The Ghost in My Brain

by Clark Elliott

  It was of interest to Donalee that there had been long-undiagnosed, but quite pronounced, attention deficit disorder (ADD) in my family, and although I had always managed this aspect of my life well, I, too, had at least a tendency toward attention difficulties. Donalee used this, along with other information from her testing, to tailor the exercises she gave me.

  “There are also strengths to consider,” she said. “Like many of the people I work with, you are a very high-functioning individual, and you also, additionally, have a prestigious Ph.D. This becomes very important when we set a baseline for our work together. ‘Normal’ functioning for you won’t be ‘normal’ for someone else. So the work has to be adjusted.”

  Donalee now pulled out a drawing I had completed for her thirty minutes earlier and put it on the table between us. When I had first arrived, she’d given me this drawing—similar to the one that had caused me so much trouble on my first visit (see Figure 3—but this time she’d had me use a series of colored markers for the task. The exercise had been timed, and after I had copied for a while using one color, she would have me discard that marker and use a new color, in a prescribed order. This way we could see not only the results of my work, but also the way in which I had gone about the task.

  “We have to take into consideration your general cognitive makeup,” she said. “What is your thinking style?” She pointed to the large shapes I had copied with the first colored marker. “In your case we can see that you started out by focusing on these large geometric shapes, then you connected them to form the big picture—the outline—and lastly, you filled in the details. You tend to see problems like this immediately as collections of concepts. Others will focus on the details first and just start copying everything in one small area. There is a wide range of styles that tend to follow professions and also personalities. Managers, for example, will often focus first on the big picture, and have little interest in the details.

  “I consider you, and my other clients, as students,” she explained. “We are going to be teaching your brain how to learn again, starting with the cognitive basics.

  “We’ll be working at a number of different levels,” she went on. “For example, in your case it’s critical that we repair the connections to the visual cortex that I can see have been damaged in the car accident. We might also have exercises to make sure that your inner metadialogue—the ongoing thought-dialogue that distinguishes us from other animals—is working at the appropriate level. Because of your prior tendencies toward attention problems, we’re going to work at teasing out what cognitive rules apply in novel situations, and when. Then we’ll have you learn to follow them appropriately, step by step.”

  She asked me questions—teasing out my comfort level—as I worked through a series of various sample puzzles that she took out of the file drawers. She observed me very closely, noting the orientation of my eyes, my motor coordination, and the choices I made. Finally, having tweaked her plan, she gave me a large stack of papers containing puzzles and other exercises to work on, and I left with careful instructions about how to proceed until I saw her again.

  “I’m on this, Clark. We’re going to fix this!” she said as I left.

  I saw Donalee regularly, every two weeks, until June 2008. In all, I visited her nine times over those first six months, and then once again for a follow-up a year later. I had daily homework assignments, which I collected and brought back for her to look over each time I returned.

  During these “brain lessons” with Donalee, I went through reams of exercises printed out in stapled collections of sheets, always working with a pencil. And I worked at them virtually every day, limited only by the requirement that I be able to function in other areas of my life after my brain grew tired from doing the exercises.

  The practice was always the same: pay attention to the instructions and the training examples, work toward the intended goal, rehearse the exercises over and over again. Attention, Intention, Rehearsal: Donalee’s mantra. The exercises started out simple, and then, as the earlier tasks were achieved, got increasingly more difficult. I followed a scaffolding model that was based on—and assumed mastery of—the earlier exercises.

  “I’m giving you experiences in the form of these pencil-and-paper exercises,” Donalee told me during one of my visits, “but also techniques for solving problems. Presumably these latter will be internalized through your extensive practice of the puzzles, and you’ll be able to generalize them to other cognitive problems that arise.”

  Donalee tailored my specific exercises carefully each week. She was always ready with some new tweak for the plan. I wondered—how many times had she been through this before?

  “I’ve worked with possibly fifty students like you over the years—people with identified traumatic brain injuries,” said Donalee thoughtfully. “I’ve had hundreds of others that have come to me with all sorts of brain problems, the roots of which aren’t known.”

  “I’m wondering . . .” I said. “A number of my students at DePaul show up with one sort of learning problem or another. In talking with the students I’ve often questioned whether some of these problems are the result of a long-forgotten, or undiagnosed, concussion earlier in their lives.”

  “We always have to suspect that might be the case,” said Donalee.

  THE GEOMETRY OF COGNITION. In my work with Donalee, I began by viewing pages of line-drawn two-dimensional shapes, like triangles, squares, and trapezoids, which had dots in the corners. Then, on the subsequent pages, looking at only the dots, or dots with some lines, I started filling in the missing line segments in the drawings to restore the original design (see Figure 4).

