Chapter 5: How Chronic Stress Compromised My Cognition

Times like that, a man raised to wild country, doesn’t think. He acts without thinking… Or he may never get a chance to think again. Louis l’Amour

The previous chapter showed how stress can lead the brain to process information differently. In a nutshell, anxiety causes us to think fast rather than to think comprehensively. I have personally experienced what it is like to experience this chronically, losing mental aptitude to chronic stress. I believe prolonged stress over months and years resulted in irreversible physical modifications to neural circuits in my hippocampus and prefrontal cortex. This substantially adversely affected my ability to carry information through time, which is the bedrock of complex thought.

I endured chronic stress throughout my twenties. Despite concerted attempts to relax, I often felt overwhelmed for days at a time. Even though I wasn’t committing criminal acts, I had surrounded myself with criminals. Partially for this reason, I was exposed to violence, threats, bullying, and life-threatening experiences. A large proportion of what were my closest friends are now homeless, in jail, or dead. In my life at work, I was shackled to a keyboard and mouse, and I used all my willpower to force myself to type for long hours. From the mix of calamity and drudgery, my mind was always racing, and after a few years of this it started to come apart. I became baffled by my mental blunders, as the stress continued to compound. My symptoms became progressively worse as I expended my cognitive reserve.

In my early twenties, I spent much of my time reading and writing about scientific concepts that I found complex. Daily, I was pushing my mental abilities to their limit. Once those abilities began to falter, it was easy to notice because I simply could not perform as I had previously. After observing that I was experiencing memory lapses of unprecedented magnitude, I carefully observed my mental handicaps and compared my level of consciousness to my earlier (premorbid) state. Doing this allowed me to identify and analyze the psychological corollaries of my predicament. I am convinced that my attention span, declarative memory, learning ability, and capacity for self-discipline declined extensively over a period of a few years.

I want to take the opportunity to offer some anecdotes from my experiences because however subjective, I feel that they may offer the reader insight into what it is like to be affected by the stress cascade and to be pushed toward the low-functioning side of the neurodiversity continuum. What follows is a memoir of the cognitive dissolution I withstood and the different ways it manifested.

The Prefrontal Cortex, Concentration and Executive Function

My ability to concentrate, an aptitude of the prefrontal cortex, was one of the first faculties I felt become adversely affected by stress. After days of intense anxiety, it became harder and harder to remember what I had just been thinking about. When I tried to grapple with a question I posed to myself, I found that I lost the important contextual elements within a few seconds. Before I could pin down one concept and evaluate a second concept relative to it, I had already lost attentive command of so many relevant features that the effort was useless. I could not collect my ideas on subjects I was thinking about unless I was highly intrinsically motivated. It was a state of constant intellectual exhaustion.

This all applied to my ability to read. In my early twenties, reading erudite academic texts was challenging and rewarding, but chronic stress made it prohibitively difficult. I could not fathom long, complicated sentences because, before I finished the sentence, I had already become oblivious to the first few phrases. My reading comprehension deteriorated because previous sentences and paragraphs were not immediately available to provide reconciliation. I found prolonged concentration impossible because my train of thought was persistently derailed.

At this point in my life, I spent much of my free time trying to force myself to come up with new scientific hypotheses and to expound on them. Over time though, I had fewer interesting insights because I could no longer pose challenging questions to myself and systematically identify the avenues that would help me answer them. After consideration, I found that my insights were trivial and insubstantial. Most of my interesting ideas were accidental in the sense that they were made through snap judgments instead of earned through inductive reasoning. I often felt that each new thought was powerful and exciting, but I soon realized that it only seemed this way because previous thoughts faded prematurely. I was distractable precisely because previous thoughts abandoned me before they could perform their function of keeping me on track. I lost the mental leverage that helped me make complex and unique associations distinct from those I had made in the past.

As things got worse, when I tried to employ a rational train of thought to a problem, I returned quickly to zero – to my five senses. Instead of being able to become “lost in thought,” I was grounded in physical immediacy. I lost the ability to find my mental considerations captivating and found myself looking around at my surroundings, thinking about how I could attain cheap, quick stimulation. Dedicated and disciplined work became too difficult to persevere through. Although I didn’t lose my drive. It was simply refocused on endeavors with short-term payoffs. The things that would capture my interest appeared important at the time, but it didn’t take long for them to be revealed as shortsighted impracticalities. As I became increasingly shallow and capricious, my activities became unproductive and even self-defeating.

