5 - Putting up a door: The workshop cupboard doors
Severe brain injury after the acute stage of rehabilitation
In the previous section I talked about the fact that it is not
helpful to see Barry’s life as a series of problems which
require solving. The brain injury is just one aspect of himself
that he has to learn to live with. When you are seven years out
from any major trauma the only hope is to stop trying to change
things which cannot be changed. This is not a counsel of despair,
but one of hope. At this time this thesis was being written Barry
was long past the acute stage of rehabilitation. Focussing on
the tragedy of the change that has been wrought is not going to
help anyone. In fact there comes a time when the only change that
is going to happen is through moving on again, as the person that
you now are. It is easy to say, but how can it be achieved? How
can you even begin to know what the next step should be when the
whole of your life script has been re-written.
Barry is living in an age when all of his cohort will be facing
huge questions about their future. Every new generation has to
find its way forward and there are some times when it is easier
to be young than others. Massive student debt has limited choices
for some young people of this generation, unemployment limits
choices for others. Barry is part of a tiny subset of his cohort
who is not struggling with either of these issues. At this moment
in time he is protected by the compensation legislation and by
a very supportive family. He does not have exactly the same things
to struggle with right now, but he is in his 20s, which is a time
of trying to sort out a direction and possibly a time to find
a lifelong relationship. He shares these dilemmas with other 26
In this age where we are told that anything is possible, and
it is our own fault if we do not achieve everything, there are
multitudes of plans and possible futures floating over people’s
heads. Who has told us that we can achieve anything that we want,
and given so much ground for disappointment as well as achievement?
Our heads are stuffed with images from the media. Some people
succeed in grounding these dreams in reality, but many do not.
The reasons can be multitude for both success or failure: circumstances,
ability, politics, socioeconomic status, health, support etc.
Lack of insight in brain injury is typical
It is useful to be able to make a realistic appraisal of yourself
in the world if you are going to achieve your goals. Barry, with
his brain injury, is forever reminded about his lack of insight
and his unrealistic goals. There seems to be a mismatch which
is obvious to us. But our own private dreams and those of our
colleagues may be equally unrealistic, if they were to be brought
to scrutiny in the light of day. We say that the brain injured
suffer from a lack of insight, as though insight is the prerogative
of the non-brain injured. I would counter that the mismatch between
our dreams and reality is endemic in our culture, there is nothing
‘given’ about the future or our place in it. Choice,
which is hailed as a blessing, is also a curse. Many people find
their way without inflicting too much misery on themselves or
on others, but Barry needed a little bit of help in finding his
The first point is that Barry was not starting from scratch.
He was not born the day that he had his brain injury, rather,
this was something that happened to a young adult with a history
behind him. He was dreamy in school, but had a way of relating
to people which made him popular at the same time. He had and
still has a well developed sense of humour, and I would say that
there was always a sense of integrity about Barry, since I experience
it in him and I doubt that it has been produced by the brain injury.
He did not like anything that smacked of work and was never cut
out to be a farm boy. However, he always loved pottering and this
is something that seemed to arise spontaneously in him, since
he did not have a lot of example from his father, in terms of
handyman skills. His family responded to this part of him by using
the very first carer hours that they got to employ someone with
whom he could potter around with in a shed.
This thread then got lost for a couple of years when he went
off to polytechnic as a student. This was a response to his previous
aptitude for art. The art and handyman threads have been woven
back and forward without ever really meeting. Both are part of
a recognition that Barry is good at doing things with his hands.
Yet this thread had got lost at the time that I started to work
with him. It was an obvious one to pick up again.
The previous story about the troll seemed to be about art, but
it was also about doing the kinds of things that a handyman would
do. We noted at that time that the fishpond needed to have some
netting put over it. And in the story about putting up the lizard
CD rack we had noted that it might be useful to put up doors along
the wall in the workshop where there was access to the underfloor
parts of the house. In each story there were the seeds of things
that could be done in the future. By the end of this story Barry
was able to say that he would like to do some of this handyman
stuff for others. The art thread was gradually getting left behind
and the handyman thread was coming to the fore.
Premorbid cognitive and personality factors are relevant to
the outcome in brain injury.
There is really nothing more to it. The past becomes woven into
the future through the uses we make of the present. Premorbid
cognitive and personality factors are relevant to the outcome
in brain injury. I helped Barry to pick up the handyman thread,
because this is the one that seemed to present itself in the things
that we did together. It feels quite inevitable once the thread
has been followed for a while, but I am aware that if I was a
different person with a different set of skills, this part of
his story might have turned out somewhat differently. For instance,
if I was an artist I may well have picked up the troll/art thread
and brought him further along this line, encouraging him to build
on his skills in ceramics and to create more wonderful creatures
along the way. However, given the ground that we were both standing
on, the handyman thread seemed to be the stronger at this time.
It was, after all, something which had interested Barry before
This art/handyman dichotomy illustrates that no matter what choices
are made, some things have to be left aside, at least for a time.
