This chapter is a perspective chapter that explores the crucial importance of understanding the full impact and architecture of a traumatic brain injury, beginning with the conception of a “Shock Trauma.”  This architecture is followed by the brain/mind architecture of “electrical and chemical disruptions in the brain,” the brain/mind architecture of “homeostasis, allostasis, and allostatic load causing further disruptions in brain and mind functioning,” and the brain/mind architecture of the “perfect storm” in the brain.  Each architecture represents a stage in the toxic, cascading progression of a traumatic brain injury.  It is generally not understood that traumatic brain injuries are not static events, and that they can quickly become neurodegenerative disease processes, especially if they are not treated.  Over time, these 4 Architectures fold into one another creating huge challenges for the healing process.  The conception of the 4 Architectures is illustrated through the case of a 20-year-old female who was thrown off a horse hitting the back of her head on a rock, when she was 7-years-old.  She was airlifted to a trauma center where she required emergency surgery to address brain hemorrhaging.  Unfortunately, there was no follow-up beyond a year and by adolescence S. was experiencing serious PCS, but this was not recognized.  Instead, she was labelled a problem child with ADHD and major depression.  And nothing was ever mentioned about her early brain trauma and how it might be affecting her now.  Her case illustrates very well, the toxic, cascading progression of a traumatic brain injury through the 4 Architectures, and how serious a condition this can become.  Finally, the author discusses how brain injuries are different from all other types of injuries to a person, because of their neurodegenerative nature.  And that these injuries need to be understood in a very different light, with a great deal more follow-up.

Leighton J Reynolds (neuro-psychoanalyst), Director of treatment and tools for trauma located in the GREATER LOS ANGELES, USA