by David Roland
‘No,’ I would say, or ‘A little.’ Once I elaborated: ‘Anna, I’m just trying to survive. Getting through the day is hard enough for me at the moment. Most of what we talk about is to do with this.’
I’d felt then that she didn’t understand how much post-traumatic stress and depression had taken over my mind, how difficult it was for me to think outside of this. I suggested that she speak to Wayne; this would help her to get a better sense of what I was going through, and let her get things off her chest. I suspected, too, that she wasn’t sure about the quality of advice I was getting, and I wanted to reassure her.
At the following session, Anna spoke with Wayne while I waited in reception. She was inside for a long time, and when she came out, I asked how she’d found talking with him. ‘He’s the first person to really listen to me,’ she said. ‘He understands what I’m going through.’
Anna felt reassured that I was seeing a capable professional. I thought that she was a little more patient with me after this, although she still asked from time to time if I’d discussed our relationship issues with Wayne. I sensed that she was hurting, but when our financial problems began to close in, it became even harder for me to think about the relationship. Mentally, I put our marriage issues on the back burner — hoping I could get to them when we’d dealt with the finances, and I had the mental space for it.
I wasn’t totally oblivious: I could see that Anna was socialising more without me, but I didn’t think she would really leave. I thought she’d stick it out, like me, until we could give our relationship proper attention. I’d told Anna before that whenever the notion of separation came up, I went into freefall. It was like the plug was being pulled from the sink, and I would drain away.
At the cafe, the food arrives. We talk about safe subjects as we eat and then make our individual ways home.
As I drive, I feel a deep sadness for what is happening to my family: we are coming apart. Is it possible for things to get any worse? The chasm between Anna and I yawns wider and wider; it feels as if I’m falling into nothingness.
AS IT HAPPENS, my old mate from Sydney, David, arrives the next day to stay for the weekend. When he learnt of my stroke, David arranged to visit as soon as he could get away. He and I first met while working in the prison system when we were both young psychologists. We discovered common interests (music and fitness) and we enjoyed cracking jokes with each other. Our lives have paralleled since then: marriage, children, and private practice. I’m excited to see him.
David’s presence is a morale booster. Anna trusts him — she has gotten to know him and his wife well over the years, and our families have even holidayed together a few times. I mention to David that Anna has talked about separating. He’s concerned. He’s a skilled psychotherapist, and agrees to speak with us individually. That night he speaks with Anna.
David’s become a keen photographer, and on Saturday morning, through a chance meeting, we tee up a photo shoot with a local band who want new publicity shots; he’ll take their pictures when they play at the markets on Sunday morning. For most of Saturday we spend time at the beach, walking and talking. I don’t feel so alone.
On Sunday, before he leaves, the three of have lunch together and he recommends one last try because, he says, ‘of all the good things you have: your relationship, the children, your mutual friendships, your finances’. ‘You’ve got to earn your separation,’ he tells us. He encourages us to have another go at therapy. ‘If you can’t do it yourself, get some help. You’ve got to try and tease out anything that might be improved.’
His words clear the air between us, and it feels as though Anna softens somewhat. I’m reminded of how much we have to lose if we don’t work things out.
As I drive David to the airport, he says, ‘She loves you enough to give it another chance. I don’t think it has gone past the point of no return. But you have to come back to life; you can’t expect Anna to lead a life of duty to you. You have to do everything in your power to be that person she married.’
The next day, Anna and I speak about having a ‘last go’. We make a plan to follow up contacts that could resolve our financial and legal predicament.
Anna makes an appointment with a sex therapist. Part of the condition for the therapy is that we remain together for three months while we work on things. It feels like the last roll of the dice.
SOME WEEKS LATER I’m back doing battle with creditors and lawyers, and by Friday, I’m wasted. I go for a gentle swim, get a haircut, and decide to treat myself to a movie.
