3 - Putting up the CD rack
Topographical disorientation in the person with brain
When he moved to the city of Rathnew Barry was lost, which was
a classic case of topographical disorientation caused by brain
injury. Surrounded by space, he confined himself to his bed, since
this was the one thing that he understood. This was his place,
the one place where he felt warm and cosy and safe. Everywhere
else confronted him with the evidence of his brain injury. So
he tried to tie space and time down in this one place, turning
them into something static. There is little dynamic sense of space
from the perspective of the bed. When he went out he was completely
lost. He had the courage to wander, but he remained lost, because
his ability to lay down familiar patterns was reduced. But he
was also lost because there was no place for him to go and nothing
for him to do.
Examples of frontal lobe deficits in concrete rigid kind of
Suddenly he had a care package and he was surrounded by different
people all day long. It was at this stage that the rigid, concrete
(frontal lobe deficits) kind of thinking became evident. Now there
were signs of him protecting his space, of setting up rules for
where people were and were not allowed to be, where things were
supposed to be, where the car was to be parked (precisely). The
house that had been bought for him had a workshop, this was the
focus of the whole house for Barry and it was what he always talked
about when asked about the house. At the beginning of this time
a number of different facilitators were allowed into his workshop.
This became more and more restricted over time and gradually it
came about that only his workmate was allowed to share this space.
After a year of working together even this was restricted.
Places for various things have been sorted out over time and
these are rigidly held to, because Barry gets upset if they are
not in the places where they are supposed to be. Some of these
rules are very sensible, while others are less so. It is useful
to always be able to find the telephone directory, but the piles
of junkmail on the table tend to get messy. It is good to be able
to find the teaspoons, but puzzling to have to leave the kettle
filled to the exact same spot at all times. It is a house where
things tend to stay put. It is not a messy house.
On my very first day with Barry in February 1998 we went
off to Hardware Galore together. He loves tools and Hardware
Galore is his favourite shop. He had not bought any tools before
this time and he was clearly anxious to begin. The men who work
in Hardware Galore are particularly amenable to talking about
all the different kinds of tools and are willing to make recommendations.
Barry always wants the best when it comes to electrical tools
and this day he was interested in drills. The salesman showed
him a ‘variable speed Bosch’, with a hammer drill,
reversible speed and a cord. It was particularly good value,
he said, at just $99. Barry would have got it immediately, but
I had no idea about what he could or could not afford and insisted
that he go away and think about it. Next day he went back with
his facilitator to buy it.
The cues used by a person with brain injury
He seemed to be really taken with the image of himself manfully
drilling at something in his workshop, he was not exactly sure
what that thing would be. He was collecting them to fill the space
that had been given to him and called a workshop. In fact the
transformation of the space of the 'workshop' into a real workshop
could only happen if there were tools in it. A drill is something
that you put in a workshop, and he was very appropriate in getting
On this return visit, the day after I had been there with
him, they had a bit of a problem finding Hardware Galore. Barry
insisted that he knew where it was and Susha trusted him since
she knew that he had been there the day before.
In the early stages of moving to Rathnew he expected to get lost
whenever he went out by himself and he would avoid this as much
as possible, by always going with a facilitator. As long as he
was being driven everywhere he was not picking up adequate cues
to allow himself to become independent in navigation. Many permanent
passengers in a car have difficulty with navigation, it is part
of the nature of their passive role in the experience that they
will not 'know' the route adequately. Being driven in the car,
addition to his problems with topographical orientation was something
which disconnected Barry from really getting to know Rathnew.
But without the car, he would have never gone anywhere, because
of his difficulty with managing time.
Ever since he moved into Friars Hill there has been this
beautifully crafted metal cd rack lying around, shaped like
a lizard. It was a birthday present from his parents, to tidy
away his fairly large collection of cds. It was one of those
elegant black things that fit with Barry's sense of style and
there was no doubt that it had been chosen with care.
Clearly there was a sense of agreement within the family about
what was ‘right’. Margaret went on to interpret that
sense of taste throughout the house, since it was evident that
Barry would never get to this point. She painted the kitchen and
the bedrooms, put in curtains and ceiling lights and much more.
It made it hard for Barry to really take possession, although
he never seemed to mind anything that she did. It meant that he
was living in a tastefully furnished house, which was easy to
live in. This was really important in terms of supporting him,
but it did nothing to help him feel connected.
I phoned him the night before I was due on again and he
talked about putting it up. Moreover, he remembered this conversation
when I came in, which was unusual. We prepared for the job all
morning and he was reasonably clear about where he wanted to
put it - it was to look as though it was walking up the space
on the wall which you see as you walk in from the workshop.
He tidied up and he practiced making holes in odd bits of wood
with his new drill and we both tried out Uncle Sid's stud finder.
We pottered around and investigated the space under the house,
which you could reach from the workshop. There were lots of
interesting things there. We wondered whether it might be a
good idea to cover up those gaps in the wall with doors.
