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The seventh in the series. Originally published in the PABIA-NEWS, March 3, 2004.

Cognitive Dissonance VII

Stereotypes, Perceptions and Facing Reality.

John Pistorius

Like George Bailey in the movie “It’s a Wonderful Life”, people who experience brain injury and related disabilities must overcome cognitive dissonance. The individuals who are suddenly thrust into a category of disability can find themselves in an ongoing pained state of mind.
 

Here is a simple equation: Brain Injury causes cognitive impairment. Cognitive impairment causes stress and cognitive dissonance. Stress compounds the dissonance by further limiting cognitive function. Real life difficulties result from reduced cognition. Thinking ability is further reduced. These difficulties compound stress. This further reduces cognitive function and increases cognitive dissonance. This spiraling cycle can plunge a person deep into despair if left unresolved.

This is the central reason for my exposition; to help people overcome dissonance and the debilitation it causes.
 

Cognitive Dissonance is further increased and worsened by:

• Others’ undignified, prejudiced, discriminatory treatment of the individual who survived brain injury.

• Discriminating, debilitating language.

• Cultural barriers.

• Unenlightened focus on inability.

• One’s own preconceived opinions, attitudes and beliefs about brain injury and related disabilities.

• Loss of a sense of self.

• Circumstances beyond one’s control.

• Smashed dreams and aspirations.

• Lack of positive recovery options.

• Lost hope.

• Fluctuations in cognitive abilities.

• Language barriers.

Battalion of Monster Attitudes and Beliefs
The following list is one of the enemies we are up against in our cognitive dissonance battle. It describes some of the many negative attitudes and beliefs we encounter regarding people who experience brain injury and resulting disabilities. The people who hold these attitudes and beliefs may be unaware of their influence. Or they might not care. Insensitivity can be a difficult attitudinal barrier to overcome. We must first recognize and deal with these negative attitudes and beliefs to defeat them. Overcoming their influences can significantly reduce cognitive dissonance.

Eternal child; This might be the most common misconception of people who experience brain injury and related disabilities. This belief causes others to treat them like children. They expect them to behave like children, without regard to their biological age. Many well-meaning parents are especially guilty of this type of abuse.

Adults with disabilities are too often shielded from authentic, real life encounters to ‘protect’ them. For example; Parents, other caregivers and program administrators forbid or restrict real life activities. In many cases, real life is replaced with ‘programs’ and programmed activities. Activities like dating are eliminated altogether.

The myth that all people recovering from brain injury are unable to care for themselves perpetuates dependence and disempowers the individual. This can cause tremendous dissonance. Sometimes it is difficult for well-meaning caregivers to release their tight grip of control.

Many programs are designed to keep people dependent upon the program and other programs. This insures an ongoing paycheck for the administrators. It also keeps the company employees paid. Simply put, it is good for the business and bad for the people. Restricting people or locking them up and calling it independent living is disempowering and immoral.

I’ve witnessed and experienced countless examples of this type of disempowering attitude. It always causes dissonance in my mind.

Faking, lazy; Too often, when an individual has any of the many brain injury related disabilities and symptoms, others discount the reality. They believe the person to be lazy or faking. This is especially true regarding people who appear to be uninjured. Those who ‘pass’ as non-disabled in appearance often suffer greatly from this monstrous attitude.

The faking/lazy attitude is reinforced in popular 30-60 minute television programs. Millions of people see ‘evidence’ of this lie every time a person is knocked unconscious and shown as ‘waking up’ and becoming fully functional before the TV show is over. These viewers receive an automatic, unfiltered message that perpetuates this belief. Hollywood also pushes this myth upon our culture in the movies it produces.

Some people who survive brain injury never regain consciousness. Others do. Of the ones that do, some require additional sleep and frequent rest periods. This is a result of neurological damage, not laziness.

Some people experience fluctuations in ability post injury. Memory, attention span, speech and other language skills can change from moment to moment and day to day. This is often used as grounds for the accusation of faking. In reality, cognitive functioning is a complex range of processes. These are affected by many things. The amount of sleep, nutrition, stress and other factors contribute greatly to anyone’s ability to think and respond to the world. Cognitive dissonance can be paralyzing to people experiencing cognitive impairments.

Helpless, incapable, powerless; People who experience Brain Injury are often kept from demonstrating their skills. This is because they are believed to be unable to do things without help. This attitude is especially difficult to overcome because the perpetrators are usually well-intentioned.

A good example of this attitude is portrayed in the children’s movie, “The Secret Garden.” A young girl (Mary) finds her cousin who is locked away in a bedroom and tended to by several people who refuse to permit him to do anything. His ‘condition’ led others down this dark path of oppression that left him writhing on a bed in diapers at the age of ten years old.

With the help of some others, Mary gets him out into the real world where she helps him to learn to walk. He experiences a great deal of dissonance at first because he has never been permitted out of his room. She teaches him that he has the power to be free from the oppression.

This monster attitude causes a great deal of dissonance every time someone insists on helping someone who is experiencing disability. It is fine to offer help, it is disempowering to insist. Everyone has the right to refuse help, even if a task is particularly difficult. Unless the individual is at risk of serious injury or death, it is polite, proper and empowering to accept their refusal. To do otherwise is disempowering, humiliating and can cause cognitive dissonance.

This attitude also inflicts pain upon another when someone refuses to let others do things for themselves. I'm not talking about the offering of assistance here. I mean doing things for others and refusing to let them do anything at all. It is cruel to stop people from enjoying life. Even if they might stumble and fall, we let babies learn to walk.

