But even if life has some challenges, it is generally better than the alternative! If we are going to consider the downsides, we should also consider, as well, the gallows humor that would sometimes arise from how ridiculous some of my symptoms became.
RULE FOLLOWING. Before he moved to San Diego, Jake and I would go out to eat every few weeks. In general, going out requires that many decisions be made: what time to meet, where to meet, what type of food, which restaurant, who is driving, where to park, what to order, where to sit, and so on. This is a potential nightmare for a concussive who has lost the ability to decide. So, knowing of my difficulties, Jake would make the decisions for both of us. I myself got in the habit of simply following rules at such times, which, to a large extent, obviated the need to make choices. For example, I might use the rule to always work from the top of the menu and order the first acceptable entree to avoid having to decide what to eat.*
One evening Jake called up. I told him I was available, so he said, “Okay, we are going to eat at Tiffin on Devon Avenue in Chicago. I am driving. I will pick you up at seven thirty. I will order for both of us. Be ready in an hour.”
I had had a long day. My brain-batteries were drained. Consequently I intentionally placed myself in rule-following mode, to avoid getting locked up over any decisions that might arise. I would follow internal scripts, and was prepared to accept imperative commands from both Jake and myself.
Devon Avenue is the center of a large ethnic Indian neighborhood in Chicago. There are many small stores with bright displays of Indian clothes, specialty groceries, Bollywood videos, and so on. An endless slow-moving traffic jam chokes the streets, and pedestrians crowd the sidewalks. It is a visually taxing environment, and to traverse it I stuck very close to my script, which included the idea of mindlessly following all the rules of eating out.
After we had left the car and walked a block and a half toward the restaurant, I stopped in the middle of the sidewalk, frozen in place. Jake doubled back.
“Come on. What are you doing?” he asked. He was peckish, and annoyed.
“I am trying to not go into that store,” I said, indicating one of the many stores whose windows were stacked high with cheap electronics.
“Why would you want to go in there?” he asked. Jake was understandably puzzled.
“I don’t!” I said. “That’s why I’m trying to not go in.” I was concentrating heavily—working hard, staring intently at the store, but—except for being able to speak—still frozen in place. I nodded toward the door and said, “Look.”
Jake looked up. On the door was a prominent sign that said COME IN!
“I’m trying not to go in,” I said again. “I’m just able to keep from doing it, with effort, but I’m not able to make my feet go down the sidewalk.”
The problem, of course, was that I was in rule-following mode, and the sign was giving me instructions: COME IN! To not go in, I had to violate the instructions. This was proving difficult for me to resist, and impossible for me to ignore.
“Why don’t you just walk past it!” exclaimed Jake. “You’re an idiot!”
“It’s true,” I responded. “I know exactly what is going on. I know that that is just a stupid sign put out to attract pedestrians into this store. I know that I don’t want to go into the store. I know that all I have to do is move my feet and walk past it. I know that I am in rule-following mode so that I can get through dinner with you despite having this concussion damage. But none of that helps. I still can’t move, except into the store.”
As usual, I also felt guilty. But the truth of it was that, once again, there was nothing I could do. People with stage fright, or motion sickness, also understand exactly what is happening to them, but they can’t stop their own symptoms from occurring either.
I started laughing at the ridiculousness of the situation, which at first annoyed the hungry Jake further—he was quite enthusiastic in his response when I suggested he give me a push. But soon he was laughing too, and I took some good-natured ribbing about it later during dinner: “What a brain-dead moron! Do you also need me to cut up your food for you?”
Once I had placed myself in rule-following mode it was difficult for me to make the transition out of it. By contrast, the healthy human brain can switch in and out of rule-following mode in the blink of an eye and with no effort whatsoever.
PROCESSING THE AUDIO SIGNAL
AUDIO SLOWNESS. One of the profound capabilities we have is turning sounds into words, words into images, and both images and words into meaning. Most of us do this effortlessly throughout the day, and at least part of the time when we are dreaming at night. If we stop to think about it, it is actually a nontrivial computation to turn, for example, the sound of the word “dog” (the phonemes) into the word dog, into an image of the written form of the word d-o-g, into an image of an actual dog, and into the conceptual meaning of dog-ness. Along the way we might also have picked up, from the context, that we mean our dog, with her attendant images, relationships, emotions, and history.
But we can perform such transformations, in all directions, without thought, seamlessly. Unless we get concussions, that is. Then the system breaks down. In the years before treatment, I became a walking laboratory for studying not only the minute details of human audio processing, but also the complex interactions between our hearing and our visual/spatial systems.
