Reflections on Brain Stories (a Dispatch from the Neurologist's Office)

A trip to the brain doctor reminded me of the power of choosing the path of more resistance.

The title of this Substack, A General Education, refers to the fact that normally I discuss works of literature or philosophy that could be found in a general education curriculum. This month I am not focusing on a text, but a life experience that I believe has “general” implications for education.

Last week I had an appointment with my neurologist, whom I see each January as part of my post-stroke care plan. I am three years out from the stroke I had in the winter of 2021—although I learned at last year’s appointment that I technically had three strokes. The first were two small ones that happened while I was on life support; the larger one happened during heart transplant surgery. These types of strokes are not uncommon during the placement and removal of heart-related life support machines, because a lot of blood is moving around, and clots can easily form and travel to the brain.

I was glad to share with Dr. L* that the stroke no longer interferes with my life activities in any significant way. I still have some physical discomfort on my right side, but very little muscle weakness, and I can now complete any physical activity that I could do before. My speech still falters, and finding the right word occasionally eludes me, but not in ways that prevent me from writing, speaking, or teaching.

After I reviewed all of this with him in detail, I finished by saying: “In short, I do still feel the effects of the stroke, but they don’t bother me; I assume that at this point, three years out, any remaining effects are permanent. I’m happy to live with that, given how much I have gained back.”

He shook his head, and said gently but emphatically:

“You can continue to regain function for the rest of your life.”

I was taken aback by this. I had always read, I told him, that most of the recovery from a stroke occurs during the first three months. Recovery can continue after that, but the gains become vanishingly small as time goes by.

“We no longer believe that’s true,” Dr. L continued. “Regaining function, and developing new functionality, can continue as long as you are alive.”

To illustrate this statement, he gave me a few examples of how I could continue to improve the areas in which I still struggle. If I wanted to regain muscle symmetry (because the stroke caused some weakness on my right side), I should make a mental commitment to that goal. When I am at the gym, and working on a group of muscles, I should push the muscles on my right side a little harder, with the goal in mind of re-achieving symmetry.

“When you do this,” he said, “you are sending a signal to your brain that this muscle matters to you. You want it to become stronger. Over time, the brain will eventually respond to this signal, and start distributing more resources to that goal. Essentially you are training your brain to give more support to your goal.”

He said I could apply the same principle to the lingering speech issues I have. For example, repetitions of the same-sounding vowels and consonants in the same word, or neighboring words, are hard for me to say; I will often clip such words. The word “institution,” for example, typically gets short shrift in my mouth.

You shouldn’t frustrate yourself too much by constantly repeating words like these, Dr. L said, but as long as you are willing to keep trying to say them, you should keep trying:

“Here as well, your brain will eventually realize that you care about saying that word, and distribute more resources to help you pronounce it correctly.”

This conversation reminded me of the powerful impact that our beliefs about learning have on what we achieve—and what we don’t achieve. If you are not familiar with the research in this area, which is abundant, I have pointed to a starter source in the second footnote below**. I have written this post not to introduce some new idea, but to illustrate one that has been well-demonstrated in the research.

The attitude with which I entered that doctor’s office was one that many students—and many teachers, frankly—carry into their education: My brain doesn’t learn like that. My poor prior education won’t allow me to do that. I don’t have the cognitive skills to achieve that. Or, in my case, a dead spot in the middle of my brain won’t allow me to finish the process of regaining all of my functions.

We always have good reasons for these beliefs. What I had heard, read, and learned about a stroke-affected brain had convinced me that my current condition had put certain barriers around my future learning. I had reached the limits of my damaged brain’s potential. Dr. L insisted, in the face of my objections, that future brain change remains if I cared about such change and if I was willing to continue struggling against my current limits.

I suspect we all have brain stories that shape our learning behaviors. Readers might have absorbed stories about their brains from lots of places: medical diagnoses, social media, popular articles about the brain, judgments from teachers or parents or peers, arguments and testimonies from others, or their own histories and convictions. Many of the readers of this Substack probably have a firm grasp on the literature on learning, and believe their brain stories are accurate ones; they feel comfortable with the brain stories that guide their lives.

I felt the same way. But my stroke recovery would have ground to a halt if I had continued to tell the brain story I had heard from a few sources, including ones that were informed by prior research on stroke recovery. Instead, a little information and encouragement from a caring and informed teacher convinced me that I had the capacity to continue growing. He drilled down and reminded me of some core imperatives for learning with a human brain: having a meaningful goal and pushing yourself against your current limits.

Neither of these two features are simple or easy to get right, especially in the classroom. The research on what makes people care evolves constantly, as does debate about the right amount of struggle for any individual learner. That latter point plays out especially in conversations about the growth mindset, learning styles, desirable difficulties, and even accessibility and accommodations. All of these are areas in which we are debating how much of a struggle a learner should face before it tips into frustration that can shut the process down altogether.

No easy answers here. In my own life, I have always pushed myself a little harder than I probably need or should have, in learning and everything else. That might explain my resistance to GenAI, which promises to help us achieve our goals more efficiently and economically. I tend to choose the path of less efficiency when I see the prospect of gaining from the struggle. My reading of the literature on cognition leads me to believe that this path, trod with full awareness of its pitfalls, has the most potential to create deep learning and personal growth.

My conversation with Dr. L reaffirmed my commitment to choosing the path of more resistance. Ever since I came home from that appointment, I have been practicing saying the word “institution” aloud. After a little reflection, I realized that I was especially clipping the first syllable, which flustered me and made me rush through the rest of it. Now I hit the “in” with a little push from my diaphragm, which forces me to slow down enough that I can hit all of the syllables correctly. I repeat it aloud a lot.

Of course, the emphasis of the word “institution,” from a phonetic perspective, belongs on the third syllable (-tu-), so I’m not quite pronouncing it quite correctly yet.

I’ll get there.

Notes

*I am not giving his real name, although he knows I am a writer, and in fact my wife made a joke at the appointment about the fact that I probably would write about our conversation—to which he said, with a laugh, “Send me a copy.”

**Many folks have written about the relationship between our beliefs about learning and how they affect our actual learning. You can see an overview in a scholarly article by some of the giants in the field.