Brave New Who?

Bereavement

Hello all,

No, nothing to do with Doctor Who’s regeneration. This month I thought we’d cover bereavement. Not the kind of bereavement people usually talk about – after a death of a loved one. I mean the kind a brain injury brings.

The following is drawn from my experience, counselling clients with ABI and stroke.

Similar to the grieving process we all go through after a death, people finding themselves with a life-changing brain condition go through their own. This process has its own stages / periods. N.B: Theses stages / periods have no particular order.

Bereavement02

  • Denial
  • Anger
  • Loss of Focus / Identity
  • Depression
  • Reflection & Self Awareness
  • Acceptance & Adaptation

Let’s look at these in turn.

(Denial)

This can be either a willful or unconscious non-recognition that a brain injury has happened. This is different to a client not perceiving the difficulties they are having; some clients know they’ve for example, suffered a stroke but remain unaware of the true extent of adaptation they need.

However, sometimes the shock of a life-changing event and the initial fears that go with it are all too much. It seems easier to go with the idea that nothing’s wrong, or that others are making things up, or exaggerating.

When it’s obvious that short-term memory problems and/or “simple jobs” are no longer being done “properly”, both the brain injured person and those close to them can find it helpful at first to pin problems on another health condition. Or age.

(Anger)

Even before a brain injury, some people have short tempers. After a brain injury those tempers can change either way – become even shorter, or if not stay the same, become harder to tell. Some people hardly ever get angry. Some are good at hiding it.

As part of bereavement, anger is often aimed at the cause of the injury, the world for not understanding, life in general or God for what’s happened. Or the patient / client can target their anger towards themselves.

N.B: Anger can alternate with guilt, for example when a person labels themselves as a “burden”. (I like to balance this with a further note: That a good number of people also find comfort in being needed by others.)

One good thing about anger is that, in the right place, time and company, it can be a great motivatior.

(Loss of Focus / Identity)

The crux of the matter. The immense yearning to again be that person who was. Because all that’s left is, for this time being, a nobody. For one client it was like the voice saying: “I don’t know who I am anymore,” was coming from a faceless shadow, not the person himself.

(Depression)

No kidding, this is a difficult period to move on from. Because of the change in neurology, medications may be necessary to help. Being actively listened to and listening to one’s self can also help. Keeping as active as possible is important too, even when not feeling motivated.

For more on motivation and ABI, click here.

(Reflection & Self Awareness)

In Western society we are quick to confuse who we are with what we do; we identify ourselves with our job. Meeting a stranger the question most asked and answered is: “What is it you do?”

Reflection and growing aware of the person who the person was who appled for that job before they had it, asking: “How much of that person is still here?” and paying attention that remaining person is very much part of the brain injury journey. Especially for the patient / client themselves.

(Acceptance & Adaptation)

This is not the end result of the process. The process goes round and around like a wheel moving forward.

Recently, I also used this metaphor: Bereavement is like two feet walking – an emotional foot, and a managing foot. Some days emotion take over, some days practicalities can be done.

Living with a brain injury yourself, or indeed getting to know someone all over again can be rewarding too. Some people consider themselves a nicer, or stronger, or more confident person than they were before. Some discover talents that had never shown themselves before.

I’m going to end this month with a song.  It’s not about brain injury. But the words kinda fit. Alicia Keys: Brand New Me Skip the ad’.

Take care.

Sean

Panic Buttons for A.B.I.

This month I’ve been asked to write about panic attacks. Wow! I thought. Why haven’t I covered it before? When any of us are unable to think straight, our biology, our emotions carry us along.

Where they carry us, we don’t know until we stop, draw breath and take in what we can of our situation. Up until that point, we don’t know which direction we’re taking ourselves. We become proverbial “headless chickens”.

Before any compensatory therapy or strategy can prove useful, Step One has to be a willingness to face fears. This is most true of clients whose cognitive functioning can be problematic, even on the happier days.

TV Static

The clouding of consciousness (brain fog) is for ABI clients / patients, physical. In a lot of cases it does not go away. Emotions determine the degree of cloud cover, but it’s always there to be lived with.

Another way to describe an injured brain might be as a faulty TV set. I am reminded of Sunday mornings I spent many, many years ago – playing around with the aerial of my parents’ gogglebox – trying to get an undistorted picture of the BBC test card before “Mr. Benn” started.

As therapists, the most we can do is reduce the amount of static and suggest positions the aerial might work better. The aerial’s actual positioning to stabilise their picture behind their static is our clients’ job.

There is no real, by the book, “how to…” with this. In my view, it has to be person-centred. Here‘s a link to Part One of a counselling session (not one of mine) with a head injured client. It lasts 9 or so minutes.

