Psychological Post-concussion Syndrome

It’s not apathy. It’s outrage depletion.

Numb. That’s what it feels like.

Spent.

Shock-weary.

Not apathetic so much as “un-pathisable” if one were to coin a word. The psyche wants to respond but it just can’t raise any more emotional energy to bring to the front. In healthcare, we label a syndrome with the prefix “pseudo-” to alert the clinician that “while the symptoms and signs you’re seeing may look like [XYZ] syndrome, don’t be fooled. This new syndrome looks just like it, but it’s not.” And then the clinician who discovered the look-alike goes on to detail how the great masquerader is significantly different.

So we could say that my obtundation, my walking around like I’m shell-shocked with that 1,000 yard stare, mouth agape, and my averting my glance from this or that breaking news item, may look like apathetic indifference. But it’s not. It’s a pseudo-apathetic syndrome which, at its dried-up heart is outrage depletion.

I don’t want to turn on the TV. I don’t want to see any more violence. I can’t stomach the nauseating rationalizing and false equivalence and reverse victimhood and the smarmy sneering know-it-all pontifications from FOX propagandists, the lynch mob rabble rousers.

I want to just zone out, like a kid in a disturbed family infested with embittered bickering whose ears are plugged with silicone-tipped buds blaring vindictive rage music, and whose mind is diverted to his/her phone, with a continuous cascade of colorful action-oriented distraction. It’s not too different from the self-harming adolescent who cuts him/herself so as to let the physical pain overpower the emotional pain.

It’s an abnormal state, admittedly. And because you know that you shouldn’t feel this way, indifferent, you feel badly about yourself. And yet, you don’t even have any mental space for such self-criticism as it only worsens one’s plight, adding to an already depleted emotional bank account.

But the thing is, you’re not indifferent, your not willfully apathetic. You’re truly “pathos-depleted.” If you could rouse fury, you would. But you just can’t. The juice is used up. It’s sort of like erectile dysfunction disorder of the psyche.

That’s the psychic cost of chronic outrage, of daily shock syndrome, of serial horror leaving one incredulous, screaming for so long “WTF!!!! You can’t do that!!!”

You really want to mobilize an emphatically angry response, to voice your moral outrage … but you just can’t. One, because you’re too weary from the fight. For another, it feels like the outrage, truly a nearly visceral form of emotional intelligence informing us that something major is offensively unfair, so out-of-whack, has so overloaded the emotional electrical system that it’s blown the shock and indignation circuits. They’re smoldering, threatening to inflame the house.

Like screaming, outrage eventually makes one hoarse. And the more one screams and sees no effect, the weaker one gets. There’s a sort of psychic energy ecology that goes on. Shut down to help restore emotional energy and to cool down the wires, or risk burning the mind down.

In psychological trauma, one sees the very same thing. A massive outpouring of shock, of fright, perhaps of rage, all part of our survival-ingrained alarm system that we instinctively mobilize when threatened. And after the immediate event has passed, there’s a shut down of the psychic system. All cognitive and emotional resources went to dealing with the assaultive, potentially life-threatening traumatic event. They’re now depleted, so depleted that coming back even into a non-emergency cognitive processing state of mind can seem effortful, if doable at all.

Likewise in torture as we’ve learned about these past two decades. While so few of us has ever been on the receiving end of torture, seeing only reenactments of it safely from our movie screens, a significant number of people experience something very akin to it, severe domestic violence. Likewise, those who have been on the targeted end of police brutality. The psychic system becomes numb. It retreats, it cowers, not because it’s cowardly but because it’s self-protective.

And yet, there’s still a part of the mental process – oh how our minds contain multitudes – that’s wanting you to respond, and even shaming you for not doing so. You engage with it at your peril. Countering that self-shaming thought takes too much energy; worse, the truly fair judge within you may not even be able to object, to call out the unfair shaming, as you’re too psychologically weakened to mount such thoughtful self-observation.

The state of being continuously psychologically assaulted and having no means to recover or even to collectively name what’s happened is a form of chronic major trauma. And it’s made none the less traumatic by the sadistic chorus of FOX-fueled bullies chanting what a sensitive snowflake you are. You feel like you’ve truly entered crazyville and, like Van Gogh’s The Scream, you want to just shut it all out, all the abusiveness and table-turning and mind-screwing, the fear that it’ll never end.

And yet, it escalates, like an increasingly loud noise, and you feel even more aghast and helpless and overwhelmed. For some, it gets to a point of psychic numbness, or a psychological fatigue state comparable to severe hypothyroidism.

