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Traumatic Brain Injury and Therapeutic Creativity

Traumatic Brain Injury and Therapeutic Creativity

Every man bears the whole stamp of the human condition. (Chaque homme porte la forme, entire de l'humane condition.)1–Michel de Montaigne

Lord Michel Eyquem de Montaigne (1533-1592) was a Renaissance writer, philosopher, landowner, politician, and diplomat who sustained a near-fatal, life-transforming accident as a young man.

Montaigne was obsessed with death up until the age of 37, when he suffered a traumatic brain injury (TBI) and PTSD from a disastrous horseback riding accident. Subsequently, he retired from public life, secluded himself in one of the towers of his chteau, and devoted himself to writing.

During the following decade, Montaigne invented a new literary form—the essay—a new literary style—“stream of consciousness”—and he resolved his obsession with death. The relationship of the TBI and PTSD to his literary creations and death obsession is explored here.

A near death experience
I felt infinite sweetness in this repose1

Montaigne and servants had been riding on a forest path a few miles from the chteau when a runaway horse slammed into him from behind, throwing him violently onto the ground several feet away. He lost consciousness for several hours and when he regained it, he began to vomit clumps of blood between bouts of dyspnea and episodic coughing.

Despite extreme physical distress and weakness, Montaigne experienced a sense of great calm and lack of concern in the face of imminent death and the anxiety of everyone about him. Montaigne’s servants put him to bed, and he lay there, perfectly happy. He was at peace, without a thought in his head apart from the sense of how pleasurable it was to rest: “I felt infinite sweetness in this repose.”1 He refused all medications, certain he would die.

Traumatic brain injury
Methought my life but just hung upon my lips1

TBI is a non-degenerative, non-congenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of consciousness. It is a major cause of death and disability worldwide, especially in children and young adults. Causes include falls, vehicle accidents, and violence. In the 16th century, horseback riding accidents were probably not uncommon, but Montaigne’s was particularly severe.

The impact of the large horse, “rushing like a Colossus upon the little man and the little horse,”1 he writes,

turned us both over, topsy turvy, with our heels in the air; so that there lay the horse, overthrown and stunned by the fall, and I ten or twelve paces from him, stretched out at length, with my face all battered and bruised, my sword, which I had I my hand, about ten paces beyond me, and my belt broken all to pieces, without any more motion or sense than a stock. Those who were with me concluding me dead…carried me to my house.1

Montaigne describes the following symptoms:

Loss of consciousness. “When I came again to myself, and to reassure my faculties ‘Ut tandem sensus convaluere’—‘As my lost senses did again return’—which was two or three hours after . . . I thought once more I was dying, but a more painful death, and to this day am sensible of the bruises of the shock.”1
Nausea and vomiting. “I threw off a great quantity of pure blood which I did also several other times on the way. I saw myself all bloody, for my doublet was stained all over with the blood I had vomited.”1
Confusion. “I knew not what I said or did; they were nothing but idle thoughts the clouds that were stirred up by the senses of the eyes and ears, and proceeded not from me. I know not any the more whence I came, or whither I was going, neither was I capable to weigh and consider what was said to me . . . I saw my house, but knew it not.”1
Drowsiness. “Methought my life but just hung upon my lips, and I shut my eyes to help, methought, to thrust it out, and took a pleasure in languishing and letting myself go. It was an imagination that only superficially floated upon my soul, as tender and weak as all the rest; but really not only exempt from pain, but mixed with that sweetness and pleasure that people are sensible of when they are falling into a slumber.”1
Blurred vision or vision loss. “When I first began to open my eyes after my trance, it was with so perplexed, so weak and dead a sight, that I could yet distinguish nothing, and could only discern the light.”1
Paralysis (severe brain injury). “My condition . . . was an extreme drooping or weakness…”1
Amnesia. “The last thing I could make them beat into my head was the memory of the accident; and I made it be over and over again repeated to me whither I was going, when I was coming, and at what time of the day this mischance befell me, before I could comprehend.”1

Memory deficits
For my part I have it [memory] not at all1

Montaigne writes that following the accident, “the very next day my memory began to return.”1

However, subsequently he states:

Memory is a faculty of wonderful use, and without which the judgment can very hardly perform its office; for my part I have not at all…I could not receive a commission by word of mouth, without a note-book . . . I must have three hours to learn three verses….”1

He said his memory was hopeless. If a thought occurred to him that he wanted to write down, he had to tell someone else at once in case he forgot it before he could walk to the room where he kept his paper. The issue of a memory deficit recurs in Montaigne’s personal inventory:

There is not a man living whom it would so little become to speak of memory as myself, for I have scarcely any at all; and do not think the world has again another so marvelously treacherous as mine. My other faculties are all very ordinary and mean; but in this I think myself so singular, and to have the defect to such a degree of excellence, that I deserve, methinks, to be famous for it, and to have more than a common reputation… [W]hen I complain of mine they [my countrymen] seem not to believe I am in earnest…”1

Montaigne describes the way he used his memory deficit to good advantage: “I derive these comforts from my infirmity; first, that it is an evil from which, principally, I have found reason to correct . . . namely ambition.”1

He attributes his honesty to the memory deficit: “It is not without good reason said that he who has not a good memory should never take upon him the trade of lying.”4Most importantly, the use of the defective memory occurred in Montaigne’s creation of the stream of consciousness writing style.

