*Understanding habit and the role it plays in recovery
*Creation of the future person
*Habits producing odd outcomes
It can be difficult for people to understand why some abilities change and others don’t. Apparent inconsistencies will largely depend on what areas of the brain were injured and how extensive the damage is.
Many people do lose competency in daily living abilities and will need to relearn how to complete tasks – even simple ones such as re-learning to tie shoelaces or make a cup of tea.
Lots of other behaviours are also related to habit and damage to neurological structures can affect the way information is relayed, and often, it isn’t sent at all causing changes in peoples habits, behaviours and abilities. It can also change the way they can communicate.
Habit and communication
In many ways, a lot of our communication is a means to get things done or is about social interaction that we use for building and maintaining relationships. When we know people well, we can expect others to understand where we were coming from and can also expect them to ‘know’ us well enough to deduce our motivations and intentions. Because of this, we don’t always explain ourselves well, and these ways of communicating can be so habitual that we don’t even think about it.
We rarely need to communicate at such intensity or depth that we need to slow down, pause, and consider our words.
We can become ‘lazy’ communicators and sometimes make assumptions instead of listening carefully.
Having said this, very often, we continue to consider things that have been reported and heard after the event, and we come to new understandings. However, we often tell ourselves that something isn’t significant enough to readdress or we may consider that a moment has passed and so choose not to bring a subject up again. Needs can change following a brain injury, and we may need to consider the ways we usually structure our relationships.
When brain injury affects someone close to us, we often find that we need to make multiple changes to allow for different abilities.
Habit and communication from the inside
Because this whole process usually happens without conscious interruption, it is incredibly hard to fix. The injured brain doesn’t recognise that there is anything wrong with the ingrained procedure of communication because it still feels the same, and so, without help and therapy, problems with connecting can persist for a long time and can affect behaviours.
Habit and communication from the outside
Communicative habit can bring a degree of rigidity. Those on the outside may be just as unaware of the fact that their usual way of conversing isn’t being received in the same way, as those who are struggling with brain injury.
Speaking to people in the way you always have done is often based on a desire to maintain normality. However, when people don’t slow down or consider their choice of language or tone, even the most well-intentioned communications can have unexpected adverse effects.
Unexpected outcomes occur because the way the incoming information is received has now changed. Not only are the neurological ‘mechanics’ different, but so too is the information people now have access to because of neurological change and damage. Cognitive understanding, awareness, self-insight and relationships between how people handle incoming and stored information can also be affected.
Sometimes it is the continuing ‘normality’ that causes people to get lost and confused. It can be challenging to understand why other people can’t see the vast chasms that have opened up and why they carry on as though the world is still the same. The world can feel like an entirely different place for people who have lost the links to so many of their memories and so much knowledge and information.
Changes in the ways life is experienced post-injury can leave people viewing the world from opposite ends of a spectrum.
For people on the inside, there can be an unconscious feeling that when people try and maintain normality that they are either avoiding reality or don’t fully understand just how much has changed. Small rifts create cracks, and these cracks widen until communication breaks down.
People on the outside need to try and learn as much as they can to enhance communication. With practice, skills can be advanced, and understanding can be significantly improved.
The effort it takes to try and fit in is enormous and exhausts available energy very quickly. The first ten minutes may be more manageable, but this ability to ‘hang-in-there’ quickly dissipates leading to confusion, difficulty maintaining attention, and an inability to keep up.
Fundamentally people are being ‘driven’ to work on their auto-pilot for the sake of speed and acceptance rather than being able to pace themselves in respect of their new normal. In turn, this denies them the opportunity to use self-observation, pauses for thinking time, and makes it impossible to manage and control their output.
The more people on the outside don’t understand, the more significant the pressure and stress resulting in increases in emotional reactions such as anger and frustration which is why help and understanding from the outside is always so crucial. It is vital for people on the outside who can incorporate changes to their communicative habits to do so.
People with brain injuries need ‘normality’ to make a drastic shift so that it includes understandings about needs, the space for learning to occur, and the opportunity for as much continuous positive feedback as possible.
