The internal scars

Not all trauma leaves a visible mark. Just like not everyone who is disabled “looks” disabled, not everyone who has had a traumatic event, even a very physical one, will have scars that show. That doesn’t mean they aren’t there, or that if you look hard enough you can’t find evidence of them, it’s just not a big flashing neon sign saying, “here I am!” It also doesn’t make them hurt any less, or make them any less real. Sometimes the trauma you can’t see is the trauma that hurts the most to carry.

I think we can generally agree war is hell. I mean everyone trying to kill each other, blah, blah, blah. I’m not a fan, despite being a veteran. I think most veterans agree if I’m being honest. It’s really just one big trauma factory under the guise of serving your country and that’s the shitty part. The people who are so adamant that you die for your country are the same ones who wouldn’t lift a finger to fight themselves. These days my general thought is if you want someone to die for your country, feel free to be the first in line.

War unfortunately isn’t the only way trauma accumulates, it’s just probably (hopefully…?) the most egregious example. Life is just a series of traumatic events that we accumulate as we go, which is probably why so many people (basically everyone) should be in therapy at the least. It’s sad we don’t prioritize mental health, but we (the US in particular) don’t even prioritize physical health, so there’s still a lot of work to be done. So it goes.

But more to my point, war doesn’t always leave physical scars, although there are plenty of those too. For example, TBI is probably one of the most common injuries for someone serving in the military. We don’t care about it much because it’s not as obvious as an amputation or a bullet hole, but it’s there all the same. A self-contained internal scarring, in the literal sense mind you, that isn’t visible externally no matter how bad it is. To see it, we use an MRI, and even then making sense of how bad the damage is, is very much a matter of how you’re functioning after the fact and not about the amount of damage sustained.

The brain is an amazing thing in that way. Despite what you may have learned in school about neurons never growing and a static picture of the brain itself, it’s forever changing. It adapts and that is a good thing because we can learn throughout our life, but also we can adapt to the trauma life throws at us, be it man-made horrors beyond our comprehension, or just an accident where you’re in the wrong place at the wrong time. In a way, we’re lucky that the brain is so plastic, so moldable.

Maybe we can’t overcome the trauma, but we can learn to skirt the edges of it. It becomes less of a barrier and more of an annoyance, always there, but time heals all wounds, even the internal ones to a certain degree.

When I say a scar, I mean that literally. The brain scars over after a TBI, it’s called glial scarring and as the name implies it is the glial cells that cause it. They are in charge of a lot of things, but basically you can think of them as the housekeepers of the nervous system. They help with the healing process, so it’s a very literal scar you get from a TBI and I would know, I have two.

Ever see a car crash video? Things continue to move even after the car has stopped. Inertia, the problem is that everything has inertia so an object in motion will tend to stay in motion. The brain has inertia too and it sits inside it’s little car (the skull) surrounded by tissues and fluid to keep it in place. It’s basically a little pool for the brain inside your head. Fun thought, right? But that means it can (and does) move independently of the skull. It’s not fixed in place. This isn’t normally a problem. It’s a feature, not a bug and helps keep your brain safe. For the most part that is.

What does this have to do with my two TBI scars? Well, they are from a single TBI incident. The prefrontal cortex (the front of the brain), smashed pretty violently into the front of my skull. But again, inertia is a thing so there’s some energy absorption and the brain literally bounces off the skill and in my case rammed hard enough to cause a secondary injury on the left side, specifically wernicke’s area.

The prefrontal cortex (PFC) is the last thing to develop in the brain. In fact, it’s not fully developed until your mid-20’s. As far as we can tell, it’s what makes you, you. It’s in charge of cognitive control, impulse inhibition, and a bunch of other “high level” functions, which is (again as far as we can tell) why teenagers act like such little shits (the technical term for it, I swear). It’s not a bad thing the PFC doesn’t develop quickly, we believe (yet again as far as we can tell…) that this helps you overcome your birth circumstances. Abused as a child? Well, at least your PFC isn’t developed yet. It doesn’t carry that trauma like it would if it had been developed. So yet another feature, not a bug.

Wernicke’s area (named after the dude who figured it out) is the part of the brain that deals with speech comprehension, among other things. As with everything we’re talking about, it too is as far as we know in charge of that stuff. It’s one of two areas of the brain associated with speech. The brain, like most things, likes to compartmentalize function.

Compartmentalizing functions is not a bad thing in terms of performance and efficiency, but damage to one area can cause a lot of downstream effects. Between the TBI and all the other trauma, PTSD, depression, anxiety, etc. Looking back a lot of the stuff I did shortly after getting out could be linked to the damage that occured. Impulse control and what not, thanks PFC. The only good side was that I got out (probably) before it was fully formed anyway, so these days I don’t generally (IMO) have a impulse problem, but that doesn’t mean that I don’t carry those scars or that they haven’t impacted my life.

The PFC damage for instance could be related to a lot of the constant battle going on in my head with convincing myself not to kill myself. That’s been… fun? But there’s a lot of other semi- more obvious things that I deal with. Speech comprehension and specifically something called aphasia, which means sometimes I can’t think of the right word even though I know it. Or I will think I’ve said the correct word, but instead said a totally different word or similar sounding word.

I also have seriously debilitating migraines, and I just recently (the inspiration for this post) met with a neurologist about it. They gave me some medications to help prevent them and to deal with them if they ever get really bad, but it’s one of those learn to live with it type things. Any relief is considered a success and that’s about all you can hope for, any relief.

While this is a physical trauma, albeit internal, there are plenty of traumas that don’t leave such obvious signs. Depression does if you look hard enough (here), but most people don’t look. It doesn’t make living with it any less real or any less painful though.

Really that’s the point of the post though, to live is to survive unfair choices. No one asked for trauma, yet somehow it seems to find us anyway. Not all scars are visible, so be kind. To those around you, but to yourself as well.