Wednesday, February 10, 2010

Executive Dysfunction: My Head Has No Czar

Brain viewed from the right side showing the 4...
According to noted neuroscientist,  Elkhonon Goldberg, there is a Russian saying describing ditzy people as people whose "head has no czar", ie there is no executive function.  The frontal lobes of our brain are the seat of executive function.  At times, my executive function dysfunctions and there is no reigning monarch in the throne of reason.

Sometimes I feel, perhaps, Dostoyevskian as in "The Possessed" or, even, "The Idiot".   Finally, I channel the anarchist, Nechayev, for a  tragic rite of self-flagellation as I descend into complete collapse.  So, madness is loosed, society approaches a collapse, boundaries between people are breached, and "revolutionary" theorizing gives way to action in a wild effort to restore some semblance of order.

To wit, I am trying to understand the cycle of dysfunction when my executive gets overly anarchic.  Maybe, in my own way, I am celebrating a festival of misrule that will  revitalize my psyche.

I'm not going mad... but I am definitely confused.   Some of this confusion has been induced by problems with my senses and body.   I have been telling the stories of my vision, hearing,  motor, stomach, and nutritional problems and how I am trying to remediate them.  And I am beginning to say what goes on psychologically and socially as a result of having these problems.  I have described some of these in previous posts, ie,  getting quite confused and lost on my first visit to Dr. Herzberg and how anxious and upset I became.  It seems as if I have some periods where there is a czar in my head and life is pretty orderly and then I get overwhelmed by something, often times based on a physical deficit, and a normal life process is thrown completely off track, I am overwelmed, my calendar isn't maintained with subsequent feelings of anxiety as I dread the consequences of my actions.  Then I have to spend an inordinate amount of effort getting Humpty Dumpty back up on his wall.

It's very funny because very simple things provoke a cascade of events.  For example, I was late to Dr. DiMartino.  I actually had planned to go there on time.  I was using my Calendar function on my Mac to keep track of things and it had reminded me in a timely fashion to go to the doctor.  But, I wasn't quite ready.  Dr. DiMartino had given me 23 pages of forms to fill out and I was busy still working on those forms.  I knew well in advance that I had to do the forms.... but filling out forms is still very hard for me as I have problems with complex visual fields.  So, I put off doing what would be a bit of work for the average person but is really quite an arduous task for me.  But, even that story is not quite so simple when you try to disentangle it.  I knew I had the forms to fill out but I kept thinking I had more time to do them and that it was OK not to start the task when I should because I always had more time.  Until I really didn't.  Well, I did get those forms filled out and got out the door to my appointment.  Since I was running late, I was huffing and puffing and trying to go as fast as I possibly can on the secondary highways of Bucks County.  Unfortunately, the main highway to Quakertown is Rte 313.  North of Doylestown, Rte 313 seems to be always congested.  I don't know why.  We really don't have bad traffic problems as a rule in this county with the exception of Rte's 313 and 202.  So I am driving along in a state of high anxiety hoping that I can make it there somewhat on time.

Unfortunately, I picked the wrong person to be late.  Dr. DiMartino is quite punctual and really gets after his patients when they don't keep their appointments on time.  From his point of view, he is a busy man who is tending to a lot of patients with really severe physical ailments.     And, quite rightfully so, he was a bit annoyed.  Also, his view of appointments has a lot to do with maintaining  boundaries and limits.  It's right out of the pyschological framework for treating alcoholism.  Alcoholics have no sense of boundaries and abuse other people's.  However, there is no mention of this sort of problem in the literature about executive dysfunction that mentions this sort of battle over boundaries.  It's just a straight problem of trying to follow a cognitive framework of Planning, Organizing, Marshalling Resources, Executing and Evaluating gone awry.  Unfortunately, there was a human being who got stomped on.  So I explained this to the good doctor.  I am not sure he is completely sold on it but he does seem to think that some of my problems might be more similar to an elderly lady's dementia and not a deliberate act of neglect. 

Unfortunately, you do run into problems when people see themselves as quite victimized.  Because there are predators in this world and they create victims.  There is a lot of innocent suffering and a tremendous cycle of victimization.  Thus, the notion of setting boundaries and limits. 

All of this is happening during a period of immense social change in America.  We are going through the same sort of epochal change that occurred in the Eastern Block after the fall of the Berlin Wall.   Asia is rising and challenging the dominant Western powers.   Very orderly bureaucracies both corporate and governmental are collapsing.  Some of the old boy networks are being broken up and some are defended to the teeth.   Power in America is diffusing to social networks both within established institutions and informal networks based on new forms of identity.  I fear we may end up going through a quite violent period.  Like Alice, we are really tumbling down the rabbit hole into a new wonderland.  In his book, The Road, Cormac MacCarthy is positing a world that has descended into complete anarchy.  We may well pass through that time but I don't see that period as an endpoint, but as an interegnum.   To quote Joyce Carol Oates:   "A stagnant social order drifts toward decadence, and decadence plunges into chaos: but chaos in itself can be a ritual experience, a pathway of redemption. For out of the primeval chaos there can arise a purified, and of course a severely modified, community."

I do wish that I had chosen another time period  to have my brain so anarchic.  You see, we are living at a period where some of the known rules, policies and procedures are being hung onto in certain relatively stable areas.  Other areas have the appearance following the old rules but everyone knows that the reality is quite different.  Other areas are in complete chaos.  And finally, there areas where people are banding together in tribes to impose some sort of order and cohesion. 

Well, to conclude... there is no conclusion... as I can wander about 50 different places until I finally get to my point... all of this is part and parcel of executive dysfunction in the inability to organize one's thoughts in a reasonable framework... so, to celebrate the misrule of executive dysfunction, I'll end with Arthur McBride Bloch:

A conclusion is the place where you got tired of thinking.

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