Interpreting the significance of grief and its effects.

Last week I went to a local MBI support meeting where a new group facilitator struggled to interpret what people were talking about, using common terms such as "stress" and "grieving". While these terms apply, they are in a larger sense misleading. They imply that there may be some drug, cognitive or relaxation technique or psychological counseling that will fix it. While it may be laudable to take on the challenge of trying to understand a group of MBIs with a general psychology background, it may be harmful to miss this important difference.

To any analysis I must add that chaotic systems are not predictable or analyzable, so that areas of damage may produce unpredictable or explosive results and trying to handle them through counseling alone may be harmful. With this proviso in mind we can make a few observations about why a new language is needed.

For a long time I have felt that one of the barriers to diagnosis and appropriate treatment of MBIs was that MBIs do not have a language to describe the "feelings" or "emotions" of a new self. This may be a more important barrier than the inability to recognize losses due to the loss of monitoring ability since it can make it impossible to communicate effectively the details of physical trauma. Thus MBIs may also have undiagnosed physical trauma.

The "distance" of the former self from the current state is directly related to communication difficulties. People who are young or fit are not likely to have developed a vocabulary to describe the "pain" and altered body "sensations" and other symptoms associated with trauma but may at the same time have a high pain or fear threshold. A high functioning person may only know stress largely in its positive aspect: a challenge to grow, to adapt, to problem solve a metaphor for life. After a TBI I have frequently heard people say "what I used to enjoy doing I now find stressful", meant in the negative sense. How can this be the term "stress" that is generally understood when positive leisure activities bring on pain and fatigue. Stress used in a generic sense connotes a somewhat treatable psychological problem or at least a somewhat controllable response. We all know fatigue but tbi-fatigue is not like the idea of fatigue before a TBI. General advice to avoid stress and get enough sleep are not just inadequate but are inappropriate advice when other supportive measures are not also in place. An IME once wrote that what I needed was encouragement from my family doctor. I had two crushed discs in my neck.

i.e.

Physical Confounding Factor + Prior state = possible TBI response

• loss of monitoring ability + good stress = bad stress
• subtle cognitive losses + idea incubation = procrastination
• loss of monitoring ability + dedication = obsession
• perseveration + denial = lack of recognition
• distractibility + activity = chaos
• altered perceptions + problem solving = loss of empathy
• fatigue + dedication = physical problems
• emotional flatness + others expectations = loss of empathy
• inadequate language + proactively seeking help = apparent hypochondriasis

Many MBIs struggle to be understood. How can you express a totally new tbi-experience that has altered your body sense, your sense of proportion and of time? You can't. How can you admit to tbi-character-flaws if you were an independent growing person? You can't. How can you admit to fatigue and exhaustion when you had developed endurance? You can't. The need for an honorable person to be truthful, and the need to reconcile a new self and with language of a new self both create a barrier to the truth. How can any neuropsychological interview process capture the tbi-truth when you don't recognize it in yourself? You have become a caricature of your former self. What was a strength is now a hindrance. What was a former character flaw may now be a blessing.

I can no longer believe in "character", or "self esteem" since the former requires physical integrity of the frontal lobes and the latter means fulfilling goals that are now beyond me. Instead I believe in TBI-character and TBI-self-esteem that makes allowances for physical brain damage.

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