Tips for Recovering From PTSD and TBI
Unpacking the many pieces of the treatment puzzle.
Posted May 29, 2020
Living as a human being in our world exposes us to many events that have the potential to cause trauma. The traumatic stimulus can be actual or threatened injury or death to self or others. One of the many stimuli for traumas that unfortunately befall many people are auto accidents, some of which are severe and cost life, limb, and livelihood.
For the past 15+ years, I have subspecialized in psychological care of people traumatized by severe car accidents. Initially in this work, I focused exclusively on the psychological dimension of the trauma, working with the criteria of post-traumatic stress disorder (PTSD) as identified in the Diagnostic and Statistical Manual (DSM). Many of the people I treated with trauma-focused psychotherapy, however, presented with neurological sequelae such as cognitive difficulties, memory problems, chronic headaches, and fatigue.
As this dimension of accident consequences became more and more apparent as a prominent feature requiring clinical attention, I delved into the literature dealing with the effects of trauma on the brain. Having received my doctoral clinical psychology training in the 1980s, many advances had been made over the past 30 years in the field of neuro-rehabilitation and traumatic brain injury (TBI) studies and treatment. The intellectual zeitgeist was shifting to a greater appreciation of brain science and understanding of how the brain can repair itself. The term for this is neuroplasticity, a word that was coined in 1948 by Polish neurophysiologist Jerzy Konorski.
The concept was further expanded by the work of Canadian psychologist Donald Olding Hebb who studied the functions of neurons and learning. Hebb has been regarded as the father of neuropsychology. His work was important in linking the fields of psychology and neuroscience by connecting behavior and the physiology of the nervous system.
The work of neuropathologist Bennet Omalu on sports-related brain injuries resulting from repetitive concussions—causing a condition he termed chronic traumatic encephalopathy (CTE)—was an important factor in shifting the zeitgeist and public awareness of how the human brain is vulnerable to injuries that can significantly impact behavior.
From my work with auto accident survivors, we still have a long way to go in terms of appreciating the potentially debilitating impact of dynamic physical forces of a car crash on the human brain. An important part of a recovery plan post-car crash is often the neuropsychological evaluation which can help to identify areas of cognitive difficulties and any impacts on behavior, mood, general mental status, and psychosocial adjustment.
Another tip to promote recovery is to consider how the brain, which has been described by some as a massive endocrine gland, is impacted post-trauma by changes in endocrine functioning. There are over 100 known hormones in the endocrine system which have the potential of being altered due to trauma.
The second tip is to have neuroendocrine follow-ups post-injury. It is important to be monitored over time, as changes may not be immediately evident. I became aware of this dimension of brain injury by exposure to the work of Mark L. Gordon, M.D., and the writings of Andrew Marr which I have covered extensively in previous blog posts. The fields of psychiatry and clinical psychology, I believe, can greatly benefit from an increased awareness of this potential dimension of brain trauma. (For an in-depth history of psychiatry’s relationship with endocrinology see Shorter & Fink, 2010.)
A final tip regarding recovery from the psychological and brain-based effects of trauma is the perspective that it takes many ingredients to make a cake. Too often, in the era of overspecialization, we tend to think that only one ingredient will make the cake. By making this mistake, we often end up with just a bowl of eggs or a cup of milk. We are blessed with many specializations that, when working together, can form a beautiful cake of recovery. There are professionals called case managers who can help injured people connect with the many "ingredient specialists" needed to move beyond the trauma to a new life worth living.
One of the specialists a TBI case manager will include are cognitive speech therapists. The benefit of these services cannot be overstated for someone attempting to recover from a brain injury. It takes a village to heal from severe trauma.
Marr, Adam & Marr, Andrew (2018). Tales from the Blast Factory. New York: Morgan James.
Shorter, Edward & Fink, Max (2010). Endocrine Psychiatry. New York: Oxford.