One Brain's journey

Over the last few months my path has crossed with several people who are troubled by the fact that they seem to be acquiring label after label from mental health practitioners. The complaint is usually expressed something like this, “I just got used to the idea that I have an attentional disorder and now I’m told I have bi-polar disorder and an anxiety disorder as well.”

I understand their discomfort as I believe everyone wants to think of themselves as normal, functional and worthy of their own self esteem. But just thinking of yourself as normal doesn’t make it so. Besides that, it really seems like sweeping the problem under the carpet. Decades ago a friend of mine began seeing a psychiatrist who told him in the first visit to pretend he was normal until he was normal. Of course the psychiatrist would analyze his actions and thoughts over a period of time and offer advice and direction that would lead him to being normal. Another friend, only a year ago, when I raised the issue of my ADHD, asked me, “Why can’t you just think of yourself as normal?” My reply astonished even me at the time when I said, “I don’t want to think of myself as normal. I want to be normal.” I went on to explain that I thought that my journey began with finding out what wasn’t working for me, such as focus and attention, and then I could do something about it. This is what I have tried to do with medication. I would go about it differently now that I know about neuroplasticity and that problems with working memory seem to be at the heart of ADHD and that you can improve working memory. In other words I would be looking for a more permanent kind of change than what medication provides. To me this represents the hope provided by the new research in neuroscience–that the brain can change and we can change it.

In addition, multiple disorders do not necessarily equate to multiple causes or underlying problems. In fact one job of the diagnostician, as I undertand it, is to find the primary disorder. In many cases treatment of this disorder will have a beneficial effect across the board. A few years ago I read a book entitled Shadow Syndromes written by John Ratey, who co-wrote Driven to Distraction with Edward Hollowell. Ratey’s thesis is that there are a number of disorders that seem to have a common underlying cause which he calls ‘noisy brain’. This spectrum of noisy brain disorders would include Bi-Polar, Tourettes Syndrome, Obsessive Compulsive Disorder, Anxiety Disorders, Mood Disorders. I know that ADHD, which would be included in the noisy brain spectrum, almost always occurs with co-morbidities as they are known, that would be in the ‘noisy brain’ spectrum. It seems a forgone conclusion that if you could alleviate the ‘noisy brain’ problem you would also alleviate symptoms of the co-occurring conditions or co-morbidities.

The idea of multiple diagnoses would then not really matter if you could just treat ‘noisy brain’. I don’t know that ‘noisy brain’ is related to problems with working memory but I would be willing to bet on it. If this is the case, improving working memory could have a positive effect on all of these ‘noisy brain’ disorders and that I find that encouraging and hopeful…

New developments in neuroplasticity happen frequently these days but every so often something turns up that truely inspires awe and wonder. The most recent such news comes from University of Rochester Eye Institute where they have just completed a study in which subjects partially blinded by strokes were able to regain some vision by doing specially designed exercises on a computer every day over a period of several months. The program involved seven patients at the Institute and was led by Dr. Krystel Huxlin who commented at the conclusion, “This is the type of brain damage that clinicians and scientists have long believed you simply can’t recover from. It’s devastating and patients are usually sent home to somehow deal with it the best they can.” He added that the results provide a ray of hope for others with damage to the visual cortex as a result of strokes. With this kind of injury patients typically have trouble reading, driving or even doing ordinary chores such as grocery shopping. The visual cortex acts as a gateway to other areas of the brain and although these patients can technically see they can’t make sense of the information.

The exercises consisted of visual dots moving within a circle on a computer screen and although the patients could not initially “see” anything, they were instructed to stare at the screen anyway and guess which way the dots moved. If their choice, or guess, was correct they heard a chime.

All of the participants had improved vision and were able to see in ways they couldn’t before and two of them were actually able to resume driving. Huxlin commented that the exercises were grueling but who of us would not persevere in similar circumstances to regain our vision…

I have a very clear memory from grade eight when the teacher, who I really liked and knew was a good teacher even at 14,  called each student up and pointed to her desk where there was a sheet of paper with each student’s graduating mark. My average was just over 75% so it was at the honors level but she was not satisfied. “You can do better,” she said.

