How I Rescued My Brain (26 page)

Good-quality sleep is also critical for brain function, he says. Brainwave patterns allow the hippocampus to send information to the left PFC and into long-term memory. Rapid eye movement (REM) sleep relieves stress. During REM, more neurotransmitters are produced, through the process of regeneration. I remember that Norman Doidge mentions something similar in his book: he states that sleep, and REM sleep in particular, facilitates neuroplastic change, as it assists the growth of new neurons and of myelin. During sleep, the brain sifts through the short-term memories of day-to-day events, consolidating the important ones into long-term memories. So I need to do whatever I can to sleep better. Wayne has already told me this too; now I've got further confirmation.

According to Pieter, changing the pattern of fearful thoughts requires mindfulness: conscious awareness of thoughts and sensations in the body. Writing about personal experiences activates the left PFC and can create a sense of safety and control. The writing process increases blood flow in the left PFC. I remember how writing out a list of trauma memories the day before the stroke was the only way I could get them ‘out' of my head.

Art therapy reduces thought loops in the right PFC by allowing the expression of emotions in a non-verbal form. Music activates the left PFC by forcing the brain to think in sequences and to remember; listening to music is less effective than making it, I learn. Conversing with a friend activates the left PFC. Travel and walking also enhance neuroplasticity, Pieter says.

Novelty — being in new situations or learning new skills — challenges the brain, keeping existing neurons alive. It is the old catch-cry of ‘use it or lose it'. Novelty promotes new neural connections, stimulates the growth of myelin, and can trigger neurogenesis. The more concentration it involves, the more neuroplastic change it induces. I think of my music: singing lessons with Lily, duets with Nick. These are new experiences and new skills, challenging my brain. I'm heartened to learn how much I'm doing right.

Someone asks how long it takes for brain changes to occur with therapy. Pieter tells us that with psychotherapy, consisting of one or two weekly sessions and daily homework exercises, it will take about four months for the therapeutic change and new neural pathways to become established. He says that psychological resistance can be thought of as a reversion to the old neural pathway.

The course is hard-going: I have a long sleep during lunchtime on the first day, which re-energises me for the afternoon. On the second day, after lunch, I can feel rubber brain setting in, but I want to stay on because it is so valuable. Yet by the mid-afternoon tea break, it's clear that I'm not taking anything in. I catch up with James and tell him that I'm leaving; he'll get a copy of any new notes for me and we'll chat about the workshop at our next meeting.

I realise after the course that one thing Pieter didn't address specifically is food for the brain. Over the next few days, as I'm reviewing my notes on the course, I consult various articles. I learn that the omega-3 fatty acids found in fish oil promote neuronal growth, improve mood, and slow cognitive decline. I read that vitamin B is critical in the synthesis of many neurotransmitters, and that vitamin E is the main antioxidant in the cellular membranes of the brain. I think I get enough Vitamin E in my diet, but I'm not sure about B.

My newest treatment practitioner is Doctor Franklin. On my fourth session with Doctor Banister, after the stroke diagnosis had been confirmed, he had seemed preoccupied and said he needed to make a home visit straight after our interview. He offered me few useful insights or advice. He was the most expensive doctor I'd seen, and I had difficulty paying his fees. I had never liked having a client of mine terminate sessions with me, but I was not happy with the service Doctor Banister was providing. I spoke with a GP acquaintance I bumped into, and she encouraged me to change psychiatrists, saying that I did not need to give a reason. I decided to move to Doctor Franklin, who has a private practice. (In our last session together, Doctor Banister said I could return to treating anxiety clients, but not traumatised ones; he was really out of touch with what was happening with me.)

So on my next visit to Doctor Franklin, I ask about vitamins. He encourages me to take omega-3, but insists that I take 1000 milligrams of the DHA and EPA combination per day. He explains how to read the information panel on the side of the bottle to assess the percentage of these fatty acids in each capsule, so I can determine how many I need to take to reach 1000 milligrams. He mentions vitamin B12 as especially important for me because I do not have a high-meat diet, although I have an adequate intake of fruit and vegetables. I've still been taking 100 milligrams of aspirin daily as a blood thinner, on Doctor Small's advice, and the St John's wort. So each morning and evening, I set up my collection of pills on the kitchen bench, pleased that I seem to have all bases covered.

15

THROUGH MY READING
and discussions with James, I learn that we possess a system of mirror neurons, as part of the motor cortex, which allows us to interpret another person's actions. Mirror neurons fire both when we act and when we observe someone else performing the same action. For example, if I see someone lift a cup in their hand, I can anticipate that they are going to drink from it because the same neurons that would be involved if I were thinking of taking a sip are firing in my brain.

Mirror neurons are also found in the frontal and parietal lobes, enabling humans to gauge another person's intentions and sensory experience. James and I are especially interested in the part the mirror-neuron system plays in therapeutic empathy.

Some locations in the brain are at the centre of several neural pathways, like busy crossroads. The insula is one of these. It is part of the cerebral cortex, and at the crossroads between the mirror-neuron system and the subcortical areas of the brain and the frontal lobe. Sensory information comes to the cortex from throughout our body — from the major organs such as the lungs, the heart, and the intestines, and from our peripheries — via the insula.

The mirror-neuron system is also part of a network that gives us the capacity to infer others' emotional states. Our feelings can originate from our bodily organs, the brain stem, and the limbic area, and the input these provide to cortical functioning. This is how a ‘gut feeling' or ‘intuition' is formed. The insula appears to be the nub of our interoceptive sense — the awareness of our internal states.