Studies in cognitive science have shown that trying to process two simultaneous aural streams at once—specifically one that is retained in memory and a live one coming in through the ears—is challenging for anyone. For concussives, who because of audio slowness may often be trying to play catch-up by buffering what was previously said and simultaneously trying to process that information along with what is currently coming in through their ears—and who are also by the way particularly stressed by doing two things at once—this is a recipe for disaster. Thus the real-time processing of speech is a serious and ubiquitous challenge for them.*
Here is how it worked:
I am listening to spoken conversation (including over a broadcast medium). I hear the first sentence, and am trying to process it in real time. But the speaker is moving too fast, and my ability to retrieve the symbolic images representing the speaker’s meaning starts to lag behind. By the time the second sentence is being uttered I have not completely made sense of the first sentence. So now I have to either buffer the sound of the first sentence in memory briefly (a form of what is known as the articulatory loop) as I work through the phonemes to figure out what they mean, or translate the sentence into an associated visual image of the words. But while I am still processing the first sentence in this way I have to simultaneously listen to the incoming sound of the second sentence being spoken.
To make matters worse, as I fall farther behind, I automatically start using error-correction algorithms to fill in the blanks for words that I have lost—and this is complex processing that uses up a lot of additional cognitive resources. So now we have at least three real-time tasks running at once: continuing to listen to the current audio stream, buffering and reviewing what was already said, and error correction on both of these interference-damaged audio streams. At this point cognitive meltdown is not far off: the size of the buffered material spirals out of control, and soon I cannot keep up.
Importantly, my ability to filter out sensory input also fails, so the incoming words can’t be tuned out, and the system can’t be turned off. Nor can I stop attempting to process the input, no matter how painful it becomes. Nausea sets in, and the incoming words and phrases become like little hand grenades setting off these cognitive explosions in my head. At this point social difficulties arise. The only remedies involve physical actions like hanging up the phone on someone, leaving the room, covering my ears, and begging the speaker to stop talking—social gaffes I am forced to commit many hundreds of times over the course of my injury.
I had
an accurate gauge for the change in the speed of my audio processing: Prior to the crash I had no problem listening to baseball scores as reported on the radio. The announcer would read through teams and scores, usually putting the winning team first (“The Phillies, at home, beat the Reds today eleven to two”), but sometimes mixing in other reversed forms for variety (“The Giants were blanked seven to nothing by the Cards at Pac Bell Park”). Immediately images of the teams, their colors, their parks, and maybe some of their stars would come to mind. My encoding of the winning and losing teams was spatial, with the winning team higher up in my mental image than the losing team. Additionally, I placed the teams geographically, not only within a mental map of the United States, but also on the NSEW grid, relative to my own current orientation. (That is, if I happened to be facing north, I could automatically point right [east] to where the Phillies and Reds played.) Following the crash, I’d only be able to make sense of perhaps three of twelve scores, and I had no geographical grounding for any of them.
Phone conversations (which importantly take place through only one ear) were the most taxing—especially via badly digitized cell phone audio streams. Speech that additionally placed specific kinds of cognitive load on me were also difficult, such as the metaphor-filled and highly intellectual sermons given at the church I attended with my children.
SPEAKING STYLE. The speaking style of a person was also critically important in determining how hard it was for me to manage a conversation with them. My friend Mary spoke in precise, descriptive language and was easy for me to follow: “Anne, Brian, and Sarah came to my apartment at seven thirty just after I had finished dinner. We sang four madrigals by de Lassus.” My friend Frank was much more of a challenge. He is smart, broadly read, and has profound reflections on many, and varied, subjects. But he tends to use imprecise language, often interspersed with ambiguous placeholders. Taken together these are a difficult combination. He might say, for example, “We were thinking about jazz groups, so I thought we should just do it. I went into the store and bought some stuff that you might like, such as Miles Davis, and I could send the thing to you.” Prior to the crash, I could queue up the placeholders “do it,” “stuff,” and “thing,” until I figured out what he was talking about. After getting the concussion, I couldn’t. I would follow him up until the phrase “do it,” then just lock up, waiting for a picture to emerge. In the meantime I had to queue up the ongoing audio stream of what he was saying. The multitasking required to sort it all out was often very fatiguing.
I also had two very specific difficulties in holding conversations with my mother, who lives in northern California. In the years since I left home, my mother picked up the habit of taking a bite of food, and then talking. When she talked with food in her mouth, the altered phonemes supported only approximations of the words she was speaking. Normals would have little problem apprehending her original meaning—performing natural error correction—but as a concussive I fell further and further behind in trying to parse her food-damaged speech. I was easily overwhelmed. I often had to get up from family gatherings and leave the room in a hurry, which was embarrassing for everyone.
More important, my mother has trouble retrieving nouns. She will start a sentence and then pause while she is trying to think of the label for whatever it is that she is talking about. While this problem tends to progress with age in many people, in my mother’s case, somewhat ironically, this speech pattern started when she fell off a horse as a teenager, fractured her skull, and suffered a concussion. My mother might, for example, say, “I am going down this afternoon to get the . . . [long pause] . . . brakes checked on my truck.”