N.B. The client reports being “snappy”, NOT “panicky”.

Panic Button Controls
  • DON’T FIGHT, TAKE FLIGHT. Remove yourself from the environment / situation causing your panic.
  • Find somewhere you can be safe and quiet.
  • Begin listening to your own breathing, taking slow, deep breathsABI and Panic
  • Close your eyes and, if possible, imagine you’re in your favourite surroundings, doing a favourite thing.
  • If imagining you are somewhere else is impossible for you, hold an object in both hands and look at it. Keep listening to your breathing as you notice each of the object’s details – shape, colour, texture, markings…
  • Keep practicing. Set a special time and place aside for yourself.

Reading what to do might be easy. Remembering and doing it, as we all know, is hard. It helps most to be with someone while you practice.

Click here for Part Two of the counselling session. Again, not a counselling session of mine. Part Two also lasts around 9 minutes.

Patchy Reception & Counselling

If you are perhaps wanting counselling, the following points may help you decide.

  1. It offers you a room clear of clutter and distraction – space to breathe and relax.
  2. Regular time slots (50-60 minutes) that can be used to off load – kind of scatter thoughts, feelings, experiences into and around that room.
  3. It provides someone who will support, not judge. Part of that support is in helping take control of the panic. Part is in helping you get organised.

If I was to counsel you, I’d combine listening with breathing techniques and other Mindfulness exercises. A new sense of self can grow. Because as your new self becomes less patchy, you could begin to identify your gut instincts – which situations cause panic more than others and how to deal with them yourself.

Take care for now.

Sean

 

SMART Pacing

 

pacingHappy New Year Everyone!

Here we are at the start of another twelve month cycle. If you’re anyone like me, this thought will have crossed your mind: “Is making a New Year resolution good for me?”

The Problem With Me

My neurologist once told me: “Sean, you can do most things most people can do. The difference is that they only need fuel themselves on one Mars bar. You need two.”

I’ve come to the conclusion, having a brain injury myself, that eagerness and enthusiasm to achieve works against me. I set myself too many ambitions. And those ambitions have been too big. I try to run before I can walk. I get fatigued and burn myself out.

I also set myself one year in which to achieve my goals. I’ve already said: “Here we are at the start of another twelve month cycle.” BIG mistake! Next Christmas becomes a Finishing Line. A Finishing Line that’s only half way down my imaginary racecourseeaster bunny.

When I get to Christmas, I feel a failure. My ambitious project still has a lot of time to be spent on it. In any case, the truth is I’d be out of puff before I’d got to Easter.

SMART Eggs

Specific   Measurable   Actionable   Relevant   Time-boundaried

That’s what S.M.A.R.T. stands for. It’s a way of working out the best goals to set. No one needs to be an egghead to use it, either… (Sorry. I couldn’t resist.)

Rather than have a New Year resolution, why not start smartly at Easter? Easter’s about new beginnings too. Better prepare yourself. Give yourself the best step forward. Consider your current experience and go on from where you are.

For example, the need for memory aids etc. Knowing who to talk through your hopes and wishes with might be your first step. Collaboration can help everyone involved be more aware and focused.

(Specific)

Be clear and certain. Set your sight on something simple. Very often, brain injury lets in all sorts of clutter – too much info’ from too many places – facts, opinions, advice. The more specific your target, the greater your chance of staying on track.

Let’s use the example of changing weight. “Changing weight” is an unclear statement. “I’d like to be 10 stone” leaves no-one uncertain about what’s wanted.

(Measurable)

For the purpose of demonstration here, let’s say “One pound difference a fortnight”. Weight can be measured every two weeks and a record kept.

(Actionable)

Again, stay specific. What treat can you not do without? Are medication and special dietary needs important factors? What is realistically achievable?

Memory and organisational problems can be reduced by dicussing meals for each day of the week. If need be, ask someone to add them to your diary, or tablet, or on something stuck to your fridge’s door.

It doesn’t have to be as strict as keeping count of how many calories per plate. Once a sensible menu has been agreed, just keep to that day’s meal.

Exercise, however possible is also something to be discussed.

(Relevant)

How relevant is weighing 10 stone to health and happiness? Maybe our existing weights are already ideal for us. Maybe something else is in more urgent need of attention.

(Time-boundaried)

Let’s say the difference between our start weight and the desired 10 stone is 3 stone. There are 14 pounds in 1 stone. 14 (pounds) x 3 (stone) = 42 (pounds). Pacing, targeting and measuring one pound difference every two weeks sets the target time 84 weeks… So we may as well, allowing a bit of leaway for celebrations and lapses, set a time boundary of two years.

