My (and My Grandma's) Neuroplasticity

It's crazy how quickly things can change when it comes to mental health diagnoses. Before my second appointment with my new therapist, she and my psychiatrist talked about my Borderline Personality Disorder diagnosis (See My Comorbidity). But because I have had a lot of head injuries throughout my life including cracking my head open when I was 1, getting knocked out by a baseball when I was 8, and a rollover car accident when I was 18 they have decided on a different diagnosis. Now my diagnosis has been changed to Traumatic Brain Injury (TBI) as my primary diagnosis. A secondary diagnosis of ADHD and Organic Personality Disorder. And then a tertiary diagnosis of Depression, and General Anxiety Disorder.

At first, all this hit me really hard. With Borderline Personality Disorder, I at least had hope that it was something I would be able to overcome because I thought it was trauma-based. But when they told me that it was most likely TBI, it suddenly felt like some sort of life sentence because it meant that my brain was physically damaged. I was literally broken. How do I get better when my brain is not able to function like a normal person's? All these thoughts came flooding into my head and they took me down a spiraling path of despair.

Thankfully though, my wife reminded me that the brain has neuroplasticity. For those that don't know, neuroplasticity is the brain's ability to modify, change, and adapt both structure and function throughout life and in response to experience. This means, that no matter what happens, or how badly your brain may be damaged, the brain is always able to find alternate neuro-pathways in order to change and adapt.

The best example I can think of to demonstrate neuroplasticity is my Grandma and a condition she developed called "Charles Bonnet Syndrome". Early disclaimer that I am not a doctor and so my explanations here are going to be more based on my own observations, as well as my understanding of neuroplasticity and research on Charles Bonnet Syndrome.

About 10 years before she passed away, she began developing age-related macular degeneration. This is a condition that, in most cases, leaves you completely blind in the central part of your vision but able to see some shapes and colors from your peripheral vision. Eventually, it got to the point where she really was legally blind and couldn't see most things. Many people with Age-Related Macular Degeneration develop Charles Bonnet Syndrome. This condition causes people to see seemingly random hallucinations. Some people see cartoon characters coming out of the walls, some people see phantom people, animals, or objects. My grandma saw mostly black dogs of all shapes and sizes in random places like up in trees or standing on my grandpa's lap. She would also see her mother in a blue dress often standing in the living room. Sometimes she would see some other very disturbing images that I will not repeat here. This was very scary for my grandmother and at first, she thought she was losing her mind. Thankfully a doctor was able to identify this as Charles Bonnet Syndrome. Still, it became very difficult for my grandma to distinguish what was real vs. what wasn't. And although my grandpa did his best to try and comfort her, he didn't understand what was going on and didn't know how to explain to her that these things weren't real.

One day I got a call from my grandpa asking me to come over as grandma was hysterical and I lived closer than any other relatives. When I got there, she was crying because she couldn't stop seeing these people doing unsightly things in her living room. Now, my grandma was a very kind and gentle woman and would never be the kind of person to think of these things that were happening in her "no-see-ems" as she called them. I knew there had to be some explanation for the things she was seeing. She could still make out things in her peripheral vision, but it was in her central vision, where she was blind that she was seeing the hallucinations. So, the first thing I thought about is how our brain puts images together in our vision. People with macular degeneration don't just see this blank black spot in the middle of their vision. What they see is basically a warped and somewhat empty area that is a composite of what the brain sees in the peripheral vision and kind of merged together blankness of color without definition. The brain doesn't allow for the eyes to just have a blank spot and so it creates composites to sort of fill in the gaps. And because we have 2 eyes it fills in the gap that one eye might not see but the other eye can form as complete of an image as we can get. An example of this is that we don't see the blood vessels that are in our eyes because they aren't moving and our brain is essentially able to block them out by filling in the gaps with what the other eye sees. This can be seen during certain eye exams where the optometrist shines a light into your eye from different angles changing the direction of the shadows of the blood vessels and suddenly the blood vessels become visible (this totally tripped me out the first time it happened to me.) Realizing this, I asked Grandma to describe the things she was seeing to me (without the unmentionable details of course). She told me she saw her mother in a blue dress standing there watching two obese naked people she had never seen before doing some very disturbing things. As I looked around the room I began to see some patterns emerge. All of the windows were open and the late afternoon sun was shining in the windows very brightly. In one of the windows, there were some royal blue bottles which the light was shining through and casting blue light in a certain spot in the room. I asked Grandma if that was where her mother was standing in the blue dress. She said "Yes, it is! Can you see her too?" I told her no, but to bear with me.

On the floor, I noticed that the light was creating a very large area of fleshy color on their tan carpet. I asked her if that's where the naked people were. She told me yes and that I was standing right on top of them. I then asked to her think back on the locations she had seen the black dogs in the living room. In one of the common locations she saw them there was a black exercise bike. With this information, I was able to determine that this is where the brain's neuroplasticity kicked in. Because my grandmother had been a very visual person her whole life, her brain didn't like the fact that she suddenly wasn't able to see. So, in order to compensate for this, her brain basically began rewiring itself.

Our brain is a massive storage cabinet for every single event in life we experience, regardless of how big or small it is. Every single person we pass on the street, every animal we see, and every conversation we have, is all there. We may not remember it, but that's only because our brain has not determined that it was important enough to create a neural pathway back to it for later recollection. This is why ADHD brains have such a hard time with working memory. Our brains have trouble distinguishing what information is important and what isn't and so it isn't able to form the correct neural pathways to allow for instant recall of information. The information is still there, and we will undoubtedly remember it later on when we are in the shower and thinking about it after the fact. It's all about the pathways to get to the information.

However, when our brains suddenly have a pathway blocked by something that it is normally used to getting to, it has the amazing ability to try and form new pathways as a sort of detour. In my grandma's case, she suddenly wasn't able to see in a place that she was able to see before. But since she still had "some" of her eyesight, her brain tried to make sense of the blank space by building new pathways through different parts of her brain that may have been tied to random memories that even she didn't remember. This doesn't necessarily mean that she saw morbidly obese people doing unsightly things to each other, but she may have seen people in general at some point. After all, she had spent many years as a nurse. Yet, because her brain was just trying to make sense of the fleshy tones she was able to make out, it created these people as the objects in that space. It had done the same thing with her mother in the blue dress for the blue light shining into the room, and the black dog in the place of the black exercise bike. When I explained this to Grandma, being the extremely intelligent woman even at 80 years old that she was, she immediately calmed down. After this (and a few more therapy appointments) Grandma began seeing less and less of the no-see-ems until they eventually stopped altogether, as she was now able to logically determine what was actually occupying the various spaces in her blind spots.

Our brains are truly miraculous things. Even writing this article, I'm reminded of how truly amazing they are at adapting to unforeseen scenarios. It is with this information that I am going to try and hold on to the hope that, no matter what has caused my brain to malfunction the way it does, whether it be from emotional or physical trauma, I will find a new pathway for it. My grandma was one of the strongest and most inspirational people I know, and her blood runs through my veins. So, if she can do it, I can do it too.