Monomaniacal death obsession
We should always . . . be booted and spurred, and ready to go1

From his earliest years, according to Montaigne biographer Sarah Bakewell,2 Montaigne was “so afraid of losing his life that he could no longer enjoy it while he had it.” A number of traumas contributed to the obsession. As a 15-year-old student (1548), Montaigne watched an angry mob brutally murder the town governor. In 1563 Montaigne’s beloved friend, tienne de La Botie, humanist writer, poet, and scholar, died from the plague. In 1568 his father died from kidney stone complications. In 1569 his brother Arnaud was struck on the head by a ball playing tennis. In 1570 the first-born child of his marriage died. Montaigne wrote, “With such frequent and ordinary examples passing before our eyes, how can we possibly rid ourselves of the thought of death and of the idea that at every moment it is gripping us by the throat?”2(p13)

Montaigne’s death obsession was ego syntonic:

Let us disarm him of his novelty and strangeness, let us converse and be familiar with him, and have nothing so frequent in our thoughts as death. Upon all occasions represent him to our imagination in his every shape; at the stumbling of a horse, at the falling of a tile, at the least prick with a pin, let us presently consider, and say to ourselves, ‘Well, and what if it had been death itself?’

Where death waits for us is uncertain; let us look for him everywhere . . . I am at all hours as well prepared as I am ever like to be, and death, whenever he shall come, can bring nothing along with him I did not expect long before. We should always, as near as we can, be booted and spurred, and ready to go . . .1

Death would never take Montaigne by surprise if he had anything to say about it:

To begin depriving death of its greatest advantage over us, let us adopt a way clean contrary to that common one; let us deprive death of its strangeness, let us frequent it, let us get used to it; let us have nothing more often in mind than death ... We do not know where death awaits us: so let us wait for it everywhere. ("That to Study Philosophy is to Learn to Die.")1

Nothing captured Montaigne’s attention more than death:

It is my custom to have death not only in my imagination, but continually in my mouth. Neither is there anything of which I am so inquisitive, and delight to inform myself, as the manner of men's deaths, their words, looks, and bearing; nor any places in history I am so intent upon; and it is manifest enough, by my crowding in examples of this kind, that I have a particular fancy for that subject. If I were a writer of books, I would compile a register, with a comment, of the various deaths of men . . .1

When consciousness returned, Montaigne began to reflect about the meaning of the near-death experience, particularly about the discrepancy between his lifelong death obsession and the sense of inner calm he felt so proximal to death. Montaigne biographer Sarah Bakewell2 writes:

In dying, Montaigne came to realize, you do not encounter death ... you die in the same way that you fall asleep, by drifting away. If other people try to pull you back, you hear their voices on 'the edges of the soul.' Your existence is attached by a thread; it rests only on the tip of your lips . . . Dying is not an action that can be prepared for. It is an aimless reverie.2(p20)

When he recovered consciousness and reflected on the experience, Montaigne found he was no longer terrified by death: “If you don't know how to die, don't worry,” he wrote, “Nature will tell you what to do on the spot, fully and adequately. She will do this job perfectly for you; don't bother your head about it.”1

Therapeutic creativity: Montaigne’s invention of the essay and stream of consciousness
PTSD, a severe anxiety disorder, develops after exposure to a psychological trauma when threat of death to self or others overwhelms one’s coping capacity. Montaigne intuited a solution to his PTSD. Two years after the near fatality, he terminated his job as magistrate in Bordeaux and retired from public life. He then moved into the Tower of the Chteau, Montaigne’s so-called “Citadelle,” where he almost totally isolated himself from every social (and familial) affair, locked himself in his 1500-book library (some from Botie), and began to work on his Essays, publishing them a decade later.3

The Citadelle was a refuge for rest and rehabilitation. Realizing the disparity between his terror of death and dying and the calm state of mind that he experienced when proximal to it, he asked himself the question, “Que sais-je?” (What do I know?), which became the subject of the Essays. Writing, which helped restore his sense of control, reducing the powerful hold of the obsessive-death fears, was therapeutic and reading was almost as restorative: “When I am attacked by gloomy thoughts, nothing helps me so much as running to my books. They quickly absorb me and banish the clouds from my mind.”1

Montaigne’s Citadelle
One is reminded of Henry David Thoreau who, after the tragic death from lockjaw of his beloved older brother, went to Walden Pond and wrote an elegy about the 2-week effluvial excursion they took shortly before his brother’s shocking death.4

Montaigne first learned about the therapeutic powers of creativity in 1569, when he wrote of his beloved friend La Botie, who was as close to him as John Thoreau, Jr, was to Henry. He evolved the essay genre and stream of consciousness style over the years.

