In a prior post, I gave a description of my current understanding of my injury. That my problems stem not from damage to functional sites, those areas of the brain that concern specific faculties such as language ability, or cognitive skills, but from damage to the arousal system.
My injury involved a compression wave, a transient energy pulse that caused injury to those parts of the brain sited toward the rear of the skull case. My understanding of brain architecture is that this area contains brain components responsible for arousal.
If we think of the brain as a form of computer, we see that it can sit there, and be merrily humming along, performing a series of internal routines not visible to us. We have no idea what the computer is doing when it is in this state. The brain appears to have a similar state. Significant proportions of brain activity are unknown to us. This insensible activity is not formed as a conscious thought. There is no apprehensible output apart from the fact the body continues to percolate, to breathe, to distribute oxygenated blood, to operate the liver and the intestines.
The Intel x86 architecture is interrupt driven. When you wish the system to perform some activity, you issue INT 21h and pass a set of parameters to the appropriate CPU registers. Certain hardware will also trigger an interrupt. At the moment I am banging away on the keyboard. The machine is in an idle state, I bang a key, the keyboard triggers a request on IRQ1 and the system ceases whatever it was doing and it directs its full attention to handling the keyboard input. The keyboard input is stored into memory and displayed on screen. The machine then returns to its idle wait state. A few microseconds later there comes another bang on the keyboard and the process is repeated. Do this enough times and you end up with a novel.
My speculation is that the brain is similar. It contains a variety of domains each of which serves a specialized purpose. Somewhere in the brain there is a mechanism which monitors CO2 levels in the blood. When CO2 levels reach a certain point the brain orders a new breath and directs the heart to pump the freshly perfused blood at some required rate. This is the involuntary system, a set of relationships over which we have little, or no, control.
The second system is the voluntary system which is under our control. This voluntary system must contain within itself something akin to INT 21H. It must also contain some form of interrupt vector table that tells the brain what to do, what functions are to be performed. This vector table will link to other sub-routines and this set of linked sub-routines, when triggered, will result in the desired action taking place. Much of this is likely learned behaviour. When we hear the word bicycle, we have trained ourselves to conjure up a specific image. When we want to say “There is a bicycle” we have trained our brain to cause our mouth to emit the required phonemes in the correct sequence. If what comes out of our mouth is “There is a cabbage” when we actually meant not “cabbage” but “bicycle” then something is seriously wrong. When we see a bicycle and are unable to identify it, or mouth the correct sounds, something else is clearly wrong. A state of apathy implies a lack of arousal. When I read Dr H’s clinical notes from 2012, that is the observation that I find.
My belief is that my injury caused some level of failure in the brain’s interrupt handler, or in the brain’s interrupt vector table. All of the subordinate functions remain present, uninjured, and available. What was injured, and therefore compromised, were those portions of the brain architecture that permitted interrupt handling. I lacked the ability to trigger and process interrupts. I was unable to arouse the required brain functions.
In the aftermath of the first insurance appeal, I found myself sitting quietly, staring at nothing. I was like a computer that was turned on, but not performing any worthwhile function. I was stuck in an idle state and lacked the means to trigger a voluntary response.
During the preparation of the insurance appeal, I forced myself into action. Performing relatively simple tasks required a huge amount of effort. My belief at the time was that if I did not make this supreme effort, my life would end, that I would never regain the lost function. I was absolutely of the belief that my survival demanded I obtain assistance from the insurer to access the required therapies to ensure full recovery.
Because of this push for life, this herculean forced effort, I obtained a sense of contrast between the extreme effort active state and the post effort vacant state. Becoming sensible of this vacant state, and the contrast between the two states, created in me the desire to return to the active state. I cast about for a project that would permit me to impose further demands upon myself. But when I did so, I bit off more than I could chew and I ended up in a huge life crisis.
What is critical is that the effort associated with the insurance appeal delivered my first awareness of the injury. This awareness derived from the contrast between the two states: 1) the period of forced activity in which I mustered all of my will and effort to create the appeal document; and 2) a subsequent period in which I returned to my post injury baseline. Because I had an opportunity to sense the difference, to experience the contrast between these two states, I had both reason and motive to engage in further activity that returned me to an active state of mental engagement. And this is exactly what I have been doing since the fall of 2012.
Note:
Have had this strange feeling that I have written on this topic before. Just found the other related post which is here. This post provides a link to a 2012 post on a related topic.