Many people experience moments when they can’t come up with the exact word, or words, they want to express, and resort to the hackneyed phrase: “It’s on the tip of my tongue.” But for those suffering from a traumatic brain injury, this phrase extends beyond its timeworn use. Word finding, or word retrieval, is one of the most common cognitive difficulties in TBI survivors. The language center of the brain is located in the left hemisphere – the frontal and temporal lobes. Difficulty with word retrieval usually means the damage has occurred in the frontal lobe, the location of most TBIs.

What does this mean for individuals who have suffered a frontal lobe injury? Called dysnomia, or anomia, they tend to have difficulty naming objects, people, and places. They may know what the object is that they are looking at, but cannot identify it.  Sometimes the process is selective, say, to colors. For instance, individuals might know the difference between blue and pink, but cannot name them. In other cases, individuals might be able to identity an object through sound – the ringing of a bell – or touch – a needle – but not sight. Others might use the wrong word. For example, instead of saying, “Can you please pass the salt,” they might say, “Can you please pass the tire?” http://www.speech-therapy-on-video.com/wordfindingdifficulty.html

Circumlocution, a strategy where you “talk around” the name of the object, person, or place you are attempting to identify, often helps. If you’re looking for your cell phone, and you want to ask your husband if he has seen it, you might say, “It’s portable and it rings.” That way he will know what you are talking about. Also, this might prompt you to remember the object. Reciting the alphabet is a strategy that triggers words for me, especially if I can’t recall someone’s name, which happens all the time, even if I just met the person five seconds earlier. So, if I’m trying to recall the name Nancy, I say the alphabet in my head until I get to N. You can also visualize the word written out on a chalkboard, or whiteboard, or even a pad of paper. Similar to circumlocution, if someone cues me by sounding out the beginning of a word I’m struggling to express, my brain synapses suddenly come to life. http://www.speech-therapy-on-video.com/wordfindingdifficulty.html

For writers with a TBI, difficulties with word retrieval interfere with crafting poetic sentences for our readers to chew on. I typically find myself staring at a sentence for several minutes, rubbing my forehead and biting on my pencil. It’s not unusual for me to spend hours working on one paragraph. I usually end up resorting to my pile of notebooks of quotes I’ve collected from some of my favorite authors. For instance, if I’ve used “walk” a hundred times in my manuscript to describe someone entering a room, I flip through the notebooks, scanning the pages for unique ways other authors describe this same action. Of course, I do not steal their phrases, but seeing alternative ways to express “walk” is similar to someone verbally cueing me: My brain lights up with all kinds of options to consider, and I feel as if I just won the lottery.

Give these exercises a try, and feel free to share what works for you.

(FYI: Including research, it took me five hours and twenty-eight minutes to write this bog post).

More than six years after an older driver ran into me, causing multiple injuries including post-traumatic stress disorder, I decided I wanted to write a memoir about the tragedy and its aftermath. I wrote (actually I typed) nearly everyday. Essentially, I dumped my brain onto the page, ignoring the logical left side as I typed fast and furious without thinking about the structure of my story. Six months later, I had 365 pages of facts muddled with emotion. Though I felt proud of myself for my accomplishment, a puddle of grief muddied the moment. I thought I was ready to write about the accident, but maybe I wasn’t. Maybe I hadn’t yet figured out how to navigate my PTSD speed bumps. As the months and years passed, I read the pages again and again, examined with a closer eye what I had written, pondered the subterranean meaning of each passage and turn of phrase. The combination of time, taking breaks from my story, and reuniting with it from the perspective of a maturing writer, helped me gain insight into my work. In essence, I had stepped outside of myself, outside of my PTSD, and looked at the endless pages from a different, non-PTSD angle.

I’m glad I stuck with writing because research shows that it helps heal PTSD, even brief periods of putting pen to paper. http://www.sciencedirect.com/science/article/pii/S0005796712001088

When we experience a trauma, physical and/or emotional, our brains work overtime to process it, interfering with our ability to be present for others, and ourselves. Writing our thoughts down helps to release the emotional burden, and helps us to organize, put our thoughts in order – clean up our metaphorical cluttered homes. Writing has been shown to benefit the immune system, and overall health. But a professor of psychology at the University of Texas in Austin, Dr. James Pennebaker, cautions: “Standing back every now and then and evaluating where you are in life is really important.” Speaking from experience, I agree.  https://www.utexas.edu/features/2005/writing/

So, where to start? Here are my ideas:

1) Journaling: Even if you jot down one sentence each day.

