The roots of post-traumatic stress disorder (PTSD) are seeded in a precipitating event(s). I believe the reactions of people toward the person with brain injury can also seed PTSD, and the PTSD grows exponentially. The closer the relationship — or the more dependent the person with brain injury on others, such as family members or specialists in charge of recovery — the worse the effect of their disrespect, disbelief, neglect, abandonment, judgement, and so on toward the injured person, especially under the rubric of loving compassionate intent. Seeking not to understand traumatizes.
Lack of Affect
Loss of affect complicates the trauma’s origin. Affect can be a fickle mistress. When affect works as it should, we are unaware of its role. We laugh, we cry, we snort, we sigh, we get serious, and we devolve into silliness. And we do it all as normal responses to the vagaries of life. But woe to your affect when you suffer a brain injury and worse to you and your affect if trauma rides along in the form of PTSD.
Effect of Affect Loss on the Person with Brain Injury
Brain injury can obliterate your affect. Every now and then some neurons may fire up and your affect will awaken and lunge like a wounded lion. Then it will sink into the void again. You never quite know how you’ll feel; you never know if you’ll be able to laugh with others or not; you never know how you’ll react to unexpected situations. And trauma adds its own fun dimension to the latter. The idea of affect consumes your mind, as in: This is weird. Where did it go? Why can’t I feel? Will I feel again?
With treatment, yes, you will.
Without treatment, maybe.
Affect may disguise PTSD. That doesn’t help with recovery. If you cannot feel the PTSD, how can you convey the symptoms or make your specialists understand? And how can you believe it if a specialist does diagnose your PTSD?
PTSD changes you so that you can’t trust your affect, and the dates of your injury, of your post-concussion traumatic experiences become imprinted in your body such that you never know how the anniversary(ies) of brain injury and PTSD events will affect you. One year, you’re fine. Your affect ticks along in happy-neutral mode except maybe for the day itself and/or a few days before or after. Other years, you’re in bed with a cold for a month or you land in the ER or it lasts all year long until the next anniversary date.
Effect of Affect Loss on Friends and Family and Others
Lack of affect also seems to drive people’s destructive responses. An affect-less visage looks abnormal, is hard to read, may not make sense, makes people uncomfortable (including the injured person), looks inappropriate, has very delayed responses, and interferes with healthy communication.
After a few years, you get the sense that people are a tad tired of you flashbacking around the time of your anniversary. They prefer you to look on the “positive side” of life.
This reminds me of how people viewed someone I knew before my brain injury. This person had a particular issue stemming from childhood. Invariably our conversations would turn to this issue. At first, after I listened for awhile while trying to advise as I’m wont to do. But after a couple of years, I realized that the person was stuck, they were unable to come to terms with their unsolvable situation, and all they needed was for me to listen. So I did. On my bad days, I’d get a bit impatient but tried to keep that to myself. The problem I had wasn’t with listening to this person’s repeating track but other people’s reactions to me listening. They wanted me to stop, to break off the relationship. “There’s no point,” they instructed me, “This person is too needy.” “Yeah. So what?” was my response. These judgemental critics didn’t see their own selves as needy, although they leaned on my listening ability as much as the stuck person did. Prior to my brain injury, I had the empathy and patience and concentration to listen. It didn’t cost me to listen but time. And I could manage time so that these conversations didn’t affect my own deadlines or work or other relationships. Except for people who hold down multiple jobs, time can be managed if you choose to learn how.
Listening is a mindset as much as a skill.
Kindness is an attitude towards others who need you.
Kindness and listening, instead of judging brain injury consequences, can inoculate against PTSD.
The Canadian physician Dr. Brian Goldman termed it, “cognitive empathy.”
After my brain injury, I lost my listening ability, all my skills and talents. “I” was gone while still being physically present. From the first anniversary of the injury on, my social network essentially took the advice of the judgemental critics: almost everyone left, one by one. They saw only the damaged brain and rejected the person trapped inside as much as they rejected the brain. That created PTSD.
Brain injury had turned me into the neediest person.
My network felt that I was taking too long to get better. I needed to be positive, to look on the bright side, get over myself, move on — pick your favourite deny-reality phrase. Some also voiced the truth of how they felt about my lack of affect: a little freaked out. People don’t want a needy person to rock their comfortable boat; they don’t want to learn how to be a friend to a person with the strange changes brain injury brings; nor can they conceive that accompanying a person with brain injury on their long, arduous path to recovery rewards both. They preferred to take the easy way out, and they did so while my affect was mostly off.
Effect of Healing Affect
Paradoxically, the lack of affect that freaked some out, protected me from the severe emotional distress of being abandoned and isolated. At that time.
However, because of treatment, my affect is returning. It still turns off unexpectedly; still suddenly spurts into life then dies back again when it’s off. But it’s more or less normalizing. Unfortunately, the memories of events I lived through while my affect was off made themselves felt as my emotion centres healed (and I assume my affect neural network, too). It’s like my brain needs to reconnect my memories with the emotions I should have felt at the time. I needed expert guidance in this part of the journey and didn’t receive it. This unpleasant experience mimics the flashbacks typical of PTSD.
False Positivity In Place of Treatment That Doesn’t Work
So when I hear those same kinds of deny-reality reactions today — even the look-how-much-you’ve-improved (like I don’t know) cheering-up kind — I hear past judgements echoing into the present. PTSD flashbacks work in the same way: the past becomes the present, and you must work to tell yourself where you are, when you are, how you are in a process called, “grounding.” However, grounding won’t heal the past. Affect killed in the past alive again today demands to be felt. The denial and minimizing of my very real suffering need to be acknowledged as traumatizing. On anniversary days, like January 15 for me, or in anniversary weeks or months, all you want to do is emote trauma’s clangor and be heard.
I get that people have an innate desire to cheer up their friends, which often comes in the form of trying to get them to stop “whining” and to focus on gratitude moments, but sometimes, paradoxically, the best way to cheer a person up in the midst of trauma recovery and/or also in an anniversary week, is to listen and empathize and perhaps share similar experiences and show small gestures of kindness, for as long as it takes. Kindnesses go a long, long way. Then phone their therapist or doctor and tell them to up their game, for neurostimulation treatments that heal brain injury also show promise for PTSD.
Trauma Therapy Issues
Trauma therapy remains essentially a make-it-up-as-you-go-along type therapy. If it wasn’t and if medication was effective, we would not be reading stories like the one about former Lieutenant-General and Senator Roméo Dallaire attempting suicide multiple times.
I’m certain brain injury complicates both PTSD and its treatment. An injured brain may not have the healthy neural networks or neuronal rhythm required to do trauma therapy. That’s when treatments like audiovisual entrainment or brain biofeedback that restore the alpha rhythm or decrease beta spindling enhance talk therapy, even make it doable.
If a specialist prescribes medications, then as I’ve discussed elsewhere, that will worsen brain injury. At best, it’ll mask PTSD and brain injury symptoms. It’ll also mask any spontaneous brain injury improvements. I believe the fundamental injury in PTSD is a relationship wound. Medications don’t heal those. Only creating a stable, healthy relationship over the long term as a model for creating new relationships and healing the originating wound(s) has a chance to work. How to do that in a person with brain injury of any kind who’s experiencing continuing trauma experiences, not simply one precipitating event or series of events in the past, with or without treatments to heal the brain injury, is the puzzle.