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Jay Lake
Date: 2012-12-09 08:21
Subject: [cancer] Entering a new phase of cognitive disfunction - emotional perseveration
Security: Public
Tags:cancer, health, personal, radiantlisa
First of all, I am both humbled and uplifted by the response to the questions I posed yesterday questions [ jlake.com | LiveJournal ]. Chemo brain permitting, I shall be re-reading your comments today, and replying to at least a few of them. I should have something more coherent to say tomorrow, but thank you. Thank you.

Speaking of chemo brain, I had another long talk with Lisa Costello yesterday evening about a new phase of cognitive dysfunction I've entered over the past week or so. Basically, old emotional "tapes" are surfacing in my head, and I'm beginning to perseverate on them. This getting stuck on dead issues from my past is sadly familiar, as I went through it during the last two series of chemotherapy in 2010 and 2011. It's not dissimilar to what can happen to people with TBI (traumatic brain injury) or various forms of brain damage and brain tumors, albeit more mild and ultimately in my case transient.

As it happens, I track a number of side effects. This will come as a surprise to no one, but I have a spreadsheet. (I've been working in sales-and-marketing and/or IT since the mid-1980s, sue me.) My oncology team thinks this is a little weird, but they're also rather admiring of my spreadsheet. And many of those side effects are cognitive, including:
  • Agoraphobia

  • Confusion

  • Dyscalculia

  • Emotional 'crashes'

  • Extreme fatigue

  • Impaired long term memory

  • Impaired observation/EQ

  • Impaired reading

  • Impaired short term memory

  • Impaired thinking skills

  • Introversion

In case you're wondering, the spreadsheet tracks things like time of onset, duration, intensity and trending within each two-week chemo cycle.

It's all pretty damned frustrating, but this emotional perseveration on prior stress is galling in some particular ways. I find myself focusing on serious problems of the past, such as the ending of prior relationships, at times and with energy levels which are highly inappropriate. We're talking about stuff that's done and gone and dealt with, but I begin to re-experience the stress and emotional trauma as if they are current or recent events.

I get to relive old pain for no good purpose. And as this goes on, I risk inflicting that old pain on my loved ones, family, friends and caregivers, again for no good purpose. As I warned Lisa, eventually weird shit is going to start coming out of my mouth, and you'll have no idea why, or even what the heck I'm talking about.

This in turn tracks with the general peevishness and narrowing chemo brings to me, both directly and as first and second order indirect effects.

The first order indirect effect being me trapped in my house by fatigue, which makes me irritable and weird. The second order indirect effect is the more general narrowing of my life because of the direct and first order indirect effects. By nature I am a nigh relentless extrovert, who is now being pushed into an extreme chemically induced introversion and social isolation. This would play hell with anyone's good nature, regardless of the other issues at hand.

So it all swirls together and becomes an even bigger problem. I am able to interpret most of my chemo side effects through the lens of cancer and its discontents, but this particular one feels like a character flaw to me. I'm well aware that I am being irrational and self-judgmental when I say that, and it's simply not true, but nonetheless, there you are. Fatigue isn't a moral weakness. Neither is lower GI distress. This stuff? I really ought to be a grown-up about it, and I'm beginning to reach the point where I just can't.

In this area, at least, cancer and chemotherapy are transmuted into what I wind up interpreting as an assault on my character.

Emotional perseveration a relatively subtle issue. It's also one that can sneak up on me without me realizing it. As opposed to, say, nausea, which I can see coming a mile away. That makes me all the more vulnerable to it, because this is where my self-awareness begins to evaporate. Not only does my self-awareness begin to evaporate, but my carefully cultivated meta-awareness by which I am mindful of my self-awareness also evaporates, so thoroughly that I don't realize it's gone until well after the fact.

Even deep in chemo I'm so verbal and glib that I can fool people, including myself, about how well I'm doing mentally and emotionally. I'm so good at falsifying affect that I don't realize I'm doing it.

And that is just scary.

So I begin the slide down another slippery slope, already steeped in regret and a burgeoning sense of dread for what it is to come.

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Debbie N.
User: wild_irises
Date: 2012-12-09 17:55 (UTC)
Subject: (no subject)
That sounds simply awful; if it happened to me, it would feel like a character defect even though I can see that it's not. I think that part of it is that we are resistant to believing in the deepest ways our brains are affected by chemistry.
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User: nicosian
Date: 2012-12-09 19:59 (UTC)
Subject: (no subject)
I'm in the early phase of a pregnancy from hell, as in, can't EAT anything without serious medication, and even then, only sparingly. The physical illness is one thing, the not being able to eat, and the resultant effects on my energy and sanity right now are brutal.

Its like its me, only not me. I'm pretty much sleepwalking through the last week of classes this week. my energy clock taps out at around 4 hours, and that's scant time to do much of anything these days.
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Jay Lake
User: jaylake
Date: 2012-12-09 20:02 (UTC)
Subject: (no subject)
Oi. Good luck with that. You have my profound empathy.
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User: a_cubed
Date: 2012-12-10 06:00 (UTC)
Subject: (no subject)
This kind of emotional rumination is a common part of some forms of depression. I've always been subject to it occasionally (and still am) but it becomes pathological during depressive episodes (which I thankfully have very few of these days, and those have tended to be short). There are drug therapies which can help, though clearly more chemicals is not really what you need right now. Long-term CBT does seem to help with this, but in the short term the only thing I've found that helped was keeping engaged with people on a minute to minute basis, focussing me on the "here and now" rather than the "there and then".
This kind of ruminative depression is something many academics are prone to. One of the things that makes a good academic is the tendency to keep attacking a problem from all sides until it's solved, seeking novel ways of considering it and including minute variations. All well and good when it's a conceptualisation of a social issue or a thorny mathemtical modelling question but not productive when it's one's own past emotional mistakes or traumas.
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Tiffany Ann
User: firewitch9
Date: 2012-12-10 07:01 (UTC)
Subject: All those side effects sounds like my life
No chemo but those cognitive effects sounds like me
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Nat S Ford
User: natf
Date: 2012-12-13 23:38 (UTC)
Subject: (no subject)
I get this happening to me as well. I suppose that it is brain damage from the MS in my case.
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LiveJournal: pingback_bot
User: livejournal
Date: 2012-12-13 23:41 (UTC)
Subject: Lakeshore - [cancer] Entering a new phase of cognitive disfunction - emotional perseveration
User natf referenced to your post from Lakeshore - [cancer] Entering a new phase of cognitive disfunction - emotional perseveration saying: [...] s. Lakeshore - [cancer] Entering a new phase of cognitive disfunction - emotional perseveration [...]
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