2) Carry a pad of paper with you at all times – when a disturbing thought crowds your brain, write it down.

3) In first person (from the perspective of “I”), write about an emotional, or traumatic, event that has kept you awake at night. Just write. Don’t think about who might see it – lock it in a safe deposit box if you have to. The rub: put it away for a month, or two, or three, and then go back to it.

4) Take the same piece you worked on in number three, and write it from a different point of view – second or third person – forcing yourself to step outside of your hypersensitive skin (I’ve engaged in this exercise – it opened a vault door I never knew existed).

Feel free to share how this exercises worked for you?

“There is no greater agony than bearing an untold story inside you.”  Maya Angelou, I Know Why the Caged Bird Sings

Additional Resource:

http://healmyptsd.com/2014/08/writing-for-ptsd-healing.html

How do individuals who are unable to walk refer to themselves on the page? Why do some choose handicapped while others choose disabled, or even crippled?

At age nineteen, Joshua Prager suffered a broken neck when a truck driver rammed into the mini bus he was riding in while  traveling through Jerusalem. He spent four years in a wheelchair. Now, he walks with the aide of a cane. Prager has written a memoir, Half-Life, in which he tells of his tragic yet hopeful story of self-awareness, identity, and the loss of physical potency.

Throughout the book, Prager employs a varied lexicon when referring to himself post-crash:

1) “I took comfort … in the thought that my body spent fewer days disabled than not (106).

2) “I was a hemiplegic and wanted to be whole again (156).”

3) “Let the doctor glimpse what it is like to be nineteen and paralyzed (146).”

4) “I wished to sit there forever and never get up and never remind Sheri that I was disabled (172-173).”

5) “If I was finally at peace with my disability, I had fallen for a girl who wasn’t (183).”

6) “And then I became a quadriplegic (189).”

7) “I … allowed myself mention of … a divided body (280).”

Why does Prager not settle on a single descriptor for his changed body? Depending on the circumstance, his preferred label (labeling is really what this post is about) changes. For instance, in number 2 above, he chooses “hemiplegic” when he talks about his need to be “whole again.” The contrast of hemi- and whole in the same sentence is stark. When we see the prefix “hemi,” we might think of the word hemisphere: half of the brain, or half of the earth. We can visualize the fissure dividing the brain in half, or the equator separating the northern and southern hemispheres. When we see the word “whole,” we might envision something intact, like a circle.

In example 3, Prager says “paralyzed” in the context of the scene in which his doctor tells him he cannot leave the hospital to attend a baseball game. Understandably, Prager is angry. “Paralyzed” might evoke the image of an individual in a wheelchair, but it also evokes emotional and spiritual paralysis. Prager looked forward to the baseball game, but the doctor’s decision slashes any promise of “openness and freedom” for his patient (145).

In example 4, Prager employs the word “quadriplegic” when he’s wondering how his family will get him home from Jerusalem after the crash. Quadriplegia affects the entire body below the neck. In a sense, the entire body is weighted down, and the burden is on others to help care for the individual. Such is the case when Prager’s family must figure out how to get him home, physically and financially. The burden is on them.

But why does Prager choose “divided body” in the last example, rather than hemiplegia? Just prior to this sentence, Prager is listening to the solipsistic soliloquy of the truck driver who ran into the mini-bus: financial troubles, loss of land, loss of work, etc. When the driver finally asks Prager about his hospitalization, Prager refers to his body as “divided.” Though his intention is not to forgive the driver, but to hear him apologize, perhaps Prager is now wondering if it was a good idea after all to meet the man who nearly killed him. Is Prager “divided” about what he actually wants? Does he really want to be sitting, face-to-face, with this self-absorbed man?

I saved examples 1, 4, and 5 for last for a reason: acceptance. Even though the girl Prager fell for does not accept his “disability,” as he claims to, and he wants to hide that he is “disabled” from Sheri, the overall tone of the three sentences come across as softer than the others listed. The C, P, and G in hemiplegic, the Q, D, G, and C in quadriplegic, and the P, Z, and D in paralyzed are all abrupt, harsh consonants. And, though the L in these words creates a liquid-like, more flexible sound, because they end in harsh consonants, there’s lingering turbulence, as there are turbulent moments in Prager’s post-accident life. The D and B in “disabled” are abrupt sounds, the T in “disability” is an angry sound, and the S is a hissing sound. But the emphatic sound of the two D’s that bookend “disabled” give the impression of certainty – certainty that Prager has accepted his changed body. And the Y at the end of “disability” resonates with a long E, creating an airy quality to the word, which carries the liquid-like sound of the L a long way.

