‘Sex With a Brain Injury’ reveals how concussions can test relationships

Transcript:

TERRY GROSS, HOST:

This is FRESH AIR. I’m Terry Gross. Concussion is often much more serious than we used to think, and that’s led to changes in places ranging from the football field to the battlefield. My guest, Annie Liontas, can attest to how life-changing concussions can be. Her new memoir is called “Sex With A Brain Injury: On Concussion And Recovery.”

Her sex life is just one of the many aspects of life that were adversely affected. During sex, which had been very pleasurable for her and her wife, she felt like a tree stump. The concussion left her with horrible migraines, serious memory problems, foods that suddenly repulsed her, anger issues, and it nearly led to divorce. Liontas also writes about concussion research and the correlation between concussion and crime, prison and homelessness. She had her first concussion when she was 35, after a bicycle accident when she wasn’t wearing a helmet. She had two more head injuries. That may sound improbable, but Liontas says it’s actually not uncommon once you’ve had one concussion to have another.

Liontas is also the author of the novel “Let Me Explain You,” a professor of writing at George Washington University and identifies as genderqueer. Liontas uses the pronouns they and she, and at this point, I’ll switch to they. Welcome to FRESH AIR. It is a pleasure to have you on the show.

ANNIE LIONTAS: Thank you, Terry.

GROSS: And also thank you for doing this while you have COVID. You’re speaking to us from your home, and I appreciate you doing it. It sounds like you’re in decent shape now.

LIONTAS: Yeah. And I’m really grateful we can do this remotely. So thank you for having…

GROSS: Yeah, yeah. Me too (laughter). So tell us what you experienced at the time you had your first concussion – like when you were taking the fall and your head hit the pavement. What was that experience and the experience in the next few minutes like for you, and what went through your mind?

LIONTAS: You know, it was quite startling. I mean, I hadn’t expected the accident, the way that folks usually don’t. I hit my head, and I remember feeling alarmed that I had hit my head. And the world started to sort of pull apart a little bit, like it almost felt like taffy. And time started to elongate. I felt just unsteady and unsure and wasn’t sure what to do.

You know, I called a friend in the area, and they helped me get to the hospital, but I couldn’t process very much at all. He was speaking to me, and I was not able to understand everything he said. I wasn’t sure what I was saying. I ended up at the hospital, really disoriented and, really, I think I lost a few minutes in between, until I got the CAT scan, which is a procedure I hadn’t expected to have to get. Honestly, it just seemed like, you know, no blood, no broken bones, went through the procedure, and they confirmed I had a concussion, which, you know, even then – I mean, I think the medical practitioners were doing what they knew to do.

And we understand now that concussions can’t be read, actually, on a CAT scan. The axons that connect the white brain matter to one another are finer than a human hair, and so they fray and tear. But our technology is not actually sophisticated enough to catch that. So usually it’s the other diagnostics that tell you you have a concussion. You know, whether it’s like memory, eyes, balance, you know, fog, dizziness, headache. I had all of that. So they were like, yeah, you definitely have a concussion. They gave me a brochure. And I kind of went home thinking, like, I should be good tomorrow. You know, they were – they essentially said, it’ll kind of feel like a bad hangover. Take some Tylenol, and you’ll be better. But don’t fall asleep alone.

GROSS: And why not?

LIONTAS: Well, I think really the impetus for a CAT scan is trying to identify that there’s not a brain bleed – right? – which is like – that’s a life-or-death situation. And it could be that that’s still the case within that 24-hour period. And the idea is like, you might fall asleep and not wake up again. So I – you know, I was OK overnight. And my symptoms got worse, as they are expected to do – right? Like, your body is reacting and healing and there’s a lot of inflammation. And after that first concussion, I was able to recover in some way. You know, like, I did the right things. I got the right care. I got some acupuncture. And I was able to come back from it. But you know, as per your introduction, after one head injury, even a mild one, you’re twice likely to have a second. After a second, you’re two to four times likely to have a third, and so on.

GROSS: And why is that?

