Mental frameworks for brain injury recovery

I previously wrote about my recovery from a Traumatic Brain Injury (TBI), and the interventions that I’ve found helpful. In this post, I cover the mental frameworks that guide me in remaining positive and staying sane.

It's taken me a lot of meditation, therapy, and reflection to get to this point. I don't always see the world through a positive lens, but over-time I've been able to increase how often I do.

The most practical move is to view the ordeal as a gift

In my experience, gratitude has been the antidote to despair.

Gratitude isn’t easy to come by after a brain injury. For a long time, I wasn’t able to read, listen to music, use electronic devices, or take care of myself. Even today, I’d still can’t walk freely, work, play sports, or go out to crowded events. A brain injury causes very real quality of life and financial concerns that make for miserable living.

Nonetheless, there are often silver linings that come with difficult situations in life. In concussion land, you may need to squint hard and get creative to find these silver linings...

The way I’ve done this is to pursue the passions I’m physically capable of doing. When I couldn’t do anything else, I went deep into meditation. More recently, I’ve started getting into writing. I’m grateful that I was able to do my first silent meditation retreat, and that I took the step to share my journey on this blog. I’m also very grateful for the opportunity to unplug and slow down after many years of running my life at 110%.

Self-kindness is generally the answer

This is by far the hardest one if you’re anything like me.

If you ever find yourself on a meditation retreat, you’ll notice that your level of awareness is intense. Little words and phrases hit you in ways you’d never imagine. On night four of my retreat, the instructor said “We’re about to get into the heart of the retreat, don’t white knuckle it.” That statement hit me hard.

In that moment, I realized I’d defaulted to white knuckling my way through life.

What began as pushing myself in school morphed into extreme intensity in investment banking, founding a startup, and my career since. It didn’t end with a concussion - I drove myself to optimize all aspects of my recovery. Even on retreat, I obsessed with things like maintaining the perfect posture.

There’s a ton of value in all this, but a major downside is that you can get stuck in a harsh, self-critical pattern. In a brain injury context, this becomes harmful since your body can’t keep up. This causes emotional suffering and leads to serious risks of exacerbating symptoms.

Who would you be if you did 80% of what you do?

I still often find my inner dictator cracking the whip. In moments when things don’t go my way or when I’m pushing myself too hard, these days I try to chill out and be kind to myself.

Research is key, but beware becoming a hypochondriac

We fear what we don’t know, but it’s easy to get obsessed with knowing everything.

With a concussion, there’s a lot of conflicting advice out there. Best practices have flipped since 2018, although many doctors still prescribe “rest and do nothing” as the cure.

It’s important to do your own research, as that sinking feeling of: “Am I even doing the right things?” can be excruciating. In the early days, I couldn’t do my own research so I got my partner to help out. Speaking to friends who had been through painful concussion recoveries was invaluable. When I was able to listen to audio, the Concussion Doc podcast was an absolute lifesaver.

I’d say I then went a bit overboard and got too obsessed about recovery. There’s so many rabbit holes to go down and I found countless obscure conditions with symptoms matching my own. For a while, I did need to research extensively, but it became clear that there was a point of diminishing return and I’d reached it.

As outlined in the Occam’s Razor model, you’re generally better off going with the simplest explanation as it's the most likely.

I benefited when I calmed down and researched less. I also stopped journaling my symptoms, which helped me think about my injury less often.

Redefining the relationship with pain

You’re always in a dance with discomfort. When you adjust how you’re sitting or you scratch an itch, discomfort is the catalyst.

After my brain injury, I’ve had a lot of difficult physical symptoms such as dizziness and nausea. When faced with frequent pain, finding a way to soften the blow becomes important. I've found it helpful to think about the pain as another form of discomfort, and to avoid fighting the pain as much as possible.

When I feel pain, I ask myself - "Do I need to do something about this right now?"

If I get a strong headache while I’m on my laptop, it’s a sign that I need to get away from screens and rest. Other times, I may feel a lot of nausea for no apparent reason but there’s nothing that can be done about it. It is what it is.

When this happens, I try to observe the sensation as deeply as I can, as opposed to getting caught up in the narrative of how my life is fucked.

When I understand that my desire for the sensation to go away is just a preference, I can then ask myself: “If this is just a preference, do I really want to cause additional emotional suffering by fighting so hard against this?”.

This tactic generally helps, but it sometimes falls apart when the pain is too strong. In that case, I resort to distraction! If, for example, I’m extremely upset that I’m dizzy, I’ll sit down and listen to a podcast or watch Youtube to pull away from it. This isn’t the most sustainable tactic as it involves avoiding pain, but it is a useful arrow to have in the quiver for when things get too intense.

Reducing over-identification with the injury

When a difficult major life event happens, it’s hard to detach your identity from it.

A brain injury is all encompassing - I constantly have to work around it and be on alert in case I cause a setback. The world keeps reminding me of how limited I am when I have to say no to social gatherings, weddings, travel plans, and sporting events. Recovery takes center stage in how I operate my life.

This makes it easy to think that I am the brain injury, and that it’s a fundamental part of me. This is a thought pattern to question, as the reality is that “I” am not my brain injury. While the injury has major impacts on my day-to-day life, there’s more to who I am than the injury itself. There are many moments throughout the day when I’m symptom free, so how could I be the injury?

Seeing the brain injury as one part of my experience as opposed to my whole experience, has reduced the emotional power it has on me. I can see past the injury by getting satisfaction and happiness from other parts of my life, which helps me feel a lot less miserable!

Embracing the lack of control

When you just can’t control something, it’s a losing strategy to force yourself to try to control it.

The speed of my recovery and the extent to which I recover is within my influence, but outside my control. I can do all the right things within my means to help my recovery, but I cannot control the ultimate outcomes.

The harder I fought to tell myself I was in control, the more I become invested in the narrative of: "I shouldn’t be feeling this - reality needs to be different." This strategy is ineffective because there really are some things that you can’t change. Fighting these types of situations is futile and causes a lot of emotional suffering on top of the other physical symptoms.

I worked hard on being at peace with my lack of control - this didn’t come easy. I placed probabilities on the likelihood of various recovery scenarios, and ran thought experiments of what I’d do with my life in each scenario. This wasn’t fun, but it made the ambiguities more concrete as I planned through how I’d survive in the worst-case scenario. All in all, this released a lot of pressure and helped me move towards acceptance of not being in control.

“I wish you a speedy recovery, but more than that, I wish you acceptance for the speed at which you recover.” - Gensan Thomson

What’s next

This concludes my short-series on my concussion recovery! For anyone who is suffering from a brain injury, I hope that this gives some guidance on what to expect and some pathways to explore.

In the interest of not over-identifying with my concussion, I’m going to write about other topics moving forward. Nonetheless, when I have major updates on my recovery, I will share them.

In the meantime, I’ll be writing about a topic I’ve become fascinated by - origin stories. There’s incredible insights to glean from the stories of how products, places, movements, and beliefs came to be. I’m interested in understanding this wisdom and how it can be applied across life, work, and happiness. I’ll be sharing what I learn over the next few weeks.

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