Balance: The Two Minds of Paul Cook

This week I have a personal story about my own experience of two independent minds inside my own head. It began with a bad car accident in 2016: My 6-year-old daughter and I were hit head-on by a car going about 50 miles per hour that ran a red light. We spun and crashed into the car behind us. We both had some broken bones and my daughter needed surgery, but we lived.

My wife was the first to notice that something was wrong with my thinking. I mixed up the dosage on medications for our daughters, twice. That's unusual because I typically have a good awareness about medications -- adherence is one of my main areas of research. As I returned to work we noticed that I was getting more and more tired, to the point where I would have to lie down after dinner or some days even before dinner. Three months after the accident, I was regularly napping in the middle of the day. I was also having a hard time concentrating or following the thread of a conversation, and I was forgetting things much more than usual. By now I was aware of the changes and frustrated by them, which led me to push even harder to keep up with my normal life; but with worse cognitive functioning I was less successful, and even minor mishaps or interruptions by family members could easily provoke an outburst of temper. I had less and less insight when these happened, and was quick both to lash out at others and to see myself as a victim. At night I was worried and depressed, with frequent insomnia. Rather than improving as I had been assured a concussion would, my problems seemed to be getting worse. Eventually I even developed some problems with voluntary muscle control, where my arm would start to wave around without any conscious intention, or I would stop suddenly to avoid tripping on the dog and be unable to get moving again. At the worst point about 6 months after the accident, I frequently found myself unable to get up from the floor or climb stairs, because I felt too dizzy and uncertain of my legs to proceed.

It took us a long time to figure out what was going on. The initial hypothesis of a concussion was quickly ruled out by most of the health care providers I visited, because my symptoms were persistent, I had only a very brief loss of consciousness during the accident itself, and I hadn't experienced nausea at the time. Neuropsychological testing revealed some problems with thinking, particularly on timed tests. That was an interesting experience for me as a psychologist who actually knows how to administer the tests -- in one example I was asked to identify a historical figure (I won't tell you who because of test security ethics); I knew perfectly well who she was and could talk around it -- when she lived, who her friends were, what she was famous for -- but I couldn't remember the one descriptor that I knew meant the difference between a 1-point and a 2-point answer on that specific test question. On another test involving processing speed, I scored 20 points lower than my overall IQ score.

A neurologist diagnosed problems with my vestibular system, the brain's connection to the inner ear that provides balance. She gave me antidepressant medication to help me sleep, and sent me to an ophthalmologist because my gaze wasn't quite tracking with my movement (there was some evidence of a problem, but not a clinically significant one). She also sent me for physical therapy, and I practiced balance exercises. I got stronger and more functional, but still had symptoms. We tried a cognitive-behavioral therapist, who mediated family conflicts, suggested coping strategies, and argued with me about theories of mind. We got frustrated with our lawyer, who kept suggesting treatments and tests. I got frustrated with myself for still having symptoms, and frustrated with my family for pointing them out. I saw a neuropsychologist who thought at first that my problems were mainly emotional, but eventually brought up vestibular problems again. She knew of a different physical therapy practice that specialized in nothing else. At this point we were over 2 years in; I wasn't optimistic but agreed to try.

This time it was different: The first thing my physical therapist did was to put me in a dark room with a little ball hanging from the ceiling. A projector moved dots of light around the room while I focused on the ball; immediately, the sense of motion made me feel so dizzy that I fell over. Later we tried a tilt-table that moved under my feet -- when I looked at my feet I couldn't balance, but when I looked out and away, I could manage it. The more tasks we tried the more it became apparent that my eyes were misleading me, showing motion where there was none. This time we tried balance exercises that focused on my eyes as well as my body, and improvement rapidly followed. When I had trouble navigating stairs, I discovered that it was perfectly easy to go up or down with my eyes closed! I recently tried this on a day when I felt dizzy during a run with my wife -- I was having a hard time even walking, but with my eyes closed I could run at full speed (as long as she kept me from hitting anything)! Removing the conflicting visual input eliminated the problem. It took nearly three years of different tests and interventions, but we had finally gotten to the source of my difficulties.

This experience taught me that the Narrative mind is a lot less independent than we think. When my sense of balance was off, a simple thing like spinning around could lead to confusion, sleeplessness, loss of muscle control, or strong emotional reactions. When I was doing exercises to build up my balance, just turning my head rapidly could make me feel instantly exhausted -- so much so that simply doing balance exercises was enough cure my insomnia when I woke up in the middle of the night. My cognitive symptoms were also tied to balance: In one test, I gave myself a timed test that measures performance IQ on a day when I felt normal, and again the next day when I felt dizzy; the 20-point gap in IQ scores again appeared, even though the second day should by all rights have generated a better score than the first because of practice effects. Most interesting of all, the cure for my complex emotional struggles and confused thinking turned out to involve purely physical interventions like closing my eyes, placing weights on my shoulders, or stomping my feet to feel more grounded. 

Balance is ubiquitous. On any given day we get up from bed, navigate through hallways and staircases, stand on one foot to get dressed, carry packages, drive a car. Each of these tasks is a challenge to balance, which most of us overcome without thinking -- I certainly did before my accident, and even afterwards didn't realize what was causing me to feel so tired and upset. Yet when we are off-balance physically, we might also become off-balance emotionally. I still have balance problems some days, and my brain clearly delivers the message that "something is wrong" on those days. In the throes of my difficulties, I interpreted that "wrongness" as a result of intolerable stressors or unreasonable family members, even though actually it was originating inside my own head. Most of the time now I can recognize what's going on, and take some simple steps to overcome it.