LIONTAS: You know, they don’t know, actually. That’s something – I mean, that’s just one part of the condition that we’re still trying to figure out. There are a lot of theories about, you know, weakness around the neck muscles, which is why you do a lot of PT for neck strengthening. There’s some ideas around reactivity and what – you know, what you don’t see coming because your capacities have been altered. And then there’s just the skull itself, and – but we don’t know. We actually don’t know.

GROSS: So your second concussion and – like, what are the odds? Was it like – you were in a shop and a baby car seat fell on your head?

LIONTAS: Mmm hmm.

GROSS: That’s crazy.

LIONTAS: Yeah. No, I felt that way too. I – you know, it was improperly shelved, and these bad luck things happen. But I – yeah, I had turned away from the shelf, and it hit me. It was entirely out of my periphery.

GROSS: How did you handle that? You knew that you were vulnerable already. You know, you already had one concussion, and here it comes again. And those things are heavy.

LIONTAS: Yeah. Yeah. It was scary. But I think I was in a little bit of disbelief – like, no, this can’t be another concussion. It wasn’t like hitting my head on asphalt. It’s just a box. It’s just a – you know, I’m in a store. There’s bright lights. Like, I have to be safe. This – you know, like, this is – this can’t be happening. And sure enough, you know, it was far worse than the first injury, which I really had clear – you know, I had kind of come out of that OK. But that second injury happened, and the symptoms were compounding.

GROSS: Is it typical that a second injury compounds the first?

LIONTAS: Well, it does depend how far apart they are, but largely the answer is yes. And for me, all three injuries happened within a year.

GROSS: Oh. And you had a third injury too. What was that?

LIONTAS: So the third injury was also a bit of a fluke. I just – I was watering a plant, and the pot fell. And in hindsight, you know – I mean, honestly, now nothing is allowed above my head anywhere. I mean, I’ll go to a hotel and take the painting off a wall if I have to.

GROSS: Seriously?

LIONTAS: Yes, I will, I will – I’m sort of pretty – and I think this is very common for people who are suffering from head injuries, that you become – you know, at the worst of it, you – there’s a kind of paranoia that can overtake you. But the – at the best, you’re quite diligent and aware, and I should say that that extends beyond me to – now my wife has an alertness, and my best friend has an alertness. And, you know, people who want you to be well and have a new understanding, become pretty rigorous themselves. But back then, I just didn’t know that – I didn’t understand the vulnerability. You know, that second concussion at the store, it wasn’t a concussion to me until I was, like, three months in and still dealing with it.

GROSS: You learned a lot about concussion and about the brain, and you write that the brain is kind of the consistency of butter in a way, and that when you’re – when something slams against your head or your head slams against something, the brain kind of sloshes against the skull? The brain pan? I’m not sure which word to use. But did having, like, a mental picture of your brain and about your brain getting damaged from the impact, was that helpful, or was that something that you obsessed on and wished you could stop obsessing on it?

LIONTAS: Well, you know, until I was in a better place beyond the acute stage of recovery, which admittedly, took around five years, I wasn’t thinking about my brain like that. I think I was – I think I would have been too freaked out. What I was thinking about was, like, the hypervigilance. And that was hard. That was hard to live with day in and day out, you know, this fear that you could get hurt again at any time and not, like, another concussion, but if I, you know, Terry, if I shake the orange juice too hard, that could lead to a migraine, you know? If I tap my head on a shelf – and I mean tap – that can lead to a migraine.

GROSS: Still? Even now?

LIONTAS: Even now.

GROSS: Well, you know, one of the ways of diagnosing a concussion is to ask you to draw the hands on a clock. So you’re given a – you know, a circle, and you have to draw the hands. And I don’t – and they don’t tell you where all the numbers are. You have to figure that out where to put the six, where to put the three, etc., and you couldn’t do it. How disturbing was it to you that you weren’t able to do that?