If one were to focus on what Barry had lost by not continuing
to work as an artist, there would be a feeling of impoverishment
in the middle of plenty. It would be foolish to do this, since
Barry was beginning to be happier as he got stronger as a handyman.
Yet that is precisely the unhappiness that inflicts many people
in our culture. We do one thing and grieve for all this things
that we are not doing. If we are not able to fully engage and
commit ourselves in the present, we will tend to live in poverty
in the midst of plenty. Barry stopped grieving for all his losses
as he began to engage with this one thread of his life.
The workshop was added on to the house at some point and
this means that it provides convenient access to the space afforded
by the piles underneath. As frequently happens, the previous
owner had left quite a lot of odds and ends stored underneath
the house. One of the first things that I did with him was to
have a good rummage through all of this. He didn’t seem
to have done so himself. The access points are between the wall
studs and some of these are filled in permanently, while others
were not. Making doors, which would allow easy access while
screening off the area under the house seemed like an obvious
job and one that needed to be done. I suggested it and he agreed
that it needed doing. We found a board that would fit the first
gap, which was beside the stairs into the workshop. It needed
a bit cut off it so that it would fit over a slight lip on the
ground. We talked about it and how to measure it precisely.
There was no measuring tape so we did a quick hunt for a ruler,
which his flatmate was able to provide. Sensing a bit of nervousness
I said that he could either do it now or later, but he replied
“whoever says that I couldn't!?” He practiced with
the jigsaw and then cut a line along the board, which was accurate
for most of its length.
We then needed some hinges so, after a break of a couple
of hours while Barry had lunch and chill time, we went off to
DDS (demolition store) on my suggestion. There were few hinges,
but the store itself was an eye opener to Barry and he commented,
'this is my kind of place.' Then when he was paying for the
hinges he announced to the assistant, who looked a bit nonplussed,
'I am going home now to work with my power tools'.
Successful therapeutic input in brain injury.
It was easy enough to know when you got things right with Barry
since there was that jolt of recognition that came when he was
on the right track. It was as though the path was already there
in him and it was my job to help him to have enough experience
so that he could recognise his direction..
That evening he hung the first door by himself and while
there was an uneven gap along the top, it fitted well enough
for what was needed. I saw Barry again 5 days later and he had
not got any further than that.
My work with Barry seemed to be succeeding because I was so firmly
focussed on the end product, success was not optional - it was
all that mattered. One of the facilitators said at about this
time: "it just gives us so much courage when we see someone
like you coming in and managing to finish something with Barry".
No one had been able to finish anything with him since he moved
down to Rathnew, because the focus had been on pleasing him or
changing him. Yet it was by focussing on the end product, knowing
the things that were associated with it that I managed to induce
him into completing things for the first time. I knew that Barry
would want to finish what was started, if he was given the means
to doing so.
It was easy to get him up, since he had gone to bed by
midnight (which was pretty unusual) and he was ready to leave
the house by 11am. Hardware Galore is one of his favourite places
and we were going there together in his car, which increased
the motivation. It took him about an hour to decide on which
screws and hinges to get. We then went home for lunch and chill
time and by 3pm he was up and keen to get on with his work.
For once he did not want another cup of coffee and a smoke,
which would normally take half an hour. He was able to make
a second door after a brief discussion and at this point I looked
superfluous, so he suggested I get a project of my own to do.
It was becoming clear that the difficulty was not in the actual
steps of the task, at least in a simple job like this.
I was back again after another 2 days and this time Barry
was feeling depressed and slow. He was ready by 11am but he
did not want to do any work until he got some cigarettes, so
we walked down to the local dairy. The 3rd door posed a few
extra problems about exactly where to put the hinges and how
the door should open. He was slow to grasp ideas, but at the
same time he wanted to get started and did not want to stop
for lunch at midday. By 1pm he was exhausted and cooking 2 minute
noodles for his lunch took him over half an hour and considerable
effort and thought.
I called him from his chill-time before I left at 3pm and,
when the facilitator arrived at 5pm, Barry said that he was
'bumming out with these doors.' The facilitator suggested some
more alternatives for how do make it and was impressed by how
determined Barry seemed to be to succeed. Barry ignored all
these suggestions, but got back to the job. Unfortunately an
hour later he hit his shoulder and there was a big cursing routine
and a few bangs. By the end of the evening, however, he had
managed to get the door finished. This completing of a task
by himself was a first and it opened up new horizons about what
was possible for and with Barry.
It would be very tempting to value the amount of perseverance
that he was showing over the final end product, but the experiences
are qualitatively different. I insist on his success because there
is much more at stake when something is actually completed. The
completed cupboard door will be there afterwards, long after the
time that the trying took place.
Putting on those three doors was done over a period of
about 10 days, which meant that he had kept at the job fairly
consistently. This was the first time that he had kept going
in any job by himself. When I came in the following Monday he
suggested that I go through to the workshop to see the finished
job. I was so proud of him. It felt like a breakthrough and,
I am sure it was with this job in mind that Barry said to me
a few days later he would 'like to do handyman stuff for others'.....
Next page: At work
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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Therapy and carer resources
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