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Columns   |    
Personal Accounts: Brain Training: An Athletic Model for Brain Rehabilitation
Lisa Halpern, M.P.P.
Psychiatric Services 2006; doi: 10.1176/appi.ps.57.4.459
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Ms. Halpern is affiliated with WestBridge Community Services in Cambridge, Massachusetts (e-mail, lhalpern@westbridge.org). Jeffrey L. Geller, M.D., M.P.H., is editor of this column.

The process of rebuilding a schizophrenia-ravaged brain strikes me as analogous to rebuilding a severely injured body. Rehabilitation of the body requires daily physical therapy and a transition from being bedridden to walking in gradual stages as the body strengthens; rehabilitation of the brain requires continuing practice and adjustment as the mind strengthens. The two kinds of rebuilding—brain and body—are extremely time-consuming, humbling, and exhausting, both mentally and physically. Neither is a solitary effort; dedicated involvement of family members and physicians is needed. An element of luck is inherent in both; results are uncertain and require patience. I have come to appreciate that just as muscles must be exercised to avoid atrophy, the brain responds to practice. In fact, many aspects of brain building remind me of training regimens for endurance sports.

The most fundamental building blocks of who I am stem from athletics—in particular, competitive running and outdoor fitness. I began track and field (sprints, middle distance, shot put, and triple jump) at eight years of age, and by the age of ten I was ranked nationally in the 400 meters and was among the top three 800-meter runners in Washington State. In seventh grade, I was selected to join Outdoor Fitness, a noncompetitive class dedicated to completing physical challenges via teamwork and a steely mind-over-matter approach. We walked 55 miles around Lake Washington (finishing in just under 24 hours, many physically ill and with feet bloodied from blisters), ran 29 miles (with breaks for food and ferry rides), routinely jumped into glacier lakes (called "quick dips") during campouts and day hikes, and survived a night in waist-deep snow with only a small coffee can filled with matches, a flashlight, and snacks.

As part of Outdoor Fitness, I competed in a half-marathon, a triathlon (my earliest triathlon was at age ten when I won first place in the IronKid), and canoe races; river rafted class 4 rapids; and built stilts from wooden slats, teaching myself to walk and run and to play soccer on them. In our meeting area for Outdoor Fitness, two slogans adorned the walls: "No Guts, No Glory" and "A Quitter Never Wins and a Winner Never Quits." I would never forget those two messages, nor would I have been able to predict the extent to which I would return to those guiding principles and seek strength from them in my nonathletic challenges in years to come.

Just before I was given a diagnosis of schizophrenia in June 1999, while I was on medical leave from graduate studies at Harvard, I spent a week on the psychotic inpatient unit at McLean Hospital. During that time, my economics professor from the interrupted previous year at Harvard's Kennedy School of Government called to offer me a summer research position. I accepted immediately, calling him on the hospital's rickety rotary phone, and was determined to use the next three months to prepare myself to return to Harvard that fall. In three months I would need to rebuild my brain from near mental retardation to a level of cognitive and emotional functioning qualitatively and quantitatively exceeding what I had experienced for many years. For example, I had been summa cum laude and Phi Beta Kappa and completed double majors with distinction at Duke, then received two merit-based fellowships that funded full tuition and living expenses at Harvard. However, as my thought disorder worsened, I lost my memory and my ability to count change, write checks, operate laundry machines, and find my way through a subway station. My IQ plummeted into the 70s. My facial expression flattened, my personality disappeared.

For even the most talented and dedicated doctors, schizophrenia is a challenging illness to understand because, in the depths of acute illness, a person loses his or her ability to communicate. I remember thinking through something logically within my head, such as "A, B, C," and then hearing myself say "X" instead. As things got worse I limited my speech, knowing I was not making sense. I mumbled. I talked to myself. Almost mute and terribly confused, I would stare blankly at walls or, when around people, look down at the ground. I had loved reading the New York Times, but I remember when the font became too bright and the pictures jumped off the page as three-dimensional objects. Frustrated more than frightened, I abruptly canceled my subscription. I stopped reading and writing altogether and retreated further inward.