LIONTAS: Oh, it was so disturbing. I mean, there are certain aspects of your own knowledge that you just take for granted, even when you’re unraveling, and that was one of maybe two or three instances in my recovery when I saw myself reflected back to myself. I hadn’t known I couldn’t draw a clock, but I was in PT for, like, vestibular therapy, ocular motor therapy and cognitive therapy, too. And the practitioner asked me to draw a clock and just put the numbers, you know, where they should go. And they were all bunched up like I was a first-grader, and I didn’t even get the six right. Which, you know, my little nephew at, like, age 3 knew the six. So I’m looking at this and looking up at the woman’s face and, you know, she’s sort of like, I think, encouraging me. And – but at the same time, I’m completely mystified and completely lost. And I couldn’t believe it, honestly, that I couldn’t draw a clock. And that was the start to, like, a pretty long road of recalibration.

GROSS: How bad had your memory become, and how did that affect your daily life and your ability to communicate with other people?

LIONTAS: Yeah. I mean, I think we tend to think of head injury in extremes, right? Like a severe injury, like a ski accident or a car wrapped around a pole or something, we tend to think of those people as, like, completely – the only model for brain injury and, like, almost like complete amnesia. They won’t remember people’s names or they’ll forget, you know, what they said three minutes ago, which can certainly happen to me. But my relationship to cognition, I mean, first of all, there’s neuroplasticity, which means that the brain is constantly growing and learning and healing, even when it doesn’t seem to be, but also, that those – there are all kinds of slips that can happen even with a mild traumatic brain injury. And so, I mean, initially, I couldn’t read – I couldn’t look at a screen and I couldn’t read at all. This was another moment where I saw myself reflected back to me. I would read it to the bottom of the page and forgot what I had read, like, a paragraph ago, which for a writer, is terrifying.

GROSS: You’re a writer and writing professor. I mean, that’s – yeah. Definitely terrifying. Did you start to feel like is this my fault? It’s happened, like, three times I’ve had concussions. What am I doing? What am I doing wrong? And did people assume that you were either crazy or that you were just careless?

LIONTAS: I mean, I definitely was interrogating. I mean, something happens three times, you know, you get hit in the head three times with a coconut, you’re sort of like, why am I sitting under this tree? And for me, I think, you know, I started to think that there’s this unsolvable knot that we all have. And by age 35, 37, whatever you’ve been running from, evading, indulging, it kind of catches up with you. And for me, it wasn’t that I, you know, some of it is just bad luck, right? But for me, a lot of it was that I just thought that I could get through life completely independently of everyone, including my wife, and I could just take care – keep taking care of myself. But, of course, you know, humans are not built that way. And if you’re injured or sick, you can’t. You are in a completely new, vulnerable, position.

But the problem with head injury, a mild head injury, particularly, is that it’s so invisible. We don’t see it. We don’t – we have no idea people are walking around with this condition. And so a lot of the people closest to me were worried that this was something else, that it was anxiety, that it was depression.

GROSS: Hypochondria.

LIONTAS: Hypochondria. Right. There’s – there was a term that my doctor and people close to me started to throw around, which is somatization which is just this, like, it’s the new form of hysteria, which, of course, was leveled against women for a really long time and still is. And so I was frustrated for a long time that people were not responding to this as its own real issue. But of course, I had to respond first, right? And then I also saw that it was like, you know, it’s not your wife, it’s not your family, it’s the culture. The culture has yet to reckon with what it means to have even a mild head injury, even a concussion.

GROSS: Well, let’s take a short break here. If you’re just joining us, my guest is Annie Liontas, author of the new book “Sex With A Brain Injury: On Concussion And Recovery.” We’ll be right back. This is FRESH AIR.

(SOUNDBITE OF MATT ULERY’S “GAVE PROOF”)

GROSS: This is FRESH AIR. Let’s get back to my interview with Annie Liontas, author of the new memoir “Sex With A Brain Injury: On Concussion And Recovery.” They also co-host the new literary podcast “LitFriends.” And I should mention, I’m using the pronoun they, that’s the pronoun that Annie prefers. Annie is genderqueer.

You’d been with your wife – or the person who is now your wife for around 13 or 14 years when you had your first concussion. Were there new ways in which you had to depend on her?

