Time to Talk Day - The Power of Small: how the still, small ‘inner voice’ of calm can aid mental health after brain injury.
Your inner voice can help guide the way after brain injury, advises Krysalis blogger and brain injury survivor, Anne Ricketts.
But how can you hear it amid the maelstrom of cognitive, physical and social changes that often occur following such a life-changing event?
As this year’s Time to Talk Day calls on the ‘power of small’ conversation to make big changes in mental health perceptions, Anne suggests we all give ourselves a proper talking to too. Here’s how…
The other day, I was chatting with some peers about mood changes and managing depression and anxiety after a brain injury.
This discussion brought to mind the amount of work I have done over the last 20 years to make my own injured brain think like and feel more like 'me' again.
Many of us these days are struggling with keeping positive and happy. A more significant number of people have suicidal ideation and depression due to changes in every aspect of their lives over the last year.
We know why more people are finding it challenging to keep their mental health balanced, and we understand why so many people are battling to keep going, so why is it so often hard to discuss?
I think many people approach others in a fix-it frame of mind, so, rather than listening, they are busy offering tips and solutions without realising how fruitless these can sometimes sound.
No one wants to remind that we use fewer muscles to smile than we do to frown.
There are, of course, many reasons why people endure depression and anxiety, and it is known that the biochemical cascade that starts after a stressful or traumatic event can be the impetus.
Over the last 20 years, I have experienced perpetual and unfathomable cognitive impairment with multiple complex challenges that remained beyond my awareness and have taken absolute diligence to unravel.
I lost all of my core beliefs, and therefore my brain no longer had a go-to list of personal preferences to support its automatic or habitual functioning.
I have learned a lot about myself and the role the automatic brain plays in our lives.
Think of your brain containing a key or index to preferred, repeated and often used information.
It is the list of contents or strategic headers that the brain uses to create our emotions, moods, thinking patterns and behaviours.
In essence, this creates who we are; the familiar self and character that everyone can recognise and predict.
When this 'index' is disrupted by poor diet, prescribed and recreational drugs and other toxins, stress, injury or emotional/psychological trauma, we can lose touch with our drivers.
The brain takes over, and it feels as though you are a victim of its whims.
Because so much of who I was had been erased by my injury, my brain knew, no more than I knew, what choices I regularly made before my injury, or why.
I had to rebuild who I am from scratch so that my brain could create the responses to life around me in ways that make me who I am.
Without a doubt, we all have unique personality profiles. Some of us are the glass-half-full type, and others are more sceptical, take more time to assess risk, or worry more about possible unknown contributors to indefinite consequences.
One thing I learned from my brain injury, that I think is useful to everyone, is that our brain isn't who we are – it is a tool that we use.
Problems with executive functioning after brain injury often leave us unable to fathom the obvious. It is a curious thing for other people to observe – especially when you don't have any noticeable outward scars.
I think people battling mental health challenges often meet the same type of uninformed judgements, which can sometimes hurt and set them back.
It took me over 18 years to be more successful at breaking things down into manageable pieces to process and understand things happening to me and my environment.
One of the components vital in this process is taking the time to ask ourselves questions. You have to investigate to gain understanding and to create tools that improve the way your mind works.
Introspection helps us understand our beliefs. Since these lay at the core of our brain's preferences, we can use any deeper understanding of what makes us tick to strengthen the brain's automatic actions.
We can, effectively, reprogramme our brain to reflect who we are in more positive ways.
Asking questions also lets the brain know that we are taking control and that we aren't letting a poor brain environment dictate our lives.
To feel this sense of control, we need to master how we hear and listen to what the inner narrator is saying.
This thinking voice should be monitoring and observing what we are doing and saying. It is a bit like having a passenger in a car with us who watches our every move and helps us be more aware.
This ability to self-monitor is called metacognition. This skill, or tool, is often lost following a brain injury and can also lose its audibility in people living with depression and other mental and mood disorders.
It feels like everything happens to you, and you have no say in the matter.
I always remember a neighbour who had bipolar saying it felt as though some great dictating finger was pointing at her choosing her life on her behalf.
I believe this is similar to how people experience loss of self-awareness and insight after brain injury.
Essentially, self-awareness is the ability to know what we are doing as we are doing, or even saying.
It starts by hearing what we are thinking about.
I will give an example. While writing this, I occasionally get stuck for a word or phrase. I know it will take a while for my brain to conjure up what I need, so I am tempted to change the screen and to go and do something else.
Because I am now aware of this temptation as it is happening and can hear myself saying, 'I'll give myself time to think,' I can catch myself in the moment.
And because I can monitor what is going on, I can make a conscious choice not to allow myself to be distracted and, instead, focus on what I am doing not to lose track.
