11/10/2009

What happens when visual processing breaks down? Rickie's story

When sensory perception breaks down, its ripple effects can spread throughout a person's life. It disrupts academic and social functioning. Worse, it can lead to emotional problems and even suicide. The underlying problems in the brain may never be diagnosed: not knowing that others see differently, a person may think their faulty sense is normal until their teenage years, by which time they have had enough hurtful reactions and misdiagnoses to avoid describing their perceptions. In A User's Guide to the Brain, John Ratey describes how this happened to a girl, Rickie. Bold for emphasis was added by me:

"Rickie's father still remembers an odd incident that took pace when his forty-five year old daughter was only three. They were standing together in front of a giant picture window, looking out into a forest. Suddenly, Rickie began to tremble. She grabbed her father's hands and stood virtually paralyzed, deathly afraid. Her father hurriedly asked her what was wrong. 'The trees are coming into the house!' she yelled. 'They're all coming in here!'

Her father was taken aback by Rickie's strange behavior, but then again, she was only three, and young children certainly have their moments. He dismissed it. But it was a defining moment that would cast Rickie into a tortured life, though at the time neither she nor her father knew it...

[Rickie] was a bright student when she first entered elementary school in the early 1960s. But by the time she had finished third grade she heard the teachers talking behind her back: 'She's stupid. We're going to have to put her with the "special" kids.' Rickie was terrified. She loved schoolwork, even though it took her a long time to read, write, and do math.

Rickie had one great friend, but that was it. At home she was vibrant and full of life. But she never played with more than one child at a time, and avoided any kind of group activity. She heard the labels again: 'She's a loner.'

Rickie's parents had her tested. Her eyesight and hearing were fine. Her cognitive abilities were well within the norms...She was placed with other children who had learning disabilities because she just couldn't keep up with the regular class.

As Rickie got older she became mystified herself. At tmes everybody and everything seemed far away. She felt as though she was sitting in a closed box and seeing things 'through a pinhole.' But she didn't tell anyone; everyone already thought she was strange, and she certainly didn't want to say anything that made her seem even more like a 'weirdo.'

Then her grandfather, the only adult who didn't judge her, died, pushing her into a descent from sadness to despair. She was admitted to a psychiatric hospital when she was thirteen. She was first diagnosed as mildly autistic and then as borderline schizophrenic. Her fate was sealed, for in psychiatry in those days...a diagnosis...was impossible to shake, and it directed all subsequent treatment.

For ten years Rickie was in and out of mental hospitals. She became severely frustrated because no one could tell her what was wrong. The insults, the scolding, the drugs they gave her, and the sense of futility made her more and more depressed. She got so bad at one point that she was given a series of eighteen shock treatments, which jolted her out of clinical depression, but only long enough for her to try to kill herself...

The damnedest thing was that often, when she was talking with a doctor, she was lucid and calm...the doctors figured her lucid spells were deliberate cover-ups.

When Rickie was twenty-three she was referred to Melvin Kaplan, a developmental optometrist--one who specializes not in how the eyes work alone but how they work together with the brain. Although standard eye exams had shown that Rickie had 20/30 vision in each eye...she was prone to accidents and falling because she walked into or tripped on objects that someone with good vision would easily have avoided...

Kaplan asked Rickie to focus on an object. She stared for a minute or so and then looked away. Kaplan asked her, 'When you look at something, how long does the image stay?'

Rickie seemed puzzled.

'Does it stay or does it disappear, vanish?' Kaplan asked.

'It stays. I mean, I can make it stay.'

'What happens when you look at me?'

'Well, if I look at you for a minute or so, you start to disappear. But if I get my will power going, I can keep you in sight for a long time.'

'And what happens to the rest of the things in the room?'

'At first I see them, and you. Then, as I concentrate harder on seeing you, they get dimmer and dimmer, until I can't see them at all.'

Kaplan expressed his surprise.

'Isn't that the way everybody sees?' Rickie asked.