LIONTAS: There were. I think that was something I had to really adjust to. Even something like I couldn’t get up to get a glass of water or I couldn’t make a phone call, because making phone calls were – it was difficult in the beginning. Those kinds of things that you sort of take for granted – and especially because it’s not like I couldn’t walk. I could walk, right? It’s not like I couldn’t talk, I could talk, but there were just these triggers that were quite difficult to navigate alone.

GROSS: How did having to depend on your wife sometimes change your feelings about yourself and your feelings about her and her feelings about you? That’s a lot to ask in one question. I apologize.

LIONTAS: (Laughter) No, it’s OK. I mean, I will say that I really resisted relying in the beginning at all. And I want to be transparent about that because I think that’s a fairly common feeling. It’s hard, especially if you are raised in America, to not be independent in certain ways, personally and professionally. And my wife, I think, had always seen me as a strong person and was attracted to that. And I had always seen her as – I mean, she’s just, like, this very loving, caring, doting person. She loves animals. She’s – you know, she’s a caretaker and deeply empathetic. But it was a hard adjustment for us, again, I would say, in part because the cultural framework wasn’t there, right?

Like, if your spouse gets cancer, which is a terrible thing – right? Like, I’m – my niece just came out of cancer and I can see, you know, like, the strain that that puts on a family. But we do have a kind of cultural framework around cancer to be able to respond to in a way that we don’t quite yet for conditions like traumatic brain injury. And so it was this big paradigmatic shift for us in our own private relationship where suddenly the roles were shifting, or we had to be present for one another in ways that we hadn’t been before.

I mean, it was a real test. And the reality is that I think most couples going through something like this, even if they start out with a great relationship – I mean, my wife and I, we’re the people that, like, you roll your eyes at because we love each other so much (laughter). Like, our friends celebrate and also envy, I think, sometimes how close we are. But even if you’re starting from a really strong place, something like brain injury can really rock the relationship and make you doubt.

GROSS: Well, you become a different person in a way if you don’t have all your memory and you don’t have all your language skills and you need assistance with some things. Anger became an issue for you, too. What were the kinds of things that made you angry that wouldn’t have made you angry before?

LIONTAS: Well, just to respond to your comment first, I would say, you know, what I was grappling with was this crisis of the conceptualized self. This is what the philosophers call it when your – you know, you literally go from knowing who you are one day to the rug kind of being pulled out from under you. And for me it was like – as a writer, as an active person, as someone who was strong in body and mind and spirit – to be truly vulnerable and incapacitated, to not be able to write, to not be able to feel confident in front of a classroom, that really taxed me, you know?

And it’s something that I’ve been crawling back from and grappling with. And other people, I think, who have had concussions are dealing with similar things. And becoming suddenly an angry person – I mean, I’m Greek so, like, you know, we know anger. We get it. But suddenly to have a very new relationship to anger and be – it was almost like I was just a pile of dry kindling and anything was a match.

GROSS: OK, we need to take another break here, so let me reintroduce you. If you’re just joining us, my guest is Annie Liontas, author of the new memoir “Sex With A Brain Injury: On Concussion And Recovery.” We’ll be right back after a short break. I’m Terry Gross, and this is FRESH AIR.

(SOUNDBITE OF CHRIS THILE AND BRAD MEHLDAU’S “INDEPENDENCE DAY”)

GROSS: This is FRESH AIR. I’m Terry Gross. Let’s get back to my interview with Annie Liontas, author of the new memoir, “Sex With A Brain Injury: On Concussion And Recovery.” It’s about how life changing a concussion can be. They – Annie uses the pronoun they – had their first concussion at age 35 after a bicycle accident when Annie wasn’t wearing a helmet. Their second injury was in a store when a baby car seat fell on their head. As a result of the concussion, Annie had debilitating migraines, serious memory problems, an inability to tolerate light and certain foods and new anger issues. They longed for the person they used to be and found it difficult to accept who they’d become. All this nearly led Annie and their wife to divorce. They made it through to the other side – recovery – but in spite of the word recovery, Liontas is still dealing with certain symptoms of the brain injury. Liontas teaches at George Washington University and identifies as genderqueer.

