The Tim Smal Show
Dr. James F. Zender – Recovering from a car accident
September 9th, 2020
Dr. James F. Zender talks about road safety in reference to his new book ‘Recovering From Your Car Accident: The Complete Guide to Reclaiming Your Life’.
Dr. James F. Zender is a clinical psychologist, certified brain injury specialist and certified traumatologist. His Psychology Today blog, The New Normal, made Healthline’s List of best traumatic brain injury blogs of 2019. For the past 15 years, his private practice in the Detroit Metro area has focused on vehicular trauma injury recovery. He has lectured at the The World Psychiatric Association, Harvard Medical School, The International Society of Traumatic Stress Studies, and The American Psychological Association.
TRANSCRIPT – PDF
Tim Smal (host): Hi folks and welcome to the show today. My name is Tim Smal. My guest on today’s show is Dr. James Zender. He’s a clinical psychologist, certified brain injury specialist and certified traumatologist. His Psychology Today blog, The New Normal, made Healthline’s List of best traumatic brain injury blogs of 2019. Dr. Zender was the founding director of The Center for the Prevention and Treatment of Psychological Trauma at Detroit Receiving Hospital and University Health Center and was a full-time Affiliate Instructor in Psychiatry at The Wayne State University School of Medicine. For the past 15 years, his private practice in the Detroit Metro area has focused on vehicular trauma injury recovery, and he has lectured at The World Psychiatric Association, Harvard Medical School, The International Society of Traumatic Stress Studies, and The American Psychological Association. Dr. Zender, welcome to the show
Dr. James F. Zender (guest): Thank you Tim, it’s my honor to be here.
[01:21] Tim Smal: Dr. Zender, you have a brand new book coming out in October 2020, which is titled ‘Recovering From Your Car Accident: The Complete Guide to Reclaiming Your Life’. Would you like to tell the listeners a little bit about this new book of yours?
[01:38] Dr. James F. Zender: I’ve worked on this book for over five years, and it deals with all the nuts and bolts of recovering from car accidents: from the emotional, psychological, physical, legal, and preventative aspects. So hopefully if someone has been in a serious car accident or they have a loved one, they’ll find some useful information here.
[02:07] Tim Smal: Can you tell us more about how you became interested in working with people that have been involved in automobile accidents?
[02:19] Dr. James F. Zender: Yes. As I worked my way through the years of helping car accident survivors, I became increasingly impressed with the neural cognitive aspects of their injuries. Even though I had taken a year of neuropsychology classes forty years ago, a lot of the neuropsychological understandings of injury didn’t really translate that much into day-to-day clinical practice. And I would have to say, it really wasn’t until the movie ‘Concussion’ came out and I saw that and was so impressed by the issue of chronic traumatic encephalopathy that Dr. Bennet Omalu identified in NFL players – which had devastating consequences for their lives, sometimes leading to suicide or violent behavior, definitely depression and early dementia – did I start to really study current developments and brain injury.
And it’s really an area that the medical profession really hasn’t, as a whole, gotten a good grasp on. So often with car accident survivors, even though they’re showing a lot of cognitive problems, often they’re not recognized by their medical practitioners.
[03:42] Tim Smal: And certainly, some of these conditions that the survivors experience, only show up days or weeks or, perhaps, months after the car accident. And so, perhaps they are discharged and they return home, only to find that they have new challenges that they have to face. And would you say that for many of these individuals, they don’t necessarily have the support that they need, as they move into this new chapter of their life where they have to wrestle with life after their car accident.
[04:16] Dr. James F. Zender: Yes, you really – you touched on quite a few issues that are very important to recognize about brain injuries in car accidents. One of the subchapters in my book is called “Treated and Released.” Basically, in the typical post accident emergency room, if the brain is not thought to be bleeding, there’s not going to be any kind of imaging studies. They basically do a very cursory kind of examination. Maybe do a couple x-rays and the person is perhaps given a pain medication and released, and told to follow up with their family doctor. Often, you know, people are released and they go home and they just don’t feel like themselves anymore: they’re having problems doing very simple things – things that prior to the accident, they would have done very, very easily. For example: just being confused about where things are in the house or how to do things – everything’s an effort, there’s extreme fatigue.
