Self-awareness after brain injury: it can feel like you’re “growing up again"
For Krysalis blogger Annie Ricketts, regaining self-awareness after her traumatic brain injury (TBI) has felt like growing up all over again, as she describes in her latest blog…
I am a ‘Grown-up’!
Throughout the last 22 years since I fell on my head, I have experienced a strong sense of growing up again.
My awareness of this phenomenon took around eight years to begin. I recall the insight of feeling like a four-year-old child in terms of wisdom and life experience around that time.
For me, conscious awareness of motive begets wisdom. It took more than 15 years for me to formulate and actively use questions, and eventually, they became part of my fabric again.
Questions help us understand our motives consciously. I still consider the following:
- What is behind my thought?
- What understanding or perspective is driving my behaviour?
- What do I believe?
- What have I learned before about this?
The funny thing is that simple awareness doesn’t create a change in activity; it takes much more practice!
Awareness grows relative to what we learn; it grows incrementally.
Think of it this way: we know much more about math when we leave school than we knew when we started. The same goes for the way we add to our knowledge about life.
Time and participation increase understanding and broaden our appreciation for depth and complexity – for perspective.
According to a paper by Crosson et al. [1] about organisational learning, awareness grows through stages:
- Intellectual knowledge of something new
- Emergent or growing recognition of more contextual information about a subject
- Anticipatory awareness (the final growth stage) is when we begin to foresee situations where this knowledge will be used and valuable
The injury to my brain entailed losing all sense of self and all my experiential memory. In other words, my history became inaccessible to my consciousness or mind.
I couldn’t make any personal consideration of ‘self’ because the book about ‘self’ was no longer in the library – there was no record of its location or who checked the book out.
Without any memory of who I was, my connection with my previous life became detached. While it didn’t feel like it was missing per se, something far more profound was distinguished.
I now know that the candle remained, but it has taken years of perpetual effort to relight it.
I felt as though I had lost my soul. 
I could no longer ‘see’ or observe myself. Every moment was fleeting. And where there should have been a conscious awareness of my thoughts, there were only dandelion seeds floating on the wind.
Sometimes I would catch a glimpse of something familiar and believe I was making progress.
I would visualise the odyssey as looking for my home in a dense expansive forest. I could smell a wood fire, and then the sense would fade. I could see a tile through the leaves only to take another step forwards, and the perspective would become lost to me.
In year six, my occupational therapist, Emma, would talk to me about the loss of experiential memory. I had no way of assimilating the information any more than someone could see a microbe without a microscope.
Emma also told me that my database of experiential memories would only rebuild as I started to venture out and embrace life again. Through living and embracing life, we can reconstruct a history of our perspectives.
I had no idea this would eventually encompass and increase my sense of who I am, but I believe the two have walked hand-in-hand.
Shifting from protective isolation is gradual!
Over the years, gentleness and patience overrode any desire to rejoin the everyday world because I knew I remained vulnerable and lacked confidence with neurotypical people.
This sensibility stays with me to this day, although I choose to grip my courage and regularly stick my head above the parapet to encourage others to keep moving forwards.
I face my fears every day, but I had no idea how far I had come until I visited a friend last week.
We met when I worked in a country house as a cook. I thought I had applied for a cleaning job, and much to my horror, I ended up in the kitchen!
Despite a previous career as a business and manufacturing consultant, I felt pressured by disappointed and embarrassed family members to do something – anything.
After a long year of chaos, periods of homelessness, and dismissal from one job after another, I returned home in debt and desperate for peace.
When I arrived in the hamlet to visit my friend (and where I first tried to regain my independence), I opened the car door and, standing up, a feeling of being extremely tall struck me like a lightning bolt!
A saturating feeling of glee overthrew my intention to say hello to the cattle in the field!
I thought, “I am a grown-up!”
While cognitive and executive functioning continue to plague me, I realised that the assertive and ‘can-do’ Annie of old was standing tall and ready to behave like an adult.
My awareness has grown, so I actively encompass other people better.
I ask them questions, and while I may still forget the answers, my world is now fuller and richer because I am greater than the small child who was so lost she became absorbed in the isolated microcosm of limited consciousness of self.
There is no choice about how an injury to the brain will affect us. There is no magic pill to get better. Rewiring the brain felt like starting from scratch – but look how far I have come!
I am a grown-up who understands the world around me, and now I consciously choose to stay outside of it.
The world is too fast, aggressive, competitive, selfish, and too senseless for me to step back into it willingly. The outside world is mindboggling, and my brain isn’t capable or ready for the daily ‘charge of the Light Brigade.’
Twenty-two years ago, I was a part of the ocean; now, however, ‘grown-up’ I am, when I step into the everyday world, I am a ping-pong ball thrown with a whim into the maelstrom. One experience and one friend at a time!
My home is my haven. Here, I can manage the ‘incoming’ from the world. Here I am, safe; here, the infinitesimally slow process of rewiring my brain isn’t an issue.
On my own, I have the time and space to figure things out. I can swim while capable and retreat to dry land as soon as needed.
*Former international businessperson, Annie is the founder and Co-director of the UK branch of GBIA INC, a global brain injury support network.
She is also a valued Krysalis blogger, having found support through occupational therapy since her accident in 2000.
Further reading
Annie talks about how neuro OT helped her to find herself again after her devastating horse-riding accident: How Neuro OT transformed me four years after a brain injury.
Knowing me, knowing who? Losing self-awareness after an acquired brain injury is one of the biggest barriers to rehabilitation. Find out what ‘small change, big impact’ OTs can make here. Self-awareness after brain injury
Catch up on some of the latest research revelations from around the world in vocational rehabilitation (VR) for people with neurological conditions: OT reality of virtual vocational rehabilitation (VR) and other updates in supporting workers with neuro conditions.
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