Because of the damage to my audio processing, I was already hypervigilant about gathering in the audio stream to form it into symbols, and especially wary of symbolic “dropouts” from parts of the stream simply lost because of the slowness of my processing. During the pauses in Mom’s speech—when she was searching for a label—I would work particularly hard to “fill in the blank,” even though it was not intended that I do so, and even though, in most cases, there was no possible way I could.
The problem was, there were already so many things that I really did miss in the audio stream that I had to be hypervigilant: when something seemed missing, I would immediately fire off a background daemon to try to find out (a) where the piece of the conversation was missing, and (b) what it was—then have it get back to me with that information. Unfortunately, with my mother’s pauses, although nothing was missing—and it would be appropriate to just wait—at an important processing level, I didn’t know this; it was too similar to the ongoing instances when concussion damage did continually cause me to drop out parts of the audio stream.
The result of this cycle was fatigue. I would often reach the point of simply having to abruptly end phone conversations with her. I love my mom. She is also fascinating to talk with. (How many eighty-year-olds read a nonfiction book a day, then try to fit in their three-mile run, and a trip to the Curves gym before they go down to give a piano recital for the “old people” at the local nursing home?) It was never that I did not want to talk with her, but this was understandably not always clear to her. It is socially awkward to have to hang up the phone on your mother.
I would coach my mom to “think first, then speak” so that she would not start to talk until she had already fully retrieved everything she was going to say. This helped, and my mom was willing, but it was an ongoing problem for us—communication between one concussive and another!
JOKES. The audio stream works in both directions, of course, and in my case this highlighted an interesting phenomenon. I generally had much less difficulty generating speech than I did understanding it. This was most obvious when trading jokes with a group of people: I could tell jokes without much trouble, yet was often almost completely unable to understand them.
Telling jokes is a creative activity, and generative in nature. It involves memory, creativity, sensitivity to one’s audience, and a sense of timing. Because concussion requires so many inventive workarounds each day, a concussive’s creativity gets a lot of exercise.
Understanding jokes, on the other hand, requires deductive reasoning, and often the comparison of more than one thread of thought at the same time. It is the odd juxtaposition of these multiple threads (such as in multiple meanings in wordplay jokes), often processed within a certain time context, that make the jokes funny. In addition, a joke teller will time the delivery of the joke to match the processing speeds of her listeners.
After getting the concussion I was often not able to follow a joke, or “get” it. It turns out that the understanding of jokes is a very specific listening/brain skill.
First, as above, I would lag behind in my ability to keep up with the audio-to-symbolic translation of the input signal, and would thus lose pieces of information. But jokes typically depend on the teller giving just exactly the right amount of such information: give too little, and listeners do not have enough cues to work out what is odd—they miss the point; give too much and there is no suspense or moment of surprise.
Second, I was not able to process more than one piece of information at a time, and even if I did catch up, it was not with the natural timing that a normal would use. When the timing is thrown off in this way, and the abstract double-meaning information that has to be just hinted at in the right way is missed, the joke is difficult to understand. If the revealing of a double meaning is made at the wrong time, a joke is not funny.
So when friends and family would gather around after a meal and tell jokes, I might tell a good joke of my own, then spend the rest of the time tuning out, smiling when others smiled, and laughing when others laughed—but I mostly didn’t have a clue what they were talking about. The following table illustrates how a damaged audio stream can particularly affect the understanding of jokes:
WHAT I HEARD
; WHAT THE KID SAID
What do you eat . . . watching movies?
. . . Dessert!
What do you eat . . . horror movies . . . computers?
. . . Potato chips!
What do you eat when you are watching horror movies?
. . . I scream!
What do you eat when you are watching horror movies about computers?
. . . Chips!
SOCIAL CHALLENGES
A concussive’s life is socially complex. In general, people won’t understand what a concussive’s limitations are. There are a number of reasons for this: Many concussives will not, themselves, fully understand what has happened to them. Those who do may very well be attempting to hide their symptoms from others anyway—trying to restore as much normalcy to their lives as they can. Then there is the strange feature—disconcerting to others—of the concussive being almost completely normal one moment, and then quite incapacitated a few minutes later.
It was my common experience that people—including both those who knew me well and strangers—saw my concussion symptoms as just weird, and also, in some global way, annoying. To be honest, their reactions were probably quite reasonable: my symptoms were weird, and often caused me to act in ways that under normal circumstances would be inexplicable. It was often difficult, if not impossible, to explain to others what was happening to me. People were naturally likely to account for my behavior in the way that made the most sense to them—that I was drunk, that I was difficult, that I was rude. Of course, that’s what we all do—we try to explain the world by using what we know of it. Unfortunately this led to repercussions in my life—some of them bizarre.
The Ghost in My Brain Page 15