Meta-Cognition:Thinking about Thinking

              Recent studies have overturned the long held belief that as you get older your brain gets weaker and more inefficient. The brain does not get worse with age; bad habits erode the mind. New brain cells are constantly being grown in the hippocampus and the brain is always building new pathways.

  The brain is like a muscle. With use it will grow stronger. With disuse it will atrophy. Unlike many other organs of the body, it never wears out, but it does fade out from lack of stimulus. 

Many people find themselves trapped after brain injury. Trapped in a body with a brain that cannot do what it used to. So they sit and wait to get better. Unfortunately, that’s not how brain injury recovery works. Brain injury recovery is work. The work doesn’t have to be unpleasant, but it must be fairly consistent. It is only by dogged determination that limitations can be overcome.

A word about limitations: Limitations aren’t permanent. Limitations are markers that say how far you’ve gone in the past. They say nothing about the future except how much further you have left to go. View your limitations as the highest rung you’ve ever reached on a ladder. You can always try to go one rung higher.

At any point in your recovery you may not get any better. The Doctors really can’t give the families or the victims of brain injury any definite answers to the questions “How long till I get better?” and “Will I regain this or that ability?” They can not wave a magic wand or give you a magic drug that will make you whole again

Take control of your brain’s functions. Accept that your brain is an amazing organ and that you can make it better and stronger. How good and how strong is up to you. You can always improve, but there may be a point of diminishing returns. You must decide how you want to proceed.

Your brain can be very obedient. It will do what you ask of it. Program your brain to perform a certain task within a certain time limit. Tell yourself that you will complete a task within a certain (reasonable) time. You will be surprised at how much more you can accomplish. They have tested for this under laboratory conditions and it is a fact that if you give yourself a goal and a time limit the brain tends to work faster and more successfully.

            Acknowledge your limitations and devise techniques for working around them. Instead of saying “I can’t remember” try saying “I will remember when X happens.” Give yourself a command such as “When I park my car I will shut my lights off.” Visualize doing this. When my wife asks me to pick up certain items for her when I go shopping I visualize selecting the item when I get to that part of the store. This works for me provided she doesn’t ask for too many things and that I know where the item is so I can visualize it. With practice you can actually get quite proficient at this sort of thing. As always, start with baby steps. Success builds success.

                Visualization is a key that you can use to improve your brainpower. It is a tool that you can use to fight the failure mechanism that we all struggle with. When we tell ourselves “I must remember” it is usually with this nagging feeling that we will forget. When you visualize actually remembering to do something you over ride that failure impulse.

            So, you start by taking control of your brain’s functions. Your brain is very obedient and will respond to commands. This does take practice. Practice being successful at something. Acknowledge your limitations. Visualize yourself being successful.

            I am not talking about saving a drowning child, landing a crippled airplane, or curing a wasting disease. I’m talking about wearing matching socks, turning off the stove, and calling your mother on her birthday. We can be successful people.

A Memory Like All Others

What do you think these three people have in common?

1.      A man tees up a golf ball and hits it straight down the fairway. After waiting a few moments for his partner to hit, the man tees up his ball again, forgetting that he hit the first drive.

2.      A man puts his glasses down on the edge of a couch. Several minutes later he realizes that he can’t find the glasses, and spends half an hour searching his home before locating them.

3.      A man temporarily places a violin on the top of his car. Forgetting that he has done so, he drives off with the violin still perched on the top of the roof.

If you guessed that they are all men you have guessed correctly, but that is not my point. What else do they all have in common?

None of these people have a brain injury.

I have recently completed reading a book, by Daniel L. Schacter who is the chair of Harvard University’s Department of Psychology, titled “The Seven Sins of Memory – how the mind forgets and remembers.” In this book he outlines seven different ways the mind manages to forget. Seven different ways!

Of course, he makes many valid points and observations, but I was looking at more than just his observations and conclusions. I was trying to determine if there would be anything valuable for a brain injured person to learn from such a book.

After reading the dozens of accounts of people’s mnemonic shortcomings in the book, I was able to make one salient observation. Everyone has an imperfect memory; our memory may be more imperfect than most, but ordinary people are constantly hampered by memory failure.

I’m not going to say that we have nothing to complain about, because if it’s bad for other people, it is that much worse for us. What I am going to suggest is that there are definite ways we can work to improve our memories. If other people can do it, so can we. Our hurdles may be higher, and the road fraught with increased perils…So what else is new?

