“A riveting account of survival and determination, told with clarity and honesty.”
∼ Dinty W Moore

Author of the memoir Between Panic & Desire, winner of the Grub Street Nonfiction Book Prize, and the editor of The Rose Metal Press Field Guide to Writing Flash Nonfiction: Advice and Essential Exercises from Respected Writers, Editors, and Teachers.

In Lucy Grealy’s memoir, Autobiography of a Face, the focus remains on the author’s identity struggle as she faces years of cancer treatment in which one third of her jaw is removed. How does she take us on her conflicted journey of needing to be accepted for who she is versus succumbing to society’s notion of acceptance?

She implants particular objects that carry the story forward: the hat she almost never takes off, and the turtleneck her mother encourages her to wear to hide her balding head and disfigured jaw. The mirror, her reflection, is Grealy’s nemesis: she says she is an “imposter” when she looks in the mirror (220). And she avoids looking at the details of her face: “Though I had looked at the scar running down the side of my still swollen face, it hadn’t occurred to me to scrutinize how I looked. I was missing a section of my jaw, but the extreme swelling, which stayed with me for two months, hid the defect (62).”

By employing phrases – “I tried to camouflage myself by sitting in the middle of the group,” and “I felt as if my illness were a blanket the world had thrown over me” – Grealy evinces her identity struggle. She does the same through metaphor: “Our house was falling apart,” and “Our home’s drastic state of disrepair” (35, 80). Her house is in disarray like that of her body and emotional state.

By narrowing in on the transformative events – surgeries, hair loss from chemotherapy, becoming a teenager and growing into a woman, interactions with men – Grealy maintains an integrated story of identity. In doing so, the reader is brought into her world, a world colliding with emotions: fear and anger, longing and loneliness, humiliation, denial, sadness.

But ultimately Grealy moves toward self-recognition: she matures from a 9-year old, unaware of what it means to have cancer and naïve as to how to cope with significant deformities, to an adult where she becomes mired in the conflict between acceptance of herself as she exists versus the desire to appear pretty in order to be accepted. She does not achieve complete resolution on, and off, the page – complete resolution is asking a lot of the writer who has suffered any kind of illness, or trauma. But, while at a café with a new lover, Grealy “experiences a moment of freedom,” and arrives at understanding (222):

As a child, I had expected my liberation to come from getting a new face to put on, but now I saw it came from shedding, shedding my image. Society … tells us again and again that we can most be ourselves by acting and looking like someone else, only to leave our original faces behind to turn into ghosts that will inevitably resent and haunt us (222).

And so, as Grealy says, “I looked with curiosity at the window … to see if I could recognize myself (223).”

Grealy, Lucy. Autobiography of a Face. New York: Harper Perennial, 1995. Print.

Traumatic brain injuries are a subset of acquired brain injures, which are not the result of trauma, but occur after birth: hypoxic brain injuries (lack of oxygen to the brain), and anoxic brain injuries (no oxygen to the brain).

In a diffuse axonal brain injury (a type of closed traumatic brain injury) the skull is not broken, but the brain is violently jarred and collides with the skull, causing tissue swelling. Since there is no opening to relieve the swelling, there is increased pressure in the brain, damaging neurons, the core cells of the nervous system. As a result, the communication network between neurons is impaired (think of a downed cable or telephone wire), and basic functions like speech, and  breathing might be affected.

A concussion is caused from direct impact to the head by an object, or sudden movement or momentum from shaking, like in whiplash. Neurons stretch and blood vessels tear, which can cause contusions – bruises on the brain. The individual may or may not lose consciousness. Shaken Baby Syndrome, also known as Abusive Head Trauma and Shaken Impact Syndrome – is a form of whiplash where the aggressor vigorously shakes the baby. Most of these cases occur when babies are between 6 and 8 weeks old, since that is when they cry the most. The trauma may cause them to experience vomiting, seizures, irritability, and poor feeding.

In an open brain injury, the skull is fractured. If it’s pierced, say, from a gunshot or knife, the skull splinters, and fragments can hit brain tissue, causing further tissue damage (a penetrating injury). Even though cell damage can occur in an open injury, there is less chance of brain swelling and therefore increased pressure. That’s why doctors consider them less dangerous than closed head injuries. But, because there is an opening in the skull, bleeding into the brain can occur. And the individual is at high risk for infection, most commonly meningitis – an infection of the membranes surrounding the brain and spinal column.

Frontal lobe injuries affect the front part of the brain. The frontal lobe controls motor skills, thoughts, emotions,and personality. The left side of the lobe controls verbal communication, and the right side controls non-verbal communication – the arty side of our brains. The right lobe also plays a role in negative emotions, while the left lobe involves positive emotions. The area of the frontal lobe that is damaged will dictate how your emotions and personality are affected. Once a cautious person, you may now find yourself to be more impulsive.

