How I Rescued My Brain (24 page)

Yet it's not a consistent progression. If I have a day with lots of telephone calls or conversations with new people, my performance on all the brain exercises deteriorates. The same thing happens if I do any strenuous physical exercise.

I found out about the link between exercise and fatigue when I met up with Doctor Mercer on a Monday for my three-monthly review. As usual, she conducted the visual-field test first. When she printed off the result, it showed that I'd gone backwards. The black area in the visual field had increased since my last test; the previous one had shown a decrease. ‘That doesn't seem right,' she said, looking puzzled.

I told her that I was feeling pretty flat, even though I hadn't done anything mentally taxing that day. I had rubber brain. As we discussed what might have brought it on, I realised that I was still physically fatigued from the competitive swim I'd done the day before. Doctor Mercer suggested a re-test a week later, when I had recovered. When I redid the test the next week, it showed that my vision was back to where it should've been.

The next weekend, at the surf club I ask Doug, ‘Have you moved yet?'

He's been trying to sell his house, but he's not getting the offers he would like for it — the housing market's still depressed. The noise of his neighbours' music and dogs is irritating him like hell, and he wants to move into a quiet housing complex for those over fifty-five. ‘I've been having trouble deciding what to do,' he tells me. ‘I consider the options and then my brain freezes. You get to a point, your health improves, and then something comes along to set you back for a while.' He motions climbing down a ladder with his hands. ‘But you don't fall back as low as you were before. You grow and learn from these experiences.'

He's right. It may not always feel like it, but the progress bar on the Brain Fitness program shows that I'm still ahead of where I started, even after a setback.

THE NEXT MONTH
I meet with Kathy, the speech pathologist whom Leanne has organised. She will conduct my speech assessment over two two-hour consultations, a week apart. She tells me she has devised a non-standard assessment that will be sensitive to my deficits and will mirror the types of tasks I might do if I return to non-clinical research work; she has read the neuropsychologist's report.

In our first consultation, Kathy gives me a one-page summary of a physical-health study. It contains medical terminology that I'm not familiar with, but she thinks I'll work out the meaning from the context. After I've read it, I answer her questions about it.

Next, she asks me to correct errors of grammar and expression on the page, which requires me to look at the text again in detail. I do most of this successfully, but when Kathy asks me to recall the main finding of the study thirty minutes later, I confidently report the opposite result from the correct one: somewhere in that time, my mischievous brain has turned the most important bit of information from the study inside out.

At the end of our session, Kathy says that she has noticed my circumlocution. During the questions, she also observed that I needed to re-read the paper to get the answers, instead of recalling them from memory. This news is disheartening, but unsurprising.

In our second consultation, a week later, she gives me a ten-page research study to read. ‘Evidence-Based Educational Guidelines for Stroke Survivors After Discharge Home' is much more challenging than the one-page summary. I understand most of what is written as I read it, but when I start a new section, I don't remember what I've read previously; conceptually, I'm not able to link the information from the different sections together in my mind. Kathy calls this a difficulty with ‘integrating information'. And she notices that when answering her questions, I omit crucial information.

Kathy also says that I have word-retrieval problems with proper nouns: the names of things and people. She suggests that this is due to damage in my left posterior hippocampus. The hippocampus consolidates memories, so this makes sense to me. Proper nouns can't be replaced with another word, so no amount of circumlocution will help. Also, she says, I repeat things, as if I am telling them to her for the first time. And I often ask her, mid-reply, to say the question again.

Prior to my consultation with Kathy, my insurer sent me to see a vocational psychologist to find out what capacity I had for work, and to come up with ideas for a work trial. The psychologist sounded enthusiastic when we first spoke over the phone, promising to come up with options I hadn't thought of. The date of our appointment was my birthday, and this seemed a good sign. But at our meeting, I'd been thrown when she opened with: ‘Tell me, where do you see yourself going with your future work?' I'd already given her my ideas over the phone and by email, and the thought of explaining it all again was deflating. I told her to ask me specific questions. I completed the questionnaires she gave me, and she promised to present me with her ideas after further research.

When her report came through, she had misspelt my name, got important dates wrong, and dismissed the suggestions I'd given her. Her ideas for a work trial did not take into account the cognitive difficulties I'd outlined. She recommended a trial answering telephone enquiries from the general public in the local-council office. This was a high-demand task for me because it relied solely on speech from people I couldn't see, and it required quick recall. As I didn't have previous knowledge of council services, I'd need to acquire a lot of new knowledge quickly.

Kathy, in the report she provides me with, says that I should avoid reception or directory tasks that rely heavily on auditory processing and the quick recall of information. I could undertake tasks that allow for delayed retrieval of information, such as writing. I would need flexibility with how, and the time I took, to produce the work. I would also need supervision from someone who could act as my editor, to help with the integration of information.

She also gives me a new insight: my good use of grammar and vocabulary masks my other cognitive deficits, giving a false impression of how well I'm functioning to others. Her conclusions confirm the feeling I'd had that the vocational psychologist was out of touch with brain impairment.

Kathy's results, like those of the neuropsychological assessment, validate my subjective experience. I am not imagining my difficulties; they are real. Her report becomes part of an arsenal of expert opinion for my insurer, treating practitioners, lawyers, and any doubters who want to query my incapacity.

When is a disability a disability? In the case of a hidden impediment, such as brain injury, I conclude that it is only a disability when others recognise the deficits. And it doesn't help that it has taken me fifteen months to work out what has changed since the stroke: it is often only in new situations that I learn what I can do as before and what I cannot. It's a meandering way to find out my limits, but there is no medical test that will work this out for me; life is the only test.

