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TBI SoS – Restoring a Sense of Self After Traumatic Brain Injury – How Can We Get Our Selves Back?

Posted Jan 20 2011 12:00am

This is the seventh part in a multi-part exploration of sense of self and how it’s affected by traumatic brain injury. Read the other sections here.

Good question. Some might say restoring the sense of Self is a mysterious process that nobody fully understands, but I think it’s worth exploring. I have seen a really marked improvement in my own sense of self over the past five years, and about six months ago, I found myself actually thinking aloud that “I feel like I’m getting myself back.”

This was never an expressed goal of my neuropsychological rehab, and indeed the times I’ve raised the question of Self with my neuropsych, they didn’t seem very interested in exploring it. Still, when I announced that I was starting to feel like my own self again, they seemed pleased with this apparently coincidental by-product of our rehab work together.

But I don’t think that the restoration of the Self needs to be a coincidence, a happy accident that just happens by chance for no apparent reason. I believe that the Self can be and is restored (or rehabbed) through specific actions and specific approaches which are no less practical in their improvements in the “gray areas” of the life of the Self, than say physical exercises are for the strengthening of atrophied muscles.

I believe that restoring the Self results from the following understandings and actions:

1. Understanding the nature of Self as an expression of an individual’s unique personal abilities.

2. The overt, conscious valuation of those abilities both by the individual and those around them.

3. The repeated practice of progressive abilities, all of which lead to further growth and improvements and expand the sense of Self beyond the limits it once had (even beyond the limits it sensed prior to the injury).


Here’s how I understand all of this more in-depth
1. Understanding the nature of Self as an expression of an individual’s unique personal abilities.

Each of us has certain abilities and activities that we do uniquely well, which make us distinct and whole persons in the world. It’s important to emphasize that while old abilities may have been altered or damaged by injury, the world is an awfully big place, and the human spirit is a profoundly powerful force, and it’s entirely possible to find other areas to gain mastery, which may not have been noticed or valued before. It needs to be understood that one’s sense of Self can indeed be restored through action and intention.

Now, along with regard for the depth and breadth of possibilities that life and the world offer, it’s also vital to understand just how devastating it can be for someone to lose their former abilities. It’s of paramount importance to understand the extent to which a person can be derailed by something as simple as not being able to butter a piece of toast without it ending up on the kitchen floor. Our Selves are elaborate and intricate, and our sense of loss and disorientation may be “wildly disproportionate” to the perceived importance of the lost skill. It’s vital to not underestimate or dismiss the impact that lost abilities can have on a person’s sense of Who They Are in the world and the role they can play in life at large.

2. The overt, conscious valuation of all forms of ability both by the individual and those around them, and treating the restoration process as an ongoing, often challenging, way of life, rather than a set group of steps that will end in time.

Once you understand what you’ve lost and why it matters that it’s gone, you can
start taking steps to turn it all around. But it can be slow going, at first. It’s important to recognize the little abilities that come with repeated practice, and every little bit of progress matters. It’s easy to tell someone that their improved performance at holding a butter knife is a great thing, but to someone who used to be able to do it with no problem, it sure as hell doesn’t feel that way. Progress needs to be put in some kind of believeable context, so that recoverers don’t feel like they’re being condescended to. Self-assessment is notoriously difficult for TBI survivors, but it’s an ability that needs to be cultivated, so they can truly appreciate their progress and continue with the work that’s required. Masteries can be large or small, but they should be measurable and they should have realistic, believeable importance attached to them for the person in recovery.

Now, some abilities may actually already exist, only the survivor didn’t recognize them before. Skills and abilities that were taken for granted prior to the injury, may suddenly come front and center, as the recovery process proceeds. And these latent talents and gifts should be recognized and valued at every turn as evidence that there’s more to the Self than what was lost. These gifts may be used to restore fluidity in injured areas (such as a talent for thoughtful regard being recruited to create a mindful environment while getting ready for work in the morning, so that the toast stays on the plate as it’s being buttered). They may also be strengthened in their own right, essentially “fleshing out” the recoverer’s sense of who they are, in a new and expanded light.