As always, the first step is attitude. In Illusions Richard Bach says, “if you argue your limitations, then sure enough they’re yours.” The mind is surprisingly obedient, if we tell ourselves we can’t do something then we can’t. If you first say that you can’t, you’re almost never wrong.

Unfortunately, the corollary is not true. If you believe you can do something, it doesn’t necessarily mean you can. I’m just saying, as a first step, you must believe you can succeed.

Tatiana Cooley, the 1999 national memory champion can remember thousands of numbers in a series as well as other memory feats. What she can not due is get through a day without post-it notes and a day planner. She is terribly absent-minded. The reasons for this are explained in Dr. Schacter’s book, but basically, there are two different kinds of memory at work here and one she is able to improve on and the other she sacrifices.

Imagine an ordinary person forgetting something, they probably will quickly dismiss it as just another memory failure in a long list of mnemonic shortcomings. If you or I forget something we say, “it’s my brain injury.”

The only people I have ever heard of who have had excellent memories are people who subsequently sustained a brain injury. Apparently, the best way to guard against a TBI is to have a bad memory to start with. I’m being facetious here, but I am making a point. We often remember our memory as being much better than it was. The logic of the last sentence is clear. Dr. Schacter calls this the sin of bias. This is what is normally called seeing the past through rose colored glasses. It is a natural condition of memory. Not surprisingly, it is that much more pronounced in a TBI survivor. We need to be easier on ourselves.

In summary let me say this. Our memories are worse than most people’s memories. Everyone has to use various compensatory strategies to make it through a day and it is more so for us. There are strategies to improve memory, though we have to realize that it is going to be harder for us, and we will accomplish less. Maybe this all seems dark and foreboding, the light to draw from what I am saying is that there is hope. Set realistic goals and expect to work hard, when you succeed you will be that much more rewarded. As Thomas Paine said, “That which we obtain too easily, we esteem to lightly.”

Learning to See

I see the world differently now. I see it with “TBI Vision.” I’m not talking about my double vision, or the difficulty my brain has in processing the information my eyes are taking in. Those are very real and serious limitations. What I am talking about is the way I see things now.

All too often, ordinary people get caught up in what they see. They place too much emphasis on what is plainly right before their eyes. If something doesn’t square with the facts then it must not be so. “A is A” as Aristotle said. “Ding an Sich” (a thing in itself) as Kant said. Time and again it is repeated that we gain knowledge of our world through direct observation. None of these beliefs allow for brain injury, where that information is confused, obfuscated, or just plain missed.

This would seem to imply that a brain-injured person is less able to operate effectively in the world. In many cases this is just not so. Blind people can operate effectively, as we know. In fact, many blind people who get their sight are unhappy with what they see; the “real world” is not a world they are comfortable in.

This is an insight into what I mean when I say that I am glad for my TBI and would not wish it away even if I could. I see so much more with my heart and I would not want to give that up. I use to see the world in very cold and hostile terms. Now I see it in warmer friendlier terms. Has the world changed? No, I have. Instead of only seeing what is, I also see what can be.

It was a long and arduous process to come to this knowing. Now that I have it I would not give it up. This is what I mean when I say that I am glad to have sustained a severe TBI. All the pressure is off. No one expects me to be the best, or the smartest, or the richest. All I have to do is be the best me I can be. I can be a good friend, a good volunteer, and a valued person.

I live my life with passion. I care. I laugh. I love. All of these are things that I gain by sharing them; they make me a wealthy soul. Because I want these things in my life (and who does not), I give them away. They rebound back to me. I like myself when I am this way, when I like myself I find others like me also. I ask no one for compassion, joy, or love. I simply give it unconditionally and I find my own cup overflowing.

This is how I choose to see the world; this is my “TBI vision.”  

Sense of Self

What is this “sense of self” that everyone is talking about? Your sense of self is that knowledge of what kind of person you are, how you feel and act, how you have developed over time, the roles you fill and the roles you play.

Your sense of self was turned off like a light bulb when you had your accident, when the light was turned back on the room had changed. It had become a shambles. It takes a long time to put it in order and it will never look the same. Who you are is a dynamic process. This sense, the personal experiences, are the sum of events over time. Permit yourself the time to become a whole new person.

How many times have you heard the phrase, “if I could do it all over again…” Well, now you can.

Brain injury is an opportunity to design yourself all over again. When you do something or behave in a way that is unsatisfactory you can tell yourself, “that wasn’t me, I’m better than that.” Saying it makes it so.

