The Blind Driver – Loss of Metacognition

The Blind Driver

Imagine being tied up, gagged and put in the back seat of a car, and then being driven through your life journey by a blind driver. 

This is exactly how it can feel to many people who struggle with thinking and cognitive clarity following a brain injury. There are very real reasons for this!

Let’s start by describing how this actually feels in the mind. Depending on the severity of injury, and how close in time people are to that point of injury, the acuteness of the experienced outcomes will range between being severe – i.e. exactly as described, – or at the other end of the scale, they will be noticeable but not so troublesome.

All of the following descriptors are not definitive lists – they are examples.

It can feel as though:-

  1. thoughts just happen – as if you have no thinking process involved
  2. there is someone else in charge and as though the ‘real’ you is being pulled behind on a gurney
  3. you can’t consciously interrupt your thoughts – they just keep happening without any control
  4. you have no choice and as though you can’t choose the subject you want to think about
  5. it is impossible to direct thoughts or to create and follow personal priorities
  6. you can’t make a thought stop
  7. a thought never progresses – it gets stuck in a loop

The outcomes of this are numerous and it very much depends on whether you are the one struggling with these outcomes, or whether you are the observer, that creates the judgements.

Based on the behavioural outcomes exhibited these deficits in thinking  can cause an observer to assume any of the following things.

That the person:-

  1. is paranoid
  2. has an attitude problem
  3. is obsessive
  4. is inflexible
  5. is uncaring or selfish
  6. has a victim mentality
  7. is undependable
  8. is irresponsible

The person struggling with these deficits may think or feel that:-

  1. despite their very best efforts they continually find themselves in situations they would never have imagined
  2. their intentions don’t map out, or filter through, into what comes out
  3. there is a lack of conscious comprehension of a situation
  4. they don’t have the space in their head to be able to weigh things up
  5. they get roped into things because they can’t think of alternative arguments
  6. they are unable to verbally defend themselves
  7. they are vulnerable and easy to manipulate
  8. they trip erratically from one thing to the next
  9. their sense of responsibility is missing
  10. there is a foreign entity taking over

These outcomes can even be misunderstood by medical professionals and it is often assumed that they are caused by mental health problems rather than by the neurological damage. For this reason many people are not referred to specialist services and instead their medical interventions are lacking or flawed. Many people are prescribed medications that are not suitable and often exacerbate problems or cause more symptoms.

Old myths about brain injury also still permeate general thinking adding further to the difficulties with being understood many people have. For example, it was once widely believed that brain injury changes the personality, but in fact this idea was partly based on misunderstandings that were often derived from the observations of family members and non-specialist doctors. In other words it all started because the only way people had of describing the cause of the exhibited behaviours was to assume that the actual driving forces within a person had been changed.

Brain injury does not change the personality. The range of cognitive dysfunctions caused by brain injury have a neurological basis and act as a barrier to the personality. You can read more about this on ‘Increasing Your Understanding.

What is really happening?

The first thing to understand is that the brain knows it is injured. It recognises the messaging in the flood of chemicals that cascade through the brain as part of the secondary biological outcomes that occur immediately after injury. This puts the brain on high alert and once the switch is in the ‘on’ position is has historically been very difficult to get it to switch off again. A variety of drug interventions are used to try and overcome the presenting symptoms, but often people report that their cognitive difficulties remain.

In effect people are in the same neurological state as people suffering from PTSD – the brain takes over and reverts to automatic systems because this is how the brain thinks it is mostly likely going to be able to sustain life.

The problem is that the natural reactive biological and neurological interventions can actually exacerbate the outcomes caused by cell death and damage to neurons and neuronal pathways. In effect the ‘on switch’ employs the ‘blind driver,’ which is the fight and flight system, and prolongs the length of time it takes for people to recover.

It is possible to turn the switch back off!

The chemical that switches the fight and flight system on is cortisol. This stress hormone usually naturally reduces back to normal levels once a perceived threat is over and the brain recognises that it – and its’ host body – is no longer in danger.

However, when the brain is injured the switch stays on. It can take a long time for the brain to rewire and to deal with cell death and the other secondary events that occur following trauma. There are certain things that will exacerbate this release of cortisol, such as, the use of alcohol, a poor diet, sugar, gluten, and the stress caused by struggling with the vast array of brain injury symptoms. Symptoms are prolonged and worsened.

To learn more about how to ditch the blind driver and regain a mind that can make choices about thinking please visit ‘Fixing Your Brain.’

Getting the cortisol flood to stop also improves our ability to recognise the effects of Executive Dysfunction.

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