Jan 122011
 

Perception.

1 a the faculty of perceiving.” Canadian Oxford Dictionary

Perceive

1 apprehend, esp. through the sight; observe. 2 apprehend with the mind; understand. 3 regard mentally in a specified manner.” Canadian Oxford Dictionary

Perception has been in the news this week, although many mayn’t have seen it that way. In Arizona, a man shot a number of people killing 6, wounding 14, including Congresswoman Gabrielle Giffords, his rather skewed way of perceiving the world urging him on. Later this week, in Toronto, yet another confrontation occurred between a man and the police; the man couldn’t see why he had to get out of the car, and it took them two hours to convince him. Luckily, the police didn’t shoot; instead they sought the guidance of a forensic psychiatrist. When the man finally opened the car door, he had to unfold himself as he is an imposing 6’7”.

The former young man was identified by his college and friends as “obviously disturbed,” possibly due to brain damage after alcohol poisoning, but no one troubled enough to help him get proper care. I heard on CBC radio this morning that Arizona has the second-worst health care for mentally ill people in the US, so maybe it wouldn’t have mattered anyway. The latter Toronto man had recently had his meds changed but a patient advocate had told him that he didn’t have to take them. It was his right to refuse, and I heard that his doctors had no clue if he was taking them or not. Behind both news headlines, the brain damage or illness interfered with the men’s ability to perceive, and so we have dead people at one end of the scale and a closed-off street and intensive use of police resources at the other end. Both cases illustrate why putting rights and privacy ahead of health and safety is deadly stupid. It’s predicated on the idea that people with damaged perception are as capable of perceiving – observing, seeing with the mind, understanding – as those with undamaged brains. Dumb.

Not everyone who is mentally ill or has a brain injury has damaged perception. Not everyone has complete damage. But when someone who is raving about grammar causing the ills of the world, it’s pretty clear their ability to perceive is royally screwed up. When someone obeys police slowly, as in the recent case of the brain-injured man kicked in the head by the beyond-stupid-going-into-criminal-assault-territory RCMP, it’s clear their ability to understand may still be there but is in slow mo, and we must give them patience. It’s the human thing to do. When a person diagnosed with schizophrenia or major depression or a brain injury does not see themselves as ill, there’s a perception problem. Some identify it as self-awareness, but that’s just one part of the ability to perceive. If the ability to perceive oneself is diminished, then that may also affect or be concomitant with diminished ability to understand body language, verbal communication, written language of others. It makes it difficult to talk to such a person, to make them get it.

Then there’s the ability to perceive one’s own body. I had the oddest experience when I first sustained my closed head injury. When I lay down for physiotherapy, I was convinced I was crooked: head facing one way, legs the opposite, arms not straight. Yet the therapist never shifted me so I thought, well, I guess being crooked is OK. I finally asked her if I was straight. She said, yes, like what a weird question to ask. I decided then that when I felt crooked, I was straight; when I felt straight, I was crooked. That has gotten largely better over time. Although that was weird, as in freaky weird, my inability to perceive situations around me was more problematic. You see, my perception, well, felt normal to me at the time. Yet each month when my perceptual abilities improved, I’d look back and go, where was my head last month?! But in that month, I’d think, OK, I’m healed now. Then the next month realise, uh, no, not really. Still, my ability to perceive wasn’t completely damaged. I often had no problems assessing situations for what they were, and that would be confirmed by the professionals. So how to know what was skewed, what was not? I finally got to the point that I decided I would look for cues from other people or take my time before assessing anything before I tried to make a judgement based on my perception. When the months finally came where there was no change and none of my perceptions differed from the professionals, I knew that that part of the brain injury had healed itself. Funnily enough, from the beginning, my self-awareness remained intact. I know because everyone who worked with me from occupational therapist to psychologist raved about it. It got a bit tiresome actually. Apparently, it’s a rare trait to have when a person has sustained a brain injury. Even after months and months or years of rehab, of working with professionals and family who tell the person that they are having x,y,z problem, the injured person cannot perceive their sight or reading or walking or mood problems.

I don’t think you have to have a mental illness or brain injury to be missing self-awareness. It amazes me how so many go through life without once putting mind to self. At worst it may be annoying to the people around you to be so blind to yourself. But if you have an illness or injury, lack of self-awareness at best leads to a wasted life of bad health and at worst to dead people. Without self-awareness when you’re sick, you can’t get the help you need and you can’t understand how treatment is helping you. So why would you stick with treatment? Why not put rights ahead of this “awful” medication with its side effects? Without being able to perceive the people around you, what they’re saying, what they’re meaning, you can’t have rational conversations, you can’t sustain meaningful relationships, you can’t hold down a job, and you will hear them say or see them do things they’re not. That’s when you most need to rely on the people around you to get you back to health. Some are lucky enough to have such people, but the system has interfered mightily with people helping people.

But then I think of the man whose mother said he had talked himself into a brain injury. Oh-kaaayyyy. And then I think of the neurologists I’ve met whose ignorance of cognitive deficits is breathtaking and other health care providers stuck in a rut of non-healing methods for brain injury, whose patients clearly are not getting the best care. It’s family members and health care professionals like that who have led to the rise of patient advocates and a mental health care system that puts rights above health and safety. That has led to masses of sick people living homeless on the streets or in hidden desperation in rooming houses or apartments like at St James Town. And it has also led to the collective washing their hands of their responsibility to the vulnerable among us, for all the healthy see are raving rags and people in jail. The government will take care of them.

The perception problem lies on both sides.

When we learn to perceive the problems in perceiving, “ours” and “theirs,” we resolve this impasse and take care of those who need our Good Samaritan instincts.

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