One thing that makes for a positive sense of self is a sense of accomplishment. Unlike many people, I get a real sense of accomplishment just from tying my shoes. In 1989 I had to re-learn how to do that. It was a lot of work, I still must work at it, but I’m getting better all the time. Now I only look back to see how far I’ve come!

Post-TBI everything is hard, so it makes little difference what I’m trying to do, whether it’s tying my shoes or learning another language. I hone my will on adversity. I started small and worked my way up. The nice thing about having no short term memory is that it rarely occurs to me how long I’ve been working at something. I just put it into my routine and work at it every day until I succeed.

            I believe you will find that success suits you.

On Being Well Liked

One thing we all need, not just TBI survivors, but everyone, is for people to like us. How come some people have lots of friends and others don’t. I will tell you what works for me. Many people will say, “Well of course you have lots of friends Mike, you’re so good looking and funny and smart, but what about everyone else?” Actually, I’m joking, nobody says that about me. So just why do I have so many friends?

            I have many friends because I like people. I’m not shy about it either. When I meet someone I am genuinely pleased to have made his or her acquaintance. When somebody I know walks in the room I am glad to see them, as if I was alone in the room until they showed up.

            In conversation, I try to talk about something I know they are interested in. If I don’t know what they are interested in I will try to notice what they are wearing and tell them I like it.

            The single most likeable thing about someone is how much he or she likes you. The important thing to note about that is that it gives you a lot of control over how others feel about you. The trick is to give others the benefit of the doubt. Assume that you have met your new best friend when you are introduced to someone. If you find out otherwise later you can just move on, no harm done.

            One piece of advice, avoid talking about yourself. Unless you are asked a question, talk about them. If you don’t know enough to talk about them then ask about them. If they ask about you, be polite and answer briefly. Save full disclosures for another time. If you want people to see past your brain injury, then you have to see past your brain injury. Here’s an example:

Them: So you have a brain injury?

You: Yes.

Them: So how did it happen, if you don’t mind me asking?

You: No, I don’t mind. I was in a motor vehicle accident.

Them: Are you all better now.

You: Actually, I still have quite a few problems.

Them: I bet its tough. I have a brother-in-law who fell off a platform at work…

You: How is he doing?

It’s usually the case that someone knows someone with a brain injury. Show concern for THAT person, are they getting the help they need, have they contacted the Brain Injury Association? When people ask about your injury they are usually just being polite, be polite and respond briefly. When you ask about someone they mention, you are just being polite, after all. This is how civil society works.

Good friendships with quality people take time and constant effort. If you wish to attract and keep quality people then you have to work at being a quality person yourself.

Giving Yourself Credit

One of the most common complaints about brain injury is that no one can “see” your disability.  We look fine and even among people who know we are brain injured we often find our disability is overlooked. Add to that the fact that so many have no idea what a brain injury is all about, and you’ve got a recipe for misunderstanding and alienation. This is one of the many reasons we are impatient for our complete recovery.

One of the most common complaints heard in any support group is frustration over the length of recovery. There is so much pain and so much hard work and so little reward. Day after day we face the same dull tasks, day after day we don’t seem to get better, and if we do improve they just raise the bar and we start over from square one. Its like being in training for the Olympics except that there is no gold medal, no adoring crowd, and no cheesy interviews from network personas in cheap suits.

There are many aspects to the outside world that we cannot change. Recovery is slow and difficult, but we can change our perspective.

That is what I decided to do. I was as bad as all the other people who would look at me and see no brain injury; who would see nothing amiss. I had to reevaluate my position; I was in such bad shape after my accident that I almost died. What I needed was a big gash or bruise on my head to remind my self that I was horribly injured. Some sort of mark that could visually remind me just how hurt I was. Since that was not to be, I just had to consider how far I had come. I had to realize just what a complicated piece of machinery the brain is. Skin can just scar over and the wound is healed. The brain doesn’t use scars. Scars are the body’s duct tape, tie wire, and Bondo, that can cover up a damaged chassis. Repairing a high performance engine will use none of those things and is a much a more involved and delicate process. If an engine is damaged severely enough, it may never run as well as it used to, I accept that. It was time to accept that my brain may never run as well as it used to.

Fortunately my heart can compensate for my brain. I believe this has made me a better person than I ever was before. As difficult as it is sometimes, I have to ignore what I’ve lost and focus on what I have gained.

