Brain Injuries and Lack of Insight

I thought I was fine. I thought I was coping. I thought I was back to normal.

If you've had a brain injury, there's a good chance you've said some version of those words. And there's an even better chance they weren't quite true.

This is the problem of lack of insight, and it's one of the most frustrating, isolating parts of living with a brain injury. Not just for survivors, but for the people around us who can see what we can't.

Why this matters for insight

Here's the cruel part: the things you're worst at after a brain injury are often the things you've done ten thousand times before. They're the things that feel the easiest, which means they're the things you least expect to fail at.

So when someone asks "Do you need help with that?" your brain thinks: "I've always known how to do this". And you believe that. Because the feeling of competence is still there, even when the ability to perform the task might not be.

That is where lack of insight affects you. Not because you're in denial, or being stubborn. Because your brain is telling you a story that isn't true anymore, and you have no way to check that from the inside.

How that works in daily life

Think about the things you do, or used to do, without thinking: tying your shoes, or pouring a glass of water at home.

When you pour a glass of water, you aren't used to thinking about it. Your hand knows how heavy the jug is, and how far to tilt it so the water comes out gently. The effort to do this feels like nothing, because to your conscious mind, it is nothing.

Now imagine that, after a brain injury, you pour the water and miss the glass. Or you forget halfway through, or you can't remember why you walked into the kitchen.

The task hasn't changed. Your brain's ability to run it on autopilot has.

My own journey with this

As I wrote at the start: I thought I was fine, and coping, and back to normal. Then I started to notice that my routine was lagging. I would plan all my events into designated time slots. And then... go and do something else.

It was ridiculous and demoralising. I would often admonish myself with 'look at everything you haven't done! You aren’t managing anything, what a failure.'

This pattern of ignoring tasks continued across digital calendars, printed diaries, and deliberate alerts. I was an equal opportunity ignorer. It was clear that the problem wasn’t how I was recording my tasks.

Nor could I blame memory either as I’d start my day looking at my tasks then...drift off into other things. Even while I was doing something, at the back of my mind would be the little niggle of tasks waiting for me. So the problem wasn’t memory, what was it?

Now we begin to see the effect of a lack of insight. I knew there was a problem, and had even managed to work out what the problem wasn’t. How could I find out what the problem was?

Answers from others

Often, those around us help us to find an answer. I found mine in a presentation by Sara Challice on attention and concentration after brain injury. She said “Memory problems may actually be a problem with concentration and attention.”

The problem was that my ability to concentrate had been decimated after brain injury.

My attention barely has time to settle on one item when it is pulled away by something elsewhere.

Effectively, I have retrained my brain to have a minimal attention span. Even when I finally focus on one thing, I am usually pulled away within minutes. I can look at a hundred different things but never actually get anything done!

Reset to a FARCE

I have come up with a little mantra which helps me to:

• Focus on what I can control. I can’t control what someone else does, or what has already happened. I can control how I react and what I choose to do next.
• Acknowledge my thoughts and feelings. Ignoring stress or anxiety is only going to make things worse. Giving myself time to notice how I'm feeling can help to manage my emotions.
• Connect with my body. Noticing what I'm doing and slowing down to pay attention has been helping me to train my attention and concentration.
• Remembering this is a marathon, not a sprint. In the depth of my recovery I found it hard to avoid the fear that my future was set. But change is a constant. I am not the same person I was a year ago, and will be different again in another year.
• Every little helps. This ties into number four, and may not be necessary for everyone. But it makes me smile to remember that 1% better today is still an achievement.

Now when I find myself training my brain the wrong way, I’ll think FARCE, have a quick smile and return to my planned tasks. And this post is proof that my concentration and attention spans have improved!

Takeaways:

• Focus on what you can control
• Acknowledge your thoughts and feelings
• Connect with your body and note what you are doing and engage with that
• Remember that this is a marathon not a sprint
• Every little helps