She explores quintessential humanity
Carrie T. tracks the effect of brain damage on people's actions, thoughts and feelings
No one knows precisely what makes us human. Some philosophers find that our mental capacity for self-awareness sets us apart from animals, which don't appear self-conscious at all. Neuropsychologist Carrie T. sometimes works with patients who have lost their self-awareness ability. "What happens when you knock out part of the brain?" she says. "Very often with head injury there is a lack of self-awareness and self-tracking."
Despondent over lost love, one of Carrie's patients shot himself in the temple. "He obliterated his frontal brain lobe," she says. The rest of his brain remained intact.
The frontal lobe handles "executive functions" such as planning or initiating action, as well as controlling voluntary muscle movements. "When he would eat, he would put his fork in the food. Halfway to his mouth, he would just stop," she says. "There was no ability to initiate the rest of that movement. Thinking about something and doing it were completely separated."
He is among the most damaged of her patients, Carrie notes. "As a human being, there is less to relate to. What makes us tick? What makes us human?" She has worked with patients who have endured more severe brain damage, but they still had their sense of humor, for example. "It may be repetitive and annoying after awhile," she says, but at least it continues to function.
Carrie, who practices psychology in Berkeley, asks to use only her first name to protect confidentiality with patients, many of whom have suffered major brain trauma. Carrie obtained a Ph.D. in clinical psychology, specializing in neuropsychological assessment and treatment. "When I was researching Ph.D. programs, I was overwhelmed by course and practicum requirements," she says. "It seemed daunting. Then I realized that I am at least as smart as some of the people in these programs. If they can do it, then I could, too. I took it one year at a time. That helped me get the courage to proceed."
Many neuropsychologists do cognitive testing and assessment more than treatment. Carrie also trained in psychoanalysis. "I've always been interested in the human condition, perception and consciousness," she says.
"He would put his fork in the food. Halfway to his mouth, he would just stop."
For a psychologist, empathy ranks as an essential tool. "I want to be able to feel where the other person is," she says. Some patients struggle with major mental and emotional troubles; they dwell in tormented spaces. "People want to dump their pain into somebody else and leave it there," Carrie says. "I am the receptacle. It takes training to not take it in and live with it as if it's inside me."
Listening to distraught or disturbed patients all day long can exhaust a psychologist. Most cannot regularly consult with more than five patients a day, according to Carrie, who earned her license in 1994. "You're not just sitting and having a conversation, though it looks like that on the surface," she says.
Researching the brain poses challenges. Brains process information through electrochemical reactions across gaps between synapses. "You either have a cadaver where you can look at the brain but not see it do anything," she says, or you you have a living person on whom most research is unethical. Magnetic resonance imaging has helped scientists observe brains in action, but the technique does little to map the effect of specific damage on a person's behavior. That's Carrie's job.
Injury to the brain due to exposure to toxins or poisons can be especially severe. "Neurotoxins are a lot worse than physical trauma to the brain," she says. "Once you get to a certain point, you are so screwed."
Sometimes Carrie works with family members of brain-damaged patients. She also sees people who otherwise would shun psychotherapy but must obtain help to regain functionality. "For the wife of someone like that, her feeling is, 'It would have been easier if my husband had been killed. I am now married to someone I didn't marry. The man I married is gone.'" Carrie says. "It's one of the most difficult challenges a person can have."
"They wake up. They see this foreign object such as their arm. They throw it out of the bed. The rest of them follows."
Rare patients of brain injury, especially stroke, may reject one of their body parts as not their own. "They may keep falling out of bed," she says. "It's not that they're falling out of bed. They wake up. They see this foreign object such as their arm. They say, 'Ew, what's this doing here?' They throw it out of the bed. The rest of them follows. That's an extreme case of not recognizing one's body as one's own. It almost seems impossible."
"I work with people who have a chance to have an independent life," Carrie says. "With head injury, you want to restrict people's freedom of movement. They lose their judgment. They are impulsive beyond belief. They don't recognize the rights of others. For the safety of themselves and others, they need containment."