'When in doubt, tidy up' is one of Barry's unspoken mottos. When
he goes into the workshop and is not quite clear about what he
is to do, he starts to tidy up, so this area is one where everything
has its place. However, the process of tidying can ‘capture’
him, so that he finds it hard to move on to doing something else.
Tidying is something that is obvious, it is easy to know what
to do and there can be no end to it once you start. It can mean
that he finds it very difficult to stop tidying and get on with
the job, because starting something is more difficult than continuing
with tidying. It is a way of claiming space, to ensure that it
is tidy and the workshop is a place which he really owns. However,
even when he is tidying the workshop, his efforts tend to be focussed
in a way which is less than helpful. For instance, he will spend
hours ensuring that there is nothing on the floor, which the workbench
itself will remain littered.
Keeping things simple is one way of compensating for the head
Throughout the rest of the house his flatmate, Freddy, had introduced
various systems for recycling waste and this involved a whole
series of labelled boxes and bins in different rooms. This was
another way of taking possession, through the way that the house
was organised. However, it became clear over time that Barry’s
value system did not encompass any of these environmental ideals.
Margaret eventually made the decision that this way of organising
the house was not what Barry wanted with his head injury, it was
too complex. She aimed for simplicity and ease in the way she
organised the house.
In general, we did everything that we could to put off
that fatal moment of drilling a hole in the immaculate walls
of his perfect home, that still feels brand new and not really
his. I tried to look competent, giving little taps and knocks
on the walls to look for studs. Then we checked and rechecked
my findings with the stud finder. Barry was totally engaged
with the little red light on the stud finder and there was a
pattern to its findings. He also concurred with my finding different
noises behind my knocks and agreed that that the duller sounds
must be studs. Funnily (and unnervingly) enough, the stud finder
and I did not agree about where the studs were. He was not keen
to start the job and I never again saw him so keen to have his
lunch promptly at 12, nor so determined to have a chill time
at 1pm. He was terrified of the job and I was not much better.
Prevarication was the tactic. The daybook tells something of
it: 'We pottered about the workshop all afternoon: waterproofed
the troll, checked the wood under the house, thought about putting
in a door where the gap is; then we put up the lizard with much
trepidation and success.' This does not tell the story of how
I kept on eyeing up that space on his bedroom wall, which you
could see through the open door of the workshop. It does not
tell about how I finally said, 'let's just do it' and how we
charged at it as though we were going into battle (with me in
the lead and Barry following up behind).
He drilled the first hole in one of the few places where
my knocking and the stud finder seemed to agree. Unfortunately,
the stud was not there, which made him panic a little. What
would we do, would the rack be held up if the screws went into
plaster alone? After the second hole missed the stud I was ready
to hand in my notice, this all felt too much. Barry on the other
hand had crossed over the thresh hold, from fear into recklessness,
and was ready for action. However, I was the responsible adult
here and I suddenly felt how accountable I was to his mother
if a large chunk was to be carved out of the wall.
The other two holes got drilled into the vacuum behind
the plaster, without a stud in sight. We had those sockets,
which you use in these circumstances, but I was not at all convinced
that I knew how to use them. It was time to put those ghastly
yellow holders into holes that were just too small, but how
big was big enough? First the holes had to be expanded by rolling
the drill around in them and them I hammered those yellow plastic
things in. I did these jobs, since, if the whole wall was going
to cave in, I wanted to be the person who was holding the hammer
or drill as the case may be. Anyway, Barry was fairly tired
at this stage and quite willing to hand over. They kind of popped
in with a bit of persuasion and a hammer and were ready to do
their trick of expanding behind the plaster when we started
to do the screwing.
It was hard work putting in the screws. I was surprised
to find that I was stronger than Barry, since he looks so well
built. We took turns at putting them in and this part was soon
done and the rack was up. The job had taken us about 2 hours,
but it felt like an eternity. I put the CDs in for him next
day, since I had a hunch that he would leave it unused if it
were not filled.
He did not seem to care whether the cds went in or not
but I could not care about whether he cared. I knew that the
purpose of the cd rack had to be honoured if he was going to
get any feeling of satisfaction from the job. I only really
knew that it had succeeded when he turned around a few weeks
later and put up the whiteboard by himself in the kitchen. He
was beginning to make his mark on the house, in very small ways.
Next page: The Troll
Methods and Ethics
Guestbook (to be enabled soon)
Brain damage stories-
Story 1 - The accident
Story 2 - The OT arrives
Story 3 - The CD rack
Story 4 - The troll
Story 5 - The door
Story 6 - At work
Story 7 - The letterbox
Story 8 - Employment
Occupation in Literature -
Being "well occupied"
The practitioner / OT
The person with brain injury
The need for occupation
Becoming well occupied
Occupation and neurology
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