It felt like the window through which I brought the immediate past had become narrower. Only the very salient or heavily familiar concepts could make it through the gap. Internally conceived notions lingered only briefly before they were irretrievable. Ideas I had been juggling in working memory would disappear before they could make their proper contributions. It seemed that even things I had been exposed to a few seconds prior had little or no bearing on my subsequent responses and perceptions. My behavior began to hold similarities to the “environmental dependency” of patients with PFC injury in the sense that I acted as if I had fewer internal representations and an exaggerated dependency on the external environment for behavioral cues.

A few years prior, I felt my conscious life was mostly comprised of planning actions and envisioning the future. By my mid-twenties it was mostly having fleeting thoughts about the repercussions of my actions that had already taken place. These were automatic, mostly unplanned actions mediated by lower brain systems. I precipitously jumped to hasty conclusions, made rash decisions, and left essential considerations unconsidered.

Often, I felt like my actions and speech came out on their own as if someone else was presiding over the minutia. In the past, a single action was broken down into many separate steps, each of which I had some attentive control or acknowledgement of before they were acted upon. But my actions became so inarticulate that I wondered how it all came together without oversight. This was especially prominent in areas of experience. However, when forced to contend with unfamiliar situations, I either floundered and struggled or sped through in a crude, poorly integrated way. Because I noticed myself doing things without any contemplation, I knew I had lost degrees of personal free will. This is a disintegration of the self. In many ways, I felt the person I had been previously was now gone.

The Hippocampus, Short-term and Episodic Memory

My spatial ability was one of the faculties that deteriorated most noticeably. I used to be able to walk deep into the journal stacks in the university library basement, absorbed in articles, while always keeping my spatial and temporal bearings. No matter how many turns I took down windowless corridors, I always knew where I was and which direction the compass would point. Only a few years later, I could quickly lose my sense of direction and orientation. This even happened outdoors and in the presence of salient landmarks. As spatial faculties are hippocampus-dependent, it seemed a clear sign of hippocampal injury. Issues with my short-term and episodic memory seemed to confirm this. 

I noticed a recurring pattern where I would try to recall a recent event. I might have a couple of memorial cues, which would usually be sufficient to recruit the rest of the memory. However, a second would pass… a few more seconds… and nothing. No recollection. It seemed like my memory worked either instantaneously or not at all. If I could not recall something I was trying to remember right away, it would be useless to spend more time trying to refresh the memory. This reminded me of the condition common in prefrontal brain injuries where a patient cannot voluntarily cue up memories from the hippocampus using their PFC, but the hippocampal memories can be jogged from environmental cues (from the sensory cortex), rendering recollections superficial and rendering associations loose. So my working memory deficit was exacerbating the recall deficit: because previous thoughts vanished quickly over a matter of seconds, related concepts could not accumulate to converge on the associated memory in question.

I found myself able to recall a much smaller proportion of things I had learned and could only remember these things if the recall cues were numerous. For instance, if I forgot a grocery list, I would not remember the items unless I actually saw them in the market (recognition without recall). Similarly, after I learned the meaning of a new word, it might look more familiar the next day, but its meaning wouldn’t stick. I required many encounters with a new word for the content to consolidate into long-term memory.

In my teens and early twenties I tried to teach myself as much about science as I could because I knew that learning begat more learning. I believed I had encyclopedic knowledge of several scientific disciplines. At times, I would visualize this knowledge bank as a transparent, crystaline castle with corridors connecting large rooms of related information. By my mid-twenties, I had a vision of that castle shattered into glass shards strewn along the ground.

Before experiencing chronic stress, I could analyze and evaluate a complex hypothesis in my head alone. Now, such complex concepts are slippery and in order to grasp them I must write about them. I must work an idea out on paper to get a feeling for whether it is correct or not. Before the stress, most of my thinking was visual. It was rarely verbal. Using language was an impediment because the time needed to form words into sentences slowed down my thought processes. Now I must put all my formal thoughts into words because I need the crutch of language and the assistance of the phonological loop (the echo-like auditory memory system) to act as memory buffers to bear concepts in mind.

The repertoire of words I can access mid conversation (working vocabulary), was vastly reduced. At first, I began to wonder if this might reflect the fact that I wasn’t reading as broadly or working hard enough to maintain my vocabulary, but it became painfully clear from the sheer extent of the loss that it must be due to stress-related cognitive impairment. In some ways my condition was similar to what I had read about anterograde amnesia. When trying to remember something I had previously read about, I often could recall how I felt about it emotionally, but the contextual features would be irretrievable. Often, I could remember something that was said, but I could not remember who said it or where I was when I heard it. This phenomenon became particularly striking when I couldn’t remember if what was said came out of someone else’s mouth or my own.

Social Abilities

The most bewildering part of it all was how normal I seemed to other people. Intact lower brain areas allowed me to move, act, and converse fluently. Internally, I was missing an entire world of planning, insight, and foresight. But to an outsider, this was not apparent.

Before the stress, I was socially inept in many ways. I came across as spacey, stilted, and neurotic. I used to think very hard before I spoke in virtually every social situation. I would even formulate nearly every sentence in my mind before I spoke it. I cannot do this anymore. Now I start a sentence before I know how I am going to finish it.

My cognitive impairment got so bad that I frequently lost my train of thought in the middle of conversation. If I strayed too far off topic, I would embarrassingly be unable to return to my main point. Formulating long, descriptive sentences became agitatingly difficult. This forced me toward brevity and simplicity and made me relinquish hope that I could recall unique technical terms that lack substitutes. Often, I know there is a specific word that I am looking for but that I will not be able to cue it up on the spot. Sometimes it seems like the only words I can trust to fall into place are those common and habitually ingrained ones I have used since childhood. Instead of being informed by thoughtful analyses, a substantial proportion of my speech was simply composed of “dominant responses,” which consisted of the easiest thing to say in each situation – the first thing that comes to mind. This forced me to say exactly what I was thinking. It was embarrassing for a few months, but not much longer than that because I had to change my approach.

After a while, I learned to simplify my discourse and to stop trying to set up complicated arrangements of sentences. I say things I have already said before, retell the same stories to different people, employ melodic contour, use trite expressions and more emotionality, and never veer off too far from the main point. If I even have one, that is. Ironically people responded better to this, and I noticed that I quickly became more socially facile.

My emotional tone matched the flow of conversations better. Instead of being labored, wooden, and detached, I was able to maintain a high level of affective fluency, which helped me build rapport with others better than I had been able to prior. Instead of seeming suppressed, excessively conscientious, and calculating, I came across as more in touch with my feelings and thus more authentic. My newfound ability to be spontaneous, improvise, and respond without deliberation made socializing much more comfortable and easy. Relatedly, it also made simple motor movements perceivably easier.

Disinhibition, Facilitated Movement, and Procedural Memory

My explicit memory was lacking, but implicit memory (habitual and procedural responses) filled in the gaps quite well. For instance, trying to learn or interact with new systems (such as a new operating system or a new supermarket) was difficult and frustrating, but interacting with familiar ones was effortless. As long as I eschewed novelty and stuck with familiar territory, I could get along well without others noticing my deficits.

Remember from the last chapter that chronic stress forces the brain to fall back on old habits. Soldiers deployed for war have lower cognitive performance on complex and abstract thinking tasks but have facilitated reflexes and faster response times. The same effects have been shown in animal studies. I was able to perceive this in my behavior from day to day. After months of particularly acute, chronic stress, I realized that I could do things physically that I could not do before. During these bouts, my reflexes were potentiated so much that even other people noticed.

I always wanted to be good at catching things that were falling, and I liked to think that I was good at it. After the acute stress, though, I was very good at it. As long as I did not hesitate, I could even catch things other people dropped. Many friends and acquaintances put their surprise into words, commenting on my nimble reactions. It felt like my body was on turbo autopilot linking dexterous movements together without me having to preside over the selection process. Moreover, I seemed to be faster at everyday activities, my balance was better, and my ability to gesticulate had taken on a smoother, more wholesome quality.

Playing a familiar sport seemed unconstrained and effortless. My friends engaged in lots of wrestling and boxing and pulled me into it. After the stress cascade took its toll, I was much more proficient, unhesitating, and passionate. I was also less predictable. Moreover, responding to other people’s movements in real time became intuitive and second nature.

Growing up, my personality was repressive and stoic, and you could hear this in my speech, feel it in my demeanor, and see it in my movements. In the past, my actions were reserved and deliberate but stress made it so that they became more spontaneous. It caused what would have been discrete motions to blend together seamlessly without guidance. I would find myself acting or speaking without deliberating beforehand, without any kind of plan, and without knowingly initiating. It was frightening at first because it felt like I had lost the buffer between stimulus and response. I had to let go and just respond without first trying to predict what the outcome would be.

