Story
4 - The Troll
'Not a problem'
Problems associated with frontal lobe injury
Barry found it really hard to bring anything to completion. The
troll was a case in point, it was sitting in his workshop for
months waiting to be finished off and placed in position. The
focus here was on helping him to connect with the things which
needed to be done (like finishing off the troll). A number of
things were taken into account when making this happen, for instance
his terrible slowness, his suspiciousness, his lack of motivation
and so on. All of these things were direct results of his head
injury but I did not attempt here to see them here as problems
needing to be solved. Rather they were factors which were taken
into account and he was given support which allowed him to get
on with the job. I found a sense of direction by focussing on
the job that needed to be done, rather than on the problems which
might or might not be solved.
There is only one problem that Barry and I have ever managed
to reach agreement on. I once read to him the whole list of his
problems, which cover just about everything that could happen
to a frontal lobe and then a bit more. Out of all those problems
the only one that he saw as a problem was motivation. I couldn't
agree more. Motivation has to be the problem that he has got,
it is intractable and insurmountable. In the words of his physiotherapist,
'it's not that his starting motor is faulty, it's that he hasn't
got one'. Yet.......yet.....I wonder.
******************************
Creativity following head injury
Towards the end of 1997 Barry began to work with Dot, an
amateur ceramicist who specialises in producing fantastic creatures.
She was the sister of one of the facilitators and I had visited
her before setting this up as an activity for Barry. He used
to travel out to her workshop in Roundwood once a week and over
the course of 2 months made 'the troll', which owed something
to the style of creatures that Dot tended to make, but which
was also clearly stamped with an expression of Barry's creativity.
These visits were sometimes fraught, because it was so difficult
to get Barry anywhere on time. They did seem to enjoy their
time together, but there was never any more contact after the
troll was completed.
Barry was creative before his head injury and art was a subject
which he got very good grades in. This troll was an expression
of skill and imagination which he needed at this time. Making
this troll connected him back to the old Barry and it was way
of using his strengths in a constructive way. His creativity is
a part of him and if you put him in a situation where he has the
opportunity to express it, he does it to a high standard. Clearly
Dot’s workshop provided just the right kind of stimulating
environment for him. He was not simply copying, although he was
guided by the ambience of the place where he was working. He could
not have done it without access to everything that Dot has in
her workshop, the atmosphere, the special techniques that she
has developed to fire large objects. He could not have done it
without finding Dot in the first place and without lots of support
in getting to and from her workshop out in Roundwood.
The troll was finally fired and brought home in January
and left sitting on the workshop bench. He had done small things
to finish it, such as spraying it with several coats of polyurethane.
I suggested that it should be put in place, assuming that it
was just a matter of lifting it from its present position and
putting it in the garden. It was a hot day and Barry felt pressured
by me and said that he felt he 'got more done when he was on
his own'. I retreated to the kitchen, leaving him in the workshop.
Cause of depression following head injury
I was acting from the position where I recognised that the troll
needed to be put into position in the garden, since this was the
purpose for which it had been made. If he did not finish this
task he would be left with the feelings that come from not completing
a thing which has been started. The feeling would be those of
uncompleteness, of things never getting finished, of it all being
pointless anyway. He may not have articulated these feelings specifically
around the troll, but they came out in other situations. If you
accept that these feelings are a symptom of a deeper sense of
disconnection, then you do things that first of all tackle that
disconnection. If everything feels pointless (a favourite remark
of Barry's), then you ensure that things are done in a way that
does have a point. In this case, the troll has been started and
so it must be finished, or there will be consequences.
The classic consequence is some form of depression and I wanted
to avoid any thought of focussing on his depression. This had
already been done year in and year out since his head injury occurred.
It seemed to me that the less I focussed on depression the less
of an issue it became.
