In the prior post Flummoxed, I documented a series of obstacles arising from my attempt to implement the TBI Proposal. When such obstacles are encountered, I become overwhelmed. The obstacles appear insurmountable, my goals out of reach and impossible of achievement.
When I encounter this mental state, I commence a downward spiral and begin to question the wisdom of continuing with life. The various factors that weigh on this matter include the following:
- I have already lived a long life and enjoyed a great variety of experience. I am at peace with both my successes and failures. I am confident that I have lived a well-examined life, that I am conscious, self-aware, and self-directed. When I examine critical inflection points in my life, I believe that I made the right decisions even though my decisions may have had negative impact in economic terms, or in terms of career trajectory. In Buddhism this is summed up in the concept of the Noble Eightfold Path. I do not believe that I have deliberately caused suffering but I acknowledge there are multiple instances of confused action on my part and that these may have caused hurt.
- The obstacles that I now face are insurmountable and not amenable to change. They are beyond my control and constitute a chronic set of conditions likely to prevail until the end of my natural life. The attempt to mitigate the situation, or adapt within the imposed constraints, requires significant effort. I begin to doubt that the degree of likely realized improvement is worth the effort expenditure.
- That it is extremely likely my circumstance will continue to worsen from this point forward. This is due to after-effects of the injury, and the likely continued decline in both physical and cognitive capacity. The medical term for this is Old Age.
- When faced with severe pain this set of decisions and choices are constantly present.
I have gained the ability to be cognizant of what I term a depressive spiral (I am sure the medical profession has a more appropriate technical term. I do not view depression as a static state but as a form of psychic activity resulting from conditional co-dependent origins). Acknowledgement of the loss of self-efficacy drives the creation of a negative emotional state which further impairs self-efficacy, which increases negative emotions, which impairs self-efficacy and this downward spiral continues until the only viable option appears to be exit.
The ways I have addressed this downward spiral include the following:
During the time around the death of Robin Williams, I recognized I was in a depressive spiral. My attempt to halt the spiral involved pushing myself to engage in physical activity. In this particular case, this involved making punishing 12 mile hikes in Gatineau Park. This physical exertion likely boosted serotonin and other positive neurotransmitters. The simple act of altering my physical environment and engaging with the natural world also appeared to have positive effect. The necessity of having to deal with injuries resulting from the forced marches also helped remove me from the depressive spiral.
When I was still volunteering on a regular basis, I would head in to the work location and spend four hours engaged in highly routinized work. I valued the opportunity to be among people. There was no need to discuss my situation or my concerns. The simple fact of sharing a physical environment with others had positive effect. The fact of being able to engage in meaningful and valued work was also significant. I spent the afternoon being accepted by others in a very conventional setting (i.e. there was no crisis intervention. The benefit to me appeared to derive from the opportunity to immerse in conventional normalcy. I suspect Crisis Intervention would have had a negative effect), I was part of the human race, and I derived the satisfaction of having made a valued contribution.
In addition to the above, I also walked the five miles to the volunteer location resulting in a ten mile round trip. The volunteer effort therefore included aspects of the forced march response.
This morning I realized I had identified a third positive response. This arises from the same problem set that triggers the sense of being overwhelmed. This morning I spent an hour lying in bed, cloaked in morning sun, contemplating a detail of the implementation plan.
The TBI Proposal, and all the implementation details associated with it, serves as a series of hooks, points of detail that require addressing. As I begin to contemplate one of these hook points, I become further engaged in elaborating on a solution. Such active engagement draws me out of the depressive spiral and toward positive activity that reinforces my sense of self-efficacy.
This engagement in positive activity works to re-frame my psychological state and has the effect of countering, or abating, the depressive spiral.
If these outcomes can be generalized to the broader TBI population, it suggests the activity promoted by the TBI Proposal may have broader application in assisting with the treatment of depressive states.
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