To introduce a little variation we are going to start this section off with a rowboat rather than a table:
| Section 2 | Psychological Consequences | ||
| 2012 | 2013 | ||
| Unscored | 0 | 0 | |
| Scored 0 | 6 | 8 | Not Present |
| Scored 1 | 0 | 2 | Present, no interference |
| Scored 2 | 7 | 2 | Mild, not disabling |
| Scored 3 | 7 | 5 | Moderate, greatly interferes |
| Scored 4 | 0 | 3 | Extremely disabling |
| Items N/A | 0 | 0 | |
| n=20 | |||
| Section 2 | Improvements | 2012 | 2013 |
| Item 2.1 | Impaired sense of self | 2 | 1 |
| Item 2.2 | Fear of loss of control | 2 | 1 |
| Item 2.5 | Feelings of paranoia | 2 | 0 |
| Item 2.6 | Spells of terror or panic | 3 | 0 |
| Item 2.19 | Insensitive to others and social context | 3 | 2 |
Item 2.1 reveals the problems associated with self reporting and subjective bias. I believe that my self awareness has improved considerably over the past several months. I find it risible that I scored this item as a “2” in September 2012. In retrospect I can see that I was almost totally lacking in self awareness when I first assigned this score. In 2012 this item should have been scored at 11.
I did not perceive my of lack of self awareness precisely because of my lack of self awareness. I am fortunate to have the service of two excellent health professionals available to me. Without their intervention I do not know how long it would have been before I arrived at a full awareness of the injury.
At one point I did fear a loss of self control. This was around the time I was first learning of the injury and was vacillating between accepting, or rejecting, the fact of the injury.
I also experienced minor feelings of paranoia at this time. My sense was that all the Doctors were somehow in cahoots in regard to this notion of a brain injury. I did not want to believe, or accept, what I was learning.
Scoring Item 2.6 as a “3” likely also reflects my ambivalence and fear at having to accept the fact of an injury which was not at first evident to me. For most of the period, and continuing through to the present, I have had a sense of calm and equanimity which seems highly inappropriate given the nature of my situation.
Item 2.19 borders on a repetition of the response to Item 5.18 Indiscreet comments and acts. My response to Item 5.18 should probably be moved here and 5.18 be revised to 0. My perception is that 5.18 is targeting sexual indiscretion while 2.19 targets social indiscretion.
| Section 2 | No Change | |
| Item 2.3 | Easily agitated or irritated | Score 3 |
| Item 2.8 | Feelings of shame or guilt | Score 3 |
| Item 2.12 | Withdrawal or social isolation | Score 2 |
| Item 2.13 | Others not appreciating your difficulties | Score 3 |
I completed Section 2 in its entirety, pressed the button to save the draft and, for reasons unknown, I have just lost four or five hours of work. So I am both irritated and frustrated. Item 2.3 Easily agitated or irritated appears to duplicate Item 5.7 Chronic frustration. The Item 5.7 response applies here.
Item 2.3 Feelings of shame or guilt appears to duplicate Item 5.22 Increased shame or guilt. To avoid inflating the scores, I have scored 5.22 as not observed. I have provided the explanation for the score of “3” in the earlier commentary associated with Item 5.22. I feel ashamed of my inability to perform normally and I also feel a sense of guilt, of being to blame for both my injury, and for the accident (I should note that I was rear ended while stopped at a light and there is strong evidence the other driver was speeding. I feel blame but I was not responsible for the accident).
When this sense of self blame, or guilt, is coupled with a down episode, it accelerates the turn to the down side. I need to be more generous with myself and less self-critical.
My withdrawal and social isolation is not by choice. When I started work for the Gargantua Computer Corporation I had to sign an undertaking that allowed the company to assign me to any shift or schedule that might be required to meet operational demands. Essentially, I signed away my right to a life.
I was one of the top three performers in the workgroup, had a broad skill set, and both a varied and deep product knowledge. I had been working for the company for over ten years at this point and I rarely needed to call on 2nd level resources for assistance in working my calls. In consequence of this excellent performance, I was tapped as a natural candidate for the overnight shift as there were no 2nd level resources available at night.
I first had this vision of working all night and having my day free for other pursuits. I quickly realized that I would need the day for sleeping. My “weekends” arrived on Wednesday. I had to devote most of a day to the attempt to reorient myself to a regular day routine, spend another full day performing all those routine errands that can only be done during normal business hours, and then spend another half day getting prepped to return to overnights. It was a very wearying schedule. If you failed to take good care of yourself, it would grind you down. The worst aspect was that I had to get my head down as soon as I got home in the morning. If I stayed awake past eight o’clock, I would enter “day mode” and experience great trouble getting to sleep. I would then be forced to struggle through a miserable night shift.