He then proceeded to think about curtains for the windows,
since he did not know how to go on. After a short while I came
back and together we talked about what to do with the troll
as we stood beside the pond. Now, in that pond were three enormous
goldfishes and we talked about them, as we often did. The pond
was uncovered and they were in imminent danger of their lives
from the local feline population. Eventually it was covered,
but not before a neighbour's cat had eaten one of the fish.
Supported activities following head injury
Barry had been brought up on a farm and his relationship with
animals was affectionate and responsible. At this time he only
had these goldfish to look after. Life gets its momentum by the
way that we recognise new needs, even as we are meeting the original
need. There are always things to be done, once you start doing
things. We had now recognised one of the next things to be done,
even as we were just standing and talking about the troll. If
we had not stood in just that position, fully engaging in the
task on hand, it is unlikely that we would have recognised the
need to cover the pond, which makes the point that it is only
by fully engaging that you can begin to recognise what needs to
be done. The person who is disconnected from the job on hand will
simply not see what needs to be done next or how to go about it.
One way of bring about this disconnection is to see the person
you are working with as presenting a series of problems that need
to be solved, before you can get to do anything. Covering the
pond provides an illustration of this conundrum between solving
a problem and meeting a need.
The pond obviously had to get covered up, Barry could see that
and so could I. But he needed support to make it happen. I did
not have the time or the knowledge to do the job with him and
so I asked among the facilitators for someone who would undertake
to do the job with him. One of them said that she had carpentry
skills would do it with him, but then was not able to get him
to do it. It was easy to see it as Barry's problem, she kept asking
him if he wanted to do it, but he could not 'initiate' or 'plan',
he was not 'motivated' and he could not relate 'appropriately'
to the facilitator. We could have worked endlessly on these problems,
but what we did not talk about was the fact that she had volunteered
for something which she did not have the skills to do. In fact
there was no problem once we employed a facilitator who was a
carpenter. He did not ask Barry if he wanted to do it. Instead,
they arrived together at a much simpler solution than the one
originally posed, and the job got done.
There were some similarities between Barry and this student facilitator.
Having said that he could do more on his own, he then proceeded
to do nothing. He did not recognise what he was and was not able
to do. He could make a plan but then not know how to put in into
action. He has since shown that he can do jobs when he is left
to do them on his own, but they cannot involve more than a few
steps and the starting point must be obvious.
Problem solving when someone has a head injury
It was my job to hold him to the task and help him to stay with
it for long enough to see the possibilities. He was not going
to get very far in his thinking about the troll as long as he
stood staring at the pile of curtains. It was my job to make the
job a success and I was there to take responsiblity for making
it happen, in a way which allowed him to own the end results.
Barry had the vision, but he needed someone who had judgement
and experience to make it happen.
In Barry's eyes, the obvious place to put the troll seemed
to be where a romantic looking female statue was already firmly
concreted into place. Removing it would involve smashing the
statue and Barry was reluctant to do this. He could not get
any further in his thinking than this and so he wanted to retreat.
We talked about alternatives. As we talked we noticed a space
at the other side of the pond that looked as though it might
work.
The problem solving mode can be very useful when it is applied
to a technical process. It is a way of thinking which belongs
properly to situations where 'things' are being worked with and
an objective stance is perfectly appropriate here. It is not appropriate
to see a person in the same way, as a problem to be solved.
He imagined the troll raised into full view on a stone
platform. He wanted to concrete it into position, and I asked
him why, since I would have wanted to try it out in several
positions before making a final decision. He said that it was
to prevent it being stolen. This seemed reasonable enough; given
how much work he had put into it and how splendid it was in
its grotesque, garden gnomish way.
Possible example of frontal lobe deficits
You can see here some examples of rigid, suspicious, damaged
frontal lobe, kind of thinking, if you choose to look closely
under a particular light. But we are choosing not to and it should
be understood that Barry is living in an area which is very densely
occupied by students. There is a fashion among students to play
pranks with garden gnomes and he was being wise in protecting
this troll that he had already invested so much energy in. It
could be used as an illustration of one of those frontal lobe
manifestations of suspiciousness, but in fact I find that Barry's
reasoning is soundly based and is a fairly typical response to
threat. We live in a society that provokes us into expressions
of caution, which would have appeared ludicrous in New Zealand
society of 30 years ago.