I go to the cinema. When I survey what’s on offer, there’s not a great choice. In the end I fork out for Disgrace, starring John Malkovich. The write-up says that it’s about an English professor who seduces one of his students, resigns in disgrace, and then recovers from his fall. I’m not drawn to the reason for his disgrace, but the idea of someone messing up, recovering, and then redeeming themselves is appealing in my current circumstances.
After his fall from grace, John Malkovich’s character, David, goes to live with his daughter, Lucy, on a farm in post-apartheid South Africa. While there, young black men invade the house and rape Lucy. David is pushed into a toilet cubicle and doused with alcohol; a lighted match is thrown in and the door locked. He frantically puts out the fire with the water from the toilet.
Afterwards, this scene keeps popping into my head. It’s as if I was there as it happened. That night, I re-experience memories of burn victims to whom I’ve provided therapy. I remember the manager of a supermarket that caught fire, an accident for which he felt responsible. He subsequently became obsessed with fire tragedies and couldn’t stop watching news reports of them.
For the rest of the weekend, suicidal thoughts invade — they’re strong enough to really scare me. On Sunday night, I tell Anna what’s happened. She says it is awful that I feel this way, and reminds me that I have three beautiful daughters. She confesses that she’s also angry and sometimes wants to tell me to snap out of it.
When I speak with Wayne several days later, he reminds me not to watch the news or movies that are emotionally charged. He’s right, of course, but movies that I think are going to be all right, such as Disgrace, ambush me. Perhaps I need to be like the alcoholic who decides on a blanket avoidance of any occasion where alcohol might be involved.
But I still need diversions. My preference becomes comedies or human-interest stories based on true events. I avoid violent, highly sexual, and despondent movies. We borrow DVDs from our local video store each week. After the incident with Disgrace, I ask the store manager, Jarrod, for his feedback before I hire a movie. If either of us is uncertain about the content, I don’t get it. I become my own censor, with Jarrod’s help.
I also try to get a lift from doing things that are proactive. My dealings with creditors and lawyers are all reactive: responding to their demands and threats, always on the back foot. I’ve been editing a manual that Anna has written for one of her business projects, and I’ve been helping to revamp her website. We’ve also been talking through an idea she has for an instruction book. These tasks are fatiguing, but I can concentrate for longer than when doing the reactive tasks, and it’s much more satisfying — I feel useful. Growing vegies in the garden also gives me this feeling.
On Sunday mornings, our three daughters participate in Nippers. The new season started a few months after the stroke. In previous years, I mostly helped out with Ashley’s group, doing water safety for the age manager, Bill. (Age managers organise the water and beach activities for those in their charge, and parents provide assistance to the manager in whatever ways they are able.) Nippers cannot operate without the required number of water-safety people when the children are doing their water events. Water safety is done by those who’ve completed volunteer surf-lifesaving training and have passed the annual proficiency test, demonstrating water rescues, CPR, and physical fitness.
Four months after the stroke, I return for a Nippers session; I’ve just recently gone back to swimming in the ocean and the pool, and I’m feeling strong enough to give it a go. Bill sends me out on a yellow safety board, the type used by lifesavers. It is long, wide, and fat, and can carry two people in a rescue situation.
A northerly wind blows as I paddle, and the swell rears up, breaking in my face. I’m pushed back into shore a few times, but I don’t give up. Yet with each effort to move through the breakers, I become weaker. I’m puzzled; normally I’d get through this.
I look back to the shore and see suddenly that I’ve drifted a long way from the group. Bill already has another water-safety person out in the surf; I’ve become redundant. I turn the board around and edge it back into shore, catch a final wave, and cut between two groups of children, their capped heads bobbing in the surf.
As I pull the board onto the sand, one of the Nippers officials comes up to me. ‘You don’t have the board skills to handle these conditions,’ she says. ‘You’ve already run into the kids on the board once before, haven’t you?’
I’m dumbfounded. I stare at her, not knowing what to say.
‘Stick to the rescue tube; you’re a good swimmer.’
