Brain Injury Dialogues

Brain Injury Dialogues consists of a number of interviews and sound bites in which people with brain injury (usually acquired in adulthood) describe how it has affected their lives after its acquisition. In some cases, the brain injury was initially undiagnosed, but resulting cognitive difficulties negatively impacted their lives (in one case, a woman ended up homeless for years) and compromised their survival in the complex world around them. In the past, brain injury in previously “normal” adults was often not recognized or acknowledged, and resulting impairments were ignored or left unrehabilitated. Besides memory and distractibility issues, acquired brain injury can also affect mood and personality in subtle ways.

A look at a support group for “high-functioning” persons with Traumatic Brain Injury is provided in which participants commiserate and state that those who are without a partner or involved person as a support system have a nearly-impossible time with the road ahead. Technical terms are eschewed, and descriptions of what exactly happened to particular centers in individuals’ brains are not given; but participants describe widely varying patterns of symptomology: one man became blind as part of the TBI package, another can’t drive because of distractibility, overstimulation, and direction perception issues, others have speech production and articulation issues.

Cognitive rehab (specialized occupational therapy) offers hope to some, albeit gradual and incremental improvement due to neuroplasticity.

One woman who actually earned a college degree post-injury described failed job searches in which she was not hired due to the perception that in trying to deal with her processing problems, she was asking for special privileges or making excuses.

A consensus emerges among TBI survivors that education of society about the needs of those with brain injury are needed, as are meaningful accommodations to assist them in accessing the services they need in public benefits offices, and helping them navigate such challenging public environments as college campuses and airports.

Companion website: http://www.braininjurydialogues.org

The Lookout

The Lookout depicts a character, Chris Pratt, dealing with the lingering effects of a traumatic brain injury in the somewhat unlikely context of a heist movie. Though he has physically recovered well, Chris attends Life Skills classes (taught by a wheelchair user) and holds down a job as a janitor on the graveyard shift at a Kansas bank. He still has flashbacks of the fateful night when he crashed his car into a stalled truck on prom night, killing two and leaving his girlfriend an amputee.

Unhappy when he contrasts the life he expected to lead (as a star hockey player in high school) with his current existence, Chris initially tries to work within the options readily available to him, asking to work as a teller in preparation for an executive training program out of his reach and discussing opening a small restaurant with his blind roommate Lewis.

Chris and Lewis have a symbiotic relationship; Chris does the cooking and presumably tasks that require sight, while Lewis prompts Chris and talks him through crises. Though Lewis serves as the somewhat cliched portrayal of the sagacious blind man, he came by his street smarts honestly; he was a biker and tough guy before blinding himself while cooking meth.

Recognizing him as vulnerable, a local crook named Gary begins grooming Chris to become one of the gang, plying him with alcohol and the attentions of an exotic dancer named Luvlee Lemons. In one scene, Gary takes Chris “home” to a new makeshift “family” (most of which are in on the heist), promising him a better life. An elderly person shuffles into the room with a walker and is quickly ushered out again with unkind words, and we quickly get the uncomfortable feeling that perhaps they’re being held captive for their Social Security check.

Lewis recognizes the signs of someone trying to manipulate Chris, but lets him make his own decisions about getting involved. When Chris gets in too deep and endangers Lewis as well, he must fall back on the life skills practices he so abhorred.

If there’s one completely unrealistic element of The Lookout (caution: here be spoilers) it’s the glib way his role in the heist was overlooked by the police and court system. In real life, mentally impaired people are rarely given any passes for criminal behavior, even when gullibility is part of their diagnosis. In the United States, it’s quite common for people with intellectual disabilities and low IQ to be executed for crimes they were talked into.

War-Torn 1861-2010

Wartorn 1861-2010 does a very good job of showing, through letters and articles written by past veterans of the Civil War and World War I, continuing with candid discussions about dysfunctional behavior on the part of World War II veterans, and the daily lives of Gulf War, Iraq and Afghanistan veterans, that exposure to traumatic sights and experiences during their military service had similar effects on returned servicemen and their families during very different historical eras in which very different technologies and cultural mores prevailed.

What is now known as PTSD was called by different names at different times: in World War I, “Shell Shock” in recognition of the paranoia caused by the sight and sound of what was then new weapons technology which brought impersonal deaths and maimings; in WWII “battle fatigue”; these various terms describe a psychic wounding which takes different forms, but in some instances has led to suicidal ideation, social isolation and feelings of anomie in those who are convinced that the people around them (in most cases the civilian population) do not understand them.