Or maybe Prager inserts “disabled” and “disability” throughout the narrative because eventually walks again, albeit with a cane – his wheelchair days are temporary. Perhaps if he called himself “crippled,” the caustic C, the in your face tone would sound more permanent. It’s worth noting that Prager refers to himself as “crippled” one time throughout the narrative. He becomes angry and says, “A cripple rebuffed at the Jewish equivalent of the Lourdes” while he’s praying at the Western Wall for his left hand to heal. He had reason to be angry – a bird had just shit on his head.

Prager, Joshua. Half-Life. Byliner. 2014. Amazon Digital Services.

When writing about a past event in the present tense, how does the author manage to control the narrative? In other words, how do readers know when the author is speaking from the present of the past versus the present of the now? It is usually much later when we are able to reflect mindfully on a past event, say, pose rhetorical questions and conjure answers about what happened. So how does the author insert reflection, or what Sue William Silverman calls the voice of experience – the metaphors for instance – in to the present tense telling of a past event?

In Jyl Felman’s memoir, Cravings, she predominately writes in the present tense with brief shifts into the past tense. She employs transitional phrases or words to indicate place and time:

“Every February until she’s too sick.”

“When we are growing up.”

“Ten years later.”

“Right before their fortieth wedding anniversary (14, 15, 18, 26).”

This is how Felman controls the overall architecture of the narrative, and the shifts between the actual now, the past, and the future. For the most part, Felman doesn’t fully step out of the present telling of the past and reflect. Rather, the reflective moments are embedded within the scenes of present tense narration. For example, in the chapter, Hyperventilation, she shows us, through scene, how her mother washes her mouth out with soap for swearing, and how she makes herself hyperventilate and needs to go to the hospital. It’s almost like a listing of events – this happened, then this happened. But intertwined is the voice of experience – metaphorical phrases – such as her descriptions of the process of passing out and how she feels like she’s suffocating. In effect, Felman is saying she needs time out from her family. We also hear the reflective voice in her telling of how she realizes the dysfunction in her family, and that she’s unhappy but no one notices (81-90). Foods, her mother’s recipes, and Jewish tradition – threads throughout the narrative – are also metaphors – the voice of experience – in the book. Felman successfully floats these within the present telling of the past.

She does revert to past tense when telling us more about her sister Judy: her anorexia, stealing, etc. It is in these passages where we gain more insight into the family dynamics – there seems to be a greater sense of interiority here. When Felman returns to the present telling of the past, again, it’s a listing of events. There’s a fast paced feeling about it – no lingering. The present tense telling has a way of building tension. There’s almost a rhythmic quality to the way Felman narrates about Judy in those pages: Judy is lost, her father finds her, Judy’s in Seattle, she’s married then divorced, and so on. At the end of the memoir, Felman does reflect from the real present into past moments. But, again, it is the precise phrases that help us know where we are: “It’s two years since she died, only the memories live in my body (187, 188).”

Here is a list of other memoirs written in the present tense: The Kiss by Kathryn Harrison Another Bullshit Night in Suck City by Nick Flynn, The Accidental Buddhist by Dinty W. Moore. Blackbird by Jennifer Lauck, When Katie Wakes by Connie Mayfowler, Because I Remember Terror Father, I Remember You by Sue William Silverman, Love Sick by Sue William Silverman

Citations: Felman, Jyl Lynn. Cravings: a Sensual Memoir. Boston: Beacon, 1997. Print.

While writing the initial drafts of my memoir I engaged in an exercise: I read the start of a chapter I had written about the earlier days of my recovery from the multiple injuries I had suffered after an elderly driver struck me. I focused on each sentence, each word and visual detail, then created a list of elements –objects, emotions, as well as the atmosphere of the piece – I anticipated would continue in the chapter. I then read the remaining pages, realizing the tone of the entire chapter smacked of self-pity in my telling of how I felt about the many bruises I suffered. I had failed to see beyond my own marred body, or ahead of me – that I would eventually heal (perhaps I needed the element of time to create emotional distance). In other words, the prose I had chosen was drowning in self-absorption.

