In response to the injury, I maintain a constant lookout for research which may have a bearing on my experience. As I expressed to Dr H at our recent meeting, the fact that medical science is up in the air with respect to the diagnosis and treatment of mTBI means that there exist no true “experts.” This implies I am operating in a field of knowledge in which I am as much an “expert” as any other interested party, perhaps more so as I have actual experience of the injury as opposed to the “experience at a remove” associated with scientific inquiry.

Unpleasant Random Discovery #1

This is found in the paper “Changing patterns in epidemiology of traumatic brain injury.” Roozenbeek, B. et al. Nat. Rev. Neurol. 9, 231–236 (2013); published online 26 February 2013; doi:10.1038 /nrneurol.2013.22 PDF available here

Key information is found in the Abstract:

“Traumatic brain injury (TBI) is a critical public health and socio-economic problem throughout the world. Reliable quantification of the burden caused by TBI is difficult owing to inadequate standardization and incomplete capture of data on incidence and outcome of brain injury, with the variability in the definition of TBI being partly to blame. Reports show changes in epidemiological patterns of TBI: the median age of individuals who experience TBI is increasing, and falls have now surpassed traffic incidents as the leading cause of this injury. Despite claims to the contrary, no clear decrease in TBI-related mortality or improvement of overall outcome has been observed over the past two decades.”

The last sentence is hard to accept. It reinforces my sense of the injury as being a life-sentence, one with minimal opportunity for full rehabilitation. I am near the end of my life so this is less meaningful a sentence than a similar injury imposed upon a 20 year old.

Unpleasant Random Discovery #2

The introduction contained the following statements:

“It (TBI) is a major cause of death, especially among young adults, and lifelong disability is common in those who survive. Although high-quality prevalence data are scarce, it is estimated that in the USA, around 5.3 million people are living with a TBI-related disability, and in the European Union (‘old’ Member States), approximately 7.7 million people who have experienced a TBI have disabilities. TBI commonly leads to neurocognitive deficits (such as impaired attention, inability to form visuospatial associations, or poor executive function) and psychological health issues; for example 30-70% of TBI survivors develop depression. TBI survivors also exhibit increased impulsivity, poor decision making and impulsive-aggressive behaviour. Such impairments in self-regulatory behaviours can affect interpersonal relationships and contribute to poor community, social and vocational integration . . .”

Here again, it was the last line that resonated with me. I believe I am wrestling with depression at the moment. I awake, find that there is no action potential, limited personal agency and minimal opportunity to affect outcomes, and I crawl back to bed.

I have also written to members of Parliament. These letters have been drawn from a deep well of something that I think matches the description of impulsive-aggressive behaviour. At no other time in my life can I remember writing similar letters. I have surprised myself with these efforts and have been attempting to understand the rationale for them. There exists a logical, objective reason for the letters. But the “will to action” appears driven by something deeper, and impulsive-aggressive behaviour provides an explanation.
 

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Views of the Same Scene

Hill in July
Hill in August
Hill in October
Hill in January