Boredom

My friend Carlos had a period during his adolescence when he didn’t have much to do. You know that age, to old for all the stuff you used to do, but not old enough to do all the things you wanted to do. Well, he came across a whole pile of rubber bands, an almost limitless supply. So he rolled one into a little ball and then he grabbed another one and wrapped it around the first one. That was so much fun and so rewarding that he selected one more rubber band and repeated the process. He did this whenever he had some spare time and wasn’t going anywhere for awhile. By the end of the summer he had a rubber band ball about the size of a basketball. He called his creation “Boredom.” Boredom became an institution to us. We took it wherever we went. That was twenty years ago, the last place I remember boredom was at college, in the Student Governing Board offices, where it was our constant companion.

            Even before I had left the hospital boredom had found me again. In my opinion, the hardest thing about brain injury is the boredom. Everyone finds being infirm to be boring, but brain injury lasts forever! If not forever, for an uncomfortably long time. Everyone with brain injury has memory problems, but everyone can still remember how much fun they used to have and how interesting their life was before their brain injury.

            It’s like the football player who is injured and told he will never play football again, except you were playing life and now it appears you will never play life again. What do you tell those well-meaning people who want to give you a kind word of support when they ask what’s wrong? Do you look at them straight on and say, “I’m bored.” In the work-a-day world where people are longing for some peace and quiet how do you convey the utter futility of your predicament? It’s like you’re waiting to get better, but that’s years away if even then.

            I do remember the first year after my accident, not in detail, but in general. I remember how bored I was. I still get bored, I think I will spend my life running from boredom. The difference between now and then is that now I’m not bored all the time. I have discovered a secret. The opposite of boredom is purpose. If you find a purpose to your life you will have a way to alleviate boredom. Purpose fills each day with opportunity and each moment with wonder. I actually find myself lamenting that there aren’t enough hours in the day!

            The tough part is actually finding a purpose. In my experience it is rarely found by sitting back and wondering what it might be, wishing upon a star. Usually, people are going through their life and this purpose just bites them on the nose. This isn’t much solace for those who are bored now, so what can a person do?

            I would look at volunteer opportunities. This is not to say that this is the best way to find your passion and purpose in life, but it does give you something to do until you find your place in the world.

            Remember to look inward. Before I was of much use to anyone I spent time improving myself. “Invest in yourself first,” a sage once told me. That is my mantra now, whenever I talk about brain injury to survivors I talk about ways that I found to improve myself after my accident, many of these techniques I have written about in these pages, but everyone is different and we all must chart our own course.

            Good luck and happy sailing.

Beyond Language

            Communicating with language is very difficult with most people that suffer from TBI. We have the idea in our mind, we may even have the sentence on the tip of our tongue, but it just doesn’t come out as we mean it to. As a demonic corollary, the more passionately we feel about something, the less it is likely that we are going to be able to say what we mean.

            The way we try to compensate for this is by taking repeated stabs at it. Stating again and again in different ways what we are trying to say, all the while we feel as though we are losing our audience until we can’t even remember what we were trying to say. AAAARRRGH!

            You would think that we would learn. Better to remain silent and be thought a fool than to open our mouths and remove all doubt. A big part of communication is effectively sharing your anger and frustration and that is not something I have mastered or even feel confident I can explore in an article like this. That is why there are people with degrees making a lot of money dealing with those issues.

            What I would like to talk about is communicating positively with friends and loved ones. Being the kind of communicator that draws people towards you instead of pushing them away.

            We all want someone to talk to. We all want someone who will hear our problems. We do not need someone to solve our problems. We especially don’t need pop-psychologists and their breezy replies like “you just gotta do what makes you happy.” We just want someone who will listen.

There is our solution. Just listen. If people know you as someone who is a good listener they will seek you out. This is an ideal situation for us because it doesn’t matter what you say, what matters is what you don’t say. All you have to say is what they just told you. For example:

Them: “I am really teed off today.”

You: “You’re really teed off?”

Them: “My mom is driving me up a wall.”

You: “Why is your mom driving you up a wall?”

 Them: “Well, today she…”

You get the point I’m sure. Just practice this a little bit and you will be surprised at how people respond. They will find they like spending time with you.

            When it comes to the “international language,” the language of love, we should find ourselves even better off. You will have to make a conscious effort however. You know how when a person is blind their other senses become heightened in order to compensate. The same can be true for verbal communication. All you need to do is watch an old silent movie and you will see that they were able to convey all the drama and pathos without words, maybe even more so than movies with words. If you are in a romantic relationship I suggest that you try an evening with out words. It will be difficult at first, but it gets easier. If someone gets angry start talking! The point of this game is greater communication, if someone gets angry and turns off, then you have stopped communicating and that is the opposite of what you are trying to accomplish.

            If you only take one point from this article let it be this: When it comes to verbal communication and brain injury, less is more.

