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Tales from the Other Side of Language 133 disabilities one by one, focus activities with practice, practice, practice. I’m certainly desolate at times, but I never give up. I find challenges that feed my soul, give me pleasure and hope in my life. Far beyond the recovery efforts, I gained treasures in my life that wouldn’t have been found but for the loss of speech, powerful ways of expressing and communicating without words. Personal passions and pleasures are, for me, core conceptions for rehabilitation. Passion gives life personal meaning and, in addition, can be used as incentive and motivation for deepening into successful rehabilitation. My first private practice patient using the model in Figure 1 was a young man with early Parkinson’s Disease who had been well maintained on medication for some years. He had given up the two major passions in his life: cross country skiing and piano playing. Explaining the principles of neuroplasticity to him, I urged a return to skiing, starting with retraining his coordination and strength so that he could resume the sport safely. Not only was he a much happier man after a year of training and another year of major cross-country treks, his trunk and head tremors were gone. His hand tremors, being more distal and more difficult to change, nonetheless were significantly reduced after resuming piano practice. He successfully pushed back the progress of the disease and now, in fact, has some personal control over it. I think often about the question: What happens, in losing speech, to my sense of self? The damaged verbal function affects how ineffective I feel in the world, to be sure. Parallel issues are uncertainty about how much function I can get back and how to construct a life. But most of the time, I see the aphasia and the sensory-perceptual issues as difficulties, just difficulties. For me the presence of significant limitation functions to soften the boundaries of self. I am more permeable to possibility. I was not in the least talented in art, yet I have become an artist. I was an agnostic and cognitive minded, and I have become a mystic. I have changed the shape of my sense of self. Rather than experiencing the various limitations as alien to self, to be fought against, I see in retrospect that I’ve used them
134 Ruth Codier Resch Without Utterance: as stepping stones to reinvent ways to live around and beyond them. My sense of self, rather than collapsing under the weight of catastrophe, which can happen, has become larger and more encompassing, more adventurous, more curious. From a clinical perspective, I draw a line between my damaged brain and my healthy “regular” brain, knowing that my healthy brain is the residence of my sense of self. I am applying this two-brain idea to how I think about some post-stroke and post-trauma patients that I see in a hospital-based rehabilitation program. Some of these patients believe that the former effective functioning of their brain is gone and therefore think of themselves as different persons. They begin to construct a new sense of self based on the information the damaged brain gives them, begin to act, and think that self-image is true, leaving them with a skewed view of self, world, and future. A middle-aged woman survived a stroke and understood clearly that her brain was impaired. She believed that she had totally lost the brain that she had; then she believed that her husband was having an affair with a former wife and that he would not take care of her after she was discharged. As a clinician, I see the self issue in this patient and others similar to her as a neurological problem and not fundamentally psychiatric. The physically damaged part of this patient’s brain was doing the major thinking, giving her garbled information and poor judgment. I think of this woman as being in a “two-brain” transitional neurodevelopmental phase: a damaged brain and a healthy one. In clinical intervention with her I told her she now has two brains and that her old healthy brain was definitely not gone, but that she was listening to the damaged brain far too much and it was giving her wrong information. I asked myself the question: Could I change the balance of her attention from the damaged brain to the healthy one, thus reinstituting the original sense of self? Yes, this patient returned to her original crabby self, but a self with vitality and brass. She began to see and work with the differences between her neurological condition and other issues involved with her discharge plans, and how to think about her future.
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PART ONE: THE PRECIPITOUS ABYSS
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