This recognition of the recoverer having more talents than what they lost to the injury could turn out to be an important foundation for the continuous work of recovery. Not everyone “bounces back” from TBI in short order, and there are many accounts of the process taking a lot longer than anyone expected, with small progresses being found at unexpected intervals, sometimes many years post-injury. Recognizing and focusing on already extant talents and abilities and valuing them for the Self-hood that they grant to the recoverer, can be vital to their ongoing work ethic and determination to persevere. It can help everyone see that not everything has been lost, and in fact some unforeseen circumstances (like the sudden discovery of a hidden talent) can work in your favor. With TBI, uncertainty is often a constant companion finding a way to make peace with some forms of uncertainty can be truly good for the soul.

3. The repeated practice of progressive abilities, all of which lead to further growth and improvements and expand the sense of Self beyond the limits it once had (even beyond the limits it sensed prior to the injury).

Once we recognize the nature of the Self, appreciate the impact of lost skills and talents, and learn to value both the hidden talents we discover as well as our steps of progress along the way, we can go about the lifelong business of taking repeated steps to achieve competency in certain areas of our lives. These areas can be as small and seemingly insignificant as figuring out how to butter a piece of toast without having it end up on the kitchen floor. Or they can be as broad as being able to interview for a better job and improve your lot in life. Whatever the scope, by constant practice and mindful application of our lessons, we can embark on achieving fluidity in activities that once stymied us. We can start to regain that sense of wholeness, that sense of mastery, that TBI ripped from our grasp without warning.

We can get our Selves back.

For example, one of the biggest steps back to feeling like myself, came when I managed to get through my morning preparations without melting down in a pile of steaming emotional wreckage. I had struggled for years with just the basics of getting out of bed, doing my morning personal care, getting downstairs, and feeding both the pet and myself. I could never figure out why I always ended up an emotional mess before I even got out the door in the morning. A host of sensory issues, balance issues, and the way I responded to my clumsiness and absent-mindedness, all contributed to my difficulties, and at times it seemed as though things would never change. I would always be doomed to never having a good morning.

But through persistence and repeated attempts, I managed to turn this around. Through the systematic use of lists to keep myself on track, changing some parts of my diet to cut down on allergic reactions (especially to dairy), as well as rethinking my reactions to my clumsiness and disorientation, I was able to create a morning routine for myself that was both mindful and increasingly fluid. The better I got at getting through the morning without melting down and beating myself up and feeling like crap, the more ability I gained, the more smoothly I was able to do the things I needed to do. And as my ability increased, my sense of Self began to return.

And with that foundation, that series of lessons about how I can plan for and take action on things that matter to me, I was able to branch out further into other areas, use the same techniques for improvement, and work my way back from a place of cowering in a corner, lashing out at anyone who approached me with the intention of helping, and disqualifying myself from participating in the world around me.

Once upon a time, I couldn’t even get my breakfast and get dressed for work without hurting everyone who came within reach of me. But with time and practice, that completely turned around, and now it’s all but a non-issue for me.

And I feel more like mySelf again.

Where had my Self gotten to, in all this? My Self got lost in the most basic of places in the way I got into my day, in the ways in which I interacted with myself and the people around me. It got lost when I got swamped in minutiae and lost track of my emotional state. But in changing the way I got into my day turning it into a mindful and thoughtful routine each moring I found my Self again. I found it in my improved ability to plan and carry out my morning routine. I found it in my improved ability to interact with my spouse each morning without shutting them out, or barking and yelling at them. I found it in the increasingly fluid ability to just get up in the morning, eat, shower, dress, and get on the road to work.

Out of mastering that seemingly simple process, I was able to build on the rest of my day, applying the same mindset and thoughtfulness to my other activities. It’s led me to a deeper understanding of myself, a deeper connection with others, and a broader and more profound use of my skills and abilities in the world.

I don’t feel like my old Self, but I do feel more like my own Self again.

 

This ends the seventh part in a multi-part exploration of sense of self and how it’s affected by traumatic brain injury. Read the other sections here. More to come…

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