‘No, that’s not right,’ I say finally, as I drag the board further up onto the sand. She is already walking away. I realise how angry I am in her judgement of me — and I haven’t run into the kids before!
I catch up to her and say, ‘Look, I’m recovering from a stroke.’
‘Well, you should know your limitations. We can’t have you putting the kids at risk,’ she says. There is no sympathy in her face.
‘I’ve only just realised I can’t do it,’ I say, waving my arm towards the surf. She looks unmoved. Why is it that when you’re trying to get back on your feet, someone goes and knees you in the guts?
I jog back to Bill’s group. ‘Sorry, Bill,’ I say when I reach him. ‘I’ve lost strength. I think it’s the up-and-down motion I’m finding hard.’
I’d told him before we started that I’d missed the recent sessions because of a stroke, and I wasn’t sure how I’d go. He’d been sympathetic. ‘Don’t worry about it, Dave,’ he said. ‘You can help out on the sand.’ I appreciated this. Bill had had some recent health setbacks himself.
I won’t do water safety again. I can’t expose myself to put-downs like this while I’m recovering; I’m too fragile. And I certainly don’t want to be a safety risk to the children.
AS THE WEEKS go on, I begin to seek out easy-to-understand articles and picture books on brain function. This type of reading is so much easier than the legal documents put in front of me.
The Human Brain Book, by Rita Carter, soon becomes one of my favourite books. I stare for long periods at the sliced images of a real human brain inside its skull. In the diagrams, the anatomically differentiated brain areas are artfully coloured and individually named; it’s like going through a natural-history museum, each page of images another room. In my own brain, I try to feel the shapes I see on the page — mental fingers feeling around inside my skull. My brain and I are getting to know each other. As strange as it may sound, the more I can remember these names and shapes, the more it feels that I can have a dialogue with my brain, and the more influence I can have on it.
I start to sense that my brain is not a black box, but a menagerie of characters: sometimes working together, sometimes not. They begin to take on personalities: the amygdala is highly strung, an overanxious protector; the hippocampus is a methodical organiser, the cataloguer of memories; the prefrontal cortex is the master controller — at times over-serious, at times visionary and creative, and often at loggerheads with the amygdala. Then there’s the mysterious limbic system: the emotional and impulsive one. The dutiful hypothalamus, the accelerator pedal of the fight–flight response, makes hormonal decisions, together with its compliant cousin, the pituitary gland.
A few weeks after the stroke, an ex-colleague lent me two books: My Stroke of Insight by Jill Bolte Taylor and The Brain That Changes Itself by Norman Doidge. It’s taken me a while to get round to reading them, but I feel ready now.
I’m still often plagued by fog brain when I read, so Taylor’s book looks the easier to start with. Soon I am riveted by her account of the early stages of her left-sided stroke, which occurred as she was getting ready for work. The onset of my stroke happened while I was asleep, and I didn’t get the extreme motor loss that she did. But she describes the sense of peace and connectedness, and a lack of perception of danger, that she experienced immediately after her stroke — something I also experienced. She loses me a bit when she talks about reaching nirvana and dissolving perceptual boundaries, but until that point I am right there with her.
What I find most comforting in her book, which is the first thing I’ve read that describes my experience, is in the final section. Taylor lists the things she needed in her recovery. I identify most with her need for sleep; for others to speak slowly and softly, and to tone down their energy levels; for a reduction in stimulation from electronic media; for others to ask specific questions rather than general ones, giving time to answer; and for others to accept her for who she is today.
Next, I begin Doidge’s book. It is a revelation, taking me into a curious, fascinating world. And it gives me hope that I can do something about my malfunctioning brain.