14

JAMES BENNETT-LEVY LEANS
forward in his chair. With a look of concern, he asks, ‘And how can I help
you
?' His spectacles concentrate the interest expressed by his eyes.

‘I want to feel useful again,' I say. ‘Be my prefrontal cortex; tell me what to do.' I explain my concentration limit for new things: two hours per day three days a week is probably all I can manage for the time being.

He nods in agreement.

After the debacle of the vocational psychologist's work recommendations and then Kathy's more informed report, I made contact with James Bennett-Levy, associate professor of mental health at the health-research unit that Leanne, the speech pathologist, had recommended to me. When we first spoke, James said that he remembered me from a positive review I wrote of one of his books, years earlier; I'd forgotten about this, but was glad for the connection.

Today he runs through a list of activities that he could use a volunteer to help with. They're all possibilities, although nothing grabs me. But my ears prick up at the last item on his list. He runs regular training programs in cognitive behaviour therapy, and has been asked by the university to design a psychotherapy course for mental-health professionals that incorporates the latest neuroscientific findings. Am I interested in neuroscience?

‘I am,' I say. How serendipitous.

In fact, over the last few weeks, as my brain's improved, I've been doing a lot of reading on the subject. I've finished
The Brain That Changes Itself
, and it's given me new ways to reflect on my trauma experiences.

Norman Doidge says that the principle of neuroplasticity can be used not only to improve cognitive and motor function after brain injury, but also to aid in emotional recovery. If we can focus the mind away from worries or troubling images and instead dwell upon something pleasant, this rewires the brain for more positive associations — like a train being switched onto different railway tracks. I
interpret this to mean that if I'm in a ruminating mood, I should distract myself with an activity that takes me out of my rumination. It's not important whether this is gardening, a coffee with friends, reading, swimming, or playing music; it's just important to do
something
.

Doug has read Doidge's book too, and he says that he's learnt to visualise his mind as an old-style telephone exchange. ‘If I can see that a thought is not good for me, I pull that one out,' he says, demonstrating with his hands, ‘and plug in a flower.'

I'm still doing psychotherapy with Wayne, and I've realised that the therapeutic progress I'm making has a neurological dimension. Traumatic memories are scorched into my brain because of the sensory and emotional impact of the original experience. In addition, when I recall a traumatic memory, with its emotional tone and patchwork of sensory associations, I'm reinforcing the memory's neural network: reimagining activates the same network all over again, etching the memory trace deeper, further sensitising me to potential threats. Wayne has reminded me that the threats I faced in the past are no longer present, so I no longer need to react. Yet my brain acts as if it doesn't know this: it still behaves as though those threats are real. In my hypervigilant state, my threat system is easily triggered: the demands of creditors, the children being difficult, and even a stern look from Anna are all enough to set it off sometimes. Present-day threats — or what I perceive as threats — set me off more than they should, even when I know that they have no direct connection with past trauma experiences.

When I can see that my emotional response to a past threat is outdated, new neural connections are made: an alternative network is created. As with learning any new skill, I need to keep activating the alternative network, separating the present from the past. For consolidation, this neuroplastic change requires that the connections in the older neural network weaken as the connections in the alternative network strengthen. In time, I will respond to what is
actually
happening around me, rather than what I imagine is happening.

Doidge refers to the work of neuropsychiatrist Eric Kandel. I remember excitedly reading an article a few years before in which Kandel was cited as saying that neuroscience has demonstrated that psychotherapy (‘talk therapy') leads to physically observable, positive changes in the brain. When we re-experience trauma memories and uncontrollable emotions, blood flow to the prefrontal cortex is reduced, meaning that our threat-based brain structures take over. The neurological aim, therefore, is to activate the prefrontal cortex as much as possible before, during, and after these experiences. Talk therapy restores the prefrontal cortex's involvement in emotional response. As I read Doidge's description of this, I picture cerebral blood flow seesawing throughout my brain, as my prefrontal cortex and my limbic system wrestle with each other.

I also find out that psychological trauma causes the hippo-campus to shrink, through the release of glucocorticoids (a class of hormones), especially cortisol. Prolonged release of cortisol, which occurs with depression and chronic stress, destroys cells in the hippocampus, causing memory loss. As people recover from depression, their hippocampal neurons can grow back, improving memory. So it's likely that even before the stroke, the ongoing financial stress, the post-traumatic stress disorder, and the depression caused shrinkage in my hippocampi; this is what the neuropsychologist was getting at. I wasn't imagining the memory and decision-making difficulties I had: there was a biological basis for them. Given that part of my left hippocampus was damaged in the stroke, it's fortunate for me that the hippocampus is one area of the brain where new neurons can grow from stem cells.

Antidepressant medications and St John's wort — and possibly psychotherapy too — can also increase the number of stem cells in the hippocampus. The creation of new neurons may be the indirect reason that antidepressant medication increases serotonin levels. Neuronal growth in the hippocampus improves a person's capacity to learn and remember, and to re-engage.

This gives me great hope. When James mentions his interest in the application of neuroscience to psychotherapy, I am already primed, keen to assist him in bringing these findings into the hands of other therapists.

After James sorts out the administration details that allow me to become an unpaid member of the research unit, he suggests a program of readings. We will meet up each month to discuss and summarise our findings. I am to concentrate on the authors Daniel Siegel, Louis Cozolino, and John Arden initially, reading their books to get an overview of the area of neuroscience and psychotherapy. Then, from time to time he will give me specific research articles to go through. Best of all, I can do this work at home, at my own pace. I'll need to make summary notes of what I read as I go, I tell him, or I'll forget it all. ‘That would be great,' he says.