Particular questions surfaced: would I continue to wallow in the bruises I sustained? Or would I be able to see beyond my eclipsed world shadowed by pain and, instead, recall the children I had cared for as a nurse, with the intention of showing how others suffer too?

Reading the chapter again, through the lens of my list, forced me to examine the self-indulging narrative I had crafted from a more objective stance. Even though my body would never be the same as it was before the accident, it would come to function quite well. On the other hand, a child who I had long ago cared for as a burn nurse, who I initially included in the chapter, did not regain even half the function she once enjoyed. Hopefully, in stepping back from the page, we return to it with 20/20 vision. In doing so, we are primed to craft a story that is unique on its own merit, yet universal, for we all encounter suffering at some point in our lives.

How do writers transition from one layer (in this essay I use thread, strand, or filament) of a narrative, then successfully return to the main, or grounding thread? In Kathryn Harrison’s memoir, The Kiss, an account of her incestuous affair with her father, there are at least four threads woven throughout the book. The main one being her father, followed by secondary threads: Harrison’s mother, her grandparents, and her struggle with Anorexia Nervosa.

Like forming a braid, Harrison first introduces the main strand – her father – by summarizing the interactions between the two of them during their travels together – then deftly weaves in a secondary strand. One way she accomplishes this is by employing reflection. In the last sentence of the first chapter she says, “These nowhere and notimes [sic] are the only home we have.” The operative word “home” introduces Harrison’s grandmother – the next thread – in chapter two. Harrison says, “My mother’s parents raise me. I live in their house until I’m seventeen” (5).

But she does not let the grounding thread – her father – slip. She goes on to explain that he was not welcomed into her grandparents’ home. The thread further remains intact through dialogue – another strategy in which Harrison weaves together the braid of figures and events in the book. ‘“Where is your dad?’ other children ask. ‘I don’t know,’ [Harrison] answer[s]” (5). This dialogue is the diving off point, which allows her to delve deeper into her past: she tells us that her parents divorced when she was an infant and that she and her mother stayed with her grandparents after her dad left.

She also employs scene as a strategy to weave in the mother thread: her grandmother screams at Harrison’s mother when a date picks her up. But her mother saves snapshots of Harrison’s father (5, 6). We now have the mother thread introduced, along with the father and grandmother – a French braid.

Through scene again, we begin to learn more about Harrison’s mother: she sleeps much of the time, and when Harrison makes noise in an attempt to wake her mother, she ignores her daughter. A theme – rejection – is beginning to unfold between the three filaments – Harrison’s father, her grandparents and mother (7, 8). And when Harrison reflects on her mother’s date, her father remains present on the page: “Though she dates other men … my mother remains romantically fixated … on my father” (9). This follows with a tighter connection to the father: he sends letters to Harrison’s mother, and, as she says, “sometimes, folded in with them, are little ones for me (11).”

These letters segue to other objects, which, in addition to dialogue and reflection, keep the father, mother and grandparent strands intact. For instance, we have Harrison’s mother’s yearbook, in which she reflects on photos of her mother: “Do I know my mother any better than the long-ago classmate … who foretold her future? ‘She will study … French (17).’” The encyclopedia set Harrison includes belongs to her grandparents, which were sold to them by her father, who was once an encyclopedia salesman. Harrison’s mother attempts to teach her daughter French by using flashcards (16, 17, 18).

By including the cards, Harrison reveals her mother’s desire for her daughter to be perfect. Harrison says about her mother, “Once she throws the flash cards down and slaps my face. My mother’s love depends on my capitulation” (19, 20). The mother-daughter relationship in this scene provides us with the first hints of Harrison’s struggle with Anorexia Nervosa, yet another thread:

I come down with an illness no one can define or cure … It goes on for weeks until the day I hear the pediatrician tell my grandmother that I’m so dehydrated I’ll have to be hospitalized … I return to school not just thinner but seemingly smaller … Very occasionally, I dream in French, and on those mornings I wake up ill: I vomit (20, 21).

Harrison then loops back to the grounding thread of her father through startling reflection: “Do my father’s accomplishments cost him as dearly as mine do me” (21)?

Harrison, Kathryn. The Kiss. New York: Random House, 1997. Print.