Most of these patients have no ill intent; they merely are extremely forgetful or unaware of how others see them. As a culture, "We have a very narrow range of behavior that we consider acceptable," Carrie says. "If we don't walk and talk within a certain range, we are considered a weirdo. Head injury should not mean that you go to jail. How can I help this person be as independent as possible?"
One patient had lost his sense of balance and frequently fell and injured himself. Instead of restricting him, Carrie recommended carpeting or padding the hard surfaces in his home, rounding off corners to minimize his risks. "Why not let him fall once in awhile? It's his life!"
Another woman would repeatedly bang her head against the wall of her room, always in the same spot. Carrie suggested taping a pillow to that spot. "That helped her not hurt herself. Fix the environment, not the person."
Practicing psychology is not always satisfying. Appointments restrict her freedom to flow with treatment opportunities. "It's feeling boxed in. My passion for it gets constricted by practicality," she says. "You have to schedule." It's also difficult to get reimbursement from third-party payers, such as insurance companies that may refuse payment if they deem treatment not medically necessary. "It drives me crazy if someone wants me to do all the work for them or is chatting, avoiding getting down to it." Cutting through patient resistance can be daunting. Family members who don't support therapy can also pose challenges.
Some patients direct their fury at their predicament at her. "You cannot take in someone else's pain or suffering for very long," Carrie says. "You have to get it back out." She creates watercolor paintings, piano compositions and handmade bead crafts as a form of self-therapy. "It can drive you crazy. You have to find balance in your own life."
"I can't drive, can't ski. I can't even go to a party because multiple conversations are too distracting. What do I do now?"
"When a person is willing to work at least as hard as I am to step outside of the way they have been looking at things, to find a new perspective, I give it my all," Carrie says. "I can't change you for you. You have to do that. Gaining trust initially is really important, and it deepens throughout the relationship. Then we can begin. How can I find a new self that I can enjoy? I can't do the things I used to do. I can't drive, can't ski. I can't even go to a party because multiple conversations are too distracting. What do I do now?"
It's as if the patient's old self has died. Her job is to help the patient invent a new life. "Life does terrible things to you. It's not a happy rebirth, but who are you now?"
Patients who suffer brain injury as a result of risky sports, such as football, tend to do better in recovery than those whose injuries came from car accidents. The difference: they willingly assumed the risks inherent in the sport, and see themselves less as victims. "When we encounter randomness personally, it really shakes us up," Carrie says. "If you walk across the street to get a cup of coffee and you find yourself tumbling head over heels, you feel it shouldn't have happened. You have to fight hard to make the world make sense again. Our sense of comfort in taking the risk to go out our front door depends on a myth: that things will go along as predicted. Most of the time that holds up."
Self-imposed injury is extremely difficult to accept. "You're a teenager on a motorcycle you're not supposed to have," Carrie says. "You run a stop sign, the cops are after you and you decide to run. You crash your motorcycle. You're never the same. All your own fault. All teenage stupidity." She has worked with patients who rode a bicycle without a helmet or drove drunk and killed a friend who was riding in the car. "They are responsible for a death."
"I can't think of a better profession for me. People used to tell me I would be a great therapist. What kind of profession do you get better at as you get older? Age is a plus, especially as a woman. I can do testing, I can teach. I can see children or adults. There's a range of things to do."
"When you're going on that journey to other people's depths, if you're not familiar with your own depths, you are going to screw up. Psychology challenged me to confront parts of myself in order to do a good job. I have to confront my fears, my insecurities. It's work. I'm glad I threw that kind of work at myself."
"I also like to work with the Freudian unconscious, the part of ourselves we don't know anything about," she says. "I am always listening with psychoanalytic ears even with my brain-injured patients. The unconscious will get in that gap and start creating meanings. Our unconscious is like a stomach. You put things in and it will digest them. The unconscious does not get injured. It's the conscious brain that we measure and has dysfunction."
"It's a rewarding profession," Carrie says. "I did not know what I wanted to do when I grew up. You can find your way by being open to life experience. That's a good thing for young women to know. I really enjoy my work. I can't think of anything more meaningful. I learn about the human spirit, about creativity. I learn so much from my patients."
—James Dunn
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