So we now identify that there are both primary and secondary injuries involving brain injury. So the primary is the blunt force trauma to the brain tissue – the brain colliding with the skull and being bruised to some extent. You know, the brain is such an amazing organ, there’s a hundred billion neurons and a hundred trillion neural connections. One neuron can have six or seven or ten thousand neural connections. So it’s quite an amazing organ, the brain and it’s basically the consistency of toothpaste or Jello – you know, it’s very, very soft with this hundred trillion connections inside of it. So these neurons can experience damage very easily with the rotational force traumas or blunt force traumas. We call it “coup contrecoup” when the brain is snapped forward and back very, very quickly.
So the primary injury is the actual injury to the brain tissue. And then the area that is really not receiving the recognition that it does in the medical community is what’s called “secondary trauma.” And that involves changes to the hormonal endocrine system that can result. The pituitary gland is particularly vulnerable to rotational injuries. And sometimes, the deficits in the human growth hormone that’s produced by the pituitary will not show up for three to six months after the accident. So these injuries can continue to unfold for months or even years after the initial trauma.
And as I talked about the movie “Concussion” which showed the effect of cumulative brain trauma, it is compounded so that if you have one brain injury, you know, the effects of a second brain injury can be much greater and so on. So you have these professional athletes who are sustaining dozens or hundreds of traumatic events and you see the degenerative functioning that is depicted in that movie.
[07:34] Tim Smal: I’ve certainly watched a number of movies about related topics. I remember watching a movie called “The Crash Reel” which was about a snowboarder Kevin Pearce, who received a traumatic brain injury in the run-up events for the 2010 Olympics. And it was quite an eye-opener for me because, of course, Kevin really loved the sport that he was involved in. But, of course, once he received the brain injury, you could definitely see there was a change to his personality and, of course, many other challenges that he had to face. But he really wanted to return to the sport and it was controversial in the sense that his family didn’t want him to continue, because they saw the effect on him, but he wanted to get back to doing the sport because it meant so much to him. And so, I just remember that film and certainly the one that you mentioned, I will watch too.
But I think that films are a great medium to communicate this message to individuals, because people, of course, don’t think about what it would be like if that happened to them, in the sense of: if they’re in a car accident, they don’t necessarily think about what that would feel like until it happens to them. And so certainly, when you consider the mantra that “prevention is better than cure” I think that that is very relevant to the topic that we’re talking about today.
And so, what I find very interesting, is that your book that is coming out is really the first book to offer comprehensive evidence-based information on how to overcome these physical and emotional traumas that individuals sustain in auto accidents. But what are your thoughts on actually working proactively to prevent these car accidents in the first place?
[09:22] Dr. James F. Zender: Well, there’s a number of things that can be done in way of prevention… but before we go to there, you mentioned something that triggered an important thought. You were talking about how nobody ever expects how an accident is going to affect them until after it happens or until they see a loved one affected. And just imagine, you know, you’re a highly functioning successful professional, for example, and everything is going great in your life. And in the blink of an eye, you’re broadsided or you’re involved in a head-on accident that isn’t even your fault. And all of a sudden, you can no longer function in your job – your profession that you spent years to build up, you’re no longer able to carry out your high-level skills. So yeah, the issue of: in a blink of an eye, everything can change – and nobody really wants to think about that, but unfortunately it happens to millions of people every year in the world.
So okay, so we can come back to the issue of prevention. It’s estimated that, maybe roughly, ninety percent of accidents are preventable by looking at human factor, human behavior issues. So I would say the number one thing that would have a huge positive impact on preventing accidents is: a zero tolerance for alcohol and driving. Alcohol is involved in a large percentage of the accidents. It really affects behavior, it affects judgment – people become reckless, they speed. The loss of judgment and coordination become huge factors in accidents. So, you know, knocking out alcohol as a factor would have a huge impact.