  Figure 4: Simple Dots Figures

  Figure 5: Simple Figures Overlaying One Another

  These exercises started very simply, but then got increasingly more difficult as the shapes began to overlay one another, with more of them per exercise, and fewer clues to distinguish the shapes hidden in the dots (see Figure 5). Donalee explained our work this way: “You’ve been trying to run a marathon with a broken leg—your brain—for these last eight years. It can’t heal that way. We’ll get there, but first we have to go through a step-by-step healing process. In the first of these dots exercises it’s like you’re lying in the hospital with a cast on, and we’re teaching you to wiggle your toes. Once you can wiggle your toes without pain, we’ll think about having you sit up in bed. Crutches are a long way off!”

  After a couple of months, I graduated to pages and pages of three-dimensional dot exercises. I was first shown the 3D shapes, then given exercises to complete based on those shapes (see Figure 6).

  The first of these exercises had all the dots, and most of the lines, but some of the lines (the “edges” of the shapes) were missing. The exercises then got gradually harder until the lines disappeared altogether, leaving only the dots.

  Over time I began to work with arrows, diamonds, pyramids, rectangular boxes, octagon-shaped bass drums, and so on. In each case, a shape first appeared on a page by itself. Then different shapes began to appear together. Then they appeared together and were also overlapping. There were page after page after page of dots that had to be connected. By the end, I was given full pages of chaotic-looking sets of dots. All of the 2D and 3D shapes had to be teased out, and drawn with pencil, such that all of the shapes were correctly constructed from connecting the right dots and all of the dots were used (see Figures 7 and 8; two full-size dots puzzles appear in the appendix for readers who want to try them out).

  Figure 6: Snippet of 3D Figures with Helper Lines

  When I brought my homework back to Donalee, she carefully went over every page, every shape, looking for the slightest deviation that would give her clues to my brain state, brain weaknesses, my intentionality about doing the homework, how the motor coordination in my hands was working, and so on.

  After a while, we simultaneously
began practicing rules that applied to collections of simple colored objects like balloons and butterflies. The rule might be “find the object that DOES NOT belong in this set.” Then I would have to exactly follow those rules to complete the subsequent exercises.

  Figure 7: 2D Page of Dots Overlaid

  For example, in Figure 9, have we circled all of—and only—the figures that are the same color, but different shape, from the sample in the square box? (No, because the colored butterfly is not white, the colored lock is neither the same color nor a different shape, and the white lock is not a different shape, so none of them should be circled; the lower right white butterfly meets the constraints but is not circled.)*

  Figure 8: 3D Page of Dots Overlaid

  Figure 9: Snippet of Butterflies Locks Balloons Rules

  In the early exercises I was given explicit instructions. After a while I graduated to working out my own rules based on what was implied in an example, and then following those rules to put the objects into correct sets.

  Figure 10: Geometric Figure Equations

  I also worked on making perfect copies of many 8.5 × 11 abstract line-drawn schematic pictures that contained parallel line segments, diagonals, circles, triangles, such as the one in Figure 3, and many other types of puzzles.

  A difficult kind of geometry puzzle involved creating equations by adding and subtracting one figure from another (see Figure 10, above). These equations ultimately got very complex, with multiple operands.

  Sometimes I was given overlapping shapes where I had to remove errors by crossing out lines that connected the dots incorrectly (see Figure 11).

  In all cases the exercises were hierarchical and methodical, were designed to address very specific weaknesses, and were used to bring my symbolic cognitive functioning within normal limits for various kinds of basic cognitive skill categories—that is, importantly, normal for a very high-functioning intellect.

  Figure 11: Shapes with Lines in the Wrong Places

  When I was working on the intense 2D and 3D mental projections like those in Figure 7 and Figure 8, Donalee wanted me to draw out the shapes, with pencil, as soon as I found them among the cloud of dots. But in keeping with the way I had always studied, I did more than was asked of me. I wanted to get better as fast as possible, and I felt that the harder I worked on these exercises, the sooner I would get back to being myself. So instead of using a pencil, I did the whole of each exercise in my head. I would visualize each of the objects in my mind’s eye, and then, keeping that object “alive” (so that I wouldn’t accidentally reuse its dots for another shape), I moved on to the next object. In this way I would work through a whole page, often containing fifteen 2D or 3D figures, many of them overlaying one another. At the end I would be able to simultaneously see all of the objects rising out of the sea of seventy or more dots as I repeatedly moved from one shape to another in my mind’s eye. This gave my eye-aiming systems and cognitive filters lots of guided exercise as I had to repeatedly return to each object to “refresh” the image of it in my mind.*

  Working through a single page of dots the first time might take me forty-five minutes of intense concentration. Because I hadn’t actually drawn on the paper—visualizing all the shapes only in my head—I was able to repeat the exercises many times each week. I would then note the number and types of the objects in a coded sequence on the bottom of the page, to later go over with Donalee.

