Who am I?
A sense of self is a uniquely human trait, we are capable of recognising ourselves when presented with our mirror-image we get that instantaneous feeling of familiarity and self-assurance so whenever something seems out of place we quickly try to fix it. Besides knowing how we appear, we know our hobbies and interests, who matters most to us, about our job, our studies, who our childhood friends were, memorable family holidays, our favourite comedians, favourite desserts, etc. – all these elements connect together into a whole, which we may call our ‘identity’.
Humans are social beings, even the most apparently anti-social of us make continuous decisions about whom we like, whether we’re making a good impression on others, about what others may think and what would please them, or if we dislike them and how to show or hide it. People we associate with become part of our identity and reflect our values, beliefs, common objectives, generation, etc.
Our identity undergoes most change during our childhood and adolescent years. Pre-adolescence, children are motivated to learn about the world, they acquire new skills very easily because during this time their brains are are at their most malleable when presented with new stimulus. Learning to speak a language feels mostly subconscious and very natural process during this phase. They don’t have a deep understanding of their place in the world as it’s still something they’re learning to understand. As we move into adolescence, however, we enter into an ‘identity crisis’, we become very self-aware, aware that we don’t know ourselves very well. One way of getting to know ourselves is through others, it’s at this stage that we form the most relationships we’ll ever have in our adult life, during which we learn the art of forming and maintaining relationships. Gradually, the older we get, the more we know ourselves and, through experience, the more discriminatory we become in choosing whom to associate with. It goes without saying therefore, that the experiences we have during our childhood and young adulthood shape our identity and that this correlates with pre-determined changes in our brains. Our identity becomes hardwired, effectively.
The “seat of consciousness” is often debated with hypothesis that it may be located, but more recent neuroscience research suggests that consciousness involves several brain areas interacting all at once. Our personality is a crucial part of our identity and is what attracts or repels others, it’s effectively an advertisement of our core values, attitudes and beliefs. Personality, develops throughout our formative years in line with the rest of our identity. However, the key point about personality is that in order for it to develop healthily, an enriched social environment is necessary. Without it, our brains simply cannot develop the social tools we use in our daily interactions. Just like a childhood devoid of positive social relations can have a detrimental effect on the personality one eventually acquires as an adult, a brain injury to regions within the frontal lobe can also cause one’s personality to change. The most infamous case is that of Phyneas Cage, railway worker who accidentally received a penetrative injury to the frontal lobe when a metal rod punctured his brain, entering through the eye socket. Despite the horrendous accident, he survived however accounts suggested his personality had radically changed.
“hard-working, responsible, and “a great favorite” with the men in his charge, his employers having regarded him as “the most efficient and capable foreman in their employ”.”
“The equilibrium or balance, so to speak, between his intellectual faculties and animal propensities, seems to have been destroyed. He is fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom), manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires, at times pertinaciously obstinate, yet capricious and vacillating, devising many plans of future operations, which are no sooner arranged than they are abandoned in turn for others appearing more feasible. A child in his intellectual capacity and manifestations, he has the animal passions of a strong man. Previous to his injury, although untrained in the schools, he possessed a well-balanced mind, and was looked upon by those who knew him as a shrewd, smart business man, very energetic and persistent in executing all his plans of operation. In this regard his mind was radically changed, so decidedly that his friends and acquaintances said he was “no longer Gage”.”
The frontal lobe is one of the regions of the brain most commonly injured in an accident. Since the brain is a soft, delicate structure that resides within a rigid bony outer shell of the skull and is located prominently at the front part of the brain, it’s a part of the brain most subject to injury, typically in vehicle accidents or falls causing the brain to squash against the skull. The non-expandable skull also contributes further damage as after an injury a build-up of fluid can cause the brain to become compressed, depriving them of oxygen and nutrients.
My accident occurred at the worst possible stage to the frontal lobe brain region undergoing the most development. In effect, my personal development became intertwined with my rehabilitation from brain injury. Distinguishing the two was very difficult, as any parent knows, teenagers can be unruly and unpredictable at the best of times. The neurosurgeon who operated on me told my parents “he may have a personality change”, but besides that fragment of information nothing else was said and no help was given. They just had to take care of me and hope for the best outcome, nothing was ever predictable or guaranteed. There was no “recovery”, I was a growing boy who would’ve refined himself from year to year. What I would’ve become as an adult is unanswerable and irrelevant as I only know who I am now, identity is a product of past experience good or bad, so my brain injury, for better or worse, is part of my identity. Some people may be repulsed by that notion, especially the people who’ve known you prior to the injury. They may come to expect you to behave in a certain manner, to laugh at the same jokes…to basically be the same.
Their agenda isn’t without principle, after an injury to the brain it undergoes repair processes where unaffected neural circuits attempt to take over the functions of those impaired or lost – a process called neuroplasticity (this process is most active in the first 6 months to 12 months after an injury, but continues on throughout our adult life. It is precisely because of the plasticity of the brain that people can continue to “recover” even decades later, albeit in more subtle ways, although over time they all add up). However, it should be understood that after an injury the individual may no longer recognise the world in which they once inhabited, things may look the same to them but they may not feel the same, they may feel the same way but have difficulty showing it. They too, have to come to terms with their new reality and sense of self and it too takes a long time. During this time, they need familiarity and structure, but they also need to relearn lost functions so need to be stimulated.
A good way of helping the brain injured person to reestablish themselves and their identity is to go over old ground. They may have had particular interests prior to their injury, in my case I learned to play the piano several years before my accident so in this example, playing again would be a good way of reinforcing old neural circuits and if they were damaged, through repeated action over a long period of time the brain would eventually compensate by working around the damaged area. Some functions may be recovered completely with little discernible change in terms of effort, others may require more of a conscious effort in order to execute which results in added stress and fatigue.
Besides doing pre-learned activities, they need family and friends to support and understand them. This is a delicate matter because when presented with someone who’s brain injury is or isn’t open-knowledge people may feel alienated by someone who behaves differently to what they’re used to such an extent that they may disassociate with them. Whether this is right or wrong, is not for debate, the fact is it can and very often does occur. To illustrate this, the divorce rate among couples is disproportionately high among couples where one spouse has had a brain injury. Lost relationships in the aftermath are akin to lost neural circuits and lost part of our identity. Some relationships are irreplaceable, but for the ones we can replace our ability to do so is hampered if we cannot relearn how they worked in the first place. If you know of someone who had a brain injury, they need you now more than ever as you were once a vital part of their identity and a key to its reestablishment.