Category Archives: Assess

Suppressed Thoughts

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On the walk to the post office to mail the reimbursement submission, I realized I have actively suppressed thoughts. I was not aware of this until today. This insight explains some of my other behaviours.

I know that I am trying very hard to avoid a depression spiral. This is the proximate cause of the problem. A thought enters my mind, I recognize the thought involves a negative association and I seek to suppress the thought. At night, when falling asleep, I am less able to suppress thought. At the edge of sleep, all those thoughts I have attempted to suppress, or ignore, come floating back into consciousness and I am unable to avoid them. This surrender to the problematic results in an extended period of wakefulness that makes it impossible to enter sleep.

Suppressed Thoughts

This may not be a complete inventory. These are some of the thoughts I found myself attempting to suppress today.

Loss of self as evidenced by projects, or objects, toward which I no longer have any emotional attachment. This has two aspects. The first is the shock that accompanies each “Pompeii moment.” In Pompeii, the citizens became frozen in time as they were smothered by the ash of the exploding volcano.

My Pompeii moments result from the accident. As I clean up the house, I discover old projects abandoned in progress, projects abruptly arrested by the after effects of the crash. I downed tools, walked away, and never returned. The project has been untouched for three years.

This phenomenon has a second aspect. It also speaks to the degree of routinization. Subsequent to the accident, I became enmeshed in a narrow routine and rarely exited this behaviour pattern. The routine focused on the most basic life skills. I cooked. I washed. I slept. I wrote. Everything else was cut away, abandoned, left untouched.  Today I have become an archaeologist, picking over old tracks, trying to interpret and make sense of what I find.

It is a cold shock to rediscover my injury in the form of these abandoned moments. Each discovery leaves me more hesitant, tentative, uncertain, mistrusting. I learn that I cannot trust myself for the world I perceive as “out there,” this world of solid phenomena, exists primarily in here, in the wet pulp between my ears. Somehow a set of operations more intimate than sex, more complex than calculus, that unfathomable nugget that is me, was me, has eroded away, become atrophied, lost, disappeared. And this ghost of ego departed on quiet cats paws, silently, without me ever noticing it had left.

There is nothing positive about this epiphany.  It leaves me shaken and choked to the core. Even when writing these words I am left to struggle with my comprehension of these effects, their implications for what it means to be “me,” to be human, a member of homo sapiens sapiens.

 

 

 

 

Submission

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Much of today was spent putting together a submission to Québec Santé to obtain reimbursement of payments made for medical services rendered in Ontario. There are very limited resources available in Québec. A year ago I wrote a complaint to Québec Santé regarding my inability to find a GP and I received an email in which they acknowledged the critical doctor shortage.

The submission is not a complex task. It requires assembling multiple documents:

1) A copy of the receipt issued by the Doctor.

2) Copies of the four cancelled cheques confirming the payment made.

3) A completed reimbursement form.

While relatively simple, this submission was difficult for me to put together. I quickly became very frustrated handling six pieces of paper, confirming they are in sequence, ensuring I print out the correct copies, and that the dates on the cancelled cheques match the treatment dates on the receipt.

As soon as I sense myself becoming frustrated, I become even more upset by my inability to perform this relatively simple task. It is beyond belief that I cannot complete this task quickly and easily. During the period when I worked for Gargantua, I was responsible for undertaking weekly performance audits for 30 persons. This was a much more difficult job than the reimbursement submission. It was undertaken under severe time constraint with a number of other variables that increased task complexity and difficulty. Despite this, I experienced no problems. Today, I undertake a much simpler task and I encounter problems.

This submissions task has been a recurring problem since I commenced seeing Doctor H two years ago. It has not become easier over the course of this interval. So there exist pockets of improvement (such as my improved ability to write, or to blog), and other areas of task performance in which improvement is limited to non-existent.

