Tuesday, November 03, 2009

Pink Talks Autonomy. It's as Valid for ABI as for Employers

One of the worst things about closed head injury is you don't know you have it for months as you slowly spiral down into an incomprehensible state of incompetencies. What used to be as natural as breathing becomes as hard as lifting boulders. What used to be your talents are gone. What used to be your strengths are your weaknesses, and your weaknesses remain. You can no longer count on skills you've had for years or decades, and people around you start looking at you funny or worse send nasty thoughts guised as good intentions towards you.

Closed head injury ices this lovely cake by also taking away your motivation, that invisible thing that gets you up and doing stuff without prodding from another. You can't feel that it's gone; you just feel like a failure for not being able to do stuff you want to but can't and have no drive to even try. It doesn't really matter that this is typical. Many people will label you lazy or depressed anyway, a failure who's missing out on opportunities. Other people's opinions slowly sink into you, as they do for all of us, and soon it'll become your own opinion of yourself. You may not have started out depressed but between the confusing disappearance of your own competencies, your AWOL motivation, and others' poor opinion of you -- as if you suddenly want to screw up your life -- you soon develop situational depression. I actually didn't but then I was so desperate to get better I had no room for depression, no room, that is until I reached my goal.

Therapists talk about how goals are the key to recovery and stress management. For everyone, goals are important to having a sense of purpose. But for those with acquired brain injuries, including closed head injuries, they become crucial to keeping your mind off the hell of everyday and striving towards the hope of tomorrow.

Goals, motivation, competency: these three make people thrive. They are important when teaching primary school kids for lifelong learning or when creating a work environment that grows successful products. These three also give back life to those of us who've had it snatched away. I realised this recently when I was talking with a primary school teacher on Twitter about grades and better ways of goal setting. He referred me to a video of Dan Pink talking about the science of motivation. And as I watched it -- thinking how much it reflected the person I had been pre-injury -- I wondered how we could apply these same lessons to the us the brain injured.

Just as children have to struggle to learn, so do we. Just as kids have to struggle to find their intrinsic motivation, so do we have to regrow ours. Just as kids learn to master skills, to find their talents, to feel good from achieving competencies, so do we need to relearn old skills, find new talents, and feel self-confident again from once again achieving competencies. It really sucks to go through childhood again, the hard part of it too, as the brain injured often do, but perhaps we can learn better ways of doing it.

Although I was told that motivation loss was typical for closed head injury, I never really understood how I was supposed to get it back. I'm sure the therapy team talked to me about compensating strategies for that. I did learn how to use the computer and Palm to get me to do things (it helped I was such a geek for years before the injury). But regrowing motivation remains a conundrum as far as I know. From what I understand, the only real treatment is just waiting for the brain to heal itself. Given the slowness of brain healing, that might be a few decades. Peachy.

Apparently, "Children from 5-8 are very vulnerable to making rash, life-lasting decisions about whether 'learning' and 'school' is for them." Similarly, rehabilitation for acquired brain injury (ABI) is so exhausting and sometimes seems so futile, that one can make the rash, life-lasting decision to give up, which rather dooms one to sitting outside the knowledge economy, the information age. To make matters worse, ABI healing is lifelong; thus giving up is really bad. Yet it takes considerable motivation, external or internal, to keep going. A goal becomes even more important then, for it becomes an internal motivator. One may have no desire, no impetus to get up, yet a goal that's very important can provide that kick to try harder at rehab. But if the goal seems unattainable, then it becomes ineffective. What do you do then? How do you create motivation to do rehab for the sake of getting better?

There are so many questions, so many problems yet to solve in ABI rehabilitation, we need to seek answers everywhere, whether in seminars for employers like Pink's or research work being done in ALS or the latest in neuroscience or what we're finding works in children's education. A brain is a brain is a brain. To pigeonhole possible solutions as coming only from ABI research is to doom us to slow, neverending rehab that keeps us out of the information age.

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