I knew I was lazy. I didn’t like doing homework, but grade eight was the first time I realized I was fairly bright. I had only just started to read on my own and almost immediately began to devour books at the rate of one-a-week.  I could do the homework at the same time the teacher put it on the blackboard and so it was completed at the same time as she finished.  One day she stopped in the middle of putting the homework on the board and turned around.  She caught me but I thought she would be impressed at how quickly I was completing the work.  She wasn’t.   She said. “It’s homework. You do it at home.” Another teacher might have been impressed but not Miss Hamilton. She knew about potential and she knew I was operating below mine.

In high school, it caught up with me in grade ten which marked the first time I failed a test. It was French Grammar, and I found memorizing vocabulary painful. I was in an experimental accelerated program at the time, the goal of which was to complete four years of high school in three. The entrance requirement was a minimum IQ of 125.  I had no trouble in grade nine. Grade ten was a different story, however, I completed the program and graduated with what was then referred to as junior matriculation in the three years. Only half of the 42 students who began the program in grade nine graduated with grade twelve in the three years.  Back in those days there was grade thirteen and you needed grade thirteen to get into university.  I went into a grade thirteen class a year younger than most of the other students.

I thought I was going to Royal Military College and so took the courses that matched the entrance requirements: algebra, geometry, trigonometry, physics and chemistry. I had a minor interest in chemistry but the rest of the subjects bored me to tears. I failed all of those required subjects except chemistry and it was a water shed moment in my life.  I can still remember what happened as I settled in to study, much too close to the actual exams.  There was too much to cover and I found that as I read something in a text book, or in my notes, I would come to the bottom of the page and realize I hadn’t retained a thing that I just had read.  I would start again only to have it happen again.  I panicked and went to tell them at the office at school. I got a strange reception because of my school record up to that time and the fact that I had done four years of high school in three and, of course, they had no idea why I was there. Neither did I. Looking back now I think I was probably looking for some understanding of what was happening to me.  Back then I was just another lazy kid who had got as far as I had on brains but didn’t have he staying power to excel.  I still have nightmares about that time.

I know now what happened but it has baffled me most of my life even though my university experience was worse. It was the maths and the sciences. It was the first instance for me of what my performance is like doing something that es not stimulating or in which I have no interest.

There was a lot more to come…

For the most part in this blog I try to avoid what may look like blatant promotion of Cogmed Working Memory Training and I have explained my relationship with them in the first post. In short, I do marketing work in Canada for them. However, to get to the point of this post, with the recession and the mass lay-offs that are occurring I recalled an article I wrote for HR Professional a year ago. HR Professional is the journal of the Human Resources Professionals Association of Ontario. Don’t let the Ontario part mislead you, this is one of the largest professional associations in North America. Anyway, to get back to the point, the thesis of the article was that in building a case to fire an employee, a supervisor may turn up what looks like poor performance but could actually be symptoms of problems with working memory and they were listed in the article. For the sake of convenience these symptoms could include work turned in late or not at all, persistent lateness, inability to get along with co-workers. Anyone familiar with HR practices knows the cost in time and revenue in building a case for dismissal, dismissing an employee and the cost of hiring a replacement. The cost of Cogmed Working Memory Training, which has a record of improving working memory in 80% of people who go through the training, is about $1,500 and this cost would certainly be less than the cost of firing any employee in any organization and you get to turn an underperforming employee into a valuable asset. Some analysts say the recession may have bottomed out. Regardless, smart employers, looking to the future, know that now is the time to start to rethink their HR practices including those around individual dismissals. Layoffs don’t usually involve much of a selection process and it is acceptable to most employers that one cost of doing it is losing some good employees. As the recovery begins, individual dismissals, once again, will become a fact of life but why fire an employee who could become a genuine asset to the organization. Retaining an employee and turning him into a valuable corporate asset is good for the company, good for the bottom line and, of course, will ensure the employee’s loyalty for a long time to come. Taking a step back and having another look at what is behind the poor performance of under performing employees could pay off in the long run. If it is a working memory problem it may be worth having a go at trying to improve it with Cogmed Training or something similar.

When I presented this argument to Bob Redford, an independent consultant in labor/management relations in Canada, his only comment was, “Well, when you look at the math its pretty much a no-brainer…”