Emotional balance and states of mind are a difficult thing to manage for me. I see many of my emotion precariously balanced on a knife-edge throughout my day-to-day life. There are small moments, events or incidents that may seem insignificant to other people of the non-disabled community, that they can brush off in a moment and see these incidents as merely small irritations in their day-to-day life. What I have found is that a moment, which could be interpreted as the smallest inconvenience for them, can turn out to be the blueprint that will reflect my mood and my attitude towards other people and the world at large for the remainder of the day (and in some cases a period of days).
We like to think (when I say “we” I mean all of us, people with a disability or anyone else) that we have these emotions under control from the start of our day to the end of our day. Much of what allows us to keep that kind of emotional control is (I believe) our cognitive abilities, in particular our social skills. For people who have not suffered an ABI/TBI, in essence the fully abled population of the UK, waking up in a bad mood is an inconvenience; they may be grumpy, have a slightly sharper tongue than usual and slightly less prone to socializing. What is more, when issues such as anger, mood and emotional instability become a problem they still have their cognitive abilities in tact to be able to deal with whatever the issue is. They can think around a problem, read a social situation and decide clearly what is the best way to respond and most importantly of all emotional reaction can be kept in check and (in the vast majority of cases) the person can put forward an appropriate emotional response.
Why Is That Different For Brain Injury Victims?
I believe that there are many factors to consider in terms of the difficulties of determining an appropriate emotional response to situations for ABI patients and the potential emotional instability that we suffer from. But these I believe are the biggest contributing factors.
Firstly, I would argue that people such as myself and many reading this post who have suffered an ABI have a tendency to focus heavily on the abilities they now lack, the things they can’t do since they suffered their injury which causes a feeling of insecurity and a sense of fear that those (what we the patients) perceive to be “weaknesses” will be exposed (a point I highlighted in last week’s blog post Anxiety & Low Self Esteem and other posts in previous weeks Go Back A Step – Depression and Identifying Triggers). Fear and anxiety are states of mind that will contribute to any emotional social interaction and by-proxy emotional reaction an ABI patient has.
Secondly, something I believe to be strongly related to the first factor, people without ABI’s or TBI’s tend to be better in social situations. I am not necessarily being specific about a patient’s ability to perform, say verbal communication, tone of voice, articulation and body language but rather an their ability to read and interpret those aspects of language and communication accurately and correctly when they are delivered by other people. The skill of interpreting the codes and conventions of communication are vital to social interaction and it is common amongst recovering ABI and TBI patients that those skills can be lessened, damaged or lost post-brain injury.
Finally, something that I suffer from a great deal and that is the ability to cope with the unexpected or with incidents that can ruin a plan that a patient has arranged. I have tried to emphasize the importance of developing a routine, developing positive habits and processes that help you manage your day and living with your condition as well as trying to find things that you can enjoy each day. When these plans go astray due to outside influences, our emotional reaction can often turn out to be disproportionate to the event itself. It is a lack of ability to get to grips with disappointment, anger or whatever emotion takes hold, master ourselves and to not let the emotions that come from that event disrupt the rest of our day and the mindset we carry throughout the day.
My intention this week is to explore these particular topics in further detail and then, in the next few weeks, try and provide some helpful techniques as to how we handle the different emotional instabilities and mental health issues that can seemingly come from nowhere and ruin days, even weeks.
Social Engagement – Self Doubt
In a society that is applying increasing pressure on people to conform, to meet a required standard in their abilities, their appearance, opinions and behavior, it is extremely difficult for people with ABI’s and TBI’s to feel comfortable with who they are, the way they act and to know if the way they are acting would be considered “normal”. This societal pressure (heavily influenced by the media) means that many ABI/TBI patients feel anxious about the idea of social engagement before it has even begun. If the activity is a pre-arranged event, I know that I myself have spent days leading up to an event fretting, worrying about how people will see me, perceive me and whether or not they are judging me. When we apply this kind of pressure to ourselves the likelihood that things can potentially go wrong in social situations increases dramatically.