Act Happy to be Happy

            Depression is almost certain with TBI. In fact, I would say that if you suffer a traumatic brain injury and don’t get depressed, then you just don’t get it. I did not become clinically depressed until about two years after my accident. It took until then for the double vision, the dizziness, the confusion, and the fact that I never felt good, to finely overwhelm me. Like many people, I despised the idea of being dependent on any medication and the thought of what those drugs would be doing to the rest of my body was just as disturbing. However, when depression finally ran through me, I surrendered to my doctor’s advice and went on anti-depressant medication. I adhered strictly to the prescribed regimen so as to affect the greatest efficacy and speediest recovery. Ultimately, this took almost a year.

            I was determined to do everything that I could to avoid becoming depressed in the future. I have determined two ways that have kept me free of depression ever since. The first way is one that I believe will work for everyone. The second way is a path that is different for each person and I only relate mine as an example.

            About eight years ago I went to a seminar given by a doctor who had studied the effects of smiling and laughter on the health of the individual. We all know that depression is a chemical imbalance. Long after the original cause of the depression may be gone the imbalance remains and this is what we call clinical depression. We know that when somebody is depressed they look depressed, their posture is bad, their shoulders droop, their head sinks, they don’t smile, and so forth. According to medical research it is this physical state that induces the body to manufacture the chemical imbalance that makes one unhappy. This chemical change must be overcome to be happy again. But how? “Simple,” says the good doctor, “just smile.” If you change your face from a frown to a smile, if you sit up straight, your body will eventually change its chemistry. Look at yourself in the mirror with a big grin on your face, how could you stay unhappy? The dissonance is startling. You have the power to smile. If you are able to get over yourself and let the smile work its magic, you will find your mood improving. I can’t suggest you do this as a way of treating severe depression, but it can’t hurt. I believe quite strongly that it has helped me.

            Laughter is even stronger than smiling. We have all heard the adage that “laughter is the best medicine.” Well, it didn’t come out of nothingness. Laughter is the strongest prescription available for pain and depression. It releases endorphins from the body’s own pharmacy. Have you ever been carrying something heavy and started laughing at something funny? Laughing so hard you had to set down what you were carrying for fear of dropping it? That’s endorphins numbing your pain and relaxing those muscles. Watching a funny movie or joking around with friends is some of the most effective therapy I know of for treating pain or low spirits.

            The second method is spirituality. Almost without exception, I have found that most survivors have a deep and abiding faith that sustains them. As an Atheist, this didn’t really work for me. I know there are others out there that also share my lack of faith, and although my spirituality is very private, I would like to share the path that I have followed to happiness. I have turned to Bhuddism, I am not a Bhuddist per se, but I have found strength in the teachings of the Dalai Lama. There is a mystical side to Bhuddism that I do not embrace, but the teachings are very relevant. The book I recommend is called “The Art of Happiness” by the Dalai Lama and Howard C. Cutler. M.D.  This book combines the teachings of the Dalai Lama with the interpretation of a psychologist.

            These two techniques have been the cornerstone of my recovery that has allowed me to face the challenges and the heartbreaks of brain injury recovery.

A Tip for Faster Recovery

A Tip for Faster Recovery

            So many times when we ask what we can do to get better we are often told to be patient, it just takes time. Attitude is the most important in my opinion, but that’s not really doing anything, so what can one do?

            Well, I came across something the other day, which I believe is just what many people are looking for. This is a study that shows a definite improvement in mental faculties. This study was done on older people and was connected to age related brain issues, but I think survivors will find this relevant.

            A study done by Prof. Arthur Kramer on what the effects of simply walking regularly would have on mental functions. Specifically, on reversing the aging process, which is very similar to brain injury recovery. What he found out will not surprise very many people; exercise is good for you. What will raise many eyebrows is how good it is for you. One half his test subjects walked for half an hour three times a week, the other half remained sedentary (inactive). The active people improved up to 15% on mental tests!

            The areas most improved were regions responsible for “executive control functions.” Those are the areas with which, as brain injured people, we suffer some of our most debilitating deficits. You know the issues I’m talking about, planning, and using working memory, making decisions, and picking out relevant information from irrelevant distractions.

            These tests were on elderly people, so even older TBI sufferers can expect some benefit from exercise, and one would imagine that younger folks might even expect more dramatic results.

            Of course, it is always a good idea to consult with your doctor before embarking on any exercise program. Also, you should try to find something that you enjoy doing so that you are more likely to keep doing it. Good luck!