What's Me, and What's My Damaged Brain? Reflections on Personality, Identity, and Traumatic Injury

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Mama and other beloved relatives: this newsletter discusses several aspects of my brain injury, including how it impacted my sexuality. You may want to give this a miss. If you like, I’ll email you a special G-rated version soon!

My brain, showing holes, divots, lesions and lumps attributable to one or more injuries

Three months ago, I was diagnosed with a traumatic brain injury. I wrote a post about it, complete with pictures of my brain scan, sharing the story of a severe concussion I sustained when I was 19. The damage was so severe that the doctor had a hard time believing that I had only had one bad concussion; the trauma was more consistent with repeated blows to the head. Dr. Frederick conceded it was possible that a single terrible injury could do this much damage.

In April, I wrote that I wasn’t yet sure what all this meant. Obviously, there was a treatment course to begin: specific brain supplements, cognitive exercises, and so on. There was also a warning that haunts me — my chances of developing dementia are significantly higher because of my TBI. There is no perfect prophylaxis against the onset of Alzheimer’s or a similar degenerative disease, but there are ways to better my chances. Eat a high-protein, moderate fat, low carb and low sugar diet; exercise regularly; and — this is serious — do puzzles. I am not good at Wordle, and unlike almost everyone and their Cousin Gertrude, I do not post my scores online, but I do try and finish the damn thing every day.

I think of it not as pleasure, but as forestalling disaster.

I have joined a couple of online support groups for high-functioning folks with brain damage. It has been wonderful to exchange stories with these remarkable people.

Over the past three months since my diagnosis, I’ve realized how much that head injury transformed my life. My first episode of serious self-harm — and my first psychiatric hospitalization — took place just two months after I fell down those stairs on the Berkeley campus. I had seen people cut themselves before my fall, but had never imagined I could want to do the same; afterwards, I couldn’t get thoughts of seeing my own blood out of my mind.

Where I had already had signs of a drinking problem before, after the bang on the head, I got drunk much faster and with much less liquor. Where I had been able to smoke weed and feel relaxed, now marijuana made me anxious to the point of paranoia and hallucinations. Where I had enjoyed political arguments and debates, now I shied away from conflict. I’d always associated these changes with the sudden onset of Borderline Personality Disorder; now I see it’s more likely that my brain began to process chemicals very differently after the concussion.

I now realize too that the TBI shifted my sexuality. The last time I had sex with an older man for money was a few weeks after I hit my head — I remember feeling panicky and disgusted in a way I hadn’t before. I decided that I simply couldn’t do the sex work anymore, no matter how much I wanted the affirmation and the cash. I couldn’t tolerate what I had tolerated before. Perhaps most odd of all, I found myself significantly less attracted to men after the concussion. I can count on the fingers of one hand the number of men I’ve had sex with since the TBI - my “number” with men was close to 100 before I was injured. Even my sexual fantasies shifted from a more or less equal focus on both genders to a 95% focus on women. (There was a definite change in the kind of porn magazines I bought in adult bookstores.)

In a follow-up appointment with Dr. Frederick a few weeks ago, I asked if it was possible that a brain injury could alter one’s sexual identity, and he pointed out that this was rare, but far from unknown. Dr. Frederick also suggested that the sex work I had done with much older men had probably been traumatic in ways I had not fully understood — and that just as the TBI made it harder for me to drink, the injury also made it harder for me to hide from myself the cost of this very secret life.

The larger question is about responsibility. How much of the chaos I caused — the four divorces, the hospitalizations, the unthinkably reckless sexual affairs with students, the chronic, compulsive infidelity, the abuse of alcohol and prescription drugs, the inability to resist attention of any sort — is a consequence of the brain injury? How much of it is Hugo’s fault, and how much of it was beyond my control?

I know that there is a distinction between an excuse and an explanation. My brain injury explains a great deal, particularly because the damage was most obvious in areas having to do with self-regulation and impulse control. But what kind of man says, “You can’t blame me for the bad I did, it was my battered brain?” Obviously, if we’re going to attribute all my most foolhardy and self-destructive conduct to the brain injury, what’s to say that my talents as a lecturer, or my gentleness as a father, or my humor as a lover, are not also characteristics of that same injury?

If I had fallen down the stairs and lost a limb, it would be clear that while the accident was traumatic, the loss of that leg or that arm was separate from my personality. But in the case of a brain injury, the identity is transformed on a fundamental level — and when one endures the injury in one’s teens and only discovers it in one’s 50s, how does one separate the damaged brain from one’s core being? (It’s worth noting that my brain injury, like most serious brain trauma, is encephalopathic — meaning that the effects of the injury are ongoing, and can worsen over time. As I look at the face of a friend and realize I’ve forgotten their name, I don’t know whether to attribute that to normal aging or the slowly spreading damage from what happened more than 35 years ago.)

As many destructive and self-indulgent things as I did, things which may or may not be attributable to the enduring effects of the concussion, I also have made a lot of good choices in my life. I don’t just mean marrying some really wonderful women (though I did, especially the last two times). I have somehow talked myself out of suicide again and again, choosing to stick a cigarette in my chest or drag a razor blade to my shoulder rather than jump off a bridge. I have been able to stop using drugs and alcohol, and to stay clean for years at a time. I have learned to be faithful, and to stop seeking sexual validation from women less than half my age. I have chosen to show up for my kids even when I am tired and when it is hard. I have even chosen to face my daughter in her hurt and her anger over my past choices.

I have been a trustworthy friend and safe mentor to many.

People don’t deserve cookies for not cheating, or for paying child support, or for showing up for their kids, or for not killing themselves. In the eyes of most, this is simply the business of being an adult, and it’s wrong to expect praise and affirmation merely for not slicing one’s stomach to ribbons, or not sexting with a self-destructive and horny 19 year-old, or not driving the old Hyundai off a cliff on the Angeles Crest Highway. Perhaps it is my brain injury that makes me feel like it is sometimes so very, very hard to stay, to behave, to keep showing up. Perhaps it is my brain injury that makes me hope that you will read this and say, softly, “I’m proud of you for what you’ve done — and what you haven’t.”

The diagnosis has not made the pain of losing my teaching job any less. What it has done is make me grateful that I was able to be a teacher (and by the accounts of my former students, a good one) for 20 years. The tragedy that I fucked up my career is balanced by the miracle that someone with as severe a brain injury (and accompanying mental illness) as me could hold down a job in the public eye and do it well for so long. I’m feeling wonder at that miracle more and more these days.

For my relationship with Victoria and my children, the diagnosis has done wonders. They know that I’m a bit different, prone to bursting into tears unexpectedly and talking to my pencils while I hop up and down on one foot in driveways. They know I’m doing my best, but because they’ve seen how good I can be with the brain injury, they wisely won’t let me use that injury as an excuse any time I disappoint or anger them. The brain injury is at the heart of my story, but it is not the sum of the entire narrative of my life and my relationship with my loved ones.

It has been, after all, just three months since I learned what happened to my head on Monday, February 2, 1987. I’ve done a lot of reflecting since then, and expect I will do a great deal more in the months and years to come.