Social Engagement – Communication
I think it is safe to say, at least from my own perspective, that after a brain injury, we are fairly unsure about ourselves. For a certain period of time I would also add that we don’t understand ourselves. We have gradually recognized that there is something different about ourselves after our injury; there is something about us that is different to everyone else. I often think that our (or at least my) emotional reactions can have a tendency to ride roughshod over our cognitive abilities and for lack of a better term, “common sense”.
I have found that I will often blurt out a response in a conversation that is a statement composed entirely by my emotions can often be blurted out without any real thought of how people around me in the conversation will interpret it. The way a statement can be interpreted by people consists of many things, the statement itself, whether or not the timing of the statement is appropriate within the “flow” of the conversation (so timing, subject, the opinions of those taking part in the conversation on the subject at hand and finally the direction of the conversation), the tone of voice, the speed of the conversation, body language and so on. From my experience with an ABI all of these things can contribute to difficulties in social engagement. Mostly because of a patient’s inability to take in all of these contributing factors, decipher the meaning, think of an appropriate considered response and deliver that response with all of the contributing factors I mentioned previously applied so that other people in the conversation can interpret the correct meaning but also the fact that those people do not consider all of the intricacies of social conduct. Those intricacies have become so engrained that they do them almost automatically. Whereas for patients, many so called automatic bodily and cognitive functions have been damaged so that understanding, performing and interpreting those functions in a social setting is incredibly difficult.
What Is The Result? Emotional Instability
Well when you consider the issues I have mentioned regarding self-doubt and the difficulties brain injury patients have when it comes to social interactions and the pressures those things ensure is that emotional knee jerk reactions can often overtake the processes of composing a measured and appropriate response.
For example, when we are involved in a conversation and (as so many of us experience) a statement we make is met with an awkward silence and the other people in the conversation staring at you, unsure how to respond, panic kicks in. The silence is deafening, we start to wonder what we have said and done, what the other people are thinking. We also feel the colour in our cheeks rise; we are embarrassed, humiliated, and angry at our inefficiency. The deafening silence continues so we try to make amends by filling the silence. We start talking again, not realizing that the things we are saying this time are just as awkward for the people listening as the last sentences were. We keep talking though like a man with a shovel who just keeps digging until finally the reaction, the looks on the faces of the other people (amusement, embarrassment, disapproval, confusion) and the overwhelming silence forces us to clam up.
Here is where the anger kicks in; we can react angrily to the people who we are talking to; “What the hell are you laughing at?” Or “Don’t you dare laugh at me!” Or we can be angry at ourselves, embarrassed and humiliated, attacking ourselves for our lack of skills, our inability to keep up with the conversation. These reactions to social engagement, ruled by emotion and reaction can be devastating to a re-integrating post-brain injury. There our many outcomes to a circumstance such as the one that is described above, each one detrimental to a patient and how they react to social engagement and how other people receive them.
The first, people can feel uncomfortable around you. These are the people I find that don’t really have the slightest clue about the type of battle we are fighting and have to fight day in day out (your true friends will understand and will know how hard this is for you and will make allowances for the social faux pas you make). The second is that you will become more resentful towards your condition, allow that anger, embarrassment and awkwardness to turn inwards so that you feel uncomfortable or even ashamed of who you are. The final one is that experiences such as the one I have described can make you unwilling to socialise and wake you more introverted. The last two issues for me are the most harmful. The ones where you start to despise yourself and your condition and become ashamed of who you are. NEVER BE EMBARRASSED OF WHO OR WHAT YOU ARE. None of us asked for this and the final two issues I have spoken about in this paragraph can lead you down a path towards isolation and loneliness which can then lead to deeper more troublesome psychological/mental health issues such as depression, anxiety or even a form of escapism through something like drugs or alcohol. All of those things are detrimental to our recovery.
Coping With The Unexpected
I have spoken before about the importance of developing a routine and how a solid dependable one can have a really positive influence on the way we live our lives post- acquired brain injury. One thing I can say though is that too much dependence on a routine to make your life tolerable can have potentially damaging consequences. This is due to the fact (particularly when parts of your routine rely on things that are under the control of other people) that things beyond your control can disrupt your routine.
