The Ghost in My Brain (9 page)

Ordinarily this information from
S
would rise to the conscious level, and would abort the question-asking process,
Q
. But because of the brain damage, this communication from
S
to
Q
(and thus to my conscious level) could not take place. I still didn't “know” what Jake had said in any way I could make use of. For example, I couldn't make use of the information to
stop walking, and tell Jake, “Thanks for your consideration. I'll wait for you here.”

Meanwhile, under the surface, the preconditions for firing off a
guilt daemon
had been met: I was inconveniencing my friend, who was trying to help me. I was “pretending” not to have heard what he said. I was exacerbating my deceitfulness by now asking him to clarify his statement, even though I already knew the answer to my question. Each of these was a violation of one of my moral principles, and so an internal censure had been issued: guilt (
G
) rose of its own accord, independent of any conscious logic. I could not control it, and I could not make it go away.

It is interesting that whatever nonconscious process it was that triggered the guilt daemon (
G
) had access to both the process of my asking for information (
Q
), and the process that was reporting already having found that same information (
S
). But
G
did not have access to the abnormal structural constraint caused by the brain damage: while I had retrieved the missing information,
I could not access it
in any way that was useful to me. This makes sense, we might suppose. The first two processes are normal, and the guilt daemon is set up to handle them; but the guilt daemon was not designed to make use of a constraint solely caused by brain damage.

My intuition is that this had to do with what we will later understand were my ongoing difficulties with the integration of central attentional focus, and peripheral contextual information—important parts of the visual/spatial reasoning capabilities of the brain. In this case the detail/focus aspect of my interaction with Jake was my asking him questions about what he meant, and the peripheral context was that I had simultaneously already figured out what he had originally said.

Alas, guilt is not pleasant, especially when there is a feeling
of having done something really bad but not knowing what it was. So this was a big moment for me—to understand why I had been feeling so guilty, so often, for two years, yet could never figure out how to “act right” so that I would not suffer from such relentless internal censuring. Our analysis allowed me to form a plan about this kind of recurring guilt such that, while it did not allow me to stop the emotion from occurring, it did allow me the solace of understanding what was happening to me: I could now ignore my guilt and simply shrug my shoulders in wonder at the marvelous design of the human mind.

Unless you have, yourself, lost efficacy in your balance system, you probably have no idea how devastating the effects of this can be in one's life. Because of inner-ear damage—yet another result of the crash—I had to deal with balance issues every day. In this section we'll start with the obvious challenges with basic motion for the concussive, but then must get progressively more sophisticated in our analysis as we examine the effects of balance difficulties on hearing, body sense, and even the most elemental aspect of cognition that make us human: the symbol creation of
thinking
.

THE THREE BALANCE SYSTEMS.
Roughly speaking, the balance system uses three overlapping components: (a) the vestibular system, or “inner ear”; (b) the visual system; and (c)
proprioception
,
the feeling of our bodies in the space around us—a position-movement sensation. While the vestibular system is primary, the other two are also very important, and the interaction among the three systems is far more complex than we generally consider.

Our vestibular and proprioceptive systems give direct information to our bodies to help them stay upright. But there is also a critical feedback loop between these two systems—processed in our brain stem—and our
eyes
. The
vestibulo-ocular reflex,
for example, takes input from the sensing of movement through neurological assessments of position and velocity and uses this information to stabilize our gaze by making microcontrolled adjustments in the
extraocular muscles
in the eyes so they counter head and body movements: the instant we move our head, our eyes adjust to stay fixed on an object. You can see this effect by looking directly at your own eyes in a mirror and moving your body around. In addition, these subsecond microadjustments are integrated with our ability to simultaneously adjust for the
pursuit
of objects moving in our environment as well, so we can turn our heads and bodies while still following the path of a bird flying across our yard. So our balance system controls our eyes.

But the relationship between our eyes and our balance system works in the other direction as well, and our
eyes control our balance
: when our vestibular system is underfunctioning—as often happens with head injury—our eyes can take over much of the load. We can illustrate this with a simple exercise: (1) Stand on one leg with your eyes open and your other knee up high—usually this is not too much of a problem. Notice the muscle adjustments in the foot that is on the floor. (2) Close your eyes, but continue standing on the one leg. Depending on
how effective your vestibular and proprioceptive systems are, you will experience varying degrees of increased difficulty when losing your visual input (and a corresponding increase in the microadjustments in your foot). The more your balance is dependent on your vision system, the more you'll start to wobble when you close your eyes.

