Gist reasoning – The most invisible loss of mild TBI

catching-up-6I am thinking a lot about losses, these days. Loss of friends, loss of doctors, loss of family, loss of jobs, loss of money, loss of hope.

I’ve been actively working on my brain injury recovery since 2007 — nearly 10 years. I got hurt at the end of 2004, so it’s been over 11 years since my last TBI. And my expectations and hopes have varied, during that time.

I always expected to be able to build back my abilities to at least some extent. I expected to be able to be able to retrain my brain to build back my memory, to address my distractability, to handle my fatigue, and basically all-round get myself back to where I wanted to be.

But that hasn’t happened. The one area where I have significantly improved, is in my gist reasoning, which is really the biggest “functional” deficit I had. Not being able to see what ideas are important in a sea of details is one of the most debilitating effects after mild TBI. It’s also a better predictor of how well people “deal” after mild TBI.

Even if we look great on other scores, even if we only have a few measurable deficits, if our gist reasoning is not great, we’re far more likely to suffer and stumble and have troubles. Nothing seems to make sense. Nothing seems to fit together. And we make one mistake after another, miscalculating and mis-reading cues in ways that really make our lives (and others’) very difficult.

And for no apparent reason.

It’s a hidden thing. And it’s a real problem. On top of that, it’s not recognized as “a thing” by a lot of folks. One refrain I’ve heard repeated, over and over from my neuropsych, is that I only have a few measurable deficits, and they aren’t even that terrible, so I should be able to get back to my life without too much struggle. It’s been kind of demoralizing, hearing that each week, as things just didn’t seem to fit together for me. Yes, my tests said that I was supposed to be in good shape — better than I felt I was. Yes, my tests said I have just a few deficits. But nothing made any sense.

It just didn’t make any sense at all. And it’s been constant work for me to get myself to a point where A) I don’t feel stupid and lazy and useless, and B) I actually understand the nature of my issues and can deal effectively with them. I’ve worked at it, I’ve really concentrated on it, and I’ve made some pretty amazing progress, actually. Even more than my neuropsych ever expected.

The thing of it is, if I’d listened to them and just and said to myself, “Well, my measurable deficits really aren’t that many, and relatively speaking, I haven’t been impacted nearly as badly as other people have,” I might have just sat back and not worried about it… and kept screwing up. I probably never would have made this much progress. I wouldn’t have had a need to. I could have just scaled back my discontent and kept my sights lowered, and eventually just settled in to working around the specific problems I had.

But a focus on the specific problems is a huge problem — especially with gist reasoning. It completely misses the point. Gist reasoning is about bringing everything together to sort through it and make sense of it, and if you just think about (and disregard) the smaller pieces, it’s not going to help you build overall strength in your gist reasoning.

So, just looking at my handful of small deficits wouldn’t have helped me at all. At the same time, sitting back and saying, “Well, I’m not nearly as bad-off a other people are, so I should just get on with my life and not worry about it,” would have put the kaibosh on my progress. Because in fact it’s the combination of taking those small things seriously and tweaking them — within the context of my overall functionality — that kept me going over the years.

And it still does.

Now I am changing neuropsychs, and it will be interesting to see how they approach things. I’m a lot less concerned than I was before, because I’ve been thinking about all the ways my old neuropsych was wrong, over the years. I’ve always felt that dealing with their wrong-ness was even more helpful than dealing with how they were right. It’s been an important process for me, to really think through what they’ve told me, and decide for myself if they were right or wrong. And the times when they were wrong – oh, so wrong – have been pretty educational for me.

So, yes, they can go, now. Sure, I’ll miss them. But it’s not the end of my world – it’s the end of one part of it, and the beginning of another.

Onward.

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Author: brokenbrilliant

I am a long-term multiple (mild) Traumatic Brain Injury (mTBI or TBI) survivor who experienced assaults, falls, car accidents, sports-related injuries in the 1960s, '70s, '80s, and '90s. My last mild TBI was in 2004, but it was definitely the worst of the lot. I never received medical treatment for my injuries, some of which were sports injuries (and you have to get back in the game!), but I have been living very successfully with cognitive/behavioral (social, emotional, functional) symptoms and complications since I was a young kid. I’ve done it so well, in fact, that virtually nobody knows that I sustained those injuries… and the folks who do know, haven’t fully realized just how it’s impacted my life. It has impacted my life, however. In serious and debilitating ways. I’m coming out from behind the shields I’ve put up, in hopes of successfully addressing my own (invisible) challenges and helping others to see that sustaining a TBI is not the end of the world, and they can, in fact, live happy, fulfilled, productive lives in spite of it all.

8 thoughts on “Gist reasoning – The most invisible loss of mild TBI”

  1. Perfect timing – I just found out about gist reasoning last week from one of my rehab specialists when I was given exercises to work on it but this explains so much!

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  2. I’m so glad you found out about it. Gist reasoning is a huge issue that hasn’t gotten as much press as I think it should. Strengthening my gist reasoning has been a huge key to my recovery. I hope it has the same benefits for you.

    If you don’t mind my asking, what sorts of rehab exercises did they give you?

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  3. Just saw your reply…I can’t find my notebook (common occurrence these days!) with the examples but my therapist will read me these passages that seem to go on and on forever and then she asks me to summarize – I think it was something like in 25 with 5 words on each line. I had left hemispheric damage and so verbal comprehension is pretty hard on me so this exercise is one of those ‘it hurts but I know it’s good for me’ sort of things. I can’t stand to think about how much I miss in conversation.

    I’m going to start to look for areas to consciously practice it – the problem is that the level of effort it takes me to focus and really listen about consumes all of my mental energy for hours. I hate that but I guess that’s just part of my recovery…

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  4. Yeah, that level of effort business can be daunting. When I was learning to juggle, it just seemed to consume so much of my energy, and I couldn’t let it go. Perseveration raising its head… What I found, though, was that when I focused on learning for a little while (maybe 30 minutes), and then walked away from it for a day or two, when I came back, I could actually do better. My brain needed time to adjust and get the new wiring in place. Resting and stepping away from the work made a huge difference.

    Good luck with the gist training. I find it works best for me when I use information I’m really excited and passionate about. Then it’s more like play.

    As for the magically disappearing notebook… sounds familiar. I’ve actually gotten worse in the past year or so… things just disappear on me all the time. I think it’s because I’m less stressed about everything, so I’m less “on point”. Now I need to figure out how to relax and not worry about things AND stay functional 😉

    One tradeoff after another… ah, the adventure of brain injury recovery!

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