Lack of Insight

Sometimes, the brain doesn’t accurately analyze reality.

Take this scenario:

   

When this happens for clinical reasons, it’s called “lack of insight.” Patients whose field of vision has been cut in half don’t realize they’re ignoring their clinician sitting to their left. Patients with newly amputated legs try to get up to go to the restroom—and fall.  Patients whose swallow muscles are impaired insist that they can take five pills at a time—and end up coughing and spluttering as something goes down the wrong pipe to the lungs. Patients who can't balance to walk ten feet beg to go home without any help or medical equipment. They fail to recognize their confusion, dysphagia, aphasia, visual impairments….

In my own life, this is called “lack of insight.” I take on tasks far too difficult too handle. I walk into emotionally triggering situations without preparing myself, and I end up exploding. I strike up sensitive conversations, unaware that I’m saying insensitive things and causing a lot of hurt. I fail to recognize my hubris, my weaknesses, my biases and prejudices, my selfishness.

Can you relate?

How can we overcome our lack of insight?

Honestly, I’m not sure I ever will, not really. I imagine I’ll always have biases and prejudices, hubris and weaknesses, and of course selfishness.

But I’d like to be intentional about gaining insight. I try to read articles and books written by people of different perspectives, especially marginalized perspectives. For folks without books and articles to speak for them (I’m thinking of my patients and their families), I have to listen intentionally to their individual needs in the moment. I try to find out what they need me to say or not say, do or not do. And often I find out what I thought was helpful was actually not really so helpful at all—in fact, I’ve been hurtful.

I’m doing a lot of praying for humility these days.

What should I do when I gain some insight? When I realize I’ve been rude or hurtful, I’d like to own up to it and apologize. When I’ve made someone else’s story of suffering about me and my response to it, I’d like to stop and listen. When I’ve put myself on a pedestal, I’d like to step down.

I’m never going to get this exactly right. And my insight will never be perfect. But I can strive for what the Greek philosophers called arête—always seeking to better myself and knowing that I will never be perfect here on this Earth.

I'm sure I'll always suffer from lack of insight.  But every day I'll pray and try to do a little bit better.  

Our abilities are _______

I’m trying to figure out a good metaphor for our abilities.  Working in a rehab hospital reminds me daily that abilities are neither static nor intrinsic.  But what are our abilities, exactly?  Are they rights?  Obligations?  Gifts?  None of these metaphors seems to quite fit the experience of being a human with limited abilities.

It’s so tempting treat my abilities as rights.  I feel it’s my right to be able to process information quickly enough to drive a car, to run errands, read and follow a recipe, to process conversational language, to read and write, to work quickly and efficiently.  But then my monthly monster visits and I’m drowning in brain fog, barely able to understand simple sentences, unable to remember basic information or even balance for walking.  I never know how long it will last—sometimes hours, sometimes days.  For over a decade, every time I “misplace” my ability to think straight, I wail and cry like a child that’s lost their favorite toy.  It’s my right to think straight, I moan, pounding the ground with the heavy thud of weak uncoordinated tear-drenched fists.  It’s my right to be “smart.”

I’m lucky that this removal of my cognitive abilities is temporary and somewhat predictable.  As a therapist, I know many people whose cognitive abilities have been more severely damaged by stroke, brain injury, dementia….  If abilities are rights, then Someone upstairs isn’t playing fair.  And yet so many of my patients, family, and friends with disabilities find moments of extreme grace, even in their suffering.  This doesn’t make sense if they have been stripped of their rights.

No, our abilities aren’t rights.  Not in the cosmic sense, anyway.

Then come the nagging doubts.  If these abilities aren’t my right, maybe they’re my responsibility.  If I fail, I have to try harder—I’m supposed to be able to do these things.  I have to strive as hard as I can to optimize my abilities until I’m burnt out and exhausted.

This never works.

So are my abilities gifts?  Have I been given the gift of language, the gift of balance, the gift of whatever my IQ is, the gift of breathing?  But what about when these “gifts” are rescinded?  A true gift-giver doesn’t ask for the gift back.

Again, the guilt.  Maybe it’s my fault.  Maybe I’ve damaged the gift/ability through some sort of negligence.  Maybe I deserve to lose the ability.

