A woman called me recently about her uncle (for confidentiality, some of the details have been scrambled), who is tending a local business that is in a property held by the family. The uncle’s assistant manages to keep the processes of the business going, but things are falling into disrepair and, she suspects, if the business got audited, that the IRS would take a dim view of the bookkeeping. Family members are getting angry about his behavior, because he refuses to deal with the problem, or even acknowledge that there is a problem. This situation has been going on for over a year.

This made me think of early scientists trying to understand the paths of the planets in the days before they knew the sun was in the center of the solar system. They observed how the planets tracked back and forth in the night skies, and came up with orbits that the planets might be following around the earth. However, there were irregularities to account for, so they came up with orbits within orbits and they still couldn’t work things out. Once they tried it with the sun in the center, it all made sense.

It’s like this with cognitive problems. Until you put the problem in the center of your analysis, you get to theorize in orbits of anger, of morality, of sabotage, of misbehavior, of unresolved psychological issues, and you go round and round. You don’t know where and when to set limits, what kind of help to get, and when you finally pull in the attorneys, it’s all up for grabs.

To see if cognitive problems might be troubling uncle, I asked a small number of questions. How long has he been like this? Is he hoarding? Is the intellectual content of his speech becoming impoverished and more about reminiscing or ruminating than inquisitive and future-focused? (Well, you word this differently in the course of the conversation, if they aren’t bookish.) Before long, I heard a big sigh of relief, as the niece felt the pieces snick into place. I shared the little solar system metaphor with her, and she said that this would really change the family dynamic, and would help them figure out what to do. I mentioned the kinds of professionals that could help them better understand what kind of neurological issues might be in play with uncle, made a referral for a real assessment, and that was it. I wasn’t practicing therapy, I was just raising questions and making suggestions as to the kind of professionals and processes might best serve them.

Since the family had its own issues that predated the uncle’s challenging behavior, getting things straightened out would require an amalgam of mediation and family therapy, if that isn’t redundant.

This series isn’t just about stigma, and it isn’t just about professional assessment and treatment. It’s about recognizing that brain damage is a very common problem, whether it is from an impact to the head, a small stroke, or any of 297 other known causes of cognitive impairment. We may encounter it in the role of employer, employee, child, parent, friend, or lover. Everyone needs to understand how to respond, and how to prevent the unnecessary dangers and chaos that may come from con artists, sociopathic corporations, wrong-headed clinicians, or misunderstandings within our own families. And, knock on wood, should you ever need follow a path of recovery from brain damage, you should have a map.

Resource

Causes of Cognitive Impairment, from WrongDiagnosis.com - This is where they counted the causes of cognitive impairment. You can, too, and more.

Non-Resource

U.S. Centers for Disease Control (CDC) - I went through endless links on their poorly designed website to get to their advice for patients. It is very short, and includes three pieces of advice for managing your affairs after a brain injury. To save you the “brain damage,” here they are:

• If it’s harder than usual to remember things, write them down.
• If you’re easily distracted, try to do one thing at a time. For example, don’t try to watch TV while fixing dinner.
• Consult with family members or close friends when making important decisions.

Related Articles

• Brain Damage, Part I: Clinical Complacence
• Brain Damage, Part II: The Last Refuge of Bigotry
• Traumatic Brain Injury: A Silent Epidemic
• Waking the Unconscious
• Functional MRI: Emerging Uses for Neurological Diseases - Part 2