As a speech pathologist, I work with veterans who have had mild traumatic brain injury (mTBI). In fact, the majority of the vets on my caseload fall in this category. I’ve been a speech pathologist for 22 years, working with vets for the past 10 years. I worked with TBI patients in my past, but working for the VA is the first time I’ve worked with people who have sustained their injuries several years prior to seeking help. The reason I bring this up and why I think it’s relevant here is the correlation between cognitive deficits and mental health.

We educate all of our patients about mental health and the need to get help in this area. Explaining that the reason they’re having problems with their cognitive functioning even years after sustaining a brain injury, is likely due to the fact that their mental health issues are not being addressed. That it is vital in order for them to make improvement in the cognitive area, they need to get a better handle on their mental health. If I were to draw a diagram listing all the deficits of mental health (in this case, PTSD) and deficits from suffering mTBI, there is a ton of overlap. For example, fatigue, forgetfulness, hyper vigilance, irritability, anger, etc.

Mental fatigue is the phenomenon that occurs with these vets, for example, where they may experience an increase in headaches, or frustration, or forgetfulness, when they are trying to concentrate on something. We work on helping them identify their mental fatigue and then provide them with tools and techniques to help “rest” their brain and recover from the fatigue. I just recently learned about decision fatigue and it is the same. Every day we make thousands of decisions, even small ones like, what I’m going to wear, what I’m having for breakfast, etc. Decision fatigue leads to using up our willpower, and in this case, by the end of the day, our brain is so exhausted, that the will to turn down a drink is virtually impossible.

Going back to the day I had that intense craving while camping, I was so exhausted all day. I couldn’t figure it out. I had been so full of energy and so motivated, I thought maybe it was the altitude or because I hadn’t been sleeping too great the past few nights. But then it dawned on me, maybe because I had been thinking so much about drinking, I was experiencing mental/decision fatigue? My thoughts were racing, “Should I drink? Why would I? Could I stop at just one?”..and on and on.

Learning about my own mental health has been so important during this journey. I’m constantly discovering things about myself, including how I handle stress. I say this all the time, I’m constantly learning from my patients, too. I had no idea that going alcohol free would lead to so much self discovery and growth. And my continued hope is that I’m reaching out to others.