Societal attitudes (and often, those of the military) in the past, did nothing for them at best, and exacerbated the problem, at worst. “Battle fatigue” was “not something you wanted to have on your record’ one WWII veteran said in the context of a discussion of PTSD-induced behaviors on the part of several of his cohorts at a meeting of a veterans organization. Another chimed in that it was equivalent to being called a coward. Though the “side” of the military Establishment of the present day is shown in the documentary, with one high-ranking officer saying that the Army is taking steps to become more effective in reducing soldier suicides and “recognizing and treating” what he referred to as “PTS”, there is still a long way to go, and this particular officer’s attitude is apparently has not always been shared by many of his contemporaries in the service.

Another issue is that Traumatic Brain Injury (which is getting a lot more recognition, both public and official, in this particular American war) and PTSD share some common symptoms and may in some instances go hand-in-hand.

Some returned soldiers who _did_ commit suicide are discussed by their families. In one instance in the documentary, a soldier who sought professional help through the proper channels while on active duty was faced with a situation in which the military psychologist spoke to him for only a few minutes, dismissed the fact that on the paperwork, he’d checked off the box saying that he was thinking of suicide, and claimed he was “faking it” and sent him back to barracks…with his weapon. This turned out to be a situation in which not only did the military bureaucracy dismiss and fail to attempt to treat the problem, they effectively facilitated the suicide.

Another left the service, after which a downward spiral commenced characterized by self-loathing and culminating in suicide.
Then there are the returned soldiers who not only replay their wartime experiences in dreams and imaginings, but do things which may have been conducive to their survival in wartime situations, but which get them into trouble in the civilian world. One former soldier who killed a Middle Eastern cab driver got a lengthy prison sentence, his conduct was explained by the notion that due to his PTSD, he had a waking hallucination of a wartime situation and killed a harmless individual in civilian life, but the PTSD was not a legal defense in their state, and the California penal system provided no treatment for the PTSD.

This documentary, perhaps of necessity, limits itself to discussion of PTSD in the military developed under combat circumstances. One criticism of this documentary is that it presents a bleak picture and prognosis for people actually living with PTSD, and says very little about what resources are available to veterans and active duty servicemembers with PTSD. The official documentary website has a list of PTSD resources and websites for veterans and family members, as well as some more nuanced interviews with former soldiers suffering with PTSD and/or their family members in which they go into more detail about the interventions available, the bureaucratic hurdles to getting help, and what worked for them. It also does not go into very much detail about current methods and means of treatment, and whether they are actually helping returned veterans, though the DVD also contains footage of a separate panel discussion in which several individuals from government departments and various capacities in the services discuss the need for a more proactive approach by the services to identifying and treating PTSD in those on active duty, before they leave the military.

Alas, the panel discussion footage is uncaptioned.

Marwencol

Marwencol is the fictional miniature town creation of artist Mark Hogancamp, who uses the model-building and elaborate staged scenarios of his World War II-inspired tableaux as both occupational therapy and art therapy following an assault by a group of men which left him with physical injuries, brain damage, and a side order of PTSD. (It is explained in one of the deleted scenes from the “extras” section of the DVD that the fictional WWII era Belgian town’s name is an amalgam of “Mark” and some female friends’ names.)

Mark had had artistic inclinations before the assault, in which a group of teenage boys literally kicked his head and stomped on his face, after they had overheard him telling someone in a bar that he was an occasional cross-dresser. In the movie, he shows some of the drawings he had made prior to the attack, and explains that his hands are now too shaky to do similar drawings, so the model-making that goes into his modified dolls, miniature interior and exterior settings, and vehicles contributes to his own efforts to restore his coordination and former spatial abilities. Mark’s pre-injury drawings were used as State’s evidence in proving the extent of the damage to his brain by showing how the assault had affected his abilities afterwards.

Mark’s extensive brain injuries had the effect of separating him from certain aspects of his past. His case of amnesia is serious enough that he claims not to clearly remember having been married. He had the wedding picture and every so often, he said, he would get (mental) “snapshots”, the occasional visual memory from his past, but nothing cogent, no clear narrative of the time they were together or particulars about her. He refers to the time after the injury as his “second life”. He not only got a second chance at life when he could have died, but he had the opportunity to “start fresh” in areas of his life he otherwise might not have. He showed on camera a set of self-written and illustrated graphic novel type books which he called “the alcohol journals” in which, prior to the injury, he had documented alcohol-motivated behavior. His former employer said on camera that he had often been absent from work due to his former life as a problem drinker. Since the amnesia from the injury resulted in his not being able to remember the feelings he got from alcohol, he said he decided to stay away from alcohol for the future, thus effectively ending a path of alcohol abuse.