Lucky, hero or special; Some people consider a person recovering from brain injury that lives independently and/or is employed as lucky, brave or special for overcoming the perceived limits of brain injury.

This attitude restricts other people from becoming fully independent. It teams up with the ‘Helpless, incapable, powerless’ belief, the ‘Inferior’ attitude, the ‘Eternal Child’ belief, the ‘Object of Pity’ attitude and the ‘Sick’ belief. It hampers individuals from reaching their full recovery potential. It makes success seem impossible to reach under most circumstances. If only the ‘lucky ones’ can reach full independence, it gives everyone an excuse for not attempting to improve services, systems and care giving.

People living and working in the community after brain injury are not heroes. They have worked very hard to maintain self-sufficiency. They fought to overcome dissonance produced by every type of cause imaginable. They had to fight their own attitudes about injuries and functional limits. And they needed to fight cultural attitudes.

It takes work and the right attitude on the part of the individual, caregivers and the rest of society to beat this monster. It takes deliberate, affirmative action.
 

Inferior; Some believe that people who experience brain injury are "second-class citizens." This causes civil rights violations. People who are considered ‘inferior’ are often denied the same rights and privileges as a person without a disability. Society is biased in favor of people who have not yet experienced disability. This myth is fed by cultural attitudes about physical and mental strength and weakness. It is also fertilized with the dung of contemporary television programming.

Many of our societal systems are difficult to access by people with disabilities. They are not considered important enough to justify the expense. The current legal controversy in Tennessee illustrates this point clearly. People are forced to be carried to upper floors in Tennessee courtrooms. The state government refuses to provide reasonable accommodations that do not humiliate people with disabilities.

The civil rights struggle faced by people who are labeled “vegetative” is another reflection of this belief. Reducing people from human status to vegetable status perpetrates this inferiority fraud upon society. Vegetables are not protected by the Bill of Rights. The lives of very real people are hanging in the balance between death and life; institutional life and independent living with appropriate supports.

Subhuman; This view is pervasive in relationship to people who live with severe consequences of brain injury. The medical community has coined the phrase ‘vegetative’ to refer to individuals who are in coma and non-responsive.

The term ‘vegetative’ was first used to describe the condition of a person who was functioning without consciousness. Due to the similarity to the word ‘vegetable’, people often replace the term ‘vegetative’ with ‘vegetable’.

If a person becomes less than whatever it is that we believe they should be, we cannot scrap, junk or kill them. However, if they can be labeled and considered to be a vegetable, then that makes it easier for society to run them through the in-sink disposal when they become non-responsive or persistently comatose.

The term ‘animal’ is sometimes used to describe a person who displays negative behaviors after brain injury happens to them. Again, any language used wrongly to refer to human beings is demeaning and creates barriers in the minds of others. This description reinforces the next belief:

Menace or threats to society; Historically, persons with disabilities were negatively viewed as contributing to the deterioration of civilization.

This belief led to segregation, persecution, dehumanization, and imprisonment of many thousands of people. People who survived Brain Injury were often considered to be mentally retarded or as having mental illness. It was common practice to institutionalize people. These large institutional settings were called ‘asylums’ and ‘sanitariums’. Many people with disabilities were kept from reproducing by the practice of segregation or sterilization.

Segregation continues today under the guise of housing ‘programs’, nursing homes, and certain so-called ‘independent living’ arrangements. Instead of teaching people how to live among the general population; many program administrators pay lip service to empowerment and independence. They do this while fattening their budgets and bottom line on disempowerment and oppression.

Object of pity or charity; By feeling sorry for a person who survives brain injury, others adopt a patronizing attitude. This attitude is driven by a non-disabled person’s sense of superiority, but it is rooted in their feelings of inadequacy. 

Historically, pity and a sentiment of charity caused others to provide services to people with disabilities. It was common for people with disabilities to have to beg with cap in hand for survival. The belief that anyone with a disability is unable to work or live independently persists today. This belief compliments others in this list by undermining a person’s abilities.
 

Object of ridicule; This can be seen by the appearance of a person with a disability in circus side shows, "freak shows" and villainous movie roles. Historically, in literature and movies, people with disabilities were depicted as clowns, fools, and court jesters.

To this day, the entertainment media mostly portrays people with disabilities in an unrealistic light, further perpetuating negative attitudes regarding people who experience disabilities.

I personally experienced this attitude after appearing on a national television talk show about amnesia. It took years for people to stop ridiculing me about brain injury and my appearance on the program. What I believed would be a positive means to help others turned into a negative experience that caused massive amounts of dissonance.

Sick; Another misconception still common today is the view of a person who survives Brain Injury as sick, often mentally ill. This has led to an emphasis on treatment in medical service provision settings.

We cannot expect all brain injury related disabilities to be completely overcome or cured; however, some disabilities such as epilepsy can be treated or controlled by drugs and Vagus Nerve Stimulation treatment. Many people who experience Brain Injury can learn to compensate for deficits and lead satisfying, productive lives.

Recognize the Enemy
Spotting dissonance producing attitudes and beliefs is the first step in combating these monsters. Once we recognize this enemy battalion, we can actively fight to stop it from advancing in our lives, the lives of our children and the rest of society.

Fighting the language that feeds these monsters and gives them ammunition is an ongoing battle. It is one that we’ll explore Next Time:

Cognitive Dissonance VIII –
Sticks and Stones Will Break My Bones
And names can surely hurt me!