Of course this is a preposterous and very harmful way of thinking.

Maybe I don’t understand the way gifts work.

Some gifts are long-lasting—a book, a ring, warm socks, a beautiful handwritten letter.  I can keep and cherish those gifts for years to come, their presence a constant reminder of the love of the giver. 

Other gifts are ephemeral—a box of chocolates, a ticket to a show, a kiss, a home-cooked meal.  Are these gifts less important or less valuable than longer lasting gifts?  Is the longevity of the gift the correct way to measure the love of the giver?  (If so, what does that say about long-lasting fruitcake?)

Every day we receive gifts.  Perhaps our abilities are more like ephemeral gifts.  We receive them anew each day, each moment.  The ability to breathe.  The ability to stand.  The ability to swallow.  The ability to speak, to read, to write, to do the things we love to do.  Gifts, all.  Given each day.  Never a guarantee.  Not rights, not obligations.  Gifts.

Some days we receive gifts we don’t want to accept.  The “gift” of not being able to stand.  The “gift” of not being able to think straight.  The “gift” of not being in our healthiest prime.  Should we reject these gifts?

Ann Voskamp, author of One Thousand Gifts, writes often about giving thanks for hard gifts and to find little gifts even in suffering.  I love this idea!  It complements beautifully the writings of St. Therese of Lisieux, who teaches us to embrace suffering.  Both authors take this idea a bit farther—we can offer our gifts to others, and to God—each gift in its own way.

So on days when I find it difficult to do the things I am accustomed to, I can choose to reject the gift like an unwanted fruitcake—or I can try to give thanks.

This is easier said than done.  And to be honest, I’m terrible at it.  But perhaps in time I will learn to receive all the gifts I’m given—even the hard ones—with grace and thanks.

This time of year is filled to the brim with gift-giving (much needed in 2020).  Let’s remember to be thankful for the gifts we receive each day—whether they are long-lasting or ephemeral. 

If our abilities are gifts, we receive them moment by moment, day by day—gifts to be cherished even if they burn bright and brief like birthday candles.  And I trust that the Giver of these gifts wants to surprise us with something spectacular each new day, each new moment.

Redefining Independence

I frequently tell this parable to my patients.  And honestly, I think I could stand to listen to it myself:

Bob was driving to work when his car stopped.  Bob valued independence above all else, so he decided to fix the problem himself.  He opened the hood of the car and tried to determine what had gone wrong.  It was hard to see through the thick smoke, but Bob kept rummaging through the parts of his car until he found an open flame.  Bob’s hands were badly burned and he fell backward in surprise, injuring himself further.  Bob had to go to the hospital.

Was Bob really independent in this story?  Of course not.  Injuring himself and putting others at risk was not true independence.

Paradoxically, to be independent in this circumstance, Bob would have called the fire department and eventually a mechanic.  To be truly independent, he would have relied on someone else’s help.

Our society seems to think “independence” means doing things on our own.  Anyone who can’t is seen as weak or inadequate.  This attitude is pervasive and has been around for generations—I can even hear it in my geriatric patients’ turns of phrase.  So often, my patients express to me that they feel they are “a burden” to their families for needing so much help.  And I myself fall prey to this lie as well. 

I’ve read enough mommy bloggers to know that a woman is supposed to be able to flip gluten-free pancakes in an immaculately kept kitchen while changing her baby’s diaper with one hand, keeping her toddler out of trouble with another, and helping her first grader with his math homework.  So when my menstrual symptoms affect my balance and I can’t even walk the dog, or I’m overwhelmed with house chores and work, or I need help processing my emotions, or I just can’t seem to do it all on my own, I feel inadequate.  I feel like I've lost my dignity, however briefly.

Maybe we all need to redefine “independence.”

True independence means taking charge of our own safety and using our resources.  Sometimes that means asking a friend or family member for help when we’re overwhelmed.  Sometimes it means making sure someone is with us when we get out of bed so we don’t fall.  Sometimes it means going to a support group or attending therapy.  Sometimes it just means using a walker or safety device.  True independence is different for everyone and changes over time.

I’d like to hear that again, because I’m prone to comparing myself to others.  In fact, I’m going to let Mneme, the Muse of Memory, repeat it for us so we can commit this to memory:

 

Thank you, Mneme.