When I first came out of the hospital I needed a check-off chart on my wall to remind me to take medications, wash dishes, and pay monthly bills. Eventually I relearned how to maintain daily functions needed for independent living; once these supports were firmly in place, cognitive rebuilding could begin. When I came home from McLean and was unable to read or concentrate, my mother started reading to me. Whether she was just trying to fill time or whether I needed to shut other thoughts out of my brain, she would seek activities that I enjoyed. At first my attention span was quite short and I could stay awake for only brief periods (brain breakdown produces incredible fatigue, and a majority of medications exacerbate sedation), so she read a few lines at a time from materials that were not very demanding and that might grab my interest. As is the case with young children, familiarity and repetition helped, so books from my youth were recited multiple times. As I got stronger, my reading tutorials became longer and my naps became fewer, and my short-term memory began to click, which increased my ability to concentrate. When I was ready to undertake reading on my own, I requested a book I remembered fondly from fifth grade: Deenie, by Judy Blume. It is the story of a young woman with scoliosis who has to confront and ultimately accept her disability. I recall ruminating about the big print and small number of pages. I do not think I fully processed the ironic parallels between the book's character and myself, but in retrospect they are quite striking.

In the first stages of regaining brain agility, my mother and I played very simple card games, such as "Go Fish," and I spent time coloring in some childhood coloring books and creating figures from colored dough. With their symbols and numbers, cards helped strengthen my mathematics-related thinking and memory; the pictures and sculptures incited creativity. As a child, I had subscribed to Games magazine, and my mother pulled out old copies for me to do word searches and other puzzles. Once my verbal skills increased and some of my characteristic resolve returned, I began working my memory—which meant old-fashioned practice. Just as running marathons requires putting in the miles, I set aside daily time to memorize passages from authors such as Shakespeare ("my love's more ponderous than my tongue") and Eleanor Roosevelt ("you gain courage by every experience in which you really stop to look fear in the face"). I also tried to memorize weekly AP basketball college rankings (made easier by the fact that I am a diehard Duke fan).

Just as one finishes a marathon and continues to run—albeit with a few days of rest and perhaps a massage—so too did my brain-rebuilding efforts extend beyond Harvard. The marathoner may decide to train for another marathon, or switch to 10Ks, or change to a different sport. As my brain continued to gain strength and reap reward from regimented, time-consuming, and often humbling efforts, I pushed myself to acquire new skills, such as sign language and sailing, both of which necessitate coordination of brain and body. As a young competitive runner and wilderness-challenge enthusiast, I had learned the value of discipline, determination, hard work, and long-term goals. These values turned out to be equally important in reconnecting and strengthening the brain.

After one year's medical leave for the 1998-1999 academic period, I returned to the Kennedy School in the fall of 1999. I was fortunate to have remarkable support from the school's administrators and professors throughout my tenure there, in the form of additional time for assignments and class credits for summer research. With the enormously generous elongation of the two fellowships that supported my studies, the Kennedy Fellowship and the Paul & Daisy Soros Fellowship for New Americans, I was able to complete the Master of Public Policy degree, with a focus on health care policy, in 2001. After graduation I sought a position with the Commissioner of the Massachusetts Department of Mental Health and spent two wonderful years there.

In December 2003 I joined a newly created private-pay privately funded assertive community treatment team in Cambridge, Massachusetts. I am its first peer mentor. Given my paucity of experience with blending the professional and the personal, a major challenge of my job is figuring out which aspects of my illness are applicable—and therefore helpful—to others. I do know that if someone is willing and able to get assistance from others, persevere over time and frustrations, and work with dedication to improving then it is worth trying to rebuild cognition by using approaches and materials that are familiar, repetitive, and interesting to the individual. It is both the Boston Marathon and the Ironman Triathlon. It is difficult but doable. There may be no finish line, but it is possible nonetheless to get closer every day.

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