Let’s get to the title of your book, “Sex With A Brain Injury.” You write that you felt like a tree stump during sex, and that had been like – sex had been really pleasurable for you. But, you know, even the best part of sex felt, like, overwhelming. Like, more than, like, your brain could accommodate. That must have felt really awful, too, to have that part of your life compromised.

LIONTAS: Well, you know, it’s something we don’t think about when we think about any chronic condition. We are sort of thinking in these very linear ways about injury and recovery. And I wanted to title the book “Sex With A Brain Injury” because it points to the reality that such an injury affects every facet of your life, right? Like, nothing is unclaimed by this kind of injury, and intimacy – right? – between two partners feels like it should be this safe harbor, and it’s not. And, you know, for me, I would get terrible migraines having sex. And it was some – it felt like another great loss, right? It’s like, not only do you lose TV or music or reading, but even just being in your body in this way that is about connection suddenly was not available to me for a very long time.

GROSS: After the concussion and the subsequent concussions, you kept waiting for the old you to return. Was your wife waiting for that, too?

LIONTAS: I think for a while, yeah. I think a big part of the grief for her was, you know, she was worried that who I had been was gone forever and who we had been was also gone. And I think that’s quite common for couples when a partner has had a head injury that you find a new normal and a new way to be together. I will say that that sounds really dark and glum and, like, I won’t sugarcoat it, it is, and it can be. But we also are much more honest in certain ways with one another and can see and support one another, I think, with more fortitude and resilience now. We laugh at more things together ’cause you kind of have to.

GROSS: How close did you and your wife come to divorce when things were bad with their symptoms?

LIONTAS: I mean, we didn’t fill out any paperwork, but we were talking about it quite a bit. We had, you know, if you’re with someone for 13, 14 years, it’s not like you get out unscathed. But these were new challenges. And I think the divorce was a byproduct of saying, like, we are strangers to one another. You know, who are you? Who am I? And that’s a really hard place to be in a marriage. Even a good marriage or one where, you know, you’ve – you still love each other, you still like each other, but you don’t recognize each other anymore. And the relationship is so frayed, it seems like how could we possibly keep going? So, you know, we came pretty – I think we were seriously discussing it and thinking, like, is this – should – is this the right thing? Should we keep going? And for a long time, even when we committed and said like, yeah, OK, let’s try, it really – it took another year or so to find our footing.

GROSS: What kept you together when you were talking about divorce?

LIONTAS: I mean, we really love each other, you know? We really do. And we see each other. And I’m grateful that I’m with someone who understands that love demands a kind of elasticity so that people can grow and can change. And of course, in this context, in the context of the brain injury, that had to happen, like, too fast. And that was the reason for the strain and the difficulty. But also, I mean, we just decided. We said, like, we’re going to keep trying. And that does make all the difference.

GROSS: I want to talk about your childhood ’cause it was a difficult one. Let’s start with your grandparents, who basically arranged a marriage for your mother and your father when she was 16 and he was 24. Why did they do that?

LIONTAS: Well, my father, you know, we’re immigrants. And my father, like any immigrant, saw an opportunity to come to America. And the arranged marriage was really the only chance he had. I can say, you know, my biological mother, both of my parents have since passed. And my biological mother, you know, she had a hard childhood. Much harder than my own. She was a queer person who could not be queer in the, you know, ’70s. And until early ’80s, that was really stifled for her. And they wanted to get her married because they saw her as a problem, right? Like, queerness was a problem. Her substance abuse addiction, which, in part, was a reaction to the measures of control in her life, the addiction was a problem, and they were looking to find her a husband to take care of that.

And my father was, you know, he was young and pretty naive. I mean, Greece today is not the Greece of, you know, 1978 or whatever. It was – he was pretty sheltered. He, you know, the – drugs had not really come to the island of Crete yet. He came to America and, like, learned about deodorant, like, you know, there were – he was from a village. And so neither of them was very prepared for the marriage that they were entering into.

