If you ask me, any type of brain injury is traumatic, whether it is acquired by a motor vehicle collision, an aneurism, a viral infection etc.
Living with the challenges of ABI, which can include headaches, nausea, fatigue, chronic pain – among other countless symptoms – can be brutal, and this brutality often comes in waves. Brain injury is often invisible, episodic, and quite often, not understood.
Sometimes I think the real trauma of acquiring a brain injury comes after the actual injury itself. I think many survivors of brain injury handle the initial challenges of their injury better than the ongoing aftermath, the reactions from others to their injury, and their own mental well-being.
I am happy for those that try, for those that don’t turn away. I am lucky to be in the position I am and to have the support I do. Nevertheless, at times, it feels as though the trauma continues.
There are times I think it is my fault: for pushing myself too hard, or for not saying enough. There are other times I simply want to yell and scream. Sometimes I even get confused and scared simply by looking in the mirror and questioning my own feelings.
I don’t want to explain what fatigue means for me, I don’t want to justify why or how it is that I just know my headaches are not the same as yours, I want to stop feeling stupid every time I forget something and I see that look on the faces of others.
The trauma lives on.
I am doing the best I can.
I don’t want anyone to feel sorry for me, I just want them to understand. Because if others can start to do that, perhaps I can keep moving forward without feeling like one step up means two steps down.
Then maybe, I can put the trauma to rest.
Mark’s passion to lend a helping hand, offer advice and give back has developed into a moral and social responsibility with the goal of sharing, inspiring and growing – for others as well as himself. His experience as a survivor, caregiver, mentor and writer has led to his credibility as an ABI Advocate and author of his life’s story, Challenging Barriers & Walking the Path. Follow him on Twitter @Mark_Koning or go to www.markkoning.com
Travelling to a foreign country to engage in combat. Witnessing injuries, death and destruction on a regular basis. Forced to endure tough living conditions. Is it any wonder members of the Canadian armed forces who see action return home not only with physical, but with mental and emotional trauma as well?
Broken bones and musculoskeletal injuries can be healed. More challenging however, are the emotional afflictions men and women in the armed services can suffer, and surely among the most devastating is Post-Traumatic Stress Disorder (PTSD).
PTSD has been much in the news over the last few years, which could give the mistaken impression that it is a new condition.
In fact, PTSD has been around for a very long time, but under different names. Among these were “shell shock” or “battle fatigue.” I remember my mother telling me about a great-uncle of a friend of hers, explaining that he had seen action in WWII and was ‘never the same again’. “He was shell-shocked and couldn’t do much after the war was over,” she used to tell me, shaking her head. While the name has become more clinical, the symptoms remain the same., PTSD is defined as:
A debilitating psychological condition triggered by a major traumatic event, such as rape, war, a terrorist act, death of a loved one, a natural disaster, or a catastrophic accident. It is marked by upsetting memories or thoughts of the ordeal,”blunting” of emotions,increased arousal, and sometimes severe personality changes”.
Most people have been involved in a frightening situation at some point in their lives, and reactions vary from person to person. Some might feel nervous at times, while others might have a difficult time sleeping as they go over the details of the incident in their minds. Over time, symptoms usually decrease, and sufferers affected eventually return to their normal lives.
However, in the case of PTSD, the effects last a considerably longer time and can seriously disrupt a person’s life.
Doctors refer to three symptoms that define PTSD: intrusion, avoidance and hyperarousal. Intrusion is the inability to keep memories of the event that sparked it from returning. Avoidance refers to the attempt to avoid anything that may trigger those memories, and hyperarousal is the constant feeling that danger or disaster is imminent. These may also be accompanied by an inability to concentrate, extreme irritability or sometimes violent behaviour.
Those affected can experience recurring nightmares, flashbacks or recollections of the event or incident. They can feel “on edge” all the time, have difficulty in concentrating, be irritable and have problems sleeping . A common symptom among veterans is something known as nocturnal myoclonus, a sudden spasm of the whole body while sleeping or drifting off into sleep. It lasts for about a fraction of a second, but may occur several times in a single night. Often people with PTSD will sleep through such a spasm, but it can be extremely disturbing to their partner.
People suffering from PTSD may also feel disconnected from their thoughts and have a hard time expressing emotions. It can lead to depression, substance abuse and create problems in a person’s personal life. Suicide is often seen as the only way out.
Not surprisingly, those in certain occupations, such as policing, firefighting and the military have much higher rates of PTSD than those in other professions. And in some cases, trauma such as warfare can cause symptoms even beyond those commonly associated with PTSD, resulting in a state known as “complex PTSD.”
Brain Injury and PTSD
A study released by the University of Southern California, Los Angeles, in February 2012, reported of a possible correlation between acquired brain injuries and PTSD, suggesting that people who suffer even a mild brain injury are more likely to develop an anxiety disorder.
UCLA professor of psychology Michael Fanselow found that this relationship was particularly prevalent among veterans who had returned from overseas. The reasons for the connection are not yet fully clear. Nevertheless, in an experiment with rats, scientists used procedures to separate physical and emotional trauma, training the rats by using “fear conditioning” techniques two days after they had experienced a concussive brain trauma, thereby demonstrating that the brain injury and the experience of fear had occurred on two separate days. As Dr. Fanselow explained:
We found that the rats with the earlier TBI acquired more fear than control rats (without TBI). Something about the brain injury rendered them more susceptible to acquiring an inappropriately strong fear. It was as if the injury primed the brain for learning to be afraid.
According to Boston’s Mayo Clinic, the primary treatment of PTSD is psychotherapy but this is also frequently combined with medication. Psychotherapy can include any of the following types:
Cognitive therapy. This type helps patients recognize the ways of thinking (cognitive patterns) that are hindering the healing process.
Exposure therapy. This type helps patients safely face what is causing them such distress so they are able to cope with it more effectively.
Eye movement desensitization and reprocessing (EMDR). EMDR combines exposure therapy with a series of guided eye movements that helps patients react better to traumatic memories.
The Canadian military has come under criticism for its seeming neglect in both the recognition and treatment of PTSD ex-soldiers are still feeling the effects of combat. Last November, three veterans took their own lives over the course of a week, bringing the total to more than 22 since the mission in Afghanistan ended.
Nevertheless, a story from CTV News in March of 2014 reported a new treatment being tested that so far, is producing positive results. Developed by the Institute for Creative Technologies at the University of Southern California, it involves the notion of virtual reality in which a sufferer affixes a device to his or her head which simulates the circumstances that brought about the trauma in the first place. The therapist can then talk the patient through the ordeal, thus helping them to overcome it.
The federal government is now in discussion with ICT in order to develop a Canadian version. The ultimate goal is not just to treat afflictions such as PTSD but to also train soldiers before going into battle, helping them to experience the sense of combat before they embark on the real thing.
PTSD can be both debilitating and life-threatening, but there is hope. If you know someone you suspect is suffering from PTSD urge them to seek help.
Those afflicted may find it difficult, for stigmas surrounding mental health issues continue to persist. Yet seeking help is the first step to recovery and it is readily available through such organizations as Canadian Mental Health. Suicide is most definitely not the solution. Those who have served in the Canadian armed forces have served their country well, and deserve whatever we can give them to continue leading happy and successful lives.
If you think you or someone you know has PTSD or needs other mental health supports: