How I Rescued My Brain (19 page)

After his fall from grace, John Malkovich's character, David, goes to live with his daughter, Lucy, on a farm in post-apartheid South Africa. While there, young black men invade the house and rape Lucy. David is pushed into a toilet cubicle and doused with alcohol; a lighted match is thrown in and the door locked. He frantically puts out the fire with the water from the toilet.

Afterwards, this scene keeps popping into my head. It's as if I was there as it happened. That night, I re-experience memories of burn victims to whom I've provided therapy. I remember the manager of a supermarket that caught fire, an accident for which he felt responsible. He subsequently became obsessed with fire tragedies and couldn't stop watching news reports of them.

For the rest of the weekend, suicidal thoughts invade — they're strong enough to really scare me. On Sunday night, I tell Anna what's happened. She says it is awful that I feel this way, and reminds me that I have three beautiful daughters. She confesses that she's also angry and sometimes wants to tell me to snap out of it.

When I speak with Wayne several days later, he reminds me not to watch the news or movies that are emotionally charged. He's right, of course, but movies that I think are going to be all right, such as
Disgrace,
ambush me. Perhaps I need to be like the alcoholic who decides on a blanket avoidance of any occasion where alcohol might be involved.

But I still need diversions. My preference becomes comedies or human-interest stories based on true events. I avoid violent, highly sexual, and despondent movies. We borrow DVDs from our local video store each week. After the incident with
Disgrace
, I ask the store manager, Jarrod, for his feedback before I hire a movie. If either of us is uncertain about the content, I don't get it. I become my own censor, with Jarrod's help.

I also try to get a lift from doing things that are proactive. My dealings with creditors and lawyers are all reactive: responding to their demands and threats, always on the back foot. I've been editing a manual that Anna has written for one of her business projects, and I've been helping to revamp her website. We've also been talking through an idea she has for an instruction book. These tasks are fatiguing, but I can concentrate for longer than when doing the reactive tasks, and it's much more satisfying — I feel useful. Growing vegies in the garden also gives me this feeling.

On Sunday mornings, our three daughters participate in Nippers. The new season started a few months after the stroke. In previous years, I mostly helped out with Ashley's group, doing water safety for the age manager, Bill. (Age managers organise the water and beach activities for those in their charge, and parents provide assistance to the manager in whatever ways they are able.) Nippers cannot operate without the required number of water-safety people when the children are doing their water events. Water safety is done by those who've completed volunteer surf-lifesaving training and have passed the annual proficiency test, demonstrating water rescues, CPR, and physical fitness.

Four months after the stroke, I return for a Nippers session; I've just recently gone back to swimming in the ocean and the pool, and I'm feeling strong enough to give it a go. Bill sends me out on a yellow safety board, the type used by lifesavers. It is long, wide, and fat, and can carry two people in a rescue situation.

A northerly wind blows as I paddle, and the swell rears up, breaking in my face. I'm pushed back into shore a few times, but I don't give up. Yet with each effort to move through the breakers, I become weaker. I'm puzzled; normally I'd get through this.

I look back to the shore and see suddenly that I've drifted a long way from the group. Bill already has another water-safety person out in the surf; I've become redundant. I turn the board around and edge it back into shore, catch a final wave, and cut between two groups of children, their capped heads bobbing in the surf.

As I pull the board onto the sand, one of the Nippers officials comes up to me. ‘You don't have the board skills to handle these conditions,' she says. ‘You've already run into the kids on the board once before, haven't you?'

I'm dumbfounded. I stare at her, not knowing what to say.

‘Stick to the rescue tube; you're a good swimmer.'

‘No, that's not right,' I say finally, as I drag the board further up onto the sand. She is already walking away. I realise how angry I am in her judgement of me — and I haven't run into the kids before!

I catch up to her and say, ‘Look, I'm recovering from a stroke.'

‘Well, you should know your limitations. We can't have you putting the kids at risk,' she says. There is no sympathy in her face.

‘I've only just realised I can't do it,' I say, waving my arm towards the surf. She looks unmoved. Why is it that when you're trying to get back on your feet, someone goes and knees you in the guts?

I jog back to Bill's group. ‘Sorry, Bill,' I say when I reach him. ‘I've lost strength. I think it's the up-and-down motion I'm finding hard.'

I'd told him before we started that I'd missed the recent sessions because of a stroke, and I wasn't sure how I'd go. He'd been sympathetic. ‘Don't worry about it, Dave,' he said. ‘You can help out on the sand.' I appreciated this. Bill had had some recent health setbacks himself.

I won't do water safety again. I can't expose myself to put-downs like this while I'm recovering; I'm too fragile. And I certainly don't want to be a safety risk to the children.

AS THE WEEKS
go on, I begin to seek out easy-to-understand articles and picture books on brain function. This type of reading is so much easier than the legal documents put in front of me.

The Human Brain Book,
by Rita Carter, soon becomes one of my favourite books. I stare for long periods at the sliced images of a real human brain inside its skull. In the diagrams, the anatomically differentiated brain areas are artfully coloured and individually named; it's like going through a natural-history museum, each page of images another room. In my own brain, I try to feel the shapes I see on the page — mental fingers feeling around inside my skull. My brain and I are getting to know each other. As strange as it may sound, the more I can remember these names and shapes, the more it feels that I can have a dialogue with my brain, and the more influence I can have on it.

I start to sense that my brain is not a black box, but a menagerie of characters: sometimes working together, sometimes not. They begin to take on personalities: the amygdala is highly strung, an overanxious protector; the hippocampus is a methodical organiser, the cataloguer of memories; the prefrontal cortex is the master controller — at times over-serious, at times visionary and creative, and often at loggerheads with the amygdala. Then there's the mysterious limbic system: the emotional and impulsive one. The dutiful hypothalamus, the accelerator pedal of the fight–flight response, makes hormonal decisions, together with its compliant cousin, the pituitary gland.

A few weeks after the stroke, an ex-colleague lent me two books:
My Stroke of Insight
by Jill Bolte Taylor and
The Brain That Changes Itself
by Norman Doidge. It's taken me a while to get round to reading them, but I feel ready now.

I'm still often plagued by fog brain when I read, so Taylor's book looks the easier to start with. Soon I am riveted by her account of the early stages of her left-sided stroke, which occurred as she was getting ready for work. The onset of my stroke happened while I was asleep, and I didn't get the extreme motor loss that she did. But she describes the sense of peace and connectedness, and a lack of perception of danger, that she experienced immediately after her stroke — something I also experienced. She loses me a bit when she talks about reaching nirvana and dissolving perceptual boundaries, but until that point I am right there with her.

What I find most comforting in her book, which is the first thing I've read that describes my experience, is in the final section. Taylor lists the things she needed in her recovery. I identify most with her need for sleep; for others to speak slowly and softly, and to tone down their energy levels; for a reduction in stimulation from electronic media; for others to ask specific questions rather than general ones, giving time to answer; and for others to accept her for who she is today.

Next, I begin Doidge's book. It is a revelation, taking me into a curious, fascinating world. And it gives me hope that I can do something about my malfunctioning brain.

As a boy, I traded football cards, marbles, and even bottle tops, but as an adult, it has been the trading of ideas — learning about them and discussing them — that has sustained me. At the time of my postgraduate clinical training, it was accepted that we had a finite number of neurons, with largely fixed connections. There was little a brain-injured person could do for cognitive rehabilitation. It was understood that brain function improved spontaneously over the first six to twelve months, and that thereafter it plateaued, with only minor improvements in the coming years. It wasn't clear why this pattern occurred. The brain-injured person was a passenger in their rehabilitation, not the driver. The more diffuse the brain injury (strokes often cause diffuse injury), the more wide-ranging the damage and the resulting deficits, and the slower the recovery.

Doidge tells me the brain is plastic: new connections can be made between existing neurons, and sometimes new neurons can grow. Neuroplasticity happens by focusing the mind's attention in specific ways so that neurons that ‘fire together, wire together'. Like a technician, we can change our brain's circuitry to suit our purposes. He mentions research by Alvaro Pascual-Leone, who, using the method of transcranial magnetic stimulation, demonstrated that blind people who learnt to read the raised dots in braille developed larger ‘maps' in the motor cortex for the fingers used for ‘reading' than for their non-reading fingers. The area devoted to these fingers in their motor cortex was also larger than the equivalent area in those who couldn't read braille. In the blind person, the occipital area of the brain, which is usually devoted to vision, gets taken over by other functions, such as sound.

I already have some understanding of brain neurology through my clinical training and my undergraduate major in zoology. But Doidge is telling me that I can apply this knowledge to myself. I'm surprised by how uplifted I feel as I absorb his ideas; it takes me out of my life's messiness. I want to know more.

Each neuron has a bulbous cell body — the grey matter of the brain — with dendrites, like spidery arms, sprouting off it. The rest of the neuron is made up of a long, thin fibre — the axon — that ends in numerous fist-shaped synapses. The dendrites and axon of a neuron can grow ‘sprouts' to make new connections. A connection between neurons is most often made when the synapse of one comes into proximity to the dendrite of another. Information passes along the axon via an electrical impulse until it reaches the synapse. Here, neurotransmitters — the brain's chemical messengers — are released, and they move, in microseconds, through the minute gap between the synapse and the neuron it is cosying up to. As a newly made connection is reactivated over and over, the synapse and dendrite become sensitised to each other: they communicate more efficiently, like good friends.

A single neuron can connect to thousands of other neurons, and it is this capacity for neuronal connectedness that provides the landscape for neuroplasticity. I think of it as being akin to families. A small nuclear family has few members to draw on for knowledge, skills, and resources. If something happens to one or two of its members, the family unit is in jeopardy. The advantage for the nuclear family is that communication between them is quick. Yet an extended family, with multiple generations, draws on more resources. As long as they cooperate, this family has greater resilience and capability because of their wide-ranging connectedness.

The neurotransmitters in the brain — especially glutamate and gamma-aminobutyric acid (GABA) — act like neuronal ‘on' and ‘off' switches. Glutamate is excitatory, activating neurons, and GABA is inhibitory, reducing activity. This ‘on' and ‘off' process is the stepping-stone of neuroplastic change.

There are also many other neurotransmitters that modulate neuronal activity, enhancing neuroplasticity. Focusing attention on something activates the nucleus basalis (above the brain stem) to release acetylcholine, which diffuses throughout the brain, helping to sustain this attention. Dopamine is released when a reward is expected or a goal has been achieved. Noradrenaline is released when we come across something new, alerting our brain to take notice. Serotonin is active in creating the emotional quality of wellbeing. So the acts of focusing attention and experiencing novelty, reward, and emotional tone all help to cement neuroplastic changes.

When a number of neurons fire together, they become a neural network, threading its way throughout the brain. A particular memory is distributed through the brain as a living chemical and electrical trace, and the more neurons employed in the memory, the more secure it is. Recall of a memory reactivates the same neural network that responded to the original event; remembering requires the brain to pull together the sensory, motor, cognitive, and emotional components of the memory. The hippocampi, left and right, act as the managers in coordinating this recall.