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It was just like every other summer day in Suburbia. My brother and sisters had gathered a few neighborhood kids on the front lawn for an impromptu baseball game, while our moms stood on the sidelines, sipping their afternoon cocktails and commiserating with one another about the high price of eggs.
I, the baby of the family at four years old, had just awoken from a nap and wandered out, sleepy-eyed, to find my Mommy. Aha! There she is! Letting the screen door slam behind me, I made a beeline for those familiar arms.
I don't recall if I even noticed that my sister was winding up for the grand-slam homer of a lifetime until the Louisville Slugger made contact with the side of my head but, to this day, I can hear the crack of the bat when it made contact with my skull - and the crack of my skull when the bat made contact with it. And, just like that - though the physical injury to my grey matter wouldn’t be visible on MRI for several more decades - I became one of approximately 2.5 million Americans who suffer a traumatic brain injury each year.
According to the National Institute of Neurological Disorders and Stroke, I suffered a non-penetrating TBI (also known as closed head injury or blunt TBI) which is caused by an external force strong enough to move the brain within the skull. This impact can cause bleeding between the brain and skull, and bruises can form. In other words, when the bat hit my head, my brain bounced off the walls of my skull and I got a really big boo-boo that no one else can see.
Often, when people refer to TBI, they are talking about the symptoms that follow the injury, but a TBI is actually the injury or event itself. The symptoms that result from a TBI are referred to as TBI-related or post-concussive symptoms, which are physical in nature:
Most TBIs are mild concussions, treated in emergency departments and urgent care centers, while tens of thousands more result in hospitalization, severe disability, or death each year, making TBI a significant public health concern.
“We’re going to try something different today, Jen.” My therapist closed the door, turned on the white noise machine and plopped down on the sofa next to me. “It’s Boxing Day, so we’re going to change roles. You get to play the therapist and I’ll be the client.”
She explained the forms that I, the therapist, was required to fill out. First, the insurance forms which required me to assign a primary diagnostic code to the client’s complaint, if I wanted to get paid for the session.
“I’ll be playing a client who's a bit...difficult...to work with because I stubbornly refuse to accept that I am experiencing trauma responses, not moral failings. It’s been particularly challenging to assign a treatment team to my case because I’m kind of all over the place, clinically, ” she said. (She was describing me, perfectly, and it stung.) “So, for this scenario, your job as head of the treatment team is to assign a primary diagnostic code to my case, and validate it with clinical evidence that I have accepted the diagnosis and voluntarily agreed to a treatment plan. Ready to play?”
She handed me a clipboard.
For the next fifty minutes, following the standard clinical procedures and protocols I learned in some college or another along the way, I conducted a client intake interview, filled in clinical evaluation forms, and completed a narrative timeline of the client’s traumatic life experiences, while my therapist responded to my queries with my own words, read back to me from the record.
“So, what’s the diagnosis?” she asked, when the session was over.
“You’re a pain in the ass,” I responded.
“Good diagnosis,” she quipped back, “but not billable. C’mon, Jen, time’s up.”
I reviewed my notes, double-checked the scores, and re-checked all the boxes. And there it was: The elephant in the room. The monster under my bed. The committee that lives in my head.
“Post-Traumatic Stress Disorder,” was all I said. It’s all I could say.
We looked at each other in silence for a heartbeat or two, then she asked, “So, I’ll see you next week?” as she rose from the sofa to tuck my file back into its alphabetical place among the other broken souls in the drawer. “Now that we have a diagnosis, we can talk about the treatment plan.” She sounded hopeful, like she actually expected this to work. Oh well, at least one of us was thinking clearly enough to come up with a plan.
"Sure," I called over my shoulder as I raced toward the exit, "I'll see you next week..."
PTSD can develop after experiencing or witnessing a traumatic event, such as violence, a serious accident, disaster, or assault. Symptoms persist beyond normal stress reactions and interfere with daily life.
There are four categories of PTSD symptoms:
Intrusion (Re-experiencing)
Avoidance
Negative Changes in Mood or Thinking
Arousal and Reactivity
PTSD is diagnosed when: