This is the first of six sections. I have decided to commence with Section 3 as it only contains 4 items. This post functions as a “trial run” and helps ensure that the review results in useful data. First a table:

Section 3      Persistent Mood Disorders

There were no unscored items, two items were not observed and two items were observed and found to be disabling. A detailed review of these items follows.

Section 3      Not Observed

• Item 3.2    Having urges to beat, injure or harm someone
• Item 3.3    Shouting or throwing things

I have many times had the urge to throw things in frustration but have caught myself feeling this way and have not acted out. I have also felt overwhelming anger leading to shouting but have managed to restrain myself. While I have not felt any urge to beat or harm someone else, I have felt the impulse to self- harm. This typically arises in the context of of despair.

Section 3      No Change

• Item 3.1    Mood swings                                                     Score 3
• Item 3.4    Temper outbursts that you could not control    Score 3

I find it interesting to see I was reporting debilitating mood swings last year. From my current perspective, I view my 2012 mood to have been relatively uniform and “flat.” During the period I first scored this survey,  I had started long daily walks on the recommendation of Dr H. After these walks I noted I was more “sparky,” that there was an evident positive change in my behaviour.

In autumn 2012 I was trying to come to grips with the reality of what my Doctors were telling me. I did not at first believe them when they advised that I was suffering from a Traumatic Brain Injury; I was sure they were wrong as I knew there had been no head-strike during the accident ( my boneheadedness on this point was partly due to my past involvement in providing emergency medical care [ including significant open wound brain trauma ] and my innate skepticism. If I cannot develop a rational sequence of events to explain an outcome then I am resistant to accepting that outcome. Occam’s Razor applies). In 2012 there were many upheavals as I first rejected what I was told and then accommodated, or accepted, the fact of an injury. The 2012 mood swings were the result of this vacillation between acceptance and rejection. It was not until November / December 2012 that I learned, and understood, the mechanism of injury.

The 2013 mood swings have a different cause and are more unsettling than those of 2012.  This year I vacillate between a belief that I am improving, or am not being negatively impacted by the injury, and my being confronted by the fact of the injury, the complications it creates in my life, and indications that it is likely there will be little or no further recovery.

The attempt to fight back and counter the cycle of despair leads me to initiate projects such as this analysis. I think I am doing better, or am improving, and then I confront reality, the real world set of facts which demonstrate there has been little change and I still face exactly the same set of problems. It is this lack of change, or extremely slow change, that I find very, very difficult to accept. I desperately want to believe in improvement. I suspect that this desire for improvement is sufficiently strong that I wilfully deceive myself in regard to my situation. It is when this self-deception is revealed to me via a confrontation with external reality that I fall into the black pit of despair.

My current strategy for dealing with these issues is to acknowledge that I may have only limited improvement going forward. If I can accept the status quo then any improvement becomes an unexpected bonus. I do not yet know if this is a viable strategy; It is my hope that it will help avoid further down cycles as these become very problematic very quickly. I am also trying to accept myself as I am and stop beating up on myself for failings which are beyond my immediate control. I may not like it, but this injury now defines the texture of my life and will do so for the immediate future. That is a reality that I must accept.

I cannot now remember the 2012 events that gave rise to temper outbursts. I do remember that these outbursts were seen only in retrospect; I surprised myself by exhibiting untypical behaviour and then attempted to understand what had happened. In 2013 my outbursts are due to frustration at my inability to perform simple tasks, or due to the fact that despite being vigilant I continue to make the same mistakes over and over again. Or I catch and correct errors through hyper-vigilance but then discover I have made stupid errors in areas not subject to hyper-vigilance. My frustration comes from the fact that I cannot put my entire life on a checklist.

In 2013 there has been only one remembered occasion when I acted out in relation to another person and this was during an interview session with a potential resource. I became extremely angry as they asked a great many questions and did not provide me with an opportunity to answer. They were also completely uncaring over the fact that I could not obtain a family physician in Québec and seemed to take delight in the fact that I was not fully re-reimbursed for medical care obtained in Ontario.  I felt they were being deliberately antagonistic and uncaring and I lost it. In retrospect, I think the truth of the situation is that they have little experience in dealing with TBI.

I now remember details of the 2012 outbursts. Two of these were occasioned by dealings with the insurance company. In both cases the person with whom I was talking was making inordinate demands. I became very upset and responded in a negative way. When I discussed this event later with Dr H, she felt that I had been overwhelmed and that the other party should have been more considerate and understanding given the nature of my injury.

And that completes Section 3. There were no improvements or declines. I am going to let this sit in draft for a day and see if it functions as a useful review.

Update

I published this to the blog and have since remembered other events in 2013 when I experienced outbursts, or near outbursts. The remembered events occurred in a shopping venue. I was curt and obnoxious, aggressive and unpleasant. A partial trigger for these events was the fact that the venue was noisy and very crowded and I was unable to handle these stimuli.