The Ghost in My Brain

by Clark Elliott

  After two days of forced fasting, and although I was loath to do it, I finally called Jake, and asked him to please instruct me to either eat the apple, or eat the salami. Jake’s simple “Okay, go eat the salami first, then eat the apple”—just that one sentence, spoken over the phone, but which gave me a command to follow similar to that which allowed me to initiate physical motion—was enough to end the forty-eight hours of struggle.

  KNOWING IS NOT CERTAINTY. People will talk about decisions as “gut-level feelings,” and indeed decisions do seem to happen as a welling-up of action from the core of our being. Yet if most of us were to look closely at the actual process of making a decision, we would find that choices are usually represented with a visual/spatial metaphor, with two or more options laid out symbolically, such that particular features are shown in contrast along some spectrum. We might, for example, find ourselves choosing between the feel of “leftness versus rightness,” “heaviness versus lightness,” “peacefulness versus chaos,” “intimacy versus expansiveness,” or “wrongness (dark?) versus rightness (light?),” with colors, or shapes, or shadings, representing aspects of those concepts along a dimension.

  The intellectual part of decision making, the “knowing” stage, is concerned with clarifying how the choices are represented, their various weights, and so on. Sometimes we might eliminate choices altogether by using logic.

  But this is only the first part of the deciding process, and, surprisingly, is neither the most important, nor actually even necessary. (All people, in certain circumstances, can operate purely on intuition and skip the “knowing” stage altogether: “I don’t know, just pick one and worry about it later!”)

  Much more critical is what follows. Once the choices have been captured in a symbolic, visceral, spatial way, certainty arises—or at least enough of it arises—and one of the choices is now marked within the 3D visual space as a goal. The body then responds by producing actions: a hand starts to reach for the apple, or the mind sees the words “Fine! I’ll call her now . . .” and starts the vocalizing process to speak the words, and so on.

  But this is the crucial step that is missing for the concussive with a fatigued brain: certainty never arises, the visual/spatial goal is never marked, and without a target the body cannot respond. No amount of inner dialogue from the “knowing” phase is of any help.

  This is why the knowledge that either choice—eat the apple or the salami first—would be far better than no choice at all did not help me. It is also why the lack of a clear visual/spatial target left me physically stuck, unable to move, in exactly the same way I would get stuck at the top of stairs, or in trying to walk through a doorway: if I could not “see” the goal, my motor system could not respond.

  Certainty also comes as a spectrum: you are completely certain that the sun came up this morning; you are reasonably certain that it was hot in Phoenix yesterday; you are somewhat certain that the Cleveland Indians will win the pennant this decade. There is a complex relationship between the degree of logically “knowing” something is likely to be true and the strength of certainty it generates—but the two are not always correctly linked, just as people sometimes use base rates correctly, and sometimes ignore them altogether.* Similarly, people will sometimes use the degree they know something to be true to create a like amount of certainty that it is; but sometimes they won’t. Most people experience this as the difference between logic and intuition. In messy environments, especially when logical antecedents are incomplete—which is much of our world—informed intuition (enough certainty to allow us to act) is a critical part of our lives.

  From an experiential standpoint, those who suffer from obsessive-compulsive disorder (OCD) often have similar problems: they might fully understand that they have already checked four times that the gas oven has been turned off; they might fully understand that they are having an OCD attack and that returning once again to the house to check the oven is not going to help. But knowing does not help them, either. They too are missing that same elusive sense of certainty that drives the lower-level planning system so closely tied to motor control. (And we should note that OCD is sometimes clearly linked to a previous TBI.)*

  Elemental cognitive certainty—a concept easily understood but so elusive it defeats any attempt at formal algorithmic description—is a necessary component of many complex cognitive functions.

  WHEN PIECES OF THE COGNITIVE MIND GO MISSING. Another difficult, insidious feature of concussion, and possibly the one that has most contributed to so many misdiagnoses and so much general misunderstanding of the condition, is that when cognitive capabilities go missing they are often so fully gone that the concussive does not miss them in the way a normal person would, or indeed sometimes even realize they’ve gone absent.

  In my case, at the time when I was struggling with the apple, I was in the still-early phases of my post-concussion trauma. I didn’t realize I had any kind of well-defined syndrome. I seemed unable to perform certain tasks, but outside of a vague uneasiness about the way things used to be, I had no real “sense” of the missing capabilities themselves.

  Consider this analogy: You have a friend Joe, who for our purposes will represent a cognitive function that goes missing, such as decision making. If Joe moves to a monastery in Thailand, you will know that you cannot call him to come over for a barbecue, and you might miss the interactions that you used to have with him. But you still know who he was, know how you would interact with him if he returned, and know exactly what is now missing from your life.

  By contrast, for a concussive, when Joe moves to Thailand, it is as though he never lived at all. All relationships between Joe and anything else in the concussive’s life have been removed, all memories of interaction with him are gone, and except for a vague, undifferentiated sadness for the way things used to be, there is no sense of missing him.