Once upon a time, when I lived briefly in a barrio in the Caribbean, I encountered a family who seemed to really get it.  In this family, there were several family members with disabilities—some children, some adults.  All the family members helped each other out—nieces and aunties, mothers and daughters all worked together.  Now, that’s not to say there wasn’t suffering, and it’s not to say it wasn’t frustrating.  But as a team, they overcame many more obstacles than any of them could have overcome alone.

We can all learn from this family. 

Many of my patients’ families are similar to the family I just described.  They rely on each other.  I have so much to learn from their bravery, compassion, and healthy interdependence.  I hope to accept help with humility and to stop judging myself for relying on my support network.

I’ll leave you with a quote from the old Claymation Rudolph the Red Nosed Reindeer:  Let’s be independent together.

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I’ve put a new handout in the SLP freebies section.  It’s a simple text-only motivational poster that’s good for SLPs, patients, and everyone else.  (It’s a little wordy, so probably best for higher level patients, especially those with lack of insight into deficits or who are feeling really discouraged.)  Click here to download the handout.  Feel free to modify however you want.  Please print and distribute freely.

To be a Muse

The Muses are taking over the website!  Melete, muse of practice, Aoide, muse of song, and Mneme, muse of memory have been inspiring me in both my speech therapy work and my writing for some time now, so I figured it was time to give them the stage here at the website too.  The Muses inspire and encourage creativity and expression.

I've been thinking:  maybe we're all muses, in one way or another.

A Muse nurtures the creative spark in others, stepping back to watch as they bloom and blossom.  A Muse uses positive language to inspire and encourage.  A Muse is honest, and delivers tough messages with kindness and love.  Like in last month's reflection on strengths and challenges.

Speech Therapists are a lot like Muses.  Our task is to help others to overcome cognitive/linguistic challenges getting in their way of self expression.  (Ok, and to help them swallow and follow safety directions and a bunch of other stuff.)   I think that's why Melete, Aoide, and Mneme are speech therapists--it comes so naturally to them.

Writers, especially journalists, give voice to those they interview.  In more creative genres, writers encourage and inspire connection:  connection with others, with the self, with nature, with the Divine.

And many other roles and professions are best carried out with the mentality of a Muse:  healing professions,  teaching, the restaurant/service industry, working at a library or even a store or business, social activism, religious vocations, marriage, motherhood/parenthood, family relationships, friendship....

Maybe we can all be muses for each other.  Let's make an intentional practice of listening carefully to those around us and encouraging others to be more and more themselves.

If you want to see more of the Muses, follow us on instagram @speakingwithkiki, where their shenanigans get uploaded much more frequently.  I hope the Muses are as inspiring to you as they are to me.

And I encourage you to re-explore the website.  The Muses have made some changes around here!

Let's rely on our strengths and resiliencies

As a speech therapist, I am sometimes tempted to focus only on improving my patients’ deficits.  After all, isn’t that what rehabilitation is about?  Fixing “broken” communication, “broken” cognition, a “broken” swallow?

 

This happens with writing too.  Growing up, I always thought that the best way to help a friend to better their story/poem/essay was to bleed red ink all over the page, pointing out what doesn’t work so they can fix it.

 

And don’t we all do this to ourselves sometimes?  Pull out the red pen, evaluate our shortcomings and limitations, focus on the "bad parts of ourselves" so we can become better, kinder, more efficient?

 

What if it’s just as important—maybe even more important sometimes—to acknowledge and nurture our talents and resiliencies?  Of course we must acknowledge our mistakes, shortcomings, and weaknesses.  But what if shift our language—what if we call them "challenges" instead—calls to action instead of traits we're stuck with?  Maybe we have the ability to overcome these challenges—or find a workaround or at least make some progress—by relying heavily on our STRENGTHS.

When I evaluate a patient’s language, thinking, and swallowing skills, I am sure to discuss their troubles with them.  But now I’m making a conscious effort to also tell them and their families about what they do really well too!  Maybe their memory isn’t working the way they want it to (a challenge), but they’re awesome at paying attention, which is going to help them to use their memory strategies.  Maybe they can’t swallow water well right now (a challenge), but they have a strong cough so we can work with that!  Maybe they have trouble focusing (a challenge), but by golly they are motivated and have a positive attitude.  Maybe they have a LOT of challenges, but their support system is working for their good.