MOTION DISORIENTATION.
Like many concussives, I had many episodes involving motion sickness that gave me trouble. For example, several weeks after the crash I tried to take the El train downtown. Within a few stops I was so sick that I vomited in the train car and had to roll myself out through the doors onto a platform.

“I'm sorry!” I said to the variously disgusted and concerned passengers. “I don't know what happened. I'm sorry.” It took me three hours to recover sufficiently before I could walk home.

On an evening almost a year later, I was exhausted from teaching class and it was hard for me to walk—it had taken me an hour to get down the stairs of the classroom building. I didn't want to face walking up the stairs again in the building where my office was, so I talked myself into thinking it would be okay to take the elevator up to the sixth floor. This was a mistake. Once the elevator doors opened on six, I tumbled out onto the floor and crawled to the wall, where I could prop myself up. I rested there for fifteen minutes, pretending to be sitting on the floor reading a book whenever students came by. Then I crawled to my office on my hands and knees, and rested on the floor for an hour to recover my equilibrium.

We'll see later that because of the strong link between our balance systems and our eyes, it is possible that many people
who suffer from what they assume to be congenital motion sickness would improve by treating their
visual
systems.

BALANCE, VISION, AND THOUGHT.
*
Because I had suffered vestibular system damage, this meant that my already-overtaxed and poorly functioning visual system had to take on the additional load of providing for many of my balance needs as well. But at the same time, any sort of high-level thinking also required the use of exactly those same visual/spatial systems in creating the internal
images
of thought.

Thus we have the following: Under the
cognitive load of thinking
—which almost always entailed visualization, pattern matching, and generating the spatial imagery to form analogies—my damaged brain would rapidly grow fatigued. The visual/spatial circuitry would get overloaded, and could no longer manage its double-duty making up for the vestibular system, and I would
lose my balance
. As we will see, the same thing would happen when I had to use my visual/spatial circuitry to interpret
meaning
in complex sensory input—such as speech, or the complicated visual patterns on store shelves. One of the worst combinations would be when I had to use the visual systems in my brain simultaneously for both complex thinking, or sensory interpretation,
and
intense balance calculations.

As my brain fatigue grew during even short periods of cognitive load my balance would grow progressively worse, and nausea would almost immediately set in. Depending on
what I was thinking about, or the physical task I was working on, I would start to lose my balance within five minutes.

I developed a surreptitious remedial balance technique: whenever I walked around the university—where I had to
think
throughout the day—I would simply run an index finger along a wall as though I were goofing around. People tended not to notice this much, especially if I kept my hand low on the wall, and it was much better than looking drunk by weaving around in hallways and classrooms.

A neurological oddity that presented itself in my case, and that you might notice in a concussive who is having balance problems, was that my index fingers would flex upward, with my thumbs out-thrust, while the rest of my fingers were relaxed downward, forming a flexed “L” between the thumb and index finger of each hand. If you put your arms out at slightly less than a forty-five-degree angle and raise your index fingers in this way, you will likely perceive this as a kind of balance-vigilant position.

WHERE THE BODY ENDS.
Our balance systems are integrated with other important but little-considered systems as well. For example, a collection of nerves in the superior parietal lobe is thought to help us distinguish where our bodies end and where the external world takes over. Without the capability to make this distinction, it would be difficult for us to navigate our way through a world filled alternately with obstructions and openings through them. At times, brain activity in this area is naturally reduced and our sense of where our bodies end is appropriately minimized—for example, when we drop off to sleep, or fall into a deep meditative state.

This body-demarcation sense is something that normals
take for granted, but it can be quite troubling when it disappears at unnatural times. It is an interesting question to consider the relationships among the brain's visual cortex, our balance systems, and this body-versus-surroundings demarcation sense. My experience suggests that there is a link. Under brain stress—primarily visual, and especially when making excessive demands on my visual system for balance—the boundary line between my body and the rest of the world became blurred.

This was most easily noticed in my almost ubiquitous (though relatively mild) difficulty passing through doorways, down tunnels (such as stairways and Jetways), and getting into cars, when my brain was tired. I would have to put my arms out to “feel” the spatialness of the opening—using my eyes to carefully examine the distinctions between my hands and the surrounding objects—and thus guide myself through manually.