The next day, which was another beautiful one, we headed
off to Glenealy to look for the stones to use as a platform.
We took my car. Barry would have undoubtedly made a fuss if
his car was driven on unsealed roads and his boot loaded with
dirty stones and this could have meant that we would not succeed
in our mission. He always loves driving around in his own car,
but I was unnerved by the inevitable criticisms of my driving.
It is not that his criticisms are not justified, it is just
that it can really ruin my day to be reminded of my shortcomings
in this way.
Barry really does seem to have a problem here. He has had a beautiful
sleek black Mazda funded by the insurance corporation who kindly
recognised (after considerable persuasion) his need for transport.
He is not allowed to drive it (his 'baby') in a world which has
been built around the motor car. Every time someone drives him
in it he is reminded of his loss and, he reminds the driver also,
that this car is his and that there was once a Barry who could
have driven much better than 'this'. He is the ultimate passenger
seat driver and every driver recognises the feelings that this
can evoke. Driving is such a complicated thing, such a fast, dangerous
thing, that someone as damaged as Barry should never be allowed
behind a wheel. Of course, there are plenty of other people in
our society who should not be let behind a wheel, but we do not
stop them.
His brain injury bars him from driving and this is an insuperable
fact of life which must be accepted. His neighbours cannot afford
a car, because they are poor, and this causes them grave problems.
Poverty may contain the seeds of hope, if you live in a society
which allows that, while brain injury is forever. Poverty and
brain injury are different kinds of tragedies, they are both part
of the human condition which is accepted in our society. The fact
that something is posed as a 'problem' suggests that there is
something ahead....a solution. If there is no solution on offer,
then 'just getting' on, within the context of accepting the tragedy
within our human condition, seems to be a more useful mode. This
is all to say that Barry’s brain injury has become his context
and that the most useful way to work with him is to accept that
context and figure out how to get on with the rest of life.
The causes of head injury
Driving is part of the human condition in our culture. In our
acceptance of, and our joy in, this mode of transport we implicitly
accept the outcomes. We accept a way of life where space and time
are compressed, where life is lived in the fast lane, where our
earnings are poured into the fuel tank, where our environment
is polluted by the exhaust fumes and where thousands of us are
killed or damaged in the most brutal way every year. It was Barry's
driving which brought about his brain injury. He is part of the
human condition which we all take part in. To see his grief as
'his problem' is to take him out of that human context. It is
our need for fast transport, together with an adherence to clocktime,
which has become the problem. In a society which did not include
the car, Barry would seem much less disabled. His predicament
with space and time can be eased by bringing about a situation
where he was chaufeurred in his own car. Taxis and buses came
next, but there was always an issue about the fact that they relied
on clock time.
We stopped on the outskirts of Glenealy where we saw a
few suitable looking stones perched on a crumbling bank beside
the road. I went to the nearby house to ask for permission to
remove them, but when there was no answer I assumed that it
would be okay and proceeded to load a few stones into my boot.
Barry carefully dissociated himself from the procedure, clearly
feeling uneasy about the legality of the operation and he refused
to help me at first. I was feeling unusually light and gay and
I enjoyed teasing him about his intrepidness. After a few minutes
he joined in and helped me.
Ethical behaviour when working with head injury
Conscience is a product of our culture which is often disturbed
when there is brain injury, yet here was Barry expressing a finer
sense of right and wrong than I was. My actions here caused Barry
to dissociate himself from the activity, which was precisely the
reaction which I did not want. My actions were therefore unethical,
not for the reasons that he might have supposed, but because they
had alienated him from the activity, when what I wanted to achieve
was a sense of connection. It was not an altogether successful
experience, and it taught me to respect the conscience of this
person. He was disconnected both from getting the stones as a
base for the trolls, but also, in his moral outrage, from a relationship
with me. This was not something that brought us closer to together.