 

Joseph Fink and Jeffrey Cranor, authors of the Welcome to Night Vale podcast and various spinoff novels and podcasts, emphasized once that in writing, a more motivating and helpful way to critique someone’s work is to point out what is working really well so they can bring out more of those aspects in their work.

 

Maybe this could work on a societal level.  When we encounter a negative societal behavior, like racism or sexism or selfishness or unwilling-to-listen-ness, first we must of course acknowledge the problem.  This takes work.  And obviously, merely acknowledging the problem is not enough—we must face it and work to overcome it.  So what's the next step?  

To face these problems, we can draw on our collective compassion and kindness as a society to work to overcome those obstacles.  By exploring and utilizing our positivities, we can fight our societal problems.  Will we ever truly overcome a societal weakness?  Probably not entirely, but a positive human trait I believe in strongly is perseverance.

This is something that I find so encouraging about the Black Lives Matter movement—I'm hearing a lot of rhetoric that readily acknowledges that we are going to make mistakes.  Everyone does.  It's uncomfortable to learn that we've made mistakes, but the emphasis is on apologizing and learning how to use our humility and kindness to do better.  Learning about our mistakes and weaknesses is not about shaming us—and it never was.  It's about creating positive change.  For a really genuine and heartfelt conversation about this, I recommend listening to Brené Brown's conversation with Austin Channing Brown on the podcast Unlocking Us.

 

I’d like to apply this principle to my own life, and I invite you all to as well.  I make TONS of mistakes—maybe even in this post you have found some mistakes.  It's easy for me to dwell on them without moving forward.

So here is my resolution:  when I recognize or am told that I’m behaving impatient or interrupty or selfish or racist or small minded or making silly mistakes or being ignorant, I’d like to label my predisposition toward a “less than ideal” or even just plain "bad" behavior as a CHALLENGE rather than a failure of character.  This way, I can be motivated to change my behaviors in the future.  If I don’t identify with my undesirable behaviors but instead see them as obstacles to overcome, I give them less power.  I’ll probably never be perfect at facing any obstacle.  But I can keep trying.

And how do I face these challenges?  By using my virtues and resiliencies to face the obstacle.  I strongly believe that all of these strengths come from God.  And He is bigger and stronger than any obstacle or challenge I could ever encounter.

 

 

The Paradox of Pascha during Quarantine (formatting is fixed now I hope)

It seems like Pascha (Easter) has come too soon. Near-empty churches are decked in white; we sing that God has trampled death.  But the death toll is still great, and we continue to make sacrifices to protect the vulnerable.

So what happens when the Paschal season begins in the middle of the world’s suffering? What happens when Easter is celebrated at home, without the physical sacrament of Communion or the comfort of family members’ hugs? What happens when Easter is celebrated with a very calculated budget because of job loss? What happens when Easter is celebrated after the death of a loved one that cannot even be commemorated with a funeral? What happens when Easter is celebrated in a hospital room, grappling with new disabilities and unbearable pain, alone because visitors are not allowed?

True Love: a Valentine's Day reflection

I have seen in the movies and read in books that true love is about finding joy in each other, about holding hands and giving roses and writing love letters.  I have heard in wedding speeches and sermons that true love is about staying faithful even when it isn’t fun. 

I believe that both of these are true.

And I have seen second-hand that true love is often about wiping dirty bottoms, and spoon-feeding, and encouragement to try one more time, to get up for another day.  True love is about staying faithful even when someone’s personality changes after a brain injury or during the onset of dementia.

This Valentine’s Day, I am reflecting about what I have learned about true love from spouses who take on the role of caregivers—and spouses who take on the role of patient.  Neither role is chosen, but when embraced, both teach us about true love.

What determines your worth?

Society has attempted to answer this question in a variety of ways, defining a person’s worth by wealth, social class, language, skin color, education, intelligence, strength, bravery, wisdom, kindness….

Although such attributes can describe a person’s experience, descriptions do not define worth.

You are much more than your attributes and your experiences.