A more striking example of this loss of body-environment demarcation occurred five years after the crash, as a result of a set of intense visual-balance demands:

One of the fifty-foot trees in my back yard had been identified as having Dutch elm disease, which can spread throughout a neighborhood, so it had to be cut down. High-ladder tree work of this kind is intense, and not for the faint of heart. I couldn't afford to have it professionally removed, so in the end I had to manage it on my own.
*

I knew I would have to contend not only with the normal rather striking visceral reactions of being so high up, but also
with the added complications from my brain damage. The following diary passage is from a day when I had climbed thirty feet into the tree to cut off the highest branches, which themselves reached another twenty feet over my head. This episode simultaneously taxed my visual/spatial system for three separate tasks: the intense spatial planning of where the heavy tree branches were to be cut, and would fall; the meaningful interpretation of the incoming barrage of sensory input; and the essential need to keep my balance based primarily on the constantly moving visual input.

I am disoriented because I can't look down, and so have to get my visual bearings from watching parts of the tree, which are themselves swaying in the wind. It's all one chaotic swirl of sunlit green. My balance system is shot, and I have to rely on my eyes only to know which way is up. The flood of data from my senses is overwhelming: the roar from the chainsaw engine; the smell of oil burning on the muffler; the feel of branches pressing against me everywhere; sawdust, salty sweat, and stinging two-stroke exhaust in my eyes and that I taste in my mouth. I am having difficulty managing the
geometry
of placing myself—my body, and the chainsaw I'm holding—within the context of the moving tree. It's as though I've lost my sense of the demarcation point of—the boundary between—my inner self and the outer world around me. Except for what my eyes can tell me as I stare intensely through the fog of my safety glasses at both my boot, and the saw ripping through the branch on which that boot is standing, I have no way of
distinguishing between the two. I have to manually, continually, walk myself through the connections in the branching of the tree, and the differential branching of my body. I can't tell the difference between the two. Terrifying—given the circumstances, but also fascinating . . .

It goes without saying that after I climbed down I was unable to walk, or even to stand up. Having to manage the chainsaw without the natural protection of knowing where my body ended was intense, and the base fear this truly odd experience generated was extreme. It took me a week to get the tree down, and another two weeks after that before my brain recovered.

BALANCE AND HEARING.
Balance is also linked indirectly to our aural processing systems because most of us process the meaning of audio input in a visual/symbolic way, and this in turn can compete with the visual processing needed for balance.

An extreme illustration of this can be found in my notes from August, two years after the crash. I was driving back east with my friend James to attend my aunt's funeral, and to visit James's relatives in Maine. Even though James knew me well, like so many others he didn't “get” that there was anything really wrong with me. James wanted to do all the driving, and traveling as a passenger in his car was a challenge. I had to keep my eyes continually focused on the horizon to help keep my equilibrium.

James liked listening to the news on the radio, but this was a problem for me: I was unable to filter out the talk-audio stream, which meant that my visual system was being
used—regardless of whether I wanted it to be—to create images of scenes from the radio news. This in turn meant that my visual system was unavailable to be used for balance, and I started to become both nauseated and disoriented. I managed to get by, sort of, until evening, but it took a heavy toll on me. My deep batteries were drained.

When it grew dark, the problem got worse because the distant horizon was no longer available for me to use for keeping my balance. And James had to have the radio on to help him stay awake.

We decided to stop driving for the night, but unfortunately we were unable to find a motel room. It seems that this was peak season for paintball, Mohican powwows, car shows, and other summer attractions in Indiana and Ohio. James grew increasingly fatigued, and frustrated, and began to whip the car around corners at each interstate exit as we tried over and over again to find a place to stay.

This violent motion of the car, combined with the extreme fatigue of my visual systems, and especially the processing demands from the car radio audio stream, made it impossible for me to keep my balance, and in the end put me over the edge. I asked James to stop the car, but he thought I was just being difficult. So at midnight, at a stoplight, a mile away from the most recent interstate exit we had taken, I poured myself out of the car and into the street. There was a brief conversation about money in my pocket, which I didn't understand, and then James drove off. I crawled over to a grassy patch under a lighted billboard, next to a truck-repair parking lot.

From the environment, I knew that I was in a seedy part of a decaying midwestern industrial town in the middle of the night. Other than that I had no idea where I was, how I got
there, or even
who I was.
I just needed the world to stop spinning inside of me, and outside of me. I needed the bell of nausea in which I was living to open and let me out. I stared up at the billboard, and the city lights reflecting off the cloudy sky above it, unable to comprehend anything at all.