Siegel calls the neural pathways that let us read others' intentions and feelings the ‘resonance circuits'. The insula and the mirror-neuron system are part of these. How well we intuit another person's state of mind depends upon how well we know our own. We use our bodies to resonate with the emotions of others. People who are more aware of their internal states can be more empathic with others.

Sensory experiences are encoded in our neural networks, so they have the potential to be recollected as memories. Scientists distinguish two types of memories: implicit and explicit. Implicit memories form without conscious focused attention. When we recall an implicit memory, we don't have the sense of bringing it up from the past. This is because the hippocampus is less involved in the formation and recall of implicit memories. Procedural memory, which is involved in riding a bicycle or driving a car, is a type of implicit memory. We do such things without needing to recall how and when we learnt them. Phobias can be underpinned by implicit memories. A phobia of dogs — an emotion-laden implicit memory — can be caused by an early childhood experience of being frightened by a dog, and yet the person with the phobia often has no conscious memory of this happening.

Implicit memories colour our psychological states without us being conscious of why. When we meet someone for the first time, we have an automatic, unconscious reaction to them, whether negative, positive, or neutral. This response is based on past experiences we've had of other people. I dislike ‘smelly fish', and when I told my sister of this once, she reminded me that our mother fed us tin after tin of sardines when we were young: something I had forgotten. My sister doesn't like smelly fish either.

An explicit memory needs to be consciously recalled or remembered. It can be a factual memory (semantic memory) or a memory of a life event (episodic memory). For example, I remember specific occasions when my father or a driving instructor gave me driving lessons: episodic memory.

Memories, with their sensory and emotional components, are stored throughout the brain. But it is the hippocampi's role to encode and recollect explicit memories. The left hippocampus specialises in facts, while the right specialises in self-related memory. If the hippocampus is temporarily shut down during an experience, a person's memory of that event is fractured. Rage, terror, and other intense emotions, as well as alcohol, drugs, and neurological illness, can shut down the hippocampus.

I realise now that my amnesia following the stroke was contributed to by my left hippocampus being partially disabled, leading me to think my first day in hospital was only an hour long.

In a flashback, as occurs in post-traumatic stress disorder, only fragments of images, sounds, touch, and smells are recalled, but the emotional re-experience can be as terrifying as the original. It feels as if it is happening all over again, not as if it is simply a memory from the past. The flashback is triggered by perceptions, emotions, and actions that bear some resemblance to the original event. Recurring flashbacks strengthen the memory.

Psychotherapy tries to bring the hippocampus and the explicit-memory system into play. This creates new neural connections. Therapy requires a dual focus of attention: the person re-experiences the traumatic memory while also being aware that they are in the present moment where nothing bad is happening.

Psychotherapy needs to be done in a safe place, with a person the client trusts, and sees as skilled and protective. The individual needs to re-experience memories while being aware that they are safe, and not in the same time and place as the original traumatic experience.

Wayne is the mental-health practitioner with whom I feel the safest, followed by Doctor Small and Doctor Franklin. Before my stroke, in early 2009, Wayne and I had gone through a process of desensitising individual trauma memories. He'd thought that I had them under control before our financial situation blew up. Yet the demands and threats from creditors had re-activated them and they were re-traumatising me; I couldn't deal effectively with the financial threats in my current state, he said.

He had explained the desensitising process while I sat on the sofa in his office. ‘I will remind you that these are memories of the past, and I will be asking you to look at them as the person you are now, with all your current strengths. We will be working with your intuition, which brings up material that needs airing.

‘I would like you to close your eyes and show me a sign — perhaps raise a finger to indicate “yes” — so I know when you are ready to proceed without you needing to speak to me,' he continued.

I raised my left index finger.

‘I would like you to go back through your past, bringing to mind a troubling memory, and when you're ready, describe it to me.'

Flashes of memory emerged out of darkness, filling my mind's eye like a slideshow and then disappearing, until I was left with one that stuck. It was of a time when I was working in the prison system. I had just run the morning group-therapy session in the Drug and Alcohol Rehabilitation Unit, which housed about eight inmates. I usually conducted individual counselling sessions with one or two of the inmates after the group. This particular day, Rob, an armed robber with a drug addiction, sat across from me at a small table in the corridor around the corner from the group room. He was a muscular man, clean-shaven, with a crew cut and tatts on both arms. Dressed in green shorts and a tan-coloured singlet, he exuded an air of angry indignation.

I was, theoretically, under the observation of the prison officers on the other side of the glass security screen that looked into the main room, with one officer present in the group room. But if an inmate became violent, the worst would've been over by the time the officers could give assistance.

Rob had been telling me he had no choice in committing the crimes of which he had been convicted.

‘But you did have a choice,' I said.

This set off an internal spring in him. ‘I fuckin' didn't,' he said, jumping to his feet. He leant over the table, staring me down, his face pale with rage, his right elbow cocked, ready to pummel me.

I threw my arm across my face and leant back in my chair. We held our poses for what seemed like minutes, and then, all of a sudden, his face transformed, as if a demon had left it, and he sat back down. His gaze rested on the table. Nothing was said. No officer came over to us.

I was shaken, but told myself that I hadn't been hurt. ‘Want to start again?' I said.

He nodded, and our conversation sputtered back into life.

At the time, I had seen this as a normal part of my job — something I should be able to deal with. But I was surprised, sitting in Wayne's office, how insistent this memory was — how alive it was — more than twenty years later.

My eyes were still closed when Wayne asked, ‘Would it be okay to look at this memory from the perspective of who you are now, with all your current strengths?'