I try and focus on the positive aspects of improvement. Doing so provides me with a confidence boost, and helps me engage the world in a positive manner. When I encounter performance deficits, such as this submissions issue, the experience is extremely deflating and it quickly undermines the narrative of performance improvement.

Submission Insight

Immediately after drafting this post I felt overwhelmed. Identification of this issue negates any narrative of self-improvement. I once again feel as if I am deceiving myself. This sense of self deception erodes all confidence and initiates a downward spiral of self-recrimination, and despair.

The insight derives from the observation that my response to despair was to commence a mindless, and highly repetitive, blog housekeeping task. Writing is soothing and calming. Performing endless repetitions of the same task is also soothing and calming. The repeated performance of routinized tasks anchors me in a context which is within my capacity. I gain a sense of achievement that serves as a salve to an ego bruised by the forced acknowledgement of a deficit.

This observation provides a psychological rationale for routinized behaviours. It also explains where the last two hours went.

 

 

 

 

 

Decision Making

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I have had this sense that emotions are critical to decision making. Yesterday, while puttering around on the Internet, I came across a story which supports that view:

Talk about a “sea change”: today cognitive neuroscientists have begun to understand how our emotions drive virtually every decision we make, from our morning cereal choice, to who we sit next to at a dinner party, to how sight, smell, and sound affect our mood.

The above quote is part of a much longer book excerpt. The full document may be found at Salon here.

A decision involves a choice between two alternate outcomes. Once you begin to examine even the most basic decisions, you quickly discover they mandate the review of a significant amount of information. Sifting through this information requires brain horsepower. It also requires considerable time. Brain horsepower, and time, are both scarce resources. The brain is able to maximize the utilization of these resources through the use of heuristics and bias. Let me give you an example.

What are you going to eat for dinner tonight? My hunch is that you have an initial response, an immediate preference which makes itself known to you almost instantly. You didn’t need to think about it much, if at all. The answer was immediately conjured up.

If you then begin to unpack your initial choice you will likely find it was based on your existing “preference envelope,” a food stuff that you prefer above all others. In fact, once you begin to search the fridge, or your shelves, you may find the desired food is not available to you.

Were you to attempt a “rational” answer, the amount of decision relevant information would increase exponentially. Do you consider the health benefits of your next meal? Do you contemplate potential weight gain? Do you estimate the micro-nutrients required to fulfill your daily requirements?

Or do you invoke an economic perspective and consider total meal cost against your available cash budget? Decision making now requires an answer to the question “What can you afford to eat?” rather than simply what you want. Or do you begin to contemplate the amount of time required for food preparation versus the amount of time you have available? I am hungry and want sustenance now! is much different from thinking about hunting through recipe books for an hour for that Mexican recipe which requires two hours of preparation time.

The point to all this is that decision making has the potential to be a difficult and time consuming process. The mind is able to shorten this process by using established bias as a trigger criterion. This results in a satisfactory quick decision. It may not be the optimum decision but it is a workable solution.

My hunch is that decision making is subject to emotion based bias. We make choices not on the basis of observable fact, and established rational criteria, but on emotional bias, on hunches, and on memories of past pleasures.

When I try and understand why it is that I spend long sleepless nights in review of very basic events, my sense is that my inability to arrive at a decision is due to some impairment consequent on the injury. I have difficult deciding what to do because the emotional bias that would assist in decision making is in some way impaired. The outcome is that I need to do two things:

  1. Follow established patterns and routines so as to reduce the burden of decision making
  2. Where I lack such established patterns and routines, I am forced to undertake an intensive review of decision relevant criteria in order to come to a decision. This intensive review is what keeps me up all night.

Update July 21st 2014

I saw Dr H today and she described my night time efforts as an attempt at problem solving. I think her view of the process is better than mine. What I am doing at night is acknowledging a problem and then attempting to arrive at a solution. I face two different obstacles. The first is gaining an overview and awareness of my situation. The second is making a decision based on that awareness. I appear to have difficulty with both of these processes.