It is impossible to maintain any friendships on this sort of schedule and, over a period of years, my friends and contacts slowly drifted away. I was so focused on performing my shift that I did not realize this was happening. It is only in retrospect that I understand what I traded away.
Since the accident, I have had to deal with a second phenomena. Brain injury is an invisible hurt. The damage is evident in slow response times, and in an inability to maintain the normal pace of social interaction. Those who do not understand the injury may be inclined to see you as slow, dimwitted, not too bright, or lacking in social graces.
This leads into Item 2.13 Others not appreciating your difficulties. I do not think it is possible to fully understand the nature of this injury unless you have had personal experience of it. From what I have been able to learn, even TBI victims with strong family relationships generate great strain within the relationship as loved ones, and life partners, have difficulty accepting the fact of the injury and coping with the demands it places on the relationship.
The other aspect of Item 2.13 is a sense of vulnerability. On multiple occasions I have made a purchase and walked away from the change, or collected the change but left my purchase behind, or left my bank card in the machine. One immediately becomes conscious of the fact that one must place increased reliance on the ethics of others and that one is also increasingly vulnerable to the predatory actions of others.
| Section 2 | Increases | |
| Item 2.7 | Feelings of depression | From 3 to 4 |
| Item 2.11 | Feelings of discouragement | From 3 to 4 |
| Item 2.14 | Feeling everything is an effort | From 3 to 4 |
| Item 2.15 | Feeling inept or worthless | From 2 to 3 |
| Item 2.20 | Diminished insight | From 2 to 3 |
These are all major obstacles. From one perspective I should be glad of this increase in scores as it indicates that I now have greater self-awareness than I did a year ago. This is clearly a good thing. But the effect of this increased self awareness is greater knowledge of my predicament, and this leads to increased discouragement, depression, and the sense that the effort is overwhelming. These feelings are accurate. Even relatively minor tasks require an effort. If I do not focus on each action then I will end up repeating an earlier error, or making a completely new one. And even if I do maintain this focus, I will still introduce errors. It is very frustrating.
Each time I make an error I feel inept, stupid, worthless. It is very hard to be accepting of the error. I just poured oatmeal into my coffee is not an action for which I want a pat on the back. I have a very hard time seeing how I will fit into the larger society. In past employment, I worked on improving employee productivity. I am now exactly the kind of employee that is not wanted on the premises. And I do not know how to overcome that stigma.
The increased score for Item 2.20 Diminished insight reflects the fact that I am now more aware of the degree to which my self knowledge has been impaired. One of the key goals of this analytic exercise is to improve my insight into my behaviour.
| Section 2 | Not Observed |
| Item 2.4 | Easily startled |
| Item 2.9 | Persistent anxiety |
| Item 2.10 | Anxiousness or feelings of fear and dread |
| Item 2.16 | Laughing or crying without apparent cause |
| Item 2.17 | Worrisome thoughts won’t leave your mind |
| Item 2.18 | Making up explanations for things |
Previous startle responses involved a whole body reaction and this typically included me nipping my tongue. I have not experienced this since Spring 2013.
In an attempt to normalize my sleep schedule, I recently stayed awake for an extended period in the hope that when I did get to sleep I would sleep through the night. When finally allowed myself to go to bed, I experienced several full body jerks, or twitches, as I fell asleep. These incidents did not include nipping my tongue and they seemed less severe than the earlier events.
I have no persistent anxiety. I have no sense of anxiety at all. I find this to be be very odd given my current predicament and my unsettled financial situation. This total lack of anxiety was one of the key factors that caused me to seek out medical attention.
There are no feelings of fear or dread. Last year I did have the feeling of wanting to be “safe.” I have not felt this recently. In the period after the accident I did have episodes of crying for no reason. These occurred at home, and in one case, when I was visiting with a friend. There was no emotional basis for the tears. There has been no observed experience of this behaviour this year.
At night I will lie in bed and be unable to sleep. I appear to be trying to bring my life into focus and am unable to do so. My thoughts are not worrisome but I seem unable to put them aside. The best explanation I have come up with is that the experience is similar to being a youngster staring up at a dark night sky filled with an infinity of stars. I would try and comprehend what I was observing and be unable to fathom it. This is reminiscent of my attempts to get to sleep. I am somehow trying to come to an understanding of my situation but am unable to fathom the full extent of it.
The last item, Item 2.18 Making up explanations for things, is a duplicate of Item 6.6 making up explanations for things. Both were scored as “Not Observed.” I have no memory of making up explanations but I do remember speaking for an extended period so as to avoid having to explain the fact that I had forgotten the thread of the conversation.