The essays
It is myself I portray1

A series of short subjective prose reflections on many subjects, the essays form one of the most intimate self-portraits ever written. Montaigne attempted to weigh or “assay” his nature, habits, and opinions: “It is myself I portray,”1 (je suis la matire de mon livre) using the microcosm of his own world to generalize about the state of humanity. “Each man bears the entire form of the human condition,” he wrote, “this great world is the mirror in which we must look at ourselves to recognize ourselves from the proper angle.”1

His modernity also resonates in the following passage:

I have seen no more evident monstrosity and miracle in the world than myself. We become habituated to anything strange by use and time, but the more I frequent myself and know myself, the more my deformity astonishes me, and the less I understand myself."2

His goal was to achieve eudaimonia (equanimity in the face of adversity). The best way to accomplish this was through ataraxia (freedom from anxiety) requiring control of the emotions and remaining in the here-and-now. Montaigne wrote with considerable humility:

The plague of man is the opinion of knowledge. I establish nothing. I do not understand. I halt. I examine. Breath fills a goatskin as opinion fills a hollow head. Not more this than that—why this and not that? Have you seen a man that believes himself wise? Hope that he is a fool. Man, a vase of clay. I am Human, let nothing human be foreign to me.1

Stream of consciousness
I portray passing1

Stream of consciousness (also known as interior monologue) is a literary technique that presents the conscious experience of an individual regarded as a continuous, flowing series of thoughts images without the usual censors, as in a dream. If a person is plagued by a defective memory, that on which he/she can best rely is the “here-and-now,” the period of time happening in the present. Consequently, Montaigne was also something of a Zen Buddhist in his approach:

When I dance, I dance; when I sleep, I sleep; yes, and when I walk alone in a beautiful orchard, if my thoughts drift to far-off matters for some part of the time for some other part I lead them back again to the walk, the orchard, to the sweetness of this solitude, to myself.1

Montaigne was so determined to be aware of and live in the present that he had a servant wake him repeatedly in the middle of the night, enabling him to catch a glimpse of his state of consciousness at different phases of the sleep cycle. He described his modus operandi:

The world eternally turns round, all things therein are incessantly moving; the earth, the rocks of Caucasus, and the pyramids of Egypt . . . even constancy itself is no other but a slower and a more languishing motion. I cannot fix my object, ‘tis always tottering and reeling by a natural drunkenness. I take it as it is at the instant I consider; I do not paint its being, I paint its passage; not a passage from one age to another…but from day to day, from minute to minute. In this condition, just as it is at the moment I give my attention to it. I do not portray being: I portray passing.1

Montaigne has had a profound impact on such subsequent literary productions as James Joyce’s Ulysses, T. S. Eliot’s The Love Song of J. Alfred Prufrock, William Faulkner’s The Sound and the Fury, and J. D. Salinger’s The Catcher in the Rye—all characterized by the narrator’s stream of associations and flight of ideas which may not always appear to have a coherent structure or cohesion.

How to live with purpose
Let death take me planting my cabbages1

Montaigne created the genre of the essay, the stream of consciousness literary style, and overcame many years of death obsession following his TBI. The underlying question pondered earlier in the Essays was “How to die?” His first response was that “We should always, as near as we can, be booted and spurred, and ready to go…”1 This shifted to "How to Live?" which became for Montagne the summum bonum:

The great and glorious masterpiece of man is to know how to live to purpose; all other things, to reign, to lay up treasure, to build, are at the most but mere appendices and littler props . . .   would always have a man to be doing, and, as much as in him lies, to extend and spin out the offices of life; and then let death take me planting my cabbages . . . No activity is wasted if it has personal value.1

The utility of living consists not in the length of days, but in the use of time; a man may have lived long, and yet lived but a little. Make use of time while it is present with you. It depends upon your will, and not upon the number of days, to have a sufficient length of life….Tis the condition of your creation; death is a part of you, and while you endeavor to evade it, you evade yourself.1

Montaigne’s response to the purpose of life provides a guide to the challenges of mind and body:

Life in itself is neither good nor evil; it is the scene of good or evil, as you make it. And if you have lived a day, you have seen all: one day is equal and like to all other days. There is no other light, not other shade; this very sun, this moon, these very stars, this very order and disposition of things, is the same your ancestors enjoyed, and that shall also entertain your posterity.1

References
1. Michel de Montaigne. Michel de Montaigne Quote Citation. http://www.brainyquote.com/quotes/authors/m/michel_de_montaigne.html. Accessed April 13, 2012.
2. Bakewell S. How to Live: A Life of Montaigne in One Question and Twenty Attempts at an Answer. London: Chatto & Windus; 2010.
3. Michel de Montaigne. http://en.wikipedia.org/wiki/Michel_de_Montaigne. Accessed April 13, 2012.
4. Thoreau HD. A Week on the Concord and Merrimack Rivers. Princeton, New Jersey: Princeton University Press; 2004.

 
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