Being aware of our go-to or core beliefs is a practical step towards better mental wellbeing.
To my mind, the instant we start being the captain of our ship again is the instant the brain falls back into line as a subordinate!
I found that teaching my brain about my most essential preferences was arduous work. It felt as though I was brainwashing myself because the minute I would make a positive choice about a core belief, my brain would forget it again, and I would have to try again, and again.
It was a perpetual battle, but I am indeed the winner in the long run.
I decided, after much deliberation over many years, that being happy was a priority for me. I wanted my brain to react to this preference before and above any other possibility.
Whatever happens to me, my brain supports me in making choices based around this personal ethos: I am always happy.
Even when I am tired or have a lot to think about, which is hard work for me cognitively, I still feel happy inside my head.
When things don't go to plan, I fall back on other core beliefs, such as knowing things always happen for a good reason, or that I have been saved from going off down the wrong path.
I accept life as it comes and adjust to any challenges.
Plans are flexible, and there are always choices. I go with what shows up rather than digging my heels in and battling against it.
The more we understand how our brains work, the more we can control what that little voice inside is saying to us.
The more we practise listening to the inner narrator, the more we can use it to our advantage.
When I catch myself having an adverse reaction or thought, I notice it immediately because I have practised becoming aware again.
I listen and then choose whether the thought serves me - in which case it will benefit others and boost my ability to be self-responsible.
If the view doesn't put a smile in my head, I put it under scrutiny, consider my options and change it.
I refuse to be a slave or victim to my brain. I am the control centre commander, and it is up to me to make sure my life works as smoothly as it can.
There are always some things we can't control in our external world, but we can always choose how we feel about it.
Knowing this gives me a sense of freedom and that all is well in my world.
When we do something positive to tackle our inner demons head-on, we gain a sense of personal accomplishment that motivates us to carry on.
If you believe that nothing can be changed, then this is what you will experience. Your beliefs dictate what your brain does or doesn't do for you, and the more you don't do for yourself, the more your brain will run the show.
Return to sender
Another thing I came to realise is that our emotions are messages from our brain. They are the only way our brain has to communicate with us, and they will always point to imbalances in our thinking.
When what we are doing, saying or thinking doesn't match our core beliefs and our own inner and sacred truths, our emotions will tell us.
When we listen to our emotions, we realise they help us know when we are externalising our responsibilities.
The minute we find fault in the external world or are blaming others for how we are thinking or feeling is the minute we should practise recognising when we need to step back and give greater consideration to our opinions and views.
No one knows us as well as we know ourselves, and for this reason, we should be able to be the best friend we will ever have. So often we fall victim to being our own worst enemy.
Once we cross the boundary with one perpetuating negative thought, we can easily find ourselves on a slippery slope into a very dark place.
Listening to and using that inner voice can help us find supportive ways of thinking that serve us better than those that take us into the abyss.
I see it as a choice, but it has taken years of practice and a nutrient-packed diet to get my brain to feel this healthy.
I believe there is a lot we can do to help ourselves and that things are never as hopeless as they seem.
Change does take time, but the sooner we make our minds up that we want to be and feel different, then we set the course to achieve this.
Lastly, I would add that I used to suffer from a lack of self-worth. I couldn't figure it out until I realised I had been trying to force mind over matter – especially when my buttons were pushed!
Eventually, I realised that I needed to look at my underlying beliefs and therein came the answer: I felt that I was worth less than everyone else, so this was what I experienced.
When it came down to it, the cause didn't actually matter.
What did matter was replacing the self-fulfilling prophecy of feeling less and replacing it with a supportive and robust belief.
One day, having instructed myself to solve the problem, I woke up thinking, 'if we are all made equal, this includes me!' I have never looked back, or ever doubted myself again, because this belief is a universal truth that we should all be holding inside!
When you need to talk, try and focus on the problem you are struggling to solve.
Peer support groups are tremendous as everyone understands what you are going through and will relate to how you feel without judgement.
You can pop in and out of online groups as you need, and we often feel better when we can be compassionate with other people who are fighting the same battles.
Everyone has a lot to offer!
Are we rubbing SALT into the wounds of brain injury survivors who have speech problems on Time to Talk Day - and if not, why not? Our Time to Talk Day - 'Neuro OT and speech & language therapy' article is out now:
For further information on the time to talk day, please head to https://www.time-to-change.org.uk/ and remember to use the hashtag #TimeToTalk on social media.
Anne Ricketts is the founder of Global Brain Injury Awareness (GBIA); a not-for-profit community interest company she launched after sustaining a traumatic brain injury in July 2000. GBIA aims to inform and support people in need after brain injury. More here: https://www.globalbia.org/ and more of Anne’s writing here: https://insidetbi.blog/