And hey, if the 10 stone weight is arrived at sooner, what the heck?

Take care. I’ll be back in February.

Writing Therapy (Part Two)

Hello everyone.

How many of you, I wonder, challenged yourselves to put something into words? If you did I hope it freed you and was a help to you in some way.

Last month I promised to show how story writing can help organisational skills. Here’s how:

Beginning, Middle and End

Diaries and journals have a “yesterday – today – tomorrow” flow to them. It’s natural. Stories, on the other hand, need to have their beginning chosen. Even if we want to retell something true as fiction, the question has to be asked: “Where did it all start?” Answering and getting our story going therefore requires memory (long-term, usually) and thought.

From then on the questions come in a mix-up that needs sorting: “What happened then?” “What led this person to behave that way?” “Could it have gone differently?” “If something had happened earlier, would it have changed the outcome?” Answering and sorting out the order of all the events and explanations forms the middle.

Endings almost write themselves in a way. Some plots within our stories will have a one way conclusion. And this can also be true of some of our characters. Those who we find reasons to change their minds, become tougher or more relaxed about things, may resolve their adventures in ways they (and we as writers) would not have thought of at the beginning.

All the above is about a true story, even if it’s told as though it’s fiction. What if it’s all a fiction and we are making it up from scratch? It can be as complicated and as much fun as you like.

Creative Writing (2)
Themes, Characters and Genres

By “theme”, I mean topic – an emotional or philosophical one. For example, our story might be our way of figuring out what makes people brave. Or exploring what the world might be like without money.

Obviously, we all know what characters are. But who do we want our characters to be? A few months ago, I introduced you to the Drama Triangle. The Perils of Penelope Pitstop is a good example of this. It has a persecutor (the Hooded Claw), victim (Penelope),  and rescuers (the Ant Hill Mob). And then there are our lesser characters playing their part.

Characters can represent things too. For example, in mythology, the Viking god of storms, Thor, is often shown as quick-tempered and sometimes moody and unpredictable – just like lightening and thunder.

“Genre” is just a posh word for story type – Romance, Comedy, Adventure… Genres can be helpful. If we are exploring bravery, Fantasy might be a really good choice. Think about it. Game of Thrones, The Hobbit, even The Wizzard of Oz all explore bravery. If we think of imagining a world with no money, how about making our story a futuristic Science Fiction story? Or maybe a satirical farce?

Conclusion

Having said all the above, it might be that all we really want to do is tell a good yarn. We have no need to write anything complicated. We just want to tell a simple joke with a few added descriptions about the places and people involved to make it more interesting, more memorable, perhaps.

Perfect. The joke becomes a story. But complicated or simple, there is always a structure and our thinking behind it. And on that note, I’ll leave you with a link to two of my comedy heroes. Haurel & Hardy in “County Hospital”.

Until next month. Take care,

Sean

Writing Therapy (PartOne)

Hello all.

I was talking to someone a couple of weeks ago who once felt they wanted to bring things to an end for themselves. But then he began to write. Not a novel, short story nor a poem; nothing complicated. Just free-flowing words about life with an injured brain.

He got out of his head and onto his computer screen, all his thoughts as they swirled to the front of his awareness again. That done, he read through it.

With all the “c**p” in front of him, he was able to put his thoughts into a kind of order – cutting and pasting, creating a beginning and a middle.

The middle is where he still is. It is a middle made of challenges and support, ups and downs, downs and ups.

He’d stopped after a while. Two weeks ago he began again.

“Writing is something you find really helpful, then,” I observed. “Any idea what it’s doing for you?”

“Do-gooders mean well. But no one else can understand what it’s like being me. It’s hard to explain in any case,” he answered.

Here’s how I see it: A way of stepping out of one’s experience.

How? By taking what’s on the inside, placing it outside, looking back at it all. Uncluttered, one’s mind is free to organise, re-read, check out if it looks/sounds right, re-organise and read again. When it does look/sound right, mixed emotions and confusion have become more understandable.

Dr. Gillie Bolton is a therapist heavilly influential in Writing Therapy circles. Click here to learn her thoughts on its benefits. It’s a publicity video for one of her books, but even so…

Typing is not for everyone. There are packages available out there that can turn speech to text. If the right words don’t come, so what? Comics / graphic novels tell it all in pictures and bubbles.

Writing Therapy

Keeping a diary can be great for compensating for poor memory too. As well as appointments, some people put descriptions of new faces as well as their names. Blessings can be counted, addresses and phone numbers, doodles – anything.

Next month, Part Two with how story writing can help organisational skills and more.

Take care.