...Kaplan conclued that Rickie could not sustain a visual image for more than a minute without beginning to shut down everything else. She had to muster all of her brain power to keep seeing...Rickie had been struggling with a serious visual perception problem that probably became evident when she was about three years old--around the time of that fateful afternoon when she became frightened that the trees were 'coming into the house,' an early sign of the eventual collapse of her depth perception...

Rickie may well have had mood problems, but the terrible sequence of events that almost led to her suicide could have been avoided with the proper detection and understanding of what was initially a pure perception problem.

...When she was a teenager, [Rickie] knew the world sometimes didn't look right, but didn't want to say anything about it because she was afraid of the consequences. On one occasion she had complained to her psychiatrist that when she tried to read, the letters would suddenly crumble. He told her she was phobic--that she was a poor reader and was afraid to read because she knew she would fail. Rickie knew that if she objected more vehemently she would be rehospitalized, so she simply shut up...

Rickie had such trouble reading [because] she would look at the words in a book, and soon they would crumble--just fold and collapse on the page, melting into a black wash. If she tried to focus on the blackboard the room would soon get dim; the teacher would start to appear farther away...she literally couldn't see the words, or the board...She wasn't a loner, either. She loved people and friends and yet because she could only focus on one object at a time, dealing with more than one person in front of her was confusing at best and frightening enough that she never got involved in any group activity...She thought it was normal to struggle to see and hold her visual field together, because that is what she had always known. She thought it was that way for everyone.

[Improving her visual focus using special glasses was easy enough.] ...the truly more difficult part of Rickie's recuperation was correcting the psychological problems she had developed...after two decades of learning that people were cruel and could not be trusted, it took her years to reverse her depression and improve her social skills permanently. Not until she was forty was Rickie able to feel normal.

But she succeeded. She went to work as a rehabilitation counselor for people recovering from mental illness. She got married, had a baby, and then twins...

At one point, however, Rickie nearly lost it all. When she began a job and moved out on her own, her vision suddenly collapsed. She panicked, horrified that all her problems would come flooding back. She was readmitted to the hospital, calmed down, trained with her glasses again, recovered quickly, and never again returned to the psychiatric halls. The episode taught Rickie and her doctors a vital lesson: stress can shut down her visual system.

...Rickie has recovered not only visually, but psychologically as well...Unfortunately, there are other Rickies in the world who have perception problems that have not been diagnosed. There are still others who have actually discovered their peculiar perception problem and had it corrected, but have not been able to rebound psychologically or socially after years of insult from the world around them."

Take-home messages
This is written as if for parents, but only because it's shorter to say "your child" than "your child, student, or other acquaintance." Teachers and others could probably benefit, as well.

  • Perception may be the most important psychological function to study, in that how you perceive information affects everything you do with it downstream.
  • If your child says something odd about what they see (i.e., "the trees are coming toward me!"), pay attention. They might just have an active imagination, but they could be describing how the world really looks to them. Don't freak out, but look for more conclusive signs of perception problems.
  • Misdiagnosis can cause real harm. A label can stick with someone for life. Avoid people who apply the diagnosis-of-the-month to every kid with a problem, and look for people who will do a complete neuropsychological evaluation before they label your child. Be careful not to assume an emotional or motivational problem when there could be a perceptual one.
  • When a student I know went to a hearing clinic to ask about her problems hearing speech in noise, they asked her if she was under a lot of stress. She was annoyed, because she knew how to handle stress and was already working to eliminate it from her life, and she thought her functioning was worse than stress alone would predict. But actually, the clinicans were asking a good question. A person with a perceptual problem or a learning disability, like a person with chronic pain, has to struggle to hold it all together and perform tasks most of us take for granted. While they may look normal from the outside, they feel exhausted from the effort that requires. Stress depletes their resources, they no longer have the mental effort to force normal performance out of themselves, and their performance plummets. This is one reason why uneven performance is considered a sign of learning disabilities. The take home message: while stress management is important for everyone, it's especially important for people who might have a perceptual problem or learning disability. Make sure your kids have good coping skills!