Though speaking from the perspective of a psychiatrist, I am not talking about “you” as much as I am about me, and us, and a recognition that my psychological experience of this madness, this being subjected to witnessing the rape of our revered institution the Capitol and the near lethal assault on those legislators fighting to protect our time-honored democratic processes, leaves one so shaken that a visceral nausea and deep fatigue, almost to the point of punch-drunk dazed, predominates one’s psychic space.

I am deeply sickened and horrified, and there is a strong part of me that, like a child, wants to just “make it go away.” Even though trying daily for more than four revolting years to make sense of this ghoulish horror, the most recent assault, the rape of our Capitol and the near assassination of our elected legislators, feels too immense to deal with. And so there is the tendency to numb it out, not look at the devastation, just avoid the ordeal of having to confront it.

This is exactly the experience of servicemen and women who have been engaged in deadly combat. And one is left with the ever-present push-pull of “go into it and confront it and try to make sense of it and thus hopefully purge it from one’s psyche” and pushing it back, suppressing it, saying “I can’t go into it right now; I’ll get back to you later; maybe.” And the latter, the avoidant self, the raw, wounded self, unconsciously wants to ally with those who would downplay the gang rape and attempted murder and hostage taking, normalizing it as just impassioned people who had a legitimate concern and who got carried away, “let’s move on and let bygones be bygones, shall we, and we sure don’t want to stir them up again, do we, and we’ve got work to do, don’t we …? Why are you making such a big deal of this? Why are you so stuck in this anger … see, you’re the sick one.”

And there’s a part of us that just wants to smack those manipulative gaslighting provocateurs repeatedly, and then again, another part restraining us, shaming us for feeling that way … the war in the head fighting out our optimal response, acutely aware that the very tug of war we’re having with ourselves is itself rapidly draining our precious reserves.

It would be foolish, and a lie, to say that I had the answer as to what is best to do. But I do know that reflecting on one’s experience, naming the offenses, reality-testing them and validating their severity with psychically grounded others, recognizing the contradictory push-pull dynamics and the psychic binds we find ourselves in, is vitally important. To give this chronic lunatic behavior and relentless moral sensibility assaultiveness a name, and to understand the profundity of its deep moral injury. It’s important to name the horror, the newest one as well as the string of horrors; to acknowledge that this is in reality what has happened, that, yes, it has been all too real, and traumatic, and psychologically stunning, much in the same way as a blunt brain concussion, leaving one dazed for a long time, unable to pull it together while also frustrated at the incapacity and fearful of no further recovery.

We’re reeling from repeated mind assaults, psychological concussions. We’re psychologically punch drunk. Psychological dementia pugilistica,

I suspect none of us knows the best course, but I’m confident in saying that we must actively digest, metabolize, this serial horror like the toxin that it has been. That we must give it the right amount of attention, neither suppressing it and avoiding its painful emotions nor insisting on fully processing it in depth, blow by blow, right now, as though we might finally cleanse ourselves and purge this nightmarish ensnarement.

I am so in awe of our democratically elected officials, yes Democrats, Independents and a growing number of humanitarian Lincolnesque Republicans, who have persisted, and who continue to persist despite their own inordinately greater trauma. I can’t even imagine being a member of the crazy house that has become the legislature. It must be a continuous WTF!? experience, at some level recognizing that the colleagues you’re dealing with, formerly human, have become enculted zombies responding on command to electronic missives from the hate-spewing tweeting wizard behind the curtain.

I truly don’t know how they and their dedicated staffs have done it. I know we’re going to have to cut them slack, some real downtime, so that they can heal. And I know also that we need to actively acknowledge and support them through their, and our, collective healing and rebuilding process.

Shocked, stunned, furious, outrage-depleted, weary, punch drunk … we’re all of that.

And we’re also a people of resilience and determination, compassionate, striving to name and hold the vision of what we stand for, as flawed in its realization as it has been. And we’re a people of indomitable hope that, together, sharing this life-changing epoch, we can heal. And not only “mend” in that “slow recovery from illness” sort of way. But heal in growing from this trauma, emerging stronger, deepening our compassion for all in the world who have been traumatized, dispossessed and are suffering. Preparing to see this as an opportunity to grow in new ways yet to unfold – as a people, as a country, as ourselves a wounded member of a world itself traumatized and yearning for tenderness and healing and hope.

p.s.

I have exciting news to share: You can now read Physician Interrupted in the new Substack app for iPhone.

With the app, you’ll have a dedicated Inbox for my Substack and any others you subscribe to. New posts will never get lost in your email filters, or stuck in spam. Longer posts will never cut-off by your email app. Comments and rich media will all work seamlessly. Overall, it’s a big upgrade to the reading experience.

The Substack app is currently available for iOS. If you don’t have an Apple device, you can join the Android waitlist here.