What people need is for the ‘old normality’ to shift into a new reality of acceptance. The quicker everyone can take on board that brain injury means change – the faster the healing can start for everyone involved.
Once this negative loop starts, it is difficult to undo because it becomes an automatic defensive system unconsciously designed for psychological protection. The brain will instil any parameter it deems necessary to sustain life without any conscious input from the host, and it does this because the brain knows it is damaged and vulnerable.
We must tread carefully and gently when communicating with those living with a brain injury to gain the speediest and best possible outcomes.
Continuous negative feedback can create new habits about expectation, can affect self-esteem, and can eventually lead to negative beliefs being created. Ultimately the negativity will impact mood, can cause isolation, and can and does increase stress and drive families apart.
It is crucial to bear in mind that repeated communicative transactions have ramifications on a person’s psyche. The focus should always be on creating habits of mental wellness for the current time and the future. Repetition creates myelin around commonly used neurological pathways, creating future habitual thinking patterns. What we do is vital to expediency and recovery.
What we practice is what we become. What we want to avoid is to spend later years trying to undo unnecessary damage.
Habits and different outcomes
If we think about the ‘seat’ of our ‘habitual’ or unconscious intentions and motivations, we can see that a common driver is producing predictable behaviours and attitudes. This universal driver is personality.
In close relationships, even when tiredness, mood, irritability, and denial get in the way, people still know what to expect.
However, when brain injury enters the picture, everything changes, including anticipated reactions and behaviours. Although the innate drivers are the same, they have to traverse through a range of neurological impairments and normal tiredness can be exacerbated into neural fatigue, frustration compounded into anger, and confusion can become isolation.
If we think about Pavlov’s famous experiment with salivating dogs, we know that we can teach habits. Keeping this experiment in mind, for someone living with a brain injury it can now feel as though every time they hit the ‘predictable’ lever with their paw, instead of being rewarded with a biscuit, they now receive a bucket of freezing water thrown over their head.
The lever no longer brings about the same results. The mechanisms have been changed, and it can be impossible to work out how and why this is so.
Some people are more readily able to ‘remember’ how their brain worked before and can make more favourable comparisons. However, for others, all that can be ‘remembered’ is that their mind once worked differently. For these people, the knowledge and information they need to be able to work out what is different or broken, is missing.
When coupled with a loss of insight and loss of self-awareness, there is also no knowledge of what needs to be compared or understood. In many ways, this can feel as though, instead of biscuits, there is only ever a maelstrom of missiles flying at you of undeterminable and indiscriminate form.
It feels as though you are on a ride in the haunted tunnel at a funfair where a god with a great sense of humour has rearranged the order of the universe without telling you. It feels as though you have walked into some manic experiment and have no idea that you stepped through the door.
Rebuilding habits through kindness, understanding, and noticing the ‘new’ predictability, are paramount to inducing a sense of security in which a person can focus on trying to rebuild their brain.
It also takes colossal amounts of work, focused effort, and support. The more isolated you are, the fewer occasions you have for learning. It is a catch-22; isolation brings thinking time but is devoid of possible opportunity and chances to learn.
You need to be able to analyse your behaviour and spot where the gaps are, in both your general knowledge base and understanding of self. To do this, you need clarity in your thinking, and many people struggle with this because of the prolongment of symptoms connected to unaddressed biochemical cascades that start immediately after the initial primary injury. The One, Two, Three Plan can help calm the brain environment and make it easier to think.
You need to be able to take back control of your inner dialogue, and one of the best ways to do this is to consider your beliefs and use these as a basis to rebuild your thinking.
Some people will be more aware of their feelings and source and strength of beliefs than others post-injury as all outcomes are unique. Others may find they have many transient ideas, and some may find that they have difficulty shifting their perspective, finding their story gets stuck in an immoveable continuum.
Just understanding what is happening and why it is can have a significant influence on our ability to rewire and take back control over our wayward habits. The basal ganglia can take years to work out that instilled habits no longer function and shearing and tearing in the neuronal tissue can mean that links to the cerebral cortex are no longer feeding the learning loop, meaning the brain can’t adjust to the changes.