I was having a great time, yet Barry was being perplexed. It was
my need for engagement which was being met here. I knew enough
about boundaries of acceptable behaviour to be able to play with
them here. Barry was excluded from this playfulness, both because
he had different values as someone who grew up on a farm, and
because he was not ready to play with boundaries when they all
seemed so uncertain to him. Play can only come about when there
is certainty and this was missing for Barry in this situation.
There was another issue which this brought up which was the fact
that, far from being certain about what I was doing, I actually
had very little idea about where to pick up stones. My interest
in stone walls had led me to notice that there were stone walls
in this area, and I therefore supposed that stones would be in
a good supply. When the stones did not immediately present themselves
I short circuited the activity and picked up the stones off the
ditch. In doing this I conscious of the kind of distress that
Barry tends to show when the facilitator does not seem to know
what they are doing. Adequate preparation and training for this
job would have ensured that I knew where these kinds of supplies
were. But I was not being employed for these skills, but because
of my knowledge about head injury.
Afterwards, since we were almost in Glenealy, he suggested
calling in to T…., ( the previous service coordinator)
and D.., her husband.. He had visited them there several times
before and this is what he associates Glenealy with. D…
was there and we stayed for a chat and a cup of coffee. By the
time we got home from this 3-hour expedition Barry was absolutely
exhausted and went to bed.
It was noteworthy that the most successful aspect of this whole
expedition was the part initiated by Barry. I facilitated the
process by making sure that I drove past their door. It was something
that happened because both Barry and I were familiar with this
place and its people. Familiarity is an important tool when you
are working in this approach. Barry, like all of us, knows what
to do because he has done the thing before. I could say in relation
to his brain injury that he responds to cues, and the only reason
that he called in there was because the place provided him with
the cue, otherwise he would not have given a thought to this couple.
But this is no more true of him than it is of me. I will not make
a big trip to call in on someone I do not know very well, but
if I happen to be passing their door I am likely to pop in and
say hello.
He spent a few days carefully scrubbing the stones with
a wire brush before trying to put them in situ. He did this
spontaneously and discovered in the process that one of the
'stones' was actually a lump of clay. He very honourably didn't
point out that the lump of mud was all my stupid fault!
We got the readimix from Hardware Galore and I tried to
remember what I know about mixing cement, which is not a lot.
On the day designated to apply the concrete he was very slow
and unmotivated. I found it really hard to get him out of bed
and it took him nearly 3 hours to get up. I finally got fed
up and said in exasperation, 'it's your day, so just get on
with it', to which he replied, 'every day is my day and it's
boring'.
Trying to change the behaviour of someone with a head injury
Getting Barry out of bed has been universally interpreted as
a problem by anyone who has attempted to do it. His mother once
said, memorably, “all I want for Barry is that he would
get out of bed”. The strength of feeling in what his mother
said would be echoed by any facilitator who ever worked with him,
yet the idea that getting out of bed should be seen as the main
issue, or even as the main problem, begs the question of whose
problem is it anyway: the young man hiding under his blankets,
or the increasingly irritable facilitator who feels that their
time is being wasted? There have been many strategies put in place
to solve the problem from both sides. For Barry there have been
token systems, contracts, various cues in the form of alarm clocks,
personable facilitators, phone calls, attempts to decrease fatigue.
For the facilitators there have been supervision, training, and
changes in the roster (so that he could not 'string them along').
Yet, 'success' in solving this problem is always tentative and
precarious. One day he will get up, the next day he will not.