The other big one is distracted driving. In the United States, everybody’s on their cell phones and even though we have laws about not using cell phones with driving, people still do it and that’s a huge problem. Then there’s other issues like fatigue. You know, fatigue plays a factor in a significant number of accidents. Condition of vehicles is another factor – people driving unsafe vehicles, not doing routine inspections. Then there is the condition of the roadways: there are some areas of the highways that see a large number of accidents due to the construction of the highways and those are certainly things that can be addressed, but can be more difficult to address because of the expenses involved.
[12:12] Tim Smal: It’s really interesting to listen to a list of reasons as to why accidents may occur and all the likely scenarios that could contribute to these incidents. And I actually thought that, perhaps, I could contribute another possible cause, which you didn’t mention. And it’s slightly difficult to articulate, but I’m sure you will agree with me, hopefully, that: Many times when people drive motor vehicles on the road, they might be in a headspace where they are in a bad mood, they might be angry or perhaps having a minor fight with a partner or they might be experiencing road rage – they might take out their anger or their frustration of the day. There’s many scenarios where individuals are not being mindful when they drive, just based on the personal emotions that the individual is feeling in that moment. They might not be on their cell phone, they might not even necessarily be speeding, but they might just be bringing a really poor attitude to driving on the road. Do you have any thoughts on that observation?
[13:23] Dr. James F. Zender: Yes, that’s a really good observation. I think that we’re talking about another more subtle form of distraction, in terms of just not being mindful – being preoccupied with one’s emotional state. And if we could, in the way of prevention, also just indoctrinate… get indoctrinated, that when we get on the roads, we’re dealing with a shared space – that we don’t have more rights than anybody else, that we have to share the rights of the roadway and to be in a mindset of being helpful to other drivers that we encounter… being courteous, cutting people some slack. And this is something that, unfortunately, we don’t see enough of it. We don’t see enough kindness on the road or maybe somebody’s just trying to get out into traffic and, you know, 10 cars pass before someone slows down and allows them to enter. Or using turn signals, very simple things like that… being courteous, mindful, looking out for the other driver. I think there’s a lot of room for improvement in that area, which you highlight in your question.
[14:39] Tim Smal: I like the phrase that you use, that “we are entering into a shared space when we drive on the road” because I think that’s what it’s about: it’s the idea that we are sharing the space with other people – it’s not just about me getting to where I need to be. And perhaps if people could start to think about that, it would help them.
Because as you mentioned, today is Labor Day in the United States. It’s a holiday that you celebrate every year as an American. But when you mentioned to me, in our pre-interview, that it’s estimated that 400 people will die in motor vehicle accidents today, that really hits home. And I think that’s a statement that nobody can really ignore, right?
[15:29] Dr. James F. Zender: Yeah, it’s very, very sobering… very sobering. And it’s truly a global pandemic that has gone on since the beginning of the automobile, and fortunately organizations are working to increase awareness. For example, the United Nations – every year they have the World Day of Remembrance for auto accident victims and their families and survivors. And, you know, this is something that doesn’t get a lot of attention – it would be great if every country would get behind the promotion of increased awareness on that day, November the 15th. It’s always the… I think, the third Sunday or maybe it’s the second Sunday of every November – but this year, it is November the 15th. There’s just such a need to increase awareness about this and yeah, I mean tragically, we know the estimates that, pretty much, prove true: that 400 people will die. How many people will be injured – you know, many times that. You know, families will be destroyed, lives will be destroyed and many of those deaths could have been prevented.
[16:43] Tim Smal: And of course, your approach in the book, and in your work, has always been to focus on empathy and positive psychology, because, of course, it’s a journey for individuals to recover from their car accident. They have to attend to their physical and their emotional well-being, and it certainly takes time. So could you perhaps speak a little bit about the importance of positive psychology, empathy and the related arenas when dealing with recovery?
[17:16] Dr. James F. Zender: I would say, the number one thing for accident survivors to remember is: it’s vitally important to stay positive. Because if they have been seriously injured, their recovery is not going to be a week or a month… we’re talking a year – a year and a half, two years, three years, five years. These are long-term recovery scenarios if you’re dealing with physical and certainly emotional injuries. And again, often the emotional injuries give people more problems than the physical injuries, even though they may be severe and serious. So it’s vitally important that people have compassion for themselves in how long it’s taking to recover, particularly when it comes to a brain injury.
The good news about the brain is that it does heal. It does recover through a process that everyone is familiar with now called neuroplasticity, that the brain is indeed malleable and can change. The neurons can rewire themselves around damaged areas. Going back to the issue of hormones and the endocrine system, once it is determined that there are deficits, there are things like hormone replacement therapy that can be brought on board or… Someone that I got to know through, actually Andrew Marr, who wrote the “Tales From The Blast Factory” book (A Brain Injured Special Forces Green Beret’s Journey Back From the Brink) is Dr. Mark Gordon, who’s done some really amazing work with hormone replacement therapy and nutraceuticals. And he’s doing work with veterans primarily. You can see a really good podcast that he and Andrew did on Joe Rogan’s program, talking about the treatment. And it’s also highlighted in the movie “Quiet Explosions.”
So the other issue that’s really important to touch on is: when someone is in an accident, it’s not just affecting them, it’s affecting their entire social circle – it’s affecting their family members, it’s affecting their employer or employees. It has ripple effects and profound ripple effects. And often, one of the really difficult challenges is for the accident survivor to learn to relate in a different way to the family, and to deal with role changes in the family. Often the sole provider is now totally dependent on everyone else who, prior to the accident was dependent on them. And these can be very difficult changes, hard for everyone in the family to accept. And there’s a real need for psychoeducation and compassionate relating and assistance with the entire family in coming to terms with a severe accident situation.
[20:18] Tim Smal: I’m sure for the listeners that are listening to this episode that perhaps know someone in that situation, your new book is going to be incredibly helpful to them. So they’re welcome to find out more information on your website which is drjameszender.com – there are also a lot of other blog posts that you have there, so an incredible amount of useful information.
But I imagine that for individuals that perhaps haven’t considered this arena – that are only starting to think about the implications of car accidents in the general population – it will be helpful to them too. So would you recommend that the book is read by any individual, regardless of where they are in their journey in exploring the implications of car accidents in the general population?
[21:14] Dr. James F. Zender: I would hope there would be something of interest for everybody, because again, we’re dealing with a global pandemic of auto crash injuries. And it’s affecting the whole world. I read, for example, in South Africa, the economic impact of injuries from car accidents is, I believe, 3.4 percent of the gross domestic product. So we’re talking about, in the US, for example, half a trillion dollars in economic impact from injuries every year. You know, just on an economic level, imagine what we could do with those resources if we weren’t dealing with helping people to recover.
[21:58] Tim Smal: Well Dr. Zender, I really appreciate your time today, it’s been very interesting speaking with you and I certainly wish you all the best with the launch of your new book in October 2020. I’m sure there will be many opportunities to talk about the book and have people ask questions, so I’m certainly going to follow the journey of the book release. And I hope you have many more opportunities to talk at length about this very important topic.
But in terms of wrapping up the show today, I was wondering if you have any closing thoughts or messages to the listeners today regarding this particular topic.
[22:39] Dr. James F. Zender: Again, I think we all have to work to monitor ourselves in traveling on the roads. As Gandhi said “We need to be the change.” So as we stay vigilant and work to make our behaviors more preventable, in terms of these horrible accidents, then we can make a better world for ourselves and our children.
[23:06] Tim Smal: Great. Well, thanks again Dr. Zender and all the best for the year ahead and the launch of your book. Thanks again for joining us today.
[23:16] Dr. James F. Zender: Thank you so much Tim. Thanks for the opportunity.