It is explained elsewhere in the film that Mark received only a limited amount of occupational therapy following the reconstructive surgery on his face. The extent of the damage to his brain was such that Mark had to start life after the injury from almost the beginning, having to literally learn to walk again. Samples of writing exercises are shown in which Mark was directed to practice pre-writing motions in order to re-learn the strokes to write in cursive. The powers-that-be discontinued all such rehabilitative therapy well before it could be said that Mark was restored to his former abilities. As an example of this, in one part of the film, Mark is shown walking by the side of the road with a model vehicle on a string. He explains that though a disability such as his brain injury is not obvious to others, it affects common everyday activities such as this. He cannot “walk and look around” as others do. If he takes his eyes away from the white line at the side of the road on which he is walking, he soon finds himself straying far from the line and in danger from the traffic.

Less tangible, but still in need of remediation, is the emotional fallout from the event. Mark uses the sort of doll play (stories and scenarios in a tangible, time-specific setting) commonly associated with little girls, to work out some of his feelings about the assault and his place in the world in general. Having unwittingly re-invented play therapy, Mark voices the regret that he has no one to talk to. If he had psychotherapy or counseling of any kind, it has not been continued. He presumably lives on Social Security Disability payments and works 1 day a week in a restaurant called The Anchorage, where he had worked full-time prior to the incident. Most of the women he meets are married or otherwise uninterested, so he reproduces them in doll form and adds them to his storyline. His friends are baffled but honored to be added to his “collection” and fantasy world as “good guys”. The “bad guys” are society’s easy targets: male dolls in SS uniforms, though Marwencol is an otherwise strangely peaceable town where 1/6 scale German and Allied uniformed action figures lay aside their arms, go to the miniature bar, party, and have a good time. His fantasy world has a disproportionately high female population: 27 Barbies. After having been assaulted, he clearly identifies with the female characters’ vulnerability, and stages a scenario in which the Barbies gruesomely defeat the Nazis.

Mark Hogancamp poses and photographs action figures in the fictional WWII era Belgian town Marwencol.

Mark Hogancamp poses and photographs action figures in the fictional WWII era Belgian town Marwencol.

A photographer friend gives him a camera, enabling Mark to photograph his tableaux. The photographs and story scenario become good enough for Eospus magazine to publish. The editor arranges an art exhibition in NYC at White Columns gallery for Mark’s photos and some of his dioramas. It is with mixed feelings and some trepidation that Mark puts together the pieces for the gallery show (he is afraid of having them lost, damaged, or otherwise taken away from him). However, though the PTSD causes him to fear large numbers of people and retreat from noise and hustle and bustle, he recognizes that people want to meet the artist, so being physically present in NYC for the gallery opening of his show is a necessary evil.

Firelight

Set in the 1800s, long before such things as feeding tubes, living wills, or functional MRI’s had been conceived of, Firelight tells the story of Charles, an English gentleman farmer who contracts with Elisabeth, an impoverished Swiss lady to bear him a child in secret. Elisabeth regrets her decision to give up the baby, and after a seven year-long search, convinces Charles’ sister-in-law to hire her as governess to Louisa, the defiant and illiterate daughter their union has produced. It is only then that the reason Charles wanted a child is revealed; he’s married to a woman, Amy, whose head injuries from a riding accident have left her in a coma since shortly after their wedding.

Amy is not portrayed being dressed, bathed, fed, or having her muscles stretched by servants or nurses, and yet this must happen off-screen, because she is neat, presumably clean, has a good appearance, and doesn’t have any apparent contractures or pressure sores, as might be expected after a decade comatose. She also seems to be of normal weight, in spite of the fact that feeding tubes and liquid nutrients have yet to be invented. Maids care for her, or at least sit with her as she lies in bed staring up at the ceiling, round the clock in the off-limits attic.

This isn’t Jane Eyre, though, and Elisabeth has no compunction against entering into a relationship with Charles, though he does initially experience pangs of guilt over the damage to his wife’s reputation. After one encounter, Charles reveals to Elisabeth in the light of the fire that he had sometimes thought of “letting her go”, but did not want to do so without a sure sign from his wife that she wanted to die.

Eventually the bills mount and the creditors close in (presumably from the cost of Amy’s care, as Charles seems to be the fiscally responsible one in the family). Elisabeth successfully bonds with Louisa, and it becomes apparent to Charles that Amy stands in the way of the happy nuclear family they desire.

Presumably divorce laws were tougher in those days, and few options for long-term care existed. On one particularly cold night, Charles makes the decision to euthanize his wife. He does ask Amy once more for a sign, but when none is forthcoming he dismisses the maid, opens the window, removes her blankets, and extinguishes her fireplace. The doctor is called when the next shift discovers her, and he pronounces her dead while everyone present looks askance at Charles.

Charles’ libertine father approves, and Amy’s sister presumes her death means that Charles is now free to marry her. Instead Charles and Elisabeth further defy social convention to marry and make their relationship known.