In the past I was like a chess player that can only make one premeditated move at a time. And I would veto every other imagined move before it could emerge. I was always double checking, second guessing, and biting my tongue. After the stress, I felt like a roving automaton that was in a state of constant impromptu activity. This had the general effect of giving my behavior the unsupervised quality of punch drunkenness or slaphappiness and led to irreverent, unprioritized, and frequently unproductive self-management.

In my childhood and early twenties, I liked to think I was decent at dancing, but truth be told, I would lose the beat within seconds. Back then, I could not grasp the tempo of the music. I would expect the next drumbeat either too early or too late and thus could not synchronize my movements with the music. Then of course, just trying to focus on the beat pattern pulled me out of it. However, after months of acute stress, it was impossible to lose cadence. My estimation of when the next beat would strike was much more precise. It began to feel natural and good to coordinate my movements to a repeating rhythm. In fact, I could smoothly alternate from a certain beat-per-second into half-time or double-time and then back again, something I had never even conceptualized before. Not only could I dance better, but all the inhibition that kept me from wanting to dance in front of other people due to shyness, flew out the window.

How did my motor movements take on a life of their own? It is generally thought that there are three forms of movement: reflex, rhythm, and voluntary movement (Kandel et al., 2000). Reflexive and rhythmic movements are stereotyped and involuntary. The prefrontal cortex, which is widely disturbed by chronic stress, mediates voluntary action. Once its dominion over behavior is weakened, brain areas responsible for more automatic behaviors are given free rein. It and the cortex in general, put a great deal of inhibitory pressure (via the corticospinal tract) on central pattern generators in the spinal cord, which are responsible for reflexes and rhythmicity.

For example, all healthy infants are born with certain reflexes, such as the Babinski reflex, which disappear within the first year of life. They disappear because axons in the corticospinal tract become myelinated during the first 12 months of life. These axons allow the frontal cortex to tonically inhibit innate spinal reflexes, which can be unmasked if the tract is damaged due to injury (Afifi & Bergman, 2005). Frontal brain damage has also been known to unmask motoric patterns that ordinarily would necessitate higher neural activation energy to surface (to overcome the neural inhibition). I believe that they hypometabolic state of my higher cortical areas was responsible for my physical fluency because it released various lower areas from inhibition, including the spinal cord, the extrapyramidal system, the basal ganglia, extrapyramidal system, and early cortical motor centers.

One interesting example of a facilitated reflex involves recovering from being tripped. The feet swing forward briskly and automatically as you walk. This makes it easy to trip if a foot collides with an unseen object. The only way to keep yourself from stumbling is to stop the forward movement of the foot. This involves switching quickly from using the quadriceps muscle to the hamstring in order to stop the leg from driving into the obstacle impinging on your stride. This is very hard to do because it requires a split-second reaction (Kandel et al., 2000). If it necessitated conscious control, it would usually not occur in time to avoid most stumbles. I was rarely able to avoid tripping by engaging the hamstring growing up. However, after the period of chronic stress, it became second nature. Even today, I am very resistant to tripping over cracks, wires, tree roots, or people’s legs. Friends of mine have even commented on how briskly and effortlessly I recover from tripping. At first, I erroneously assumed the grace and agility required to do this were under my conscious control. In quick reactions thought awareness plays a minor role, if any.

I realized that I could not give my conscious self any credit for this maneuver, because one day, my foot swung forward and collided with a flimsy obstacle, one that gave way easily and thus could not trip me. If the foot maneuver was deliberate, I should have been able to recognize that the collision was insufficient to trip me up. No such luck. I often find that my hamstring pulls my swinging foot back quickly when the obstacle is as light as a pillow or insubstantial as a loose cord. This is a perfect example of the tradeoff between fast inflexible movements and slower adjustable ones. Rapid movements are quick enough to accomplish things that conscious ones are too slow to achieve, but again, they are susceptible to pragmatic errors and to being miscued.

At the end of this chapter, I will discuss how I believe I have recovered from some of the neurological symptoms of chronic stress. Interestingly, even though some of the cognitive deficits have faded, I feel I have retained much of the coordination and motoric adroitness.  

Reflex and Reaction Time

Animals function over a great range of time scales. For human behavior, 100 milliseconds (one-tenth of a second) is generally the fastest we can react reflexively to a stimulus (such as an eyeblink). It generally takes at least 300 to 500 milliseconds for an experience to enter full conscious awareness. More complex reactions involving our legs and arms can take several hundred milliseconds. A simple voluntary reaction to a visual stimulus takes a human about 180 milliseconds. Cats have reaction times between 20 and 70 milliseconds. Some flies have exhibited reaction times of less than 10 milliseconds. That is one one hundredth of a second. This gets close to the time it takes a typical neuron to integrate its inputs, fire, and reset itself (about five milliseconds). Reaction time is an indication of the amount of processing taking place although it can be decreased with learning. “More voluntary” responses take longer to process. The delay between the input and output of a system is phase lag. Lag increases with the number of synapses interposed between the input and the output.

Less intelligent animals generally have faster reaction times, and many can respond on the order of tens of milliseconds. If a rhesus monkey can perform the same cognitive decision task that a human can (such as pointing to the larger of two squares), their reaction time in reporting their decision is much shorter. This is because every reaction to the environment involves a circuit, and the more neurons involved in the circuit, the slower the reaction will be. The stress cascade limits the full function of our higher cortical areas and thus decreases the length of these behavioral circuits.

Another way the stress cascade speeds up reactions is by downplaying the role of interneurons. As discussed in Chapter 3, animals have three types of neurons: sensory neurons, motor neurons, and interneurons. The interneurons are inhibitory, and slow down chains of neural firing tremendously. They can be beneficial because they provide negative feedback allowing an impulse to be checked or negated. But an environment that calls for impulse over control would probably not be friendly to interneurons. There is not much research into how the stress cascade might speed up reaction time, but it may interfere with the function of interneurons leading to speedier but less controlled actions.

Stress trims our neural circuits. The effortless coordination of simple motor patterns that I experienced was, in my opinion, striking and unmistakable. The effects were entertaining to experience despite the sobering reality that they were actualized by the decline of higher-order brain centers.

Hallucinations

During a particularly stressful few months, I began to experience perceptual errors that bordered on hallucination. Imagined sights and sounds felt exquisitely real momentarily in ways that they never had in the past. After imagining that a dog was in my vicinity, it almost seemed as if it could run over and bite me. Moreover, I would analyze misperceptions, as if they were correct, for inordinately long periods before I recognized them for what they were. Once I mistook a shoe hanging from a telephone wire for a bird hanging upside down. It might be normal for a misperception like this to last for a fraction of a second, but not five full seconds.

I began to mistake typical household or neighborhood noises for human voices. During much of my twenties, I lived alone with my cat. While at home, I often thought I saw my cat in the corner of my eye, but usually once I looked, it was just a shoe or some dark object on the light carpet. Sometimes the apparition would be embellished by his physical body language. Sometimes I felt I could even “sense” his presence or emotional tone. Once I started “seeing” my cat outside my home, I knew things were bad.

I once heard my cat cry while I was shampooing my hair in the shower after a jog outdoors. He cried several times in a row, and I wondered if he was hurt. My trembling hands dropped the shampoo bottle, and I heard my resultant gasp as a wheeze. Immediately, I wondered if I had mistaken my own wheezing for my cat’s cry. “I couldn’t have,” I thought to myself, “I swear I heard my cat’s unique vocal signature.” Once I realized the enormity of this type of perceptual aberration, my heart sunk. Just one full auditory hallucination can be sufficient for a diagnosis of schizophrenia. I knew that if my cat was not in the bathroom or the adjoining bedroom, I could be considered certifiably insane. I quickly stepped out of the shower, dried off, and searched the two rooms to no avail. I opened the bedroom door and walked to the other end of my home to find him asleep on the couch.

At my worst, on days when caffeine exacerbated my stress, I could be totally immersed in my sensory experience to a point where it felt like I didn’t have thoughts of my own. The din of cafeteria chatter could drown out my thoughts and it felt as if my internal thought process was replaced by the noise. It felt like my consciousness experience had lost most of its personal narrative and been taken over by external perceptions. It felt as if I had merged with my environment. If I was in such a hypofrontal state during an interaction with others, I would struggle to produce reasonable dialogue, and much of what I would say would be non-sequiturs. To this day, drinking caffeine often makes me feel panicked and after a few hours on it I feel loopy. This is likely because caffeine is a central nervous system stimulant that increases adrenaline and when combined with negative affect boosts the stress hormone cortisol. There are still times when I am not sure if I experienced something or only imagined it. 

My Delusions

Reality testing became another cognitive task I had difficulty with. I would have a recollection of something, but I would not be sure if it really happened because I could not recall the details about the situation. I wouldn’t be able to remember if the event in question took place, was a dream, or was a hypothetical scenario I had imagined. It became disconcerting when I realized that my reduced capacity for testing reality began leading to delusional thinking. I would catch myself devising absurd and unrealistic explanations for my behavior – confabulations of a degree and severity that were previously foreign to me. I was like a person incapable of seeing the big picture, using associations applicable in one respect but irrelevant in others. Such superficial associations would cause me to disregard or flout important concerns and norms. I believe this lies at the heart of psychotic impulsivity.

I have three friends that developed schizophrenia in their twenties, and I watched them slowly succumb to it. They had each been under a lot of stress and after particularly difficult events they would become delusional for days. Each of them had breakdowns that were so severe they had to be hospitalized for weeks. Before hospitalization, their thinking was so distorted that they began to believe totally irrational things. My first friend thought I was a saint and that he was an angel responsible for preventing an ensuing apocalypse. My other friend thought that every video on youtube.com was a personal message giving him clues about his future. As a person that had spent much of their childhood reading about science, I told myself that there was no way I could have the same delusions if I had schizophrenia. I assumed that even if I experienced a powerful psychotic break, I would not give in to supernatural, superstitious, or irrational thinking.

It may be true that I am too scientific minded to have delusions like those of my friends. My first friend had some belief in the existence of angels and I do not, and this must be one reason he had this specific delusion.

As we will discuss in the next chapter, chronic stress usually plays a significant role in the onset of schizophrenia. If the stress is severe enough and one has a genetic predisposition for it, the brain’s chemistry can change profoundly. Dopamine transmission to the prefrontal cortex is one the things affected the most, and this skews perceptions (causing hallucinations) but also skews conceptions (causing delusions). In a general sense, schizophrenic thinking causes people to take fewer mental representations into account when making decisions. This makes it so that the conclusions they generate can be hasty or poorly informed. For example, in the previous section, I explained that I might see a dark shoebox on the carpet in the corner of my eye and assume it was my cat. Anybody could make this mistake, but the person with schizophrenia might feel certain that it was their cat, and that certainty might last for longer. The same brand of certainty and the brain chemistry underlying it responsible for hallucinations is also involved in delusions.

Our brains automatically generate assumptions and use them to draw conclusions. They do this so often and so well that we rarely question them. If we had to perform reality testing on every snap judgement our brain makes, we would never get anything done. We are much less likely to question our assumptions if they are accompanied by a feeling of certainty. Delusions happen when someone feels certainty even though it is based on superficial or limited evidence. I had long wondered, “if the certainty thermostat in my brain was off the mark, what would I be delusional about?”

The snap judgments that a psychotic person makes are less informed than they used to be, but they don’t recognize this until their friends tell them they are acting crazy. It seems that in schizophrenia, and with some street drugs, this sense of certainty can be very compelling. In a psychotic episode, I might see someone do something vaguely familiar to something I saw in a horror movie. Because I wasn’t thinking on all cylinders, I might implicitly jump to the conclusion that this person was threatening me despite other evidence to the contrary. Because I have almost always been able to trust my sense of certainty in the past, I might fail to question or observe this impulse.

I was able to feel an impelling degree of certainty after reaching absurdly premature conclusions. Mere chance coincidences felt ominously significant. When this happened, I would have to use reason and patience to fight the overwhelmingly convincing sham certitude. This quasipsychosis was especially pronounced after long days of public speaking.

I have spent much of my life actively avoiding unscientific thinking. When I am not running on all cylinders, I don’t come up with fantastic, imaginative scenarios; instead, rather I become dull and slow. I may still have the same deficits, but what I would be delusional about might not be quite as socially inappropriate or clinically recognizable as my friends’ delusions. Also, my clinical knowledge of schizophrenia and its symptoms might keep me from acting stereotypically schizophrenic. In fact, there are many people with schizophrenia that are conscientious and socially mindful making it difficult to recognize their diagnosis.