  In this way—as I experienced during my unsuccessful ER visits—concussives are often unable to articulate what is wrong with them. The cognitive machinery that is missing is also, exactly, the machinery necessary even to conceive of the machine itself. In the case of the apple, the capability was easily described and easily understood: there are two objects, or paths of action, so pick one. Thus, intellectually, I knew what a decision was. But—and this is important to understand—I had no visceral sense of what a decision was. I had no feeling for what led up to the making of a decision except that magic used to happen, and now it no longer did.

  NO LONGER HUMAN. This brings us, now, to one of the most troubling aspects of TBI, and one that we have to at least suspect is a significant contributor to the reported increase in the suicide rate among those of us with concussions: that we have, in many ways, already lost that which makes us human.* For a concussive, no matter how long the list of identified cognitive deficits might become, there will still be hundreds of other small cognitive changes that are much less easy to define—though collectively they are perhaps even more important in the end.

  This ubiquitous phenomenon is ultimately quite troubling for a concussive. For example, suppose you had lost the ability to naturally order your words as “the big blue box,” instead of saying “the blue big box.” Well, you would sort of know that something was wrong, and so would others, but exactly where is this syntactical preference capacity stored? A concussive is not privy to the internal workings of the brain, any more than anyone else is. It just feels strange. This kind of small breakdown happens all the time in so many ways—each contributing to the sense of alienation that many concussives share.

  The net result is an overall feeling that we are no longer part of the human race: We look the same. We talk the same. People around us don’t really notice too much difference. We haven’t grown feebleminded, and the individual quirks that give us our essential personalities are all still in place. But inside, without really comprehending why, we are hugely changed. The person we have always known is strangely missing. Thi
s feeling is so pervasive among the concussives I’ve met over the years that it has become a standard private joke: Welcome to life in exile. Welcome to life among the nonhumans.

  This feeling of being lost carries with it a sometimes terrible sadness—a longing to go home again, to taste again, just for a little while, the joys, and even sorrows, of being truly human just one more time. But, ultimately, it also carries with it the knowledge that the only way back is after first passing through the gates of death.

  This is a dangerous combination. On the one hand, a concussive may feel that to a large extent he has already died. The step from life as a nonhuman to the ending of life altogether may not seem to matter very much. On the other hand, there is a longing to return home, to be human again. At some juncture, usually after the first two years have passed, most every concussive will finally approach the realization that in this life anyway, he is never going home again. When this happens, it is easy to imagine that finally shedding one’s broken-down body—a body that can no longer support being human—might allow the spirit to return home on its own. Taken together we can see that in this way, for a concussive, pondering suicide might have nothing to do with a depressed and painful mental state, or being a cry for help, but rather a giving in, a simple final acknowledgment of what really, inside, has already happened. It is a walking to, instead of a walking from.

  Another aspect of concussion that can be emotionally troubling is that the business of getting through the day just becomes so much work. As we’ve already seen in my own life, tasks that require any sort of visualization, or planning, or pattern matching, or balance, or decision making—in other words, more or less even the simplest things one might desire to do—become a struggle. Often a concussive will just want to put that burden down. Considering all the small battles fought just to get through a single day, life with concussion can feel like the labors of Sisyphus endlessly pushing his boulder up the hill.

  On more than one occasion I wrote in my notes that I would have preferred to have lost two legs and one arm than to have suffered from concussion. I judged this to be a reasonable trade-off in my favor. At least I’d still be human.

  BRAIN DAEMONS. In my academic field, artificial intelligence, there are two ways to simulate human intelligence: write computer programs using human AI techniques that attempt to model the actual processes of human thinking, or write programs using alien AI in which we write whatever sort of intelligent programs we feel like, as long as they get the job done, with no attempt to duplicate the way a human achieves the same goals. The former is typical of cognitive science, wherein we try to replicate the functional structures present in the brain. The latter captures the spirit of a device I’ll use in this book, called cognitive daemons, wherein we simulate, and discuss, the effect of such processes on our lives, without regard to their real, underlying neural structure. That is, even without knowing how a human actually arranges to get more than one thing done at a time, using the simple computer science construct of a cognitive daemon allows us to accurately describe our feelings and behavior in a way that is easy to understand. In this way, even without proposing any neurological or anatomical models, we can nonetheless still claim that the design constraints on models of such systems, represented by my recorded experiences, are real.*

  A daemon, for the purposes of our discussion, can be thought of as a “little guy that wakes up when needed to go perform some task, and reports back to you later with the results.” Then he goes back to sleep (or dies off) until needed again. In the brain, what I refer to as daemons are thought processes that run independently, in the background (think, perhaps, of subconscious processing), and do their job over the course of seconds, minutes, days, or even weeks—working on some particular subproblem, and then interrupting conscious thought (or a different daemon) sometime in the future with their results. Sometimes daemons will spawn sub-daemons of their own.*

  We cannot always control when these daemons get started; we can seldom control turning them off. A daemon tends to run its course—either solving the problem with which it has been tasked, or naturally and gradually giving up, as other problems take precedence. Daemons may be somewhat anxiety-driven, and slightly obsessive, as in “I just cannot remember that guy’s name from California—the one who took us on his boat. What was that darn guy’s name?”