As a boy, I traded football cards, marbles, and even bottle tops, but as an adult, it has been the trading of ideas — learning about them and discussing them — that has sustained me. At the time of my postgraduate clinical training, it was accepted that we had a finite number of neurons, with largely fixed connections. There was little a brain-injured person could do for cognitive rehabilitation. It was understood that brain function improved spontaneously over the first six to twelve months, and that thereafter it plateaued, with only minor improvements in the coming years. It wasn’t clear why this pattern occurred. The brain-injured person was a passenger in their rehabilitation, not the driver. The more diffuse the brain injury (strokes often cause diffuse injury), the more wide-ranging the damage and the resulting deficits, and the slower the recovery.
Doidge tells me the brain is plastic: new connections can be made between existing neurons, and sometimes new neurons can grow. Neuroplasticity happens by focusing the mind’s attention in specific ways so that neurons that ‘fire together, wire together’. Like a technician, we can change our brain’s circuitry to suit our purposes. He mentions research by Alvaro Pascual-Leone, who, using the method of transcranial magnetic stimulation, demonstrated that blind people who learnt to read the raised dots in braille developed larger ‘maps’ in the motor cortex for the fingers used for ‘reading’ than for their non-reading fingers. The area devoted to these fingers in their motor cortex was also larger than the equivalent area in those who couldn’t read braille. In the blind person, the occipital area of the brain, which is usually devoted to vision, gets taken over by other functions, such as sound.
I already have some understanding of brain neurology through my clinical training and my undergraduate major in zoology. But Doidge is telling me that I can apply this knowledge to myself. I’m surprised by how uplifted I feel as I absorb his ideas; it takes me out of my life’s messiness. I want to know more.
Each neuron has a bulbous cell body — the grey matter of the brain — with dendrites, like spidery arms, sprouting off it. The rest of the neuron is made up of a long, thin fibre — the axon — that ends in numerous fist-shaped synapses. The dendrites and axon of a neuron can grow ‘sprouts’ to make new connections. A connection between neurons is most often made when the synapse of one comes into proximity to the dendrite of another. Information passes along the axon via an electrical impulse until it reaches the synapse. Here, neurotransmitters — the brain’s chemical messengers — are released, and they move, in microseconds, through the minute
gap between the synapse and the neuron it is cosying up to. As a newly made connection is reactivated over and over, the synapse and dendrite become sensitised to each other: they communicate more efficiently, like good friends.
A single neuron can connect to thousands of other neurons, and it is this capacity for neuronal connectedness that provides the landscape for neuroplasticity. I think of it as being akin to families. A small nuclear family has few members to draw on for knowledge, skills, and resources. If something happens to one or two of its members, the family unit is in jeopardy. The advantage for the nuclear family is that communication between them is quick. Yet an extended family, with multiple generations, draws on more resources. As long as they cooperate, this family has greater resilience and capability because of their wide-ranging connectedness.
The neurotransmitters in the brain — especially glutamate and gamma-aminobutyric acid (GABA) — act like neuronal ‘on’ and ‘off’ switches. Glutamate is excitatory, activating neurons, and GABA is inhibitory, reducing activity. This ‘on’ and ‘off’ process is the stepping-stone of neuroplastic change.
There are also many other neurotransmitters that modulate neuronal activity, enhancing neuroplasticity. Focusing attention on something activates the nucleus basalis (above the brain stem) to release acetylcholine, which diffuses throughout the brain, helping to sustain this attention. Dopamine is released when a reward is expected or a goal has been achieved. Noradrenaline is released when we come across something new, alerting our brain to take notice. Serotonin is active in creating the emotional quality of wellbeing. So the acts of focusing attention and experiencing novelty, reward, and emotional tone all help to cement neuroplastic changes.
When a number of neurons fire together, they become a neural network, threading its way throughout the brain. A particular memory is distributed through the brain as a living chemical and electrical trace, and the more neurons employed in the memory, the more secure it is. Recall of a memory reactivates the same neural network that responded to the original event; remembering requires the brain to pull together the sensory, motor, cognitive, and emotional components of the memory. The hippocampi, left and right, act as the managers in coordinating this recall.
