Allow me to introduce you to some people I’ve met in the past. First, please meet my 76-year old friend, Mimi. At 74, she was active in her church, minister of communion to those at home, running to meetings and luncheons, heading out to her exercise class followed by coffee and talk with the ladies. Now, she sits in her chair most days, can’t concentrate long enough to read, so she pages through magazines occasionally and frequently tells the same story over and over—or forgets things completely.
I’d also like you to meet Jackie. A professional woman who used to run her own business, hire and fire, as well as take care of a family and participate in many recreational activities. Today she struggles to organize her day, has mood swings and sleeping problems that tire her out, and rather than the 20 hour day with 4 hours of sleep it is 4 hours activity and 20 hours of rest.
Finally, let me introduce you to James, who 3 years ago, was top salesman in his region. Running, going, stretching to meet those demands as well as be dad and hubby. Then, suddenly, the phone was terrifying and the thought of leaving the house too much.
What happened? And, what’s the big deal, right? I’ve just described plain old, ordinary garden-variety Alzheimer’s and Depression right? It’s not as easy as that.
We are learning so much more about the brain. When I began in this field over 20 years ago we would have treated these from the paradigm of mental illness and taken it no further. Today, research has shown us that the brain, that gelatin-like mass under our skull, does so much more, and much more precisely than we’d ever imagined. Thus the condition of the brain itself, the way it sends messages, how blood and oxygen flow through it, and the way in which it may have been jolted in the past and impacted the present, all are considerations in the condition of someone, all extremely important.
Have you ever worked on a computer that is DOS based, not Microsoft Windows, or Apple iOS based? If you have and attempted to run a program that is Windows based on it you’ll know that you must have the right software for the program running your computer. If it’s on a Windows platform you must have Windows software, etc. Or have you tried to load a program for which your computer doesn’t have enough space? Or even better, attempted to retrieve information from a corrupted disc? Brought back your worst nightmare at the computer, huh? Well, this is like our brain.
The hardware is the structure of the brain and the protective skull that covers it. The software consists of all the electrical impulses, the neurotransmitters, the thousands of ways in which the brain communicates to allow us to move our right hand when we want to, or know which is left, or figure out a puzzle, or allows us to be appropriately angry or sad without feeling out of control. There is nothing that we do, literally nothing, that doesn’t come in some way from the functioning of our brain.
So that’s new? Haven’t we always known this? Well, not so much. We used to think it took a massive head injury that resulted in surgery and/or coma to cause difficulties later. Thus after an accident when taken to the emergency room if you could walk, your eyes reacted to light, and you sounded like you knew who you were then you were sent home deemed “shaken up but fine”. No one paid attention or related the fact that another woman I know couldn’t organize her work space, was teary for months and months, became very depressed, couldn’t remember things, and had become extremely irritable after an auto accident. Well guess what? When she was rear-ended by a semi-truck going 55 miles an hour and walked away from a totaled vehicle–she wasn’t fine. Her brain had been jolted and, think of a Jell-O mold here, had sloshed back and forth against her skull, causing trauma to the structure of the brain that can’t be seen on X-rays, CT, or sometimes even MRI. But can be seen in neuropsychological testing that allowed her to finally realize she isn’t crazy, she’s lost function in her frontal lobe that controls her organization as well as to her temporal region that controls memory. And what is more important is that all the psychotherapy in the world will not correct this. She needs specific tools to overcome the deficits and make life easier. She also needs time for her brain to heal. And the understanding that it isn’t her fault, it isn’t a moral defect, it is an injury. Thankfully, in her case, after 2 years she regained most of her abilities but still deals with difficulty in organizing and planning and has to work much harder at it than she ever did.
So, let’s go back to the individuals you met earlier. First, back to Mimi, our 76-year old with “Alzheimer’s”. The doctors for a year and a half said it was just “aging” when she complained of not remembering everything. Possibly true. And then there was a surgery with aftercare mismanaged by the surgeon and a cardiologist, a physician, and mental health provider who all deemed her depressed. Eventually, 6 months later she was diagnosed and treated for the pulmonary embolisms that were impacting her ability to breathe and eventually her heart so that very little oxygen was getting through her body. Now, we have a woman who has had mood problems in the past, but her memory, moodiness, ability to initiate and concentration are all poor. Why? The brain needs oxygen which it didn’t get it and these damaged pieces can never be regained. So, Alzheimer’s? Likely not from the brain scans and MRI’s already done. Oxygen deprivation to her brain, highly likely. Reversible? No. In her case she’s not gotten worse, fortunately with oxygen flow restored, her symptoms stabilized and with help from her family she is able to live with her husband well.
Remember Jackie? The previously successful “superwoman”? She had hit her head numerous times throughout life in sports injuries and domestic violence. She did okay, had some problems, but managed. But then came a sports injury that left her significantly impaired for a few days and gradually her overall functioning reduced and she needed more and more support from staff. Eventually the coping became too much, her mood took a huge dive, and her ability to work became compromised. Just depression? No. Just a personality disorder? No. Significant damage to temporal and frontal lobes, some parietal dysfunction, and both her hardware and software have been impaired.
Finally, James, no major head injury. But he has a genetic background of bipolar and major depression. The software is corrupted, and the stress of managing on a corrupted software program became too much. Much as your computer starts freezing when a patch or some other fix is needed, he also froze. And it’s been a long way back to speed with medication and life management changes and dealing with pain in his emotional past. Not just depression, but bipolar disorder.
We can’t be too careful when it comes to evaluating ourselves, our loved ones, and our clients in terms of hardware and software deficiencies. The 76-year old woman had family members who kept asking questions, and asking for new doctors, and pushing hospital staff to reconsider what they found to be obvious. Eventually the answer was found, but not before the damage was relatively severe. We must be proactive in evaluating people and not just settle for the easiest, the quickest, and the least difficult explanation when the “fixes” for these diagnoses are not helpful. We must demand our health providers keep looking and search for the answers. And you deserve to understand your brain and your loved one’s brains. It may never happen to you or a loved one, but we don’t know what we’ll be given to deal with, do we? As Mrs. Gump said, “Life is like a box of chocolates…You never know what you’re gonna get”. If you are interested in learning more, any of the following books are great references and fairly easy reads on the basics of the brain. Then you too, can advocate for someone — or perhaps for yourself.
The Brain that Changes Itself by Norman Doidge
The Whole Brain Child by Daniel Siegel and Tina Bryson
Change Your Brain, Change Your Life (Revised) by Dr. Daniel Amen
CDC Website for Sports and Children – Heads Up Program at http://www.cdc.gov/headsup/youthsports/index.html