  Daemons run independently, but they can interfere with other, unrelated cognitions in at least two important ways: First, these background processes take up brain resources, leaving fewer resources for other processes, both conscious and subconscious. For example, if you are worried about your son’s health, and in the back of your mind you are continually thinking about hypothetical diagnoses for his condition, you will appear preoccupied to others. You will perform less well on the other tasks in your life; you’ll misplace your gloves and forget to feed your pet fish. This makes sense: there is only so much cognitive processing power to go around.

  Second, these background daemons appear to communicate with other parts of the brain via an interrupt system. (The use of interrupts is a style of computer programming in which one program is allowed to interrupt the processing of another program to communicate with it.) You can certainly see this happen in your own life: While you are in the middle of making lunch, you might pause for a minute because the cheese you are slicing reminds you of a bicycle picnic with your friend Lisa ten years ago, at which you ate cheese sandwiches while sitting beside a stream. Lisa was friends with Gary, and Gary, Indiana, was where the California guy (with the boat!), whose name you’ve been trying to remember, had family. So you stop making the cheese sandwiches for a moment—you get interrupted by the try-to-remember-boat-guy’s-name daemon that has just jumped at its chance opportunity—because you now almost have boat-man’s name. . . .

  Thus, these background processes, or daemons, are an important part of human cognitive processing. And, it seems that the more typically intellectual one’s life is—I am guessing associated also with a more high-functioning-personality lifestyle—the more important these background daemons become. In concussives, these processing daemons are negatively affected, sometimes dramatically, as follows:

  Because daemons use up resources, a healthy brain regulates triggering them: it generally won’t spawn a daemon unless that daemon is likely to do something useful, and it will put a cap on the number of daemons it will run simultaneously. But even in healthy brains this triggering process is not an exact, or even very conscious, process. You might, for example, get a song stuck in your head, and be driven by curiosity to play it over and over until you figure out what it is—even when you do not like the song, care about it, or care what its name is. A delicate balance exists between firing up daemons that might come up with something useful—following creative and heuristically intelligent “hunches”—and filtering out possible triggers that are not likely to lead to useful results.

  This filtering process is an important part of intelligence, and of the efficient use of whatever native brainpower a person has at his disposal. If Gina fires up too few daemons, she’ll be a dull, plodding sort of person who learns slowly, and only what is clearly directed by others. If she fires up just the right number, it will help her to be a witty, inquisitive, intuitive, creative sort of person who seems to make connections that others do not. If she fires up too many daemons, she will be a distracted, brain-fatigued, nonlinear, confused sort of person with all sorts of ideas that no one seems to “get,” and which do not lead to much.

  In concussives, the filtering process itself is affected. Inappropriate daemons are continually triggered, needlessly searching for meaning in unfiltered minutiae. Concussives’ automatic sensory filters no longer work correctly, so the world has a tendency to become a nightmare of cognitive input that is “noticed,” and thus must be consciously filtered: the sound of a truck driving down the road outside is given the same initial importance as the sound of a question from your daugh
ter, sitting in front of you, with whom you are having a conversation:

  Your daughter asks, “Hey Dad, have you seen my car keys?”

  You are trying to parse the words, to separate them from the rest of the aural stream. A daemon has fired itself off and is looking for how the truck sound relates to the sound of the word keys: The truck is a garbage truck, which sounds like garage, which is where cars live. Cars have keys. This train of thought interferes with the understanding of your daughter’s question. Why would the keys be in the garage? Did I see her keys in the garage?

  A concussive also loses the ability for his daemons to interrupt other daemons in the middle of their processing. I myself experienced this frequently: the phenomena of realizing that I knew something, and knowing that I knew it, but not being able to use that information, while at the same time realizing that the conscious, focused part of my brain was in need of exactly that same information.*

  Lastly—and very importantly—because low-level visual/spatial representations can be damaged in a concussive’s brain, daemons may not realize, so to speak, that their conditions for termination have been met—the match against current circumstances fails—and they just keep running, well beyond their useful life.*

  In each of these cases—spawning unneeded and unwanted daemons, being unable to solve problems because of a lack of information even though it may actually have already been located through another part of the brain’s processing, and being unable to terminate daemons that have completed their tasks but can’t form a visual/spatial pattern match to realize it—the result is that the brain grows increasingly fatigued, which in turn causes increasing difficulty with both sensory filtering and daemon communication, in a downward spiral of cognition failure.