In a recent post, Item 9 called for a review of the application of Kaizen to recovery from mTBI. in the next post, such an application was dismissed due to the fact the mTBI victim lacks the ability to gain full process control. Absent such control, it is impossible to establish a baseline state that may be used to measure performance excursions. Without a defined baseline, any intervention is reduced to tinkering, a series of blind attempts to achieve positive change without an understanding of the drivers, or obstacles, to that positive change. This suggests Kaizen may have limited application in an intervention targeting mTBI victims.
On today’s walk, I realized this dismissal of Kaizen may not be entirely appropriate. It is correct with respect to the need for a baseline state, and for full process control. But the true benefit of Kaizen to the mTBI victim is that it delivers a robust methodology which may offer significant benefit despite the lack of full process control.
Increased Patient Autonomy
An increase in patient autonomy is one such benefit. My proposed Sleep Experiments are not yet complete but the fact of having established a structured approach to the problem has delivered a sense of self-empowerment, the awareness that I now have the capacity to effectively address aspects of my injury, and that this outcome may be achieved independent of outside medical intervention.
Increased Discovery Potential
A second benefit comes from the discovery potential associated with implementing a methodology for self-monitoring. Data collection is not yet complete (data collection is to be performed over a 30 day period to obtain an accurate picture of existing sleep habits) but there already exists evidence of a highly fragmented sleep cycle. This discovery of a high degree of sleep fragmentation is one positive outcome of undertaking the review.
Benefits to Therapists
Increased patient autonomy, and increased self-discovery, delivers benefits to medical personnel. While my sleep disruption has been ongoing for a considerable period of time, I do not believe it was reported to the medical professionals treating me. I did not report it as I did not “see” it. This may sound an outlandish claim but I my experience of my injury is holistic, integral, and complete. Without the application of reductionist science, I simply took it for granted the sleep issues were part and parcel of the mTBI. I did not break out the sleep issues from the constellation of events associated with the injury. My primary concern has been with not burning the place down, not with how many hours of sleep I may, or may not, be getting.
The fact that I now have, or soon will have, valid data to present to my physicians is a benefit to both them and to me. This same approach may be extended to other aspects of my day to day functional performance.
mTBI and Loss of Self-Identity
The mTBI victim is faced with the loss of a self identity which has been developed over a period of years (I am defining self-identity as being a collection of learned behaviours unique to the individual subject). Self-identity is associated with, or confirmed by, the effective capacity of the individual. Self-efficacy delivers an unconscious appreciation of our individual performance limits and boundaries. I know I can swim across the pool. I doubt my ability to swim the English Channel. Self-identity also hosts a Self Narrative, a concept discussed in this post.
This awareness of self-efficacy, and the identity narrative constructed on this awareness, persists past the date of injury and may form an obstacle to recovery. I am thinking of the quote from Lezak to be found here. In my own experience, a key source of psychological conflict has derived from the discrepancy between my pre-injury self narrative and my compromised abilities consequent to the injury. It has been extremely difficult to release my prior sense of self and accept a refreshed sense of self wholly contingent on my current degraded capabilities. This lack of acceptance has resulted in significant psychological problems; it has been a major trigger for recurrent depressive states.
This disjunction between past and present, between the effective past and the impaired present, has not been wholly negative. The resulting cognitive dissonance has served as a major motivation to embrace new therapeutic approaches and to undertake an aggressive attempt to reacquire my past abilities. I have been extremely unwilling to surrender to the injury.
This unwillingness to surrender to the injury also results in negative outcomes. These have taken the form of denial, a refusal to accept the wisdom of my doctors, and the adoption of a “bulldozer” mentality that may have impeded a positive recovery rather than supported it.
Kaizen offers a means by which the injured subject may conduct his/her own structured performance reviews. More importantly, it delivers to the individual a methodology by which the subject may define metrics which identify baseline performance for a specific date. This then permits the subsequent confirmation of any degree of improvement that may be achieved.
Even if no improvement is possible, Kaizen offers the potential for a self-directed constructive coping strategy which assists the victim in accommodating to their present day capabilities.