Facilitators have resigned over this issue, saying that what he
really needs is a work ethic and that all the effort we put into
him was spoiling him. The difficulties with 'getting him out of
bed' are now considered a rite of passage in the job, you're not
'in' until you have survived one such period. All in all, this
is the one area where a problem based approach has been extensively
used, with remarkable lack of success, given the amount of energy
expended.
There is another way of seeing the issue, reflected by what his
father once said, “Barry will get up when he has something
to get up for”. This simple shift in focus has resulted
in a remarkable success. The 'problem' of getting up, like all
the other components of his brain injury, is always there, but
it is simply not an issue when there is really something to get
up for. In seeing his day as a whole in this way we were able
to help him to connect back into a normal rhythm for our society.
I was really fed up with him so I mixed the concrete and
left him to get on with it. After about 20 minutes he came and
asked me for some trivial advice, which suggested that he wanted
my company and was reason enough for reconciliation. And so
I stood at his elbow while he got on with the next stage, giving
him cues as necessary. He only needs those cues when the task
changes, while he can get on with it himself for the rest of
the time. After 2 hours there were 2 buckets of concrete used
and 3 stones were set in place. He tended to use his fingers
to fill in the smaller holes which was effective in terms of
doing the job, but which burnt the skin on his fingers. I told
him this would happen, but he did not take any particular notice.
We had gone over one of those emotional humps, which I
have become all too familiar with. It was much easier to get
him out of bed and he managed to disarm me completely the next
morning by asking how I was and by making an attempt to remember
the children's names.
It is impossible to stay mad with Barry for any length of time.
He has a delightful sense of humour and negative feelings blow
over very quickly. One can easily and repeatedly get exasperated
by his slowness, so his facility to deal lightly with emotions
is wonderfully adaptive. It takes patience to stand and be ready
to give cues, but not to do the job, which is his work. One of
the difficulties of this job is the excruciating boredom which
can be inflicted on the facilitators as they wait for him to need
a cue from them. This 'problem' has increasingly been alleviated
by bringing about a situation where Barry and a workmate work
alongside each other on the same project.
He knew what he was doing now and over the next few days
completed concreting the stone base by himself, without prompting.
He also found a piece of wood to use for a fishing line after
trying several when we were rummaging under the house. He sanded
this off and tried to plait some fishing line to make it look
thicker and hang better. This didn't succeed and eventually
he attached a huge hook to the end of some fishing line, which
was the perfect accompaniment to the troll. He propped an empty
beer can in the other hand and the picture was complete.
The whole project of putting it in place had taken a month
in between other tasks. Most people would probably have completed
the whole job over the course of a weekend, in between other
tasks. He was really proud of this job though; it was something
that he had done from start to finish which he could really
claim as his own. He had done projects before, such as those
when he was at the Ashford Polytechnic, but it was one of the
rare moments when he could know that he had really finished
something and receive acknowledgement for it. The troll was
in a good place to be admired and it was something to be proud
of. There is no doubt in my mind that he was proud of it and
I felt really good for him and with him. He made the comment
that the troll appeared to be leering at the nymph, which was
indeed true, and funny.
It's not a bad outcome at all when you are able to make a joke
about your work.
Next page: The door
|
Site
Links
Home
page
Abstract
Introduction
Methods and Ethics
Guestbook (to be enabled soon)
Brain damage stories-
Stories intro
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 -
Literature intro
Occupation
Alienation
Being "well occupied"
The practitioner / OT
The person with brain injury
Discussion -
The need for occupation
Becoming well occupied
Facilitation
Ethical concerns
Occupation and neurology
Future research
Conclusion
Works cited
Bibliography
Brain
injury and head injury resources
Occupational
Therapy and carer resources
OT
jobs
Rehab equipment
Physical rehab
Brain
injury web sites
General
brain injury resources
Organizations and programs
USA Brain injury association chapters
Headway branches
Brain injury Research
Brain injury support and chat
Brain injury mailing lists
Personal stories
Residential programs and similar
services
|