Rest and Oxygenation: Why we all need to stop and breathe

Sometimes I do too much for too long.  Constantly taking on more and more tasks, I pretend to be a Type A overachiever who has her life together and can do it all.  But on the inside, I’m gasping for breath, wondering when I will find relief from the hustle.

Have you ever felt like you were drowning?

Deep breaths are essential.  Without them, even the brain cannot function well.  Put simply, it runs out of oxygen.  Allow me to illustrate:

Moving Forward Without Looking Back: Neuroplasticity and Hope

“When will our lives be back to normal?”

This is probably the most common question I receive from patients and their families.  I usually dodge it:  Instead, I estimate the timeline for reaching the patient’s goals and establishing a daily communication (or eating/swallowing) routine.  Because honestly, what is “normal”?

This isn’t a pithy rhetorical question.  Does “normal” mean following an established pattern with the resources you have?  That can start during the recovery process, although there may be great suffering in it.  Does “normal” mean a predictable life with no obstacles?  I can confidently say that will never happen.  What was expected yesterday may not be expected today.  Yet this clinging, this preference for the past over the future, is common.  We long for the security of the known.

How can we shift our expectations to allow for the changes that are happening in our lives?  How do I, as a therapist, talk about moving forward with my patients—and with myself?

The Power of Praise: Research-based ways to Encourage and Empower

Sometimes, I fail.  I don't finish my daily to-do list.  I overcook dinner.  My words fall flat, or worse, hurt someone’s feelings.  Too often, my response to myself is harsh:  I’m lazy, I am not a good cook, I’m a bad communicator.  My failures define me.

Conversely, when I succeed, I own a success as if it is a part of me.  I am a great planner, a gourmet cook, the next Madeleine L’Engle.

Praising and criticizing myself for my innate abilities can create the illusion that my successes and my failures define me and determine my worth.  That’s a lot of pressure!  Also, I am reinforcing the idea that my successes and failures are due to innate abilities, which are difficult to change. 

The good news is that our dignity is inherent, no matter how talented we are (or aren’t).  And we do have the power to try again if we want to.  So how can we use our words to remind ourselves—and others—that our successes and failures do not define us?  How can we use our words to encourage each other to keep trying even when things don’t work out the way we hope?

Stop Striving and Start Thriving (with feeding resources for families and SLPs)

Stop Striving and Start Thriving (with feeding resources for families and SLPs)

It’s easy to believe that if you provide the perfect care for your family, you can raise kids who never get sick, have genius IQs, perfect skin, perfect behavior, and amazing athletic abilities.  But is all of this optimization actually best for the children in our care?  I have seen too many parents in tears because they feel they are somehow failing to provide their children the “optimal” experience.  But what if what’s praised as “best” by society isn’t actually the best option for everyone?  What if by working so hard to meet a perceived societal standard, we are actually distracting ourselves from the ways we can thrive in our own unique situations?  And what if to thrive, we have to let go of control and allow ourselves to rely on tools, resources, and others’ helping hands?  

If you feel insufficient, it’s because we are all insufficient.  God doesn’t expect us to do everything on our own, or even to do everything an exact specific predetermined way.  He asks us to rely on His help, often offered through others, and sometimes using surprising resources.  And there are some decisions with neither a right nor a wrong answer.  What matters isn’t that your life looks optimal or perfect.  What matters is that you can find ways to thrive in whatever situation you are in.

To consider the many kinds of resources and choices God provides for us, let’s take a closer look at feeding kids. 

Finding freedom in a disability: Katherine Wolf

"I realized very clearly that happiness has nothing to do with the material things which surround us; it dwells in the very depths of the soul. One can be just as happy in a gloomy prison as in a palace." ~St. Therese of Lisieux, Story of a Soul

Sometimes I become frustrated when I find myself limited. I can't get enough things done during the day. I sleep for too long. I talk too much and can't get at what I'm trying to say. My weaknesses seem to bind me, to steal my happiness.

My instinct is to fight. I want to overcome my limitations. There I go, pulling chains behind me as if I could outrun them.

Welcome

Hello, and welcome to a place where words nourish even more than bread and every day we do the best we can—even when that means making mistakes and falling flat on our faces.