GROSS: How did you find out that your mother was a lesbian, and how old were you when you found out?

LIONTAS: Yeah.

GROSS: Did she tell you, or did you just kind of figure it out yourself?

LIONTAS: I mean, I think that had been relayed to me by the adults around me pretty quickly, again, because we conflate, especially in that time period, queerness, addiction, abandonment of children – it was all seen as the same problem. And so it was almost delivered as a warning to me. But she also was quite open about it and shared that part of herself with me. But because it was such a warning, you know, it was such a dangerous existence, one that put you outside of the law and family and had, like, real consequences for my sister and I, I just didn’t want to be anything like that, you know, and told myself for a long time that I wasn’t.

GROSS: You told yourself that you weren’t gay because of her.

LIONTAS: Yeah. Oh, yeah. Oh, yeah.

GROSS: You write that, years later, as an adult, you assumed the gender of, quote, “delicate man.”

(LAUGHTER)

GROSS: How did you come up with delicate man?

LIONTAS: (Laughter) I mean, it sort of springs from, you know, the self. I mean, I think I was deeply influenced by George Michael, both, like, very attracted to and wanting to be George Michael, who is very much, I think, on some level, a delicate man. But also, you know, if we’re thinking about genderqueerness (ph) as a spectrum – right? – like, and thinking about having both traits of femininity and masculinity – and I think that probably – that was coming through for me even at a young age.

GROSS: You didn’t want to and still don’t want to ever be pregnant. Did that help you understand your mother and her inability to cope with motherhood? I know some of that had to do – probably a lot of that had to do with her addictions, but nevertheless.

LIONTAS: I think so. I think when I realized that I didn’t want to ever be pregnant – I’d heard other women say that, but – and not disingenuously. But I think the idea of bearing children is, like, absolutely terrifying for most humans, right? I mean, it’s a lot of pain. And I’m deeply admiring of the people who do it. But, you know, for me, it seemed really foreign, really just outside of my physical capacity and something I just viscerally did not want. And that was maybe the first indication, you know, of, like, this is a clear genderqueer line. And I was – I think as I got older, I was – I understood that my mother had children because she was kind of put in that position, forced to do that, you know? And she, like, cursed my father out after my sister was being born. She said, you did this to me. And I know – you know, I know on some level, she didn’t want to bear children, though I think did ultimately want to wish she could be a mother.

But for me, with my biological mother, I just – I really put so much distance between us. I scorned her for a long time because of her erratic behavior and irresponsibility. And in researching this book, I came across these studies that suggest that brain injury and drug addiction actually look quite similar in the brain. Like, the regions of the brain affected or damaged, are synonymous – right? – because we only have so much, you know, biological data that can be impaired, right? And then the symptoms, the emotional lability, the irritability, the impulsive behaviors – those end up looking the same. Even the cognitive impairments – there are echoes of one another. And when I reckoned with that, I mean, I kind of couldn’t believe it. I’d spend all of these years thinking I was nothing like this woman. And not only am I queer, but our brains have been injured similarly. And it helped me have so much more compassion. You know, I didn’t just pity her anymore. I understood, I think, on a fundamental level what she must have been dealing with day in and day out.

GROSS: Well, let’s take another short break here. If you’re just joining us, my guest is Annie Liontas, author of the new memoir “Sex With A Brain Injury: On Concussion And Recovery.” We’ll be right back. This is FRESH AIR.

(SOUNDBITE OF PAQUITO D’RIVERA’S “CONTRADANZA”)

GROSS: This is FRESH AIR. Let’s get back to my interview with Annie Liontas, author of the new memoir “Sex With A Brain Injury: On Concussion And Recovery.”

We’ve talked about how concussion affected everything – you know, your brain, your ability to read, your ability to speak and to write, your memory, your taste, your sense of smell, foods that repulsed you, your ability to be in the light, you know, around certain kinds of light and how isolating all this was and how it made you, like, question who you are. I want to read an excerpt of the New York Times review of your novel, your first novel, “Let Me Explain You.” And the excerpt reads, (reading) the experience of “Let Me Explain You” is less of reading a book than of renting a room in someone’s brain, a room boisterous with moving bodies, food smells, noises. It’s a festive place to visit.

That description is the absolute opposite of your brain after concussion. And I’m wondering if you wrote this before the concussion or you were still able to write so well and so convincingly of joy and boisterousness that you were able to exit the feelings of your concussion and write.

LIONTAS: Yeah, I mean, the mood is definitely – it’s definitely a shift.

GROSS: So was this before or after the concussion that you wrote the novel?

LIONTAS: Oh, I wrote the novel before the concussions.

GROSS: Oh, OK.

LIONTAS: That was part of the reason that I was grieving so much is I had written this novel that, you know, was a pretty big achievement for a writer. You get really excited, and you put this work out into the world, and it has its own life. But I felt so far away from that book that I turned the spines the other way.

GROSS: Oh.

LIONTAS: I couldn’t even look at the title anymore. And I think I might have hurt my editor’s feelings when I put that line in the book. But I just – it was so painful to me to have lived in that boisterous, you know, vibrant world and all of a sudden to not have that anymore. And I tried to come back, you know, I was working on a novel. But when I started with the title essay for this book, I realized I would do the experience a disservice if I wrote it as a novel. You know, all we have about concussion are false narratives, whether that’s Hollywood or special interests reporting out about the NFL. Like, we just don’t actually have an awareness.

And we are – I do think we’re on the brink of a shift in public perception about head injury maybe the way we were about smoking in the ’80s and ’90s, right? Like, we’d had all the data about smoking. I mean, we were getting the surgeon general’s report every year after 1964, after – you know, in the ’70s, cigarette ads are banned from TV and radio. But we don’t actually have that cultural shift for many more decades. I mean, when I was growing up in the ’80s, you could smoke in hospitals and schools and on planes.

And I mean, imagine getting into a smoke-filled, pressurized cabin today, like, that just wouldn’t happen (laughter). But it took, really, until, you know, the aughts and the 2010s for not just the legislation or public policy to start to shift, but also our consciousness and awareness. And I think we might be on the brink of that now with head trauma. And so for me, this book felt like – it felt like it demanded to be told both as nonfiction and also really starkly, to say, you know, this is what it’s like to deal with this for years and not know if you’re going to get better.

GROSS: Annie, thank you so much for talking with us. And it’s really been a pleasure to talk with you. And I know that you have suffered, like, language problems because of your concussion. You seem to be in great shape now.

LIONTAS: Yeah.

GROSS: You have great facility with language now, so that must be a relief.

LIONTAS: Thank you. Well, you know, just to be transparent, because I would hate to misrepresent the condition, I have a lot of notes in front of me (laughter).

GROSS: Oh.

LIONTAS: And I memorized parts of these answers. And I, you know, sort of treated this like studying for the boards, mostly because I know that it’s really important to get the information out there. But I also think it’s important to be transparent about the fact that this does take a lot of work, this extroversion and relaying of this kind of knowledge. And I just want people out there who are suffering to know that I can appreciate that that’s what they’re going through.

GROSS: Well, this leads me to one more question. Do you keep a journal so that you actually have a record of your experience, because it sounds like your memory is still a little unreliable?

LIONTAS: I keep a lot of notes, but also the book was a way of keeping notes, too. Yeah.

GROSS: Yeah. Well, Annie, thank you so much.

LIONTAS: Thank you.

GROSS: Annie Liontas is the author of the new memoir “Sex With A Brain Injury: On Concussion And Recovery.”

The HBO series “True Detective” returns with a new season next Sunday. It stars Jodie Foster and former champion boxer Kali Reis playing, respectively, a chief of police and an Indigenous detective investigating mysterious deaths in a remote Alaskan town. Our TV critic David Bianculli will have a review after a short break. This is FRESH AIR.

(SOUNDBITE OF DANIEL FREEDMAN’S “LOVE TAKES TIME”)