking, but little actual danger. However, our brains assume all stress comes from physical threat and that thinking is irrelevant in such situations.)

  • Hypervigilance paying too much attention to sounds. This is our brains trying to listen out for danger. It is the reason we get more annoyed by noise when we are stressed and trying to concentrate, because under stress our brains think we are in danger and so are trying to listen for any evidence of that.
  • Not sleeping deep sleep is never a good idea when there is danger.
  • Physical symptoms of stress – tight muscles, gritting teeth, restlessness, these are all signs that the body is ready to fight or flee.
  • Over interpreting situations – looking for any sign that something might have gone wrong and then fretting about it.
  • Struggling to eat – you brain doesn’t want you eating because it is difficult to fight or flee if you’ve just had a big meal.

Knowing that this is what’s happening doesn’t make the symptoms go away, but it does at least give an awareness that our understanding of the world is distorted: that we have no reason to be afraid, that people around us aren’t threatening or dangerous.

One knock on effect of this constant level of threat is exhaustion. When emotions are always set to 11, the body is working too hard all the time, without any proper rest.

People talk quite a lot about the dramatic symptoms of PTSD (flashbacks and panic attacks) but the exhaustion was most debilitating effect for me. It was so complete that it felt supernatural – as if all my limbs had been injected with lead and my mind was filled with fog.

Next BI and PTSD blog: The Basics of Caring for Yourself with BI and PTSD

18 thoughts on “Brain Injury and PTSD: Adventures in Brain

  1. Thanks for an enlightening post, and for the links which I will follow up. My wife’s a psychologist and some of these processes are familiar to me from discussions with her, but your discourse just underscores how complex and interconnected these processes are. You’re doing well to maintain a handle on so much of them.

    By the way, I gather the responses epitomised by the terms ‘flight’ or ‘fight’ are now agreed to be joined by a third, ‘freeze’.

    Liked by 1 person

    1. Thank you for the encouragement and information. The ‘freeze’ addition is interesting, I hadn’t heard that before, but it makes sense, I shall need some time to think about what that might mean and how it explains symptoms. Very helpful.

      Liked by 2 people

      1. Most interesting I read this just before meeting with someone who is dealing with PTSD and I was not aware that they had been diagnosed. Some of the things you wrote about actually helped me understand a little better what my friend was speaking about.

        Liked by 1 person

  2. My partner especially experiences the hypervigilance. I’ve noticed him checking every corner and exit when we enter an unfamiliar room or a place with high traffic of people he doesn’t know. That and the sleeplessness. He has a lot of nightmares. I had never thought about it before you mentioned it in this post, but it *would* be so exhausting, all the time. I can’t even begin to imagine what it must be like going through the world in that state of exhaustion.

    The bit about over interpreting was enlightening, too. I was unaware of that as a symptom but it makes some of my partner’s reactions make a lot of sense.

    Liked by 2 people

    1. I’m really glad I was able to help, thank you for the response. I wish you and your partner peace and happiness, I hope he is getting the help he needs.

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  3. Thanks for the interesting and informative post. It’s quite fascinating the way our brains can shape our realities, and the extent to which this can happen.

    BI and PTSD sound like very difficult things to experience. I get *some* of these symptoms myself,( sleeplessness, hypervigilance, overinterpreting, and the resultant exhaustion) but due to bipolar disorder rather than BI or PTSD. In the early days i had a few hallucinations, too, but only for a brief period of time. It’d be awful going through that regularly. I can’t even begin to imagine how frustrating the inconsistent functionality of memory and related processes would be. Everyday life would become quite confusing and distressing. It mustn’t be easy to write about such things, so thanks for taking the time to do so

    Liked by 2 people

    1. Thank you for reading and taking the time to write. I think like any illness, you learn how to adapt to the way that you are, so what starts out as distressing can eventually become routine and just an inconvenience. I’m sorry you’re having to deal with bipolar disorder, I know that also brings many difficulties. Wishing you a beautiful and peaceful day 🙂

      Liked by 1 person

  4. Another stellar post – clearly you have spent so much time trying to sort out what has happened to you – and this sharing of your research and personal experiences, I’m sure, helps others to understand and learn. 🙂

    “Sometimes I couldn’t open my eyes, because trying to process what I saw hurt too much – this pain is difficult to explain. The sensation was a little like trying to do complicated arithmetic in your head, in a noisy room. It was a pain of extreme struggle and frustration which would quickly intensify into migraines, muscle pain etc.”

    Oh how exhausting is this. And the stupid bit? Trying in the moments when its happening, and not necessarily understanding at that time, why? Something so simple and yet it literally hurts – and experience like nothing one has ever lived before. And it is bewildering. And then, with new information and knowledge, it makes it easier to deal with when it happens the next time round – but oh, that sensation, the absolutely oddest “reasoning” of “seriously? again?” … it is so tiring.

    And oh, you’ve really nailed it – the debilitating exhaustion. Constant. As you’ve mentioned, when regular stress, and even in some circumstances of PTSD – the exhaustion can be easily understood and managed. Because it does abate, with proper care and once the “panic and fight flight” response is over – and one has the sense of mind to examine the situation/circumstances and can learn to stop or ease triggers. But when the brain, in all its complexities and mysteries, suddenly loses its “normal processing features” – it all goes sideways and runs right throw the window – full leap. And so, it becomes such a “fight” – even when not threatened – it feels as if you have to be on Red Alert all of the time – and trying to be “normal” so that you can function – without appearing off your nut? Ugh….. nasty business.

    But as you’ve conversed and mentioned throughout the comments – when the brain heals enough that we can begin understanding what’s happening, and processing it all from a better place and frame of mind and emotions, then yes, we can learn to adapt – and life, ultimately is about that – adaptation and change. It just helps when we’re not feeling overrun by it all.

    Great great post 🙂

    Liked by 1 person

  5. Any number of ways of explaining brain injury to neuro-typical people is helpful. I find my ability compromised because of my brain injury, but I have various friends who want to know what I’m dealing with. The many different brain processes to respond to someone’s question creates it’s own problems. Thanks for sharing your experiences.

    Liked by 1 person

    1. Trying to explain what’s happening with your brain when it is acting in such a nonsensical way is near impossible. I hope you find the help and support you need. Take care of yourself, Jasper 🙂

      Like

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