Saturday, December 22, 2012

Self-Awereness with TBI or PTSD

Also see my "What does PTSD look like?  I'm Fine, How are You?" post

A veteran slams a door, he hollers, he is angry.  Yet, the vet doesn't recognize that this is not normal acceptable behavior and doesn't realize there is a problem.

A doctor asks, "Where is your pain?" 
The vet looks puzzled and replies, "my back." 
The doctor then questions, "Where at specifically in your back?"
"Hum.." ponders the vet.  "It is kind of towards the bottom."
Upon examination, the doctor finds that the vet cringes with pain when his middle back is touched.
With a jerk and gasp, the vet replies, "That's it...right there."

  What is Self-Awareness?  

The above are two examples of a lack of awareness. In the first example, the vet may likely blame someone or something else, externalizing the problem and failing to realize that it was his behavior that was inappropriate.  The second example demonstrates a vet who does not even pay enough attention to his pain to accurately report where it is coming from.

In the most simplest form, the Miriam-Webster Dictionary defines this self-awareness as "an awareness of one's own personality or individuality."  But what is awareness? Why might it be difficult for some?  Self-awareness is something most people have to purposefully work at and be attentive to. 

Awareness, according to Wikipedia,  "is the state or ability to perceive, to feel, or to be conscious of events, objects, or sensory patterns. In this level of consciousness, sense data can be confirmed by an observer without necessarily implying understanding. More broadly, it is the state or quality of being aware of something."

I have found that many times people with Traumatic Brain Injury (TBI) and/or Post Traumatic Stress Disorder (PTSD) along with other disabilities often have trouble with self-awareness.  Perhaps denial, that great defense mechanism, plays a large part with people ignoring problems or disabilities and simply believing they are "fine." Delusions can also play a part in one's lack of self awareness.  Delusions of one's disability are common. Often people deny or ignore that there is a problem in the first place.  When one has injuries and problems, either visible or invisible, with the functioning of the brain there is likely to be lack of awareness.

With a lack of self awareness it is difficult for a person to talk about feelings, sensations, and physical complaints.  This may lead them to manage their emotions and relationships effectively.  Mr. Rogers sums it up nicely below.

Fred Rogers“Part of the problem with the word 'disabilities' is that it immediately suggests an inability to see or hear or walk or do other things that many of us take for granted. But what of people who can't feel? Or talk about their feelings? Or manage their feelings in constructive ways? What of people who aren't able to form close and strong relationships? And people who cannot find fulfillment in their lives, or those who have lost hope, who live in disappointment and bitterness and find in life no joy, no love? These, it seems to me, are the real disabilities.”― Fred Rogers, The World According to Mister Rogers: Important Things to Remember

It is almost normal for many, especially soldiers, to ignore disabilities as much as they can and still believe that they are capable of much more than they can physically or mentally endure.  They may try to tackle a large project or attempt to attend a large gathering, yet not be able to finish the project or get through the gathering without panic and paranoia. Without adequate awareness, one can become frustrated, frustrate those around them, and retreat to loneliness, disappointment, and lack of fulfillment and satisfaction with life. 

Self-Awareness Theory 

Self-Awareness Theory states that when we focus our attention on ourselves, we evaluate and compare our current behavior to our internal standards and values. We become self-conscious as objective evaluators of ourselves.  People with mental illness, like PTSD, or TBI can have great problems with objectively evaluating themselves.  They can have problems recognizing reality and awareness.  

Additionally, a component of Social Psychology is that one wants his or her behavior to be congruent with the beliefs and values that he or she has.  When those behaviors and beliefs don't line up, there is conflict.  For example, when one believes that he or she should be the bread-winning worker in the family and is disabled and no longer to fill that role it can lead to cognitive dissonance and leaving the disabled person uneasy and likely depressed until resolution can be made.  One can resolve cognitive dissonance in several different ways. He or she can change his or her ideas to believe that the disability is accepted and that not being the bread winner is alright.  They might also pursue VA compensation or Social Security disability or other resources that  are available as an alternative that is acceptable in the place of being the primary wage earner.

Overcoming this lack of awareness

C.G. Jung“Until you make the unconscious conscious, it will direct your life and you will call it fate.”― C.G. Jung

How does a person overcome a lack of awareness?  This can take a long time.  It doesn't happen immediately.  It is a process and for those with disabilities, it can be a very taxing and seemingly impossible task.  Awareness can start with a simple quiet reflection of ones surroundings and being mindful of what is present.  Quietly sit with your eyes closed and pay attention to what you hear or feel.  Do you hear cars going by?  The hum of the computer? Do you feel the weight of your arms against the chair?  Do you have a headache? Are you anxious because of your eyes being closed?

Next, one can also do progressive muscle relaxation training.  With relaxation training, one does a body scan paying attention to the muscles and the tension in the body.  The person then systematically tenses muscle groups, then relaxes them, noticing the difference between tension and relaxation.  The goal here is two fold.  First, the person can create a more relaxed state in his or her body and secondly, that he or she can be more aware of where they are harboring tension or stress so they can relieve that bodily stress by the contraction exercises.  One example of a relaxation exercise is that when you feel tension or tightness in your shoulders, that you pull them up towards your ears (like you are shrugging them).  Hold your shoulders up in this position for about 10 seconds and then release them.  Let them fall back down to the normal position and recognize the difference between tension and relaxation.  

See this video on YouTube for a great relaxation exercise or watch a person do the exercises here to get an idea of what they look like. 

Be patient with the person as he attempts to learn how to be more aware.  Ask open ended questions to help them come up with answers for how they feel and ask specific questions when needed to help someone become more aware of pain or emotional awareness.  

Good resources on my shelf that I recommend to clients and students are:
  • The PTSD Workbook. Link to this book on Amazon:

  • The Anxiety and Phobia Workbook by Bourne.  Link to this book on Amazon:

Both these books are now available on Kindle.
Kindle eBooks

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