Even though I may have been psychologically sane enough not to do anything too out of the ordinary, the biological toll that prolonged stress took on me caused me to do things that I would generally know better than to do. After pronounced stress, I began to take up an obsessive interest in comics and Legos (holdovers from my childhood). I kept going to work, and kept trying to act normal and professional. Still, I began to buy toys and intricately decorate whole rooms with them. I was so caught up with this that I did not question it the way I would have before the stress. At first, I just saw it as a fun hobby that wasn’t taking up too much time but now, with hindsight, I believe that I never would have taken the juvenile, resurgent interest in Legos to the same extent had my brain chemistry, my level of certainty, and my judgment not been substantially altered.

Brain Injury

Because of its emphasis on evolution this book mostly considers natural or inborn genetic conditions. But acquired brain disorders are also extremely common. They can be acquired from collisions, strokes, poisoning, infections, and brain surgery. The most common cause may be traumatic brain injury (TBI). It is currently recognized that there is a silent epidemic of TBIs, mostly coming from concussions. You likely have come across many people with brain injuries, but didn’t realize it. Moreover, many of those people were probably not aware that they have a condition either.

I have surmised that many of my closest friends have acquired brain damage. Let me summarize so that you have an idea for how these things can occur. I have two friends whose mothers drank during pregnancy, and they have the signs and symptoms of a subtle version of fetal alcohol syndrome, called fetal alcohol effects. I have a friend who fell from five feet directly onto his head at four years old. I have a friend who lost brain matter after asphyxiation in a suicide attempt. I have a friend who acquired psychopathy (i.e. pseudopsychopathy) subsequent to multiple TBIs sustained in sports injuries. I have a friend with diminished cognitive capacity from being born prematurely in the sixth month of gestation. I have a friend who declined a doctor’s orders and contracted a brain infection that has seriously compromised his working and long-term memory. I have a friend who went mad after being beaten within an inch of his life on multiple occasions. I have a friend who went through two car windshields after stealing the vehicles and is now criminally insane. I have several friends with persistent mental deficits after violent motor vehicle accidents. I have several friends who have irreparably poisoned their brains with illicit recreational drugs like meth and crack cocaine. Most of these people are not aware that their cognition may be compromised.

I have personally lost cognitive reserve from sources other than chronic stress. I have lost it from boxing and sparring without headgear. Because I used to spar hard in the dark at night I would “see stars.” Each flush heavy blow is accompanied by a bright explosion of vibrant, liquid color. I am certain that doing this over the course of years has taken some kind of toll on my mental acuity. My brain was also damaged from Covid 19 as I have “long covid” or chronic post-Covid brain fog. I also have the accompanying vertigo, tinnitus, insomnia, hyperacusis, and something called “post concussive symptoms.”

The brain is a delicate, complex system and the entropy of the natural world is always trying to reduce complexity. Accidents and various insults are cumulatively tearing away at us, pulling us further from our premorbid state. We are all victims of brain injury to different extents. But let’s not forget that in some ways these injuries are constructive. They build character and make us who we are. I have learned a tremendous amount about neurodiversity from observing others and paying careful attention to my own mental lapses and shortcomings. I challenge and urge you to do so too.

Conclusion

Once my higher-order intellectual faculties were diminished, I could not will them back. I couldn’t do anything to revert to the old me. This hard fact reinforced the idea that the mind emerges entirely from the brain. It also underscored that my previous mental abilities were physical (materialistic) and could not be resurrected voluntarily. It taught me that PFC-mediated thought is, in a way, as involuntary and insubstantial as lower-order cognitive faculties are. Chronic stress could take my executive functioning away from me because it was not inherent in who I was but rather automatic and reliant upon its neural substrates. This helped me comprehend that my previous intellect was never earned or willed. It was simply biological chattel.

Many but not all the effects of stress on cognition are reversible. The altered dopaminergic response to stress can reverse within a few hours of the stressor. The dendritic retraction appears to reverse after several weeks. Much of the harm can be undone. Of course, the death of hippocampal neurons may not be reversible at all (Sapolsky, 1996) but many other facets of the stress cascade can be overturned. I found that after years of keeping stress at bay, that I experienced a dramatic reduction of symptoms and reinstatement of clear thinking.

By my early 30s, I believe I recovered much of my cognitive deterioration. I credit many sources. Mindful meditation, heavy cardiovascular exercise, caffeine and cigarette cessation, abstention from violent video games, yoga, Buddhism, ego-restraint, positive psychology, biofeedback, and efforts at increasing my social support network have all seemed to help me tremendously in my efforts to reduce and recover from stress. As mentioned earlier, and discussed in this book’s final chapter, I distilled these methods into a free self-care system available for free at http://www.programpeace.com.