Humans assume normal inner mental state. Paula’s experience show us that this is a mistake and leads to bad science and bad medical care. Never assume, always measure. We found that simply checking Paula’s memory for her own permanent address gave us a window into her cognitive status on any given day. And we found out that she was unaware of her own cognitive mental status. That is scary. This means she couldn’t tell us when she was cognitively impaired; she simply did not know. She knew she felt distress, she felt upset, she felt anguish…but she did not know why and did not know that her brain knew that her mind we [reversibly impaired.
It seems that the brain understands what is going on in the mind, even when the mind cannot understand the what the brain is doing or why. And when this happens, it means that the conditions of the body and brain, allowing mind to flourish are faltering.
When Paula was completely healed, she still was not completely sure whether she was still impaired and would test herself to see if she knew her own permanent address. Only then could she be sure….for that moment.
This is pretty humbling, I think. It seems, that the assumption that mental status is consistent from minute to minute, hour to hour, day to day is incorrect, under certain unfavourable physiological circumstances. That is terrifying, really.
And you will not know when you have become mentally impaired. Because this realization requires mental insight, which you no longer have when cognitively impaired.
Think of being “under the influence” of a drug or alcohol. You may think you are “all there” but you are not. And your mental state may become visible with your behaviour [if your behaviour becomes odd – think of driving “under the influence”] or, if you remain quiet, introspective, keep to yourself, people may not notice. Unless they look carefully at physiological indicators , skin colour changes, pupil reactions, body temperature, respiratory rate, blood pressure changes, heart rate changes, etc…..And who does that? Nobody. It simply is not a natural response to sudden behaviour change.
We can learn to change this and respond more scientifically, especially if you are a neurologist or psychiatrist wishing to solve the puzzle of bipolar illness or chronic delirium or checking if dementia might be the reversible kind. [eg think thiamine deficiency etc…]
To be continued.