Topic: Miscellaneous - Making Decisions

Question:

Dear Kathy M.,

I had an accident three years ago and thought I would be doing better by now. Some parts of my life are almost back to normal, but others are not. I am now able to get up in the morning and take care of myself (eat breakfast, take a shower, get ready for my day, things like that), even drive some, but I can't seem to hold down a job and parts of my personal and family life are more difficult than they should be. My wife seems stressed out most of the time.

My last boss told me that I "lacked judgment." A different supervisor (before the last one) told me that I seemed to have difficulty making decisions. I didn't think they were right at the time, but the other day I had to make a decision about buying a computer desk and I gave up in TOTAL FRUSTRATION! I ran out of the house screaming that I was going to throw out my *&^%#(@% computer, since I wasn't smart enough to figure out how to buy the right desk for it. My wife told me that this isn't "normal" and she is right! Before my head injury I would have been able to figure out what to buy without feeling like I was going crazy, and if I ended up not buying a computer desk, I wouldn't have considered tossing my computer in the garbage (I would have put it someplace else). These are examples of both decision-making and judgment problems, right?

Help!! I feel like a child much of the time and I think my wife is probably getting tired of being the "mommy."

George

Kathy's Response:

Dear George,

You are not alone with any of these things -- problems with making good decisions, problems with making good judgments, as well as problems with a spouse feeling they have to "care take" rather than be a full marriage partner, are all problems many of us with brain injury have experienced.

Let's look at this one step at a time.

Decision-making
Decision-making is a thinking skill, just like planning, problem-solving and making judgments. When a brain injury occurs, all forms of "thinking" can be disrupted, so it's not surprising that people who have had brain injuries struggle with making decisions.

Your story rang a bell with me because I went through something very similar early in my recovery -- when I struggled with deciding on what kind of file cabinet to buy. I knew I needed one (because all my papers were piling up in my home office), but I was stuck on the fact that I wanted it to "match" my computer desk. I couldn't figure out how to get one to match, since taking drawers with me to the office supply store wasn't working. I lived in paper chaos for about six months before my OT (Occupational Therapist) suggested that we work together on "decision-making skills."

She started by outlining the steps that go into making any decision. I didn't realize that decision-making was so complicated! But it is. Our little brains go through quite a few steps to evaluate sitatuations and produce decisions.

She mapped out -- on paper -- what these steps were, and then helped me follow them as I was looking at the guidelines on paper. The key is doing the process ON PAPER! To this day, even though I am now almost nine years post, I make most of my decisions on paper. I'm generally happier with the results when I do it this way.

Steps for making a decision
These are the steps the brain goes through to make a decision (according to my Memory Notes from when I was in my cognitive rehabilatation program):

1. Identify the issue you want to make a decision about and write it down;
2. Brainstorm a list of options without making judgments (get input from others if necesssary);
3. Rank each option with the number 1, 2 or 3, as follows:

   1 = beneficial consequences are likely
   2 = mediocre (or unknown) consequences are likely
   3 = consequences are not likely to be particularly beneficial

4. Look at all the #1's again and select the option that is most likely to produce the best outcome.
5. Write down your decision where you write the day's Memory Notes.
6. Write down the steps you need to take to implement the decision.
7. Schedule all the parts (steps) in your planner.

For me, the key is doing all this on paper and practicing the steps over and over with simple decisions (like deciding what filing cabinet to buy). More complicated decisions (like changing careers) requires the ability to follow these steps with some comfort and familiarity.

By the way, after I did this process outlined above, I ended up buying a cream colored metal filing cabinet. It turned out fine because it blended with my other furnishings and it was less expensive than a wooden one, to boot! The reason it was on the list of options was because I had put it on the brainstormed list (Step #2) even though I had pre-judged that this wouldn't work (remember I wanted a "matching" file cabinet, not thinking that a "complimentary" cabinet would be acceptable). It's important to do Step #2 (brainstorming) without making judgments -- just produce a nice long list of possible options (emphasis on the word "possible").

Judgment
Making good (some peole use the term "appropriate") judgment calls is similar to making decisions - at least, in terms of the process (steps) your brain goes through. Sometimes I think judgment seems different from making decisions because we are used to taking our time with making decisions but may be used to making "judgment calls" more quickly.

It's probably best to illustrate what I mean by "judgments" vs. "decisions" by using examples. I use the term "decisions" when it comes to things like deciding what to order from a menu, what movie I want to see this weekend, what to do about a neighbor's barking dog, or what color blouse I want to wear. On the other hand, when I use the term "judgment," I apply it to situations like this:

• If a person's boss is upset with them and the person decisdes to quit on the spot, we are likely to say the person probablly lacks appropriate judgment (if the consequences are that they cannot pay their bills, are not likely to find another job right away, etc.). We would say the person's judgement is particularly poor if there were other options they could have selected that would have likely had more positive consequences.
• If a person puts themselves in a dangerous situation without thinking about the possible consequences, we are likely to say they lack judgment. An example could be getting in the car of a stranger just because you need a ride home. Or having "just one drink" with some friends, even though you have been told that drinking alcohol could cause a seizure. Or not taking precautions by writing good directions and running the risk of getting lost in a part of town you don't want to be lost in.
• If a person overreacts to something, and causes more harm to themselves or their loved ones than would have happened if they had not over-reacted, we would likely say they are excercising "poor judgment."

George, it seems like your "decision" to throw out your computer fits into this last group, don't you think? Now that you have calmed down, you would probably agree that anyone who chooses to throw out their computer instead of figuring out how to buy a desk for it, probably lacks judgement, at least at that particular moment.

If this makes sense to you, I would like to suggest that you apply the steps for making decisions to whatever it is you are making a "judgment" about too, and see if following the steps help. I suspect it will.

Dependency on one's spouse
In the work I do, I hear this complaint all the time -- from people with brain injuries and from their spouses. When decision-making is difficult, or when judgements are not sound, the spouse of the person who is having the difficulty can often get stuck in a parental-type role. They start making all the decisions. They start making all the judgment calls. And if their spouse is having other cognitive problems in the areas of planning and follow-through, they could end up making all the plans, paying all the bills, doing all the work -- basically taking care of all the aspects of living their brain-injured partner is not able to handle.

It doesn't have to be like this! While a person who has had a brain injury may not be able to solve the mysteries of universe, they often can be taught how to make decisions, make good judgment calls, and do other things -- like make plans and solve problems. The key is knowing the steps the brain takes to do these things and having strategies in place to follow the steps on paper -- instead of just relying on the grey matter between our ears. That way we are sure to follow all the steps and not miss some of them.

Hope this helps.

Kathy M.

P.S. And some of us probably are capable of solving some of the mysteries of the universe too!

University of Missouri - Columbia
School of Health Professions
Great Plains RCEP