Cracked

Firstly, I am not entirely convinced by the edifice of using fancy fonts to illustrate confusion, pain, damage, humiliation, and various onomatopoeias: at times it is effective, at times not.  I am ambivalent. At times it detracts from the strengths of a survivor's account of traumatic brain injury followed by dense confusion and loss.  At time it illustrates much of the fogginess of her brain, for the uninformed.

Speaking of the uninformed, the word recovery is also problematic as so many times even specialists (albeit naïve ones, to quote Muriel Lezak) use the term to mean improvement, rather than return to pre-injury cognitive status quo.  Again, Anthony and others now use the term in psychiatric rehab to imply recovery of psychosocial status, so I am beginning to be somewhat more than resistant to the term.

Anyway.  Getting back to the true storybook, Lynsey is a teenager clearly functioning well on the psychosocial stage, enjoying her life and her identity, when, as it does, life turns on a dime, and she falls off a chair.  It's not a trivial injury, and Lynsey, as she knows her, dies off into a murky retrograde amnesia.  The anterograde amnesia bit isn't great either, and the burden and sense of estrangement from herself and others dominates the book, as she lives in the twilight zone of return to family and school, looking like a zombie. 

She repeats many of the themes so common to this tragic group, who bear the stigmata of their injuries silently and invisibly.  Like Twinkies, if it looks good, surely it is good?  So for Lynsey, those outside of her brain see her apparent return to physical wholeness as indicative of recovery.  Unable to see the bad brain, others make fundamental attribution errors and see bad girl, and that includes, most painfully, the professional carers as well as her schoolmates.

After all, if your leg is gone, and you bear a prosthesis, all around you will note that you no longer enter the hurdles dash, and will be sympathetic.  When your brain is maimed, invisibly, your failure to dash through the hurdles of everyday life is regarded as indication of bad person, not bad brain, or bad family.  We are superficial in our evaluation of others when the scars are not evident.

So Lynsey descends into bulimic anorexia, a scrabbling attempt to gain a sense of control over a visceral brain gone mad, her depression evident and painful to read.

She leaves her school, finds another, where no one knows or expects anything from the old Lynsey, someone she has grown to hate, or grieve, in bouts of sad rage.

The hopeless ignorance of the public comes over again and again.  For instance, when a bully assaults her, a passing adult regards her as 'drunk.' When told of her injury, the same passer-by notes, oh well, the blow may restore her memory, I have seen that on TV.

Detective stories, or James Bond educates us.  Heavily and serially conked on the noodle, such heroes wake hours later, have sex with a blonde, go "Ow" and then go on to solve a complex case. In Dances With Wolves, Kevin Costner's character gets a significant concussion a few times, in rapid series, and yet he goes on to represent the Lakota Sioux in their fight against discrimination: this is our education in brain injury.

Lynsey's poignant struggle meanders through the book, not so much a journey of recovery, but of exquisite and overwhelmingly lonely pain.  She is acutely aware that she is damaged goods, afraid that no one will want her, afraid that someone will, and then will find that she is now a straw girl, of no substance, lost in time, lost in space, and meaning, to quote Frank N Furter, a changed character from another world, of uncertain gender and social role, and alone.  It is her loneliness that dominates the pages of her fractionated recall.  One of the saddest moments in the book is her observation of her grandmother's decline in dementia, her shock at seeing someone else in her family acquiring brain-based disability.  Lynsey writes of the concept of poison seeping through the cracked mind:

Clutching my chest, I breathed a huge sigh of relief.  My eyes circled her bedroom, one last time, penetrating the dust of the untouched furniture before stopping to rest on the vast, vulgar crack in the mirror.  As the mist on the grey windows clouded over, all my secreted memories of the hospital come seeping back into my mind like a poisonous gas (page 138).

 Out of school, unable to continue, Lynsey joins the club no one wants to be accepted into, the Brain Injured Community. Hovering around on the periphery of her mind, circling the firelight, are the vampire figures of catastrophic reality, holding the sense that there is not complete awareness of deficit, and if she lets the crack open too wide, then AAAAAAAAAAAAAAAAAAAAAAAAAAARGH will come through like poison (that's what she does with fonts).

It's a painful and sad little book.  I know its blurb paints it as a reconstruction, a triumph over adversity, but her closing words are no different to her opening really, with burden and estrangement dominating.

You are just left wondering why it has to be so hard.  There are many such accounts in publication, many from the UK, as Lynsey's is. Her loneliness and pain are condemnations of the care offered her, of her incarceration in a psychiatric ward, a strange place in a strange world, populated by middle world carer-figures.  Her treating psychiatrist writes that it is interesting that from the mist of her disaster, Lynsey emerges as a poet and writer: it in fact is not unusual.  Humans in pain have turned to such edifices to try to re-make contact with the world, to reconnect with a world that no longer makes sense.  After the loss of most of her right sided frontal and temporal lobes, leaving her brain damaged, epileptic and with Borderline Personality features and rapid cycling mood, another survivor writes, in her unpublished "Magnum Opus",

"I woke up in a world gone mad.  I had lost myself, my family, my friends, my boyfriends my career, my life, my Faith, my self.  I had gone from being my mother's shining star to being my mother's burden.  Damaged goods, who will ever want me?"

She goes on to live her life, return to university, and marry, and live her finest hours.

I wish the same for Lynsey, 14 years after her injury, now a 28 year old, dependent on her family, and now involved in a day to day struggle to find her socks, her diary, gloves, jacket shoes, and the lost bouquets of her stemmed life.

© 2004 Roy Sugarman

Roy Sugarman PhD, Clinical Director: Clinical Therapies Programme, Principal Psychologist: South West Sydney Area Health Service, Conjoint Senior Lecturer in Psychiatry, University of New South Wales, Australia