So I suppose it shouldn’t come as a surprise that the brain is susceptible to injury. Weighing a slight 3.4 pounds, and encompassing more than 1 billion neurons with an infinite number of connections, the brain is a delicate mass of tissue floating in a fluid environment, much like a fetus in a uterus.

http://www.msktc.org/tbi/factsheets/Understanding-TBI/What-Happens-During-Injury-And-In-Early-Stages-Of-Recovery

http://www.braininjuryinstitute.org/Brain-Injury-Types/Open-Head-Injury.html

http://kidshealth.org/parent/medical/brain/shaken.html

How do you predict who will suffer from PTSD after a traumatic event and who will not? Most people who experience a traumatic event actually do not suffer from PTSD: about 56% of people will experience a traumatic event in their lifetime, but only 8% will develop PTSD.

Research studies show that individuals with a variant of two genes – TPH1 and TPH2 – are more likely to develop symptoms. These genes, which control levels of serotonin – a chemical in the nervous system that regulates mood, sleep, and alertness – are altered in PTSD sufferers.

Genetics aside, other factors increase the risk for PTSD:

Having experienced other trauma earlier in life, including childhood abuse or neglect.

Having other mental health problems, such as anxiety or depression Lacking a good support system of family and friends Having biological (blood) relatives with mental health problems, including PTSD or depression.

Gender: Because there is more societal pressure on females to take care of others, we are twice as likely than men to suffer from anxiety disorders, such as PTSD.

Personality: People who are worriers, and cannot tolerate unpredictability. These traits may have a biological basis. It’s possible that the amygdala, the part of the brain that controls emotion, is oversensitive in worriers.

Have you been diagnosed with PTSD? If so, it may come as a relief to know that you can blame your symptoms on factors beyond your control.

http://www.ncbi.nlm.nih.gov/books/NBK49142

http://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/basics/risk-factors/con-20022540

http://www.nimh.nih.gov/statistics/1AD_PTSD_ADULT.shtml

http://newsroom.ucla.edu/releases/ucla-study-identifies-first-genes-231248

http://psychnews.psychiatryonline.org/newsArticle.aspx?articleid=1130400

When exposed to danger, it’s natural to be afraid. Our bodies are triggered to make a split-second decision to either face the danger, or run from it: the “flight-or-fight” response. This is a healthy reaction. But in those with PTSD, they continue to be afraid and feel stressed long after the danger has passed – in my case, the speeding car at the Santa Monica Farmers’ Market. Symptoms, like avoiding places that trigger memories of the event, nightmares, depression, and hyper-vigilance – heightened awareness of your surroundings – may interfere with day-to-day-life. In hyper-vigilance, there is a perpetual scanning of the environment for sights, sounds, smells, or anything that is a reminder of threat or trauma. Just because you have been in a car accident, for instance, doesn’t mean you’ll be hyper-vigilant only for screeching brakes or beeping horns.

A month after my psychologist told me I had PTSD, I called her, wondering if I should go to the emergency room because my toe was red – I thought I had a life-threatening infection (I’m a nurse, and sometimes nurses know too much). I wouldn’t sleep in my bedroom on the third floor of my apartment because I was afraid of dying in a fire (I worked as a burn nurse years ago).

Months later, when shopping at an outside market with my father, I suddenly felt short of breath and couldn’t swallow. I told him he needed to drive me to the emergency room because I thought I was having a heart attack. I was a physically fit, non-smoking, lover-of-veggies thirty seven year old. I was not at risk for a heart attack. I called 911 three more times in the next few months, because I thought I was having allergic reaction: first to chocolate, then shellfish, then a bug bite. Miraculously, each time the EMT’s arrived, my rapid pulse slowed and my quivering body relaxed. I was suffering from panic attacks.

Before the accident, I had been known for my calm demeanor, and my no-worry attitude in my family. When working in the neonatal intensive care unit, I had been known for my in-control, I-can-handle-this disposition, even when a baby’s heart rate plummeted to near zero. After the accident, I felt as if there was a circuit breaker inside my brain that tripped at random moments, sending sparks into my nervous system. I didn’t know exactly where the breaker was located, or how to stop it from tripping. I reasoned that my brain had been re-wired. My reasoning was accurate – recently, I learned that researchers have found differences in the structure and circuitry of the brain between those with PTSD and those without it.

http://www.ptsd.va.gov/professional/treatment/overview/clinicians-guide-to-medications-for-ptsd.asp