Take yesterday as an example. I woke up in the morning after having a dream. The dream was about a person (she broke my heart actually but that’s a story I wont go into) so I woke up angry, reflecting on all the ways she had hurt me and how those wounds were still sore. So I was angry before I even started the day. There are things I should have done in the morning to gather myself but I didn’t think properly, I was overwhelmed by a sadness and anger. Already, here was something I can’t control affecting me in a negative way.
After I had a cup of tea and had appropriately woken up, I decided to go into the local town where I would have breakfast and do some work in a local café (this is something I do often as the mile long walk to town gets me some exercise and gets me out of the house amongst people, both of which are important as being a writer can be a lonely profession and by its very nature is a sedentary one). I undertook the walk, with that haze of anger, frustration and sadness still hanging over me like a rain cloud. But I had my routine to look forward to; get a bacon sandwich at my favorite place (they do THE BEST BACON SANDWICHES EVER!) and a cup of tea, go to one of my favorite coffee shops where I have a cappuccino, use my E-Cigarette and listen to music for about half an hour before going to a different coffee shop to do my work.
I arrived in town, still feeling less than happy but the walk had done me some good. I went to get my bacon sarnie but as I approached the doors I saw that the blinds were down and there was a notice on the door that read: CLOSED FOR REFURBISHMENT – UNDER NEW OWNERSHIP. When reading this I couldn’t help but feel as though this might not be my day. I tried to continue as normal, I went to my café to try to enjoy my coffee, enjoy my E-Cig and listen to music. I tried to compensate for the absence of a bacon sandwich with a pastry in the café but it just wasn’t the same. I listened to my music, watching the other people sat outside drinking coffee and smoking REAL cigarettes (bastards! I gave up seven months ago).
My mood was moving further into decline, I was thinking about the girl, I was thinking about the lack of bacon sandwiches and cigarettes. So I moved on to my next café where I could work on my blogs, thinking I could take my mind off of things and concentrate on something else. However, when I started to write, I realized that the topic I was writing about (brain injury and emotional response) was making me think about all the other things in my life that I hate and resent. That hatred normally stays under the surface but today it was bubbling over. Then, the final nail in the coffin of the day; I received my coffee from the barista and received a luke-warm beverage. This was the climax of a day of complete crapiness. I closed my laptop left the cup of (now stone-cold) coffee on the table and walked home with thoughts of the girl that broke my heart, the effects and manifestations of my disability, the lack of bacon sandwiches, the fact that I wanted a REAL cigarette but couldn’t and the fact that someone who is paid to make coffee as a profession couldn’t make one to a suitable temperature, weighing heavily on my mind. I was so unbelievably angry at how the big things in life had all popped up at once to impact on my day combined with a series of little things aiding them in their sabotage of my emotional stability, state of mind and mental well being. This is actually the reason this blog comes to you a day later than anticipated.
That’s Life So…
My point is that I had expected for things to go my way the other day and in many ways (nearly all the ways I can think of) they certainly did not. So from that experience I’ve had and the issues I spoke regarding socialisation earlier is that we cannot necessarily predict how life and events are going to work out for us. I think it is important that we don’t set too much store by whether or not things go well for us first time or indeed, all the time. I think that what we have to do is to try and do our best to handle situations the best that we can and not be too disheartened when things do not go our way. Equally important is our ability to overcome the disappointments, the times we do not succeed and develop an ability to come back and try again. We mustn’t allow the times where it seems as though the world is against us and we become angry, embarrassed or humiliated to dictate our actions in the future.
There are plenty of disciplines, thought processes and physical actions we can take that can improve our emotional stability as well as our state of mind and mental wellbeing that I will be exploring over the coming weeks. I hope that this has been beneficial to you all and that you will be back to read over the coming weeks. Meanwhile follow me on Twitter @ABIblogger to follow what I am up to. See you soon!Emotional Instability