  I also took to working through the exercises in a different variation wherein I practiced as though I were physically drawing the lines, but without actually picking up a pencil to do so. That is, rather than simply staring at the page waiting for the shapes to “rise out of” the dots, I imagined I could feel my hand holding a pencil, drawing the objects.

  I had always been naturally gifted at these kinds of intense symbolic-geometric visualizations as I worked out many kinds of problems, so this was normal mental exercise for me, and was in keeping with Donalee’s belief in matching the exercises to baseline cognitive capabilities. I felt that for my brain the intensity of doing the many exercises completely in my head was the only way I could ever hope to restore the levels of reasoning I needed for my work as a professor. At times I would concentrate so hard on the exercises that it was as if I were in another world. It was intensely hard work, but it felt right.

  Yet Donalee was neither mollified nor persuaded. “I need you to actually write down your interpretation of the shapes!” she admonished. “I have to check for cognitive deficits in your work, and I need to see how you are drawing your lines. These give me clues about your brain state as you work.

  “And look, an important part of the brain’s work, as you have seen, is in using cognitive symbols to guide the motor control of your hands, arms, hips, back, and neck muscles. Need I remind you that you’ve got a problem there?” She laughed. “We need you to be physically translating your inner vision, through your body, into the real world. My exercises are designed to work with these motor skills!”

  Despite her objection, we compromised. I would work through the exercises in my own way by visualizing the shapes in my head, and imagining also, in a different version of each exercise, that I was physically drawing them with a pencil. I would do this many times for each exercise, but then, before I returned, I would use a real pencil to actually connect all the dots.

  Working through the exercises felt good, but despite the great advances I had made, they were still debilitating. After working on them—especially in the first two months—I often could not walk, or do much of anything, so I had to carefully portion out time to work on my homework while leaving enough resources to get through my still-challenging days.

  ATTENTION DISORDER AND THE FOLLOWING OF RULES. “Donalee,” I said at one of my visits two months after I had started with her, “I really don’t want to be working on these annoying ‘find the rule’ exercises anymore. I figured them out right away, weeks ago, and they don’t present any challenge to me.”

  The exercises were maddening. Donalee was giving me long collections to work through. I had to flip to a page, read the instructions or tease out the rule, and then, using the instructions or the rule, isolate objects that did not match. It was not in my nature to put much effort into such essentially boring, rote work.

  Donalee was adamant. “You have to keep working on them,” she replied. “You have a tendency toward attention difficulties. It runs in your family. In your own case this weakness—which you were able to manage prior to your brain injury—has now become problematic. So it’s a brain area we’ve got to strengthen.”

  She went on. “In my experience, people with attention difficulties—especially high-functioning people—always find reasons why they shouldn’t have to follow the rules. Their reasons take many forms, but often are some subset of ‘these rules are stupid and it doesn’t make any sense to follow them’—a variation on what you are telling me now.

  “In fact, these tactics are mostly, unwittingly, used to mask the problem that attention-disordered people cannot follow the rules. They can’t attend long enough to do so. Life would often be much easier, less chaotic, and more productive, if they could address their cognitive difficulties such that they could learn to follow rules.

  “I’m giving you these exercises so that you can identify the rules, and follow them. Just that. Not only do you have to attend to what the rules are, but you have to form the intention to follow them, and then rehearse, over and over again, the following of those rules. Whether you’ve figured them out, or agree with them, or they suit you, is irrelevant.”*

  I thought about this and, much to my chagrin, realized that she was right. I came from an intellectually high-functioning, iconoclastic family that generally questioned all rules, and followed them only “when it made sense” to do so. Neither of my parents—each of them a graduate of UC Berkeley—was good at following rules
. My parents would happily expend three times the energy to avoid following a “stupid” rule as it would have taken to simply “waste” the time following it.

  “We need to end as much of the chaos in your life as possible,” Donalee said bluntly. “It is mentally exhausting for you. You will be needing all of your brain resources to lead a normal life.”

  Surprisingly, but wonderfully, I found that working through Donalee’s puzzles, building solid cognitive capabilities from the ground up, began to translate into real life.

  The processes of determining relationships between symbols (such as part-whole, belongs or doesn’t belong, left-to-right ordering, same color/different color) and of figuring out the rule, then following it to the letter were, essentially, the same when manipulating puzzle icons as they were when reasoning about the real world. In both cases the objects and problem-solving procedures got translated into the same internal iconic forms.

  Because of all the practice visualizing objects and relationships in the dot puzzles, my ability to generally visualize symbols and relationships from real life gradually got better as well. My ability to figure out the rule in a real-life organizational task, then follow it, got better. My ability to organize visual scenes got better. My ability to balance background context and attentional focus got better. And, the complex 3D puzzles seemed to exercise a very important spatial part of my symbolic-reasoning system that I used to solve complex real-world problems.